bluuebunny/crossref_metadata_2025 huggingface dataset:
The reduction of the productivity burden of cardiovascular disease by improving the risk factor control Among Australians with type 2 diabetes: a 10-year dynamic analysis
Authors: Abushanab Dina , Al-Badriyeh Daoud , Marquina Clara , Morton Jedidiah I , Lloyd Melanie , Zomer Ella , Talic Stella , Liew Danny , Ademi Zanfina
Published: September 2024

Aims

To quantify the productivity burden of cardiovascular disease (CVD) in type 2 diabetes and the potential benefits of improved CVD risk factor control.

Methods and results

We designed models to quantify the productivity burden (using the productivity-adjusted life-year; PALY) of CVD in Australians with type 2 diabetes aged 40–69 years from 2023–2032. PALYs were ascribed a financial value equivalent to gross domestic product (GDP) per full-time worker (AU$204 167 (€124 542)). The base-case model was designed to quantify the productivity burden of CVD in the target population. Then, other hypothetical scenarios were simulated to estimate the potential productivity gains resulting from improved control of risk factors. These scenarios included reductions in systolic blood pressure (SBP), number of smokers, total cholesterol, and incidence of type 2 diabetes. All future costs and outcomes were discounted at an annual rate of 5%. In the base-case (i.e. current projections), the estimated total PALYs lost due to CVD in type 2 diabetes were 1.21 million [95%CI (1.10–1.29 million)], contributing to an AU$258.93 (€157.94) billion [95%CI (AU$258.73–261.69 (€157.83–159.63) billion)] lost in the country’s GDP. If there were reductions in SBP, number of smokers, total cholesterol, and incidence of type 2 diabetes, there would be gains of 7,889, 28,971, 7,117, and 320 124 PALYs, respectively. These improvements would also lead to economic gains of AU$1.72 (€1.05) billion, AU$6.21 (€3.79) billion, AU$1.55 billion (€947.33 million), and AU$68.34 (€41.69) billion, respectively.

Conclusion

Targeted ‘early lifestyle’ strategies that can prevent CVD in Australians with type 2 diabetes are likely to positively impact Australian health and work productivity.
The rs6576457 G > A variant in the MKRN3 gene promoter significantly increases the risk of central precocious puberty and lung cancer in Hubei Chinese population
Authors: Wu Feng , Zhou Weiguang , Yue Zhengchu , Deng Xiangyuan , Kang Wenqiang , Yu Zhiyan , Zhang Haixia , Zhang Bixin , Feng Xianhong , Xiong Qiantao , Chen Bifeng
Published: September 2024

Makorin RING finger protein 3 (MKRN3) is a key inhibitor of the hypothalamic–pituitary-gonadal (HPG) axis. The association between MKRN3 gene variants and central precocious puberty (CPP) has been repeatedly examined. In a recent study, MKRN3 has been assigned a role of tumor suppressor in lung carcinogenesis. Therefore, it is hypothesized that MKRN3 may be the link between CPP and lung cancer (LC), and certain MKRN3 gene variants may affect individuals' susceptibility to CPP and LC. The rs12441287, rs6576457 and rs2239669 in the MKRN3 gene were selected as the target variants. Sanger sequencing was applied to genotype them in two sets of case–control cohorts, namely 384 CPP girls and 422 healthy girls, 550 LC patients and 800 healthy controls. The results showed that rs6576457 but not rs12441287 or rs2239669 was significantly associated with the risk of CPP and LC. Their association with CPP risk was further confirmed in the following meta-analysis. Subsequent functional assays revealed that the rs6576457 genotypes were correlated with differentially expressed MKRN3, and the rs6576457 alleles affected the transcription repressor Oct-1 binding affinity to the MKRN3 promoter. Collectively, the MKRN3 gene rs6576457 may participate in the CPP pathology and LC tumorigenesis in the Hubei Chinese population. However, the present findings should be validated in additional investigations with larger samples from different ethnic populations.
Low-Frequency, Sustained CD4 T-Cell Responses Chlamydia trachomatis in Women: Predominant Targeting of Chlamydial Proteaselike Activity Factor (CPAF)
Authors: Li Yanli , Warren Joanna A , Poston Taylor B , Clutton Genevieve , Shaw Fiona R , Conrad Shayla Z , Xu Yinyan , Zheng Xiaojing , Yount Kacy S , O’Connell Catherine M , Wiesenfeld Harold C , Darville Toni , Goonetilleke Nilu
Published: September 2024

Background

Chlamydia trachomatis (CT) is a globally prevalent sexually transmitted infection that can result in pelvic inflammatory disease, ectopic pregnancy, and infertility in women. Currently, there is no prophylactic vaccine.

Methods

This study examined T-cell immunity in a cohort of women recently infected with CT. Participants were screened against peptides spanning 33 of 894 possible CT proteins, either ex vivo or using short-term cell lines. CT-specific T cells were characterized by interferon (IFN) γ enzyme-linked immunospot (ELISPOT) assay and flow cytometry.

Results

Ex vivo CT-specific T cells were rarely detected; however, in vitro expanded CT-specific T cells were detected by IFN-γ ELISPOT in 90% (27 of 30) of participants. Notably, >50% of participants had T-cell responses targeting chlamydial proteaselike activity factor (CPAF). T-cell epitopes were dispersed across the CPAF protein. Flow cytometric analysis of short-term cell lines found that CT-specific cells, mainly CD4, produced IFN-γ and tumor necrosis factor (TNF) α and were sustained over 12 months. Ex vivo analysis suggested that CT-specific T cells mostly exhibited a central memory phenotype.

Conclusions

Our results indicate that CT infection elicits low-frequency, persistent CD4 T-cell responses in most women and that the secreted protein, CPAF, is an immunoprevalent CT antigen. Altogether, these data support development and testing of CT vaccines that enhance CD4 T cells against CPAF.
The impact of print exposure on deaf student literacy
Authors: Colin Stéphanie , Ecalle Jean , Magnan Annie
Published: September 2024

Recent studies suggest that benefiting early from both a cochlear implant (CI) and exposure to cued speech (CS, support system for the perception of oral language) positively impacts deaf children’s speech perception, speech intelligibility, and reading. This study aims to show how: 1/CS-based speech perception (“cue reading”), and speech intelligibility might also constitute precise measures for determining the impact of CI and CS on deaf students’ literary performance; 2/print exposure might also be a predictive factor in this equation. We conducted regression analyses to examine the impact of these three variables in two experiments conducted on Grade 2–3 deaf children and Grade 6–9 deaf adolescents. Results indicate print exposure significantly contributes to literacy skills across experiments, with additional contributions from cue reading and speech intelligibility in older students. The predictive aspect of the print exposure, cue reading, and speech intelligibility variables will be discussed, as will the consequences for educational and pedagogical practices.
Leishmania amazonensis-derived extracellular vesicles (EVs) induce neutrophil extracellular traps (NETs)
Authors: Pereira-Silva Gean C , Medina Jorge Mansur , Paschoaletto Letícia , Mangeth Luana , Coelho Felipe Soares , Attias Márcia , Domont Gilberto B , Nogueira Fábio C S , Sosa-Acosta Patrícia , de Oliveira Santos Eidy , Ferreira Carlos Vinicius , de Miranda Beatriz Toja , Mignaco Julio Alberto , Calegari-Silva Teresa , Lopes Ulisses Gazos , Saraiva Elvira Maria
Published: September 2024

Neutrophils interact with Leishmania when the sandfly vector inoculates these parasites in the host with saliva and promastigotes-derived extracellular vesicles (EVs). It has been shown that this co-injection induces inflammation and exacerbates leishmaniasis lesions. EVs are a heterogeneous group of vesicles released by cells that play a crucial role in intercellular communication. Neutrophils are among the first cells to interact with the parasites and release neutrophil extracellular traps (NETs) that ensnare and kill the promastigotes. Here, we show that Leishmania amazonensis EVs induce NET formation and identify molecular mechanisms involved. We showed the requirement of neutrophils’ toll-like receptors for EVs-induced NET. EVs carrying the virulence factors lipophosphoglycan and the zinc metalloproteases were endocytosed by some neutrophils and snared by NETs. EVs-induced NET formation required reactive oxygen species, myeloperoxidase, elastase, peptidyl arginine deiminase, and Ca++. The proteomic analysis of the EVs cargo revealed 1,189 proteins; the 100 most abundant identified comprised some known Leishmania virulent factors. Importantly, L. amazonensis EVs-induced NETs lead to the killing of promastigotes and could participate in the exacerbated inflammatory response induced by the EVs, which may play a role in the pathogenesis process.
What role for law in refugee studies? Towards a transdisciplinary agenda
Authors: Gammeltoft-Hansen Thomas , Ghezelbash Daniel
Published: September 2024

Refugee law has historically formed an important part of refugee studies. Yet, in the past decades, the legal study of refugees has increasingly developed out of sync with refugee studies more generally. The purpose of this special issue is to help bridge the gap between refugee law and refugee studies and foster a broader transdisciplinary research agenda on law within refugee studies scholarship. The special issue serves two overarching purposes. The first is to exemplify and celebrate methodological heterodoxy in refugee law scholarship—deliberately foregrounding perspectives often marginalized within more mainstream legal scholarship. To this end, this issue presents a range of contributions that draw on methods and theories from different disciplines in the study of refugee law, including anthropology, history, psychology, political science, organization studies, and data science. Second, by anchoring this special issue in the Journal of Refugee Studies, we hope to convince the wider refugee studies community that empirical and interdisciplinary legal methods may provide new and important insights into some of the core debates on and long-standing challenges to refugee law.
Granulosis rubra nasi from plastic surgery perspective
Authors: Almutairi Rahaf H , Shah Mardan Qutaiba N M , Al Qurashi Abdullah A , Mrad Mohamed Amir
Published: September 2024

Affecting the eccrine glands, granulosis rubra nasi (GRN) is an inherited disorder that manifests itself as redness, sweating, and papules distributed mainly in the center of the face. It is diagnosed clinically and the cornerstone of management is reassurance and education about the benign nature of the condition. A wide array of treatment modalities has been proposed, such as Botox and corticosteroids injections; however curative measures are yet to be discovered. In this paper, we present a case of a 26-year-old man complaining of chronic nose sweating. The case was successfully managed with Botox injections, though we suggested our theory of undercutting the glands through aggressive defatting as part of open rhinoplasty to the patient; he declined our suggested modality. It remains an untested option and caution should be exercised in high-risk patients to avoid compromising blood supply to the skin and risking skin necrosis.
The two lives of the Mental Capacity Act: rethinking East-west binaries in comparative analysis
Authors: Chua Hillary , Kong Camillia , Dunn Michael
Published: September 2024

The Mental Capacity Act 2005 in England and Wales and Singapore’s Mental Capacity Act 2008 (which substantially transplants provisions from the former statute) might appear to be twins on paper, but they have gone on to lead very different lives. In this article, we examine how two broadly identical laws have taken on divergent identities within their respective jurisdictions when implemented and interpreted in the courtroom. We reveal and analyse differences in parliamentary intent concerning at what stage a person’s decision-making agency is putatively empowered; judicial development of central concepts; underlying socio-cultural commitments; and outline opportunities for bi-directional learning in mental capacity law across both jurisdictions.
Systemic Mycoses by Novel Onygenalean Fungal Pathogens Emergomyces spp and Blastomyces percursus in Rwanda
Authors: Laga Alvaro C , Ruhangaza Deogratias , Izimukwiye Annie Isabelle , Vilela Raquel , Mendoza Leonel
Published: September 2024

We report 2 cases of infection by fungi unprecedented in Rwanda. One patient with emergomycosis presented with disseminated disease and prominent cutaneous involvement and one patient with African blastomycosis had cutaneous and osseous disease. These cases illustrate the clinicopathologic and molecular traits of novel dimorphic onygenalean species in Rwanda.
Traditional “Asset Locks” in non-traditional mixed legal systems: a journey from West to East
Authors: Puder Markus G
Published: September 2024

This article endeavors to broaden the discussions through a case study on asset locks that identifies solutions fashioned in four non-traditional mixed jurisdictions. Asset locks are understood here broadly as legal institutions that allow property to be separated, isolated, bound and shielded for designated purposes. Our selection of legal institutions along a journey from West to East includes Louisiana’s trust, Liechtenstein’s foundation, Russia’s fiduciary management, and Irans’ property endowment. After highlighting the essentials of each institution, a comparative screen will explore in more detail how the four sample jurisdictions differ with regard to how a particular asset lock is accomplished.
The classification, origin, and evolutionary dynamics of severe fever with thrombocytopenia syndrome virus circulating in East Asia
Authors: Sang Shaowei , Chen Peng , Li Chuanxi , Zhang Anran , Wang Yiguan , Liu Qiyong
Published: September 2024

The classification of severe fever with thrombocytopenia syndrome virus (SFTSV) lacked consistency due to limited virus sequences used across previous studies, and the origin and transmission dynamics of the SFTSV remains not fully understood. In this study, we analyzed the diversity and phylodynamics of SFTSV using the most comprehensive and largest dataset publicly available for a better understanding of SFTSV classification and transmission. A total of 1267 L segments, 1289 M segments, and 1438 S segments collected from China, South Korea, and Japan were included in this study. Maximum likelihood trees were reconstructed to classify the lineages. Discrete phylogeographic analysis was conducted to infer the phylodynamics of SFTSV. We found that the L, M, and S segments were highly conserved, with mean pairwise nucleotide distances of 2.80, 3.36, and 3.35% and could be separated into 16, 13, and 15 lineages, respectively. The evolutionary rate for L, M, and the S segment was 0.61 × 10−4 (95% HPD: 0.48–0.73 × 10−4), 1.31 × 10−4 (95% HPD: 0.77–1.77 × 10−4) and 1.27 × 10−4 (95% HPD: 0.65–1.85 × 10−4) subs/site/year. The SFTSV most likely originated from South Korea around the year of 1617.6 (95% HPD: 1513.1–1724.3), 1700.4 (95% HPD: 1493.7–1814.0), and 1790.1 (95% HPD: 1605.4–1887.2) for L, M, and S segments, respectively. Hubei Province in China played a critical role in the geographical expansion of the SFTSV. The effective population size of SFTSV peaked around 2010 to 2013. We also identified several codons under positive selection in the RdRp, Gn–Gc, and NS genes. By leveraging the largest dataset of SFTSV, our analysis could provide new insights into the evolution and dispersal of SFTSV, which may be beneficial for the control and prevention of severe fever with thrombocytopenia syndrome.
Performance Pay Increases Dog Vaccinations to Reduce Human Rabies
Authors: Lankester Felix , Manian Shanthi , Yoder Jonathan
Published: September 2024

Rural development projects often depend on local community members to coordinate community participation. Using a randomized controlled trial, this paper examines how pay-for-performance for community coordinators affects participation in dog vaccination events to prevent human rabies in Tanzania. Three treatments were implemented: fixed payment only, pay-for-performance only, or a mix of fixed payment and pay-for-performance. Using dog vaccination histories, the experiment equalizes the total expected payment across treatments, isolating the effect of payment type. Mixed payment increases dog vaccinations by 16 percent compared to fixed payment. Each 10 percent increase in per-dog payment raises vaccinations by 0.4 percent. Changing the fixed payment rate has a negligible effect. Thus, pay-for-performance induces higher effort than the fixed component. The findings suggest pay-for-performance can improve the effectiveness of rural development projects such as mass immunization events.
Simulation Training to Interrupt Microaggressions
Authors: Srinivasan Sushant , Evaristo Claudia E. , Ali Haroon , Tranel Gina E. , DiMarco Shannon M. , Takahashi Naomi , Bidar-Sielaff Shiva , Ruedinger Emily
Published: September 2024

Microaggressions in health care occur frequently and negatively impact the well-being of trainees. High-realism simulation can effectively train health care providers to communicate in emotionally difficult situations. In 2023, we developed and piloted 4 simulation scenarios for pediatric residents centered on addressing microaggressions in the clinical environment that built on an existing didactic curriculum. These scenarios included single and intersecting forms of oppression including racism, sexism, ableism, ethnocentrism, and weight bias. We also trained faculty, who had no prior simulation debriefing experience, to facilitate and debrief the simulation sessions. Thirty-three residents participated and reported an increase in confidence immediately following the simulation training; this increase was sustained at 3 months. Faculty participants reported increased empathy for residents, recognition of microaggressions, and confidence facilitating conversation after microaggressions that occur both in the simulated setting and in real life. High-realism simulation holds promise as a way to bridge the gap between classroom and real-life interruption of microaggressions, a necessary skill to improve the health care environment for learners and patients.
Simulation vs RISE UP: A Comparative Study of Approaches for Teaching Emergency Medicine Trainees How to Manage Microaggressions
Authors: Fernandez David , Gorgens Sophia , McCann-Pineo Molly , Sperandeo Michael , Cassara Michael , Moadel Tiffany
Published: September 2024

Purpose

Microaggressions are discriminatory actions or words targeted at people for their perceived or expressed identities. The study aimed to address the critical need for training emergency medicine (EM) resident-physicians to manage microaggressions. The authors compared the effectiveness of the Realizing Inclusion and Systemic Equity in Medicine: Upstanding in the Medical Workplace (RISE UP) curriculum from Inova Children’s Hospital and a simulation (SIM) curriculum created by a research team specifically for this study. The new SIM curriculum was guided by the original RISE UP curriculum but incorporates simulation as a learning tool. These 2 educational modalities were selected based upon previous literature showing their efficacy as tools in medical education.

Method

Through a collaboration with residency leadership, EM residents were recruited to participate in a comparison study in which they received either the RISE UP or newly created SIM curriculum as part of their regular simulation training. Pre- and post-intervention surveys assessed perceived knowledge on handling microaggressions. A follow-up survey was sent 1 month post-intervention to evaluate retention of self-reported knowledge.

Results

Out of 81 eligible residents, 69 residents participated: 37 in the new SIM curriculum group and 32 in the RISE UP curriculum group. Participants in both groups self-reported significant improvements in perceived knowledge immediately post-intervention. At the 1-month follow-up, both intervention groups retained higher levels of perceived knowledge. Additionally, while both curricula were effective, the RISE UP group showed slightly higher retention rates of self-reported knowledge compared with the SIM group, although this difference was not statistically significant.

Conclusions

Both the SIM and RISE UP curricula were effective in improving resident knowledge about handling workplace microaggressions, with participants in the RISE UP curriculum showing marginally better retention of skills. Implementing such educational programs may enhance workplace awareness and response to microaggressions among EM residents.
Using Machine Learning and Multifaceted Preoperative Measures to Predict Adult Cochlear Implant Outcomes: A Prospective Pilot Study
Authors: Patro Ankita , Lawrence Patrick J. , Tamati Terrin N. , Ning Xia , Moberly Aaron C.
Published: September 2024

Objectives:

To use machine learning and a battery of measures for preoperative prediction of speech recognition and quality of life (QOL) outcomes after cochlear implant (CI) surgery.

Design:

Demographic, audiologic, cognitive-linguistic, and QOL predictors were collected from 30 postlingually deaf adults before CI surgery. K-means clustering separated patients into groups. Reliable change index scores were computed for speech recognition and QOL from pre-CI to 6 months post-CI, and group differences were determined.

Results:

Clustering yielded three groups with differences in reliable change index for sentence recognition. One group demonstrated low baseline sentence recognition and only small improvements post-CI, suggesting a group “at risk” for limited benefits. This group showed lower pre-CI scores on verbal learning and memory and lack of musical training.

Conclusions:

Preoperative assessments can prognosticate CI recipients’ postoperative performance and identify individuals at risk for experiencing poor sentence recognition outcomes, which may help guide counseling and rehabilitation.
Cost-effectiveness of Risk Stratified Care vs Usual Care for Low Back Pain in the Military Health System
Authors: Rhon Daniel I. , Kim Minchul , Asche Carl , George Steven Z.
Published: September 2024

Study Design.

Cost-effectiveness of two trial interventions for low back pain

Objective.

To investigate the incremental cost-effectiveness between risk-stratified and usual care for low back pain.

Summary of Background Data.

A recent trial compared risk-stratified care to usual care for patients with low back pain (LBP) in the US Military Health System. While the outcomes were no different between groups, risk-stratified care is purported to use fewer resources and therefore could be a more cost-effective intervention. Risk-stratified care matches treatment based on low, medium, or high risk for poor prognosis.

Methods.

The cost-effectiveness of usual care versus risk-stratified care for low back pain was assessed, using the healthcare perspective. Patients were recruited from primary care. The main outcome was indicating incremental cost-effectiveness between two alternative treatments. Acceptability curves of bootstrapped incremental cost effectiveness ratios (ICER) were used to identify the proportion of ICERs under the specific willingness-to-pay (WTP) level ($50,000 to $100,000). Health system costs (total and back-related) and health-related quality-of-life (HRQoL) based on quality-adjusted-life-years (QALYs) were obtained.

Results.

271 participants (33.6% female), mean age 34.3 +/-8.7 were randomized 1:1 and followed for 1 year. Mean back-related medical costs were not significantly different (mean difference $5; 95CI -$398, $407; P=0.982), nor were total medical costs (mean difference $827, 95CI -$1748, $3403; P=0.529). The mean difference in QALYs was not significantly different between groups (0.009; 95CI -0.014, 0.032; P=0.459). The incremental net monetary benefit (NMB) at the willingness to pay (WTP) threshold of $100,000 was $792 for back-related costs, with the lower bound confidence interval negative at all WTP levels.

Conclusion.

Risk-stratified care was not cost-effective for medium- and low-risk individuals compared to usual care. Further research is needed to assess whether there is value for high-risk individuals or for other risk-stratification approaches.
Stevens–Johnson syndrome and toxic epidermal necrolysis: Updates in pathophysiology and management
Authors: Hasegawa Akito , Abe Riichiro
Published: September 2024

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions characterized by extensive detachment of the epidermis and mucous membranes. These severe disorders carry a high mortality rate, and their pathogenesis remains largely unclear. Furthermore, optimal therapeutic strategies for SJS/TEN remain a subject of ongoing debate. Early diagnosis of SJS/TEN is challenging, and reliable biomarkers for diagnosis or severity prediction have not been firmly established. Certain drugs, such as carbamazepine and allopurinol, have shown a strong association with specific human leukocyte antigen (HLA) types. Recently, the potential benefits of HLA screening prior to administering these drugs to reduce the incidence of SJS/TEN have been explored. Epidermal cell death in SJS/TEN lesions is caused by extensive apoptosis, primarily through the Fas–Fas ligand (FasL) and perforin/granzyme pathways. Our findings suggest that necroptosis, a form of programmed necrosis, also contributes to epidermal cell death. Annexin A1, released from monocytes, interacts with the formyl peptide receptor 1 to induce necroptosis. Several biomarkers, such as CC chemokine ligand (CCL)-27, interleukin-15, galectin-7, receptor-interacting protein kinases 3 (RIP3), and lipocalin-2, have been identified for diagnostic and prognostic purposes in SJS/TEN. Supportive care is recommended for treating SJS/TEN, but the efficacy of various therapeutic options–including systemic corticosteroids, intravenous immunoglobulin, cyclosporine, and tumor necrosis factor-α antagonists–remains controversial. Recent studies have investigated the potential benefits of tumor necrosis factor-α antagonists. In this review, we discuss recent advances in the understanding and management of SJS/TEN.
Incidence, mortality, and disability-adjusted life years of female breast cancer in China, 2022
Authors: Sun Kexin , Zhang Bailin , Lei Shaoyuan , Zheng Rongshou , Liang Xin , Li Li , Feng Xiaolong , Zhang Siwei , Zeng Hongmei , Yao Yifei , Ma Peiqing , Wang Shaoming , Chen Ru , Han Bingfeng , Wei Wenqiang , He Jie
Published: September 2024

Background:

Breast cancer is ranked among the most prevalent malignancies in the Chinese female population. However, comprehensive reports detailing the latest epidemiological data and attributable disease burden have not been extensively documented.

Methods:

In 2018, high-quality cancer surveillance data were recorded in 700 population-based cancer registries in China. We extracted data on female breast cancers (International Classification of Diseases, Tenth Revision [ICD-10]: C50) and estimated the incidence and mortality in 2022 according to the baseline data and corresponding trends from 2010 to 2018. Pathological types were classified according to the ICD for Oncology, 3rd Edition codes. Disability-adjusted life years (DALYs) were calculated as the sum of the years of life lost (YLLs) and years lived with disability (YLDs).

Results:

In 2022, approximately 357,200 new female breast cancer cases and 75,000 deaths occurred in China, accounting for 15.59% and 7.94% of total new cancer cases and deaths, respectively. The age-standardized incidence rate (ASIR) was 33.04 per 100,000. When analyzed by pathological type, the ASIRs for papillary neoplasms, invasive breast carcinoma, rare and salivary gland-type tumors, and other types were 1.13, 29.79, 0.24, and 1.88 per 100,000, respectively. The age-standardized mortality rate (ASMR) was 6.10 per 100,000. A total of 2,628,000 DALYs were found to be attributable to female breast cancer in China, comprising 2,278,300 YLLs and 349,700 YLDs. The ASIR, ASMR, and age-standardized rate (ASR) for DALYs in urban areas were consistently higher than those in rural areas. We observed a four-fold increase in the ASIR and ASR for DALYs and an eight-fold increase in the ASMR among females over 55 years compared with those aged under 55 years.

Conclusion:

These data provide invaluable insights into the latest epidemiology of female breast cancer in China and highlight the urgency for disease prevention and control strategy formulation.
Maintenance Therapy in Acute Myeloid Leukemia
Authors: Sabakhtarishvili Giorgi , Ansari Amir , Tabbara Imad A.
Published: September 2024

Acute myeloid leukemia (AML) poses significant challenges due to its high relapse rates despite initial successful induction chemotherapy. Maintenance therapy aims to prevent disease recurrence, particularly in high-risk patients. This review explores current maintenance treatments, their impacts on patient outcomes, and ongoing studies shaping the treatment landscape for AML. Hypomethylating agents like azacitidine and decitabine have shown promise in improving relapse-free and overall survival, particularly in older patients with AML ineligible for transplantation. Combination regimens involving azacitidine and venetoclax have demonstrated encouraging outcomes post–hematopoietic stem cell transplantation. Targeted therapies, particularly FLT3 inhibitors like midostaurin and quizartinib, have shown significant benefits in improving survival outcomes, especially in FLT3-mutated AML cases. Gilteritinib and sorafenib also exhibit the potential to reduce relapse rates post-transplant. Isocitrate dehydrogenase inhibitors, including ivosidenib and enasidenib, present novel options for postchemotherapy and posttransplantation maintenance. Immunotherapies, such as Wilms tumor 1 peptide-based vaccines and checkpoint inhibitors, are being explored, although results vary. Despite ongoing research, the role of maintenance chemotherapy remains uncertain, with inconsistent outcomes across trials. The approval of oral azacitidine represents a significant advancement, emphasizing the need for further investigation into personalized maintenance approaches. In conclusion, the evolving landscape of maintenance therapy and integrating targeted therapies in AML offers promising avenues for improving patient outcomes.
Hyoid Position and Aging: A Comprehensive Analysis Using AI-assisted Segmentation of 282 Computed Tomography Scans
Authors: Meira Pazelli Alexandre , Shehab Abdallah A. , Rames Jess D. , Hussein Sara M. , Bustos Samyd S , Sears Victoria A. , Wentworth Adam J. , Morris Jonathan M. , Sharaf Basel A.
Published: September 2024

Background:

With neck, aging the cervicomental angle becomes obtuse and may be influenced by hyoid bone aging. An understanding of hyoid position changes with aging will further our understanding of its role in neck contour changes.

Methods:

A 3D volumetric reconstruction of 282 neck computed tomography scans was performed. The cohort was categorized into three groups based on age: 20 years or older and younger than 40 years, 40 years or older and younger than 60 years, and 60 years or older and younger than 80 years. The vertical and horizontal hyoid distances in relation to the mandible were calculated for each patient.

Results:

A total of 282 patients (153 women, 129 men) were included in the cohort. The age groups were evenly distributed in men and women. Mean hyoid vertical and horizontal distances differed between women and men in all age groups. There was a significant difference in the hyoid vertical distance between 20–39 years old to 40–59 years old in men (P < 0.01), and 20–39 years old to 60–79 years old in both genders (women P = 0.005, men P < 0.01). Hyoid horizontal distance was not affected by age and sex (age and sex: P > 0.05), but rather by body mass index (BMI). Every 5 BMI points corresponded to a forward movement of 2 mm.

Conclusions:

As individuals age, the hyoid bone descends in both sexes, and an increase in BMI is associated with forward movement. Additional studies are needed to assess the correlation of the hyoid position between upright and supine positions.
Nonsurgical Correction of Surgical Rhinoplasty Complications with Hyaluronic Acid Fillers: A Retrospective Review of 2088 Cases
Authors: Harb Ayad , Abdul-Razzak Amane
Published: September 2024

Background:

Surgical rhinoplasty is a highly complex cosmetic procedure with significant revision rates. Unfortunately, surgical revision rhinoplasty is associated with many challenges. Nonsurgical correction of surgical rhinoplasty complications with injectable hyaluronic acid fillers is an alternative with less cost and downtime. In this article, we present the first author’s experience with 2088 cases of nonsurgical revision rhinoplasty, including technical considerations, patient-reported outcomes, and adverse events.

Methods:

A retrospective chart review was completed on patients 18 years and older who received nonsurgical rhinoplasty treatment between March 2018 and August 2022. Patient demographic data, and data on indications for treatment, volume of filler used, patient-reported satisfaction, and adverse events (including erythema, infection, vascular occlusion, and necrosis) were collected up to 1 year after the initial injection.

Results:

A total of 2088 patient cases are included in this study. The most common indications for treatment included bridge collapse or asymmetry (49.0%), an under-projected tip (44.0%), and surface irregularity/scarring (35.4%). The mean volume of filler used at initial treatment was 0.49 mL (SD 0.19). Median patient satisfaction immediately after treatment was 9 (visual analog scale ranging from 1 to 10). The most common adverse event reported at the 2-week follow-up was erythema (36.4%). Three patients presented with skin necrosis (0.47%). All three of these were transient and self-resolving.

Conclusions:

Nonsurgical correction of rhinoplasty complications with hyaluronic acid fillers can be a safe, minimally invasive option with high patient satisfaction and immediate and predictable results. This should be considered first line before surgical revision.
Low and standard intra-abdominal pressure during laparoscopic cholecystectomy: An observational study based on colorimetric determination of serum concentration variation of the radical cation of N,N-DIETHYL-para-PHENYLDIAMINE
Authors: Clementi Marco , Palumbo Paola , Sponta Anna Maria , Cappelli Sonia , Guadagni Stefano , Masedu Francesco
Published: September 2024

Background:

This prospective observational open-label cohort study on patients submitted for elective laparoscopic cholecystectomy is aimed to investigate the association of low (8–10 mm Hg) and high (11–14 mm Hg) intra-abdominal pressure with the variation of serum colorimetric determination of the radical cation of N,N-Diethyl-para-phenyldiamine (DEPPD), measured immediately before pneumoperitoneum and 10 min after deflation, and intended as a proxy of oxidative stress.

Methods:

In 117 patients, subdivided into low-pneumo (n. 49 pts.) and high-pneumo (n. 68 pts.) groups, biochemical analyses were performed and analyzed by T tests and a multivariable regression model.

Results:

The results of the biochemical analyses showed that the variation of the radical cation of DEPPD values resulted in no significant difference between low and high pneumoperitoneum. Moreover, low intra-abdominal pressure compared with high pressure was not significantly associated with age, body mass index, and previous abdominal surgery. On the contrary, both the female gender and the iatrogenic gallbladder perforation were significantly associated with a positive variation of the radical cation of DEPPD. Notably, when the operation length was longer than 45 minutes, a significant association with a negative variation was observed.

Conclusions:

This study on patients submitted for elective laparoscopic cholecystectomy, despite some limitations, suggested that the use of a low-pressure pneumoperitoneum is not associated with a postoperative lower production of oxidants compared with standard pressure.
Understanding Experiences and Needs of Patients With Prostate Cancer Across Asia-Pacific: A Cross-Sectional Mixed-Methods Study
Authors: Tran Ben , Mizokami Atsushi , Wang Shian-Shiang , Li Yonghong , Takeuchi Tsutomu , Bain Paul , Liu Yiting , Maeng Chan Young , Singh Anildeep , Kishiwada Naomi , Cheng Marie Simone , Gowindah Regina , Si Jennifer , Han Hyunho
Published: September 2024

Purpose:

To understand the impact of prostate cancer (PC) and identify gaps in existing care from patients, caregivers, and physicians in Australia, Japan, Mainland China, South Korea, and Taiwan.

Materials and Methods:

This study comprised qualitative interviews among patient-caregiver pairs and quantitative surveys among patients (high-risk localized [HRLPC] or metastatic castration-resistant [mCRPC]) and physicians. Thematic interpretation from qualitative interviews, to facilitate the quantitative survey development, was guided by the Psycho-Onco Emotional Anxiety (POEM) Framework and COM-B (Capability, Opportunity, Motivation-Behavior) model.

Results:

Patients reported experiencing high anxiety about fear of cancer recurrence (HRLPC: 83.3%; mCRPC: 88.9%), which increased along the course of their illness (68.8%; 48.1%). More mCRPC (40.7%) than HRLPC (20.8%) patients perceived delays in cancer diagnosis, with reasons related to time between consultation and diagnosis, belief that symptoms were not severe, prostate-specific antigen testing not a routine, or unaware of symptoms. More mCRPC (25.9%) than HRLPC (8.3%) were confused about treatment options, consistent with physicians' clinical observations. More mCRPC than HRLPC patients felt their physicians did not clearly explain potential treatment benefits, risks, and side effects or inform new therapies. Physicians (39.4%-49.5%) reported having insufficient consultation time to talk to patients. Despite majority of physicians (>80%) encouraging patients to make treatment decisions, 77.8% to 83.3% of patients relied on their doctors.

Conclusions:

Challenges to current PC care included gaps in knowledge, patient-physician communication, shared decision-making, and psychosocial support which are interrelated. There is a need for multidisciplinary efforts to boost patient awareness and psychosocial support to enhance the quality of comprehensive PC care.
Prognostic Factors for Patients With Urachal Carcinoma Undergoing Radical Surgery: Risk Stratification for Future Prospects of Precision Oncology
Authors: Kirisawa Takahiro , Maeshima Akiko , Kikkawa Nao , Nakamura Eijiro , Shimoi Tatsunori , Maejima Aiko , Imai Toru , Hagimoto Hiroki , Okuno Tomoya , Matsuda Ayumu , Shinoda Yasuo , Komiyama Motokiyo , Fujimoto Hiroyuki , Yonemori Kan , Matsui Yoshiyuki
Published: September 2024

Purpose:

To determine poor prognostic factors for patients with urachal carcinoma (UrC) undergoing radical surgery; identify candidates for precision oncology, including adjuvant therapy; and improve survival outcome of this rare malignant disease.

Materials and Methods:

We included 51 patients with UrC who underwent radical or partial cystectomy at our institution between 1991 and 2023. Kaplan-Meier curves and log-rank test were performed to estimate overall survival (OS) and recurrence-free survival by applying the Ontario staging system. A Cox proportional hazard regression model was used for multivariate analysis to evaluate prognostic factors for patients undergoing radical surgery.

Results:

Univariate and multivariate analyses showed that tumor involvement of perivesical fat (Ontario stage T3) and tumor grade were significant prognostic factors for OS. Tumor involvement of perivesical fat was a common factor for both OS and recurrence-free survival. Patients with both adverse factors showed significantly poor OS compared with those with 1 or no adverse factors (P = .014 and .0014, respectively).

Conclusions:

Tumor involvement of perivesical fat and tumor grade were strong predictors of survival outcome. Adjuvant therapy might be indicated in patients with high recurrence risk. Our results warrant further, multidisciplinary investigation into the impact of precision oncology for patients with UrC and high recurrence risk.
Psychopathology in Infants, Toddlers, and Preschool Children with Nonsyndromic Clefts of the Lip and/or Palate: A Case-Control Study
Authors: Baghaki Semih , Karacetin Gul , Yerlikaya Oral Elif , Guzel Tuncer Ayse Beste , Demir Turkay , Bingol Caglayan Hulya , Uysal Omer , Ozdamar Mandi Ozlem
Published: September 2024

Objective:

The aim of this study is to assess psychopathology and maternal interactions in infants, toddlers, and preschool children with nonsyndromic clefts of the lip and/or palate (NSCLP) and association of psychopathology with cleft-related factors and maternal interactions.

Design:

Twenty-six children from 4 to 72 months of age with NSCLP, who were attending the Plastic, Reconstructive and Aesthetic Surgery Department were included as the case group. Fifty-two healthy children who were matched on age and sex with the case group were taken as controls. Children were assessed in aspects of psychiatric diagnosis, articulation, and development.

Results:

Speech and language disorders (SLD) (P<0.001), disorders of affect (DA) (P=0.005), feeding behavior disorder (P=0.002), sleep-behavior disorder (SBD) (P=0.038), and disordered mother-child relationship (P<0.001) were more prevalent in children with NSCLP. Dental alignment (P=0.024), number of operations (P=0.006), and type of operations (P=0.012) were associated with DA. The children in the case group, who had disordered relationship with their mothers had significantly more SLD (P=0.036) and SBD (P=0.039).

Conclusions:

Children with NSCLP are at risk of developing psychopathology, especially SLD and DA. Maternal interactions and the above cleft-related factors and may be the target of interventions to prevent and treat psychiatric disorders in these children.
Trauma video review through the legal lens: Improving care while minimizing risk
Authors: Succar Bahaa , Vella Michael A. , Holena Daniel , Estroff Jordan , Rule Beatrice , Rivera Madeline , Studwell Spencer , Shukla Dhara , Dumas Ryan P.
Published: September 2024

Video-based platforms have emerged as a transformative force in the field of trauma surgery. Despite its potential, the adoption of trauma video review (TVR) faces challenges. In this review, we describe the use of TVR and examine medicolegal issues pertaining to spoliation, patient privacy, and consent. Research highlights the multifaceted benefits of TVR, from refining performance metrics and medical education to improving processes of care and patient outcomes. Despite these advantages, medicolegal risks may prevent many centers from embracing this technology. Our review identified only two cases that explicitly mentioned the TVR process, where specific state statutes offered protection against video disclosure. In fact, much of the case law related to the disclosure of hospital video recording systems pertains to spoliation (destruction of evidence). Most importantly, when the creation of TVR videos is directly linked to quality assurance activities and peer review programs, Peer Review Statutes may shield these recordings from being disclosed. These statutes are thus defenses courts rely on when refusing to invoke the spoliation inference. The implementation of the Health Insurance Portability and Accountability Act act historically discouraged centers from pursuing their TVR programs due to patient privacy concerns. Nonetheless, integrating the video review consent as part of the general hospital consent can mitigate this issue. Litigation and privacy considerations still raise the alarm among providers, however, the potential for performance improvement and reduced medicolegal risk outweigh the concerns. Although TVR remains relatively underutilized, its significance will only grow as technology continues to advance.
Extracorporeal membrane oxygenation in severe traumatic brain injury: Is it safe?
Authors: Rafaqat Wardah , Luckoski John , Lagazzi Emanuele , Abiad May , Panossian Vahe , Nzenwa Ikemsinachi , Kaafarani Haytham M. A. , Hwabejire John O. , Renne Benjamin C.
Published: September 2024

BACKGROUND

Patients with severe traumatic brain injury (TBI) are at an increased risk of respiratory failure refractory to traditional therapies. The safety of extracorporeal membrane oxygenation (ECMO) in this population remains unclear. We aimed to examine outcomes following ECMO compared with traditional management in severe TBI patients.

METHODS

We performed a retrospective cohort study using the Trauma Quality Improvement Program (2017–2020). We identified patients 18 years or older with severe TBI (Abbreviated Injury Score head, ≥3) who underwent ECMO or had either in-hospital cardiac or acute respiratory distress syndrome during their hospitalization. The study excluded pPatients who arrived without signs of life, had a prehospital cardiac arrest, had an unsurvivable injury, were transferred out within 48 hours of arrival, or were received as a transfer and died within 12 hours of arrival Patients with missing information regarding in-hospital mortality were also excluded. Outcomes included mortality, in-hospital complications, and intensive care unit length of stay. To account for patient and injury characteristics, we used 1:1 propensity matching. We performed a subgroup analysis among ECMO patients, comparing patients who received anticoagulants with those who did not.

RESULTS

We identified 10,065 patients, of whom 221 (2.2%) underwent ECMO. In the propensity-matched sample of 134 pairs, there was no difference in mortality. Extracorporeal membrane oxygenation was associated with a higher incidence of cerebrovascular accidents (9% vs. 1%, p = 0.006) and a lower incidence of ventilator-associated pneumonia. In the subgroup analysis of 64 matched pairs, patients receiving anticoagulation had lower mortality, higher unplanned return to the operating room, and longer duration of ventilation and intensive care unit length of stay.

CONCLUSION

Extracorporeal membrane oxygenation use in severe TBI patients was not associated with higher mortality and should be considered a potential intervention in this patient population. Systemic anticoagulation showed mortality benefit, but further work is required to elucidate the impact on neurological outcomes, and the appropriate dosing and timing of anticoagulation.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.