bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimizing peripheral regional anaesthesia: strategies for single shot and continuous blocks
Authors: Johnstone David , Taylor Alasdair , Ferry Jenny
Published: July 2024

Purpose of review

Regional anaesthesia is increasingly prominent within anaesthesia, offering alternative analgesic options amidst concerns over opioid-based analgesia. Since Halsted's initial description, the field has burgeoned, with ultrasound visualization revolutionizing local anaesthetic spread assessment, leading to the development of numerous novel techniques. The benefits of regional anaesthesia have gained increasing evidence to support their application, leading to changes within training curricula. Consequently, regional anaesthesia is at a defining moment, embracing the development of core skills for the general anaesthesiologist, whilst also continuing the advancement of the specialty.

Recent findings

Recent priority setting projects have focussed attention on key aspects of regional anaesthesia delivery, including pain management, conduct and efficacy, education, and technological innovation. Developments in our current understanding of anatomy and pharmacology, combined with strategies for optimizing the conduct and maximizing efficacy of techniques, minimizing complications, and enhancing outcomes are explored. In addition, advancements in education and training methodologies and the integration of progress in novel technologies will be reviewed.

This review highlights recent scientific advances in optimizing both single-shot and continuous peripheral regional anaesthesia techniques. By synthesizing these developments, this review offers valuable insights into the evolving landscape of regional anaesthesia, aiming to improve clinical practice and patient care.
An update on the perioperative management of postcraniotomy pain
Authors: Dean Cassandra , McCullough Ian , Papangelou Alex
Published: July 2024

Purpose of review

Pain after craniotomy is often severe and undertreated. Providing adequate analgesia while avoiding medication adverse effects and physiological complications of pain remains a perioperative challenge.

Recent findings

Multimodal pain management includes regional anesthesia and analgesic adjuncts. Strategies aim to reduce or eliminate opioids and the associated side effects. Many individual pharmacologic interventions have been studied with beneficial effects on acute pain following craniotomy. Evidence has been accumulating in support of scalp blockade, nonsteroidal anti-inflammatory drugs (NSAIDs), dexmedetomidine, paracetamol, and gabapentinoids. The strongest evidence supports scalp block in reducing postcraniotomy pain and opioid requirements.

Improving analgesia following craniotomy continues to be a challenge that should be managed with multimodal medications and regional techniques. Additional studies are needed to identify the most effective regimen, balancing efficacy and adverse drug effects.
Neuromodulation treatments for migraine: a contemporary update
Authors: Kramer Jeffery , Hayek Salim , Levy Robert
Published: July 2024

Purpose of review

Neuromodulation approaches have been a part of a revolution in migraine therapies with multiple devices approved or in development. These devices vary in the nerve(s) being targeted, implantable versus noninvasive form factors as well as their effectiveness for acute pain reduction or migraine prevention. This review will summarize these recent advancements and approaches that are being developed which build upon prior work and improved technology that may help enhance the effectiveness as well as the patient experience.

Recent findings

Both noninvasive and implantable devices primarily targeting cranial nerves have shown the ability to help alleviate migraine symptoms. Multiple prospective and retrospective studies have demonstrated clinically meaningful reductions in headache intensity with noninvasive approaches, while prevention of migraine demonstrates more modest effects. Implantable neuromodulation technologies focusing on occipital and supraorbital stimulation have shown promise in migraine/headache prevention in chronic migraine patients, but there is a need for improvements in technology to address key needs for surgical approaches.

Electrical neuromodulation approaches in the treatment of migraine is undergoing a transformation towards improved outcomes with better technologies that may suit various patient needs on a more individualized basis.
A Source Control Model for Treatment-Resistant Substance Use Disorder
Authors: Dernbach Matthew Robert , Drexler Karen , McCord Elizabeth , Carpenter Joseph E.
Published: July 2024

We propose applying the “source control” model of infectious disease treatment to the management of treatment-resistant substance use disorder (SUD). We believe that this conceptual framework complements other models for understanding SUD, fills a gap in our current understanding of treatment-resistant SUD, and advances the destigmatization of SUD by reinforcing SUD as a disease similar to other medical conditions. The model also harmonizes the need for multimodal treatment and novel interventions for both acute supportive care and long-term treatment of SUD. In this manuscript, we discuss the justification for, as well as the strengths and limitations of, the “source control” model for the management of treatment-resistant SUD. We also discuss the model’s potential to direct innovative research questions and therapeutic interventions.
Trend in Prescription Medication Utilization for Opioid Use Disorder and Alcohol Use Disorder From 2015 to 2021: A Population-wide Study in a Canadian Province
Authors: Abbott Kearley , Hyrsak Rachel , Bolton James M. , Sareen Jitender , Enns Murray W. , Konrad Geoffrey , Knight Erin , Eltonsy Sherif , Kowalec Kaarina , Falk Jamison , Alessi-Severini Silvia , Liu Kun , Prior Heather , Leong Christine
Published: July 2024

Objective

To examine the quarterly incidence and prevalence of medications for opioid use disorder (OUD) and alcohol use disorder (AUD) from 2015 to 2021.

Methods

A retrospective population-wide observational study in Manitoba, Canada, was conducted using administrative claims data from the Manitoba Centre for Health Policy to examine the incidence and prevalence of OUD (methadone, buprenorphine-naloxone, buprenorphine) or AUD medications (naltrexone, acamprosate, disulfiram) per 10,000 individuals in each quarter between January 1, 2015, and December 31, 2021.

Results

There were 1179 and 451 individuals who received at least one prescription for OUD and AUD, respectively, in the first quarter of 2020. The prevalence of OUD medications more than doubled from 6.3 to 14.3 per 10,000 from January 1, 2015, to December 31, 2021. Likewise, AUD medication prevalence increased almost 10-fold from 0.68 to 6.5 per 10,000 from January 1, 2015, to December 31, 2021, primarily due to naltrexone. The incidence of AUD prescription use increased 8.6-fold from 0.29 to 2.51 per 10,000 during the study period. In contrast, the incidence of opioid agonist therapy declined from 2.1 per 10,000 in the first quarter of 2015 to 0.53 per 10,000 the first quarter of 2016, primarily due to methadone. Whereas methadone incidence declined, buprenorphine-naloxone incidence increased almost 15-fold during the study period.

Conclusion

An increase in both AUD medication prevalence and incidence in addition to an increase in buprenorphine-naloxone incidence was observed. These findings reflect an increase in the uptake of medications for treating AUD and OUD following changes to improve coverage and access to these medications.
Surgical Outcomes and Sociodemographic Disparities Across All Races: An ACS-NSQIP and NHIS Multi-Institutional Analysis of Over 7.5 Million Patients
Authors: Matar Dany Y. , Knoedler Samuel , Matar Anthony Y. , Friedrich Sarah , Kiwanuka Harriet , Hamaguchi Ryoko , Hamwi Carla M. , Hundeshagen Gabriel , Haug Valentin , Kneser Ulrich , Ray Keisha , Orgill Dennis P. , Panayi Adriana C.
Published: July 2024

Background:

This study aims to fill the gap in large-scale, registry-based assessments by examining postoperative outcomes across diverse races/ethnicities. The focus is on identifying disparities and comparing them with socioeconomic demographics.

Methods:

In a registry-based cohort study using the 2008 to 2020 American College of Surgeons National Surgical Quality Improvement Program, we evaluated 24 postoperative outcomes through multivariable analysis, incorporating 28 preoperative risk factors. In a separate, independent analysis of the 2019 to 2020 National Health Interview Survey (NHIS) database, we examined sociodemographic racial/ethnic normative data.

Results:

Among 7,504,734 American College of Surgeons National Surgical Improvement Database patients specifying race, 83.8% were White (WT), 11.8% Black or African American (B/AA), 3.3% Asian (AS), 0.7% American Indian or Alaska Native (AI/AN), 0.4% Native Hawaiian or Pacific Islander (NH/PI), 7.3% Hispanic. Reoperation trends reveal favorable outcomes for WT, AS, and NH/PI patients compared with B/AA and AI/AN patients. AI/AN patients exhibit higher rates of wound healing issues, while AS patients experience lower rates. AS and B/AA patients are more prone to transfusions, with B/AA patients showing elevated rates of pulmonary embolism, deep vein thrombosis, renal failure, and insufficiency. Disparities in discharge destinations exist. Hispanic patients fare better than non-WT Hispanic patients, contingent on race. Racial groups (excluding Hispanic patients) with superior surgical outcomes from the NSQIP analysis were found in the NHIS analysis to report higher wealth, better healthcare access, improved food security, greater functional and societal independence, and lower frailty.

Conclusions:

Our study underscores racial disparities in surgical outcomes. Focused investigations into these complications could reveal underlying causes, informing healthcare policies to enhance surgical care universally.
Time-Dependent Changes in Pulmonary Turnover of Thrombocytes During Critical COVID-19
Authors: Aarskog Nikolai Ravn , Hallem Ronja , Godhavn Jakob Strand , Rostrup Morten
Published: July 2024

OBJECTIVES (BACKGROUND):

Under normal conditions, pulmonary megakaryocytes are an important source of circulating thrombocytes, causing thrombocyte counts to be higher in arterial than venous blood. In critical COVID-19, thrombocytes may be removed from the circulation by the lungs because of immunothrombosis, possibly causing venous thrombocyte counts to be higher than arterial thrombocyte counts. In the present study, we investigated time-dependent changes in pulmonary turnover of thrombocytes during critical COVID-19 by measuring arteriovenous thrombocyte differences. We hypothesized that the early stages of the disease would be characterized by a net pulmonary removal of circulating thrombocytes because of immunothrombosis and that later stages would be characterized by a net pulmonary release of thrombocytes as normal pulmonary function is restored.

DESIGN:

Cohort study with repeated measurements of arterial and central venous thrombocyte counts.

SETTING:

ICU in a large university hospital.

PATIENTS:

Thirty-one patients with critical COVID-19 that were admitted to the ICU and received invasive or noninvasive mechanical ventilation.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We found a significant positive association between the arteriovenous thrombocyte difference and time since symptom debut. This finding indicates a negative arteriovenous thrombocyte difference and hence pulmonary removal of thrombocytes in the early stages of the disease and a positive arteriovenous thrombocyte difference and hence pulmonary release of thrombocytes in later stages. Most individual arteriovenous thrombocyte differences were smaller than the variance coefficient of the analysis.

CONCLUSIONS:

The results of this study support our hypothesis that early stages of critical COVID-19 are characterized by pulmonary removal of circulating thrombocytes because of immunothrombosis and that later stages are characterized by the return of normal pulmonary release of thrombocytes. However, in most cases, the arteriovenous thrombocyte difference was too small to say anything about pulmonary thrombocyte removal and release on an individual level.
Blood Tumor Mutational Burden Alone Is Not a Good Predictive Biomarker for Response to Immune Checkpoint Inhibitors in Patients With Gastrointestinal Tumors
Authors: Yu James , Park Robin , Miao Ruoyu , Imanirad Iman , Shahzad Moazzam , Laborde Jose M. , Knepper Todd C. , Walko Christine M. , Kim Richard
Published: July 2024

There has been a controversy about the predictive value of tissue-TMB-H for immune checkpoint inhibitors (ICIs) with limited data regarding blood-TMB (bTMB) in GI tumors. We aim to evaluate the predictive value of bTMB compared with MSI-H in GI tumors. Patients with unresectable/metastatic GI cancer, harboring either MSS with bTMB-H (≥10 mut/Mb) or dMMR/MSI-H who received ICI were included. We compared ICIs’ efficacy between MSS-bTMB-H (N=45) versus MSI-H (N=50) in GI tumors. Ninety-five patients were identified with the majority having colorectal (49.5%) or esophagogastric (34.7%) cancers. MSS-bTMB-H group had more esophagogastric cancer and later-line ICI recipients, with no significant differences in other known prognostic variables. At a median follow-up of 9.4 months, MSI-H group showed superior ORR (58.0% vs. 26.7%), DCR (84.0% vs. 42.2%), DoR (not-reached vs. 7.6 mo), PFS (22.5 vs. 3.8 mo), and OS (Not-reached vs. 10.1 mo) compared with MSS-bTMB-H. Multivariable analysis showed that MSI-H was an independent favorable factor over MSS-bTMB-H for PFS (HR=0.31, CI 0.15-0.63, P=0.001) and OS (HR=0.33, CI 0.14-0.80, P=0.014). MSI-H group showed favorable outcomes compared with MSS-bTMB-16+ (ORR: 58.0% vs. 26.9%; DCR: 84.0% vs. 42.3%; PFS:22.5 vs. 4.0 mo) and MSS-bTMB-20+ (ORR: 58.0% vs. 31.6%; DCR: 84.0% vs. 42.1%; PFS:22.5 vs. 3.2 mo). There was no difference between MSS-bTMB10–15 compared with MSS-bTMB-16+ in ORR, DCR, and PFS, or between MSS-bTMB10–19 compared with MSS-bTMB20+. Regardless of bTMB cutoff at 10, 16, or 20, bTMB-H did not appear to be a predictive biomarker in MSS GI tumors in this retrospective analysis.
Emesis as a Risk Factor for Postoperative Hematoma in Abdominoplasty: A Retrospective Study in 189 Cases
Authors: Scharfetter Sandra , Puchner Julia , Schwaiger Karl , Hitzl Wolfgang , Buben Philipp , Wechselberger Gottfried
Published: July 2024

Background:

Among aesthetic procedures, abdominoplasty is associated with an increased complication rate. In general, postoperative nausea and vomiting is frequently experienced. As vomiting increases the intraabdominal pressure and blood pressure, and results in an increased mechanical friction on the abdominal wall, intraoperatively ligated vessels are prone to reopen. However, previous studies have not investigated the impact of postoperative emesis on postoperative hematoma in patients undergoing abdominoplasty.

Methods:

We performed a retrospective analysis on all patients who underwent abdominoplasty between 2017 and 2019 in our institution. Patients were divided into two groups, group 1 including patients experiencing postoperative vomiting and group two including patients without postoperative vomiting. Data extraction focused on patient characteristics, intraoperative characteristics, and postoperative complications, particularly the proportion of patients developing postoperative hematoma. Finally, statistical analysis was performed to analyze the impact of postoperative vomiting on the risk to develop a postoperative hematoma.

Results:

We identified 189 patients fitting our inclusion criteria. Overall, the proportion of postoperative hematoma was 13.7%. Thereby, a statistically significant difference was found between both groups: 62.5% of patients in group 1 (vomiting group) and only 9.25% in group 2 (nonvomiting group) developed a postoperative hematoma [odds ratio: 16.4 (95% confidence interval, 5.3–50.9), P < 0.000001].

Conclusion:

In patients undergoing abdominoplasty, postoperative vomiting increases the risk to develop a postoperative hematoma.
Differential Transcriptional Responses in Corneal and Lung Epithelial Cells to Seasonal Influenza With Potential Function of LGALS9
Authors: Han Yang , Zhang Ting , Bai Dan , Wu Changcheng , Ye Beiwei , Zhou Jianfang , Zhao Yingze , Gao George F. , Liu Jun
Published: July 2024

Seasonal flu, primarily caused by influenza A H1N1 and H3N2 subtype viruses or influenza B viruses, is the most prevalent respiratory tract infection globally and leads to substantial morbidity and mortality annually. Despite the influenza virus being initially recognized as a respiratory pathogen with well-characterized transmission through respiratory droplets, its impact on the ocular epithelium and associated gene expression remains relatively unexplored. In this study, we investigated the transcriptional profiles of immortalized human corneal epithelial cells (HCE-S) and A549 human lung epithelial cells infected with H1N1 and H3N2 influenza virus. In comparison with A549 cells, a reduced number of differentially expressed genes was observed in HCE-S upon influenza virus infection. Specifically, there was a significant upregulation of the genes IFI44L and OAS1, along with lower release of the CCL5/RANTES protein. Notably, our findings revealed uniquely upregulated LGALS9 (encoding galectin-9) in HCE-S following infection with the 2009 pandemic H1N1 virus. Furthermore, targeted knockdown of LGALS9 in these cells resulted in a measurable decrease in viral infection, highlighting its role in the cellular responses to influenza virus and suggesting a novel avenue for antiviral therapy. Overall, our findings provide insight into the distinct mechanisms of influenza virus interactions with different epithelial cells and underscore the importance of studying the ocular surface in understanding influenza pathogenesis.
Staged Excision Technique for Periocular Cutaneous Melanoma: Long-Term Outcomes of the Square Procedure
Authors: Mirzania Delaram , Zhao Zhenyang , Weber Madeline , Ahdoot Rodney , Juntipwong Sarinee , Harms Kelly , Aakalu Vinay K. , Kim Denise S. , Demirci Hakan , Nelson Christine C.
Published: July 2024

Purpose:

To examine the long-term outcome of the staged excision via the square procedure for the treatment of periocular thin cutaneous melanoma.

Methods:

A retrospective chart review of 95 periocular cutaneous melanoma-in-situ and microinvasive melanoma tumors that were treated with the square procedure between April 1, 1994 and December 31, 2018 at the University of Michigan. Demographic and clinical data were evaluated.

Results:

Of 95 cases, 19 (20%) were atypical junctional melanocytic proliferation with features of early melanoma-in-situ, 63 (66.3%) were melanoma-in-situ and 13 (13.7) were microinvasive melanoma with Breslow depth less than 1 mm. Tumor-free margins were achieved with a median margin of 10 mm (range 5–40 mm). Most cases (68.4%) required multiple excision stages. Surgical revision was necessary in 17.9% of cases and was associated with larger defect size. Local recurrence was noted in 8 patients (8.4%) at a median of 42 months postreconstruction. No tumor characteristics were found to predict recurrence.

Conclusions:

The square procedure for periocular melanoma offers an 8.4% recurrence rate, consistent with literature reports on similar staged excision approaches. The staged excision provides an excellent option for comprehensive margin review and tumor control with acceptable cosmetic results after reconstruction.
Clinicians’ Perspectives of Activity Monitoring Applications and Facilitators for Lower-Limb Prosthetic Service Provision
Authors: Patricks Victoria , Twiste Martin , Granat Malcolm , Curtin Samantha , Worsley Peter
Published: July 2024

Introduction

Clinicians involved in lower-limb prosthetic provision and care do not have an objective method for measuring patients’ real-world prosthesis usage. This results in a poor understanding of the full picture of the patient’s everyday life impacting the reporting of outcome following prosthetic prescriptions. There is need to understand what information from wearable prosthetic monitors would be relevant to clinicians and how that information should be displayed to enable health care professionals to make informed decisions. Moreover, clinicians’ perspectives regarding potential use and application of information from monitoring technologies are important in the development and implementation of this technology to improve evidence-based systems for informed clinical decisions for lower-limb prosthesis users. This study aims to explore clinicians’ experiences and perceptions of information obtained from free-living wearable prosthetic monitors used in clinical practice.

Methods

Seven clinicians from private practice and academia were recruited to participate in the study. A semistructured interview was held for each participant, which lasted about 30–45 minutes. Data and transcripts were analyzed using inductive thematic analysis method.

Results

Themes of objectiveness and motivation were identified as specific applications of monitoring technologies. Other themes such as awareness and integration were identified as the facilitators of monitoring technologies for prosthetic care in clinical settings. Clinicians identified frameworks in which these monitoring technologies could be incorporated into the clinic, how they can receive feedback as a multidisciplinary team, and the inclusion within patients’ medical records.

Conclusions

This information from prosthetic monitoring technologies could potentially change clinical practice in several ways: by improving the clinical assessment process, improving the prescription process, and improving the rehabilitation process.

To improve the clinical assessment process, prosthetic monitoring information can provide real-world data of prosthesis user’s utilization, which could be used to quantify patients’ self-reports. To improve the prescription process, prosthetic monitoring information can enable clinicians to see if a patient was actively involved in any form of exercise and support them to position their prescription of components within an activity category for their patients. To improve the rehabilitation process, prosthetic monitoring information can be used to plan goals for patients, to measure the progress of patients, and to check for patients’ compliance.

Clinical Relevance Statement

The impact of these potential changes in clinical practice can ultimately lead to improved clinical decisions in prosthetic care and creation of an evidence-based system.
The Dynamic Donning Technique of Prosthetic Liners
Authors: Sedki Imad , Yiu Roy
Published: July 2024

Introduction

Prosthetic liners are widely used for a variety of indications such as improving prosthetic socket fit and suspension. However, these are associated with complications affecting the skin, including skin rubs, breakdown, and ulceration.

Methods and Discussion

We outline the splinting effect of prosthetic liners as a possible contributing factor that results in increased shear during joint motion and propose a simple liner donning technique to minimize these shear forces by spreading liner/skin tension over the whole range of motion of the proximal joint.

Clinical Relevance

The proposed dynamic donning technique would minimize the risk of skin ulcerations and improve joint range of motion in prosthetic limb users.
Are Sub-elite Athletes at Higher Risk of Eating Disorders, Exercise Addiction, Depression, and Low Energy Availability Compared With Elite Athletes?
Authors: Lichtenstein Mia Beck , Hertz Søren Peter Thygesen , Johansen Karen Krogh , Rytter Josefine , Sundgot-Borgen Jorunn , Torstveit Monica Klungland , Holm Lars , Melin Anna K.
Published: July 2024

Objective:

The main objective of this study was to investigate the risk of eating disorders, exercise addiction, depression, and low energy availability (LEA) in Danish female and male elite compared with sub-elite athletes.

Design:

A cross-sectional study.

Setting:

An online survey.

Participants:

A total of 410 elite athletes (mean age 20.1 years, 51% females) and 206 sub-elite athletes (mean age 21.3 years, 52% females) from 15 different sports.

Assessment of Risk Factors: Eating Disorders, exercise addiction, depression, and LEA.

Main Outcome Measures:

The Sick Control, One Stone (6.5 kg), Fat, Food, the Eating Disorder Examination-Questionnaire, the Exercise Addiction Inventory, the Major Depression Inventory, and the Low Energy Availability in Females Questionnaire or the Low Energy Availability in Males Questionnaire.

Results:

We found that more female sub-elite athletes compared with elite athletes had risk of eating disorders (EDs) (37.4% vs 23.4%; P < 0.012) and the same was found for males (23.2% vs 10.4%; P = 0.005). More athletes with risk of EDs had risk of exercise addiction (12.8 vs 5.4%, P = 0.006), depression (27.3 vs 4.2%, P < 0.001), and LEA (females 55.1 vs 40.7%, P = 0.024, and males 29.4 vs 13.7%, P = 0.036, respectively) compared with athletes without risk of EDs.

Conclusions:

Sub-elite athletes have a higher risk of eating disorders compared with elite athletes. Regular screening of ED symptoms and associated conditions in elite and especially sub-elite athletes may ensure early identification.
Joint deficiency of coagulation factors VII and IX: a case report
Authors: Rueda Jhon Alexander Avila , de la Hoz Cesar , Manrique-Hernández Edgar Fabián
Published: July 2024

The diagnostic and therapeutic approach for an unusual clinical situation is presented. Twenty-three-year-old female patient is evaluated for hematuria and metrorrhagia. She reported irregular follow-up with hematology because of bleeding in childhood. She has also been receiving factor VII for 2 years, denying hospitalizations because of bleeding. Laboratory reported hb: 5.2 g/dl; platelets: 234 000/mm3; PT: 100 s; PTT: 112 s, fibrinogen: 90 mg/dl without other alterations. Abdominal ultrasound reported uterine myoma, urinalysis was pathological. The gynecology indicated oral progesterone. She started antibiotic therapy, transfusion of red-blood cells, plasma, and cryoprecipitates and subsequently reported: factor VII: 2%, IX: 1% and VIII: 70%. She received factor VII-recombinant (rFVII), achieving resolution of bleeding. She was prescribed prophylactic rFVII and hematology monitoring. Readmission due to acute abdomen with Hb 5 g/dl, prolonged prothrombin time (PT)/partial thromboplastin time (PTT) and abdominal tomography reported hemoperitoneum. She received rFVII and required laparotomy and left oophorectomy. Then readmission to metrorrhagia, hb6 g/dl, prolonged PT/PTT and factor VII-IX of two coagulation factors were reported, without reports found in the literature consulted.
Real-world clinical outcomes with fostamatinib for the treatment of refractory chronic immune thrombocytopenia: a single-center experience
Authors: Moore Donald C. , Elmes Joseph B. , Arnall Justin R. , Pineda-Roman Mauricio
Published: July 2024

Fostamatinib is a spleen tyrosine kinase inhibitor indicated for the treatment of chronic immune thrombocytopenia (ITP) unresponsive to a previous treatment. Real-world studies evaluating the utilization and effectiveness of fostamatinib outside the context of a clinical trial are lacking. The objective of this analysis was to evaluate the effectiveness of fostamatinib for the treatment of ITP in a real-world cohort.

We conducted a single-center, retrospective, observational study to evaluate the effectiveness of fostamatinib for the treatment of ITP. The primary endpoint was durable response as defined by the American Society of Hematology ITP response criteria. Secondary endpoints included overall response rate, time to response, and safety. Subgroup analysis was performed to assess frequency of durable response in key subgroups of patients based on prior therapies.

Thirty-one patients treated with fostamatinib for ITP were included in our analysis. Patients had received a median of four prior lines of therapy. Ten patients (32%) achieved a durable response. Most durable responders maintained their response at 24 months (n = 7; 70%). The median time to response was 9 days. Four patients (13%) discontinued fostamatinib due to an adverse event. Subgroups who had higher rates of durable responses included those who had received two to three prior lines of therapy (40%), splenectomized patients (50%), and those who had not received prior rituximab (55%).

Fostamatinib therapy in a real-world population of patients with heavily pretreated ITP led to a durable response in a third of patients, which was maintained for most responders.
Chemical burn wounds as a risk factor for gastric cancer: in-silico analyses—experimental research
Authors: Zabihi Mohammad Reza , Akhoondian Mohammad , Tohidian Mobina , Karkhah Samad , Ghorbani Vajargah Pooyan , Mazhari Seyed Amirhossein , Farhadi Bahar , Farzan Ramyar
Published: July 2024

Introduction:

The present study employs bioinformatics tools to identify shared upregulated genes between chemical burns and gastric cancer.

Methods:

Gene Expression Omnibus (GEO) retrieved gene sets for this investigation. GSEs with P value less than 0.05 and LOG fold change (FC) greater than 1 were valid and upregulated. Gastric cancer and chemical burn common elevated genes were found using Venn diagram online tools. In the second stage, the “string” visualized gastric cancer elevated genes network, and non-coding RNAs were deleted, and “interaction” greater than 1 was examined to choose important gene nodes. Next, they explored the String gene-interaction network for common genes. To determine the most interacting genes, Gephi (V 0.9.7) used “betweenness centrality” greater than “0” to evaluate the twenty-gene network. TISIDB and drug banks provide gene-related medications.

Results:

In the present study, two genes, including ALOX5AP and SERPINB2, were obtained, with the highest centrality among chemical burns and gastric cancer shared genes. Additionally, the current study presented five drugs, including Urokinase, Tenecteplase, DG031, AM103, and Fiboflapon, which can have predicted effects on gastric cancer following chemical burns.

Conclusion:

According to current in-silicon analyses, ALOX5AP and SERPINB2 are linked genetic keys between gastric chemical burn and cancer. Considering that burn is an environmental factor that leads to the upregulation of the two genes thus, the chemical burn can be related to the incidence of gastric cancer.
Clinical management controversy caused by a rare case of silver clip detachment and displacement after tubal silver clip sterilization
Authors: Zheng Chunyan , Wu Guangxing , Wu Linli , Zheng Yaqin , Li Zijun
Published: July 2024

Introduction and importance:

The treatment of rare long-term complications such as ectopic silver clips after tubal silver clip sterilization, still follows the principle of removing metal foreign body (MFB) in the abdominal cavity: first choice removal, which seems to be a habitual treatment method by clinical gynecologists. However, this measure has recently been greatly questioned.

Case presentation:

A 54-year-old postmenopausal woman who had undergone tubal sterilization with a silver clip 32 years ago, presented to the emergency department (ED) with severe left upper abdominal colic, paroxysmal, accompanied by vomiting and radiating pain. Her vital signs were stable, and an emergency routine urine test showed microscopic hematuria. Preliminary consideration was given to ureteral stones, and abdominal pain was relieved after treatment. Abdominal computed tomography confirmed the previous consideration, but unexpectedly found that the left tubal sterilization metal clip disappeared and was ectopic in the perihepatic space.

Clinical discussion:

This traditional conception of removing MFB in the abdominal cavity is often accepted by many surgeons. Based on the management measures of this case and the systematic review of the literature, we found that the detached ectopic silver clip did not cause serious long-term complications, possibly due to its good tissue receptivity and other characteristics.

Conclusion:

Although an ectopic silver clip is an MFB in the abdominal cavity, it has been increasingly shown that removing the silver clip is not necessary because of the good receptivity of silver to human tissue and the uncertainty of long-term side effects on the human body.
Revolution in malaria detection: unveiling current breakthroughs and tomorrow’s possibilities in biomarker innovation
Authors: Obeagu Emmanuel Ifeanyi , Okoroiwu G. I.A. , Ubosi N. I. , Obeagu Getrude U. , Onohuean Hope , Muhammad Tukur , Adias Teddy C.
Published: July 2024

The ongoing battle against malaria has seen significant advancements in diagnostic methodologies, particularly through the discovery and application of novel biomarkers. Traditional diagnostic techniques, such as microscopy and rapid diagnostic tests, have their limitations in terms of sensitivity, specificity, and the ability to detect low-level infections. Recent breakthroughs in biomarker research promise to overcome these challenges, providing more accurate, rapid, and non-invasive detection methods. These advancements are critical in enhancing early detection, guiding effective treatment, and ultimately reducing the global malaria burden. Innovative approaches in biomarker detection are leveraging cutting-edge technologies like next-generation sequencing, proteomics, and metabolomics. These techniques have led to the identification of new biomarkers that can be detected in blood, saliva, or urine, offering less invasive and more scalable options for widespread screening. For instance, the discovery of specific volatile organic compounds in the breath of infected individuals presents a revolutionary non-invasive diagnostic tool. Additionally, the integration of machine learning algorithms with biomarker data is enhancing the precision and predictive power of malaria diagnostics, making it possible to distinguish between different stages of infection and identify drug-resistant strains. Looking ahead, the future of malaria detection lies in the continued exploration of multi-biomarker panels and the development of portable, point-of-care diagnostic devices. The incorporation of smartphone-based technologies and wearable biosensors promises to bring real-time monitoring and remote diagnostics to even the most resource-limited settings.
Leishmaniasis in transplant patients: what do we know so far?
Authors: Monge-Maillo Begoña , López-Vélez Rogelio
Published: July 2024

Purpose of review

The number of cases of visceral leishmaniasis associated with transplant-associated immunosuppression has increased in recent years. Reviewing and updating the latest developments in its diagnostic management, treatment, and follow-up is necessary and relevant.

Recent findings

Visceral leishmaniasis cases associated with non-HIV immunosuppression are a growing cause of the parasitic infections, and the transplant patients are included in this context. These have been described especially in kidney transplantation. Liposomal amphotericin B is the first-line treatment. Due to immunosuppression, these patients often suffer from recurrent infections. The use of markers that indicate whether the patient has developed an adequate cellular response against Leishmania after treatment seems to be good biomarkers of cure and useful for monitoring and guiding secondary prophylaxis.

There is a lack of consensus regarding the need for leishmaniasis screening in donors and recipients and the indications for secondary prophylaxis. The study of new biomarkers of cure may be useful in all three contexts.
A Peculiar Tau Accumulation Pattern Identified Via 18F-Florzolotau PET Imaging in a Patient With Frontotemporal Dementia Caused by a Mutation in the MAPT Gene
Authors: Li Qijun , Li Hang , Huang Zhaoxia , Li Yanfeng , Cui Ruixue
Published: July 2024

We reported imaging findings with a peculiar tau accumulation pattern in a 56 year-old woman with frontotemporal dementia caused by Q351R mutation in the microtubule-associated protein tau (MAPT) gene. She had a 10-year history of gradually worsening memory loss. 18F-FDG PET demonstrated hypometabolism in medial temporal lobes, but 18F-florbetapir PET manifested no abnormal amyloid beta deposition, which ruled out Alzheimer disease. 18F-florzolotau PET showed tau proteins accumulated in medial temporal lobes, basal ganglia brainstem, and cerebellum. The pattern is different from other known MAPT gene mutation. Multitracer imaging can help differentiate between Alzheimer disease and frontotemporal dementia caused by MAPT mutation
Clinical Factors Affecting Discrepancy Between Predicted and Long-term Actual Lung Function Following Surgery
Authors: Ju Jae-Woo , Suh Minseok , Choi Hongyoon , Na Kwon Jooong , Park Samina , Cheon Gi Jeong , Kim Young Tae
Published: July 2024

Purpose

Lung cancer surgery outcomes depend heavily on preoperative pulmonary reserve, with forced expiratory volume in 1 second (FEV1) being a critical preoperative evaluation factor. Our study investigates the discrepancies between predicted and long-term actual postoperative lung function, focusing on clinical factors affecting these outcomes.

Methods

This retrospective observational study encompassed lung cancer patients who underwent preoperative lung perfusion SPECT/CT between 2015 and 2021. We evaluated preoperative and postoperative pulmonary function tests, considering factors such as surgery type, resected volume, and patient history including tuberculosis. Predicted postoperative lung function was calculated using SPECT/CT imaging.

Results

From 216 patients (men:women, 150:66; age, 67.9 ± 8.7 years), predicted postoperative FEV1% (ppoFEV1%) showed significant correlation with actual postoperative FEV1% (r = 0.667; P < 0.001). Paired t test revealed that ppoFEV1% was significantly lower compared with actual postoperative FEV1% (P < 0.001). The study identified video-assisted thoracic surgery (VATS) (odds ratio [OR], 3.90; 95% confidence interval [CI], 1.98–7.69; P < 0.001) and higher percentage of resected volume (OR per 1% increase, 1.05; 95% CI, 1.01–1.09; P = 0.014) as significant predictors of postsurgical lung function improvement. Conversely, for the decline in lung function postsurgery, significant predictors included lower percentage of resected lung volume (OR per 1% increase, 0.92; 95% CI, 0.86–0.98; P = 0.011), higher preoperative FEV1% (OR, 1.03; 95% CI, 1.01–1.07; P = 0.009), and the presence of tuberculosis (OR, 5.19; 95% CI, 1.48–18.15; P = 0.010). Additionally, in a subgroup of patients with borderline lung function, VATS was related with improvement.

Conclusions

Our findings demonstrate that in more than half of the patients, actual postsurgical lung function exceeded predicted values, particularly following VATS and with higher volume of lung resection. It also identifies lower resected lung volume, higher preoperative FEV1%, and tuberculosis as factors associated with a postsurgical decline in lung function. The study underscores the need for precise preoperative lung function assessment and tailored postoperative management, with particular attention to patients with relevant clinical factors. Future research should focus on validation of clinical factors and exploring tailored approaches to lung cancer surgery and recovery.
American Society of Transplant Surgeons Normothermic Regional Perfusion Standards: Abdominal
Authors: Croome Kristopher , Bababekov Yanik , Brubaker Aleah , Montenovo Martin , Mao Shennen , Sellers Marty , Foley David , Pomfret Elizabeth , Abt Peter
Published: July 2024

Background.

Normothermic regional perfusion (NRP) has emerged as a vital technique in organ procurement, particularly in donation after circulatory death (DCD) cases, offering the potential to optimize organ utilization and improve posttransplant outcomes. Recognizing its significance, the American Society of Transplant Surgeons (ASTS) convened a work group to develop standardized recommendations for abdominal NRP in the United States.

Methods.

The workgroup, comprising experts in NRP, DCD, and transplantation, formulated recommendations through a collaborative process involving revisions and approvals by relevant committees and the ASTS council. Four key areas were identified for standardization: Preprocedure communication, NRP procedure, Terminology and documentation, and Mentorship/credentialing.

Results.

The recommendations encompass a range of considerations, including preprocedure communication protocols to facilitate informed decision-making by transplant centers and organ procurement organizations, procedural guidelines for NRP teams, uniform terminology to clarify the NRP process, and standards for mentorship and credentialing of NRP practitioners. Specific recommendations address logistical concerns, procedural nuances, documentation requirements, and the importance of ongoing quality assurance.

Conclusions.

The standardized recommendations for abdominal NRP presented in this article aim to ensure consistency, safety, and efficacy in the organ procurement process. By establishing clear protocols and guidelines, the ASTS seeks to enhance organ utilization, honor donor wishes, and uphold public trust in the donation process. Implementation of these recommendations can contribute to the advancement of NRP practices and improve outcomes for transplant recipients.
A modelling framework for cancer ecology and evolution
Authors: Adler Frederick R.
Published: July 2024

Cancer incidence increases rapidly with age, typically as a polynomial. The somatic mutation theory explains this increase through the waiting time for enough mutations to build up to generate cells with the full set of traits needed to grow without control. However, lines of evidence ranging from tumour reversion and dormancy to the prevalence of presumed cancer mutations in non-cancerous tissues argue that this is not the whole story, and that cancer is also an ecological process, and that mutations only lead to cancer when the systems of control within and across cells have broken down. Aging thus has two effects: the build-up of mutations and the breakdown of control. This paper presents a mathematical modelling framework to unify these theories with novel approaches to model the mutation and diversification of cell lineages and of the breakdown of the layers of control both within and between cells. These models correctly predict the polynomial increase of cancer with age, show how germline defects in control accelerate cancer initiation, and compute how the positive feedback between cell replication, ecology and layers of control leads to a doubly exponential growth of cell populations.
Green analytical quality by design RP-HPLC technique with fluorimetric detection for simultaneous assay of cinnarizine and dompridone
Authors: Barakat Neamat T. , El-Brashy Amina M. , Fathy Mona E.
Published: July 2024

A green and sensitive factorial design-assisted reversed-phase high-performance liquid chromatography (RP-HPLC) approach with fluorimetric detection has been developed for simultaneous determination of cinnarizine and domperidone in pure materials, commercial single and combined tablets. Both drugs are co-formulated in one dosage form and are commonly used for the effective treatment of motion sickness in the ratio of 4 : 3 for cinnarizine and domperidone, respectively. To achieve the developed method’s best performance and reliability, a 2
3
full factorial design was applied during the optimization of chromatographic conditions. Subsequently, isocratic elution on a C18 column with a mobile phase mixture of methanol and 0.02 M potassium dihydrogen phosphate buffer (85 : 15 v/v, pH 3.0) was performed to achieve the best separation. Moreover, the flow rate of 0.8 ml min
−1
was applied during the analysis with fluorescence detection at λ
ex
283 nm/λ
em
324 nm. The elution process was time effective; it consumed less than 6 min for a complete run as retention time for cinnarizine and domperidone, was 4.5 and 3.5, respectively. Good linearity of the proposed method was achieved within the concentration ranges of 0.2–4.5 and 0.4–5.0 µg ml
−1
for domperidone and cinnarizine, respectively. The suggested approach was carefully validated according to the International Council for Harmonization (ICH) guidelines. Moreover, green analytical procedure index (GAPI), national environmental methods index (NEMI), analytical greenness (AGREE) and analytical eco-scale methods were applied to assess and confirm method greenness.
Sea anemones (
Actinia equina
) show consistent individual differences in boldness and thoroughness but lack a behavioural syndrome
Authors: Simpson Samantha , Briffa Mark
Published: July 2024

Behavioural syndromes are suites of behaviours that corelate between-individuals but the same behaviours may also show within-individual correlations owing to state dependency or trade-offs. Therefore, overall phenotypic behavioural correlations must be separated into their between- and within-individual components. We investigate how startle response duration (an index of boldness) and time taken to reject an inert item (an index of investigation thoroughness) covary in beadlet sea anemones,
Actinia equina
. Anemones took longer to reject a more complex item compared to a simpler one, validating this measure of investigation thoroughness. We then quantified between- and within-individual correlations using a Bayesian analysis and an alternative frequentist analysis, which returned the same results. Startle responses decreased with anemone size while thoroughness decreased across repeated observations, indicative of simple learning. For each behaviour, repeatability was significant but relatively low and there was no behavioural syndrome. Rather, the two behaviours showed a negative within-individual correlation in most individuals. Thus, boldness and thoroughness are unlikely to be under correlative selection, and they may instead be expressed independently, in line with the general pattern that cross-contextual behavioural syndromes are comparatively rare. It now appears that this pattern may extend broadly across animal diversity.
Association between genotypes ofABCB1, ABCG2andCYP3A5and the risk of atrial fibrillation
Authors: Pan Tzu-Yu , Lin Tzu-Yen , Tsai Wei-Chung , Wu Ming-Tsang
Published: July 2024

Background

Atrial fibrillation (AF) is a prevalent clinical condition worldwide, with a high global incidence that significantly impacts disease burden and mortality rates. Single nucleotide polymorphisms inABCB1,ABCG2andCYP3A5are common, but the clinical outcomes are poorly understood. This study examines the association between the genetic variations ofABCB1, ABCG2andCYP3A5and the risk of AF in a Taiwanese population.

Methods

This case-control study recruited 216 AF patients from two hospitals in Taiwan between 2021 and 2023. Control groups were matched by age (± one year), gender, and AF-related variables from the Taiwan Biobank. Logistic regression analyzed the association between three genetic variants and AF risk.

Results

A significant association was noted betweenABCG2 rs2231142and AF risk. Those withABCG2 rs2231142 G/TandT/Tgenotypes had a 1.91-fold (95% CI = 1.04-3.53) increased risk of AF compared to those with the G/G genotype. This association was particularly pronounced in males in those carryingABCG2 rs2231143 T/Tgenotype having a 4.47-fold (95% CI = 1.02-19.67) increased risk after adjusting for covariates. There were no overall significant associations between AF risk and the polymorphisms ofABCB1 rs4148738andrs1128503,norCYP3A5 rs776746.

Conclusion

A robust risk association between theABCG2 rs2231142 T alleleand AF in Asian populations, particularly in male adults, suggests that genetic testing for this polymorphism could be integrated into risk assessment models for AF.