bluuebunny/crossref_metadata_2025 huggingface dataset:
(143) Hostile Field: Surgical Management Strategies After Multiple Explants of Artificial Urinary Sphincters
Authors: Lopategui D , Demus T , Cordon B
Published: May 2023

Introduction

Placement of artificial urinary sphincters (AUS) is the gold standard treatment for moderate to severe stress urinary incontinence in men. Erosion, infection, and mechanical malfunction of the AUS are well known complications that require removal of the device. Replacement of AUS after several explants represents a surgical challenge and is performed by a minority of urologists.

Objective

We describe our experience with management of complex cases after multiple AUS complications.

Methods

Retrospective review of patients who underwent artificial urinary sphincter (AUS) removal after prior device explantations. Surgical and clinical data was collected, including demographic characteristics, indication for AUS explantation, number of prior AUS, presence of an IPP, and surgical outcomes and complications. Descriptive statistics were used for both categorical and nominal variables.

Results

Between 2017 and 2021, 8 patients presented with recurrent stress urinary incontinence (SUI) with a history of AUS with or without explant. 2 patients presented with one prior AUS, 1 patient with two prior, 4 patients with 3 prior AUS, and 1 patient with 4 prior AUS. 5/8 patients achieved >90% continence following one revision. The remaining patients underwent cuff downsizing. 1 patient failed multiple revisions and required urethral ligation with permanent suprapubic tube placement (SPT). Patient history and surgical course is summarized in Table 1.

Conclusions

AUS placement after multiple explants presents a surgical challenge. It is associated with a higher rate of complications and need for explant. It is however feasible and safe, and can provide resolution of incontinence to the majority of patients. In patients with a devastated urethra where additional AUS does not seem feasible a urinary diversion or urethral ligation with SPT may be a satisfactory alternative.

Disclosure

No
Heterotopic Ossification Formation in Military Beneficiaries Following Hip- and Pelvic-Level Amputations
Authors: Porter Kaitlin S , Harrington Colin J , Babikian Aline , Heltzel David , Potter Benjamin K , Smith Douglas G , Pasquina Paul F
Published: May 2023

Introduction

Traumatic hip and pelvic level amputations are uncommon but devastating injuries and associated with numerous complications that can significantly affect quality of life for these patients. While heterotopic ossification (HO) formation has been reported at rates of up to 90% following traumatic, combat-related amputations, previous studies included few patients with more proximal hip and pelvic level amputations.

Materials and Methods

We conducted a retrospective review of the Military Health System medical record and identified patients with both traumatic and disease-related hip- and pelvic-level amputations performed between 2001 and 2017. We reviewed the most recent pelvis radiograph at least 3 months following amputation to determine bony resection level and the association between HO formation and reason for amputation (trauma versus disease related).

Results

Of 93 patients with post-amputation pelvis radiographs available, 66% (n = 61) had hip-level amputations and 34% (n = 32) had a hemipelvectomy. The median duration from the initial injury or surgery to the most recent radiograph was 393 days (interquartile range, 73–1,094). HO occurred in 75% of patients. Amputation secondary to trauma was a significant predictor of HO formation (χ2 = 24.58; P < .0001); however, there was no apparent relationship between the severity of HO and traumatic versus non-traumatic etiology (χ2 = 2.92; P = .09).

Conclusions

Amputations at the hip were more common than pelvic-level amputations in this study population, and three-fourths of hip- and pelvic-level amputation patients had radiographic evidence of HO. The rate of HO formation following blast injuries and other trauma was significantly higher compared with patients with non-traumatic amputations.
Studying the warm hot intergalactic medium in emission: a reprise
Authors: Parimbelli G , Branchini E , Viel M , Villaescusa-Navarro F , ZuHone J
Published: May 2023

The warm-hot intergalactic medium (WHIM) contains a significant portion of the ‘missing baryons’. Its detection in emission remains a challenge. Integral field spectrometers like X-IFU on board of the Athena satellite will secure WHIM detection in absorption and emission and, for the first time, allow us to investigate its physical properties. In our research, we use the CAMELS simulations to model the surface brightness maps of the OVII and OVIII ion lines and compute summary statistics like photon counts and 2-point correlation functions to infer the properties of the WHIM. Our findings confirm that detectable WHIM emission is primarily associated with galaxy haloes, and the properties of the WHIM show minimal evolution from z ∼ 0.5 to the present time. By exploring a wide range of parameters within the CAMELS suite, we investigate the sensitivity of WHIM properties to cosmology and energy feedback mechanisms influenced by active galactic nuclei and stellar activity. This approach allows us to separate the cosmological aspects from the baryonic processes and place constraints on the latter. Additionally, we provide forecasts for WHIM observations using a spectrometer similar to X-IFU. We anticipate detecting 1–3 WHIM emission lines per pixel and mapping the WHIM emission profile around haloes up to a few tens of arcminutes, surpassing the typical size of a WHIM emitter. Overall, our work demonstrates the potential of emission studies to probe the densest phase of the WHIM, shedding light on its physical properties and offering insights into the cosmological and baryonic processes at play.
A twisted and precessing Cepheid warp in the outer Milky Way disc
Authors: Dehnen Walter , Semczuk Marcin , Schönrich Ralph
Published: May 2023

We examine the Galactic warp in a sample of all classical Cepheids with Gaia Data Release 3 radial velocity. In each radial bin, we determine (1) the inclined plane normal to the mean orbital angular momentum of the stars and (2) that best fitting their positions. We find no warping inside $R\approx 11\,$kpc; for larger R, the disc is increasingly inclined, reaching i ∼ 3° at $R\ge 14\,$kpc. With larger R, the azimuth of the warp’s ascending node shifts from φlon ≈ −15° at 11 kpc by about 14° kpc−1 in the direction of Galactic rotation, implying a leading spiral of nodes, the general behaviour of warped galaxies. From the method of fitting planes to the positions, we also obtain ${\dot{\varphi }}_{\mathrm{lon}}$ and find prograde precession of ${\dot{\varphi }}_{\mathrm{lon}}\sim 12\, \rm{km{}\,s^{-1}{}\,kpc^{-1}}$ at 12 kpc decreasing to ${\sim}\,6\, \rm{km{}\,s^{-1}{}\,kpc^{-1}}$ at 14 kpc and beyond. This would unwind the leading spiral of nodes in ${\sim}\,100\,$Myr, suggesting that our instantaneous measurements of ${\dot{\varphi }}_{\mathrm{lon}}$ reflect transient behaviour. This is consistent with existing simulations, which show oscillations in ${\dot{\varphi }}_{\mathrm{lon}}$ overlaying a long-term retrograde differential precession that generates the leading spiral of nodes.
Investigating kinematics and dynamics of three open clusters towards Galactic anticentre
Authors: Rangwal Geeta , Yadav R K S , Bisht D , Durgapal Alok , Sariya Devesh P
Published: May 2023

We present the intracluster kinematics and dynamics of three open clusters: NGC 1193, NGC 2355, and King 12 by incorporating kinematical and photometric data from Gaia DR3, as well as a ground-based telescope. After selecting cluster members based on proper motion data, clusters’ fundamental and structural parameters are investigated. We found the clusters at distances of 4.45, 1.97, and 3.34 kpc from the Sun in the direction of the Galactic anticentre. The luminosity function of the cluster NGC 1193 is flat, whereas it advances towards the fainter ends of the other two clusters. We observed a dip in the luminosity function of King 12. The mass function slopes for all three clusters differ from the solar neighbourhood reported by Salpeter, with NGC 1193 and NGC 2355 being flatter and King 12 having a higher value than the Salpeter value. The intra-cluster kinematics depict that stars in King 12 are moving outwards due to tidal forces from the Galactic disc, which we confirmed by plotting the cluster’s orbit in the Galaxy. Stars in NGC 2355 are moving with smaller relative velocities and have zero mean relative motion, which signifies that the cluster is neither contracting nor evaporating. The Galactic orbits of NGC 1193 suggest that it is orbiting farther from the Galactic disc, and so is less impacted by the Galactic tidal forces.
Mitochondria-targeted cyclometalated iridium-β-carboline complexes as potent non-small cell lung cancer therapeutic agents
Authors: Chen Jincan , Guo Xinhua , Li Dunhui , Tang Hong , Gao Jie , Yu Wenzhu , Zhu Xufeng , Sun Zirong , Huang Zunnan , Chen Lanmei
Published: May 2023

Natural products and metals play a crucial role in cancer research and the development of antitumor drugs. We designed and synthesized three new carboline-based cyclometalated iridium complexes [Ir(C-N)2(PPβC)](PF6), where PPβC = N-(1,10-phenanthrolin-5-yl)-1-phenyl-9H-pyrido[3,4-b]indole-3-carboxamide, C-N = 2-phenylpyridine (ppy, Ir1), 2-(2,4-difluorophenyl) pyridine (dfppy, Ir2), 7,8-benzoquinoline (bzq, Ir3), by combining iridium with β-carboline derivative. These iridium complexes exhibited high potential antitumor effects after being promptly taken up by A549 cells. Accumulating in mitochondria rapidly and preferentially, Ir1-3 caused a series of changes in mitochondrial events, including the loss of mitochondrial membrane potential, the depletion of cellular ATP, and the elevation of reactive oxygen species, leading to significant death of A549 cells. Moreover, the activation of intracellular caspase pathway and apoptosis was further validated to contribute to iridium complexes-induced cytotoxicity. These novel iridium complexes exerted a prominent inhibitory effect on tumor growth in a three-dimensional multicellular tumor spheroid model.
ResFinderFG v2.0: a database of antibiotic resistance genes obtained by functional metagenomics
Authors: Gschwind Rémi , Ugarcina Perovic Svetlana , Weiss Maja , Petitjean Marie , Lao Julie , Coelho Luis Pedro , Ruppé Etienne
Published: May 2023

Metagenomics can be used to monitor the spread of antibiotic resistance genes (ARGs). ARGs found in databases such as ResFinder and CARD primarily originate from culturable and pathogenic bacteria, while ARGs from non-culturable and non-pathogenic bacteria remain understudied. Functional metagenomics is based on phenotypic gene selection and can identify ARGs from non-culturable bacteria with a potentially low identity shared with known ARGs. In 2016, the ResFinderFG v1.0 database was created to collect ARGs from functional metagenomics studies. Here, we present the second version of the database, ResFinderFG v2.0, which is available on the Center of Genomic Epidemiology web server (https://cge.food.dtu.dk/services/ResFinderFG/). It comprises 3913 ARGs identified by functional metagenomics from 50 carefully curated datasets. We assessed its potential to detect ARGs in comparison to other popular databases in gut, soil and water (marine + freshwater) Global Microbial Gene Catalogues (https://gmgc.embl.de). ResFinderFG v2.0 allowed for the detection of ARGs that were not detected using other databases. These included ARGs conferring resistance to beta-lactams, cycline, phenicol, glycopeptide/cycloserine and trimethoprim/sulfonamide. Thus, ResFinderFG v2.0 can be used to identify ARGs differing from those found in conventional databases and therefore improve the description of resistomes.
FunARTS, the Fungal bioActive compound Resistant Target Seeker, an exploration engine for target-directed genome mining in fungi
Authors: Yılmaz Turgut Mesut , Mungan Mehmet Direnç , Berasategui Aileen , Ziemert Nadine
Published: May 2023

There is an urgent need to diversify the pipeline for discovering novel natural products due to the increase in multi-drug resistant infections. Like bacteria, fungi also produce secondary metabolites that have potent bioactivity and rich chemical diversity. To avoid self-toxicity, fungi encode resistance genes which are often present within the biosynthetic gene clusters (BGCs) of the corresponding bioactive compounds. Recent advances in genome mining tools have enabled the detection and prediction of BGCs responsible for the biosynthesis of secondary metabolites. The main challenge now is to prioritize the most promising BGCs that produce bioactive compounds with novel modes of action. With target-directed genome mining methods, it is possible to predict the mode of action of a compound encoded in an uncharacterized BGC based on the presence of resistant target genes. Here, we introduce the ‘fungal bioactive compound resistant target seeker’ (FunARTS) available at https://funarts.ziemertlab.com. This is a specific and efficient mining tool for the identification of fungal bioactive compounds with interesting and novel targets. FunARTS rapidly links housekeeping and known resistance genes to BGC proximity and duplication events, allowing for automated, target-directed mining of fungal genomes. Additionally, FunARTS generates gene cluster networking by comparing the similarity of BGCs from multi-genomes.
PanDrugs2: prioritizing cancer therapies using integrated individual multi-omics data
Authors: Jiménez-Santos María José , Nogueira-Rodríguez Alba , Piñeiro-Yáñez Elena , López-Fernández Hugo , García-Martín Santiago , Gómez-Plana Paula , Reboiro-Jato Miguel , Gómez-López Gonzalo , Glez-Peña Daniel , Al-Shahrour Fátima
Published: May 2023

Genomics studies routinely confront researchers with long lists of tumor alterations detected in patients. Such lists are difficult to interpret since only a minority of the alterations are relevant biomarkers for diagnosis and for designing therapeutic strategies. PanDrugs is a methodology that facilitates the interpretation of tumor molecular alterations and guides the selection of personalized treatments. To do so, PanDrugs scores gene actionability and drug feasibility to provide a prioritized evidence-based list of drugs. Here, we introduce PanDrugs2, a major upgrade of PanDrugs that, in addition to somatic variant analysis, supports a new integrated multi-omics analysis which simultaneously combines somatic and germline variants, copy number variation and gene expression data. Moreover, PanDrugs2 now considers cancer genetic dependencies to extend tumor vulnerabilities providing therapeutic options for untargetable genes. Importantly, a novel intuitive report to support clinical decision-making is generated. PanDrugs database has been updated, integrating 23 primary sources that support >74K drug–gene associations obtained from 4642 genes and 14 659 unique compounds. The database has also been reimplemented to allow semi-automatic updates to facilitate maintenance and release of future versions. PanDrugs2 does not require login and is freely available at https://www.pandrugs.org/.
ProAct: quantifying the differential activity of biological processes in tissues, cells, and user-defined contexts
Authors: Sharon Moran , Gruber Gil , Argov Chanan M , Volozhinsky Miri , Yeger-Lotem Esti
Published: May 2023

The distinct functions and phenotypes of human tissues and cells derive from the activity of biological processes that varies in a context-dependent manner. Here, we present the Process Activity (ProAct) webserver that estimates the preferential activity of biological processes in tissues, cells, and other contexts. Users can upload a differential gene expression matrix measured across contexts or cells, or use a built-in matrix of differential gene expression in 34 human tissues. Per context, ProAct associates gene ontology (GO) biological processes with estimated preferential activity scores, which are inferred from the input matrix. ProAct visualizes these scores across processes, contexts, and process-associated genes. ProAct also offers potential cell-type annotations for cell subsets, by inferring them from the preferential activity of 2001 cell-type-specific processes. Thus, ProAct output can highlight the distinct functions of tissues and cell types in various contexts, and can enhance cell-type annotation efforts. The ProAct webserver is available at https://netbio.bgu.ac.il/ProAct/.
Miniature RNAs are embedded in an exceptionally protein-rich mitoribosome via an elaborate assembly pathway
Authors: Valach Matus , Benz Corinna , Aguilar Lisbeth C , Gahura Ondřej , Faktorová Drahomíra , Zíková Alena , Oeffinger Marlene , Burger Gertraud , Gray Michael W , Lukeš Julius
Published: May 2023

The mitochondrial ribosome (mitoribosome) has diverged drastically from its evolutionary progenitor, the bacterial ribosome. Structural and compositional diversity is particularly striking in the phylum Euglenozoa, with an extraordinary protein gain in the mitoribosome of kinetoplastid protists. Here we report an even more complex mitoribosome in diplonemids, the sister-group of kinetoplastids. Affinity pulldown of mitoribosomal complexes from Diplonema papillatum, the diplonemid type species, demonstrates that they have a mass of > 5 MDa, contain as many as 130 integral proteins, and exhibit a protein-to-RNA ratio of 11:1. This unusual composition reflects unprecedented structural reduction of ribosomal RNAs, increased size of canonical mitoribosomal proteins, and accretion of three dozen lineage-specific components. In addition, we identified >50 candidate assembly factors, around half of which contribute to early mitoribosome maturation steps. Because little is known about early assembly stages even in model organisms, our investigation of the diplonemid mitoribosome illuminates this process. Together, our results provide a foundation for understanding how runaway evolutionary divergence shapes both biogenesis and function of a complex molecular machine.
Presenteeism—the case for action
Authors: Kinman Gail , Clements Andrew J
Published: May 2023

There is evidence that presenteeism (working while sick) is commonplace and is increasing, especially among homeworkers. Working while not fully fit can be therapeutic and functional, but growing knowledge of its wide-ranging impact means that it can be a potentially high-risk behaviour. This editorial presents an overview of the factors that encourage people to work while sick and the wide-ranging implications for their health and functioning. Also provided is evidence-informed guidance on the actions that organizations can take to reduce dysfunctional presenteeism and develop a ‘healthier’ sickness absence culture.
Multiregional Population-Based Cohort Study for Evaluation of the Association Between Herpes Zoster and mRNA Vaccinations for Severe Acute Respiratory Syndrome Coronavirus-2: The VENUS Study
Authors: Ishiguro Chieko , Mimura Wataru , Uemura Yukari , Maeda Megumi , Murata Fumiko , Fukuda Haruhisa
Published: May 2023

Background

This study was performed to assess the increased risk of herpes zoster (HZ) associated with mRNA vaccines for coronavirus disease 2019.

Methods

This population-based cohort study was conducted in 4 municipalities in Japan. Individuals covered under public health insurance systems without a history of HZ were followed from October 1, 2020 to November 30, 2021. Incidence rates of HZ within 28 days of BNT162b2 or mRNA-1273 vaccination were compared. Adjusted incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using a Poisson regression model, including vaccination status as a time-dependent covariate. Subgroup analyses by sex, age, and municipality were also conducted.

Results

A total of 339 548 individuals (median age, 74 years) were identified. During follow up, 296 242 individuals (87.2%) completed the primary series, among whom 289 213 and 7019 individuals received homologous BNT162b2 and mRNA-1273 vaccines, respectively. The adjusted IRRs of the first and second BNT162b2 vaccinations were 1.05 (95% CI, 0.84–1.32) and 1.09 (95% CI, 0.90–1.32), respectively. No cases of HZ were observed after mRNA-1273 vaccination. In subgroup analysis, the adjusted IRR of the second BNT162b2 vaccination was 2.94 (95% CI, 1.41–6.13) in individuals aged <50 years old.

Conclusions

No increased risk of HZ was found after BNT162b2 vaccination in the overall study population. However, an increased risk was observed in the younger subgroup.
Functional outcomes and health-related quality of life following penile cancer surgery: a comprehensive review
Authors: Croghan Stefanie M , Cullen Ivor M , Raheem Omer
Published: May 2023

Introduction

Organ-sparing surgery (OSS) in penile cancer management aspires to maintain organ form and function and preserve health-related quality of life (HRQoL), yet there is a lack of integrated evidence exploring these outcomes.

Objectives

The aim sought to review HRQoL, functional, aesthetic, and psychological outcomes following OSS or radical penectomy for penile cancer.

Methods

A systematic review of MEDLINE and Cochrane databases included studies reporting on function (sexual, urinary or sensory), genital appearance or HRQoL/psychological well-being following surgical treatment of primary penile cancer. English-language reports (2000-2022), incorporating patient-reported or objective clinical outcome measures, were eligible. Studies of nonsurgical treatment strategies and those in the context of metastatic disease were excluded. Data were compiled and analyzed.

Results

Twenty-six studies were included. Sexual function was the most studied outcome (754 pooled respondents; 19 studies), most frequently with the original 15-item and abridged 5-item International Index of Erectile Function. Preservation of erectile function following OSS is generally described, with some reduction in overall sexual satisfaction cited. Heterogeneous assessment of voiding function with little preoperative evaluation render interstudy comparison difficult. Most patients appear able to void from a standing position following OSS, with spraying the most common symptom. Maintenance of some sensory function is described with both split-thickness skin grafting and urethral glanduloplasty following radical glansectomy. Limited studies suggest reasonable patient satisfaction with genital cosmesis post-OSS. A negative impact on HRQoL is described in most studies following penile cancer surgery, variably correlated with aggressiveness of penile surgery and addition of lymphadenectomy. Anxiety, depression, and reduced self-esteem have been reported in penile cancer survivors. Relationship well-being varies, with some survivors reporting this to be unchanged.

Conclusion

OSS can preserve elements of sexual, urinary, and sensory function, supporting advantages over radical penectomy for eligible patients. However, a comprehensive understanding remains limited due to small, heterogeneous patient cohorts, challenges in obtaining premorbid data, and variability in outcome measures. Standardization of patient-reported outcomes following OSS is desirable.
Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) in Appalachia: protocol for a group randomized, delayed intervention trial
Authors: Paskett Electra D , Kruse-Diehr Aaron J , Oliveri Jill M , Vanderpool Robin C , Gray Darrell M , Pennell Michael L , Huang Bin , Young Gregory S , Fickle Darla , Cromo Mark , Katz Mira L , Reiter Paul L , Rogers Melinda , Gross David A , Fairchild Vickie , Xu Wendy , Carman Angela , Walunis Jean M , McAlearney Ann Scheck , Huerta Timothy R , Rahurkar Saurabh , Biederman Erika , Dignan Mark
Published: May 2023

Appalachian regions of Kentucky and Ohio are hotspots for colorectal cancer (CRC) mortality in the USA. Screening reduces CRC incidence and mortality; however, screening uptake is needed, especially in these underserved geographic areas. Implementation science offers strategies to address this challenge. The aim of the current study was to conduct multi-site, transdisciplinary research to evaluate and improve CRC screening processes using implementation science strategies. The study consists of two phases (Planning and Implementation). In the Planning Phase, a multilevel assessment of 12 health centers (HC) (one HC from each of the 12 Appalachian counties) was conducted by interviewing key informants, creating community profiles, identifying HC and community champions, and performing HC data inventories. Two designated pilot HCs chose CRC evidence-based interventions to adapt and implement at each level (i.e., patient, provider, HC, and community) with evaluation relative to two matched control HCs. During the Implementation Phase, study staff will repeat the rollout process in HC and community settings in a randomized, staggered fashion in the remaining eight counties/HCs. Evaluation will include analyses of electronic health record data and provider and county surveys. Rural HCs have been reluctant to participate in research because of concerns about capacity; however, this project should demonstrate that research does not need to be burdensome and can adapt to local needs and HC abilities. If effective, this approach could be disseminated to HC and community partners throughout Appalachia to encourage the uptake of effective interventions to reduce the burden of CRC.
Nursing Students’ Experiences of a Student-Led Collaborative Online International Learning Program
Authors: Malik Gulzar , Johnston Jacqueline , Peddle Monica
Published: May 2023

AIM

The aim of the study was to explore undergraduate nursing and midwifery students’ perspectives of participating in a student-led collaborative online international learning (COIL) program.

BACKGROUND

Research on COIL programs is limited. This program, developed across three global universities, was implemented to provide an internationalization-at-home experience for students during the COVID-19 pandemic.

METHOD

An exploratory descriptive qualitative design was employed using nursing students’ reflections and interviews.

RESULTS

Data analysis revealed four key themes: student-led learning experiences, personal gains, influence on professional practice, and becoming a global citizen. Students’ experiences offer insights into positive aspects of the program and highlight challenges to overcome.

CONCLUSION

The student-led COIL experience increased nursing students’ understanding of the dynamics of culture and nursing practices across different countries. Students’ personal growth and professional gains will potentially prepare them to work in multicultural environments and develop global citizenship attributes.
Epithelialization of Free Flap Vascular Pedicles through the Nasal Cavity after Long-term Follow-up: A Case Report
Authors: Wada Mana , Akita Shinsuke , Yasuda Saori , Ikeda Jun-Ichiro , Mitsukawa Nobuyuki
Published: May 2023

A 59-year-old man with right maxillary cancer presented with a right buccal fistula and an ectropion of the lower eyelid after multidisciplinary treatment. With no suitable vessels in the right face or neck for anastomosis, we planned reconstruction with a free thinned deep inferior epigastric artery perforator flap using the contralateral left facial artery and vein as the recipient. To simulate the length of the vascular pedicle, we used our original software and determined to use the route passing through the nasal cavity. The vascular pedicle was passed through a tunnel from the medial wall of the right maxillary sinus, through the nasal septum and the medial-frontal wall of the left maxillary sinus, to the left facial artery and vein. The flap survived completely, and facial deformity was corrected. At 1 year postoperatively, there had been concerns about the fragility of the vascular pedicle in the nasal cavity and the possibility of easy bleeding. Endoscopic examination revealed that the vascular pedicle in the nasal cavity was covered by fibrous tissue and multirow lineage epithelium, and an excisional biopsy indicated a low possibility of hemorrhage. Cutting off the vascular pedicle to prevent bleeding may not be necessary because the vascular pedicle through the nasal cavity becomes fibrotic and epithelialized in the surrounding area in the long term.
Reengagement strategies for hepatitis C patients lost to follow-up: A randomized clinical trial
Authors: Morales-Arraez Dalia , Hernández-Bustabad Alberto , Reygosa Castro Cristina , Benitez-Zafra Federica , Nicolás-Pérez David , Crespo Orestes , Díaz-Flores Felicitas , Hernández-Guerra Manuel
Published: May 2023

Background and Aims:

To achieve the World Health Organization’s goal of eliminating HCV by 2030, reengagement of lost to follow-up cases is mandatory. However, there is lack of evidence concerning the best strategy. Our study evaluated the effectiveness, efficiency, predictive factors, and costs of 2 different strategies.

Methods:

We identified patients positive for HCV antibodies without RNA requests from 2005 to 2018. Patients fulfilling trial criteria (NCT04153708) were randomized to (1) phone call or (2) letter of invitation to schedule an appointment, followed by switching strategy.

Results:

Three hundred forty-five patients among 1167 lost to follow-up were identified. An analysis of the first 270 randomized patients (72% male, 51±13 y) showed a higher contact rate in the mail than in the phone call strategy (84.5% vs. 50.3%). In the intention-to-treat analysis, no differences were found related to appointment attendance (26.5% vs. 28.5%). Regarding efficiency, 3.1 letters and 8 phone calls were needed to successfully link 1 patient (p<0.001) but dropped down to 2.3 phone calls if we only considered the first call attempt (p=0.008). Prior specialist’s evaluation and HCV testing in the predirect-acting antiviral era were the only factors associated with no showing up for the appointment. The cost per patient was €621.3 (2.5 quality-adjusted life-years) in the phone call strategy and €611.8 (2.4 quality-adjusted life-years) in the mail letter strategy.

Conclusions:

Reengagement of patients with HCV is feasible, and equally effective with similar costs in both strategies. The mail letter was more efficient, except when only 1 phone call was considered. Prior specialist’s evaluation and testing in the predirect-acting antiviral era were factors associated with nonattendance to the appointment.
Biliary microbial patterns in primary sclerosing cholangitis are linked to poorer transplant-free survival
Authors: Özdirik Burcin , Scherf Maria , Brumercek Ana , Nicklaus Jule M. , Kruis Tassilo , Haber Philipp K. , Pratschke Johann , Tacke Frank , Sigal Michael
Published: May 2023

Background:

Factors that determine individual disease course of patients with primary sclerosing cholangitis (PSC) are poorly understood. Although an association between gut microbes and disease outcome has been suggested, little is known about the role of microbes in the biliary tract.

Methods:

We analyzed microbial cultures from bile specimens obtained during routine endoscopic retrograde cholangiopancreatography (ERCP) and intraoperatively before liver transplantation in 114 patients with PSC in our tertiary academic center. The presence of bacterial and fungal species was correlated with clinical characteristics and outcome data.

Results:

A total of 87 patients (76%) had positive bile culture results. The presence of concomitant inflammatory bowel disease (IBD) was associated with positive bile culture results in multivariate analysis (OR, 4.707; 95% CI, 1.688–13.128; p=0.003). Enterococcus spp. in the bile was associated with a more frequent occurrence of liver transplantation and/or death (OR, 2.778; 95% CI, 1.147–6.728; p=0.021) and recurrent (≥3) cholangitis episodes (OR, 2.839; 95% CI, 1.037–7.768; p=0.037). Biliary candidiasis was linked to a higher frequency of recurrent (≥3) cholangitis episodes (OR, 5.677; 95% CI, 1.940–16.616; p=0.001). Proton pump inhibitor intake conferred a clinical feature associated with biliary candidiasis in multivariate analysis (OR, 3.559; 95% CI, 1.275–9.937; p=0.016).

Conclusions:

Our data indicate that in patients with PSC, presence of Enterococcus spp. and Candida spp. in bile is associated with an adverse outcome. Concomitant IBD is linked to presence of microbes in bile, and proton pump inhibitor intake is a feature associated with biliary candidiasis in patients with PSC.
Assessment of Protective Action Decision Making during Nuclear Power Plant Biennial Exercises
Authors: Smith Todd , Reese Steven
Published: May 2023

Radiological emergency preparedness for commercial nuclear power plants provides planning for implementing predetermined, prompt protective actions such as evacuation and shelter-in-place. In the event of a significant radiological release, onsite emergency response organizations will notify offsite response organizations and provide a protective action recommendation. The cognizant offsite authority will then make a protective action decision and inform the public of the need to act. Both the protective action recommendation and decision are driven by US Environmental Protection Agency protective action guides. Protective action strategies contain conservatisms and are intended to balance protection against other factors to ensure that actions result in more benefit than harm. But added conservatism can potentially shift the risks to those inherent to the protective action with no added benefit of protection. Protective action recommendations and protective action decisions made during biennial exercises were analyzed to assess how well they comport with the protective action guides. Trends in precautionary actions and the use of potassium iodide were also investigated. The analysis shows that protective action decisions typically exceed the protective action recommendation, resulting in an increase in the number of potential evacuees. However, exercise dose projection data do not appear to support such extensive initial evacuation decisions based on consideration of the protective action guides.
Neurogenic Thoracic Outlet Syndrome in Division 1 Collegiate Athletes: Presentation, Diagnosis, and Treatment
Authors: Olson Emily Miller , Dyrek Paige , Harris Taylor , Fereydooni Arash , Lee Jason T. , Kussman Andrea , Roh Eugene
Published: May 2023

Objective:

Athletes who engage in repetitive upper-extremity exercise are susceptible to neurogenic thoracic outlet syndrome (nTOS). We sought to identify typical presenting symptoms and common findings on diagnostic workup, in addition to evaluating rates of return to play following various treatment interventions.

Design:

Retrospective chart review.

Setting:

Single institution.

Participants:

Medical records of Division 1 athletes containing the diagnosis of nTOS between the years 2000 and 2020 were identified. Athletes with arterial or venous thoracic outlet syndrome were excluded.

Independent Variables:

Demographics, sport, participation status, clinical presentation, physical examination findings, diagnostic workup, and treatments provided.

Main Outcome Measures:

Rate of return to play (RTP) to collegiate athletics.

Results:

Twenty-three female and 13 male athletes were diagnosed and treated for nTOS. Digit plethysmography showed diminished or obliterated waveforms with provocative maneuvers in 23 of 25 athletes. Forty-two percent were able to continue competing despite symptoms. Of the athletes who were initially unable to compete, 12% returned to full competition after physical therapy alone, 42% of those remaining were able to RTP after botulinum toxin injection, and an additional 42% of the remaining athletes RTP after thoracic outlet decompression surgery.

Conclusions:

Many athletes diagnosed with nTOS will be able to continue competing despite symptoms. Digit plethysmography is a sensitive diagnostic tool for nTOS to document anatomical compression at the thoracic inlet. Botulinum toxin injection had a significant positive effect on symptoms and a high rate of RTP (42%), allowing numerous athletes to avoid surgery and its prolonged recovery and associated risks.

Clinical Relevance:

This study demonstrates that botulinum toxin injection had a high rate of return to full competition in elite athletes without the risks and recovery needed for surgical intervention, suggesting that this may be a good intervention especially among elite athletes who only experience symptoms with sport-related activities.
Incidence of Cochlear Implantation Among Adult Candidates in the United States
Authors: Nassiri Ashley M. , Marinelli John P. , Lohse Christine M. , Carlson Matthew L.
Published: May 2023

Objectives

To investigate the associations of age and year of cochlear implantation (CI) with CI incidence among adults 20 years and older residing in the US.

Study Design

Deidentified cochlear implant data were acquired from prospective patient registries from two cochlear implant manufacturers (Cochlear Americas and Advanced Bionics), which supply an estimated 85% of cochlear implants in the US. Population estimates for severe-to-profound sensorineural hearing loss by age group were extracted from Census and National Health and Nutrition Examination Survey data.

Setting

US CI centers.

Patients

Adults 20 years and older who underwent CI.

Interventions

CI.

Main Outcome Measures

CI incidence.

Results

The study cohort included 30,066 adults 20 years and older who underwent CI from 2015 to 2019. When combining actual and estimated data from all three manufacturers, the annual number of cochlear implants increased 5,406 in 2015 to 8,509 in 2019. Overall, the incidence of CI among adult traditional (bilateral severe-to-profound hearing loss) CI candidates increased from 244 per 100,000 person-years in 2015 to 350 in 2019 (p< 0.001). Although the elderly (80 years and older) population had the lowest incidence of CI, this cohort experienced the largest growth from an incidence of 105 per 100,000 person-years to 202 during the study period.

Conclusions

Despite growing incidence among those with qualifying hearing loss, cochlear implants remain widely underutilized. Elderly adults continue to exhibit the lowest relative cochlear implant utilization rates; however, trends over the last half-decade suggest a shift has occurred, resulting in improved access among this underserved subset.
Case report of tokophobia
Authors: Kattan Wid , Albarraq Rahaf
Published: May 2023

Introduction:

Tokophobia is a pathological fear of pregnancy that can lead to avoidance of childbirth. It is classified as primary or secondary. Approximately 20% to 78% of pregnant women report fears associated with pregnancy and childbirth. This report describes a patient with tokophobia: presentation, risk factors, comorbidities, and treatment.

Case presentation:

A 43-year-old Saudi woman experienced tokophobia upon becoming pregnant for the fifth time. She was assessed in 2 clinical interviews by a consultant psychiatrist specializing in women’s mental health. In addition, she completed several questionnaires that aimed to assess different aspects of her mental health: overall depression, perinatal depression, generalized anxiety, maternal functioning, and fear of childbirth. Several risk factors and comorbidities that may have contributed to the development of tokophobia in this patient were discussed, including traumatic experiences in previous deliveries, the unplanned nature of the pregnancy, perinatal depression, and pronounced symptoms of anxiety. A collaborative decision to perform a C-section was made, in line with obstetric guidelines and good mental health practices. Full symptomatic recovery was achieved immediately after delivery.

Conclusion:

We hope to increase clinical awareness of the assessment and management of tokophobia, which is a relatively new concept and, as yet, understudied.
Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans
Authors: Han Benjamin H. , Bronson Jennifer , Washington Lance , Yu Mengfei , Kelton Katherine , Tsai Jack , Finlay Andrea K.
Published: May 2023

Background:

Older veterans involved in the criminal legal system (CLS) may have patterns of multimorbidity that place them at risk for poor health outcomes.

Objectives:

To estimate the prevalence of medical multimorbidity (≥2 chronic medical diseases), substance use disorders (SUDs), and mental illness among CLS-involved veterans aged 50 and older.

Research Design:

Using Veterans Health Administration health records, we estimated the prevalence of mental illness, SUD, medical multimorbidity, and the co-occurrence of these conditions among veterans by CLS involvement as indicated by Veterans Justice Programs encounters. Multivariable logistic regression models assessed the association between CLS involvement, the odds for each condition, and the co-occurrence of conditions.

Subjects:

Veterans aged 50 and older who received services at Veterans Health Administration facilities in 2019 (n=4,669,447).

Methods:

Mental illness, SUD, medical multimorbidity.

Results:

An estimated 0.5% (n=24,973) of veterans aged 50 and older had CLS involvement. For individual conditions, veterans with CLS involvement had a lower prevalence of medical multimorbidity compared with veterans without but had a higher prevalence of all mental illnesses and SUDs. After adjusting for demographic factors, CLS involvement remained associated with concurrent mental illness and SUD (adjusted odds ratio [aOR] 5.52, 95% CI=5.35–5.69), SUD and medical multimorbidity (aOR=2.09, 95% CI=2.04–2.15), mental illness and medical multimorbidity (aOR=1.04, 95% CI=1.01–1.06), and having all 3 simultaneously (aOR=2.42, 95% CI=2.35–2.49).

Conclusions:

Older veterans involved in the CLS are at high risk for co-occurring mental illness, SUDs, and medical multimorbidity, all of which require appropriate care and treatment. Integrated care rather than disease-specific care is imperative for this population
Unique Morphologic Findings in the Liver After Stereotactic Radiation for Cholangiocarcinoma
Authors: Soon Gwyneth S.T. , Yasir Saba , Wu Tsung-Teh , Welle Christopher , Venkatesh Sudhakar K. , Torbenson Michael S. , Chen Zongming Eric
Published: May 2023

Newer radiotherapy techniques, such as stereotactic body radiation, have been increasingly used as part of the treatment of cholangiocarcinomas, particularly as a bridge to liver transplantation. Although conformal, these high-dose therapies result in tissue injury in the peritumoral liver tissue. This retrospective study characterized the morphologic changes in the liver after stereotactic body radiation in a series of liver explant specimens with perihilar cholangiocarcinoma. The morphologic changes in the irradiated zone were compared against the nonirradiated background liver parenchyma to control for chemotherapy-related changes. Of the 21 cases studied, 16 patients (76.2%) had underlying primary sclerosing cholangitis, and 13 patients (61.9%) had advanced liver fibrosis. The average duration between completion of radiotherapy and liver transplantation was 33.4 weeks (range: 6.29 to 67.7). Twelve patients (57.1%) had no residual tumor in the liver. The most frequent histologic changes in the peritumoral irradiated liver tissue were sinusoidal congestion (100%), sinusoidal edematous stroma (100%), and hepatocellular atrophy (100%), followed by partial/complete occlusion of central veins (76.2%), sinusoidal cellular infiltrates (76.2%), and hepatocyte dropout (66.7%). The findings in the radiated areas were more extensive than in the background liver (P<0.01). Sinusoidal edematous stroma was striking and dominated the histologic findings in some cases. Over time, there was less sinusoidal congestion but more hepatocyte dropout (rs=−0.54, P=0.012 and rs=0.64, P=0.002, respectively). Uncommon findings, such as foam cell arteriopathy in the liver hilum, were also observed. In summary, postradiation liver specimens have distinctive morphologic findings.
High-Risk Markers and Infection Rates in Febrile Infants Aged 29 to 60 Days Presenting to an Emergency Department During the COVID-19 Pandemic
Authors: Schissler Kathryn , Stewart Sidney , Phamduy Timothy , Brimacombe Michael , Waynik Ilana , Hoppa Eric
Published: May 2023

Objectives

There was an overall decline in pediatric emergency department visits during the COVID-19 pandemic. Caregivers are educated to bring febrile neonates promptly to the emergency department; however, for infants aged 29 to 60 days, there may not be the same urgency especially during a pandemic. There may have been a resultant change in the clinical and laboratory high-risk markers and infection rates in this patient population during the pandemic.

Methods

This was a single-center retrospective cohort study of infants aged 29 to 60 days presenting to the emergency department of an urban tertiary care children's hospital because of fever (>38°C) between March 11 and December 31, 2020, compared with those presenting in the same period during the 3 prior years (2017 through 2019). Patients were categorized as having high-risk criteria on a predetermined definition of ill appearance, white blood cell count, and urinalysis based on our hospital's evidence-based pathway. Information on infection type was also collected.

Results

A total of 251 patients were included in the final analysis. Comparison of the prepandemic and pandemic cohorts showed a significant increase in the proportion of patients with urinary tract infections (P = 0.017) and bacteremia (P = 0.02) and those presenting with high-risk white blood cell count (P = 0.028) and urinalysis (P = 0.034). There was no significant difference in patient demographics or in high-risk ill appearance (P = 0.208).

Conclusions

This study demonstrates a significant increase in the rates of urinary tract infection and bacteremia in addition to the objective markers used to risk-stratify febrile infants aged 29 to 60 days. This supports the need for attentiveness in evaluating these febrile infants in the emergency department.
A Summer of Fevers and Fussiness
Authors: Calardo Sarah J. , Raj Niketa , Miller Jonathan , Loiselle Claire , Zerhusen Holli , Solaiman Adil
Published: May 2023

Objective

To define the presentation, spectrum of illness, and outcomes in infants with parechovirus (PeV) meningitis admitted to our inpatient general pediatrics service during a spike in incidence of admissions in summer 2022.

Patients and Methods

This study is a retrospective case series of all patients aged 3 months and younger discharged from our institution with a CSF BioFire (BioFire Diagnostics, Salt Lake City, UT) FilmArray Polymerase Chain Reaction Meningitis/Encephalitis Panel result positive for PeV between January 1 and September 19, 2022. We collected and analyzed clinical and demographic data.

Results

Eighteen infants with PeV meningitis were admitted within our time frame, with 8 (44%) of the admissions occurring in July. Patients' mean age was 28.7 days and mean length of stay was 50.5 hours. Although all had a history of fever, only 72% were febrile on presentation. Laboratory findings showed a procalcitonin of less than 0.5 ng/mL in 86% of the 14 patients who had it drawn and no cerebrospinal fluid (CSF) pleocytosis in 83% of the patients who had CSF cell counts sent. Neutropenia was present in 17%. Although 89% of infants were given initial antibiotics, antibiotics were discontinued in 63% once their CSF panel returned positive for PeV, and in all by 48 hours.

Conclusions

Infants hospitalized with PeV meningitis were febrile and fussy, but experienced uncomplicated hospital stays without neurological deficits. Parechovirus meningitis must be considered as a common cause of acute viral meningitis in young infants even without CSF pleocytosis. This study, although limited in scope and follow-up, can potentially assist in the diagnosis and treatment of PeV meningitis at other institutions.