bluuebunny/crossref_metadata_2025_split huggingface dataset:
E42 Severe infectious adverse events in children treated with biological agents
Authors: Lotfi S , Benbrahim G , Aboufariss H , Sakhi A , Bouayed K 
Published: August 2023

Abstract

Background
Since the 90’s, biologics, as a novel class of drugs, have revolutionized the therapeutic field of autoimmune and inflammatory diseases in children by providing effective treatment options. Biologics aim to modify targeted pathways to interfere with the immunologic aberration creating the clinical disease, However, alteration of the pathways increase the risk of infection. We report a series of severe infectious adverse events (SIAE) in children treated with biologics.

Objectives and Methods
This is a retrospective study over a period of 10 years (January 2012-October 2022) conducted in the Department of Pediatric Rheumatology and internal Medicine, A. Harouchi Mother and Child Hospital CHU Ibn Rochd, Casablanca, Morocco. The aim of our study is to assess SIAE in children treated with

Results
The study included 76 patients on biologics with different diseases dominated by systemic juvenile idiopathic arthritis. Six patients developed SIAE, sex-ratio was 1, four patients received TNF-alpha inhibitors (Infliximab, Adalimumab, Etanercept), 1 on Tocilizumab and 1 on Rituximab. Our 6 patients were on other immunosuppressive agents simultaneously (Corticosteroids, MMF, Azathioprine, Methotrexate). The delay of occurrence of SIAE after the initiation of biologics ranged from 10 days to 7 years. We report 3 cases of Tuberculosis, 2 of which were treated with anti-TNF agents, 1 case of CMV hepatitis, 1 case of Herpes zoster and 1 case of orbital cellulites. Treatment consisted of temporary discontinuation of biologic with specific management of the SIAE by an appropriate anti-infectious agent. The evolution was favorable except one case of death.

Discussion and Conclusion
Biologics have become an important component of effective management of patients with autoimmune and inflammatory diseases. However, there is an increased risk of SIAE for those patients, especially the risks of Tuberculosis and viral infections, even though systematic screening is performed prior to the start of biotherapy, requiring physician vigilance.
E44 Differences of hematological abnormalities between COVID-19 infection and multisystemic inflammatory syndrome (MIS-C)
Authors: Glai M , Guedri R , Fitouri Z , Becher S Ben 
Published: August 2023

Abstract

Introduction
SARS-CoV-2 virus was associated with hypercoagulability and hematological abnormalities.

Objectives
We aim to compare hematological findings in acute COVID-19 and MIS-C syndrome.

Methods
This was a retrospective cohort study conducted for one year (March 2020 to March 2021) in the isolation unit of the children’s hospital. Children with confirmed COVID-19 infection and those who met the criteria for MIS-C by the World Health Organization definition were included. Laboratory results were collected through patients ‘files.

Results
We enrolled 99 children in our case series. Sixty-seven (68%) had COVID-19 infection (median age: 3.8 years) and 32 (32%) had MIS-C syndrome (median age: 7.5 years). Sex ratio was 1.8 (64 boys’ vs 35 girls). In COVID-19 infection, 24 patients (35.8%) had anaemia (median value: 11 g/dl). Leucocytosis was found in 13 cases (19.4%) (median value: 18 187/mm3, range: 6540–86 250) vs leucopenia in two cases. Lymphopenia was detected in 22 (32.8%) (median value: 1317 109/l, range: 800–3500). In MIS-C syndrome cohort, anaemia was detected in 20 (62.5%) with a median value of 10.8 g/dl (range : 6–12.8). Leucocytosis and leukopenia were in 7 (21.9%) and 1 (3.1%) cases respectively (median value: 20 650 cells/ml vs 3620 cells/ml). Lymphopenia was marked in 24 (75%) (median value : 896x109/l) and thrombocytopenia was present in 10 (31.3%) (median value : 125 200 cells/ml). Raised level of D-dimers was found in 21 (65.6%, range: 500-20 780 ng/ml) but no one had thrombosis.

Conclusions
Anaemia, lymphopenia and hypercoagulopathy were more related to MIS-C syndrome rather to acute COVID-19 form.

Ethics
no conflicts of interest
E60 Localized scleroderma and venous thrombosis: an uncommon association in a case report
Authors: Mehaba N , Gacem O , Bakkar B , Tenkout K , Ouahbi K , Guers S , Boukandoura F , Ayad N , Mansouri N , Laboune L , Ladj M S 
Published: August 2023

Abstract

Introduction
Morphea or localized scleroderma is a rare paediatric inflammatory disease. It causes sclerosis of the skin and subcutaneous tissues. The condition does not have serious systemic implications, except in rare cases. However, it can cause functional and aesthetic sequelae. There is no truly effective consensus treatment, hence the importance of correctly assessing the extent and severity of the disease before any therapeutic approach.

Objective
Through the case of a girl presenting with linear scleroderma, revealed at the exploration of a superficial venous thrombosis; we report the diagnostic and therapeutic difficulty.

Results
Hadjer, a 14 years old girl, with no particular personal or family history, presented with thrombosis of the great saphenous vein. Thrombophilia work-up and anti-phospholipid antibodies were normal. She was treated by stripping; then she was lost to follow-up. One year later, hadjer’s clinical examination revealed thickened, inflamed skin on the left lower limb, extending from the dorsal surface of the ankle to the upper third of the thigh along its inner surface, suggesting linear scleroderma in the inflammatory phase. There was also a varicose vein sequelae of the thrombosis. The patient had no Raynaud's phenomenon or systemic damage. The skin biopsy confirmed the diagnosis. The search for multi-visceral involvement was non-contributory: capillaroscopy, chest X-ray, cardiac ultrasound, ophthalmological examination, liver, kidney and haematological tests. Muscle enzymes and magnetic resonance imaging for deep involvement were also normal. The autoimmune assessment revealed the positivity of Antinuclear Antibodies. The patient benefited from oral corticosteroid therapy and physiotherapy. After three months of partial remission, methotrexate was started.

Discussion and conclusion
Morphea is a rare autoimmune condition in paediatrics. A correlation between antinuclear antibody positivity and the severity of Morphea has been suggested. Certain risk factors have been incriminated. The linear form is by far the most frequent. The presence of venous thrombosis suggests the probable association of other autoimmune diseases, hence the interest of a rigorous follow-up, to watch for other clinical signs. The treatment and prognosis of morphea depend on the clinical form and the time to diagnosis; functional and aesthetic sequelae can be observed in the deep forms which require treatment with corticoids and immune modulators.

Ethics
this work is ethically approved.
Deficiency of Pdk1 drives heart failure by impairing taurine homeostasis through Slc6a6
Authors: Li Chen , Zhou Yi , Niu Yan , He Wenting , Wang Xinyi , Zhang Xi , Wu Yali , Zhang Wenli , Zhao Liangcai , Zheng Hong , Song Weihong , Gao Hongchang 
Published: August 2023

Abstract3‐Phosphoinositide‐dependent protein kinase‐1 (Pdk1) as a serine/threonine protein kinase plays a critical role in multiple signaling pathways. Analysis of the gene expression omnibus database showed that Pdk1 was significantly downregulated in patients with heart diseases. Gene set enrichment analysis of the proteomics dataset identified apoptotic‐ and metabolism‐related signaling pathways directly targeted by Pdk1. Previously, our research indicated that Pdk1 deletion‐induced metabolic changes might be involved in the pathogenesis of heart failure; however, the underlying mechanism remains elusive. Here, we demonstrated that deficiency of Pdk1 resulted in apoptosis, oxidative damage, and disturbed metabolism, both in vivo and in vitro. Furthermore, profiling of metabonomics by 1H‐NMR demonstrated that taurine was the major differential metabolite in the heart of Pdk1‐knockout mice. Taurine treatment significantly reduced the reactive oxygen species production and apoptosis, improved cardiac function, and prolonged the survival time in Pdk1 deficient mice. Proteomic screening identified solute carrier family 6 member 6 (Slc6a6) as the downstream that altered taurine levels in Pdk1‐expression cells. Consistently, cellular apoptosis and oxidative damage were rescued by Slc6a6 in abnormal Pdk1 expression cells. These findings collectively suggest that Pdk1 deficiency induces heart failure via disturbances in taurine homeostasis, triggered by Slc6a6.
Technical Factors Contributing to Nonunion in Supracondylar Distal Femur Fractures Treated with Lateral Locked Plating: A Risk-Stratified Analysis
Authors: Stockton David J. , O’Hara Nathan N. , Brodke Dane J. , McKibben Natasha , Healey Kathleen , Goch Abraham , Demyanovich Haley , Devana Sai , Hernandez Adolfo , Burke Cynthia E. , Gupta Jayesh , Marchand Lucas S. , Dekeyser Graham J. , Steffenson Lillia , Shymon Stephen J. , Fairres Marshall J. , Perdue Paul W. , Barber Colby , Atassi Omar H. , Mitchell Thomas W. , Working Zachary M. , Black Loren O. , El Naga Ashraf N. , Roddy Erika , Hogue Matthew , Gulbrandsen Trevor , Morellato John , Gillon W. Hunter , Walters Murphy M. , Hempen Eric , Slobogean Gerard P. , Lee Christopher , O’Toole Robert V. 
Published: August 2023

Abstract

Objective:
To identify technical factors associated with nonunion after operative treatment with lateral locked plating.

Design:
Retrospective cohort study.

Setting:
Ten Level 1 trauma centers.

Participants:
Six hundred fifteen adult patients with supracondylar distal femur fractures (OTA/AO Type 33A or C).

Intervention:
Lateral locked plating.

Main Outcome Measurements:
Surgery for nonunion.

Results:
We observed nonunion rates of 2% in a low-risk of nonunion group (n = 129), 4% in a medium-risk group (n = 333), and 14% in a high-risk group (n = 153). Varus malreduction with an anatomic lateral distal femoral angle (aLDFA) greater than 84 degrees, was associated with double the odds of nonunion (OR, 2.1; 95% CI, 1.1 to 4.2; P = 0.03). Malreduction by medial translation of the articular block increased the odds of nonunion, with 30% increased odds per 4 mm of medial translation (95% CI, 1.0 to 1.6; P = 0.03). Working length increased the odds of nonunion primarily in the medium risk group, with an 18% increase in nonunion per 10 mm increase in working length (95% CI, 1.0 to 1.4; P = 0.01). Proximal screw density was protective against nonunion (OR, 0.71; 95% CI, 0.53 to 0.92; P = 0.02). Lateral plate length and type of plate material were not associated with nonunion.

Conclusions:
Malreduction is a surgeon-controlled variable associated with nonunion after lateral locked plating of supracondylar distal femur fractures. Longer working lengths were associated with nonunion, suggesting that simple bridge plating may be less likely to succeed for longer fractures.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Surgeon Learning Curve for the Sinus Tarsi Approach to Intra-articular Calcaneus Fractures – Improvement with Experience
Authors: Joseph Noah M. , McCaskey Meghan , Bhatt Fenil R. , Watson David T. , Sanders Roy W. , Mir Hassan R. 
Published: August 2023

Abstract

Objective:
To analyze the relationship between surgeon experience with the sinus tarsi approach (STA) and outcomes in the treatment of displaced intra-articular calcaneus fractures (DIACF).

Setting:
Single level 1 trauma center

Design:
Retrospective.
Patients/Participants: 103 consecutive DIACF (OTA/AO 82C; Sanders II-IV) treated operatively using STA from 2015 to 2021.

Intervention:
Open management using the STA performed by two fellowship-trained orthopaedic traumatologists.

Main Outcome Measurement:
Quality of anatomic reduction based on postoperative CT scans and standard radiographs.

Results:
Sixty-six patients met inclusion criteria. Patients were primarily men (75.8%) with mean age 41 years (range 20-71 years), including 14 smokers (21.2%), 9 diabetics (13.6%), and 10 open fractures (15.2%). Sanders III fractures were most common (68.2% vs 28.5% and 6.1% Sanders II/IV respectively). Reduction quality was predominantly Good (59.1%, n=39) or Excellent (25.8%, n=17). Complications included wound necrosis (1), superficial infection (1), deep infection (1), and symptomatic posttraumatic arthritis requiring arthrodesis (3). There was a 29.3% reduction in likelihood of surgical complication with each year in surgeon experience with the STA and an 8.9% reduction per case (p<0.001). The likelihood of achieving a Good or Excellent reduction was 1.8 and 2.3 times greater than achieving a Fair reduction, respectively, for each year increase in surgeon experience with the STA (p=0.012 and 0.007, respectively). For each successive case, there was a 1.2 times greater likelihood of achieving a Good reduction (p=0.03).

Conclusion:
Surgeon experience plays a critical role in outcomes. We found that outcomes (reduction, complications) improve with each cumulative case and year of experience with the STA to treat DIACF.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Artificial intelligence and telemedicine in the field of anaesthesiology, intensive care and pain medicine
Authors: Bignami Elena Giovanna , Russo Michele , Bellini Valentina , Berchialla Paola , Cammarota Gianmaria , Cascella Marco , Compagnone Christian , Sanfilippo Filippo , Maggiore Salvatore Maurizio , Montomoli Jonathan , Vetrugno Luigi , Boero Enrico , Cortegiani Andrea , Giarratano Antonino , Pelosi Paolo , De Robertis Edoardo 
Published: August 2023

BACKGROUND
The potential role of artificial intelligence in enhancing human life and medical practice is under investigation but the knowledge of the topic among healthcare providers is under-investigated.

OBJECTIVES
To investigate knowledge of artificial intelligence in physicians working in the field of anaesthesiology, intensive care, and pain medicine. As secondary outcomes, we investigated the main concerns on the implementation of artificial intelligence.

DESIGN
Online survey.

SETTING
Anaesthesiology, intensive care and pain medicine.

VOLUNTEERS
We invited clinicians specialised in anaesthesia, resuscitation, intensive care and pain medicine who were active members of the European Society of Anaesthesiology and Intensive Care (ESAIC).

INTERVENTION
Online survey from 28 June 2022 to 29 October 2022.

MAIN OUTCOME MEASURES
Primary outcome was to investigate knowledge of artificial intelligence and telemedicine of participants.

RESULTS
A total of 4465 e-mails were sent and 220 specialists, age 46.5 ± 10.2; 128 men (58.2%) responded to the survey. In general, some knowledge of artificial intelligence and machine learning was reported by 207 of 220 (94.1%) and 180 of 220 (81.8%) members, respectively. In anaesthesiology, 168 of 220 (76.4%) and 151 of 220 (68.6%) have heard of artificial intelligence and machine learning. In intensive care, 154 of 220 (70.0%) and 133 of 220 (60.5%) had heard of artificial intelligence and machine learning, while these figures were much lower in pain medicine [artificial intelligence: only 70/220 (31.8%) and machine learning 67/220 (30.5%)]. The main barriers to implementing these tools in clinical practice were: lack of knowledge of algorithms leading to the results; few validation studies available and not enough knowledge of artificial intelligence. Knowledge of telemedicine was reported in 212 of 220 (96.4%) members.

CONCLUSION
Most anaesthesiologists are aware of artificial intelligence and machine learning. General thinking about the application of artificial intelligence in anaesthesiology, intensive care and pain management was positive overall, with most participants not considering this tool as a threat to their profession.
Twin charts should be the standard reference to assess growth in twin pregnancy
Authors: Prasad Smriti , Khalil Asma 
Published: August 2023

Purpose of reviewTwin pregnancies are characterized by slower growth velocity compared with singletons, especially during the third trimester and, therefore, tend to be smaller than singletons. Growth surveillance is instrumental in the identification of twin pregnancies at risk of adverse outcomes. Whether the phenomenon of slow growth is an adaptive physiological response or represents pathological growth lag, is controversial. In this review, we focus on the evidence related to the types of growth charts employed for twin pregnancies.Recent findingsConsistent evidence has emerged over the past few years from large independent cohorts in different countries suggesting that twin-specific standards perform better in identifying growth-restricted twin pregnancies at risk of adverse perinatal outcomes, without resulting in an increase in interventions or iatrogenic prematurity.SummaryThe current evidence supports the use of twin-specific reference charts. Concerted efforts should be made to derive prospective evidence from large multicentre studies on various aspects of the implementation of twin-specific standards.
Resistance training reduces platelet activation in hypertensive women: the role of purinergic signaling
Authors: Cardoso Andréia Machado , Aneli Nyasmin Mendes , Lammers Mônica , Mânica Aline , Zanini Daniela , Maciel Sarah Franco Vieira de Oliveira , Sévigny Jean , Corralo Vanessa da Silva , De Sá Clodoaldo Antônio 
Published: August 2023

Background and aim:
Essential arterial hypertension is a risk factor for stroke, myocardial infarction, heart failure, and arterial aneurysm, which are related to the activation of platelets. Purinergic signaling has a central role in platelet aggregation. Although ATP and ADP can act as a proaggregant agent, adenosine inhibits platelet aggregation and reduces vascular injury. Physical exercise exhibits antiaggregant properties and can modulate purinergic system. The aim of this study was to evaluate the effect of 6 months of resistance training on purinergic system components in platelets and on platelet activation, hemodynamic and anthropometric parameters in hypertensive woman.

Method:
A total of 31 hypertensive and 28 normotensive middle-aged sedentary women were submitted to 6 months of resistance training. Purinergic enzymes activities were assessed in platelets; ATP and Tromboxane B2 (TXB2) levels were measured in serum. Blood pressure (BP), BMI, and body fat were also measured. All variables were statistically analyzed, considering P value less than 0.05.

Results:
Six months of resistance training was able to significantly reduce BP, ATP, and TXB2 levels as well as NTPDase, ecto-5’nucleotidase, and ADA activities in hypertensive group. After 6 months of resistance training, purinergic system components and TXB2 of hypertensive group were similar to normotensive group in platelets, demonstrating that resistance training was able to modulate platelet activation. A positive correlation was found between BP, enzyme activities, and levels of ATP and TXB2.

Conclusion:
Our findings demonstrated the relationship between purinergic signaling and platelet activation in hypertension and suggests that resistance training serve as tool to reduce platelet aggregation in hypertensive woman by modulating purinergic system.
Impact of corrected refractive power on the corneal denervation and ocular surface in small-incision lenticule extraction and LASIK
Authors: Liu Chang , Lin Molly Tzu-Yu , Lee Isabelle Xin Yu , Mehta Jodhbir S. , Liu Yu-Chi 
Published: August 2023

Purpose:
To evaluate the impact of corrected refractive power on the corneal denervation and ocular surface in small-incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK).

Setting:
Singapore National Eye Center, Singapore.

Design:
Prospective study.

Methods:
88 eyes undergoing SMILE or LASIK were divided into low-moderate (manifest refractive spherical equivalent [MRSE] <−6.0 diopters [D]) and high myopic (MRSE ≥−6.0 D) groups. In vivo confocal microscopy and clinical assessments were performed preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively.

Results:
In SMILE, high myopic treatment presented with significantly greater reduction in the corneal nerve fiber area (CNFA) and nerve fiber fractal dimension (CFracDim) compared with low-moderate myopic treatment (both P < .05). There was a significant and negative correlation between the corrected MRSE and the reduction in corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length, CNFA, and CFracDim after SMILE (r = −0.38 to −0.66, all P < .05). In LASIK, a significant correlation between the MRSE and the changes in CNBD, corneal nerve fiber total branch density, CNFA (r = −0.37 to −0.41), and corneal nerve fiber width (r = 0.43) was observed (all P < .05). Compared with SMILE, LASIK had greater reduction in CNBD and CNFA for every diopter increase in the corrected MRSE. High myopic SMILE, compared with low-moderate myopic SMILE, resulted in significantly lower tear break-up time at 1 and 6 months (both P < .05). The changes in CNFA and CFracDim were significantly associated with Schirmer test values (both P < .001).

Conclusions:
Postoperative corneal denervation was related to corrected refractive power in both SMILE and LASIK. With the same refractive correction, LASIK led to more prominent corneal denervation.
Cataract surgical training in Europe: European Board of Ophthalmology survey
Authors: Ní Dhubhghaill Sorcha , Sanogo Massira , Lefebvre François , Aclimandos Wagih , Asoklis Rimvydas , Atilla Huban , Creuzot-Garcher Catherine , Curtin Denise , Cvenkel Barbara , Flanagan Lisa , Kivelä Tero T. , Maino Anna , Martinez Costa Rafael , Priglinger Siegfried , Prior Filipe Helena , Stopa Marcin , Strong Brendan , Sturmer Joerg , Tassignon Marie José , Ivekovic Renata , Bourcier Tristan 
Published: August 2023

Purpose:
To survey recently graduated European ophthalmologists concerning cataract surgery (CS) training opportunities.

Setting:
Countries affiliated to the European Board of Ophthalmology (EBO).

Design:
Cross-sectional study of anonymous survey results.

Methods:
A 23-question online survey was emailed to candidates who sat the EBO Diploma Examination as residents between 2018 and 2022.

Results:
821 ophthalmologists from 30 countries completed the survey. The mean residency duration was 4.73 (SD 0.9) years. The mean reported number of entire CS procedures performed was 80.7 (SD 100.6) at the end of residency, but more than 25% of respondents (n = 210) had received no live CS training during their residency. The self-confidence (scale, 1 to 10) to perform a simple case or challenging case, manage posterior capsular rupture, and realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and self-reported confidence to perform CS between European trainees. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (P < .05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (P < .001). The importance of fellowships to complete surgical education was rated 7.7 out of 10.

Conclusions:
CS training across European countries lacks harmony. Female ophthalmology trainees continue, as in other specialties, to experience apparent gender bias. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and promote post-residency fellowship training programs.