Comparative efficacy of systemic treatments for atopic dermatitis in adults.

INTRODUCTION: Atopic dermatitis is a prevalent skin condition causing dry, pruritic, inflammatory skin lesions that can result in patient distress. Various emerging classes of therapy, including biologics and Janus kinase inhibitors, have been developed in recent years. AREAS COVERED: A literature search of PubMed was conducted to explore existing literature and clinical trials. Treatment options and adverse effects were summarized by class and severity. JAK inhibitors and biologics are efficacious options for adults with severe atopic dermatitis. Using the Eczema Area and Severity Index (EASI) from 11 randomized control trials, the highest efficacy was seen with upadacitinib 30 mg with 70% of patients achieving EASI-75. Older, immune-inhibiting treatment options are still appropriate options to improve patient conditions. A meta-analysis of 39 randomized control trials concluded high dose cyclosporine is more effective at improving quality of life and itch when compared to azathioprine and methotrexate. Newly developed topical and systemic medications improve disease and itch severity and can be considered in patients without adequate control with their initial treatment regimen. Adverse effects must be considered when using the newer options, although major adverse events were not seen. EXPERT OPINION: Current management options are efficacious, but adherence is required for any effect.

A decade-long analysis of gender, race, and ethnic representation of incoming cardiothoracic anesthesiology fellows.

PURPOSE OF REVIEW: This study calls attention to the necessity for increasing representation of minority groups among cardiothoracic fellowship programs. RECENT FINDINGS: Demographics in medicine are changing, with more women and varying ethnicities contributing to the physician pool. Despite this change, diversity among cardiothoracic anesthesia fellows has not mirrored this trend. SUMMARY: In November of 2022, medical student, anesthesia resident and cardiothoracic fellow demographics were analyzed from 2011 to 2021 to assess the changes in program diversity. Although male and female individuals have relatively similar representation in medical schools, female individuals only represent 34.8% of total US anesthesia residents. Cardiothoracic anesthesia fellowship programs continue to be male-sex dominant and white racial representation has consistently made up a majority of the total trainees. Increasing diversity amongst healthcare providers increases the likelihood of providing culturally competent care, thereby decreasing the healthcare gap in minority communities.

Development of audiology in Ghana: past, present, and future.

OBJECTIVES: This paper provides an overview of Ghana's audiology journey, tracking its evolution since the 1970s. It explores the historical context, transitions, and current state of audiology in Ghana, highlighting the challenges and prospects. DESIGN: Descriptive and analytic approach drawing from diverse qualitative and quantitative data sources. STUDY SAMPLE: The study encompasses various sources and data types, such as reports, academic literature, and statistical data. It also incorporates information related to developing audiology programmes in tertiary institutions, mobile van outreach units, cochlear implant surgeries and newborn hearing screening. RESULTS: Ghana's audiology journey has transformed significantly since its inception in the 1970s. From its humble beginnings with few audiologists and limited facilities, audiology has transitioned from an unknown field to growing recognition. The emergence of audiology programmes in tertiary institutions signals progress. Challenges persist such as disparity in facility distribution, low professional employability, and limited access. Nevertheless, initiatives like cochlear implant surgeries, and newborn hearing screening programmes reflect proactive steps. CONCLUSION: Ghana's audiology journey is a testament to visionary thinking, dedication, and collaborative efforts. While the journey has been marked by significant developments, bridging disparities, ensuring equitable facility distribution, and formulating comprehensive policies are pivotal.

Tailoring the growth route of lithium peroxide through the rational design of a sodium-doped nickel phosphate catalyst for lithium-oxygen batteries.

Tailoring the morphology and structure of Li2O2, the discharge product of lithium-oxygen batteries (LOBs), through the rational design of cathode catalysts is an efficient strategy to promote the electrochemical performance of LOBs. In this work, sodium-doped nickel phosphate nanorods (Na-NiPO NRs) grown on Ni foam (NF) were prepared by the hydrothermal method and subsequent calcination. For the Na-NiPO NRs, the electronic structure could be optimized and abundant void space among the nanorods would provide abundant transport channels. Adopted as the cathodes, the Na-NiPO NRs could facilitate the uniform growth of sea cucumber-like Li2O2 with sufficient Li2O2-electrolyte and Li2O2-catalyst interfaces, significantly promoting the charge process. Therefore, LOBs could deliver a high discharge capacity of 10365.0 mA h g-1 at 100 mA g-1. And a low potential gap of 1.16 V can be achieved at 200 mA g-1 with a capacity of 500 mA h g-1. The proposed strategy demonstrates the role of the morphology and electronic structure of the cathode catalysts in tuning the Li2O2 morphology and provides a novel approach for achieving high-performance LOBs.

Tailoring the Growth and Morphology of Lithium Peroxide: Nickel Sulfide/Nickel Phosphate Nanotubes with Optimized Electronic Structure for Lithium-Oxygen Batteries.

Heterogeneous crystalline-amorphous structures, with tunable electronic structures and morphology, hold immense promise as catalysts for lithium-oxygen batteries (LOBs). Herein, a nanotube network constructed by crystalline nickel sulfide/amorphous nickel phosphate (NiS/NiPO) heterostructure is prepared on Ni foam through the sulfurization of the precursor generated hydrothermally. Used as cathodes, the NiS/NiPO nanotubes with optimized electronic structure can induce the deposition of the highly porous and interconnected structure of Li2 O2 with rich Li2 O2 -electrolyte interfaces. Abundant active sites can be created on NiS/NiPO through the charge redistribution for the uniform nucleation and growth of Li2 O2 . Moreover, nanotube networks endow cathodes with efficient transport channels and sufficient space for the accommodation of Li2 O2 . A high discharge capacity of 27 003.6 mAh g-1 and a low charge overpotential of 0.58 V at 1000 mAh g-1 can be achieved at 200 mA g-1 . This work provides valuable insight into the unique role of the electronic structure and morphology of catalysts in the formation mechanisms of Li2 O2 and the performances of LOBs.

Prospective study of laparoscopic management of appendicitis during the COVID pandemic in a single paediatric centre.

Background: The coronavirus (COVID-19) pandemic affected the presentation of many conditions. This study analyses and describes the impact of the COVID-19 pandemic on the management of appendicitis in children and the role of laparoscopy. Materials and Methods: We performed a prospective (during the pandemic) and retrospective (historic control) review of the management of appendicitis in a tertiary paediatric surgical unit. Preoperative data, operative findings and patient outcomes were compared between groups to identify differences between the study periods and to identify any factors predictive of outcomes. Results: Sixty-two patients were identified in the pre-pandemic cohort, 72 in the pandemic cohort. There was no significant difference in patient demographics, length of admission or time between admission and surgery between groups. There was however a significantly longer time to presentation to hospital in the pandemic group. Clinical outcomes were comparable between the two groups, with no difference in the presence of surgical complications or histologically advanced appendicitis between the two groups. Laparoscopic surgery was safely used to manage appendicitis in the pandemic cohort through utilisation of a COVID-19 pathway that included guidance on testing, and use of personal protective equipment (PPE). Conservative management in the pandemic cohort was reserved for patients with appendicitis with the presence of mass formation. Conclusion: Despite a delayed presentation to hospital, there was no rise in the incidence of complicated appendicitis, complications of surgery or length of stay during the COVID-19 pandemic. Laparoscopic appendicectomy was also shown to be a safe and effective standard for the management of appendicitis during the pandemic. Level of Evidence: III, treatment.

Neurotoxicity following CD19/CD28ζ CAR T-cells in children and young adults with B-cell malignancies.

BACKGROUND: Neurotoxicity is an established toxicity of CD19 CAR T-cell therapy; however, there is little information on neurotoxicity in children, adolescents, and young adults (CAYA) receiving CD19/CD28ζ CAR T-cells for B-cell malignancies. METHODS: We analyzed neurotoxicity of CD19/CD28ζ CAR T-cells in CAYA treated on a phase I study (NCT01593696). Assessments included daily inpatient monitoring, caregiver-based neuro-symptom checklist (NSC), exploratory neurocognitive assessments, clinically-indicated imaging, CSF analysis, and systematic cytokine profiling, outcomes of which were associated with cytokine release syndrome (CRS) and treatment response postinfusion. Patients with active CNS leukemia were included. RESULTS: Amongst 52 patients treated, 13 patients had active CNS leukemia at infusion. Neurotoxicity was seen in 11/52 (21.2%) patients, with an incidence of 29.7% (11/37) in patients with CRS. Neurotoxicity was associated with the presence and severity of CRS. Those with neurotoxicity had higher levels of peak serum IL-6, IFNγ, and IL-15. Additionally, CNS leukemia was effectively eradicated in most patients with CRS. Pilot neurocognitive testing demonstrated stable-to-improved neurocognitive test scores in most patients, albeit limited by small patient numbers. The NSC enabled caregiver input into the patient experience. CONCLUSIONS: This is the first systematic analysis of neurotoxicity utilizing a CD19/CD28ζ CAR construct in CAYA, including in those with active CNS involvement. The experience demonstrates that the neurotoxicity profile was acceptable and reversible, with evidence of anti-leukemia response and CNS trafficking of CAR T-cells. Additionally, neurocognitive testing, while exploratory, provides an opportunity for future studies to employ systematic evaluations into neurotoxicity assessments and validation is needed in future studies.

Comparison of Postoperative Pain and Analgesic Requirements Between Laparoscopic and Open Hernia Repair in Children.

BACKGROUND: This study analyses the impact of anaesthetic blockade and intraperitoneal local anaesthetic infiltration on paediatric laparoscopic inguinal hernia repair. METHOD: A retrospective review of paediatric laparoscopic hernia repairs versus open repairs. Anaesthetic blockade, analgesic consumption and postoperative pain scores were compared between groups. RESULTS: 155 children underwent laparoscopic repair, 150 underwent open repairs. Median age was 7.2 months (16 days-14 years) in the laparoscopic group, 6 months (17 days-13 years) in the open group. Anaesthetic blockade varied significantly; 62.7% of open cases had caudal blockade compared to 21.6% laparoscopic (p < 0.001). A subset of laparoscopic patients had peritoneal local anaesthetic infiltration. 10.1% of laparoscopic cases required recovery analgesia, compared to 1.3% of open cases (p = 0.001). Postoperative analgesic consumption was significantly higher in the laparoscopic group. Peritoneal infiltration reduced analgesic consumption in the laparoscopic group (p = 0.038). Age < 2 was associated with use of caudal (p < 0.001), which reduced analgesic consumption. CONCLUSIONS: Laparoscopy was associated with increased use of recovery analgesia. Caudal reduced the need for rescue and postoperative analgesia. Intraperitoneal infiltration of local anaesthetic is associated with reduced postoperative analgesia in laparoscopy. In suitable patients undergoing laparoscopic surgery, combination caudal and peritoneal infiltration may prove a useful adjunctive analgesic strategy.

Isolated copper-tin atomic interfaces tuning electrocatalytic CO2 conversion.

Direct experimental observations of the interface structure can provide vital insights into heterogeneous catalysis. Examples of interface design based on single atom and surface science are, however, extremely rare. Here, we report Cu-Sn single-atom surface alloys, where isolated Sn sites with high surface densities (up to 8%) are anchored on the Cu host, for efficient electrocatalytic CO2 reduction. The unique geometric and electronic structure of the Cu-Sn surface alloys (Cu97Sn3 and Cu99Sn1) enables distinct catalytic selectivity from pure Cu100 and Cu70Sn30 bulk alloy. The Cu97Sn3 catalyst achieves a CO Faradaic efficiency of 98% at a tiny overpotential of 30 mV in an alkaline flow cell, where a high CO current density of 100 mA cm-2 is obtained at an overpotential of 340 mV. Density functional theory simulation reveals that it is not only the elemental composition that dictates the electrocatalytic reactivity of Cu-Sn alloys; the local coordination environment of atomically dispersed, isolated Cu-Sn bonding plays the most critical role.

Social norms as possible causes of stillbirths.

OBJECTIVE: High stillborn rates are a concern in developing countries. Hence, this article aims to describe the sociocultural norms contributing to the high number of stillbirths as perceived by mothers, significant others, midwives and records of the Pregnancy Problem Identification Programme (PPIP). DESIGN & SETTING: A multimethod qualitative descriptive study was conducted in a district in the Free State, South Africa. Each of the five sub-districts has a district hospital where most pregnant women give birth. Eighty per cent of the community is black of which about a quarter live in poor conditions below the poverty line. PARTICIPANTS: The first author conducted unstructured in-depth interviews with 36 mothers and their significant other who gave birth to a stillborn. She also extracted relevant data from the PPIP record of each mother. A skilled moderator conducted three focus group interviews with a convenience sample of midwives. The data were inductively analysed to identify subthemes under the central theme of social norms. KEY CONCLUSIONS: The authors concluded that traditional practices, traditional role players (traditional healer, mother-in-law, partner), abuse, and prescriptive social norms might contribute to stillbirths. Pregnant women are oppressed as they adhere to traditional social norms and are unable to make independent, informed healthcare decisions. The midwives, who are mostly female, may find it difficult to empower pregnant women because they are under the same social oppression as their clients. IMPLICATIONS FOR PRACTICE: It is imperative that healthcare providers consider social determinants of health, including social norms, when providing healthcare, especially to pregnant women as some social practices may have detrimental outcomes for the mother and/or baby.

Save the foreskin: Outcomes of preputioplasty in the treatment of childhood phimosis.

BACKGROUND: Symptomatic phimosis is a common childhood urology complaint. Circumcision was traditionally the treatment of choice, but its popularity in cases of non-scarred phimosis has been superseded by more conservative methods like preputioplasty. We sought to examine outcomes of preputioplasty for the treatment of non-scarred pathological phimosis in two UK paediatric surgery tertiary centres. METHODS: Retrospective case series selecting cases performed in both departments over a 4 year period (January 2012-December 2015). INCLUSION CRITERIA: non-scarred pathological phimosis treated with preputioplasty. EXCLUSION CRITERIA: diffuse scarring of foreskin or presence of balanitis xerotica obliterans (BXO), preputioplasty performed as part of hypospadias repair. Outcome measure was treatment success as evidenced by fully retractile prepuce at follow up. Follow up occurred between 3 and 24 months. RESULTS: We identified 126 patients, 6 were excluded due to the above criteria. Median age was 13.4 years (range 10 months-18 years). Median follow up was 13 months (range 3-24 months). 115 patients (96%) had successful treatment as evidenced by satisfactory post-operative cosmesis and complete resolution of phimosis at follow up. Recurrence of phimosis occurred in 5 patients (4%). Mean time of recurrence was 6 months, with a median age of recurrence of 15.3 years (range 10.7-16.7 years). All patients with recurrence were successfully treated with circumcision. CONCLUSION: Foreskin conserving methods like preputioplasty are a valid option in the treatment of non-scarred pathological phimosis.

A Flexible Film toward High-Performance Lithium Storage: Designing Nanosheet-Assembled Hollow Single-Hole Ni-Co-Mn-O Spheres with Oxygen Vacancy Embedded in 3D Carbon Nanotube/Graphene Network.

Ternary transition metal oxides (TMOs) are highly potential electrode materials for lithium ion batteries (LIBs) due to abundant defects and synergistic effects with various metal elements in a single structure. However, low electronic/ionic conductivity and severe volume change hamper their practical application for lithium storage. Herein, nanosheet-assembled hollow single-hole Ni-Co-Mn oxide (NHSNCM) spheres with oxygen vacancies can be obtained through a facile hydrothermal reaction, which makes both ends of each nanosheet exposed to sufficient free space for volume variation, electrolyte for extra active surface area, and dual ion diffusion paths compared with airtight hollow structures. Furthermore, oxygen vacancies could improve ion/electronic transport and ion insertion/extraction process of NHSNCM spheres. Thus, oxygen-vacancy-rich NHSNCM spheres embedded into a 3D porous carbon nanotube/graphene network as the anode film ensure efficient electrolyte infiltration into both the exterior and interior of porous and open spheres for a high utilization of the active material, showing an excellent electrochemical performance for LIBs (1595 mAh g-1 over 300 cycles at 2 A g-1 , 441.6 mAh g-1 over 4000 cycles at 10 A g-1 ). Besides, this straightforward synthetic method opens an efficacious avenue for the construction of various nanosheet-assembled hollow single-hole TMO spheres for potential applications.

Bladder injury in a child during laparoscopic surgery.

Injury to intra-abdominal organs occurs in approximately 0.2% of adult laparoscopic general surgery cases. This risk is increased in the paediatric population due to the comparatively smaller operative field. Laparoscopic appendicectomy is the most common laparoscopic procedure performed in children. Placement of a suprapubic working port is common; this is associated with a risk of bladder injury. We present our experience of managing a 6-year-old boy who sustained an extra-peritoneal bladder injury during port placement for a laparoscopic appendicectomy. We will also review the relevant current literature.

Disorganization of Retinal Inner Layers (DRIL) and Neuroretinal Dysfunction in Early Diabetic Retinopathy.

Purpose: To elucidate the relationship between disorganization of retinal inner layers (DRILs) and retinal function in diabetic patients without diabetic retinopathy (DR) and with nonproliferative DR, but without diabetic macular edema (DME). Methods: Fifty-seven participants with diabetes mellitus (DM) and 18 healthy controls underwent comprehensive ophthalmic examination, fundus photography, and spectral-domain optical coherence tomography. Scans of the fovea were evaluated for the presence of DRIL. Retinal function was evaluated using Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, the quick contrast sensitivity function (qCSF) on the AST Sentio Platform, short-wavelength automated perimetry (SWAP), standard automated perimetry (SAP), and frequency doubling perimetry (FDP). ANOVA and Kruskal-Wallis were used to compare retinal function in subjects with and without DRIL. Tukey-Kramer test and Wilcoxon were used for post hoc analysis. Results: DRIL was identified in 9 of 57 diabetic subjects. DRIL subjects had higher body mass index and longer diabetes duration compared to diabetic subjects without DRIL (P = 0.03 and P = 0.009, respectively). Subjects with DRIL had reduced ETDRS visual acuity (P = 0.003), contrast sensitivity function (P = 0.0003), and SAP performance (PSD, P < 0.0001) compared to controls and diabetic subjects without DRIL. Structural analysis revealed inner retinal thinning, and some outer retinal thinning, associated with DRIL. Conclusions: Diabetic subjects with DRIL have reduced retinal function compared to those without DRIL, and defective retinal lamination may be an early cellular consequence of diabetes responsible for this in some patients. Following further longitudinal studies, DRIL may be a readily available and reliable structural biomarker for reduced retinal function in early diabetic neuroretinal disease.

Dorsal ruffles enhance activation of Akt by growth factors.

In fibroblasts, platelet-derived growth factor (PDGF) and epidermal growth factor (EGF) stimulate the formation of actin-rich, circular dorsal ruffles (CDRs) and phosphatidylinositol 3-kinase (PI3K)-dependent phosphorylation of Akt. To test the hypothesis that CDRs increase synthesis of phosphorylated Akt1 (pAkt), we analyzed the contributions of CDRs to Akt phosphorylation in response to PDGF and EGF. CDRs appeared within several minutes of growth factor addition, coincident with a peak of pAkt. Microtubule depolymerization with nocodazole blocked CDR formation and inhibited phosphorylation of Akt in response to EGF but not PDGF. Quantitative immunofluorescence showed increased concentrations of Akt, pAkt and phosphatidylinositol (3,4,5)-trisphosphate (PIP3), the phosphoinositide product of PI3K that activates Akt, concentrated in CDRs and ruffles. EGF stimulated lower maximal levels of pAkt than did PDGF, which suggests that Akt phosphorylation requires amplification in CDRs only when PI3K activities are low. Accordingly, stimulation with low concentrations of PDGF elicited lower levels of Akt phosphorylation, which, like responses to EGF, were inhibited by nocodazole. These results indicate that when receptor signaling generates low levels of PI3K activity, CDRs facilitate local amplification of PI3K and phosphorylation of Akt.This article has an associated First Person interview with the first author of the paper.

Flexible Graphene-Wrapped Carbon Nanotube/Graphene@MnO2 3D Multilevel Porous Film for High-Performance Lithium-Ion Batteries.

The ingenious design of a freestanding flexible electrode brings the possibility for power sources in emerging wearable electronic devices. Here, reduced graphene oxide (rGO) wraps carbon nanotubes (CNTs) and rGO tightly surrounded by MnO2 nanosheets, forming a 3D multilevel porous conductive structure via vacuum freeze-drying. The sandwich-like architecture possesses multiple functions as a flexible anode for lithium-ion batteries. Micrometer-sized pores among the continuously waved rGO layers could extraordinarily improve ion diffusion. Nano-sized pores among the MnO2 nanosheets and CNT/rGO@MnO2 particles could provide vast accessible active sites and alleviate volume change. The tight connection between MnO2 and carbon skeleton could facilitate electron transportation and enhance structural stability. Due to the special structure, the rGO-wrapped CNT/rGO@MnO2 porous film as an anode shows a high capacity, excellent rate performance, and superior cycling stability (1344.2 mAh g-1 over 630 cycles at 2 A g-1 , 608.5 mAh g-1 over 1000 cycles at 7.5 A g-1 ). Furthermore, the evolutions of microstructure and chemical valence occurring inside the electrode after cycling are investigated to illuminate the structural superiority for energy storage. The excellent electrochemical performance of this freestanding flexible electrode makes it an attractive candidate for practical application in flexible energy storage.

Common femoral artery aneurysm repair using bifurcated graft.

Common femoral artery aneurysms are rare, and surgical repair is indicated if they are significantly large, or if they are symptomatic (thrombosis causing limb ischaemia and compression of surrounding structures). Synthetic grafts are preferred, especially in cases involving large aneurysms, or the bifurcation of the common femoral artery. We present a case of bilateral common femoral artery aneurysms extending into the bifurcation repaired using a synthetic graft which is traditionally used for an axillobifemoral bypass. This technique was employed due to the specific anatomical relationship between the profunda femoris and the superficial femoral artery in our patient. We will also review the current literature on the operative approaches to repair of common femoral artery aneurysms.

Two hybrid Au-ZnO aggregates with different hierarchical structures: A comparable study in photocatalysis.

Two hierarchical ZnO micro/nano-materials have been prepared by a short-time (45min) hydrothermal reaction without any surfactants. The different morphologies have been characterized comprehensively by XRD, SEM, TEM and XPS technologies. The hierarchical micro- and nano-structures are respectively consisted by the subordinate nano-pieces and nano-hexagonal-rods. Under the illumination of the simulated solar light, the nano-piece-aggregate spends 40min to degrade the 98% of rhodamine 6G solution (10-5mol/L), whereas the nano-rod-aggregate only degrades the 78% of the solution in the same condition. Moreover, the photocatalytic performances of the two ZnO aggregates are significantly improved by loading with Au nanoparticles (NPs) in the same assembly process. The nano-piece-aggregate decorated with the Au NPs spends 24min to decompose the rhodamine 6G solution completely, while nano-rod-aggregate decorated with the Au NPs needs 28min. The related photocatalytic mechanisms are proposed in this paper.