bluuebunny/crossref_metadata_2025 huggingface dataset:
Hysterectomy Techniques and Outcomes for Benign Large Uteri
Authors: Mamik Mamta M. , Kim-Fine Shunaha , Yang Linda , Sharma Vidya , Gala Rajiv , Aschkenazi Sarit , Sheyn David , Howard David , Walter Andrew J. , Kudish Bela , Balk Ethan M. , Antosh Danielle D.
Published: May 2024

OBJECTIVE:

To identify the optimal hysterectomy approach for large uteri in gynecologic surgery for benign indications from a perioperative morbidity standpoint.

DATA SOURCES:

PubMed and Embase databases were searched from inception through September 19, 2022. Meta-analyses were conducted as feasible.

METHODS OF STUDY SELECTION:

This review included studies that compared routes of hysterectomy with or without bilateral salpingo-oophorectomy for large uteri (12 weeks or more or 250 g or more) and excluded studies with any concurrent surgery for pelvic organ prolapse, incontinence, gynecologic malignancy, or any obstetric indication for hysterectomy.

TABULATION, INTEGRATION, AND RESULTS:

The review included 25 studies comprising nine randomized trials, two prospective, and 14 retrospective nonrandomized comparative studies. Studies were at high risk of bias. There was lower operative time for total vaginal hysterectomy compared with laparoscopically assisted vaginal hysterectomy (LAVH) (mean difference 39 minutes, 95% CI, 18–60) and total vaginal hysterectomy compared with total laparoscopic hysterectomy (mean difference 50 minutes, 95% CI, 29–70). Total laparoscopic hysterectomy was associated with much greater risk of ureteral injury compared with total vaginal hysterectomy (odds ratio 7.54, 95% CI, 2.52–22.58). There were no significant differences in bowel injury rates between groups. There were no differences in length of stay among the laparoscopic approaches. For LAVH compared with total vaginal hysterectomy, randomized controlled trials favored total vaginal hysterectomy for length of stay. When rates of blood transfusion were compared between these abdominal hysterectomy and robotic-assisted total hysterectomy routes, abdominal hysterectomy was associated with a sixfold greater risk of transfusion than robotic-assisted total hysterectomy (6.31, 95% CI, 1.07–37.32). Similarly, single studies comparing robotic-assisted total hysterectomy with LAVH, total laparoscopic hysterectomy, or total vaginal hysterectomy all favored robotic-assisted total hysterectomy for reduced blood loss.

CONCLUSION:

Minimally invasive routes are safe and effective and have few complications. Minimally invasive approach (vaginal, laparoscopic, or robotic) results in lower blood loss and shorter length of stay, whereas the abdominal route has a shorter operative time.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42021233300.
Enhancement of vincristine sensitivity in retinoblastoma through Janus kinase inhibition by ruxolitinib
Authors: Ke Feng , Wang Nan , Zhang Xuan , Liu Rui , Ren Tingting , Ke Jing , Yang Jianye , Yan Haihan , Ma Jianmin
Published: May 2024

Chemotherapy remains the main approach conserving vision during the treatment of retinoblastoma, the most prevalent eye cancer in children. Unfortunately, the development of chemoresistance stands as the primary reason for treatment failure. Within this study, we showed that prolonged exposure to vincristine led to heightened expression of JAK1 and JAK2 in retinoblastoma cells, while the other members of the JAK family exhibited no such changes. Employing a genetic intervention, we demonstrated the efficacy of depleting either JAK1 or JAK2 in countering vincristine-resistant retinoblastoma cells. In addition, the dual depletion of both JAK1 and JAK2 produced a more potent inhibitory outcome compared to the depletion of either gene alone. We further demonstrated that ruxolitinib, a small molecular inhibitor of JAK1/2, effectively reduced viability and colony formation in vincristine-resistant retinoblastoma cells. It also acts synergistically with vincristine in retinoblastoma cells regardless of inherent cellular and genetic heterogeneity. The effectiveness of ruxolitinib as standalone treatment against chemoresistant retinoblastoma, as well as its combination with vincristine, was validated in multiple retinoblastoma mouse models. Importantly, mice exhibited favorable tolerance to ruxolitinib administration. We confirmed that the underlying mechanism of ruxolitinib’s action in chemoresistant retinoblastoma cells is the inhibition of Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling. Our study reveals that the underlying mechanism driving ruxolitinib’s impact on chemoresistant retinoblastoma cells is the inhibition of JAK/STAT signaling. This study reveals the contribution of JAK1/2 to the development of chemoresistance in retinoblastoma and underscores the effectiveness of targeting JAK1/2 as a strategy to sensitize retinoblastoma to chemotherapy.
A Prospective Self-controlled Clinical Trial of Nonactivated Low Leukocyte PRP in Female Pattern Hair Loss Patients of Childbearing Age
Authors: Peng Xie-Ling , Li Shao-Wen , Zhou Xue-Qing , Zhu Ke-Xin , Ni Xiang-Rong , Qi Xiang-Dong
Published: May 2024

BACKGROUND

Alopecia significantly affects the mental health and social relationship of women since childbearing age, highlighting the need for a safe, effective, and convenient treatment.

METHODS

The authors have conducted a prospective self-controlled trial involving 15 female patients at childbearing age with alopecia. These patients received a subcutaneous scalp injection of platelet-rich plasma once every 4 weeks for 3 treatments in total. Outcome measurements were included below: changes in hair density (hair/cm2), hair follicle density (hair follicle/cm2), and overall photographic assessment (improved or not) at 4, 12, and 24 weeks right after the first treatment.

RESULTS

Comparing the photographs taken before and after the intervention, 67% of patients' hair density increased from 151 ± 39.82 hairs/cm2 (preintervention) to 170.96 ± 37.14 hairs/cm2 (at 24-week follow-up), representing an approximate increase of 19 hairs/cm2. Meanwhile, hair follicle density increased by approximately 15 follicles/cm2 after 24 weeks since the first treatment, rising from 151.04 ± 41.99 follicles/cm2 to 166.72 ± 37.13 follicles/cm2. The primary adverse reactions observed were local swelling and pain due to injections.

CONCLUSION

Local injection of nonactivated platelet-rich plasma with low leukocytes concentration could be an effective strategy to alleviate alopecia symptoms in female patients.
Traffic-related air pollution, road traffic noise, and Parkinson’s disease: Evaluations in two Dutch cohort studies
Authors: Lomme Jara , Reedijk Marije , Peters Susan , Downward George S. , Stefanopoulou Magdalini , Vermeulen Roel , Huss Anke
Published: May 2024

Background:

Environmental factors such as air pollution have been associated with Parkinson’s disease (PD), but findings have been inconsistent. We investigated the association between exposure to several air pollutants, road traffic noise, and PD risk in two Dutch cohorts.

Methods:

Data from 50,087 participants from two Dutch population-based cohort studies, European Prospective Investigation into Cancer and Nutrition in the Netherlands and Arbeid, Milieu en Gezondheid Onderzoek were analyzed. In these cohorts, 235 PD cases were ascertained based on a previously validated algorithm combining self-reported information (diagnosis, medication, and symptoms) and registry data. We assigned the following traffic-related exposures to residential addresses at baseline: NO2, NOx, particulate matter (PM)2.5absorbance (as a marker for black carbon exposure), PM with aerodynamic diameter ≤2.5 µm (PM2.5), ≤10 µm (PM10), PMcoarse (size fraction 2.5–10 µm), ultrafine particles <0.1 µm (UFP), and road traffic noise (Lden). Logistic regression models were applied to investigate the associations with PD, adjusted for possible confounders.

Results:

Both single- and two-pollutant models indicated associations between exposure to NOx, road traffic noise, and increasing odds of developing PD. Odds ratios of fully adjusted two-pollutant models in the highest compared with the lowest exposure quartile were 1.62 (95% CI = 1.02, 2.62) for NOx and 1.47 (95% CI = 0.97, 2.25) for road traffic noise, with clear trends across exposure categories.

Conclusions:

Our findings suggest that NOx and road traffic noise are associated with an increased risk of PD. While the association with NOx has been shown before, further investigation into the possible role of environmental noise on PD is warranted.
High-density lipoprotein metrics during midlife and future subclinical atherosclerosis in women: the SWAN HDL study
Authors: Nasr Alexis , Brooks Maria M. , Barinas-Mitchell Emma , Orchard Trevor , Billheimer Jeffrey , Wang Norman C. , McConnell Daniel , Rader Daniel J. , El Khoudary Samar R.
Published: May 2024

Objective

The clinical utility of high-density lipoprotein cholesterol (HDL-C) in risk classification is limited, especially in midlife women. Novel metrics of HDL may better reflect this risk. We clustered a comprehensive profile of HDL metrics into favorable and unfavorable clusters and assessed how these two clusters are related to future subclinical atherosclerosis (carotid intima media thickness [cIMT], interadventitial diameter [IAD], and carotid plaque presence) in midlife women.

Methods

Four hundred sixty-one women (baseline age: 50.4 [2.7] years; 272 White, 137 Black, 52 Chinese) from the Study of Women's Health Across the Nation HDL ancillary study who had baseline measures of HDL cholesterol efflux capacity (HDL-CEC), lipid contents (HDL-phospholipids [HDL-PL] and HDL triglycerides [HDL-Tg]), and HDL particle (HDL-P) distribution and size, followed by carotid ultrasound (average 12.9 [SD: 2.6] years later), were included. Using latent cluster analysis, women were clustered into a favorable (high HDL-CEC, HDL-PL, large and medium HDL-P, less HDL-Tg and small HDL-P, larger size) or an unfavorable HDL cluster (low HDL-CEC, HDL-PL, large and medium HDL-P, more HDL-Tg, and small HDL-P, smaller size) and then linked to future subclinical atherosclerosis using linear or logistic regression.

Results

The favorable HDL cluster was associated with lower cIMT, IAD, and odds of carotid plaque presence. These associations were attenuated by body mass index, except in Chinese women where the association with cIMT persisted (0.72 [0.63, 0.83]).

Conclusions

The association between favorable HDL clusters and a better postmenopausal subclinical atherosclerosis profile is largely explained by body mass index; however, racial/ethnic differences may exist.
Physical activity to reduce the burden of frailty after menopause: effectiveness and adherence rate of a resource saving exercise plan
Authors: García-Vigara Alicia , Fernandez-Garrido Julio , Carbonell-Asíns Juan-Antonio , Sánchez-Sánchez M. Luz , Monllor-Tormos Aitana , García-Pérez Miguel-Ángel , Tarín Juan J. , Cano Antonio
Published: May 2024

Objective

Frailty may be increased by menopause. Physical activity has been proposed to reduce frailty, but poor adherence and cost limit effectiveness. We aimed to investigate both the effectiveness against the frailty burden and the adherence rate of a multicomponent physical activity scheme partially managed by the participating women themselves.

Methods

Prospective controlled study consisting of a twice-weekly group physical activity scheme divided into two consecutive periods, one supervised by a health professional (12 wk) and the other supervised by the women themselves (36 wk). Group cohesion and mutual support during the patient-only period were aided by social networking via smartphones. Community-dwelling postmenopausal women were divided into a physical activity group (PAG = 126) and a usual activity control group (UAG = 126), both assessed at baseline and at the end of the study. Participants self-assigned to one of the two study arms.

Results

Overall, women in the PAG were more likely to improve their frailty status (60.2% vs 42.6%, P < 0.05). The frailty reversal rate from prefrail to robust was significantly higher in the PAG than in the UAG (34.04 vs 8.00%, P < 0.05). Logistic regression confirmed that women in the PAG were more likely to improve their frailty phenotype (odds ratio [OR], 9.12; 95% confidence interval [CI], 3.45-31.52; P < 0.001). Adherence, defined by participants attending 75% of sessions, was attained by 56.35% of women at 48 wk.

Conclusion

A physical activity scheme implemented to improve frailty proved effective and attained acceptable adherence. Conditions in the peer-supervised 36-wk phase may increase sustainability.
Hypertrophic cardiomyopathy and competitive sports: let ‘em play?
Authors: Masilamani Mats Steffi Jennifer , Cannon Bryan
Published: May 2024

Purpose of review

Hypertrophic cardiomyopathy (HCM) is one of the most common cardiovascular genetic conditions. Although most patients with HCM typically do well clinically, there is a small but real incidence of sudden cardiac death. A diagnosis of HCM was previously a reason for complete exclusion in sports, particularly competitive sports.

However, many of these recommendations are based on expert consensus, and much data has been published in the last decade furthering the scientific knowledge in this area, and allowing athletes who may have been previously excluded the potential to participate in strenuous activities and competitive sports.

Recent findings

With recent publications on participation in sports with HCM, as well as an emphasis on shared decision-making, more athletes with HCM are participating in competitive sports, even at a professional level. Even contact sports in the presence of an implantable cardioverter-defibrillator are no longer mutually exclusive in the current era.

Previous guidelines were likely overly restrictive for patients with HCM. Although there is a risk of sudden death that cannot be ignored, the potential for shared decision making as well as medical guidance are entering a new era in all aspects of medicine, particularly in sports participation.
Prediction of the small aperture intraocular lens on visual acuity in patients with keratoconus
Authors: van den Berg Roberta M. , van den Berg Arthur B. , Maia Rocha Karolinne , Fetrin de Barros Marcela , Dodhia Maya , Shahid Michel , Klyce Stephen D.
Published: May 2024

Purpose:

To investigate the impact of corneal higher-order aberrations (HOAs) on predicted corrected distance visual acuity (CDVA) in patients with keratoconus at varying simulated pupil apertures.

Setting:

Ophthalmology Clinics, Medical University of South Carolina, Charleston, South Carolina.

Design:

Retrospective chart review study.

Methods:

56 eyes with keratoconus were examined using Scheimpflug tomography during routine examinations before medical intervention. The severity of keratoconus was graded using the Amsler-Krumeich classification. Zernike analysis was used to obtain corneal aberrations using simulated pupil diameters of 6 mm, 4 mm, and 2 mm. These data were extrapolated to obtain the total root mean square HOAs for a 1.6 mm simulated pupil to evaluate the potential effect of a small aperture intraocular lens (IOL). Correlation analysis was used to study the impact and relative contributions of HOAs on CDVA. Convolution of HOAs from OPD-Scan III provided a clinical method to predict CDVA with different simulated pupil sizes in corneas with irregular astigmatism.

Results:

There were statistically significant positive correlations between photopic CDVA and the magnitude of total and individual (coma, spherical aberration, and trefoil) HOAs in this cohort of keratoconus participants. A keratoconus case with the small aperture IOL confirms the improvement in vision due to the pinhole effect.

Conclusions:

The small aperture IOL is expected to markedly reduce aberrations in patients with keratoconus up to Amsler-Krumeich class 4 severity to levels consistent with the levels seen in healthy patients. Convolution of corneal HOAs with the Early Treatment Diabetic Retinopathy Study chart provides a useful simulation of the impact of pinhole optics in aberrated eyes.
Data-driven identification of distinct pain drawing patterns and their association with clinical and psychological factors: a study of 21,123 patients with spinal pain
Authors: Chang Natalie Hong Siu , Nim Casper , Harsted Steen , Young James J. , O'Neill Søren
Published: May 2024

The variability in pain drawing styles and analysis methods has raised concerns about the reliability of pain drawings as a screening tool for nonpain symptoms. In this study, a data-driven approach to pain drawing analysis has been used to enhance the reliability. The aim was to identify distinct clusters of pain patterns by using latent class analysis (LCA) on 46 predefined anatomical areas of a freehand digital pain drawing. Clusters were described in the clinical domains of activity limitation, pain intensity, and psychological factors. A total of 21,123 individuals were included from 2 subgroups by primary pain complaint (low back pain (LBP) [n = 15,465]) or midback/neck pain (MBPNP) [n = 5658]). Five clusters were identified for the LBP subgroup: LBP and radiating pain (19.9%), radiating pain (25.8%), local LBP (24.8%), LBP and whole leg pain (18.7%), and widespread pain (10.8%). Four clusters were identified for the MBPNP subgroup: MBPNP bilateral posterior (19.9%), MBPNP unilateral posterior + anterior (23.6%), MBPNP unilateral posterior (45.4%), and widespread pain (11.1%). The clusters derived by LCA corresponded to common, specific, and recognizable clinical presentations. Statistically significant differences were found between these clusters in every self-reported health domain. Similarly, for both LBP and MBPNP, pain drawings involving more extensive pain areas were associated with higher activity limitation, more intense pain, and more psychological distress. This study presents a versatile data-driven approach for analyzing pain drawings to assist in managing spinal pain.
Use of patient-reported global assessment measures in clinical trials of chronic pain treatments: ACTTION systematic review and considerations
Authors: Langford Dale J. , Mark Remington P. , France Fallon O. , Nishtar Mahd , Park Meghan , Sharma Sonia , Shklyar Isabel C. , Schnitzer Thomas J. , Conaghan Philip G. , Amtmann Dagmar , Reeve Bryce B. , Turk Dennis C. , Dworkin Robert H. , Gewandter Jennifer S.
Published: May 2024

Establishing clinically meaningful changes in pain experiences remains important for clinical trials of chronic pain treatments. Regulatory guidance and pain measurement initiatives have recommended including patient-reported global assessment measures (eg, Patient-Global Impression of Change [PGIC]) to aid interpretation of within-patient differences in domain-specific clinical trial outcomes (eg, pain intensity). The objectives of this systematic review were to determine the frequency of global assessment measures inclusion, types of measures, domains assessed, number and types of response options, and how measures were analyzed. Of 4172 abstracts screened across 6 pain specialty journals, we reviewed 96 clinical trials of chronic pain treatments. Fifty-two (54.2%) studies included a global assessment measure. The PGIC was most common (n = 28; 53.8%), with relatively infrequent use of other measures. The majority of studies that used a global assessment measure (n = 31; 59.6%) assessed change or improvement in an unspecified domain. Others assessed overall condition severity (n = 9; 17.3%), satisfaction (n = 8; 15.4%), or overall health status/recovery (n = 5; 9.6%). The number, range, and type of response options were variable and frequently not reported. Response options and reference periods even differed within the PGIC. Global assessment measures were most commonly analyzed as continuous variables (n = 24; 46.2%) or as dichotomous variables with positive categories combined to calculate the proportion of participants with a positive response to treatment (n = 18; 34.6%). This review highlights the substantial work necessary to clarify measurement and use of patient global assessment in chronic pain trials and provides short- and long-term considerations for measure selection, reporting and analysis, and measure development.
Hospital Based Violence Intervention Programs Using Peer Support Specialists: A Concise Review
Authors: Webb Lakyn , Urban Kelly , Capps Natalie
Published: May 2024

BACKGROUND:

Interpersonal violence remains a significant public health problem in the United States. The toll of violence has spurred the development of hospital-based violence intervention programs that use peer support specialists or navigators. Yet, their effectiveness remains uncertain. This study aims to concisely review the recent literature on the effectiveness of hospital-based violence intervention programs using the peer support specialist role.

METHODS:

A systematic search of articles from PubMed, OVID, and Google Scholar was performed for this review. Peer reviewed studies addressing hospital-based violence intervention programs using peer support specialists between 2017 and 2022 were selected. Key data points were extracted and analyzed by consensus of the authors.

RESULTS:

Eight of the 232 studies reviewed met eligibility requirements. Across these studies, the recidivism rate was reduced between 43% and 95% in victims participating in hospital-based violence intervention programs with peer support specialists.

CONCLUSION:

The peer support specialist (navigator) role is central to the success of the violence intervention programs. This role guides and coordinates health services for victims of violence, extending after discharge into the community. Programs showed the most success with helping victims reach short-term goals focused on immediate basic needs but are more challenged meeting longer-term goals, such as education or relocation. This review reveals that hospital-based violence intervention programs using peer support specialists (navigators) lead to the achievement of meeting victim goals and reduce recidivism rates.
Genetic Assessment of Intraductal Papillary Mucinous Neoplasm for Predicting Concomitant Pancreatic Ductal Adenocarcinoma
Authors: Oi Hideyuki , Hozaka Yuto , Akahane Toshiaki , Fukuda Kosuke , Idichi Tetsuya , Tanoue Kiyonori , Yamasaki Yoichi , Kawasaki Yota , Mataki Yuko , Kurahara Hiroshi , Higashi Michiyo , Tanimoto Akihide , Ohtsuka Takao
Published: May 2024

Objective

The role of Krüppel-like transcription factor 4 (KLF4) mutations in IPMNs with concomitant pancreatic ductal adenocarcinoma (PDAC) remains unclear. This study clarified the rate and effect of KLF4 mutations in IPMN with concomitant PDAC.

Materials and Methods

DNA was extracted from 65 formalin-fixed and paraffin-embedded samples from 52 patients including 13 IPMNs with concomitant PDAC and 39 IPMNs alone. A comprehensive screening using next-generation sequencing and then targeted sequencing for KLF4, GNAS, and KRAS mutations were performed.

Results

In next-generation sequencing screening, KRAS mutations were observed in all samples except for one, GNAS mutation in 2 IPMNs with concomitant PDAC, and a KLF4 mutation in 1 IPMN with concomitant PDAC. Targeted sequence detected KLF4 mutations in 11 of the 52 IPMNs. Concomitant PDAC developed only in the nonintestinal, noninvasive, and branch-duct IPMNs, and KLF4 mutations were more frequent in this IPMN type than in the other type. For this IPMN type with KLF4 mutation, PDAC-prediction sensitivity, specificity, and accuracy were 63%, 82%, and 79%, respectively.

Conclusion

For selected IPMNs with nonintestinal, noninvasive, and branch-duct, genetic assessment might be helpful for predicting the possible development of concomitant PDAC, although a prospective validation study using a larger study population is needed.
Landau–Kleffner syndrome (LKS) in an 8-year-old girl: a case report and review of the literature
Authors: Salahaldin Mohammed M. , Shehadeh Mohammad Hakam , Abu Keshek Abdullah , Abdullah Tala Watheq , Abueita Hany
Published: May 2024

Introduction and importance:

Landau–Kleffner syndrome (LKS) is a rare epileptic encephalopathy characterized by language regression and abnormal electroencephalogram (EEG) patterns. This case report highlights the importance of early recognition and intervention in LKS, as well as the challenges in diagnosis and management due to its varied clinical manifestations.

Case presentation:

An 8-year-old girl presented with delayed speech, suspected hearing loss, and regression in language skills. Diagnostic tests revealed mild sensorineural hearing loss and EEG abnormalities consistent with LKS. The patient underwent speech therapy and received pharmacological treatment with valproic acid, resulting in significant improvements in language function.

Clinical discussion:

This case report provides insights into the typical features of LKS, including language regression and EEG abnormalities. It also highlights uncommon findings such as sensorineural hearing loss and mild intellectual delay. The multidisciplinary approach involving neurology, audiology, speech therapy, and education is crucial in the diagnosis and management of LKS.

Conclusion:

Early recognition and intervention, along with tailored pharmacological approaches and a multidisciplinary care approach, are essential in managing LKS. Further research is needed to better understand the pathophysiology, natural history, and optimal treatment of LKS, aiming to improve long-term outcomes for affected children and their families.
Clinical and electroencephalographic correlates of carbamazepine-associated hiccups in epileptic patients
Authors: Elendu Chukwuka , Jeswani Bijay M. , Madekwe Chinelo C. , Chukwuneta Chidera P. , Sidhu Alamjeet K. , Okorie Confidence O. , Banerjee Aakash V. , Oshin Boluwatife D.
Published: May 2024

Carbamazepine, a commonly prescribed antiepileptic drug, is known to induce hiccups in a subset of epileptic patients. Although relatively uncommon, can have significant clinical implications. This comprehensive review delves into the clinical and electroencephalographic correlates of carbamazepine-associated hiccups, aiming to enhance understanding and management of this neurological side effect. The authors’ review synthesizes qualitative epidemiological data, revealing that carbamazepine-induced hiccups occur in a subset of patients receiving the medication, with reported incidence rates ranging from 2.5 to 40%. Despite its relatively low prevalence, hiccups pose substantial challenges for patients and healthcare providers. Complications associated with carbamazepine-induced hiccups include disruption of sleep, impaired social functioning, and decreased quality of life, underscoring the clinical significance of this side effect. Effective management strategies can be implemented through a multidisciplinary approach, including collaboration among neurologists, pharmacists, and other healthcare professionals. These may include dose adjustments, medication discontinuation, and adjunctive therapies such as diaphragmatic breathing exercises or acupuncture. Additionally, close monitoring for adverse effects and timely intervention are essential to mitigate the impact of hiccups on patient well-being. Essentially, carbamazepine-induced hiccups represent a clinically relevant phenomenon that warrants attention in the management of epilepsy. By recognizing the clinical manifestations, understanding the underlying pathophysiology, and implementing evidence-based management strategies, healthcare providers can optimize patient care and improve outcomes in this patient population.
Teicoplanin in peritoneal dialysis: efficacy, safety, and pharmacological considerations
Authors: Kalluru Pavan Kumar Reddy Kalluru , Gundakaram Samhitha , Mamilla Mahesh , Yartha Sai Goutham Reddy , Dabbara Sagar , Lingam Sai Teja , Gugulothu Kalyan Naik , Gangannapalle Mahesh , Thada Pawan Kumar
Published: May 2024

Peritoneal dialysis (PD) is a vital treatment modality for renal failure patients, facilitating the removal of excess fluid and unwanted substances. However, peritonitis, a significant complication experienced by PD patients, necessitates careful selection of antibiotics to ensure successful treatment. Commonly used antibiotics in PD patients, such as cephalosporins and glycopeptides like vancomycin, have been associated with undesirable side effects and high failure rates. In response to these challenges, teicoplanin, a novel glycopeptide antibiotic, has gained attention due to its similar range of activity to vancomycin, extended half-life, reduced side effects, and improved elimination. The objective of this study is to comprehensively review the efficacy, mechanism of action, adverse effects, and pharmacological benefits of teicoplanin in peritoneal dialysis patients. Our research involved an extensive review of 21 articles from reputable databases, including Google Scholar, PubMed, and ScienceDirect. The data extracted from these studies was meticulously evaluated to comprehensively understand teicoplanin’s clinical profile in this specific patient population. Major findings of these studies are that glycopeptide-based regimens have higher cure rates over first-generation cephalosporins or fluoroquinolones, and teicoplanin demonstrated several advantages over vancomycin, such as a higher therapeutic index, good tolerance, longer half-life, lower rates of nephrotoxicity, improved elimination while being equally effective. Teicoplanin is typically administered to peritoneal dialysis patients with a loading dose of 400 mg, aiming to achieve a trough concentration of 10–15 mg/dl. Teicoplanin’s improved tolerability and lack of regular serum level monitoring requirements make it a promising alternative to traditional antibiotics for clinical use.
Peripheral Intravenous Catheter-Related Phlebitis and Infiltration in an Emergency Department
Authors: Bakcek Akcelik Özgü , Ayhan Hatice
Published: May 2024

This study aims to analyze the incidences of peripheral intravenous catheter-related phlebitis and infiltration and the associated risk factors in emergency departments. This descriptive cross-sectional, nonexperimental study was conducted with 300 participants in the emergency department of a university hospital in Türkiye between January 15 and February 15, 2018. The incidence of peripheral intravenous catheter-related phlebitis was 31%, which was grade 1 in 29.7% and grade 2 in 1.3% of the emergency department participants. Additionally, the incidence of peripheral intravenous catheter-related infiltration was 55.4%, including grades 1, 2, and 3 in 36.0%, 12.7%, and 6.7% of the participants, respectively. Incidences of phlebitis and infiltration were related to age, duration of peripheral intravenous catheterization longer than 24 hours, and repeated use of the catheter insertion site. The findings of this study may draw attention to the factors that trigger phlebitis and infiltration due to peripheral intravenous catheter insertions in the emergency department and may guide practices to prevent these complications before they develop. In this context, the Phlebitis Scale and Infiltration Scale developed by the Infusion Nurses Society are recommended to be used in the emergency department.
Reducing Undue Burden on Nurses Related to Limited Care Partner Visitation
Authors: Zachmann Sara , Peele Chana , Santhin Katelin , Alisch Anna , Mannello Michael , Emilio Carinna , Whalen Madeleine
Published: May 2024

OBJECTIVE

The purpose of this article was to report best practices for reducing undue burden on nurses related to limited care partner visitation.

BACKGROUND

Care partners are beneficial to hospitalized patients. Restricted care partner visitation not only impacts patients and care partners but also affects nurses.

METHODS

Using the Johns Hopkins Evidence-Based Practice model, best practices for reducing nurse burden during periods of restricted visitation were evaluated.

RESULTS

Best practices include evidence-based visiting policies, technology to facilitate communication, creation of a communication liaison role or team, and communication skills training for nurses.

CONCLUSIONS

Nursing leaders should proactively prevent the harmful impact that visitor restrictions have on nurses.
Understanding Pediatric Physical Therapists’ Experiences With Middle Eastern Patients and Arabic Interpreters: A Qualitative Study
Authors: Woodberry Natalie , Bogard Connie , Cropsey Maegan , DeTemple Naomi , Oster Allison , Rindflesch Aaron
Published: May 2024

Purpose:

The purpose of this study was to explore pediatric physical therapists’ (PTs’) experiences including successes, challenges, and barriers with cross-cultural communication with Arabic-speaking Middle Eastern children and their families who require interpreter services.

Methods:

Eight PTs consented to participate in qualitative dyadic interviews. Transcription and interviews were conducted virtually in Microsoft Teams. Quality criteria included member checking for validity and trustworthiness and bracketing to minimize investigator bias. Inductive thematic analysis was used to identify meaning units and major themes.

Results:

The 6 themes that emerged were: fostering therapeutic relationships, practicing culturally sensitive care, communicating intentionally, experiencing successes, recognizing challenges, and tailoring a physical therapy plan of care. Representative quotations support each theme.

Conclusions:

Therapists perceive their experiences with Arabic-speaking children, families, and interpreters positively despite challenges related to cultural and language barriers. In sharing their experiences, therapists demonstrated self-reflection, openness to learning, and desire to build strong therapeutic alliances.
Patients Requiring Multiple Surgeries for Velopharyngeal Insufficiency: Findings From a 10-Year Retrospective Review
Authors: Sink Matthew C. , Hopper Samuel J. , Phillips John B. , Goza Shelby D. , Brown Madyson I. , Brown Kathryn W. , Fernstrum Colton J. , Humphries Laura S. , Hoppe Ian C.
Published: May 2024

This study analyzed patients undergoing multiple surgeries for velopharyngeal insufficiency (VPI) and reviewed their preoperative evaluations and techniques selected for subsequent surgeries. A retrospective chart review was performed including patients having undergone multiple surgeries for VPI at the authors’ institution between 2012 and 2022. All patients were evaluated and managed at the author’s institution under the direction of 4 senior surgeons. The objective of this study was to provide insight into preoperative evaluation, surgical technique selection, and other factors that may contribute to patients who require multiple VPI surgeries. Of 71 patients having undergone surgery for VPI, 8 required at least 1 additional operation for persistent VPI following the initial intervention. Six patients who initially underwent a superiorly based posterior pharyngeal flap (PPF) required additional surgery, and for those patients’ subsequent operations, 5 different techniques were used throughout their treatment. Of the remaining 2 patients who had multiple VPI surgeries, 1 initially received autologous fat transfer and 1 initially underwent a furlow palatoplasty. Finally, 0 patients that initially underwent buccal flaps or collagen injection required further unplanned surgical intervention. This study demonstrates the importance of selecting an appropriate surgical approach when operating on patients following a failed VPI surgery. The algorithm developed from these findings emphasizes the importance of properly identifying the anatomical deficiency resulting from the failed intervention. A review of the advantages of nasopharyngoscopy as a preoperative evaluative technique of velopharyngeal form and function when compared to lateral barium video fluoroscopy was also included.
Mandibular Deviation With Longstanding Temporomandibular Joint Dislocation Caused by Lateral Pterygoid Muscle Hyaline Degeneration
Authors: Zheng Zhixin , Hao Wei , Long Xing , Wei Fang
Published: May 2024

The present report described a rare case of mandible deviation with longstanding unilateral temporomandibular joint dislocation caused by lateral pterygoid muscle hyaline degeneration. A 28-year-old male was referred for mandible deviation for 2 years. It was found that the left condyle was dislocated just below the articular eminence with the dilated capsule in magnetic resonance imaging images. After surgical dissection of the lateral pterygoid muscle, which was excessively attached to the condyle, the left condyle was reduced, and the patient’s mandibular deviation was greatly improved. The pathologic results showed lateral pterygoid muscle hyaline degeneration.
ZO-1 Serum Levels as a Potential Biomarker for Psychotic Disorder
Authors: Aydogan Avşar Pinar , Akkuş Merve
Published: May 2024

Objective

There are limited studies in the literature on the relationship between intestinal and blood-brain barrier permeability and the etiology of schizophrenia. We hypothesized that the difference in serum ZO-1 levels in patients with schizophrenia may affect the severity of the disease. The aim of this study was to investigate the role of changes in serum ZO-1 concentrations in the etiopathogenesis of patients with schizophrenia.

Methods

A total of 46 patients, 34 with schizophrenia, 12 with a first psychotic attack, and 37 healthy controls, were included in the study. Symptom severity was determined by applying the Positive and Negative Syndrome Scale and the Clinical Global Impression–Severity Scale. Serum ZO-1 levels were measured from venous blood samples.

Results

Serum ZO-1 levels were higher in patients with psychotic disorder compared to healthy controls. There was no statistically significant difference between the groups in the first psychotic attack group and the schizophrenia patients. There was a statistically significant positive correlation between serum ZO-1 levels and Positive and Negative Syndrome Scale positive symptom score.

Conclusions

These findings regarding ZO-1 levels suggest that dysregulation of the blood-brain barrier in psychotic disorder may play a role in the etiology of the disorder.
Metronidazole-Induced Encephalopathy With Probable Crohn Encephalitis: A Case Report
Authors: Klevor Raymond , Jarti Mariama , Chraa Mohamed , Louhab Nissrine , Krati Khadija , Kissani Najib
Published: May 2024

Objectives

Metronidazole central nervous system toxicity is a rare finding in patients receiving the medication. We report a peculiar case of metronidazole central nervous system toxicity in which both the underlying condition (Crohn disease) and the drugs used to treat it are potential causes of encephalopathy.

Methods

A 26-year-old female with 6-year history of Crohn's disease for 6 years presented acute-onset encephalopathy. We provide bibliographic evidence to support metronidazole toxicity and potential Crohn disease-associated neurologic involvement.

Results

The patient presented dystonia, cerebellar ataxia, and altered mental status. Magnetic resonance imaging of the brain revealed typical findings of metronidazole toxicity and white matter involvement of the centrum semiovale. Immunoelectrophoresis and immunofixation of serum and cerebrospinal fluid proteins were consistent with a systemic inflammatory process. We concluded on an association between drug toxicity and probable Crohn-associated neurologic involvement. Metronidazole was stopped and the patient was placed on vitamin therapy and diazepam to control dystonia. She deteriorated and was transferred to the intensive care unit where she expired.

Conclusions

Acute behavioral changes in a young patient constitute an emergency and differential diagnoses should include infective, inflammatory, metabolic, and toxic causes. Metronidazole is a potential toxic etiology.
Utility of thromboelastography with platelet mapping (TEG-PM) for monitoring platelet transfusion in qualitative platelet disorders
Authors: Lee Robert H , Rudran Tanvi , Bergmeier Wolfgang
Published: May 2024

Patients with pathogenic variants inRASGRP2(inherited platelet disorder (IPD)-18) have normal platelet counts but show impaired platelet aggregation due to diminished activation of αIIbβ3 integrin. This defect results in moderate to severe bleeding episodes, especially following surgical procedures, which require patients to be transfused with platelets and/or pro-hemostatic agents. We recently demonstrated that the hemostatic efficacy of transfused platelets is limited by dysfunctional endogenous platelets in a mouse model of IPD-18 (Rasgrp2-/-mice), as dysfunctional platelets were recruited to the forming hemostatic plug but did not participate in clot contraction. Consequently, higher amounts of transfused platelets were required to outcompete these dysfunctional cells and to reverse bleeding. We here studied the usefulness of thromboelastography with platelet mapping (TEG-PM), a method to evaluate platelet-dependent clot contraction, forex vivomonitoring of the hemostatic potential inRasgrp2-/-mice transfused with various amounts of wild-type (WT) platelets.Rasgrp2-/-whole blood samples did not contract in TEG-PM, consistent with a critical role of this protein in αIIbβ3 activation. Addition of WT platelets improved TEG parameters (K time, α-angle, MA) in a ratio dependent manner, consistent with our recent in vivo studies showing impaired hemostasis at a 5:1, but not at a 2:1 ratio of mutant to WT platelets. Interestingly, K and α values were identified as better predictors of transfusion efficacy than MA, the most platelet-dependent TEG parameter. In conclusion, this proof-of-concept study supports the use of TEG-PM to monitor platelet transfusion ratios and hemostatic potential in IPD-18 and potentially other platelet disorders.
Proteasome regulation of petite-negativity in fission yeast
Authors: Amberg Katie Lin , Hao Lyrica , Cranz-Mileva Susanne , Zaratiegui Mikel
Published: May 2024

Mitochondria carry out essential functions in eukaryotic cells. The mitochondrial genome encodes factors critical to support oxidative phosphorylation and mitochondrial protein import necessary for these functions. However, organisms like budding yeast can readily lose their mitochondrial genome, yielding respiration-deficientpetitemutants. The fission yeastSchizosaccharomyces pombeis petite-negative, but some nuclear mutations enable the loss of its mitochondrial genome. Here, we characterize the classicalpetite-positive mutationptp1-1as a loss of function allele of the proteasome 19S regulatory subunit componentmts4/rpn1, involved in the Ubiquitin-dependent degradation pathway. The mutation results in an altered oxidative stress response, with increased levels of oxidized glutathione, and increased levels of mitochondrial and cytoplasmic chaperones. We propose that Ubiquitin-proteasome regulation of chaperones involved in the Unfolded Protein Response and mitochondrial protein import underlies petite-negativity in fission yeast.
Placental Malaria Induces a Unique Methylation Profile Associated with Fetal Growth Restriction
Authors: Ozarslan Nida , Mong Corina , Ategeka John , Li Lin , Buarpung Sirirak , Robinson Joshua F. , Kizza Jimmy , Kakuru Abel , Kamya Moses R. , Dorsey Grant , Rosenthal Philip J. , Gaw Stephanie L.
Published: May 2024

Background

Fetal growth restriction (FGR) is associated with perinatal death and adverse birth outcomes, as well as long-term complications, including increased childhood morbidity, abnormal neurodevelopment, and cardio-metabolic diseases in adulthood. Placental epigenetic reprogramming associated with FGR may mediate these long-term outcomes. Placental malaria (PM), characterized by sequestration ofPlasmodium falciparum-infected erythrocytes in placental intervillous space, is the leading global cause of FGR, but its impact on placental epigenetics is unknown. We hypothesized that placental methylomic profiling would reveal common and distinct mechanistic pathways of non-malarial and PM-associated FGR.

Results

We analyzed placentas from a US cohort with no malaria exposure (n = 12) and a cohort from eastern Uganda, a region with a high prevalence of malaria (n = 12). From each site, 8 cases of FGR (defined as birth weight <10%ile for gestational age by Intergrowth-21 standard curves) and 4 healthy controls with normal weight were analyzed. PM was diagnosed by placental histopathology. We compared the methylation levels of over 850K CpGs of the placentas using Infinium MethylationEPIC v1 microarray. Non-malarial FGR was associated with 65 differentially methylated CpGs (DMCs), whereas PM-FGR was associated with 133 DMCs, compared to their corresponding controls without FGR. One DMC (cg16389901, located in the promoter region ofBMP4) was commonly hypomethylated in both groups. We identified 522 DMCs between non-malarial FGR vs. PM-FGR placentas, which was independent of differing geographic location or cellular composition.

Conclusion

Placentas with PM-associated FGR have distinct methylation profiles as compared to placentas with non-malarial FGR, suggesting novel epigenetic reprogramming in response to malaria. Larger cohort studies are needed to determine the distinct long-term health outcomes in PM-associated FGR pregnancies.
Quality of primary healthcare for chronic diseases in low-resource settings: evidence from a mixed methods study in rural China
Authors: Li Mingyue , Zhang Xiaotian , Tang Haoqing , Zheng Huixian , Long Ren , Cheng Xiaoran , Cheng Haozhe , Dong Jiajia , Wang Xiaohui , Zhang Xiaoyan , Geldsetzer Pascal , Liu Xiaoyun
Published: May 2024

Background There is a paucity of evidence regarding the definition of the quality of primary healthcare (PHC) in China. This study aims to develop a modified conceptual framework PHC quality based on the context of rural China and evaluate the PHC quality for chronic diseases in rural areas. Methods This mixed-methods study, involving a patient survey, a provider survey and chart abstraction, and second-hand registered data, was set in three low-resource counties in rural China from 2021 to 2022. Rural patients with hypertension or type 2 diabetes, health care workers providing care on hypertension or diabetes were involved. Standardized PHC quality score was generated by arithmetic means or Rasch models of Item Response Theory. Results A modified PHC quality framework was presented. High-quality PHC for chronic diseases encompasses three core domains: a competent PHC system (comprehensiveness, accessibility, continuity, and coordination), effective clinical care (assessment, diagnosis, treatment, disease management, and provider competence), and positive user experience (information sharing, shared decision-making, respect for patients’ preferences, and family-centeredness). This study included 1355 patients, 333 healthcare providers and 2203 medical records. Ranging from 0 (the worst) to 1 (the best), the average quality score for PHC system was 0.718, with 0.887 for comprehensiveness, 0.781 for accessibility, 0.489 for continuity, 0.714 for coordination. For clinical care, average quality was 0.773 for disease assessment, 0.768 for diagnosis, 0.677 for treatment, 0.777 for disease management, and 0.314 for provider competence. The average quality for user experience was 0.727, with 0.933 for information sharing, 0.657 for shared decision-making, 0.936 for respect for patients’ preferences, and 0.382 for family-centeredness. The differences in quality among population subgroups, although statistically significant, were small. Conclusion The PHC quality in rural China has showed strengths and limitations. We identified large gaps in continuity of care, treatment, provider competence, family-centeredness, and shared decision-making. Policymakers should invest more effort in addressing these gaps to improve PHC quality.