bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association Between Catheter Type and Dialysis Treatment: A Retrospective Data Analysis at Two U.S.-Based ICUs
Authors: Gilmore Nathan T. , Alsbrooks Kimberly , Hoerauf Klaus
Published: January 2023

IMPORTANCE:

Dialysis catheter type may be associated with differences in continuous renal replacement therapy (CRRT) treatment in the critically ill, with potential implications for patient outcomes and healthcare costs.

OBJECTIVES:

To evaluate the association between the catheter type and multiple dialysis treatment outcomes among the critically ill.

DESIGN:

Retrospective, observational study.

SETTING:

Two U.S.-based ICUs.

PARTICIPANTS:

Critically ill patients receiving CRRT between April 1, 2018, and July 1, 2020. A total of 1,037 CRRT sessions were analyzed.

MAIN OUTCOMES AND MEASURES:

Circuit life, alarm interruption frequency (including a subset of vascular access [VA]-related alarms), termination type (elective vs nonelective), and blood flow rates. Pre- (n = 530) and post-catheter change (n = 507) periods were assessed, and the post-change period was further divided into intervals of pre-COVID (n = 167) and COVID contemporaneous (n = 340) to account for the pandemic’s impact.

RESULTS:

Compared with pre-change sessions, post-change sessions had 31% longer circuit life (95% CI, 1.14–1.49; p < 0.001), 3% higher blood flow rate (1.01–1.05; p < 0.01), and lower proportion of nonelective terminations (adjusted odds ratio [OR], 0.42 [0.28–0.62]; p < 0.001). There were fewer interruptions for all alarms (adjusted count ratio, 0.95 [0.87–1.05]; p = 0.31) and VA-related alarms (0.80 [0.66–0.96]; p = 0.014). The sessions during COVID period were statistically similar to pre-COVID sessions for all outcomes except a lower proportion of nonelective terminations (adjusted OR, 0.39 [0.22–0.70]; p < 0.01).

CONCLUSIONS:

A change in catheter type was associated with longer CRRT sessions with fewer interruptions and unexpected terminations in a population of critical patients.
Articulation Rate, Pauses, and Disfluencies in Professional Fighters: Potential Speech Biomarkers for Repetitive Head Injury
Authors: Neel Amy , Krasilshchikova Sofiya , Richardson Jessica D. , Arenas Richard , Bennett Lauren , Banks Sarah , Ritter Aaron , Bernick Charles
Published: January 2023

Objective:

As part of a larger study dedicated to identifying speech and language biomarkers of neurological decline associated with repetitive head injury (RHI) in professional boxers and mixed martial artists (MMAs), we examined articulation rate, pausing, and disfluency in passages read aloud by participants in the Professional Athletes Brain Health Study.

Setting:

A large outpatient medical center specializing in neurological care.

Participants, Design, and Main Measures:

Passages read aloud by 60 boxers, 40 MMAs, and 55 controls were acoustically analyzed to determine articulation rate (the number of syllables produced per second), number and duration of pauses, and number and duration of disfluencies in this observational study.

Results:

Both boxers and MMAs differed from controls in articulation rate, producing syllables at a slower rate than controls by nearly half a syllable per second on average. Boxers produced significantly more pauses and disfluencies in passages read aloud than MMAs and controls.

Conclusions:

Slower articulation rate in both boxers and MMA fighters compared with individuals with no history of RHI and the increased occurrence of pauses and disfluencies in the speech of boxers suggest changes in speech motor behavior that may relate to RHI. These speech characteristics can be measured in everyday speaking conditions and by automatic recognition systems, so they have the potential to serve as effective, noninvasive clinical indicators for RHI-associated neurological decline.
Ophthalmology Resident Oculofacial Surgery Case Exposure: An ACGME Case Log Analysis
Authors: Abousy Mya , Schilling Andy , Qiu Mary , Rajaii Fatemeh , Li Ximin , Woreta Fasika A.
Published: January 2023

Purpose:

The authors quantified trends in resident oculofacial surgery exposure between 2009 and 2018, reviewed specific procedure volume, and correlated procedure volume with program characteristics.

Methods:

The authors requested de-identified case logs of residents graduating US ophthalmology residency programs in 2018 from all 118 programs. Current Procedural Terminology codes of all oculofacial procedures were analyzed. Current Procedural Terminology codes were grouped into 25 unique categories that the authors created in addition to the 11 Accreditation Council for Graduate Medical Education categories.

Results:

One hundred and sixty-six of 488 (34%) US ophthalmology residents graduating in 2018 provided case logs (32.2% of programs). According to Accreditation Council for Graduate Medical Education case logs, residents graduating in 2018 completed significantly fewer eye removal/implant procedures, lacrimal surgeries, “other orbital” procedures, entropion/ectropion repairs, and temporal artery biopsies as primary surgeon than residents graduating in 2009, yet significantly more eyelid laceration repairs, chalazion excisions, tarsorrhaphies, ptosis repairs, and blepharoplasty/reconstruction procedures (p < 0.05). No difference was found between the total number of oculofacial cases between 2009 and 2018 (p = 0.051). The most frequently logged procedure per resident in the sample was blepharoplasty/reconstruction (17.2 ± 15) followed by “other oculoplastic” (12.7 ± 10.6). The least commonly performed procedures included temporal artery biopsy (1.5 ± 2.2) and “other orbital” (1.9 ± 3.1). Program size, location, and presence of oculofacial fellowship program all impacted case volume.

Conclusions:

Oculofacial surgery has the second highest case number requirement for residents per Accreditation Council for Graduate Medical Education guidelines. However, resident exposure to oculofacial surgery cases greatly varies in each ophthalmology residency program.
Predictive models for fentanyl dose requirement and postoperative pain using clinical and genetic factors in patients undergoing major breast surgery
Authors: Kumar Shathish , Kesavan Ramasamy , Sistla Sarath Chandra , Penumadu Prasanth , Natarajan Harivenkatesh , Chakradhara Rao Uppugunduri S. , Nair Sreekumaran , Vasuki Venkatesan , Kundra Pankaj
Published: January 2023

Fentanyl exhibits interindividual variability in its dose requirement due to various nongenetic and genetic factors such as single nucleotide polymorphisms (SNPs). This study aims to develop and cross-validate robust predictive models for postoperative fentanyl analgesic requirement and other related outcomes in patients undergoing major breast surgery. Data regarding genotypes of 10 candidate SNPs, cold pain test (CPT) scores, pupillary response to fentanyl (PRF), and other common clinical characteristics were recorded from 257 patients undergoing major breast surgery. Predictive models for 24-hour fentanyl requirement, 24-hour pain scores, and time for first analgesic (TFA) in the postoperative period were developed using 4 different algorithms: generalised linear regression model, linear support vector machine learning (SVM—Linear), random forest (RF), and Bayesian regularised neural network. The variant genotype of OPRM1 (rs1799971) and higher CPT scores were associated with higher 24-hour postoperative fentanyl consumption, whereas higher PRF and history of hypertension were associated with lower fentanyl requirement. The variant allele of COMT (rs4680) and higher CPT scores were associated with 24-hour postoperative pain scores. The variant genotype of CTSG (rs2070697), higher intraoperative fentanyl use, and higher CPT scores were associated with significantly lower TFA. The predictive models for 24-hour postoperative fentanyl requirement, pain scores, and TFA had R-squared values of 0.313 (SVM—Linear), 0.434 (SVM—Linear), and 0.532 (RF), respectively. We have developed and cross-validated predictive models for 24-hour postoperative fentanyl requirement, 24-hour postoperative pain scores, and TFA with satisfactory performance characteristics and incorporated them in a novel web application.
Monoamine Oxidase Inhibitors for Trichotillomania
Authors: Grant Jon E. , Chamberlain Samuel R.
Published: January 2023

Purpose/Background

Despite several decades of research, there are no US Food and Drug Administration–approved medications for trichotillomania or medications generally approved in other geographical jurisdictions. Monoamine oxidase inhibitors show efficacy in the treatment of depression and some possible promise for obsessive compulsive disorder.

Methods/Procedures

We present new data from a case series collected in a specialty clinical practice over a 4-year period.

Findings/Results

In 5 treatment-resistant patients whose trichotillomania had not improved with at least 1 course of cognitive behavior therapy and trials of n-acetyl cysteine, an antipsychotic, and a serotonin selective reuptake inhibitor, 2 had marked clinical improvement (>40% improvement) on phenelzine, 1 improved on tranylcypromine, and 2 showed no improvement (<10%) on phenelzine. In 2 of the 3 patients who experienced improvement, there was co-occurring depression.

Implications/Conclusions

Monoamine oxidase inhibitors in trichotillomania may deserve large-scale randomized controlled trials, particularly in specialist settings where first-line interventions have proven inadequate to manage severe symptoms.
Emergency Department Presentations of Strangulation in Intimate Partner Violence Relationships
Authors: Scarlett Tammy
Published: January 2023

Patients presenting to the emergency department after strangulation are in need of specialized care and treatment. Patient presentations after nonfatal strangulations vary dramatically; however, regardless of variation, no assumptions should be made about the seriousness of the injury. The clinician's goal should be a thorough assessment and evaluation, followed by treatment in accordance with individual patient needs. One way to ensure this comprehensive care is through the implementation of forensic nursing care and a detailed nonfatal strangulation assessment. In this case report, three different cases of women who reported to the emergency department after strangulation by their intimate partners are presented. Although all three patients presented differently, it is imperative to remember that not all patients present in the same manner, and therefore, bias associated with lack of injury, or presentation with injury, should not deter the treatment provided.
Novel intervertebral space release for the treatment of moderate and severe degenerative scoliosis
Authors: Yuan Hang , Xie Yaming , Zheng Jie , Yang Yonghong
Published: January 2023

To investigate the clinical effectiveness and feasibility of novel intervertebral space release without Smith–Petersen osteotomy/pedicle subtraction osteotomy/Ponte osteotomy in the treatment of adults with moderate to severe degenerative scoliosis. The data of 49 patients with moderate to severe degenerative scoliosis treated with a novel intervertebral space release and balance correction technique from January 2010 to January 2016 and followed up until January 2021 were collected based upon pre-designated inclusive and exclusive criteria for retrospective analyses. The Japanese Orthopaedic Association score and coronal Cobb angle were employed for the assessment of clinical symptoms and scoliosis correction improvements. Forty-nine patients were followed for a median time of 5.2 (1–11) years. The Japanese Orthopaedic Association score was significantly increased from 9.45 ± 3.33 preoperatively to 19.65 ± 4.58 postoperatively (P < .001), and the coronal Cobb angle was significantly improved from 39.95º ± 9.04º preoperatively to 8.28º ± 4.21º (P < .001) after 1 year. There were no major complications occurred in patients. The novel intervertebral space release and balance correction at the original lesion and maximal unbalance site without vertebral osteotomy showed a promising clinical profile and may be considered as an alternative for the treatment of moderate to severe degenerative scoliosis.
Comparison of patellar anchor fixation graft and graft through patellar tunnel reconstruction of medial patellofemoral ligament in the treatment of recurrent patellar dislocation: A protocol for a meta-analysis of comparative studies
Authors: Tian Jian , Yang Jingfan , Dong Wei , Zhang Xiaoyan , Liu Weitong , Chen Jiankun , Yin Hong , Zhou Xing , Yuan Changfei , Li Jinlei
Published: January 2023

Background:

Recurrent patellar dislocation (RPD) occurs in people who have their own patellofemoral dysplasia and who have not been properly treated after their first patellar dislocation. For RPD where conservative treatment is ineffective, medial patellofemoral ligament (MPFL) reconstruction is the first choice for surgical treatment, but there are various and controversial ways of MPFL reconstruction and fixation. Initially, more scholars adopted the patellar lateral tunneling (PT) approach to contain and stabilize the graft, but with the newer materials and techniques, some experts adopted the lateral patellar anchor fixation (AF) of the graft, which can avoid the collateral damage caused by the patellar lateral tunneling and can obtain the same definite efficacy. Therefore, a meta-analysis must be performed to provide evidence whether there is a difference between AF and PT reconstruction of the MPFL in the treatment of RPD.

Methods:

We will search, with no time restriction, without any restriction of language and status, the time from the establishment of the database to October 2022, on the following databases: PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), Chinese Scientific Journals Database (VIP), and Chinese databases SinoMed (CBM) electronic databases. The electronic database search will be supplemented by a manual search of the reference lists of included articles. We will apply the risk-of-bias tool of the Cochrane Collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software.

Results:

This systematic review and meta-analysis will evaluate the functional outcomes of the two fixation modalities, AF and PT, in reconstructing MPFL for RPD.

Conclusion:

The findings of this study will provide a basis for clinical judgment of whether there is a difference between the two forms of AF and PT reconstructed MPFL for RPD.
Osteochondritis dissecans of the metacarpal head in a soldier treated with osteochondral autograft transplantation surgery: A case report
Authors: Kang Dong-Geun , Lee Dong Hyun , Im Jin-Hyung
Published: January 2023

Rationale:

Osteochondral autograft transplantation surgery (OATS) was introduced as a treatment for hand osteochondritis dissecans (OCD), and successful results were reported. However, the cartilage height of the donor plug has not yet been established compared with that of other joints. We present a case using OATS for OCD of the 3rd metacarpal (MCP) head that occurred in a soldier and the findings of magnetic resonance imaging (MRI) images taken at 12 weeks after surgery.

Patient concerns:

A 21-year-old male presented with a painful, swollen 3rd MCP joint in the right hand. He was a soldier and right-handed; in addition, he did not recall any traumatic events, nor had he taken any corticosteroid medications before. The patient was excluded from military training and underwent conservative treatment with medication and a brace in a military hospital for 3 months.

Diagnosis:

The patient was diagnosed with OCD due to avascular necrosis of the 3rd MCP head of the right hand through X-ray and MRI.

Interventions:

OATS was planned as a surgical treatment. Surgery uncovered a 10 × 10 mm2, isolated cartilage defect of the 3rd MCP head that had an irregular margin and a loose body. Using Arthrex OATS, a 10-mm diameter, 10-mm depth hole was made at the articular defect site, and an 11-mm diameter, 12-length plug was harvested from the left lateral femoral condyle. The donor plug was inserted into the prepared defect site with press-fit fixation.

Outcomes:

At the last follow-up, the height of the articular cartilage had subsided with union on MRI 12 weeks after the surgery. However, the patient was asymptomatic with a normal range of motion of the right hand, and he returned to military training.

Lessons:

Although the joints of the hand are small and non-weight bearing, the level of articular cartilage of the donor plug was subsided in a follow-up MRI in our case. We suggest that the difference in cartilage thickness between the donor and the recipient might have been the cause of subsidence of the articular cartilage, and therefore, it may be helpful to transplant donors with similar thicknesses of articular cartilage.
Bioinformatic analysis of differentially expressed profiles of lncRNAs and miRNAs with their related ceRNA network in endometrial cancer
Authors: Li Fengfan , Zhou Chunlei , Li Shuxuan , Wang Jingyu , Li Ming , Mu Hong
Published: January 2023

Increasing evidence suggests that long non-coding riboneucleic acids (lncRNAs), as competing endogenous RNA (ceRNA), play a key role in the initiation, invasion, and metastasis of cancer. As a new hypothesis, the lncRNA-micro RNA (miRNA)-messenger RNA (mRNA), ceRNA regulatory network has been successfully constructed in a variety of cancers. However, lncRNA, which plays a ceRNA function in endometrial cancer (EC), is still poorly understood. In this study, we downloaded EC expression profiling from The Cancer Genome Atlas database and used the R software “edgeR” package to analyze the differentially expressed genes between EC and normal endometrium samples. Then, differentially expressed (DE) lncRNAs, miRNAs and mRNAs were selected to construct a lncRNA-miRNA-mRNA prognosis-related regulatory network based on interaction information. The Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis were performed on the genes in the network to predict the potential underlying mechanisms and functions of lncRNAs in EC. Kaplan–Meier method and the log-rank test were used for survival analysis. Based on the “ceRNA hypothesis,” we constructed a co-expression network of mRNA and lncRNA genes mediated by miRNA in the process of tumor genesis. Furthermore, we successfully constructed a dysregulated lncRNA-associated ceRNA network containing 96 DElncRNAs, 27 DEmiRNAs, and 74 DEmRNAs. Through Kaplan–Meier curve analysis, we found that 9 lncRNAs, 3 miRNAs, and 12 mRNAs were significantly correlated with the overall survival rate of patients among all lncRNAs, miRNAs, and mRNAs involved in ceRNA (P < .05). Our research provides a new perspective for the interaction among lncRNAs, miRNAs, and mRNA and lays the foundation for further research on the mechanism of lncRNAs in the occurrence of EC.
Body size influences heart rate in children aged 6 to 18 years old
Authors: Turcanu Simona , Gusetu Gabriel , Ciobanu Dana Mihaela , Istratoaie Sabina , Rosu Radu , Alexandru Minciuna Ioan , Muresan Lucian , Lazea Cecilia , Pop Dana , Zdrenghea Dumitru , Cismaru Gabriel , Barsu Cristian , Negru Alina Gabriela , Cismaru Andrei , Cainap Simona Sorana
Published: January 2023

Previous research established age-related normal limits for children’s heart rates (HRs). However, children of the same age can have significantly different HRs, depending on whether they are overweight or underweight, tall or short. Studies on children HR have failed to find a clear correlation between HR and body size. The goal of our study was to create Z scores for HR based on weight (W), height (H), body mass index (BMI), and body surface area (BSA) and compare them to normal age-related HR limits. Electrocardiograms were recorded from a total of 22,460 healthy children ranging in age from 6 to 18 years old using BTL machines. A comparison was made between different age groups, in function of W, H, BMI, and BSA, based on the HR that was automatically detected by using the digitally stored electrocardiogram. Z scores were computed for each of the categories that were mentioned. Incremental Z score values between −2.5 and 2.5 were calculated to establish upper and lower limits of HR. The BSA’s estimation of HR is the most accurate of the available methods and can be utilized with accuracy in clinical practice. Z scores for HR in children differ in function of the age, W, H, BMI and BSA. The best estimation is based on BSA. The novelty of our study is that we developed Z scores for HR in relation to body size, age and sex, producing a standardized, consistent, and reproducible result without requiring practitioners to learn and remember cutoff values for a wide range of variables across age groups and sexes. Z scores minimize observer and institutional bias, hence generating uniform and reproducible standards.
Adolescent idiopathic scoliosis patients treated with bracing, surgery, or observation showed no difference in behavioral and emotional function over a 2-year period
Authors: Jalloh Hulaimatu , Andras Lindsay M. , Sanders Austin , Iantorno Stephanie , Hamilton Anita , Choi Paul D. , Skaggs David L.
Published: January 2023

The purpose of this study was to assess if behavior and emotional function, as measured by the Pearson Behavioral Assessment Survey for Children, Second Edition (BASC-2) in patients and parents, changes with differing treatment protocols in patients with adolescent idiopathic scoliosis (AIS). One previous study showed abnormal BASC-2 scores in a substantial number of patients diagnosed with AIS; however, no study has assessed how these scores change over the course of treatment. AIS patients aged 12 to 21 years completed the BASC-2. The 176-item questionnaire was administered to subjects at enrollment, assessing behavioral and emotional problems across 16 subscales of 5 domains: school problems, internalizing problems, inattention/hyperactivity, emotional symptoms index, and personal adjustment. Parents were given an equivalent assessment survey. Surveys were administered again after 2 years. Subject treatment groups (bracing, surgery, and observation) were established at enrollment. Patients were excluded if they did not complete the BASC-2 at both time points. Forty-six patients met the inclusion criteria, with 13 patients in the surgical, 20 in the bracing, and 13 in the observation treatment groups. At enrollment, 26% (12/46) of subjects with AIS had a clinically significant score in 1 or more subscales, and after 2 years 24% (11/46) of subjects reported a clinically significant score in at least 1 subscale (P = .8). There were no significant differences in scores between enrollment and follow-up in any treatment group. Similar to what was reported in a previous study, only 36% (4/11) of patients had clinically significant scores reported by both patient and parent, conversely 64% (7/11) of parents were unaware of their child’s clinically significant behavioral and emotional problems. Common patient-reported subscales for clinically significant and at-risk scores at enrollment included anxiety (24%; 11/46), hyperactivity (24%; 11/46), attention problems (17%; 8/46), and self-esteem (17%; 8/46). At 2-year follow-up, the most commonly reported subscales were anxiety (28%; 13/46), somatization (20%; 9/46), and self-esteem (30%; 14/46). Patients with AIS, whether observed, braced or treated surgically, showed no significant change in behavior and emotional distress over the course of their treatment, or compared with each other at 2-year follow-up.
Bone metastatic carcinoma with EGFR amplification and mutation: A case report and literature review
Authors: Du Hong-Juan , Chen Fang-Fang , Liu Yu , Zhou Yu
Published: January 2023

Rationale:

Mutations in the epidermal growth factor receptor (EGFR) gene are highly prevalent in non-small cell lung cancer, while rare in other cancers. Primarily it’s hardly present in bone metastases from cancer of unknown primary (BMCUP). Currently, no specific treatment options for bone metastases from unknown primary cancers exist.

Patient concerns:

The right shoulder and back pain of a 72-years-old man had been persistent for 2 weeks and had developed worse on 1 particular day. The right upper arm was compromised, which also hindered the arm’s ability to raise and flex, and nighttime sleep was impacted. After applying the analgesic patch externally, the symptoms did not improve. No coughing or sputum production, chest tightness, shortness of breath, acid reflux, belching, abdominal pain, distension, diarrhea, backache, hematuria, black or bloody feces, or other discomforts appeared over the course of the illness.

Diagnoses:

The patient had a particular type of bone metastases from primary cancers with genetic test results indicating EGFR amplification and mutation.

Interventions:

A third-generation tyrosine kinase inhibitors drug, oral Osimertinib 80 mg once a day with bisphosphonates anti-bone destruction treatment was performed on schedule.

Outcomes:

Following treatment, the patient’s tumor-related symptoms were significantly improved by controlling the disease for up to 11 months and providing great pain relief.

Lesson:

EGFR-based genetic testing has emerged as a key measure for targeted therapy in non-small cell lung cancer. However, there are fewer relevant studies for other tumor types like BMCUP. Combined with literature reviews and our report, we provide evidence that targeting EGFR mutations according to the “basket theory” for the treatment of BMCUP is effective.
Clinical effect of standardized nursing for lymphoma patients and the influencing factors of nosocomial infection
Authors: Yang Dong-Na , Zhong Li-Ming , Huang Feng-Qiong
Published: January 2023

To analyze the clinical effect of standardized nursing for lymphoma patients and the influencing factors of nosocomial infection, a total of 360 diffuse large B-cell lymphoma patients with disease recurrence or progression after first-line treatment were retrospectively selected from our hospital from January 2021 to July 2022. After standardized nursing, the overall infection rate of lymphoma patients was 2.50% (9/360), which was significantly lower than the overall infection rate of our hospital in 2021 (7.44%, 844/11342) (P < .05). The proportion of 3 kinds of pathogenic bacteria detected were G+ bacteria (33.5%), G− bacteria (53.3%), and fungi (13.2%). The pathogenic bacteria genus with the most G+ bacteria is Enterococcus, the pathogenic bacteria genus with the most G+ bacteria is Enterobacteriaceae, and the pathogenic bacteria with the most fungi is Candida albicans. Female infection rate was significantly higher than male (P < .05). There was no significant difference in nosocomial infection among different marital status/fertility status (P > .05). The nosocomial infection of patients with different hospitalization times was statistically significant (P < .05). The duration of hospitalization in the infected group was significantly higher than that in the non-infected group (P < .05). The clinical effect of standardized nursing for lymphoma patients is significant, and the influencing factors of nosocomial infection include patient gender, hospitalization frequency, and hospitalization duration.
Integration of patient experience factors improves readmission prediction
Authors: Burke Harry M. , Carter Jocelyn
Published: January 2023

Many readmission prediction models have marginal accuracy and are based on clinical and demographic data that exclude patient response data. The objective of this study was to evaluate the accuracy of a 30-day hospital readmission prediction model that incorporates patient response data capturing the patient experience. This was a prospective cohort study of 30-day hospital readmissions. A logistic regression model to predict readmission risk was created using patient responses obtained during interviewer-administered questionnaires as well as demographic and clinical data. Participants (N = 846) were admitted to 2 inpatient adult medicine units at Massachusetts General Hospital from 2012 to 2016. The primary outcome was the accuracy (measured by receiver operating characteristic) of a 30-day readmission risk prediction model. Secondary analyses included a readmission-focused factor analysis of individual versus collective patient experience questions. Of 1754 eligible participants, 846 (48%) were enrolled and 201 (23.8%) had a 30-day readmission. Demographic factors had an accuracy of 0.56 (confidence interval [CI], 0.50–0.62), clinical disease factors had an accuracy of 0.59 (CI, 0.54–0.65), and the patient experience factors had an accuracy of 0.60 (CI, 0.56–0.64). Taken together, their combined accuracy of receiver operating characteristic = 0.78 (CI, 0.74–0.82) was significantly more accurate than these factors were individually. The individual accuracy of patient experience, demographic, and clinical data was relatively poor and consistent with other risk prediction models. The combination of the 3 types of data significantly improved the ability to predict 30-day readmissions. This study suggests that more accurate 30-day readmission risk prediction models can be generated by including information about the patient experience.
Antiepileptic drug-induced hypersensitivity syndrome with liver function abnormality and fever as the first manifestation: A case report
Authors: Liu Mei , Ci Xin-Yu , Huang Han , Zhang Mei-Juan
Published: January 2023

Rationale:

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe cutaneous drug reaction characterized by fever, lymphadenopathy, hematologic abnormalities, single or multiple organ involvement, and viral reactivation.[1] The most frequently reported offending drugs are aromatic antiepileptic agents, antibiotics, and allopurinol.[2] Though a relatively rare syndrome, DRESS can lead to severe multi-organ system dysfunction, and in some cases even death. DRESS is one of the severe drug eruptions in dermatological diseases, but it is difficult to diagnose for internist. In this paper, a typical drug hypersensitivity syndrome with abnormal liver function and fever as the first manifestations was reported. The objective of this study was to improve the understanding of rare drug hypersensitivity syndrome in digestion and other fields, and to avoid missed diagnosis and misdiagnosis.

Patient Concerns:

A 33-year-old Chinese female was initially diagnosed with acute hepatic insufficiency. Combined with the suspicious drug history, she developed DRESS with fever, target erythema, left lymph node enlargement, hematological abnormalities, and abnormal liver function.

Diagnoses:

Combined with the above characteristics, liver toxicity is the main manifestation, accompanied by fever, mainly moderate to high fever (above 38 °C) , sporadic rash, other organs (kidney, immune system) damage, and a marked increase in eosinophil granulocytic. Therefore the patient was diagnosed with definite case of DRESS syndrome based on clinical and laboratory findings.

Interventions:

Hormones (methylprednisolone 60 mg/day for 12 days and 80 mg/day for 12 days) and immunoglobulins (intravenous immunoglobulin 10 g/day for 5 days and 20 g/day for 7 days) were given.

Outcomes:

The patient was discharged from the hospital after recovery. One month after discharge, she was re-admitted to the hospital because of elevated blood sugar and was diagnosed as diabetes.

Lessons:

DRESS syndrome is a rare but life-threatening hypersensitivity reaction. The mortality will be very high if it’s not diagnosed and treated timely. This paper presents a successful case of methylprednisolone plus intravenous immunoglobulin therapy, which provides a stronger evidence for the future diagnosis and treatment of the disease.
Evaluation of accuracy, reliability, quality, and readability of online patient information materials on coccyx injury
Authors: İzci Emir Kaan , Keskin Fatih
Published: January 2023

The aim of this research is to evaluate the websites containing “coccydynia, coccyx trauma or fracture” in terms of readability, reliability, accuracy, and quality. Searches for “coccydynia, coccyx trauma, coccyx fracture” were carried out in the 3 most used search engines in the USA: Google, Yahoo, and Bing in February 2022. A total of 141 websites were rated by 2 different neurosurgeons for the “Global Quality Score” and “Alexa Popularity Rank.” 97.2% of the sites examined include the definition of the disease, 66% include the importance of the disease, 92.9% include the symptoms of the disease, 88.7% include the treatment of the disease, 78% include the signs of the disease, 77.3% include the mechanism of the disease It has been determined that the websites examined within the scope of the research have high global quality score (GQS) and APR and are enriched with images to a large extent.
NCAPD2 is a novel marker for the poor prognosis of lung adenocarcinoma and is associated with immune infiltration and tumor mutational burden
Authors: Li Zihao , Zheng Yuxuan , Wu Zuotao , Zhuo Ting , Zhu Yongjie , Dai Lei , Wang Yongyong , Chen Mingwu
Published: January 2023

Lung adenocarcinoma (LUAD) is at present the most prevalent subtype of lung cancer worldwide. Non-SMC condensin I complex subunit D2 (NCAPD2) is one of the 3 non-SMC subunits in condensin I. Previous studies have confirmed that NCAPD2 plays a critical role in chromosome cohesion and segregation. NCAPD2 may be involved in tumorigenesis and progression by participating in abnormal cell cycle division, but the prognostic value of NCAPD2 in LUAD remains unclear. We investigated differences in the expression levels of NCAPD2 and determined their association with clinical features, as well as their diagnostic and prognostic value using the cancer genome atlas database. The function of NCAPD2 was analyzed using gene ontology, Kyoto encyclopedia of genes and genomes, and gene set enrichment analysis. CIBERSORT, single-sample gene set enrichment analysis, and ESTIMATE were used to analyze the immune microenvironment of tumor patients. Tumor mutational burden (TMB) and immune checkpoints were analyzed, while hub genes were identified using weighted gene coexpression network analysis and were used to construct prognostic models. Subsequently, the competing endogenous RNAs network of NCAPD2 in LUAD was explored. Finally, we performed qPCR to verify differences in NCAPD2 expression between the tumor and normal tissues. The expression of NCAPD2 in LUAD was significantly upregulated compared with normal lung tissues. NCAPD2 has been linked to the T stage, N stage, and tumor stage. The elevated expression of NCAPD2 in LUAD can predict a poor prognosis. Functional enrichment analysis indicated that the main function of NCAPD2 was in cell cycle regulation. Moreover, NCAPD2 was also associated with immune cell infiltration and TMB. NCAPD2 is a novel prognostic marker in LUAD and is associated with immune infiltration and TMB.
Paraspinal muscles atrophy on both sides and at multiple levels after unilateral lumbar partial discectomy
Authors: Lee Doyoung , Cha Byungwoo , Kim Jongwook , Choi Yong-Soo , Kim MinYoung , Han Inbo , Min Kyunghoon
Published: January 2023

To identify the changes in cross-sectional areas (CSAs) and fatty infiltration of both sides of the paravertebral muscles and their associations with prognostic factors in patients who underwent unilateral lumbar discectomy. We retrospectively reviewed 27 patients who underwent magnetic resonance imaging before and after 1- or 2-level lumbar discectomy. The CSAs and functional cross-sectional areas of the paraspinal muscles were bilaterally measured from L1 to L2 to L5 to S1 based on T2-weighted axial images. These parameters were compared pre-and postoperatively. CSAs and functional cross-sectional areas decreased also in non-operative, non-surgical levels, not only in operated levels after discectomy. In the correlation analysis, the CSA of psoas major muscle at L1 to L2 was significantly decreased in patients with lower preoperative lordosis (r = 0.598, P = .040). The postoperative CSA of psoas major muscle at L4 to L5 was lower in those with the higher Pfirrmann grade (r = –0.590, P = .002); however, the CSA of quadratus lumborum muscle at L1 to L2 showed the opposite result (r = 0.526, P = .036). Similar results were also observed in the partial correlation adjusted for age and postoperative duration. Patients who underwent discectomy experienced overall paraspinal muscle atrophy in the lumbar region, including surgical and non-surgical sites. Such atrophic changes emphasized the need for core strengthening and lumbar rehabilitation from the early period after partial discectomy.
Diffuse large B-cell lymphoma involving multiple immunoprivileged sites presenting as painful ophthalmoplegia: A case report
Authors: Zhang Yimei , Jianfeng Zhang
Published: January 2023

Rationale:

Primary diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma. It is very rare to find lymphoma in immune -privileged sitesat the same time. We report a case of rapidly progressing DLBCL involving multiple sites in the central nervous system, testis, and orbit.

Patient concerns:

A 57-years-old man developed diplopia 1 month ago with severe right periorbital pain and right eyelid ptosis. He developed dysphagia 1 week ago and hoarseness 5 days ago.

Diagnoses:

The pathology of the left testicle confirmed DLBCL. Immunohistochemical analysis showed that CD20, CD79α, multiple myeloma oncogene-1, BCL2, BCL6 atypical lymphocyte aggregation was positive. Positron emission tomography reveals DLBCL involving the central nervous system, testes, eyes, and other parts of the body.

Interventions:

We administered glucocorticoids for pre-chemotherapy treatment, but the patient’s condition progressed quickly and was generally poor. The patient’s family decided to discharge automatically.

Outcomes:

Two weeks after he was discharged, we called for a follow-up visit and were told the patient had died.

Lessons:

Atypical clinical symptoms of the disease often confuse the doctor’s diagnosis. Adequate examination should be performed before glucocorticoid treatment in order to avoid obscuring the true condition. In some rare diseases, early use of PET-CT may lead to early detection.
Global research trends in the COVID-19 and digestive disease: A review of visualization and bibliometric study
Authors: Gan Peiling , Huang Shu , Pan Xiao , Xia Huifang , Zeng Xinyi , Ren Wensen , Shi Lei , Lü Muhan , Zhou Xian , Tang Xiaowei
Published: January 2023

Background:

The rapid spread of coronavirus disease 2019 (COVID-19) has attracted worldwide attention. There were also reported gastrointestinal symptoms in patients with COVID-19. This work aims to analyze the global research trends in COVID-19 and digestive disease.

Methods:

The related papers on COVID-19 and digestive disease were identified with Pubmed and web of science core collection on September 3, 2021. Bibliometric visualization was conducted through VOSviewer and CiteSpace.

Results:

The analytic research was based on original articles and reviews. There were 997 articles found, with citations ranging from 0 to 878. These articles were distributed among 86 countries and 355 journals. The USA mainly contributed (288 articles), where 3 of the top 10 institutions were located. Followed by China (215 articles) and Italy (160 articles). The highest level of scientific collaboration has been formed between the USA to China. The World Journal of Gastroenterology (39 papers) published the most significant number of articles. Concerning the research topic, the colon/small bowel had the largest number of articles, followed by the liver and pancreaticobiliary. “Liver injury,” “inflammatory bowel disease,” “management,” and “endoscopy” were the hotspot keywords. The largest cluster of liver transplantation had offered hints regarding research frontiers.

Conclusion:

The analytic results showed that the liver, especially liver transplantation, and inflammatory bowel disease were the 2 most influential research topics in COVID-19 and digestive disease.
Treatment of arteriovenous fistula with aneurysm using the forearm branch of the cephalic vein as a candidate vessel: A case report
Authors: Wang Bo , Hu Ying
Published: January 2023

Background:

Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis patients due to its better patency rates and fewer complications than other access types. However, some complications related to AVF could not be ignored, including swollen hands and an aneurysm. Although a patient could not continue hemodialysis, it might threaten the patient’s life if the rupture of the aneurysm is not immediately treated by the surgeon. A report of using the cephalic vein branch to treat this complication is uncommon.

Case presentation:

Herein, we present a case of a 42-year-old man in whom an AVF with an aneurysm was successfully treated using the excess cephalic vein branch. This method is a simple and effective intervention for managing aneurysm-associated complications. Additionally, this approach helps maintain the benefits of autogenous access while conserving future dialysis sites.

Conclusion:

The surgery was effective and safe for this kind of complication with swollen hands and aneurysm. Using the excess cephalic vein branch could reconstruct the AVF.
Gout of feet and ankles in different stages: The potentiality of a new semiquantitative DECT scoring system in monitoring urate deposition
Authors: Zhong Huanhuan , Wang Minghua , Zhang Heng , Huang Zhitian , Zou Baochang , Zou Guannan , Xie Nanai , Liang Yiwen , Zhu Yuhui , Ma Wanling
Published: January 2023

The purpose of this study was to investigate the diagnostic performance of a novel semi-quantitative dual-energy computed tomography (DECT) scoring system in monitoring urate deposition. This study included 287 patients with gout. All patients underwent ankle/foot DECT scans. DECT scores at different stages were compared and their diagnostic efficacies evaluated. Associations between DECT scores and clinical variables were evaluated. Gouts with positive DECT results in early, middle, and late stages were 78.5 %, 81.4 %, and 95.8 %, respectively (all P > .05). The total and ankle/midfoot DECT scores at different stages significantly increased with disease duration (all P < .05). DECT scores of 4 regions excluding the first metatarsophalangeal joint in early and middle stages were lower than those in late stage (all P < .05). DECT scores achieved excellent diagnostic performance for differentiating gout in early stage from middle and late stages (area under the curve, 0.923 and 0.949), with high sensitivity, specificity, positive predictive value, and negative predictive value (all > 85 %). Total DECT score was highly positively correlated with the volume of urate crystals (R = 0.873, P < .001). Disease duration, serum uric acid level, bone erosion, and Achilles tendon involvement significantly affected total DECT scores (all P < .01). In conclusion, longer disease duration, higher serum uric acid levels, bone erosion, and Achilles tendon involvement were closely associated with total DECT scores. DECT scoring system may be an invaluable tool for gout diagnosis owing to its high detection efficacy and a surrogate method to evaluate the amount of urate crystals and erosion of surrounding tissues.
Single lateral approach for open reduction and internal fixation of posterior malleolar fragment in Weber B rotational ankle fracture
Authors: Lee Jaehyung , Ryu Hwan , Park Jae Yong
Published: January 2023

Ankle fractures involving the posterior malleolus are a relatively common injuries, but various surgical approaches are still being introduced, and the selection of an appropriate surgical method is still controversial. The aim of this study was to introduce the surgical method using a single lateral approach for open reduction and internal fixation for posterior malleolar (PM) fractures associated with Weber B type ankle fractures. In this retrospective study, the single lateral approach was used for osteosynthesis of the PM fracture with Weber B lateral malleolar fractures. A total of 40 patients were followed up at for least 12 months (mean, 23.3; range, 12–88). Clinical assessment was based on the Olerud and Molander score, Foot and Ankle Outcome Score, visual analog scale, and subjective patient satisfaction 1 year after surgery. The accuracy of reduction was evaluated as <1 mm of displacement on the lateral view of the postoperative radiographs. The mean Olerud and Molander ankle score was 85.6 ± 12.7 and the mean Foot and Ankle Outcome Score was 82.7 ± 15.9 at 1-year postoperatively. Acceptable reduction was achieved in 38 of 40 (95%) cases. During the follow-up period, arthritic change was observed in 1 case and limited range of motion was confirmed in 2 cases. There was 1 case of postoperative wound problem and no case of sural nerve injury. The single lateral approach is a relatively simple and convenient method that enables accurate reduction and minimizing complication for fixation of the PM fractures with Weber B lateral malleolar fractures.
Effectiveness and safety of Inclisiran in hyperlipidemia treatment: An overview of systematic reviews
Authors: Li Jiayi , Lei Xiangguo , Li Zihao , Yang Xi
Published: January 2023

Background:

This paper aimed to comprehensively evaluate the effectiveness and safety of Inclisiran in treating hyperlipidemia through an overview of systematic reviews (SRs).

Methods:

The Cochrane Library, EMBASE, PubMed, CNKI, WANGFANG database, VIP database, ClinicalTrials.gov, and ICRT were searched electronically to collect SRs and meta-analysis of Inclisiran in hyperlipidemia treatment from the establishment of the database till May 2022. Two researchers independently screened the relevant literature, then the assessment of multiple systematic reviews tool was made into assess the methodological quality of the included studies. Data extracted were used to perform the study through RevMan5.3 software. The grading of recommendations assessment, development, and evaluation tool was used to grade the quality of the evidence of the outcomes included in the SRs. Prospero ID: CRD 42022326845.

Results:

A total of 10 relevant SRs were included, involving 7 randomized controlled trials. The assessment results of the assessment of multiple systematic reviews tool suggested that the quality of the SRs included needed to be improved. The reduced level of low-density lipoprotein cholesterol of the experimental group was lower than the control group, and the difference in the amount of effectiveness was statistically significant (MD = –50.13, 95%CI: –56.2 to –44.06, P < .00001). The grading of recommendations assessment, development, and evaluation results showed that out of 27 outcomes, 8 were high-quality, 3 were of medium quality, 6 were of low quality, and 10 were of the most inferior quality.

Conclusion:

300mg Inclisiran with 2 injections a year has the best therapeutic effect, which can significantly reduce low-density lipoprotein cholesterol and total cholesterol, and increase high-density lipoprotein cholesterol levels in patients with hyperlipidemia. Inclisiran has a favorable safety profile, with no significant difference in the incidence of adverse reactions compared to a placebo. Most of the adverse effects were associated with the reaction on the injection site.