bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and Current Status of the COVID-19 Vaccine among Patients with Breast cancer: A Cross-Sectional Study from China
Authors: Zhang Shaohua , Li Jianbin , Xu Ruonan , Chen Qianjun , Sun Gang , Lin Ying , Jin Feng , Liu Xinlan , Fan Zhimin , Chen Yiding , Cao Yali , Li Xinzheng , Nie Jianyun , Xu Guiying , Wang Xiaojia , Teng Yuee , Sun Tao , Liu Hong , Luo Jing , Geng Cuizhi , Li Man , Luo Ting , Liu Yinhua , Wang Fu-Sheng , Jiang Zefei
Published: June 2023

In this study, we aimed to explore the safety and vaccination coverage data of Chinese patients with breast cancer receiving coronavirus disease 2019 (COVID-19) vaccination. The patients were recruited from 41 hospitals across 20 Chinese provinces. The vaccination coverage was approximately 22.4%, and the frequency of total adverse events was 13.3% after the first dose and 9.9% after the second dose. The most frequent adverse reaction within 14 days of the first dose was local pain (5.7%). Unvaccinated patients were very likely to reject the vaccine rather than be hesitant in patients with old age (odds ratio [OR], 1.238; 95% confidence interval [CI], 1.101–1.391), chronic disease history (OR, 1.189; 95% CI, 1.057–1.337), and cancer relapse (OR, 1.398; 95% CI, 1.233–1.585). Of the unvaccinated patients with breast cancer, 54.1% opted to receive COVID-19 vaccines if more data were available. Considering the safety but low vaccination coverage for breast cancer, increased positive attitudes and acceptance toward COVID-19 vaccines are important.
Cardiovascular Disease Risk Factors Predict the Development and Numbers of Common Musculoskeletal Disorders in a Prospective Cohort
Authors: Hegmann Kurt T. , Thiese Matthew S. , Wood Eric M. , Kapellusch Jay , Foster James C. , Drury David L. , Kendall Richard , Merryweather Andrew S.
Published: June 2023

Objective

The aim of the study is to assess risk of common musculoskeletal disorders (MSDs) based on cardiovascular disease (CVD) risk scores.

Methods

Data from a 9-year prospective cohort of 1224 workers in three states were analyzed. Baseline data included questionnaires, structured interviews, physical examinations, anthropometric measurements, nerve conduction studies, and individualized measurement of job physical factors. Monthly follow-ups were conducted. Framingham risk scores were calculated. A priori case definitions were constructed for carpal tunnel syndrome, lateral epicondylopathy, medial epicondylopathy, and rotator cuff tendinopathy.

Results

Adjusted RRs for one or more MSDs increased to 3.90 (95% confidence interval, 2.20–6.90) among those with 10-year cardiovascular disease risk scores greater than 15% and 17.4 (95% confidence interval, 3.85–78.62) among those with more than 4 disorders.

Conclusions

Cardiovascular disease factors are strongly associated with the subsequent development of common MSDs. Risks among those with multiple MSDs are considerably stronger.
Coccygectomy for coccygodynia: A single-center experience
Authors: Izci Emir Kaan , Keskin Fatih
Published: June 2023

Spine fractures are most commonly observed among older people due to weak bones and irregular postures. These fractures of 10 lead to coccygodynia. Women are 5 times more prone to developing coccygodynia as compared to men. Initially, different painkillers, physiotherapy, and other non-surgical treatments are recommended to reduce the pain. However, in case of the failure of these treatments, a surgical procedure (named coccygectomy) is considered to remove the tailbone to achieve effective outcomes. The main aim of this study is to determine the effectiveness of coccygectomy in treating coccygodynia (after the failure of different non-surgical treatments) in the context of patients who were treated at Konya City Hospital neurosurgery department, Turkey. In this study, a total of 14 cases of coccygodynia treated with coccygectomy at Konya City Hospital were selected from the period of August 2020 and January 2022. These patients were given different treatments for 6 to 7 months before the operation. Therefore, due to the lack of positive outcomes, a coccygectomy was performed by a senior surgeon. Visual analogue scale was used to assess the pain of the patients after the surgery. Statistical Package for the Social Sciences was used for statistical analysis. The level of significance was set at P < .05. The results of this study showed that more women suffered from coccygodynia as compared to men. Most of the patients had Type I (35.7%) and Type IV (35.7%) coccyx. The visual analogue scale was reduced after the surgery (P < .0011), showing positive outcomes. Ten (71.4%) cases showed excellent outcomes, whereas only one (7.1%) case showed poor outcomes after the surgery, and wound infections were observed in two (14.2%) cases post-operatively. The results obtained from this study concluded that in case of failure of conservative non-surgical treatments for coccygodynia, coccygectomy has emerged as an effective surgical method which is recommended by various surgeons to reduce the pain by removing the tailbone. Additionally, only a few complications such as infection as a relevant concern after this type of surgery were observed, and most of the patients were satisfied with the outcomes and also recommended it to others.
Impact of occupational health coaching on irrational career beliefs and workplace deviant behaviors among school employees: Implications for Educational administrative policy
Authors: Ekwueme Hope Uchechukwu , Ede Moses Onyemaechi , Eze Emmanuel Chukwuma , Mezieobi Daniel I. , Aroh Patricia Nwamaka , Oneli Joy O. , Nweke Prince O. , Enyi Chinwe
Published: June 2023

Background:

Workplace-disruptive behavior is an important public and organizational health issue that calls for public discourse. The high rates in Nigeria and its associated career illogical assumptions among teachers brought about this study to investigate the impact of rational emotive occupational health coaching (REOHC) on irrational career beliefs and workplace deviant behaviors in a sample of Nigerian primary school teachers.

Methods:

A sample of 128 primary school teachers in Nigeria was recruited as participants. They were assigned to REOHC and control groups. Work deviance behavior scale and teacher irrational belief scale were used to assess the participants at 3 points. A pretest-post-test and follow-up design was used in this study.

Results:

The findings indicated that the REOHC program significantly reduced work-deviant behaviors and irrational career beliefs among primary school teachers. The outcome also demonstrates the connection between groups and gender.

Conclusion:

This study concluded that primary school teachers’ work-related deviant behaviors and illogical beliefs were reduced as a result of the REOHC treatment. Therefore, occupational therapists should help teachers with deviant behaviors and irrational beliefs to change using rational emotive behavioral techniques.
Knowledge, attitudes, and practices (KAP) during the malaria elimination phase: A household-based cross-sectional survey
Authors: Abdelwahab Siddig Ibrahim , Elhassan Ibrahim M. , Albasheer Osama , Taha Manal Mohamed Elhassan , Ali Nasir Ahmed , Al-Jabiri Yahya Salem , Madkhali Waleed , Sahly Ahmad A. , Oraibi Bassem , Altraifi Ahmed Abdallah Ahmed , Hakami Nasser , Alshehri Mohammed M. , Abu Shaphe Mohammad , Beg Rashid Ali , Alshamrani Meshal
Published: June 2023

Malaria is a major health problem in Southwestern Saudi Arabia. This study aimed to measure the level of community understanding of malaria transmission, protection, and treatment. A questionnaire-based cross-sectional study enrolled 1070 participants from 2 districts with different malaria prevalence rates in Jazan Province. The response rate was 97.27%. Of the 1070 total; 754 (70.5%) had heard about malaria. Sixty-seven percentage know that fever was the main symptom. Approximately 59.8% did not know that stagnant water is one of the most important locations for mosquito breeding. Nevertheless, we found that 50% of the participants knew that mosquitoes bite at night and 96.9% confirmed that mosquitoes did not bite during the day. The most effective sources of information were distributed leaflets (41.8%) and video awareness (31.9%). The most significant factors affecting participants knowledge were gender, residence, family members, income, and education (P< .05). Knowledge levels were satisfactory in this study, and the majority of participants exhibited adequate attitudes and practices related to malaria prevention. However, knowledge differences were observed with regard to the place of residence. Greater emphasis should be directed towards education programs in malaria-endemic areas to ensure complete eradication of malaria.
Medical equipment that improve safety and outcomes of inter-facility transportation of critically ill patients: A systematic review
Authors: Kikutani Kazuya , Shimatani Tatsutoshi , Kawaguchi Atsushi , Ikeyama Takanari , Yamaguchi Daisuke , Nishida Osamu , Ohshimo Shinichiro
Published: June 2023

Background:

Although many critically ill patients require inter-facility transport for definitive or specialized therapy, the medical equipment required to enhance transport safety remains unclear. This review was performed to summarize the evidence regarding devices used to improve the safety and survival in patients requiring such transport.

Methods:

We searched MEDLINE, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi for randomized controlled trials and observational studies comparing outcomes according to the presence or absence of devices (or new vs conventional devices) during transfer of critically ill patients.

Results:

Four studies focusing on continuous blood pressure monitoring, extracorporeal membrane oxygenation, pelvic circumferential compression devices, and cuffed tracheal tubes, respectively, met the inclusion criteria. A meta-analysis was not performed because the 4 studies focused on different devices. Near-continuous blood pressure monitoring increased interventions such as intravenous fluid administration during transport, shortened the intensive care unit and hospital lengths of stay, and reduced the incidence of multiple-organ failure compared with use of oscillometric devices. Despite the small sample size and varying severity of illness among the groups, transport of patients with severe respiratory failure under extracorporeal membrane oxygenation resulted in fewer hypoxemic events during transport than transport on conventional ventilators. During transport of patients with pelvic fractures, pelvic belts may help to reduce mortality and the transfusion volume. Cuffed (vs uncuffed) tracheal tubes may reduce post-transport tube replacement events in pediatric patients.

Conclusion:

Studies on devices needed for inter-facility transport of critically ill patients are scarce, but some devices may be beneficial.
Comparison between cone-beam breast-CT and full-field digital mammography for microcalcification detection depending on breast density
Authors: Wienbeck Susanne , Andrijevska Viktorija , Kück Fabian , Perske Christina , Unterberg-Buchwald Christina , Fischer Uwe , Lotz Joachim , Kunze Meike
Published: June 2023

The purpose of this study was to evaluate the impact of breast density on the diagnostic performance of cone-beam breast-CT (CBBCT) in comparison to full-field digital mammography (FFDM) for the detection of microcalcifications. This retrospective IRB-approved study was conducted between December 2015 and March 2017 and enrolled 171 women with Breast Imaging Reporting and Data System category 4 or 5 lesions on FFDM and additional CBBCT; 56 of which were ineligible. The inclusion was restricted to 83 women (90 breasts, 90 lesions) with microcalcifications. All lesions underwent histology or were monitored by FFDM and a clinical examination at least 2 years after enrollment. Two breast radiologists independently read each data set twice. Sensitivity, specificity and area under the curve were compared between the modalities. Thirty-two breasts (35.5%) were grouped as non-dense breasts (American College of Radiology types a/b) and 58 breasts (64.5%) as dense breasts (American College of Radiology types c/d). Histopathological assessment was performed in 61 of 90 breast lesions (32 malignant, 1 high-risk and 28 benign). Area under the curve was larger for FFDM than for CBBCT (P = .085). The sensitivity was significantly higher for FFDM compared to CBBCT (P = .009). The specificity showed no significant differences comparing FFDM (both readers: 0.62) versus CBBCT (reader 1: 0.76, reader 2: 0.60; P = .192). Inter-observer-reliability on BI-RADS readings was almost perfect for FFDM and moderate for CBBCT (κ = 0.84, κ = 0.54, respectively). Intra-observer agreement was substantial to almost perfect for both methods and readers. Compared with FFDM, CBBCT demonstrated non-comparable results for microcalcification detection in dense and non-dense breasts.
Spontaneous migration of peripherally inserted central catheter into the azygos vein during postoperative gastrointestinal dysmotility: A case report
Authors: Liu Weinan , Wei Wei , Wang Yang , Liu Bing , Pang Yan , Sun Wenyan
Published: June 2023

Rationale:

The spontaneous migration of the peripherally inserted central catheter (PICC) is the displacement of the PICC tip from a satisfactory documented position in the superior vena cava (SVC) into its adjacent veins after several days or months of PICC insertion, and most frequently occurs in the ipsilateral internal jugular vein. However, it is rarely reported to detect migration of PICC tip into the azygos vein in patients who suffered from gastrointestinal dysmotility after abdominal surgery. We report 2 cases of spontaneous malposition of PICC into the azygos vein here and discuss the predisposing factors and processing procedures of this condition.

Patient concerns:

Two female patients with pancreatic disease were inserted PICCs on the left limbs before the abdominal surgery. After the surgery, 1 patient suffered from gastroparesis, and the other suffered from constipation. The nurses found that blood could not be aspirated from the PICCs while normal saline could be injected through the PICCs smoothly.

Diagnoses:

We identified the position of the PICC tip step-by-step, using ultrasound, intracavitary electrocardiogram, and chest X-ray, and confirmed that the tip of the PICC migrated into the azygos vein.

Interventions:

The patients were placed in the semi-reclining position from the supine position, and blood could be easily aspirated from the PICC after flushing with the push-pause flush technique. Intracavitary electrocardiogram displayed the elevated P, indicating that the PICC tip reentered the SVC and was at the lower 1/3 of SVC.

Outcomes:

The PICCs of the 2 patients functioned well afterward and were removed after the parenteral nutrition support was completed.

Lessons:

It is critical to assess the function of the PICC before every time of infusion. For patients who undergo abdominal surgery with PICC on the left side, when they had gastrointestinal dysmotility combined with PICC dysfunction, the possibility of spontaneous migration of PICC tip into the azygos vein should be considered.
Tubal ectopic twin pregnancy of complete hydatidiform mole and coexisting embryo: A rare case report
Authors: Shen Yun , Wang Jianing , Shao Yawei , Gong Chanchan , Zhao Ruiheng
Published: June 2023

Rationale:

Ectopic twin gestation involving a complete hydatidiform mole (CHM) and coexisting embryo is an exceedingly rare occurrence.

Patient concerns:

In this report, we present the case of a 22-year-old female (gravida2, para 1) who was in her 8th week of gestation and presented with abdominal pain. Due to the detection of active bleeding and a ruptured right fallopian tube, the patient underwent a salpingectomy on the right side.

Diagnosis:

The patient was diagnosed with an ectopic twin gestation involving a CHM and coexisting embryo.

Interventions:

The patient was treated with right-side salpingectomy.

Outcomes:

The operation was successful and her recuperation was satisfactory.

Lessons:

In the management of ectopic pregnancy involving CHM, it is crucial to enhance the accuracy of preoperative diagnosis. Additionally, histopathological examination of the salpingectomy specimen and conceptus is definitely essential for accurate diagnosis and appropriate follow-up management of tubal pregnancies.
Stenting or angioplasty for the treatment of deep vein thrombosis: Systematic review and meta-analysis of randomized controlled trials
Authors: Flumignan Ronald Luiz Gomes , Civile Vinicius Tassoni , Areias Libnah Leal , Flumignan Carolina Dutra Queiroz , Amorim Jorge Eduardo , Lopes Renato Delascio , Nakano Luis C. U. , Baptista-Silva Jose Carlos Costa
Published: June 2023

Background:

Although the cornerstone treatment for deep vein thrombosis (DVT) remains anticoagulation, clinicians perform stenting or angioplasty (SA) in particular patients. To assess the effects of SA in this setting, we performed a systematic review of randomized controlled trials.

Methods:

Based on the Cochrane standards, we searched the Cochrane CENTRAL, MEDLINE, Embase, CINAHL, LILACS and IBECS databases, and trial registries. Our primary outcomes were post-thrombotic syndrome (PTS), venous thromboembolism (VTE) and all-cause mortality.

Results:

We included 7 randomized controlled trial (1485 participants). There was no clinically significant difference between SA and best medical practice (BMP) for the additional treatment of acute DVT regarding PTS (standardized mean difference −7.87, 95% confidence interval [CI] −12.13 to −3.61; very low-certainty) and VTE (risk ratio [RR] 1.19, 95% CI 0.28–5.07, very low-certainty), and no deaths. Compared to BMP, the SA plus BMP and thrombolysis results in little to no difference in PTS (mean difference [MD] −1.07, 95% CI −1.12 to −1.02, moderate-certainty), VTE (RR 1.48, 95% CI 0.95–2.31, low-certainty), and mortality (RR 0.92, 95% CI 0.34–2.52, low-certainty). There was no clinical difference between stenting and BMP for chronic DVT regarding PTS (MD 2.73, 95% CI −2.10 to 7.56, very low certainty) and no VTE and death events.

Conclusions:

SA results in little to no difference in PTS, VTE and mortality in acute DVT compared to BMP. The evidence regarding SA in chronic DVT and whether SA, compared to BMP and thrombolysis, decreases PTS and VTE in acute DVT is uncertain. Open Science Framework (osf.io/f2dm6)
Effectiveness of scapular mobilization in patients with primary adhesive capsulitis: A systematic review and meta-analysis
Authors: Olguín-Huerta Cristian , Araya-Quintanilla Felipe , Moncada-Ramírez Victoria , Estrella-Flores Evelin , Cuyúl-Vásquez Iván , Gutiérrez-Espinoza Héctor
Published: June 2023

Background:

The aim of this study was to determine the effectiveness of scapular mobilization on range of motion, shoulder disability, and pain intensity in patients with primary adhesive capsulitis (AC).

Methods:

An electronic search was performed in the MEDLINE, EMBASE, SCOPUS, CENTRAL, LILACS, CINAHL, SPORTDiscus, and Web of Science databases up to March 2023. The eligibility criteria for selected studies included randomized clinical trials that included scapular mobilization with or without other therapeutic interventions for range of motion, shoulder disability, and pain intensity in patients older than 18 years with primary AC. Two authors independently performed the search, study selection, and data extraction, and assessed the risk of bias using the Cochrane Risk of Bias 2 tool.

Results:

Six randomized clinical trials met the eligibility criteria. For scapular mobilization versus other therapeutic interventions, there was no significant difference in the effect sizes between groups: the standard mean difference was -0.16 (95% confidence interval [CI] = −0.87 to 0.56;P= .66) for external rotation, −1.01 (95% CI = −2.33 to 0.31;P= .13) for flexion, −0.29 (95% CI = −1.17 to 0.60;P= .52) for shoulder disability, and 0.65 (95% CI = −0.42 to 1.72;P= .23) for pain intensity.

Conclusions:

Scapular mobilization with or without other therapeutic interventions does not provide a significant clinical benefit regarding active shoulder range of motion, disability, or pain intensity in patients with primary AC, compared with other manual therapy techniques or other treatments; the quality of evidence was very low to moderate according to the grading of recommendation, assessment, development and evaluation approach.
The significance of endoscopic Kyoto classification of gastritis in the gastric cancer risk assessment: A systematic review and meta‑analysis
Authors: Zhang Hangbin , Yang Xinyu , Zhang Xinyi , Huang Xuan
Published: June 2023

Background:

Kyoto Classification of Gastritis is a newly proposed gastric cancer risk assessment in recent years. It selects important gastroscopic manifestations that have been reported and calculates score values. Although it has been extensively employed in clinical practice, there is no thorough review or systematic summary of its usage.

Methods:

We looked for works published before May 2022 on the correlation between the Kyoto Classification of Gastritis and gastric cancer (GC) risk in Web of Science, EMBASE, China National Knowledge Infrastructure, PubMed, Wanfang database, and other suitable sources. Statistical analysis was carried out using Stata 14.0 and RevMan 5.40. Two statistical methods were employed.

Results:

Eight case-control studies involving 6927 patients (continuous variables group: 1961 patients; dichotomy variables group: 4966 patients) were included, and the meta-analysis results showed a significant association between Kyoto Classification of Gastritis and GC. A Kyoto classification score ≥ 4 might indicate a risk of GC (odds ratios 7.30; 95% confidence intervals [CI] 3.62–14.72; P < .00001. There was a significant difference between gastritis and GC scores (mean difference [MD] 0.86; 95% CI 0.73–0.99; P < .00001). Moreover, we found that intestinal metaplasia and atrophy highly affected the Kyoto Classification score (MD = 0.35, MD = 0.72 95% CI 0.20–0.50,0.56–0.88). However, there was considerable heterogeneity in both statistical analyses. We found the source of heterogeneity in the first analysis method but failed to find it in the second analysis method, which may be due to the small number of studies.

Conclusions:

The Kyoto Classification of gastritis score is crucial for detecting early stomach cancer. A score >4 suggests a significant risk for gastric cancer, with atrophy and intestinal metaplasia having the most impact. This score may be promoted at primary hospitals; however, because of the small number and quality of included studies, the results mentioned above need to be verified by randomized control trials with large samples and high-quality methods.
Decrease of 5-hydroxymethylcytosine in hepatitis B virus-related hepatocellular carcinoma: A cross-sectional study
Authors: Jia Yansheng , Liu Zhiquan , Dai Muwei , Feng Junhua , Ye Lihong , Zhang Haicong , Dai Erhei
Published: June 2023

Many epigenetic studies had found the decrease of 5-hydroxymethylcytosine (5-hmC) in various tumor tissues. However, limited information is available for hepatitis B virus-related hepatocellular carcinoma (HBV-related HCC). The present study aimd to investigate whether the decrease also existed in tumor tissues of HBV-related HCC and, if possible, to disclose its mechanism. We used immunohistochemistry and Image Pro Plus 6.0 Image Analysis Software to quantify the expression of 5-hmC, 5-methylcytosine, 10-eleven translocation (TET), isocitrate dehydrogenase (IDH) in pathological sections of tumor tissues and its para cancerous tissues of 40 HBV-related HCC patients. Our results showed that 5-hmC was decreased while 5-methylcytosine was increased in tumor tissues. We also detected TET1 and IDH2 were decreased in the tumor tissues and the decrease were positively correlated with the 5-hmC. The results suggested that the deficiency of 5-hmC was an epigenetic characteristic of HBV-related HCC and was mainly caused by the decrease of TET1 and IDH2.
Epidural Hematoma related to lower limb pain and massive liver bleeding in Gorham-Stout disease: A case report
Authors: Kumakura Yasutomo , Hasuda Norio , Akita Kazuki , Iijima Tetsuya , Matsukawa Takashi
Published: June 2023

Rationale:

Gorham-Stout disease (GSD) is a rare disease that causes massive osteolysis and proliferation of abnormal lymphangiomatous tissues. Patients with GSD often experience pain associated with bone fractures and chylothorax. However, bleeding caused by abnormal lymphangiomatous tissue or hematological dysfunction rarely occurs.

Patient concerns:

A 22-year-old female patient with GSD presented with severe left hip and lower limb pain. The GSD had disappeared her right pelvic bone and femur, but no abnormalities were found in the bones at the site of the pain.

Diagnoses:

The patient presented with a chylothorax and cerebrospinal fluid leakage. She was treated with sirolimus and an epidural blood patch, and her symptoms resolved. Computed tomography and magnetic resonance imaging revealed an epidural hematoma extending from L3 to the caudal region, and blood results revealed a consumption coagulopathy.

Interventions:

We presumed that the hematoma caused pain and prescribed pregabalin and morphine. The pain gradually subsided.

Outcomes:

An unexpected liver subcapsular hemorrhage occurred 4 months later, and the patient went into hemorrhagic shock. Transcatheter arterial embolization was promptly performed, and the patient recovered.

Lessons:

GSD infrequently causes bleeding related to abnormal lymphangiomatous tissues and coagulopathy, yet it can lead to serious events if it occurs.
A single-center, retrospective, cross-sectional study comparing the number of non-diagnostic measurements ratio in the pSWE and SSI ultrasound elastography methods
Authors: Cebula Maciej , Kufel Jakub , Gruszczyńska Katarzyna
Published: June 2023

The point shear wave elastography and supersonic shear imaging methods were compared regarding incorrect measurements during the liver examinations. A report-based, single-center, retrospective analysis of 425 liver elastography examinations was performed. A lower success ratio was observed for the point shear wave elastography method, as well as the older and obese patients pre-dominated in non-diagnostic studies. In our center experience, it is easier to obtain diagnostic data using the supersonic shear imaging method. However, further investigation of the subject is needed.
Changes in the number and characteristics of patients with acute acquired concomitant esotropia over time: An 8-year retrospective study
Authors: Lim Chae Won , Lee Jinwoo , Kim Won Jae
Published: June 2023

This study aimed to evaluate changes in the number and clinical characteristics of patients with acute acquired concomitant esotropia (AACE) over the course of 8 years. This retrospective study enrolled patients with AACE who visited our clinic between July 2014 and June 2022. The total study period was divided into 4 periods in chronological order. The number of patients who initially visited the clinic and underwent surgery was compared over time by dividing the time period into 8 quarters (quarters, 2 years). Clinical factors were analyzed between patients with and without surgery. Ninety-seven patients were enrolled (mean age, 29.5 years; 43 females). Among these, 65 patients (67.0%) underwent surgery. The number of patients with AACE increased steadily throughout the study period. The number of patients who underwent surgery was the highest during the 2020 Q3 to 2022 Q2. There was an increasing trend in patients with large ocular deviation (≥30 prism diopters) over time among patients with AACE who underwent surgical treatment (P = .037). Mean ocular deviation at the initial visit was greater in patients who underwent surgery than in those who did not (P < .001). The mean age of patients who underwent surgery was lower than that of patients who did not (P = .005). The number of patients with AACE has been increasing over time. Patients who underwent surgical treatment showed more ocular deviation and were younger at the initial visit than patients who did not.
Managing the older adult with inflammatory bowel disease: is age just a number?
Authors: Bermudez Helen , Faye Adam S. , Kochar Bharati
Published: June 2023

Purpose of review

This review summarizes the most recent literature on older adults with inflammatory bowel diseases (IBD). Additionally, we review geriatric syndromes that may be pertinent to the management of older adults with IBD.

Recent findings

Traditionally chronological age has been used to risk stratify older adults with IBD, however physiologic status, including comorbidities, frailty, and sarcopenia, are more closely associated with clinical outcomes for older adults. Delaying care for and undertreating older adults with IBD based upon advanced chronologic age alone is associated with worse outcomes, including increased mortality. Treatment decisions should be made considering physiologic status, with an understanding of the differential risks associated with both ongoing disease and treatment. As such, there is an increasing recognition of the impact geriatric syndromes have on older adults with IBD, which need to be further explored.

Older adults with IBD are less likely to receive advanced therapies and timely surgery. They are also more likely to have adverse outcomes despite having similar disease courses to younger adults with IBD. Focusing on biological age as opposed to chronological age can shift this trajectory and improve quality of care for this growing population of patients with IBD.
Recent surgical advances and continued controversies in medically refractory Meniere's disease
Authors: Lucas Jacob C. , Hong Robert S.
Published: June 2023

Purpose of review

Meniere's disease is caused by hydropic changes in the endolymphatic system, and manifests as a collection of vertigo, hearing loss, tinnitus, and aural fullness. Although high-quality clinical practice guidelines exist for the diagnosis and initial management of Meniere's disease, there is no strong consensus for treatment of medically refractory Meniere's disease. This review summarizes treatment options and highlights controversies surrounding surgical treatment of Meniere's disease.

Recent findings

Intratympanic steroid and intratympanic gentamicin injections continue to be widely used as in-office therapies in medically refractory Meniere's disease. Despite historical controversy surrounding the use of endolymphatic sac (ELS) surgery, the use of ELS decompression has been widely adopted by the international neurotologic community due to high vertigo control rate, coupled with low risk of audiovestibular loss. Wider decompression of the sac and surgical manipulation of the endolymphatic duct may impact outcome and are the subject of discussion. An emerging surgical technique called Triple Semicircular Canal Occlusion (TSCO) holds promise as a partially ablative procedure with high vertigo control rate in Meniere's disease. Cochlear implants may be placed in active Meniere's disease patients, or during an ablative surgery such as labyrinthectomy.

For the medically refractory Meniere's disease patient, treatment options include intratympanic steroid injection, endolymphatic sac decompression, medical or surgical labyrinthectomy, and vestibular nerve section. TSCO holds promise as an emerging partially ablative procedure. Cochlear implants maintain an important role in the rehabilitation of hearing loss associated with Meniere's disease.
Team-Based Approach in Hypertension Management
Authors: Anand Vini
Published: June 2023

Background/Local Problem:

Hypertension is a major risk factor for heart diseases and stroke among Americans; only 25% have this under control nationwide.

Methods:

This quality improvement project evaluated the outcomes of team-based care in hypertension control by registered nurses and certified nurse practitioners in a primary care setting. Pre/post–data analysis of blood pressure (BP) control, and BP knowledge, was done.

Intervention:

The team provided education and counseling based on knowledge assessment during visits and used unattended automated blood pressure measurement (uAOBPM) techniques to measure BP.

Results:

There was a significant reduction in systolic and diastolic BP control (P < .001). There was a statistically significant increase in disease knowledge score pre- and postintervention (P < .001).

Conclusion:

The team-based care approach improved patients' BP control and knowledge of the disease. The uAOBPM technique could be incorporated into clinical settings for accurate BP measurements.
Design and Validation of a Novel Evaluation Scale to Predict Inpatient Large Vessel Occlusion Strokes: Clinical Assessment Stroke Severity for Inpatient Scale
Authors: Qiu Kai , Wei Ke , Jia Zhen-Yu , Liu Sheng
Published: June 2023

Objectives

A large quantity of ischemic stroke events occur in patients hospitalized for non-stroke–related reason. No scale has been developed to identify the large vessel occlusion (LVO) among inpatient stroke alerts. We aimed to develop a novel evaluation scale to predict LVO from in-hospital stroke alerts.

Methods

Data from consecutive in-hospital stroke alerts were analyzed at a single high volume stroke center between January 2016 and October 2020. We developed a predictive scale based on the first half of patients (training group) using multivariate logistic regression and evaluated it in the remaining half of patients (validation group) adopting receiver operating curve. Receiver operating characteristics of the scale were analyzed to evaluate its value for the detection of LVO.

Results

A total of 243 patients were enrolled for further study, among them, 94 (38.7%) had confirmed LVO. Three risk factors independently predicted the presence of LVO: recent cardiac or pulmonary procedure (1 point), neurological deficit scale (≥1: 2 points), and history of atrial fibrillation (1 point). The CAPS scale was generated based on predictive factors and demonstrated highly effective discrimination in identifying the presence of LVO in the training group (area under curve = 0.956) and the validation group (area under curve = 0.940). When the score ≥2, CAPS scale showed 97.9% sensitivity, 79.2% specificity, 74.8% positive predictive value, and 98.3% negative predictive value for discriminating LVO.

Conclusions

CAPS scale was developed for identifying LVO among inpatient stroke alerts with high sensitivity and specificity, which may help to quickly prompt responses by appropriate stroke teams.
Quantitative Computed Tomography Analysis of the Longitudinal Change Between Centrilobular and Paraseptal Emphysema Subtypes: A Retrospective Study
Authors: Haraguchi Takafumi , Matsuoka Shin , Yagihashi Kunihiro , Matsushita Shoichiro , Yamashiro Tsuneo , Kobayashi Yasuyuki , Mimura Hidefumi
Published: June 2023

Objective

This study aimed to investigate the difference between the extent of centrilobular emphysema (CLE) and paraseptal emphysema (PSE) on follow-up chest CT scans and their relationship to the cross-sectional area (CSA) of small pulmonary vessels.

Methods

Sixty-two patients (36 CLE and 26 PSE) who underwent 2 chest CT scans were enrolled in this study. The percentage of low attenuation volume (%LAV) and total CSA of the small pulmonary vessels <5 mm2 (%CSA < 5) were measured at the 2 time points. Analysis of the initial %CSA < 5 and the change in the %LAV and %CSA < 5 on follow-up imaging was performed.

Results

The initial %CSA < 5 was not significantly different between the CLE and the PSE groups (CLE, 0.66 vs. PSE, 0.71; P = 0.78). There was no significant difference in the longitudinal change in the %LAV between the 2 groups (CLE, −0.048% vs. PSE, 0.005%; P = 0.26). The longitudinal change in the %CSA < 5 in patients with PSE significantly decreased compared with those with CLE (CLE, 0.025% vs. PSE, −0.018%; P = 0.02).

Conclusions

The longitudinal change in the %CSA < 5 was significantly different for patients with CLE and PSE, demonstrating an important pathophysiological difference between the subtypes.
Comprehension of Cochlear Duct Length for Incomplete Partition Types
Authors: Aksoy Direnç Özlem , Meltem Emine , Karagöz Yeşim , Yildirim Gülşah , Mahmutoğlu Özdeş , Mahmutoğlu Abdullah Soydan
Published: June 2023

Objective

Preoperative assessment of the cochlear duct length (CDL) and cochlear dimensions allows the selection of optimized implants. We aimed to evaluate the CDL measurements in incomplete partition (IP) defect patients and to create a reference to the literature.

Methods

Forty-one patients with IP (13 IP I, 23 IP II, and 5 IP III) and 30 controls were included in the study. The standardized cochlear image showing the basal turn in the most expansive plane was reconstructed from temporal high-resolution computed tomography images. Cochlear duct length measured manually (CDL-M) was measured by points placed consecutively on the lateral wall of the cochlea. The defined equations for estimating CDL (CDL measured according to Schurzig et al formula [CDL-Ɵ], CDL measured according to Escudé et al formula [CDL-E], CDL measured according to Alexiades et al formula [CDL-A]) were calculated from the same images. Cochlear duct length mean values obtained by each method were compared for each IP type.

Results

The longest CDL value was found in the control group, irrespective of the calculation method. Incomplete partition II cases had the most extended mean CDL among IP types. Incomplete partition III had the shortest CDL among all groups' CDL-M values. However, the mean CDL-M values of IP types I and III showed close results. There was no significant difference between the CDL-E and CDL-M values of the control group. Similarly, no significant difference was found between CDL-Ɵ and CDL-M values in IP type III cases. However, the results of other estimating formulations of all groups differed significantly from CDL-M values.

Conclusion

Cochlear duct length differences were detected between the control group and IP subtypes. These differences should be considered when choosing the appropriate electrode length. Because the results of formulas estimating CDL may differ from CDL-M in both control and IP cases, it would be more appropriate to use manual measurements in clinical practice.
Respiratory Invariant Textures From Static Computed Tomography Scans for Explainable Lung Function Characterization
Authors: Huang Yu-Hua , Teng Xinzhi , Zhang Jiang , Chen Zhi , Ma Zongrui , Ren Ge , Kong Feng-Ming (Spring) , Ge Hong , Cai Jing
Published: June 2023

Purpose:

The inherent characteristics of lung tissue independent of breathing maneuvers may provide fundamental information for function assessment. This paper attempted to correlate textural signatures from computed tomography (CT) with pulmonary function measurements.

Materials and Methods:

Twenty-one lung cancer patients with thoracic 4-dimensional CT, DTPA-single-photon emission CT ventilation (V
NM) scans, and available spirometry measurements (forced expiratory volume in 1 s, FEV1; forced vital capacity, FVC; and FEV1/FVC) were collected. In subregional feature discovery, function-correlated candidates were identified from 79 radiomic features based on the statistical strength to differentiate defected/nondefected lung regions. Feature maps (FMs) of selected candidates were generated on 4-dimensional CT phases for a voxel-wise feature distribution study. Quantitative metrics were applied for validations, including the Spearman correlation coefficient (SCC) and the Dice similarity coefficient for FM-V
NM spatial agreement assessments, intraclass correlation coefficient for FM interphase robustness evaluations, and FM-spirometry comparisons.

Results:

At the subregion level, 8 function-correlated features were identified (effect size>0.330). The FMs of candidates yielded moderate-to-strong voxel-wise correlations with the reference V
NM. The FMs of gray level dependence matrix dependence nonuniformity showed the highest robust (intraclass correlation coefficient=0.96 and P<0.0001) spatial correlation, with median SCCs ranging from 0.54 to 0.59 throughout the 10 breathing phases. Its phase-averaged FM achieved a median SCC of 0.60, a median Dice similarity coefficient of 0.60 (0.65) for high (low) functional lung volumes, and a correlation of 0.565 (0.646) between the spatially averaged feature values and FEV1 (FEV1/FVC).

Conclusions:

The results provide further insight into the underlying association of specific pulmonary textures with both local (V
NM) and global (FEV1/FVC, FEV1) functions. Further validations of the FM generalizability and the standardization of implementation protocols are warranted before clinically relevant investigations.
Transfrontal External Ventricular Drainage Combined with OMMAYA Sac Implantation under Laser Navigation were Performed: A Technical Note
Authors: yuan Zhengbo , Cao Zhijie , Li Zefu , Sun Qikai
Published: June 2023

Background:

Hydrocephalus caused by spontaneous intracerebral hemorrhage (ICH) is an independent risk factor with adverse effects on the progression of the disease. Until now, the choice of intraventricular catheter placement and intraventricular fibrinolysis (IVF) has been mainly based on the personal experience of the neurosurgeon.

Objective:

We will introduce the clinical effect of the new external ventricular drainage (EVD), an independent innovation of our medical center, on ICH patients, hoping to inspire more neurosurgeons to apply our method.

Methods:

In this open retrospective study, We analyzed the clinical data, radiological manifestations, and prognostic scores of 10 patients with the spontaneous intracerebral hemorrhage who received transfrontal lateral ventricle puncture and drainage under laser navigation in our hospital.

Results:

A total of 10 patients with an average age of 58.10±9.97 years were enrolled for emergency surgery. All operations were completed according to the consensus specifications. It took 11.25±3.81 days for the intracranial pressure to return to normal. On admission, patients had a median GCS of 10. The median preoperative GCS was 8. The median GCS at discharge score was 15. At discharge, the median NIHSS score was 4. After 6 months of follow-up, patients had a median NIHSS score of 4. At discharge, the median ADL score of patients was 85. After 6 months of follow-up, the median ADL score of the patients was 95.

Conclusion:

In treating patients with ICH, the emergency treatment of transfrontal external ventricular drainage combined with OMMAYA sac implantation under laser navigation is a surgical method worthy of further study.
Developmental Outcomes for Children With Unoperated Metopic or Sagittal Craniosynostosis: Findings at 3 and 7 Years From the Craniofacial Collaboration UK
Authors: Qi Robert , Piggott Katie , Lloyd-White Samuel , Kearney Anna
Published: June 2023

The Craniofacial Collaboration UK (CC-UK) is a shared initiative with the aim of addressing key limitations in the existing literature and examining the development of homogenous samples of children with craniosynostosis. This article preliminarily describes developmental, behavioral, and cognitive outcomes for children with either metopic synostosis (MS) or sagittal synostosis (SS), who were unoperated and managed conservatively under the CC-UK protocol. A total of 112 patients were included, and assessments conducted at 3 and/or 7 years of age are presented. The majority of unoperated patients were assessed as having mild clinical severity. Findings are broadly consistent with previous work, indicating that the majority of unoperated patients perform within the average ranges across assessments. For unoperated MS patients, higher than expected rates of developmental concerns were seen at 3 years, particularly relating to gross and fine motor skills, and personal social skills. Slightly elevated rates of behavioral concerns relating to hyperactivity and prosocial behavior were also consistently shown. Few developmental issues were found for SS patients at 3 years. Some minor concerns with peer relationships and prosocial behavior at 3 years, and emotional problems at 7 years were shown, but these were inconsistent over time. Cognitive ability in both groups at 7 years seems to be close to average. Overall findings are positive, and future work should build on these findings by recruiting larger samples and examining longer-term outcomes in adolescence and adulthood, to better understand the developmental trajectory of patients with unoperated craniosynostosis.
PREDICTIVE VALUE OF SOLUBLE PROGRAMMED CELL DEATH LIGAND-1 IN THE PROGRESSION OF SEPTIC PATIENTS TO CHRONIC CRITICAL ILLNESS IN THE INTENSIVE CARE UNIT: A PROSPECTIVE OBSERVATIONAL CLINICAL STUDY
Authors: Zeng Chenyu , Li Xing , Lu Zhongqian , Mu Genhua , Deng Yijun
Published: June 2023

Background: As an immune marker, serum soluble programmed cell death ligand-1 (sPD-L1) is significantly increased in sepsis and is predictive of mortality. We investigated the prognostic value of sPD-L1 in postseptic immunosuppression and progression to chronic critical illness (CCI). Methods: Adults with sepsis in intensive care units (ICUs) for the first time were screened and assigned to either a CCI group (ICU stay ≥14 days with persistent organ dysfunction) or a rapid recovery (RAP) group based on clinical outcome. Data regarding basic admission information and clinical parameters were collected and compared across the two groups. Serum sPD-L1 levels were detected by enzyme-linked immunosorbent assay at admission and on the seventh day (D7). Logistic regression analysis was used to determine the factors affecting septic patients' lymphocytopenia diagnosis on day 7 and CCI progression during hospitalization. The receiver operating characteristic curve and DeLong test were used to assess variable predictive power. Results: During the study period, a total of 166 septic patients were admitted to the ICU, and 91 septic patients were enrolled after screening. Compared with those in healthy individuals, the sPD-L1 levels in septic patients were significantly higher and positively correlated with traditional inflammatory markers and disease severity scores (P < 0.05). In a multivariate regression analysis, sPD-L1 alone predicted lymphocytopenia on day 7 (P < 0.05). In the sepsis cohort, 59 patients (64.8%) experienced RAP, and 32 patients (35.2%) developed CCI. Compared with the RAP group, the patients in the CCI group had a higher mean age, greater severity of disease, and higher mortality (P < 0.05). D7-sPD-L1 remained higher in the CCI group, and the area under the curve that predicted the occurrence of CCI was equivalent to the APACHE II score, with areas under the curve of 0.782 and 0.708, respectively. Conclusions: The severity of infection and immunosuppression in sepsis may be linked to serum sPD-L1. D7-sPD-L1 is valuable in predicting the progression of CCI in patients.