bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of hemorrhage-to-treatment time with outcomes in patients with brainstem cavernous malformations: a nationwide cohort study
Authors: Li Zongze , Lu Junlin , Liu Mingjian , Ma Li , Quan Kai , Zhang Hongfei , Liu Peixi , Shi Yuan , Dong Xuchen , You Chao , Tian Rui , Zhu Wei
Published: April 2024

Background:

Brainstem cavernous malformations (BSCMs) often present with haemorrhage, but the optimal timing for microsurgical intervention remains unclear. This study aims to explore how intervention timing relates to neurological outcomes in haemorrhagic BSCM patients undergoing microsurgery, offering insights for clinical decisions.

Methods:

A total of 293 consecutive patients diagnosed with BSCMs, who underwent microsurgery were identified between March 2011 and January 2023 at two comprehensive centres in China, with a postoperative follow-up duration exceeding 6 months. Utilizing logistic regression models with restricted cubic splines, distinct time groups were identified. Subsequently, matching weight analysis compared these groups in terms of outcomes, new haemorrhage rates, cranial nerve deficits, and perioperative complications. The primary outcome was an unfavourable outcome, which was defined as a mRS score greater than 2 at the latest follow-up.

Results:

Among the 293 patients, 48.5% were female, median age was (39.9±14.3) years, and median haemorrhage-to-treatment time was 42 days. Patients were categorized into acute (≤21 days), subacute (22–42 days), and delay (>42 days) intervention groups. After matching, 186 patients were analyzed. Adjusted analysis showed lower unfavourable outcome rates for acute [adjusted odds ratio (OR), 0.73; 95% CI, 0.65–0.82;P<0.001] and subacute (adjusted OR, 0.83; 95% CI, 0.72–0.95;P=0.007) groups compared to the delay group. Subacute intervention led to fewer cranial nerve deficits (adjusted OR, 0.76; 95% CI, 0.66–0.88,P<0.001). New haemorrhage incidence didn’t significantly differ among groups.

Conclusions:

For haemorrhagic BSCMs patients, delayed microsurgical intervention that exceeded 42 days after a prior haemorrhage were associated with an increased risk of unfavourable neurological outcomes.
A novel self-inflatable balloon for treating refractory benign esophageal strictures: a prospective, single-arm, multicenter study
Authors: Li Longsong , Xu Ning , Wang Pengju , Liu Li , Gong Wei , Bi Yawei , Ru Nan , Su Song , Wang Nanjun , Xiang Jingyuan , Han Ke , Chai Ningli , Linghu Enqiang
Published: April 2024

Background and Aim:

Current treatments for refractory benign esophageal strictures (BESs) often take several years and have poor effects. The authors propose a novel method of self-help inflatable balloon (SHIB) and evaluate its efficacy and safety.

Methods:

A prospective, multicenter study was conducted from January 2019 to March 2022. All enrolled patients were diagnosed with refractory BESs and received SHIB. The primary endpoint was the clinical success rate at 12 months after removing SHIB. The secondary endpoints were the number of days of placing SHIB, and changes from baseline in BMI and health-related quality of life at 1, 3, 6, and 12 months.

Results:

The clinical success rate was 51.2% (21/41) with the median days of placing SHIB being 104.0 days (range: 62.0–134.5 days), which was higher in the endoscopic group compared to the caustic and surgery groups (63.3 vs. 28.6% vs. 0, P=0.025). All patients (100%) showed significant improvement in dysphagia scores during placing SHIB. Although 20 patients (48.8%) experienced recurrent stricture, the median stricture length was decreased (P<0.001) and the median intervention-free interval was prolonged (P<0.001). In all patients, the mean BMI at and health-related quality of life at 1, 3, 6, and 12 months were significantly increased compared with baseline (P<0.05). On multivariate analysis, stricture etiology and wearing time were independent predictors of recurrent stricture.

Conclusions:

The SHIB has high efficacy and safety in treating refractory BESs of different origins, especially for endoscopic resection. Stricture etiology and wearing time were independent predictors of recurrent stricture.
Development and comprehensive validation of a predictive prognosis model for very early HCC recurrence within one year after curative resection: a multicenter cohort study
Authors: Liu Lei , Qin Shangdong , Lin Kongying , Xu Qingguo , Yang Yuan , Cai Jinzhen , Zeng Yongyi , Yuan Shengxian , Xiang Bangde , Lau Wan Yee , Zhou Weiping
Published: April 2024

Background:

The high incidence of early recurrence after liver resection (LR) for hepatocellular carcinoma (HCC) is the main obstacle in achieving good long-term survival outcomes. The aim of the present study is to develop a prognostic model in predicting the risk of very early (1-year) recurrence.

Material and methods:

Consecutive patients who underwent LR for HCC with curative intent at multicenters in China were enrolled in this study. The VERM-pre (the Preoperative Very Early Recurrence Model of HCC) with good performance was derived and validated by internal and external cohorts retrospectively and by another two-center cohort prospectively.

Results:

Seven thousand four hundred one patients were enrolled and divided randomly into three cohorts. Eight variables (tumor diameter, tumor number, macrovascular invasion, satellite nodule, alpha-fetoprotein, level of HBV-DNA, γ-GT, and prothrombin time) were identified as independent risk factors for recurrence-free survival on univariate and multivariate analyses. The VERM-pre model was developed which showed a high capacity of discrimination (C-index: 0.722; AUROC at 1-year: 0.722)) and was validated comprehensively by the internal, external, and prospective cohorts, retrospectively. Calibration plots showed satisfactory fitting of probability of early HCC recurrence in the cohorts. Three risk strata were derived to have significantly different recurrence-free survival rates (low-risk: 80.4–85.4%; intermediate-risk: 59.7–64.8%; high-risk: 32.6–42.6%). In the prospective validation cohort, the swimming plot illustrated consistent outcomes with the beginning predictive score.

Conclusion:

The VERM-pre model accurately predicted the 1-year recurrence rates of HCC after LR with curative intent. The model was retrospectively and prospectively validated and then developed as the online tool.
Family caregiver outcomes after participating in a hospital-based family involvement program after major gastrointestinal surgery: a subgroup analysis of a patient preferred cohort study
Authors: Musters Selma C.W. , Kreca Sani M. , van Dieren Susan , van der Wal-Huisman Hanneke , Romijn Johannes A. , Chaboyer Wendy , Nieveen van Dijkum Els J.M. , Eskes Anne M. ,   on behalf of the ARTIS Consortium
Published: April 2024

Background:

Engaging families in postsurgical care is potentially beneficial for improving cancer patient outcomes and quality of care. The authors developed a family involvement program (FIP) and in this study, the authors aim to evaluate the impact of the FIP on family caregiver burden and well-being. Moreover, the authors aim to assess the fidelity of the program.

Materials and methods:

This is a preplanned subgroup analysis of a patient-preferred prospective cohort study that included family caregivers of patients who underwent major oncological surgery for gastrointestinal tumors. Only patient-nominated family caregivers could participate in the FIP. Caregivers received structured training in fundamental caregiving tasks from healthcare professionals and then actively participated in these tasks. Caregiver burden and well-being were measured four times (at hospital admission, at hospital discharge, and at 1 and 3 months posthospital discharge) using the Caregiver Strain Index+ (CSI+) and the Care-related Quality of Life instrument (CarerQoL-7D). The fidelity of the FIP was assessed by recording completion of care activities. In addition, family caregivers were asked whether they would participate in the FIP again.

Results:

Most of the 152 family caregivers were female (77.6%), and their mean age was 61.3 years (SD=11.6). Median CSI+ scores ranged between −1 and 0 and remained below the cutoff point of experiencing burden. CarerQoL-7D results indicated no significant differences in family caregivers’ well-being over time. Upon discharge, over 75% of the family caregivers stated that they would recommend the FIP to others. The highest compliance with all fundamental care activities was observed during postoperative days 2–4.

Conclusion:

The family caregivers of oncological surgical patients who participated in the FIP exhibited acceptable levels of caregiver burden and well-being. These findings suggest that the FIP is a valuable intervention to equip family caregivers with the skills to navigate the uncertain period following a patient’s hospital discharge.
Clinical outcomes of on-pump versus off-pump coronary-artery bypass surgery: a meta-analysis
Authors: He Liaoming , Tiemuerniyazi Xieraili , Chen Lianxin , Yang Ziang , Huang Shengkang , Nan Yifeng , Song Yangwu , Feng Wei
Published: April 2024

Background:

The ongoing debate regarding off-pump coronary artery bypass grafting (CABG) and on-pump CABG has endured for over three decades. Although numerous randomized controlled trials (RCTs) and meta-analyses have been reported, new evidence has emerged. Therefore, an updated and comprehensive meta-analysis to guide clinical practice is essential.

Materials and Methods:

A comprehensive search for eligible articles published after 2000, reporting RCTs involving at least 100 patients and comparing off-pump CABG with on-pump CABG, was performed throughout the databases including Embase, Ovid Medline, and Web of Science. The primary interested outcomes included the short-term incidence of stroke and long-term mortality. The primary analysis utilized fixed-effect model with the inverse variance method. The Grade of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the certainty of evidence.

Results:

After thorough screening, 39 articles were included, consisting of 28 RCTs and involving a total of 16 090 patients. Off-pump CABG significantly reduced the incidence of short-term stroke (1.27 vs. 1.78%, OR: 0.74, P=0.03, high certainty). However, it was observed to be associated with increased mid-term coronary reintervention (2.77 vs. 1.85%, RR: 1.49, P<0.01, high certainty) and long-term mortality (21.8 vs. 21.0%, RR: 1.09, P=0.02, moderate certainty).

Conclusions:

Off-pump CABG significantly reduces the short-term incidence of stroke, but it also increases the incidence of mid-term coronary reintervention. Moreover, it may increase long-term mortality.
Running Biomechanics and Clinical Features Among Adolescent Athletes With Lower Leg Chronic Exertional Compartment Syndrome
Authors: Chanchi Mayela Leal , DeJong Lempke Alexandra F. , Kocher Mininder , Shore Ben , Meehan William , Willwerth Sarah , Dawkins Corey , Hunt Danielle , d’Hemecourt Pierre , Stracciolini Andrea , Whitney Kristin
Published: April 2024

Objective:

To compare clinical measures between patients with chronic exertional compartment syndrome (CECS) and healthy controls and evaluate running biomechanics, physical measurements, and exertional intracompartmental (ICP) changes in adolescent athletes with lower leg CECS.

Design:

Cross-sectional case–control study.

Setting:

Large tertiary care hospital and affiliated injury prevention center.

Participants:

Forty-nine adolescents with CECS (39 F, 10 M; age: 16.9 ± 0.8 years; body mass index (BMI): 23.1 ± 2.9 kg/m2; symptom duration: 8 ± 12 months) were compared with 49 healthy controls (39 F, 10 M; age: 6.9 ± 0.8 years; BMI: 20.4 ± 3.7 kg/m2).

Interventions:

All participants underwent gait analyses on a force plate treadmill and clinical lower extremity strength and range of motion testing. Patients with chronic exertional compartment syndrome underwent Stryker monitor ICP testing.

Main Outcome Measures:

Symptoms, menstrual history, and ICP pressures of the patients with CECS using descriptive statistics. Mann–WhitneyUand χ2analyses were used to compare CECS with healthy patients for demographics, clinical measures, and gait biomechanics continuous and categorical outcomes, respectively. For patients with CECS, multiple linear regressions analyses were used to assess associations between gait biomechanics, lower extremity strength and range of motion, and with ICP measures.

Results:

The CECS group demonstrated higher mass-normalized peak ground reaction force measures (xBW) compared with controls (0.21 ± 0.05 xBW (P< 0.001) and were more likely to have impact peak at initial contact (P= 0.04). Menstrual dysfunction was independently associated with higher postexertion ICP (ß = 14.6;P= 0.02).

Conclusions:

The CECS group demonstrated increased total force magnitude and vertical impact transient peaks. In women with CECS, menstrual dysfunction was independently associated with increased postexertion ICP. These biomechanical and physiological attributes may play a role in the development of CECS.
Massive Transfusion in Pediatric Patients on Extracorporeal Membrane Oxygenation: A Secondary Analysis of the Massive Transfusion in Children (MATIC) Study
Authors: Hargrave Emily , Alexander Robin , Leeper Christine M. , Leonard Julie C. , Josephson Casandra D. , Steiner Marie E. , Spinella Philip C. , Muszynski Jennifer A. ,   for the MATIC Investigators and PALISI BloodNet
Published: April 2024

Few data describe pediatric patients who receive massive transfusion for life-threatening hemorrhage (LTH) while on extracorporeal membrane oxygenation (ECMO). We present a retrospective secondary analysis of a multicenter prospective observational study to describe resource utilization and mortality in pediatric patients with LTH while on ECMO. Children who were on ECMO during an LTH were compared to children with LTH who were not on ECMO. Primary outcomes were volumes of blood products administered and 28 day mortality. Comparisons were assessed by two-sided Fisher’s exact test or Wilcoxon rank sum test. A total of 449 children, including 36 on ECMO, were included. Compared to those not on ECMO, children on ECMO received a higher volume of blood products (110 [50–223] vs. 59 [28–113]) ml/kg, p = 0.002) and were more likely to receive antifibrinolytic therapy (39% vs. 10%, p < 0.001). Blood product ratios were similar. Extracorporeal membrane oxygenation patients had higher 28 day mortality (64% vs. 35%, p = 0.001), although 24 hour mortality was similar (17% vs. 23%, p = 0.5). In conclusion, children on ECMO with LTH experience high resource utilization and 28 day mortality. Studies are needed to identify children at risk for LTH and to evaluate ECMO-specific treatment strategies.
Causal effect between gut microbiota and gastroesophageal reflux disease: a bidirectional two-sample Mendelian randomization study
Authors: Liu Jingyu , Zhang Tongxin , Liu Xiao , Wang Qian , Zhang Huawei
Published: April 2024

Previous observational studies have found that the gut microbiota is closely related to the pathogenesis of gastroesophageal reflux disease (GERD), while their causal relationship is unclear. A two-sample multivariate Mendelian randomization analysis was implemented to estimate the causal effect of gut microbiota on GERD. The gut microbiota aggregated statistics were derived from a meta-analysis of the largest available genome-wide association studies (GWAS) conducted by the MiBioGen alliance (n = 13 266). GERD aggregated statistics were derived from published GWAS (129 080 cases and 473 524 controls). A bidirectional two-sample Mendelian randomization study was conducted to explore the causal relationship between gut microbiota and GERD using the inverse variance weighted (IVW), Mendelian randomization Egger, single model, weighted median, and weighted model. To verify the stability of the main results of Mendelian randomization analysis, we performed sensitivity analysis. Based on the results of IVW, we found that Anaerostipes was causally associated with an increased risk of GERD [odds ratio (OR): 1.09, P = 0.018]. Eight gut microbiota taxa (Actinobacteria, Bifidobacteriales, Bifidobacteriaceae, Clostridiales vadin BB60 group, Rikenellaceae, Lachnospiraceae UCG004, Methanobrevibacter, and unknown genus id.1000000073) are predicted to act causally in suppressing the risk of GERD (P < 0.05). In addition, reverse Mendelian randomization analyses revealed that the abundance of 15 gut microbiota taxon was found to be affected by GERD. No significant estimation of heterogeneity or pleiotropy is detected. Our study presents a complicated causal relationship between gut microbiota and GERD that offers guidance on the selection of appropriate probiotics as clinical interventions for GERD.
Long-term outcomes of intestinal penetrating Crohn’s disease following successful nonoperative management
Authors: Sun Zhenya , Cao Lei , Chen Yusheng , Zhu Weiming , Li Yi
Published: April 2024

There is a paucity of data on the surgical or medical treatment for abscess/fistula complicating Crohn’s disease after successful nonsurgical management. We conducted a cohort study to investigate the long-term outcomes and the risk factors for the requirement of subsequent surgical intervention in Crohn’s disease patients with complicating fistulas/abscess following successful nonsurgical management. Data were collected on penetrating Crohn’s disease experiencing successful nonsurgical treatment between December 2012 and December 2021. Long-term outcomes and risk factors of surgery were assessed by univariate and multivariate analysis, and subgroup analysis was performed based on penetrating phenotype including abscess, fistula, and phlegmon. A total of 523 penetrating Crohn’s disease patients; there were 390, 125, and 60 patients complicated with fistulas, abscess, and phlegmon, respectively. Long-term outcomes showed that BMI < 18.5 (kg/m2), the recurrent abscess, and stricture were independent risk factors of surgery. Biologics and resolution of abscess were independent protective factors of surgery. Furthermore, in 399 patients undergoing early surgery, stricture and BMI < 18.5 (kg/m2) were independent risk factors, and biologics and abscess resolution were protective of the early surgery. Subgroup analysis based on fistula, abscess, and phlegmon phenotype also demonstrated that concomitant stricture was an independent risk factor and the use of biologics was protective of surgical resection. Our data indicate that biologics can delay the requirement of surgery and may be given to patients with penetrating complicating Crohn’s disease who have been successfully treated nonoperatively, but surgical resection should be considered in the setting of malnutrition and stenosis formation.
Appraisal of a newly developed ALBI-sarcopenia score as a prognostic marker in patients with hepatocellular carcinoma
Authors: Elsabaawy Maha , Badran Hanaa , Ragab Amr , Abdelwahab Rasha , Sayed Eman , Afify Sameh , Othman Warda
Published: April 2024

Objective

This study aimed to evaluate the impact of the combined Albumin–bilirubin (ALBI)/sarcopenia score as a newly developed prognostic model for hepatocellular carcinoma (HCC), with a focus on its utility in predicting mortality.

Methods

This prospective study was conducted on HCC patients who were followed for 1 year or until death. Sarcopenia was assessed radiologically by computed tomography at the level of L3. The study consisted of two sets: a development set in which the new ALBI-sarcopenia score was created, comprising 262 HCC patients, followed by an internal validation set with 100 patients.

Results

The development cohort primarily included males (69.5%), aged 59.6 ± 8.09 years. In patients with sarcopenia, the ALBI score was −2.03 ± 0.42 (P < 0.006), the model for end-stage liver disease (MELD) score was 11.29 ± 2.43 (P < 0.001*), and the MELD-sarcopenia score was 21.29 ± 2.43 (P < 0.001*). The distribution of barcelona clinic liver cancer (BCLC) staging was as follows: BCLC A 18 (15.9%), BCLC B 63 (55.8%) and BCLC C 32 (28.3%) (P < 0.001*), with a notable association with higher mortality (P < 0.001). Multivariate analysis identified sarcopenia and ALBI scores as independent predictors of mortality in HCC (P < 0.001*). In the development set, the ALBI-sarcopenia score successfully predicted mortality at a cutoff >−11 with an area under a curve of 0.837 (95% CI, 0.784–0.889), while in the validation set, it predicted mortality at a cutoff >−11.55 with an area under a curve of 0.842 (95% CI, 0.753–0.930).

Conclusion

The newly introduced ALBI-sarcopenia score has demonstrated superior effectiveness in comparison to MELD-sarcopenia score, overcoming the shortcomings associated MELD score in forecasting outcomes for patients with HCC.
Improvement of quality of care provided to outpatients with hepatic cirrhosis after an educational intervention
Authors: Amador Alberto , Salord Silvia , Xiol Xavier , Garcia-Guix Marta , Cachero Alba , Rota Rosa , Hernandez Aretxabaleta Nerea , Baliellas Carme , Castellote Jose
Published: April 2024

Objective

A set of indicators has been reported to measure the quality of care for cirrhotic patients, and previously published studies report variable adherence rates to these indicators. This study aimed to assess the quality of care provided to cirrhotic outpatients before and after an educational intervention by determining its impact on adherence to quality indicators.

Methods

We conducted a quasi-experimental, cross-sectional study including 324 cirrhotic patients seen in 2017 and 2019 at a tertiary teaching hospital in Spain. Quality indicators were assessed in five domains: documentation of cirrhosis etiology, disease severity assessment, hepatocellular carcinoma (HCC) screening, variceal bleeding prophylaxis, and vaccination. After identifying areas for improvement, an educational intervention was implemented. A second evaluation was performed after the intervention to assess changes in adherence rates.

Results

Before the intervention, adherence rates were excellent (>90%) for indicators related to variceal bleeding prophylaxis and documentation of cirrhosis etiology, acceptable (60–80%) for HCC screening and disease severity assessment, and poor (<50%) for vaccinations. After the educational intervention, there was a statistically significant improvement in adherence rates for eight indicators related to HCC screening (70–90%), disease severity assessment (90%), variceal bleeding prophylaxis (>90%), and vaccinations (60–90%).

Conclusion

Our study demonstrates a significant improvement in the quality of care provided to cirrhotic outpatients after an educational intervention. The findings highlight the importance of targeted educational interventions to enhance adherence to quality indicators in the management of cirrhosis.
Turner syndrome with isochromosome Xq as a cause of granulomatous hepatitis: a case report
Authors: Ali Ayman F. , Haffar Lina
Published: April 2024

Introduction:

Turner syndrome (TS) is the most common sex chromosome abnormality in women, caused by a complete or partial absence of the second sex chromosome. The karyotype 46, X,i(Xq) is the underlying cause in about 10% of the cases of TS. Hepatic abnormalities are frequent in TS. Granulomas are relatively common in liver samples but are very rarely reported in TS.

Case presentation:

A 15-year-old female with TS attended a consultation for evaluation of elevated liver enzymes. Her chromosomal analysis showed mosaicism 46, X (iso xq)100%. There were no stigmata of chronic liver disease. A liver biopsy showed granulomatous hepatitis. Other causes of hepatic granulomas have been excluded. Ursodeoxycholic acid (UDCA) therapy leads to the normalization of transaminases.

Clinical discussion:

Although Hepatic involvement is common and mostly asymptomatic in TS, the mechanism of liver injury is not well understood. The hepatic histological changes in these cases are variable and range from minimal abnormalities to nonalcoholic steatohepatitis (NASH), liver architectural changes, and biliary lesions. Hepatic granulomas are associated with a wide range of systemic disorders but are very rarely reported in tuner syndrome. Normalization of liver enzymes after treatment with UDCA was previously reported, but the importance of this approach is to be determined.

Conclusion:

Granulomatous hepatitis may be associated with TS and may be added to the histological patterns encountered in this disorder.
Unmasking Sturge–Weber syndrome in adulthood: a case with extrafacial port-wine stain and delayed neurological symptoms
Authors: Yadav Pramodman Singh , Adhikari Pratik , Mehta Binod , Khadka Shuvam , Bhurtel Min Raj , Dahal Alok , Acharrya Sujan
Published: April 2024

Background:

Sturge–Weber syndrome (SWS) is a rare neurocutaneous disorder characterized by a facial port-wine birthmark, leptomeningeal angiomatosis, and glaucoma. This case report highlights the challenges of diagnosing SWS when presenting with atypical features. Here, the authors present a 55-year-old man with an extrafacial port-wine stain and delayed-onset seizures, deviating from the classic triad.

Case presentation:

A 55-year-old man presented with a recent seizure and a characteristic port-wine birthmark extending beyond the typical facial region. Neurological examination revealed no weakness, speech difficulties, or coordination problems. Ophthalmological examination didn’t reveal glaucoma. Limited resources restricted access to advanced imaging like MRI scans. However, based on the constellation of clinical findings, including the facial birthmark with angiomatosis and the new-onset seizure, the patient received a diagnosis of SWS. Treatment with Levetiracetam was initiated to prevent future seizures, and patient education on managing diabetes and hypertension was provided.

Clinical discussion:

This case underscores the importance of considering SWS in diagnosing adult-onset seizures, especially with a characteristic facial birthmark. The delayed presentation and isolated seizure suggest potentially less severe brain involvement. Resource limitations necessitated a clinical diagnosis and treatment with readily available medications.

Conclusion:

This case highlights the challenges of diagnosing atypical SWS presentations. Early diagnosis is crucial for prompt management and improved patient outcomes. Future research should focus on developing robust diagnostic tools and exploring novel treatment options for atypical SWS presentations.
Neurotoxicity and acute renal injury secondary to Russell’s viper bite in an individual: a case report from Nepal
Authors: Pahari Nabin , Sharma Bishnu Dhakal , Ghimire Sagun , Sharma Shanta , Kafle Bikram , Upadhaya Tekraj , Montasir Ahmed Al
Published: April 2024

Introduction and importance:

Owing to the high number of envenomation and fatalities, the Russell’s viper holds greater medicinal significance than any other Asian serpent. South East Asia is one of the most snakebite-prone regions in the world. Dense population, extensive agricultural practices, the abundance of venomous snake species, and an overall lack of knowledge about primary treatment (first aid) are the major culprits associated with snake bite-related morbidity and mortality. The venom of vipers is known to produce vasculotoxicity and contains hemotoxins.

Case presentation:

The authors describe a patient who was bitten by a viperine snake and showed signs of both neurotoxicity and acute kidney injury (AKI). The 20 years male was treated in a tertiary care centre in Nepal. The patient developed respiratory failure and needed ventilator support. Further, more haemodialysis was also done to manage AKI. Later, the patient was discharged after a smooth recovery.

Discussion:

Numerous clinical manifestations, such as neurotoxicity and vasculotoxicity, can result from a viperine bite. The majority of viperine snakebites are hemotoxic. Dual neurotoxic symptoms are possible after a viperine bite despite their rarity. The prevention of respiratory failure depends critically on the early detection of neurotoxicity.

Conclusion:

Unusual neuromuscular paralysis is caused by Russell’s vipers (Daboia russelii) in South East Asia. Physicians should know the exceptional presentations of snakebites to diagnose and treat patients.
Physical Activity Levels and Factors Affecting Them in Hospitalized Children With Leukemia
Authors: Huang Yuru , Zheng Xiaofen , Chen Qianhe , Jiang Kaiyao , Zheng Afen , Jin Liya , Wang Runping , Chen Jun , Zou Ping , Zhang Chunmei
Published: April 2024

Background

Physical activity promotes healthy physical and mental development in children with leukemia. However, the level of physical activity in hospitalized children with leukemia and the factors that influence it are unknown.

Objectives

The aims of this study were to understand the physical activity level of hospitalized children with leukemia and to explore the factors influencing it to provide a reference for physical activity assessment and intervention in such children.

Methods

A total of 133 hospitalized children with leukemia completed a general information questionnaire, the Chinese University of Hong Kong Physical Activity Rating for Children and Youth, and the Children’s Social Anxiety Scale. A cross-sectional study was used to explore the effects of different variables on the children’s activity levels.

Results

Among the study participants, 44.4% had a low-intensity activity level, 35.3% had a moderate-intensity activity level, and 20.3% had a high-intensity activity level, with a total physical activity rating of 3 (1, 6). Chemotherapy phase (P= .007), screen time (P= .001), and social anxiety (P= .012) were identified as influential factors.

Conclusions

Our results showed that children with hospitalized leukemia had lower-intensity physical activity levels, especially in the chemotherapy phase of induction remission. Furthermore, screen time and social anxiety had negative effects on the children’s activity levels.

Implications for Practice

According to the physical activity level of the children and the influencing factors, healthcare professionals should gradually improve children’s mobility and promote their physical and mental health development through guidance and encouragement, and the development of personalized activity intervention programs.
A Clinical Nurse Specialist in Home Healthcare
Authors: Hinck Susan M.
Published: April 2024

Purpose

Opportunities and challenges in home healthcare are discussed from the perspective of a gerontological clinical nurse specialist who has served as an expert clinician, administrator, and compliance director of a home health agency in the Midwest United States.

Description

Home-based nursing care requires a distinct set of knowledge and skills centered on the home environment and the way the home health patient responds emotionally and physically to become confident and self-sufficient. A Theoretical Framework for Home-Based Professional Nursing Practice is presented identifying the 6 concepts (primacy of home, patient authority, patient self-management, caregivers as collaborators, interprofessional clinical team collaboration, nurse autonomy) that are building blocks to describe the experience of patients in their homes and interactions with providers. The quality of clinical care and documentation influence reimbursement for care and the financial survival of the home health agency.

Outcome

Six management priorities both within the administrative office and the clinical teams are highlighted to improve quality of care, promote efficiency, and retain staff.

Conclusion

Exciting opportunities are available for the clinical nurse specialist in home-based care.
Patient Perspectives Following Obstetric Anal Sphincter Injury
Authors: Nutaitis Alexandra C. , Ferrando Cecile A. , Propst Katie
Published: April 2024

Importance

An obstetric anal sphincter injury can significantly affect patients. Support for these patients is both limited and not well understood.

Objective

The aim of this study was to describe patient experiences after an obstetric anal sphincter injury.

Study Design

This is a prospective cross-sectional qualitative study of patients who experienced an obstetric anal sphincter injury within a tertiary care network between May and June of 2022. Demographic data, clinical data regarding the delivery, and the Edinburgh Postnatal Depression Scale were collected. Prospective semistructured interviews were conducted approximately 5–12 weeks postpartum to address opportunities to improve obstetric anal sphincter injury care. Qualitative analysis was performed using a grounded theory approach.

Results

Fifteen women with a mean age of 31 (±3.93) years participated. The majority identified as White (93.3%) and non-Hispanic (100%). All participants identified as being married to men and completing undergraduate education; 9 (60%) also received postgraduate education. Five participants (33.3%) screened positive (score of 10 or greater) for postnatal depression on the Edinburgh Postnatal Depression Scale. Thematic saturation was reached with 3 major themes identified: (1) pain control, (2) desire for multifactorial support, and (3) obstetric anal sphincter injury knowledge and awareness.

Conclusions

Experiencing an obstetric anal sphincter injury represents a great unknown to most women. This study identifies opportunities for improved postpartum care through education, pain control, and patient support. Interventions are needed to improve the postpartum experience for women who experience an obstetric anal sphincter injury with childbirth.
Progress of uric acid in cardiovascular disease
Authors: Gan Tian-ming , Ye Yu-yu , Mo Guan-lian , Li Jin-yi
Published: April 2024

Due to the global prevalence of hyperuricemia (HUA), there is growing interest in research on uric acid (UA). HUA is a common condition that has various adverse consequences, including gout and kidney disease. However, recent studies have also implicated UA in the development of cardiovascular diseases (CVD) such as atrial fibrillation (AF) and coronary heart disease (CHD). Experimental and clinical research has extensively demonstrated the detrimental effects of elevated serum UA levels on cardiovascular health. Furthermore, serum UA levels have been identified as predictors of CVD outcomes following percutaneous coronary intervention (PCI) and catheter ablation. Additionally, the use of UA-lowering therapy holds important implications for the management of CVD. This review aims to consolidate the current evidence on the relationship between serum UA and CVD.
Denis Aristide Baylor. 30 January 1940—16 March 2022
Authors: Lamb FRS Trevor D. , Yau King-Wai
Published: April 2024

Denis Baylor was one of the leading sensory neuroscientists of the latter part of the twentieth century. His research on the rod and cone photoreceptors of the retina provided a deep understanding of the electrical responses of these cells to light and also of the molecular mechanisms of photo­transduction, whereby light absorption is linked via biochemical reactions within the cell to ion channels in its membrane and thence to cellular membrane voltage changes. He also made major contributions to knowledge of the transmission of these signals to the retina's ganglion cells, which forward information to the brain. Over his career, he invented and/or exploited three important methods for electrophysiological recording: ultra-high-resistance sharp microelectrodes; the suction-pipette technique for photoreceptors; and multielectrode arrays for retina. His research findings have provided important advances in our understanding of visual neuroscience, from the detection of individual photon absorptions by rod photoreceptors, through the underlying molecular mechanisms, to the processing and transmission of these visual signals through the retina. He instilled a love for experimental neuroscience and rigorous scientific investigation into a generation of postdoctoral trainees, students and colleagues. He died of a heart attack on 16 March 2022.
Predicting HIV Drug Resistance among Persons Living with HIV/AIDS in Sub-Saharan Africa using Population-based HIV Impact Assessment Surveys: 2015-2019
Authors: Nsonga Edson , Goma Mtumbi , Ng’ambi Wingston Felix , Zyambo Cosmas
Published: April 2024

Introduction

HIV drug resistance (HIVDR) remains a significant challenge in sub-Saharan Africa (SSA), where access to effective treatment and healthcare resources varies widely. Socioeconomic status, demographic factors, clinical parameters, and regional disparities have been associated with patterns of HIVDR across SSA. Understanding the interplay of these factors is crucial for designing effective interventions to mitigate the impact of HIVDR and improve treatment outcomes in the region.

Methods

We conducted a secondary analysis of the Population-based HIV Impact Assessment (PHIA) HIV drug resistance datasets from Cameroon, Malawi, Eswatini, Ethiopia, Namibia, Rwanda, Tanzania, Zambia and Zimbabwe. All recipients of care aged between 15+ years were included in this analysis. The outcome of interest was whether a person had HIVDR resistant strains or no HIVDR resistant strains. Predictive analysis, chi-square test, univariable and multivariable logistic regression analyses were conducted in R. Statistical significance was set at P<0.05.

Results

The total sample size across the nine countries was 1008. Tanzania had the highest representation (16.8%), followed by Zambia (16.3%) and Zimbabwe (14.2% while Rwanda had the lowest representation (5.1%). Significant associations were observed between ARV status, viral suppression, country of residence and HIVDR in SSA. Individuals residing in Rwanda had significantly higher odds of HIVDR (adjusted OR = 3.63, 95% CI: 1.22-11.0, p = 0.021) compared to other countries. Additionally, individuals with suppressed viral loads had significantly lower odds of HIVDR (adjusted OR = 0.31, 95% CI: 0.21-0.45, p < 0.001), while those on ART exhibited higher odds of HIVDR (adjusted OR = 2.6, 95% CI: 1.75-3.91, p < 0.001).

Conclusion

This study focused on how clinical and sociodemographic factors influence HIVDR patterns in SSA. To mitigate the effects of HIVDR and improve treatment outcomes in the region, it is critical to address barriers to treatment access and adherence and upgrade the healthcare system.
Individualized Glycemic Index: A New Approach to Personalized Glycemic Control
Authors: de Oliveira Andrade Luís Jesuíno , de Oliveira Gabriela Correia Matos , de Oliveira Luísa Correia Matos , Rocha Roseanne Montargil , de Oliveira Luís Matos
Published: April 2024

Introduction

The assessment of glycemic control is fundamental for diabetes management. However, traditional measures have limitations, including susceptibility to non-glycemic factors. To address these limitations, there is a growing need for personalized metrics of glycemic control that take into account individual variability and provide a more comprehensive assessment of glycemic response.

Objective

To develop the Individualized Glycemic Index (IGI) as a new marker of glycemic control. Methods: A simulated dataset representing individuals with varied glycemic profiles, including fasting glucose levels, glycemic variability measures, glycemic response to foods, HbA1c, fructosamine, and other relevant factors, was created. An algorithm was implemented in the Python language using designated libraries. We evaluated: the algorithm’s performance using simulated data with known glycemic control outcomes; the algorithm’s ability to accurately predict glycemic control based on the provided data; the algorithm’s performance with glycemic control analyses.

Results

The IGI algorithm uses a comprehensive set of input data to provide a personalized assessment of glycemic control. A program in Python language was developed to calculate the IGI, with a comprehensive metric for evaluating glycemic control. The structured algorithm incorporated the most relevant factors to create a program taking into account each patient’s individuality.

Conclusion

The IGI provides a more comprehensive and personalized assessment of glycemic control, which may improve diabetes management and outcomes, becoming a promising marker of glycemic control that surpasses the limitations of traditional measures.
Dynamics of sensorimotor reweighting: How light touch alters vestibular-evoked balance responses
Authors: Goar Megan H. , Barnett-Cowan Michael , Horslen Brian C.
Published: April 2024

Integrated multisensory feedback plays a crucial role in balance control. Minimal fingertip contact with a surface (light-touch), reduces center of pressure (CoP) by adding sensory information about postural orientation and balance state. Electrical vestibular stimulation (EVS) can increase sway by adding erroneous vestibular cues. This juxtaposition of conflicting sensory cues can be exploited to explore the dynamics of sensorimotor reweighting. We used continuous stochastic EVS (0-25Hz; ±4mA; 200-300s) to evoke balance responses in CoP (Exp-1, Exp-2) and segment accelerations (Exp-2). Systems analyses (coherence, gain) quantified coupling and size of balance responses to EVS. We had participants either touch (TOUCH; <2N) or not touch (NO-TOUCH) a load cell during EVS (Exp-1, Exp-2), or we intermittently removed the touch surface (Exp-2) to measure the effects of light touch on vestibular-evoked balance responses. We hypothesized that coherence and gain between EVS and CoP would decrease, consistent with the CNS down-weighting vestibular cues that conflict with light touch. Light touch reduced CoP displacement, but increased variation in the CoP signal explained by EVS input. Significant coherence between EVS and CoP was observed up to ∼30Hz in both conditions but was significantly greater in the TOUCH condition from 12-28.5-Hz. Conversely, EVS-CoP gain was 63% lower in TOUCH, compared to NO-TOUCH. Our findings show that light touch can re-weight vestibular-evoked responses by reducing their size but also increasing high frequency vestibular contributions for sway. This suggests that the CNS can use novel sensory inputs to alter balance behavior but cannot completely ignore a salient balance cue.

New and Noteworthy

This study reveals that minimal fingertip contact (light touch) during balance tasks not only diminishes the impact of electrical vestibular stimulation (EVS) on sway, but also enhances the central nervous systems ability to integrate high-frequency vestibular cues. Specifically, light touch decreases the magnitude of EVS-induced sway while increasing coherence with EVS at higher frequencies, illustrating the central nervous system’s capacity to adaptively reweight sensory inputs for improved balance control without fully disregarding dominant cues.
Stimulative piezoelectric nanofibrous scaffolds for enhanced small extracellular vesicle production in 3D cultures
Authors: Johnston James , Jeon Hyunsu , Choi Yun Young , Kim Gaeun , Shi Tiger , Khong Courtney , Chang Hsueh-Chia , Myung Nosang Vincent , Wang Yichun
Published: April 2024

Small extracellular vesicles (sEVs) have great promise as effective carriers for drug delivery. However, the challenges associated with the efficient production of sEVs hinder their clinical applications. Herein, we report a stimulative 3D culture platform for enhanced sEV production. The proposed platform consists of a piezoelectric nanofibrous scaffold (PES) coupled with acoustic stimulation to enhance sEV production of cells in a 3D biomimetic microenvironment. Combining cell stimulation with a 3D culture platform in this stimulative PES enables a 15.7-fold increase in the production rate per cell with minimal deviations in particle size and protein composition compared with standard 2D cultures. We find that the enhanced sEV production is attributable to the activation and upregulation of crucial sEV production steps through the synergistic effect of stimulation and the 3D microenvironment. Moreover, changes in cell morphology lead to cytoskeleton redistribution through cell–matrix interactions in the 3D cultures. This in turn facilitates intracellular EV trafficking, which impacts the production rate. Overall, our work provides a promising 3D cell culture platform based on piezoelectric biomaterials for enhanced sEV production. This platform is expected to accelerate the potential use of sEVs for drug delivery and broad biomedical applications.
Measuring the dynamic balance of integration and segregation underlying consciousness, anesthesia, and sleep
Authors: Jang Hyunwoo , Mashour George A. , Hudetz Anthony G. , Huang Zirui
Published: April 2024

Consciousness requires a dynamic balance of integration and segregation in functional brain networks. An optimal integration-segregation balance depends on two key aspects of functional connectivity: global efficiency (i.e., integration) and clustering (i.e., segregation). We developed a new fMRI-based measure, termed the integration-segregation difference (ISD), which captures both aspects. We used this metric to quantify changes in brain state from conscious wakefulness to loss of responsiveness induced by the anesthetic propofol. The observed changes in ISD suggest a profound shift to segregation in both whole brain and all brain subnetworks during anesthesia. Moreover, brain networks displayed similar sequences of disintegration and subsequent reintegration during, respectively, loss and return of responsiveness. Random forest machine learning models, trained with the integration and segregation of brain networks, identified the awake vs. unresponsive states and their transitions with accuracy up to 93%. We found that metastability (i.e., the dynamic recurrence of non-equilibrium transient states) is more effectively explained by integration, while complexity (i.e., diversity and intricacy of neural activity) is more closely linked with segregation. The analysis of a sleep dataset revealed similar findings. Our results demonstrate that the integration-segregation balance is a useful index that can differentiate among various conscious and unconscious states.
A dual-receptor model of serotonergic psychedelics
Authors: Juliani Arthur , Chelu Veronica , Graesser Laura , Safron Adam
Published: April 2024

Serotonergic psychedelics have been identified as promising next-generation therapeutic agents in the treatment of mood and anxiety disorders. While their efficacy has been increasingly validated, the mechanism by which they exert a therapeutic effect is still debated. A popular theoretical account is that excessive 5-HT2a agonism disrupts cortical dynamics, relaxing the precision of maladaptive high-level beliefs and making them more malleable and open to revision. We extend this perspective by developing a simple energy-based model of cortical dynamics based on predictive processing which incorporates effects of neuromodulation. Using this model, we propose and simulate hypothetical computational mechanisms for both 5-HT2a and 5-HT1a agonism. Results from our model are able to account for a number of existing empirical observations concerning serotonergic psychedelics effects on cognition and affect. Using the findings of our model, we provide a theoretically-grounded hypothesis for the clinical success of LSD, psilocybin, and DMT, as well as identify the design space of biased 5-HT1a agonist psychedelics such as 5-MeO-DMT as potentially fruitful in the development of more effective and tolerable psychotherapeutic agents in the future.