bluuebunny/crossref_metadata_2025 huggingface dataset:
Exposure to ambient air pollution and metabolic kidney diseases: evidence from the Northeast China Biobank
Authors: Zhang Yixiao , Xia Yang , Chang Qing , Ji Chao , Zhao Yuhong , Zhang Hehua
Published: March 2023

Background

At present, there is no epidemiological evidence of the association between metabolic kidney diseases (MKD) and exposure to air pollution.

Methods

We investigated the association between exposure to long-term air pollution and the risk of developing MKD using samples from the Northeast China Biobank.

Results

Data from 29 191 participants were analyzed. MKD prevalence was 3.23%. Every standard deviation increment in PM2.5 increased the risk of MKD [odds ratio (OR) = 1.37, 95% confidence interval (CI) 1.19–1.58), diabetic kidney disease (DKD) (OR = 2.03, 95% CI 1.52–2.73), hypertensive kidney disease (BKD) (OR = 1.31, 95% CI 1.11–1.56), hyperlipidemic kidney disease (PKD) (OR = 1.39, 95% CI 1.19–1.63) and obese kidney disease (OKD) (OR = 1.34, 95% CI 1.00–1.81). PM10 increased the risk of MKD (OR = 1.42, 95% CI 1.20–1.67), DKD (OR = 1.38, 95% CI 1.03–1.85), BKD (OR = 1.30, 95% CI 1.07–1.58) and PKD (OR = 1.50, 95% CI 1.26–1.80). Sulfur dioxide increased the risk of MKD (OR = 1.57, 95% CI 1.34–1.85), DKD (OR = 1.81, 95% CI 1.36–2.40), BKD (OR = 1.44, 95% CI 1.19–1.74) and PKD (OR = 1.72, 95% CI 1.44–2.04). Ozone decreased the risk of PKD (OR = 0.83, 95% CI 0.70–0.99). Age, ethnicity and air pollution interacted to affect the risk of MKD, BKD and PKD. Associations between air pollution and CKD or metabolic disease were weaker than those with MKD. The association between air pollution and MKD became stronger when compared with participants with non-metabolic disease.

Conclusions

Air pollution may cause MKD or facilitate the progression from metabolic disease to renal failure.
Polio virotherapy targets the malignant glioma myeloid infiltrate with diffuse microglia activation engulfing the CNS
Authors: Yang Yuanfan , Brown Michael C , Zhang Gao , Stevenson Kevin , Mohme Malte , Kornahrens Reb , Bigner Darell D , Ashley David M , López Giselle Y , Gromeier Matthias
Published: March 2023

Background

Malignant gliomas commandeer dense inflammatory infiltrates with glioma-associated macrophages and microglia (GAMM) promoting immune suppression, evasion, and tumor progression. Like all cells in the mononuclear phagocytic system, GAMM constitutively express the poliovirus receptor, CD155. Besides myeloid cells, CD155 is widely upregulated in the neoplastic compartment of malignant gliomas. Intratumor treatment with the highly attenuated rhino:poliovirus chimera, PVSRIPO, yielded long-term survival with durable radiographic responses in patients with recurrent glioblastoma (Desjardins et al. New England Journal of Medicine, 2018). This scenario raises questions about the contributions of myeloid versus neoplastic cells to polio virotherapy of malignant gliomas.

Methods

We investigated PVSRIPO immunotherapy in immunocompetent mouse brain tumor models with blinded, board-certified neuropathologist review, a range of neuropathological, immunohistochemical, and immunofluorescence analyses, and RNAseq of the tumor region.

Results

PVSRIPO treatment caused intense engagement of the GAMM infiltrate associated with substantial, but transient tumor regression. This was accompanied by marked microglia activation and proliferation in normal brain surrounding the tumor, in the ipsilateral hemisphere and extending into the contralateral hemisphere. There was no evidence for lytic infection of malignant cells. PVSRIPO-instigated microglia activation occurred against a backdrop of sustained innate antiviral inflammation, associated with induction of the Programmed Cell Death Ligand 1 (PD-L1) immune checkpoint on GAMM. Combining PVSRIPO with PD1/PD-L1 blockade led to durable remissions.

Conclusions

Our work implicates GAMM as active drivers of PVSRIPO-induced antitumor inflammation and reveals profound and widespread neuroinflammatory activation of the brain-resident myeloid compartment by PVSRIPO.
Resting-state functional connectivity in lifelong musicians
Authors: Eierud Cyrus , Michael Andrew , Banks David , Andrews Edna
Published: March 2023

Background

It has been postulated that musicianship can lead to enhanced brain and cognitive reserve, but the neural mechanisms of this effect have been poorly understood. Lifelong professional musicianship in conjunction with novel brain imaging techniques offers a unique opportunity to examine brain network differences between musicians and matched controls.

Objective

In this study we aim to investigate how resting-state functional networks (FNs) manifest in lifelong active musicians. We will evaluate the FNs of lifelong musicians and matched healthy controls using resting-state functional magnetic resonance imaging.

Methods

We derive FNs using the data-driven independent component analysis approach and analyze the functional network connectivity (FNC) between the default mode (DMN), sensory-motor (SMN), visual (VSN), and auditory (AUN) networks. We examine whether the linear regressions between FNC and age are different between the musicians and the control group.

Results

The age trajectory of average FNC across all six pairs of FNs shows significant differences between musicians and controls. Musicians show an increase in average FNC with age while controls show a decrease (P = 0.013). When we evaluated each pair of FN, we note that in musicians FNC values increased with age in DMN–AUN, DMN–VSN, and SMN–VSN and in controls FNC values decreased with age in DMN–AUN, DMN–SMN, AUN–SMN, and SMN–VSN.

Conclusion

This result provides early evidence that lifelong musicianship may contribute to enhanced brain and cognitive reserve. Results of this study are preliminary and need to be replicated with a larger number of participants.
Beyond Dividing the Pie: Multi-Issue Bargaining in the Laboratory
Authors: Bochet Olivier , Khanna Manshu , Siegenthaler Simon
Published: March 2023

We design a laboratory experiment to study bargaining behaviour when negotiations involve multiple issues. Parties must discover both trading prices and agreement scopes, giving rise to unexplored information structures and bargaining strategies. We find that bargainers often trade the efficient set of issues despite lacking information about individual aspects. However, beneficial agreements critically hinge on integrated negotiations that allow deals on bundles of issues. Moreover, access to more information boosts agreement rates in small-surplus negotiations but can also backfire as it triggers increased risk-taking and conflicting fairness preferences in large-surplus negotiations. Finally, successful negotiations display a specific bargaining convention that emerges endogenously. It involves alternating offers that meet the other side’s most recent demand halfway.
Cognitive Control System Gates Insula Processing of Affective Stimuli in Early Psychosis
Authors: Koussis Nikitas C , Burgher Bjorn , Jeganathan Jayson , Scott James G , Cocchi Luca , Breakspear Michael
Published: March 2023

Background and Hypothesis

Impairments in the expression, experience, and recognition of emotion are common in early psychosis (EP). Computational accounts of psychosis suggest disrupted top-down modulation by the cognitive control system (CCS) on perceptual circuits underlies psychotic experiences, but their role in emotional deficits in EP is unknown.

Study Design

The affective go/no-go task was used to probe inhibitory control during the presentation of calm or fearful faces in young persons with EP and matched controls. Computational modeling of functional magnetic resonance imaging (fMRI) data were performed using dynamic causal modeling (DCM). The influence of the CCS on perceptual and emotional systems was examined using parametric empirical bayes.

Study Results

When inhibiting motor response to fearful faces, EP participants showed higher brain activity in the right posterior insula (PI). To explain this, we used DCM to model effective connectivity between the PI, regions from the CCS activated during inhibition (dorsolateral prefrontal cortex [DLPFC] and anterior insula [AI]), and a visual input region, the lateral occipital cortex (LOC). EP participants exerted a stronger top-down inhibition from the DLPFC to the LOC than controls. Within the EP cohort, increased top-down connectivity between the LOC and AI was associated with a higher burden of negative symptoms.

Conclusions

Young persons with a recent onset of psychosis show a disturbance in the cognitive control of emotionally salient stimuli and the suppression of irrelevant distractors. These changes are associated with negative symptoms, suggesting new targets for the remediation of emotional deficits in young persons with EP.
Extracellular Vesicles in the Arbuscular Mycorrhizal Symbiosis: Current Understanding and Future Perspectives
Authors: Holland Samuel , Roth Ronelle
Published: March 2023

The arbuscular mycorrhizal (AM) symbiosis is an ancient and highly conserved mutualism between plant and fungal symbionts, in which a highly specialized membrane-delimited fungal arbuscule acts as the symbiotic interface for nutrient exchange and signaling. As a ubiquitous means of biomolecule transport and intercellular communication, extracellular vesicles (EVs) are likely to play a role in this intimate cross-kingdom symbiosis, yet, there is a lack of research investigating the importance of EVs in AM symbiosis despite known roles in microbial interactions in both animal and plant pathosystems. Clarifying the current understanding of EVs in this symbiosis in light of recent ultrastructural observations is paramount to guiding future investigations in the field, and, to this end, this review summarizes recent research investigating these areas. Namely, this review discusses the available knowledge regarding biogenesis pathways and marker proteins associated with the various plant EV subclasses, EV trafficking pathways during symbiosis, and the endocytic mechanisms implicated in the uptake of these EVs.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
An Accurate and Individualized Preoperative Estimation Method for the Linear Insertion Depth of Cochlear Implant Electrode Arrays Based on Computed Tomography
Authors: Jia Gaogan , Song Zijun , Wu Lingjie , Sun Qiushi , Sheng Yaru , Ni Yusu , Li Huawei , Li Wenyan
Published: March 2023

Objectives:

Cochlear implantation or auditory brainstem implantation is currently the only accepted method for improving severe or profound sensorineural hearing loss. The length of the electrodes implanted during cochlear implantation is closely related to the degree of hearing improvement of hearing after the surgery. We aimed to explore new methods to accurately estimate the electrode array (EA) linear insertion depth based on computed tomography (CT) images prior surgery, which could help surgeons select the appropriate EA length for each patient.

Design:

Previous studies estimated the linear insertion depth by measuring the length of the lateral wall of the cochlea rather than the electrode’s path in the cochlea duct. Here, we determined the actual position of the EA on the CT image after cochlear surgery in order to predict the path of the EA, and the length of the predicted EA path was measured by the contouring technique (CoT) to estimate the linear insertion depth of the EA. Because CoT can only measure the length of the estimated EA path on a two-dimensional plane, we further modified the measurement by weighting the height of the cochlea and the length of the EA tail (the length of the last stimulating electrode to the end, which cannot be displayed on the CT image), which we termed the modified CoT + height + tail (MCHT) measurement.

Results:

Based on our established method, MCHT could reduce the error to the submillimeter range (0.67 ± 0.37 mm) when estimating the linear insertion depth of various kinds of EAs compared with the actual implant length. The correlation coefficient between the linear insertion depth as predicted by MCHT and the actual was 0.958. The linear insertion depth estimated by this method was more accurate than that estimated using the classical CoT technique (R = 0.442) and using the modified Escudé’s method (R = 0.585).

Conclusions:

MCHT is a method based on CT images that can accurately predict the linear insertion depth of cochlear implants preoperatively. This is the first report that we are aware of a method for predicting linear insertion depth before cochlear implantation with only submillimeter errors and that is tailored to different types of EAs.
The role of PET/CT in disease activity assessment in patients with large vessel vasculitis
Authors: Galli Elena , Pipitone Nicolò , Salvarani Carlo
Published: March 2023

Purpose of review

The aim of this article was to review the recent contributions on the role of PET in assessing disease activity in patients with large-vessel vasculitis (giant cell arteritis and Takayasu arteritis).

Recent findings

18FDG (fluorodeoxyglucose) vascular uptake in large-vessel vasculitis at PET shows moderate correlation with clinical indices, laboratory markers and signs of arterial involvement at morphological imaging. Limited data may suggest that 18FDG (fluorodeoxyglucose) vascular uptake could predict relapses and (in Takayasu arteritis) the development of new angiographic vascular lesions. PET appears to be in general sensitive to change after treatment.

While the role of PET in diagnosis large-vessel vasculitis is established, its role in evaluating disease activity is less clear-cut. PET may be used as an ancillary technique, but a comprehensive assessment, including clinical, laboratory and morphological imaging is still required to monitor patients with large-vessel vasculitis over time.
Magnetic Resonance Imaging in the Management of Significantly Displaced Adolescent Posterior Sternoclavicular Joint Injuries
Authors: Tytherleigh-Strong Graham , Cuthbert Rory , Poutoglidou Freideriki , Tang Quen
Published: March 2023

Background:

Computed tomography (CT) scans are the standard imaging modality for the diagnosis and treatment guide for adolescent posterior sternoclavicular joint (SCJ) injuries. However, the medial clavicular physis is not visualized and it is not possible to differentiate between a true SCJ dislocation and a physeal injury (PI). An magnetic resonance imaging (MRI) scan can visualize the bone and the physis.

Methods:

We treated a series of patients with adolescent posterior SCJ injuries diagnosed on CT scan. Patients underwent an MRI scan to differentiate between a true SCJ dislocation and a PI and to further differentiate between a PI with or without residual medial end clavicular bone contact. Patients with a true SCJ dislocation and a PI with no contact underwent an open reduction and fixation. Patients with a PI with contact were treated nonoperatively with repeat CT scans at 1 and 3 months. At final follow-up SCJ clinical function was assessed using Quick-DASH, Rockwood, modified Constant, and single assessment numeric evaluation (SANE) scores.

Results:

Thirteen patients (2 female and 11 male) with an average age of 14.9 years (12 to 17) were included in the study. Twelve patients were available at final follow-up (mean 50 mo, 26 to 84). One patient had a true SCJ dislocation and 3 had an off-ended PI and were treated with an open reduction and fixation. Eight patients had a PI with residual bone contact and were treated nonoperatively. For these patients serial CT scans showed that the position was maintained, with a serial increase in callus formation and bone remodeling. The average follow-up was 42.9 months (24 to 62). At final follow-up the mean Quick-disabilities of the arm, shoulder and hand (DASH) was 0.4 (0 to 2.3), Rockwood was 15, modified Constant was 98.8 (89 to 100) and SANE was 99.5% (95 to 100).

Conclusion:

In this case series of significantly displaced adolescent posterior SCJ injuries MRI scans allowed identification of true SCJ dislocations and off-ended PIs, which were successfully treated by open reduction, and PIs with residual physeal contact which were successfully treated nonoperatively.

Level of Evidence:

Level IV—case series.
An Exploration of Critical Care Professionals’ Strategies to Enhance Daily Implementation of the Assess, Prevent, and Manage Pain; Both Spontaneous Awakening and Breathing Trials; Choice of Analgesia and Sedation; Delirium Assess, Prevent, and Manage; Early Mobility and Exercise; and Family Engagement and Empowerment: A Group Concept Mapping Study
Authors: Mion Lorraine C. , Tan Alai , Brockman Audrey , Tate Judith A. , Vasilevskis Eduard E. , Pun Brenda T. , Rosas Scott R. , Balas Michele C.
Published: March 2023

OBJECTIVES:

The goals of this exploratory study were to engage professionals from the Society for Critical Care Medicine ICU Liberation Collaborative ICUs to: 1) conceptualize strategies to enhance daily implementation of the Assess, prevent, and manage pain; Both spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assess, prevent, and manage; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle from different perspectives and 2) identify strategies to prioritize for implementation.

DESIGN:

Mixed-methods group concept mapping over 8 months using an online method. Participants provided strategies in response to a prompt about what was needed for successful daily ABCDEF bundle implementation. Responses were summarized into a set of unique statements and then rated on a 5-point scale on degree of necessity (essential) and degree to which currently used.

SETTING:

Sixty-eight academic, community, and federal ICUs.

PARTICIPANTS:

A total of 121 ICU professionals consisting of frontline and leadership professionals.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A final set of 76 strategies (reduced from 188 responses) were suggested: education (16 strategies), collaboration (15 strategies), processes and protocols (13 strategies), feedback (10 strategies), sedation/pain practices (nine strategies), education (eight strategies), and family (five strategies). Nine strategies were rated as very essential but infrequently used: adequate staffing, adequate mobility equipment, attention to (patient’s) sleep, open discussion and collaborative problem solving, nonsedation methods to address ventilator dyssynchrony, specific expectations for night and day shifts, education of whole team on interdependent nature of the bundle, and effective sleep protocol.

CONCLUSIONS:

In this concept mapping study, ICU professionals provided strategies that spanned a number of conceptual implementation clusters. Results can be used by ICU leaders for implementation planning to address context-specific interdisciplinary approaches to improve ABCDEF bundle implementation.
Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis
Authors: Chandel Abhimanyu , Leazer Sahar , Alcover Karl C. , Farley Josiah , Berk Joshua , Jayne Christopher , Mcnutt Ryan , Olsen Meredith , Allard Rhonda , Yang Jiahong , Johnson Caitlyn , Tripathi Ananya , Rechtin Maria , Leon Mathew , Williams Mathias , Sheth Phorum , Messer Kyle , Chung Kevin K. , Collen Jacob
Published: March 2023

OBJECTIVES:

To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support.

DATA SOURCES:

A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021.

STUDY SELECTION:

Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients.

DATA EXTRACTION:

Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included.

DATA SYNTHESIS:

One hundred fifty-seven studies evaluating 948,309 patients were included. The CFR for in-hospital mortality, ICU mortality, MV, RRT, and ECMO were 25.9% (95% CI: 24.0–27.8%), 37.3% (95% CI: 34.6–40.1%), 51.6% (95% CI: 46.1–57.0%), 66.1% (95% CI: 59.7–72.2%), and 58.0% (95% CI: 46.9–68.9%), respectively. MV (52.7%, 95% CI: 47.5–58.0% vs 31.3%, 95% CI: 16.1–48.9%;p= 0.023) and RRT-related mortality (66.7%, 95% CI: 60.1–73.0% vs 50.3%, 95% CI: 42.4–58.2%;p= 0.003) decreased from 2020 to 2021.

CONCLUSIONS:

We present updated estimates of CFR for patients hospitalized and requiring intensive care for the management of COVID-19. Although mortality remain high and varies considerably worldwide, we found the CFR in patients supported with MV significantly improved since 2020.
Utility of Multimodal Treatment Protocols in the Management of Scalp Cutaneous Angiosarcoma
Authors: Alharbi Adel , Kim Young-Chul , AlShomer Feras , Choi Jong-Woo
Published: March 2023

Background:

Cutaneous angiosarcomas are rare, aggressive tumors with high recurrence and poor prognosis. We share our experiences with the challenging surgical management of these lesions, focusing on both ablative and reconstructive outcomes.

Methods:

Retrospective cross-sectional chart review was conducted of patients diagnosed with scalp cutaneous angiosarcoma between 2005 and 2021. Resectability, defect reconstruction, and survival outcomes were analyzed.

Results:

Thirty patients were included, 27 (90%) men and three (10%) women, with a mean age at diagnosis of 71.77 ± 7.3 years, and mean follow-up of 429.43 ± 305.6 days. Only 12 patients completed their regular follow-up, while the remaining patients died. There was a median survival of 443.50 days (range, 42–1283) and median time to recurrence of 21 days (range, 30–1690). Multimodal therapy compared with surgery alone had a significantly better overall median survival (468 days versus 71 days; P = 0.021). Defect coverage was obtained in 24 cases (75%) through an anterolateral thigh flap, two patients (6%) with a local transposition flap, and one patient (3%) with a transverse rectus abdominis myocutaneous flap. The remaining three patients received a skin graft. All of the flaps survived, with one requiring a vein graft for venous congestion.

Conclusions:

Timely multimodal therapy with a histologically safe margin, combined with adjuvant therapy, improves survival and delays recurrence and metastasis, in cutaneous angiosarcoma patients. An anterolateral thigh flap facilitates the coverage of wide defects. Further investigations of advanced treatment modalities such as immunotherapy and/or gene therapy are required to deal with this highly aggressive tumor.
Lymphaticovenular Anastomosis for Lymphorrhea after Expander-based Breast Reconstruction: A Case Report
Authors: Shikano Yusuke , Tomita Koichi , Otani Naoya , Kuroda Kazuya , Kubo Tateki
Published: March 2023

Refractory axillary lymphorrhea is a postoperative complication of breast cancer with no established standard treatment. Recently, lymphaticovenular anastomosis (LVA) was used to treat not only lymphedema but also lymphorrhea and lymphocele in the inguinal and pelvic regions. However, only a few reports have been published on the treatment of axillary lymphatic leakage with LVA. This report presents a case of successful treatment of refractory axillary lymphorrhea after breast cancer surgery with LVA. A 68-year-old woman underwent nipple-sparing mastectomy for right breast cancer, axillary lymph node dissection, and immediate subpectoral tissue expander placement. Postoperatively, the patient developed refractory lymphorrhea and subsequent seroma around the tissue expander, and underwent postmastectomy radiation therapy and frequent percutaneous aspiration of the seroma. However, lymphatic leakage persisted, and surgical treatment was planned. Preoperative lymphoscintigraphy showed lymphatic outflow from the right axilla to the space around the tissue expander. There was no dermal backflow in the upper extremities. To reduce lymphatic flow into the axilla, LVA was performed at two sites in the right upper arm. The lymphatic vessels used for anastomosis were 0.35 mm and 0.50 mm in diameter, and each was anastomosed to the vein in an end-to-end fashion. The axillary lymphatic leakage stopped shortly after the operation, and there were no postoperative complications. LVA may be a safe and simple option for the treatment of axillary lymphorrhea.
Combined Tripier and V-Y Advancement Flaps for Reconstruction of Large Lid-cheek Junction Defects
Authors: Mookerjee Vikram G. , Prassinos Alexandre J. , Alper David P. , Clune James E.
Published: March 2023

Reconstruction of lid-cheek junction defects has a known risk of ectropion. Cervicofacial flaps require significant dissection and can still be prone to ectropion. V-Y advancement flaps have been described as less morbid, but their use is limited to moderate-size defects that do not involve the lid margin. The authors present a technique of combined Tripier and V-Y advancement flaps for reconstruction of large defects of the lid-cheek junction involving the lower eyelid. A retrospective review of patients undergoing the authors’ technique was performed. A facial artery perforator flap was designed in a V-Y fashion and advanced into the cheek. An orbicularis oculi myocutaneous flap (Tripier flap) was elevated from the upper eyelid and rotated into the lower eyelid/upper cheek to meet the superior edge of the V-Y flap. A separate review of patients undergoing cervicofacial flap reconstruction was also performed. Demographics, operative details, and complications were recorded and compared. This technique was applied to five patients with large-size (19.9 ± 5.6 cm2) defects of the lid-cheek. In all cases, healing was achieved without ectropion, hematoma, infection, dehiscence, flap necrosis, or facial nerve injury. Twenty-four patients separately underwent cervicofacial flap reconstruction for defects of comparable size (15.8 ± 10.7 cm2). Two patients developed ectropion, one patient developed a hematoma, and two patients developed an infection. Combined Tripier and V-Y advancement flaps is a useful technique to reconstruct lid-cheek junction defects. This method allows for the reconstruction of large lid-cheek junction defects that involve the lid margin.
Spontaneous Extrusion of a Conjunctivolith Containing Herpes Virus Confirmed by Electron Microscopy and Energy Dispersive Spectroscopy
Authors: Borchert Grace A. , Blah Tyler R. , Fu Michele Y. , Cheng Adrian C. M. , Kaushik Natasha , Francis Ian C.
Published: March 2023

: This report describes the spontaneous extrusion from between the eyelids of a presumed conjunctivolith in a patient with resolving severe herpes zoster ophthalmicus. A 57-year-old man presented for ophthalmologic assessment and management due to severe left herpes zoster ophthalmicus. At one subsequent ophthalmologic assessment, a conjunctivolith spontaneously egressed the lateral commissure of the OS when the lateral fornix was inspected. The conjunctivolith was retrieved from the floor of the consulting room. Electron microscopic analysis and energy dispersive spectroscopy was undertaken to determine its composition. Scanning electron microscopy showed that the conjunctivolith was composed of carbon, calcium, and oxygen. Transmission electron microscopy diagnosed Herpes virus within the conjunctivolith. Conjunctivoliths, or possible lacrimal gland stones, are a very rare phenomenon, and their etiology is currently unclear. In this case, there was likely to have been an association between herpes zoster ophthalmicus and the conjunctivolith.
Rotational stability of plate-haptic toric intraocular lenses in Asian eyes: risk period for intraocular lens rotation and its influencing factors
Authors: Ma Dongmei , Shen Jiying , Qiu Tian , Zhang Limei , Hua Zhixiang , Cai Lei , Yang Jin
Published: March 2023

Purpose:

To investigate the rotational stability of plate-haptic toric intraocular lenses (IOLs) during 3-month follow-up.

Setting:

Eye and ENT Hospital of Fudan University, Shanghai, China.

Design:

Prospective observational study.

Methods:

Patients with cataracts implanted with AT TORBI 709M toric IOLs were enrolled and followed at 1 hour, 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months postoperatively. A linear mixed model of repeated measures was applied to investigate the time course of absolute IOL rotation change. The 2-week overall IOL rotation was analyzed in the age, sex, axial length (AL), lens thickness (LT), preexisting astigmatism, and white-to-white subgroups.

Results:

A total of 328 eyes of 258 patients were included. The rotation from the end of surgery to 1 hour and 1 day to 3 days was significantly smaller compared with the rotation from 1 hour to 1 day but more than that at other time intervals in the overall group. 2 weeks postoperatively, the mean uncorrected distance visual acuity and remaining positive cylinder were 0.19 ± 0.22 logMAR and 0.60 ± 0.44 diopters, respectively. Significant between-group differences in 2-week overall rotation were found in the age, AL, and LT subgroups.

Conclusions:

Maximum rotation occurred within 1 hour to 1 day postoperatively, and the first 3 days postoperatively was a high-risk period for the plate-haptic toric IOL rotation. Surgeons should make the patients aware of this.
Perspective of molecular imaging and peptide receptor radionuclide therapy in pancreatic neuroendocrine tumors: where do we stand?
Authors: Zhu Wenjia , Liu Meixi , Huo Li
Published: March 2023

The clinical use of nuclear medicine imaging and therapy in pancreatic neuroendocrine tumors has been greatly strengthened since the approval of 68Ga-DOTATATE and 177Lu-DOTATATE. However, many aspects are still under discussion. In this 2-part article, we aim to collect and discuss current evidence of molecular imaging and peptide receptor radionuclide therapy (PRRT) in pancreatic neuroendocrine tumor. In the first part, we will address some critical aspects of 68Ga-SSAs imaging, including diagnostic efficacy, recurrence detection and follow-up, patient selection for PRRT, and pitfalls in image interpretation. Besides, we will also briefly discuss the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, special imaging strategy in regard to insulinoma, and the status of radiolabeled somatostatin receptor antagonist. In the second part, we aim to review the current evidence of PRRT in pancreatic neuroendocrine tumor, focusing on efficacy and safety in particular. We will also introduce the recent development of PRRT, including PRRT in high-grade neuroendocrine neoplasms, retreatment PRRT, upfront PRRT, PRRT in the setting of neoadjuvant therapy and conversion therapy, combination therapies with PRRT, PRRT with αradionuclides, and PRRT with antagonists.
Intracannula Thrombus Formation Associated With Dual Lumen ProtekDuo Cannula in Extracorporeal Membrane Oxygenation (ECMO)
Authors: Spelde Audrey E. , Usman Asad A. , Olia Salim E. , Ibrahim Michael E. , Szeto Wilson Y. , Cevasco Marisa , Grimm Joshua C. , Bermudez Christian A. , Steinberg Toby B. , Vernick William J. , Gutsche Jacob T.
Published: March 2023

Extracorporeal membrane oxygenation (ECMO) is used in cases of severe respiratory failure refractory to medical management. Use of ECMO is increasing, along with new cannulation strategies including oxygenated right ventricular assist devices (oxy-RVADs). Multiple dual lumen cannulas are now available, which increase the potential for patient mobility and decrease the number of vascular access sites. However, dual lumen, single cannula flow can be limited by adequate inflow, requiring the need for an additional inflow cannula to meet patient demands. This cannula configuration may result in differential flows in the inflow and outflow limbs and altered flow dynamics, increasing the risk of intracannula thrombus. We describe a series of four patients treated with oxy-RVAD for COVID-19–associated respiratory failure complicated by dual lumen ProtekDuo intracannula thrombus.
Airborne transmission of respiratory viruses including severe acute respiratory syndrome coronavirus 2
Authors: Tang Julian W. , Marr Linsey C. , Tellier Raymond , Dancer Stephanie J.
Published: March 2023

Purpose of review

The coronavirus disease 2019 pandemic has had a wide-ranging and profound impact on how we think about the transmission of respiratory viruses This review outlines the basis on which we should consider all respiratory viruses as aerosol-transmissible infections, in order to improve our control of these pathogens in both healthcare and community settings.

Recent findings

We present recent studies to support the aerosol transmission of severe acute respiratory syndrome coronavirus 2, and some older studies to demonstrate the aerosol transmissibility of other, more familiar seasonal respiratory viruses.

Current knowledge on how these respiratory viruses are transmitted, and the way we control their spread, is changing. We need to embrace these changes to improve the care of patients in hospitals and care homes including others who are vulnerable to severe disease in community settings.
A Comparison of Variable Versus Fixed Insulin Infusion Rate on Resolution of Diabetic Ketoacidosis
Authors: Bohach Nathan , Moorman John M. , Cunningham Brittany , Mullen Chanda , Fowler Melissa
Published: March 2023

Background:

Diabetic ketoacidosis (DKA) is a well-known, potentially fatal complication of diabetes. The American Diabetes Association hyperglycemic crises guidelines suggest the use of intravenous insulin in patients presenting with DKA, along with a recommended rate of glucose reduction of 50–75 mg/dL/h. However, no specific guidance is provided regarding how to best achieve this rate of glucose decline.

Study Question:

Is there a difference in time to DKA resolution between a variable intravenous insulin infusion strategy and a fixed infusion strategy in the absence of an institutional protocol?

Study Design:

Single-center, retrospective cohort study of DKA patient encounters in 2018.

Measures and Outcomes:

Insulin infusion strategy was considered to be variable if the infusion rate changed within the first 8 hours of therapy or was considered fixed if the rate remained unchanged for the same period. The primary outcome was time to resolution of DKA. Secondary outcomes were hospital length of stay, intensive care unit length of stay, hypoglycemia, mortality, and DKA recurrence.

Results:

The median time to resolution of DKA was 9.3 hours in the variable infusion group compared with 7.8 hours in the fixed infusion group (HR, 0.82; 95% CI, 0.43–1.5, P = 0.5360). Severe hypoglycemia was observed in 13% of patients in the variable infusion group and in 50% of patients in the fixed infusion group (P = 0.006).

Conclusions:

In this analysis, insulin infusion strategy (variable vs. fixed) was not associated with a significant difference in the time to resolution of DKA in the absence of an institutional protocol. The fixed infusion strategy was associated with a higher incidence of severe hypoglycemia.
Short-term and long-term predictors of balance function in stroke patients: a 6-month follow-up study
Authors: Lee Eun Young , Na Yoonhye , Cho Minjae , Hwang Yu Mi , Kim Hyun-Soo , An Hyonggin , Pyun Sung-Bom
Published: March 2023

We aimed to determine early predictors of balance function (Berg Balance Scale, BBS) at 3 and 6 months after stroke using clinical, neurophysiological, and neuroimaging variables. Seventy-nine patients with hemiparesis after a stroke were included. Demographics, stroke characteristics, and clinical variables [Mini-Mental State Examination, BBS, strength in the hemiparetic hip, knee, and ankle muscles, and Fugl-Meyer Assessment Lower Extremity (FMA-LE)] were evaluated 2 weeks post-stroke, on average. Somatosensory-evoked potentials (SEP) from both tibial nerves and diffusion tensor imaging data were collected respectively within 3 weeks and 4 weeks post-onset to calculate the SEP amplitude ratio and the laterality index of fractional anisotropy of the corticospinal tract. In multiple linear regression analysis, younger age, higher FMA-LE score, and stronger hemiparetic hip extensors were independent predictors of higher BBS at 3 months post-stroke (adjusted R
2 = 0.563, P < 0.001). At 6 months post-stroke, significant predictors of higher BBS were younger age, higher FMA-LE, stronger hemiparetic hip extensors, and larger SEP amplitude ratio (adjusted R
2 = 0.552, P < 0.001), although the incremental contribution of the latter was rather small (R
2 = 0.019). We conclude that age and the initial motor impairment of the affected lower limb can inform the state of balance function at 3 and 6 months after stroke.
Gastrojejunocolic fistula after gastrojejunostomy in eastern Ethiopia: a case report
Authors: Umer Keno M. , Nureta Tilahun H. , Akalu Tiruwork F. , Shale Wongel T.
Published: March 2023

Background:

Gastrojejunocolic fistula (GJF) is an infrequent condition that presents late as a complication of gastroenterostomy conducted for complications of peptic ulcer disease and is believed to be a result of continuous acid secretion due to insufficient stomach resection and incomplete vagotomy. Symptoms of the fistula present late, usually 20 years or more after gastroenterostomy. Patients with GJF usually present with chronic on-and-off diarrhea, weight loss, fecal-smelling belching or vomiting, and malnutrition.

Case Presentation:

The case is of a 45-year-old man with GJF who presented with diarrhea, weight loss, and foul-smelling vomiting. The diagnosis was made intraoperatively despite preoperative investigations with computerized tomography scan and endoscopy. The patient underwent a single-stage operation, and the postoperative course was uneventful.

Conclusion:

Knowledge of this uncommon illness can aid in prevention through improved operative strategy and medical treatment during the stomal ulcer phase with proton pump inhibitor and Helicobacter pylori eradication
Uncommon presentation of a giant psoas muscle lipoma: a case report and brief literature review
Authors: Rastrelli Marco , Hoxhaj Ilda , Di Maggio Antonio , Sbaraglia Marta , Chiusole Benedetta , Tropea Saveria , Mazza Marcodomenico , Del Fiore Paolo , Mocellin Simone
Published: March 2023

Giant retroperitoneal lipomas, particularly within the psoas muscle, are a rare condition. We herein present one such case of a 45-year-old Italian man and a literature review. There are only two case reports published in the literature, thus posing challenges for the appropriate diagnosis and treatment. Our patient was admitted to the emergency department with colicky abdominal pain. Computerized tomography (CT) with contrast enhancement revealed kidney stones and a 19.5×13.6×18 cm mass of adipose tissue with septa located in the right retroperitoneum, in close continuity with the right psoas major muscle. Magnetic resonance imaging showed a voluminous neoformation with predominantly adipose content and a compressive effect on adjacent vascular structures. The CT-guided biopsy indicated spindle cell mesenchymal neoplasm, not otherwise specified. Surgical resection of the retroperitoneal mass with the capsule was performed, and a histopathology examination confirmed the diagnosis of spindle cell lipoma. Despite the fact that CT and MRI are the main diagnostic tools, this case report emphasizes the need for a CT-guided core needle biopsy prior to surgery for appropriate diagnosis.
Conservative surgical staging as a means to preserve fertility in patients with dysgerminoma: a case report
Authors: Maidarti Mila , Garinasih Prini D. , Anggraeni Tricia D.
Published: March 2023

Introduction and importance:

Ovarian tumor is a rare condition in pediatrics. Due to the improvement in surgical techniques and chemotherapy in recent years, it is currently possible to preserve fertility in selected cases of patients who desire motherhood.

Case presentation:

We present a case of pregnancy following conservative surgery and complete chemotherapy for ovarian dysgerminoma stage IIA. A 16-year-old female presented with complaints of abdominal mass and discomfort. Histopathological examination displayed dysgerminoma arising from the right ovary. Conservative treatment with right salpingo-oophorectomy and six cycles of chemotherapy was performed. Within 2 years following the surgery, the patient conceived and did not indicate tumor recurrence.

Clinical discussion:

Dysgerminoma is the most common ovarian malignant germ cell tumor and usually affects women at a young age. Conservative surgery followed by chemotherapy is the treatment of choice, particularly in young patients with a strong desire to have a family. Conservative fertility-sparing surgery does not have inferior outcomes in terms of survival or recurrence. It is possible that in certain cases, patients previously treated for ovarian cancer may retain their fertility, thereby improving their quality of life.

Conclusion:

Most patients with dysgerminoma can be treated with the maintenance of normal reproductive function. Reassurance regarding the high probability of conceiving and having normal children after conservative surgery and chemotherapy should be informed to the patient and family.
Rising toxicity of the antidiarrheal drug: loperamide in Pakistan
Authors: Habib Ashna , Mahfooz Arisha , Nazir Zainab
Published: March 2023

Loperamide, an opioid-based anti-diarrheal drug, frequently purchased without a prescription over-the-counter in Pakistan, the majority of the community thinks it is safe to use. It has been speculated that loperamide toxicity is greatly underreported since it is not frequently included in drug screening. The Pakistani government has to reevaluate its loperamide over-the-counter regulations. By media campaigns, the general population of Pakistan should be made aware of the risky consequences of high doses of loperamide.
Culture-negative tricuspid valve endocarditis in an intravenous drug abuser masquerading as pulmonary tuberculosis in Nepal: a case report
Authors: Rajkarnikar Ruja , Sharma Shriya , Yadav Sumit , Ghimire Nirmal
Published: March 2023

Introduction:

Infective endocarditis is an infection of the heart valves or endocardium caused by bacterial, viral, or fungal microorganisms. Blood cultures are used to detect the bacteria causing infective endocarditis, and echocardiography is performed to find the damaged heart valves. In blood culture-negative endocarditis, no endocarditis-causing organisms can be found in blood cultures, and blood cultures using usual laboratory methods remain sterile after inoculation of at least three independent blood samples.

Case presentation:

A 24-year-old male with a history of polysubstance abuse presented with complaints of fever, cough, and shortness of breath. He had a past history of pulmonary tuberculosis 4 years ago, for which he was treated with antitubercular therapy. High-resolution computed tomography of the chest revealed multiple cavitary lesions and consolidative areas in the bilateral lungs. Based on these findings, a provisional diagnosis of reactivation of pulmonary tuberculosis was considered, and antitubercular therapy was started. Due to his deteriorating condition, he was readmitted and evaluated. Bronchoalveolar lavage was done and sent for culture and sensitivity testing, which showed the presence of Staphylococcus aureus, and treatment was started accordingly. Despite continuing intravenous antibiotics for 5 days, the patient was not improving. Three sets of samples were withdrawn for blood culture and sensitivity testing, which came out to be negative. Transthoracic echocardiography was done, which revealed vegetation in the tricuspid valve. The patient was diagnosed with culture-negative tricuspid valve endocarditis based on the clinical criteria.

Discussion:

Blood culture-negative endocarditis is difficult to diagnose and presents challenges. When faced with a diagnosis like culture-negative endocarditis in the context of a condition that can appear very similar, like tuberculosis, a broad differential diagnostic approach is important.

Conclusion:

Intravenous drug use is the main cause of right-sided valvular infective endocarditis. Endocarditis should be considered in intravenous drug users even in the absence of positive blood cultures. An appropriate antibiotic regimen and long-term follow-up with a multidisciplinary team are necessary for a good outcome.
Lateral medullary syndrome: uncommon form of brainstem stroke
Authors: Ahmed Ibrahim Abdiwahid , Bakir Ahmet , Osman Sidow Nor , Mohamed Ali Abdiladhif , Farah Osman Mohamed , Ahmed Abdulkadir , Sheikh Hassan Mohamed
Published: March 2023

Introduction and Importance:

Lateral medullary syndrome (LMS) is a less common form of a brainstem stroke. It is the result of occlusion of the posterior inferior cerebellar artery (PICA). It is caused by atherosclerosis, thrombosis, or emboli from another source.

Case Presentation:

A 60-year-old male patient presented to the emergency department with vertigo, vomiting, slurred speech, hiccups, and left-side weakness associated with paresthesia for 1 day. He had a past medical history of uncontrolled hypertension and a smoking habit. The neurological examination revealed ataxia, and left hemiparesis associated with paresthesia. A cranial nerve examination revealed slight right-sided ptosis, mouth deviation, and loss of sensory sensation on the right side of the face. Brain MRI showed right medullary infarct consistent with LMS. Electrocardiogram, echocardiography, and vertebral artery color Doppler were normal. He was admitted to the neurology ward and was treated with low molecular weight heparin 60 mg subcutaneously, aspirin 300 mg, neuroprotective agents, and antihypertensive treatment. After 6 days of medical treatment, his condition has improved massively (dysarthria and dysphagia disappeared). He was discharged for physical rehabilitation.

Clinical Discussion:

LMS (Wallenberg syndrome) is one of the brainstem stroke syndromes caused by occlusion of PICA. Vertigo, vomiting, dysphagia, dysarthria, ipsilateral ataxia, Horner’s syndrome, and contralateral hemiparesis define this syndrome. Brain MRI is necessary for diagnosis alongside clinical syndrome.

Conclusion:

LMS is a rare form of brainstem stroke and carries a favorable prognosis if early hospitalization and treatment is applied. Brain MRI, including diffusion sequence, is the most useful diagnostic tool for detecting LMS.
Psychiatric Issues Encountered in Home Healthcare in the age of COVID-19
Authors: Hellwig Karen
Published: March 2023

The COVID-19 pandemic has caused physical and mental harm to home healthcare clinicians as well as the patients we serve. As home healthcare professionals, we became acutely aware of our patients' suffering while simultaneously dealing with our own personal and professional challenges. It is critical that those who provide healthcare learn how to manage the deleterious effects of this frightening virus. This article focuses on the effects of the COVID-19 pandemic on patients and healthcare providers and suggests ways of developing resilience. Home healthcare providers must be able to manage their own psychological needs before they can assess and intervene with the multiple mental health consequences of anxiety and depression in their patients that can result from COVID-19.