bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal and Neonatal Outcomes in Pregnancies With Adenomyosis [ID: 1375447]
Authors: Hguig Soukaina , Abenhaim Haim Arie , Czuzoj-Shulman Nicholas
Published: May 2023

INTRODUCTION:

Adenomyosis is a common gynecologic disease involving the uterus with effect on pregnancy being poorly understood. This study aimed to evaluate the associations between adenomyosis and obstetrical and newborn outcomes.

METHODS:

Using the Healthcare Cost and Utilization Project–National Inpatient Sample from the United States, we conducted a retrospective cohort study of all birth-related admissions from 2016 to 2019. Pregnancies with adenomyosis were identified using the ICD-10 code N80.0, with the remaining pregnancies being the reference group. Multivariate logistic regression models, adjusting for baseline maternal demographics, were used to determine the effect of adenomyosis on pregnancy outcomes. In light of the diagnosis bias inherent in births by cesarean delivery, adjustment for mode of delivery was performed on all outcome analyses.

RESULTS:

Among the 2,943,532 women who delivered between 2016 and 2019, 1,084 had adenomyosis, for an overall prevalence of 36 cases per 100,000 births, which was stable throughout the study period. Adenomyosis in pregnancy was associated with increased frequency of placenta abruptio (odds ratio 1.67, 95% CI 1.17–2.39), preterm delivery (1.36, 1.16–1.59), preterm premature rupture of membranes (1.31, 1.07–1.61), postpartum hemorrhage (2.65, 2.14–3.27), postpartum transfusion (2.20, 1.62–2.99), disseminated intravascular coagulation (9.31, 4.15–20.92), sepsis (2.67, 1.60–4.45), congenital anomalies (1.95, 1.34–2.84), and intrauterine fetal demise (1.98, 1.02–3.84).

CONCLUSION:

Adenomyosis in pregnancy is associated with adverse obstetric and fetal outcomes. Pregnancies in patients with adenomyosis should be considered at higher risk and may benefit from delivering in centers capable of managing postpartum hemorrhage.
Maternal and Neonatal Outcomes of Pregnancies With Periviable and Previable Preterm Premature Rupture of Membranes [ID: 1380561]
Authors: Browning Danielle , Fandozzi Eva , Megli Christina , Sasaki Alexandria
Published: May 2023

INTRODUCTION:

Preterm premature rupture of membranes (PPROM) accounts for one-third of preterm deliveries and is associated with significant perinatal morbidity. Neonatal resuscitation has been extended to earlier gestational ages, including for patients with PPROM, but maternal and neonatal outcomes are not well characterized. Our objective is to compare outcomes after PPROM diagnosis prior to viability (23 weeks 0 days) or in the periviable period (23–25 weeks).

METHODS:

A retrospective cohort of 101 pregnancies and 112 neonates from July 2015 to May 2018 were identified by maternal ICD-9/10 codes for PPROM. Exclusion criteria include PPROM greater than 24 weeks 6 days and neonatal congenital anomalies. Detailed chart review was performed. Patients were stratified by gestational age (GA) at PPROM and groups were compared according to GA. Chi-square test was used for dichotomous variables and t test for continuous variables. Institutional review board approval was obtained for this study.

RESULTS:

27.9% of patients who elected for expectant management delivered after viability (23 weeks 0 days or later). Neonatal death was greater after delivery from pregnancies with previable PPROM in comparison to periviable PPROM with similar gestational age at birth, P=.005. The composite adverse neonatal outcomes occurred in 100% of neonates born after previable PPROM. Maternal outcomes were elevated with both previable and periviable PPROM who elected for expectant management (52.4% versus 35.3%, NS). The maternal morbidity rate after termination of pregnancy was significantly less (26.9%) (P=.047).

CONCLUSION:

Previable PPROM is associated with higher neonatal death rates, despite similar GA at delivery in comparison to periviable PPROM. Maternal morbidity is high with both previable and periviable PPROM.
Assessing Interest in Peer Doula-Facilitated Empathy and Self-Compassion Training Among Women With History of Early Pregnancy Loss (AIDES for EPL) [ID: 1344944]
Authors: Conroy Carmen , Jain Tanya , Mody Sheila
Published: May 2023

INTRODUCTION:

Limited data exist regarding the type of support patients need when experiencing early pregnancy loss (EPL). The objective of this study is to explore how patients emotionally cope with EPL and to assess whether there is interest in a peer EPL doula program with a self-compassion component.

METHODS:

We conducted semistructured interviews with 21 patients who had experienced EPL in the past 2 years. We evaluated the kinds of support that patients felt were most helpful, interest in a possible peer EPL doula intervention, and concerns or suggestions for the creation of such a program. Content analysis was utilized to process the data and identify themes.

RESULTS:

52.38% (n=11) of interviewees reported expectant management of their EPL, 23.81% (n=5) reported medication management, and 23.81% (n=5) reported undergoing a dilation-and-curettage procedure. Participants represented various races and ethnicities, income brackets, and insurance statuses. We identified five themes: 1) therapy and in-person support groups are helpful when experiencing EPL, but are sometimes inaccessible; 2) social media support groups are initially advantageous for creating a sense of solidarity, but in the long term can be triggering; 3) support from a peer who has also experienced EPL is valuable; 4) developing self-compassion is important in emotionally coping with EPL; and 5) there is a demand for emotional and informational support after EPL.

CONCLUSION:

Given the unique types of support participants identified in this study, a peer EPL doula could feasibly provide the emotional and informational support patients desire when experiencing an EPL.
Obtaining Consent for Educational Pelvic Exams Under Anesthesia: Patient Perspectives [ID: 1337224]
Authors: Konrad Beatrice , Grimm Barry
Published: May 2023

INTRODUCTION:

Historically, procedural education on pelvic exams has included students performing them on anesthetized gynecologic surgical patients—oftentimes, without the patient's explicit consent. What constitutes acceptable consent in this situation? We surveyed patients on minimally acceptable methods of obtaining verbal consent for a medical student to perform a pelvic exam while a patient is under general anesthesia (EUA).

METHODS:

Our study population was Vanderbilt University Medical Center gynecology outpatients 18+ who had no history of gynecologic surgery under anesthesia nor planned surgery of this kind in the future. Patients were screened for eligibility via chart and then approached at clinic. If they agreed to participate, they received a secure REDCap survey to submit an anonymous response.

RESULTS:

Overall, 31 patients received surveys and 21 responses were collected (response rate 67%). Results demonstrated patients are willing to participate in educational exams and consider informed consent via verbal discussion to be critically important. Among these respondents there was consensus the surgeon is the ideal person to lead discussion. A resident was acceptable, but a medical student alone was considered unacceptable by significant portion of respondents (38.1%). Free text responses indicated chaperoning or supervision of a medical student was of great importance, both during consent process and exam. Respondents indicated multiple time points (before and day of surgery) and locations (office and in hospital) were ideal, but day of surgery was acceptable. Finally, there was consensus language used to describe the exam should be specific and detailed; generalizations or omissions were considered unacceptable, not just unideal.

CONCLUSION:

Responses suggest informed consent discussion before pelvic EUA with student and supervising educator present is highly important to these participants and should be as detailed and specific as possible. Additionally, these results agree with prior evidence that this discussion would not likely cause patients to decline to participate in EUAs.
Fertility Knowledge and Educational Experiences of Graduating Medical Students: A Multi-Institution Survey [ID: 1363003]
Authors: Hunt Kelby , Blakemore Jennifer , Dauer Laura Chamorro , Faubion Laura , Marshall Ariela , Melikian Ryan
Published: May 2023

INTRODUCTION:

There is a paucity of data regarding medical students' knowledge and education in fertility and reproductive life planning (RLP). Our goal was to assess fertility knowledge and educational experiences of graduating medical students to determine knowledge gaps and goals for future educational interventions.

METHODS:

Institutional review board-waived, online cross-sectional questionnaire was disseminated to graduating medical students at five participating institutions.

RESULTS:

The survey was distributed to 815 graduating medical students, and 117 (14.4%) completed the survey. Twenty-three (22%) overestimated the age of most precipitous fertility decline and 50 (52%) overestimated the chance of getting pregnant for a 40-year-old couple. One-third of students (30, 32%) incorrectly believe that physicians have equivalent infertility rates to the general population. Students were less cognizant of male fertility issues, incorrectly believing there was no negative effect on male fertility by age (43, 42%), certain sexual lubricants (73, 72%), and gonorrhea or chlamydia infections (45, 44%). Seventy-five (81%) report less than 5 hours of fertility-related education in medical school. Only 30 (32%) are satisfied or very satisfied with the fertility and family-building education they received. In an open-response survey question, students expressed interest in more education on transgender and cancer patient care, fertility preservation, assisted reproductive technologies, and RLP for medical professionals.

CONCLUSION:

This study identified deficits in medical student knowledge regarding fertility and RLP. This poses an opportunity for medical training programs to improve the amount and content of fertility-related education, both for their students' personal RLP and their ability to provide accurate, effective counseling for their patients.
Assessing Fertility Awareness in Female Medical Students, Trainees, and Attending Physicians [ID: 1374645]
Authors: Doxsey Martha , Faschan Kristin , Reyes Lilia
Published: May 2023

INTRODUCTION:

The incidence of female physician infertility is greater in comparison to the general public. In this study, we utilized a validated instrument to assess fertility and infertility knowledge among biologically female medical students, trainees, and attending physicians.

METHODS:

The validated Fertility & Infertility Treatment Knowledge Score (FIT-KS) instrument was distributed from April 2022 to July 2022 to biologically female medical students, trainees, and attending physicians. Demographics were obtained to assess for differences between groups via contingency table analysis. The IRB found this study exempt.

RESULTS:

Participants answered 20 of the 29-item FIT-KS instrument correctly. Nine items had a less than 50% correct response rate, four pertained to fertility knowledge, and five pertained to infertility treatment knowledge. Most participants (81.4%) correctly identified the years of peak fertility, but 44.8% overestimated the fecundity of a 30-year-old woman and 36.9% underestimated the chance of miscarriage in peak reproductive years. Most participants (76.6%) underestimated in vitro fertilization (IVF) success for a woman under 35 year old and overestimated IVF success for a woman over 44 year old (56.0%). Obstetrics and gynecology performed significantly better on the FIT-KS instrument overall in comparison with other specialties. No differences in performance were present based on participant age, parity, or position.

CONCLUSION:

Female medical students and physicians recognize that fecundity decreases with age but overestimate successful pregnancy rates with increasing age. In concordance with low knowledge surrounding infertility treatment success, medical trainees are underequipped to make informed family planning decisions while in medical training.
Elimination of 24-Hour Call Shifts in an Obstetrics and Gynecology Residency Training Program [ID: 1375098]
Authors: Sinow Carolyn , Bowen Andrea , Nguyen Anh , Zaid Eisha
Published: May 2023

INTRODUCTION:

Resident duty hour restrictions have resulted in improved resident safety with mixed results on patient safety. There are limited data about 24-hour shifts in obstetrics and gynecology. This project studies resident wellness and performance after eliminating 24-hour call shifts.

METHODS:

This is a preliminary analysis of a quality improvement project. Physicians were surveyed before and after implementation of a call schedule that reduced 24-hour shifts to 14-hour shifts. Resident performance was assessed by self-reported and attending-reported ability to perform tasks.

RESULTS:

At preintervention survey, 13 out of 16 residents and 8 out of 17 attendings favored eliminating 24-hour call shifts. Attendings had more confidence in residents' performance on 24-hour shifts than residents did (P<.02) when stratified by task and residency year. At 3-month follow-up, all residents (19/19) preferred 14-hour shifts. Residents reported improvements in wellness (13/13), sleep (13/13), and burnout (10/13). Residents felt more confident in their ability to perform a vaginal delivery (11/13), cesarean birth (12/13), or communicate effectively (11/13) with 14-hour compared to 24-hour shifts. Thematic analysis showed that residents felt happier and better able to care for patients. Two residents cited improved ability to learn, while only one resident cited lost learning opportunities.

CONCLUSION:

Data suggest that obstetrics and gynecology residency programs should eliminate 24-hour shifts to improve resident wellness and performance, while decreasing burnout. Final follow-up data (to be collected March 2023) will assess whether attendings see a change in resident performance.
Efficacy of Hematoma Block After Intramedullary Rod Fixation of Femoral Shaft Fractures: A Prospective, Double-Blinded, Randomized Controlled Trial
Authors: Yue Ruixian Alexander , Shah Nihar S. , Matar Robert N. , Sagi H Claude
Published: May 2023

Objectives:

To evaluate the efficacy of an intraoperative, postfixation fracture hematoma block on postoperative pain control and opioid consumption in patients with acute femoral shaft fractures.

Design:

Prospective, double-blinded, randomized controlled trial.

Setting:

Academic Level I Trauma Center.

Patients/Participants:

Eighty-two consecutive patients with isolated femoral shaft fractures (OTA/AO 32) underwent intramedullary rod fixation.

Intervention:

Patients were randomized to receive an intraoperative, postfixation fracture hematoma injection containing 20 mL of normal saline or 0.5% ropivacaine in addition to a standardized multimodal pain regimen that included opioids.

Main Outcome Measurements:

Visual analog scale (VAS) pain scores and opioid consumption.

Results:

The treatment group demonstrated significantly lower VAS pain scores than the control group in the first 24-hour postoperative period (5.0 vs. 6.7, P = 0.004), 0–8 hours (5.4 vs. 7.0, P = 0.013), 8–16 hours (4.9 vs. 6.6, P = 0.018), and 16–24 hours (4.7 vs. 6.6, P = 0.010), postoperatively. In addition, the opioid consumption (morphine milligram equivalents) was significantly lower in the treatment group compared with the control group over the first 24-hour postoperative period (43.6 vs. 65.9, P = 0.008). No adverse effects were observed secondary to the saline or ropivacaine infiltration.

Conclusions:

Infiltrating the fracture hematoma with ropivacaine in adult femoral shaft fractures reduced postoperative pain and opioid consumption compared with saline control. This intervention presents a useful adjunct to multimodal analgesia to improve postoperative care in orthopaedic trauma patients.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Factors Influencing Maintenance of Alignment and Functional Improvement Following Adult Spinal Deformity Surgery
Authors: Passias Peter G. , Passfall Lara , Moattari Kevin , Krol Oscar , Kummer Nicholas A. , Tretiakov Peter , Williamson Tyler , Joujon-Roche Rachel , Imbo Bailey , Burhan Janjua Muhammad , Jankowski Pawel , Paulino Carl , Schwab Frank J. , Owusu-Sarpong Stephane , Singh Vivek , Ahmad Salman , Onafowokan Tobi , Lebovic Jordan , Tariq Muhammad , Saleh Hesham , Vira Shaleen , Smith Justin S. , Diebo Bassel , Schoenfeld Andrew J.
Published: May 2023

Study Design.

This was a retrospective review.

Objective.

To assess the factors contributing to durability of surgical results following adult spinal deformity (ASD) surgery.

Summary of Background.

Factors contributing to the long-term sustainability of ASD correction are currently undefined.

Materials and Methods.

Operative ASD patients with preoperatively (baseline) and 3-year postoperatively radiographic/health-related quality of life data were included. At 1 and 3 years postoperatively, a favorable outcome was defined as meeting at least three of four criteria: (1) no proximal junctional failure or mechanical failure with reoperation, (2) best clinical outcome (BCO) for Scoliosis Research Society (SRS) (≥4.5) or Oswestry Disability Index (ODI) (<15), (3) improving in at least one SRS-Schwab modifier, and (4) not worsening in any SRS-Schwab modifier. A robust surgical result was defined as having a favorable outcome at both 1 and 3 years. Predictors of robust outcomes were identified using multivariable regression analysis with conditional inference tree for continuous variables.

Results.

We included 157 ASD patients in this analysis. At 1 year postoperatively, 62 patients (39.5%) met the BCO definition for ODI and 33 (21.0%) met the BCO for SRS. At 3 years, 58 patients (36.9%) had BCO for ODI and 29 (18.5%) for SRS. Ninety-five patients (60.5%) were identified as having a favorable outcome at 1 year postoperatively. At 3 years, 85 patients (54.1%) had a favorable outcome. Seventy-eight patients (49.7%) met criteria for a durable surgical result. Multivariable adjusted analysis identified the following independent predictors of surgical durability: surgical invasiveness >65, being fused to S1/pelvis, baseline to 6-week pelvic incidence and lumbar lordosis difference >13.9°, and having a proportional Global Alignment and Proportion score at 6 weeks.

Conclusions.

Nearly 50% of the ASD cohort demonstrated good surgical durability, with favorable radiographic alignment and functional status maintained up to 3 years. Surgical durability was more likely in patients whose reconstruction was fused to the pelvis and addressed lumbopelvic mismatch with adequate surgical invasiveness to achieve full alignment correction.
Risk Factors for Postoperative Unfavorable Ambulatory Status After Spinal Surgery for Metastatic Spinal Tumor
Authors: Yamada Kentaro , Yoshii Toshitaka , Toba Mikayo , Kudo Atsushi , Egawa Satoru , Matsukura Yu , Hirai Takashi , Inose Hiroyuki , Fushimi Kiyohide , Okawa Atsushi
Published: May 2023

Study Design.

A retrospective comparative study.

Objective.

This study aimed to investigate factors associated with postoperative unfavorable ambulatory status following surgery for metastatic spinal tumors using a nationwide in-hospital database.

Summary of Background Data.

Surgical treatment for metastatic spinal tumors can improve the ambulatory status and quality of life. However, some patients fail to regain the ability to walk, thereby resulting in poor quality of life. No large-scale study has previously evaluated factors associated with postoperative poor ambulatory status in this clinical context.

Materials and Methods.

The Diagnosis Procedure Combination database from 2018 to 2019 was used to extract data from patients who underwent surgical procedures for spinal metastasis. Postoperative unfavorable ambulatory status was defined as (1) nonambulatory at discharge or (2) a decreased mobility score of the Barthel Index between admission and discharge. Multivariable logistic regression was used to evaluate factors associated with postoperative unfavorable ambulatory status while adjusting for confounders.

Results.

This study analyzed 1786 eligible patients. Of whom, 1061 (59%) patients were ambulatory on admission and 1249 (70%) on discharge. Postoperative unfavorable ambulatory status was observed in 597 (33%) patients, with a significantly lower rate of discharge to home (41%/81%, P<0.001) and a longer postoperative hospital stay (46.2 days/31.4 days, P<0.001). Multivariable regression analysis revealed male sex [odds ratio (OR): 1.43, P=0.002], laminectomy without fusion (OR: 1.55, P=0.034), Charlson Comorbidity Index of ≥7 (OR: 1.37, P=0.014), and preoperative nonambulatory status (OR: 6.61, P<0.001) as factors associated with postoperative unfavorable ambulatory status.

Conclusions.

Our large-scale database analysis revealed that 33% of patients experienced unfavorable ambulatory status following spinal metastasis surgery. Laminectomy without fusion and preoperative nonambulatory status were among several factors influencing the prospect of unfavorable ambulatory status following surgery.
Impact of Frailty on the Development of Proximal Junctional Failure
Authors: Krol Oscar , McFarland Kimberly , Owusu-Sarpong Stephane , Sagoo Navraj , Williamson Tyler , Joujon-Roche Rachel , Tretiakov Peter , Imbo Bailey , Dave Pooja , Mir Jamshaid , Lebovic Jordan , Onafowokan Oluwatobi O. , Schoenfeld Andrew J. , De la Garza Ramos Rafael , Janjua Muhammad Burhan , Sciubba Daniel M. , Diebo Bassel G. , Vira Shaleen , Smith Justin S. , Lafage Virginie , Lafage Renaud , Passias Peter G.
Published: May 2023

Background.

Patients undergoing surgery for adult spinal deformity (ASD) are often elderly, frail, and at elevated risk of adverse events perioperatively, with proximal junctional failure (PJF) occurring relatively frequently. Currently, the specific role of frailty in potentiating this outcome is poorly defined.

Purpose.

To determine if the benefits of optimal realignment in ASD, with respect to the development of PJF, can be offset by increasing frailty.

Study Design.

Retrospective cohort

Methods.

Operative ASD patients (scoliosis >20°, SVA>5 cm, PT>25°, or TK>60°) fused to pelvis or below with available baseline (BL) and 2-year (2Y) radiographic and HRQL data were included. The Miller Frailty Index (FI) was used to stratify patients into 2 categories: Not Frail (FI <3) and Frail (>3). Proximal Junctional Failure (PJF) was defined using the Lafage criteria. “Matched” and “unmatched” refers to ideal age-adjusted alignment post-operatively. Multivariable regression determined impact of frailty on development of PJF.

Results.

284 ASD patients met inclusion criteria (62.2yrs±9.9, 81%F, BMI: 27.5 kg/m2±5.3, ASD-FI: 3.4±1.5, CCI: 1.7±1.6). 43% of patients were characterized as Not Frail (NF) and 57% were characterized as Frail (F). PJF development was lower in the NF group compared to the F group, (7% vs. 18%; P=0.002). F patients had 3.2X higher risk of PJF development compared to NF patients (OR: 3.2, 95% CI: 1.3-7.3, P=0.009). Controlling for baseline factors, F unmatched patients had a higher degree of PJF (OR: 1.4, 95% CI:1.02-1.8, P=0.03), however, with prophylaxis there was no increased risk. Adjusted analysis shows F patients when matched post-operatively in PI-LL had no significantly higher risk of PJF.

Conclusions.

An increasingly frail state is significantly associated with the development of PJF after corrective surgery for ASD. Optimal realignment may mitigate the impact of frailty on eventual PJF. Prophylaxis should be considered in frail patients who do not reach ideal alignment goals.
Perceived Advantages and Disadvantages of Online Continuing Professional Development (CPD) During COVID-19: CPD Providers' Perspectives
Authors: MacNeill Heather , Paton Morag , Schneeweiss Suzan , Wiljer David
Published: May 2023

COVID-19 precipitated many CPD providers to develop new technology competencies to create effective online CPD. This study aims to improve our understanding of CPD providers' comfort level, supports, perceived advantages/disadvantages, and issues in technology-enhanced CPD delivery during COVID-19. A survey was distributed to CPD providers at the University of Toronto and members of the Society for Academic Continuing Medical Education and analyzed using descriptive statistics. Of the 111 respondents, 81% felt very to somewhat confident to provide online CPD, but less than half reported IT, financial, or faculty development supports. The top reported advantage to online CPD delivery was reaching a new demographic; top disadvantages included videoconferencing fatigue, social isolation, and competing priorities. There was interest in using less frequently used educational technology such as online collaboration tools, virtual patients, and augmented/virtual reality. COVID-19 precipitated an increased comfort level in using synchronous technologies to provide CPD, giving the CPD community an increased cultural acceptance and skill level to build on. As we move beyond the pandemic, it will be important to consider ongoing faculty development, particularly toward asynchronous and HyFlex delivery methods to continue expand CPD reach and negate negative online experiences such as videoconferencing fatigue, social isolation, and online distractions.
Variable Delta-9-Tetrahydrocannabinol Pharmacokinetics and Pharmacodynamics After Cannabis Smoking in Regular Users
Authors: Liyanage Marlon , Nikanjam Mina , Capparelli Edmund V. , Suhandynata Raymond T. , Fitzgerald Robert L. , Marcotte Thomas D. , Grant Igor , Momper Jeremiah D.
Published: May 2023

Background:

Despite its federally restricted status, cannabis is widely used medicinally and recreationally. The pharmacokinetics (PK) and central nervous system (CNS) effects of tetrahydrocannabinol (THC), the major psychoactive cannabinoid, are not well understood. The objective of this study was to develop a population PK model of inhaled THC, including sources of variability, and to conduct an exploratory analysis of potential exposure–response relationships.

Methods:

Regular adult cannabis users smoked a single cannabis cigarette containing 5.9% THC (Chemovar A) or 13.4% THC (Chemovar B) ad libitum. THC concentrations in whole blood were measured and used to develop a population PK model to identify potential factors contributing to interindividual variability in THC PK and to describe THC disposition. Relationships between model-predicted exposure and heart rate, change in composite driving score on a driving simulator, and perceived highness were evaluated.

Results:

From the 102 participants, a total of 770 blood THC concentrations were obtained. A two-compartment structural model adequately fit the data. Chemovar and baseline THC (THCBL) were found to be significant covariates for bioavailability, with Chemovar A having better THC absorption. The model predicted that heavy users—those with the highest THCBL—would have significantly higher absorption than those with lighter previous use. There was a statistically significant relationship between exposure and heart rate, and exposure and perceived highness.

Conclusions:

THC PK is highly variable and related to baseline THC concentrations and different chemovars. The developed population PK model showed that heavier users had higher THC bioavailability. To better understand the factors affecting THC PK and dose–response relationships, future studies should incorporate a wide range of doses, multiple routes of administration, and different formulations relevant to typical community use.
The correlation between dietary inflammatory index and risk of hyperuricemia in the U.S. population
Authors: Wang Lijuan , Liu Huoliang , Wang Dan , Huang Xiaoyan , Hong Xiaofan , Wang Yi , Li Ping , Bao Kun , Zhao Daixin
Published: May 2023

The dietary inflammatory index (DII) has been reported to be related to chronic diseases as a novel inflammatory marker. However, the correlation between DII score and hyperuricemia in adults in the United States is still unclear. Therefore, our goal was to explore the correlation between them. A total of 19,004 adults were enrolled in the National Health and Nutrition Examination Survey from 2011 to 2018. DII score was calculated according to 28 dietary items obtained by 24-hour dietary interview data. Hyperuricemia was defined by serum uric acid level. We used multilevel logistic regression models and subgroup analysis to determine whether the 2 were associated. DII scores were positively associated with serum uric acid and the risk of hyperuricemia. Per unit increased in DII score was associated with a 3 mmol/L increase in serum uric acid in males (β 3.00, 95% confidence interval (CI) 2.05–3.94) and 0.92mmol/L in females (β 0.92, 95% CI 0.07–1.77), respectively. Compared with the lowest tertile of DII score, the rise of DII grade increased the risk of hyperuricemia among the whole participants (T2: odds ratio (OR) 1.14, 95% CI 1.03, 1.27;T3: OR 1.20 [1.07, 1.34],Pfor trend = .0012) and males [T2: 1.15 (0.99, 1.33),T3: 1.29 (1.11, 1.50),Pfor trend = .0008]. For females, the correlation between DII score and hyperuricemia was statistically significant in the subgroup stratified by body mass index (BMI) (BMI < 30, OR 1.08, 95% CI 1.02–1.14,Pfor interaction = .0134), which indicates that the association depends on BMI. In the United States male population, the DII score has a positive correlation with hyperuricemia. Anti-inflammatory dietary intake can be beneficial for lower serum uric acid.
Improvement in cerebral oxygen saturation with sinus conversion during off pump coronary artery bypass graft: A case report
Authors: Hwang He Won , Kim Jin Ho , Ahn So Woon
Published: May 2023

Rationale:

Near-infrared spectroscopy (NIRS) is a noninvasive bedside tool for monitoring regional cerebral oxygen saturation (rSO2). The sinus conversion of atrial fibrillation (AF) was shown to be responsible for increasing rSO2. However, the reason for this improvement has not yet been clearly explained.

Patient concerns:

We report the case of a 73-year-old woman who underwent cardioversion during an off-pump coronary artery bypass under NIRS and live hemodynamic monitoring.

Interventions:

Unlike previous studies that failed to control and compare all conditions during procedures, this case showed real-time fluctuating hemodynamic and hematological values, such as hemoglobin (Hgb), central venous pressure (CVP), mean arterial pressure (MAP), cardiac index (CI), left ventricular end-diastolic pressure (LVEDP), and SVO2.

Outcomes:

The rSO2 increased immediately after cardioversion and decreased during the obtuse marginal (OM) graft and after AF was obtained. However, no other hemodynamic data showed the same or opposite directional changes in the rSO2.

Lessons:

Significant instantaneous changes were observed in rSO2 using NIRS after sinus conversion, without obvious hemodynamic alterations in the systemic circulation or other monitoring values.
Pain–depression relationship, quality of life and acceptance of illness among patients with Chiari malformation type I: A cross-sectional study
Authors: Balasa Artur , Bala Aleksandra , Olejnik Agnieszka , Marchel Andrzej , Kunert Przemysław
Published: May 2023

Chiari malformation type I (CM-I) is a congenital anomaly of the hindbrain. The most common symptoms include suboccipital tussive headache, dizziness and neck pain. Recently there has been growing interest in the psychological and psychiatric aspects of functioning in patients with CM-I, which have a significant effect on treatment outcomes and quality of life (QoL). The aim of the study was to assess the severity of depressive symptoms and the QoL in patients with CM-I and to identify the main factors responsible for these phenomena. A total of 178 people participated in the study and were divided into 3 groups: patients with CM-I who had undergone surgery (n = 59); patients with CM-I who had not undergone surgery (n = 63); and healthy volunteers (n = 56). Psychological evaluation included a set of questionnaires: the Beck Depression Inventory II, the World Health Organization shortened version of the WHOQOL-100 quality of life questionnaire, the Acceptance of Illness Scale and the Beliefs about Pain Control Questionnaire. Results showed that the control group participants obtained significantly better results than both groups of CM-I patients in terms of all indicators of QoL, symptoms of depression, acceptance of illness, pain level (average and present) and perceived influence of doctors regarding coping with pain. Patients with CM-I (operated and non-operated) obtained similar results in most of the questionnaires and the QoL indices correlated significantly with the majority of the analyzed variables. Moreover, CM-I patients with higher depression scores described their pain as more severe and had a stronger belief that pain levels were not influenced by them but only by doctors, or that it could be controlled randomly; they were also less willing to accept their illness. CM-I symptoms affect the mood and QoL of patients. Psychological and psychiatric care should be the golden standard in managing this clinical group.
Hypertrophic cardiomyopathy caused by a heterozygous variant in TTR gene: A case report
Authors: Yuan Huayuan , Lin Ya , Wang Jiao , Li Jialian , Chen Xuefeng , Guo Yulong , Tang Jiong
Published: May 2023

Rationale:

We report a rare case of hypertrophic cardiomyopathy (HCM) caused by a heterozygous variant in TTR gene.

Patient concerns:

The proband had been vomiting without obvious inducement since the age of 27, accompanied by the expulsion of stomach contents. At the age of 28, she began to suddenly syncope.

Diagnosis:

Cardiac magnetic resonance showed thickening of the right ventricular lateral wall and ventricular septum. The left ventricular diastolic function was limited. Targeted Sanger sequencing validates the presence of mutation p.Leu75Pro in TTR gene.

Interventions and outcomes:

After admission to hospital for syncope, she was given metoprolol tablets 25 mg bid, spironolactone tablets 20 mg qd, and trimetazidine 20 mg tid. Her symptoms improved after taking the medicine.

Lessons:

The results of this case show that HCM caused by TTR mutation is not easy to be identified and treatment is easy to be delayed. Therefore, high-risk patients with amyloidosis should be evaluated as soon as possible. Timely diagnosis of HCM caused by TTR mutation before irreversible organ damage is essential for proper treatment and better outcomes.
Ulcerative colitis and thrombocytosis: Case report and literature review
Authors: Zhou Yaqi , Zhu Fengqin , Jing Dehuai , Wang Quanyi , Zhou Guangxi
Published: May 2023

Rationale:

Ulcerative colitis (UC) is an autoimmune disease of unknown etiology, sometimes associated with anemia and thrombocytosis. Platelets (PLTs) play a role in amplifying inflammatory and immune responses in chronic inflammation. This study discusses the diagnosis and treatment of a case of UC combined with secondary thrombocytosis and reviews the relevant literature. We report an interaction between thrombocytosis and UC to raise clinicians’ awareness of this condition.

Patient concerns:

In the current report, we discuss the case of a 30-year-old female patient who presented with frequent diarrhea and thrombocytosis.

Diagnosis:

Severe UC combined with intestinal infection was diagnosed based on colonoscopy and intestinal biopsy. The patient had a PLT count >450 × 109/L and was diagnosed with reactive thrombocytosis.

Interventions and outcomes:

The patient was discharged from the hospital in remission after receiving vedolizumab and anticoagulant treatment.

Lessons:

In patients with severe UC with thrombocytosis, clinicians should pay attention to PLTs promoting inflammatory progression, as well as screening for venous thromboembolism risk and prophylactic anti-venous thromboembolism therapy at the time of dosing to avoid adverse effects.
Does the SARS-CoV-2 mRNA vaccine damage the ovarian reserve?
Authors: Yildiz Elif , Timur Burcu , Guney Gurhan , Timur Hakan
Published: May 2023

To search whether or not the severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) messenger ribonucleic acid (mRNA) vaccine affects the fertility of women at the 6th months by using AMH, which is an ovarian reserve test. Our study, designed as a prospective case-control study, included 104 women who presented to the GOP EAH obstetrics and gynecology outpatient clinic in January and February 2022. The study group included 74 women who presented to the outpatient clinic and planned to be vaccinated and 30 women who refused to be vaccinated as the control group. Anti-COVID-19 antibody levels in all participants were checked before participation in the study, and participants who were positive were excluded from the study. Blood was taken from the participants in both control and study groups to evaluate their AMH levels before the 2 doses of vaccination. After 2 doses of the vaccine, they were called for follow-up, and serological tests were performed to check whether they were positive for anti-COVID-19 antibodies. Participants in both groups were referred for follow-up after 6 months, samples were taken again for AMH, and the data were recorded. The mean age of the study group was 27.6 ± 5.3 years, and the mean age of the control group was 28.65 ± 5.25 years (P = .298). There was no statistically significant difference between the vaccinated and nonvaccinated groups in terms of AMH levels measured at the 6th month (P = .970). When the vaccinated group was compared in terms of AMH values at the first visit before vaccination and at the 6th month after vaccination, no statistically significant difference was found between them (p:0.127) mRNA vaccination to protect against SARS-CoV-2 does not adversely affect ovarian reserve, which is an indirect indicator of fertility. mRNA vaccines continue to be the most important method of protection against epidemics. Carefully and accurately informing women who are hesitant to get vaccinated is of great importance for the success of the fight against the epidemic.
Network analysis to explore the pharmacological mechanism of Shenmai injection in treating granulocytopenia and evidence-based medicine approach validation
Authors: Hou Xianbing , Chen Dandan , Wang Yao , Cui Bixian , Xu Hui , Wang Yuanyuan , Chen Hongzhou , Wang Dan , Chen Ying , Cheng Tongfei , Dai Xiaojun
Published: May 2023

Background:

Shenmai injection is frequently utilized in China to clinically treat granulocytopenia in oncology patients following chemotherapy. Despite this, the drug’s therapeutic benefits remain a topic of contention, and its active components and potential treatment targets have yet to be established. The present study utilizes a network pharmacology approach to investigate the drug’s active ingredients and possible therapeutic targets, and to evaluate the effectiveness of Shenmai injection in treating granulocytopenia through meta-analysis.

Methods:

In our subject paper, we utilized the TCMID database to investigate the active ingredients present in red ginseng and ophiopogon japonicus. To further identify molecular targets, we employed SuperPred, as well as OMIM, Genecards, and DisGeNET databases. Our focus was on targets associated with granulocytopenia. The DAVID 6.8 database was utilized to perform gene ontology functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. Additionally, a protein-protein interaction network was established. The resulting “drug-key component-potential target-core pathway” network was used to predict the mechanism of action of Shenmai injection in the treatment of granulocytopenia. In order to evaluate the quality of the studies included in our analysis, we utilized the Cochrane Reviewers’ Handbook. We then conducted a meta-analysis of the clinical curative effect of Shenmai injection for granulocytopenia, utilizing the Cochrane Collaboration’s RevMan 5.3 software.

Results:

After conducting a thorough screening, the study identified 5 primary ingredients of Shenmai injection – ophiopogonoside a, β-patchoulene, ginsenoside rf, ginsenoside re, and ginsenoside rg1–that can potentially target 5 essential proteins: STAT3, TLR4, PIK3CA, PIK3R1, and GRB2. Additionally, Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed that Shenmai injection can be beneficial in treating granulocytopenia by interacting with pathways such as HIF-1 signaling, T-cell receptor signaling, PI3K-Akt signaling, chemokine signaling, and FoxO signaling. The results of meta-analysis indicate that the treatment group exhibited superior performance in terms of both efficiency and post-treatment leukocyte count when compared to the control group.

Conclusion:

In summary, studies in network pharmacology demonstrate that Shenmai injection exerts an impact on granulocytopenia via various components, targets, and mechanisms. Additionally, evidence-based studies provide strong support for the effectiveness of Shenmai injection in preventing and treating granulocytopenia.
A bibliometric analysis of global publication trends on rTMS and aphasia
Authors: Wang Taiwei , Huang Xuemiao , Zhao Lijing , Wang Yuan , Zhang Shuang , Fu Xiaochen , Zhang Tingyu , Jiang Junjie
Published: May 2023

Background:

Aphasia is one of the most devastating cognitive disorders caused by brain injury and seriously hinders patients’ rehabilitation and quality of life. Repetitive transcranial magnetic stimulation involves the repeated application of extracranial pulsed magnetic fields to the local central nervous system to alter the membrane potential of cortical nerve cells, generating induced currents that affect brain metabolism and electrical activity. As one of the most popular noninvasive brain stimulation techniques, it has been used to treat aphasia. However, only a few bibliometric studies have examined the research direction and main findings in the field.

Methods:

To obtain an in-depth understanding of the research status and trend in this area, a bibliometric analysis based on the Web of Science database was conducted. VOSviewer (Leiden University, Leiden, Netherlands) and Microsoft Excel (Microsoft, Redmond, USA) were used to extract bibliometric information. Analysis of global distribution was conducted using the webpage mapping implement GunnMap2 (http://lert.co.nz/map/).

Results:

Publications in this field were retrieved from the Web of Science Core Collection database, and 189 articles met the final inclusion criteria. The most influential authors, institutions, journals, and countries were Ralph MA from the University of Manchester, Harvard University, Neuropsychologia, and the USA, respectively.

Conclusion:

This study revealed publication patterns and emerging trends in the literature, providing a detailed and objective overview of the current state of research on repetitive transcranial magnetic stimulation for the treatment of aphasia. This information will be of great benefit to anyone seeking information about this field and can serve as a reference guide for researchers aiming to conduct further research.
Testicular ischemia secondary to acute epididymitis: A case report
Authors: Wang Zhichao , Qiu Mengzhen , Gao Xinghua , Zhang Longyang
Published: May 2023

Rationale:

Rare side effects of acute epididymitis include testicular infarction and ischemia. Distinguishing them from testicular torsion is challenging, both clinically and radiologically. However, only a few such cases have been reported to date.

Patient concerns:

A 12-year-old child presented with persistent right testicular pain for 3 days. It developed after trauma and was accompanied by gradual swelling and enlargement of the right scrotum, with nausea and vomiting. Scrotal color Doppler ultrasonography demonstrated right epididymitis, right scrotal wall swelling, and right testicular torsion. Routine blood tests revealed leukocyte and neutrophil counts were both above normal.

Diagnosis:

Scrotal exploration revealed edema and adhesions in all layers of the scrotal wall. The right testicle was pale. The patient was diagnosed with testicular ischemia secondary to acute epididymitis.

Interventions:

The patient underwent simultaneous lower spermatic cord sheath dissection and decompression, testicular sheath reversal, and right testicular fixation.

Outcomes:

Blood flow to the testicles gradually recovered after decompression, as did the color. Postoperatively, the patient’s scrotal swelling and pain improved significantly.

Lessons:

Despite the rarity of this condition, it is a potentially serious consequence of epididymitis and should be considered when patients experience sudden scrotal pain.
Cannabis and Cannabinoids in Multiple Sclerosis: From Experimental Models to Clinical Practice—A Review
Authors: Sirbu Carmen-Adella , Georgescu Ruxandra , Pleşa Florentina Cristina , Paunescu Alina , Marilena Ţânţu Monica , Nicolae Alina Crenguţa , Caloianu Ionut , Mitrica Marian
Published: May 2023

Background:

As far as 80% of people diagnosed with multiple sclerosis (MS) experience disabling symptoms in the course of the disease, such as spasticity and neuropathic pain. As first-line symptomatic therapy is associated with important adverse reactions, cannabinoids have become increasingly popular among patients with MS. This review intends to provide an overview of the evidence of the role of cannabinoids in treating symptoms related to MS and to encourage further research on this matter.

Areas of Uncertainty:

To date, the evidence supporting the role of cannabis and its derivatives in alleviating the MS-related symptoms comes only from studies on experimental models of demyelination. To the best of our knowledge, relatively few clinical trials inquired about the therapeutic effects of cannabinoids on patients with MS, with variable results.

Data Sources:

We conducted a literature search through PubMed and Google Scholar from the beginning until 2022. We included articles in English describing the latest findings regarding the endocannabinoid system, the pharmacology of cannabinoids, and their therapeutic purpose in MS.

Results:

Evidence from preclinical studies showed that cannabinoids can limit the demyelination process, promote remyelination, and have anti-inflammatory properties by reducing immune cell infiltration of the central nervous system in mice with experimental autoimmune encephalomyelitis. Moreover, it has been established that experimental autoimmune encephalomyelitis mice treated with cannabinoids experienced a significant reduction of symptoms and slowing of the disease progression. Given the complexity of human immune and nervous systems, cannabinoids did not have the anticipated effects on human subjects. However, data obtained from clinical trials showed some beneficial results of cannabinoids as a single or as add-on therapy in reducing the spasticity and pain related to MS.

Conclusion:

Considering their various mechanisms of action and good tolerability, cannabinoids remain an interesting therapy for spasticity and chronic pain related to MS.