bluuebunny/crossref_metadata_2025 huggingface dataset:
Caregiver Experiences Using Orthotic Treatment Options for Developmental Dysplasia of the Hip in Children
Authors: Grzybowski Georgia , Bliven Emily , Wu Luke , Schaeffer Emily K. , Gibbard Marissa , Zomar Bryn O. , Casagrande Cesconetto Alice , Mundy Claire , Mulpuri Kishore ,   International Hip Dysplasia Registry Knowledge Translation Advisory Board
Published: January 2023

Background:

Developmental dysplasia of the hip (DDH) is a common condition affecting 5 in 1000 newborns. The standard first line of treatment is the use of an orthotic, which has generally high success rates, but can pose substantial difficulties and put undue burden on caregivers. The general experience of caregivers using these orthotics has not been well documented on an orthotic-specific basis. The purpose of this study was to investigate caregiver experience using prescribed DDH orthotics to identify challenges, differences between treatment options, and areas of improvement.

Methods:

A survey assessing treatment prescription, respondent demographics, and caregiver experience was distributed online to caregivers whose child/children were treated for DDH with an orthotic. Seven-point positively phrased Likert scale statements and open-ended questions were included to assess caregiver experience. The results were analyzed using summary statistics and orthotics with more than 30 responses were selected for more in-depth analysis.

Results:

A total of 530 survey responses were collected with 63% (334/530) of respondents using a Pavlik harness, 45% (236/530) a Rhino brace, and 13% (67/530) a Denis Browne Bar. The overall weighted average score across all Likert Scale statements was positive for the Pavlik harness, Rhino brace, and Denis Browne Bar at 4.19 (95% CI, 3.83 to 4.54), 4.63 (95% CI, 4.27 to 4.99) and 4.91 (95% CI, 4.58 to 5.24), respectively. In the open-ended responses, all 3 orthotics were perceived as easy to use and not hindering child-caregiver bonding, but raised concerns of discomfort and skin irritation, as well as preventing the ability to cuddle their child the way they desired. The Pavlik harness respondents consistently brought up concerns regarding cleanability.

Conclusions:

The results show that the DDH orthotics analyzed are generally easy to use and perceived positively by caregivers, but have orthotic-specific challenges that should be a focus of future improvement work.

Clinical Relevance:

This study evaluated opinions and attitudes of caregivers for children being treated with DDH orthotics, revealing experiences, concerns, and challenges associated with the use of commonly prescribed options.
Anterior Cervical Discectomy and Fusion in the Ambulatory Surgery Center Versus Inpatient Setting: One-Year Cost-Utility Analysis
Authors: Monk Steve H. , Hani Ummey , Pfortmiller Deborah , Smith Mark D. , Kim Paul K. , Bohl Michael A. , Coric Domagoj , Adamson Tim E. , Holland Christopher M. , McGirt Matthew J.
Published: January 2023

Study Design.

Retrospective analysis of prospectively collected data.

Objective.

Assess the cost-utility of anterior cervical discectomy and fusion (ACDF) performed in the ambulatory surgery center (ASC) versus inpatient hospital setting for Medicare and privately insured patients at one-year follow-up.

Summary of Background Data.

Outpatient ACDF has gained popularity due to improved safety and reduced costs. Formal cost-utility studies for ambulatory versus inpatient ACDF are lacking, precluding an accurate assessment of cost-effectiveness.

Materials and Methods.

A total of 6504 patients enrolled in the Quality Outcomes Database (QOD) undergoing one-level to two-level ACDF at a single ASC (520) or the inpatient hospital setting (5984) were compared. Propensity matching generated 748 patients for analysis (374 per cohort). Demographic data, resource utilization, patient-reported outcome measures, and quality-adjusted life-years (QALYs) were assessed. Direct costs (1-year resource use×unit costs based on Medicare national allowable payment amounts) and indirect costs (missed workdays×average US daily wage) were recorded. Incremental cost-effectiveness ratios were calculated.

Results.

Complication rates and improvements in patient-reported outcome measures and QALYs were similar between groups. Ambulatory ACDF was associated with significantly lower total costs at 1 year for Medicare ($5879.46) and privately insured ($12,873.97) patients, respectively. The incremental cost-effectiveness ratios for inpatient ACDF was $3,674,662 and $8,046,231 for Medicare and privately insured patients, respectively, reflecting unacceptably poor cost-utility.

Conclusion.

Inpatient ACDF is associated with significant increases in total costs compared to the ASC setting without a safety, outcome, or QALY benefit. The ASC setting is a dominant option from a health economy perspective for first-time one-l to two-level ACDF in select patients compared to the inpatient hospital setting.
Hyperbaric Oxygen Treatment in Spinal Cord Injury Recovery: Profiling Long Noncoding RNAs
Authors: Liu Xuehua , Liang Fang , Sun Zhencheng , Yang Jing , Su Qingjun
Published: January 2023

Study Design.

A functional, transcriptome, and long noncoding RNAs (lncRNAs) expression analysis in the spinal cord of mice after hyperbaric oxygen (HBO) treatment.

Objective.

We aimed to explore the mechanism by which HBO treats spinal cord injury (SCI) at the level of lncRNAs.

Summary of Background Data.

Immense amounts of research have established that HBO treatment promotes the recovery of neurological function after SCI. The mechanism of action remains to be clarified.

Methods.

High-throughput RNA sequencing, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes enrichment analysis were used to profile lncRNA expression and analyze biological function in the spinal cords of mice from sham-operated, SCI, and HBO-treated groups. The differential expression of lncRNA between the groups was assessed using real-time quantitative polymerase chain reaction.

Results.

Differential expression across 577 lncRNAs was identified among the three groups. GO analysis showed that free ubiquitin chain polymerization, ubiquitin homeostasis, DNA replication, synthesis of RNA primer, single-stranded telomeric DNA binding, and alpha-amylase activity were significantly enriched. Kyoto Encyclopedia of Genes and Genomes enrichment analysis displayed that vitamin B6 metabolism, one carbon pool by folate, DNA replication, lysine degradation, beta-alanine metabolism, fanconi anemia pathway, and Notch signal pathway were the main pathways with enrichment significance. LncRNAs NONMMUT 092674.1, NONMMUT042986.2, and NONMMUT018850.2 showed significantly different expression between the SCI and the other two groups (P<0.05, <0.01).

Conclusions.

This study is the first to determine the expression profiles of lncRNAs in the injured spinal cord after HBO treatment. We identified several important dysregulated lncRNAs in this setting. These results help us better understand the mechanism by which HBO treats SCI and provide new potential therapeutic targets for SCI.
Novel strategies to improve efficacy of treatment with tumor-infiltrating lymphocytes (TILs) for patients with solid cancers
Authors: Tas Liselotte , Jedema Inge , Haanen John B.A.G.
Published: January 2023

Purpose of review

Treatment with tumor-infiltrating lymphocytes (TILs) has shown remarkable clinical responses in patients with advanced solid tumors. Although the TIL production process is very robust, the original protocol stems from the early nineties and lacks effective selection for tumor-reactivity and functional activity. In this review we highlight the limitations of the current production process and give an overview of improvements that can be made to increase TIL efficacy.

Recent findings

With the recent advances in single cell sequencing technologies, our understanding of the composition and phenotype of TILs in the tumor micro environment has majorly increased, which forms the basis for the development of new strategies to improve the TIL production process. Strategies involve selection for neoantigen-reactive TILs by cell sorting or selective expansion strategies. Furthermore, gene editing strategies like Clustered regularly interspaced short palindromic repeats-Cas (CRISPR-Cas9) can be used to increase TIL functionality.

Although combining all the possible improvements into a next generation TIL product might be challenging, it is highly likely that those techniques will increase the clinical value of TIL therapy in the coming years.
Tumor Response-speed Heterogeneity as a Novel Prognostic Factor in Patients With Metastatic Colorectal Cancer
Authors: Liu Junjia , Wang Xuefeng , Sahin Ibrahim H. , Imanirad Iman , Felder Seth I. , Kim Richard D. , Xie Hao
Published: January 2023

Purpose:

Differential tumor response to therapy is partially attributed to tumor heterogeneity. Additional efforts are needed to identify tumor heterogeneity parameters in response to therapy that is easily applicable in clinical practice. We aimed to describe tumor response-speed heterogeneity and evaluate its prognostic value in patients with metastatic colorectal cancer.

Patients and Methods:

Individual patient data from Amgen (NCT00364013) and Sanofi (NCT00305188; NCT00272051) trials were retrieved from Project Data Sphere. Patients in the Amgen 5-fluorouracil, leucovorin, oxaliplatin (FOLFOX) arm were used to establish response-speed heterogeneity. Its prognostic value was subsequently validated in the Sanofi FOLFOX arms and the Amgen panitumumab+FOLFOX arm. Kaplan-Meier method and Cox proportional hazards models were used for survival analyses.

Results:

Patients with high response-speed heterogeneity in the Amgen FOLFOX cohort had significantly shorter (P<0.001) median progression-free survival (PFS) of 7.27 months (95% CI, 6.12-7.96 mo) and overall survival (OS) of 16.0 months (95% CI, 13.8-18.2 mo) than patients with low response-speed heterogeneity with median PFS of 9.41 months (95% CI, 8.75-10.89 mo) and OS of 22.4 months (95% CI, 20.1-26.7 mo), respectively. Tumor response-speed heterogeneity was a poor prognostic factor of shorter PFS (hazard ratio, 4.17; 95% CI, 2.49-6.99; P<0.001) and shorter OS (hazard ratio, 2.57; 95% CI, 1.64-4.01; P<0.001), after adjustment for other common prognostic factors. Comparable findings were found in the external validation cohorts.

Conclusion:

Tumor response-speed heterogeneity to first-line chemotherapy was a novel prognostic factor associated with early disease progression and shorter survival in patients with metastatic colorectal cancer.
Renal Safety of Sacubitril/Valsartan: A Meta-Analysis of Randomized Controlled Trials
Authors: Zheng Shaohua , Zhang Yujiao , Gu Lei , Ma Kai , Wang Xuehan , Hou Yinglong , Zhang Fenglei , Gao Mei
Published: January 2023

As a first-line therapy, sacubitril/valsartan (S/V) plays a significant role in the treatment of heart failure. However, its effect on renal function is still uncertain. We searched PubMed, EMBASE, the Cochrane Library, and Clinical Trials for randomized controlled trials to evaluate the effect of S/V on renal function in patients. The results are reported as the mean difference, relative ratio, and 95% confidence intervals. A total of 13 randomized controlled trials were included (19,367 patients). Among them, 11 studies focused on patients with heart failure, 1 on patients with acute myocardial infarction, and 1 on patients with chronic kidney disease. We found that fewer worsening renal function events, elevated creatine level events, and severe hyperkalemia events (blood potassium >6.0 mmol/L) occurred in the S/V group than those in the renin–angiotensin–aldosterone system inhibitor (RASi) group. The estimated glomerular filtration rate decreased in both the S/V group and the RASi group, but the change was more obvious in the RASi group. There was no significant difference in hyperkalemia events (blood potassium >5.5 mmol/L) between the 2 groups. Subgroup analysis showed that with the extension of follow-up time (>6 months), worsening renal function events occurred less frequently in the S/V group than in the RASi group. Existing evidence has shown that S/V is superior to RASi in general renal safety. Perhaps with the prolongation of treatment time, the advantages of S/V are more obvious.
Mechanisms of SGLT2 Inhibitors in Heart Failure and Their Clinical Value
Authors: Xie Yafei , Wei Yujie , Li Dan , Pu Jie , Ding Hong , Zhang Xiaowei
Published: January 2023

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are widely used to treat diabetes mellitus. Abundant evidence has shown that SGLT2 inhibitors can reduce hospitalization for heart failure (HF) in patients with or without diabetes. An increasing number of studies are being conducted on the mechanisms of action of SGLT2 inhibitors in HF. Our review summarizes a series of clinical trials on the cardioprotective effects of SGLT2 inhibitors in the treatment of HF. We have summarized several classical SGLT2 inhibitors in cardioprotection research, including empagliflozin, dapagliflozin, canagliflozin, ertugliflozin, and sotagliflozin. In addition, we provided a brief overview of the safety and benefits of SGLT2 inhibitors. Finally, we focused on the mechanisms of SGLT2 inhibitors in the treatment of HF, including ion-exchange regulation, volume regulation, ventricular remodeling, and cardiac energy metabolism. Exploring the mechanisms of SGLT2 inhibitors has provided insight into repurposing these diabetic drugs for the treatment of HF.
Effect of Dexmedetomidine on Cardiac Surgery Patients
Authors: Xiao Man , Jiang Chong-Fa , Gao Qin , Pan Jue , Zhang Hong , Wu Sheng-Nan , Dou Mao-Sen
Published: January 2023

Dexmedetomidine, an alpha-2 adrenoreceptor agonist that is widely used as a sedative medication, is becoming more and more attractive in clinical application on cardiac surgery patients. In this review, we aim to summarize and discuss both retrospective studies and clinical trials regarding the effect of dexmedetomidine on patients who underwent cardiac surgery (including coronary artery bypass grafting, valve surgery, aortic surgery, percutaneous coronary intervention, and so on), which illustrates that the clinical effects of dexmedetomidine could effectively reduce mortality, major complications, and the intensive care unit and hospital length of stay without comprising safety. In addition, inconsistent results from both retrospective studies and clinical trials have also been demonstrated. Although the effectiveness and safety of dexmedetomidine on cardiac surgery patients is suggested, high-quality clinical trials are needed for further verification.
Prescription Rates and Prognostic Implications of Optimally Targeted Guideline-Directed Medical Treatment in Heart Failure and Atrial Fibrillation: Insights From The MISOAC-AF Trial
Authors: Moysidis Dimitrios V. , Kartas Anastasios , Samaras Athanasios , Papazoglou Andreas S. , Patsiou Vasiliki , Bekiaridou Alexandra , Baroutidou Amalia , Tsagkaris Christos , Karagiannidis Efstratios , Daios Stylianos , Anastasiou Vasileios , Tsalikakis Dimitrios , Efthimiadis Georgios , Ziakas Antonios , Tzikas Apostolos , Giannakoulas George
Published: January 2023

Heart failure (HF) and atrial fibrillation (AF) commonly coexist in real-life clinical practice. Among patients with HF with reduced ejection fraction (HFrEF) or HF with mildly reduced ejection fraction (HFmrEF), guidelines call for evidence-based target doses of renin–angiotensin–aldosterone system inhibitors and beta-blockers. However, target doses of guideline-directed medical treatment (GDMT) are often underused in real-world conditions, including HF–AF comorbidity. This retrospective cohort study of a randomized trial (Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with nonvalvular AF) included hospitalized patients with AF and HFrEF or HFmrEF. Optimally targeted GDMT was defined as intake of evidence-based target doses of renin–angiotensin–aldosterone system and beta-blockers at 3 months after discharge. Rates of optimally targeted GDMT achievement across the baseline estimated glomerular filtration rate (eGFR) were assessed. Independent predictors of nontargeted GDMT and its association with all-cause mortality and the composite of cardiovascular death or HF hospitalization were assessed by regression analyses. In total, 374 patients with AF and HFrEF or HFmrEF were studied. At 3 months after discharge, 30.7% received target doses of GDMT medications. The rate of optimally targeted GDMT was reduced by 11% for every 10 mg/min/1.73 m2 decrease in baseline eGFR [adjusted β = 0.99; 95% confidence interval (CI), 0.98–0.99] levels. After a median 31-month follow-up period, 37.8% patients in the optimally targeted GDMT group died, as compared with 67.8% (adjusted hazard ratio: 1.49; 95% CI, 1.05–2.13) in the nontargeted GDMT group. The risk of cardiovascular death or HF hospitalization was also higher in these patients (adjusted hazard ratio: 1.60; 95% CI, 1.17–2.20). Target doses of all HF drugs were reached in roughly one-third of patients with AF and HFrEF or HFmrEF 3 months after hospital discharge. Nontargeted GDMT was more frequent across lower eGFR levels and was associated with worse outcomes.
A qualitative study of the dark and bright sides of physicians' electronic health record work outside work hours
Authors: Attipoe Selasi , Walker Daniel M. , Schweikhart Sharon B. , Hefner Jennifer L.
Published: January 2023

Background

The introduction of electronic health records (EHRs) has contributed considerably to EHR work outside work (WOW) hours for physicians. Prior research has identified the pressures associated with stress resulting from EHR WOW, yet developing a nuanced understanding of how physicians appraise and respond to this stress, and the resulting impacts, remains absent from the literature.

Purpose

Grounded in the technostress model, this study takes a qualitative approach to explore both the pressures and opportunities associated with EHR WOW.

Methods

Thematic analysis of data from semistructured interviews was utilized to examine the pressures and opportunities associated with EHR WOW among primary care pediatricians (n = 15) affiliated with a large Midwestern pediatric health system.

Results

The physicians in this study regularly spent time working in the EHR outside work hours. They felt the EHR contributed to their documentation burden, which ultimately increased their EHR WOW, and reported a sense of burden from ubiquitous EHR availability. Conversely, they appreciated the flexibility the EHR provided in terms of work–life balance. Suggestions for improvement under the direct purview of practice management included enhanced EHR usability, improvements in workflow during work hours to free up time to document, and more training on both EHR documentation strategies and ongoing software upgrades.

Conclusion

Physicians perceive that the EHR exerts certain pressures while affording new opportunities and conveniences. This study provides evidence of both the pressures and opportunities of EHR WOW and their effect on physician well-being.

Practice Implications

Specific opportunities are identified for health administrators to enable physicians to better manage EHR WOW.
Clinical and Ethical Dilemmas in the Involuntary Treatment of Anorexia Nervosa
Authors: Tumba Jenny , Smith Megan , Rodenbach Kyle E.
Published: January 2023

Learning objectives

After completing this activity, practitioners will be better able to:

• Discuss the growing body literature emphasizing moderation and harm-reduction in patients with severe and enduring anorexia nervosa (SE-AN)

• Outline and discuss the legal, ethical, and medical challenges inpatient providers face when treating patients with SE-AN

Patients with severe and enduring anorexia nervosa (SE-AN) present numerous clinical and ethical challenges for the hospital psychiatrist. Patients typically come to the hospital in a state of severe medical compromise. Common difficulties in the period of acute medical stabilization include assessment of decision-making capacity and the right to decline treatment, as well as legally complex decisions pertaining to administering artificial nutrition over the patient’s objection. Following acute medical stabilization, the psychiatric consultant must decide whether psychiatric hospitalization for continued treatment is indicated, and if so, whether involuntary hospitalization is indicated. The standard of care in these situations is unclear. Pragmatic issues such as lack of appropriate facilities for specialized treatment are common. If involuntary hospitalization is not approved or not pursued, there may be difficulty in determining whether, when, and how to involve palliative care consultants to guide further management. These cases are complex and largely reside in a medico-legal and ethical gray area. This article discusses the difficulties associated with these cases and supports a growing body of literature emphasizing moderation and harm-reduction in patients with SE-AN. Physician-assisted dying (PAD) is also discussed.
Enhanced sodium channel inactivation by temperature and FHF2 deficiency blocks heat nociception
Authors: Marra Christopher , Hartke Timothy V. , Ringkamp Matthias , Goldfarb Mitchell
Published: January 2023

Transient voltage-gated sodium currents are essential for the initiation and conduction of action potentials in neurons and cardiomyocytes. The amplitude and duration of sodium currents are tuned by intracellular fibroblast growth factor homologous factors (FHFs/iFGFs) that associate with the cytoplasmic tails of voltage-gated sodium channels (Navs), and genetic ablation of Fhf genes disturbs neurological and cardiac functions. Among reported phenotypes, Fhf2

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mice undergo lethal hyperthermia-induced cardiac conduction block attributable to the combined effects of FHF2 deficiency and elevated temperature on the cardiac sodium channel (Nav1.5) inactivation rate. Fhf2

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mice also display a lack of heat nociception, while retaining other somatosensory capabilities. Here, we use electrophysiological and computational methods to show that the heat nociception deficit can be explained by the combined effects of elevated temperature and FHF2 deficiency on the fast inactivation gating of Nav1.7 and tetrodotoxin-resistant sodium channels expressed in dorsal root ganglion C fibers. Hence, neurological and cardiac heat-associated deficits in Fhf2

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mice derive from shared impacts of FHF deficiency and temperature towards Nav inactivation gating kinetics in distinct tissues.
Brachial-femoral pulse wave velocity in 2–4-year-old children: a feasibility study
Authors: Jones Melissa A. , Whitaker Kara M. , Paley Joshua L. , Thrower Alexis , Stoner Lee , Barone Gibbs Bethany
Published: January 2023

Background

Cardiovascular disease (CVD) progression occurs across the lifespan. However, available measures of CVD risk in young children are limited. Carotid-femoral pulse wave velocity (cfPWV) is a gold-standard, noninvasive measure of CVD risk that has been studied in children ages 6–18 years. Yet, cfPWV has been measured to a lesser extent in younger children, a population whose temperament or attention span may pose unique challenges. Brachial-femoral PWV (bfPWV) may be feasible, more acceptable, and could provide similar CVD risk assessment to cfPWV in younger children. This study aimed to determine the feasibility of bfPWV measurement in children ages 2–4 years including assessment of comparability of bfPWV to cfPWV normative data.

Methods

In 10 children (mean 2.9 ± 0.5 years), oscillometric cuffs were placed on the upper thigh and upper arm. Following a 5-min rest, cuffs were inflated to a subdiastolic pressure three times, and waveforms were captured. Procedures were repeated after a 15-min rest. Measured values were compared to age-predicted cfPWV extrapolated from published normative data in children 6–18 years of age.

Results

We successfully obtained at least one acceptable quality bfPWV scan in all participants. Among the subset with a repeated measurement (n = 5), mean (SD) difference between measurements was 0.013 (0.28) m/s. Mean bfPWV was slightly higher than age-predicted cfPWV (observed: 4.55 m/s; predicted: 3.99 m/s; P = 0.012) with larger residuals among younger children and those not reclined in a chair during measurement.

Conclusion

bfPWV appears to be feasible tool for noninvasive CVD risk assessment in children ages 2–4 years.
Device-guided slow breathing with direct biofeedback of pulse wave velocity – acute effects on pulse arrival time and self-measured blood pressure
Authors: Mengden Thomas , Bachler Martin , Sehnert Walter , Marschall Philip , Wassertheurer Siegfried
Published: January 2023

Background

There isevidence that device-guided slow breathing using biofeedback acutely reduces blood pressure (BP) and pulse wave velocity [i.e. increased pulse arrival time (PAT)].

Objectives

The objectives of the study presented here were to test whether the results of changes observed in PAT in earlier studies are reproducible over 1 week and how changes in pulse wave velocity/PAT translate into absolute self-measured BP changes.

Methods

Patients with a systolic BP 130–160 mmHg or treated essential hypertension (21 females/23 males) were trained to perform unattended device-guided slow breathing exercises for 10 min daily over 5 days. Furthermore, they were skilled to perform self-measurement of BP before and after the breathing exercise using a validated upper-arm device.

Results

Office BP at screening [median (1, 3. Q)] was 137 (132, 142)/83 (79, 87) mmHg. We observed a significant (P < 0.05) increase in PAT of 5 ms (SD 12.5 ms) on average after 10 min of guided breathing and an additional 1 ms (P < 0.05, SD 8 ms) during the following 5 min of spontaneous breathing compared to baseline. PAT before the exercise remained constant over 5 days paralleled by constant self-measured BP before the exercise. Device-guided breathing was associated with a significant reduction of self-measured SBP of 5 mmHg (P < 0.01, SD 8 mmHg). Data furthermore demonstrated that these changes were highly reproducible over 1 week.

Conclusions

Device-guided slow breathing and biofeedback lead to reproducible and favorable changes (increase) in PAT and SBP (decrease).
Disseminated nontuberculous mycobacteria infection in an immunocompetent host: A case report
Authors: Shin Hye Soon , Yang Bumhee , Kim So Rae , Kim Hee-Sung , Shin Kyeong Seob , Shin Yoon Mi
Published: January 2023

Rationale:

Disseminated nontuberculous mycobacterial (NTM) infections are rare and occur primarily in immunocompromised hosts. Mycobacterium abscessus complex (MABC), including M abscessus subsp. massiliense (hereafter M massiliense) is a complex of rapidly growing mycobacterial (RGM) species of NTM. Here, we present a rare case of disseminated NTM infection with RGM bacteremia caused by M massiliense in an immunocompetent host.

Patient concerns:

A 64-year-old woman with a recent history of spine fracture and septic pneumonia was transferred to our emergency room for dyspnea and fever. A peripherally inserted central catheter (PICC) had been placed over 6 months prior.

Diagnoses:

Chest computed tomography (CT) showed multifocal patchy consolidations and ground-glass opacity in both lungs. NTM suspected of RGM was isolated from the blood cultures. During hospitalization, multiple erythematous and hemorrhagic crusted nodules developed on the patient’s upper and lower extremities, which were confirmed as disseminated NTM infection on skin biopsy.

Interventions:

After NTM suspected of RGM was isolated from the blood cultures, the patient was empirically treated with antibiotics used for NTM infection, and the PICC was removed. Thereafter, the subspecies of NTM was reported as M massiliense and she was treated according to the antibiotic susceptibility testing results.

Outcome:

Although skin lesions and inflammatory markers improved gradually during antibiotic treatment over 10 weeks, NTM could still be isolated from the blood culture.

Lessons:

Disseminated NTM infections with RGM bacteremia in an immunocompetent host have rarely been reported. In this case, PICC placement for more than 6 months was suspected to be an important risk factor for RGM bacteremia in an immunocompetent patient. To date, there are only insufficient case reports, moreover no clear guidelines regarding the optimal choice of antibiotics or length of treatment for disseminated NTM infection. Therefore, it is necessary to establish treatment guidelines for patients with disseminated NTM infection and bacteremia.
Effect of educational music intervention on college students’ aggressive behaviour
Authors: Nwokenna Edith N. , Sewagegn Abatihun Alehegn , Falade Temitope Ayodeji
Published: January 2023

Background:

Students’ aggressive behavior and its negative implications have continued to intrigue researchers. Thus, the present study examined the effect of educational music intervention in reducing aggressive behavior among college students.

Method:

Quantitative data were collected from 30 college student participants in the treatment group and 30 college student participants in the control group using the teacher-rating of students’ aggressive behaviors and self-rated aggression scale instruments. This study adopted the IBM SPSS version 25 program and JASP statistical program for data analysis.

Results:

The result of the study indicated that college students in the educational music group showed considerable mean decline in aggressive behavior at posttest compared to their counterparts in the control group. At follow-up, it was revealed that educational music intervention consistently reduced the college students’ aggressive behavior.

Conclusion:

Educational music intervention proved to be a helpful intervention in reducing Nigerian college students’ aggressive behavior. In light of this, it would be beneficial to implement educational music intervention to reduce aggressive behavior among college students in other localities.
The efficacy and safety of Shenfu injection in patients undergoing percutaneous coronary intervention for ST segment elevation myocardial infarction: A protocol for systematic review and meta-analysis
Authors: Yan Xiafeng , Dong Minya , Qin Xiao , Li Nannan , Li Na
Published: January 2023

Background:

Shenfu injection is a traditional Chinese medicine formulation that alleviates ischemia–reperfusion injury through multiple pharmacologic effects. However, there is lack of evidence regarding its efficacy in myocardial infarction. We performed a protocol for systematic review and meta-analysis to evaluate the efficacy and safety of Shenfu injection for ST segment elevation myocardial infarction after primary percutaneous coronary intervention.

Methods:

This review has been reported following the preferred reporting items for systematic reviews and meta-analyses protocol. A literature search was performed in November 2022 without restriction to regions, publication types, or languages. The primary sources were the electronic databases of PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure database, Chinese Biomedical Database, and Chinese Science and Technology Periodical database. Risk of bias will be assessed according to the Cochrane Risk of Bias Tool. Data analysis was performed using Reviewer Manager 5.4.

Results:

The results of this systematic review will be published in a peer-reviewed journal.

Conclusion:

This systematic review will provide evidence to judge whether Shenfu injection is effective and safe in patients undergoing percutaneous coronary intervention for ST segment elevation myocardial infarction.
Laparoscopic fundoplication performed in community hospital settings: A protocol for systematic review
Authors: Fadaee Neesa , Gaszynski Rafael , Merrett Neil , Gray Andrew
Published: January 2023

Background:

Laparoscopic fundoplication (LF) is well-established as the surgical intervention of choice for management of refactory gastro-esophageal reflux disease. Much of its success lies in the reported benefits in symptom control outlined by the postoperative patient. It is unclear whether patient-reported outcomes differ according to the institution type providing care. This review aimed to address this knowledge gap by reviewing the available evidence examining patient-reported outcomes of LF in non-metropolitan centers.

Objectives:

To investigate patient-reported outcomes of LF performed in regional or community-based hospitals.

Data sources:

Four electronic databases, and citations of relevant articles.

Study eligibility criteria:

Only studies that separately reported patient-reported outcomes of LF performed in regional or community hospitals were included; papers deemed to be unclear about the type of facility in which LF surgeries were performed, or in which data from LF surgeries performed in regional/community hospitals was combined with data from major metropolitan hospitals, were excluded.

Study appraisal:

Only studies that were graded as fair or good using Quality Assessment Tool for Observational Cohort and Cross-sectional studies were eligible for inclusion in this review. Seven studies were then eligible for inclusion, all of which were observational cohort studies with 6 of the studies reporting on a single intervention arm.

Results:

Seven observational cohort studies were included in the review, with a combined total of 1071 patients who underwent LF at non-metropolitan centers. Of these, data was collected for 742 patients, yielding an overall response rate of 69.3%. All 7 studies assessed patients’ post-operative outcomes through questionnaires that were based on a modified Likert scale or a similar tool. Overall patient satisfaction was high (86%) and a significant majority of patients stated they would recommend the procedure to others (93.3%). Post-operative prevalence of reflux and dysphagia compared favorably to rates generally reported in the literature (11.9% and 17.6% respectively). Further research is required to ascertain the safety of performing these procedures in non-metropolitan hospitals.

Conclusion:

Current evidence suggests that patient-reported outcomes are favorable for patients undergoing LF in community settings, and are broadly comparable to those undergoing LF in tertiary-level centers.
The effect of heart rate variability biofeedback in patients with acute coronary syndrome: A protocol for systematic review and meta-analysis
Authors: Wang Yuxia , Liu Yinghua , Zeng Juan , Lu Haiying
Published: January 2023

Background:

Acute coronary syndrome (ACS), the acute manifestation of ischemic heart disease, remains a major cause of morbidity and mortality worldwide. Soon after ACS, autonomic imbalance acts to preserve the proper functioning of the cardiovascular system and consequently of the whole body. In this study, we perform a protocol for systematic review and meta-analysis to evaluate the efficacy of heart rate variability biofeedback in improving the prognosis in patients with ACS.

Methods:

The protocol of this review was registered in PROSPERO (CRD42022379184). Meanwhile, it will be reported follow the guidelines of the preferred reporting items for systematic reviews and meta-analyses protocol. We will search 3 foreign electronic databases (Cochrane Library, Embase, Pubmed) and 4 Chinese electronic databases (China National Knowledge Infrastructure, WangFang Database, Chinese Biomedical Literature Database and Chinese Scientific Journal Database) to collect potential studies from their inceptions to December 2022. Risk of bias will be assessed according to the Cochrane Risk of Bias Tool. Data synthesis and statistical analysis will be performed using the RevMan 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, Denmark) software.

Results:

The results of this systematic review will be published in a peer-reviewed journal.

Conclusion:

This systematic review will provide high quality evidence to assess the efficacy of heart rate variability biofeedback in patients with ACS.
Citrobacter freundii induces sepsis with new-onset status seizure in an adult: A case report and literature review
Authors: Chen Xiao-bo , Zhou Ya-xiong , Feng Yan
Published: January 2023

Rationale:

Sepsis with brain abscess induced by Citrobacter freundii in adults has rarely been reported and is extremely pathogenic with a high mortality rate. Early diagnosis of the infection still remains challenging.

Patient Concerns:

A 27-year-old woman was transferred to our emergency department for fever, status seizure and refractory hypotension. Administration of midazolam, propofol and sodium valproate could not attenuate the seizure except for the addition of vecuronium. The blood white blood cell count was 42.91 (109/L) with 80% neutrophils, and procalcitonin was 22.46ng/mL.

Diagnoses:

Both deoxyribonucleic acid and ribonucleic acid of C freundii were detected in blood by metagenomic next-generation sequencing of pathogens,the diagnosis of septic shock and brain abscess caused by C freundii was highly suspected.

Interventions:

On day 1, antibiotics of cefoperazone sodium and sulbactam sodium 6g/day, immunoglobulin, and hydrocortisone were used with suspected septic shock. Continuous renal replacement therapy was used to eliminate excessive lactate, ammonia, myohemoglobin and creatinine. On day 2, a brain computed tomography scan revealed multiple patchy slightly low densities in the brain, antibiotics were adjusted to meropenem intravenously 3g/day.

Outcomes:

On day 2, a brain computed tomography scan revealed multiple patchy slightly low densities in the brain, she died on day 3.

Lessons:

Clinicians should consider the possibility of brain abscess when evaluating a patient with new-onset dizziness, fever, seizure, or other neurologic symptoms or signs, especially for patients whose mental status changes. metagenomic next generation sequencing and resistance genes could be considered when cerebrospinal fluid or blood results are negative and clinical manifestations are highly suspected of infection or when the treatment time is limited.
Clinical and genetic diagnosis of Cowden syndrome: A case report of a rare PTEN germline variant and diverse clinical presentation
Authors: Arai Hironori , Akagi Kiwamu , Nakagawa Ayako , Onai Yasuhide , Utsu Yoshikazu , Masuda Shinichi , Aotsuka Nobuyuki
Published: January 2023

Introduction:

Cowden syndrome is a rare autosomal dominant disease characterized by the development of hamartomas and increased risks of other tumors, including breast, thyroid, and uterine cancers. Most patients with Cowden syndrome show mutations of the phosphatase and tensin homolog (PTEN) gene on chromosome 10; however, some patients with mutations do not show clinical symptoms, while patients with clinical symptoms may not have detectable PTEN mutations.

Case presentation:

A 39-year-old woman with macrocephaly had previously been diagnosed with Cowden syndrome at another hospital, when she presented with the onset of breast cancer. A wide variety of complications were detected, including cerebellar tumors treated by resection, hydrocephalus, and multiple polyps in the stomach and large intestine. She was further diagnosed with adult-onset Lhermitte–Duclos disease as a complication of Cowden syndrome. She subsequently developed a dural arteriovenous fistula treated by transvenous embolization. After transfer to our hospital, she developed adenomatous goiter treated by resection, recurrent breast cancer treated with hormonal therapy, and multifocal oral mucosal papillomatosis. Her older sister had previously been diagnosed with Cowden syndrome and her father was undiagnosed but had macrocephaly, hydrocephalus, and multifocal oral mucosal papillomatosis, suggestive of Cowden syndrome. After consultation with a genetic specialist, analysis of the PTEN gene showed a rare but likely pathogenic germline c.801 + 2T>A variant located at the splice donor site of intron 7. The patient’s clinical diagnosis of Cowden syndrome was accordingly confirmed by the genetic findings. Appropriate surveillance procedures were put in place to detect any further tumors.

Conclusions:

The clinical symptoms of Cowden syndrome do not always correlate with the genetic results. However, recent improvements in genetic testing suggest the importance of diagnosing this disease using both clinical and genetic approaches, in collaboration with genetic experts, to ensure an accurate diagnosis and appropriate surveillance for malignant tumors.
Acupoint stimulation for alcohol use disorder: A systematic review and meta-analysis
Authors: Chen Huishan , Feng Jiaxin , Chen Li , Huang Jiarong , Zhang Peiming , Chen Chen , Lu Liming , Tang Chunzhi
Published: January 2023

Background:

To assess the effect of acupoint stimulation for Alcohol use disorders (AUD).

Methods:

AUD is a complex disease that threatens the health of the global population. Acupoint stimulation, a sort of therapy applying stimulation on acupoints to produce a therapeutic effect without side effects, has been widely used in AUD patients, but its efficacy remains controversial. Electronic databases (the Cochrane Library, EMBASE, PubMed, CNKI, VIP, Wan-Fang) were systematically searched for randomized controlled trials (RCTs) on acupoint stimulation for AUD from database inception to September 30, 2022. A meta-analysis was performed using Review Manager 5.4 software. Continuous data (scales) were expressed as mean differences (MDs) or standardized mean difference (SMD) with 95% confidence intervals (95% CI). Study methodological quality was assessed according to the Cochrane risk-of-bias tool for trials. The grading of recommendations assessment, development and evaluation was used to assess the certainty of evidence for outcomes.

Results:

A total of 16 RCTs with 1097 participants were included. Compared to psychotherapy or drug therapy alone, the combination of acupoint stimulation and other sorts of therapies presented advantages in alleviating alcohol craving (SMD = –1.09, 95% CI = –1.40 to –0.77, df = 2, P < .00001, grading of recommendations assessment, development and evaluation very low certainty), (SMD = –2.25, 95% CI = –3.17 to –1.34, df = 3, P < .00001, low certainty) and the severity of alcohol withdrawal symptoms (MD = –1.21, 95% CI = –2.32 to –0.1, df = 2, P = .03, low certainty), as well as improving anxiety (MD = –3.41, 95% CI = –4.06 to –2.76, df = 4, P < .00001, very low certainty) and depression levels (MD = –3.27, 95% CI = –4.92 to –1.62, df = 4, P = .0001, very low certainty) on patients with AUD. In addition, a greater effect was also found with the 4-week treatment courses in reducing craving (SMD = –2.18, 95% CI = –2.61 to –1.75, P < .00001, low certainty).

Conclusion:

Acupoint stimulation and its combined therapy may better relieve AUD symptoms effectively and the treatment duration should be set at more than 2 weeks. However, due to the low-quality of the included RCTs, high-quality studies are needed to further confirm it in the future.
Spontaneous regression of immunoglobulin G4-related dacryoadenitis and multiple organ involvement: A case report
Authors: Ito Mayari , Vaidya Aric , Kakizaki Hirohiko , Takahashi Yasuhiro
Published: January 2023

Purpose:

Immunoglobulin G4 (IgG4)-related dacryoadenitis is rarely resolved spontaneously without steroids. Here, we report a case of IgG4-related dacryoadenitis and extra-ophthalmic lesions with spontaneous regression.

Methods:

This is a clinical case report. A 56-years-old man had a 1-year and 7-month-old histories of neck and eyelid swelling, respectively. On the first examination, the lacrimal and submandibular glands were palpable bilaterally. Computed tomographic images showed enlargement of the lacrimal gland on both sides, right pulmonary hilar lymph node, and pancreas, and thickening of the abdominal aortic wall. Blood tests demonstrated elevated serum IgG4 level and positive hepatitis B surface antibody. Pathological examination of the biopsied lacrimal gland specimens revealed marked IgG4-positive plasma cell infiltration.

Results:

The patient was monitored carefully without steroid administration. Serum IgG4 level had gradually decreased during follow-up period and reached the normal range 3 years after the biopsy. At 4-year follow-up, the lacrimal and submandibular glands were not palpable on either side. Computed tomographic images demonstrated no enlargement of the lacrimal gland, submandibular gland, or lymph nodes, and improvement of the enlarged pancreas and thickened abdominal aortic wall.

Conclusion:

Our case indicates that careful observation can be an option in selected cases with risks of steroid treatment or silent clinical course.
The effect of ultrasound-guided acupotomy and Juanbi decoction on lumbar disc herniation: A randomized controlled trial
Authors: Wang Ye-hui , Zhou Yi , Xie Yi-zhou , Fan Xiao-hong , Liang Wan-qiang , Wei Xing , Zhao Ming-dong , Huo Yu-xiong , Zhang Ting , Yin Yun
Published: January 2023

Background:

Acupotomy as well as Juanbi decoction has been used in the treatment of lumbar disc herniation. However, there is no study on ultrasound-guided acupotomy combined with Juanbi decoction in the treatment of lumbar disc herniation.

Method:

This study was supported by the Sichuan Provincial Administration of Traditional Chinese Medicine [grant number: 2020LC0163] and the Science and Technology Department of Sichuan Province [grant number: 2022YFS0418]. This study was 3 center, open, randomized, controlled trial, and was carried out from December 2020 to December 2022. A total of 60 eligible patients with LDH were split into group A and group B at random. The group B received Juanbi Decoction 3 times daily for 2 weeks along with an acupotomy assisted by ultrasound. The acupotomy was administered once a week. The same protocol was used with the group A, but the Juanbi Decoction was replaced with normal saline.

Observation index:

Visual analogue scale (VAS) score on 1 day and 1 week after treatment, VAS score, Japanese orthopedic association low back pain score(JOA) rate, Oswestry Disability Index (ODI), and low back outcome scale (LBOS) at 1, 3, 6, and 12 months after treatment in 2 groups.

Results:

There were no significant differences in general information, VAS score before treatment, JOA, ODI, and LBOS between the 2 groups (P > .05). Intra-group comparison: VAS score, JOA rate, ODI, and LBOS were compared before and after treatment in both groups, and the differences were statistically significant (P < .05). There were significant differences in VAS and LBOS between the 2 groups at 3 and 6 months after treatment, and there were statistically significant differences in ODI and JOA rates at 3, 6, and 12 months after treatment between the 2 groups.

Conclusion:

Acupotomy aided by ultrasound combined with Juanbi Decoction significantly relieves lumbar pain and can improve lumbar function in patients with LDH, and the clinical efficacy lasts for about 6 months.