bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial Intelligence to Preoperatively Predict Proximal Junction Kyphosis Following Adult Spinal Deformity Surgery: Soft Tissue Imaging May Be Necessary for Accurate Models
Authors: Johnson Graham W. , Chanbour Hani , Ali Mir Amaan , Chen Jeffrey , Metcalf Tyler , Doss Derek , Younus Iyan , Jonzzon Soren , Roth Steven G. , Abtahi Amir M. , Stephens Byron F. , Zuckerman Scott L.
Published: August 2023

Study Design.

Retrospective cohort.

Objective:

In a cohort of patients undergoing adult spinal deformity (ASD) surgery, we used artificial intelligence to compare three models of preoperatively predicting radiographic proximal junction kyphosis (PJK) using: (1) traditional demographics and radiographic measurements, (2) raw preoperative scoliosis radiographs, and (3) raw preoperative thoracic magnetic resonance imaging (MRI).

Summary of Background Data.

Despite many proposed risk factors, PJK following ASD surgery remains difficult to predict.

Materials and Methods.

A single-institution, retrospective cohort study was undertaken for patients undergoing ASD surgery from 2009 to 2021. PJK was defined as a sagittal Cobb angle of upper-instrumented vertebra (UIV) and UIV+2>10° and a postoperative change in UIV/UIV+2>10°. For model 1, a support vector machine was used to predict PJK within 2 years postoperatively using clinical and traditional sagittal/coronal radiographic variables and intended levels of instrumentation. Next, for model 2, a convolutional neural network (CNN) was trained on raw preoperative lateral and posterior-anterior scoliosis radiographs. Finally, for model 3, a CNN was trained on raw preoperative thoracic T1 MRIs.

Results.

A total of 191 patients underwent ASD surgery with at least 2-year follow-up and 89 (46.6%) developed radiographic PJK within 2 years. Model 1: Using clinical variables and traditional radiographic measurements, the model achieved a sensitivity: 57.2% and a specificity: 56.3%. Model 2: a CNN with raw scoliosis x-rays predicted PJK with a sensitivity: 68.2% and specificity: 58.3%. Model 3: a CNN with raw thoracic MRIs predicted PJK with average sensitivity: 73.1% and specificity: 79.5%. Finally, an attention map outlined the imaging features used by model 3 elucidated that soft tissue features predominated all true positive PJK predictions.

Conclusions.

The use of raw MRIs in an artificial intelligence model improved the accuracy of PJK prediction compared with raw scoliosis radiographs and traditional clinical/radiographic measurements. The improved predictive accuracy using MRI may indicate that PJK is best predicted by soft tissue degeneration and muscle atrophy.
Advances in immunotherapy for biliary tract cancers
Authors: Zhao Yuhao , Yang Mao , Feng Jiayi , Wang Xu'an , Liu Yingbin
Published: August 2023

Biliary tract cancers (BTC), a heterogeneous disease with poor prognosis, including gallbladder cancer (GBC), intrahepatic cholangiocarcinoma (ICC), and extrahepatic cholangiocarcinoma (ECC). Although surgery is currently the primary regimen to treat BTC, most BTC patients are diagnosed at an advanced stage and miss the opportunity of surgical eradication. As a result, non-surgical therapy serves as the main intervention for advanced BTC. In recent years, immunotherapy has emerged as one of the most promising therapies in a number of solid cancers, and it includes immune checkpoint inhibitors (ICIs) monotherapy or combined therapy, tumor vaccines, oncolytic virus immunotherapy, adoptive cell therapy (ACT), and cytokine therapy. However, these therapies have been practiced in limited clinical settings in patients with BTC. In this review, we focus on the discussion of latest advances of immunotherapy in BTC and update the progress of multiple current clinical trials with different immunotherapies.
Genetically predicted waist circumference and risk of atrial fibrillation
Authors: Wang Wenting , Tan Jiang-shan , Wang Jingyang , Xu Wei , Bai Liting , Jin Yu , Gao Peng , Zhang Peiyao , Li Yixuan , Yang Yanmin , Liu Jinping
Published: August 2023

Introduction:

Observational studies have revealed an association between waist circumference (WC) and atrial fibrillation (AF). However, it is difficult to infer a causal relationship from observational studies because the observed associations could be confounded by unknown risk factors. Therefore, the causal role of WC in AF is unclear. This study was designed to investigate the causal association between WC and AF using a two-sample Mendelian randomization (MR) analysis.

Methods:

In our two-sample MR analysis, the genetic variation used as an instrumental variable for MR was acquired from a genome-wide association study (GWAS) of WC (42 single nucleotide polymorphisms with a genetic significance of P <5 × 10–8). The data of WC (from the Genetic Investigation of ANthropometric Traits consortium, containing 232,101 participants) and the data of AF (from the European Bioinformatics Institute database, containing 55,114 AF cases and 482,295 controls) were used to assess the causal role of WC on AF. Three different approaches (inverse variance weighted [IVW], MR–Egger, and weighted median regression) were used to ensure that our results more reliable.

Results:

All three MR analyses provided evidence of a positive causal association between high WC and AF. High WC was suggested to increase the risk of AF based on the IVW method (odds ratio [OR] = 1.43, 95% confidence interval [CI], 1.30–1.58, P = 2.51 × 10-13). The results of MR–Egger and weighted median regression exhibited similar trends (MR–Egger OR = 1.40 [95% CI, 1.08–1.81], P = 1.61 × 10-2; weighted median OR = 1.39 [95% CI, 1.21–1.61], P = 1.62 × 10-6). MR–Egger intercepts and funnel plots showed no directional pleiotropic effects between high WC and AF.

Conclusions:

Our findings suggest that greater WC is associated with an increased risk of AF. Taking measures to reduce WC may help prevent the occurrence of AF.
Novel Biomaterial Containing Gelatin, Manuka Honey, and Hydroxyapatite Enhanced Secondary Intention Healing Versus Standard Secondary Intention Healing in Mohs Surgical Defects on the Head and Distal Lower Extremities—A Randomized Controlled Trial: Pilot Study
Authors: Arnaud Karen , Wallace Matthew M. , Wheless Lee E. , Stebbins William G. , Clayton Anna S.
Published: August 2023

BACKGROUND

Randomized, comparative studies evaluating augmented secondary intention healing (SIH) compared with conventional SIH in dermatologic surgery are limited. This study aimed to evaluate whether the use of a novel biomaterial enhances SIH, particularly in shortening time to complete re-epithelialization.

OBJECTIVE

The purpose of this study was to elucidate whether a novel biomaterial containing gelatin, manuka honey, and hydroxyapatite enhances SIH when compared with conventional SIH for surgical defects after Mohs micrographic surgery (MMS) on the head and distal lower extremities.

MATERIALS AND METHODS

Thirty-seven patients were enrolled in this randomized controlled trial. Patients undergoing MMS on the head or distal lower extremities were eligible for recruitment. After clear surgical margins were obtained post-MMS, patients were randomized to receive standard SIH or biomaterial enhanced SIH. Patients had regularly scheduled follow-ups with questionnaires at each visit until complete re-epithelialization was achieved.

RESULTS

Overall, there was no significant difference in time to re-epithelialization between standard SIH and biomaterial-enhanced SIH. However, there was a significant decrease in pain scores and skin thickness in the biomaterial-enhanced SIH group.

CONCLUSION

Biomaterial-enhanced SIH is noninferior to standard SIH and produces less pain and favorable skin thickness compared with standard SIH. ClinicalTrials.gov listing: NCT04545476.
Supporting Women’s BIA-ALCL Decision-making: Role of the Individual Consult in Empowering the Patient–Physician Team
Authors: Park Jade O. , Webb Carmen E. , Temple-Oberle Claire F.
Published: August 2023

Background:

Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a T-cell non-Hodgkin’s lymphoma and an uncommon risk of textured breast implants. Over the past decade, concern about BIA-ALCL has been increasing among both patients and surgeons. Patients are seeking a better understanding of their BIA-ALCL risk toward identifying a personalized care plan. This quality improvement project examines the value added by pairing group-based patient education seminars with one-on-one consults.

Methods:

Individual consults were held following educational group seminars. Consult field notes underwent qualitative thematic analysis. Themes were cross referenced against a quantitative chart review of patient BIA-ALCL prophylaxis decisions over time.

Results:

Four key themes were identified: weighing, perceiving, guiding, and supporting. Weighing considers the risk-benefit assessments patients make when weighing their BIA-ALCL risk. Perceiving describes the underlying psychosocial factors that frame patient perceptions of BIA-ALCL risk. Guiding presents the levels of guidance that patients require when making BIA-ALCL prophylaxis decisions. Supporting explores the therapeutic value of the individual consult. Ultimately, 41% of post-seminar consult attendees sought explantation, compared with 4% among patients who did not participate in this program (P < 0.001).

Conclusions:

Key lessons include the following: (1) patients weigh BIA-ALCL risk against perceived surgical risks and the value of their reconstruction; (2) patients can benefit from a personalized balance of autonomy and surgeon guidance when selecting a BIA-ALCL prevention plan; (3) surgeons should seek to understand the psychosocial factors that may underlie patient perceptions of BIA-ALCL risk; and (4) individual consults can be therapeutic and help strengthen the patient–surgeon relationship.
Evaluation of Artificial Intelligence–generated Responses to Common Plastic Surgery Questions
Authors: Copeland-Halperin Libby R. , O’Brien Lauren , Copeland Michelle
Published: August 2023

Background:

Artificial intelligence (AI) is increasingly used to answer questions, yet the accuracy and validity of current tools are uncertain. In contrast to internet queries, AI generates summary responses as definitive. The internet is rife with inaccuracies, and plastic surgery management guidelines evolve, making verifiable information important.

Methods:

We posed 10 questions about breast implant-associated illness, anaplastic large lymphoma, and squamous carcinoma to Bing, using the “more balanced” option, and to ChatGPT. Answers were reviewed by two plastic surgeons for accuracy and fidelity to information on the Food and Drug Administration (FDA) and American Society of Plastic Surgeons (ASPS) websites. We also presented 10 multiple-choice questions from the 2022 plastic surgery in-service examination to Bing, using the “more precise” option, and ChatGPT. Questions were repeated three times over consecutive weeks, and answers were evaluated for accuracy and stability.

Results:

Compared with answers from the FDA and ASPS, Bing and ChatGPT were accurate. Bing answered 10 of the 30 multiple-choice questions correctly, nine incorrectly, and did not answer 11. ChatGPT correctly answered 16 and incorrectly answered 14. In both parts, responses from Bing were shorter, less detailed, and referred to verified and unverified sources; ChatGPT did not provide citations.

Conclusions:

These AI tools provided accurate information from the FDA and ASPS websites, but neither consistently answered questions requiring nuanced decision-making correctly. Advances in applications to plastic surgery will require algorithms that selectively identify, evaluate, and exclude information to enhance the accuracy, precision, validity, reliability, and utility of AI-generated responses.
Health-related Quality of Life Profile of Newly Diagnosed Patients With Myelodysplastic Syndromes by Age, Sex, and Risk Group: A Real-world Study by the GIMEMA
Authors: Efficace Fabio , Al Essa Wael , Platzbecker Uwe , Niscola Pasquale , Palumbo Giuseppe A. , Caocci Giovanni , Cottone Francesco , Breccia Massimo , Luppi Mario , Stauder Reinhard , Ricco Alessandra , Petranovic Duska , Baron Frederic , Voso Maria Teresa , Fianchi Luana , Frairia Chiara , Capodanno Isabella , Sarlo Chiara , Fedele Marilena , Lemoli Roberto Massimo , Invernizzi Rosangela , Vallisa Daniele , Di Renzo Nicola , Fozza Claudio , Doro Maribel , Giesinger Johannes M. , Vignetti Marco
Published: August 2023

Health-related quality of life (HRQoL) is an important goal of therapy for patients with myelodysplastic syndromes (MDS); however, little is known about HRQoL of these patients at clinical presentation. We report HRQoL profile of newly diagnosed patients with MDS across both the the International Prognostic Scoring System (IPSS) and IPSS-Revised (IPSS-R) classifications, stratified by sex and age group categories, aiming to also establish European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 (EORTC QLQ-C30) reference values for these patients. Analysis was based on 927 patients with a median age of 73.3 years (interquartile range, 66.0–79.2), of whom 506 and 421 with lower- and higher-risk disease respectively, according to the IPSS classification. HRQoL was assessed with the EORTC QLQ-C30 and substantial differences by age groups and sex, between and within lower- and higher-risk disease categories were observed. For example, within higher-risk disease patients, the youngest group (ie, 30–59 years) tended to report clinically meaningful worse outcomes across various functional and symptom domains compared with older age groups. We also developed 2 regression models allowing for the prediction of EORTC QLQ-C30 reference scores for patients classified according to either the IPSS or the IPSS-R. Investigation of prevalence rates for clinically important problems and symptoms at diagnosis revealed a substantial burden of the disease with >50% of patients reporting clinically important problems with physical functioning and dyspnea in both lower- and higher-risk disease. Our findings may help to enhance the interpretation of HRQoL outcomes in future MDS studies and to better contextualize HRQoL data from routine practice settings.
Intracranial Empyema in Children: A Single-center Retrospective Case Series
Authors: Gilchrist James J. , Hoy Tom , Bijker Else M. , Lees Emily A. , Wilkins Laura , Oliver Madeleine , Kelly Dominic F. , Paulus Stéphane C. , Calisto Amedeo
Published: August 2023

We conducted a retrospective, observational study of 42 children with intracranial empyema admitted to a pediatric neurosurgical center over a 9-year period. Intracranial empyema is rare, but causes significant morbidity and mortality. Twenty-eight cases had neurosurgical source control, more commonly for subdural collections. Streptococcus anginosus group bacteria are important pathogens in subdural empyema, whose isolation predicts more complicated postoperative courses.
Students' Perception of Servant Leadership by Physical Therapy Faculty Mentors Is Associated With Interprofessional Socialization
Authors: Willis Brad W.
Published: August 2023

Introduction.

Promoting interprofessional collaborative practice (IPCP) is necessary. Consequently, investigating strategies associated with increased interprofessional socialization, the beliefs, behaviors, and attitudes underlying socialization toward IPCP is suggested. The purpose of this study was to examine the relationship, in the presence of control variables, between students' perception of servant leadership by physical therapy faculty mentors and interprofessional socialization.

Review of the Literature.

Although faculty mentors are associated with influencing students' socialization process and servant leadership is suggested to support collaborative care, investigations exploring these concepts within physical therapy education are limited.

Subjects.

Three cohorts of students (60 each) at an entry-level physical therapist education program in the Midwest of the United States. One hundred seventy individuals completed an anonymous paper-based composite survey, with 117 identifying the presence of an informal physical therapy faculty mentor.

Methods.

This cross-sectional survey study, inclusive of student demographic control variables, examined the relationship between interprofessional socialization and perceptions of physical therapy faculty mentors, as measured by the Interprofessional Socialization and Valuing Scale (ISVS-21) and the Servant Leadership Measure (SL-7), respectively. Multiple linear regression was used to obtain the semi-partial correlation (sr) between the SL-7 and the ISVS-21, with significance accepted at P < .05.

Results.

Upon necessary assumptions being met, 114 participants were included with an analysis of variance identifying the model to be significant (F(8,105) = 2.59, P = .01). Multiple linear regression analysis found that the SL-7, in the presence of control variables, was associated with a significant proportion of ISVS-21 scores (R
2 = 0.17, F(8,105) = 2.59, P = .01). Notably, only the SL-7 demonstrated a significant contribution to ISVS-21 estimates (β = 0.358, P < .001), with a significant and positive sr of 0.34 (P < .001).

Discussion and Conclusion.

Perceptions of servant leadership by faculty mentors were positively correlated with interprofessional socialization. Findings bolster the theoretical link between servant leadership and interprofessional socialization, servant leadership in the development of faculty and mentorship programs, and the relevance of informal social interactions.
What the X? Understanding changes in buprenorphine prescribing regulation
Authors: Speight Chandra
Published: August 2023

Opioid use disorder remains an epidemic in the United States. Buprenorphine is a Food and Drug Administration–approved medication for opioid use disorder that is associated with decreased opioid-related mortality and morbidity. Until recently, providers had to have a specialized wavier, a Drug Enforcement Agency (DEA) X, to prescribe buprenorphine for opioid use disorder. The 2023 Consolidated Appropriations Act, signed into law by President Biden, removed X waiver requirements and implements new training requirements for all new and renewing DEA registrants. This brief report outlines the history of buprenorphine prescribing regulation, reviews the recent regulatory changes and their implications for nurse practitioner buprenorphine prescribing, and concludes by considering the importance of promoting buprenorphine access.
Point-of-care Ultrasound (POCUS) Program for Critical Care Nurse Practitioners and Physician Assistants in an Oncological Intensive Care Unit and Rapid Response Team
Authors: Chen Leon L. , Tayban Kate , Tomicich Joanna , Buchholz Tara , Barzola Melissa , Mead Elena , Halpern Neil A.
Published: August 2023

Implementation of a comprehensive point-of-care ultrasound (POCUS) program for nurse practitioners (NPs) and physician assistants (PAs) in an intensive care unit (ICU) setting improves their diagnostic and therapeutic skills and enhances patient care. Overcoming staffing, IT infrastructure, and administrative challenges has allowed our critical care medicine service to develop a successful program that empowers NPs and PAs and boosts their professional growth. Our POCUS program underscores the necessity of institutional support, dedicated mentorship, collaboration with qualified faculty, and creation and maintenance of a curriculum that adheres to accepted national guidelines. Insights gained from our experiences can serve as a valuable resource for institutions aiming to develop their own POCUS programs.
Autosomal recessive otospondylo-mega-epiphyseal dysplasia: comprehensive clinical review of a pediatric cohort
Authors: Mutlu Hatice , Elçioğlu Nursel , Kiliç Esra
Published: August 2023

Autosomal recessive otospondylo-mega-epiphyseal dysplasia (OSMEDB) is characterized by short stature with short limbs, dysmorphic facial features, and hearing loss, which is caused by biallelic, loss-of-function, variants in the COL11A2 gene. Geno-phenotypic data from the medical records of eight affected individuals from five unrelated families was abstracted, recorded in an Excel spreadsheet and analyzed using simple frequency analysis. Either short femora or short extremities with or without other ultrasonographic abnormalities were demonstrated in five patients antenatally. The mean height was -2.29 SDS. Pectus deformity, including either chest asymmetry or pectus excavatum, was present in five patients. Bilateral hearing loss was verified in all patients. Severe speech delay and learning disabilities were present in two patients whose deafness was realized after the age of 12 months. Four novel loss-of-function variants in COL11A2 were found in this cohort. We present novel geno-phenotypic findings in a pediatric cohort with OSMEDB. The age of manifestation of short stature was variable, ranging from birth to middle childhood, and the severity of short stature varied even within the same family. Hearing loss may not be evident in the neonatal period and manifest later in OSMEDB. Intermittent hearing tests should be performed for early intervention of neurolinguistic delay and learning disabilities.
Clinical and molecular study of Egyptian patients with Treacher Collins syndrome
Authors: Elbagoury Nagham M. , Nabil Amira , Abdel-Aleem Asmaa F. , Habib Ahmed , Ashaat Engy A. , Sharaf-Eldin Wessam E. , Esswai Mona L.
Published: August 2023

Treacher Collins syndrome (TCS) is a rare disorder of craniofacial development following different patterns of inheritance. To date, mutations in four genes (TCOF1, POLR1D, POLR1C, and POLR1B) have been found to cause the condition. The molecular defect remains unidentified in a significant proportion of patients. In the current study, whole exome sequencing including analysis of copy number variants was applied for genetic testing of eight Egyptian patients with typical TCS phenotype, representing the first molecular analysis of TCS patients in Egypt as well as in Arab countries. Five heterozygous frameshift mutations were reported, including four variants in the TCOF1 gene (c.3676_3694delinsCTCTGG, c.3984_3985delGA, c.4366_4369delGAAA, and c.3388delC) and one variant in the POLR1D gene (c.60dupA). Four variants were novel extending the disease mutation spectrum. In three affected individuals, no variants of interest were identified in genes associated with TCS or clinically overlapping conditions. Additionally, no relevant variant was detected in genes encoding other subunits of RNA polymerase (pol) I. Molecular analysis is important to provide accurate genetic counseling. It would also contribute to reduced disease incidence. Further studies should be designed to investigate other possible etiologies when no pathogenic variants were revealed in either of the known genes.
Application of a New Hemostatic Clip to Prevent Delayed Bleeding After Endoscopic Sphincterotomy
Authors: Dong Jinpei , Feng Qiushi , Teng Guigen , Niu Haixia , Bian Dapeng
Published: August 2023

Background and Aim:

Delayed bleeding after endoscopic sphincterotomy (ES) is a serious adverse event of endoscopic retrograde cholangiopancreatography. The aim of this study is to evaluate the effect of prevent delayed bleeding of hemostatic clip (Sureclip) after ES.

Methods:

Consecutive patients diagnosed with common bile duct stones with a high risk of delayed bleeding who received ES from January 1, 2013, to July 31, 2022, were analyzed retrospectively. A 1:1 propensity score–matching analysis and logistic regression analysis were used. The patients were allocated into the hemostatic clip and control groups. The rate of delayed bleeding, hyperamylasemia, pancreatitis, and hemostatic clip closing the bile duct or pancreatic duct by mistake were compared between the 2 groups.

Results:

Overall, 161 and 232 patients were allocated to the control and hemostatic clip groups, respectively, propensity score matching created 120 matched pairs. The rate of delayed bleeding was significantly lower in the hemostatic clip group than in the control group (1.67% vs. 7.5%, P=0.031). After adjusting for confounding factors, logistic regression showed hemostatic clip was associated with decreased odds of delayed bleeding (0.134, 95% CI: 0.025-0.719). No case of hemostatic clip closing the bile duct or pancreatic duct by mistake occurred in the hemostatic clip group. No significant differences were observed in postoperative hyperamylasemia and pancreatitis between the 2 groups.

Conclusions:

This study indicated that the prophylactic application of a hemostatic clip is associated with a significantly reduced rate of delayed bleeding after ES in high-risk patients. This approach did not increase the risk of adverse event.
Application Value of the Automated Machine Learning Model Based on Modified Computed Tomography Severity Index Combined With Serological Indicators in the Early Prediction of Severe Acute Pancreatitis
Authors: Zhang Rufa , Yin Minyue , Jiang Anqi , Zhang Shihou , Liu Luojie , Xu Xiaodan
Published: August 2023

Background and Aims:

Machine learning (ML) algorithms are widely applied in building models of medicine due to their powerful studying and generalizing ability. To assess the value of the Modified Computed Tomography Severity Index (MCTSI) combined with serological indicators for early prediction of severe acute pancreatitis (SAP) by automated ML (AutoML).

Patients and Methods:

The clinical data, of the patients with acute pancreatitis (AP) hospitalized in Hospital 1 and hospital 2 from January 2017 to December 2021, were retrospectively analyzed. Serological indicators within 24 hours of admission were collected. MCTSI score was completed by noncontrast computed tomography within 24 hours of admission. Data from the hospital 1 were adopted for training, and data from the hospital 2 were adopted for external validation. The diagnosis of AP and SAP was based on the 2012 revised Atlanta classification of AP. Models were built using traditional logistic regression and AutoML analysis with 4 types of algorithms. The performance of models was evaluated by the receiver operating characteristic curve, the calibration curve, and the decision curve analysis based on logistic regression and decision curve analysis, feature importance, SHapley Additive exPlanation Plot, and Local Interpretable Model Agnostic Explanation based on AutoML.

Results:

A total of 499 patients were used to develop the models in the training data set. An independent data set of 201 patients was used to test the models. The model developed by the Deep Neural Net (DL) outperformed other models with an area under the receiver operating characteristic curve (areas under the curve) of 0.907 in the test set. Furthermore, among these AutoML models, the DL and gradient boosting machine models achieved the highest sensitivity values, both exceeding 0.800.

Conclusion:

The AutoML model based on the MCTSI score combined with serological indicators has good predictive value for SAP in the early stage.
Feeding modality evolution in traumatic brain injury patients with severe alteration of consciousness: A observational study
Authors: Prum Grégoire , Cadeau Anna , Mallart Remi , Verin Eric
Published: August 2023

The aim of this study was to compare feeding modalities and the level of consciousness in patients with a severe brain injury during reeducation and rehabilitation. The clinical data of vegetative state or minimal conscious state due to severe traumatic brain injury hospitalized in a coma arousal unit were collected from 2012 to 2019. Feeding modalities were evaluated clinically and with functional endoscopy evaluation of swallowing or video fluoroscopy and functional oral intake scale. Evolution of consciousness was evaluated using Wessex Head Injury Matrix scale (WHIM). Comparison between WHIM score and feeding modalities were performed at admission and at discharge of the arousal unit. Of the 93 patients considered, 33 were included corresponding to inclusion criteria (traumatic brain injury, disorder of consciousness and age > 18 years). The mean age was 44.8 ± 16.8 years, and there were 6 females for 27 males. At admission, all patients were fed by gastrostomy (n = 25) or by nasogastric tube (n = 8) and 27 had a tracheostomy. At discharge, 10 patients keep an exclusive alimentation by gastrostomy (Group 1, G1) as 23 had exclusive oral feeding (Group 2, G2). The score of the WHIM at admission was identical in both groups (21.7 ± 10.9 (G1) vs. 21.0 ± 15.33 (G2) (ns)). At discharge, WHIM increased to 38.3 ± 15.4 in G1 and to 49.8 ± 9.7 in G2 (P < .05). WHIM score was significantly higher in G2 than in G1 (P < .05). There was a positive correlation between functional oral intake scale and WHIM at discharge. Our results demonstrated that recovery of oral feeding in patients with a severe traumatic brain injury appeared in those who had the better improvement of consciousness level.
General anesthesia in patients with hepatic encephalopathy and acute variceal bleeding undergoing endoscopic treatment: A retrospective study
Authors: Chen Tao , Wen Lin , Zhong Rui , Chen Xia
Published: August 2023

The management of cirrhotic patient with encephalopathy and acute variceal bleeding (AVB) remains a clinical challenge with a high mortality. Early endoscopic therapies are frequently applied in patients with AVB. However, the application of general anesthesia in endoscopic surgery for patients with hepatic encephalopathy (HE) is pretty challenging. The present study aimed to evaluate the possible effect of general anesthesia with tracheal intubation on patient complicated with encephalopathy and AVB during endoscopic procedure. Thirty-six cirrhotic patients with encephalopathy and AVB were retrospectively studied, 14 patients underwent endoscopic treatment under general anesthesia with tracheal intubation, and 22 patients received pharmacological treatment, or and endoscopic therapy without general anesthesia served as the control group. Routine clinical and laboratory data were collected. The total mortality rate was 13.9% (5/36), 2 (14.3%) in the anesthesia group, 3 (13.6%) in the control group. The child-Pugh class of death cases were all grade C, 3 (60%) of them were in the stage IV of HE. The stage of HE was all improved in the 2 groups, 12 (85.8 %) patients were totally recovered from consciousness disturbance in the anesthesia group and 16 (72.7 %) in the control group respectively, the difference between the 2 groups was not significant (P>0.05). Except the death cases, there were still 3 patients in the control group had impaired consciousness at discharge. Child-Pugh score, Child-Pugh class and the stage of HE in the anesthesia group were significantly improved at discharge compared with those before operation. General anesthesia does not aggravate the severity of encephalopathy, and endoscopic treatment under general anesthesia with tracheal intubation is effective for HE patients complicated with AVB.
Drug-eluting beads versus conventional transarterial chemoembolization for the treatment of unresectable hepatocellular carcinoma: A meta-analysis
Authors: Wang Zi-Yu , Xie Chun-Feng , Feng Kun-Liang , Xiong Cheng-Ming , Huang Jun-Hai , Chen Qing-Lian , Zhong Chong , Zhou Zhai-Wen
Published: August 2023

Background:

Transarterial chemoembolization (TACE) consists of conventional TACE (cTACE) and drug-eluting beads TACE (DEB-TACE). The benefits of the 2 treatments remain controversial. We conduct this meta-analysis to assess the efficacy and safety of the 2 methods for the patients with unresectable hepatocellular carcinoma.

Methods:

In order to get a sound conclusion, we did thorough search all relevant studies with clear and stringent keyword criteria on the main databases. Objective tumor response rate, overall survival (OS) rate and adverse events were calculated and analyzed by RevMan 5.3 software. The random-effects or fixed-effects model was applied to pool the estimates according to Cochran Q test and I
2 statistics.

Results:

Twenty-four studies involving 2987 patients were eligible. DEB-TACE significantly improved objective tumor response rate (OR) (risk ratio [RR] = 1.27, 95% confidence interval [CI] [1.08, 1.48]; P = .003). While as for 1-year, 2-year, 3-year, 5-year OS rates, there were no evidences to indicate that DEB-TACE was significantly better than cTACE (RR = 1.05, 95% CI [0.99, 1.11]; P = .08), (RR = 1.02, 95% CI [0.93, 1.11]; P = .68), (RR = 0.92, 95% CI [0.77, 1.10]; P = .37), (RR = 0.92, 95% CI [0.47, 1.80]; P = .81), respectively. Adverse events rate (AE) was also similar in both groups (RR = 1.11, 95% CI [0.99,1.26]; P = .08).

Conclusion:

This meta-analysis demonstrates that DEB-TACE is not superior than cTACE regarding to OS and AE. However, DEB-TACE still be considered to provide a better objective tumor response rate for patients with unresectable hepatocellular carcinoma.
Efficacy of photorejuvenation combined with tranexamic acid and hydroquinone cream in the treatment of complex facial pigmentation
Authors: Lin Caihui , Zhu Xuehua
Published: August 2023

The aim of this study was to assess the effectiveness of photo rejuvenation combined with tranexamic acid and hydroquinone cream in the treatment of complex facial pigmentation. A total of 108 patients with complex facial pigmentation between October 2019 and October 2021 were included in this retrospective study and divided into 2 groups according to the treatment that they received, with 54 cases in each group. The control group received treatment with tranexamic acid and hydroquinone cream. On the basis of the control group, the observation group was treated with photo rejuvenation combined with tranexamic acid and hydroquinone cream. The effectiveness of the treatments in both groups was determined through photographs and melasma area severity index score. The skin conditions were also compared before and after treatment. The effective rate of the observation group was significantly higher than that of the control group (98.15% vs 83.33%, P = .025). The melasma area and severity index score in the observation group was significantly lower than that in the control group after treatment (1.58 ± 0.14 vs 2.96 ± 0.13, P < .001). Before treatment, there was no significant difference in the skin elasticity and skin water content between the observation group and control group (P > .05). After treatment, the skin elasticity and skin water content were significantly higher than that in the control group (P < .05). Photo rejuvenation combined with tranexamic acid and hydroquinone cream has a significant curative effect on patients with complex facial pigmentation, which can significantly improve skin elasticity, increase skin water content, and reduce the degree of skin lesions.
Neonatal hepatic hemangioma with intestinal obstruction: A report of two cases
Authors: Yan Jinghao , Yasenjiang Abudula , Yao Haixia , He Jun , Zhou Ling , Li Shuixue
Published: August 2023

To explore the treatment experience of neonatal hepatic hemangioma (HH) with intestinal obstruction. Case 1 was 2.5 kg at birth and was 7 days old at the time of the visit. Case 1 underwent surgery 2 weeks after birth, and it was confirmed that HH was located in the left inner lobe of the liver, and it adhered to the ileocecal area to form an acute angle, leading to intestinal obstruction. The intestinal obstruction was significantly relieved. Postoperative pathology showed that case 1 had a congenital hemangioma. Case 1 started breastfeeding 3 days after the operation; the bowel function was well recovered, and the abdominal distension was significantly relieved. The child was discharged 1 week after the operation. Case 2 was 2.7 kg at birth and was 1 day old at the time of the visit. Case 2 was operated on 2 days after birth. During the operation, it was confirmed that the hepatic blood vessels were in the right anterior lobe of the liver. Postoperative pathology showed that case 2 had an infantile hemangioma. The posterior intestinal obstruction was significantly relieved. Case 2 began to drink a small amount of water on the 5th day after the operation and started breastfeeding on day 7. The abdominal distension was significantly relieved, and the stools were normal. reexamination showed no obvious recurrence of HH during a 2-year follow-up. Active surgical treatment should be considered if there is a risk of intestinal perforation to prevent serious complications.
Clinical efficacy of low-dose aspirin combined with calcium in preventing preeclampsia: A systematic review and meta-analysis
Authors: Chen Wen-Yue , Sun Su-Fang
Published: August 2023

Objective:

This systematic review and meta-analysis aimed to evaluate the clinical effectiveness of low-dose aspirin combined with calcium supplements for the prevention of preeclampsia.

Methods:

China National Knowledge Infrastructure, VIP, Wanfang, PubMed, EMBASE, and Cochrane Library databases were searched from inception until December 2022. Randomized controlled trials investigating the preventive use of aspirin in combination with calcium supplementation for preeclampsia in high-risk pregnant women were included. The quality of the literature was evaluated, and a meta-analysis was conducted using RevMan 5.3 software to analyze the clinical efficacy of low-dose aspirin combined with calcium supplementation in preventing preeclampsia.

Results:

Seven randomized controlled trials were included in this meta-analysis, and compared with the control group, the experimental group had lower incidence rates of preeclampsia with gestational hypertension (odds ratios [OR]: 0.17, 95% confidence interval [CI]: 0.11–0.28), preeclampsia (OR: 0.20, 95% CI: 0.10–0.37), gestational hypertension (OR: 0.15, 95% CI: 0.07–0.31), preterm birth (OR: 0.26, 95% CI: 0.16–0.44), postpartum hemorrhage (OR: 0.15, 95% CI: 0.08–0.27), and fetal growth restriction (OR: 0.16, 95% CI: 0.08–0.33).

Conclusion:

Compared with aspirin alone, low-dose aspirin combined with calcium supplementation was more effective in preventing preeclampsia, reduced the risk of preterm birth and postpartum hemorrhage, and promoted fetal growth. This intervention has clinical value and should be considered for high-risk pregnant women.
Efficacy and safety of paliperidone palmitate 6-monthly long-acting injectable in reduction of relapses in patients with schizophrenia: An Asian subgroup analysis of phase 3, randomized study
Authors: Richarz Ute , Han John , Bai Ya-Mei , Yu-Hai Chen Eric , Chung Young Chul , Jhanwar Venu Gopal , Kim Sung-Wan , Sulaiman Ahmad Hatim , Knight Karl , Gopal Srihari
Published: August 2023

Background:

Evaluate efficacy and safety of paliperidone palmitate 6-monthly (PP6M) for patients with schizophrenia in the Asian subgroup of a global, multicenter, noninferiority phase-3 study (NCT03345342).

Methods:

Patients received paliperidone palmitate 1-monthly (PP1M, 100/150 mg eq.) or paliperidone palmitate 3-monthly (PP3M, 350/525 mg eq.) during the maintenance phase and entered a 12-month double-blind (DB) phase, wherein they were randomized (2:1) to PP6M (700/1000 mg. eq.) or PP3M (350/525 mg eq.). Subgroup analysis was performed for 90 (12.7%) patients from Asia region (India, Taiwan, Malaysia, Hong Kong, and Korea). Primary endpoint was time-to-relapse during DB phase (Kaplan–Meier estimates). Secondary endpoints were changes from baseline in Positive and Negative Syndrome Scale, Clinical Global Impression-Severity scale, Personal and Social Performance (PSP) scale score.

Results:

In Asian subgroup, 91.9% (82/90) of patients completed DB phase (PP6M: 54/62 [87%]; PP3M: 28/28 [100%]). Median time-to-relapse was “not-estimable” due to low relapse rates in both groups. Estimated difference (95% confidence interval [CI]) between relapse-free patients in PP6M and PP3M groups of Asian subgroup was −0.1% [−8.5%, 8.4%] (global study population: −2.9% [−6.8%, 1.1%]). Mean change from baseline in secondary efficacy parameters was comparable between both groups, similar to the global study population. The incidence of extrapyramidal symptoms was higher in the Asian subgroup than in the global study population.

Conclusion:

Consistent with the global study population, PP6M was noninferior to PP3M in preventing relapse in patients with schizophrenia from the Asia region. Findings suggest the possibility of switching from PP1M/PP3M to twice-yearly PP6M without loss of efficacy and with no unexpected safety concerns.
Investigation of the status of depression and anxiety among leaders and staff in pharmacy intravenous admixture services in China
Authors: Yang Chunsong , Li Dan , Yang Yaya , Hu Yong , Zhang Lingli
Published: August 2023

We aimed to investigate the status of depression and anxiety among leaders and staff in pharmacy intravenous admixture services (PIVAS) and analyze influencing factors to provide a reference for improving their mental health status. This study involved a multi-center cross-sectional survey. PIVAS leaders and staff from across China were invited to participate. The Generalized Anxiety Disorder-7 and 9-item Patient Health Questionnaire were used to measure the status of anxiety and depression. A multiple linear regression model was used to analyze influencing factors. In total, 137 PIVAS leaders and 501 staff were included in this study. The results showed that 43.8% (60/137) of the leaders had anxiety and 38.7% (53/137) had depression. Among staff, 47.3% (237/501) had anxiety and 46.5% (233/501) had depression. Multiple linear regression showed that for PIVAS leaders, the degree of recognition by doctors was associated with anxiety scores, whereas PIVAS charge standard, PIVAS profit and loss situation, and the degree of recognition by doctors were associated with depression scores. For PIVAS staff, satisfaction with working in PIVAS was associated with anxiety scores, and job title, working hours per day, and satisfaction with working in PIVAS were associated with depression scores. Depression and anxiety are common among PIVAS leaders and staff working in hospitals in China. Hospitals should implement measures to improve the mental health of PIVAS leaders and staff.
The effects of paroxetine therapy on depressive symptom and motor function in the treatment of depression with Parkinson’s disease: A meta-analysis
Authors: Jiang Li-Lin , Wu Yu-Lin , Mo Ye , Gou Ling , Chen Mei-Ling , Wang Yan , Zang Qing-Min , Jiang De-Qi
Published: August 2023

Background:

Paroxetine therapy has been used for treatment of patients with depression and Parkinson’s disease (dPD) in many clinical studies, but, the effects of paroxetine in dPD patients are not completely understood. The aim of this study was to systematically evaluate the effects of paroxetine therapy on depressive symptom and motor function in the treatment of dPD, in order to confer a reference for clinical practice.

Methods:

Randomized controlled trials (RCTs) of paroxetine for dPD published up to October, 2022 were retrieved. Standardised mean difference (SMD), odds ratio (OR), and 95% confidence interval (CI) were calculated and heterogeneity was measured with the I
2 test. The outcomes of interest were as follows: the efficacy, Hamilton depression rating scale score, unified Parkinson’s disease rating scale score, Hamilton anxiety rating scale score or adverse events.

Results:

Thirty-four RCTs with 2819 participants were included. Compared with control group, the pooled effects of paroxetine therapy on depression were (22 trials; OR 3.62, 95% CI 2.63 to 4.98, P < .00001) for antidepressant response (25 trials; SMD -2.14, 95% CI -2.73 to -1.56, P < .00001) for Hamilton depression rating scale score, the pooled effects of paroxetine therapy on motor function were (10 trials; OR 4.63, 95% CI 3.15 to 6.79, P < .00001) for anti-PD efficacy (18 trials; SMD -2.02, 95% CI -2.48 to -1.55, P < .00001) for total unified Parkinson’s disease rating scale score. The Hamilton anxiety rating scale score showed significant decrease in the paroxetine treatment group compared to control group (10 trials; SMD -1.93, 95% CI -2.65 to -1.22, P < .00001). In addition, paroxetine therapy reduced the number of any adverse events obviously in dPD patients (twenty trials; OR 0.42, 95% CI 0.31 to 0.57, P < .00001).

Conclusions:

Paroxetine therapy has clinical benefits for improvement of depressive symptom and motor function in dPD patients, moreover, it is of high drug safety. Further well-designed, multi-center RCTs needed to identify these findings.
The mechanism of dehydroandrographolide inhibiting metastasis in gastric cancer based on network pharmacology and bioinformatics
Authors: Luo Yan-hai , Yuan Ling , Lu Dou-dou , Yang Ya-ting , Yang Yi , Du Yu-hua , Zhang Jun-fei , Chen Yan , Zhang Lei , Nan Yi
Published: August 2023

Gastric cancer (GC) is the most aggressive malignant tumor of the digestive tract. However, there is still a lack of effective treatment methods in clinical practice. Studies have shown that dehydroandrographolide (DA) has been shown to have anti-cancer activity in a variety of cancers, but it has not been reported in GC. Firstly, we obtained data on DA target genes, GC-related genes, and differentially expressed genes (DEGs) from the PharmMapper, GeneCards, and GEO databases, respectively. Then, the STRING database was used to construct the protein–protein interaction network of intersection genes, and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses of intersection genes were performed. Finally, 8 hub target genes were identified by analyzing their expression and prognostic survival, and molecular docking between the hub genes and DA was performed. In this study, 293 DA drug target genes, 11,366 GC-related genes, and 3184 DEGs were identified. Gene Ontology and KEGG analysis showed that the intersection genes of DA targets and GC-related genes were mainly related to cancer pathways involving apoptosis and cell adhesion. The intersection genes of DEGs, DA targets, and GC-related genes were also mainly related to cancer pathways involving chemical carcinogenesis, and drug metabolism. The molecular docking results showed that the 8 hub target genes had an apparent affinity for DA, which could be used as potential targets for DA treatment of GC. The results of this study show that the molecular mechanism by which DA inhibits GC metastasis involves multiple target genes. It may play an essential role in inhibiting the invasion and metastasis of GC by regulating the expression and polymorphism of hub target genes, such as MMP9, MMP12, CTSB, ESRRG, GSTA1, ADHIC, CA2, and AKR1C2.