bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative analysis of clinical efficacy between laparoscopic and open pancreaticoduodenectomy
Authors: Li Linyang , Bo Zhang , Liu Qiuhua , Wang Gang , Zhang Wangji , Liang Qinyu
Published: April 2023

Laparoscopic pancreaticoduodenectomy (LPD) is a technically demanding procedure but is gradually gaining acceptance in clinical practice. This study was performed to compare the short-term outcomes of LPD with open pancreaticoduodenectomy (OPD). The perioperative data of the patients who underwent LPD (n = 25) and OPD (n = 40) from January 1, 2017 to December 31, 2021 at Zhangjiagang Hospital Affiliated to Soochow University were collected and retrospectively analyzed. All patients received R0 resection, and none of the patients died within the perioperative period. The preoperative data (gender, age, body mass index [BMI], and preoperative bilirubin), the intraoperative data (operative time, number of retrieved lymph nodes), and postoperative data (level 1 monitoring time, postoperative fluid diet time, postoperative fluid feeding time, and hospitalization cost) were comparable between the 2 groups (P > .05). The estimated blood loss, abdominal drainage tube removal time, postoperative hospital stay, catheter removal time, and analgesic drug use were significantly lesser in the LPD group, when compared to the OPD group (P < .05). LPD is safe and feasible. Compared to OPD, LPD has less surgical trauma, less intraoperative bleeding, and faster postoperative recovery.
Treatment of large gastric trichobezoar in children: Two case reports and literature review
Authors: Kwon Hyung Jun , Park Jinyoung
Published: April 2023

Rationale:

Gastric trichobezoars are a rare form of bezoar formed from swallowed human hair as well as hair from dolls or animals, blankets, and carpets. They usually develop in young women who are emotionally disturbed, depressed, or mentally retarded, with trichotillomania and trichophagia. They can lead to abdominal pain, gastric ulceration, bleeding, obstruction, and perforation.

Patient concerns:

A 13-year-old girl was admitted to our institution with complaints of nausea, vomiting, and epigastric pain for 2 days. She underwent laparoscopic removal of a large gastric trichobezoar at our institution 5 years ago. A 12-year-old girl presented at our institution due to epigastric pain, dizziness, and melena for 2 days.

Diagnosis:

They were diagnosed with gastric trichobezoar by abdominal computed tomography scan and upper gastrointestinal endoscopy.

Interventions:

Large gastric trichobezoars were removed via a mini-laparotomy.

Outcomes:

They recovered well postoperatively without complication.

Lessons:

Although the recurrence of gastric trichobezoar after surgery is rare, few recurrent cases were reported in the literature. Therefore, psychiatric consultation and regular follow-up after treatment should be considered in the children and their parents to prevent the recurrence of gastric trichobezoar.
Marital status is an independent prognostic factor for cervical adenocarcinoma: A population-based study
Authors: Zhou Di , Yang Yong-Jing , Niu Chun-Cao , Yu Yong-Jiang , Diao Jian-Dong
Published: April 2023

Marriage has been reported as a beneficial factor associated with improved survival among cancer patients, but conflicting results have been observed in cervical adenocarcinoma (AC). Thus, this study is aimed to examine the relationship between the prognosis of cervical AC and marital status. Eligible patients were selected from 2004 to 2015 using the surveillance, epidemiology and end results (SEER) database. Cancer-specific survival (CSS) and overall survival (OS) were compared between married and unmarried groups. A total of 3096 patients had been identified, with married ones accounting for 51.29% (n = 1588). Compared to unmarried groups, more patients in the married group were relatively younger (aged ≤ 45) and belonged to white race, with grade I/II, Federation of International of Gynecologists and Obstetricians (FIGO) stage I/II and tumor size ≤4 cm. Apart from that, more patients received surgery, whereas fewer patients received chemotherapy and radiotherapy (all P < 0.05). The 5–year CSS and OS rates were 80.16% and 78.26% in married patients, 68.58% and 64.62% in the unmarried group (P < .0001). Multivariate analysis showed that marital status was an independent prognostic factor, and the married group performed better CSS (hazard ratio [HR]: 0.770; 95% confidence interval [CI]: 0.663–0.895; P = .001) as well as OS (HR: 0.751; 95%CI: 0.653–0.863; P < .001). As demonstrated by the results of subgroup analysis, married patients had better CSS and OS survival than unmarried ones in nearly all the subgroups. Marital status was identified as an independent prognostic factor for improved survival in patients with cervical AC.
Combined Tui na and Western medicine treatment improves pulmonary function and quality of life in patients with amyotrophic lateral sclerosis: A case report
Authors: Li Bei , Liu Haijing , Li Cuiling , Yang Meidi , Zhang Tingting
Published: April 2023

Rationale:

Amyotrophic lateral sclerosis is a rare disease that cannot be cured. We report a case of a patient with amyotrophic lateral sclerosis whose pulmonary function and quality of life were improved by a combined tui na treatment and Western medicine.

Patient concerns:

A 48-year-old male was diagnosed with ALS 1 year ago and was treated with western medicine and herbal medicine with no significant effect. This time, he was admitted to our department because of slurred speech, coughing and choking, and weakness of the left upper limb for more than 1 year.

Intervention and outcome:

After 1 month of treatment with tui na and traditional western medicine, the patient’s lung function and quality of life improved and he was discharged from the hospital.

Diagnoses:

Motor neuron disease. Amyotrophic lateral sclerosis.

Lessons:

The physiological function of ALS patients can be improved through the intervention of tui na.
Exploring the molecular mechanism of Nux Vomica in treating ischemic stroke using network pharmacology and molecular docking methods
Authors: Zhang Chengdong , Gai Jialin , Fan Xiaohua , Lei Junfang , Tang Jiqin
Published: April 2023

Background:

Nux Vomica (NV) has the effects of dredging collaterals, relieving pain, dispersing knots, and detumescence, and has a verified effect in treating ischemic stroke (IS), but its molecular mechanism for treating IS remains unclear. In this study, network pharmacology and molecular docking methods were adopted to explore the pharmacological mechanism of NV in treating IS.

Methods:

The Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) and the HERB database were searched to screen the active components and targets of NV. IS disease targets were retrieved from the DisGeNET, DrugBank, GeneCards, and Therapeutic Target Database. Venn diagram and intersection targets were obtained from the Venny website. Subsequently, the STRING database was employed to analyze the interrelationship of the intersection targets. Metascape database was used for Gene Ontology (GO) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of intersection targets. Furthermore, Cytoscape was employed to plot a drug-component-target network, and other networks, and molecular docking method was adopted to predict the effective components and targets of NV for treating IS.

Results:

A total of 14 active compounds and 59 targets of NV were screened, of which 35 targets were related to IS. Stigmasterol, brucine, isobrucine, isostrychnine N-oxide (I), (S)-stylopine, icaride A, and (2R)-5,7-dihydroxy-2-(4-hydroxyphenyl)chroman-4-one were the main active ingredients, and SLC6A4, NR3C1, SLC6A3, HTR3A, CHRNA7, MAOA, PTGS2, ESR1, catalase (CAT), ADRB2, and AR were the core targets. Molecular docking shows that these compounds bind well to the core targets. In addition, the treatment of IS by NV may mainly involve salivary secretion, serotonergic synapse, calcium signaling pathway, cGMP-PKG signaling pathway, and neuroactive ligand-receptor interaction.

Conclusions:

This study revealed that NV exerts its therapeutic effect on IS through multi-component, multi-target, and multi-pathway, which provides a basis for clinical treatment of IS.
Mortality after discharge from a public tertiary cardiovascular referral hospital
Authors: Lederman Carlos , Ferreira João Fernando Monteiro , Albuquerque Cicero Piva de , Lima Antonio Carlos Pedroso de , Barroso Lucia Pereira , Souza João Cláudio Miranda de , Lima Victor Hugo Vieira de , Castro Guilherme Jordan de , Luduvice Nicole Zukowski , Morais Lilian Cristina Correia , Perdigao Magaly De Losso , Freitas Rosa Maria Vieira De , Teixeira Monica LaPorte , Waldvogel Bernadette Cunha , Mansur Alfredo José
Published: April 2023

It is critically important for stakeholders with distinct foci of attention on healthcare to understand patient evolution in the presence of an established diagnosis or with a suspected diagnosis of various diseases, specially considering death as an outcome. To study the long-term mortality of patients at a cardiovascular referral hospital. Deterministic binding (selection of pairs of registers from the hospital electronic health records and the mortality records of São Paulo state) from 2002 to 2017 was performed. Studied variables were: age, sex, hospital treatment unit where the first visit occurred (Emergency Unit, Outpatient Unit, Hospital Admissions, Diagnostics Services), treatment type, elapsed time between the first visit and death, diagnosis at first and last visits and variables related to death. Statistical Methods: descriptive, survival (with Kaplan–Meier method), correspondence and competitive risks analyses; in case of nonoccurrence of death until the end of 2017, the patients were considered alive. Statistical significance was set at values of P < .05. Median age at the first visit to the Hospital was 51.9 years. Birth locations included 4496 cities, 17.33% in São Paulo, 0.41% in Rio de Janeiro, 0.40% in Osasco, 24.04% in other cities. Sex included females (46.7%), males (44.2%), not defined (6.3%), and other (2.8%). We observed an association between diseases in ICD-10 Chapter 16 (certain conditions originating in the perinatal period) and Chapter 17 (congenital malformations, deformations, and chromosomal abnormalities), both as diagnoses and underlying causes of death, as well as between neoplasms as diagnoses and as the underlying cause of death. In this sample, there was an association between admission diagnoses and underlying causes of death, such as neoplasms, cardiovascular diseases, and congenital heart malformations. Additionally, patients who underwent a cardiac intervention had a smaller less mortality rate than those who were not operated on. There were also differences in cardiovascular mortality between distinct treatment units of the hospital ((Emergency Unit, Outpatient Unit, Hospital Admissions, Diagnostic Services).
The Characteristics of Isolated Bulb Celiac Disease in Children
Authors: Behl Supriya , Khan Muhammad Rehan , Ismail Yasmine , Swantek Courtney , Chen Zong-Ming (Eric) , Murray Joseph A. , Absah Imad
Published: April 2023

Objectives:

Mucosal injury in celiac disease (CD) patients can be patchy, and up to 12% of CD patients can have mucosal changes limited to the duodenal bulb. Hence, recent guidelines recommend obtaining bulb biopsies in addition to distal duodenum. This study aimed to describe a cohort of children with isolated bulb CD and assess the benefit of separating bulb biopsies.

Methods:

A retrospective chart review between January 2011 and January 2022 at 2 medical centers was conducted. We included children with CD who underwent endoscopy with separated biopsies from the bulb and distal duodenum. A blinded pathologist performed Marsh-Oberhuber grading on selected cases.

Results:

We identified 224 CD patients, of which 33 (15%) had histologically confirmed isolated bulb CD. Patients with isolated bulb CD were older at diagnosis (10 vs 8 years; P = 0.03). Median anti-tissue transglutaminase immunoglobulin A (TTG IgA) level was lower in isolate bulb CD (2.8 vs 16.7 times the upper limit of normal [ULN], P < 0.001). Almost 88% (29/33) of isolated bulb CD patients had an anti-TTG IgA value of less than 10 times the ULN. Time to anti-TTG IgA normalization (mean 14 months) was similar between the 2 groups. A pathologist review of diagnostic biopsies could not distinguish between the bulb and distal duodenum biopsies in approximately one-third of the reviewed samples.

Conclusions:

Separating bulb from distal duodenum biopsies can be considered during CD diagnosis, particularly in children with anti-TTG IgA levels less than 10 times the ULN. Larger prospective cohorts are needed to decide whether isolated bulb CD is a unique cohort or an early stage of the conventional CD.
Characterization of Eosinophilic Esophagitis in Infants and Toddlers
Authors: Hirsch Suzanna , Cohen Alexandra , Rahbar Reza , Rubinstein Eitan , Rosen Rachel
Published: April 2023

Objectives:

The objective of this study is to determine demographic and clinical characteristics of infants and toddlers <2 years with eosinophilic esophagitis (EoE) and to assess treatment response in this rarely studied pediatric age group.

Methods:

Retrospective study of children <2 years diagnosed with EoE at a single center from 2016 to 2018. EoE was defined by ≥15 eosinophils per high power field (eos/hpf) on at least 1 esophageal biopsy. Demographics, symptoms, and endoscopic findings were collected via chart review. EoE treatment [proton pump inhibitor (PPI), swallowed steroids, dietary restriction, or a combination] and treatment responses on all follow-up endoscopies were reviewed, with remission defined as <15 eos/hpf.

Results:

Forty-two children ages 1.3 ± 0.4 years underwent 3.8 ± 2.3 endoscopies over 3.6 ± 1.7 years of follow-up. Thirty-six children (86%) were male, and comorbidities included atopy (86%), reflux (74%), and a history of cow’s milk protein allergy (40%). Common symptoms were feeding difficulties in 67% of patients (with gagging or coughing with feeding in 60% and difficulty with progression to pureed or solid foods in 43%), vomiting (57%), and coughing/wheezing (52%). Of the 37 patients with follow-up endoscopies, 25 (68%) had histologic remission. There was an effect of therapy type on histologic response (P = 0.004) with the best responses seen on combinations of diet/steroids or diet/PPI and the worst response seen on PPIs alone. All patients showed improvement in ≥1 symptom at the time of first follow-up endoscopy.

Conclusions:

EoE should be considered in young children with feeding difficulties, vomiting, or respiratory symptoms. All patients improved clinically with standard medical or dietary interventions, however there is dissociation between clinical and histologic response with only 2 of 3 patients achieving histologic remission.
Subcutaneous Microabscesses and Myositis as Part of Immune Reconstitution Inflammatory Syndrome due to Chronic Disseminated Candidiasis in a Child With Acute Lymphoblastic Leukemia
Authors: Reddy Nalla A. , Addala Soundarya , S.S. Shyam , Lashkari Harsha P.
Published: April 2023

Background:

Immune reconstitution inflammatory syndrome (IRIS) occurs when there is immune recovery after a prolonged period of leucopenia as a response to an underlying latent or chronic infection due to a proinflammatory cascade. It can occur in a child on chemotherapy for acute lymphoblastic leukemia (ALL) with underlying chronic disseminated candidiasis (CDC).

Observation:

We present a 7-year-old girl with pre-B ALL on chemotherapy who had prolonged febrile neutropenia and CDC with microabscesses in the liver, spleen, and kidney and a prolonged intensive care unit stay. Upon neutrophil recovery, she continued to have high-grade fever (blood and urine cultures negative). She also presented severe myositis of bilateral thigh muscles and developed unusual granulomas in the subcutaneous region of the lower back and right thigh. Although IRIS was suspected, she could not be initiated on steroids due to right upper lobe collapse consolidation due to multidrug-resistant Acinetobacter baumanni, which was treated with sensitive antibiotics. Treatment with steroids resolved her fever and normalized inflammatory markers. She is currently well on maintenance chemotherapy.

Conclusions:

IRIS can complicate the treatment of ALL in children. Diagnosing it while having a concurrent bacterial infection is challenging. Rarely CDC can present with subcutaneous granulomas. Treatment with steroids at the right time is very crucial.
COVID-19 Infection and Outcomes in Newborn Screening Cohorts of Sickle Cell Trait and Sickle Cell Disease in Michigan and Georgia
Authors: Paulukonis Susan T. , Snyder Angela , Smeltzer Matthew P. , Sutaria Ankit N. , Hurden Isabel , Latta Krista , Chennuri Swathi , Vichinsky Elliott , Reeves Sarah L.
Published: April 2023

The sickle cell mutation increases morbidity in those with sickle cell disease (SCD) and potentially sickle cell trait, impacting pulmonary, coagulation, renal, and other systems that are implicated in COVID-19 severity. There are no population-based registries for hemoglobinopathies, and they are not tracked in COVID-19 testing. We used COVID-19 test data from 2 states linked to newborn screening data to estimate COVID outcomes in people with SCD or trait compared with normal hemoglobin. We linked historical newborn screening data to COVID-19 tests, hospitalization, and mortality data and modeled the odds of hospitalization and mortality. Georgia’s cohort aged 0 to 12 years; Michigan’s, 0 to 33 years. Over 8% of those in Michigan were linked to positive COVID-19 results, and 4% in Georgia. Those with SCD showed significantly higher rates of COVID-19 hospitalization than the normal hemoglobin Black cohort, and Michigan had higher rates of mortality as well. Outcomes among those with the trait did not differ significantly from the normal hemoglobin Black group. People with SCD are at increased risk of COVID-19–related hospitalization and mortality and are encouraged to be vaccinated and avoid infection. Persons with the trait were not at higher risk of COVID-related severe outcomes.
Pulmonary embolism at CT pulmonary angiography in patients with COVID-19 at a tertiary care center in Nepal: a cross-sectional study
Authors: Amatya Isha , Regmi Pradeep R. , Adhikari Gauri , Pokhrel Bidushi , Baniya Anish , Dangol Anisha
Published: April 2023

Introduction:

Coronavirus disease 2019 (COVID-19) began to spread in December 2019 and was declared a pandemic by WHO on 11 March 2020. Pulmonary embolism (PE) is a known sequel to COVID-19 infection. Many patients showed worsened symptoms of thrombotic events of pulmonary arteries during the second week of the disease for which computed tomography pulmonary angiography (CTPA) is recommended. The most frequent complications in critically ill patients are prothrombotic coagulation abnormalities and thromboembolism. So, this study aimed to assess the prevalence of PE in patients with COVID-19 infection and to evaluate the relation to disease severity on CTPA findings.

Methods:

This cross-sectional study was performed to evaluate the patients who tested positive for COVID-19 and underwent CTPA. COVID-19 infection in participants was confirmed by a PCR of nasopharyngeal or oropharyngeal swab samples. Frequencies of computed tomography severity scores and CTPA were calculated and compared with clinical and laboratory findings.

Results:

The study included 92 patients with COVID-19 infection. Positive PE was found in 18.5% of the patients. The mean age of the patients was 59.83±13.58 years with an age range of 30–86 years. Among the total participants, 27.2% underwent ventilation, 19.6% died during treatment, and 80.4% of them got discharged. PE was developed in patients who did not receive prophylactic anticoagulation, which is statistically significant (P≤0.001). There was also a significant relationship between mechanical ventilation and CTPA findings.

Conclusions:

The authors conclude from their study that PE is one of the complications of COVID-19 infection. Rising D-dimer during the second week of disease alerts clinicians to do CTPA to exclude or confirm PE. This will help in the early diagnosis and treatment of PE.
Evidence-based guideline on management of status epilepticus in adult intensive care unit in resource-limited settings: a review article
Authors: Besha Aschalew , Adamu Yayeh , Mulugeta Hailemariam , Zemedkun Abebayehu , Destaw Belete
Published: April 2023

Background:

Status epilepticus (SE) is a life-threatening condition associated with at least 5 min of continuous seizures or repeated seizures without regaining consciousness between episodes. It is a medical emergency with significant morbidity and mortality. The most common causes of SE are previous seizures, stroke, trauma, metabolic disorders, and central nervous system tumor. The aim of this review was to systematically review articles and ultimately develop evidence-based guidelines for the management of SE in resource-limited settings.

Methods:

This review was presented under the Protocol for Systematic Reviews and Meta-Analyses (PRISMA). A literature search was performed in PubMed, Google Scholar, Cochrane, and Medline databases from 2007 to 2021. The keywords for the literature search were (SE or controlled clinical trial) AND (SE or randomized controlled trial), (SE or multicenter trial) AND (SE or meta-analysis) AND (SE or crossover study).

Conclusion:

SE is an urgent medical emergency that requires early recognition and aggressive treatment. Medical treatment is initiated when seizures continue for more than 5 min after all stabilization measures have been taken. Based on the available evidence, diazepam can be used as a substitute for lorazepam in the treatment of SE. Ketamine is effective when given before other anesthetics as a third-line treatment in refractory and very refractory epilepsy. Propofol reduced the number of days of mechanical ventilation in the treatment of SE and has better seizure control than thiopental. Music has been recommended as an adjunctive therapy for epilepsy medication.
Association of d-dimer levels with in-hospital outcomes among COVID-19 positive patients: a developing country multicenter retrospective cohort
Authors: Tahir Muhammad Junaid , Yasmin Farah , Naeem Unaiza , Najeeb Hala , Kumar Kamlesh , Arti  , Kumar Rahul Robaish , Robaish Kumar Rahul , Majeed Abdul , Kumar Rahul , Wali Agha , Sandhya  , Shahab Ramsha , Shahab Ramsha , Hegazi Moustafa , Ahmed Khabab Abbasher Hussien Mohamed , Asghar Muhammad Sohaib
Published: April 2023

Introduction

D-dimer levels, which originate from the lysis of cross-linked fibrin, are serially measured during coronavirus disease 2019 illness to rule out hypercoagulability as well as a septic marker.

Methods

This multicenter retrospective study was carried out in two tertiary care hospitals in Karachi, Pakistan. The study included adult patients admitted with a laboratory-confirmed coronavirus disease 2019 infection, with at least one measured d-dimer within 24 h following admission. Discharged patients were compared with the mortality group for survival analysis.

Results

The study population of 813 patients had 68.5% males, with a median age of 57.0 years and 14.0 days of illness. The largest d-dimer elevation was between 0.51–2.00 mcg/ml (tertile 2) observed in 332 patients (40.8%), followed by 236 patients (29.2%) having values greater than 5.00 mcg/ml (tertile 4). Within 45 days of hospital stay, 230 patients (28.3%) died, with the majority in the ICU (53.9%). On multivariable logistic regression between d-dimer and mortality, the unadjusted (Model 1) had a higher d-dimer category (tertile 3 and tertile 4) associated with a higher risk of death (OR: 2.15; 95% CI: 1.02–4.54,P=0.044) and (OR: 4.74; 95% CI: 2.38–9.46,P<0.001). Adjustment for age, sex, and BMI (Model 2) yields only tertile 4 being significant (OR: 4.27; 95% CI: 2.06–8.86,P<0.001).

Conclusion:

Higher d-dimer levels were independently associated with a high risk of mortality. The added value of d-dimer in risk stratifying patients for mortality was not affected by invasive ventilation, ICU stays, length of hospital stays, or comorbidities.
Learning curve of the 67 steps of conventional total knee replacement: an experimental study
Authors: Hafez Mahmoud A. , Nasser Eltayeb , Nabeel Ahmed
Published: April 2023

Background:

The instrumentation system for total knee replacement (TKR) has been there since the 1970s. The many steps and instruments are the main features despite several modifications over the last 50 years. This may lead to the accumulation of errors as certain steps are dependent on others. This study aimed to identify the errors while performing TKR by three trainees at different levels of training.

Methods:

Three trainees with different expertise performed the steps of TKR on bone models. One senior supervisor recorded the outcomes, including operative time and errors made during the experiment. Errors were further categorized into correctable and uncorrectable ones.

Results:

Most of the errors were made by the trainee with the least experience during the stages of femoral cutting, sizing, and rotation. The first-year resident has taken 1.25 times longer than the fellow in preparing the femur and 1.11 times in preparing the tibia. The recorded mistakes were 28, 8, and 3 for the first-year resident, the second-year resident, and the fellow surgeon, respectively. Fifteen of the mistakes were uncorrectable, and none of them were from the senior surgeon.

Conclusion:

The results of this study highlight the type of errors made by different trainees. This shows the steep learning curve of conventional instrumentation systems for trainees. Increasing cognitive skills and applying computer-assisted technologies may help trainees overcome this steep learning curve.
How is ischemic stroke linked to a COVID-19-infected patient different from other cardiovascular risk factors? a case report
Authors: Bereda Gudisa
Published: April 2023

Background:

Ischemic stroke is a recognized neurological consequence of an acute coronavirus disease 2019 (COVID-19) infection. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) directly infects endothelial cells, generating widespread endothelial inflammation. This may be the mechanism leading to an ischemic stroke. Infection with SARS-CoV-2 and inflammatory responses cause vascular damage, hypercoagulability, thrombin activation, platelet aggregation, and plaque shedding as a result of hemodynamic alterations, which increase the risk of ischemic stroke.

Case presentation:

On 19 September 2022, 3 h after the commencement of the right-sided weakness, a 61-year-old black African male farmer was sent to transported to the emergency room. When an radiography of the chest was performed, it showed diffuse bilateral infiltrates, coarse, slightly bilateral crepitation, and scattered reticulations. Cardiovascular testing of the patient turned up nothing unexpected. The eye-opening reaction was 1/4 (no eye opening) on the Glasgow Coma Scale, the motor response was 3/6 (abnormal flexion), and the verbal response was 3/5 (inappropriate words). When his breathing became difficult, he needed five intranasal doses of oxygen every minute to maintain saturation. He started taking low-dose aspirin daily for a month at 81 mg. He took consumed 75 mg of clopidogrel once a day for a month.

Clinical discussion:

Stroke was associated with in-hospital death among hospitalized patients with the COVID-19 infection. In patients who have risk factors for stroke, such as high blood pressure, obesity, and diabetes, COVID-19 increases the risk of stroke. The risk of stroke was highest in older people within the first few days after receiving a COVID-19 diagnosis.

Conclusion:

Patients with COVID-19 are more likely to get an ischemic stroke from large infarctions, mostly as a result of major artery thrombosis. From the start of COVID-19 signs, neurological problems can appear anywhere between 3 and 14 days later. Due to severe inflammation, immobility, hypoxia, and diffuse intravascular coagulation, SARS-CoV-2 also possesses neurological invasive capabilities and may migrate from the respiratory system to the central nervous system
Systematic extended right posterior sectionectomy (SERPS), a single center serial cases for secondary liver tumors
Authors: Tendean Michael , Mambu Toar D.B. , Tjandra Ferdinand , Panelewen Jimmy
Published: April 2023

Introduction and importance:

Liver resection in secondary liver tumors may associated with the consequences of posthepatectomy liver failure (PHLF). Systematic extended right posterior sectionectomy (SERPS) is offered as an alternative to resect secondary liver tumors in segment 6–7 with vascular invasion of right hepatic vein, with less risk of PHLF compared to right hepatectomy. This case series is important to demonstrate the effectivity and safety of SERPS procedure performed in developing country.

Cases presentation:

The authors reported the case of four patients that underwent SERPS procedure due to metachronous and synchronous liver metastases caused by gastric gastrointestinal stromal tumor and colorectal cancer. Thulium doped fiber laser and harmonic scalpel were used as an energy device. Intra and postoperative parameters were evaluated. SERPS data was collected in 2020–2021 at Prof. dr. R.D. Kandou General Hospital. There were no postoperative complications and no tumor recurrences were found in all four patients in two years surveillance.

Clinical discussion:

Liver resection poses a relatively moderate risk of mortality and morbidity. Nowadays, parenchyma-sparing liver surgery is the procedure of choice compared to major liver resection whenever feasible. SERPS was first developed to minimize the need for major resection. SERPS may serve as a first-choice procedure due to its superior safety and comparable effectivity compared to major hepatectomy.

Conclusion:

SERPS is a safe and promising alternative for secondary liver tumors at segments 6–7 and right hepatic vein vascular invasion, compared to right hepatectomy. Thus, minimizing the risk of PHLF by saving a larger volume of future liver remnant.
Association Between Low-Density Lipoprotein-Cholesterol Level and Risk of Intracranial Atherosclerotic Stenosis
Authors: Shen Yuan , Wang Jing , Wang Anxin , Zhao Xingquan
Published: April 2023

Background:

It is unknown whether plasma low-density lipoprotein-cholesterol level (LDL-C) can predict the occurrence of intracranial atherosclerotic stenosis (ICAS), especially asymptomatic (A)ICAS. This study investigated whether LDL-C level is independently associated with AICAS.

Methods:

The Asymptomatic Polyvascular Abnormalities Community study is an ongoing community-based, prospective, long-term follow-up observational study with 3387 participants. AICAS was diagnosed by transcranial Doppler ultrasonography. The participants were divided into 3 groups based on LDL-C level. Cox regression was used to evaluate the association between LDL-C level and incidence of AICAS.

Results:

During 2 years of follow-up, 9.98% of participants were diagnosed with AICAS. The incidence of AICAS (person-years with 95% CI) was 4.99% (4.48%-5.50%). AICAS incidence did not increase with increasing LDL-C level. Compared with the <2.6 mmol/l subgroup, the incidence of asymptomatic ICAS was not significantly higher in the 2.6 to 3.4 and >3.4 mmol/l subgroups after adjusting for confounding factors (hazard ratio=0.95, 95% CI: 0.86-1.03 and hazard ratio=0.96, 95% CI: 0.84-1.10, respectively).

Conclusions:

LDL-C is not an independent predictor of AICAS incidence in the Chinese population.
ASSESSMENT OF THE IMPLEMENTATION OF ELECTRONIC RECORDS MANAGEMENT SYSTEM IN BAYELSA STATE
Authors: Abaya Samuel Terungwa , Orga Chris , Raimi Aziba-anyam Gift , Raimi Morufu Olalekan , Kakwi Daniel Josephine
Published: April 2023

  

The information quality that medical practitioners have access to when providing care to patients affects the outcome of service delivery. Health information technology has been proven to enhance patient safety and treatment quality in the healthcare industry. This study's goal is to pinpoint the enablers and impediments to NDUTH, Okolobiri's adoption of an electronic records management system. The descriptive cross-sectional research design was adopted for this investigation. The sample was drawn using stratified random sampling from the 204 staff members that took part in the survey at NDUTH Okolobiri. A small number of hospital employees who had implemented the electronic records system were also subjected to phone interviews. The results show that the majority of participants (51.0%) were female, and that their average age was 37(SD+9.0) years. The overall knowledge of electronic records management system among the respondents was 45.9%. The overall level of implementation was 22.8%. The facilitators in the study were of support from leadership and availability of ICT equipment’s while the barriers were funding, lack of power supply, inadequate ICT infrastructures, administrative challenge, poor staff compliance, lack of government support, poor maintenance of software and ICT equipment’s. The findings show that there is a need for government and private organizations to invest more in healthcare delivery through electronic records management system. This is very important because the effectiveness of health services delivery is influenced by the quality of information that medical professionals have access to when caring for patients. It is also found to ensure efficient management of health facilities.
Primary Neuroblastoma of the Thymus
Authors: Chaurasiya Kailash , Kireeva Elena , Shamanskaya Tatyana , Kachanov Denis , Likar Yury
Published: April 2023

Primary neuroblastoma is the most common extracranial solid tumor in children and may occur anywhere along the sympathetic chain, but most commonly occur in abdominal/retroperitoneal region including the adrenal glands, followed by the thorax. In children, the most primary neuroblastomas in the thorax are in the posterior mediastinum. We present herein an extremely rare case of primary neuroblastoma of thymus in pediatric patient.
Mast Cells in Kidney Transplant Biopsies With Borderline T Cell-mediated Rejection and Their Relation to Chronicity
Authors: Varol Hilal , van der Elst Guus , Baan Carla C. , van Baardwijk Myrthe , Hesselink Dennis A. , Duong van Huyen Jean-Paul , Kramann Rafael , Rabant Marion , van den Bosch Thierry P.P. , Clahsen-van Groningen Marian C.
Published: April 2023

Background.

Mast cells are potential contributors to chronic changes in kidney transplants (KTx). Here, the role of mast cells (MCs) in KTx is investigated in patients with minimal inflammatory lesions.

Methods.

Fourty-seven KTx biopsies (2009–2018) with borderline pathological evidence for T cell-mediated rejection according to the Banff’17 Update were retrospectively included and corresponding clinical data was collected. Immunohistochemistry for tryptase was performed on formalin-fixed paraffin-embedded sections. Cortical MCs were counted and corrected for area (MC/mm²). Interstitial fibrosis was assessed by Sirius Red staining and quantified using digital image analysis (QuPath).

Results.

Increased MC number was correlated to donor age (spearman’s r = 0.35, P = 0.022), deceased donor kidneys (mean difference = 0.74, t [32.5] = 2.21, P = 0.035), and delayed graft function (MD = 0.78, t [33.9] = 2.43, P = 0.020). Increased MC number was also correlated to the amount of interstitial fibrosis (r = 0.42, P = 0.003) but did not correlate with transplant function over time (r = −0.14, P = 0.36). Additionally, transplant survival 2 y post-biopsy was not correlated to MC number (mean difference = −0.02, t [15.36] = −0.06, P = 0.96).

Conclusions.

MC number in suspicious (borderline) for acute T cell-mediated rejection is correlated to interstitial fibrosis and time post-transplantation, suggesting MCs to be a marker for cumulative burden of tissue injury. There was no association between MCs and transplant function over time or transplant survival 2 y post-biopsy. It remains unclear whether MCs are just a bystander or have pro-inflammatory or anti-inflammatory effects in the KTx with minimal lesions.
Soil microbial gene expression in an agricultural ecosystem varies with time and neonicotinoid seed treatments
Authors: Parizadeh Mona , Mimee Benjamin , Kembel Steven W.
Published: April 2023

Neonicotinoids, a class of systemic insecticides, have been widely used for decades against various insect pests. Previous studies have reported non-target effects of neonicotinoids on some beneficial macro- and micro-organisms. Considering the crucial role the soil microbiota plays in sustaining soil fertility, it is critical to understand how neonicotinoid exposure affects the microbial taxonomic composition and gene expression. However, most studies to date have evaluated soil microbial taxonomic compositions or assessed microbial functions based on soil biochemical analysis. In this study, we have applied a metatranscriptomic approach to quantify the variability in soil microbial gene expression in a 2 year soybean/corn crop rotation in Quebec, Canada. We identified weak and temporally inconsistent effects of neonicotinoid application on soil microbial gene expression, as well as a strong temporal variation in soil microbial gene expression among months and years. Neonicotinoid seed treatment altered the expression of a small number of microbial genes, including genes associated with heat shock proteins, regulatory functions, metabolic processes and DNA repair. These changes in gene expression varied during the growing season and between years. Overall, the composition of soil microbial expressed genes seems to be more resilient and less affected by neonicotinoid application than soil microbial taxonomic composition. Our study is among the first to document the effects of neonicotinoid seed treatment on microbial gene expression and highlights the strong temporal variability of soil microbial gene expression and its responses to neonicotinoid seed treatments.
No immunological interference or safety concerns when adjuvanted recombinant zoster vaccine is coadministered with a COVID-19 mRNA-1273 booster vaccine in adults aged 50 years and older: A randomized trial
Authors: Naficy Abdi , Kuxhausen Adrienne , Pirrotta Paola , Leav Brett , Miller Jacqueline , Anteyi Kate , Adams Mark S , Danier Jasur , Breuer Thomas , Mwakingwe-Omari Agnes
Published: April 2023

Background

There is growing consensus that COVID-19 booster vaccines may be coadministered with other age-appropriate vaccines. Adding to the limited available data supporting coadministration, especially with adjuvanted vaccines, could enhance vaccine coverage in adults.

Methods

In this phase 3, randomized, open-label study, eligible adults aged ≥50 years were randomly assigned (1:1) to receive mRNA-1273 (50µg) booster vaccination and a first dose of recombinant zoster vaccine (RZV1) 2 weeks apart (Seq group) or concomitantly (Coad group). The second RZV dose (RZV2) was administered 2 months post- RZV1 in both groups. Primary objectives were noninferiority of anti-glycoprotein E and anti-Spike protein antibody responses in the Coad group compared to the Seq group. Safety and further immunogenicity assessments were secondary objectives.

Results

273 participants were randomized to the Seq group, 272 to the Coad group. Protocol-specified non-inferiority criteria were met. The adjusted geometric mean concentration ratio (Seq/Coad) was 1.01 (95% confidence interval [CI], 0.89–1.13) for anti- gE antibodies 1-month post-RZV2, and 1.09 (95% CI 0.90–1.32) for anti-Spike antibodies 1- month post-mRNA-1273 booster. No clinically relevant differences were observed in overall frequency, intensity, or duration of adverse events between the 2 study groups. Most solicited adverse events were mild/moderate in intensity, each with median duration ≤2.5 days.

Administration site pain and myalgia were the most frequently reported in both groups.

Conclusions

Coadministration of mRNA-1273 booster vaccine with RZV in adults aged ≥50 years was immunologically noninferior to sequential administration and had a safety and reactogenicity profile consistent with both vaccines administered sequentially (clinicaltrials.govNCT05047770).

Visual abstract
Systematic review of genotype-stratified treatment for monogenic insulin resistance
Authors: Semple Robert K. , Pate Kashyap A. , Auh Sungyoung ,   ADA/EASD PMDI, Brown Rebecca J.
Published: April 2023

Objective

To assess the effects of pharmacologic and/or surgical interventions in monogenic insulin resistance (IR), stratified by genetic aetiology.

Design

Systematic review.

Data sources

PubMed, MEDLINE and Embase, from 1 January 1987 to 23 June 2021.

Review methods

Studies reporting individual-level effects of pharmacologic and/or surgical interventions in monogenic IR were eligible. Individual subject data were extracted and duplicate data removed. Outcomes were analyzed for each affected gene and intervention, and in aggregate for partial, generalised and all lipodystrophy.

Results

10 non-randomised experimental studies, 8 case series, and 21 single case reports met inclusion criteria, all rated as having moderate or serious risk of bias. Metreleptin was associated with lower triglycerides and hemoglobin A1c in aggregated lipodystrophy (n=111), in partial lipodystrophy (n=71) and generalised lipodystrophy (n=41)), and inLMNA,PPARG,AGPAT2orBSCL2subgroups (n=72,13,21 and 21 respectively). Body Mass Index (BMI) was lower after treatment in partial and generalised lipodystrophy overall, and inLMNA or BSCL2, but notPPARGorAGPAT2subgroups. Thiazolidinedione use was associated with improved hemoglobin A1c and triglycerides in aggregated lipodystrophy (n=13), improved hemoglobin A1c only in thePPARGsubgroup (n=5), and improved triglycerides only in theLMNAsubgroup (n=7). InINSR-related IR, use of rhIGF-1, alone or with IGFBP3, was associated with improved hemoglobin A1c (n=15). The small size or absence of all other genotype-treatment combinations precluded firm conclusions.

Conclusions

The evidence guiding genotype-specific treatment of monogenic IR is of low to very low quality. Metreleptin and Thiazolidinediones appear to have beneficial metabolic effects in lipodystrophy, and rhIGF-1 appears to lower hemoglobin A1c in INSR-related IR. For other interventions there is insufficient evidence to assess efficacy and risks either in aggregated lipodystrophy or in genetic subgroups. There is a pressing need to improve the evidence base for management of monogenic IR.
Evaluation of coronavirus decay in French coastal water and application to SARS-CoV-2 risk evaluation using Porcine Epidemic Diarrhea Virus as surrogate
Authors: Contrant Maud , Bigault Lionel , Andraud Mathieu , Desdouits Marion , Rocq Sophie , Le Guyader Françoise S. , Blanchard Yannick
Published: April 2023

SARS-CoV-2 in infected patient mainly display pulmonary and oronasal tropism however, the presence of the virus has also been demonstrated in stools of patients and consequently in wastewater treatment plant effluents, questioning the potential risk of environmental contamination (such as seawater contamination) through inadequately treated wastewater spill-over into surface or coastal waters. The environmental detection of RNA alone does not substantiate risk of infection, and evidence of an effective transmission is not clear where empirical observations are lacking.

Therefore, here, we decided to experimentally evaluate the persistence and infectious capacity of the Porcine epidemic diarrhea virus (PEDv), considered as a coronavirus representative model and SARS-CoV-2 surrogate, in the coastal environment of France. Coastal seawater was collected, sterile-filtered, and inoculated with PEDv before incubation for 0–4 weeks at four temperatures representative of those measured along the French coasts throughout the year (4, 8, 15, and 24°C). The decay rate of PEDv was determined using mathematical modeling and was used to determine the half-life of the virus along the French coast in accordance with temperatures from 2000 to 2021.

We experimentally observed an inverse correlation between seawater temperature and the persistence of infectious viruses in seawater and confirm that the risk of transmission of infectious viruses from contaminated stool in wastewater to seawater during recreational practices is very limited. The present work represents a good model to assess the risk of transmission of not only SARS-CoV-2 but may also be used to model the risk of other coronaviruses, specifically enteric coronaviruses.

Importance

This present work is a follow up addressing the question of the persistence of coronavirus in marine environment owing to the fact that SARS-CoV-2 is regularly detected in wastewater treating plan and the coastal environment is particularly at risk since it is subjected to increasing anthropogenic pressure and is the final receiver of surface waters and treated or sometimes insufficiently depurated waste waters. Our findings are of interest to researchers and authorities seeking to monitor SARS-CoV-2 and also enteric coronaviruses in the environment, either in tourist areas or in regions of the world, where centralized systems for wastewater treatment are not implemented, and more broadly, to the scientific community involved in “One Health” approaches.
CRB3 and ARP2/3 regulate cell biomechanical properties to set epithelial monolayers for collective movement
Authors: Massey-Harroche Dominique , Conte Vito , Gouirand Niels , Sebbagh Michäel , Bivic André Le , Bazellières Elsa
Published: April 2023

Several cellular processes during morphogenesis, tissue healing or cancer progression involve epithelial to mesenchymal plasticity that leads to collective motion (plasticity?). Even though a rich variety of EMP programs exist, a major hallmark unifying them is the initial breaking of symmetry that modifies the epithelial phenotype and axis of polarity. During this process, the actin cytoskeleton and cellular junctions are extensively remodelled correlating with the build-up of mechanical forces. As the collective migration proceeds, mechanical forces generated by the actin cytoskeleton align with the direction of migration ensuring an organized and efficient collective cell behaviour, but how forces are regulated during the breaking of symmetry at the onset of EMP remains an unaddressed question. It is known that the polarity complex CRB3/PALS1/PATJ, and in particular, CRB3 regulates the organization of the actin cytoskeleton associated to the apical domain thus pointing at a potential role of CRB3 in controlling mechanical forces. Whether and how CRB3 influences epithelial biomechanics during the epithelial-mesenchymal plasticity remains, however, largely unexplored. Here, we systematically combine mechanical and molecular analyses to show that CRB3 regulates the biomechanical properties of collective epithelial cells during the initial breaking of symmetry of the EMP. CRB3 interacts with ARP2/3 and controls the remodelling of actin throughout the monolayer via the modulation of the Rho-/Rac-GTPase balance. Taken together, our results identified CRB3, a polarity protein, as a regulator of epithelial monolayer mechanics during EMP.