bluuebunny/crossref_metadata_2025 huggingface dataset:
CE: Current and Emerging Applications of Fecal Microbiota Transplantation
Authors: Baker Kathy A. , Poole Carsyn
Published: September 2023

Fecal microbiota transplantation (FMT) is a life-changing treatment for people with recurrent Clostridioides difficile infection (rCDI). Frequently acquired in the hospital, CDI can cause serious gastrointestinal symptoms, including persistent watery diarrhea, abdominal pain, and severe dehydration. Antibiotics, the primary treatment, can unfortunately disrupt the gut microbiome and lead to antimicrobial resistance. FMT involves introducing stool from a healthy donor into the affected recipient to strengthen their compromised microbiome. Individuals receiving this treatment have reported remarkable improvement in clinical outcomes and quality of life. In addition to a discussion of rCDI within the context of the gastrointestinal microbiome, this article provides an overview of the FMT procedure, discusses nursing management of individuals undergoing FMT, and highlights emerging applications beyond rCDI. A case scenario is also provided to illustrate a typical trajectory for a patient undergoing FMT.
Chronic Hypertension in Pregnancy and Racial–Ethnic Disparities in Complications
Authors: Leonard Stephanie A. , Formanowski Brielle L. , Phibbs Ciaran S. , Lorch Scott , Main Elliott K. , Kozhimannil Katy Backes , Passarella Molly , Bateman Brian T.
Published: September 2023

OBJECTIVE:

To evaluate whether there are individual- and population-level associations between chronic hypertension and pregnancy complications, and to assess differences across seven racial–ethnic groups.

METHODS:

This population-based study used linked vital statistics and hospitalization discharge data from all live and stillbirths in California (2008–2018), Michigan (2008–2020), Oregon (2008–2020), Pennsylvania (2008–2014), and South Carolina (2008–2020). We used multivariable log-binomial regression models to estimate risk ratios (RRs) and population attributable risk (PAR) percentages with 95% CIs for associations between chronic hypertension and several obstetric and neonatal outcomes, selected based on prior evidence and pathologic pathways. We adjusted models for demographic factors (race and ethnicity, payment method, educational attainment), age, body mass index, obstetric history, delivery year, and state, and conducted analyses stratified across seven racial–ethnic groups.

RESULTS:

The study included 7,955,713 pregnancies, of which 168,972 (2.1%) were complicated by chronic hypertension. Chronic hypertension was associated with several adverse obstetric and neonatal outcomes, with the largest adjusted PAR percentages observed for preeclampsia with severe features or eclampsia (22.4; 95% CI 22.2–22.6), acute renal failure (13.6; 95% CI 12.6–14.6), and pulmonary edema (10.7; 95% CI 8.9–12.6). Estimated RRs overall were similar across racial–ethnic groups, but PAR percentages varied. The adjusted PAR percentages (95% CI) for severe maternal morbidity—a widely used composite of acute severe events—for people who were American Indian or Alaska Native, Asian, Black, Latino, Native Hawaiian or Other Pacific Islander, White, and Multiracial or Other were 5.0 (1.1–8.8), 3.7 (3.0–4.3), 9.0 (8.2–9.8), 3.9 (3.6–4.3), 11.6 (6.4–16.5), 3.2 (2.9–3.5), and 5.5 (4.2–6.9), respectively.

CONCLUSION:

Chronic hypertension accounts for a substantial fraction of obstetric and neonatal morbidity and contributes to higher complication rates, particularly for people who are Black or Native Hawaiian or Other Pacific Islander.
Janus kinase inhibitors: efficacy and safety
Authors: Cohen Stanley , Reddy Virginia
Published: September 2023

Purpose of review

Janus kinase inhibitors (JAKi) have been available for the treatment of rheumatoid arthritis (RA) since 2012 and are indicated for patients with active disease despite csDMARD therapy. Efficacy and safety, as demonstrated in the clinical trials, was similar to biologics. A recent post marketing trial suggested safety concerns with the JAKi, which will be reviewed.

Recent findings

A post marketing Food and Drug Administration (FDA) mandated open-label randomized clinical trial of tofacitinib 5 and 10 mg twice daily (b.i.d.) compared with adalimumab and etanercept was conducted in RA patients on background methotrexate who were at a high risk for cardiovascular disease. This was a noninferiority study evaluating the incidence of major adverse cardiovascular events (MACE) and malignancy with the therapies. Noninferiority for both doses of tofacitinib was not achieved with a numerical increase in MACEs and malignancy with tofacitinib compared to the TNF inhibitors. A dose-dependent increase in venous thromboembolism (VTE) risk with tofacitinib was observed. The findings from this study resulted in the FDA and European Medicines Agency (EMA) restriction of use for all Jaki to RA patients who had failed TNF inhibitors.

JAK inhibitors are effective treatments for RA. Issues have been raised regarding safety in patients with an increase in cardiovascular risk and VTE risk resulting in the need for risk stratification.
Epidemiology and demographics of pediatric proximal femur fractures in Türkiye: results from a government-based health registry
Authors: Söylemez Mehmet Salih , Bingöl İzzet , Yaşar Niyazi Erdem , Dumlupinar Ebru , Ayvali Mustafa Okan , Ata Naim , Ülgü M. Mahir , Birinci Şuayip , Özdemir Güzelali , Aslantürk Okan
Published: September 2023

We evaluate the epidemiology and incidence of pediatric proximal femur fractures, treatment trends among different hospital levels, and complication rates among different treatment modalities by examining a national health registry in Türkiye. The health records of individuals aged ≤16 years admitted to public, private, and university hospitals were collected via the e-health database of the Turkish Ministry of Health. A total of 2388 children treated for proximal femur fractures from 2016 to 2021 with at least 2 years of follow-up were included in the study. While 2033 (85.1%) patients were treated with closed reduction and spica casts, 355 (14.8%) were operated on. Mean age was 8.603 ± 5.11 years. Male incidence was 2-fold greater compared to female patients (36.4% female and 63.6% male patients; P < 0.001). The frequency of cases was significantly increased in the age groups of 3–4 and 13–16 years. Comorbidities causing limited ambulation were detected in 6.5% of all cases, and 163 (8.0%) patients in the conservative group and 98 (27.6%) patients in the surgery group had at least one complication. The incidence was 0.45 per 100 000 children aged ≤16 years. This study reports the largest patient cohort to date, providing evidence on the epidemiology and incidence of pediatric proximal femur fractures using health registry data. We have found that the most common treatment modality for proximal femur fractures is closed reduction with spica casts. The rate of avascular necrosis is similar among patients treated surgically and those treated conservatively.
Association of Early Beta-Blocker Exposure and Functional Outcomes in Critically Ill Patients With Moderate to Severe Traumatic Brain Injury: A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study
Authors: Kelly-Hedrick Margot , Liu Sunny Yang , Temkin Nancy , Barber Jason , Komisarow Jordan , Manley Geoffrey , Ohnuma Tetsu , Colton Katharine , Treggiari Miriam M. , Monson Eric E. , Vavilala Monica S. , Grandhi Ramesh , Laskowitz Daniel T. , Mathew Joseph P. , Hernandez Adrian , James Michael L. , Raghunathan Karthik , Goldstein Ben , Markowitz Amy J. , Krishnamoorthy Vijay ,   the Transforming Clinical Research and Knowledge in Traumatic Brain Injury Investigators
Published: September 2023

OBJECTIVES:

We aimed to 1) describe patterns of beta-blocker utilization among critically ill patients following moderate–severe traumatic brain injury (TBI) and 2) examine the association of early beta-blocker exposure with functional and clinical outcomes following injury.

DESIGN:

Retrospective cohort study.

SETTING:

ICUs at 18 level I, U.S. trauma centers in the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study.

PATIENTS:

Greater than or equal to 17 years enrolled in the TRACK-TBI study with moderate–severe TBI (Glasgow Coma Scale of <13) were admitted to the ICU after a blunt TBI.

INTERVENTIONS:

None.

MEASUREMENTS:

Primary exposure was a beta blocker during the first 7 days in the ICU, with a primary outcome of 6-month Glasgow Outcome Scale-Extended (GOSE). Secondary outcomes included: length of hospital stay, in-hospital mortality, 6-month and 12-month mortality, 12-month GOSE score, and 6-month and 12-month measures of disability, well-being, quality of life, and life satisfaction.

MAIN RESULTS:

Of the 450 eligible participants, 57 (13%) received early beta blockers (BB+ group). The BB+ group was on average older, more likely to be on a preinjury beta blocker, and more likely to have a history of hypertension. In the BB+ group, 34 participants (60%) received metoprolol only, 19 participants (33%) received propranolol only, 3 participants (5%) received both, and 1 participant (2%) received atenolol only. In multivariable regression, there was no difference in the odds of a higher GOSE score at 6 months between the BB+ group and BB– group (odds ratio = 0.86; 95% CI, 0.48–1.53). There was no association between BB exposure and secondary outcomes.

CONCLUSIONS:

About one-sixth of subjects in our study received early beta blockers, and within this group, dose, and timing of beta-blocker administration varied substantially. No significant differences in GOSE score at 6 months were demonstrated, although our ability to draw conclusions is limited by overall low total doses administered compared with prior studies.
Operation Diversify Plastic Surgery: An Innovative Strategy to Increase Diversity in Plastic and Reconstructive Surgery
Authors: Downer Mauricio A. , Hill Dorian , Mulenga Chilando , Vinson Ariel , Soto Edgar , Bashorun Olatunde , McCauley DeCoria , Wiltz Kylar , Newman Ashley , Butler Paris D.
Published: September 2023

Healthcare disparities remain a significant problem facing the US healthcare system with recent evidence of persistent racial and ethnic disparities especially among patients from minority backgrounds. Recent studies have documented advantages to a racially and ethnically diverse surgical workforce such as higher patient satisfaction scores, superior patient compliance with physician recommendations, and increased participation in clinical research studies by minority patients. In plastic and reconstructive surgery (PRS), there is a noted deficit among residents and faculty that come from ethnically underrepresented in medicine (URiM) backgrounds despite recent efforts to increase diversity in PRS surgeons. URiM medical students from three of the four historically Black medical universities organized to discuss pathways to PRS. Operation Diversify Plastic Surgery is a student-led organization that was developed to address the lack of diversity in PRS, challenges faced by students from institutions that lack PRS residency training programs, and unique factors that affect URiM students interested in PRS. Available studies note that mentoring relationships and research opportunities were instrumental in recruiting URiM students into PRS residency programs. Operation Diversify Plastic Surgery is an innovative solution to the insufficient URiM PRS residency candidate pool by increasing medical student exposure to PRS via educational lectures, virtual mentoring opportunities, and insights into research fellowships.
Establishment of a Simple, Reproducible, and Long-lasting Hind Limb Animal Model of Lymphedema
Authors: Morita Yuichi , Sakata Naoaki , Kawakami Ryo , Shimizu Masayuki , Yoshimatsu Gumpei , Wada Hideichi , Kodama Shohta
Published: September 2023

Background:

Lymphedema is an intractable disease for which there is currently no established curative therapy. A reliable and long-lasting lymphedema model is essential for development of better treatments. In this study, we aimed to establish a simple, reproducible and long-lasting mouse model of lymphedema.

Methods:

Our model is characterized by a combination of a circumferential skin incision in the femoral region, complete dissection of regional lymph nodes, and ablation of the inguinal route in the femoral region. The characteristics of the lymphedema were evaluated and compared with those of two other models. One of these models involved dissection of the subiliac, popliteal, and sciatic lymph nodes (model A) and the other excision of the subiliac, popliteal, and sciatic lymph nodes with cauterization of lymphatic vessels and closure without a skin excision (model B).

Results:

Although the lymphedema in models A and B resolved spontaneously, that in the new model lasted for a month with increases in femoral circumference and hind limb volume, thickening of the skin, especially subcutaneous tissue, and congestion of peripheral lymphatic vessels. Furthermore, this model could be used for assessing the therapeutic effects of syngeneic mesenchymal stem cell transplantation. The average operation time for the new model was 14.4 ± 1.3 minutes.

Conclusion:

Long-lasting lymphedema can be achieved by our new model, making it suitable for assessing therapies for lymphedema.
Efficiency Determinants in Healthcare: A Systematic Review With an Integrated Canonical Correlation Analysis–Data Envelopment Analysis/Assurance Region Model
Authors: Samut Pınar Kaya
Published: September 2023

Goal:

Instead of considering many variables for the accurate measurement of healthcare efficiency, working with the select few variables that really affect efficiency will provide more accurate efficiency scores. In addition, calculating the efficiency by weighting the inputs and outputs according to their effect and severity levels will give more realistic results. In this article, a three-step hybrid system with a two-stage CCA (canonical correlation analysis)–DEA/AR (data envelopment analysis/assurance region) model is proposed to obtain results of health efficiency.

Methods:

Healthcare efficiency studies conducted between 2000 and 2020 were reviewed. In this examination of the input and output variables used in the DEA of 63 previous studies, the 6 inputs and 5 outputs preferred by previous researchers were determined. Afterward, the health efficiency scores of countries represented in the research were calculated with weight-restricted DEA, and CCA was used for a priori statistical analysis in determining the weights. Thus, in this analysis of the preferred outputs and inputs with the help of CCA to estimate the relationship between multiple input and output sets, the variables that had no effect were eliminated and the ones that had an effect were included in DEA/AR with their degree of effectiveness.

Principal Findings:

For the model proposed here, three inputs and three outputs were identified by following a five-item variable reduction procedure. The numbers of doctors and nurses were identified as the most effective inputs, and infant mortality rates were found to be the most effective outputs. Therefore, health efficiency scores obtained with the proposed CCA–DEA/AR model and the basic DEA are presented together. A review of the results found fewer health-efficient countries with the weight-restricted DEA. This is proof that weighting the variables into the DEA increases the discriminating power of the method.

Practical Applications:

By applying the proposed model, healthcare administrators can analyze healthcare efficiency accurately and thus improve efficiency by transferring limited resources to the right places according to deficiencies or surpluses identified by the model's inputs. Resources can be allocated at both private and public hospitals in a way that increases healthcare efficiency outputs.
Effect of differing flap reconstruction strategies in perineal closure following advanced pelvic oncological resection: a retrospective cohort study
Authors: Galbraith Norman J. , McCollum Catherine , Di Mascio Lucia , Lowrie Joanna , Hinckley Matthew , Lo Steven , Watson Stuart , Telfer John R.C. , Roxburgh Campbell S. , Horgan Paul G. , Chong Peter S. , Quinn Martha , Steele Colin. W.
Published: September 2023

Introduction:

Advancing approaches to locally invasive pelvic malignancy creates a large tissue defect resulting in perineal wound complications, dehiscence, and perineal hernia. Use of reconstructive flaps such as vertical rectus abdominus myocutaneous (VRAM) flap, gracilis, anterolateral thigh (ALT) and gluteal flaps have been utilised in our institution to address perineal closure. We compared outcomes using different flap techniques along with primary perineal closure in advanced pelvic oncological resection.

Methods:

A prospectively maintained database of patients undergoing advanced pelvic oncological resection in a single tertiary hospital was retrospectively analysed. This study included consecutive patients between 2014 and 2021 according to the Strengthening The Reporting of Cohort Studies in Surgery (STROCSS) criteria. Primary outcome measures were the frequency of post-operative perineal complications between primary closure, VRAM, gluteal and thigh (ALT and gracilis) reconstruction.

Results:

122 patients underwent advanced pelvic resection with perineal closure. Of these, 40 patients underwent extra-levator abdominoperineal resection (ELAPE), and 70 patients underwent pelvic exenteration. Sixty-four patients received reconstructive flap closure, which included VRAM (22), gluteal (21) and thigh flaps (19). Perineal infection and dehiscence rates were low. Infection rates were lower in the flap group despite a higher rate of radiotherapy (P<0.050). Reoperation rates were infrequent (<10%) but specific for each flap, such as donor-site hernia following VRAM and flap dehiscence after thigh flap reconstruction.

Conclusions:

In patients who are at high risk of post-operative perineal infections, reconstructive flap closure offers acceptable outcomes. VRAM, gluteal and thigh flaps offer comparable outcomes and can be tailored to the individual patient.
Implementing the first program of minimally invasive esophagectomy for cancer in Israel: shifting the paradigm in a high-volume center. a cohort study
Authors: Solomon Daniel , Sarfaty Elad , Menasherov Nikolai , Bard Vyacheslav , Bueno Raphael , Kashtan Hanoch
Published: September 2023

Background:

Esophagectomy is associated with significant perioperative morbidity. Limited data are available on the process of implementation of minimally invasive techniques in esophagectomy and related outcomes. We sought to describe implementation processes and outcomes following implementation of the first minimally invasive esophagectomy (MIE) program at a high-volume center in Israel under the mentorship of American early adopters.

Methods:

Patients who underwent esophagectomy for esophageal carcinoma 2011–2022 were included. Early and late cohorts were created for learning curve analysis. Secondary analysis included patients who underwent open esophagectomy 1997-2011.

Results:

Overall, 300 patients underwent MIE: three-field MIE (3F-MIE) was performed in 242 (80.7%) patients, two-field MIE (2F-MIE) in 58 (19.3%) patients. Following program implementation in 2012, the number of MIE performed increased during the first 3 years (n=33, 86.8% in 2015). Among 3F-MIE patients, a higher number of retrieved lymph nodes was reported during later cases (median, IQR1-3 17, 12-23 vs. 12, 8-12, P<0.001) while surgeries required a longer time (median, IQR1-3 300 minutes, 261-355 vs. 262.5, 239-300, P<0.001). Among 2F-MIE patients, the late cohort had lower rates of prolonged ICU admissions than earlier counterparts (n=2, 6.9% vs. n=9, 31%, P=0.041), overall and severe 30-day complications (n=12, 41.4% vs. n=23, 79.3%, P<0.001 and n=7, 24.1% vs. n=23, 79.3%, P=0.003).

Conclusions:

Minimally invasive esophagectomy was safely implemented. Nodal yield was higher among MIE patients than open esophagectomy. During the study years, open approach was gradually abandoned in favor of 3F-MIE procedures, while 2F-MIE increased over the course of the last years.
Comparison of National Early Warning Score with shock index in patients with necrotizing fasciitis
Authors: Kuo Yen-Ting , Hsiao Cheng-Ting , Wu Po-Han , Wu Kai-Hsiang , Chang Chia-Peng
Published: September 2023

Shock index (SI) and national early warning score (NEWS) are more frequently used as assessment tools in acute illnesses, patient disposition and early identification of critical condition. Both they are consisted of common vital signs and parameters including heart rate, systolic blood pressure, respiratory rate, oxygen saturation and level of conscious, which made it easy to evaluate in medical facilities. Its ability to predict mortality in patients with necrotizing fasciitis (NF) in the emergency department remains unclear. This study was conducted to compare the predictive capability of the risk scores among NF patients. A retrospective cohort study of hospitalized patients with NF was conducted in 2 tertiary teaching hospitals in Taiwan between January 2013 and March 2015. We investigated the association of NEWS and SI with mortality in NF patients. Of the 395 NF patients, 32 (8.1%) died in the hospital. For mortality, the area under the receiver curve value of NEWS (0.81, 95% confidence interval 0.76–0.86) was significantly higher than SI (0.76, 95% confidence interval 0.73–0.79, P = .016). The sensitivities of NEWS of 3, 4, and 5 for mortality were 98.1%, 95.6%, and 92.3%. On the contrast, the sensitivities of SI of 0.5, 0.6, and 0.7 for mortality were 87.8%, 84.7%, and 81.5%. NEWS had advantage in better discriminative performance of mortality in NF patients. The NEWS may be used to identify relative low risk patients among NF patients.
The association between angiotensin receptor blockers and lung, bladder, and colon cancer development: A 10-year multicentric retrospective Lebanese study
Authors: Dagher Yara G. , El Helou Sandra , Haifa Karen G. , Chalhoub Issam G. , Boulos Rita T. , Atallah Bachir , Nasr Fadi , Kassab Issam , Chahine Mirna N.
Published: September 2023

Cardiovascular diseases (CVD) are the leading cause of death globally, followed by cancer. Angiotensin II contributes greatly to CVD pathogenesis, and Angiotensin II receptor blockers (ARBs) constitute a mainstay in hypertension and CVD management. However, the relationship between ARBs and cancer initiation is controversial, with no clear data in Lebanon. Therefore, our study aimed to determine the association between ARBs intake and lung, bladder, and colorectal cancers development in the Lebanese population. A retrospective study was conducted on 709 subjects divided into 2 main groups: Control (subjects without cancer; n = 177), and Cases (patients with cancer (n = 532): lung, bladder, or colorectal), taking ARBs (n = 236, (n = 121 in control and n = 115 in cases)) or not (n = 473). Collected information included the patients demographics, comorbidities, cancer’s risk factors, and ARBs dose and duration intake. Bivariate, multivariate, and binary logistic analyses were enrolled. ARBs use was significantly protective (P value = 0.000) against overall cancer development (odds ratio [OR] = 0.127) and against each, lung (OR < 1), bladder (OR < 1), and colorectal cancers (OR < 1). A duration-response relationship was established. This protective effect and the time-dependent relationship remained unchanged after omitting the most relevant risk factors. In summary, a significant overall protective effect of ARBs against lung, bladder and colorectal cancers was found. This beneficial response was time-dependent. These results can guide patients on treatment options and clinicians for informed decision-making.
Diagnostic value of exfoliated tumor cells combined with DNA methylation in bronchoalveolar lavage fluid for lung cancer
Authors: Lu Huiling , Lin Dang
Published: September 2023

Background:

To evaluate the diagnostic value of exfoliated tumor cells (ETCs) numbers combined with DNA methylation levels in bronchoalveolar lavage fluid (BALF) in lung cancer.

Methods:

BALF samples were collected from 43 patients with lung cancer and 23 with benign lung disease. ETCs were detected by the nano-enrichment method, and the methylation status of the short stature homeobox gene 2 (SHOX2) and the RAS association domain family 1, isoform A (RASSF1A) gene were detected by RT-PCR. The diagnostic value of each metric was evaluated by receiver operating characteristic curve analysis, specificity and sensitivity.

Results:

The sensitivity/specificity of RASSF1A and SHOX2 methylation detection were 44.12%/76.47% and 93.75%/87.50%, respectively. When “RASSF1A/SHOX2 methylation” was used as a positive result, the sensitivity increased to 88.24%, and the specificity decreased to 81.25%. When “RASSF1A + SHOX methylation” was used as positive, the sensitivity was reduced to 32.35%, but the specificity was increased to 100.00%. The sensitivity and specificity of ETCs detection in BALF were 89.47% and 16.67%, respectively. When “SHOX2/RASSF1A methylation + ETCs was used as a positive result, the sensitivity and specificity of the detection were 79.31% and 81.82%, respectively. When “SHOX2 + RASSF1A + ETCs” was used as positive, the sensitivity was 34.48% and the specificity was 90.91%. Receiver operating characteristic curve analysis showed that when SHOX2, RASSF1A methylation and ETCs were combined, the diagnostic sensitivity increased to 0.778.

Conclusion:

ETCs counting in combination with SHOX2 and RASSF1A methylation assays in BALF samples has demonstrated excellent sensitivity for lung cancer diagnosis and is an effective complementary tool for clinical diagnosis of lung cancer.
Correlation study and clinical value analysis between cerebral microbleeds and white matter hyperintensity with high-field susceptibility-weighted imaging
Authors: Zhao Xiumin , Yin Liang , Yu Lei , Jiang Xiangsen , Tian Ning , Yin Zudong
Published: September 2023

This study aimed to investigate the relationship between white matter hyperintensity (WMH) and cerebral microbleeds (CMBs) using susceptibility-weighted imaging (SWI) with high resolution. Additionally, it sought to analyze the clinical significance of SWI with high resolution and its potential to guide intravenous thrombolysis in stroke patients. In this retrospective analysis, we examined 96 patients with hypertension after acute stroke in our hospital using SWI. Demographic and medical data of these 96 patients were collected. Spearman correlation analysis was performed to investigate the relationship between CMBs and the grading of WMH. A significant positive correlation was observed between CMBs and the grade of WMH (R = 0.593, P < .05). The data also revealed a superior ROC area under the curve for the modified Fazekas grading of WMH, which was 0.814 (P < .05). There is a positive correlation between CMBs and the grading of leukoaraiosis in patients with acute stroke and hypertension. The higher the degree of WMH, the more severe the microvascular lesions, increasing the likelihood of intracranial hemorrhage. SWI can provide valuable guidance for administering intravenous thrombolysis in patients with acute stroke.
Research hotspots and trend of a emerging novel endoscopic technique of peroral endoscopic myotomy from 2010 to 2022: A bibliometric analysis
Authors: Zhu Qingliang , Zhang Han , Huang Shu , Gan Peiling , Wang Ruiyu , Peng Yan , Lü Muhan , Tang Xiaowei
Published: September 2023

Peroral endoscopic myotomy (POEM), which has been used to treat achalasia and other esophageal motility disorders for the past 10 years, has proven to be secure and efficient. Every year, more and more essays on this subject are published. We sought to investigate the global scientific outputs and hotspots of POEM produced by various nations, organizations, and authors. From 2010 to October 2022, there were 875 papers on POEM that were found in the Web of Science Core database. The bibliometric visualization analyses of nations/regions, institutions, authors, journals, references, and keywords were conducted by CiteSpace V.5.8.R3. Eight hundred seventy-five publications were included in this analysis. With 68 publications, Inoue H had the highest output. While Showa University in Japan was the most productive institution, the United States was the most productive nation. Among the journals, Surgical Endoscopy published the highest number of articles, followed by Gastrointestinal Endoscopy and Endoscopy. The top 10 keywords that appeared most frequently were achalasia, peroral endoscopic myotomy, POEM, myotomy, esophageal achalasia, dysphagia, heller myotomy, endoscopy, gastroparesis and peroral endoscopic myotomy. Seven frontiers, including meta-analysis, high-resolution esophageal manometry, geriatric patient, third space endoscopy, adverse event, endoscopic submucosal dissection, and gastric peroral endoscopic myotomy, had an impact on future research on POEM. The previous 10 years have seen a considerable rise in POEM research, and this trend will continue. The most recent research frontiers, which require more attention, are meta-analysis, high-resolution esophageal manometry, geriatric patient, third space endoscopy, adverse event, and gastric peroral endoscopic myotomy.
Vascular supply of postresection pancreatic remnant after pancreaticoduodenectomy: A cadaveric study
Authors: Rousek Michael , Kachlík David , Záruba Pavel , Pudil Jiří , Schütz Štěpán Ota , Balko Jan , Pohnán Radek
Published: September 2023

Objectives:

The vascular supply to the neck and body of the pancreas is highly variable. The dorsal pancreatic artery is the dominant artery feeding this area. The aim of this study was to describe the vascular supply of postresection pancreatic remnants after pancreaticoduodenectomy. Patients with hazardous anatomical arrangement may be at a higher risk of postresection remnant ischemia and postoperative pancreatic fistula development.

Methods:

The modified Whipple procedure was performed on 20 cadaveric donors. The macroscopic anatomical supply of the postresection pancreatic remnant of each donor was evaluated.

Results:

The arterial supply of the postresection remnant was highly variable. In 30% of cases (6/20), the dorsal pancreatic artery was cut during the pancreatoduodenectomy or it was missing. In these cases, the area of the pancreaticojejunostomy construction was fed only through anastomoses between the transverse pancreatic artery and the pancreatic branches of the splenic artery.

Conclusions:

In 30% of cases, the arterial supply of the postresection pancreatic remnant was dependent on inconstant intraparenchymal arterial anastomoses. These patients may be at a higher risk of postoperative pancreatic fistula development.
Infection status and clinical characteristics of COVID-19 in maintenance hemodialysis patients in Wuhan during the omicron pandemic
Authors: Liu Hong , Jiang Nan , Min Yonglong , Huang Dan , Liu Huizhen , Li Hongbo , Xiong Fei
Published: September 2023

Maintenance hemodialysis (MHD) patients are the high-risk population of infection and death of novel coronavirus disease 2019 (COVID-19), our study aimed to investigate the infection status and clinical characteristics of COVID-19 in MHD patients at a single-center in Wuhan during the Omicron pandemic. In this retrospective, single-center study, we analyzed the clinical data of all MHD patients in Hemodialysis Center of Wuhan No. 1 Hospital from December 2, 2022 to January 6, 2023 during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron pandemic outbreak. We analyzed the epidemiological and clinical characteristics of deaths and survivors of MHD patients. The infection rate of SARS-CoV-2 in MHD patients was 93.32% (573/614), mortality rate was 8.14% (50/614), hospitalization rate was 23.29% (143/614), and the vaccination rate of COVID-19 was 4.89% (30/614). The median survival time of dead patients was 11 days, the mortality rate of male MHD patients was significantly higher than female. Elderly MHD patients had a higher mortality rate, with a average age of death higher than 70 years old. Additionally, the mortality rate of MHD patients infected with SARS-CoV-2 was higher if the primary disease was hypertensive renal damage or diabetic nephropathy. Laboratory results showed that the lower the albumin level and the higher the C-reactive protein level of MHD patients who died of SARS-CoV-2 infection and severe and critical survival patients. In surviving MHD patients infected with SARS-CoV-2, the most common symptoms were hypodynamia (84.70%), decreased appetite (81.26%) and cough (80.69%). The symptoms of fever, chest tightness and panting, cough, pharyngalgia, hypodynamia, decreased appetite in surviving MHD patients with severe and critical type were significantly higher than those in patients with mild and moderate type. MHD patients are a highly vulnerable population at increased risk of mortality during the Omicron pandemic. Elderly, male, primary disease was hypertensive renal damage or diabetic nephropathy, hypoproteinemia and high C-reactive protein level, all of which will lead to increased mortality in MHD patients.
Effect of extracurricular tutoring on adolescent students cognitive ability: A propensity score matching analysis
Authors: Zhang Qi , Yang Jiafei , Wang Wenlong , Liu Zhihong
Published: September 2023

In recent years, there has been a substantial increase in the number of adolescent students attending extracurricular tutoring. However, extracurricular tutoring, being a distinct form of education, may have varying effects on cognitive capabilities compared to conventional education. Accordingly, the purpose of this paper is to conduct a thorough examination of the effects of extracurricular tutoring on cognitive abilities among adolescent students. The study utilized national data from the China Family Panel Study 2018 to explore the relationship between involvement in extracurricular tutoring among students and cognitive abilities. The study included 2567 valid respondents. A binary logistic regression model was built to determine the factors associated with tutoring involvement while controlling for 19 individual, family, and school factors. Furthermore, a propensity score-matched analysis was conducted in order to mitigate potential bias by using confounding variables identified in the previous step. The study results show that participation in extracurricular tutoring can significantly increase the level of cognitive ability of adolescent students, with adjustments made for age, gender, ethnicity, number of family members, net family income per capita, education and training expenditure in the past years, change of residence for enrollment, change of domicile address for enrollment, locality of the current school, class size, hold a position as a class cadre, average daily study time on weekdays, average study time per day during weekends. The findings imply that the government should provide tutorial subsidies to disadvantaged groups of adolescent students, allocate educational resources equitably, and invest more in education resources in less developed regions to foster fair and healthy development of education and improve the cognitive abilities of young students in the long-term.
Research progress of ferroptosis in Alzheimer disease: A review
Authors: Han Qi , Sun Li , Xiang Ke
Published: September 2023

Ferroptosis is an emerging form of programmed cell death triggered by iron-dependent lipid peroxidation and reactive oxygen species (ROS). Alzheimer disease (AD), a neurodegenerative disorder, is characterized by the degeneration of nerve cells. Recent research has indicated a significant association between ferroptosis and AD; however, the precise underlying mechanism remains elusive. It is postulated that ferroptosis may impact the accumulation of iron ions within the body by influencing iron metabolism, amino acid metabolism, and lipid metabolism, ultimately leading to the induction of ferroptosis in nerve cells. This article centers on the attributes and regulatory mechanism of ferroptosis, the correlation between ferroptosis and AD, and the recent advancements in the therapeutic approach of targeting ferroptosis for the treatment of AD. These results suggest that ferroptosis could potentially serve as a pivotal focus in future research on AD.
Virtual volunteering, community support, and self-care in Chinese communities in Canada
Authors: Tan Weijia , Zhu Yidan , Wu Liuxi , Hou Jingyi , Yi Jingjing , Qi Tianyang , Zhang Weiguo
Published: September 2023

Objective:

Our study aimed to explore the link between environment and health, driven by a virtual volunteering program, and discuss the implications of virtual volunteering in community support in the postpandemic era.

Methods:

Using a purposive sampling strategy, we recruited 21 participants with diverse backgrounds, including age and sex. They participated in individual interviews of 1–2 hours, all of which followed a semistructured interview guide centered on topics, such as volunteer experiences, impacts, and understanding of volunteering. The audio recordings were transcribed verbatim and analyzed using a grounded theory approach.

Results:

Our data showed that interpersonal interactions through the virtual volunteering program helped participants deal with loneliness, and boosted their mental health. The social network provided participants with social support. Moreover, activities, such as dancing, yoga, Tai Chi, and singing, facilitated physical health. Participants not only learned various skills but also served as mentors, through which they increased self-efficacy through reciprocal role transformation.

Conclusions:

Our study concludes that virtual volunteer programs have a positive impact on people’s physical and mental health. The participants demonstrated different levels of resilience when their environments changed. By situating virtual volunteering as the center of people’s health, our findings suggest that people gain informational, instrumental, and emotional support through virtual volunteering. Future research should examine the experiences of individuals from other ethnic groups and settings to supplement this study.
Bleeding in Critically Ill Children With Malignancy or Hematopoietic Cell Transplant: A Single-Center Prospective Cohort Study
Authors: Levasseur Julie , Fikse Lauren , Mauguen Audrey , Killinger James S. , Karam Oliver , Nellis Marianne E.
Published: September 2023

OBJECTIVES:

To determine the incidence of bleeding in critically ill children with malignancy and to describe associated patient characteristics, interventions, and clinical outcomes.

DESIGN:

Prospective cohort study.

SETTING:

PICU in a specialized cancer hospital.

PATIENTS:

Children with malignancy or hematopoietic cell transplant 0–18 years of age were admitted to the PICU from November 2020 to November 2021.

INTERVENTIONS:

None.

MEASUREMENTS:

Patient demographic data, laboratory values, and PICU outcome data were collected. Bleeding was classified according to the Bleeding Assessment Scale in Critically Ill Children.

MAIN RESULTS:

Ninety-three bleeding patients were enrolled, and a total of 322 bleeding days were recorded. The median (interquartile range [IQR]) age was 5.8 (2.9–11.8) years and 56% (52/93) of the patients were male. There were 121 new bleeding episodes, in 593 at-risk person-days, translating into a 20% incidence rate per day (95% CI, 17–24%). The incidence of severe, moderate, and minimal bleeding was 2% (95% CI, 1–3), 4% (95% CI, 3–6), and 14% (95% CI, 12–17), respectively. Of the new bleeding episodes, 9% were severe, 25% were moderate and 66% were minimal. Thrombocytopenia was the only laboratory value independently associated with severe bleeding (p = 0.009), as compared to minimal and moderate bleeding episodes. History of radiation therapy was independently associated with severe bleeding (p = 0.04). We failed to identify an association between a history of stem cell transplant (p = 0.49) or tumor type (p = 0.76), and bleeding severity. Patients were transfused any blood product on 28% (95% CI, 22–34) of the bleeding days. Severe bleeding was associated with increased length of mechanical ventilation (p = 0.003), longer PICU stays (p = 0.03), and higher PICU mortality (p = 0.004).

CONCLUSIONS:

In this prospective cohort of children with malignancy, the incidence rate of bleeding was 20%. Most events were classified as minimal bleeding. Low platelet count and radiation therapy were variables independently associated with severe bleeding episodes.
18F-FDG PET/CT in a Patient With Epididymo-Testicular Malacoplakia
Authors: Zhao Xulong , Long Zaiying , Yu Liming , Wang Xinjie , Fu Zhanli
Published: September 2023

A 56-year-old man presented with a 2-month history of a mass in the right epididymo-testicular region, which exhibited heterogeneous high avidity for 18F-FDG on PET/CT. Malignant tumor was highly suspected, leading to subsequent right orchiectomy and epididymectomy. Histopathological examination revealed the presence of characteristic Michaelis-Gutmann bodies within von Hansemann macrophages, confirming the diagnosis of malacoplakia.
The genome of a steinernematid-associated Pseudomonas piscis bacterium encodes the biosynthesis of insect toxins
Authors: Awori Ryan Musumba , Hendre Prasad Suresh , Amugune Nelson O.
Published: September 2023

Several species of soil-dwelling Steinernema nematodes are used in the biocontrol of crop pests, due to their natural capacity to kill diverse species of lepidopterans. Although this insect-killing trait is known to be augmented by the nematodes’ Xenorhabdus endosymbionts, the role of other steinernematid-associated bacterial genera in the nematode lifecycle remains unclear. This genomic study aimed to determine the potential of Pseudomonaspiscis to contribute to the entomopathogenicity of its Steinernema host. Insect larvae were infected with three separate Steinernema cultures. From each of the three treatments, the prevalent bacteria in the haemocoel of cadavers, four days post-infection were isolated. These three bacterial isolates were morphologically characterised. DNA was extracted from each of three bacterial isolates and used for genome sequencing and assembly. Assemblies were used to delineate species and identify genes that encode insect toxins, antimicrobials, and confer antibiotic resistance. We assembled three complete genomes. Through digital DNA-DNA hybridisation analyses, we ascertained that the haemocoels of insect cadavers previously infected with Steinernema sp. Kalro, Steinernema sp. 75, and Steinernema sp. 97 were dominated by Xenorhabdus griffiniae Kalro, Pseudomonas piscis 75, and X. griffiniae 97, respectively. X. griffiniae Kalro and X. griffiniae 97 formed a subspecies with other X. griffiniae symbionts of steinernematids from Kenya. P. piscis 75 phylogenetically clustered with pseudomonads that are characterised by high insecticidal activity. The P. piscis 75 genome encoded the production pathway of insect toxins such as orfamides and rhizoxins, antifungals such as pyrrolnitrin and pyoluteorin, and the broad-spectrum antimicrobial 2,4-diacetyl phloroglucinol. Its genome encoded resistance to over ten classes of antibiotics, including cationic lipopeptides.  Steinernematid-associated P. piscis bacteria hence have the biosynthetic potential to contribute to nematode entomopathogenicity.
Effect of Artificial Intelligence or Machine Learning on Prediction of Hip Fracture Risk: Systematic Review
Authors: Cha Yonghan , Kim Jung-Taek , Kim Jin-Woo , Seo Sung Hyo , Lee Sang-Yeob , Yoo Jun-Il
Published: September 2023

Background: Dual energy X-ray absorptiometry (DXA) is a preferred modality for screening or diagnosis of osteoporosis and can predict the risk of hip fracture. However, the DXA test is difficult to implement easily in some developing countries, and fractures have been observed before patients underwent DXA. The purpose of this systematic review is to search for studies that predict the risk of hip fracture using artificial intelligence (AI) or machine learning, organize the results of each study, and analyze the usefulness of this technology.Methods: The PubMed, OVID Medline, Cochrane Collaboration Library, Web of Science, EMBASE, and AHRQ databases were searched including “hip fractures” AND “artificial intelligence”.Results: A total of 7 studies are included in this study. The total number of subjects included in the 7 studies was 330,099. There were 3 studies that included only women, and 4 studies included both men and women. One study conducted AI training after 1:1 matching between fractured and non-fractured patients. The area under the curve of AI prediction model for hip fracture risk was 0.39 to 0.96. The accuracy of AI prediction model for hip fracture risk was 70.26% to 90%.Conclusions: We believe that predicting the risk of hip fracture by the AI model will help select patients with high fracture risk among osteoporosis patients. However, to apply the AI model to the prediction of hip fracture risk in clinical situations, it is necessary to identify the characteristics of the dataset and AI model and use it after performing appropriate validation.
Osteoporosis Feature Selection and Risk Prediction Model by Machine Learning Using a Cross-Sectional Database
Authors: Cha Yonghan , Seo Sung Hyo , Kim Jung-Taek , Kim Jin-Woo , Lee Sang-Yeob , Yoo Jun-Il
Published: September 2023

Background: The purpose of this study was to verify the accuracy and validity of using machine learning (ML) to select risk factors, to discriminate differences in feature selection by ML between men and women, and to develop predictive models for patients with osteoporosis in a big database.Methods: The data on 968 observed features from a total of 3,484 the Korea National Health and Nutrition Examination Survey participants were collected. To find preliminary features that were well-related to osteoporosis, logistic regression, random forest, gradient boosting, adaptive boosting, and support vector machine were used.Results: In osteoporosis feature selection by 5 ML models in this study, the most selected variables as risk factors in men and women were body mass index, monthly alcohol consumption, and dietary surveys. However, differences between men and women in osteoporosis feature selection by ML models were age, smoking, and blood glucose level. The receiver operating characteristic (ROC) analysis revealed that the area under the ROC curve for each ML model was not significantly different for either gender.Conclusions: ML performed a feature selection of osteoporosis, considering hidden differences between men and women. The present study considers the preprocessing of input data and the feature selection process as well as the ML technique to be important factors for the accuracy of the osteoporosis prediction model.
Thymoquinone-Protoflavone Hybrid Molecules as Potential Antitumor Agents
Authors: Ahmed Sara H. H. , Tayeb Bizhar A. , Gonda Tímea , Girst Gábor , Szőri Kornél , Berkecz Róbert , Zupkó István , Minorics Renáta , Hunyadi Attila
Published: September 2023

We describe herein the synthesis of eight new ester-coupled hybrid compounds from thymoquinone and protoflavone building blocks, and their bioactivity testing against multiple cancer cell lines. Among the hybrids, compound 14 showed promising activities in all cell lines studied. The highest activities were recorded against breast cancer cell lines with higher selectivity to MDA-MB-231 as compared to MCF-7. Even though the hybrids were found to be completely hydrolysed in 24 h under cell culture conditions, compound 14 demonstrated a ca. three times stronger activity against U-87 glioblastoma cells than a 1:1 mixture of its fragments. Protoflavone-thymoquinone hybrids may therefore serve as potential new antitumor leads particularly against glioblastoma.