bluuebunny/crossref_metadata_2025 huggingface dataset:
The Consilia by Learned Physicians Pietro Andrea Mattioli and Francesco Partini: Dialectic Relations between Doctrine, Empirical Knowledge and Use of the Senses in Sixteenth-century Europe
Authors: Quaranta Alessandra
Published: October 2021

The present article focuses on the medical practice of Pietro Andrea Mattioli from Siena and Francesco Partini from Rovereto (Trent), learned physicians who worked for the Habsburg courts in the second half of the sixteenth century. They paid particular attention to the body signs of disease and described them in detail through the senses of sight, touch, smell and taste. Such a method allowed them to formulate a plausible diagnosis, which concerned not only a general humoral imbalance but also often a specific organ. Furthermore, the empirical data they observed were interpreted in the light of Galenic medicine, a fluid and adaptable system, capable of including relatively new elements. Partini and Mattioli’s medical consultations reveal peculiar aspects of body examination and offer the opportunity both to seize the inventiveness of Galenic medicine and to explore the complex relationship between learned physicians and the written medical tradition.
Mycorrhiza helper bacterium Bacillus pumilus HR10 improves growth and nutritional status of Pinus thunbergii by promoting mycorrhizal proliferation
Authors: Wang Ya-Hui , Hou Liang-Liang , Wu Xiao-Qin , Zhu Mei-Ling , Dai Yun , Zhao Yin-Juan
Published: October 2021

Mycorrhizal helper bacteria (MHB) play an important role in mediating mycorrhizal symbiosis, which improves the growth and nutrient uptake of plants. This study examined the growth-promoting effects and mechanisms of pine growth after inoculation with the MHB Bacillus pumilus HR10 and/or Hymenochaete sp. Rl. The effect of B. pumilus HR10 on Hymenochaete sp. Rl growth, enzyme activity and gene expression related to mycorrhiza formation were determined. The growth, root activity, nitrogen, phosphorus, and potassium content and chlorophyll fluorescence activity of Pinus thunbergii and the mycorrhizal colonization intensity of Hymenochaete sp. Rl-inoculated pine seedlings after inoculation with B. pumilus HR10 were also evaluated. The results showed that B. pumilus HR10 promoted growth, regulated the expression of mycorrhizal-related genes and affected the β-1,3-glucanase activity of Hymenochaete sp. Rl. The mycorrhizal colonization intensity of pine seedlings co-inoculated with B. pumilus HR10 and Hymenochaete sp. Rl was 1.58-fold higher than seedlings inoculated with only Hymenochaete sp. Rl. Inoculation with B. pumilus HR10 and/or Hymenochaete sp. Rl increased lateral root number and root activity of pine seedlings and chlorophyll fluorescence activity of pine needles compared with the control. Bacillus pumilus HR10 facilitated nutrient uptake by enhancing the mycorrhizal proliferation of pine and induced greater photosynthesis and root activity of pine seedlings, which confirms its role as an outstanding plant-growth-promoting rhizobacterium. These findings improve our understanding of the mechanism of B. pumilus HR10 promotion of mycorrhizal symbiosis.
Diverging responses of water and carbon relations during and after heat and hot drought stress in Pinus sylvestris
Authors: Rehschuh Romy , Ruehr Nadine K
Published: October 2021

Forests are increasingly affected by heatwaves, often co-occurring with drought, with consequences for water and carbon (C) cycling. However, our ability to project tree resilience to more intense hot droughts remains limited. Here, we used single tree chambers (n = 18) to investigate transpiration (E), net assimilation (Anet), root respiration (Rroot) and stem diameter change in Scots pine seedlings in a control treatment and during gradually intensifying heat or drought-heat stress (max. 42 °C), including recovery. Alongside this, we assessed indicators of stress impacts and recovery capacities.

In the heat treatment, excessive leaf heating was mitigated via increased E, while under drought-heat, E ceased and leaf temperatures reached 46 °C. However, leaf electrolyte leakage was negligible, while light-adapted quantum yield of photosystem II (F′v/F′m) declined alongside Anet moderately in heat, but strongly in drought-heat seedlings, in which respiration exceeded C uptake. Drought-heat largely affected the hydraulic system as apparent in stem diameter shrinkage, declining relative needle water content (RWCNeedle) and water potential (ΨNeedle) reaching −2.7 MPa, alongside a 90% decline of leaf hydraulic conductance (KLeaf).

Heat alone resulted in low functional impairment and all measured parameters recovered quickly. Contrary, following drought-heat, the recovery of KLeaf was incomplete and stem hydraulic conductivity (KS) was 25% lower than the control. However, F′v/F′m recovered and the tree net C balance reached control values 2 days post-stress, with stem increment rates accelerating during the second recovery week. This indicates a new equilibrium of C uptake and release in drought-heat seedlings independent of hydraulic impairment, which may slowly contribute to the repair of damaged tissues. In summary, Scots pine recovered rapidly following moderate heat stress, while combined with drought, hydraulic and thermal stress intensified, resulting in functional damage and slow recovery of hydraulic conductance. This incomplete hydraulic recovery could critically limit evaporative cooling capacities and C uptake under repeated heatwaves.
Phylodynamic study of the conserved RNA structure encompassing the hemagglutinin cleavage site encoding region of H5 and H7 low pathogenic avian influenza viruses
Authors: Dupré Gabriel , Hoede Claire , Figueroa Thomas , Bessière Pierre , Bertagnoli Stéphane , Ducatez Mariette , Gaspin Christine , Volmer Romain
Published: October 2021

Highly pathogenic avian influenza viruses (HPAIVs) evolve from low pathogenic avian influenza viruses (LPAIVs) of the H5 and H7 subtypes. This evolution is characterized by the acquisition of a multi-basic cleavage site (MBCS) motif in the hemagglutinin (HA) that leads to an extended viral tropism and severe disease in poultry. One key unanswered question is whether the risk of transition to HPAIVs is similar for all LPAIVs H5 or H7 strains, or whether specific determinants in the HA sequence of some H5 or H7 LPAIV strains correlate with a higher risk of transition to HPAIVs. Here, we determined if specific features of the conserved RNA stem-loop located at the HA cleavage site-encoding region could be detected along the LPAIV to HPAIV evolutionary pathway. Analysis of the thermodynamic stability of the predicted RNA structures showed no specific patterns common to HA sequences leading to HPAIVs and distinct from those remaining LPAIVs. However, RNA structure clustering analysis revealed that most of the American lineage ancestors leading to H7 emergences via recombination shared the same viral RNA (vRNA) structure topology at the HA1/HA2 boundary region. Our study thus identified predicted secondary RNA structures present in the HA of H7 viruses, which could promote genetic recombination and acquisition of a multibasic cleavage site motif (MBCS).
Later Life Workplace Index: Validation of an English Version
Authors: Finsel Julia S , Wöhrmann Anne M , Wang Mo , Wilckens Max R , Deller Jürgen
Published: October 2021

Research on measures for organizational practices targeted toward older employees has grown during the past decade. However, existing measures tend to capture the construct with unidimensional scales, use single-item operationalizations, or focus on specific domains. Thus, the Later Life Workplace Index (LLWI) was developed to serve as a multidimensional framework for measuring organizational practices for the aging workforce. The LLWI covers 9 domains, namely organizational climate, leadership, work design, health management, individual development, knowledge management, transition to retirement, continued employment after retirement, and health and retirement coverage. The index has recently been operationalized and validated in Germany. Given that the quantitative evidence for the framework is limited to Germany so far, we aimed to translate and validate an English version of the LLWI using a sample of older U.S. employees (N = 279). Findings regarding the psychometric properties of the measure are presented, supporting the domain level factor structure through confirmatory factor analyses, but revealing some redundancy among the items for the overall 9 domain factor structure. Multigroup factor analyses comparing the U.S. sample to a German sample (N = 349) further confirmed configural and (partial) metric measurement invariance of the English version of the LLWI. Results also supported convergent and discriminant validity as well as criterion and incremental validity regarding individual level attitudinal, health-related, intention, and behavioral outcomes. Based on these findings, implications for the use of the LLWI in research and practice and future research directions are discussed.
Orogastric Tube Insertion in Extremely Low Birth-Weight Infants
Authors: Benefield Danielle , Salas Ariel A.
Published: October 2021

Background:

Orogastric (OG) tube insertion is a frequent practice performed by nurses in the neonatal intensive care unit (NICU). Combining the nose–ear–mid-umbilicus (NEMU) method with a birth weight (BW)–based method to determine optimal insertion length of OG tubes could reduce misplacement in extremely low birth-weight (ELBW) infants.

Purpose:

The objective of this study was to determine whether combining the NEMU method with a BW-based method to determine insertion length of OG tubes reduces misplacement of OG tubes in ELBW infants younger than 6 hours.

Methods:

The study included 129 ELBW infants in the NICU younger than 6 hours. We compared the frequency of OG tube misplacements in ELBW infants during 2 different time periods. In period I, the insertion length of OG tubes was estimated with the NEMU method alone. In period II, the insertion length of OG tubes was estimated by combining the NEMU method with a BW-based method. OG tubes were considered misplaced if the tip was above the diaphragm (high) or near the pylorus (low) in radiographs obtained after placement.

Results:

Infants who had OG tubes placed by combining both methods were less likely to have low OG tubes (53% in period I vs 34% in period II; P < .05). The BW-based method alone predicted optimal OG tube insertion length in 57 of 89 infants (64%).

Implications for Practice and Research:

Combining the NEMU method with the BW-based method increases the probability of optimal OG tube placement in ELBW infants. Additional studies across multiple centers would validate the diagnostic accuracy of this method.

Video abstract available at
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.
Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery
Authors: Goldsmith Michael P. , Nadkarni Vinay M. , Futterman Craig , Gazit Avihu Z. , Baronov Dimitar , Tomczak Adam , Laussen Peter C. , Salvin Joshua W.
Published: October 2021

OBJECTIVES:

Advanced clinical decision support tools, such as real-time risk analytic algorithms, show promise in assisting clinicians in making more efficient and precise decisions. These algorithms, which calculate the likelihood of a given underlying physiology or future event, have predominantly been used to identify the risk of impending clinical decompensation. There may be broader clinical applications of these models. Using the inadequate delivery of oxygen index, a U.S. Food and Drug Administration-approved risk analytic algorithm predicting the likelihood of low cardiac output state, the primary objective was to evaluate the association of inadequate delivery of oxygen index with success or failure of weaning vasoactive support in postoperative cardiac surgery patients.

DESIGN:

Multicenter retrospective cohort study.

SETTING:

Three pediatric cardiac ICUs at tertiary academic children’s hospitals.

PATIENTS:

Infants and children greater than 2 kg and less than 12 years following cardiac surgery, who required vasoactive infusions for greater than 6 hours in the postoperative period.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Postoperative patients were identified who successfully weaned off initial vasoactive infusions (n = 2,645) versus those who failed vasoactive wean (required reinitiation of vasoactive, required mechanical circulatory support, renal replacement therapy, suffered cardiac arrest, or died) (n = 516). Inadequate delivery of oxygen index for final 6 hours of vasoactive wean was captured. Inadequate delivery of oxygen index was significantly elevated in patients with failed versus successful weans (inadequate delivery of oxygen index 11.6 [sd 19.0] vs 6.4 [sd 12.6]; p < 0.001). Mean 6-hour inadequate delivery of oxygen index greater than 50 had strongest association with failed vasoactive wean (adjusted odds ratio, 4.0; 95% CI, 2.5–6.6). In patients who failed wean, reinitiation of vasoactive support was associated with concomitant fall in inadequate delivery of oxygen index (11.1 [sd 18] vs 8.9 [sd 16]; p = 0.007).

CONCLUSIONS:

During the de-escalation phase of postoperative cardiac ICU management, elevation of the real-time risk analytic model, inadequate delivery of oxygen index, was associated with failure to wean off vasoactive infusions. Future studies should prospectively evaluate utility of risk analytic models as clinical decision support tools in de-escalation practices in critically ill patients.
LOW VULNERABILITY OF THE POSTERIOR EYE SEGMENT TO SARS-COV-2 INFECTION
Authors: Künzel Steffen Emil , Bürgel Thore , Künzel Sandrine Helene , Pohlmann Dominika , Zeitz Oliver , Joussen Antonia , Dubrac Alexandre
Published: October 2021

Purpose:

Retinal manifestations have been described in COVID-19 patients, but it is unknown whether SARS-CoV-2, the causal agent in COVID-19, can directly infect posterior ocular tissues. Here, we investigate SARS-CoV-2 host factor gene expression levels and their distribution across retinal and choroidal cell types.

Methods:

Query of single-cell RNA sequencing data from human retina and choroid.

Results:

We find no relevant expression of two key genes involved in SARS-CoV-2 entry, ACE2 and TMPRSS2, in retinal cell types. By contrast, scarce expression levels could be detected in choroidal vascular cells.

Conclusion:

Given the current understanding of viral host cell entry, these findings suggest a low vulnerability of the posterior eye segment to SARS-CoV-2 with a potential weak spot in the vasculature, which could play a putative causative role in ocular lesions in COVID-19 patients. This may qualify the vasculature of the human posterior eye segment as an in vivo biomarker for life-threatening vascular occlusions in COVID-19 patients.
Aseptic Meningitis Following the Second Dose of Comirnaty Vaccination in an Adolescent Patient
Authors: Lee Joon Kee
Published: October 2021

Vaccination is currently the best strategy to control the coronavirus disease 2019 epidemic. This report describes a case of aseptic meningitis 3 weeks after administration of the second dose of Comirnaty. The patient recovered with conservative and symptomatic care after 5 days of admission. Surveillance of rare adverse events, including aseptic meningitis, and their management should be prompt and appropriate.
Cause of hospitalization and death in the antiretroviral era in Sub-Saharan Africa published 2008–2018
Authors: Ghislain Manimani Riziki , Mushebenge Gloire-Aime Aganze , Magula Nombulelo
Published: October 2021

Background:

Worldwide despite the availability of antiretroviral therapy, human immunodeficiency virus/acquired immunodeficiency syndrome still causes morbidity and mortality among patients. In Sub-Saharan Africa, human immunodeficiency virus/acquired immunodeficiency syndrome remains a major public health concern. The aim of this study was to identify the causes of morbidity and mortality in the modern antiretroviral therapy era in Sub-Saharan Africa.

Methods:

We conducted a systematic review according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. We searched relevant studies from 3 databases which are Google Scholar, PubMed, and CINAHL. Two review authors independently screened titles, abstracts, and full-text articles in duplicate, extracted data, and assessed bias. Discrepancies were resolved by discussion or arbitration of a third review author. R software version 3.6.2 was used to analyze the data. Maximum values were used in order to show which disease was mostly spread out by looking at the highest prevalence reported. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO).

Results:

A total of 409 articles were obtained from the database search, finally 12 articles met the inclusion criteria and were eligible for data extraction. Among them, 3 were conducted in Nigeria, 2 were conducted in Uganda, 3 were conducted in South Africa, 1 in Gabon, 1 in Ethiopia, 1 in Ghana, and 1 in Burkina Faso. In most of the included studies, tuberculosis was the leading cause of hospitalization which accounted for between 18% and 40.7% and it was also the leading cause of death and accounted for between 16% and 44.3%, except in 1 which reported anemia as the leading cause of hospitalization and in 2 which reported wasting syndrome and meningitis respectively as the leading causes of death. Opportunistic malignancies accounted between for 1.8% to 5% of hospitalization and 1.2% to 9.8% of deaths.

Conclusions:

Tuberculosis is the commonest cause of hospitalization and death in Sub-Saharan Africa, but it is always followed by other infectious disease and other non-AIDS related causes.
Cerebral astroblastoma with oligodendroglial-like cells
Authors: Gu Jian , Wang Yihua , Yu Juanhan
Published: October 2021

Rationale:

Astroblastoma is a rare tumor of the central nervous system with uncertain biological behavior and origin. Its histopathological features have been well established, while, to our knowledge, astroblastoma with oligodendroglial-like cells have not been reported.

Patient concerns:

A 15-year-old girl presented with nausea, vomiting, headache, and visual disturbance.

Diagnosis:

Magnetic resonance imaging revealed a large neoplasm in the left temporal. Histologically, the tumor showed solid and pseudopapillary structure. Immunohistochemical staining showed that the tumor cells were positive for glial fibrillary acidic protein and vimentin. The oligodendroglial-like cells were positive for glial fibrillary acidic protein, vimentin, and oligodendrocyte transcription factor 2. The antigen KI67 labeling index was about 4%. Sequencing for isocitrate dehydrogenase (IDH) 1 codon 132 and IDH2 codon 172 gene mutations showed negative results. Furthermore, fluorescent analysis revealed neither 1p nor 19q deletion in the lesion. Based on these findings, the girl was finally diagnosed as astroblastoma.

Interventions:

A craniotomy with total excision of the tumor was performed.

Outcomes:

The follow-up time was 1 year, no evidence of disease recurrence was found in magnetic resonance imaging.

Lessons:

Cerebral astroblastoma with oligodendroglial-like cells is a clinically rare tumor of central nervous system. Clear distinction and diagnosis are critical.
Transversus abdominis plane block provides effective and safe anesthesia in the cesarean section for an amyotrophic lateral sclerosis parturient
Authors: Wang Yun , Zhang Yi , Li Shitong , Chen Lianhua , Jiang Jihong
Published: October 2021

Rationale:

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with the fatal course of muscle weakness. The published experience of anesthesia management in the cesarean section with ALS parturient is scant.

Patient concerns:

A 34-year-old woman was admitted to our center complaining of obvious dysphagia together with atrophy and weakness of quadriceps at 24 weeks of her pregnancy. Cesarean was planned at 36 weeks’ gestation due to the rapid deterioration of the mother.

Diagnoses:

The results of neurological examination, electromyography and spinal magnetic resonance imaging suggested ALS according to the EI Escorial World Federation of Neurology criteria.

Interventions:

Ultrasound-guided transversus abdominis plane block with 0.6 minimum alveolar concentration sevoflurane was used in this ALS parturient during her cesarean section procedure.

Outcomes:

This anesthesia strategy successfully met the demands of the surgery, helped avoid prolonged ventilation and prevent maternal respiratory complications.

Lessons:

Transversus abdominis plane block with subanesthetic concentrations of sevoflurane can provide effective and safe anesthesia in the cesarean section for a patient with ALS.
Hypertension as a risk factor for retinal vein occlusion in menopausal women
Authors: Oh Tae Ryom , Han Kyung-Do , Choi Hong Sang , Kim Chang Seong , Bae Eun Hui , Ma Seong Kwon , Kim Soo Wan
Published: October 2021

Retinal vein occlusion (RVO) is an important cause of blindness. Hypertension is a well-known risk factor for RVO. Although the prevalence of hypertension increases in women after menopause, the relationship between blood pressure and RVO in women before and after menopause has not been studied in detail.

We retrospectively analyzed 2,619,206 patients from the Korean National Health Insurance System database. A Cox proportional hazard regression model was used to evaluate the independent association between blood pressure and the risk of RVO development and identify differences between premenopausal and postmenopausal women.

The incidence of RVO was higher among postmenopausal women than in premenopausal women. In the model adjusted for socioeconomic and clinical variables, there was an association between blood pressure and RVO development in premenopausal and postmenopausal women; however, this was stronger than premenopausal women.

Both systolic and diastolic blood pressure are associated with an increased risk of RVO, and their effects are more potent in premenopausal women than postmenopausal women. Thus, comprehensive management of hypertension in premenopausal women is essential to reduce the risk of RVO.
Carbohydrate antigen 125, carbohydrate antigen 15–3 and low-density lipoprotein as risk factors for intraocular metastases in postmenopausal breast cancer
Authors: Tang Jing , Yan Bo , Li Gao-Feng , Li Qiu-Yu , Liu Wen-Feng , Liang Rong-Bin , Ge Qian-Min , Shao Yi
Published: October 2021

The prognosis of patients with postmenopausal breast cancer (PBC) could be improved by the early detection of intraocular metastases (IOMs). However, serum biomarkers for IOMs in PBC remain elusive. In the current study, we investigated patients with PBC, and compared serum parameters in an IOM and a non-IOM group, and then differentiated the risk factors related to IOMs. A comparison between an IOM and a non-IOM (NIOM) group was performed using Student t-test and a Chi-Squared test. After constructing a Poisson regression model to identify risk factors, we plotted receiver operating characteristic curves to evaluate the predictive value of significant risk factors in detecting IOMs. The incidence of IOMs in PBC was 1.16%. The histopathology results were not significantly different between the 2 groups. The levels of serum carbohydrate antigen 125 (CA-125), carbohydrate antigen 15–3 (CA15–3) and alkaline phosphatase were significantly elevated in IOMs compared with NIOMs (P = .082, P < .001, and P < .001, respectively). Compared with NIOMs, age, carbohydrate antigen 19 to 9, hemoglobin, calcium, total cholesterol, low-density lipoprotein (LDL) and apolipoprotein A1 were remarkably lower in IOMs (P = .038, P < .001, P < .001, P = .032, P = .041, P < .001, and P = .001, respectively). Poisson regression suggested that CA-125, CA15–3 and LDL were contributing to IOMs in PBC as risk factors (OR = 1.003, 95% CI: 1.001–1.005; OR = 1.025, 95% CI: 1.019–1.033; OR = 0.238, 95% CI: 0.112–0.505, respectively). A receiver operating characteristic curve revealed that the cut-off values for CA-125, CA15–3 and LDL were 16.78 0 U/mL, 63.175 U/mL, and 2.415 mmol/L, respectively. The combination of CA-125 and CA15–3 showed significant diagnostic value (area under the curve [AUC] = 0.982, P < .001). Our investigation suggests that CA-125, CA15–3 and LDL remarkably predict IOMs in PBC as risk factors, and the combination of CA-125 and CA15–3 shows considerable diagnostic value.
A case report of atypical uterine leiomyoma
Authors: Kim Yun Sook , Lee Hyun Joo
Published: October 2021

Introduction:

Atypical uterine leiomyoma (ALM) shows benign behavior and does not require adjuvant therapy. As the distinction between uterine leiomyoma, ALM, and leiomyosarcoma is only possible through pathology, it is almost impossible to diagnose ALM before surgery.

Patient concerns:

A 34-year-old multigravida woman who had undergone myomectomy for leiomyoma ten years earlier presented with fibroids that had gradually increased in size.

Diagnoses:

An ultrasound scan and abdominal and pelvic computed tomography revealed large myomas. The postoperative pathologic findings confirmed the diagnosis of ALM. The Ki-67 proliferation index was 15%.

Interventions:

We performed laparoscopic myomectomy.

Outcomes:

The patient recovered well after the surgery. The patient has undergone ultrasound follow-up every six months after surgery and has been doing well for three years without any recurrence.

Conclusion:

The combination of clinical features, imaging, pathological findings, and tumor suppressor gene Ki-67 expression may be of great value in the assessment of benign, atypical, and malignant uterine smooth muscle tumors. There are still no precise methods to differentiate them before surgery, and pathology remains the gold standard for diagnosis. Periodic monitoring is recommended until menopause, although the recommended interval remains controversial.
MGMT promoter methylation in large-cell neuroendocrine carcinoma
Authors: Wang Xuefeng , Li Jingyun , Wang Yanan , Zhang Xi , Shi Hongyun
Published: October 2021

Introduction:

Currently, there is no consensus on the treatment of O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in large-cell pulmonary neuroendocrine carcinoma. Some studies have shown that MGMT promoter methylation could be a predictive factor for objective response and survival, but there are few reports on MGMT promoter methylation in pulmonary large-cell neuroendocrine tumors treated with radiotherapy combined with temozolomide.

Patient Concerns:

An 80-year-old man with large-cell neuroendocrine carcinoma of the lung complained of weakness in the right lower limb. Multiple organ metastases were detected on imaging examination.

Diagnosis:

Large-cell neuroendocrine carcinoma was confirmed by pathological examination after the surgery.

Interventions:

The patient had local recurrence four months after surgical treatment that progressed after administration of a variety of chemotherapeutic drugs. Good local control was achieved after local chest radiotherapy. After the occurrence of brain metastasis and multiple organ metastases, brain radiotherapy combined with oral temozolomide was administered. Subsequently, the brain metastases disappeared and metastases in the other organs decreased. Furthermore, the original pathological gene detection showed that the MGMT promoter was methylated.

Outcomes:

Owing to economic reasons, the patient stopped taking temozolomide and died of liver metastasis with hypoproteinemia four months later.

Conclusion:

Radiotherapy had a significant effect on the local lesions of this patient with pulmonary large-cell neuroendocrine carcinoma, and temozolomide was effective against systemic lesions in this case with MGMT promoter methylation. Simultaneous treatment with radiotherapy and chemotherapy in this elderly patient was effective, and the side effects were tolerable.
Accurate measurement of coronary artery calcium in cancer patients using the CT component of PET/CT scans
Authors: McConachie Peter , McKay Erin , Crane Alexis , Nguyen Nicholas , Quinn Renee , Butler S. Patrick
Published: October 2021

Objective

The aim of this study is to establish the correlation between a CAC score derived from the CT component of PET/CT scan (CAC-PET) using in-house software as compared to the conventional technique (CAC-Standard). In addition, the incidence of high CAC scores in asymptomatic cancer patients with low-to-intermediate cardiovascular risk will be determined.

Methods

100 patients referred for oncologic PET/CT were prospectively recruited to have a conventional CAC score after their PET/CT. Patients with a history of cardiac disease were excluded. The nongated CT images from the PET/CT (CAC-PET) were analysed using validated in-house software with the results compared to those from gated CT analysed using the standard technique (CAC-Standard).

Results

The correlation of CAC scores between the two scan types was moderate [slope, 0.95; R
2 = 0.91; limits of agreement (LOA) = 0.29–5.65]. Using a conventional categorical analysis, there was complete agreement in 73% of patients with one category difference in the remainder. [interclass correlation (ICC) = 0.90; Cohen’s kappa = 0.63]. In total 28% of these asymptomatic low-to-intermediate-risk cancer patients had CAC scores over 300.

Conclusion

Estimation of CAC from the CT component of PET/CT scans is a reliable method for the detection of significant CAC in cancer patients and correlates well with the standard method. This technique should permit the calculation of cardiovascular risk in cancer patients undergoing PET/CT without any additional radiation exposure. A significant number of asymptomatic low-to-intermediate-risk cancer patients were found to have a high risk of cardiovascular disease.
Peripheral Blood Cell Variables Related to Systemic Inflammation in Patients With Unresectable or Metastatic Pancreatic Cancer
Authors: Colloca Giuseppe , Venturino Antonella
Published: October 2021

Systemic inflammatory response (SIR) plays a central role in the prognosis of unresectable or metastatic pancreatic ductal adenocarcinoma (mPDAC), and many SIR-related peripheral blood cell (PBC)-derived variables have been proposed as prognostic factors. The study aims to perform a systematic review and, for the more studied PBC-derived variables, a meta-analysis. A systematic review from 2000 to 2020 on 2 databases by predefined criteria was performed for PBC-derived variables in patients with mPDAC receiving chemotherapy in relation with overall survival. Eligible studies were selected by inclusion criteria, and only the PBC variables reported in at least 10 studies were evaluated by meta-analysis. Three hundred and eighty articles were found, and 28 studies were selected. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were reported in 28 and 10 articles, respectively. The subsequent meta-analyses supported the prognostic effect for both, NLR (hazard ratio, 2.10; 95% confidence interval, 1.87–2.37) and PLR (hazard ratio, 1.22; 95% confidence interval, 1.08–1.37). Heterogeneity was significant for NLR (I2 = 62%) and low for PLR (I2 = 24%). Among SIR-related PBC-derived variables, NLR is the most suitable prognostic factor for future clinical trials of patients with mPDAC.
Effect of Laparoscopic Pancreaticoduodenectomy in Elderly People
Authors: Zhang Wei , Huang Zhangkan , Zhang Jianwei , Che Xu
Published: October 2021

Pancreaticoduodenectomy is considered to be the most complicated operation in abdominal surgery. The purpose of this study was to evaluate the safety and efficacy of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients. We searched PubMed, Embase, and Cochrane Library databases for relevant studies that were published before June 2020. Seven cohort studies were eligible with 3200 patients. The result of meta-analysis showed that, for the elderly, severe complications, clinical pancreas fistula, and delayed gastric emptying in the LPD group were significantly lower than those in the open pancreaticoduodenectomy (OPD) group. There was no significant difference in postoperative bleeding, reoperation, and readmission between the 2 groups. For the LPD, the mortality, delayed gastric emptying, and severe complication in elder patients were significantly higher than those in young patients. There was no significant difference in postoperative bleeding, R0 rate, reoperation rate, and readmission rate between the aged and the young. Therefore, LPD can reduce postoperative complications in elderly patients compared with OPD, which can be used as a potential alternative to OPD in elderly patients. However, laparoscopic approach cannot eliminate the high risk of postoperative death and severe complications caused by age. More high-quality studies need to be done for further verification.
Characteristics and Outcomes of Psychiatric Inpatients With Severe Mental Illness and COVID-19
Authors: Yalçin Murat , Sönmez Güngör Ekin , Ergelen Mine , Beşikçi Keleş Didem , Yerebakan Tüzer Melike , Öcek Baş Tuba , Güneş Mustafa , Genç Davut , Kirşavoğlu Betül , Metin Merve , Bülbül Alper , Kayacan Asli
Published: October 2021

Recent studies indicated that psychiatric inpatients with severe mental illness (SMI) are at a greater risk of morbidity and mortality from COVID-19. However, there is still little data about the impact of comorbid COVID-19 infection on the course and outcome of acute exacerbations in this population. We conducted a prospective historically matched case control study. The sociodemographic and clinical characteristics of acute psychiatric inpatients with SMI and comorbid COVID-19 (n = 21) were compared with those of historically-matched non-COVID-19 controls with SMI (n = 42). The outcomes for acute inpatients with SMI and COVID-19 were also investigated. The new-onset SMI rate was relatively higher (23.8%) in the COVID-19 group, which has characteristics similar to those of the non-COVID-19 group except for working status (p < 0.05). The COVID-19 group had a high rate of relapse (47.6%) within 6 months of discharge. Our study suggests that patients with SMI who contracted SARS-CoV-2 may have a higher rate of new-onset mental disorder. Considering the high rate of relapse during the pandemic, chronically ill patients with SMI and COVID-19 should be closely monitored after discharge.
Oral Manifestations of Coronavirus Disease 2019 (COVID-19)
Authors: Soares Ciro D. , Souza Lucas L. , de Carvalho Maria G.F. , Pontes Hélder A.R. , Mosqueda-Taylor Adalberto , Hernandez-Guerrero Juan C. , do Nascimento Medeiros Sanderson D. , de Oliveira Sales Alexandre , Alves Fábio A. , Lopes Pinto Clóvis A. , de Almeida Oslei P.
Published: October 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents rapid transmission and significant mortality worldwide. It is responsible for coronavirus disease 2019 (COVID-19). The disease presents diverse clinical symptoms, including fever, cough, dyspnea, and pneumonia. However, other manifestations associated with COVID-19 need to be clarified, leading specialists to an early diagnosis and better prognosis. We describe the spectrum of clinicopathologic COVID-19-related oral lesions that can be the first and/or the unique manifestation of the disease. Fourteen patients with a mean age of 58 years (range: 23 to 88 y) with oral lesions were included. All patients were confirmed to be infected with SARS-CoV-2 by reverse transcription polymerase chain reaction testing. Patients demonstrated mild symptoms, including dysgeusia, anosmia, fever, and headache. The lesions were recognized and classified into 2 groups: (1) lesions caused by ischemia and/or hemorrhage and (2) lesions secondary to inflammatory events associated with viral load. The palate was most affected (n=8), followed by the tongue (n=4), and both the lip and palate (n=2). Histologic analysis demonstrated thrombosis of small arteries and capillaries, associated with areas of hemorrhage and chronic inflammatory infiltrate. Immunohistochemistry showed positive staining for spike protein (SARS-CoV and SARS-CoV-2) and angiotensin-converting enzyme 2 in the surface epithelium, salivary glands, inflammatory cells, and endothelial cells. Although the incidence of oral lesions among patients infected with SARS-CoV-2 appears to be uncommon, these findings suggest that the oral mucosa can also be a target organ for SARS-CoV-2.
Evaluation of a Pediatric Early Warning Score as a Predictor of Occult Invasive Bacterial Infection in the Pediatric Emergency Department
Authors: Gardiner Michael A. , Allen Coburn H. , Singh Nidhi V. , Tresselt Erin , Young Andrew , Hurley Kara K. , Wilkinson Matthew H.
Published: October 2021

Objectives

The aims of the study were to evaluate the diagnostic performance of Pediatric Early Warning Score (PEWS) to predict occult invasive bacterial infection (IBI) in well-appearing pediatric emergency department (PED) patients without known risk factors for bacterial infection and to compare PEWS to heart rate (HR) and Emergency Severity Index (ESI).

Methods

We performed a retrospective case-control analysis of febrile PED patients aged 60 days to 18 years over a 2-year period. Subjects were excluded if they were ill appearing, admitted to an intensive care unit, or had a known high-risk condition. Cases of occult IBI were included if they had a noncontaminant positive culture other than an isolated positive urine culture. Two febrile control subjects were identified for each case. Odds ratios and receiver operating characteristic curves were evaluated to determine performance characteristics of PEWS at triage and disposition, age-adjusted HR at triage and disposition, and ESI at triage.

Results

Compared with 178 controls, 89 cases had higher disposition PEWS, higher disposition HR, lower ESI, and higher rate of hospital admission. Disposition PEWS ≥3 (odds ratio, 2.57; 95% confidence interval, 1.08–6.18), disposition HR > 99th percentile, and ESI demonstrated increased odds of occult IBI. Area under the receiver operating characteristic curve for disposition PEWS (0.56) was similar to triage PEWS (0.54), triage HR (0.54), disposition HR (0.58), and ESI (0.65).

Conclusions

Subjects with PEWS ≥3 at PED disposition have increased odds of occult IBI; however, PEWS has poor discriminative ability at all cutoffs. We cannot recommend PEWS used in isolation to predict occult IBI.
Chronic Nerve Pain after Burn Injury: An Anatomical Approach and the Development and Validation of a Model to Predict a Patient’s Risk
Authors: Klifto Kevin M. , Yesantharao Pooja S. , Lifchez Scott D. , Dellon A. Lee , Hultman C. Scott
Published: October 2021

Background:

A model that predicts a patient’s risk of developing chronic, burn-related nerve pain may guide medical and/or surgical management. This study determined anatomy-specific variables and constructed a mathematical model to predict a patient’s risk of developing burn-related nerve pain.

Methods:

A retrospective analysis was conducted from 1862 adults admitted to a burn center from 2014 to 2019. One hundred thirteen patients developed burn-related nerve pain. Comparisons were made using 11 anatomy-specific locations between patients with and without burn-related nerve pain. The modified Delphi technique was used to select 14 potential risk variables. Multivariate regression techniques, Brier scores, area under the curve, Hosmer-Lemeshow goodness-of-fit, and stratified K-fold cross-validation was used for model development. Chronic pain was defined as pain lasting 6 or more months after release from the Burn Center.

Results:

Prevalence rates of burn-related nerve pain were similar in the development (6.1 percent) and validation (5.4 percent) cohorts [Brier score = 0.15; stratified K-fold cross-validation (K = 10): area under the curve, 0.75; 95 percent CI, 0.68 to 0.81; Hosmer-Lemeshow goodness-of-fit, p = 0.73; n = 10 groups]. Eight variables were included in the final equation. Burn-related nerve pain risk score = −6.3 + 0.02 (age) + 1.77 (tobacco use) + 1.04 (substance abuse) + 0.67 (alcohol abuse) + 0.84 (upper arm burn) + 1.28 (thigh burn) + 0.21 (number of burn operations) + 0.01 (hospital length-of-stay). Burn-related nerve pain predicted probability = 1 − 1/[1 + exp(burn-related nerve pain risk score)] for 6-month burn-related nerve pain risk score. As the number of risk factors increased, the probability of pain increased.

Conclusions:

Risk factors were identified for developing burn-related nerve pain at 11 anatomical locations. This model accurately predicts a patient’s risk of developing burn-related nerve pain at 6 months. Age, tobacco use, substance abuse, alcohol abuse, upper arm burns, thigh burns, the number of burn operations, and hospital length of stay represented the strongest predictors.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Fine Details That Improve Nasal Reconstruction
Authors: Borsuk Daniel E. , Papanastasiou Constantine , Chollet Andre
Published: October 2021

Learning Objectives:

After studying this article, the participant should be able to: 1. Identify common negative outcomes that arise with conventional nasal reconstruction. 2. Understand the technical refinements that help avoid and reduce negative outcomes in nasal reconstruction. 3. Learn about the utility of regional axial island flaps for nasal reconstruction, in particular, the lateral nasal artery flap.

Nasal reconstruction has been a preoccupation of surgeons dating to before 600 bc. The nose is the central focal point of the face and a key identifying facial feature, and surgery to the nose can prove to be challenging to even the most experienced surgeon. The objective of this CME article is to outline the most commonly used surgical options for each nasal aesthetic subunit, and the specific complications observed for each. The best surgical options and technical refinements are highlighted, and principles that may help restore the nose are outlined.
Failure to restore CD4+ cell count associated with infection-related and noninfection-related cancer
Authors: Malmström Stina , Wagner Philippe , Yilmaz Aylin , Svedhem Veronica , Carlander Christina
Published: October 2021

Objective:

To assess incidence and relative risk of cancer in Sweden, by HIV status, from 1988 to 2017.

Design:

Population-based register study.

Methods:

From the Swedish Total Population Register, all people born between 1940 and 2000 (n = 8 587 629), and resident in Sweden sometime 1983–2017 were identified and linked to National HIV Register InfCareHIV, National Cancer Register, and LISA database. We present incidence and adjusted hazard ratios (adjHR) of infection and noninfection-related cancer for three periods between 1988 and 2017.

Results:

Incidence and relative risk of infection-related cancer decreased but remained higher in people with HIV (PWH) than in HIV-negative. The proportion attributable to infection remained higher in PWH than in HIV-negative (44 vs. 9%). Women with HIV had lower risk of infection-related cancer than men with HIV [adjusted hazard ratio (adjHR) 0.6, 95% CI 0.4–0.9], mainly driven by lower incidence of Kaposi's sarcoma (adjHR 0.1, 95% CI 0.0–0.4). Current viral suppression (adjHR 0.3, 95% CI 0.2–0.5) was associated with lower risk of infection-related cancer. Current CD4+ cell count less than 200 cells/μl was associated with both infection-related (adjHR 15.3, 95% CI 10.7–21.8) and noninfection-related cancer (adjHR 2.5, 95% CI 1.5–4.1), as was CD4+ cell count increases less than 100 cells/μl post antiretroviral therapy (ART) (infection-related cancer adjHR 6.6, 95% CI 4.2–10.6, noninfection-related cancer adjHR 2.0, 95% CI 1.2–3.3).

Conclusion:

Current CD4+ cell count and failure to restore CD4+ cell count both associated with infection and noninfection-related cancer. Viral suppression associated with lower risk of infection-related cancer. Early HIV detection and early adherent ART remain essential for cancer prevention.
HIV Incidence Among Pregnant and Nonpregnant Women in the FACTS-001 Trial: Implications for HIV Prevention, Especially PrEP Use
Authors: Rees Helen , Chersich Matthew Francis , Munthali Richard J. , Brumskine William , Palanee-Phillips Thesla , Nkala Busi , Ahmed Khatija , Sebe Modulakgotla , Mabude Zonke , Nchabeleng Maphoshane , Bekker Linda-Gail , Kotze Philip , Mogodiri Thembisile , Naidoo Ishana , Panchia Ravindre , Myer Landon , Lombard Carl , Doncel Gustavo F. , Gray Glenda , Delany-Moretlwe Sinead
Published: October 2021

Background:

During pregnancy and postpartum period, the sexual behaviors of women and their partners change in ways that may either increase or reduce HIV risks. Pregnant women are a priority population for reducing both horizontal and vertical HIV transmission.

Setting:

Nine sites in 4 South African provinces.

Methods:

Women aged 18–30 years were randomized to receive pericoital tenofovir 1% gel or placebo gel and required to use reliable modern contraception. We compared HIV incidence in women before, during, and after pregnancy and used multivariate Cox Proportional hazards models to compare HIV incidence by pregnancy status.

Results:

Rates of pregnancy were 7.1 per 100 woman-years (95% confidence interval [CI]: 6.3 to 8.1) and highest in those who reported oral contraceptive use (25.1 per 100 woman-years; adjusted hazard ratio 22.97 higher than other women; 95% CI: 5.0 to 105.4) or had 2 children. Birth outcomes were similar between trial arms, with 59.8% having full-term live births. No difference was detected in incident HIV during pregnancy compared with nonpregnant women (2.1 versus 4.3%; hazard ratio = 0.56, 95% CI: 0.14 to 2.26). Sexual activity was low in pregnancy and the early postpartum period, as was consistent condom use.

Conclusions:

Pregnancy incidence was high despite trial participation being contingent on contraceptive use. We found no evidence that rates of HIV acquisition were elevated in pregnancy when compared with those in nonpregnant women. Risks from reductions in condom use may be offset by reduced sexual activity. Nevertheless, high HIV incidence in both pregnant and nonpregnant women supports consideration of introducing antiretroviral-containing pre-exposure prophylaxis for pregnant and nonpregnant women in high HIV prevalence settings.