bluuebunny/crossref_metadata_2025 huggingface dataset:
A case of renal solid-cystic angiomyolipoma: A case report
Authors: Shen Yu , Wang Zilin , Liu Zhenhua
Published: September 2024

Rationale:

The different variants of renal angiomyolipoma pose diagnostic and therapeutic challenges in clinical practice. We report a rare case of renal solid-cystic angiomyolipoma, with the aim of offering new insights into the preoperative imaging assessment of renal masses.

Patient concerns:

A 72-year-old female was admitted to our hospital because of a solid-cystic mass discovered in her right kidney during an abdominal computed tomography scan at another hospital. Her medical history includes a 5-year history of hypertension treated with medication, as well as hepatic cysts and bilateral renal cysts.

Diagnoses:

The postoperative pathological diagnosis is renal solid-cystic angiomyolipoma.

Interventions:

The solid-cystic mass in the right kidney was surgically removed via laparoscopic partial nephrectomy under general anesthesia.

Outcomes:

The patient had an uneventful recovery and was discharged on the second postoperative day without complications.

Lessons:

Renal angiomyolipoma is usually easily distinguishable on imaging, but this case aims to alert clinicians to differentiate the rare variants of renal angiomyolipoma from other renal tumors. In the future, more cases are needed to summarize the characteristics of different variants of renal angiomyolipoma.
Clinical characteristics of pyoderma gangrenosum: Case series and literature review
Authors: Su Rina , Tan Yaqi , Peng Shiguang
Published: September 2024

Background:

Pyoderma gangrenosum (PG) is a neutrophilic skin disease characterized by recurrent painful cutaneous ulcers, often accompanied by inflammatory bowel disease, joint pain, and other systemic damage. This disease is relatively rare in clinical practice and its diagnosis and treatment are often delayed, leading to secondary infections in the skin lesions, prolonged disease course, and increased disease burden on patients. This study retrospectively analyzed the clinical characteristics and treatment strategies of patients with PG admitted to our hospital and conducted a literature review, in order to improve the understanding of the disease among clinical doctors, enable patients to receive better diagnosis and treatment, and ultimately improve patient prognosis.

Methods:

Clinical data of patients diagnosed with PG and hospitalized in Beijing Chaoyang Hospital, Capital Medical University from January 2014 to December 2022 were retrospectively collected. The clinical manifestations, treatment strategies, efficacy, and disease outcomes were analyzed.

Results:

A total of 14 patients, including 8 males and 6 females, aged 14 to 66 years, were included. Skin lesion types: 13 cases were ulcer-type, 1 case was pustule combined with ulcer-type, and the lower limbs were the most commonly affected areas. All the 14 patients presented with comorbidities. All patients were treated with glucocorticoids, with a daily dose equivalent to 20 to 100 mg prednisone and a median dose of 40 mg. Among them, 3 patients were treated with minocycline in combination, 1 patient was treated with mycophenolate mofetil 0.5 twice daily in combination, 1 patient was treated with cyclophosphamide 0.1 once daily in combination, and 1 patient was treated with thalidomide 0.1 every night in combination.

Conclusion:

PG is a relatively rare immune-related skin disease. Our small sample data analysis found that male PG is not uncommon in the Chinese population. Systemic glucocorticoids can quickly control the symptoms of PG in most patients with PG. In patients with poor efficacy or limited use of glucocorticoids, immunosuppressive drugs or novel targeted drugs such as biologics or small-molecule drugs should be used in combination as early as possible. Skin lesion care focuses on preventing infection, avoiding surgical debridement, and emphasizing pain management and the symptomatic treatment of comorbidities.
Construction and validation of a prognostic model for esophageal cancer based on prognostic-related RNA-binding protein
Authors: Sha Yinzhong , Reyimu Abdusemer , Liu Wen , He Chuanjiang , Kaisaier Aihemaitijiang , Paerhati Pawuziye , Li Li , Zou Xiaoguang , Xu Aimin , Cheng Xiang , Abuduaini Maimaitituersun
Published: September 2024

Background:

Construction of a prognostic model for esophageal cancer (ESCA) based on prognostic RNA-binding proteins (RBPs) and preliminary evaluation of RBP function.

Methods:

RNA-seq data of ESCA was downloaded from The Cancer Genome Atlas database and mRNA was extracted to screen differentially expressed genes using R. After screening RBPs in differentially expressed genes, R packages clusterProfiler and pathview were used to analyze the RBPs for Gene Ontology enrichment and Kyoto Encyclopedia of Genes and Genomes pathway. Based on the prognosis-related RBPs, COX regression was used to establish the prognostic risk model of ESCA. Risk model predictive ability was assessed using calibration analysis, receiver operating characteristic curves, Kaplan–Meier curves, decision curve analysis, and Harrell consistency index (C-index). A nomogram was established by combining the risk model with clinicopathological features.

Results:

A total of 105 RBPs were screened from ESCA. A prognostic risk model consisting of 6 prognostic RBPs (ARHGEF28, BOLL, CIRBP, DKC1, SNRPB, and TRIT1) was constructed by COX regression analysis. The prognosis was worse in the high-risk group, and the receiver operating characteristic curve showed (area under the curve = 0.90) that the model better predicted patients’ 5-year survival. In addition, 6 prognostic RBPs had good diagnostic power for ESCA. In addition, a total of 39 mRNAs were identified as predicted target molecules for DKC1.

Conclusion:

ARHGEF28, BOLL, CIRBP, DKC1, SNRPB, and TRIT1, as RBPs, are associated with the prognosis of ESCA, which may provide new ideas for targeted therapy of ESCA.
Effect of different growth hormone pretreatment times in assisted reproductive therapy for patients with diminished ovarian reserve: A retrospective pilot cohort study
Authors: Zhang Yongmei , Liu Liu , Xu Aike , Jin Yuanyang , Tong Xiaomei , Zhou Feng , Zhang Songying
Published: September 2024

This study aimed to evaluate the effect of different growth hormone (GH) pretreatment times in assisted reproductive therapy in patients with diminished ovarian reserve (DOR). A retrospective pilot cohort analysis was performed on patients with DOR receiving GH pretreatment in the Assisted Reproduction Unit of Sir Run Run Shaw Hospital. A total of 1459 patients met the criteria and were divided into four groups according to GH pretreatment time as follows: 53 were in the 2-month pretreatment group (GH1), 400 were in the 1-month pretreatment group (GH2), 414 were in the ovulation induction period pretreatment group (GH3), and 592 were in the non-GH pretreatment group (control group). In addition, GH1, GH2, and GH3 were combined in the GH pretreatment group. Baseline characteristics and treatment outcomes were compared between the groups. The number of oocytes retrieved in the GH pretreatment, GH1, GH2, and GH3 groups was significantly higher than that in the control group (all P < .01). The numbers of oocytes retrieved in the GH1 and GH2 groups were similar but were nominally higher than those in the GH3 group. Estradiol concentrations in the GH pretreatment, GH2, and GH3 groups were significantly higher than those in the control group on the day of human chorionic gonadotropin injection (all P < .01). In the GH1 group, 22 patients had >1 assisted reproductive therapy cycle (non-GH pretreatment) before GH pretreatment, and the number of oocytes retrieved in the GH pretreatment cycle was higher than that in the non-GH pretreatment cycle, but this was not significant. These findings suggest that the GH pretreatment time was appropriately prolonged, and the number of oocytes retrieved nominally increased. In patients with DOR, GH pretreatment improved treatment outcomes. More than 1 month of GH pretreatment did not increase the number of oocytes retrieved.
Effects of synbiotics on necrotizing enterocolitis and full enteral feeding in very low birth weight infants: A double-blind, randomized controlled trial
Authors: Mahboobipour Amir Ali , Bitaraf Ali , Mohammadi Pourang , Khosravifar Mina , Babaei Homa , Shahidolahi Amir
Published: September 2024

Background:

Necrotizing enterocolitis (NEC) is a multifactorial disease primarily affecting infants with very low birth weight (VLBW). Research has shown that the pathogenesis of NEC is associated with abnormal bacterial colonization. Synbiotics, dietary supplements containing probiotics (beneficial bacteria) and prebiotics (non-digestible food), can alter the gut microbiome.

Methods:

A double-blind, randomized controlled trial was conducted to assess the efficacy of PediLact®, an oral drop multi-strain synbiotic containing Lactobacillus rhamnosus, Lactobacillus reuteri, and Bifidobacterium infantis, on nutritional parameters and the occurrence of NEC in VLBW neonates. In this study, 118 VLBW neonates from neonatal intensive care units were randomly allocated in a 1:1 ratio to receive either a synbiotic or a placebo. The synbiotic administration continued until the infant was fully fed. The primary outcomes were the occurrence of NEC and the number of days required to achieve full enteral feeding. Log-binomial regression and ANOVA/ANCOVA models were used for analysis.

Results:

In the group that received the synbiotic, the incidence of NEC decreased significantly (adjusted RR = 0.22, 95% CI: 0.07–0.72, P value = .01; adjusted RD = −0.22, 95% CI: −0.33 to −0.12, P value < .001; NNT = 5). Additionally, feeding intolerance was less frequent in this group (adjusted RR = 0.27, 95% CI: 0.14–0.51, P value < .001; NNT = 3). Furthermore, consumption of the synbiotic was associated with significant weight gain (approximately 40 g) in infants (adjusted SMD = 0.63; 95% CI: 0.26–1.00, P value < .001). The duration of hospitalization and the time required to reach full enteral feeding were also significantly shorter in the synbiotic group (by approximately 3 days). No serious side effects were reported.

Conclusion:

Prescribing multi-strain synbiotics reduces the incidence of NEC in VLBW infants and has beneficial effects on breastfeeding tolerance and weight gain velocity. Therefore, physicians may consider prescribing synbiotics to VLBW neonates.
Tailoring nonsurgical therapy for elderly patients with head and neck squamous cell carcinoma: A deep learning-based approach
Authors: Li Yang , Xiao Qinyu , Chen Haiqi , Zhu Enzhao , Wang Xin , Dai Jianmeng , Zhang Xu , Lu Qiuyi , Zhu Yanming , Yang Guangliang
Published: September 2024

To assess deep learning models for personalized chemotherapy selection and quantify the impact of baseline characteristics on treatment efficacy for elderly head and neck squamous cell carcinoma (HNSCC) patients who are not surgery candidates. A comparison was made between patients whose treatments aligned with model recommendations and those whose did not, using overall survival as the primary metric. Bias was addressed through inverse probability treatment weighting (IPTW), and the impact of patient characteristics on treatment choice was analyzed via mixed-effects regression. Four thousand two hundred seventy-six elderly HNSCC patients in total met the inclusion criteria. Self-Normalizing Balanced individual treatment effect for survival data model performed best in treatment recommendation (IPTW-adjusted hazard ratio: 0.74, 95% confidence interval [CI], 0.63–0.87; IPTW-adjusted risk difference: 9.92%, 95% CI, 4.96–14.90; IPTW-adjusted the difference in restricted mean survival time: 16.42 months, 95% CI, 10.83–21.22), which surpassed other models and National Comprehensive Cancer Network guidelines. No survival benefit for chemoradiotherapy was seen for patients not recommended to receive this treatment. Self-Normalizing Balanced individual treatment effect for survival data model effectively identifies elderly HNSCC patients who could benefit from chemoradiotherapy, offering personalized survival predictions and treatment recommendations. The practical application will become a reality with further validation in clinical settings.
Network pharmacological mechanism analysis and evidence-based medical validation of Dahuang Mudan Decoction in the treatment of acute pancreatitis
Authors: Chen Jinhan , Jiang Mengjie , Ying Yuou , Ji Yuan , Chi Yuying , Tao Linghui , Wu Fuping , Chen Mingxian
Published: September 2024

Background:

Dahuang Mudan Decoction is commonly used in China for the treatment of acute pancreatitis. Nevertheless, the therapeutic efficacy of the drug remains a subject of debate, and its active ingredients and potential therapeutic targets remain to be determined. The present study used a network pharmacological approach to investigate the active ingredients and possible targets of the drug, and illustrated the clinical effectiveness of Dahuang Mudan Decoction in the treatment of acute pancreatitis by meta-analysis.

Methods:

The present study investigated the active ingredients of the constituent herbs of Dahuang Mudan Decoction using the TCMID database. In order to further identify molecular targets, Swiss Target Prediction, OMIM and Genecards databases was be used. The present study used metascape database for gene ontology function enrichment analysis and Kyoto Genome Encyclopedia pathway enrichment analysis. A gene interaction network diagram was established for predicting the main targets and mechanism of action to Dahuang Mudan Decoction for acute pancreatitis. To further illustrate the validity of the gene targets and the clinical efficacy of the drug, 13 relevant studies were included for meta-analysis and analyzed using the Cochrane Collaboration’s Review Manager 5.4 software.

Result:

After a thorough screening process, the present study identified three main components of Dahuang Mudan Decoction: kaempferol, quercetin and eupatin. These three major components have the potential to target 5 important proteins: AKT1, TNF-a, IL-6, TP53, HIF1A. In addition, pathway analyses by the Kyoto Genome Encyclopedia showed that Dahuang Mudan Decoction is active through the Pathways in cancer, AGE-RAGE signaling pathway in diabetic complications, PI3K-Akt signaling pathway, etc signaling pathway to act on acute pancreatitis. The results of meta-analysis showed that compared with the control group, the experimental group had superior performance in terms of overall treatment efficacy, reduction of hospital stays and inflammatory factor levels after treatment.

Conclusion:

In summary, network pharmacological studies have shown that Dahuang Mudan Decoction affects acute pancreatitis through different components, targets, and mechanisms. In addition, the meta-analysis study strongly supported the effectiveness of Dahuang Mudan Decoction in the treatment of acute pancreatitis.
Task-specific facial dystonia following COVID-19 infection: A case report
Authors: Lee Jong-Mok , Ko Pan-Woo
Published: September 2024

Rationale:

During the coronavirus disease of 2019 (COVID-19) pandemic, various movement disorders associated with COVID-19 infection have been reported. However, the incidence of dystonia specifically associated with COVID-19 infection has been particularly rare.

Patient concerns:

A 43-year-old male patient presented to the movement disorders clinic with complaints of facial grimacing while chewing and experiencing spasms during nasal breathing. These symptoms appeared 2 weeks after he tested positive for COVID-19.

Diagnoses:

Based on normal diagnostic test results, including brain imaging and blood tests, it was concluded that task-specific facial dystonia following COVID-19 infection.

Interventions:

Despite treatment with clonazepam, trihexyphenidyl, and carbamazepine, his condition did not improve. Subsequently, botulinum toxin injections were administered to the affected facial muscles identified through video analysis.

Outcomes:

Botulinum toxin injections led to a significant improvement in the patient’s symptoms.

Lessons:

Task-specific dystonia affecting the facial muscles, particularly induced by specific actions such as chewing and nasal breathing, is rare and may represent an atypical post-infectious manifestation of COVID-19.
The role of corticosteroids in preventing invasive procedures in patients with parapneumonic effusion in the exudative phase: An observational study
Authors: Kirac Ali , Satici Celal , Erinc Aysegul , Kosar Filiz
Published: September 2024

The aim of the study was investigate the effect of corticosteroid use on the need for invasive procedure like tube thoracostomy with underwater seal drainage (TT-UWSD) and Video Assisted Thoracoscopic Surgery (VATS) in adult patients diagnosed with parapneumonic effussion in the exudative phase. A retrospective cohort study was performed in a chest diseases hospital. A total of 65 patients were included in the study. While 30 patients received only medical treatment, 35 patients underwent invasive procedures. Data on characteristics, vital signs, and laboratory parameters were recorded from electronic medical records. Univariate and multivariate logistic regression analyses were performed to identify corticosteroid and other predictors of the need for invasive procedures. The outcomes of the multivariate regression analysis revealed that an longer duration of symptoms (OR = 1.10, 95% CI: 1.01–1.21, P < .033) and the presence of dyspnea (OR = 5.44, 95% CI: 1.26–23.50, P < .023) independently associated with an increased need for invasive procedures, while corticosteroid treatment (OR = 0.15, 95% CI: 0.02–0.81, P < .028) was observed to be associated with a reduced necessity for invasive procedures. Treatment with metilprednisolone, together with the absence of dyspnea and shorter symptom duration may independently decrease the need for invasive procedure in patients with parapneumonic pleural effusion in the exudative phase.
Effects of acupuncture on shoulder impingement syndrome: A systematic review and meta-analysis
Authors: An Sang-Joon , Shin Woo-Chul , Joo Sungjun , Cho Jae-Heung , Chung Won-Seok , Song Mi-Yeon , Kim Hyungsuk
Published: September 2024

Background:

Shoulder impingement syndrome (SIS) is a common condition that causes chronic shoulder pain. The effectiveness of acupuncture in treating chronic shoulder pain has been documented in previous studies; however, existing systematic reviews and meta-analyses have often excluded Chinese databases and combined different types of acupuncture interventions, such as electroacupuncture, warm acupuncture, pharmacopuncture, and acupotomy. Thus, this study specifically examines the exclusive impact of manual acupuncture on SIS.

Methods:

Several databases, including PubMed, Cochrane Central, Embase, 1 Chinese database (China National Knowledge Infrastructure), and 5 Korean databases (ScienceON, Oriental Medicine Advanced Searching Integrated System, KoreaMed, Korean Studies Information Service System, and KMBASE), were systematically searched for relevant studies. The quality of the included studies was evaluated using the Cochrane Assessment Tool for Risk of Bias Version 2. Data collected from the selected studies were synthesized for meta-analysis. The primary outcome was a pain scale score, and the secondary outcomes were shoulder function and disability.

Results:

This study included 5 randomized controlled trials. The primary outcome assessment revealed significantly reduced pain (standardized mean difference [SMD] = −0.50, 95% confidence interval [CI] = −0.74 to −0.27) and improvements in shoulder function and disability (SMD = −0.57, 95% CI = −0.96 to −0.19). A subgroup analysis based on treatment duration indicated that short-term acupuncture treatment (≤4 weeks) exhibited a high level of confidence with low heterogeneity (SMD = −0.37, 95% CI = −0.73 to −0.02).

Conclusion:

Manual acupuncture is effective for relieving pain and improving shoulder function and disability in patients with SIS. However, further research is necessary to validate these findings owing to the limited number of patients and heterogeneity among the studies reviewed.
Sleep disorders are closely associated with coronary heart disease in US adults (≥20 years): A cross-sectional study
Authors: Gan Tian-Ming , Yang Ying-Jie , Mo Guan-Lian , Wang Shi-Rong , Li Shu-Hu , Li Jin-Yi
Published: September 2024

The purpose of this research was to assess the association between sleep disorders and coronary heart disease (CHD) using data from the National Health and Nutrition Examination Survey (NHANES) database. This cross-sectional study included 9886 eligible participants with valid data on sleep disorders and CHD from the NHANES from 2011 to 2014. The complex NHANES sampling led to use of sample weights in analyses. Various statistical methods and covariates were utilized. Significance was set at P < .05. Receiver operating characteristic curves were used to assess the diagnostic efficacy of sleep disorders in relation to CHD. Sleep disorders were significantly associated with CHD (P < .001). In the model corrected for age, sex, race, hypertension, diabetes, and uric acid as covariates, sleep disorders and CHD remained significantly associated (P < .001, odds ratio = 1.83 [95% confidence interval: 1.31–2.58]). The correlation between sleep disorders and CHD varies by age and gender. Sleep disorders have some predictive value for CHD (0.5 < area under curve ≤ 0.7). Sleep disorders were associated with and predictive of CHD risk, warranting consideration in clinical assessments.
Causal relationship between thyroid function and multiple sclerosis: A bidirectional Mendelian randomization study
Authors: Cui Wenhui , Wang Bin , Shi Keqing , Wang Xin , Chen Shuyu , Xu Aolong , Shi Fuyan , Wang Suzhen , Zhang Xueli , Yang Xiaorong , Wang Qiang
Published: September 2024

An association between thyroid function and multiple sclerosis (MS) has been reported in several observational studies, but the causal relationship between them is still unclear. Thus, this study used a bidirectional Mendelian randomization (MR) to investigate the associations between thyroid function and MS. Bidirectional MR was used to explore the causal relationship between thyroid function (thyroid-stimulating hormone [TSH], free thyroxine [FT4], hyperthyroidism, and hypothyroidism) and MS. Genome-wide association study (GWAS) data of thyroid function and MS were obtained from the ThyroidOmics Consortium and the FinnGen Consortium, respectively. Inverse-variance weighted method (IVW) was the primary analysis method to assess causality with Weighted median, MR-Egger regression, weighted mode, and simple mode as auxiliary methods. Sensitivity analyses were performed using heterogeneity tests, horizontal pleiotropy tests and leave-one-out method. There was a positive causal relationship between TSH and MS (IVW: OR = 1.202, 95% CI: 1.040–1.389, P = .013), and no strong evidence was found for an effect of FT4 (IVW: OR = 1.286, 95% CI: 0.990–1.671, P = .059), hypothyroidism (IVW: OR = 1.247, 95% CI: 0.961–1.617, P = .096), and hyperthyroidism (IVW: OR = 0.966, 95% CI: 0.907–1.030, P = .291) on the risk of MS. In the reverse MR results, there was no causal relationship between MS and TSH (IVW: β = −0.009, P = .184), FT4 (IVW: β = −0.011, P = .286), hypothyroidism (IVW: OR = 0.992, 95% CI: 0.944–1.042, P = .745), and hyperthyroidism (IVW: OR = 1.026, 95% CI: 0.943–1.117, P = .549). Cochran’s Q test, MR-Egger intercept test, MR-PRESSO global test, and Leave-one-out did not observe horizontal pleiotropy and heterogeneity. In conclusion, MR analysis supported a positive causal relationship between TSH and MS.
Diagnosis of a large cystic teratoma of accessory ovary complicated with torsion by ultrasound: A case report
Authors: He Yeping , Yan Xiaofang , Guo Jianfeng
Published: September 2024

Rationale:

An accessory ovary complicated by cystic teratoma and torsion is extremely rare and requires prompt diagnosis and surgical treatment. However, evidence for effective preoperative imaging diagnosis has barely been reported. Our study presented a case in which preoperative ultrasound reasonably suspected ovarian tumor torsion and an accessory ovary, and laparoscopic surgery was strategically performed.

Patient concerns:

An 18-year-old girl had persistent pain in the lower right abdomen for over 7 hours accompanied by nausea and vomiting, and she had a 14.1 × 10.1 × 9.0 cm hypo-echoic cystic lesion containing a 6.4 × 4.9 × 3.0 cm solid component accompanied by the whirlpool sign on the right side of the pelvis. Additionally, a hyper-echoic ovary with a size of 2.5 × 1.4 cm and a normal ovary appearance of 2.4 × 0.8 cm were detected on the right side of the adnexal area by ultrasound.

Diagnosis:

The cystic lesion was a large accessory ovarian cystic teratoma, complicated by torsion. The hyperechoic ovary appears as accessory ovarian stromal edema and the normal ovary appearance is eutopic.

Interventions:

Single-port laparoscopic resection of the ovarian lesion, release of the ovarian torsion, and oophoroplasty were performed.

Outcomes:

Postoperative recovery was unremarkable. Antral follicles were detected in both eutopic and accessory ovaries by ultrasound 20 days and 4 months after surgery. In addition, during the second postoperative ultrasound follow-up, the accessory ovary showed no difference in echo compared to the normal ovary, except for a slightly larger volume.

Lessons:

Clinical manifestations of accessory ovarian tumors combined with torsion are similar to those of eutopic ovarian torsion, and timely surgery is required.
A case of eosinophilic granulomatosis with polyangiitis combined with pulmonary tuberculosis: A case report
Authors: Lai Yuting , Xiao Shan , Shen Yan
Published: September 2024

Rationale:

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare autoimmune disease that can affect multiple organ systems. The standard treatment mainly relies on glucocorticoids and immunosuppressive agents. In our study, we present an EGPA patient who had pulmonary tuberculous mycobacteria infection, such cases are rarely reported.

Patient concerns:

A 71-year-old male patient was diagnosed with EGPA (systemic type) and pulmonary tuberculosis simultaneously.

Diagnoses:

The Five-Factor score indicated that the patient required glucocorticoids combined with immunosuppressive agents for induction therapy, however, the use of immunosuppressive agents would significantly inhibit antituberculosis treatment. Nowadays, treating active autoimmune disease in patients with infections remains a clinical challenge.

Interventions:

Considering the patient did not show life-threatening or severe organ involvement and reduced the effect of antituberculosis immunity, we used glucocorticoids alone.

Outcomes:

Finally, the patient had no adverse events, the eosinophil counts were markedly decreased and symptoms of EGPA were relieved.

Lessons:

The patient of EGPA combined with pulmonary tuberculosis successfully treated with glucocorticoids alone may provide significant support in selecting the appropriate treatments for similar cases in the future.
Case-control analysis of hip fractures with concurrent benzodiazepine and opioid use and surgery class at a single teaching institution
Authors: Coskey Andrew Z. , Nicanord Ernst J. , Goodwin Margaret A. , Vakil Haris , Jupiter Daniel C. , Hagedorn II John C. , Bhardwaj Namita
Published: September 2024

In this study, we analyze the relationship between polypharmacy and surgical treatment in a population at a single teaching institution. The design of the study is a case-control analysis of hip fractures. The setting is at a single teaching institution located in Galveston, Texas, USA. Over a 5-year period, we conducted a retrospective review of patients within our medical record who underwent surgery for a hip fracture, identified by current procedural terminology codes 27235 and 27236. Our primary variable was a prescription of opioids, benzodiazepines, or both 30 days preoperatively and surgery performed. The main outcome measures were prescription of controlled medications and surgical class. We used descriptive analysis to summarize each variable as mean or frequency for continuous and categorical variables and subsequently assessed the association between demographic variables and drug prescription and surgical class. Of the 378 patients who met our inclusion criteria, 68.0% were females and 32.0% were males. The average age was 77.8 years. Most patients had a displaced hip fracture (61%). Most patients underwent a hip hemiarthroplasty (233, 61.6%) versus either a closed reduction with percutaneous pinning (125, 33.1%) or hip open reduction internal fixation (20, 5.3%). There was no significant difference between polypharmacy and hip fracture surgery; however, reported alcohol use was significant in both groups. In our patient population, opioid and/or benzodiazepine prescriptions were not significantly linked to hip fracture surgery, but documented alcohol use was found to be significant in both groups. We noted a higher prevalence of opioid and benzodiazepine prescriptions than was previously reported. As patients age, we should be cautious about the effects of polypharmacy and alcohol use and their impacts on the elderly.
Bladder transitional cell carcinoma anatomic primary site as a predictor of survival and mortality: a population-based retrospective cohort study
Authors: Hemade Ali , Hallit Souheil
Published: September 2024

Background:

Bladder cancer is a heterogeneous disease with varying prognostic outcomes based on the primary tumor site within the bladder. This study aims to evaluate the impact of tumor location on overall survival and cancer-specific survival in bladder cancer patients.

Methods:

The authors conducted a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results database. Patients with primary transitional cell carcinoma of the bladder were categorized based on their tumor locations. Survival outcomes were assessed using Kaplan–Meier analysis and Cox proportional hazards regression models, adjusted for age, sex, race, cancer stage, and treatment modalities. Additionally, binary logistic regression models were employed to predict overall mortality (OM) and cancer-specific mortality (CSM) at 1, 5, and 10 years.

Results:

The study included 107 909 patients diagnosed with primary bladder cancer between 2000 and 2021. Significant differences in survival outcomes were observed across different tumor sites. Bladder cancer originating in the urachus had the worst OS before 100 months and the worst CSS overall. Tumors in the anterior wall showed the worst OS after 100 months. In the Cox multivariable analysis, anterior wall tumors were associated with a 1.513-fold increased risk of death compared to lateral wall tumors. The binary logistic regression models showed that anterior wall tumors predicted the highest OM and CSM at 1-year, while urachal tumors had the worst outcomes at 5 and 10 years.

Conclusions:

The primary site of bladder cancer is a significant predictor of survival outcomes, with tumors in the urachus and anterior wall associated with a poorer prognosis. These findings underscore the importance of considering tumor location in the prognosis and management of bladder cancer. Future studies should aim to validate these findings in more diverse populations and explore the underlying biological mechanisms that drive these differences.
The Neo-Pitanguy Ligament: A Three-Flap Technique For Skin Tensioning
Authors: Ghavami Ashkan , Vranis Neil M.
Published: September 2024

Background:

Creating a stable, long-lasting supratip break continues to be a challenge, particularly in patients with moderate to severe skin thickness. Multiple techniques have been previously described to address this, including Pitanguy’s ligament preservation, re-suturing, and cartilage frame alterations to increase the tip-to-septal angle differential. Each have noteworthy limitations.

Methods:

The senior author developed a novel technique which utilizes the native Pitanguy ligament augmented by two bilateral, medially-based superficial musculo-aponeurotic system (SMAS)/soft tissue flaps. This reduces supratip dead space, prevents tissue glide while controlling supratip/tip shape and position.

Results:

Twenty-six (n=26) primary rhinoplasties in which the supratip and tip skin sleeve was of appropriate thickness were selected and followed for 1-year post operatively. The tri-laminar neo-Pitanguy ligament (NPL) technique was employed in all patients. Every patient maintained a varied degree of supratip break at an average follow up time of 14 months (range: 12-16 months). There was one revision requiring local anesthesia. No patients requested or were indicated for a return to the operating room. No cases of post-operative pollybeak deformity were observed.

Conclusion:

The power of this novel supratip control technique is multidimensional. It allows the surgeon to precisely control the location of supratip break, creating a broad based, diamond-shaped supratip depression. Tri-lamination with the use of the two SMAS/soft tissue flaps provides added strength, control, and long-term stability compared to simple suturing. Soft tissue tensioning above, around, and below the new tip complex prevents dorsal skin tissue glide and further secures the infratip/columella in appropriate position.
Comparing Wise Pattern to Non–Wise Pattern Skin-Sparing Mastectomy: A Critical Evaluation of Patient Demographics and Surgical Outcomes
Authors: Brodsky Casey N. , Torres Sydney J. , Shabet Christina L. , Parker Naomi F. , Frecentese Grace I. , Myers Paige L.
Published: September 2024

Background:

Multiple skin-sparing incisions are used in immediate postmastectomy breast reconstruction; however, the Wise pattern incision (WPI) may have superior cosmetic outcomes for large, ptotic breasts compared with the non–Wise pattern incision (NWPI). The authors evaluated patient demographics and surgical outcomes with WPI versus NWPI.

Methods:

An electronic medical record search was performed for patients at a single academic institution from 2019 to 2022 with International Classification of Diseases, 10th Revision, Clinical Modification diagnosis code Z42.1: “Encounter for breast reconstruction following mastectomy.” Retrospective chart review evaluated patient demographics, intraoperative factors, postoperative complications, and surgical cost.

Results:

A total of 288 patients were included: 58 underwent WPI and 230 underwent NWPI. Median body mass index (BMI) differed between WPI (30.5 kg/m2) and NWPI (26.4 kg/m2) (P < 0.001). Fifty-seven percent of WPI had preoperative grade 3 ptosis versus 23% of NWPI (P < 0.001). No difference was found in median operative times (WPI, 219 minutes; NWPI, 194 minutes; P = 0.38). Overall rates of postoperative complications differed between WPI (62%) and NWPI (45%) on univariate but not multivariate analysis. Median total surgery charge was higher for WPI (WPI, $36,223; NWPI, $31,185; P < 0.001), whereas implant cost was higher for NWPI (WPI, $2700; NPWI, $8040; P < 0.001).

Conclusions:

There was no significant difference in operative time, overall complication rate, or charge between incision types once adjusted for confounding factors. The higher complication rate in the WPI group was likely driven by higher BMI, a known risk factor for surgical complications regardless of approach. Surgeons can consider WPI as a noninferior option for patients with higher BMI and ptosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
“Temporal MORE (Modified Orbicularis REpositioning): going beyond the limits of temporal lifting”.
Authors: Pascali Michele , Savani Luca , Gratteri Marco , Rega Umberto , Marchese Gloria , Persichetti Paolo
Published: September 2024

Background:

Periorbital rejuvenation is often challenging and requires comprehensive evaluation of its various components to obtain satisfying results. Considering the crucial role of the orbicularis muscle in the periorbital aging process, the first author recently described his personal technique for temporal lifting through a subcutaneous approach in conjunction with an orbicularis muscle flap. In the current article, the authors present a modified and extended temporal lift approach, which allows for remarkable improvement not only in the temporal and brow region, but in the whole periorbital area up to the malar region, therefore named “Temporal MORE” (Modified Orbicularis REpositioning).

Methods:

212 consecutive patients underwent Temporal MORE by the same surgeon between May 2021 and September 2022. Each patient filled a FACE-Q© questionnaire preoperatively and 12 months postoperatively. 5 independent surgeons were asked to score the results evaluating patients’ preoperative and postoperative pictures.

Results:

No major complications were recorded. The most satisfying aspect of this technique was dramatic periorbital rejuvenation noticeable in all patients.

FACE-Q pre-operative score was 34.29±5.872, while the post-operative was 80.11±6.796 (p<0.05); delta (post-pre) mean value was 45.82±8.925. Surgeons’ questionnaire mean value was 41.92±6.010. Statistical analysis showed a strong correlation between surgeons’ and patients’ satisfaction (“r” value 0.7488).

Conclusions:

Temporal MORE proved to achieve a comprehensive rejuvenation of the periorbital area in a straightforward and reproducible way, with a fast recovery and a low complication rate. In this cohort, patient satisfaction with the result was remarkable and comparable to the judgment of the surgeons interviewed.
Diagnosing Maxillary Occlusal Cant with average 3D Skeletofacial Model Template
Authors: Cheng Shun-Chien , Lin Hsiu-Hsia , Kuo Jyun-Cheng , Lo Lun-Jou , Ho Cheng-Ting
Published: September 2024

Background:

Diagnosing maxillary occlusal cant involves varied methods, yet classification remains incomplete. This includes determining if the cant results from equal faults on both sides or if one side exhibits overdevelopment while the other underdevelops. This study introduces an innovative average 3D skull template for classifying maxillary occlusal cant instances.

Methods:

Sixty adult patients were divided into two groups: 30 with a mesoprosopic facial type and 30 with a leptoprosopic facial type. Using seven pairs of anatomical landmarks (N, Or (L, R), Lo (L, R), Zy (L, R)), the average skull models were aligned and superimposed onto the patients' skull models. Image resizing facilitated optimal registration area fitting. Vertical distances from the U6 mesial buccal cusp tip to the FH plane were measured to analyze occlusal cant, classified into three classes: overdevelopment (Class A), underdevelopment (Class B) and equal fault on both sides (Class C).

Results:

In the mesoprosopic group, Class B t was most common (40%), followed by Class A (27%) and Class C (33%). In the leptoprosopic facial type group, Class B remained prevalent (50%), followed by Class A (43%) and Class C (7%). Statistical analysis revealed a significant association between facial types and the three classes.

Conclusions:

Contrary to expectations, equal fault patterns were not predominant; instead, underdevelopment of the maxilla constituted the majority of occlusal cant cases. Utilizing average 3D skeletofacial models as templates emerges as an effective tool and alternative for diagnosing the instance of maxillary occlusal cant.

RISK STUDIES/LEVEL OF EVIDENCE:

Therapeutic, II.
Strategy of Severe Pneumonia and Management of Related Complications After Autogenous Cartilage Microtia Reconstruction
Authors: Ruan Jingjing , Wei Qingqian , Wu Jiajia , Chen Zeman , Liu Xuehong , Liu Na
Published: September 2024

Since the pioneering use of autologous costal cartilage for microtia reconstruction, significant progress has been made in treating microtia, effectively improving patients' quality of life and reducing their psychological burden. Cartilage auricle reconstruction is the primary treatment, but many postoperative complications can occur. Common postoperative complications include infection and hematoma at the recipient site, pleural tears at the donor site, and thoracic scoliosis. Among these, severe postoperative pneumonia is a rare but potentially fatal complication. This study presents a case of severe pneumonia after auricular reconstruction with autologous cartilage. It details the complications associated with autologous cartilage microtia reconstruction, especially pulmonary complications, and suggests a possible relationship between pulmonary complications and auricular reconstruction using cartilage.
Middle Meningeal Artery Embolization Reduces the Recurrence Rate of Chronic Subdural Hematoma: A Propensity Score Matching Analysis
Authors: Wang Ying , Wang Wei , Huang Qinghua , Yan Wei , Lan Meijuan
Published: September 2024

To evaluate the effect of middle meningeal artery embolization (MMAE) on chronic subdural hematoma (CSDH). The authors enrolled consecutive patients with CSDH who underwent burr hole craniostomy (BHC) between January 2020 and February 2023. The primary outcome was recurrence rate, defined as an increase of hematoma width on imaging compared with the immediate postoperative imaging at a 3-month follow-up. Secondary outcomes included the rate of complications and adverse prognosis. Cohorts were balanced using 1:2 propensity score matching (PSM). A total of 271 patients were eligible for this study and divided into the MMAE group (n=23) and the BHC group (n=205). Compared with the BHC group, there was more use of anticoagulant or antiplatelet medication (47.8% vs 22.4%, P=0.008), bilateral hematoma (19.5% vs 19.5%, P=0.043), and hematoma with septations (47.8% vs 21.5%, P=0.005) in the MMAE group. After PSM, 64 cases were finally successfully matched. The logistic analysis result showed that MMAE was associated with the decreased recurrence rate of CSDH in the cohort after PSM (OR 0.072, 95% CI: 0.322~0.746, P=0.028) but not with the improved clinical prognosis (OR 0.065, 95% CI: 0.533~4.786, P=0.562). MAAE has a positive therapeutic effect on reducing the recurrence rate of CSDHs as an adjunct postoperative treatment after burr hole surgery.
Textbook Outcomes in Solid Transplantation: A Systematic Review
Authors: Martinino Alessandro , Ladowski Joseph Matthew , Schilirò Davide , Hartwig Matthew G. , Moris Dimitrios , Barbas Andrew S.
Published: September 2024

Background.

The concept of TO is expanding across various surgical disciplines to establish a standardized, comprehensive quality benchmark. Traditional metrics such as 1-y patient and graft survival have been key for evaluating transplant program performance but are now deemed inadequate because of significant field advancements. This systematic review aims to provide a comprehensive understanding of the applicability and validity of textbook outcome (TO) in the setting of solid organ transplantation.

Methods.

A structured search, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted across PubMed, Embase, and Scopus databases on March 10, 2024.

Results.

Fourteen articles were identified for inclusion in this review. Of these, 2 studies addressed TO in heart transplantation, 3 in lung transplantation, 2 in kidney transplantation, and 7 in liver transplantation. A subgroup analysis was conducted to categorize the different definitions of TOs and identify the most common reasons for TO failure.

Conclusions.

Our systematic review highlights the ongoing efforts in the field of solid organ transplantation to define TO and emphasizes the importance of developing a universally recognized set of TO criteria for each type of transplant. TO provides a valuable framework for transplant centers to benchmark their performance against similar institutions on a risk-adjusted basis and to pinpoint specific areas for enhancing patient outcomes. Even the most successful programs may discover aspects within the composite outcome with scope for improvement.
Deceased Organ Donor HTLV Screening Practices Postelimination of Universal Screening in the United States
Authors: Yamauchi Junji , Raghavan Divya , Imlay Hannah , Jweehan Duha , Oygen Suayp , Marineci Silviana , Remport Adam , Hall Isaac E. , Molnar Miklos Z.
Published: September 2024

Background.

In the United States, universal screening for human T-lymphotropic virus (HTLV) in deceased organ donors was discontinued in 2009. Since then, the transplant guideline suggests considering targeted screening. However, the outcomes of this change in HTLV screening have not been evaluated.

Methods.

Using the Organ Procurement and Transplantation Network database between 2010 and 2022, we analyzed the HTLV antibody screening frequency and seroprevalence in potential deceased organ donors and their correlations with HTLV infection risks, including race and high-risk behaviors for blood-borne pathogen infection. Although targeted screening has not been established for HTLV, we hypothesized that screening rates should correlate with the proportions of donors with infection risk if screening is targeted. We also evaluated the organ utilization of HTLV-seropositive donors.

Results.

Of 130 284 potential organ donors, 22 032 (16.9%) were tested for HTLV antibody. The proportion of donors tested for HTLV varied between Organ Procurement Organizations (median [interquartile range], 3.8% [1.0%–23.2%]; range, 0.2%–99.4%) and was not correlated to HTLV infection risks. There were 48 seropositive donors (0.22%), and at least 1 organ from 42 of these donors (87.5%) was transplanted. The number of organs recovered and transplanted per donor was significantly lower in HTLV-seropositive than in HTLV-negative donors (recovered, 2 [2–3] versus 3 [3–5], P < 0.001; transplanted, 2 [1–3] versus 3 [2–4], P < 0.001). However, HTLV-1 infection was not attributed as the cause of nonrecovery except for only 1 HTLV-seropositive donor.

Conclusions.

HTLV screening practices varied across the United States. Our findings suggest that targeted screening was not performed after the elimination of universal screening.
Premeiotic endoreplication is the mechanism of obligate parthenogenesis in rock lizards of the genus
Darevskia
Authors: Dedukh Dmitry , Altmanová Marie , Petrosyan Ruzanna , Arakelyan Marine , Galoyan Eduard , Kratochvíl Lukáš
Published: September 2024

Among vertebrates, obligate parthenogenesis occurs exclusively in squamate reptiles. Premeiotic endoreplication in a small subset of developing oocytes has been documented as the mechanism of production of unreduced eggs in minutely explored obligate parthenogenetic lineages, namely in teiids and geckos. The situation in the lacertid genus
Darevskia
has been discussed for decades. Certain observations suggested that the ploidy level is restored during egg formation through a fusion of egg and polar body nuclei in
Darevskia unisexualis
and
D. armeniaca
. In this study, we re-evaluated the fusion hypothesis by studying diplotene chromosomes in adult females of sexual species
D. raddei nairensis
and obligate parthenogens
D. armeniaca, D. dahli
and
D. unisexualis
. We revealed 19 bivalents in the sexual species and 38 bivalents in the diploid obligate parthenogens, which uncovers premeiotic endoreplication as the mechanism of the production of non-reduced eggs in parthenogenetic females. The earlier contradicting reports can likely be attributed to the difficulty in identifying mispairing of chromosomes in pachytene, and the fact that in parthenogenetic reptiles relying on premeiotic endoreplication only a small subset of developing oocytes undergo genome doubling and overcome the pachytene checkpoint. This study highlights co-option of premeiotic endoreplication for escape from sexual reproduction in all independent hybrid origins of obligate parthenogenesis in vertebrates studied to date.