bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of an ICT-Based Exergame Program for Children with Developmental Disabilities
Authors: Kwon Hyunjin , Maeng Hyokju , Chung Jinwook
Published: October 2022

The purpose of this study was to develop an information and communications technology (ICT)-based exergame for children with developmental disabilities (DD) and to examine its impacts on physical fitness and fundamental motor skills (FMS). The ICT-based exergame consisted of visual and auditory demonstrations of diverse locomotor movement and object manipulation activities by the virtual characters. A total of 52 children with DD participated in the present study. The participants were divided into twenty-seven children in the experimental group and 25 children with DD in the control group. The experimental group participants engaged in the exergame program for 12 weeks. All participants’ muscle strength (i.e., standing long jump) and four fundamental motor skills, such as the horizontal jump, hop, overhand throw, and dribble, were assessed during the pre- and post-test process. There were significant impacts on physical fitness and FMS (p < 0.001) between the groups. Specifically, the results of three FMS (hop, overhand throw, and dribble) and standing long jump significantly improved in children with DD except for the horizontal jump skill. The results of this study is evidence that the ICT-based exergame program for children with DD may be utilized to improve physical fitness and FMS in children with DD.
The Present and Future of Clinical Management in Metastatic Breast Cancer
Authors: Lin Pauline H. , Laliotis George
Published: October 2022

Regardless of the advances in our ability to detect early and treat breast cancer, it is still one of the common types of malignancy worldwide, with the majority of patients decease upon metastatic disease. Nevertheless, due to these advances, we have extensively characterized the drivers and molecular profiling of breast cancer and further dividing it into subtypes. These subgroups are based on immunohistological markers (Estrogen Receptor-ER; Progesterone Receptor-PR and Human Epidermal Growth Factor Receptor 2-HER-2) and transcriptomic signatures with distinct therapeutic approaches and regiments. These therapeutic approaches include targeted therapy (HER-2+), endocrine therapy (HR+) or chemotherapy (TNBC) with optional combination radiotherapy, depending on clinical stage. Technological and scientific advances in the identification of molecular pathways that contribute to therapy-resistance and establishment of metastatic disease, have provided the rationale for revolutionary targeted approaches against Cyclin-Dependent Kinases 4/6 (CDK4/6), PI3 Kinase (PI3K), Poly ADP Ribose Polymerase (PARP) and Programmed Death-Ligand 1 (PD-L1), among others. In this review, we focus on the comprehensive overview of epidemiology and current standard of care treatment of metastatic breast cancer, along with ongoing clinical trials. Towards this goal, we utilized available literature from PubMed and ongoing clinical trial information from clinicaltrials.gov to reflect the up to date and future treatment options for metastatic breast cancer.
Early Epilepsy Surgery in Benign Cerebral Tumors: Avoid Your ‘Low-Grade’ Becoming a ‘Long-Term’ Epilepsy-Associated Tumor
Authors: Mann Catrin , Conradi Nadine , Neuhaus Elisabeth , Konczalla Jürgen , Freiman Thomas M. , Spyrantis Andrea , Weber Katharina , Harter Patrick , Rosenow Felix , Strzelczyk Adam , Schubert-Bast Susanne
Published: October 2022

Epilepsy surgery in low-grade epilepsy-associated neuroepithelial tumors (LEAT) is usually evaluated in drug-resistant cases, often meaning a time delay from diagnosis to surgery. To identify factors predicting good postoperative seizure control and neuropsychological outcome, the cohort of LEAT patients treated with resective epilepsy surgery at the Epilepsy Center Frankfurt Rhine-Main, Germany between 2015 and 2020 was analyzed. Thirty-five patients (19 males (54.3%) and 16 females, aged 4 to 40 years (M = 18.1), mean follow-up 33 months) were included. Following surgery, 77.1% of patients remained seizure-free (Engel IA/ILAE 1). Hippocampus and amygdala resection was predictive for seizure freedom in temporal lobe epilepsy. In total, 65.7% of all patients showed cognitive deficits during presurgical workup, decreasing to 51.4% after surgery, predominantly due to significantly less impaired memory functions (p = 0.011). Patients with presurgical cognitive deficits showed a tendency toward a longer duration of epilepsy (p = 0.050). Focal to bilateral tonic-clonic seizures (p = 0.019) and young age at onset (p = 0.018) were associated with a higher likelihood of cognitive deficits after surgery. Therefore, we advocate early epilepsy surgery without requiring proof of drug-resistance. This refers especially to lesions associated with the non-eloquent cortex.
A Novel Prediction Tool for Endoscopic Intervention in Patients with Acute Upper Gastro-Intestinal Bleeding
Authors: Veisman Ido , Oppenheim Amit , Maman Ronny , Kofman Nadav , Edri Ilan , Dar Lior , Klang Eyal , Sina Sigal , Gabriely Daniel , Levy Idan , Beylin Dmitry , Beylin Ortal , Shekel Efrat , Horesh Nir , Kopylov Uri
Published: October 2022

(1) Background: Predicting which patients with upper gastro-intestinal bleeding (UGIB) will receive intervention during urgent endoscopy can allow for better triaging and resource utilization but remains sub-optimal. Using machine learning modelling we aimed to devise an improved endoscopic intervention predicting tool. (2) Methods: A retrospective cohort study of adult patients diagnosed with UGIB between 2012–2018 who underwent esophagogastroduodenoscopy (EGD) during hospitalization. We assessed the correlation between various parameters with endoscopic intervention and examined the prediction performance of the Glasgow-Blatchford score (GBS) and the pre-endoscopic Rockall score for endoscopic intervention. We also trained and tested a new machine learning-based model for the prediction of endoscopic intervention. (3) Results: A total of 883 patients were included. Risk factors for endoscopic intervention included cirrhosis (9.0% vs. 3.8%, p = 0.01), syncope at presentation (19.3% vs. 5.4%, p < 0.01), early EGD (6.8 h vs. 17.0 h, p < 0.01), pre-endoscopic administration of tranexamic acid (TXA) (43.4% vs. 31.0%, p < 0.01) and erythromycin (17.2% vs. 5.6%, p < 0.01). Higher GBS (11 vs. 9, p < 0.01) and pre-endoscopy Rockall score (4.7 vs. 4.1, p < 0.01) were significantly associated with endoscopic intervention; however, the predictive performance of the scores was low (AUC of 0.54, and 0.56, respectively). A combined machine learning-developed model demonstrated improved predictive ability (AUC 0.68) using parameters not included in standard GBS. (4) Conclusions: The GBS and pre-endoscopic Rockall score performed poorly in endoscopic intervention prediction. An improved predictive tool has been proposed here. Further studies are needed to examine if predicting this important triaging decision can be further optimized.
Diagnostic Accuracy and Complication of Computed Tomography (CT)-Guided Percutaneous Transthoracic Lung Biopsy in Patients 80 Years and Older
Authors: Shin Yoon Joo , Yi Jeong Geun , Son Donghee , Ahn Su Yeon
Published: October 2022

This research evaluated the diagnostic accuracy and complication rate of computed tomography (CT)-guided percutaneous transthoracic lung biopsy (PTNB) in patients 80 years and older. The study sought to identify risk factors for diagnostic failures or complications of PTNBs. We examined 247 CT-guided PTNBs performed from January 2017 through December 2020, noting patient demographics, lesion or procedure types, pathology reports, and other procedure-related complications. Study groups were divided into two: one with patients aged 80 years and older (Group 1) and the other with patients aged 60 to 80 years (Group 2). The research first determined each groups’ diagnostic accuracy, sensitivity, specificity, diagnostic failure rate, and complication rate and then evaluated the risk factors for diagnostic failures and complications. The diagnostic accuracy, sensitivity, specificity, and diagnostic failure rates were 95.6%, 94.9%, 100%, and 18.9%, respectively, in Group 1. The overall and major complication rates in Group 1 were 29.6% and 3.7%, respectively. Lesion size was the only risk factor for diagnostic failure (adjusted odds ratio [OR], 0.46; 95% confidence interval [CI], 0.24–0.90). There was no significant risk factor for complications in Group 1. CT-guided PTNBs in patients 80 years and older indicate comparable diagnostic accuracy and complication rates.
Impact of First-Line FOLFIRINOX-Induced Peripheral Neuropathy on the Efficacy of Second-Line GnP in Patients with Unresectable Advanced Pancreatic Cancer
Authors: Sadaka Shiori , Iwashita Takuji , Fujii Hironori , Kato-Hayashi Hiroko , Ohata Koichi , Uemura Shinya , Shimizu Masahito , Suzuki Akio
Published: October 2022

Modified FOLFIRINOX (mFFX) and Gemcitabine plus nab-paclitaxel (GnP) are effective first-line chemotherapies for unresectable advanced pancreatic cancer (APC); however, both lead to peripheral neuropathy (PN). Aims: To evaluate the impact of first-line mFFX-induced PN on the efficacy of second-line GnP in patients with APC. Methods: A database containing patients with APC was retrospectively analyzed to evaluate patients who received second-line GnP after first-line mFFX failure between September 2014 and January 2021. The efficacy and safety of GnP were compared between patients with PN ≥ Grade 2 (PN group) and PN ≤ Grade 1 (non-PN group) at the start of second-line GnP. Cox proportional hazards analysis was also performed to examine the effect on overall survival (OS) and time-to-treatment failure (TTF). Results: Fifty-nine patients (PN group, 18 patients; non-PN group, 41 patients) were included. Median OS and TTF in the PN versus non-PN group were 7.7 versus 5.7 months (p = 0.19) and 3.8 versus 2.7 months (p = 0.18), respectively. Multivariate analysis showed that PN (≥Grade 2) was not a significant factor affecting either OS (hazard ratio (HR) 0.66, 95% confidence interval [CI] 0.33–1.31, p = 0.24) or TTF (HR 0.71, 95% CI 0.38–1.33, p = 0.28). No significant difference was observed in the relative dose intensity of GEM or nab-PTX, and incidence of adverse events. Conclusions: mFFX-induced PN has little impact on the efficacy and safety of second-line GnP in patients with APC. Second-line GnP could be a possible treatment option regardless of the presence of PN.
The Consequences of the Pandemic on Medical Students’ Depressive Symptoms and Perceived Stress: A Repeated Cross-Sectional Survey with a Nested Longitudinal Subsample
Authors: Lo Moro Giuseppina , Carletto Sara , Zuccaroli Lavista Vittoria , Soro Giovanna , Bert Fabrizio , Siliquini Roberta , Leombruni Paolo
Published: October 2022

This study aimed to explore the impact of the pandemic on medical students’ mental health in Italy using a repeated cross-sectional survey with a nested longitudinal subsample (first timepoint: 2018; second: 2020/2021). Three research questions (RQs) were investigated. Study 1 (longitudinal sub-sample) explored whether medical students had higher levels of depressive symptoms and stress during the pandemic compared with a pre-pandemic period (RQ1) and what variables were associated with these conditions during the pandemic adjusting for baseline levels (RQ2). Study 2 (repeated cross-sectional data) aimed to examine whether medical students had higher levels of these conditions during the pandemic compared with their same-year peers during a pre-pandemic period (RQ3). In Study 1, higher levels of depressive symptoms and stress were shown during the pandemic (RQ1). Multivariable models highlighted associations between poor mental health and worsening of the judgment of medical school choice, worsened psychological condition due to the pandemic, economic repercussions due to the pandemic, and baseline levels of symptoms (RQ2). In Study 2, our findings reported higher levels of depressive symptoms and stress during the pandemic, also adjusting for other variables (RQ3). In conclusion, depressive symptoms and stress were greater during the pandemic. The most relevant variables were pandemic-related items and medical school choice judgment.
Expression Patterns of Tumor Markers in Liver Transplant Recipients Showing Complete Pathological Response of Hepatocellular Carcinoma
Authors: Kim Min-Jae , Kang Woo-Hyoung , Hwang Shin , Ahn Chul-Soo , Moon Deok-Bog , Ha Tae-Yong , Song Gi-Won , Jung Dong-Hwan , Park Gil-Chun
Published: October 2022

Complete pathological response (CPR) is achieved with various pretransplant locoregional treatments for hepatocellular carcinoma (HCC). This study aimed to investigate pretransplant expression of HCC tumor markers in liver transplantation (LT) recipients showing CPR. For the CPR group, 166 patients were selected from a single-institution LT database. Two control groups of 332 patients without HCC and 184 patients with partial pathological response (PPR) were also selected. The model for end-stage liver disease score in the CPR group was 11.5 ± 7.7. The number of transcatheter arterial chemoembolization sessions before LT was one in 68 patients (14.0%), two in 38 patients (22.9%), and three or more in 60 patients (36.1%). A solitary non-viable tumor was identified in 120 (86.4%) of the explant livers and the largest tumor size was 2.4 ± 1.3 cm. Living-donor and deceased-donor LTs were performed in 152 (91.6%) and 14 (8.4%) patients, respectively. The median levels of α-fetoprotein (AFP) and protein induced by Vitamin K absence or antagonist-II (PIVKA-II) measured within two weeks before LT were 4.2 ng/mL and 20 mAU/mL, respectively. These tumor marker levels were comparable to those in the no-HCC control group, but much lower than those in the PPR group (p < 0.001). Receiver operating characteristic curve analysis of AFP and PIVKA-II showed no definite cutoff values for CPR in the cohort of CPR and no-HCC patients, but significant cutoffs of 6.5 ng/mL for AFP and 29 mAU/mL for PIVKA-II were obtained in the cohort of CPR and PPR patients. The 1-, 3- and 5-year HCC recurrence and overall patient survival rates of the CPR group were 5.1% and 93.3%, 7.6% and 89.6%, and 7.6% and 89.6%, respectively. These tumor recurrence rates were much lower than those in the PPR group (p < 0.001). In conclusion, the present study results suggest that normalizing AFP and PIVKA-II after locoregional treatment is indicative of CPR. However, some CPR patients showed high expression of tumor markers; thus, pretransplant values of HCC tumor markers should be interpreted with caution.
Cardiac Implantable Electronic Devices Infection Assessment, Diagnosis and Management: A Review of the Literature
Authors: Toriello Filippo , Saviano Massimo , Faggiano Andrea , Gentile Domitilla , Provenzale Giovanni , Pollina Alberto Vincenzo , Gherbesi Elisa , Barbieri Lucia , Carugo Stefano
Published: October 2022

The use of increasingly complex cardiac implantable electronic devices (CIEDs) has increased exponentially in recent years. One of the most serious complications in terms of mortality, morbidity and financial burden is represented by infections involving these devices. They may affect only the generator pocket or be generalised with lead-related endocarditis. Modifiable and non-modifiable risk factors have been identified and they can be associated with patient or procedure characteristics or with the type of CIED. Pocket and systemic infections require a precise evaluation and a specialised treatment which in most cases involves the removal of all the components of the device and a personalised antimicrobial therapy. CIED retention is usually limited to cases where infection is unlikely or is limited to the skin incision site. Optimal re-implantation timing depends on the type of infection and on the results of microbiological tests. Preventive strategies, in the end, include antibiotic prophylaxis before CIED implantation, the possibility to use antibacterial envelopes and the prevention of hematomas. The aim of this review is to investigate the pathogenesis, stratification, diagnostic tools and management of CIED infections.
Clinical Characteristics of Actinic Keratosis Associated with the Risk of Progression to Invasive Squamous Cell Carcinoma: A Systematic Review
Authors: Balcere Alise , Konrāde-Jilmaza Laura , Pauliņa Laura Agnese , Čēma Ingrīda , Krūmiņa Angelika
Published: October 2022

Background: Actinic keratosis (AK) is one of the most common lesions on chronically sun-damaged skin that has the risk of progression to invasive squamous cell carcinoma (SCC). With the possibilities of using digital technologies for following-up skin lesions and their increased use in the past few decades, our objective was to update the review by Quaedvlieg et al., 2006, and to review prospective studies from 2005 onwards to identify the clinical characteristics of AK that later progressed to SCC. Methods: The PubMed, Scopus, and ScienceDirect databases were searched for relevant articles. The search had the following criteria: English language, human subjects and year from 2005 onwards. The study protocol was registered in the Prospero database with the record number CRD42020200429 and followed the PRISMA guidelines. The risk-of-bias assessment was performed using the QUIPS tool. Results: From the 5361 studies screened, 105 reports were evaluated for eligibility, and 2 articles with 621 patients were included. The main AK types associated with the development of SCC were found to be baseline AK, also known as a long-standing AK, and merging AK, also called an “AK patch”.
Pulmonary Capillary Wedge Pressure during Exercise Is Prognostic for Long-Term Survival in Patients with Symptomatic Heart Failure
Authors: Ahlgrim Christoph , Kocher Sascha , Minners Jan , Jander Nikolaus , Savarese Gianluigi , Neumann Franz-Josef , Arentz Thomas , Jadidi Amir , Mueller-Edenborn Björn
Published: October 2022

Aims: Exercise stress testing can stratify specific populations of heart failure patients for mortality risk, but is not universally applied. The aim of the present study was to investigate the prognostic capabilities of invasive exercise testing in a real-world cohort of suspected heart failure patients in whom non-cardiac causes of dyspnea were excluded. Methods: We retrospectively analyzed the survival of 682 patients who underwent right heart catheterization at rest and during exercise between 2007 and 2017 for dyspnea and expected heart failure. Pulmonary capillary wedge pressure (PCWP) at rest and the PCWP response to exercise, expressed as the ratio of PCWP at peak exercise to workload normalized to body weight (PCWL (mmHg/W/kg)), were determined. Mortality data were retrieved from the official German death registry. Results: Over a median follow-up period of 8.5 years, PCWL is a stronger predictor of all-cause mortality than PCWP. Patients featuring a reduced left ventricular ejection fraction (LVEF; <50%), but favorable response to exercise (PCWL <34.7 mmHg/W/kg), have a similar mortality risk to patients with a normal LVEF and low PCWL (hazard ratio (HR) 1.180, 95% CI 0.48–2.91, p = 0.719). Irrespective of LVEF, an increased PCWL during exercise was associated with a significantly increased mortality (HR 1.950 with preserved LVEF, 95% CI 1.12–3.34, p = 0.018; and HR 3.212 with impaired LVEF, 95% CI 1.75–5.70, p < 0.001). Conclusions: In patients with clinical heart failure, invasive exercise testing improves the prediction of mortality. Subjects with a favorable response to exercise have a relatively low mortality irrespective of left ventricular systolic function.
Headaches and Dizziness as Disabling, Persistent Symptoms in Patients with Long COVID–A National Multicentre Study
Authors: Rodríguez-Pérez Mª Pilar , Sánchez-Herrera-Baeza Patricia , Rodríguez-Ledo Pilar , Serrada-Tejeda Sergio , García-Bravo Cristina , Pérez-de-Heredia-Torres Marta
Published: October 2022

Background: Currently, about 15% of coronavirus disease-19 (COVID-19) patients are affected by Long COVID worldwide; however, this condition has not yet been sufficiently studied. The aim of this study was to identify the impact of symptom persistence as well as clinical and socio-demographic variables in a cohort of people with Long COVID. Methods: We conducted a descriptive cross-sectional study of a sample of adult patients from different Spanish regions presenting with Long COVID. Data collection was conducted between April and July 2021. Functional status and dependency were assessed. Results: A multivariate linear regression was performed, and the model was statistically significant (F (7; 114) = 8.79; p < 0.001), according to the overall ALDQ score. The variables with a statistically significant effect on the degree of dependence were age (p = 0.014), time since diagnosis (p = 0.02), headaches (p = 0.031), and dizziness (p = 0.039). Functional status post-COVID showed a positive and significant relationship with the percentage of dependence (p < 0.001). Conclusions: People affected by Long COVID showed moderate dependency status and limitations in functionality. Those with neurological symptoms, such as dizziness and headaches, as well as older age, showed a higher degree of dependency. Improvements in dependency status occurred with increasing time since diagnosis.
Impact of the COVID-19 Pandemic on the Perceived Quality of Palliative Care in Nursing Homes
Authors: Mota-Romero Emilio , Campos-Calderon Concepcion Petra , Puente-Fernandez Daniel , Hueso-Montoro Cesar , Esteban-Burgos Ana A. , Montoya-Juarez Rafael
Published: October 2022

The Nursing Homes End-of-life Programme (NUHELP) was developed in 2017 and is based on quality standards of palliative care, but it was not implemented due to the outbreak of the COVID-19 pandemic. Objectives: To describe perceptions among staff at nursing homes and primary health care (PHC) centres regarding the relevance, feasibility, and degree of achievement of quality standards for palliative care in nursing homes and to determine the differences in these perceptions before and after the pandemic. Methodology: Cross-sectional descriptive study. Professionals at eight nursing homes and related PHC centres who participated in NUHELP development assessed 42 palliative care standards at two time points (2018 and 2022). The Mann–Whitney U test was applied to analyse differences in the scores between these two times and between perceptions at nursing homes and at PHC centres. Results: The study population consisted of 58 professionals in 2018 and 50 in 2022. The standard regarding communication with persons affected by the death of a family member was considered less relevant (p = 0.05), and that concerning the culturally sensitive and dignified treatment of the body was less fully achieved (p = 0.03) in 2022 than in 2018. Social support (p = 0.04), sharing information among the care team (p = 0.04), patient participation (p = 0.04) and information about the treatment provided (p = 0.03) were all more poorly achieved in 2022 than in 2018. The perceptions of nursing home and PHC workers differed in several respects. Conclusions: Professional intercommunication and social support should be reinforced, and residents should be more actively involved in decision-making.
Inflammatory Biomarkers of Extracellular Matrix Remodeling and Disease Activity in Crohn’s Disease and Ulcerative Colitis
Authors: Domislovic Viktor , Høg Mortensen Joachim , Lindholm Majken , Kaarsdal Morten Asser , Brinar Marko , Barisic Ana , Manon-Jensen Tina , Krznaric Zeljko
Published: October 2022

Extracellular matrix (ECM) homeostasis is highly affected in active inflammatory bowel disease (IBD). The aim of the study was to investigate serological biomarkers of type III, IV, and V collagen degradation and formation, and their association with disease activity in IBD. ECM remodeling serum biomarkers were measured in 162 IBD patients, 110 with Crohn’s disease (CD) and 52 with ulcerative colitis (UC), and in 29 healthy donors. Biomarkers of type III collagen degradation (C3M) and formation (PRO-C3), type IV collagen degradation (C4M) and formation (PRO-C4), and type V collagen formation (PRO-C5) were measured using ELISA. Inflammatory activity was assessed using endoscopic, clinical, and biochemical activity indices. The highest diagnostic value was identified in discriminating endoscopically moderate to severe disease in CD (PRO-C3, C3M/PRO-C3, and C4M with AUC of 0.70, 0.73, and 0.69, respectively) and UC (C3M, C3M/PRO-C3, and C4M with AUC of 0.86, 0.80, and 0.76, respectively). C4M and C3M/PRO-C3 in combination yielded AUC of 0.93 (0.66–0.90) in CD and 0.94 (0.65–0.99) in UC. This study confirmed that ECM remodeling reflected disease activity in CD and UC. A combination of C4M, C3M, and PRO-C3 biomarkers may potentially be considered as a biomarker differentiating moderate to severe endoscopic disease.
Prospective Evaluation of the Quality of Life of Patients after Surgical Treatment of Rectal Cancer: A 12-Month Cohort Observation
Authors: Tarkowska Magdalena , Głowacka-Mrotek Iwona , Skonieczny Bartosz , Jankowski Michał , Nowikiewicz Tomasz , Jarzemski Marcin , Zegarski Wojciech , Jarzemski Piotr
Published: October 2022

This study constitutes a prospective, three-stage evaluation of quality of life among patients receiving surgical treatment for colorectal cancer depending on the type of surgery performed (open anterior resection, laparoscopic anterior resection, abdominoperineal resection, or Hartmann’s procedure). The study included 82 patients treated at the Surgical Oncology Outpatient Department of the Oncology Center in Bydgoszcz from June 2019 to August 2021. The study tools consisted of diagnostic surveys and analyses of medical records. The standardized study tools were the surveys EORTC QLQ-C30 and QLQ-CR29. In addition, a proprietary questionnaire was developed to collect demographic data. Quality of life was measured at three time-points: the day before the surgery and 6 and 12 months post-surgery. Statistically significant differences (p < 0.05) were observed in the domains of role functioning (III, p = 0.030), body image (II, p < 0.001; III, p < 0.001), sexual functioning (II, p = 0.037), buttocks/anal area/rectum pain (III, p = 0.031), and embarrassment (II, p = 0.022; III, p = 0.010). Statistically significant differences in the functional and symptom scale scores were also observed within each group at different stages of cancer treatment. As shown by our study, the quality of life of patients treated for colorectal cancer is determined not only by the operating technique but also by sociodemographic and clinical factors. The use of minimally invasive surgical techniques enables patients to return to their social roles more quickly and improves their self-assessment of body image.
Prognostic Factors for Pulmonary Fibrosis Following Pneumonia in Patients with COVID-19: A Prospective Study
Authors: Lee Inhan , Kim Joohae , Yeo Yohwan , Lee Ji Yeon , Jeong Ina , Joh Joon-Sung , Kim Gayeon , Chin Bum Sik , Kim Yeonjae , Kim Min-Kyung , Jeon Jaehyun , Yoon Yup , Jin Sung Chan , Kim Junghyun
Published: October 2022

The frequency and clinical manifestation of lung fibrosis accompanied by coronavirus disease (COVID-19) are not well-established. We aimed to identify the factors attributed to post-COVID-19 fibrosis. This single-center prospective study included patients diagnosed with COVID-19 pneumonia from 12 April to 22 October 2021 in the Republic of Korea. The primary outcome was the presence of pulmonary fibrosis on a CT scan 3 months after discharge; the fibrosis risk was estimated by a multiple logistic regression. The mean patient age was 55.03 ± 12.32 (range 27–85) years; 65 (66.3%) were men and 33 (33.7%) were women. The age, Charlson Comorbidity Index, lactate dehydrogenase level, aspartate aminotransferase level, and Krebs von den Lungen-6 level were significantly higher and the albumin level and the saturation of the peripheral oxygen/fraction of inspired oxygen (SpO2/FiO2) ratio were significantly lower in the fibrosis group than in the non-fibrosis group; the need for initial oxygen support was also greater in the fibrosis group. An older age (adjusted odds ratio (AOR) 1.12; 95% confidence interval (CI) 1.03–1.21) and a lower initial SpO2/FiO2 ratio (AOR 7.17; 95% CI 1.72–29.91) were significant independent risk factors for pulmonary fibrosis after COVID-19 pneumonia. An older age and a low initial SpO2/FiO2 ratio were crucial in predicting pulmonary fibrosis after COVID-19 pneumonia.
Association Study of the SLC1A2 (rs4354668), SLC6A9 (rs2486001), and SLC6A5 (rs2000959) Polymorphisms in Major Depressive Disorder
Authors: Rodek Patryk , Kowalczyk Małgorzata , Kowalski Jan , Owczarek Aleksander , Choręza Piotr , Kucia Krzysztof
Published: October 2022

The membrane excitatory amino acid transporter 2 (EAAT2), encoded by SLC1A2, is responsible for the uptake and redistribution of synaptic glutamate. Glycine modulates excitatory neurotransmission. The clearance of synaptic glycine is performed by glycine transporters encoded by SLC6A9 and SLC6A5. Higher synaptic glycine and glutamate levels could enhance the activation of NMDA receptors and counteract the hypofunction of glutamate neurotransmission described in major depressive disorder (MDD). The aim of the study was to assess whether polymorphisms of SCL1A2 (rs4354668), SCL6A5 (rs2000959), and SCL6A9 (rs2486001) play a role in the development of MDD and its clinical picture in the Polish population. The study group consisted of 161 unrelated Caucasian patients with MDD and 462 healthy unrelated individuals for control. Polymorphisms were genotyped with PCR-RLFP assay. We observed that the frequency of genotype CC and allele C of the SLC1A2 polymorphism rs4354668 was twice as high in the MDD group as in control. Such differences were not detected in SLC6A5 and SLC6A9 polymorphisms. No statistically significant association of the studied SNPs (Single Nucleotide Polymorphisms) on clinical variables of the MDD was observed. The current study indicates an association of polymorphism rs4354668 in SCL1A2 with depression occurrence in the Polish population; however, further studies with larger samples should be performed to clarify these findings.
Epidermal Junctions and Skin Inflammation
Authors: Donetti Elena
Published: October 2022

Epidermal junctions help to preserve cutaneous homeostasis and, consequently, protect the body against a wide range of environmental stresses [...]
Do We Need Psychological Outcome Measures in the Management of Lateral Elbow Tendinopathy (LET)?
Authors: Stasinopoulos Dimitrios
Published: October 2022

Many outcome measures have been developed in the evaluation of LET [...]
Impella 5.0/5.5 Implantation via Innominate Artery: Further Expanding the Opportunities for Temporary Mechanical Circulatory Support
Authors: Bertolin Stephanie , Maj Giulia , Cavozza Corrado , Cardinale Astrid , Pullara Alberto , Audo Andrea , Pappalardo Federico
Published: October 2022

When axillary/subclavian arteries are not suitable because of size or anatomy, alternative access for the Impella pump 5.0/5.5 via the innominate artery allows circulatory support and eventually de-escalation from VA-ECMO to isolated left-side support. Moreover, less invasive surgery without the need to open the pericardium reduces the risk of RV dysfunction and bleeding. Finally, upper body strategies allow early rehabilitation during support, which is associated with improved survival in cardiogenic shock.
Physical Inactivity and Sedentarism during and after Admission with Community-Acquired Pneumonia and the Risk of Readmission and Mortality: A Prospective Cohort Study
Authors: Ryrsø Camilla Koch , Dungu Arnold Matovu , Hegelund Maria Hein , Faurholt-Jepsen Daniel , Pedersen Bente Klarlund , Ritz Christian , Lindegaard Birgitte , Krogh-Madsen Rikke
Published: October 2022

Background: Bed rest with limited physical activity is common during admission. The aim was to determine the association between daily step count and physical activity levels during and after admission with community-acquired pneumonia (CAP) and the risk of readmission and mortality. Methods: A prospective cohort study of 166 patients admitted with CAP. Step count and physical activity were assessed with accelerometers during and after admission and were categorised as sedentary, light, or moderate-vigorous physical activity. Linear regression was used to assess the association between step count and length of stay. Logistic regression was used to assess the association between step count, physical activity level, and risk of readmission and mortality. Results: Patients admitted with CAP were sedentary, light physically active, and moderate-to-vigorous physically active 96.4%, 2.6%, and 0.9% of their time, respectively, with 1356 steps/d. For every 500-step increase in daily step count on day 1, the length of stay was reduced by 6.6%. For every 500-step increase in daily step count during admission, in-hospital and 30-day mortality was reduced. Increased light and moderate-to-vigorous physical activity during admission were associated with reduced risk of in-hospital and 30-day mortality. After discharge, patients increased their daily step count to 2654 steps/d and spent more time performing light and moderate-to-vigorous physical activity. For every 500-step increase in daily step count after discharge, the risk of readmission was reduced. Higher moderate-to-vigorous physical activity after discharge was associated with a reduced risk of readmission. Conclusions: Increased physical activity during admission was associated with a reduced length of stay and risk of mortality, whereas increased physical activity after discharge was associated with a reduced risk of readmission in patients with CAP. Interventions focusing on increasing physical activity levels should be prioritised to improve the prognosis of patients admitted with CAP.
A Multisite Non-Inferiority Randomized Controlled Trial of the Efficacy of Cognitive-Behavior Therapy for Generalized Anxiety Disorder Delivered by Videoconference
Authors: Bouchard Stéphane , Dugas Michel J. , Belleville Geneviève , Langlois Frédéric , Gosselin Patrick , Robillard Geneviève , Corno Giulia , Marchand André
Published: October 2022

Delivering psychotherapy by videoconference has been studied in a number of clinical trials, but no large controlled trial has involved generalized anxiety disorder (GAD). This multicenter randomized controlled non-inferiority trial was conducted to test if cognitive-behavior psychotherapy delivered by videoconference (VCP) is as effective as cognitive-behavior psychotherapy delivered face-to-face, using a strict margin of tolerance for non-inferiority. A total of 148 adults received a 15-session weekly manualized program. The treatment was based on the intolerance of uncertainty model of GAD. The impact of treatment was assessed using primary (GAD severity), secondary (worry, anxiety, and intolerance of uncertainty) and tertiary (general functioning) variables measured before and after treatment and at 6-month and 12-month follow-ups. Results showed that: (a) the treatment was effective; (b) VCP for GAD was statistically non-inferior to face-to-face psychotherapy on primary, secondary and tertiary measures at all assessment points; (c) change in intolerance of uncertainty significantly predicted change in the primary outcome measure over and above important clinical factors common to all psychotherapies (motivation, working alliance, perceived therapist competence, and client satisfaction). These findings support the use of VCP as a promising treatment option for adults with GAD. Clinical trial registry: ISRCTN#12662027.
Neuromodulation Applied to Diseases: The Case of HRV Biofeedback
Authors: Gitler Asaf , Vanacker Leen , De Couck Marijke , De Leeuw Inge , Gidron Yoram
Published: October 2022

The vagus or “wandering” nerve is the main branch of the parasympathetic nervous system (PNS), innervating most internal organs crucial for health. Activity of the vagus nerve can be non-invasively indexed by heart-rate variability parameters (HRV). Specific HRV parameters predict less all-cause mortality, lower risk of and better prognosis after myocardial infarctions, and better survival in cancer. A non-invasive manner for self-activating the vagus is achieved by performing a slow-paced breathing technique while receiving visual feedback of one’s HRV, called HRV-biofeedback (HRV-B). This article narratively reviews the biological mechanisms underlying the role of vagal activity and vagally mediated HRV in hypertension, diabetes, coronary heart disease (CHD), cancer, pain, and dementia. After searching the literature for HRV-B intervention studies in each condition, we report the effects of HRV-B on clinical outcomes in these health conditions, while evaluating the methodological quality of these studies. Generally, the levels of evidence for the benefits of HRV-B is high in CHD, pain, and hypertension, moderate in cancer, and poor in diabetes and dementia. Limitations and future research directions are discussed.
Use of Human Albumin Administration for the Prevention and Treatment of Hyponatremia in Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis
Authors: Bai Zhaohui , Wang Le , Lin Hanyang , Tacke Frank , Cheng Gang , Qi Xingshun
Published: October 2022

Background. Hyponatremia is a common complication of liver cirrhosis and aggravates patients’ outcomes. It may be corrected by human albumin (HA) infusion. Herein, we have conducted a systematic review and meta-analysis to evaluate the efficacy of intravenous HA administration for the prevention and treatment of hyponatremia in liver cirrhosis. Methods. Literature was searched in the PubMed, EMBASE, and Cochrane Library databases. If possible, a meta-analysis would be conducted. Incidence of hyponatremia, rate of resolution of hyponatremia, and serum sodium level were compared between cirrhotic patients who received and did not receive HA infusion. Odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated. The quality of evidence was assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results. Initially, 3231 papers were identified. Among them, 30 studies, including 25 randomized controlled trials (RCTs) and 5 cohort studies, were eligible. Among cirrhotic patients without hyponatremia, the HA infusion group had significantly lower incidence of hyponatremia (OR = 0.55, 95%CI = 0.38–0.80, p = 0.001) and higher serum sodium level (MD = 0.95, 95%CI = 0.47–1.43, p = 0.0001) as compared to the control group. Among cirrhotic patients with hyponatremia, the HA infusion group had a significantly higher rate of resolution of hyponatremia (OR = 1.50, 95%CI = 1.17–1.92, p = 0.001) as compared to the control group. Generally, the quality of available evidence is low. Conclusions. Based on the current evidence, HA may be considered for preventing the development of hyponatremia in liver cirrhosis, especially in those undergoing LVP, and treating hyponatremia. Well-designed studies are required to clarify the effects of HA infusion on hyponatremia in liver cirrhosis.
Why Tic Severity Changes from Then to Now and from Here to There
Authors: Iverson Ann M. , Black Kevin J.
Published: October 2022

Much of the research regarding Tourette’s syndrome (TS) has focused on why certain individuals develop tics while others do not. However, a separate line of research focuses on the momentary influences that cause tics to increase or decrease in patients who are already known to have TS or another chronic tic disorder (CTD). Environmental and internal variables such as fatigue, anxiety, and certain types of thoughts all have been shown to worsen tic severity and may even overcome the positive effects of treatment. Other influences such as stress, distraction, and being observed have had mixed effects in the various studies that have examined them. Still, other variables such as social media exposure and dietary habits have received only minimal research attention and would benefit from additional study. Understanding the impact of these environmental and internal influences provides an opportunity to improve behavioral treatments for TS/CTD and to improve the lives of those living with these conditions. This review will examine the current literature on how these moment-to-moment influences impact tic expression in those with TS/CTD.
Visual Performance, Satisfaction, and Spectacle Independence after Implantation of a New Hydrophobic Trifocal Intraocular Lens
Authors: Cano-Ortiz Antonio , Sánchez-Ventosa Álvaro , González-Cruces Timoteo , Cerdán-Palacios David , Díaz-Mesa Vanesa , Gallego-Ordóñez Rubén , Gálvez-Gómez Teresa , García Parrizas Jose A. , Zurera Baena Javier , Villarrubia-Cuadrado Alberto
Published: October 2022

The main objective was to evaluate distance, intermediate, and near vision in patients who have undergone cataract extraction with bilateral implantation of a new trifocal diffractive intraocular lens (IOL), along with patient-reported outcomes (PRO). A total of 50 eyes from 25 patients after AsqelioTM Trifocal IOL (AST Products, Inc., Billerica MA, USA) implantation were assessed in this study. At 3 months after surgery, the photopic visual acuity (VA) at distance, intermediate, and near distances was measured. Binocular photopic defocus curves were also obtained. Three questionnaires to assess patients’ visual satisfaction and spectacle dependence, among other items, were completed: the Catquest-9SF, the patient-reported spectacle independence questionnaire (PRSIQ), and the patient-reported visual symptoms questionnaire (PRVSQ). The average spherical equivalent was 0.21 ± 0.37 D at 3 months post-operation, and the average absolute tolerance to defocus was 3.64 ± 0.70 D. The mean binocular uncorrected VAs for distance, intermediate, and near vision were −0.02 ± 0.09, 0.06 ± 0.08, and 0.11 ± 0.07 logMAR, respectively. The best-corrected VA was better than 0.1 logMAR for the whole range from distance to near. PROs revealed spectacle independence and general satisfaction with vision, and the incidence of photic phenomena were low. This study shows that the new bi-aspheric diffractive trifocal IOL provides a good visual performance at different distances under photopic conditions, accompanied by patient satisfaction and spectacle independence.
A Review of the Prevalence of Thromboembolic Complications among Pregnant Women Infected with COVID-19
Authors: Mohd Ariff Nurul Syafiqah , Abdul Halim Zaki Izzati , Mohd Noordin Zakiah , Md Hussin Nur Sabiha , Goh Khang Wen , Ming Long Chiau , Zulkifly Hanis Hanum
Published: October 2022

Background: Thrombotic conditions triggered by SARS-CoV-2 virus can result in high mortality, especially in pregnant women as they are already in a hypercoagulability state. This thereby leads to excessive inflammation that will increase the risk of thromboembolic (TE) complications. Objective: The aim of this study is to review the prevalence of thromboembolic complications such as deep venous thrombosis, pulmonary embolism, and intervillous thrombosis, and their preventive strategies among pregnant women infected with COVID-19. Method: The articles were retrieved from online databases PubMed and ScienceDirect published from February 2020 to April 2022. Findings: A total of 5249 participants including 5128 pregnant women and 121 placentas from 19 studies were identified for having TE complications after being infected with COVID-19. The types of TE complications that developed within pregnant women were disseminated intravascular coagulation (DIC) (n = 44, 0.86%), unmentioned thromboembolic complications (TE) (n = 14, 0.27%), intervillous thrombosis (IVT) (n = 9, 0.18%), pulmonary embolism (PE) (n = 6, 0.12%), COVID-19 associated coagulopathy (CAC) (n = 5, 0.10%), and deep venous thrombosis (DVT) (n = 2, 0.04%). Whereas the prevalence of TE complications reported from studies focusing on placenta were IVT (n = 27, 22.3%), subchorionic thrombus (SCT) (n = 9, 7.44%), and placental thrombosis (n = 5, 4.13%). Thromboprophylaxis agent used among pregnant women include low molecular weight heparin (LMWH) at prophylactic dose (n = 9). Conclusions: The prevalence of thromboembolic complications among pregnant women infected by COVID-19 is low with DIC being the most common form and placental thrombosis being the least common form of TE complications that occurred within pregnant women infected with COVID-19. Anticoagulation, in particular LMWH (variable dose), is frequently used to prevent TE complications.
The Role of the Microbiota Gut–Liver Axis during HCV Chronic Infection: A Schematic Overview
Authors: Marascio Nadia , De Caro Carmen , Quirino Angela , Mazzitelli Maria , Russo Emilio , Torti Carlo , Matera Giovanni
Published: October 2022

Hepatitis C virus (HCV) still represents one of the most important worldwide health care problems. Since 2011, direct-acting antiviral (DAA) drugs have increased the number of people who have achieved a sustained virological response (SVR). Even if the program to eradicate HCV by 2030 is still ongoing, the SARS-CoV-2 pandemic has created a delay due to the reallocation of public health resources. HCV is characterized by high genetic variability and is responsible for hepatic and extra-hepatic diseases. Depending on the HCV genotype/subtype and comorbidities of patients, tailored treatment is necessary. Recently, it has been shown that liver damage impacts gut microbiota, altering the microbial community (dysbiosis) during persistent viral replication. An increasing number of studies are trying to clarify the role of the gut–liver axis during HCV chronic infection. DAA therapy, by restoring the gut microbiota equilibrium, seems to improve liver disease progression in both naïve and treated HCV-positive patients. In this review, we aim to discuss a snapshot of selected peer-reviewed papers concerning the interplay between HCV and the gut–liver axis.
Mortality Prediction Model before Surgery for Acute Mesenteric Infarction: A Population-Based Study
Authors: Lin Shang-Wei , Chen Chung-Yen , Su Yu-Chieh , Wu Kun-Ta , Yu Po-Chin , Yen Yung-Chieh , Chen Jian-Han
Published: October 2022

Surgery for acute mesenteric infarction (AMI) is associated with high mortality. This study aimed to generate a mortality prediction model to predict the 30-day mortality of surgery for AMI. We included patients ≥18 years who received bowel resection in treating AMI and randomly divided into the derivation and validation groups. After multivariable analysis, the ‘Surgery for acute mesenteric infarction mortality score’ (SAMIMS) system was generated and was including age >62-year-old (3 points), hemodialysis (2 points), congestive heart failure (1 point), peptic ulcer disease (1 point), diabetes (1 point), cerebrovascular disease (1 point), and severe liver disease (4 points). The 30-day-mortality rates in the derivation group were 4.4%, 13.4%, 24.5%, and 32.5% among very low (0 point), low (1–3 point(s)), intermediate (4–6 points), and high (7–13 points)-risk patients. Compared to the very-low-risk group, the low-risk (OR = 3.332), intermediate-risk (OR = 7.004), and high-risk groups (OR = 10.410, p < 0.001) exhibited higher odds of 30-day mortality. We identified similar results in the validation group. The areas under the ROC curve were 0.677 and 0.696 in the derivation and validation groups. Our prediction model, SAMIMS, allowed for the stratification of the patients’ 30-day-mortality risk of surgery for acute mesenteric infarction.
Non-Communicable Diseases: The Invisible Epidemic
Authors: Piovani Daniele , Nikolopoulos Georgios K. , Bonovas Stefanos
Published: October 2022

Historically, communicable diseases, such as HIV/AIDS, viral hepatitis, malaria, poliomyelitis, tuberculosis, influenza and, more recently, the coronavirus disease 2019, have been at the center of global health concerns and initiatives, as they are transmitted from one person to another with a variety of ways, easily spread across national borders, and threaten the lives of millions of people all over the globe [...]