bluuebunny/crossref_metadata_2025 huggingface dataset:
Persistent opioid use after hospital admission due to trauma: a population-based cohort study
Authors: Gong Jiayi , Beyene Kebede , Yan Chan Amy Hai , Frampton Chris , Jones Peter
Published: July 2024

Persistent opioid use (POU) is a common marker of harm related to opioid use after trauma. This study determined the incidence and risk factors for POU after hospitalisation due to trauma in New Zealand, among opioid-naïve patients. This was a population-based, retrospective cohort study, using linked data, involving all trauma patients of any age admitted to all NZ hospitals between 2007 and 2019. We included all patients who received opioids after discharge and were considered opioid naïve, defined as not having received opioids or not having a prior diagnosis of opioid-use disorder up to 365 days preceding the discharge date. The primary outcome was the incidence of POU defined as opioid use after discharge between 91 and 365 days. We used a multivariable logistic regression to identify independent risk factors for POU. A total of 177,200 patients were included in this study. Of these, 15.3% (n = 27,060) developed POU based on criteria used for the primary analysis, with sensitivity analyses showing POU incidence ranging from 14.3% to 0.8%. The opioid exposure risk factors associated with POU included switching between different opioids (adjusted odds ratio [aOR] 2.62; 95% confidence interval [CI] 2.51-2.73), prescribed multiple opioids (vs codeine, aOR 1.44; 95% CI 1.37-1.53), slow-release opioid formulations (aOR 1.32; 95% CI 1.26-1.39), and dispensed higher total doses of on the initial discharge prescription (aOR 1.26; 95% CI 1.20-1.33). Overall, 1 in 7 opioid-naïve patients who were exposed to opioids after trauma developed POU. Our findings highlight clinicians should be aware of these factors when continuing opioids on discharge.
A Multidisciplinary Approach to Increase Dysphagia Compliance in Stroke Patients
Authors: Serber Stacy L. , Wachtel Noah , Fox Madison , Petrushonis Corrine
Published: July 2024

BACKGROUND: The objective was to optimize conditions that increase dysphagia compliance after stroke—a measure recognized by The Joint Commission in designating institutions as primary or comprehensive stroke centers and by the American Heart Association that promotes stroke treatment adherence and bestows achievement and quality awards. Failure to meet stroke measures, including medication documentation, may produce poor patient outcomes that directly affect consumer confidence and choice of treatment facility. Stroke patient care requires multidisciplinary team collaboration to manage multiple factors; variations in practice create fallouts that need correction, the absence of which jeopardizes standards for maintaining stroke center designation. PURPOSE: Aims were to determine the nature of dysphagia fallouts in our quaternary academic teaching hospital, assess multidisciplinary workflows and barriers to success, and develop strategies to enhance dysphagia compliance. DESCRIPTION: We used a multidisciplinary approach using James Reason's Swiss cheese model to examine compliance. The clinical nurse specialist interviewed physicians, advanced practice providers, pharmacists, speech-language pathologists (SLPs), nurses, and informaticists to ascertain discipline-specific success barriers, targeting top issues for each discipline to develop solutions. Unit educators unified their dysphagia reduction strategies; physicians, pharmacists, and informaticists collaborated to clarify standardized medication route orders and to increase electronic health record swallow screen visibility to multidisciplinary users; and SLPs adjusted workflow and documentation. EVALUATION: Outcomes included reinforcing correct nursing charting, pharmacy oral-to-feeding tube conversion order revision, optimization of delivery and awareness of medication routes, electronic health record system enhancements, and SLPs aligning documentation with nursing medication administration. The multidisciplinary approach proved successful and increased dysphagia compliance by 9.6% (P = .001). These outcomes contributed to a successful The Joint Commission survey, redesignation as a comprehensive stroke center, and American Heart Association Gold Plus achievement award.
Unveiling the prognostic role of blood inflammatory indexes in a retrospective cohort of patients undergoing liver resection for intrahepatic cholangiocarcinoma
Authors: Milana Flavio , Polidoro Michela A. , Soldani Cristiana , Franceschini Barbara , Famularo Simone , Di Tommaso Luca , Terracciano Luigi M. , Lleo Ana , Donadon Matteo , Torzilli Guido
Published: July 2024

Background:

Systemic inflammation is relevant in intrahepatic cholangiocarcinoma (iCCA), but controversial results exist on the prognostic role of inflammatory indexes and their correlation with tumor microenvironment. The authors aimed to explore the biological and prognostic values of these indexes.

Materials and methods:

A retrospective cohort study involving iCCA patients who underwent hepatic resection between 2010 and 2021 was conducted. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and clinic-pathological factors were recorded. Immune-cell subpopulations, isolated from surgical specimens, were analyzed by flow cytometry. NLR and LMR cut-offs were calculated by X-Tile software. Linear regression, Kaplan–Meier, and Cox regression analyses were conducted.

Results:

A total of 101 iCCA patients were considered. NLR ≥3.83 and LMR <2.28 correlated with worse survival. Patients were divided into groups: 67 (66.3%) in the low-risk and 34 (33.7%) in the high-risk (having at least one worse prognostic ratio). The 5-year overall survival was 49.8 and 18.9% for low- and high-risk groups, respectively (P=0.003). An elevated CA19-9 in the high-risk group gives 2.148 HR (95% CI: 1.060–4.349) of mortality and 2.182 HR (95% CI: 1.206–3.948) of disease recurrence. Flow cytometry analysis of 20 surgical specimens highlighted that NLR was associated with tumor-derived NLR (P=0.026) and LMR with tumor-infiltrating lymphocytes (P=0.002). In a subset of five high-risk vs five low-risk patients, T-cell evaluation showed a higher prevalence of CD4+ compared to CD8+ cells in the high-risk group (78.5 vs. 21.5%, P<0.0001). Conversely, low-risk patients demonstrated a noteworthy infiltration of CD8+ cells compared to the high-risk group (21.5 vs. 48.7%, P=0.037).

Conclusions:

The combination of blood inflammatory indexes determined two survival-risk profiles. The correlation between the blood scores and the iCCA microenvironment suggests a link between immune-cell infiltration and the risk group. These findings open the possibility of patient stratification with the chance to identify subgroups suitable for dedicated follow-up and targeted immuno-chemotherapy protocols.
Epithelioid trophoblastic tumor with lung metastasis: A case report and literature review
Authors: Li Jing , Du Zhenwu , Xu Tianmin , Li Chenhong , Ba Shumin , Zhu He
Published: July 2024

Rationale:

Epithelioid trophoblastic tumor (ETT) is an extremely rare variant of gestational trophoblastic neoplasms (GTNs). The biological behavior and therapeutic schedule of ETT remains to be defined which frequently poses diagnostic and therapeutic challenges. Although ETT is a relatively indolent malignancy tumor, the therapeutic efficacy and survival rate decrease significantly when presented with metastases. The lung is the most common site of ETT metastasis.

Patient concerns:

A 39-year-old female patient presented with irregular vaginal bleeding and slight distention pain in lower abdomen.

Diagnoses:

The patient was diagnosed ETT with lung metastasis after surgery and immunohistochemical staining.

Interventions:

A total abdominal hysterectomy plus bilateral salpingectomy and histopathology were performed. The patient received 3 cycles of etoposide, methotrexate, actinomycin-D/etoposide, cisplatin (EMA/EP) regimen chemotherapy after surgery. Due to the presence of lung metastasis, she received pulmonary lesion resection and another cycle of postoperative chemotherapy.

Outcomes:

The patients showed a good response to treatment initially. However, the patient did not complete the full initial treatment for family reasons and had signs of recurrence after 2.5 months. The serum β-hCG level gradually elevated and the lung imaging showed that the lesion area gradually expanded. After 15 months of follow-up, the patient declined further treatment due to a lack of presenting symptoms.

Lessons:

The diagnosis of ETT should be taken into consideration in patients with abnormal vaginal bleeding and low levels of β-hCG. Patients with metastatic disease should be treated with complete surgical resection and intensive combination chemotherapy to maximize the opportunity for cure. Targeted biological agents might be potential therapeutic strategies for chemotherapy-resistant or recurrent patients.
A study on the correlation of Doppler ultrasound in the diagnosis of cervical lymph nodes in patients with laryngeal and hypopharyngeal cancers: An observational study
Authors: Xiao Kailan , Xiao Yan , Liu Shuhua
Published: July 2024

The objective was to assess the diagnostic efficacy of Doppler ultrasound in detecting cervical lymph nodes in patients diagnosed with laryngeal and hypopharyngeal cancers. Patients undergoing surgery for laryngeal and hypopharyngeal cancers in the Otolaryngology Department from January 2021 to January 2023 were included. Two groups, with equal numbers, underwent ultrasound examination and intensive CT examination in the experimental and control groups, respectively, along with routine cervical lymph node dissection. A resident with over 6 years of clinical experience in the otolaryngology department performed routine bilateral cervical lymph node palpation. Sensitivity, specificity, and validity were compared among different examination methods. The McNemar test assessed specificity and sensitivity between palpation, color Doppler ultrasonography, and enhanced CT, while the Kappa concordance test evaluated the concordance between the 2 examination methods. Data were statistically analyzed using SPSS 23.0. Palpation showed a diagnostic sensitivity (DS) of 52.83% and specificity of 91.11% for all patients with cervical lymph node metastasis. Ultrasonography demonstrated a DS of 77.78% and specificity of 81.82% in patients with cervical lymph node metastasis, while intensive CT had a DS of 75.86% and specificity of 60.00%. Statistical significance (P < .05) was observed in the sensitivity between palpation and ultrasonography, and between palpation and enhanced CT. The specificity between enhanced CT and ultrasonography (P = .021) and between palpation and enhanced CT scan (P = .003) both showed statistical significance (P < .05). Doppler ultrasound yields diagnostic results highly consistent with pathological diagnoses in patients with laryngeal and hypopharyngeal cancers. Utilizing Doppler ultrasound can enhance the accuracy of diagnosing these cancers, aiding physicians in devising more suitable treatment plans for patients.
Quantitative measurements of dual-energy CT parameters in the diagnosis of osteoporosis – a highly sensitive and specific technique: An observational study
Authors: Chen Si , Guo Lin , Zhao Hui , Wan Xin , Zang Jiacheng
Published: July 2024

With the aging of the population in our society, osteoporosis (OP) has become one of the chronic diseases that seriously threaten the physical health of the elderly, leading to a heavy burden on healthcare. In recent years, with the continuous development of dual-energy CT (DECT) technology, quantitative measurements of DECT parameters, which is highly sensitive to OP, provides accurate results, is convenient and cost-effective, and is expected to be widely used in bone density testing. This study was aimed to explore the value of quantitative measurements of DECT parameters in diagnosing OP, in order to better guide clinical judgments and treatment. A total of 187 patients who underwent dual-energy X-ray and DECT examinations at Tianjin hospital between January 2022 and June 2023 were included as participants in this study. The bone mineral density (BMD) values of the lumbar spine (L1–L4) were determined using dual-energy X-ray absorptiometry. Simultaneously, CT scans of the lumbar spine (L1–L4) were conducted to measure the CT values of contrast media (CM), mixed-energy image CT values (regular CT value [rCT]), calcium concentration (CaD), as well as fat fraction (FF). Pearson correlation analysis was used to examine the relationship between the quantitative measurements of L1 to L4 vertebral bodies obtained from DECT and BMD. The values of CM, rCT, and CaD in the OP group were all lower than those in the non-OP group with statistical significance (P < .001). Conversely, the fat fraction parameter value in the OP group was significantly higher in contrast with the non-OP group (P = .004); there was a positive correlation between CM, rCT, CaD, and BMD values (R = 0.579, P < .001; R = 0.604, P < .001; R = 0.563, P < .001); CM, rCT, and CaD had high diagnostic value for OP, as evidenced by AUCs of 0.935 (95% CI: 0.900–0.971), 0.956 (95% CI: 0.925–0.987), and 0.926 (95% CI: 0.858–0.954), respectively, all with P values < .001. Quantitative measurement of DECT parameters showed a high sensitivity as well as a high specificity in the diagnosis of OP. It is also highly feasible and holds significant clinical diagnostic value, making it a suitable candidate for widespread application.
Comparison of dienogest or combinations with ethinylestradiol/estradiol valerate on the pain score of women with endometriosis: A prospective cohort study
Authors: Yurtkal Aslihan , Oncul Mahmut
Published: July 2024

Endometriosis is one of the most frequent gynecologic disorders. The pathognomonic symptom of endometriosis is pelvic pain. The recommended pain medications are oral hormonal contraceptives, progestin therapy, danazol, gonadotropin-releasing hormone analogs, nonsteroidal anti-inflammatory drugs, and aromatase inhibitors. In this study, we aimed to compare the efficiency of costing dienogest (DNG) and low-cost oral contraceptives regarding visual analog scores (VAS) score of pelvic pain and also cancer antigen-125 (CA-125), anti-Mullerian hormone (AMH) levels, and size of endometrioma in the patients with endometriosis which is a chronic disease that requires a lifelong management plan. In our study, 18 to 45-year-old patients presented to our institution’s gynecology and obstetrician department for various complaints over 2 years, and endometriosis diagnoses were included. Patients were divided into 3 groups (20 patients in each medication group) according to the given medication: cyclic DNG (Visanne) or 0.03 mg ethinylestradiol combined with 2 mg DNG (Dienille) or estradiol valerate combined with 2 mg DNG (Qlarista). We recorded all patients’ CA-125/AMH values and VAS scores of pelvic pain. All patients gave informed consent. There was no statistically significant difference between pre-medication and post-medication levels of CA-125, AMH, VAS score, and cyst size in all groups. However, statistically, significant decreases were seen in the cyst size and VAS score, indicating response to therapy in all groups. In conclusion, we think it is more reasonable to use cost-effective oral contraceptive medications, which also cause common side effects, instead of costing DNG since all drugs have the same efficiency and success.
The impact of electrical stimulation at the back-shu acupoint with an extrinsic diaphragmatic pacing mode on respiratory function and extubation success rate in tracheostomized stroke patients: An observational study
Authors: Zhang Qian , Wang Yingying , Liu Heng , Yang Huiwei
Published: July 2024

To observe of the effect of electrical stimulation at the back-shu acupoint with extrinsic diaphragmatic pacing (EDP) mode on respiratory function and extubation success rate in tracheostomized stroke patients. A total of 200 patients who underwent tracheostomy after a stroke from January 2022 to February 2023 were included in this study. They were divided into 2 groups based on whether electroacupuncture was used: the EDP + electroacupuncture group and the EDP group. We assessed the differences in cough reflex scores and clinical lung infection scores between the 2 groups, and measured levels of blood gas analysis indicators, diaphragmatic function, lung function, maximum inspiratory pressure, and maximum expiratory pressure in both groups. The total effective rate in the EDP + electroacupuncture group was 91.00% (91/100), which was higher than the EDP group’s 80.00% (80/100) (P < .05). After treatment, both groups showed a decrease in clinical lung infection scores and cough reflex scores compared to before treatment, with the EDP + electroacupuncture group having lower scores than the EDP group (P < .05). After treatment, the pH value, arterial oxygen pressure, and oxygenation index all increased compared to before treatment, with the EDP + electroacupuncture group showing higher values than the EDP group (P < .05). After treatment, both groups showed a decrease in arterial carbon dioxide pressure compared to before treatment, with the EDP + electroacupuncture group having lower PaCO2 levels than the EDP group (P < .05). After treatment, both groups showed an increase in forced vital capacity as a percentage of predicted value (FVC%), diaphragm thickness, diaphragm mobility, maximum inspiratory pressure, maximum expiratory pressure, forced expiratory volume in the first second as a percentage of predicted value (FEV1%), and diaphragm contraction speed compared to before treatment. Additionally, the EDP + electroacupuncture group had higher values in these parameters compared to the EDP group (P < .05). The EDP + electroacupuncture group had a shorter average extubation time and a higher extubation success rate compared to the EDP group (P < .05). The combination of EDP mode and electroacupuncture at the back-shu acupoint appears to be effective in improving lung function and diaphragmatic function in tracheostomized stroke patients. It also leads to a shorter extubation time and higher extubation success rates.
Mitochondrial biological function and risk of atrial fibrillation and atrial flutter: A 2-sample Mendelian randomization study
Authors: Zhang Tianyang , Chen Hailong , Shi Yanyu , Jin Ying , Zhang Yuan , An Shan , Chen Ying
Published: July 2024

Current research suggests that mitochondrial dysfunction can be a contributing factor in the development of cardiac arrhythmias. In pursuit of elucidating the causal link between the biological functions of mitochondria and the occurrence of atrial fibrillation/flutter, we conducted a 2-sample Mendelian randomization (MR) study. Mitochondrial proteins were selected for exposure in this study. To enhance the accuracy of our study, we selected data on AF/AFL from the FinnGen study and the UK Biobank for MR analysis, respectively. The inverse variance-weighted method was utilized as the primary analysis technique for MR. In addition, we performed a series of sensitivity analyses to detect heterogeneity and horizontal pleiotropy. MR results indicated a significant positive association between NAD-dependent protein deacylase sirtuin-5 and AF/AFL (odds ratio = 1.084, 95% confidence interval: 1.037–1.133, P = 3.679 × 10−4, Adjusted P = .024), with consistent outcomes observed in replication analysis (odds ratio = 1.002, 95% confidence interval: 1.001–1.003, P = 4.808 × 10−4, Adjusted P = .032). NAD-dependent protein deacylase sirtuin-5 can significantly promote the occurrence of AF/AFL, and its specific mechanisms warrant further investigation.
Efficacy and safety of BaitouWeng decoction for ulcerative colitis: A meta-analysis of randomized and controlled trials
Authors: Xie Qian , Yu Wenlong , He Yuancong , Deng Guocheng , Yang Hongyan , Chen Jiarou , Liang Jianlong , Zeng Xuxin , Guo Jialiang , Ma Rong
Published: July 2024

Background:

To systematically evaluate the therapeutic effect of BaitouWeng Decoction in patients with ulcerative colitis (UC), evaluate its safety and effectiveness, and provide a reference for clinical medication.

Methods:

The research literature on the treatment of UC with BaitouWeng Decoction was searched in databases such as China National Knowledge Infrastructure, Wanfang Data, VIP database for Chinese Technical Periodicals, Chinese BioMedical Literature Database, and PubMed. The literature was screened by setting inclusion and exclusion criteria, strictly following the inclusion and exclusion criteria, and following the search strategy for literature screening, data extraction, and methodological quality evaluation. According to the Cochrane System Evaluation Manual, methodological quality evaluation was conducted on the included studies using the bias risk assessment tool for randomized controlled trials. For meta-analysis, Review Manager software was used.

Results:

A total of 24 articles were included, including 2131 patients. Meta-analysis showed that compared with conventional Western medicine, BaitouWeng Decoction can significantly improve the effective rate (odds ratio = 5.10, 95% confidence interval [CI] [3.74–6.96], P < .00001), reduce the traditional Chinese medicine syndrome score (mean difference [MD] = −4.23, 95% CI [−5.17–−3.30], P < .00001), Baron endoscopic score (MD = −0.68, 95% CI [−0.78–−0.58], P < .00001), and intestinal lesion activity score (MD = −2.29, 95% CI [−1.15–−1.03], P < .00001); improve serum factors and reduce serum tumor necrosis factor α levels (MD = −16.84, 95% CI [−19.92–−13.76], P < .00001), serum interleukin-8 levels (MD = −10.41, 95% CI [−10.87–−9.95], P < .00001), and increased serum interleukin-10 levels (MD = 4.96, 95% CI [2.76–7.16], P < .00001).

Conclusion:

BaitouWeng Decoction has good efficacy and safety in treating UC. BaitouWeng Decoction improved the symptoms of colitis injury and inhibited inflammatory response. However, more rigorously designed randomized controlled trials with blinding, concealment, and placebo controls should be conducted on Baitouweng decoction to generate higher quality evidence and longer-term studies on sustained benefits are needed.
Smoking cessation rate and predictors of successful quitting in Jordan: A cross-sectional study
Authors: Qasem Nuha W. , Al-Omoush Batool H. , Altbeinat Sami K. , Al-Dlaijem Moutasem M. , Salahat Reham I. , Okour Samer A.
Published: July 2024

Tobacco smoking in Jordan is the highest in the Middle East, with health consequences and economic burdens. Smoking cessation improves health and grows the economy. This study aimed to determine the prevalence of smoking cessation in Jordan and to identify the determinants of effective quitting. This cross-sectional study was conducted using an online survey directed towards the general population of Jordan. The questionnaire was formulated in Arabic and inquired about sociodemographic factors, health status, behaviors, smoking habits, previous quitting attempts, utilization of smoking cessation services, attitudes towards quitting, and barriers to quitting. Data were analyzed using Statistical Package for Social Science version 25. A total of 463 participants were included in this study. Twenty-one percent of them were ex-smokers (n = 97), 86% were male, 63.3% were from the middle governorates, and 29.2% were 24 years old or younger. The rate of sustained quitting for at least 3 months among participants was 13.6%. The factors associated with successful quitting included age > 50 years (P = .001), practicing regular physical activity (P = .003), using more than 1 tobacco product (P = .000), smoking waterpipes or e-cigarettes (P = .000 and .015, respectively), lower levels of nicotine dependence (P = .009), duration of smoking (P = .000), higher number of smoking cessation attempts (P = .000), having 1 or more chronic diseases (P = .049), and having DM (P = .003). More than half of the ex-smokers needed 2 to 5 attempts before successfully quitting smoking. There was a low rate of utilization of smoking cessation services and medications in both groups. On the other hand, there is a high rate of use of other smoking methods, particularly waterpipes and e-cigarettes, as an aid for quitting. Current smokers reported being in a stressful situation as a barrier to quitting significantly more often than did ex-smokers (P = .013). Both groups had moderately positive attitudes toward quitting. Ex-smokers had significantly better attitudes toward their ability to manage stress, weight gain, and increased appetite after quitting (P = .004, .004, and .007, respectively). This study provides valuable insights into the complex dynamics of smoking behavior, cessation attempts, and attitudes. These findings can inform the development of targeted smoking cessation programmes and policies.
Effects of virtual reality-based robot therapy combined with task-oriented therapy on upper limb function and cerebral cortex activation in patients with stroke
Authors: Choi Jong-Bae , Cho Kyung-In
Published: July 2024

Background:

This study aimed to investigate the effects of virtual reality (VR)-based robot therapy combined with task-oriented therapy on cerebral cortex activation and upper limb function in patients with stroke.

Methods:

This study included 46 patients with hemiplegia within 1 year of stroke onset. Patients were divided into an experimental group (n = 23) and a control group (n = 23) using a computer randomization program. The experimental group received VR-based robot and task-oriented therapies, whereas the control group received only task-oriented therapy. All participants received interventions for 40 minutes per session, 5 times a week, for 8 weeks. For the pre- and post-evaluation of all participants, the Fugl–Meyer Assessment for the upper extremity, manual function test, motor activity log, and Jebsen–Taylor Hand Function Test were used to evaluate changes in upper limb function and motor-evoked potential amplitudes were measured to compare cerebral cortex activation.

Results:

In comparison to the control group, experimental group demonstrated an improvement in the function of the upper limb (P < .01) and activation of the cerebral cortex (P < .01).

Conclusion:

The combined intervention of VR-based robot and task-oriented therapies is valuable for improving upper limb function and cerebral cortex activation in patients with stroke.
Risk factors for vertebral fracture in rheumatoid arthritis patients using biological disease-modifying anti-rheumatic drugs (cases over 5 years): An observational study
Authors: Tokumoto Hiroto , Tominaga Hiroyuki , Maeda Shingo , Sasaki Hiromi , Kawamura Ichiro , Setoguchi Takao , Taniguchi Noboru
Published: July 2024

While biological disease-modifying anti-rheumatic drugs (bDMARDs) are considered beneficial for preventing osteoporosis and bone fracture, it is unclear whether bone loss is involved in the development of vertebral fracture, and few reports have examined the factors related to vertebral fracture in rheumatoid arthritis (RA) patients using bDMARDs. This study aims to identify factors influencing vertebral fracture in RA patients treated with bDMARDs. We retrospectively examined the records of 129 RA patients treated with bDMARDs for over 5 years. The lumbar spine and femoral bone mineral density, Disease Activity Score-28-C-Reactive Protein (DAS28-CRP) value, Simplified Disease Activity Index (SDAI), and modified Health Assessment Questionnaire (mHAQ) score were evaluated. The frequency of new vertebral fracture during the study and their risk factors were investigated. A comparison between the fracture group and the nonfracture group was performed. Multivariate analysis was performed using logistic regression analysis to detect risk factors for new vertebral fracture. The number of patients with new vertebral fracture during follow-up was 15 (11.6%) of the 129 patients in the study. Age and mHAQ score were significantly higher and lumbar spine and femoral neck bone mineral density were significantly lower in the fracture group than the nonfracture group. The risk factors for new vertebral fracture during the disease course were older age and higher mHAQ score indicating no remission over the 5 years of follow-up. In this study, there was no significant difference in disease indices such as the DAS28-CRP value and the SDAI between the fracture and nonfracture groups, suggesting an effective control of RA with bDMARDs. However, age and the mHAQ score, an index of RA dysfunction, were significantly higher in the fracture group. These results suggest that improving functional impairment may be important to prevent vertebral fracture in patients using bDMARDs.
A Mendelian randomization study: Years of education and nonalcoholic fatty liver disease
Authors: Chen Jun , Li Jing , Qu Hongyan , Ning Ting , Xie Haoyuan , Lu Gang
Published: July 2024

Though years of education have been connected to nonalcoholic fatty liver disease (NAFLD), the exact mechanism underlying this linkage is still unknown. To investigate the causal association between years of education and NAFLD, we will use a 2-sample Mendelian randomization (MR) technique. : Genome-wide association studies data on years of education (n = 766,345) and genome-wide association studies data on nonaffiliated mental illness (n = 778,614) were screened for genetic variations as instrumental variables in the Mr-Base database. MR–Egger regression, weighted median, and inverse variance weighted were used in the MR analysis. Years of education (odds ratio = 0.63; 95% confidence interval: 0.47–0.79; P = 1.28 × 10−8) might be protective against the development of NAFLD. Among the sensitivity analyses were the following: the MR–Egger intercept test revealed P > .05, suggesting that there was no horizontal pleiotropy in the MR analysis and that the inverse variance weighted results were trustworthy; the Cochran Q test revealed P > .05, suggesting that there was no heterogeneity between the 2 samples; Funnel plot results demonstrated that there was no bias in the link between the measure of variability and the impact size. Leave-1-out analysis results demonstrated that no 1 single nucleotide polymorphism had a significant effect on the study’s results, showing that the MR results were stable. This study has investigated the connection between years of education and NAFLD, offering novel suggestions for NAFLD treatment and prevention.
Global contribution of statistical control charts to epidemiology monitoring: A 23-year analysis with optimized EWMA real-life application on COVID-19
Authors: Waqas Muhammad , Xu Song Hua , Usman Aslam Muhammad , Hussain Sajid , Shahzad Khurram , Masengo Gilbert
Published: July 2024

Control charts help epidemiologists and healthcare professionals monitor disease incidence and prevalence in real time, preventing outbreaks and health emergencies. However, there remains a notable gap in the comprehensive exploration and application of these techniques, particularly in the context of monitoring and managing disease outbreaks. This study analyses and categorizes worldwide control chart applications from 2000 to 2023 in outbreak monitoring in over 20 countries, focusing on corona-virus (COVID-19), and chooses optimal control charts for monitoring US COVID-19 death waves from February 2020 to December 2023. The systematic literature review analyzes available 35 articles, categorizing data by year, variable, country, study type, and chart design. A selected optimal chart is applied to monitor COVID-19 death patterns and waves in the USA. Control chart adoption in epidemiology monitoring increased during the COVID-19 pandemic, with annual patterns showing a rise in 2021 to 2023 (18%, 36%, 41%). Important variables from 2000 to 2019 include influenza counts, Salmonella cases, and infection rates, while COVID-19 studies focus more on cases, infection rates, symptoms, and deaths. Among 22 countries, the USA (29%) is the top applier of control charts. The monitoring of USA COVID-19 deaths reveals 8 waves with varying severity

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associated with the JN.1 variant, highlights ongoing challenges. This study emphasizes the significance of control charts in outbreak monitoring for early disease diagnosis and intervention. Control charts help healthcare workers manage epidemics using data-driven methods, improving public health. COVID-19 mortality analysis emphasizes their importance, encouraging worldwide use.
Assessing the efficacy of a graded pulmonary rehabilitation protocol in mechanically ventilated patients following brainstem hemorrhage
Authors: Yang Weijuan , Xu Bin , Zhao Lin , Guo Anna , Zhang Min , Lin Zheng
Published: July 2024

Background:

The objective of this study is to assess the impact of an early-graded pulmonary rehabilitation training program on patients undergoing mechanical ventilation due to brainstem hemorrhage.

Methods:

Eighty patients receiving mechanical ventilation due to brainstem hemorrhage at our hospital’s neurosurgery department between August 2022 and October 2023 were enrolled as participants. A sampling table was generated based on the order of admission, and 80 random sequences were generated using SPSS software. These sequences were then sorted in ascending order, with the first half designated as the control group and the second half as the intervention group, each comprising 40 cases. The control group received standard nursing care for mechanical ventilation in brainstem hemorrhage cases, while the intervention group underwent early-graded pulmonary rehabilitation training in addition to standard care. This intervention was conducted in collaboration with a multidisciplinary respiratory critical care rehabilitation team. The study compared respiratory function indices, ventilator weaning success rates, ventilator-associated pneumonia incidence, mechanical ventilation duration, and patient discharge duration between the 2 groups.

Results:

The comparison between patients in the observation group and the control group regarding peak expiratory flow and maximum inspiratory pressure on days 1, 3, 5, and 7 revealed statistically significant differences (P < .05). Additionally, there was a statistically significant interaction between the main effect of intervention and the main effect of time (P < .05). The success rate of ventilator withdrawal was notably higher in the observation group (62.5%) compared to the control group (32.5%), with a statistically significant difference (P < .05). Moreover, the incidence rate of ventilator-associated pneumonia was significantly lower in the observation group (2.5%) compared to the control group (17.5%) (P < .05). Furthermore, both the duration of mechanical ventilation and hospitalization were significantly shorter in the observation group compared to the control group (P < .05).

Conclusion:

Early-graded pulmonary rehabilitation training demonstrates effectiveness in enhancing respiratory function, augmenting the ventilator withdrawal success rate, and reducing both the duration of mechanical ventilation and hospitalization in mechanically ventilated patients with brainstem hemorrhage. These findings suggest the potential value of promoting the application of this intervention in clinical practice.
Attenuated adenomatous polyposis with MSH6 variation: Two case reports
Authors: Ha Gi Won , Lee Min Ro , Ahn Ae Ri , Chung Myoung Ja , Kim Kyoung Min
Published: July 2024

Rationale:

Adenomatous polyposis (AP) is a genetic disorder characterized by the occurrence of numerous adenomatous polyps in the colon and rectum and can be classified into classical AP and attenuated AP (AAP). AAP is diagnosed when the number of observed adenomas is between 10 and 99. The detection of AAP is significantly increasing mainly due to the improvement of the imaging technique and application of the screening program for colorectal cancer detection. Currently, the germline variations of the APC and MUTYH genes are reported as the main cause of classical AP. However, the underlying genetic basis of AAP is not well understood. In this study, we report 2 cases of AAP with MSH6 variations.

Patient concerns:

Both patients visited the hospital after multiple polyps were detected during colonoscopies conducted as part of their health checkups.

Diagnoses:

The 2 patients were diagnosed with AAP through colonoscopic examination at our hospital.

Interventions:

The 2 received genetic consultation; and, for follow-up purposes, both patients agreed to be tested for an underlying genetic condition through next generation sequencing. And germline MSH6 variations were detected in both AAP patients.

Outcomes:

There was no recurrence for both patients for 3 years follow-up.

Lessons:

Minor portion of AAP can cause by genetic mutation in MSH6, and further research is needed.
Effects of perioperative application of esketamine on postpartum depression in cesarean section: A systematic review and meta-analysis
Authors: Ma Baoyu , Tao Xinyi , Qi Yanyu , Cao Hong , Cao Qianqian , Zhou Zhixia , Wang Shoushi
Published: July 2024

Background:

To evaluate the effect of perioperative esketamine administration on postpartum depression in pregnant women undergoing cesarean section.

Methods:

Data sources was PubMed, Embase, Web of Science, and Cochrane Library from inception to February 1, 2024. Randomized controlled trials in pregnant women undergoing cesarean section were selected and compared to the use of esketamine in the perioperative period. The primary outcome measure was the incidence of postpartum maternal depression. Preferred reporting items for systematic reviews and meta-analyses were used. Data pooled by random-effects models are presented as risk ratios (RR) (95% confidence intervals, 95% CI) or mean differences (95% CI). This review was registered in PROSPERO (ID: CRD42023431197).

Results:

We included 8 studies with a total of 1655 participants. The quality of the studies was rated high or unclear. Seven studies involving 1485 participants reported the incidence of postpartum depression. Compared with pregnant women undergoing cesarean section without the use of esketamine, those using esketamine in the perioperative period showed a 48% decreased risk of developing postpartum depression (RR: 0.52, 95% CI: 0.35–0.79) and a 1.43-point reduction in EPDS (Edinburgh Postnatal Depression Scale) (mean difference: −1.43, 95% CI: −2.32 to −0.54). For immediate intraoperative adverse reactions, the application of esketamine caused maternal nausea and vomiting (RR: 2.16, 95% CI: 1.22–3.81), dizziness (RR: 6.11, 95% CI: 1.49–24.98), and hallucinations (RR: 6.83, 95% CI: 1.57–29.68) compared to no esketamine use.

Conclusions:

Perioperative use of esketamine in pregnant women undergoing cesarean section may reduce postpartum depression and increase intraoperative adverse reactions, but has no significant effect on postoperative adverse reactions.
Eye and adnexa hospitalization in Australia: An ecological study
Authors: Hassanin Fadi Fouad , Naser Abdallah Y. , Aalam Waseem A. , Hanbazazh Mehenaz
Published: July 2024

To investigate the trends of hospital admissions concerning diseases of the eye and adnexa in Australia in the past 2 decades. This is a descriptive ecological study on the population level that examined hospitalization data for the duration between 1998 and 2021 in Australia. Hospitalization data were extracted from the National Hospital Morbidity Database. The chi-squared test was utilized to assess the difference in admission rates between the years 1998 and 2021. Hospital admission rate for diseases of the eye and adnexa increased by 1.20-fold (from 852.32 [95% confidence interval [CI] 848.16–856.47] in 1998 to 1873.72 [95% CI 1868.48–1878.96] in 2021 per 100,000 persons, P < .01). The most common cause of hospitalization for diseases of the eye and adnexa was disorders of the lens (65.7%), followed by disorders of the choroid and retina (15.6%), followed by disorders of the eyelid, lacrimal system, and orbit (7.7%). Hospital admission rate among males increased by 1.25-fold (from 737.67 [95% CI 732.18–743.16] in 1998 to 1657.19 [95% CI 1650.19–1664.20] in 2021 per 100,000 persons). Hospital admission rate among females increased less sharply by 1.03-fold (from 965.37 [95% CI 959.14–971.59] in 1998 to 1964.35 [95% CI 1956.80–1971.90] in 2021 per 100,000 persons). There are clear gender and age roles in the epidemiology of hospital admissions related to eye and adnexa disorders. Lens disorders were the most common cause of hospital admission. The admission rate increase during the past decades could be due to increases in life expectancy, lifestyle changes, and improvements in screening protocols.
Ideal strategy for nonvariceal upper gastrointestinal bleeding
Authors: Kavitt Robert T. , Gralnek Ian M.
Published: July 2024

Purpose of review

Over 300 000 hospital admissions in the United States each year are due to patients with upper gastrointestinal (GI) bleeding (UGIB). Common etiologies of nonvariceal UGIB include peptic ulcers, mucosal erosions of the esophagus, stomach or duodenum, Mallory-Weiss tears, Dieulafoy lesions, upper GI tract malignancy, or other etiology.

Recent findings

Peptic ulcers classified as Forrest Ia, Ib, or IIa require endoscopic hemostasis, while IIb ulcers may be considered for endoscopic clot removal with endoscopic treatment of any underlying major stigmata. Endoscopic hemostasis for ulcers classified as Forrest IIc or III is not advised due to the low risk of recurrent bleeding. Endoscopic hemostasis in ulcer bleeding can be achieved using injection, thermal, and/or mechanical modalities.

This review focuses on the currently recommended endoscopic therapies of patients presenting with acute nonvariceal upper gastrointestinal hemorrhage.
Immune markers of severe acute pancreatitis
Authors: Lee Peter J. , Papachristou Georgios I. , Speake Cate , Lacy-Hulbert Adam
Published: July 2024

Purpose of review

Acute pancreatitis is a common acute inflammatory disorder of the pancreas, and its incidence has been increasing worldwide. Approximately 10% of acute pancreatitis progresses to severe acute pancreatitis (SAP), which carries significant morbidity and mortality. Disordered immune response to pancreatic injury is regarded as a key event that mediates systemic injury in SAP. In this article, we review recent developments in immune biomarkers of SAP and future directions for research.

Recent findings

Given the importance of the NLRP3-inflammasome pathway in mediating systemic inflammatory response syndrome and systemic injury, recent studies have investigated associations of SAP with systemic levels of activators of NLRP3, such as the damage associated molecular patterns (DAMPs) for the first time in human SAP. For example, circulating levels of histones, mitochondrial DNAs, and cell free DNAs have been associated with SAP. A panel of mechanistically relevant immune markers (e.g., panel of Angiopoeitin-2, hepatocyte growth factor, interleukin-8 (IL-8), resistin and sTNF-α R1) carried higher predictive accuracies than existing clinical scores and individual immune markers. Of the cytokines with established relevance to SAP pathogenesis, phase 2 trials of immunotherapies, including tumor necrosis factor (TNF)-alpha inhibition and stimulation of IL-10 production, are underway to determine if altering the immunologic response can reduce the severity of acute pancreatitis (AP).

Circulating systemic levels of various DAMPs and a panel of immune markers that possibly reflect activities of different pathways that drive SAP appear promising as predictive biomarkers for SAP. But larger multicenter studies are needed for external validation. Studies investigating immune cellular pathways driving SAP using immunophenotyping techniques are scarce. Interdisciplinary efforts are also needed to bring some of the promising biomarkers to the bedside for validation and testing for clinical utility. Studies investigating the role of and characterization of altered gut-lymph and gut-microbiota in severe AP are needed.
Has the Coronavirus Disease 2019 Pandemic Played a Role in the Early Detection of Pulmonary Embolism in Children?
Authors: Eryilmaz Polat Sanem , Akyan Soydaş Şule Selin , Ocak Ece , Gençoğlu Murat Yasin , Uytun Salih , Özkan Tabakci Sati , Kürtül Meltem , Bilgiç Işil , Kaşikçi Merve , Ademhan Tural Dilber , Tuğcu Gökçen Dilşa , Cinel Güzin
Published: July 2024

Objective:

Pulmonary embolism (PE) poses a significant threat to children, and nonspecific symptoms lead to delayed diagnosis. The emergence of coronavirus disease 2019 (COVID-19) has increased the complexity as it is associated with similar symptoms and increased risk of thrombotic complications. This study aimed to assess the risk factors, clinical presentations, and diagnostic features of PE in pediatric patients and to examine the impact of the COVID-19 pandemic on children with PE.

Materials and Methods:

We conducted a retrospective descriptive study examining the clinical and diagnostic data of 44 pediatric patients with radiologically confirmed PE. The study compared and analyzed patients diagnosed before and during the COVID-19 pandemic.

Results:

In the study, 21 of 44 pediatric patients were diagnosed in the 4 years before the COVID-19 pandemic, and 23 were diagnosed with PE during the COVID-19 pandemic. The mean time to diagnosis was 8 (2 to 14) days before the pandemic and 1 (1 to 2) days during the pandemic (P < 0.001). The most common associated condition in both groups was infection (65.9%). Dyspnea (65.9%) and tachypnea (50.0%) were common symptoms. Except for deep vein thrombosis, there were no significant differences according to associated conditions between the groups (P = 0.001). Pulmonary emboli were anatomically detected using computed tomography angiography, showing bilateral involvement in 45.4% of patients, segmental artery involvement in 38.6%, and main artery involvement in 15.9%.

Conclusion:

The COVID-19 pandemic heightened suspicion of pediatric PE and accelerated diagnosis. Standardized diagnostic guidelines are increasingly necessary to balance accurate diagnosis with avoiding excessive imaging.
The cutoff values of functional independence measure scores for predicting discharge destination in the early stroke phase
Authors: Toi Kennosuke , Ishiyama Daisuke , Aoyagi Yoichiro , Suzuki Kentaro , Takayama Toshiyuki , Yazu Hitomi , Yoshida Madoka , Kimura Kazumi
Published: July 2024

This study aimed to determine cutoff values of functional independence measure (FIM) scores to predict the discharge destinations of patients with acute stroke. The sample included 318 patients with acute stroke (mean age, 72.0 years; women, 39%). The discharge destination was categorized into three groups: home, postacute rehabilitation (hospital with convalescent rehabilitation wards), and postacute care (institution without convalescent rehabilitation wards). We assessed FIM after lifting bed restriction. Multinomial logistic regression analyses were used to estimate odds ratios (OR) and 95% confidence intervals (CI) of the FIM scores for predicting discharge destinations, with postacute rehabilitation as a reference. Cutoff values of motor and cognitive FIM scores for distinguishing home from postacute rehabilitation and postacute care from postacute rehabilitation were determined using receiver operating characteristic curves. The proportion of home, postacute rehabilitation, and postacute care were 34.6%, 41.8%, and 23.6%, respectively. After adjustments for clinical variables, the ORs (95% CIs) for motor and cognitive FIM scores for home versus postacute rehabilitation were 1.08 (1.04–1.11) and 1.05 (0.98–1.12). Furthermore, those for postacute care versus postacute rehabilitation were 1.01 (0.98–1.04) and 0.92 (0.87–0.98). The cutoff values of the motor and cognitive FIM scores for distinguishing home from postacute rehabilitation were 37.5 (sensitivity: 0.92; specificity: 0.64) and 23.5 (sensitivity: 0.78; specificity: 0.67). Furthermore, those for distinguishing postacute care from postacute rehabilitation were 15.5 (sensitivity, 0.81; specificity, 0.51) and 12.5 (sensitivity, 0.74; specificity, 0.64). The identified cutoff values may serve as early indicators for predicting discharge destinations from acute stroke care.