bluuebunny/crossref_metadata_2025 huggingface dataset:
Normative Bone Mineral Density Measured on CT scan in Children and Adolescents
Authors: Nagata Kosei , Dimar John R. , Schmidt Grant O , Brown Morgan , Daniels Christy , Glassman Steven D. , Carreon Leah Y.
Published: March 2023

Study Design.

Retrospective chart review

Objective.

To provide reference values for HU measured on CT scan of children and adolescents.

Summary of Background Data.

Spine surgeons increasingly use Hounsfield Units (HU) on spine CT as a measure of bone mineral density (BMD). This has not been described in children and adolescents.

Methods.

Pediatric patients who had a spine CT between 2012 and 2022 were identified. Patients who had more than one comorbidity or were syndromic were excluded. Using the bone window, three axial images (cephalad, middle and caudal) of each vertebra were selected. In each axial view, the HU was measured using a Region of Interest (ROI) that included the total cancellous bone area and an ROI excluding the radiolucency present in the posterior vertebral body (Total vs. Limited). HU values were compared between Total and Limited areas, and between the axial images at the cephalad, middle, and caudal levels. Each age category data was estimated and stratified.

Results.

A total of 144 patients (79 female, 65 male) from 2 to 17 years old were included. Mean Limited HU was consistently lower than Total HU across all images and lumbar levels except for L1. Limited HU taken mid-vertebral body was also consistently lower than those taken cephalad or caudad. Mean Limited HU across all ages including all levels was 227±50 (range: 109 to 357). Stratifying by age showed a gradual decrease in BMD from age 2 to 10 followed by an increase.

Conclusions.

This is the first study to measure HU on lumbar CTs in children and adolescents. The technique of measuring BMD in adults should be modified in children by using an ROI that excludes the rarefaction present in the posterior vertebral body. Further studies are needed to evaluate the age dependent changes in BMD seen in this study.
Linking Patterns of Intraoperative Neuromonitoring (IONM) Alerts to the Odds of a New Postoperative Neurological Deficit
Authors: Wilent W. Bryan , Tesdahl Eric A. , Epplin-Zapf Thomas , Cohen Jeffrey , Rhee John , Klineberg Eric O. , Harrop James S. , Vaccaro Alexander R. , Sestokas Anthony K.
Published: March 2023

Study Design/Setting:

Retrospective review of a national multi-institutional database of 27,808 extradural cervical spine procedures performed between January 2017 and May 2021.

Objective:

Characterize intraoperative neuromonitoring alerts by the patterns of modalities and nerves/muscles involved and quantify risk of new-onset neurological deficit for patients with a primary diagnosis of myelopathy, stenosis, or radiculopathy.

Summary of Background Data:

Phenotyping alert patterns and linking those patterns with risk is needed to facilitate clinical decision-making.

Methods:

Cases with alerts were categorized by patterns of modalities or nerves/muscles involved, and alert status at closure. Unadjusted odds ratios (ORs) for new-onset neurological deficit were calculated. A mixed-effects logistic regression model controlling for demographic and operative factors, with random intercepts to account for clustering in outcomes by surgeon and surgical neurophysiologist was also used to calculate ORs and probabilities of neurological deficit.

Results:

There was significantly increased risk of a new neurological deficit for procedures involving posterior compared with anterior approaches (OR: 1.82, P=0.001) and procedures involving three levels compared with one (OR: 2.17, P=0.001). Odds of a deficit were lower for patients with radiculopathy compared with myelopathy (OR: 0.69, P=0.058). Compared with cases with no alerts, those with unresolved Spinal Cord alerts were associated with the greatest elevation in risk (OR: 289.05) followed by unresolved C5–6 Nerve Root (OR: 172.7), C5–T1 Nerve Root/Arm (OR: 162.89), C7 Nerve Root (OR:84.2), and C8–T1 Nerve Root alerts (OR:75.49, all P<0.001). Significant reductions in risk were seen for resolved Spinal Cord, C5–6 Nerve Root, and C8–T1 nerve alerts. Overall, unresolved motor evoked potential and somatosensory evoked potential alerts were associated with the greatest elevation in risk (OR:340.92) followed by unresolved motor evoked potential-only (OR:140.6) and unresolved somatosensory evoked potential-Only alerts (OR:78.3, all P<0.001). These relationships were similar across diagnostic cohorts.

Conclusions:

Risk elevation and risk mitigation after an intraoperative neuromonitoring alert during surgery is dependent on the type and pattern of alert.
Pasteurella multocida Bacteremia in a Large Community Teaching Hospital, 2011–2020: A Quality Improvement Project—Lessons Learned Regarding Immunizations
Authors: Myer Ashley B. , Myers Joseph P.
Published: March 2023

Introduction

Pasteurella multocida is a small, pleomorphic, nonflagellated, gram-negative coccobacillus found as a commensal of the upper respiratory tract of mammals and birds. Human infections are linked primarily to dog and cat bites, scratches, and licks. As part of an institutional review board–approved quality improvement project, we reviewed 10 years of experience (2011–2020) with P. multocida bacteremia (PMB) at our institution.

Materials and Methods

We identified all episodes of PMB at our institution from January 1, 2011, to December 31, 2020, from computerized blood culture records. We recorded information regarding epidemiology, source of bacteremia, comorbid medical conditions, laboratory data, radiographic data, antimicrobial treatment, and patient outcomes as well as information regarding providers' inquiries about animal contact, animal rabies vaccine status, and patient tetanus immunization status.

Results

During the 10-year study period, we identified 21 patients with 20 episodes of PMB. One patient experienced 2 episodes of PMB 1 year apart. The mean/median ages of patients with PMB were 71/68 years, respectively. Of the 21 PMB episodes, 17 (81%) occurred in women. Notably, 8 of 21 episodes (38%) occurred in patients with underlying liver dysfunction: 5 with severe alcohol use disorder (AUD), 1 with chronic hepatitis C virus infection, and 2 with nonalcoholic cirrhosis. Three of 21 patients (14%) died because of complications of PMB despite appropriate antimicrobial therapy. All 3 fatal cases were women who met criteria for severe AUD. In 14 of 21 episodes (65%), the patient was asked about pet exposure: 12 of 14 exposures (86%) involved a cat. Rabies vaccination status of the pet was documented in 3 of 21 episodes (14%). Tetanus vaccination status of the patient was explored in 7 of 21 PMB episodes (33%).

Conclusions

There were 21 episodes of PMB in 20 patients during the 10-year study period. Pasteurella multocida bacteremia was associated with female sex (81%), multiple comorbid conditions, and, notably, with liver dysfunction resulting from severe AUD, hepatitis C virus infection, or cirrhosis from other causes. Mortality was 3/21 (14%) and all 3 patients who died had underlying liver disease. Opportunities for improvement in patients with PMB were identified including routine inquiries about patient's animal exposure, rabies vaccination status of involved animal, and tetanus verification/administration of patients with PMB. In addition, women with cirrhosis/AUD are at high risk for severe, fatal PMB when it occurs.
Structural Integrity of Absorbable Gelatin Sponges for Middle Ear Packing in Otologic Surgery
Authors: Li Hao , Roy Catherine F. , Cerruti Marta , Yeung Jeffrey C.
Published: March 2023

Objective

This study investigates the physical properties upon immersion of two gelatin sponges commonly used in otologic surgery.

Background

Absorbable gelatin sponges are often used in middle ear surgery to achieve hemostasis and, perhaps more importantly, to provide a “scaffolding” to support ossicular chain and/or tympanic membrane reconstructions. Their rate of dissolution may therefore affect the success of tympanic membrane closure.

Methods

An in vitro study was conducted to quantify the material changes of two absorbable gelatin sponges, a standard-density sponge and one with fewer collagen cross-linkages (low-density sponge). Volume loss (%) in 0.9% saline, 0.3% ciprofloxacin, and/or 0.1% dexamethasone as single-agent otic drops in a combination formulation was measured at 15-minute intervals for the first hour and at days 1, 3, and 5 postimmersion. Secondary end points included compressibility, porosity under microscopy, and infrared spectroscopy analysis.

Results

The low-density sponge immersed in any of the three otic solutions showed a statistically significant greater volume loss at all time points when compared with the standard-density sponge (27.2% ± 5.4% vs. 15.4% ± 6.0% at 15 minutes and 44.8% ± 5.1% vs. 34.6% ± 2.9% at 5 days, p < 0.001). Interestingly, both sponges immersed in normal saline had lost almost half of their original volume after 15 minutes when compared with samples immersed in an otic solution (48.3% ± 4.6% vs. 21.3% ± 8.3%, respectively, p < 0.001).

Conclusion

The standard-density sponge immersed in an otic solution of ciprofloxacin, dexamethasone, or a combination formulation best maintained its structural integrity. Ancillary in vivo studies are required to assess the hemostatic properties, surgical outcomes, and middle ear synechiae of the above study conditions.

Level of evidence

Foundational evidence.
VA-ECMO Cardiac Support During Liver Transplant: A Case Report
Authors: Siniscalchi Antonio , Laici Cristiana , Facciotto Lucia , Vitale Giovanni , Fallani Guido , Ravaioli Matteo , Bianchini Amedeo
Published: March 2023

Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for cardiovascular collapse during and after liver transplantation (LT). According to the most recent guidelines, patients with severe cardiomyopathy are excluded from LT because of high-mortality risk during surgery. Intraoperative ECMO support could give these patients the opportunity to undergo LT by reducing the risk of heart failure and reperfusion syndrome. In this case report, we present a case of veno-arterial ECMO (VA-ECMO) support started before LT surgery in a patient with severe pulmonary hypertension, mitral valve steno-insufficiency, and right heart dysfunction. The presence of severe heart disease would have contraindicated LT, but simultaneous liver cirrhosis contraindicated mitral valve surgery, leaving the patient locked in a “Catch-22” state. The best solution was to perform LT with VA-ECMO support before, during, and after the surgery to reduce cardiac load and possible heart failure. LT was performed with good hemodynamic stability and the patient was successfully weaned from ECMO a few hours after surgery. At the 6 month follow-up, normal liver and kidney functions were recorded as well as an overall improvement of heart function; the patient successfully underwent mitral valve replacement and tricuspid annuloplasty 10 months after transplant and is now in good condition.
The economic impact of asthma on private healthcare system in Brazil: Economic impact of asthma in Brazil
Authors: Nascimento Oliver A. , Cançado José Eduardo Delfini , Gazzotti Mariana Rodrigues , dos Santos Felipe Moraes , Saturnino Luciana Tarbes Mattana , da Silva Danielle Oliveira , Gomes Ana Luisa Bessa Bacellar , Viana Karynna Pimentel , Alfonso-Cristancho Rafael , Rodrigues Claudia Soares
Published: March 2023

To assess healthcare resource utilization and costs of patients with asthma in Brazilian Supplementary Healthcare System, focusing on hospitalization data. Retrospective cohort study, using data from an administrative database of a private company (Orizon). Patients aged ≥ 12 years with at least one record of emergency visit/hospitalization in the database with the ICD-10 J45 between January/2010 and June/2015 were included and followed until June/2016, death or inactivation of health plan. Sociodemographic characteristics, emergency visit and hospital admission per patient per year (exacerbation rate), physician visit with a procedure, exams, length of hospitalization (with/without intensive care unit (ICU)), and in-hospital treatments were assessed. A total of 54,568 patients were included in this analysis. Regarding resource utilization, emergency visit and hospital admission rates of 0.34 and 0.04 per person-year were observed, respectively. Mean length of hospital stay were 8.82 (SD = 36.48), 5.24 (SD = 19.06) and 19.53 (63.89) days for hospitalizations in general, without and with ICU, respectively. An exacerbation rate of 0.36 per person year was observed with a mean cost per episode of 3178 Brazilian Real (BRL) (SD = 31,667). Mean cost related to emergency department visits was estimated at 293 BRL (SD = 328). Hospitalization costs were stratified by the need of ICU and values observed were of 9307 BRL (SD = 18,979) without ICU, and 75,252 BRL (SD = 174,248) with ICU need. Asthma exacerbations may cost ~75,000 BRL for an ICU-dependent event in the Supplementary Healthcare System. To improve disease control may reduce disease burden for both healthcare system and patients.
Smartwatch gait coordination index: New measure for human gait utilizing smartwatch sensor
Authors: Han Sumin , Paul Rob
Published: March 2023

Human walking reflects the state of human health. Numerous medical studies have been conducted to analyze walking patterns and to diagnose disease progression. However, this process requires expensive equipment and considerable time and manpower. Smartwatches are equipped with gyro sensors to detect human movements and graph-walking patterns. To measure the abnormality in walking using this graph, we developed a smartwatch gait coordination index (SGCI) and examined its usefulness. The phase coordination index was applied to analyze arm movements. Based on previous studies, the phase coordination index formula was applied to graphs obtained from arm movements, showing that arm and leg movements during walking are correlated with each other. To prove this, a smartwatch was worn on the arms and legs of 8 healthy adults and the difference in arm movements was measured. The SGCI values with abnormal walking patterns were compared with the SGCI values obtained during normal walking. In the first experiment, the measured leg SGCI in normal walking averaged 9.002 ± 3.872 and the arm SGCI averaged 9.847 ± 6.115. The movements of both arms and legs showed stable sinusoidal waves. In fact, as a result of performing a paired t test of both exercise phases measured by the strike point using the maximum and minimum values, it was confirmed that the 2 exercises were not statistically different, as it yielded a P value of 0.469 (significance level α = 0.05). The arm SGCI measured after applying the 3 kg weight impairment on 1 leg was 22.167 ± 4.705. It was confirmed that the leg SGCI and 3 kg weight arm SGCI were statistically significant, as it yielded a P value of 0.001 (significance level α = 0.05). The SCGI can be automatically and continuously measured with the gyro sensor of the smartwatch and can be used as an indirect indicator of human walking conditions.
Intensive care unit-acquired pneumonia caused by Klebsiella pneumoniae in China: Risk factors and prediction model of mortality
Authors: Li Lanyu , Huang Liying , Liu Xiaolei , Ye Yan , Sai Fangfang , Huang Huan
Published: March 2023

Intensive care unit (ICU)-acquired pneumonia (ICUAP) is a major concern owing to its associated high mortality rate. Few studies have focused on ICUAP caused by Klebsiella pneumoniae (KP). This study aimed to investigate the risk factors for ICUAP-associated death due to KP and to develop a mortality prediction model. Patients with KP-associated ICUAP at Renji Hospital were enrolled from January 2012 to December 2017. The patients were registered from the ICU units of the Surgery, Gynecology and Obstetrics, Neurosurgery, Emergency and Geriatric Departments, and were followed for 30 days. A multivariate analysis was performed to analyze the differences between 30-day survivors and nonsurvivors, and to determine the independent risk factors. Receiver operator characteristic (ROC) curves were also used to determine the predictive power of the model. Among the 285 patients with KP-associated ICUAP, the median age was 70.55 years, and 61.6% were men. Fifty patients died. The nonsurvivors had a lower Glasgow coma score (GCS), platelet count, and albumin concentrations, but higher lactate concentrations, than the survivors. The nonsurvivors were also more likely to be admitted to the ICU for respiratory failure and surgery, and they received less appropriate empirical antimicrobial therapy than the survivors. A lower GCS (odds ratio [OR] = 0.836, 95% confidence interval [CI]: 0.770–0.907), lower albumin concentrations (OR = 0.836, 95% CI: 0.770–0.907), higher lactate concentrations (OR = 1.167, 95% CI: 1.0013–1.344) and inappropriate empirical treatment (OR = 2.559, 95% CI: 1.080–6.065) were independent risk factors for mortality in patients with KP-associated ICUAP. ROC curve analysis showed that the risk of death was higher in patients with 2 or more independent risk factors. The predictive model was effective, with an area under the ROC curve of 0.823 (95% CI: 0.773–0.865). The number of independent risk factors is positively correlated with the risk of death. Our model shows excellent predictive performance.
Does shortening the duration of radiotherapy treatment in breast cancer increase the risk of radiation pneumonia: A retrospective study
Authors: Tepetam Huseyin , Karabulut Gul Sule , Alomari Omar , Caglayan Merve , Demircioglu Ozlem
Published: March 2023

Randomized studies evaluating hypofractionation and conventional fractionation radiotherapy treatments (RT) in patients with breast cancer have shown that hypofractionation achieves similar results to conventional fractionation in terms of survival and local control rates. It has also been shown that their long-term toxicities are similar. This study aimed to evaluate the effects of hypofractionated radiotherapy (H-RT) and conventional radiotherapy (C-RT) on lung toxicity and identify factors affecting this toxicity in patients with breast cancer. The study included 118 patients who underwent adjuvant RT following breast-conserving surgery (BCS). Out of these, 63 patients were assigned to receive C-RT, while the remaining 55 were assigned to receive H-RT. To clarify, we treated 63 patients with C-RT and 55 patients with H-RT. 60 patients were treated using 3-dimensional conformal radiotherapy (3DCRT) and 58 patients were treated using intensity modulated radiotherapy (IMRT). The patients were evaluated weekly for toxicity during radiotherapy (RT) treatment and were called every 3 months for routine controls after the treatment. The first control was performed 1 month after the treatment. Statistical analysis was performed using the SPSS20 program, and a P value of <.005 was considered statistically significant. The study found that the median age of the participants was 54.9 years and tomographic findings were observed in 70 patients. Radiological findings were detected at a median of 5 months after RT. The mean lung dose (MLD) on the treated breast side (referred to as ipsilateral lung or OAR) was 10.4 Gy for the entire group. Among patients who received 18 MV energy in RT, those with an area volume (V20) of the lung on the treated breast side >18.5%, those with a mean dose of the treated breast side lung (ipsilateral lung) >10.5 Gy, and those who received concurrent hormone therapy had significantly more tomographic findings. However, patients treated with YART had fewer tomographic findings. No symptomatic patients were observed during the follow-up period. Our findings show that the risk of lung toxicity is similar with H-RT and C-RT, and H-RT can be considered an effective and safe treatment option for breast cancer. The key factors affecting the development of lung toxicity were found to be the type of RT energy used, RT to the side breast, volume receiving 20 Gy in the side lung, side lung mean dose, and simultaneous hormonal therapy.
Effect of different bone cement distributions in percutaneous kyphoplasty on clinical outcomes for osteoporotic vertebral compression fractures: A retrospective study
Authors: Song Qichun , Zhao Yan , Li Dong , Liu Zhaoying , Zhang Yuankai , Shang Donglong , Geng Zilong , Shi Zhibin , Fan Li-Hong
Published: March 2023

Osteoporotic fractures and their complications are becoming increasingly harmful to the elderly. This study aimed to evaluate the clinical results of connected or unconnected bilateral cement after bilateral percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCF). The clinical data of 217 patients with single-segment OVCF were retrospectively collected. Patients were allocated into 2 groups according to the bilateral bone cement in the vertebrae was connected or unconnected after surgery. The surgery-related indexes of the 2 groups were compared, including operation time; bone cement injection volume; contact situation between bone cement and the upper and lower endplates of the vertebral body; visual analogue scale (VAS) scores before surgery, 1 week and 1 year after surgery; Oswestry disability index (ODI) before surgery, 1 week and 1 year after surgery; local kyphosis angle (LKA) before surgery, 1 week and 1 year after surgery; postoperative vertebral body height at 1 week and 1 year after surgery; vertebral body height restoration rate (HRR) at 1 week and 1 year after surgery. The follow-up results of all patients were recorded. The postoperative VAS, ODI, vertebral body height, LKA and other indexes of the 2 groups were significantly improved compared with those before the operation (P < .05), and there was no significant difference between the 2 groups (P > .05). At the same time, there were no significant difference in vertebral body HRR and bone cement leakage rate between the 2 groups (P > .05). X-ray examination showed that 21 of 217 patients (21/217, 9.8%) had a refracture of the injured vertebral body, including 16 cases (16/121, 13.2%) in the unconnected group and 5 cases (5/96, 5.2%) in the connected group (P < .05). Adjacent vertebrae fractures occurred in 25 cases (25/217, 11.5%), while 19 cases (19/121, 15.7%) were in the unconnected group and 6 cases (6/96, 6.3%) were in the connected group (P < .05). PKP has a good therapeutic effect on OVCF no matter whether the bilateral bone cement is connected or not. However, if the bilateral cement inside the vertebra was connected, the risk of recollapse of the injured vertebrae and the new fracture of adjacent vertebrae could be reduced.
Effect of sterile ice water versus menthol spray on thirst symptoms of fasted children in the intensive care unit: A prospective cohort study
Authors: Ma Fangyan , He Haiting , Xu Banghong , Zhou Jing , Pu Kai
Published: March 2023

Background:

Thirst is a very common symptom in fasted children in intensive care unit (ICU). This study aimed to evaluate the effect of sterile ice water versus menthol spray in ICU fasted children, to provide insights to the clinical care of fasted children.

Methods:

The children admitted to the ICU of our hospital from June 1, 2021 to August 31, 2022 and needed to fast were included. Children were randomly assigned to the ice water group or menthol group. We evaluated and compared the thirst distress scale (TDS), oral mucosa wetness scale (OMWS), children medical fear scale (CMFS), numerical rating scale (NRS), unstimulated whole saliva (UWS) flow rate between 2 groups.

Results:

A total of 139 children were included, involving 69 children in ice water group and 70 children in menthol group. There were no significant differences in the baseline characteristics, TDS, OMWS, OMWS, CMFS, and NRS score, UWS flow rate before intervention between ice water group and menthol group (all P > .05). After intervention, the TDS, OMWS, NRS score of menthol group was statistically less than that of ice water group (all P < .05), the UWS flow rate of menthol group was statistically higher than that of ice water group (P = .034).

Conclusions:

Compared with ice water spray, menthol spray may be more beneficial to relieve the thirst and increase the comfort in ICU fasted children. Future studies with larger sample size and rigorous design are needed to evaluate the effects and safety of ice water and menthol spray in the nursing care of children.
Effect of patient characteristics on vessel enhancement on arterio-venous fistula CT angiography in a retrospective cohort study
Authors: Masuda Takanori , Nakaura Takeshi , Funama Yoshinori , Sato Tomoyasu , Masuda Shouko , Yoshiura Takayuki , Gotanda Rumi , Arao Keiko , Imaizumi Hiromasa , Arao Shinichi , Ono Atsushi , Hiratsuka Junichi , Awai Kazuo
Published: March 2023

To evaluate the effects of various patient characteristics on vessel enhancement on arterio-venous fistula (AVF) computed tomography (CT) angiography (AVF-CT angiography). A total of 127 patients with suspected or confirmed shunt stenosis and internal AVF complications were considered for inclusion in a retrospective cohort study. The tube voltage was 120 kVp, and the tube current was changed from 300 to 770 mA to maintain the image quality (noise index: 14) using automatic tube current modulation. To evaluate the effects of age, sex, body size, and scan delay on the CT number of the brachial artery or vein, we used correlation coefficients and multivariate regression analyses. There was a significant positive correlation between the CT number of the brachial artery or vein and age (R = 0.21 or 0.23, P < .01). The correlations were inverse with the height (r = −0.45 or −0.42), total body weight (r = −0.52 or −0.50), body mass index (r = −0.21 or −0.23), body surface area (body surface area [BSA]; r = −0.56 or −0.54), and lean body weight (r = −0.55 or −0.53) in linear regression analysis (P < .01 for all). There was a significant correlation between the CT number of the brachial artery or vein and scan delay (R = 0.19 or 01.9, P < .01). Only the BSA had significant effects on the CT number in multivariate regression analysis (P < .01). The BSA was significantly correlated with the CT number of the brachial artery or vein on AVF-CT angiography.
Prognostic value of modified-Gustave-Roussy Immunity Score in resectable proximal gastric cancer
Authors: Shi Yujing , Ju Mengyang , Di Xiaoke , Sun Xinchen , Chen Xiaojiao , He Chenhong , Liang Liang
Published: March 2023

The prognostic evaluation of GRIm score has been confirmed in many tumor species. The purpose of this study is to clarify the value of GRIm score in the prognostic evaluation of patients with resectable proximal gastric cancer. A single center retrospective study was conducted in 174 patients with proximal gastric cancer who underwent radical total gastrectomy. An in-depth analysis was carried out to explore the prognostic differences between high and low GRIm, and the influencing factors of disease-free survival rates and overall survival rates were analyzed by Cox regression model and Kaplan–Meier method. A total of 174 patients were divided into two groups: 135 patients were marked in L-mGRIm and 39 patients in H-mGRIm groups respectively. The median OS of the H-mGRIm and L-mGRIm groups were 23.2 and 38.6 months, respectively. The median DFS of the H-mGRIm and L-mGRIm groups was 16.9 and 31.7 months, respectively. Both DFS and OS were significantly different between groups (P = .000, P = .000). In multivariate analysis, ZPS (2 vs 0–1: HR 1.99 95% CI 1.05–3.76 P = .035), LDH (≥193 vs <193:HR 0.6; 95% CI 0.38–0.95 P = .028), mGRIm score (2–3 vs 0–1: HR 2.4; 95% CI 1.09–5.23 P = .029) was independent risk factors of OS. The age (>65 vs ≤65 years HR 0.63; 95% CI 0.4–0.95 P = .003), LDH (>193 U/L vs ≤193 U/L: HR 0.55; 95% CI 0.37–0.82 P = .004) and mGRIm score (2–3 vs 0–1: HR 4.74; 95% CI 2.24–9.9 P = .000) as an independent risk factor for DFS. mGRIm score is a novel, simple and effective index for prognosis evaluation of resectable cardiac cancer and can be used as a part of the risk stratification process.
Application of the Knowledge, Attitude, and Practice model combined with motivational interviewing for health education in female patients with systemic lupus erythematosus
Authors: Kang Juan , Zhu Xinran , Kan Yan , Zhuang Shumei
Published: March 2023

To explore the application effect of the Knowledge, Attitude, and Practice (KAP) model combined with motivational interviewing for health education in the chronic disease management of female patients with systemic lupus erythematosus (SLE). In this study, 84 women with SLE who were admitted to a tertiary hospital in Tianjin from July 2021 to April 2022 were enrolled in this study and divided into observation (n = 42) and control groups (n = 42). The control group received routine health education and treatment for chronic diseases. Based on the control group, the KAP method and questionnaire survey were adopted. Health literacy and compliance in the 2 groups were compared in the first and third months after the intervention. The observation group had a higher total score of health literacy in the third month than the control group. From before the intervention to the first and third months, improvement in the observation group was compared with that in the control group (F = 36.543, P 6..001; F = 4.884, P = .03; F = 23.881, P 3..001). The observation group had a higher total compliance score in the third month than the control group (t = 5.101, P = .007). From before the intervention to the first and third months of the intervention, the improvement in the observation group demonstrated an interaction with the time group compared with that in the control group (F = 68.116, P 8..001; F = 4.884, P = .032; F = 24.789, P < .001). Motivational interviewing based on the KAP model is effective in the short-term overall health literacy of female patients with SLE, especially in terms of communication, health improvement, and information acquisition; after 3 months, it can influence and maintain high patient compliance.
Global hotspots and trends in Myofascial Pain Syndrome research from 1956 to 2022: A bibliometric analysis
Authors: Tang Fei , Jiang Changgui , Chen Jun , Wang Liangyong , Zhao Fukun
Published: March 2023

Myofascial Pain Syndrome (MPS) is a prevalent disease, and the related literature research has been increasing in recent years. However, there is a lack of scientific and comprehensive bibliometric analyses in the MPS research field. This study aimed to summarize and visualize the literature distribution laws, research hotspots and development trends in MPS based on bibliometric methods. Relevant literature on MPS research from 1956 to 2022 was retrieved from the Web of Science Core Collection database. Quantitative and visual analyses of the collected literature were performed using Microsoft Office 2021, Bibliometrics, VOSviewer, and CiteSpace. A total of 1099 papers were included, and the number of papers in this research field is generally upward. The USA has the most publications (270), and Univ Sao Paulo is the institution with the most publications (31). Hong CZ and Calvo-Lobo C have the same number of publications and are the authors with the most publications (20), and Simons DG is the author with the most co-citations (1078). Journal of Musculoskeletal Pain is the journal with the most publications (61), and Pain is the journal with the most co-cited papers (2598) and the highest impact factor (7.926). Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response is the reference with the highest number of co-citations (136). The top 5 keywords in this period are myofascial pain syndrome (571), trigger points (218), pain (97), myofascial pain (92), and myofascial trigger point (80). The keywords of recent bursts are dry needling (2016–2022), efficacy (2020–2022), validity (2020–2022), temporomandibular joint disorder (2020–2022), and orofacial pain (2020–2022). This study summarizes and visualizes the evolution, research hotspots, and future trends of the global MPS domain from 1956 to 2022. It is helpful for scholars to understand the general situation of MPS research quickly and provide a reference for clinical decision-making and future research directions.
A study on smartphone dependence and depression in Korean high school students
Authors: Park Soohee , Yoo Jin-Yeong
Published: March 2023

Using the 10th Korean Youth Risk Behavior Web-based Survey in 2020, we attempted to determine the relationship between smartphone addiction and depression in 25,987 high school students. The demographic characteristics of the subjects were reviewed frequently, and the correlation between smartphone dependence and depression were determined. The results show that it is difficult to track the time spent on smartphones to determine the level of depression (R = 0.143, P < .01), it is difficult concentrating on other tasks due to smartphones (R = 0.140, P < .01), and it is difficult to remove images/data received on smartphones from the head (R = 0.141, P < .01). Further, the impulse to use smartphones is strong (R = 0.157, P < .01), health concerns (r = .124, P < .01) and family conflicts exist due to the use of smartphones (r = .149, P < .01), problems with social relations exist due to the use of smartphones (R = 112, P < .01), and difficulties exist in performing tasks due to the use of smartphones (R = 0.153, P < .01). According to the results of the study, it was determined that there is a relationship between smartphone usage and depression among Korean high school students. The findings from this study can be referenced to help guide the development of smartphone usage parameters for Korean teenagers in depression management programs.
Dietary fiber intake associated with risk of rheumatoid arthritis among U.S. adults: NHANES 2010-2020
Authors: Liu Li , Xie Songlin
Published: March 2023

Rheumatoid arthritis (RA) is a prevalent inflammatory joint disease that imposes a significant medical burden and morbidity. Recent scientific evidence suggests that dietary components and patterns could be associated with RA risk. In this study, we aim to investigate the possible relationship between dietary fiber intake and RA risk. We included 15,114 participants from the 2010 to 2020 National Health and Nutrition Examination Survey database in our study. Participants aged 20 or above were categorized into those with and without RA. Univariate logistic regression analysis and multivariate regression models were used to test the association between dietary fiber intake, high-sensitivity C-reactive protein, and RA. Out of all the participants, 1053 were diagnosed with RA (6.97%). Multivariate logistic regression analysis indicated that fiber intake was negatively associated with high-sensitivity c-reactive protein (−0.09 [−0.18, −0.02]) and RA risk (0.99 [0.98, 0.99]). Furthermore, our sensitivity analysis suggested that individuals with higher fiber intake (>19.1 g/day) had a 25% lower risk of developing RA than those with lower fiber intake [0.75 (0.63, 0.88)]. Our findings suggest that higher dietary fiber intake is associated with a reduced risk of RA and may help reduce systemic inflammation, thereby potentially slowing down RA progression.
First report of surgery for anencephaly in twin pregnancies: Technical notes and postoperative management
Authors: Menekşe Güner , Kahvecioğlu Dilek , Aksoy Hatice Tatar , Kankaya Yüksel , Bayar Mehmet Akif
Published: March 2023

Anencephaly, the most severe form of neural tube defect, has no known cure, and in most cases, patients die before or shortly after birth. To date, no surgical intervention has been reported in the management of anencephaly. This study presents a case of dichorionic-diamniotic twin pregnancy in which 1 twin was anencephalic and describes the surgical management of this complex case. We aimed to share the problems experienced during the follow up of a patient who survived for a long time after surgery. We also aimed to highlight several clinical issues, including the challenges of managing anencephaly in twin pregnancies, problems experienced during the follow up process in our case, diagnosis of brain death in anencephaly cases, and ethical dilemmas related to organ donation. This case is notable because of the challenging nature of the surgical procedure and complexity of postoperative care. By highlighting the difficulties encountered during the follow up period, we hope to provide insights to health professionals that can inform the management of similar cases in the future.
Long-term follow up of surgical management of blood blister-like aneurysms at non-branching sites of the internal carotid artery
Authors: Kim Hyeon-Ju , Lee Jong-Myong
Published: March 2023

To describe long-term follow-up of 25 patients who presented with subarachnoid hemorrhages due to blood blister-like aneurysms (BBAs) treated with direct clipping or clip reinforcement with or without direct neck repair. Between June 1993 and July 2009, 25 consecutive patients with ruptured BBAs of the supraclinoid internal carotid artery were retrospectively reviewed. The mean age of patients was 39.5 ± 11.3 years. The mean duration of clinical follow-up was 128.9 months (range, 85–196 months). All aneurysms were located in the supraclinoid portion of the internal carotid artery. The mean aneurysm diameter was 4.04 ± 1.3 mm on intra-operative microscopic field. Tearing of the aneurysmal neck during dissection occurred in 8 (32%) patients. Six of 7 patients with neck tearing underwent direct neck repair. Surgeons treated aneurysms via direct clipping with a Bemsheet® in 5 (20%) patients or by clip reinforcement with a silicone sheet in 20 (80%) patients. Clinical outcomes were favorable (modified Rankin Scale [mRS]: 0–2) in 21 (84%) of 25 patients. Four (16%) patients had an unfavorable outcome (mRS: 3–6). The patient with severe disability (mRS: 4) was treated with clip reinforcement and direct neck repair. Mild stenosis, moderate stenosis, and total occlusion of the parent artery were confirmed in 10 (40%) patients, 6 (24%) patients, and 1 (4%) patient, respectively. Although surgical treatment of BBAs was associated with varying degrees of parent vessel patency loss, long-term follow-up results for more than 10 years showed that direct surgical clipping or clip reinforcement with a silicone sheet appeared to be a curative surgery.
Intervention for modifying risk level of hypersexual behaviors among male parents with sexual offending history
Authors: Egenti Nkechi T. , Ede Moses Onyemaechi , Okeke Chinedu Ifedi , Oneli Joy Obiageli
Published: March 2023

Background:

The increased sexual assault committed against women and young girls by people of the opposite gender has put their safety in danger in recent years. This has contributed to a growing number of adult sex offenders who have aggressive sexual attitudes. This study investigated the efficacy of cognitive behavior therapy (CBT) in reducing the risk level of hypersexual behaviors among male parents.

Methods:

A total of convicted 48 inmates participated in this study. In pursuance of this aim, 3 dependent measures were employed in evaluating the participants’ violent sexual attitudes at 3 points. The simple random technique was adopted in selecting 24 participants who participated in the CBT program while 24 participants were used as the no-intervention control group.

Results:

The ANCOVA analysis shows a positive treatment outcome in reducing the risk level of hypersexual behaviors among male parents who participated in the CBT program when compared to the no-intervention control group. This study found that cognitive behavioral therapy intervention is a coping strategy for reducing hypersexual behaviors among male parents with sexual offending history in favor of participants in the intervention group at the 3 levels of assessments. The study showed a significant difference between groups in the risk level of hypersexual behaviors among male parents with a sexual offending history. Also, the result showed a significant interaction between time and treatment. Regarding the moderating impact of sexual behavior on the risk level of hypersexual behaviors,

Conclusion:

Given this, this study suggests that CBT intervention reduces the risk level of hypersexual behaviors among male parents. Implications for protection agencies and policies were highlighted.
Inferior mesenteric artery arteriovenous malformation, a rare cause of ischemic colitis: A case report
Authors: Chang Ching-Tang , Lim Wei-Xiong , Liu Ting-Ting , Lin Yueh-Ming , Chang Ching-Di
Published: March 2023

Rationale:

An arteriovenous malformation (AVM) is an abnormal tangle of blood vessels that connects the arteries and the veins. Because normal capillary bed is partially or completely absented in the AVM, the blood passes quickly from the arteries to the veins, which disrupts normal blood flow and oxygen supply to the surrounding tissues. This is called “steal phenomenon,” and in the inferior mesenteric artery (IMA) territory, this may lead to abdominal pain, gastrointestinal bleeding, portal hypertension, and even ischemic colitis.

Patient concerns:

A 67-year-old man presented to our emergency department because of left side abdominal pain.

Diagnoses:

The abdominal computed tomography with contrast enhancement revealed a cluster of abnormal vascular lesions abutting the IMA with early opacification of the left colonic marginal vein. In addition, poor enhancement of segmental colonic wall was found from proximal descending colon to middle rectum. The diagnosis of AVM of the IMA and ischemic colitis was made.

Interventions:

The patient underwent left hemicolectomy as well as the AVM resection.

Outcomes:

He was discharged uneventfully after the surgery without complications.

Lessons:

IMA AVM carries the risk of ischemic colitis. computed tomography scan is helpful not only to the diagnosis of AVMs but also to exclude other lesions as well. Treatment options include endovascular embolization, surgical intervention, and a combination of both. Due to the complexity of this disease, treatment requires a case-specific multidisciplinary approach and a coordination of medical, radiological, and surgical staffs.
Learned Nocebo Effects on Cutaneous Sensations of Pain and Itch: A Systematic Review and Meta-analysis of Experimental Behavioral Studies on Healthy Humans
Authors: Thomaidou Mia A. , Blythe Joseph S. , Peerdeman Kaya J. , van Laarhoven Antoinette I. M. , Van Schothorst Myrthe M. E. , Veldhuijzen Dieuwke S. , Evers Andrea W. M.
Published: March 2023

Objective

In past decades, the field of nocebo research has focused on studying how sensory perception can be shaped by learning. Nocebo effects refer to aggravated sensory experiences or increased sensitivity to sensations such as pain and itch resulting from treatment-related negative experiences. Behavioral conditioning and verbal suggestions of a negative treatment outcome may aggravate pain and itch perception. Gaining a comprehensive view of the magnitude of nocebo effects and contributing factors will help steer nocebo research toward fruitful directions for understanding complex sensory phenomena.

Methods

We conducted a systematic review and meta-analysis of a total of 37 distinct experimental nocebo studies on healthy participants (all published in English between 2008 and 2021), with four separate meta-analyses for nocebo effects on pain or itch. We conducted subgroup analyses and meta-regression on factors such as type and intensity of sensory stimuli, and length of conditioning paradigms.

Results

This meta-analysis showed that, on average, effect sizes of nocebo effects were moderate to large (Hedges g between 0.26 and 0.71 for the four primary outcomes). The combination of conditioning and verbal suggestions yielded stronger nocebo responses on pain in particular. Subgroup analyses, including factors such as the type of sensory stimulation, did not explain the moderate heterogeneity in nocebo magnitudes between different studies. Risk of bias was generally low and was not related to nocebo magnitudes either.

Conclusions

We discuss these results in relation to the role of conditioning and aversive learning, and we recommend more consistency in designing and reporting nocebo experiments.
Peripheral Artery Disease and Markers of Endothelial Dysfunction and Platelet Activation in People With HIV
Authors: Bundgård Johanne , Jensen Anne Marie R. , Suarez-Zdunek Moises A. , Høgh Julie , Gerstoft Jan , Benfield Thomas , Ostrowski Sisse R. , Nielsen Susanne D. , Knudsen Andreas D.
Published: March 2023

Background:

People with HIV (PWH) have an increased risk of peripheral artery disease (PAD), but the pathogenesis is unknown. We aimed to determine the associations between markers of endothelial dysfunction and platelet activation and both PAD at baseline and de novo PAD in PWH.

Methods:

In total, 1012 PWH from the longitudinal Copenhagen Comorbidity in HIV-infection (COCOMO) study and 57 age-matched and sex-matched population controls were included. Plasma samples were collected at baseline and analyzed for soluble thrombomodulin, syndecan-1, and CD40 ligand (sCD40L). The ankle-brachial index was measured at baseline and two-year follow-up in PWH. Logistic and Poisson regression models were used to test associations.

Results:

PWH had higher concentrations of soluble thrombomodulin (P = 0.03) and syndecan-1 (P < 0.001) and lower concentration of sCD40L (P < 0.001) compared with controls. High concentration of soluble thrombomodulin, but not syndecan-1 or sCD40L, was associated with lower odds of PAD in PWH at baseline after adjustments (adjusted odds ratio: 0.50 [0.28, 0.90], P = 0.02). None of the markers were associated with de novo PAD.

Conclusions:

PWH had higher concentrations of soluble thrombomodulin and syndecan-1 and lower concentration of sCD40L compared with controls. Soluble thrombomodulin was associated with lower odds of PAD at baseline. Further studies are needed to elucidate the pathogenesis of PAD in people with HIV.
The Efficacy and Tolerability of Continuation and Maintenance Electroconvulsive Therapy for Depression
Authors: Rowland Tobias , Mann Roshani , Azeem Samina
Published: March 2023

Electroconvulsive therapy (ECT) is a highly effective treatment for severe and treatment-resistant depression, but relapse rates remain high despite maintenance pharmacotherapy. Continuation or maintenance ECT (C/M-ECT) offers the potential to prevent relapses in the most unwell patients, but there remains disagreement among guidelines regarding its efficacy and tolerability. This review aims to summarize and assess the current evidence for the efficacy and tolerability of continuation and maintenance ECT for depression, including data from randomized and observational studies, which included an appropriate control group. Twenty studies were found meeting inclusion criteria. There was evidence from 14 studies suggesting that relapse rates are reduced in those receiving C/M-ECT. There was evidence from 6 studies suggesting that C/M-ECT had no effect on global cognitive function. Detailed neuropsychological testing was limited, but within studies that assessed specific cognitive domains, there was not consistent evidence for deficits in C/M-ECT compared with the control group. The certainty of evidence across outcomes was low or very low because of inclusion of observational studies, heterogeneity of study design, and patient populations. The findings add further weight to evidence suggesting that C/M-ECT is a viable treatment option to prevent relapse in severe depression and provides clinicians with further evidence for the benefits and risks of C/M-ECT when discussing treatment options with patients. Future research should focus on randomized or well-designed prospective studies with sufficient follow-up to determine longer-term outcomes, while including a standardized, detailed neurocognitive battery to assess potential adverse effects.