bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of anxiety and depression with chronic liver diseases in patients with noncardiac chest pain: A cross-sectional study
Authors: Chang Rei-Yeuh , Hsueh-Hua Ho Sheri , Tsai Han-Lin , Koo Malcolm
Published: August 2022

Causes of chest pain can vary from benign to life-threatening conditions, and in many cases not necessary of cardiac origin. A possible reason for noncardiac chest pain could be anxiety or depression caused by chronic liver diseases. The aim of this study was to investigate the association of anxiety and depression with chronic liver disease in patients with noncardiac pain.

Patients with chest tightness or pain referred for treadmill exercise testing were recruited from a regional hospital in southern Taiwan. Medical records of the patients were used to define the presence and type of chronic liver disease. Multiple logistic regression analyses were conducted to assess the association of anxiety and depression with chronic liver disease.

A total of 2537 patients with liver function test results and abdominal sonography data were analyzed, and 1965 patients showed a negative treadmill exercise testing. The mean age of these 1965 patients was 51.9 years and 54.2% were male. The prevalence of alcoholic liver disease, hepatitis B, hepatitis C, and fatty liver disease was 10.6%, 10.9%, 3.7%, and 27.0%, respectively. Results from multiple logistic regression analyses showed that the risk of anxiety (adjusted odds ratio [aOR] = 1.83, P < .001) and depression (aOR = 1.85, P < .001) was significantly higher in patients with alcoholic liver disease. Anxiety was significantly higher in patients with fatty liver disease (aOR = 1.30, P = .031), and the risk of depression was significantly higher in patients with chronic hepatitis C (aOR = 2.18, P = .005).

In conclusion, in patients with noncardiac chest pain, alcoholic liver disease was significantly associated with anxiety and depression, while those with fatty liver and chronic hepatitis C were associated with anxiety and depression, respectively. Clinicians should be vigilant to these correlations in their practice.
Characteristics and quality of life of substance users and their caregivers
Authors: Maksimovic Jadranka M. , Sbutega Olivera B. , Pavlovic Aleksandar D. , Vlajinac Hristina D. , Kavecan Ivana I. , Vujcic Isidora S. , Grujicic Sipetic Sandra B.
Published: August 2022

The correlation between substance use and depression has been emphasized in the literature. Substance use disorders can also adversely affect the caregivers of drug-addicted persons.

A cross-sectional study was conducted at the Special Hospital for Addiction Diseases in Belgrade in 2015 to analyze the characteristics, consequences, and health-related quality of life of drug users and their caregivers. The sample comprised 136 users of various substances, and 136 caregivers. A questionnaire on socio-demographic characteristics, the Short Form Health Survey 36 (SF-36), and Beck Depression Inventory were administered to all participants.

According to multivariate logistic regression analysis, compared with caregivers, substance users were significantly more frequently male (P < .001), ≤ 39 years old (P < .001), and more frequently reported the use of sedatives (P = .009) and smoking (P < .001). Some level of depression was present in all participants, but severe forms were more frequent in substance users (P = .010). Among substance users, mean scores of SF-36 domains ranged from 56.62‒87.17, and among their caregivers, from 50.37‒75.07; however, the difference was significant only for the health change domain (P = .037), the score for which was lower in caregivers.

Substance users suffered from more severe forms of depression compared to their caregivers, who had lower SF-36 scores in the domain of health change.
Traumatic injury mortality prediction (TRIMP-ICDX): A new comprehensive evaluation model according to the ICD-10-CM codes
Authors: Zhang Guohu , Wang Muding , Cong Degang , Zeng Yunji , Fan Wenhui
Published: August 2022

Various assessment methods based on the International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM), such as ICD-10-CM Injury Severity Score (ICISS), trauma mortality prediction model (TMPM-ICD10), and injury mortality prediction (IMP-ICDX), are purely anatomic trauma assessment, which need to be further improved. Traumatic injury mortality prediction (TRIMP-ICDX) is a comprehensive assessment method based on anatomic injuries and incorporating available information to determine whether it is superior to Trauma and Injury Severity Score (TRISS) and IMP-ICDX in predicting trauma outcomes. This retrospective cohort study was based on data from 704,287 trauma patients admitted to 710 trauma centers in the National Trauma Data Bank of the United States in 2016. The TRIMP-ICDX was established using anatomical injury, physiological reserves, and physiological response indicators. Its performance was compared with the IMP-ICDX and TRISS by examining the area under the receiver operating characteristic curve (AUC), calibration (Hosmer-Lemeshow goodness-of-fit test, HL), and the Akaike information criterion (AIC). The TRIMP-ICDX showed significantly better discrimination (AUCTRIMP-ICDX 0.968; 95% confidence interval (CI), 0.966–0.970, AUCTRISS 0.922; 95% CI, 0.918–0.925, and AUCIMP-ICDX 0.894; 95% CI, 0.890–0.899), better calibration (HLTRIMP-ICDX 5.6; 95% CI, 3.0–8.0, HLTRISS 72.7; 95% CI, 38.4–104.5, and HLIMP-ICDX 53.1; 95% CI, 26.6–77.8), and a lower AIC (AICTRIMP-ICDX 24,774, AICTRISS 30,753, and AICIMP-ICDX 32,780) compared with TRISS and IMP-ICDX. Similar results were found in statistical comparisons among different body regions. As a comprehensive evaluation method based on the ICD-10-CM lexicon TRIMP-ICDX is significantly better than IMP-ICDX and TRISS with respect to both discriminative power and calibration. The TRIMP-ICDX should become a research method for the comprehensive evaluation of trauma severity.
The efficacy and safety of immune checkpoint inhibitors in metastatic castration-resistant prostate cancer: A systematic review and meta-analysis
Authors: Wang Xing-Hui , Wang Zhi-Qiang , Mu Zhen-Yu , Zhu Li-Ping , Zhong Chong-Fu , Guo Shanchun
Published: August 2022

Background:

We aim to assess the efficacy and safety profiles of immune checkpoint inhibitors in patients with metastatic castration-resistant prostate cancer using a meta-analysis.

Methods:

We extracted and examined data from phase I, II and III clinical trials from PubMed, Embase, Web of Science, and Cochrane Library, which included patients with metastatic castration-resistant prostate cancer who were treated with immune checkpoint inhibitors. We performed a meta-analysis to investigate several indexes of efficacy and safety, including the objective response rate, 1-year overall survival (OS) rate, prostate-specific antigen response rate, and adverse event rate of immune checkpoint inhibitors. The material data were calculated and pooled using The R Project for Statistical Computing and STATA 12.0 software.

Results:

We identified 12 clinical trials in our study. We assessed the pooled frequencies of all-grade AEs and grade ≥ 3 AEs first and showed 0.82 (95% CI: 0.74–0.91, I2 = 94%, P < .01) and 0.42 (95% CI: 0.33–0.54, I2 = 96%, P < .01), respectively. The objective response rate was 0.10 (95% CI: 0.04–0.19, I2 = 70%, P < .01), and the 1-year OS and prostate-specific antigen response rate were 0.55 (95% CI: 0.45–0.67, I2 = 93%, P < .01) and 0.18 (95% CI: 0.16–0.20, I2 = 43%, P = .03), respectively.

Conclusion:

The immune checkpoint inhibitors therapy was well tolerated and showed potential to improve tumor responses in patients with metastatic castration-resistant prostate cancer.
The method for termination of mid-trimester pregnancy with placenta previa: A case study
Authors: Long Qingyun , Wu Shiyao , Du Shuguo , Li Ruyan , Zhao Yun , Tang Fei
Published: August 2022

Background:

Prenatal bleeding is very dangerous for pregnant women with placenta previa during termination of pregnancy in the mid-trimester. Traditionally, cesarean section or hysterectomy is used to stop bleeding. This study aims to investigate the method for termination of mid-trimester pregnancy with placenta previa, especially emergency uterine artery embolization (UAE) combined with cervical double balloon (CDB).

Methods:

A retrospective study was conducted based on 261 cases of mid-pregnancy termination in our hospital, where 34 cases with placenta previa were set as the observation group, and the remaining 227 cases were set as control group. At first, the termination method of Mifepristone combined with Misoprostol/Ethacridine Lactate was adopted. If the volume of prenatal bleeding was up to 400 mL, emergency uterine artery embolization (UAE) was implemented to stop bleeding, then cervical double balloon (CDB) was used to promote cervical ripening. Receiver operating characteristic (ROC) curves analysis was performed to assess the accuracy in predicting the length of placental edge crossed the cervical os for prenatal bleeding.

Results:

The number of gravidity/parities, the rate of cesarean section, the medical cost, the rate of previous cesarean section were all higher in the observation group than in the control group (P < .05). The volume of prenatal hemorrhage, postpartum hemorrhage, the rate of puerperal morbidity, emergency UAE rate and ICU rate were higher in the observation group than in the control group (P < .05). There were 4 cases showing prenatal hemorrhage up to 400 mL and undergoing emergency UAE + CDB in the observation group, while there were no such cases in the control group (P < .05). An optimal cut-off value of 1.7cm for the length of placental edge crossed the cervical os in diagnosing prenatal hemorrhage demonstrated sensitivity and specificity of 75.0% and 86.7%, respectively (area under the ROC curve, 0.858).

Conclusion:

The combined therapy of mifepristone and Misoprostol/Ethacridine Lactate was useful for termination of mid-trimester pregnancy with placenta previa, and attention needs to be attached to prenatal hemorrhage during labor induction. Emergency UAE + CDB is a good combination method to treat prenatal hemorrhage and promote cervical ripening during the induction.
Association of eccentric quadriceps torque with pain, physical function, and extension lag in women with grade ≤ II knee osteoarthritis: An observational study
Authors: Arab Fares , Quddus Nishat , Khan Sohrab A. , Alghadir Ahmad H. , Khan Masood
Published: August 2022

Knee osteoarthritis (OA) is a prevalent disabling disease among women and quadriceps weakness is attributed to one of the causes of knee pain (KP) and disability. The study aimed to test the correlation of eccentric quadriceps torque (EQT) with 2 subscales of the reduced WOMAC questionnaire (KP and physical function) and extension lag range of motion (ROM) at the knee joint in osteoarthritic women.

A cross-sectional design was used. A total of 70 patients (mean age 41.1 years) who had grade I or II knee OA participated in the study. The pearson correlation coefficient was used to test the correlation between the EQT and 2 subscales of the reduced WOMAC questionnaire and extension lag ROM.

EQT presented a significant moderate negative correlation with pain (r = –0.489, P < .001) and physical function (r = –0.425, P < .001), and low positive correlation with available ROM (R = 0.349, P < .001).

KP, physical function, and extension lag in the early stages of knee OA in women are associated with EQT. Therefore, designing a rehabilitation program that has eccentric quadriceps strengthening exercises may improve KP and physical activities, but more randomized controlled trials are needed to verify this.
Effects of myofascial release with tennis ball on spasticity and motor functions of upper limb in patients with chronic stroke: A randomized controlled trial
Authors: Parikh Rutu J. , Sutaria Jayshree M. , Ahsan Mohammad , Nuhmani Shibili , Alghadir Ahmad H. , Khan Masood
Published: August 2022

Background:

Impaired motor function and upper extremity spasticity are common concerns in patients after stroke. It is essential to plan therapeutic techniques to recover from the stroke. The objective of this study was to investigate the effects of myofascial release with the tennis ball on spasticity and motor functions of the upper extremity in patients with chronic stroke.

Methods:

Twenty-two chronic stroke patients (male-16, female-6) were selected to conduct this study. Two groups were formed: the control group (n=11) which included conventional physiotherapy only and the experimental group (n=11) which included conventional physiotherapy along with tennis ball myofascial release – in both groups interventions were performed for 6 sessions (35 minutes/session) per week for a total of 4 weeks. The conventional physiotherapy program consisted of active and passive ROM exercises, positional stretch exercises, resistance strength training, postural control exercises, and exercises to improve lower limb functions. All patients were evaluated with a modified Ashworth scale for spasticity of upper limb muscles (biceps brachii, pronator teres, and the long finger flexors) and a Fugl-Meyer assessment scale for upper limb motor functions before and after 4 weeks. Nonparametric (Mann–Whitney U test and Wilcoxon signed-rank test) tests were used to analyze data statistically. This study has been registered on clinicaltrial.gov (ID: NCT05242679).

Results:

A significant improvement (P < .05) was observed in the spasticity of all 3 muscles in both groups. For upper limb motor functions, significant improvement (P < .05) was observed in the experimental group only. When both groups were compared, greater improvement (P < .05) was observed in the experimental group in comparison to the control group for both spasticity of muscles and upper limb motor functions.

Conclusion:

Myofascial release performed with a tennis ball in conjunction with conventional physiotherapy has more beneficial effects on spasticity and motor functions of the upper extremity in patients with chronic stroke compared to conventional therapy alone.
Research on depression in Parkinson disease: A bibliometric and visual analysis of studies published during 2012–2021
Authors: Liu Yan , Ding Linlin , Xianyu Yunyan , Nie Shuke , Yang Jiying
Published: August 2022

Background:

The diagnosis and treatment rate of Parkinson disease (PD) with depression has a low diagnostic rate, and there is no consensus on the choice of treatment mode. This study evaluates the global research trends of scientific outputs related to depression in PD from multiple perspectives, using a bibliometric analysis and visualization tool to scientifically analyze the knowledge from the literature.

Methods:

Literature related to depression in PD published from 2012 to 2021 was included and selected from the Web of Science Core Collection database in October 2021. CiteSpace software was used to visualize and analyze co-occurrence analyses for countries, institutions, authors, and keywords.

Results:

A total of 4533 articles from the Web of Science database were included. The United States made the largest contribution with the majority of publications (1215; 29.40%). Toronto University was the most productive institution. PD, depression, quality of life, dementia, nonmotor symptom, prevalence, anxiety, Alzheimer disease, symptom, and disorder would be significantly correlated with depression in PD. The current hot spots in this field focus on the following: risk factors for depression in PD, assessment scale of depression in PD, and rehabilitation of depression in PD.

Conclusions:

This analysis not only reveals the current research trends and hotspots but also provides some instructive suggestions on the development of depression in PD.
Bibliometric and visual analysis of research on nutcracker syndrome from 1974 to 2021: A systematic review
Authors: Jiang Yuchang , Gan Zaili , Wang Qinsheng , Chen Yang , Jiang Yong
Published: August 2022

Background:

At present, researchers have obtained fruitful results in the study of nutcracker syndrome (NCS), but there is still a lack of systematic research on the overall status of this disease. This article aims to describe the past and current status of research into NCS, and predict future research trends and popular research topics.

Methods:

Using bibliometric and visualization methods, 552 articles related to NCS collected from the Scopus database from 1974 to 2021 were analyzed from multiple perspectives.

Results:

Overall, the amount of literature related to NCS is on the rise every year, and the number of citations is the turning point in 2006. The United States has the largest number of publications and has the most extensive cooperation with other countries. The main contents of the co-authored study focused on the symptoms, surgical procedures, and concomitant diseases of NCS. Keywords such as peak velocity, ultrasonography, orthostatic proteinuria, etc appeared earlier, whereas diagnosis, chronic pelvic pain, endovascular stents, etc appeared later.

Conclusions:

The literature utilization rate of NCS is relatively insufficient. The pathogenesis and pathological mechanisms need to be further studied, and the diagnostic criteria and surgical methods will continue to be favored by clinicians.
Effect of adding a supervised physical therapy exercise program to photobiomodulation therapy in the treatment of cervicogenic somatosensory tinnitus: A randomized controlled study
Authors: Eladl Hadaya Mosaad , Elkholi Safaa M. , Eid Marwa M. , Abdelbasset Walid Kamal , Ali Zeinab A. , Bahey El-Deen Heba A.
Published: August 2022

Objectives:

To evaluate the effectiveness of adding a supervised physical therapy exercise program to photobiomodulation therapy (PBMT) in the treatment of cervicogenic somatosensory tinnitus (CST).

Methods:

Forty patients suffering from CST with age 45–55 years were included in the study. They were assigned randomly into 2 groups, 20 per each. (Study group) Group (A) received a supervised physical therapy exercise program in addition to 20 minutes PBMT with a 650-nanometer wavelength and a 5 milliWatt power output, spot size of 1 cm2, and energy density of 6 Joules, 3 sessions per week for 8 consecutive weeks, plus traditional medical treatment. While (control group), group (B) received the same PBMT protocol, 3 sessions per week for 8 consecutive weeks in addition to the traditional medical treatment. Tinnitus visual analog scaling (VAS), tinnitus handicap inventory (THI), and cervical range of motion (ROM) were measured at baseline and after 8 weeks.

Results:

Mixed MANOVA showed a statistically significant reduction in tinnitus VAS, THI, and a significant improvement in cervical ROM (flexion, extension, right bending, left bending, right rotation, and left rotation) in favor of Group A (P< .05). There was a significant decrease in posttreatment VAS treatment (P> .001) MD [−2.05(−2.68:−1.41)], and THI relative to pretreatment mean difference [−5.35(−8.51: −2.19)] and a significant increase in posttreatment neck ROM in Groups A and B relative to pretreatment neck ROM (P> .001). Flexion range posttreatment MD[3.65(1.64:5.65)], Extension MD [6.55(1.35:11.75)], right bending MD[3.8(2.51:5.08)], left bending MD[1.75(0.19:3.3)], right rotation MD [3.5(1.28:5.71)] and left rotation [2.75(0.67:4.82)].

Conclusions:

Adding a supervised physical therapy exercise program to PBMT showed positive and beneficial effects in the treatment of CST using VAS, THI, and Cervical ROM assessment tools.
Surface ECG–based complexity parameters for predicting outcomes of catheter ablation for nonparoxysmal atrial fibrillation: efficacy of fibrillatory wave amplitude
Authors: Park Jong-Il , Park Seung-Woo , Kwon Min-Ji , Lee Jeon , Kim Hong-Ju , Lee Chan-Hee , Shin Dong-Gu
Published: August 2022

Catheter ablation (CA) is a well-established therapy for rhythm control in atrial fibrillation (AF). However, CA outcomes for persistent AF remain unsatisfactory because of the high recurrence rate despite time-consuming efforts and the latest ablation technology. Therefore, the selection of good responders to CA is necessary. Surface electrocardiography (sECG)-based complexity parameters were tested for the predictive ability of procedural termination failure during CA and late recurrence of atrial arrhythmias (AA) after CA. A total of 130 patients with nonparoxysmal AF who underwent CA for the first time were investigated. A 10-second sECG of 4 leads (leads I, II, V1, and V6) was analyzed to compute the fibrillatory wave amplitude (FWA), dominant frequency (DF), spectral entropy (SE), organization index (OI), and sample entropy (SampEn). The study endpoints were procedural termination failure during CA and late (≥1 year) AA recurrence after CA. In the multivariate analysis, FWA in lead V1 and DF in lead I were independent predictors of successful AF termination during CA (P <.05). The optimal cut-off values for FWA in lead V1 and DF in lead I were 60.38 μV (area under the curve [AUC], 0.672; P = .001) and 5.7 Hz (AUC, 0.630; P = .016), respectively. The combination of FWA of lead V1 and DF of lead I had a more powerful odds ratio for predicting procedural termination failure (OR, 8.542; 95% CI, 2.938–28.834; P < .001). FWA in lead V1 was the only independent predictor of late recurrence after CA. The cut-off value is 65.73 μV which was 0.634 of the AUC (P = .009).

These sECG parameters, FWA in lead V1 and DF in lead I, predicted AF termination by CA in patients with nonparoxysmal AF. In particular, FWA in lead V1 was an independent predictor of late recurrence of AA after CA.
Which combination of different ultrasonography modalities is more appropriate to diagnose breast cancer?: A network meta-analysis (a PRISMA-compliant article)
Authors: Zhou Yang , Wu Jialing
Published: August 2022

Background:

Abundant amount of literature that analyze the various detection of different ultrasound methods, no comprehensive literature that investigates the diagnostic values of breast cancer (BC) by different ultrasonography modalities through a network meta-analysis (NMA) has been made available. Each imaging diagnostic examination has its own advantages and disadvantages, and any imaging examination is not enough to make an accurate diagnosis of the disease. Thus, this study aimed to compare diagnostic values among different ultrasonography modalities, including the information of 2-dimension, stiffness and blood flow, by a network meta-analysis in the hopes of understanding which imaging methods are better and which combination of different ultrasonography modalities is more appropriate to diagnose BC.

Methods:

We made use of Cochrane Library, PubMed, and Embase in order to obtain literature and papers. The combination analysis of both direct and indirect evidence in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value(NPV) and accuracy was conducted so as to assess the odds ratios (ORs) and surface under the cumulative ranking curve (SUCRA) values of the 8 different ultrasound methods.

Results:

A total of 36 eligible diagnostic tests regarding 8 ultrasound methods were included in the study. According to this network meta-analysis, Breast Imaging Reporting and Data System (BI-RADS) 4b exhibited higher specificity, PPV, and accuracy and lower sensitivity and NPV than BI-RADS 4a. Contrast-enhanced ultrasound (CEUS) had the highest sensitivity, PPV, NPV and accuracy and superb microvascular imaging (SMI) had the highest specificity among color Doppler flow imaging (CDFI), power Doppler imaging(PDI), SMI and CEUS. There was no significant difference in diagnostic indexes between SMI and CEUS. Shear wave elastrography (SWE) had higher PPV and accuracy and lower sensitivity, specificity NPV than strain elastography (SE).

Conclusion:

The results of this network meta-analysis suggested more appropriate combination of different ultrasound modalities is BI-RADS 4b, SMI, and SWE for the diagnosis of breast cancer.
Time resolved DCE-MRI of the kidneys: Evaluation of the renal vasculatures and tumors using F-DISCO with and without compressed sensing in normal and wide-bore 3T systems
Authors: Yamada Takahiro , Masui Takayuki , Sasaki Masako , Katayama Motoyuki , Iwadate Yuji , Takei Naoyuki , Miyoshi Mitsuharu
Published: August 2022

Dynamic contrast-enhanced MR imaging (DCE-MRI) has been widely used for the evaluation of renal arteries. This method is also useful for tumor and renal parenchyma characterization. The very fast MRI may provide stable and precise information regarding vasculature and soft tissues. The purpose of this study was to evaluate the ability of DCE-MRI to assess renal vasculatures and tumor perfusions using Differential subsampling with Cartesian ordering with spectrally selected inversion recovery with adiabatic pulses (F-DISCO) with and without compressed sensing (CS) in normal and wide-bore 3T systems.

Fifty-one patients who underwent DCE-MRI using F-DISCO with or without CS for evaluation of renal or adrenal regions were included. Image quality, artifacts, fat saturation, and selective visual recognition of renal vasculatures were assessed by using a 5-point scale. Tumor recognition was verified by using a 5-point scale of confidence level. Signal intensities of each structure were also measured.

In all cases, the temporal resolution of each phase for DCE-MRI was 1.9 to 2.0 seconds. Image quality, artifacts, fat saturation, and selective visual recognition of vasculatures were all acceptable (mean score 4.2–4.9). The selective visualization of renal arteries and veins was successfully accomplished (mean score 4.0–4.9). Contrast media perfusion for renal vasculature, renal parenchyma, and tumors was also recognized.

DCE-MRI for the evaluation of renal vasculatures and tumors using F-DISCO with or without CS can be performed with high temporal and spatial resolutions in normal and wide-bore 3T systems. This information can be obtained in a stable fashion throughout the dynamic contrast study. CS can additionally provide benefits that the total imaging time may be shorter than without CS.
The clinical significance of thyroid hormone-responsive in thyroid carcinoma and its potential regulatory pathway
Authors: Yu Zhen-xing , Xiang Cheng , Xu Sheng-gui , Zhang Yang-ping
Published: August 2022

The study aimed to evaluate the clinical significance of thyroid hormone-responsive (THRSP) and explore its relevant pathways in thyroid carcinoma (THCA).

The gene expression data of THRSP were obtained and the prognostic significance of THRSP in THCA was analyzed through various bioinformatics databases. Then, the factors influencing THRSP mRNA expression were explored, and the function of THRSP in predicting the lymph node metastasis (LNM) stage was determined. We further performed the enrichment analysis and constructed a protein–protein interaction (PPI) network to examine potential regulatory pathways associated with THRSP.

THRSP gene expression was significantly increased in THCA compared with the normal tissues. High THRSP mRNA expression had a favorable overall survival (OS) in THCA patients (P < .05). Additionally, the mRNA expression of THRSP was related to stage, histological subtype, and methylation among THCA patients (all P < .05). Besides, THRSP served as a potent predictor in discriminating the LNM stage of thyroid cancer patients. According to Kyoto Encyclopedia of Genes and Genomes (KEGG) and gene set enrichment analysis (GSEA) on THRSP-associated genes, THRSP was positively related to metabolic pathways.

The upregulation of THRSP predicted a good OS in THCA patients. Furthermore, THRSP might inhibit THCA progression through positive regulation of metabolism-associated pathways.
Radiofrequency ablation (RFA) compared to observation for benign thyroid nodules: emerging considerations for judicious use
Authors: Sinclair Catherine F. , Bastien Amanda J. , Ho Allen S.
Published: August 2022

Purpose of review

Radiofrequency ablation (RFA) for thyroid nodules confers tangible advantages over surgery, which include promising outcomes in the context of a minimally invasive procedure and the functional benefits of organ preservation. However, the ubiquity of benign nodules worldwide may spur the risk of misuse in cases where there is negligible gain over conventional surveillance. This review summarizes new developments in RFA and examines its judicious utilization in benign nodules.

Recent findings

RFA appears to be safe and effective for addressing compressive or cosmetic issues caused by benign functional and nonfunctional thyroid nodules. Volume regression occurs over 12 months, with some cases requiring multiple staged RFA procedures to achieve adequate shrinkage or to address regrowth. Complication rates including recurrent laryngeal nerve injury are reportedly low and are mitigated by strategic technical maneuvers, training, and experience. Consensus guidelines across international societies have emerged to better define appropriate patient candidates. Although association of overuse in analogous disciplines has been well established, no evidence of misuse in thyroid RFA has been described thus far.

Compelling multi-institutional data support RFA as first-line treatment for select benign thyroid nodules. Defining the nuances of patient selection and long-term surveillance are necessary to substantiate current observed results. Given the high incidence of thyroid nodules worldwide, it is important to emphasize that the majority of benign nodules will not require any intervention. Thorough consideration and careful implementation of recommended guidelines will hopefully lead to measurable benefit and avoid financial misuse.
Considerations for routinely testing for high lipoprotein(a)
Authors: Nurmohamed Nick S. , Moriarty Patrick M. , Stroes Erik S.G.
Published: August 2022

Purpose of review

Lipoprotein (a) [Lp(a)] is a likely causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic valve disease, confirmed by Mendelian randomization. With reliable assays, it has been established that Lp(a) is linearly associated with ASCVD. Current low-density lipoprotein cholesterol (LDL-C) lowering therapies do not or minimally lower Lp(a). This review focuses on the clinical importance and therapeutic consequences of Lp(a) measurement.

Recent findings

Development of RNA-based Lp(a) lowering therapeutics has positioned Lp(a) as one of the principal residual risk factors to target in the battle against lipid-driven ASCVD risk. Pelacarsen, which is a liver-specific antisense oligonucleotide, has shown Lp(a) reductions up to 90% and its phase 3 trial is currently underway. Olpasiran is a small interfering RNA targeting LPA messenger RNA, which is being investigated in phase 2 and has already shown dose-dependent Lp(a) reductions up to 90%.

Lp(a) should be measured in every patient at least once to identify patients with very high Lp(a) levels. These patients could benefit from Lp(a) lowering therapies when approved. In the meantime, therapy in high Lp(a) patients should focus on further reducing LDL-C and other ASCVD risk factors.
Types of Social Support That Colorectal Cancer Survivors Need by Treatment Phase
Authors: Yoon Jaehee , Jeong Donghoon , Son Heesook
Published: August 2022

Background

Evaluating the needs of colorectal cancer survivors is critical for developing and providing effective supportive services; however, little is known about the specific needs of the survivors.

Objectives

The aim of this study was to examine the types of social support that colorectal cancer survivors need at each treatment phase.

Methods

Data were extracted using text-mining analysis from posts on an online self-help group for colorectal cancer survivors in Korea from 2011 to 2020. Classification analysis was performed based on the frequency of terms posted, and word clouds were created.

Results

In the pretreatment phase, support for pain and diagnostic testing were needed. In the treatment phase, needing support for colorectal cancer treatment and managing subsequent adverse events were frequently mentioned. In the posttreatment phase, informational interventions providing information on adjusting to changes in bowel functions and preventing cancer recurrence were needed.

Conclusions

There were differences in the types of social support and the number of words frequently used across phases of treatment, highlighting the need for phase-specific supportive interventions. The highest identified needs, including colorectal cancer treatment and adverse events in the treatment phase, suggest that colorectal cancer survivors need additional information about treatment within the healthcare system.

Implications for Practice

Colorectal cancer survivors have specific needs that vary by their treatment stage. Supportive services that reflect the needs of each treatment phase are needed to improve the physical and mental health and quality of life of colorectal cancer survivors.
Transcanal Endoscopic Versus Microscopic Tympanoplasty: Is There a Difference in Perforation Closure Rates?
Authors: Mitton Tanner , Kim Jenny , Killeen Daniel E. , Hunter Jacob B. , Isaacson Brandon , Kutz Joe Walter
Published: August 2022

Objective:

To compare closure rates of endoscopic and microscopic tympanoplasty (MT) as influenced by perforation size, perforation location, and graft position.

Study Design:

Retrospective chart review.

Setting:

Tertiary university medical center.

Patients:

Adult patients who underwent tympanoplasty by a fellowship-trained neurotologist from January 2010 to December 2019, had at least 2 months of follow-up, and had a tympanic perforation with no cholesteatoma before surgery.

Interventions:

Transcanal endoscopic tympanoplasty (ET) or MT.

Main Outcome Measures:

The primary outcome is postoperative closure of the tympanic membrane perforation as assessed using otomicroscopy at the last follow-up appointment.

Results:

Two-hundred and eleven patients—98 in the transcanal ET group and 113 in the MT group—were identified. Tympanic membrane closure rates were not significantly different between the ET and MT groups (79.6% and 84.1% respectively; P = 0.473), and further multivariable analysis revealed that closure rates for ET relative to MT had an insignificant odds ratio (0.56; P = 0.144). Similar analyses also found no significant difference between the 2 methods in subsets of perforation size (small, large, subtotal/total), perforation location (anterior, posterior, inferior), and graft position (underlay, overlay).

Conclusions:

ET resulted in similar rates of postoperative closure rates compared with the microscopic technique.
Breast Cancer Recurrence after Smooth vs. Textured Implant-Based Breast Reconstruction: A Matched Cohort Study
Authors: Wu Zhen-Yu , Han Hyun Ho , Han Jing , Son Byung-Ho , Eom Jin Sup , Kim Sung-Bae , Gong Gyungyub , Kim Hak Hee , Ahn Sei-Hyun , Ko BeomSeok
Published: August 2022

Background:

An increasing number of reports on breast implant-associated anaplastic large cell lymphoma have recently raised concerns about the potential influence of breast implants on carcinogenicity, particularly implants with a textured surface. We compared the recurrence outcomes between smooth and textured implant reconstructions for breast cancer.

Methods:

All patients who underwent immediate direct-to-implant (DTI)-based breast reconstruction for primary breast cancer between January 2010 and December 2016 were reviewed. A total of 590 patients were included. After propensity score 1:2 matching, 138 patients were included in the smooth implant group and 276 patients in the textured implant group. Locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), and distant metastasis-free survival (DMFS) rates were compared between the groups.

Results:

After matching, the median follow-up periods were 62 months and 66 months for the smooth and textured groups, respectively. We observed no significant differences between the smooth and textured implant groups in terms of locoregional recurrence (10.9% vs. 11.6%; P = 0.827), distant metastasis (3.6% vs. 4.0%; P = 0.547), or first recurrence (12.3% vs. 13.4%; P = 0.757) rates. No significant differences were observed between the groups in five-year LRRFS (89.5% vs. 89.4%; P = 0.840), DFS (87.7% vs. 88.1%; P = 0.794), or DMFS (98.8% vs. 96.8%; P = 0.741) rates.

Conclusions:

No significant differences were observed between the smooth and textured implant groups in this matched cohort analysis of recurrence outcomes in patients with primary breast cancer who underwent immediate DTI reconstruction. Further larger-scale investigations are necessary to validate our results.
Complications Associated with Contralateral Prophylactic Mastectomy: A Systematic Review and Meta-Analysis
Authors: Murphy Alexander I , Asadourian Paul A , Mellia Joseph A , Rohde Christine H
Published: August 2022

Background:

No prior systematic review and meta-analysis has aimed to answer the frequently-studied question: does a contralateral prophylactic mastectomy (CPM) increase complication risk for unilateral breast cancer patients undergoing unilateral mastectomy (UM)?

Methods:

A February 2021 search for studies on complications of UM+CPM identified 15 articles meeting inclusion criteria. Meta-analyses were conducted to compare complications of 1) diseased versus CPM breasts for UM+CPM patients and 2) patients undergoing UM+CPM versus UM alone when grouped by their different reconstructive methods. Outcomes included incidence of any complication and any severe complication requiring re-operation, re-admission, or delay in adjuvant therapy.

Results:

For all UM+CPM patients, the diseased breast was slightly more prone to complications versus the CPM breast (RR:1.24, CI:1.02-1.51). In studies that stratified by reconstructive method, incidence of complications was higher for UM+CPM versus UM alone for patients with no reconstruction (RR:2.03, CI:1.38-2.98), prosthetic-based reconstruction (RR:1.42, CI:1.13-1.80), and autologous reconstruction (RR:1.32, CI:1.09-1.61). Similar results were found by the only prospective trial on the topic, which showed the same for more severe complications. Other smaller retrospective studies that did not stratify by reconstructive method showed similar complications for UM+CPM versus UM alone (RR:1.06, CI:0.79-1.42). These groups had similar incidences of complication-related delay in adjuvant therapy, as demonstrated by one study.

Conclusions:

After UM+CPM, CPM breasts incur only slightly fewer complications. Stronger evidence supports more complications for UM+CPM than UM alone, although some studies report no difference. More work is needed to determine the effect of complications on timing of adjuvant therapy.
The Palpable Nodule After Autologous Fat Grafting: Distinguishing Benign Versus Malignant Lesions in a Breast Reconstruction Cohort
Authors: Fracol Megan , Allison Sophia , Chu Yuyang , Yu Yufan , Sood Rachita , Feld Lauren N. , Kim John Y.S.
Published: August 2022

Background:

Nodule formation after autologous fat grafting (AFG) to the breast is the most common complication. In the reconstructive population, this generates significant patient anxiety and presents a diagnostic challenge. We characterized palpable nodule occurrence after AFG in breast reconstruction and compared benign versus malignant nodule characteristics.

Methods:

Chart review of the senior author’s experience with breast fat grafting was performed. Data extracted included demographics, intra-operative details, nodule data, radiographic characteristics and biopsy results. Logistic regression identified risk factors for nodule formation. Unpaired t-tests and Fisher’s exact tests compared characteristics of benign versus malignant nodules.

Results:

In total, 7 75 breasts were identified that underwent 1,158 fat grafting procedures, of which 67 (8.6%) developed palpable nodules. Sonographic characterization of nodules included presumed fat necrosis (38.2%), benign lesion (27.6%), presumed oil cysts (17.1%), indeterminate (8.9%) and concerning for malignancy (8.1%). Lesions concerning for malignancy were more often irregular (10.0% versus 0-2.9% of benign nodules) and more often larger than 0.8 cm in greatest dimension (80% versus 42.9%-61.8% of benign nodules). Six patients developed a palpable local recurrence. Malignant nodules tended to be larger (1.45 cm versus 0.70 cm, p=0.03), were more often vascular (50% versus 3.8%, p=0.03) and tended to occur later (17.5 months versus 10.0 months, p=0.60). Benign nodules occurred in the setting of larger fat graft volumes (64.2 cc versus 40.0 cc, p=0.008).

Conclusion:

This study provides the first comparison of radiographic and clinical characteristics between benign and malignant palpable nodules post-AFG in breast reconstruction.
“In Free Flap Autologous Breast Reconstruction Frailty Is a More Accurate Predictor of Postoperative Complications than Age, Body Mass Index, or ASA class: A Retrospective Cohort Analysis on the ACS-NSQIP Database.”
Authors: Joo Alex , Giatsidis Giorgio
Published: August 2022

Background:

Free flap autologous breast reconstruction (f-ABR) improves quality of life in cancer survivors but has a 5-47% higher postoperative complication (PCs) rate in vulnerable patients, such as those with obesity or the elderly. Given the high (respectively: 43% and 16%) and rising prevalence of these conditions, operative risk prediction is critical to guide targeted care. Age, BMI, and ASA class have shown inaccuracies as predictive factors of PCs in f-ABR. Since frailty, a measure of vulnerability, was reported to be a reliable predictor of PCs in multiple other surgical fields, we hypothesized that it would be an accurate predictor of PCs also in f-ABR.

Methods:

Patients undergoing f-ABR (CPT: 19364) were identified using the ACS-NSQIP (American College of Surgeons-National Surgical Quality Improvement Program) database (01/2010-12/2018). Frailty was calculated using the validated modified Frailty Index (mFI). Rates of wound complications, bleeding episodes, readmissions, returns to operating room (ROR), and DVTs were compared across mFI score, BMI, age, and ASA class.

Results:

mFI ≥ 2 was associated with 22.22% (p <0.001) wound complications; 15.79% (p <0.001) bleeding episodes; 8.20% (p <0.001) readmissions; 17.19% (p <0.001) ROR; and 1.81% (p <0.05) DVTs. Higher BMI, age, and ASA class did not significantly correlate with increased rates in one or more PCs. Only a high mFI was consistently associated with significantly higher odds of complications in all complication types.

Conclusions:

As a reliable and accurate predictor of PCs in f-ABR, frailty could be used preoperatively to counsel patients and guide surgical care.
“Closed Incision Negative Pressure Therapy (ciNPT) reduces abdominal donor site surgical wound dehiscence in Deep Internal Epigastric Perforator (DIEP) flap breast reconstructions: DEhiscence PREvention Study II (DEPRES II) - a Randomized Clinical Trial”
Authors: Muller-Sloof Emmy , de Laat Erik , Kenç Onur , Kumaş Ali , Vermeulen Hester , Hummelink Stefan , Ulrich Dietmar J.O.
Published: August 2022

Background:

In breast reconstruction surgeries, surgical wound dehiscence is a serious complication which generates a significant burden on patients and healthcare systems. There are indications that postoperative treatment with closed incision negative pressure therapy (ciNPT) has been associated with reduced wound dehiscence rates. This randomized clinical trial examines the effect of ciNPT application on abdominal donor site surgical wound dehiscence in low- and high-risk patients undergoing a breast reconstruction with a deep internal epigastric perforator (DIEP) flap.

Methods:

Eighty eligible women, stratified as low- or high-risk patients, were included and were randomized for treatment with either ciNPT or adhesive strips (AS) by drawing sealed, opaque envelopes. All surgeons were kept blind for allocation. Primary outcomes were surgical wound dehiscence and surgical site infection at the abdominal donor site upon follow-up after 12 weeks. Secondary outcomes were seroma and hematoma formation. Five patients were excluded from the study due to non-sufficient exposure to the study treatment (n=4) or major protocol deviation (n=1).

Results:

A total of 75 women, low-risk (n=38) and high-risk (n=37), received either ciNPT (n=36) or AS (n=39). Patients’ demographics did not differ significantly. Donor-site surgical wound dehiscence occurred in 23 patients; the Absolute Risk Reduction was statistically significant (21.6%, 95% Confidence Interval [1.5-41.7]). No statistically significant differences were found in surgical site infection or secondary outcomes.

Conclusions:

In this randomized clinical trial, postoperative treatment with ciNPT decreased the incidence of surgical wound dehiscence at the abdominal donor site in low- and high-risk DIEP flap breast reconstruction patients.
Duration of antibiotic therapy in Gram-negative infections with a particular focus on multidrug-resistant pathogens
Authors: Haddad Sara F. , Allaw Fatima , Kanj Souha S.
Published: August 2022

Purpose of review

Antimicrobial overuse is a major health problem that contributes to antimicrobial resistance (AMR). Infections with Gram-negative bacilli (GNB) and multidrug-resistant organisms (MDRs) are associated with high morbidity and mortality, particularly in patients with underlying medical conditions.

Recent findings

Although many recent studies have been published about the novel antibiotics in treating infections including those due to MDR-GNB, the optimal duration of treatment (DOT) remains inconclusive. Recent observation has supported that short antibiotic therapy (SAT) decreases AMR and adverse effects. This narrative review provides an overview of the most recent published studies on the duration of therapy in the treatment of GNB infections, including hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), intra-abdominal infections (IAIs), bloodstream infections (BSIs) and urinary tract infections (UTIs), with a particular focus on MDR-GNB.

Studies showed different outcomes when comparing SAT to long antimicrobial therapy (LAT). No generalization can be made on all sites of infections and different GNBs. Further studies are needed to address the optimal DOT in MDR-GNB, as this group is underrepresented in recent studies.
Mycetoma, chromoblastomycosis and other deep fungal infections: diagnostic and treatment approach
Authors: Seas Carlos , Legua Pedro
Published: August 2022

Purpose of review

to review recent advances in the epidemiology, diagnosis, and treatment of deep fungal infections

Recent findings

Mycetoma and chromoblastomycosis are the only deep fungal infections incorporated in the list of neglected tropical diseases. These infections start in the skin but progress to deep tissues if not recognized early. A wide array of fungal pathogens are the causative agents. Molecular methods allow for early and accurate identification of the pathogens, but are unfortunately not available in endemic areas. Treatment options are mostly based upon clinical experience rather than on well-designed clinical trials

Deep fungal infections of the skin and soft tissues are rare conditions of wide world distribution but mostly reported from tropical countries. Urgent need for affordable and easily accessible molecular methods and well-conducted studies to allow for accurate diagnosis and to provide evidence to guide proper therapy are urgently needed.