bluuebunny/crossref_metadata_2025 huggingface dataset:
A qualitative study of patients’ and carers’ perspectives on factors influencing access to hypertension care and compliance with treatment in Nigeria
Authors: Ukoha-Kalu Blessing O. , Adibe Maxwell O. , Ukwe Chinwe V.
Published: March 2023

Objective:

We explored patients’ and carers’ perspectives on factors influencing access to hypertension care and compliance with treatment.

Methods:

This was a qualitative study using in-depth interviews with hypertensive patients and/or family carers receiving care at a government-owned hospital in north-central Nigeria. Eligible participants were patients who had hypertension, receiving care in the study setting, were aged 55 years and over and had given their written/thumbprint consent to participate in the study. An interview topic guide was developed from the literature and through pretesting. All the interviews were held face-to-face by a member of the research team. This study was conducted between December 2019 and February 2020. NVivo version 12 was used to analyse the data.

Results:

A total of 25 patients and 13 family carers participated in this study. To understand the barriers to compliance with hypertension self-management practices, three themes were explored, namely: personal factors, family/societal factors and clinic/organization factors. Support was the key enabling factor for self-management practices, which were categorized to emerge from three sources namely: family members, community and government. Participants reported that they do not receive lifestyle management advice from healthcare professionals, and do not know the importance of eating low-salt diets/engaging in physical activities.

Conclusion:

Our findings show that study participants had little or no awareness of hypertension self-management practices. Providing financial support, free educational seminars, free blood pressure checks, and free medical care for the elderly could improve hypertension self-management practices among patients living with hypertension.
Deep Learning-Based Classification of Subtypes of Primary Angle-Closure Disease With Anterior Segment Optical Coherence Tomography
Authors: Eslami Yadollah , Mousavi Kouzahkanan Zahra , Farzinvash Zahra , Safizadeh Mona , Zarei Reza , Fakhraie Ghasem , Vahedian Zakieh , Mahmoudi Tahereh , Fadakar Kaveh , Beikmarzehei Alireza , Tabatabaei Seyed Mehdi
Published: March 2023

Précis:

We developed a deep learning-based classifier that can discriminate primary angle closure suspects (PACS), primary angle closure (PAC)/primary angle closure glaucoma (PACG), and also control eyes with open angle with acceptable accuracy.

Purpose:

To develop a deep learning-based classifier for differentiating subtypes of primary angle closure disease, including PACS and PAC/PACG, and also normal control eyes.

Materials and Methods:

Anterior segment optical coherence tomography images were used for analysis with 5 different networks including MnasNet, MobileNet, ResNet18, ResNet50, and EfficientNet. The data set was split with randomization performed at the patient level into a training plus validation set (85%), and a test data set (15%). Then 4-fold cross-validation was used to train the model. In each mentioned architecture, the networks were trained with original and cropped images. Also, the analyses were carried out for single images and images grouped on the patient level (case-based). Then majority voting was applied to the determination of the final prediction.

Results:

A total of 1616 images of normal eyes (87 eyes), 1055 images of PACS (66 eyes), and 1076 images of PAC/PACG (66 eyes) eyes were included in the analysis. The mean ± SD age was 51.76 ± 15.15 years and 48.3% were males. MobileNet had the best performance in the model, in which both original and cropped images were used. The accuracy of MobileNet for detecting normal, PACS, and PAC/PACG eyes was 0.99 ± 0.00, 0.77 ± 0.02, and 0.77 ± 0.03, respectively. By running MobileNet in a case-based classification approach, the accuracy improved and reached 0.95 ± 0.03, 0.83 ± 0.06, and 0.81 ± 0.05, respectively. For detecting the open angle, PACS, and PAC/PACG, the MobileNet classifier achieved an area under the curve of 1, 0.906, and 0.872, respectively, on the test data set.

Conclusion:

The MobileNet-based classifier can detect normal, PACS, and PAC/PACG eyes with acceptable accuracy based on anterior segment optical coherence tomography images.
Retinal Nerve Fiber Layer Defect Associated With Progressive Myopia
Authors: Song Ji Eun , Wy Seoyoung , Kim Ji-Ah , Lee Eun Ji
Published: March 2023

Purpose:

The purpose of this study was to report a case with bilateral paravascular inner retinal defects (PIRDs) enlarging with progressive myopia, which had different structural characteristics from the glaucomatous retinal nerve fiber layer (RNFL) defect.

Patients and Methods:

A 10-year-old girl with high myopia was referred to a glaucoma clinic for evaluation of RNFL defects shown in color fundus photographs. Fundus photographs and optical coherence tomography examinations were serially reviewed to examine the changes in the RNFL.

Results:

Cleavage of inner retinal layers involving the layers deeper than the RNFL was identified in optical coherence tomography, which appeared and enlarged in both eyes along with progressive myopia and axial elongation during the follow-up period of 8 years.

Conclusions:

PIRD developed and enlarged with progressive myopia and axial elongation in childhood. It should be differentiated from the widening of RNFL defect shown with glaucoma progression.
High-Throughput Drug Screening on Borrelia garinii and Borrelia afzelii Identified Hypocrellin A as an Active Drug Candidate Against Borrelia Species
Authors: Li Tingting , Xin Yuxian , Liu Dongxia , Sun Jingrong , Li Jingwei , Zhang Ying , Feng Jie
Published: March 2023

Lyme disease (LD) is a tick-transmitted infection caused by Borrelia burgdorferi sensu lato species, which include B. burgdorferi, Borrelia afzelii and Borrelia garinii. The majority of patients with early LD can be cured by the standard treatment, yet some still suffer from posttreatment LD syndrome. The presence of Borrelia persisters has been proposed as a contributing factor, because they cannot be completely eradicated by the currently used antibiotics for LD. Finding new pharmaceuticals targeting Borrelia persisters is crucial for developing more effective treatments. Here, we first confirmed the existence of persisters in B. garinii and B. afzelii cultures and then conducted a high-throughput screening of a custom drug library against persister-rich stationary-phase B. garinii and B. afzelii cultures. Among 2427 compounds screened, hypocrellin A (HA), anthracycline class of drugs and topical antibiotics along with some other natural compounds were identified to have strong potential for killing persisters of B. garinii and B. afzelii. HA was the most active anti-Borrelia compound, capable of eradicating stationary-phase Borrelia persisters, in particular when combined with doxycycline and/or ceftriaxone. Liposoluble antioxidant vitamin E was found to antagonize the activity of HA, indicating HA’s target is the cell membrane where HA triggers the generation of reactive oxygen species in the presence of light. HA was found to have distinct bactericidal activity against Borrelia species but had poor or no activity against gram-positive and gram-negative bacteria. Identification of the abovementioned drug candidates may help develop more effective therapies for LD.
Sense of Security Mediates the Relationship Between Self-care Behavior and Health Status of Patients With Heart Failure
Authors: Ingadottir Brynja , Jaarsma Tiny , Norland Kristján , Ketilsdóttir Auður
Published: March 2023

Background

Promoting patients' sense of security is among the goals of nursing care within heart failure management.

Objective

The aim of this study was to examine the role of sense of security in the relationship between self-care behavior and health status of patients with heart failure.

Methods

Patients recruited from a heart failure clinic in Iceland answered a questionnaire about their self-care (European Heart Failure Self-care Behavior Scale; possible scores, 0–100), their sense of security (Sense of Security in Care–Patients' Evaluation; possible scores, 1–100), and their health status (Kansas City Cardiomyopathy Questionnaire, including symptoms, physical limitations, quality of life, social limitations, and self-efficacy domains; possible scores, 0–100). Clinical data were extracted from electronic patient records. Regression analysis was used to examine the mediation effect of sense of security on the relationship between self-care and health status.

Results

The patients (N = 220; mean [SD] age, 73.6 [13.8] years; 70% male, 49% in New York Heart Association functional class III) reported a high sense of security (mean [SD], 83.2 [15.2]) and inadequate self-care (mean [SD], 57.2 [22.0]); their health status, as assessed by all domains of the Kansas City Cardiomyopathy Questionnaire, was fair to good except for self-efficacy, which was good to excellent. Self-care was associated with health status (P < .01) and sense of security (P < .001). Regression analysis confirmed the mediating effect of sense of security on the relationship between self-care and health status.

Conclusions

Sense of security in patients with heart failure is an important part of daily life and contributes to better health status. Heart failure management should not only support self-care but also aim to strengthen sense of security through positive care interaction (provider-patient communication) and the promotion of patients' self-efficacy, and by facilitating access to care.
Application of a new frailty care model
Authors: Siegmund Lee Anne , Novosel Lorraine
Published: March 2023

Frailty is an age-related physiological deterioration that results in weakness, slowness of movement, fatigue, weight loss, and multimorbidity. These limitations lead to an inability to respond to stressors, which ultimately increase risk for poor outcomes including falls, disability, hospitalization, and mortality. Although many medical and physiology-based frailty screening tools and associated theories exist, none are specific to advanced practice nurses and the care of the older adult. For this reason, the authors present the case of a frail older adult and the application of the Frailty Care Model. The authors developed the Frailty Care Model which illustrates a theory that states: Frailty is a fluid condition of aging that will respond to interventions and will progress in the absence of interventions. It is an evidence-based model that helps the nurse practitioner (NP) screen for frailty; apply important nutritional, psychosocial, and physical frailty interventions; and evaluate the care provided to the older adult. The purpose of this article is to present the case of Maria, an 82-year-old woman with frailty, and demonstrate how the NP can apply the Frailty Care Model to inform care of the older adult. The Frailty Care Model is designed so that it can be easily integrated into the workflow of the medical encounter and require little additional time or resources. This case study describes specific examples of using the model to avoid, stabilize, and reverse frailty.
Adrenaline auto-injector injuries: Practical considerations in emergency management in a tertiary hand surgery unit
Authors: McCaughran Pierre William , Ellis Kate , Southall Clea , Zargaran David , Nikkhah Dariush , Mosahebi Afshin
Published: March 2023

Adrenaline auto-injectors are the first line treatment for anaphylaxis in the community setting. Both anaphylaxis and auto-injector carriage are increasing in prevalence. Adrenaline auto-injector injuries are common and most often involve the hand or digits. Such injuries carry a risk of ischemic necrosis due to profound vasoconstriction, especially if there is undying vascular pathology such as Raynaud’s disease. The effects can be readily reversed with local infiltration of phentolamine. A survey was circulated to 40 clinicians working in the emergency and hand surgery departments of a major urban center. Knowledge of adrenaline duration of action and its reversal (agent, dose and location in the hospital) was assessed. All clinicians working within the two departments were eligible for participation. Only 25% of clinicians surveyed were aware of the duration of action of adrenaline. Half were aware of the correct reversal agent and only 20% knew the correct dose. Only one person was aware of phentolamine’s location within the hospital. There is relatively poor clinician knowledge surrounding adrenaline reversal and a lack of easily accessible information available about dosing and drug location within the hospital. Given the time dependent nature of adrenaline auto-injector injuries Emergency Departments should consider stocking phentolamine in an emergency drugs fridge within the department along with a dosing guide. This is likely to greatly reduce time from presentation to treatment and thus the chances of digital ischemia progressing to necrosis.
Effects of acupuncture and pelvic floor muscle training on bladder dysfunction after spinal cord injury: A meta-analysis
Authors: Zang Y.T. , Bai M.J. , Wang L. , Zhang M.X. , Li L.
Published: March 2023

Objective:

We aimed to systematically review and quantify the association between acupuncture and pelvic floor muscle exercise and bladder dysfunction rehabilitation in individuals with spinal nerve injury.

Methods:

A meta-analysis was conducted using an evidence-based nursing analysis method based on clinical evidence. China National Knowledge Infrastructure, PubMed, VIP database, Wan Fang database, Cochrane Library, and other databases were searched by computer from January 1, 2000 to January 1, 2021. The literature was searched for clinical randomized controlled trials on acupuncture stimulation, pelvic floor muscle function training, and bladder function recovery training after spinal cord nerve injury. Two reviewers independently used The Cochrane Collaboration recommended randomized controlled trial risk of bias assessment tool to evaluate the quality of the literature. Then, the meta-analysis was performed using RevMan 5.3 software.

Results:

A total of 20 studies were included, with a total sample size of 1468 cases, including 734 patients in the control group and 734 patients in the experimental group. The results of our meta-analysis showed that acupuncture treatment [OR = 3.98, 95% CI (2.77, 5.72), Z = 7.49, P < .001] and pelvic floor muscle treatment [OR = 7.63, 95% CI (4.47, 13.04), Z = 7.45, P < .001] was statistically significant.

Conclusion:

Acupuncture and pelvic floor muscle exercise are effective intervention and treatment methods, which have obvious effects on rehabilitation treatment of bladder dysfunction after spinal nerve injury.
Patatin-like phospholipase domain-containing 3 gene (PNPLA3) polymorphic (rs738409) single nucleotide polymorphisms and susceptibility to nonalcoholic fatty liver disease: A meta-analysis of twenty studies
Authors: Zhao Yan , Zhao Wenli , Ma Jingchao , Toshiyoshi Maeda , Zhao Ye
Published: March 2023

Background:

To investigate the correlation between rs738409 polymorphism of patatin-like phospholipase domain-containing protein 3 (PNPLA3) gene (encoding I148m) and genetic susceptibility to nonalcoholic fatty liver disease (NAFLD).

Methods:

Web of Science, Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform databases were subjected to study retrieving, from the earliest records to November 2022. International databases were searched using the key words (PNPLA3 gene or PNPLA3 polymorphism or patatin-like phospholipase domain-containing pro-tein3) and (nonalcoholic fatty liver disease or NAFLD or nonalcoholic steatohepatitis) and their possible combination. There was no limitation to language. Ethnicity and country restrictions were not applied. Hardy–Weinberg equilibrium about the genotype frequencies of rs738,409 polymorphism in group of controls was assessed using a chi-square goodness-of-fit test (P > .05). A chi-square-based Q test was applied to assess heterogeneity among studies. The random-effect model (DerSimonian–Laird method) was used when a probability value of P < .10, I
2 > 50%. If not, the fixed-effect model (Mantel–Haenszel method) was adopted. The current meta-analysis was done by using STATA 16.0.

Results:

Twenty studies are selected for this meta-analysis, which includes totally 3240 patients in the treatment group and 5210 patients in the control group. These studies demonstrated a significant increased association between rs738,409 and NAFLD under 5 models: allelic contrast (odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.65–2.37, P
heterogeneity = 0.000, Z = 7.346, P = .000), homozygote comparison (OR = 3.59, 95% CI = 2.56–5.04, P
heterogeneity = 0.000, Z = 7.416, P = .000), heterozygote comparison (OR = 1.93, 95% CI = 1.63–2.30, P

heterogeneity
= 0.002, Z = 7.507, P = .000), the dominant allele model (OR = 2.33, 95% CI = 1.89–2.88, P
heterogeneity = 0.000, Z = 7.856, P = .000), and the recessive allele model (OR = 2.56, 95% CI = 1.96–3.35, P
heterogeneity = 0.000, Z = 6.850, P = .000). Subgroup analysis shows that the rs738,409 polymorphism of PNPLA3 gene in Caucasians and those with a sample size of < 300 is significantly associated with the susceptibility to nonalcoholic fatty liver. Sensitivity analysis shows that the results of meta-analysis are stable.

Conclusion:

PNPLA3 rs738,409 may play a significant role in increasing risk of NAFLD.
Right ventricular area predicts short-term mortality in acute pulmonary embolism based on CT pulmonary angiography: A retrospective study
Authors: Hu Jie , Tian Xin , Liu Xiaowei , Ma Guojing , Li Caiying
Published: March 2023

We performed this cohort study to assess the prognostic value of right ventricular size, including diameter, area, and volume, in short-term mortality of acute pulmonary embolism (APE) based on 256-slice computed tomography compared with D-dimer, creatine kinase muscle and brain isoenzyme, and Wells scores. A total of 225 patients with APE, who were followed up for 30 days were enrolled in this cohort study. Clinical data, laboratory indices (creatine kinase, creatine kinase muscle and brain isoenzyme, and D-dimer), and Wells scores were collected. The 256-slice computed tomography was used to quantify cardiac parameters (RVV/LVV, RVD/LVD-ax, RVA/LVA-ax, RVD/LVD-4ch, RVA/LVA-4ch) and the diameter of the coronary sinus. Participants were divided into non-death and death groups. The values mentioned above were compared between the 2 groups. The RVD/LVD-ax, RVA/LVA-ax, RVA/LVA-4ch, RVV/LVV, D-dimer, and creatine kinase levels were significantly higher in the death group than in the non-death group (P < .05). The active period of the malignant tumor, heart rate ≥ 100 beats/minutes, and RVA/LVA-ax were positively correlated with early death from APE (P < .05). Active stage of malignant tumor (OR:9.247, 95%CI:2.682–31.888, P < .001) and RVA/LVA-ax (OR:3.073, 95%CI:1.447–6.528, P = .003) were independent predictors of early death due to APE. According to the receiver operating characteristic curve, the cutoff point of RVA/LVA-ax was 1.68 with a sensitivity of 46.7% and specificity of 84.8%. The measurement of ventricular size in the short-axis plane is more convenient and reliable than that in the 4-chamber cardiac plane. RVA/LVA-ax is an independent predictor of early death from APE, and when RVA/LVA-ax > 1.68, the risk of early death from APE increases.
Effect of initial foot angle (IFA) on kinematics and dynamics of body during sit-to-stand transfer
Authors: Yang Shuo , Yi Zicheng , Zhou Binwei , Xue Qiang
Published: March 2023

Sit-to-stand (STS) is considered the most common functional activities in daily life and the basis for other activities. The elderly and patients with lower limb disorders could not complete the STS motion very well due to limb pain and muscle weakness. Physiotherapist find that specific STS transfer strategies can make patients more easily to complete this task. However, few researchers pay attention to the effect of initial foot angle (IFA) on STS motion. Twenty-six healthy subjects were randomly selected to perform STS transfer experiment. The motion characteristic parameters of subjects under 4 different IFAs (nature, 0°, 15°, and 30°) were obtained, including the percentage of duration in each phase, the velocity of joints, rotation angle and angular velocity of joints (shoulder, hip and knee), center of gravity (COG) trajectory. the change of plantar pressure parameters, and dynamic margin of stability. By comparing the motion characteristic parameters obtained under different IFAs and carrying out statistical analysis, the influence of different IFAs on body kinematics and dynamics during STS task was further explored. The kinematic parameters obtained under different IFAs are significantly different. The percentage of duration in each phase of the STS transfer was different with different IFA, the main differences were in phase I and phase II. The phase I of U15 took 24.5% T, while phase I of N, U0 and U30 took about 20% T, and the maximum difference was (U15-U0) 5.4%. The phase II of U15 took the least time, about 30.8% T. When the IFA is nature (N) and 15°(U15), the trajectories of COG are basically in coincidence; when the IFA is 0°(U0) and 30°(U30), the displacement of COG in anterior-posterior direction is larger. The larger the IFA, the smaller the plantar pressure parameter. When the IFA is 15°, the COG is close to the center of limits of stability, which can provide a better stability. This paper summarizes the influence under 4 different experimental conditions of IFAs on STS transfer, so as to provide a starting point and bases for clinicians to develop rehabilitation training protocols and STS motion strategies for patient.
The value of Pediatric Early Warning Score combined with SBAR in neonatal pneumonia nursing: A retrospective cohort study
Authors: Ye Lei , Zhu Meijun , Hong Fei , Zhang Weiyan , Song Lei
Published: March 2023

To observe the effect of the Pediatric Early Warning System (PEWS) score combined with the situation-background-assessment-recommendation (SBAR) shift communication system in neonates with severe pneumonia in the pediatric intensive care unit. A total of 230 neonates admitted to the pediatric intensive care unit of our hospital from January 2018 to January 2021 were enrolled in this study. Participants were divided into an experimental group (110 patients, PEWS score combined with SBAR shift communication system) and a control group (120 patients, routine diagnosis and treatment and shift change). The early recognition rate, incidence of handover problems, and prognosis of critically ill children in the 2 groups were analyzed. Compared to the control group, the correct recognition rate of disease observation and early recognition rate of critically ill children in the experimental group were significantly higher, and the incidence of handover problems was significantly lower (P < .05). There was no significant difference in the incidence of asphyxia, heart failure, and toxic encephalopathy between both groups. The application of the PEWS score combined with the SBAR shift communication system can facilitate timely identification of deterioration of the condition of children with severe pneumonia, reduce handover problems, and help to implement interventions or rescue according to the changes in a patient’s condition, which may be beneficial in improving the patient’s prognosis.
Application of a novel M-NED in ENBD patients: A case series report
Authors: Liu Zhaohui , Lin Runhua , Wu Ruinuan , Deng Jiwen , Sun Dayong
Published: March 2023

Rationale:

The traditional methods for exchanging the endoscopic nasobiliary drainage (ENBD) tube from the mouth to the nose, such as the guidewire method, sponge holding forceps method, and finger method, have significant drawbacks including pharyngeal stimulation symptoms, high incidence of epistaxis, low success rate, and potential bite injuries to the operator.

Patient concerns:

A case series of 9 patients who underwent ENBD at Shenzhen Second People’s Hospital from January 2021 to December 2021 was collected.

Diagnoses:

The study included 9 patients diagnosed with choledocholithiasis, with 3 males and 6 females, with an average age of (55 ± 9.798) years (range 43–71).

Interventions:

The M-NED was used to exchange the ENBD tube, and the success rate, operation time, and complications were recorded.

Outcomes:

All patients successfully completed the operation in one go with an average mouth-nose exchange time of (44.67 ± 13.388) seconds (range 28–65). Two patients had mild adverse events, one of which was controllable bleeding caused by nasal mucosal injury with an estimated blood loss of 1 mL. The other patient had nausea during the operation, which improved after completion.

Lessons:

The novel M-NED is an effective and safe method for exchanging the ENBD tube from the mouth to the nose with a high success rate and low incidence of complications. It is a device with potential clinical application value.
A bibliometric analysis of chronic obstructive pulmonary disease and COVID-19
Authors: Li Yaolin , Wang Huiqin , Jiang Lixiang , Chen Long , Zhao Kai , Li Xiayahu
Published: March 2023

The coronavirus disease 2019 (COVID-19) outbreak became the worst epidemic in decades. Since its inception, COVID-19 has had a dramatic impact on chronic obstructive pulmonary disease (COPD) patients. This study explores explore the current status, hot spots, and research frontiers of COVID-19 and COPD based on a bibliometric approach. The Web of Science Core Collection was used to search the literature related to COPD and COVID-19, and VOSviewer and CiteSpace software were applied to analyze the distribution characteristics, research hotspots, and research frontiers of literature in related fields and to map the scientific knowledge domains. A total of 816 valid publications were included, among which USA, China, and England are the core countries/regions publishing related literature, and the research institutions are concentrated in Huazhong University of Science and Technology (18 papers), University College London (17 papers), and Imperial College London (16 papers). Guan WJ is the most prolific author with the most articles. The journals with the most publications are PLOS ONE, JOURNAL OF CLINICAL MEDICINE, and FRONTIERS IN MEDICINE. The main research hotspots in this field are clinical features, disease management, and mechanism research. By constructing COPD and COVID-19 research network diagrams, we reveal the hot spots, frontiers, and development trends of relevant research fields, which provide a reference for subsequent researchers to quickly grasp the current status of related research fields.
Effect of low-dose propofol combined with dexamethasone on the prevention of postoperative nausea and vomiting in gynaecological day surgery under remimazolam-based general anesthesia
Authors: Xiao Hongyi , Liu Mingming , Man Yan , Wei Yaxin , Ji Fanceng
Published: March 2023

Background:

To observe the effect of low-dose propofol combined with dexamethasone on the prevention of postoperative nausea and vomiting (PONV) in gynaecological day surgery under remimazolam-based general anesthesia.

Methods:

A total of 120 patients, aged from 18 to 65 years old, American Society of Anesthesiologists grade I or II, were scheduled to undergo hysteroscopy under total intravenous anesthesia. The patients were divided into 3 groups (n = 40 each): dexamethasone plus saline group (DC group), dexamethasone plus droperidol group (DD group) and dexamethasone plus propofol group (DP group). Dexamethasone 5 mg and flurbiprofen axetil 50 mg were given intravenously before induction of general anesthesia. Anesthesia induction: remimazolam 6 mg/kg/hours was continuously pumped until sleep and slow intravenous injection of alfentanil 20 ug/kg and mivacurium chloride 0.2 mg/kg was given. Anesthesia maintenance: remimazolam 1 mg/kg/hour and alfentanil 40 ug/kg/hours were continuously pumped. After the start of surgery, DC group was given 2 mL saline, DD group was given droperidol 1 mg, and DP group was given propofol 20 mg. Primary outcome: incidence of PONV in the postanesthesia care unit (PACU). Secondary outcome: incidence of PONV in patients within 24 hours after surgery, as well as general patient data, duration of anesthesia, the recovery time of patients, dose of remimazolam and alfentanil, etc.

Results:

In PACU, patients of group DD and DP showed less PONV than those in group DC (P < .05). Within 24 hours after operation, there was no significant difference in the incidence of PONV among the 3 groups (P > .05), but the incidence of vomiting in DD group and DP group was significantly lower than that in DC group (P < .05). There was no significant difference in general data, anesthesia time, the recovery time of patients and dosage of remimazolam and alfentanil among the 3 groups (P > .05).

Conclusion:

The effect of low-dose propofol combined with dexamethasone to prevent PONV under remimazolam-based general anesthesia was similar to that of droperidol combined with dexamethasone, both of which significantly reduced the incidence of PONV in the PACU compared to dexamethasone alone. However, low-dose propofol combined with dexamethasone had little effect on the incidence of PONV within 24 hours compared to dexamethasone alone and only reduced the incidence of postoperative vomiting in patients.
Prognostic value of elevated plasma angiotensin-converting enzyme 2 in cardiometabolic diseases: A review
Authors: Zhou Gang , Liu Jingchen
Published: March 2023

Angiotensin-converting enzyme 2, as an internal anti regulator of the renin-angiotensin hormone cascade reaction, plays a protective role in vasodilation, inhibition of fibrosis, and initiation of anti-inflammatory and antioxidative stress by degrading angiotensin II and generating angiotensin (1–7). Multiple studies have shown that plasma angiotensin-converting enzyme 2 activity is low in healthy populations without significant cardiometabolic disease, and elevated plasma angiotensin-converting enzyme 2 levels can be used as a novel biomarker of abnormal myocardial structure and/or adverse events in cardiometabolic diseases. This article aims to elaborate the determinants of plasma angiotensin-converting enzyme 2 concentration, the relevance between angiotensin-converting enzyme 2 and cardiometabolic disease risk markers, and its relative importance compared with known cardiovascular disease risk factors. Confronted with the known cardiovascular risk factors, plasma angiotensin-converting enzyme 2 (ACE2) concentration uniformly emerged as a firm predictor of abnormal myocardial structure and/or adverse events in cardiometabolic diseases and may improve the risk prediction of cardiometabolic diseases when combined with other conventional risk factors. Cardiovascular disease is the leading cause of death worldwide, while the renin-angiotensin system is the main hormone cascade system involved in the pathophysiology of cardiovascular disease. A multi-ancestry global cohort study from the general population by Narula et al revealed that plasma ACE2 concentration was strongly associated with cardiometabolic disease and might be an easily measurable indicator of renin-angiotensin system disorder. The association between this atypical hormone disorder marker and cardiometabolic disease is isolated from conventional cardiac risk factors and brain natriuretic peptide, suggesting that a clearer comprehending of the changes in plasma ACE2 concentration and activity may help us to improve the risk prediction of cardiometabolic disease, guide early diagnosis and feasible therapies, and develop and test new therapeutic targets.
Polo-like kinase 1 Decrease During Induction Therapy Could Indicate Good Treatment Response, Favorable Risk Stratification, and Prolonged Survival in Pediatric Acute Lymphoblastic Leukemia: [RETRACTED]
Authors: Zhao Yiran , Li Chunmei , Cai Chunquan , Fu Hongtao , Zhao Zinian , Han Jing , Zhang Fang , Wang Jing
Published: March 2023

Objective:

Polo-like kinase 1 (PLK1) modulates leukemia cell apoptosis, proliferation, and cell cycle arrest in the progression of acute lymphoblastic leukemia (ALL). This study intended to investigate the dysregulation of PLK1 and its association with induction therapy response and prognosis in pediatric ALL patients.

Materials and Methods:

Bone marrow mononuclear cell samples were collected from 90 pediatric ALL patients at baseline and on the 15th day of induction therapy (D15), as well as from 20 controls after enrollment, for the detection of PLK1 by reverse transcription-quantitative polymerase chain reaction.

Results:

PLK1 was increased in pediatric ALL patients compared with controls (P<0.001). In pediatric ALL patients, PLK1 decreased from baseline to D15 (P<0.001). Lower PLK1 at baseline was associated with a good prednisone response (P=0.002), while decreased PLK1 at D15 was related to good prednisone response (P=0.001), better bone marrow response (P=0.025), and favorable risk stratification (P=0.014). In addition, reduced PLK1 at baseline was linked with better event-free survival (EFS) (P=0.046), and decreased PLK1 at D15 was related to prolonged EFS (P=0.027) and overall survival (OS) (P=0.047). Moreover, PLK1 decline ≥25% was linked to favorable EFS (P=0.015) and OS (P=0.008). Further multivariate Cox proportional regression analysis revealed that PLK1 decline ≥25% was independently linked with prolonged EFS (hazard ratio (HR)=0.324, P=0.024) and OS (HR=0.211, P=0.019).

Conclusion:

The reduction of PLK1 after induction therapy reflects a good treatment response and correlates with a favorable survival profile in pediatric ALL patients.
Vincristine Side Effects With Concomitant Fluconazole Use During Induction Chemotherapy in Pediatric Acute Lymphoblastic Leukemia
Authors: Cave Caleb , Ramirez Reyna , High Robin , Ford James , Raulji Chittalsinh , Beck Jill
Published: March 2023

As a mainstay of treatment for acute lymphoblastic leukemia (ALL), vincristine’s side effect profile is well known. Parallel administration of the antifungal fluconazole has been shown to interfere with the metabolism of vincristine, potentially resulting in increased side effects. We conducted a retrospective chart review to determine whether concomitant administration of vincristine and fluconazole during pediatric ALL induction therapy impacted the frequency of vincristine side effects, namely, hyponatremia and peripheral neuropathy. We also evaluated whether the incidence of opportunistic fungal infections was impacted by fluconazole prophylaxis. Medical charts of all pediatric ALL patients treated with induction chemotherapy at Children’s Hospital and Medical Center in Omaha, NE, from 2013 to 2021 were retrospectively reviewed. Fluconazole prophylaxis did not significantly impact the rate of fungal infections. We found no correlation between fluconazole use and increased incidence of hyponatremia or peripheral neuropathy, which supports the safety of fungal prophylaxis with fluconazole during pediatric ALL induction therapy.
Hopping as an Indicator of Chemotoxicity: Gait Analysis in Patients With Leukemia and Lymphoma
Authors: Parker Kellee , Durben Nancy , Oleson David , Yu Yun , Lim Jeong Y. , Recht Michael , Lindemulder Susan
Published: March 2023

Background:

Survivors of acute lymphoblastic leukemia (ALL) can experience chemotherapy-related changes in neuromuscular function, which can persist and impact the quality of life. Clinically, neuromuscular changes are assessed by observing gait. The primary aims of this study were to compare observational gait/functional movement analysis to matched electronic gait analysis in children with ALL and lymphoblastic lymphoma at specific time points during and after treatment.

Patients and Methods:

Participants 2 to 27 years old diagnosed with ALL/lymphoblastic lymphoma who were on or off therapy within 10 years were eligible. Participants underwent electronic gait assessment using GAITRite, observational gait, and functional movement analysis and completed quality of life questionnaires. Parents also completed quality-of-life assessments.

Results:

Electronic gait parameters were not different in this cohort compared with controls. Mean overall scores on observational gait and functional movement analysis improved over time. Hopping was the most frequent and walking was the least frequent noted deficit. Participants had a lower patient and parent-reported QoL scores compared with the general population

Conclusion:

Observational gait and functional movement analysis identified more deficits than the electronic gait assessment. Future studies are warranted to determine whether hopping deficits are an early clinical indicator of toxicity and signal for intervention.
Prognostic Factors and Long-term Outcomes in 41 Children With Primary Hemophagocytic Lymphohistiocytosis: Report of a Single-center Experience and Review of the Literature
Authors: Bayram Cengiz , Tahtakesen Tuba Nur , Arslantaş Esra , Yilmaz Ebru , Özdemir Gül Nihal , Pasli Uysalol Ezgi , Gökçe Müge , Akçay Arzu , Tuğcu Deniz , Ayçiçek Ali
Published: March 2023

Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening hyperinflammatory syndrome with diverse clinical manifestations leading to major diagnostic and therapeutic difficulties. This study aimed to evaluate clinical manifestations, prognostic factors, and long-term outcomes in children with primary HLH. Forty-one patients diagnosed with primary HLH were retrospectively evaluated for patient characteristics, HLH gene mutations, clinical and laboratory manifestations, prognostic factors, and long-term outcomes. The median age of the patients at the time of diagnosis was 3 months (minimum to maximum: 1 to 144 mo). There were 23 patients who had HLH mutation analysis performed, 10 patients with PRF1 mutation, 6 with STX11 mutation, and 7 with UNC13D mutation. Thirteen patients (31.7%) had central nervous system involvement. No correlation was found between overall survival and central nervous system involvement. The estimated 5-year overall survival for the patient who had hematopoietic stem cell transplantation was 9.4 times better than the patients who did not receive hematopoietic stem cell transplantation (81.3% vs 16.7%; P = 0.001). Median serum sodium and blood urea nitrogen levels were significantly higher in deceased HLH patients compared with surviving HLH patients (P = 0.043, and P = 0.017, respectively). Primary HLH has a poor outcome with high mortality, which necessitates well-designed and international clinical trials to improve diagnosis, therapy, and long-term outcomes.
Determinants of Frame Running capacity in athletes with cerebral palsy to improve training routines and classification strategies: A cross-sectional observational study
Authors: Hjalmarsson Emma , Lidbeck Cecilia , Barrero Santiago Laura , Pingel Jessica , Norrbom Jessica , Sanz Gema , Palmcrantz Alexandra , Pontén Eva , von Walden Ferdinand , Fernandez-Gonzalo Rodrigo
Published: March 2023

Objective

Investigate 1) what physical and physiological parameters are most important for Frame Running (FR) capacity, a parasport for individuals with ambulatory difficulties, and 2) determine if FR capacity can be predicted in athletes with cerebral palsy (CP).

Design

Athletes with CP (n = 62, GMFCS I-V; 2/26/11/21/2) completed a 6-minute FR test (6-MFRT). Before the 6-MFRT, muscle thickness, passive range of motion (hip, knee, ankle), selective motor control, and spasticity (hip, knee, ankle) were measured in both legs. In total, 54 variables per individual were included. Data were analyzed using correlations, Principal Component Analysis (PCA), Orthogonal Partial Least Square (OPLS) regression, and Variable Importance in Projection (VIP) analysis.

Results

Mean 6-MFRT distance was 789 ± 335 m and decreased with motor function severity. The OPLS analysis revealed a modest degree of covariance in the variables analyzed, and that the variance in the 6-MFRT distance could be predicted with 75% accuracy based on all the variables measured. VIP analysis indicated hip and knee extensor spasticity (negative effect), and muscle thickness (positive effect) arose as the most important factors contributing to FR capacity.

Conclusions

These results are an important resource to enable optimization of training regimes to improve FR capacity and contribute to evidence-based and fair classification for this parasport.
Medial gastrocnemius muscle properties of children with cerebral palsy after different tone treatments – a pilot study
Authors: Raymond-Pope Christiana J. , Hoffman Daniel B. , Bloxsom Rachael M. , Greising Sarah M. , Novacheck Tom F. , Boyer Elizabeth R.
Published: March 2023

Objective

Spasticity in children with cerebral palsy (CP) can be managed by a spectrum of approaches, from conservative therapy to temporary botulinum toxin A (BoNT-A) injections, to permanent transection of sensory nerves with a selective dorsal rhizotomy (SDR). This pilot study investigated whether these three tone management approaches are associated with histological and biochemical properties of the medial gastrocnemius.

Design

A convenience sample of children with CP undergoing gastrocnemius lengthening surgery were enrolled. Intraoperative biopsies were obtained from three individuals (1 each: minimal tone treatment; frequent gastrocnemius BoNT-A injections; prior SDR). All individuals had plantarflexor contractures, weakness, and impaired motor control prior to the biopsy.

Results

Differences between participants were observed for muscle fiber cross-sectional area, fiber type, lipid content, satellite cell density, and centrally located nuclei. The most pronounced difference was the abundance of centrally located nuclei in the BoNT-A participant (52%) compared to the others (3-5%). Capillary density, collagen area and content, and muscle protein content were similar across participants.

Conclusions

Several muscle properties appeared to deviate from reported norms, though age- and muscle-specific references are sparse. Prospective studies are necessary to distinguish cause and effect and to refine the risks and benefits of these treatment options.
Odds of Influenza in Patients Receiving Intra-Articular Corticosteroid Injections: A Cohort Study
Authors: Sytsma Terin T. , McCoy Rozalina G. , Fischer Karen M. , Dean Kelly R. , Greenlund Laura S.
Published: March 2023

Objective

Although intra-articular corticosteroid (IACS) is injected locally, some systemic absorption occurs, potentially causing immunosuppression in recipients. This study examined odds of influenza in patients who received IACS compared to matched controls.

Design

Adults in our health system who received IACS from May 2012 through April 2018 were 1:1 matched to adults without IACS. The primary outcome was overall odds of influenza. Secondary analyses examined influenza odds by timing of IACS, joint size, and vaccination status.

Results

23,368 adults (mean age 63.5 years, 62.5% female) received IACS and were matched to a control. While there was no difference in influenza odds by IACS status overall (OR 1.13,[95%CI,0.97-1.32]), patients receiving IACS during influenza season had higher odds of influenza than matched controls (OR 1.34,[95%CI,1.03-1.74]). Furthermore, unvaccinated patients who received IACS during influenza season had higher influenza odds compared to matched controls (OR 1.41,[95%CI,1.04-1.91]), while there was no difference among vaccinated patients.

Conclusion

Patients receiving IACS injections during influenza season had higher odds of influenza. However, vaccination appeared to mitigate this risk. Patients receiving IACS injections should be counseled on infection risk and importance of vaccinations. Further research is needed to examine IACS effects on other viral illnesses.
MR Elastography in Cancer
Authors: Guo Jing , Savic Lynn Jeanette , Hillebrandt Karl Herbert , Sack Ingolf
Published: March 2023

The mechanical traits of cancer include abnormally high solid stress as well as drastic and spatially heterogeneous changes in intrinsic mechanical tissue properties. Whereas solid stress elicits mechanosensory signals promoting tumor progression, mechanical heterogeneity is conducive to cell unjamming and metastatic spread. This reductionist view of tumorigenesis and malignant transformation provides a generalized framework for understanding the physical principles of tumor aggressiveness and harnessing them as novel in vivo imaging markers. Magnetic resonance elastography is an emerging imaging technology for depicting the viscoelastic properties of biological soft tissues and clinically characterizing tumors in terms of their biomechanical properties. This review article presents recent technical developments, basic results, and clinical applications of magnetic resonance elastography in patients with malignant tumors.
The Illness Experiences of Chinese Adolescent Patients Living with Crohn Disease
Authors: Chen Lingxi , Wang Danyan , Zhou Yunxian
Published: March 2023

The purpose of this qualitative study was to explore the illness experience of adolescent patients with Crohn disease and describe the impact of the disease on the everyday lives of these individuals within the Chinese social and cultural context to provide references for targeted interventions for the healthcare team. A descriptive qualitative design was adopted. Purposive sampling was used to select Chinese adolescent patients with Crohn disease to participate in face-to-face in-depth interviews. Data analysis was performed using the conventional content analysis method. Through the analysis of data from 14 adolescent patients with Crohn disease, four themes were formed: (1) I am different from others, (2) I am a burden to my parents, (3) I want to be the master of my own body, and (4) I grow up suffering from illness. Healthcare providers should offer more psychological support to adolescent Crohn disease patients and advise parents to shift more attention to the mental health of their children.
Impact of Spousal Donation on Postoperative Outcomes of Living-donor Lobar Lung Transplantation
Authors: Kayawake Hidenao , Tanaka Satona , Yutaka Yojiro , Yamada Yoshito , Ohsumi Akihiro , Hamaji Masatsugu , Nakajima Daisuke , Yurugi Kimiko , Hishida Rie , Date Hiroshi
Published: March 2023

Background.

The effect of human leukocyte antigen mismatches between donors and recipients on postoperative outcomes of lung transplantation remains controversial. We retrospectively reviewed adult recipients receiving living-donor lobar lung transplantation (LDLLT) to examine the difference in de novo donor-specific antibody (dnDSA) development and clinically diagnosed unilateral chronic lung allograft dysfunction per graft (unilateral CLAD) between lung grafts donated by spouses (nonblood relatives) and nonspouses (relatives within the third degree). We also investigated the difference in prognoses between recipients undergoing LDLLTs including spouse donors (spousal LDLLTs) and not including spouse donors (nonspousal LDLLTs).

Methods.

In this study, 63 adult recipients undergoing LDLLTs (61 bilateral and 2 unilateral LDLLTs from 124 living donors) between 2008 and 2020 were enrolled. The cumulative incidence of dnDSAs per lung graft was calculated, and prognoses were compared between recipients undergoing spousal and nonspousal LDLLTs.

Results.

The cumulative incidence of both dnDSAs and unilateral CLAD in grafts donated by spouses was significantly higher than that in grafts donated by nonspouses (5-y incidence of dnDSAs: 18.7% versus 6.4%, P = 0.038; 5-y incidence of unilateral CLAD: 45.6% versus 19.4%, P = 0.011). However, there were no significant differences in the overall survival or chronic lung allograft dysfunction-free survival between recipients undergoing spousal and nonspousal LDLLTs (P > 0.99 and P = 0.434, respectively).

Conclusions.

Although there were no significant differences in prognoses between spousal and nonspousal LDLLTs, more attention should be paid to spousal LDLLTs because of the higher development rate of dnDSAs and unilateral CLAD.