bluuebunny/crossref_metadata_2025 huggingface dataset:
Hotspots and development frontiers of postoperative complications of AD: Bibliometric analysis – a review
Authors: Feng Danni , Huang Sufang , Wang Quan , Lang Xiaorong , Liu Yuchen , Zhang Kexin
Published: March 2023

The research on the postoperative complications of aortic dissection (AD) has received great attention from scholars all over the world, and the number of research articles in this field has consistently increased year after year. However, no bibliometric reports have been published yet to analyze the scientific output and the current situation in this field. The Bibliometrix R-package, VOSviewer, and CiteSpace software were used to conduct a bibliometric analysis of the hotspots and development frontiers of AD. A total of 1242 articles were retrieved. The USA, China, and Japan had the highest number of publications. The five keywords with the highest frequency were “analysis,” “incidence,” “acute type,” “graft,” and “risk factor.” The results also indicated that the research in related fields had shifted from surgical treatment and utilizing experience to the evidence-based exploration of risk factors and the construction of prediction models to help better manage postoperative complications of AD. This is the first bibliometric analysis of global publications on the postoperative complications of AD. The current research hotspots focus on three areas: common postoperative complications of AD, exploration of the related risk factors, and management of complications. Future research could focus on identifying risk factors through meta-analysis and using a multicenter database for AD as well as building relevant models to predict the development of complications to better facilitate the clinical management of AD patients.
Using coword analysis and chord diagrams to examine the effect of nutritional counseling and support (DCNS) on patients with oral and oropharyngeal cancer
Authors: Tu Mei-Yu , Chien Tsair-Wei , Lin Cheng-Yao , Chou Willy
Published: March 2023

Background:

Dietary counseling and nutritional support (DCNS) are generally accepted as being necessary for patients with oral cancer and oropharyngeal cancer (OC). However, there is no evidence that dietary counseling plays a significant role in weight loss. In this study, we examined the DCNS based on persistent weight loss during and after treatment in oral cancer and OC patients, as well as the effect of body mass index (BMI) on survival in both groups.

Methods:

A retrospective chart review was conducted on 2622 patients diagnosed with cancer between 2007 and 2020, including 1836 oral and 786 oropharyngeal patients. In comparison with the sample of patients treated by DCNS, differences in proportional counts for key factors associated with survival were compared between oral cancer and OC patients using the forest plot. An analysis of cowords was conducted to determine CNS associated with weight loss and overall survival. The Sankey diagram was used to display DCNS effectiveness. The log-rank test was used to evaluate the chi-squared goodness of fit test on the null assumption model of equal survival distributions between the groups.

Results:

Almost 41% of the patients (=1064/2262) received DCNS, with a frequency ranging from 1 to 44. Counts for 4 DCNS categories were 566, 392, 92, and 14, respectively, against BMI increases or decreases from much to less with counts of 3, 44, 795, 219, and 3, respectively. In the first year following treatment, DCNS decreased sharply to 50%. One year after hospital discharge, the overall weight loss increased from 3 to 9% (mean = −4%, standard deviation = 14%). Patients with a BMI above average had a significantly longer survival time (P < .001). Statistically, OC patients have a significantly higher survival rate than oral cancer patients.

Conclusion:

Despite receiving frequent DCNS, patients continued to lose body weight during and 1 year after treatment. The survival time of an individual with a BMI above average appears to be increased. Future studies should preferably use randomized trials to compare standard DCNS with more intensive DCNS, which includes earlier and/or prolonged treatment.
Evaluating disparities by social determinants in hospital admission decisions for patients with COVID-19 quaternary hospital early in the pandemic
Authors: Olds Peter K. , Musinguzi Nicholas , Geisler Benjamin P. , Haberer Jessica E.
Published: March 2023

The COVID-19 pandemic has highlighted significant disparities in hospital outcomes when focusing on social determinants of health. Better understanding the drivers of these disparities is not only critical for COVID-19 care but also to ensure equitable treatment more generally. In this paper, we look at how hospital admission patterns, both to the medical ward and the intensive care unit (ICU), may have differed by race, ethnicity, and social determinants of health. We conducted a retrospective chart review of all patients who presented to the Emergency Department of a large quaternary hospital between March 8 and June 3, 2020. We built logistic regression models to analyze how race, ethnicity, area deprivation index, English as a primary language, homelessness, and illicit substance use impacted the likelihood of admission while controlling for disease severity and timing of admission in relation to the start of data collection. We had 1302 recorded Emergency Department visits of patients diagnosed with SARS-CoV-2. White, Hispanic, and African American patients made up 39.2%, 37.5%, and 10.4% of the population respectively. Primary language was recorded as English for 41.2% and non-English for 30% of patients. Among the social determinants of health assessed, we found that illicit drug use significantly increased the likelihood for admission to the medical ward (odds ratio 4.4, confidence interval 1.1–17.1, P = .04), and that having a language other than English as a primary language significantly increased the likelihood of ICU admission (odds ratio 2.6, confidence interval 1.2–5.7, P = .02). Illicit drug use was associated with an increased likelihood of medical ward admission, potentially due to clinician concerns for complicated withdrawal or blood-stream infections from intravenous drug use. The increased likelihood of ICU admission associated with a primary language other than English may have been driven by communication difficulties or differences in disease severity that our model did not detect. Further work is required to better understand drivers of disparities in hospital COVID-19 care.
Cost-effectiveness analysis of herbal medicines in children with idiopathic short stature
Authors: Jang Soobin , Lee Sun Haeng , Kim Ye Ji , Lee Boram
Published: March 2023

Background:

Herbal medicines have been used for a long time to treat idiopathic short stature (ISS) in children in East Asian countries. The aim of this study was to analyze the cost-effectiveness of 5 herbal medicines frequently used in clinical settings for children with ISS based on medical records.

Methods:

Patients with ISS who had been prescribed a 60-day supply of herbal medicines in 1 Korean medicine hospital were included in this analysis. Their height and height percentile were measured before and after treatment within 6-months. The average cost-effectiveness ratios (ACERs) of 5 herbal medicines for height (cm) and height percentile were calculated for boys and girls, respectively.

Results:

The ACERs per 1 cm height growth were USD 56.2 (Naesohwajung–Tang), USD 74.8 (Ogapi–Growth decoction), USD 86.6 (Gamcho–Growth decoction), USD 94.6 (Gwakhyangjeonggi–San plus Yukmijihwang–Tang), and USD 113.8 (Boyang–Growth decoction). The ACERs per 1 percentile height growth were USD 205 (Naesohwajung–Tang), USD 293 (Ogapi–Growth decoction), USD 470 (Gamcho–Growth decoction), USD 949 (Boyang–Growth decoction), and USD 1051 (Gwakhyangjeonggi–San plus Yukmijihwang–Tang).

Conclusion:

Herbal medicine might be a potential economical alternative treatment for ISS.
Evaluation of retinal microcirculation alterations using optical coherence tomography angiography in patients with hyperopia ametropic amblyopia: A case-control study
Authors: Rao Ting , Zou Wen , Hu Xiaoqin , He Hai , Luo Wei , You Zhipeng
Published: March 2023

Given that there are controversial findings regarding vessel density in amblyopia, we quantified retinal microcirculation using optical coherence tomography angiography and compared it between hyperopic ametropic amblyopia eyes and age-matched control eyes. This case-control study was conducted from March 2021 to March 2022 at the Affiliated Eye Hospital of Nanchang University, Nanchang, China. Both groups included 72 eyes. Foveal avascular zone area, circularity and perimeter, perfusion density and vessel density of macular superficial retinal capillary plexus, macular thickness, macular volume, peripapillary retinal nerve fiber layer thickness, and ganglion cell-inner plexiform layer thickness were compared between hyperopia ametropic amblyopia eyes and age-matched control eyes. Additionally, best-corrected visual acuity, maximum corneal curvature, minimum corneal curvature, and anterior chamber depth were measured. In the hyperopia ametropic amblyopia eyes and control eyes, vessel density was 7.51 ± 2.13 and 9.91 ± 2.71 mm-1 in the central, 17.20 ± 1.38 and 18.25 ± 1.37 mm-1 in the inner, and 17.90 ± 0.88 and 18.43 ± 0.97 mm-1 in the full regions, respectively. The perfusion densities were 0.17 ± 0.06 and 0.23 ± 0.07 in the central, 0.41 ± 0.05 and 0.44 ± 0.03 in the inner, and 0.44 ± 0.03 and 0.46 ± 0.02 in the full regions, respectively. The central macular thicknesses of hyperopia ametropic amblyopia and control eyes were 240.04 ± 20.11 and 235.08 ± 24.41 µm, respectively. Foveal avascular zone perimeter and circularity (P < .043 and P = .001) significantly differed between the 2 groups. Hyperopia ametropic amblyopia eyes showed lower appreciably in vessel and perfusion densities, which could be one of the major pathophysiological mechanisms of hyperopia ametropic amblyopia and provide a new direction for the diagnosis and treatment of amblyopia.
Hand-Schüller-Christian syndrome combined with empty sella syndrome: A case report and literature review
Authors: Ji Wei , Chen Xiaoyang
Published: March 2023

Rational:

Hand-Schüller-Christian syndrome (HCS) is a rare disease with little clinical awareness, but the condition is more dangerous, and it combines with empty sella syndrome (ESS) which is extremely rare.

Presentation:

A 26-year-old male patient who had proptosis, headaches, and diabetes insipidus for more than 10 years, and chronic cough and wheeze for 8 years presented to our hospital due to an abrupt onset of chest pain for 2 days.

Diagnosis:

Hand-Schüller-Christian syndrome is diagnosed based on the typical clinical manifestations of diabetes insipidus and bilateral proptosis, magnetic resonance imaging (MRI) pituitary imaging and pathology. Empty sella syndrome is diagnosed based on hormonal indicators, clinical manifestations and MRI pituitary scan results. Type 1 respiratory failure and severe pneumonia can be diagnosed based on the results of clinical examination, chest imaging (including chest x-ray and computed tomography), pathology and blood gas analysis. Left pneumothorax can be diagnosed with chest imaging.

Interventions:

“Meropenem and Cefdinir” were given for antimicrobrial coverage, “Desmopressin acetate” for anti-diuretic treatment, “Forcodine” for cough relief, “Ambroxol and acetylcysteine” for phlegm reduction, and continuous closed chest drainage was performed.

Outcomes:

The patient discharged after cough, wheezing, headache and other symptoms improved, and vital signs were stable. The patient has been followed up once a month for 17 months ongoing after discharge. At present, symptoms such as cough, sputum, and wheezing have improved considerably, and the mMRC score of dyspnea is 2 points. The reexamination of the chest X-ray shows that the absorption of lung exudates is better than before, and there is no recurrence of pneumothorax.

Lessons:

Consider whether isolated diabetic insipidus is related to HSC, and if so, conduct an MRI, a biopsy, and other examinations as soon as possible.
Effects of NBP injection on the inflammatory response, oxidative stress response and vascular endothelial function in patients with ACI: A systematic review and meta-analysis
Authors: Liu Xinxin , Ma Yingqi , Wang Yiguo , Zhang Qiming
Published: March 2023

Background:

Acute cerebral infarction (ACI) is a common medical emergency. This study is the first systematic review of the use of Dl-3-n-butylphthalide (NBP) injection in the treatment of ACI. The purpose of this study was to systematically evaluate the effects of NBP injection on the inflammatory response, oxidative stress response and vascular endothelial function in patients with acute ACI. The objective is to provide reference for clinical application.

Methods:

From the establishment of the database until August 2022, we systematically searched EMbase, PubMed, Cochrane Library, Web of Science, CNKI, VIP, and Wanfang Database. RCTs and retrospective studies were included in this study, and the results that qualified for inclusion were screened by 2 researchers and cross-checked. After the relevant data were extracted, a meta-analysis was performed using RevMan5.3 software.

Results:

A total of 3307 patients with ACI from 34 studies were analyzed. The meta-analysis showed that the C-reactive protein levels in the NBP combined group were effectively reduced compared with those in the control group (MD = −3.75, 95% confidence intervals [95% CI] [−4.95, −2.56], P < .00001). Based on comparison with the control group, it is evident that combination treatment with NBP is more effective than control group in reducing the oxidative stress response of ACI (MD[superoxide dismutase levels] = 22.16, 95% CI [14.20,30.11], P < .00001; MD[malondialdehyde levels] = −1.97, 95% CI [−2.62, −1.32], P < .00001). Comparison with the control group shows that combination treatment with NBP is more effective in improving vascular endothelial function in ACI patients (MD[vascular endothelial growth factor levels] = 71.44, 95% CI [41.22, 101.66], P < .00001; MD[endothelin-1 levels] = −11.47, 95% CI [−17.39, −5.55], P = .0001; MD[nitric oxide levels] = 9.54, 95% CI [8.39, 10.68], P < .00001) than control group. The NBP combined group also showed a greater reduction in cerebral infarct volume (CIV) and cerebral infarct size (CIS) of ACI (MD[CIV] = −1.52, 95% CI [−2.23, −0.81], P < .0001; MD[CIS] = −2.79, 95% CI [−3.65, −1.94], P < .00001). The NBP combined group did not show an increase in the incidence of adverse reactions compared with the control group (odds ratio = 1.06, 95% CI [0.73, 1.53], P = .77).

Conclusion:

In summary, the use of NBP in combination with control group for ACI can reduce the degree of nerve damage, reduce inflammation and oxidative stress, improve vascular endothelial function, and reduce CIS and CIV in ACI patients, without increasing the incidence of clinical adverse events.
Patterns and trends of primary drug-resistant tuberculosis in Chongqing, China, from 2012 to 2020
Authors: Zhang Huizheng , Yang Jing , Zhang Zhen , Hu Kui , Wu Ping , Zhang Haiyan , Li Jungang , Li Mei , Wang Xiaoying
Published: March 2023

Primary drug-resistant tuberculosis (DR-TB) contributes significantly to the global TB epidemic, particularly in countries with high TB burdens. This study aimed to investigate the characteristics of primary DR-TB prevalence in Chongqing, China, from 2012 to 2020. A total of 4546 newly diagnosed and 2769 relapse TB patients admitted to the hospital from 2012 to 2020 were included. Categorical variables were compared using Pearson chi-square test or Fisher exact test, as appropriate. Logistic regression analysis was performed to determine factors associated with primary DR-TB. The rate of primary DR-TB was 24.5%, whereas that of acquired DR-TB was 67.8%. Among newly diagnosed TB cases, the percentage of DR-TB (from 48.9 to 44.2%), mono-resistant TB (from 11.8 to 9.7%), multidrug-resistant TB (MDR-TB; from 25.3 to 6.9%), and pre-extensive drug-resistant TB (from 13.7 to 5.8%) showed a decreasing trend from 2012 to 2020. Age from 15 to 64 years was a risk factor for the development of primary DR-TB (15–44 years: adjusted odds ratio = 2.227, 95% confidence interval: 1.053–4.710; 45–64 years: adjusted odds ratio = 2.223, 95% confidence interval: 1.048–4.717). The rates of primary DR-TB (P = .041) and MDR-TB (P = .007) were significantly higher in the age group of 15 to 64 years than in the age groups of ≤14 years and ≥65 years. Noticeably, rising trends of primary DR-TB (from 0 to 27.3%) and MDR-TB (from 0 to 9.1%) in the population of ≤14 years were observed from 2012 to 2020. Although the rate of primary DR-TB showed a downward trend, a rising drug-resistance rate among some particular subgroups was still observed. Further control of primary DR-TB should focus more on TB patients aged 15 to 64 years.
Correlation between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and postoperative cognitive dysfunction in elderly patients with esophageal cancer
Authors: Zhao Jie , Dai Tingting , Ding Ling , Liang Yu , Yuan Wanshi , Jiang Yunqin , Zheng Yifeng
Published: March 2023

The present study intends to investigate the correlation between neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and postoperative cognitive dysfunction (POCD) in elderly patients with esophageal cancer. Elderly patients >65 years old with esophageal cancer in our department from October 2017 to June 2021 were included in the study. The cognitive function of the patients was assessed by the mini-mental state examination (MMSE) Scale at 1day, 3 days, and 7days after surgery. POCD was considered when the scores were <27 points, and the remaining patients were included in the control group. A total of 104 elderly patients with esophageal cancer were included in this study, and 24 patients developed POCD, with an incidence of 23.1%. The expression of NLR and PLR in both 2 groups was increased on the 1st postoperative day compared with that before surgery. There was no significant difference in the expression of NLR and PLR between the 2 groups before operation, but the expression of both in the POCD group was significantly higher than that in the control group after operation (P < .05). Logistic regression analysis showed that smoking, postoperative NLR and postoperative PLR were independent risk factors for POCD. Spearman test showed that NLR was negatively correlated with MMSE scores at postoperative 1 day and 3 days (P < .05), while PLR was negatively correlated with MMSE scores at postoperative 1 day, 3 days and 7 days (P < .05). The Area Under receiver operating characteristic curve (AUC) of postoperative NLR for predicting POCD in elderly patients with esophageal cancer was 0.656, and the AUC of postoperative PLR was 0.722. After combination of NLR and PLR, the AUC increased to 0.803 with the sensitivity of 66.7% and specificity of 82.5%. The expression level of postoperative NLR and PLR in elderly patients with esophageal cancer combined with POCD is significantly increased, which is associated with postoperative cognitive impairment. Moreover, the combination of NLR and PLR has a good predictive ability for POCD, which could be used as a potential biomarker for early diagnosis of POCD.
Compare image quality of T2-weighted imaging with different phase acceleration factors
Authors: Ding Wen-Hong , Lu Yuan-Fei , Xu Meng-Xi , Yu Ri-Sheng
Published: March 2023

Previous studies demonstrated that adjusting the phase acceleration (PA) factors could influence image quality. To improve image quality and decrease respiratory artifacts of lesions in the liver on T2-weighted image by adjusting PA factor and number of excitation (NEX). Sixty consecutive patients with hepatic lesions were enrolled in this prospective research between May 2020 and June 2020. All patients had 3.0T magnetic resonance imaging with 4 sequences (combining PA factors and NEXs, the former was 2 and 3, the latter were 1.5 and 2, respectively, with the same other scanning parameters). Two readers used 5-point quality scales to assess image quality. The signal intensity was measured by drawing regions of interest in the liver, spleen, and background on the T2-weighted imaging. Artifacts, overall image impression, and vascular conspicuity were better when the PA factor was 3 than 2. Artifacts and vascular conspicuity were better when NEX was 2 than 1.5. PA factor 3 and NEX 2 got a higher score in 5-point quality scales and less scan time than the other 3 sequences. Meanwhile, the signal-to-noise ratio of PA factor 3 and NEX 2 was best among these 4 sequences. PA factor and NEX could influence the imaging quality and lesion-to-hepatic contrast in detecting hepatic lesions on T2-weighted images. PA factor 3 and NEX 2 may have a positive effect in the clinic, especially for those with irregular respiration, as it decreased artifacts and reduced scan time.
Optimising cylinder model dimensions for VARSKIN to simulate a droplet of radionuclide skin contamination using Geant4 Monte Carlo code
Authors: James Gregory , O’Brien Joseph , Thomson Bill
Published: March 2023

Aim

VARSKIN provides a convenient way of calculating skin dose from predefined geometries but the models are limited to concentric shapes such as discs, cylinders and point sources. The aim of this article is to use the Geant4 Monte Carlo code to independently compare the cylindrical geometries available in VARSKIN to more realistic droplet models obtained from photography. It may then be possible to recommend an appropriate cylinder model that can be used to represent a droplet within acceptable accuracy.

Method

Geant4 Monte Carlo code was used to model various droplets of radioactive liquid on the skin based on photographs. The dose rates were then calculated to the sensitive basal layer 70 µm beneath the surface for three droplet volumes (10, 30 and 50 µl) and 26 radionuclides. The dose rates from the cylinder models were then compared against the dose rates from the ‘true’ droplet models.

Results

The table gives the optimum cylinder dimensions that best approximate a true droplet shape for each volume. The mean bias and 95% confidence interval (CI) from the true droplet model are also quoted.

Conclusion

The evidence from the Monte Carlo data suggests that different droplet volumes require different cylinder aspect ratios to approximate the true droplet shape. Using the cylinder dimensions in the table in software packages such as VARSKIN, dose rates from radioactive skin contamination are expected to be within ± 7.4% of a ‘true’ droplet model at 95% CI.
Well-differentiated gastro-entero-pancreatic neuroendocrine tumors with positive FDG-PET/CT: a retrospective chart review
Authors: Haidar Mohamad , Al Mahmasani Layal , Chehade Laudy , Elias Charbel , El Jebai Malak , Temraz Sally , Charafeddine Maya , Al Darazi Monita , Shamseddine Ali
Published: March 2023

Purpose

Rarely, well-differentiated gastro-entero-pancreatic neuroendocrine tumors (GEP NETs) can have positive uptake on 18F-fluorodeoxyglucose-PET/computerized tomography (18F-FDG-PET/CT), with or without a positive 68Ga-PET/CT. We aim to evaluate the diagnostic role of 18F-FDG-PET/CT in patients with well-differentiated GEP NETs.

Methods

We retrospectively reviewed a chart of patients diagnosed with GEP NETs between 2014 and 2021, at the American University of Beirut Medical Center, who have low (G1; Ki-67 ≤2) or intermediate (G2; and Ki-67 >2–≤20) well-differentiated tumors with positive findings on FDG-PET/CT. The primary endpoint is progression-free survival (PFS) compared to historical control, and the secondary outcome is to describe their clinical outcome.

Results

In total 8 out of 36 patients with G1 or G2 GEP NET met the inclusion criteria for this study. The median age was 60 years (range 51–75 years) and 75% were male. One patient (12.5%) had a G1 tumor whereas 7 (87.5%) had G2, and seven patients were stage IV. The primary tumor was intestinal in 62.5% of the patients and pancreatic in 37.5%. Seven patients had both 18F-FDG-PET/CT and 68Ga-PET/CT positive and one patient had a positive 18F-FDG-PET/CT and negative 68Ga-PET/CT. Median and mean PFS in patients positive for both 68Ga-PET/CT and 18F-FDG-PET/CT were 49.71 months and 37.5 months (95% CI, 20.7–54.3), respectively. PFS in these patients is lower than that reported in the literature for G1/G2 NETs with positive 68Ga-PET/CT and negative FDG-PET/CT (37.5 vs. 71 months; P = 0.0217).

Conclusion

A new prognostic score that includes 18F-FDG-PET/CT in G1/G2 GEP NETs could identify more aggressive tumors.
Comparison of 99mTc-methylenediphosphonate and 68Ga-BPAMD PET/computed tomography imaging in bone metastasis
Authors: Vatsa Rakhee , Kaur Damanpreet , Shekhar Shashank Singh , Chhabra Anupriya , Chakraborty Sudipta , Dash Ashutosh , Shukla Jaya , Mittal Bhagwant Rai
Published: March 2023

Objective

Bone is considered as the third most common site of metastases, besides lung and liver. Early detection of skeletal metastases aids in better management of skeletal-related events. In the present study cold kit-based 2,2′,2′′-(10-(2-((diphosphonomethyl)amino)-2-oxoethyl)-1,4,7,10-tetraazacyclododecane-1,4,7-triyl) triacetic acid (BPAMD) was labeled with 68Ga. The radiolabeling parameters and clinical evaluation in patients with suspected bone metastases were compared with routinely used 99mTc-methylenediphosphonate (99mTc-MDP).

Methodology

The kit components of MDP were incubated with

at room temperature for 10 min, followed by radiochemical purity testing using thin-layer chromatography. For radiolabeling of BPAMD, the cold kit components reconstituted in 400 μL of HPLC grade water were transferred and incubated with 68GaCl3 in the reactor vessel of the fluidic module at 95°C for 20 min. Radiochemical yield and purity were determined with instant thin-layer chromatography using 0.5 M sodium citrate as mobile phase. For clinical evaluation, patients (n = 10) with suspected bone metastases were enrolled. 99mTc-MDP and 68Ga-BPAMD scans were performed on two different days in random order. Imaging outcomes were noted and compared.

Results

Radiolabeling of both tracers is facile using cold kit, although BPAMD requires heating. The radiochemical purity was observed to be greater than 99% for all preparations. Both MDP and BPAMD detected skeletal lesions; however, additional lesions were detected in total of seven patients which were not visualized clearly on 99mTc-MDP scan.

Conclusion

BPAMD can be easily tagged with 68Ga using cold kits. The radiotracer is suitable and efficient for detection of bone metastases using PET/computed tomography.
Precursor B-cell Lymphoblastic Lymphoma in Children: Hacettepe Experience
Authors: Susam-Sen Hilal , Yalcin Bilgehan , Orhan Diclehan , Aydin Burca , Kurucu Nilgun , Varan Ali , Uner Aysegul , Kutluk Tezer
Published: March 2023

The purpose of the study was to review the clinical and pathologic characteristics and treatment results of children with precursor B-cell lymphoblastic lymphoma. Of 530 children diagnosed with non-Hodgkin lymphomas between 2000 and 2021, 39 (7.4%) were identified as having precursor B-cell lymphoblastic lymphoma. Clinical characteristics, pathologic, radiologic, laboratory data, treatments, responses, and overall outcomes were recorded from hospital files and analyzed. The median age of 39 patients (males/females, 23/16) was 8.3 years (range 1.3 to 16.1). The most common sites of involvement were the lymph nodes. At a median follow-up of 55.8 months, 14 patients (35%) had a recurrence of disease (11 stage IV, 3 stage III); 4 were in complete remission with salvage therapies, 9 died of progressive disease and one died due to febrile neutropenia. Five-year event-free survival and overall survival rates were 65.4% and 78.3% for all cases, respectively. Survival rates were higher in patients with a complete remission at the end of induction therapies. The survival rates were lower in our study compared with other studies, which could be explained by the high relapse rate and higher incidence of advanced-stage disease due to bone marrow involvement. We demonstrated a prognostic impact of treatment response at the end of the induction phase. Cases with a disease relapse have poor prognosis.
Out-of-pocket costs and affordability of upper limb prostheses
Authors: Resnik Linda J. , Borgia Matthew , Clark Melissa A. , Ni Pengsheng
Published: March 2023

Background:

Given the funding policies in the Department of Veterans Affairs, the affordability of prostheses may be less of a concern among Veterans as compared to civilians.

Objectives:

Compare rates of out-of-pocket prosthesis-related payments for Veterans and non-Veterans with upper limb amputation (ULA), develop and validate a measure of prosthesis affordability, and evaluate the impact of affordability on prosthesis nonuse.

Study design:

Telephone survey of 727 persons with ULA; 76% Veterans and 24% non-Veterans.

Methods:

Odds of paying out-of-pocket costs for Veterans compared with non-Veterans were computed using logistic regression. Cognitive and pilot testing resulted in a new scale, evaluated using confirmatory factor and Rasch analysis. Proportions of respondents who cited affordability as a reason for never using or abandoning a prosthesis were calculated.

Results:

Twenty percent of those who ever used a prosthesis paid out-of-pocket costs. Veterans had 0.20 odds (95% confidence interval, 0.14–0.30) of paying out-of-pocket costs compared with non-Veterans. Confirmatory factor analysis supported unidimensionality of the 4-item Prosthesis Affordability scale. Rasch person reliability was 0.78. Cronbach alpha was 0.87. Overall, 14% of prosthesis never-users said affordability was a reason for nonuse; 9.6% and 16.5% of former prosthesis users said affordability of repairs or replacement, respectively, was a reason for abandonment.

Conclusions:

Out-of-pocket prosthesis costs were paid by 20% of those sample, with Veterans less likely to incur costs. The Prosthesis Affordability scale developed in this study was reliable and valid for persons with ULA. Prosthesis affordability was a common reason for never using or abandoning prostheses.
Delirium and Behavioral Symptoms in Persons With Dementia at Hospital Admission
Authors: Boltz Marie , Kuzmik Ashley , Resnick Barbara , BeLue Rhonda , Jao Ying-Ling , Paudel Anju , Behrens Liza , Leslie Doug , Sinvani Liron , Galvin James E.
Published: March 2023

Background:

Hospitalized persons with dementia are at risk of delirium with behavioral symptoms, predisposing them to a higher rate of complications and caregiver distress. The purpose of this study was to examine the relationship between delirium severity in patients with dementia upon admission to the hospital and the manifestation of behavioral symptoms, and to evaluate the mediating effects of cognitive and physical function, pain, medications, and restraints.

Methods:

This descriptive study used baseline data from 455 older adults with dementia enrolled in a cluster randomized clinical trial that tested the efficacy of family centered function-focused care. Mediation analyses were conducted to determine the indirect effect of cognitive and physical function, pain, medications (antipsychotics, anxiolytics, sedative/hypnotics, narcotics, and number of medications), and restraints on behavioral symptoms, controlling for age, sex, race, and educational level.

Results:

The majority of the 455 participants were female (59.1%), had an average age of 81.5 (SD=8.4), were either white (63.7%) or black (36.3%), and demonstrated one or more behavioral symptoms (93%) and delirium (60%). Hypotheses were partially supported in that physical function, cognitive function, and antipsychotic medication partially mediated the relationship between delirium severity and behavioral symptoms.

Conclusion:

This study provides preliminary evidence identifying antipsychotic use, low physical function, and significant cognitive impairment as specific targets for clinical intervention and quality improvement in patients with delirium superimposed on dementia at hospital admission.
A Case of Oral Cenesthopathy Treated With the Combination of Brexpiprazole and Mirtazapine
Authors: Umezaki Yojiro , Motomura Haruhiko , Egashira Rui , Toyofuku Akira , Naito Toru
Published: March 2023

Objectives

Oral cenesthopathy is an uncomfortable and bizarre oral sensation without corresponding organic findings. Although some treatment options, including antidepressants and antipsychotic drugs, have been reported to be effective, the condition remains refractory. Here, we report a case of oral cenesthopathy treated with brexpiprazole, a recently approved D2 partial agonist.

Methods and Results

A 57-year-old woman presented with a complained of softened incisors. Furthermore, she could not perform housework because of the discomfort. The patient did not respond to aripiprazole. However, she responded to a combination of mirtazapine and brexpiprazole. The visual analog scale score for the patient's oral discomfort decreased from 90 to 61. The patient's condition improved enough to resume housework.

Conclusions

Brexpiprazole and mirtazapine may be considered for the treatment of oral cenesthopathy. Further investigations are warranted.
Impact on Electroconvulsive Therapy Services, Including Patient Relapse and Death, During the COVID-19 Pandemic
Authors: Sarma Shanthi , Branjerdporn Grace , McCosker Laura , Dong Vanessa , Martin Donel , Loo Colleen
Published: March 2023

Objectives

Electroconvulsive therapy (ECT) is important in the management of major, life-threatening, and treatment-resistant psychiatric illness. The COVID-19 pandemic has significantly disrupted ECT services. The need for new infection control measures, staff redeployment and shortages, and the perception that ECT is as an “elective” procedure have caused changes to, and reductions in, ECT delivery. The aim of this study was to explore the impact of COVID-19 on ECT services, staff, and patients globally.

Methods

Data were collected using an electronic, mixed-methods, cross-sectional survey. The survey was open from March to November 2021. Clinical directors in ECT services, their delegates, and anesthetists were asked to participate. Quantitative findings are reported.

Results

One hundred and twelve participants worldwide completed the survey. The study identified significant impacts on services, staff, and patients. Importantly, most participants (57.8%; n = 63) reported their services made at least 1 change to ECT delivery. More than three-quarters (81.0%; n = 73) reported that their service had identified at least 1 patient who could not access ECT. More than two-thirds (71.4%; n = 67) reported that their service identified patients who experienced a relapse in their psychiatric illness due to lack of ECT access. Six participants (7.6%) reported that their service had identified at least 1 patient who died, by suicide or other means, due to lack of ECT access.

Conclusions

All ECT practices surveyed were impacted by COVID-19 with decreases in capacity, staffing, changes in workflow, and personal protective equipment requirements with relatively little change to ECT technique. Lack of access to ECT resulted in significant morbidity and mortality, including suicide, internationally. This is the first multisite, international survey to explore the impacts of COVID-19 on ECT services, staff, and patients.
Electroconvulsive Therapy in Switzerland
Authors: Wilhelmy Saskia , Brühl Annette Beatrix , Himmighoffen Holger , Conca Andreas , Grözinger Michael
Published: March 2023

Objectives

The prevalence and use of electroconvulsive therapy (ECT) varies widely across Europe. Historically, Switzerland played an important role in the worldwide spread of ECT. Nevertheless, an overview of current ECT practice in Switzerland is still lacking. The present study aims to fill this gap.

Methods

A cross-sectional study was conducted in 2017 using a standardized questionnaire to investigate current ECT practice in Switzerland. Fifty-one Swiss hospitals were contacted by email and followed up by telephone. In early 2022, we updated the list of facilities that offer ECT.

Results

Thirty eight of the 51 hospitals (74.5%) provided feedback to the questionnaire, 10 of them claimed to offer ECT. They reported 402 treated patients, which corresponds to an ECT-treated person rate of 4.8 persons per 100,000 inhabitants. Depression was the most frequent indication. All hospitals reported an increase in ECT treatments between 2014 and 2017 except for one with constant numbers. The number of facilities offering ECT almost doubled between 2010 and 2022. Most ECT facilities performed the treatment predominantly on an outpatient rather than an inpatient basis.

Conclusions

Historically, Switzerland relevantly contributed to the worldwide spread of ECT. In an international comparison, the treatment frequency is in the lower middle range. The outpatient treatment rate is high compared with other countries in Europe. The supply and spread of ECT in Switzerland have increased over the past decade.
Acute effects of static stretching to hamstrings on spatiotemporal variables and leg kinematics in late swing at maximal sprint speed phase and its relationship with Nordic hamstring strength
Authors: Ozaki Yusuke , Ueda Takeshi
Published: March 2023

This study aimed to determine the acute effects of static stretching of the hamstrings on maximal sprint speed and its spatiotemporal variables, and lower limb kinematics during the late swing phase, and its relationship with Nordic hamstring strength. Sixteen healthy male college sprinters were asked to sprint 80 m without static stretching and with static stretching of the hamstrings for 120 s per leg before the sprint, and both conditions were counterbalanced. The knee flexion peak force and torque were measured using the Nordic hamstring. The differences between no static stretch and static stretch, and their relationship with Nordic hamstring strength were investigated. The results showed that the touchdown distance and support time increased, and flight distance decreased in under static stretch conditions with a decrease in maximal sprint speed. Moreover, under static stretch conditions, the angular velocity of knee extension at contralateral release was lower, while the theoretical hamstring length (difference between knee angle and hip angle) at ipsilateral touchdown was greater. In addition, the lower the peak force and torque of the Nordic hamstring, the more significant the decrease in maximal sprint speed, increase in support time, decrease in flight distance, and decrease in peak angular velocity of hip extension at static stretch. Furthermore, the more significant the decrease in maximal sprint speed at static stretch, the smaller the peak theoretical hamstring length at the no static stretch. Therefore, it is suggested that long- term static stretching immediately before sprinting in sprinters with poor Nordic hamstring strength and low hamstring compliance during the late swing phase may induce unfavorable kinematics to prevent hamstring strain injury and maximal sprint speed reduction.
What the analysis of causes of death in France in 2020 reveals about the impact of the Covid-19 epidemic
Authors: Toubiana Laurent , Mucchielli Laurent , Bouaud Jacques , Chaillot Pierre
Published: March 2023

Context

In 2020, the French population lived under the threat of the Covid-19 epidemic, which would allegedly cause an exceptional excess mortality rate. Mortality data by cause of death for the year 2020 are now available. These data allow us to quantify and qualify the impact of the epidemic. This analysis presents the evolution of the main mortality indicators by cause and by age group. It is intended to demonstrate how 2020 was an exceptional year.

Materials and methods

In France, causes of death are labeled according to the International Classification of Diseases (ICD-10) based on medical death certificates. The study focuses on aggregated data for the year 2020 as well as complete data from 1979 to 2017 available online. To estimate excess mortality by cause of death, mortality data were standardized to 2020 to consider changes in the age structure of the population.

Results

The year 2020 is marked, on the one hand, by the introduction of “Covid-19” as a cause of death, which accounts for 10.4% of deaths; and, on the other hand, by a strong downward trend in most other causes of death.

Discussion

In 2020, we show that the overall number of additional deaths due to the Covid-19 epidemic is paradoxically lower than the number of deaths caused by this disease. According to official sources, the number of Covid-19-labeled deaths is nearly 50% higher than the number of additional deaths. Besides excess mortality in 2020 being modest compared to other years that saw health events and it affecting only individuals over 65 years of age, what could explain that this disease has caused more deaths than additional deaths? This analysis shows that the emergency implementation of the “Covid-19” classification led to many biases. A significant number of deaths, usually labeled for other major causes (e.g., neoplasm, circulatory system diseases) were, in a way, transferred to this new label. This analysis of mortality by cause of death provides quantitative answers to the overestimation of the impact of the Covid-19 epidemic in France.
Mapping Dysfunctional Circuits in the Frontal Cortex Using Deep Brain Stimulation
Authors: Hollunder Barbara , Ostrem Jill L. , Sahin Ilkem Aysu , Rajamani Nanditha , Oxenford Simón , Butenko Konstantin , Neudorfer Clemens , Reinhardt Pablo , Zvarova Patricia , Polosan Mircea , Akram Harith , Vissani Matteo , Zhang Chencheng , Sun Bomin , Navratil Pavel , Reich Martin M. , Volkmann Jens , Yeh Fang-Cheng , Baldermann Juan Carlos , Dembek Till A. , Visser-Vandewalle Veerle , Alho Eduardo Joaquim Lopes , Franceschini Paulo Roberto , Nanda Pranav , Finke Carsten , Kühn Andrea A. , Dougherty Darin D. , Richardson R. Mark , Bergman Hagai , DeLong Mahlon R. , Mazzoni Alberto , Romito Luigi M. , Tyagi Himanshu , Zrinzo Ludvic , Joyce Eileen M. , Chabardes Stephan , Starr Philip A. , Li Ningfei , Horn Andreas
Published: March 2023

Frontal circuits play a critical role in motor, cognitive, and affective processing – and their dysfunction may result in a variety of brain disorders. However, exactly which frontal domains mediate which (dys)function remains largely elusive. Here, we study 534 deep brain stimulation electrodes implanted to treat four different brain disorders. By analyzing which connections were modulated for optimal therapeutic response across these disorders, we segregate the frontal cortex into circuits that became dysfunctional in each of them. Dysfunctional circuits were topographically arranged from occipital to rostral, ranging from interconnections with sensorimotor cortices in dystonia, with the primary motor cortex in Tourette’s syndrome, the supplementary motor area in Parkinson’s disease, to ventromedial prefrontal and anterior cingulate cortices in obsessive-compulsive disorder. Our findings highlight the integration of deep brain stimulation with brain connectomics as a powerful tool to explore couplings between brain structure and functional impairment in the human brain.
Metagenomic analysis after selective culture enrichment of wastewater demonstrates increased burden of antibiotic resistant genes in hospitals relative to the community
Authors: Acosta Nicole , Lee Jangwoo , Bautista Maria A. , Bhatnagar Srijak , Waddell Barbara J. , Au Emily , Pradhan Puja , Clark Rhonda G. , Meddings Jon , Ruecker Norma , Achari Gopal , Pitout Johann D. , Conly John , Frankowski Kevin , Hubert Casey R.J. , Parkins Michael D.
Published: March 2023

Antimicrobial resistance (AMR) is an ever-increasing threat to global health. Wastewater-based surveillance is an emerging methodology that objectively enables an inclusive and comprehensive assessment of population AMR in an observed sewershed. Here we compared the resistome of two tertiary-care hospitals with two separate neighborhoods, using complimentary targeted qPCR and metagenomics of wastewater before and after selective culture enrichment for clinically important Gram negatives. In total 26 ARG-type (1225 ARG-subtypes) were found across all samples, in which β-lactam ARG was the richest (the number of different ARG-subtypes found) followed by multidrug, fluoroquinolone, macrolide-lincosamide-streptogramin (MLS) and aminoglycoside. The composition of ARGs in wastewater differed between raw wastewater pellets and culture-enriched wastewater samples and the resistomes clustered based on the type of location (Hospitals vs neighborhoods). Hospital wastewater was found to have higher diversity and greater abundance of ARGs compared to neighborhood wastewater when the composition profiles of ARGs in both raw and culture-enriched wastewater pellets. Clinically relevant ARG (i.e., VIM, NDM metallo-ß-lactamases) were detected in culture enrichment samples that were not identified in raw samples, despite a lower targeted sequencing depth. Wastewater-based surveillance is an effective, and potentially extremely important and powerful tool that could be developed to augment hospital-based infection control and antimicrobial stewardship programs, creating a safer space for those receiving care.
Identification of CAA as highly specific and sensitive antibody target for acute schistosomiasis diagnostics
Authors: Kildemoes Anna O. , Veldhuizen Tom , Hilt Stan T. , van Lieshout Lisette , Supali Taniawati , Sartono Erliyani , Yazdanbakhsh Maria , Camprubí-Ferrer Daniel , Muñoz Jose , Clerinx Joannes , Corstjens Paul L.A.M. , van Dam Govert J. , Visser Leo G. , Roestenberg Meta , van Diepen Angela , Hokke Cornelis H.
Published: March 2023

Background

The WHO 2030 roadmap for schistosomiasis calls for development of highly sensitive and specific diagnostic tools to continue and sustain progress towards elimination. Serological assays are excellent for sensitive detection of primary schistosome infections and for schistosomiasis surveillance in near- and post-elimination settings. To develop accurate assay formats, it is necessary to identify defined antibody targets with low cross-reactivity and potential for standardized production. Here we focus on defined schistosome glycan antigens.

Methods

Target identification was performed by assessing antibody responses in well characterized cross-sectional and cohort sample sets (n=366 individuals) on tailor-made antigen microarrays. IgM and IgG binding to candidate diagnostic targets was measured for serum/plasma samples from: controlled human schistosome infection model (CSI), schistosome infected travellers, soil-transmitted helminth infected and non-infected individuals.

Findings

We found that antibodies to circulating anodic antigen (CAA) identify schistosome infection with high sensitivity (IgM≥100%, IgG≥97%) and specificity (IgM≥93%, IgG≥97%) in the test samples. Infection dose affected timing of anti-CAA antibody isotype switch. Furthermore, we demonstrate the presence of shared and non-specific glycan epitopes in crude schistosome cercarial and egg antigen preparations. Many non-specific glycan epitopes contained in crude antigen mixes are responsible for a large proportion of false schistosomiasis positives in standard serological assays.

Interpretation

CAA is target for development of highly sensitive and specific tools for schistosomiasis serology with use cases for travellers and surveillance in near and post-elimination settings as well as emerging transmission zones.

Funding

Global Health Innovative Technology Fund (GHIT), HIC-Vac, Leiden University Medical Center (LUMC)