bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of traditional Chinese medicine syndrome elements and clinical symptoms in prediabetes: A systematic review
Authors: Lan Qin , Fang Jianhe , Yu Xinyu , Yang Caiyun , Lin Xingzhen , Wu Juan , Yan Lei , Jian Hui
Published: July 2024

Background:

Prediabetes mellitus (PDM) and impaired glucose regulation precedes diabetes and serve as early warning signals. A 2018 Chinese epidemiological survey reported prediabetes at 25.5% prevalence and type 2 diabetes at 10.8%, respectively. Untreated carries one-third of the risk of diabetes progression. This study aimed to understand traditional Chinese medicine syndromes in PDM to guide clinical practice and diabetes prevention.

Methods:

We systematically searched the Chinese and English literature in PubMed, EMBASE, Sinomed, CNKI, VIP, Wanfang until March 31, 2023. We manually explored the Chinese prediabetes literature, trial registrations, and references, adhering to predefined criteria. The results were independently summarized by 2 researchers. Statistical analysis was performed using EXCEL, IBM SPSS 27.0, and IBM SPSS Modeler 18.0, with data mining techniques including association and cluster analysis.

Results:

Analysis of 23 clinical trials (8943 patients) identified phlegm dampness syndrome as predominant, with qi deficiency, dampness, and phlegm as the principal pathogenic elements. Spleen syndrome elements dominated, with a priori correlation analysis favoring spleen dampness. The prevalent PDM clinical symptoms include amnesia, mental fatigue, limb fatigue, dizziness, and lumbar discomfort.

Conclusion:

Prediabetes is strongly associated with spleen dampness, highlighting its role. Common traditional Chinese medicine syndrome elements include qi deficiency, phlegm, and dampness. Clinical diagnosis and treatment should prioritize syndrome differentiation and emphasize spleen-focused approaches. Although limited research exists on prediabetes syndromes, further exploration of PDM and spleen dampness is crucial.
Comparisons of different general anesthetic techniques on immune function in patients undergoing flap reconstruction for oral cancer
Authors: Qin Chuanqi , Fan Guo , Huang Lili
Published: July 2024

Background:

Anesthetic-induced immunosuppression is of particular interest in tumor surgery. This study aimed to investigate the influence of the 4 most common general anesthetic techniques on immune function in patients undergoing flap reconstruction for oral cancer.

Methods:

116 patients were randomly divided into 4 groups. Patients in group S were given sevoflurane-based anesthesia. Group P was administered propofol-based anesthesia. The SD group received sevoflurane combined with dexmedetomidine anesthesia. The propofol combined with dexmedetomidine anesthesia (PD) group received PD. Blood samples were obtained at 5 time points: baseline (T0), 1 hour after the start of the operation (T1), end of the operation (T2), 24 hours (T3), and 48 hours (T4) after the operation. Lymphocyte subsets (including CD3+, CD4+, CD8+, and B lymphocytes) and dendritic cells were analyzed by flow cytometry. Blood glucose, norepinephrine, and cortisol levels were measured using ELISA and a blood gas analyzer respectively.

Results:

In total, 107 patients were included in the final analysis. Immunological indicators, except CD8+ counts, were all decreased in groups S, P, and SD at T1-4 compared with the baseline value, and the counts of CD3+, CD4+, and dendritic cells, as well as CD4+/CD8+ ratios, were significantly higher in the PD group than in the S, P, and SD at T1-3 (P < .05). There were no significant differences between groups P and SD at any observation time point. Intraoperative stress indices, including norepinephrine and cortisol levels, were significantly lower in the PD group than in the other 3 groups at T1-2 (P < .05).

Conclusion:

These findings suggest that PD as a probably optimal choice can alleviate immunosuppression in patients undergoing flap reconstruction for oral cancer.
A meta-analysis supporting the superiority of staged carotid artery stenting and coronary artery bypass grafting in patients with concurrent severe coronary and carotid artery stenosis
Authors: Hao Dong , Jiang Yunshan , Wang Peijian , Mao Limei
Published: July 2024

Background:

This study sought to ascertain whether a staged approach involving carotid artery stenting (CAS) and coronary artery bypass grafting (CABG) holds superiority over the synchronous (Syn) strategy of CAS or carotid endarterectomy (CEA) and CABG in patients necessitating combined revascularization for concurrent carotid and coronary artery disease.

Method:

Studies were identified through 3 databases: PubMed, EMBASE, and the Cochrane Library. Statistical significance was defined as a P value of less than .05 for all analyses, conducted using STATA version 12.0.

Results:

In the comparison between staged versus Syn CAS and CABG for patients with concomitant severe coronary and carotid stenosis, 4 studies were analyzed. The staged procedure was associated with a lower rate of 30-day stroke (OR = 8.329, 95% CI = 1.017–69.229, P = .048) compared to Syn CAS and CABG. In the comparison between staged CAS and CABG versus Syn CEA and CABG for patients with concomitant severe coronary and carotid stenosis, 5 studies were examined. The staged CAS and CABG procedure was associated with a lower rate of mortality (OR = 2.046, 95% CI = 1.304–3.210, P = .002) compared to Syn CEA and CABG.

Conclusion:

The Syn CAS and CABG was linked to a higher risk of peri-operative stroke compared to staged CAS and CABG. Additionally, patients undergoing staged CAS and CABG exhibited a significantly decreased risk of 30-day mortality compared to Syn CEA and CABG. Future randomized trials or prospective cohorts are essential to confirm and validate these findings.
The measured healthy lifestyle habits among Saudi university females in Medina, Saudi Arabia: A cross-sectional study
Authors: Surrati Amal M. Qasem , Altayeb Eilaf Hasan , Almohammadi Wedyan Ali , Aljohani Rahaf Mustafa , Altouri Haya Shaher Ali , Alhawsawi Rahaf Abdullah
Published: July 2024

Lifestyle plays a crucial role in shaping an individual’s health outcomes, we aim to calculate the prevalence of lifestyle habits among female populations in the College of Medicine, Taibah University including poor dietary habits, lack of physical activity (PA), poor coping with stress, and impaired sleep patterns and to find factors that are correlated to them. A cross-sectional study was conducted among Saudi females at the College of Medicine, Taibah University, from January 1 to June 1, 2023. Data were collected through interviewing them using validated questionnaires assessing 5 different lifestyle domains. Statistical analysis was performed using Statistical Package for the Social Sciences version 21.0. A total of 263 cases were interviewed. The mean age was 22 ± 8.4 years old. The average sleep quality measured by the Pittsburgh Sleep Quality Index of 2.6 ± 1.1, suggesting relative difficulty in sleep quality. A total of 68.6% participated in moderate PA. Dietary habits indicated a high prevalence of consumption of sweets, and fast meals, alongside low intake of fruits and vegetables. Emotional well-being, as assessed by the World Health Organization-5 questionnaire, yielded an average score of 7.8 ± 5.7, 58.9% moderate stress, and 8% high perceived stress. Adequate sleep quality is crucial for well-being, necessitating lifestyle modifications, particularly weight management, to address sleep disorders. Varied PA levels (46% meeting recommendations) highlight the need for standardized guidelines and tailored interventions. The high prevalence of unhealthy dietary habits underscores the importance of targeted nutritional interventions. Stress prevalence (40%) emphasizes the need for individualized stress management strategies.
Construction and validation of prognostic signature for transcription factors regulating T cell exhaustion in hepatocellular carcinoma
Authors: Jin Xi , Zhou Kun , Zhang Rongzheng , Li Jingbo , Guo Mengrui , Qiao Han , Wu Meng , Cao Xinyang , Dong Guanglu , Zhang Shuyun
Published: July 2024

In the tumor microenvironment (TME), CD8+ T cells showed stage exhaustion due to the continuous stimulation of tumor antigens. To evaluate the status of CD8+ T cells and reverse the exhaustion is the key to evaluate the prognosis and therapeutic effect of tumor patients. The aim of this study was to establish a prognostic signature that could effectively predict prognosis and response to immunotherapy in patients with hepatocellular carcinoma (HCC). We used univariate Cox analysis to obtain transcription factors associated with CD8+ T cell exhaustion from The Cancer Genome Atlas dataset. Then, the prognostic signature for transcription factors basic leucine zipper ATF-like transcription factor, Eomesodermin, and T-box protein 21 regulating T cell exhaustion was constructed using LASSO Cox regression. The relative expression levels of the mRNA of the 3 transcription factors were detected by reverse transcription-quantitative polymerase chain reaction in 23 pairs of HCC and paracancer tissues, and verified internally in The Cancer Genome Atlas dataset and externally in the International Cancer Genome Consortium dataset. Cox regression analysis showed that risk score was an independent prognostic variable. The overall survival of the high-risk group was significantly lower than that of the low-risk group. The low-risk group had higher immune scores, matrix scores, and ESTIMATE scores, and significantly increased expression levels of most immune checkpoint genes in the low-risk group. Therefore, patients with lower risk scores benefit more from immunotherapy. The combination of the 3 transcription factors can evaluate the exhaustion state of CD8+ T cells in the TME, laying a foundation for evaluating the TME and immunotherapy efficacy in patients with HCC.
Real-life effectiveness and safety of vedolizumab in moderate-to-severe ulcerative colitis: A single-center experience in Northern China
Authors: Yan Jing , Ding Xueli , Wu Jun , Liu Ailing , Fang Liang , Xu Yonghong
Published: July 2024

Vedolizumab (VDZ), a monoclonal antibody to α4β7 integrin, is available for patients with moderate-to-severe ulcerative colitis (UC). This study planned to assess the real-world effectiveness and safety of VDZ for UC patients in Northern China. We enrolled patients with moderate-to-severe UC who underwent VDZ induction therapy from March 2021 to November 2022 at the Affiliated Hospital of Qingdao University. The primary outcome was clinical remission at weeks 14 and 52 after the initial VDZ therapy. Overall adverse events and risk factors associated with loss of response (LOR) were also evaluated. Seventy-three UC patients receiving VDZ therapy were included in this study. The rates of clinical response, clinical remission, and steroid-free clinical remission were 69.9%, 39.7%, and 34.2% at week 14 and 90.5%, 66.7%, and 64.4% at week 52, respectively. The mucosal remission rates were 37.5% (18/48) at week 14 ± 8 and 27.3% (9/33) at week 52 ± 16, while only 2 and 3 patients achieved mucosal healing at weeks 14 ± 8 and 52 ± 16, respectively. Of the UC patients, 23.3% experienced adverse events associated with VDZ, most of which were mild and self-limiting. Until the last follow-up, 37 of 73 UC patients experienced LOR during the maintenance period. Patients with a higher ulcerative colitis endoscopic severity index (UCEIS), partial Mayo scores (PMS), or hemoglobin below 120 g/L at baseline were more likely to experience LOR after VDZ induction therapy. VDZ is an effective and safe agent for patients with moderate-to-severe UC in Northern China. A high baseline UCEIS, PMS, or hemoglobin < 120 g/L may be an independent risk factor for LOR during the maintenance period.
Toward a cure – Advancing HIV/AIDs treatment modalities beyond antiretroviral therapy: A Review
Authors: Alum Esther Ugo , Uti Daniel Ejim , Ugwu Okechukwu Paul-Chima , Alum Benedict Nnachi
Published: July 2024

Antiretroviral therapy, also known as antiretroviral therapy (ART), has been at the forefront of the ongoing battle against human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDs). ART is effective, but it has drawbacks such as side effects, medication resistance, and difficulty getting access to treatment, which highlights the urgent need for novel treatment approaches. This review explores the complex field of HIV/AIDS treatment, covering both established alternative treatment modalities and orthodox antiretroviral therapy. Numerous reliable databases were reviewed, including PubMed, Web of Science, Scopus, and Google Scholar. The results of a thorough literature search revealed numerous therapeutic options, including stem cell transplantation, immunotherapy, gene therapy, latency reversal agents, and pharmaceutical vaccinations. While gene therapy has promise for altering cellular resistance to infection and targeting HIV-positive cells, immunotherapy treatments seek to strengthen the immune system’s ability to combat HIV. Latency reversal agents offer a promising method of breaking the viral latency and making infected cells vulnerable to immune system destruction or antiretroviral drugs. Furthermore, there is potential for improving immune responses against HIV using medical vaccinations. This review stresses the vital significance of ongoing research and innovation in the hunt for a successful HIV/AIDS treatment through a thorough examination of recent developments and lingering challenges. The assessment notes that even though there has been tremendous progress in treating the illness, there is still more work to be done in addressing current barriers and investigating various treatment options in order to achieve the ultimate objective of putting an end to the HIV/AIDS pandemic.
A case series of osseous metastases in patients with glioblastoma
Authors: Webb Lauren Michelle , Webb Mason J. , Campian Jian L. , Caron Samantha J. , Ruff Michael W. , Uhm Joon H. , Sener Ugur
Published: July 2024

Background:

Extracranial metastases occur in <2% of cases of glioblastoma (GBM). When metastases do occur, bone is the most common destination. Herein, we review clinical characteristics of GBM patients with osseous metastases and evaluate both potential risk factors and prognostic significance.

Methods:

Using an institutional database, we identified and retrospectively analyzed 6 patients with both GBM and osseous metastases. We collected data on patient demographics, tumor genetics, clinical courses, and outcomes. Given the rarity of metastatic GBM, we conducted historical comparisons using previously published literature.

Results:

Five patients with osseous metastases (83%) were male, with a median age of 46 years at GBM diagnosis (range: 20–84). All patients had IDH-wildtype, MGMT promoter unmethylated GBM and 5 (83%) had alterations in TP53. All patients underwent surgical resection for GBM followed by radiation with concurrent and adjuvant temozolomide. Four patients (67%) received bevacizumab prior to bone metastasis diagnosis. Bone metastases were discovered at a median of 12.2 months (range: 5.3–35.2) after GBM diagnosis and 4.8 months after starting bevacizumab (range: 3.5–13.2). Three patients (50%) received immunotherapy. After osseous metastasis diagnosis, the median survival was 25 days (range: 13–225).

Conclusion:

In our cohort, most patients were male and young at the time of GBM diagnosis. All patients had IDH-wildtype, MGMT promoter unmethylated GBM, and most had alterations in TP53, which may be important for osseous metastasis. Most patients received bevacizumab, which has been associated with earlier metastasis. Osseous metastases of GBM occur and portend a dismal prognosis in an already aggressive malignancy.
Inter- and intra-individual differences regarding SARS-CoV-2 and influenza vaccination in pediatric kidney transplant recipients: An observational study
Authors: Kanai Takahiro , Ito Takane , Saito Takashi , Aoyagi Jun , Kurosaki Masanori , Betsui Hiroyuki , Maru Tomomi , Ono Marika , Tajima Toshihiro
Published: July 2024

In kidney transplant recipients (KTRs), viral infection can lead to antibody and/or T-cell mediated rejection, resulting in kidney transplant dysfunction. Therefore, it is critical to prevent infections. However, KTRs exhibit suboptimal responses to SARS-CoV-2 and/or influenza vaccines, partly due to immunosuppressant therapy. Inter- and intra-individual differences in the biological responses to vaccines may also affect patients’ antibody production ability. This study included KTRs who received an messenger RNA SARS-CoV-2 vaccine (3 doses), and an inactivated quadrivalent influenza vaccine (1 or 2 doses). We measured the patients’ total antibody titers against SARS-CoV-2 spike antigen, and hemagglutination inhibition (HI) titers against influenza A/H1N1, A/H3N2, B/Yamagata, and B/Victoria. Five patients were eligible for this study. Of these 5 KTRs, two produced anti-SARS-CoV-2 spike antibody titers to a seroprotective level, and also produced HI titers against A/H1N1 to a seroprotective level. Another 2 KTRs did not produce seroprotective anti-SARS-CoV-2 antibody titers, but produced seroprotective HI titers against A/H1N1. The remaining KTR produced a seroprotective anti-SARS-CoV-2 antibody titer, but did not produce a seroprotective HI titer against A/H1N1. The 2 KTRs who did not produce seroprotective anti-SARS-CoV-2 antibody titers following vaccination, later developed COVID-19, and this infection increased their titers over the seroprotective level. This study demonstrated that inter- and intra-individual differences in biological responses to vaccines should be considered in pediatric KTRs, in addition to immunosuppressant effects. Personalized regimens, such as augmented or booster doses of vaccines, could potentially improve the vaccination efficacy against SARS-CoV-2 and influenza.
The impact of simulation-based training in medical education: A review
Authors: Elendu Chukwuka , Amaechi Dependable C. , Okatta Alexander U. , Amaechi Emmanuel C. , Elendu Tochi C. , Ezeh Chiamaka P. , Elendu Ijeoma D.
Published: July 2024

Simulation-based training (SBT) has emerged as a transformative approach in medical education, significantly enhancing healthcare professionals’ learning experience and clinical competency. This article explores the impact of SBT, tracing its historical development and examining the various types of simulations utilized today, including high-fidelity mannequins, virtual reality environments, standardized patients, and hybrid simulations. These methods offer a safe and controlled environment for students to practice and hone technical and non-technical skills, ultimately improving patient safety and clinical outcomes. The benefits of SBT are manifold, including enhanced skill acquisition, error reduction, and the opportunity for repeated practice without risk to actual patients. Immediate feedback and structured debriefing further solidify learning, making Simulation an invaluable tool in medical education. However, the implementation of SBT is challenging. It requires substantial financial investment, specialized equipment, and trained faculty. Additionally, there are concerns about the realism of simulations and the transferability of skills to real-world clinical settings. Despite these challenges, numerous case studies and empirical research underscore the effectiveness of SBT compared to traditional methods. Looking ahead, advancements in technology, such as artificial intelligence and improved virtual reality applications, promise to enhance the efficacy and accessibility of simulation training. The integration of Simulation with other training modalities and its adoption in diverse global contexts highlight its potential to revolutionize medical education worldwide. This article affirms the crucial role of SBT in preparing the next generation of healthcare professionals and its ongoing evolution driven by technological innovations.
Intralobar bronchopulmonary sequestration in an adult: a case report
Authors: Pandey Abhishek , Pandey Archana , Keshari Suraj , Dulal Aliza , Acharya Suyash , Chaudhary Aashutosh , Chaudhary Ashlesha , Pande Prasamsa , Bhardwaj Sushant
Published: July 2024

Introduction:

Bronchopulmonary sequestration (BPS) is typically a rare congenital disorder characterized by the presence of non-functioning lung tissue. There are two types of BPS: intralobar and extralobar sequestration, where extralobar sequestration can either be intrathoracic or sub-diaphragmatic.

Case presentation:

In this case report, we present the case of a 70-year-old male with intralobar BPS who presented with recurrent chest infections, and a diagnosis of intralobar pulmonary sequestration was made based on a computed tomography (CT) scan.

Discussion:

The diagnosis of intralobar pulmonary sequestration can be delayed as the intralobar type can present with varying imaging findings. A diagnosis can be made based on CT or MRI findings. A CT scan or MRI can show mass or consolidation with or without a cyst. Both CT and MRI can be reliable modalities to identify the arterial supply of the sequestered lung tissue, which is commonly a branch of the descending aorta.

Conclusion:

Sequestration should be suspected when a posterobasal lung abnormality is supplied by an abnormal artery from the aorta or another systemic artery.
Transcutaneous oxygen tension-guided hyperbaric oxygen therapy for preventing skin necrosis after hyaluronic acid filler injections
Authors: Yang Qiqiong , Shi Zhiyuan , Pan Shuyi , Li Hang
Published: July 2024

Introduction:

Hyaluronic acid (HA) fillers, popular for facial cosmetic enhancements, pose risks of vascular complications like skin necrosis due to arterial blockage, necessitating effective treatments such as hyperbaric oxygen therapy (HBOT).

Methodology:

This study presents a series of cases where measurements of transcutaneous oxygen pressure (TcPO2) informed the application of HBOT for skin necrosis induced by HA.

Clinical presentation and outcomes:

In cases 1 and 3, following the injection of HA, potential skin necrosis was observed. In addition to standard treatment, TcPO2 revealed values below 40 mmHg, indicating tissue hypoxia. Treatment with HBOT increased TcPO2 levels to above 200 mmHg, suggesting that HBOT could correct the hypoxia. Monitoring TcPO2 levels also aided in determining the optimal time to discontinue HBOT. In cases 2 and 4, patients received standard treatment, resulting in TcPO2 levels above 40 mmHg, indicating adequate tissue oxygenation, and no additional HBOT was administered. All four patients mentioned above showed good clinical recovery.

Conclusion:

This study investigates the application of TcPO2 measurement technology in aiding decisions on whether to utilize HBOT in the treatment of complications arising from HA fillers, as well as in optimizing HBOT protocols.
Artificial Intelligence or Nursing Student? Revisiting Clues in the Connectives
Authors: Abbott Miriam R. Bowers , Abbott Wyatt W.
Published: July 2024

Background:

Recent research at a single-purpose nursing institution has suggested a means to authenticate student writing by distinguishing it from artificial intelligence (AI)-generated text through the detection of key terms.

Purpose:

The purpose was to replicate and expand the research that identified key terms present in student writing but absent from AI-generated text.

Methods:

A total of 5 generative AI writing tools were fed prompts to collect 14 787 words. Using the Search function on word processing software, the frequency of the terms, because, since, so, then, thing, think, and too, was measured and compared against earlier published findings from AI and students.

Results:

The replication study was successful for the terms since, then, thing, think, and too.

Conclusions:

Measuring key term frequency may be a path to authenticate student writing. While no tool can provide certainty of original authorship, the absence of key terms in a student submission may suggest AI authorship.
Long-Term Outcome of Secondary Cleft Rhinoplasty in Patients with Secondary Nasal Deformity: Optimal Indications for Tajima Technique
Authors: Liu Yingmeng , Zhang Chong , Yao Meilin , Wei Minxing , Long Yifei , Zheng Qian , Low David W. , Shi Bing , Li Chenghao
Published: July 2024

Background:

The authors investigated the timing of and indications for the Tajima reverse-U incision for correcting secondary unilateral cleft nasal deformities.

Methods:

Nonsyndromic patients with secondary cleft lip and nasal deformity who received Tajima reverse-U incision rhinoplasty were grouped by age (4 to 13 years, n = 56; 13 to 18 years, n = 22; older than 18 years, n = 18) and severity of deformity (mild deformity, n = 7; moderate deformity = 22; severity deformity = 67) during 5-year follow-up. FACE-Q assessment and nasal symmetry measurements were used in this study.

Results:

Ninety-six patients completed the FACE-Q assessment for the nose and nostril. The results showed higher satisfaction with nostril appearance 1 week after surgery (85.95 ± 13.01) compared with before surgery (79.72 ± 11.89), maintained at the 5-year follow-up (82.61 ± 14.06). Significant differences were observed in 5 nasal parameters (nasal height ratio, one-fourth media part of nostril height ratio, nasal sill height ratio, columellar angle, and inner nostril height-to-width ratio [cleft]) at 1 week postoperatively, and the corrected outcome of the Tajima technique was maintained 5 years after surgery in the 4- to 13-year age group. The same statistically significant changes were found in nasal sill height ratio in the mild deformity group and nostril width ratio, one-fourth media part of nostril height ratio, columellar angle, and inner nostril height-to-width ratio (cleft) in the moderate deformity group.

Conclusion:

The Tajima procedure was beneficial for preadolescent children and children with mild to moderate unilateral cleft nasal deformities.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
What Computed Tomography Findings Are Predictive of Posttraumatic Enophthalmos in Orbital Fractures?
Authors: Lentskevich Marina A. , Nguyen Alvin , Choudhary Akriti , Obaid Oday , Purnell Chad A.
Published: July 2024

Background:

Enophthalmos is a surgical indication for orbital fracture repair. However, guidelines to predict enophthalmos in orbital fractures are ambiguous. The authors systematically reviewed the existing literature on using computed tomographic findings to establish objective metrics to predict enophthalmos in asymptomatic patients during initial trauma work-up.

Methods:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. PubMed and Embase were used to identify studies of interest. The Quality in Prognosis Studies tool was used for risk of bias assessment. Random-effects model meta-analyses of orbital volume change and fracture area values were completed. Regression analyses were performed to determine thresholds that predicted 2 mm of enophthalmos.

Results:

Of the initial 2236 abstracts, 36 met inclusion criteria. Thirty retrospective studies evaluated a total of 2851 patients, and 6 prospective studies evaluated 211 patients. All 36 studies had predominantly low risk of bias. Predictors of enophthalmos assessed were orbital volume change (21 articles), fracture surface area (13 articles), inferior rectus muscle displacements (7 articles), and fracture location (4 articles). Studies reporting on orbital volume change offered values ranging from 0.69 to 4.26 cm3. Fracture area predictor values ranged from 1.50 to 3.38 cm2. Meta-analyses confirmed the validity of both predictors. Pooled regression analyses demonstrated that 3.33 cm3 of orbital volume increase or fracture area of 3.12 cm2 were predictors of 2 mm of enophthalmos.

Conclusions:

Both orbital volume change and fracture area measured on computed tomographic scan are good predictors of late posttraumatic enophthalmos. Pooled data indicate that 3.12 cm2 of fracture area or 3.33 cm3 of orbital volume increase is predictive of enophthalmos.
The Contribution of Socioeconomic Factors to HIV RNA Suppression in Persons With HIV Engaged in Care in the NA-ACCORD
Authors: Chandran Aruna , Feng Xinyi , Coburn Sally B. , Kasaie Parastu , Malone Jowanna , Horberg Michael A. , Hogan Brenna , Rebeiro Peter F. , Gill M. John , McGinnis Kathleen A. , Silverberg Michael J. , Karris Maile Young , Napravnik Sonia , Konkle-Parker Deborah , Lee Jennifer , Freeman Aimee M. , Ghidey Ronel , Garza Venezia , Marconi Vincent C. , Kirk Gregory D. , Thorne Jennifer , Crane Heidi M. , Lang Raynell , Kitahata Mari M. , Moore Richard D. , Althoff Keri N.
Published: July 2024

Introduction:

Socioeconomic status (SES) influences well-being among people living with HIV (people with HIV [PWH]); when individual-level SES information is not available, area-level SES indicators may be a suitable alternative. We hypothesized that (1) select ZIP code–level SES indicators would be associated with viral suppression and (2) accounting for ZIP code–level SES would attenuate racial disparities in viral suppression among PWH.

Setting:

The NA-ACCORD, a collaboration of clinical and interval cohorts of PWH, was used.

Methods:

Participants with ≥1 viral load measurement and ≥1 US residential 5-digit ZIP code(s) between 2010 and 2018 were included. In this serial cross-sectional analysis, multivariable logistic regression models were used to quantify the annual association of race and ethnicity with viral suppression, in the presence of SES indicators and sex, hepatitis C status, and age.

Results:

We observed a dose–response relationship between SES factors and viral suppression. Lower income and education were associated with 0.5–0.7-fold annual decreases in odds of viral suppression. We observed racial disparities of approximately 40% decreased odds of viral suppression among non-Hispanic Black compared with non-Hispanic White participants. The disparity persisted but narrowed by 3%–4% when including SES in the models.

Conclusions:

ZIP code–based SES was associated with viral suppression, and accounting for SES narrowed racial disparities in viral suppression among PWH in the NA-ACCORD. Inclusion of ZIP code–level indicators of SES as surrogates for individual-level SES should be considered to improve our understanding of the impact of social determinants of health and racial disparities on key outcomes among PWH in North America.
Radiogenomics of Intrahepatic Cholangiocarcinoma: Correlation of Imaging Features With BAP1 and FGFR Molecular Subtypes
Authors: Cox Veronica , Javle Milind , Sun Jia , Kang Hyunseon
Published: July 2024

Purpose

Clinical research has shown unique tumor behavioral characteristics of BRCA-associated protein-1– (BAP1-) and fibroblast growth factor receptor (FGFR)–mutated intrahepatic cholangiocarcinomas (CCAs), with BAP1-mutated tumors demonstrating more aggressive forms of disease and FGFR-altered CCAs showing more indolent behavior. We performed a retrospective case-control study to evaluate for unique imaging features associated with BAP1 and FGFR genomic markers in intrahepatic CCA (iCCA).

Methods

Multiple imaging features of iCCA at first staging were analyzed by 2 abdominal radiologists blinded to genomic data. Growth and development of metastases at available follow-up imaging were also recorded, as were basic clinical cohort data. Types of iCCA analyzed included those with BAP1, FGFR, or both alterations, as well as cases with low mutational burden or mutations with low clinical impact, which served as a control or “wild-type” group. There were 18 cases in the FGFR group, 10 with BAP1 mutations, and 31 wild types (controls).

Results

Cases with BAP1 mutations showed significantly larger growth at first year of follow-up (P = 0.03) and more frequent tumor-associated biliary ductal dilatation (P = 0.04) compared with controls. FGFR-altered cases showed more infiltrative margins compared with controls (P = 0.047) and demonstrated less enhancement between arterial to portal venous phases (P = 0.02). BAP1 and FGFR groups had more cases with stage IV disease at presentation than controls (P = 0.025, P = 0.006).

Conclusion

Compared with wild-type iCCAs, FGFR-mutated tumors often demonstrate infiltrative margins, and BAP1 tumors show increased biliary ductal dilatation at presentation. BAP1-mutated cases had significantly larger growth at first-year restaging.
Incidental Breast Cancer Diagnosis From Lymphoscintography Using 99mTc-Labeled Nanocolloid for Cutaneous Melanoma of the Upper Arm
Authors: Chan Kayan , Chan James , Roshan Amit
Published: July 2024

A 51-year-old woman with a 2-mm-Breslow-thickness melanoma on her arm had 99mTc-nanocolloid lymphoscintigraphy to localize the associated sentinel lymph node. A single axillary node was identified, and histology confirmed a micrometastasis of breast tissue origin. Imaging of the patient’s breasts and subsequent biopsy confirmed ipsilateral stage III breast cancer, which was treated with lumpectomy and axillary node clearance. This is the first reported case of an incidental solid cancer diagnosis from a sentinel lymph node biopsy undertaken for a different tumor origin. This illustrates the importance of recognizing overlapping lymphatic distribution of sentinel lymph nodes, which can drain multiple organs.
FDG PET/CT in Staging and Response Evaluation of Primary Urothelial Carcinoma of the Urethra
Authors: Zhang Jun , Dong Aisheng , Wang Yang
Published: July 2024

Primary urethral urothelial carcinoma is a rare aggressive tumor with a high propensity for local invasion and regional and distal metastases. We describe the usefulness of FDG PET/CT in management of a patient with primary urethral urothelial carcinoma. FDG PET/CT at initial staging showed FDG-avid primary tumor and lymph node metastasis of the left groin, and mild or no activity of the lung metastases due to small size. FDG PET/CT after 4 cycles of chemotherapy showed progression of the primary tumor and lung metastases, partial response of the left inguinal lymphadenopathy, and multiple new sites of FDG-avid metastases.
Atypical Bone Involvement in Erdheim-Chester Disease Showing No or Subtle Structure Changes and Increased Activity on FDG PET/CT
Authors: Xiao Zhengguang , Dai Shun , Dong Aisheng , Bai Yushu
Published: July 2024

Bones are the most common sites involved in Erdheim-Chester disease. On imaging, the bone involvement in Erdheim-Chester disease typically presents as osteosclerotic lesions, and osteolytic lesions are unusual. Bone lesions showing no or subtle structure changes are rarely reported. We describe FDG PET/CT findings in a case of Erdheim-Chester disease with atypical bone involvement. The bone lesions showed no or subtle structure changes without obvious osteosclerosis or osteolysis on radiographs and CT, and increased FDG activity mimicking lymphoma. Familiarity with these atypical imaging findings of bone involvement in Erdheim-Chester disease is helpful for the diagnosis.
A Rare Case of Follicular Dendritic Cell Tumor of the Abdominal Cavity Visualized by 18F-AlF-NOTA-Octreotide PET/CT
Authors: Hou Guozhu , Cheng Xin , Sun Li , Wang Xuejuan , Zheng Rong
Published: July 2024

Positivity of follicular dendritic cell tumor in somatostatin receptor imaging is rare. A 68-year-old woman underwent ultrasound in health examination. The results showed abnormal echoes in the pancreatic head region, suggestive of a neuroendocrine tumor of the pancreatic head. 18F-AlF-NOTA-octreotide PET/CT was performed for staging. 18F-AlF-NOTA-octreotide PET/CT revealed an irregular mass between the caudate lobe of the liver and the pancreatic head with heterogeneously increased uptake, which was later confirmed as follicular dendritic cell tumor by pathological examination.
68Ga-FAPI PET/CT Visualized Benign Metastasizing Leiomyoma With Bone Invasion
Authors: Fang Tianxing , Li Chongjiao , Tian Yueli , Xiao Zhiwei , He Yong
Published: July 2024

Benign metastasizing leiomyoma (BML) is a rare disease associated with pelvic leiomyoma. We report 18F-FDG and 68Ga-FAPI PET/CT findings in a 51-year-old woman with multiple BMLs. The mass in the abdominopelvic cavity and other metastatic lesions showed highly increased 68Ga-FAPI uptake, whereas uptake of 18F-FDG in those lesions was low. Our report demonstrates that 68Ga-FAPI PET/CT showed a different result in detecting BML to 18F-FDG PET/CT, and 68Ga-FAPI PET/CT may be a promising method for whole-body evaluate metastases.
Establishment of Cephalic Index by Computed Tomography in Sampled Chinese Children
Authors: Liang Qin-Chuan , Chen Xi , Liu Hui-Qing , Xia Ze-Yang , Gao Ping-Ping , Bao Nan
Published: July 2024

Objective:

Cephalic Index (CI), the ratio of head width to length, is one of the indexes reflecting cranial morphological characteristics. Current norms were established by European and American countries. The purpose of the study was to study anthropometry of cranial parameters using computed tomography scans to establish the CI of the sampled Chinese Children.

Methods:

The cross-sectional study was carried out on patients of age younger than 14 years old at Shanghai Children’s Medical Center. The measurement of maximum cranial breadth and maximum cranial length were taken on a computed tomography scan machine and recorded for analysis. Cephalic Index was calculated for each age and sex group and compared with previously established norms.

Results:

Five hundred eighteen patients met the inclusion criteria, including 301 males and 217 females. The means for boys and girls were 87.1 (SD: 4.3) and 85.8 (SD: 4.3), respectively. There was a significant difference between boys and girls (P < 0.01). Cephalic Index in different ages and on applying the 1-way analysis of variance association was statistically insignificant (P = 0.19).

Conclusions:

Chinese head shape was brachycephalic. A statistically significant correlation was seen between the CI and sex, while not age.
Who Do We Fail to Rescue after Pancreatoduodenectomy? Outcomes Among >4000 Procedures Expose Windows of Opportunity
Authors: Kinny-Köster Benedict , Halm Darius , Tran Duc , Kaiser Jörg , Heckler Max , Hank Thomas , Hinz Ulf , Berchtold Christoph , Al-Saeedi Mohammed , Roth Susanne , Mehrabi Arianeb , Marchegiani Giovanni , Büchler Markus W. , Loos Martin
Published: July 2024

Objective:

Our investigation on in-hospital mortality after 4474 pancreatoduodenectomies aimed to identify time-dependent risks as well as windows of opportunity to rescue patients from complications.

Background:

Pancreatoduodenectomy is generally considered a safe procedure with a 1-10% perioperative mortality based on complexity and surgical volume. Yet, patients are susceptible for life-threatening complications particularly with extended resections. Recognition of distinct vulnerabilities over time while patients recover is required to permit focused monitoring, sophisticated resource allocation, and greatest surgical safety.

Methods:

Patients who deceased in-hospital after pancreatoduodenectomy between 2003-2021 were retrieved from the institutional pancreatectomy registry and analyzed in detail with respect to their postoperative course.

Results:

Among 4474 pancreatoduodenectomies, 156 patients deceased in-hospital (3.5%). When assessing root causes of mortality, we observed 3 different clusters of complications which were postpancreatectomy-specific (47.4%), visceral vasculature-associated (25.6%), or cardiopulmonary in origin (23.7%). The median times of root cause onset in the 3 categories were postoperative day (POD) 9, POD 4.5 (P=0.008) and POD 3 (P<0.001), and medians of in-hospital mortality were POD 31, POD 18 (P=0.009) and POD 8 (P<0.001), respectively. Intervals between root cause onset and mortality varied with medians of 23 days, 11 days (P=0.017), and 1 days (P<0.001). The 3 categories were similarly distributed between different types of surgical complexity.

Conclusion:

Postpancreatectomy-specific complications prompt almost half of in-hospital mortalities after pancreatoduodenectomy, with rather long intervals for interventions to prevent failure to rescue. In contrast, visceral vasculature-related events and cardiopulmonary complications dominate early in-hospital mortalities with short intervals until mortality, demanding rigorous management of such events or preoperative conditioning. These data externally validate a previous high-volume initiative and highlight distinct windows of opportunity to optimize perioperative safety.
Optimizing DCD Liver Grafts With Prolonged Warm Ischemic Time Using Stabilized Plasmin in a Static Cold Storage Orthotopic Rat Liver Transplant Model
Authors: Kahan Riley , Abraham Nader , Zhang Min , Novokhatny Valery , Alderete Isaac , Cray Paul , Chen Fengming , Gao Qimeng , Cywinska Greta , Neill Ryan , Nakata Kentaro , Hassan Ahmed , Rush Caroline , Penaflor Jude , Pollara Justin J. , Hartwig Matthew G. , Hughes Benjamin , Barbas Andrew S.
Published: July 2024

Background.

The clinical success of liver transplantation has led to increased demand, requiring further expansion of the donor pool. Therapeutic interventions to optimize organs from donation after circulatory death (DCD) have significant potential to mitigate the organ shortage. Dysfunction in DCD liver grafts is mediated by microvascular thrombosis during the warm ischemic period, and strategies that reduce this thrombotic burden may improve graft function. We hypothesized that the administration of the fibrinolytic enzyme plasmin to the donor organ during the cold storage period would reduce the thrombotic burden and improve DCD liver graft function.

Methods.

In 2 separate cohorts, 32 syngeneic orthotopic rat liver transplants were performed in Lewis rats. Livers were procured from donors with 45 min of warm ischemic injury. Liver grafts were flushed with histidine-tryptophan-ketoglutarate preservation solution mixed with either plasmin (experimental group) or albumin (control group). All investigators were blinded to treatment group. After preparing the liver for implant using a modified cuff technique, the liver was stored for 1 h by static cold storage at 4 °C. Immediately before implantation, the liver graft was flushed, and this effluent was analyzed for fibrin degradation products to determine graft clot burden. Twenty-four hours following transplantation, animals were euthanized, and samples were collected.

Results.

Recipient survival was significantly higher for DCD liver grafts treated with plasmin compared with control. Moreover, histology of liver graft tissue immediately before implant reflected significantly reduced congestion in plasmin-treated livers (score, mean ± SD: 0.73 ± 0.59 versus 1.12 ± 0.48; P = 0.0456). The concentration of fibrin degradation products in the final flush before implantation was significantly reduced in plasmin-treated livers (743 ± 136 versus 10 919 ± 4642 pg/mL; P = 0.0001), reflecting decreased clot burden in the graft.

Conclusions.

The present study demonstrates that plasmin improves survival and may reduce thrombotic burden in DCD liver grafts with prolonged warm ischemic injury, meriting further study.
IDO+ Endothelial Cells in Glomeruli of Kidney Transplantation Patients With Glomerulitis
Authors: Hendriks Sanne H. , Heidt Sebastiaan , Krop Juliette , IJsselsteijn Marieke E. , Eggermont Jeroen , Kers Jesper , Reinders Marlies E.J. , Koning Frits , van Kooten Cees
Published: July 2024

Background.

Kidney transplantation is the preferred treatment option for patients with end-stage renal disease. However, long-term graft survival remains a challenge. The enzyme indoleamine 2,3 dioxygenase (IDO) has been reported to have immunomodulatory effects with IDO transcripts being elevated in both antibody-mediated rejection and T cell–mediated rejection.

Methods.

A metal-conjugated antibody panel for the staining of kidney biopsies was developed, allowing the visualization of 41 structural and immune markers on a single tissue slide to gain in-depth insight into the composition and localization of the immune cell compartment. Staining was applied to week 4 and 24 protocol biopsies of 49 patients as well as on 15 indication biopsies of the TRITON study and 4 additional transplantation biopsies with glomerulitis.

Results.

A highly distinctive and specific glomerular IDO expression was observed in biopsies from 3 of 49 patients in imaging mass cytometry. Immunohistochemistry confirmed IDO expression in glomeruli of 10 of 10 cases with glomerulitis. IDO was found to be expressed by CD31+ glomerular endothelial cells, accompanied by the presence of granzyme-B+Tbet+CD7+CD45RA+ natural killer cells and CD68+ macrophages. Furthermore, a proportion of both the immune cells and endothelial cells expressed Ki-67, indicative of cell proliferation, which was not observed in control glomeruli.

Conclusions.

Our results show glomerular IDO expression in transplanted kidneys with glomerulitis, which is accompanied by increased numbers of natural killer cells and macrophages and likely reflects local immune activation.
Normothermic Machine Perfusion Is Associated With Improvement in Mortality and Graft Failure in Donation After Cardiac Death Liver Transplant Recipients in the United States
Authors: Okumura Kenji , Dhand Abhay , Misawa Ryosuke , Sogawa Hiroshi , Veillette Gregory , Nishida Seigo
Published: July 2024

Background.

Use of normothermic machine perfusion (NMP) may help to expand the liver transplantation (LT) donor pool by potentially increasing the utilization of donation after circulatory death (DCD) organs. The aim of this study was to assess the impact of NMP on LT from DCD organs.

Methods.

Data among DCD adult LT recipients in the United Network for Organ Sharing between January 2016 and December 2022 were analyzed. Outcomes were compared between 2 groups: NMP versus non-MP using propensity score matching.

Results.

During the study period, 4217 DCD LT recipients (NMP: 257 and non-MP: 3960) were identified. compared with non-MP, DCD LT recipients in NMP group were older (median recipient age: 61 versus 59 y, P = 0.013), had lower model for the end-stage liver disease score, longer wait time (126 versus 107 d, P = 0.028), and received organs from older donors (median age: 42 versus 38 y, P < 0.01) with longer preservation time (9.9 versus 5.3 h, P < 0.001). Two-year overall survival (NMP 94.4% versus non-MP 89.7%, P = 0.040) and 2-y graft survival (NMP 91.3% versus non-MP 84.6%, P = 0.017) were better in the NMP group. After propensity score matching, 2-y overall survival (NMP 94.2% versus non-MP 88.0%, P = 0.023) and graft survival (NMP 91.3% versus non-MP 81.6%, P = 0.004) were better in the NMP group. On multivariable cox regression analysis, NMP was an independent factor of protection against mortality (hazard ratio, 0.43; 95% confidence interval: 0.20-0.91; P = 0.029) and against graft failure (hazard ratio, 0.26; 95% confidence interval: 0.11-0.61; P = 0.002).

Conclusions.

Use of NMP for LT from DCD donors was associated with improved posttransplant patient and graft survival.
Notification of bacterial strains made available by the United Kingdom National Collection of Type Cultures in 2022
Authors: Turnbull Jake David , Dicks Jo , Adkin Rachael , Dickinson Alexander , Kaushal Dorota , Semowo Mojisola , McGregor Hannah , Alexander Sarah ,   The NCTC 2022 Depositors Cohort
Published: July 2024

Here, we report on the one hundred and twenty-five bacterial strains made available by the National Collection of Type Cultures in 2022 alongside a commentary on the strains, their provenance and significance.