bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Macrocalcification in Raising the Suspicion of Malignancy among the ACR TIRADS Thyroid Nodules Detected by Ultrasonography
Authors: Abdelrahman Ahmed Samy , Ahmed Farag Amina Mohamed , Amr Mohamed Dina Mohamed
Published: July 2024

Background

Thyroid nodules are a frequent finding on neck sonography. The US is the most commonly used imaging technique for the evaluation of thyroid nodules. The Thyroid Imaging, Reporting and Data System (TIRADS) developed by the American college of radiology (ACR) for classification of thyroid nodules is a practical and convenient method for risk stratification of thyroid malignancy, based on allocating points for different sonographic features of thyroid nodules in five morphologic categories (composition, echogenicity, margins, shape, and presence of echogenic foci).

Objective

To evaluate the role of macrocalcification in raising the suspicious of malignancy among ACR TIRADS 3 and 4 group without macrocalcification

Patients and Methods

Our study was conducted on 60 adult patients, 20 patients with TIRADS 3 nodule, 20 patients with TIRADS 4 group with macrocalcification nodules and 20 patients group TIRADS 4 without macrocalcification nodules, whose ages range between 23 and 65 years old and were referred to undergo FNA procedures.

Results

The present study concludes parenchymal macrocalcifications showed no statistically significant difference in raising percentage of malignancy among TIRADS 4 patients.

Conclusion

We conclude that the added macrocalcification showed no statistically significant difference in raising percentage of malignancy compared to TIRADS 4 without calcification group. Also, presence of macrocalcification should not prevent clinicians from making further assessments in case of nondiagnostic results to exclude their association with rather than their causal relation with thyroid malignancies.
The Role of Cardiac MRI and Late Gadolinium Enhancement Grading Protocol in Evaluation of the Right Ventricle in Patients with Repaired Fallot Tetralogy
Authors: Ibrahim Ayman Mohamed , Elsaied Naiad Medhat , Ali Ali Haggag
Published: July 2024

Background

Tetralogy of Fallot represents 7–10% of congenital heart diseases occurring in 0.5/1000 live births and is the second most common form of complex congenital heart diseases. The four elements of Tetralogy of Fallot: (a) sub-pulmonary obstruction resulting in (b) right ventricle hypertrophy, and (c) malalignment ventricular septal defect resulting in (d) apparent overriding of the aorta over both ventricles. Primary cardiac repair for Fallot Tetralogy patients includes right ventricular out flow tract widening interventions and ventricular septal defect closure. For such patients right ventricular assessment in the postoperative period is essential in aiding further management planning. The purpose of this study is to emphasize the role of cardiac MRI in functional and structural assessment of the right ventricle in Fallot tetralogy patients after surgical management.

Results

The current study included 30 Fallot Tetralogy patients underwent cardiac MRI after surgical management. The majority of patients 26 out of 30 (86.6%) showed right ventricular dilatation. Four patients had right atrial dilatation. Less than one-third of patients 8 out of 30 (26.6%) had right ventricular systolic dysfunction. The majority of patients 29 out of 30 (96.6%) had main pulmonary artery regurgitation. More than half of the patients 18 out of 30 (60%) had main pulmonary artery stenosis. The majority of patients 25 out of 30 (83.3%) had right ventricular outflow tract late gadolinium enhancement and 18 patients (60%) had base of interventricular septal enhancement.

Conclusions

MRI is an extremely useful imaging method for functional and structural assessment of the right ventricle after surgical repair of Fallot tetralogy patients with absence of ionizing radiation.
Predicting the Prognosis of Acute Pulmonary Embolism Using Computed Tomography Pulmonary Angiography Measurable Parameters in Comparison to Pulmonary Embolism Severity Index (PESI)
Authors: Refaat Salem Sophia Muhammed , Yousry ELNaggar Heba T-allah Mohammed , Ahmed Othman Amal Ibrahim
Published: July 2024

Background

Pulmonary embolism is a leading cause of cardiovascular death and with CTPA being the gold standard in its diagnosis, it is feasible with radiologic parameters to stratify and early identify patients at risk of death.

Aim of the Work

To detect the prognostic value of radiologic parameters of CT pulmonary angiography (CTPA) in comparison to pulmonary embolism severity index (PESI).

Patients and Methods

This was a prospective study done at Ain Shams University Hospitals and included 84 patients diagnosed with acute pulmonary embolism and referred to the radio-diagnosis department for CT pulmonary angiography examination.

Results

3.6% of patients died within 24 hours and 44% died within 30 days of diagnosis of PE. All patients who died within 30 days had abnormal CTPA findings especially RV/LV ratio, PT diameter, septal bowing and contrast reflux in the IVC which revealed significant relationship between them and 30-day-mortality. Meanwhile PESI showed contradictory results and was less reliable than the radiologic parameters.

Conclusion

The CTPA radiological parameters appeared valuable for the prediction of 30-day mortality in patients with acute PE, and was superior to the PESI.
Role of Multi-Detector Computed Tomography (MDCT) in Assessment of Biliary Neoplasms
Authors: Abdel Aziz Tougan Taha , Youssef Ekladious Mena El Erian , Abd El Kader Mona Hussein , Mohamed Sarah Mahmoud
Published: July 2024

Background

Biliary neoplasms are commonly encountered in the day-to-day radiological practice and can be benign or malignant. Multidetector CT (MDCT) is a noninvasive imaging modality for evaluation of patients with biliary obstruction, to localize the cause of obstruction, detect the presence of mass lesion, and define its extension and identify remote metastasis.

Objective

To find out the role of MDCT scan in the evaluation of biliary neoplasms with respect to nature, cause and level of obstruction.

Methods

During the period from January 2022 to August 2022, the present study included 30 patients with clinically suspected biliary obstruction and previously radiological or laboratory diagnosed cases of biliary malignancy after fulfilling the inclusion and exclusion criteria and taking written /verbal informed consent. 16 patients were males and 14 were females, their ages ranged between 36– 85 years with mean age of 64years old.

Results

The mean age of participants was 63.73±11.11 years old; and slight male predominance (53.3%). in correlation to histopathological findings, MDCT was 95.2% sensitive in detection of cholangiocarcinoma (20/21*100). It was 100% sensitive in detection of combined cholangiocarcinoma & HCC (1/1*100). Also it was 85.75 sensitive in detection of gall bladder carcinoma (6/7*100). While it was false positive in detection a case of HCC. The sensitivity of MDCT to detect biliary neoplasm is 96.4% (27/28*100) with specificity of 0% (0/2*100), the positive predictive value is 93.1% (27/29*100) while the negative predictive value is 0% (0/1%). We found significant association between MDCT Final outcome with resectability (P-value 0.002) and between resectability and TNM Staging (P-value <0.0001)

Conclusion

Multidetector computed tomography MDCT can be considered a noninvasive fast with high sensitivity imaging tool in the assessment of patients with biliary neoplasms. The MDCT is satisfactory for staging of biliary neoplasms and for accurate preoperative assessment of the tumor extent.
Predicting of Hepatic Steatosis in Living Liver Donor via CT Liver Attenuation Index (LAI) and Fibroscan Controlled Attenuation Parameter (CAP) Correlation with Biopsy Result
Authors: Ali Mahfouz Somaia Mohammed , eldin Mohamed Fatma Salah , Moneium Chalabi Nivine Abdel , Abdel Rahman Hazem Ibrahim
Published: July 2024

Background

The most prevalent persistent parenchymatous liver alterations in healthy individuals are thought to be hepatic steatosis. The liver biopsy is the most crucial procedure for the identification and measurement of hepatic steatosis. By identifying the liver attenuation index (LAI) at an unenhanced CT image, hepatic steatosis can be evaluated without the risk of liver resection.

Objective

Using liver biopsy histological analysis as a reference standard, to examine the precision of the CT liver attenuation index (LAI) and fibroscan controlled attenuation parameter (CAP) for quantitative evaluation of macro vesicular steatosis in living related liver donors.

Methods

In this study comparing CT liver attenuation index & fibroscan controlled attenuation parameter with liver pathology of steatosis in subject's candidate for liver living donors 50 subjects in each two study's correlation with biopsy results, conducted at Ain Shams Shams Specialized hospital and other Private hospitals over about 2 years.

Results

Our study reported that liver – spleen attenuation index of 9 is the cutoff value with sensitivity 100% and specificity 80% that make it a very good method to exclude donor to have steatosis ≥15%, which mean if donor had LS index < 9 we can safely do proceed do liver biopsy. Our study reported that CAP measurement had an AUROC OF 0.780, for detecting steatosis ≥ 15 %, with sensitivity is only 60% with specificity as CT LAI of 80%, which consider low compared to other study, that could be due to small number of donors in out study with steatosis ≥ 15 % (5 case from 50 donors) unlike the other studies.

Conclusion

When used to estimate the amount of liver fat in liver donors, the examined CAP and CT indices worked equally. But according to multivariate analysis, the only factor strongly linked with hepatic steatosis in alive donors was the CT L-S attenuation index. We contend that the combination of CT L-S attenuation index and CAP allows for the detection of the degree of hepatic steatosis and can be used as an option to liver biopsy, reserving liver biopsy for those with positive steatosis donors.
Correlation between Severity of Lung Disease in COVID-19 Infection and Acute CNS Abnormalities
Authors: El Fattah Ramadan Hayam Gamal Abd , Azab Enas Ahmed , Mohamed Zedan Nehal Sayed
Published: July 2024

Background

Sever acute respiratory syndrome corona virus 2 (SARS-COV 2) began in Wuhan,China,in December 2019 and has rapidely spread around the world to become pandemic,as COVID-19 can produce pathologic changes in chest imaging,COVID-19 related brain imaging findings are also well known.

Aim of the Work

The aim of this current study is to correlate retrospectively between the severity of lung affection in patients with COVID-19 infections and development of acute CNS abnormalities.

Patients and Methods

This study is Retrospective study, the study was conducted at Ain Shams University Hospitals over a course of six months from march 2022 to September 2022 and the main source of data for this study was the archived CT and MRI imaging of the patients referred to the department of Radiology. Our inclusion criteria were patients that diagnosed with sever acute respiratory syndrome corona virus 2 infection with acute neurologic manifestation and available chest CT and brain imaging. The 5 lobes of the lungs were individually scored on a scale 0-5 (0 correspond to no involvement and 5 > 75% involvement),A CT lung severity score was determined as the sum of lung involvement,ranging from 0 (no involvement) to 25 (maximum involvement).

Results

A total 55 patients met the inclusion criteria,In attempt to describe and evaluate the brain and lung imaging correlation in patients with COVID-19, Compared to 20 patients without acute abnormal findings on neuroimaging,there were 35 patients with acute abnormal findings on neuroimaging and those patients were found to have significantly higher mean CT lung severity score (p < 0.0001) and they are more likely to present with ischemic stroke (14, 40%), A threshold of CT lung severity score > 18 was found to be 97% sensitive and 90% specific for acute abnormal findings on neuroimaging, the neuroimaging hallmark of these patients were acute ischemic infarcts (40%),invasive fungal sinusitis (22.9.%), Isolated cavernous sinus thrombosis,PRES,and vasculitis (each one 8.6%),cerebral venous sinus thrombosis other than cavernous sinus (5.7%),cerebritis and abnormal white matter signal (each one 2.8%).The predominant CT chest findings were peripheral ground -glass opacities with or with out consolidation.

Conclusion

The CT lung severity score may be predictive of acute abnormalities on neuroimaging in patients with COVID-19 with neurologic manifestation. This can be used as predictive tool in patients management to improve clinical outcome.
The Regional Ain Shams Telemedicine Network
Authors: Wahba Hoda , Elbokl Ahmed , Emara Tamer
Published: July 2024

With the deficiency in specialized care and low resources it is vital to come up with new healthcare delivery systems that utilize available resources in an efficient way.

The hub-spoke model is not new but has recently been revisited as it aids in sharing of specialized services. A central hub is able to support attached spokes through physical and virtual healthcare services.

To manage such a network a strong software platform with several integral features should be in place. Using available solutions may not satisfy all required features and may fragment the patient’s health records.

Ain Shams University Virtual Hospital (AVH) dedicated to healthcare transformation in Egypt and the region, manages and connects its spokes through TREAT platform (The REgional Ainshams Telemedicine network) that was funded by the Science and Technology Development Fund. The software platform supports provider-to-provider (P2P) telemedicine but for the sake of continuity of care other telemedicine modules and physical services are present. It helps utilize available resources in an efficient way with the capacity to audit user and system performance. The patient module has a seperate entry point and integrates with the rest of the system. Inpatients and outpatients from inside the system and outside can be managed physically and remotely.
Risk Predictors of Severity in Egyptian Patients with Covid-19 Infection
Authors: El-hamied Seliem Muhammed Abo El-naga Abd , Khaskia Mohammad Almohamady , Elsayed Ashraf Mahmoud
Published: July 2024

Background

In modern human history, infectious diseases have posed a threat to public health several times, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a global public health crisis.

Objective

Identification of demographic, laboratory and radiological predictors of progression of COVID-19 infection in Egyptian patients. A special concern is focused on the poor prognostic factors associated with mortality, this will help to classify and monitor COVID-19 patients to deliver best medical care in order to decrease mortality and morbidity in Egyptian patients.

Patients and Methods

A single-center, retrospective cohort study. This study was conducted in Almaza Fever Hospital after obtaining approval from the Research Ethical Committee.

Results

The current study conducted on (325) known positive COVID-19 patients divided into 2 groups: Group I (204) patients and Group II (121) patients. It was found that an increase in age among Group II (mean age was 66.22 ± 12.18) in comparison to Group I (mean age was 47.78 ± 14.73) with a statistically significant difference (p-value <0.001). There was no statistically significant difference (p-value 0.432) between Sex and severe disease patients. Among Group II (121) out of the total study population 103 (85%) of these were found to have co-morbidities (highly significant, p value < 0.001. Moreover, there was a higher prevalence of co-morbidities among non survivors however this didn’t reach the level of statistical significance (p-value 0.174). The current study showed that there was an increase in hematological parameters (TLC, Neutrophils), biochemical parameters (Urea, Creatinine, AST, D-Dimer, Ferritin, CRP, LDH, IL-6) and a decrease in Lymphocytes within Group II in comparison with Group I with statistically Significant difference (p-value < 0.001), also there was a trend toward higher levels of ALT in group II, however this didn’t reach the level of statistical significance (p-value 0.068). Statistically significant difference (p-value < 0.001) was found between disease severity and CT findings as from a total of (121) severe disease patients 105(86.8%) had CORADS (4-5).

Conclusion

The current study shows old age, elevated biochemical parameters (creatinine, urea, AST, D-dimer, IL-6, CRP, ferritin and LDH), hematological parameters (TLC) and extensive lung affection could be considered predictors of severity and mortality among Covid-19 patients. Also lymphopenia and associated co-morbidities are considered predictors of severity.
Assessment the Role of Non Invasive Biomarkers as an Early Predictors of Mucosal Healing in Ulcerative Colitis Patients Treated with the Biological Therapy
Authors: Al Breedy Ashraf Mohamed , Eltabbakh Mohamed Mahmoud , Abd El Razek Yasser Arafat , Ahmed Shaimaa Abdelrahman
Published: July 2024

Background

Ulcerative colitis (UC) is characterized by confluent mucosal inflammation and erosions starting from the anal verge and extending to a variable extent, where patients often complain of diarrhea associated with rectal bleeding, abdominal tenderness, and weight loss. Numerous disease biomarkers have been studied in ulcerative colitis (UC) such as Erythrocyte sedimentation rate(ESR) and C- reactive protein(CRP). On the other hand, fecal calprotectin and Lactoferrin are more specific and sensitive but expensive and still not commonly used in clinical practice due to the need for on demand specimen collection.

Objective

To evaluate the role of the non-invasive biomarkers as an early predictor of mucosal healing in ulcerative colitis patients treated with biological therapy.

Methods

Twenty adult patients with ulcerative colitis who received biological therapy (after adequate screening) were included in our study. The patients met the indications for treatment with biological therapy according to European Crohn and Colitis Organization guidelines. The patients were presented to our IBD clinic at tropical medicine department, Ain shams university in the period from 1/2018 to 9/2021.

Results

There is a strong relationship between clinical response and mucosal healing at 6 months of starting biological therapy as 100% of patients who achieved mucosal healing showed clinical response. Median N/L ratio, median PLT/L ratio and CRP/albumin ratio were 1.58, 425 and 1.19 respectively in patients who achieved mucosal healing at 6 months after 3 months of starting biological therapy with statistical significance (p-value = 0.019, 0.019 and 0.008) respectively in comparison to the patients who didn’t achieve mucosal healing. Both median of L/M ratio and PLT/M ratio were decreased in patients achieved mucosal healing at 6 months after 3 months of starting biological therapy (3.43 and 660) respectively in comparison to patients who didn’t achieve mucosal healing but it didn’t reach any statistical significance.

Conclusion

Non invasive biomarkers at 3 months like N/L ratio, PLT/L ratio, L/M ratio and PLT/M ratio may be used as non invasive predictors of mucosal healing at 6 months after starting treatment with biological treatment.
Comparative transcriptome provides new insights into the molecular regulation of olive trees to chilling stress
Authors: Wu Wenjun , Jiang Chengying , Wei Qianqian , He Ling , Jin Gaoming , Zheng Yuming , Qi Jianli , Zhang Rong , Yao Yufang , Wan Dongshi , Lv Jiaojiao
Published: July 2024

Olive (Olea europaea L.), an economically important oil-producing crop, is sensitive to low temperature, which severely limits its productivity and geographical distribution. However, the underlying mechanism of cold tolerance in olive remains elusive. In this study, a chilling experiment (4 °C) on the living saplings of two olive cultivars revealed that O. europaea cv. Arbequina showed stronger cold tolerance with greater photosynthetic activity compared with O. europaea cv. Leccino. Transcriptome analyses revealed that early light-inducible protein 1 (ELIP1), the main regulator for chlorophyll synthesis, is dramatically induced to protect the photosynthesis at low temperatures. Furthermore, weighted gene co-expression network analysis, yeast one-hybrid and luciferase assays demonstrated that transcription factor bHLH66 serves as an important regulator of ELIP1 transcription by binding to the G-box motif in the promoter. Taken together, our research revealed a novel transcriptional module consisting of bHLH66-ELIP1 in the adaptation of olive trees to cold stress.
Linkages between stem vulnerability curves and tree demography and their implications for plant physiological modeling
Authors: Song Chaoqing , Fu Yangyang , Zhu Shidan , Xu Wenfang , Ye Qing , Yuan Wenping
Published: July 2024

Vulnerability curves (VCs) have been measured extensively to describe the differences in plant vulnerability to cavitation. Although the roles of hydraulic conductivity (Ks,max) and hydraulic safety (P50, embolism resistance), both of which are parameters of VCs (‘sigmoidal’ type), in tree demography have been evaluated across different forests, the direct linkages between VCs and tree demography are rarely explored. In this study, we combined measured VCs and plot data of 16 tree species in Panamanian seasonal tropical forests to investigate the connections between VCs and tree mortality, recruitment and growth. We found that the mortality and recruitment rates of evergreen species were most significantly positively correlated with P50. However, the mortality and recruitment rates of deciduous species only exhibited significant positive correlations with parameter a, which describes the steepness of VCs and indicates the sensitivity of conductivity loss with water potential decline, but is often neglected. These differences among evergreen and deciduous species may contribute to the poor performance of existing quantitative relationships (such as the fitting relationships for all 16 species) in capturing tree mortality and recruitment dynamics. Additionally, evergreen species presented a significant positive relationship between relative growth rate (RGR) and Ks,max, while deciduous species did not display such relationship. The RGR of both evergreen and deciduous species also displayed no significant correlations with P50 and a. Further analysis demonstrated that species with steeper VCs tended to have high mortality and recruitment rates, while species with flatter VCs were usually those with low mortality and recruitment rates. Our results highlight the important role of parameter a in tree demography, especially for deciduous species. Given that VC is a key component of plant hydraulic models, integrating measured VC rather than optimizing its parameters will help improve the ability to simulate and predict forest response to water availability.
Surgical Technique For Chronic Symptomatic Peroneal Sheath Pain in Young Patients
Authors: Washburn Stephanie R. , Pilc Emily , Tuten H. Robert
Published: July 2024

To present the clinical and radiographic data, emphasize our surgical technique and how it was used, and the outcome measures in a case series of patients with chronic symptomatic peroneal sheath pain. A retrospective chart and radiograph review was conducted involving 36 adolescent patients (ages 8 to 20 y) treated surgically for chronic symptomatic peroneal sheath pain from 2010 to 2020. Findings that include chief complaint, magnetic resonance imaging findings, and surgical measures were documented. The patients’ postoperative and clinic visit notes were analyzed and outcome scores (FAOS Foot & Ankle Survey, AOFAS Ankle-Hindfoot Scale, and Kaikkonen Functional Scale) were calculated to determine the long-term results of the procedure. In our case series of 36 patients undergoing surgical treatment for chronic symptomatic peroneal sheath pain the procedures performed were as follows: 35 peroneal sheath repairs (97.22%), 34 ankle arthroscopies (94.44%), 27 resections of anomalous peroneus brevis muscle belly (75.00%), 2 resections of accessory peroneus quartus muscle (5.56%), 7 partial synovectomies (19.44%), 29 debridements (80.56%), and 6 Brostrom repairs (16.67%). magnetic resonance imaging findings showed 50% of our patient population had low-lying peroneus brevis muscles, and on examination during surgery, 61.11% of peroneus brevis muscles extended past the fibular tip. The average time in the cast post-operatively was 4.33 weeks. The average time from surgery to return to activity was 9.03 weeks. Twenty-two of the 36 patients (61.11%) were athletes and 100% were able to return to their sport. Outcome scores were retrospectively determined to be 99.27 for the FAOS Foot and Ankle Survey, 98.72 for the AOFAS Ankle-Hindfoot Scale, and 99.31 for the Kaikkonen Functional Scale. Complications were minimal and included 1 postoperative infection, 3 cast impingements, and 2 reported instances of post-operative pain. In our retrospective case series of 36 patients, the outcomes of surgical intervention for peroneal tendon pathology unresponsive to nonsurgical management in pediatric patients were evaluated. Our surgical method utilizes debridement, synovectomy, excision of low lying peroneus brevis muscle belly, excision of peroneus quartus if present, repair of split-tears of the tendons, and repair of the peroneal tendon sheath using “pants over vest” sutures to tighten the sheath. Our chart review shows all 36 patients were satisfied with the outcome, demonstrated improvement in relevant patient-reported outcome measures, and would elect to undergo the procedure again. Therefore, the novel surgical techniques outlined in this study appear to be viable options to treat chronic symptomatic peroneal tendon sheath pain resistant to conservative methods.

Level of Evidence: Retrospective Case Series, Level IV.
Early Fluid Is Less Fluid: Comparing Early Versus Late ICU Resuscitation in Severely Injured Trauma Patients
Authors: Beni Catherine E. , Arbabi Saman , Robinson Bryce R. H. , O’Keefe Grant E.
Published: July 2024

OBJECTIVES:

The temporal trends of crystalloid resuscitation in severely injured trauma patients after ICU admission are not well characterized. We hypothesized early crystalloid resuscitation was associated with less volume and better outcomes than delaying crystalloid.

DESIGN:

Retrospective, observational.

SETTING:

High-volume level 1 academic trauma center.

PATIENTS:

Adult trauma patients admitted to the ICU with emergency department serum lactate greater than or equal to 4 mmol/dL, elevated lactate (≥ 2 mmol/L) at ICU admission, and normal lactate by 48 hours.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

For the 333 subjects, we analyzed patient and injury characteristics and the first 48 hours of ICU course. Receipt of greater than or equal to 500 mL/hr of crystalloid in the first 6 hours of ICU admission was used to distinguish early vs. late resuscitation. Outcomes included ICU length of stay (LOS), ventilator days, and acute kidney injury (AKI). Unadjusted and multivariable regression methods were used to compare early resuscitation vs. late resuscitation. Compared with the early resuscitation group, the late resuscitation group received more volume by 48 hours (5.5 vs. 4.1 L; p ≤ 0.001), had longer ICU LOS (9 vs. 5 d; p ≤ 0.001), more ventilator days (5 vs. 2 d; p ≤ 0.001), and higher occurrence rate of AKI (38% vs. 11%; p ≤ 0.001). On multivariable regression, late resuscitation remained associated with longer ICU LOS and ventilator days and higher odds of AKI.

CONCLUSIONS:

Delaying resuscitation is associated with both higher volumes of crystalloid by 48 hours and worse outcomes compared with early resuscitation. Judicious crystalloid given early in ICU admission could improve outcomes in the severely injured.
Reference values of carotid intima-media thickness and arterial stiffness in Chinese adults based on ultrasound radio frequency signal: A nationwide, multicenter study
Authors: Xing Changyang , Xie Xiujing , Wu Yu , Xu Lei , Guan Xiangping , Li Fan , Zhan Xiaojun , Yang Hengli , Li Jinsong , Zhou Qi , Mu Yuming , Zhou Qing , Ding Yunchuan , Wang Yingli , Wang Xiangzhu , Zheng Yu , Sun Xiaofeng , Li Hua , Zhang Chaoxue , Zhao Cheng , Qiu Shaodong , Yan Guozhen , Yang Hong , Mao Yinjuan , Zhan Weiwei , Ma Chunyan , Gu Ying , Chen Wu , Xie Mingxing , Jiang Tianan , Yuan Lijun
Published: July 2024

Background:

Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.

Methods:

A total of 3053 healthy Han Chinese adults (1922 women) aged 18–79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere–Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.

Results:

All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex.

Conclusions:

The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.
Burden of six major types of digestive system cancers globally and in China
Authors: Zhou Yueyang , Song Kai , Chen Yuqing , Zhang Yuelun , Dai Min , Wu Dong , Chen Hongda
Published: July 2024

Background:

Digestive system cancers constitute a significant number of cancer cases, but their burden is not uniform. As Global Cancer Observatory (GLOBOCAN) 2022 has recently updated its estimates of cancer burden, we aimed to investigate the burden of six major digestive system cancers both worldwide and in China, along with geographical and temporal variations in cancer-specific incidence and mortality.

Methods:

We extracted data on primary cancers of the esophagus, stomach, colorectum, liver, pancreas, and gallbladder from the GLOBOCAN database for 2022. Age-standardized incidence and mortality rates were calculated and stratified by sex, country, region, and human development index (HDI). We used the 2022 revision of the World Population Prospects (United Nations) to obtain demographic data for various age groups in China from 1988 to 2012 and used the joinpoint model and the average annual percentage change (AAPC) to analyze cancer incidence trends in China.

Results:

In 2022, the estimated global incidence of digestive system cancers reached 4,905,882, with an estimated 3,324,774 cancer-related deaths. Colorectal cancer was most prevalent in terms of incidence and mortality. There was a significant correlation between the burden of gastrointestinal cancers and country HDI. From 1988 to 2012, the incidence of esophageal, gastric, and liver cancers declined in China, whereas colorectal and pancreatic cancer incidences continued to increase. By 2050, colorectal and liver cancers are projected to remain the leading cancer types in China in terms of incidence and mortality, respectively.

Conclusions:

Digestive system cancers remain a significant public health challenge globally and in China. Although progress has been made in the prevention and control of some cancers, the burden of digestive system cancers persists. The implementation of tertiary prevention strategies must be intensified to reduce the incidence and mortality of digestive system cancers, mitigating their impact on public health.
Research on the genetic etiology of polycystic ovary syndrome in the post-GWAS era
Authors: Zhao Shigang , Zhao Han , Chen Zi-Jiang
Published: July 2024

Great progress has been made in the genetic research of PCOS, thanks to the application of genome association study (GWAS) technology. However, in the post-GWAS era, investigating the pathogenic mechanisms related to numerous genetic loci has become challenging, leading to the current generalized approach to treating PCOS. To address this issue, taking the significantly associated susceptibility gene THADA as an example, we share a series of advancements from the perspectives of genetic evolution, epigenetics, and gene function studies. Our aim is to provide guidance for a better understanding of the essence of PCOS.
Male factor infertility and implication of fertility treatment in low resource settings
Authors: Anyanwu Matthew , Touray Alhaji , Kujabi Tuti , Suwareh Karamba , Sumbunu Adama , Drammeh Ramatoulie , Odeku Thompson , Nwanganga Ifeoma
Published: July 2024

Introduction:

The prevalence of infertility has increased worldwide. The etiological factors are also changing in trend and prominence. Male infertility is driving the epidemic in many regions of the world. Therefore, the aim of this study was to explore male factor infertility in the Gambia.

Methodology:

The design was a longitudinal descriptive study of subfertile couples at a specialist tertiary hospital in Banjul, the Gambia, from August 2022 to May 2023. Data were extracted from patients folders and entered into a computer database. Descriptive statistics were used to analyze the data and results expressed in tables, graphs, and percentages.

Results:

Total number of subfertile couples analyzed was 152: male factor 69 (45.4%), ovulation disorder 34 (22.4%), tubal factor 20 (13.2%), uterine factor 8 (5.3%), and unexplained 21 (13.8%). The median age of male folk was 50 years, with an age range of 31 to 64 years. The rates of asthenoteratozospermia, oligospermia, and azospermia were 37.8%, 36.2%, and 26%, respectively. In azoospermic males, over 75% had elevated FSH (12–44 miu/mL).

Conclusions:

The prevalence of male infertility is at 45.4%, which is 3-fold and 2-fold higher than tubal and ovarian factors, respectively. Male infertility is a problem with obvious implications. The predominant types of male infertility we observed in this study will almost always require multidisciplinary care and ICSI.
Spherical equivalent prediction analysis in intraocular lens power calculations using Eyetemis: a comprehensive approach
Authors: Kan-Tor Yoav , Abulafia Adi , Zadok David , Kohnen Thomas , Savini Giacomo , Hoffer Kenneth J. , Benjamini Yuval
Published: July 2024

Purpose:

To compare 2 different datasets, using Eyetemis, an online analytical tool designed for assessing the spherical equivalent prediction errors (SEQ-PEs) of intraocular lens (IOL) power calculation formulas after cataract surgery.

Setting:

Institutional.

Design:

Retrospective case series.

Methods:

The study comprised 2 distinct datasets of patients who had undergone successful cataract surgery. Dataset 1 includes standard eyes, whereas Dataset 2 includes eyes with keratoconus. An online tool was used for SEQ-PE analysis across the 2 datasets, adhering to ISO standards for evaluating accuracy based on trueness and precision. The tool incorporates robust t tests for comparing the trimmed mean of the data, adjusting for heteroscedasticity. IOL constants in Dataset 1 were optimized for the comparison of Hoffer Q, Holladay 1, SRK/T, Haigis, and Barrett Universal II (BUII) formulas. In Dataset 2, IOL constants from the IOLCon website were used for the comparison of the BUII and its designated KCN version: Barrett TrueK Keratoconus (TrueK [KCN]).

Results:

For Dataset 1, the trimmed mean SEQ-PE values of all formulas were not significantly different from zero. BUII had superior precision and accuracy compared with all other formulas, except from Haigis (P ≤ .04). For Dataset 2, BUII's trimmed-mean SEQ-PE was significantly different from zero (0.59 diopters [D], P < .01), unlike the TrueK (KCN) (0.12 D, P = .10). In addition, TrueK (KCN) exhibited enhanced precision and accuracy relative to BUII (P < .01).

Conclusions:

The online analysis tool provides a streamlined approach for assessing the prediction accuracy of SEQ refraction after cataract surgery, effectively evaluating trueness, precision, and overall accuracy through the use of advanced statistical methods.
Protected cardiac surgery: strategic mechanical circulatory support to improve postcardiotomy mortality
Authors: Salazar Leonardo , Lorusso Roberto
Published: July 2024

Purpose of review

To examine the evolving landscape of cardiac surgery, focusing on the increasing complexity of patients and the role of mechanical circulatory support (MCS) in managing perioperative low cardiac output syndrome (P-LCOS).

Recent findings

P-LCOS is a significant predictor of mortality in cardiac surgery patients. Preoperative risk factors, such as cardiogenic shock and elevated lactate levels, can help identify those at higher risk. Proactive use of MCS, rather than reactive implementation after P-LCOS develops, may lead to improved outcomes by preventing severe organ hypoperfusion. The emerging concept of “protected cardiac surgery” emphasizes early identification of these high-risk patients and planned MCS utilization. Additionally, specific MCS strategies are being developed and refined for various cardiac conditions, including AMI-CS, valvular surgeries, and pulmonary thromboendarterectomy.

This paper explores the shifting demographics and complexities in cardiac surgery patients. It emphasizes the importance of proactive, multidisciplinary approaches to identify high-risk patients and implement early MCS to prevent P-LCOS and improve outcomes. The concept of protected cardiac surgery, involving planned MCS use and shared decision-making, is highlighted. The paper also discusses MCS strategies tailored to specific cardiac procedures and the ethical considerations surrounding MCS implementation.
Strategies to minimize procedure-related pain and anxiety: lessons from pediatric dermatology
Authors: Abouchaleh Nadine , Bayart Cheryl
Published: July 2024

Purpose of review

Recent studies have suggested that prolonged or repeated episodes of general anesthesia early in childhood may adversely affect neurodevelopment. This, combined with rising healthcare costs and decreasing access, has sparked interest in performing pediatric procedures in the office setting when possible. It is essential to address the physical and psychological discomfort that often accompany this experience, particularly in children.

Recent findings

Healthcare providers performing procedures on children can draw from a spectrum of established techniques, new technology, and novel use of medications to decrease peri-procedural pain and anxiety. These techniques include distraction, optimization of local anesthesia, and mild to moderate sedation.

We recommend using a combination of techniques to minimize pain and anxiety to improve safety, decrease healthcare costs, improve patient experience, and prevent childhood trauma and persistent negative perception of the healthcare system.
What's new in pediatric genetic cholestatic liver disease: advances in etiology, diagnostics and therapeutic approaches
Authors: Pinon Michele , Kamath Binita M.
Published: July 2024

Purpose of review

To highlight recent advances in pediatric cholestatic liver disease, including promising novel prognostic markers and new therapies.

Findings

Additional genetic variants associated with the progressive familial intrahepatic cholestasis (PFIC) phenotype and new genetic cholangiopathies, with an emerging role of ciliopathy genes, are increasingly being identified. Genotype severity predicts outcomes in bile salt export pump (BSEP) deficiency, and post-biliary diversion serum bile acid levels significantly affect native liver survival in BSEP and progressive familial intrahepatic cholestasis type 1 (FIC1 deficiency) patients. Heterozygous variants in the MDR3 gene have been associated with various cholestatic liver disease phenotypes in adults. Ileal bile acid transporter (IBAT) inhibitors, approved for pruritus in PFIC and Alagille Syndrome (ALGS), have been associated with improved long-term quality of life and event-free survival.

Next-generation sequencing (NGS) technologies have revolutionized diagnostic approaches, while discovery of new intracellular signaling pathways show promise in identifying therapeutic targets and personalized strategies. Bile acids may play a significant role in hepatic damage progression, suggesting their monitoring could guide cholestatic liver disease management. IBAT inhibitors should be incorporated early into routine management algorithms for pruritus. Data are emerging as to whether IBAT inhibitors are impacting disease biology and modifying the natural history of the cholestasis.
Priorities for Clinical Research in Pediatric Extracorporeal Membrane Oxygenation Anticoagulation From the Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference
Authors: Muszynski Jennifer A. , Bembea Melania M. , Gehred Alison , Lyman Elizabeth , Cashen Katherine , Cheifetz Ira M. , Dalton Heidi J. , Himebauch Adam S. , Karam Oliver , Moynihan Katie M. , Nellis Marianne E. , Ozment Caroline , Raman Lakshmi , Rintoul Natalie E. , Said Ahmed , Saini Arun , Steiner Marie E. , Thiagarajan Ravi R. , Watt Kevin , Willems Ariane , Zantek Nicole D. , Barbaro Ryan P. , Steffen Katherine , Vogel Adam M. , Alexander Peta M.A. ,   for the Pediatric Extracorporeal Membrane Oxygenation (ECMO) Anticoagulation CollaborativE (PEACE), in collaboration with the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, the Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric ECMO subgroup of PALISI and the Extracorporeal Life Support Organization (PediECMO)
Published: July 2024

OBJECTIVES:

To identify and prioritize research questions for anticoagulation and hemostasis management of neonates and children supported with extracorporeal membrane oxygenation (ECMO) from the Pediatric ECMO Anticoagulation CollaborativE (PEACE) consensus.

DATA SOURCES:

Systematic review was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021, followed by serial consensus conferences of international, interprofessional experts in the management of ECMO for critically ill neonates and children.

STUDY SELECTION:

The management of ECMO anticoagulation for critically ill neonates and children.

DATA EXTRACTION:

Within each of the eight subgroups, two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts.

DATA SYNTHESIS:

Following the systematic review of MEDLINE, EMBASE, and Cochrane Library databases from January 1988 to May 2021, and the consensus process for clinical recommendations and consensus statements, PEACE panel experts constructed research priorities using the Child Health and Nutrition Research Initiative methodology. Twenty research topics were prioritized, falling within five domains (definitions and outcomes, therapeutics, anticoagulant monitoring, protocolized management, and impact of the ECMO circuit and its components on hemostasis).

CONCLUSIONS:

We present the research priorities identified by the PEACE expert panel after a systematic review of existing evidence informing clinical care of neonates and children managed with ECMO. More research is required within the five identified domains to ultimately inform and improve the care of this vulnerable population.
Prophylactic Transfusion Strategies in Children Supported by Extracorporeal Membrane Oxygenation: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference
Authors: Nellis Marianne E. , Moynihan Katie M. , Sloan Steven R. , Delaney Meghan , Kneyber Martin C.J. , DiGeronimo Robert , Alexander Peta M.A. , Muszynski Jennifer A. , Gehred Alison , Lyman Elizabeth , Karam Oliver ,   for the Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE (PEACE), in collaboration with the Pediatric Critical Care Blood Research Network (BloodNet), and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, and the Pediatric ECMO subgroup of PALISI and the Extracorporeal Life Support Organization (PediECMO)
Published: July 2024

OBJECTIVES:

To derive systematic-review informed, modified Delphi consensus regarding prophylactic transfusions in neonates and children supported with extracorporeal membrane oxygenation (ECMO) from the Pediatric ECMO Anticoagulation CollaborativE.

DATA SOURCES:

A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2020, with an update in May 2021.

STUDY SELECTION:

Included studies assessed use of prophylactic blood product transfusion in pediatric ECMO.

DATA EXTRACTION:

Two authors reviewed all citations independently, with a third independent reviewer resolving conflicts. Thirty-three references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form.

MEASUREMENTS AND MAIN RESULTS:

The evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. Forty-eight experts met over 2 years to develop evidence-informed recommendations and, when evidence was lacking, expert-based consensus statements or good practice statements for prophylactic transfusion strategies for children supported with ECMO. A web-based modified Delphi process was used to build consensus via the Research And Development/University of California Appropriateness Method. Consensus was based on a modified Delphi process with agreement defined as greater than 80%. We developed two good practice statements, 4 weak recommendations, and three expert consensus statements.

CONCLUSIONS:

Despite the frequency with which pediatric ECMO patients are transfused, there is insufficient evidence to formulate evidence-based prophylactic transfusion strategies.