bluuebunny/crossref_metadata_2025 huggingface dataset:
P20.05.A USE OF VISMODEGIB IN ADULT PATIENTS WITH NEOPLASTIC MENINGITIS FROM SONIC HEDGEHOG (SHH)-ACTIVATED MEDULLOBLASTOMAS: A CASE REPORT
Authors: Bruno F , Pellerino A , Palmiero R , Pronello E , Bertero L , Levis M , Soffietti R , Rudà R
Published: September 2023

BACKGROUND

Vismodegib is a SHH-inhibitor that proved to be effective in locally-recurrent SHH-activated medulloblastoma. However, whether vismodegib is effective in case of neoplastic meningitis (NM) as well has not been assessed so far. Here, we present a case of a patient with NM from SHH-activated medulloblastoma who showed a dramatic response to vismodegib. Case Report: A 34-year-old patient was diagnosed with a SHH-activated cerebellar medulloblastoma in 2015. He underwent gross-total resection, cranio-spinal radiotherapy (RT) and 5 cycles of lomustine, vincristine and cisplatin. Then, he remained disease-free until October 2021, when the MRI showed a new single contrast-enhanced nodule in the spine (T10), which was treated with stereotactic RT. However, the following MRI showed a diffuse leptomeningeal involvement, with new multiple linear and nodular lesions. The CSF cytology confirmed the presence of neoplastic cells. Therefore, in April 2022 vismodegib (150 mg daily) was started. The treatment was well tolerated, except for increased creatine phosphokinase (CTCAE v3.0 grade 1). After only 2 months of therapy, a reduction of the meningeal enhancement was seen on MRI, and after 4 months all nodular and linear lesions disappeared. Similarly, CSF cytology became negative after 4 months of treatment. However, after 8 months of treatment (December 2022), the MRI of the spine showed the new appearance of meningeal contrast-enhanced lesions, and CSF cytology confirmed the presence of neoplastic cells. Therefore, vismodegib was dismissed. In few days, the patient (who did not have any symptoms so far) developed severe meningeal symptoms, and palliative care was started, until his death in February 2023.

CONCLUSION

To our knowledge, this is the first report of an adult patient with NM from SHH-activated medulloblastoma achieving a complete response with vismodegib, even if temporary. Data from larger series are needed to confirm the effectiveness and safety of vismodegib in case of leptomeningeal spread.
P20.11.A TEMPORAL MUSCLE THICKNESS AS PROGNOSTIC MARKER IN PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA - A VALIDATION STUDY
Authors: van der Meulen M , Gahrmann R , van der Holt B , Doorduijn J K , Issa S , Bromberg J E C
Published: September 2023

BACKGROUND

Primary central nervous system lymphoma (PCNSL) is a rare, aggressive diffuse large B-cell lymphoma, confined to the central nervous system. Age and performance status are validated prognostic variables in PCNSL. Frailty may also be a factor but is not easily quantified. Temporal muscle thickness (TMT), as parameter of sarcopenia, is believed to reflect frailty, is easily measurable and may be a valuable additional prognostic factor: mean TMT has been described as an independent prognostic factor in PCNSL patients. This study aims to validate these results in a prospective cohort.

MATERIAL AND METHODS

All patients from a large phase III trial (HOVON 105/ALLG NHL 24; EudraCT 2009-014722-42) of whom baseline axial T1 weighted magnetic resonance images (MRI) were available were included. Sarcopenia is defined as a mean TMT <6.3mm for men and <5.2mm for women, measured on axial T1-weighted MRI. The TMT was measured by a radiologist (RG) with and a neurologist (MvdM) without correction for angulation of images. Sarcopenia, together with known other prognostic factors were analyzed in a Cox-regression analysis for progression-free (PFS) and overall survival (OS) for both investigators.

RESULTS

TMT measurements were possible in 164/199 trial patients. The median mean TMT was 7.62mm (IQR: 6.58-9.00; measured by RG) and 5.94mm (IQR: 5.09-7.01; measured by MvdM). The mean TMT was not significantly different between those who used dexamethasone, and those who did not. Sarcopenia was present in 75 patients (46%), measured by MvdM without correction for angulation of the images and in 21 patients (13%), measured by RG with correction for angulation of the images. In univariate analyses, age (>60 years-old) and baseline Mini-Mental State Examination-score <27 were significantly associated with adverse PFS and OS. In multivariate analyses, only age remained as independent prognostic factor for adverse PFS and OS. Sarcopenia, as measured by either of the investigators, was not associated with survival. For measurements by RG, presumed to be most accurate, the Hazard Ratio (95% confidence interval) was 0.68 (0.33-1.40), p=0.30 for PFS, and HR (95% CI): 0.97 (0.42-2.20), p=0.93 for OS in the multivariate analysis.

CONCLUSION

There was a low interobserver agreement between a neurologist and a radiologist regarding TMT measurements, which questions the use of this parameter in daily practice by non-radiologists. Sarcopenia, based on the mean TMT, was not a prognostic factor in PCNSL patients for PFS and OS. The small number of patients with sarcopenia in this series may have influenced results.
Left Ventricular Assist Device: Review of Antimicrobial Prophylaxis Strategies and Incidence of Infections at a Tertiary Care Center 12-Year Experience
Authors: Mendoza Maria Alejandra , Ranganath Nischal , Garcia Bismarck Bisono , Stevens Ryan W , Lahr Brian , O’Horo John , Stulak John , Shah Aditya
Published: September 2023

Background

Left ventricular assist devices (LVAD) have an associated infection rate of 13%–80% postimplant. An optimal strategy for surgical infection prophylaxis (SIP) at the time of implantation has not been well defined. We aimed to evaluate the different LVAD implantation antibiotic prophylaxis regimens as well as the incidence of LVAD infection at our institution.

Methods

We performed a single-center, retrospective study of patients who underwent LVAD implantation between February 2007 and June 2019. The primary outcome was the incidence of LVAD infection (LVADI), within 3 months and 1 year of placement, between patients who received expanded or narrow-spectrum regimens for SIP. We assessed outcomes using Kaplan-Meier, time-to-first event. We used a noninferiority analysis, which was established if the narrow-spectrum event rate was no more than 5% greater than the expanded-spectrum event rate.

Results

We included 399 patients, 305 (76.4%) patients received narrow-spectrum SIP, whereas the remaining 94 (23.6%) patients received the expanded-spectrum regimen. Statistical noninferiority of the narrow spectrum to the multiple drug regimen was demonstrated at both time points, and statistical superiority of the narrow-spectrum group across 12-month follow up was further evident (P = .037).

Conclusions

We report evidence supporting noninferiority, or even superiority, of the narrow-spectrum over expanded-spectrum antimicrobial prophylaxis strategy with respect to LVADI. These findings support data-driven antimicrobial prophylaxis strategies.
Biological and Clinical Implications of the Vascular Endothelial Growth Factor Coreceptor Neuropilin-1 in Human Immunodeficiency Virus
Authors: Schnittman Samuel R , Kolossváry Márton , Beck-Engeser Gabriele , Fitch Kathleen V , Ambayec Gabrielle C , Nance Robin M , Zanni Markella V , Diggs Marissa , Chan Fay , McCallum Sara , Toribio Mabel , Bamford Laura , Fichtenbaum Carl J , Eron Joseph J , Jacobson Jeffrey M , Mayer Kenneth H , Malvestutto Carlos , Bloomfield Gerald S , Moore Richard D , Umbleja Triin , Saag Michael S , Aberg Judith A , Currier Judith S , Delaney Joseph A C , Martin Jeffrey N , Lu Michael T , Douglas Pamela S , Ribaudo Heather J , Crane Heidi M , Hunt Peter W , Grinspoon Steven K
Published: September 2023

Plasma vascular endothelial growth factor (VEGF) coreceptor neuropilin-1 (NRP-1) had the largest association with coronary plaque in the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) proteomics analysis. With little known about NRP-1 in people with human immunodeficiency virus (PWH), we explored its relation to other proteins in REPRIEVE and validated our findings through a Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) case-cohort study by assessing its relation to host factors and incident cardiovascular disease and cancer. Within REPRIEVE, NRP-1 was associated with proteins involved in angiogenesis, signal transduction, immunoregulation, and cell migration/adhesion. Within CNICS, NRP-1 was associated with key host factors, including older age and male sex. NRP-1 was associated with an increased hazard of multiple cancers but a decreased prostate cancer risk. Finally, NRP-1 was most strongly associated with mortality and type 2 myocardial infarction. These data suggest that NRP-1 is part of a clinically relevant immunoregulatory pathway related to multiple comorbidities in PWH.

Clinical Trials Registration. NCT02344290.
Sex differences of brain cortical structure in major depressive disorder
Authors: Mou Jingping , Zheng Ting , Long Zhiliang , Mei Lan , Wang Yuting , Yuan Yizhi , Guo Xin , Yang Hongli , Gong Qiyong , Qiu Lihua
Published: September 2023

Background

Major depressive disorder (MDD) has different clinical presentations in males and females. However, the neuroanatomical mechanisms underlying these sex differences are not fully understood.

Objective

The purpose of present study was to explore the sex differences in brain cortical thickness (CT) and surface area (SA) of MDD and the relationship between these differences and clinical manifestations in different gender.

Methods

High-resolution T1-weighted images were acquired from 61 patients with MDD and 61 healthy controls (36 females and 25 males, both). The sex differences in CT and SA were obtained using the FreeSurfer software and compared between every two groups by post hoc test. Spearman correlation analysis was also performed to explore the relationships between these regions and clinical characteristics.

Results

In male patients with MDD, the CT of the right precentral was thinner compared to female patients, although this did not survive Bonferroni correction. The SA of several regions, including right superior frontal, medial orbitofrontal gyrus, inferior frontal gyrus triangle, superior temporal, middle temporal, lateral occipital gyrus, and inferior parietal lobule in female patients with MDD was smaller than that in male patients (P < 0.01 after Bonferroni correction). In female patients, the SA of the right superior temporal (r = 0.438, P = 0.008), middle temporal (r = 0.340, P = 0.043), and lateral occipital gyrus (r = 0.372, P = 0.025) were positively correlated with illness duration.

Conclusion

The current study provides evidence of sex differences in CT and SA in patients with MDD, which may improve our understanding of the sex-specific neuroanatomical changes in the development of MDD.
Female sexual dysfunction in undergraduate medical education: a survey of U.S. medical students
Authors: Goddard Brian , Brucker Benjamin
Published: September 2023

Background

Physicians often report low levels of confidence in diagnosing and treating female sexual dysfunction (FSD), which may stem from inadequate education and exposure to the topic.

Aim

The study sought to determine the extent to which FSD is covered in undergraduate medical education and evaluate student comfort with the topic and familiarity with treatments.

Methods

We created a novel, 50-question survey to be administered online to any current U.S. medical student. Obstetrician-gynecologist clerkship directors at 146 U.S. medical schools were contacted and asked to invite any current student at their school to participate. A link to the electronic REDCap (Research Electronic Data Capture) survey was distributed to eligible students via the clerkship directors. The survey collected data regarding (1) coverage of FSD and male sexual dysfunction (MSD) in preclinical and clinical curricula, (2) student self-ratings of comfort in hypothetical scenarios in which a patient exhibits symptoms of FSD or MSD, and (3) student familiarity with treatments for FSD and MSD.

Outcomes

Outcomes included the proportion of students reporting that their school covered FSD/MSD in its preclinical/clinical curriculum, the mean comfort ratings for each of the FSD and MSD scenarios, and the proportion of students indicating knowledge of various FSD and MSD treatments.

Results

A smaller proportion of students (N = 236) reported receiving instruction in FSD (58.5%) compared with MSD (78.4%) in their preclinical curriculum (P < .001). Students’ average self-ratings of comfort in the sexual dysfunction scenarios were significantly lower for patients with symptoms of FSD compared with MSD (P < .001). Students had higher average self-ratings of confidence in FSD scenarios if their intended specialty was obstetrician-gynecologist (P = .003), if their school included FSD in its clinical curriculum (P = .01), and if they had ever participated in the care of a patient with FSD (P = .006).

Clinical Implications

There are important gaps in the coverage of FSD in undergraduate medical education that may be mitigated through improvements to curriculum and increased exposure to patients with FSD.

Strengths and Limitations

This is the first study, to our knowledge, to directly survey medical students regarding their educational experience and comfort with FSD. Our study was limited by a small sample size, the use of a novel and nonvalidated questionnaire, and the potential for bias given our sampling method.

Conclusion

Medical schools must work toward improving instruction in FSD for their students to address these disparities and improve students’ comfort with the topic.
Phenomenology and psychiatric correlates of pseudocataplexy
Authors: Menchetti Marco , Biscarini Francesco , Sallemi Giombattista , Antelmi Elena , Franceschini Christian , Vandi Stefano , Neccia Giulia , Baldini Valentina , Plazzi Giuseppe , Pizza Fabio
Published: September 2023

Study Objectives

Pseudocataplexy is a rare functional neurological disorder that mimics cataplexy, pathognomonic for narcolepsy type 1 (NT1). We describe the psychiatric comorbidity and personality traits of patients with pseudocataplexy versus NT1 cases.

Methods

The case–control observational study enrolled consecutive patients with pseudocataplexy and a control group of age-matched consecutive NT1 patients. The diagnostic work-up included a structured interview, 48-hour polysomnography, multiple sleep latency test, cataplexy provoking test, and hypocretin-1 measurement in cerebrospinal fluid. All participants were administered Beck Depression Inventory, State-Trait Anxiety Inventory, Patient Health Questionnaire-15 (PHQ-15), Personality Inventory for DSM-5 brief form, and quality-of-life (QoL) measurement by 36-item Short Form health survey (SF-36).

Results

Fifteen patients with pseudocataplexy and 30 with NT1 were included. Despite the suspicion of possible cataplexy, none of the pseudocataplexy participants fulfilled international diagnostic criteria for NT1. Pseudocataplexy patients presented higher rates of moderate state anxiety (40% vs. 10%, p = 0.018), medium level of somatic symptoms, defined by PHQ-15 score > 10 (66.7% vs. 16.7%, p = 0.003), and a trend towards moderate-to-severe depressive symptoms (33.3% vs. 10%, p = 0.054) compared to NT1. No significant differences in personality traits emerged. Pseudocataplexy patients had worse QoL profiles in almost all SF-36 domains including physical (mean ± SD: 37.7 ± 9.88 vs. 51.13 ± 7.81, p < 0.001) and mental (mean ± SD: 33.36 ± 12.69 vs.42.76 ± 11.34, p = 0.02) summary scores.

Conclusions

Patients with pseudocataplexy present more severe psychiatric symptoms and a lower QoL profile in comparison with patients with NT1. The severe somatoform and affection impairment in pseudocataplexy may explain the poorer QoL and should require a tailored therapeutic approach.
Longitudinal sleep multi-trajectories from age 1 to 5.5 years and their early correlates: results from the Étude Longitudinale Française depuis l’Enfance birth cohort study
Authors: Kim Mihyeon , Saade Danielle , Dufourg Marie-Noëlle , Charles Marie-Aline , Plancoulaine Sabine
Published: September 2023

Study Objectives

To identify sleep multi-trajectories in children from age 1 to 5.5 years and their early correlates.

Methods

We collected early family, maternal, and child characteristics, including children’s nighttime sleep duration (NSD) and daytime sleep duration (DSD), night waking (NW), and sleep-onset difficulties (SOD), by parental phone interviews at age 2 months and 1-, 2-, 3.5-, and 5.5 years. Group-based multi-trajectory modeling identified sleep multi-trajectory groups. Multinomial logistic regression assessed associations with early factors.

Results

We identified five distinct sleep multi-trajectory groups for NSD, DSD, NW, and SOD in 9273 included children. The “Good sleepers” (31.6%) and “Long sleepers” (31.0%) groups had low NW and SOD prevalence and shorter NSD but longer DSD in “Good sleepers” than in “Long sleepers.” The “Good sleepers but few SOD” group (10.3%) had long NSD and DSD but a SOD peak at age 3.5 years; the “Improving NW and SOD” group (9.6%) showed short but rapidly increasing NSD to a plateau and high but decreasing NW and SOD; the “Persistent NW and SOD” group (17.5%) had persistent high NW and SOD. Maternal depression during pregnancy and sleep habits at age 1 (e.g. parental presence or feeding to fall asleep, sleeping at least part of the night away from own bed) were common risk factors associated with the most disordered sleep multi-trajectory groups.

Conclusions

We identified distinct sleep multi-trajectory groups and early life-associated factors in preschoolers. Most of the factors associated with the most sleep-disordered multi-trajectory groups are likely modifiable and provide clues for early prevention interventions.
Circadian misalignment alters resting-state functional connectivity of the salience network in rotating shift workers
Authors: Kim Sun-Young , Lee Kyung Hwa , Lee Ha Young , Jeon Jeong Eun , Park Cho Won , Shin Jiyoon , Seo Min Cheol , Jeon Sehyun , Kim Seog Ju , Lee Yu Jin
Published: September 2023

Study Objectives

This study compared resting-state functional connectivity (rsFC) of the salience network (SN) between rotating shift workers (RSWs) and controls. Furthermore, we examined whether rsFC of the SN was correlated with sleep, emotion, cognition, and attention.

Methods

The 60 RSWs and 57 controls enrolled in this study completed self-report questionnaires and sleep diaries to assess subjective sleep quality, and polysomnography and actigraphy to evaluate objective sleep and 24-hour rest-activity rhythm parameters. The participants also underwent resting-state functional magnetic resonance imaging and structural T1 scans. We performed a seed-based rsFC analysis of the SN using the anterior cingulate cortex (ACC) and anterior insula (AI) as seed regions. Furthermore, AI and ACC rsFC were compared in RSWs and controls, and we analyzed correlations between rsFC and variables of interest showing significant group differences.

Results

Compared with controls, RSWs showed reduced rsFC between the ACC and right insula, and increased rsFC of the ACC with the left occipital lobe and right superior frontal gyrus extending to the supplementary motor area (SFG/SMA). Moreover, RSWs showed reduced rsFC between the right AI and right superior parietal lobule (SPL). Finally, rsFC between the ACC and right AI was correlated with 24-hour rest-activity rhythmicity.

Conclusions

Although RSWs did not show sleep disturbance, emotional distress, cognitive impairment, or attention deficits, alterations of right insula, left occipital lobe, right SFG/SMA, and right SPL rsFC in the SN indicate that impairments in salience detection and top-down attentional control may emerge in shift workers over time.
LcMYB106 suppresses monoterpene biosynthesis by negatively regulating LcTPS32 expression in Litsea cubeba
Authors: Zhao Yunxiao , Chen Yicun , Gao Ming , Wu Liwen , Wang Yangdong
Published: September 2023

Litsea cubeba, the core species of the Lauraceae family, is valuable for the production of essential oils due to its high concentration of monoterpenes (90%). The key monoterpene synthase and metabolic regulatory network of monoterpene biosynthesis have provided new insights for improving essential oil content. However, there are few studies on the regulation mechanism of monoterpenes in L. cubeba. In this study, we investigated LcTPS32, a member of the TPS-b subfamily, and identified its function as an enzyme for the synthesis of monoterpenes, including geraniol, α-pinene, β-pinene, β-myrcene, linalool and eucalyptol. The quantitative real-time PCR analysis showed that LcTPS32 was highly expressed in the fruits of L. cubeba and contributed to the characteristic flavor of its essential oil. Overexpression of LcTPS32 resulted in a significant increase in the production of monoterpenes in L. cubeba by activating both the MVA and MEP pathways. Additionally, the study revealed that LcMYB106 played a negative regulatory role in monoterpenes biosynthesis by directly binding to the promoter of LcTPS32. Our study indicates that LcMYB106 could serve as a crucial target for metabolic engineering endeavors, aiming at enhancing the monoterpene biosynthesis in L. cubeba.
PFKFB3‐driven vascular smooth muscle cell glycolysis promotes vascular calcification via the altered FoxO3 and lactate production
Authors: Chen Jiaxin , Yu Hongjiao , Tan Xiao , Mok Simon Wing Fai , Xie Yuchen , Wang Yueheng , Jiang Xueyan , Macrae Vicky E. , Lan Lan , Fu Xiaodong , Zhu Dongxing
Published: September 2023

A link between increased glycolysis and vascular calcification has recently been reported, but it remains unclear how increased glycolysis contributes to vascular calcification. We therefore investigated the role of PFKFB3, a critical enzyme of glycolysis, in vascular calcification. We found that PFKFB3 expression was upregulated in calcified mouse VSMCs and arteries. We showed that expression of miR‐26a‐5p and miR‐26b‐5p in calcified mouse arteries was significantly decreased, and a negative correlation between Pfkfb3 mRNA expression and miR‐26a‐5p or miR‐26b‐5p was seen in these samples. Overexpression of miR‐26a/b‐5p significantly inhibited PFKFB3 expression in VSMCs. Intriguingly, pharmacological inhibition of PFKFB3 using PFK15 or knockdown of PFKFB3 ameliorated vascular calcification in vD3‐overloaded mice in vivo or attenuated high phosphate (Pi)‐induced VSMC calcification in vitro. Consistently, knockdown of PFKFB3 significantly reduced glycolysis and osteogenic transdifferentiation of VSMCs, whereas overexpression of PFKFB3 in VSMCs induced the opposite effects. RNA‐seq analysis and subsequent experiments revealed that silencing of PFKFB3 inhibited FoxO3 expression in VSMCs. Silencing of FoxO3 phenocopied the effects of PFKFB3 depletion on Ocn and Opg expression but not Alpl in VSMCs. Pyruvate or lactate supplementation, the product of glycolysis, reversed the PFKFB3 depletion‐mediated effects on ALP activity and OPG protein expression in VSMCs. Our results reveal that blockade of PFKFB3‐mediated glycolysis inhibits vascular calcification in vitro and in vivo. Mechanistically, we show that FoxO3 and lactate production are involved in PFKFB3‐driven osteogenic transdifferentiation of VSMCs. PFKFB3 may be a promising therapeutic target for the treatment of vascular calcification.
New therapies in anti-MDA5 antibody-positive dermatomyositis
Authors: Yasui Masahiro , Iwamoto Taro , Furuta Shunsuke
Published: September 2023

Purpose of review

This review focuses on treatments for anti-MDA5 antibody-positive dermatomyositis (MDA5-DM), which is a subgroup of dermatomyositis and characterized by frequent rapidly progressive interstitial lung disease and the high mortality rate. Despite conventional immunosuppressive therapies, there are still refractory cases. Newer treatment options are needed.

Recent findings

The triple combination therapy (high-dose glucocorticoids, calcineurin inhibitor, and intravenous cyclophosphamide) improved patient survival compared to high-dose glucocorticoids and step-wise addition of the immunosuppressants. The triple therapy now has been widely used, but there are still refractory cases. In addition to the conventional-type immunosuppressants, recently the efficacy of Janus kinase inhibitors, biologic agents such as rituximab, plasma exchange, and polymyxin B perfusion for refractory MDA5-DM patients have been reported. However, the majority of those reports regarding new treatments are limited to case series, retrospective studies, and small single-arm studies. Adding antifibrotic drugs to immunosuppressive therapies might have some ancillary benefits.

Several new therapies for MDA5-DM patients have emerged, although the optimal use of those therapies is still unknown. Further research and evidence accumulation will be needed. It is also noted that the intensive immunosuppressive therapies are associated with the higher infection risk.
Pathologic Nodal Staging Before SBRT for Early-stage NSCLC Does Not Impact Overall Survival
Authors: Cantrell James N. , Acharya Pawan , Vesely Sara K. , Gunter Tyler C.
Published: September 2023

Objective:

Stereotactic body radiation therapy (SBRT) for early-stage non–small cell carcinoma of the lung (NSCLC) is increasingly utilized. We sought to assess overall survival (OS) for early-stage NSCLC patients receiving SBRT depending on staging method.

Methods:

Early-stage NSCLC patients treated with definitive SBRT were identified in the National Cancer Database (NCDB), and OS was determined based on method of staging. Patient, disease, and treatment characteristics were also analyzed.

Results:

A total of 12,106 patients were included; 865 (7%) received invasive staging (nodal sampling, NS) and 11,241 (93%) had no nodal sampling (NNS). From this larger dataset, a propensity score matching (1:1 without replacement) was performed, which yielded 839 patients for each group (NNS and NS). With a median follow-up time of 3.12 years, median survival for all patients included in the matched dataset was 2.75 years (95% CI: 2.55-2.93 y), with 2- and 5-year OS estimated at 63.9% and 25.7%, respectively. In a multivariable analysis on matched data, there was no difference in mortality risk between the NNS and NS groups (hazard ratio=1.08, 95% CI: 0.94-1.24, P=0.25). Negative prognostic factors identified in the multivariable analysis of the matched data included: age more than 65, male sex, Charlson-Deyo Score ≥1, and tumor size ≥3 cm.

Conclusions:

SBRT use in early-stage NSCLC steadily increased over the study period. Most patients proceeded to SBRT without nodal staging, conflicting with National Comprehensive Cancer Network (NCCN) guidelines which recommend pathologic mediastinal lymph node evaluation for all early-stage NSCLC cases, except stage IA. Our findings suggest similar OS in patients with early-stage NSCLC treated with SBRT irrespective of nodal staging. Furthermore, we highlight patient-related, disease-related, and treatment-related prognostic factors to consider when planning therapy for these patients.
Cost-Effectiveness of New Quadruple Therapy Compared With Standard Treatment for Patients With Heart Failure in China
Authors: Huang Yun , Zhou Hua , Fang Chongbo , Ma Lili , Zhang Yuyu , Rong Weibo , Liu Xiaoli , Ye Honghua
Published: September 2023

This study aimed to compare the cost-effectiveness of the new quadruple therapy regimen of adding sodium-glucose–linked transporter 2 (SGLT2) inhibitors, with standard treatment for patients with heart failure (HF) in China. From the payer's perspective, the dates of cardiovascular event recurrences were extracted from a meta-analysis including 6 trials, combined with the treatment cost for patients with HF in China to construct a Markov model. The outcomes included per capita medical costs and incremental cost-effectiveness ratio, using quality-adjusted life years (QALYs) data. Single-factor, probability sensitivity analysis, and scenario analysis were used to explore the potential uncertainties of the model. The per capita costs of the new quadruple therapy regimen and standard treatment were $87441.26 and $87087.54, respectively. The new regimen was associated with a mean of 21.44 QALYs gained, compared with 18.60 QALYs gained with the standard treatment. The incremental cost-effectiveness ratio was $124.03 per QALY gained. The sensitivity analysis revealed that changes in the parameters within the set range did not affect the model results. In China, compared with standard treatment, the new quadruple therapy regimen with SGLT2 inhibitors reduce the frequency of cardiovascular events among patients with HF, and it has economic advantages.
One-step Glandular Reconstruction after Breast Implant Removal: Technical Refinements and Grafting of the Inferior Dermoglandular Flap
Authors: Ioppolo Leonardo , Amenta Antonio , Alessandri-Bonetti Mario , Borelli Francesco , Calapai Marco , Veronesi Paolo , De Lorenzi Francesca
Published: September 2023

The number of breast implant removal procedures are rising. Among the reasons why patients seek breast implant removal, the autoimmune/inflammatory syndrome induced by adjuvants (ASIA), also named breast implant illness, is increasingly common. ASIA is an entity that incorporates diverse autoimmune conditions induced by the exposure to various adjuvants, including silicone, and it is characterized by systemic symptoms reminiscent of autoimmune disorders. Implant removal has the most effective treatment for ASIA. We describe a technique for glandular cone reconstruction after complete capsulectomy and implant removal. It combines an inverted-T superomedial pedicled mastopexy with fat grafting of the breast quadrants and of the inferior dermoglandular flap in two patients affected by ASIA. Implant removal allowed symptom resolution in both patients at 10 and 12 months follow-up. Both patients were satisfied with the aesthetic outcome after implant removal in terms of breast softness, projection, and volume. Our technique is easy, reproducible, and allowed for restoration of breast contour, volume, and shape after implant removal. Although initially conceived in patients with ASIA, this technique can be used for patients seeking implant removal for any indication.
Safety and Sustainability: Optimizing Outcomes and Changing Paradigms in Global Health Endeavors
Authors: Malapati Sri Harshini , Ramly Elie P. , Riesel Johanna , Pusic Andrea L. , Lee Gordon K. , Magee William P. , Nthumba Peter M.
Published: September 2023

Background:

The need to address inequities in global surgical care has garnered increased attention since 2015, after the Lancet Commission on Global Surgery underscored the importance of ensuring safe, accessible, affordable, and timely surgical and anesthetic care. The vast unmet global plastic surgery needs make plastic surgery care essential in reducing the global burden of disease. In the past, many nonprofit organizations undertook humanitarian activities within low- and middle-income countries that were primarily service-provision oriented. The Lancet Commission on Global Surgery report prompted a shift in focus from direct patient care models to sustainable global surgical models. The realization that 33% of deaths worldwide were due to unmet surgical needs led to a global shift of strategy toward the development of local systems, surgical capacity, and a focus on patient safety and quality of care within international global surgery partnerships.

Methods:

In this report, the authors explore some of the primary components of sustainable international global surgical partnerships discussed in a recent panel at the American Society of Plastic Surgeons Plastic Surgery The Meeting 2022, titled “Safety and Sustainability Overseas: Optimizing Outcomes and Changing Paradigms in Global Health Endeavors.” A literature review elaborating the topics discussed was performed.

Results:

This report focuses on cultural competence and humility, international collaboration, and the use of technology and innovation, all of which are needed to promote sustainability and patient safety, within global surgery efforts.

Conclusions:

The adoption of these components into international surgical collaborations will lead to greatly enhancing the development and sustainability of mutually beneficial relationships.
Increased blood pressure after nonsevere COVID-19
Authors: Schmidt-Lauber Christian , Alba Schmidt Elisa , Hänzelmann Sonja , Petersen Elina L. , Behrendt Christian-Alexander , Twerenbold Raphael , Blankenberg Stefan , Huber Tobias B. , Wenzel Ulrich O.
Published: September 2023

Background:

Various sequelae have been described after nonsevere coronavirus disease 2019 (COVID-19), but knowledge on postacute effects on blood pressure is limited.

Methods:

This is a cross-sectional analysis of blood pressure profiles in individuals after nonsevere COVID-19 compared with matched population-based individuals without prior COVID-19. Data were derived from the ongoing and prospective Hamburg City Health Study, a population-based study in Hamburg, Germany, and its associated COVID-19 program, which included individuals at least 4 months after COVID-19. Matching was performed by age, sex, education, and preexisting hypertension in a 1 : 4 ratio.

Results:

Four hundred and thirty-two individuals after COVID-19 (mean age 56.1 years) were matched to 1728 controls without prior COVID-19 (56.2 years). About 92.8% of COVID-19 courses were mild or moderate, only 7.2% were hospitalized, and no individual had been treated on an intensive care unit. Even after adjustment for relevant competing risk factors, DBP [+4.7 mmHg, 95% confidence interval (95% CI) 3.97–5.7, P < 0.001] was significantly higher in individuals after COVID-19. For SBP, a trend towards increased values was observed (+1.4 mmHg, 95% CI -0.4 to 3.2, P = 0.120). Hypertensive blood pressures at least 130/80 mmHg (according to the ACC/AHA guideline) and at least 140/90 mmHg (ESC/ESH guideline) occurred significantly more often in individuals after COVID-19 than matched controls (odds ratio 2.0, 95% CI 1.5–2.7, P < 0.001 and odds ratio 1.6, 95% CI 1.3–2.0, P < 0.001, respectively), mainly driven by changes in DBP.

Conclusion:

Blood pressure is higher in individuals after nonsevere COVID-19 compared with uninfected individuals suggesting a significant hypertensive sequela.
The effectiveness of microcurrent neurofeedback on depression, anxiety, post-traumatic stress disorder, and quality of life
Authors: Duke Gloria , Yotter Courtney N. , Sharifian Beverly , Duke Gary , Petersen Sandra
Published: September 2023

Background:

The world faces a mental health crisis with elevated rates of depression, anxiety, and post-traumatic stress, leaving a profound impact on daily quality of life (QOL). Current treatments show varying degrees of efficacy and carry burdensome challenges. Evidence exists for use of an innovative neurotechnology to reduce symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), but the science is lacking for use in the general population.

Purposes:

The purpose of this pilot study was to explore the effects of microcurrent neurofeedback on depression, anxiety, PTSD symptoms, and QOL in adults.

Methodology:

This was a one-group, exploratory pilot study that tested outcomes of depression, anxiety, PTSD risk, suicide risk, and QOL in 20 adults using convenience sampling. IASIS microcurrent neurofeedback (I-MCN) was the intervention that was delivered twice a week for 10 weeks; data collection was baseline, 5 weeks, and 10 weeks.

Results:

Depression, anxiety, PTSD risk, and QOL improved significantly by the 10th and 20th session; suicidal risk showed nonsignificant reduction. Use of a more feasible interventional procedure established a foundation for use in clinical settings for the population.

Conclusions:

Using a more simpler procedure than what was used in a previous study reflected positive outcomes earlier and sustained over 10 weeks. This safe and effective technology carries rare but easily overcome adverse effects and could be an alternative to existing treatments or treatment-resistant conditions.

Implications:

Advanced practice nurses can apply the evidence to reduce symptoms of depression, anxiety, and PTSD. Randomized controlled trials and testing on diverse populations are needed.
Idiopathic hypereosinophilic syndrome presenting as capsular warning syndrome: A case report and literature review
Authors: Lai Ze-Hua , Ding Kai-Qi , Tu Xuan-Qiang , Song Yuan-Yue , Zeng Li-Li
Published: September 2023

Rationale:

Few reports of idiopathic hypereosinophilic syndrome exist presenting as ischemic cerebrovascular disease, and the majority are watershed infarction. We report the first case of idiopathic hypereosinophilic syndrome that has clinical features of capsular warning syndrome lasting 6 weeks.

Patient concerns:

A 26-year-old man complained of recurrent right limb weakness, accompanying slurred speech, and right facial paresthesia.

Diagnoses:

The patient was diagnosed with idiopathic hypereosinophilic syndrome (IHES).

Interventions:

Adequate glucocorticoid and anticoagulant treatments were given.

Outcomes:

The patient’s motor ability improved, and he was discharged 2 weeks later. Muscle strength in the right-side extremities had fully recovered at a 3-month follow-up after discharge.

Lessons:

This case suggests that idiopathic hypereosinophilic syndrome should be considered as a cause of capsular warning syndrome, and the dose of glucocorticoid and the efficacy evaluation index needs to be reevaluated for the treatment of ischemic cerebrovascular disease associated with idiopathic hypereosinophilic syndrome.
A randomized controlled trial involving college student: Comparing 0.15% hyaluronic acid with 0.05% cyclosporine A and 3% diquafosol sodium in the Treatment of Dry Eye
Authors: Xu Wenhao , Zhao Xinrui , Jin Haiyan , Jin Hua , Jia Fali , Jiang Lilan , Li Zhengri
Published: September 2023

Background:

To compare the efficacy of 0.15% hyaluronic acid (HA), 0.05% cyclosporine A (CsA) and 3% diquafosol sodium (DQS) ophthalmic solution for the treatment of moderate-to-severe dry eye disease (DED) in college students and the effect on inflammatory factors in tears.

Methods:

This was a prospective, randomized, multicenter trial. A total of 282 college students diagnosed with moderate-to-severe DED between October 2, 2022 and March 1, 2023 were included. A total of 282 patients were randomized to treatment in the group of 0.15% HA or 0.05% CsA or 3% DQS in a 1:1:1 assignment. There was a main end point which is the variations in the corneal staining score to determine non-inferiority of 0.15% HA. Secondary target end points were ocular surface disease index score, Schirmer test, tear meniscus height and tear film breakup time. In addition, the inflammatory factor levels of Interleukin-1β, Interleukin-6, transforming growth factor-β1 in tears were measured. Effectiveness was assessed at baseline, 4- and 12-weeks.

Results:

In our analysis, the average change from baseline in corneal staining score confirmed non-inferiority of 0.15% HA to 0.05% CsA and 3% DQS and manifested obvious improvement of all groups as well (P < .05). Values for ocular surface disease index score, Schirmer test, tear meniscus height and tear film breakup time showed obvious improvements in all groups (P < .05), however, the difference intergroup was not statistically significant. Value for inflammatory factor was significant improvement across all groups, although inflammatory factor scores in the 0.05% CsA group showed a clear trend of better improvement at 12 weeks compared with 0.15% HA groups (P < .01). No serious adverse reactions were observed.

Conclusions:

College students taking 0.15% HA had clinically and statistically significant improvement in corneal staining score and other indicators, but it was inferior to 0.05% CsA in anti-inflammatory therapy for moderate to severe DED. However, 0.15% HA is still an effective, safe and well-tolerated treatment option that may offer additional benefits in terms of convenience and compliance.
Development and evaluation of an early rehabilitation nursing program for patients with pulmonary tuberculosis
Authors: Xie Lei , Wang Dandan , Xie Xinger
Published: September 2023

To develop and evaluate an early rehabilitation nursing program for patients with pulmonary tuberculosis to improve their exercise endurance, pulmonary function, and self-care ability, promote their rehabilitation, improve their quality of life, and explore the construction and application of early rehabilitation nursing program. From March 2021 to August 2022, 104 patients with pulmonary tuberculosis in the improvement stage were recruited and randomly assigned to an intervention group (n = 52) and a control group (n = 52). Exercise endurance was assessed before and 12 weeks after the nursing program, and the groups were compared. Changes in pulmonary function were also analyzed. The exercise of self-care agency scale, self-rating depression scale, self-rating anxiety scale, and generic quality of life inventory-74 were used to assess differences in patients’ quality of life. Patients in the intervention group performed significantly better than those in the control group in the 6-minute walking test, and had significantly higher arterial blood oxygen partial pressure and significantly lower arterial partial pressure of carbon dioxide after the intervention (P < .001). After the intervention, the forced vital capacity and forced expiratory volume in 1 second in the intervention group were significantly higher than those in the control group (P < .001). After the intervention, the scores for health knowledge (P < .001), self-care skills (P = .001), self-concept (P < .001) and self-care responsibility (P = .002) of patients in the intervention group were significantly higher, and the self-rating depression scale, self-rating anxiety scale, and generic quality of life inventory-7 scores were significantly lower in the intervention group than in the control group (P < .001). This study demonstrates the clinical value of early rehabilitation nursing during the improvement period in patients with pulmonary tuberculosis.
Efficacy and safety of Zhenyuan capsule in the treatment of chronic heart failure: A meta-analysis and trial sequential analysis
Authors: Zhang Zengyu , Liu Jianhe
Published: September 2023

Background:

Chronic heart failure (CHF) is a common and difficult-to-treat disease in clinical practice. The efficacy and safety of Zhenyuan capsule (ZYC) in the treatment of CHF were evaluated by meta-analysis and trial sequential analysis (TSA) of published relevant data.

Methods:

Searched 8 databases for clinical literature on ZYC in the treatment of CHF, up to December 2022. Then the meta-analysis and TSA were performed on the studies that met the inclusion criteria.

Results:

Meta-analysis showed that compared with conventional treatment, combined use of ZYC could significantly increase the clinical effective rate (risk ratio 1.20, 95% confidence interval [CI] 1.14~1.26, P < .00001) by 20%, left ventricular ejection fraction (MD 8.85, 95%CI 4.57~13.12, P < .0001) by 8.85%, and 6-minutes walking distance (MD 47.91, 95%CI 18.66~77.17, P = .001) by 47.91 m, and significantly reduce brain natriuretic peptide (MD −247.86, 95%CI −330.62~−165.09, P < .00001) by 247.86 pg/mL. TSA showed that the benefits suggested by the original results were conclusive. In terms of safety, the total adverse events in the combined group of ZYC were comparable to those in the conventional group, and TSA demonstrated that this result needed more research and demonstration.

Conclusion:

ZYC can effectively improve the clinical efficacy of treating CHF, significantly increase left ventricular ejection fraction and 6-minute walk distance, and remarkably reduce brain natriuretic peptide. ZYC, with definite efficacy and safety, has the value of clinical application and in-depth research.
Association of single nucleotide polymorphisms of IL-6 gene with frailty in the Chinese Bai nationality
Authors: Li Xueqiong , Yang Yan , Meng Qi , Shen Yun
Published: September 2023

To investigate the impact of 3 single nucleotide polymorphisms (SNPs) in the interleukin-6 (IL-6) gene and their interaction on susceptibility to frailty in the elderly in rural areas of China Bai nationality. Taking the Bai people in Dali, China as the research object, and according to the frailty phenotype scale, there were 2 groups: frail and non-frail. Basic information about the study participants was gathered using a questionnaire. Clinical biochemical indices were also evaluated and the Sanger method was used to identify the sequences of the IL-6 gene loci at rs1524107, rs1800796, and rs10499563. SHEsis online software was used to analyze the linkage disequilibrium of IL-6 gene sites and the relationship between haploids and frailty. The MDR software was used to analyze the 3 sites and their interactions. Among 231 rural Bai elderly people, 63 (27.3%) were frail and 168 (72.7%) were non-frail. The SNPs of rs1524107, rs1800796, and rs10499563 in the IL-6 gene were not associated with the occurrence of frailty, nor were they associated with clinical indicators such as grip strength and gait speed. After adjusting for age and gender, there was no significant difference in the distribution of the 3 genetic models composed of the 3 SNPs between frail and non-frail populations (all P > .05). The 3 haplotypes were not associated with the occurrence of frailty, and the interaction between the 3 loci was not associated with the susceptibility to frailty. The SNP of rs1524107, rs1800796, and rs10499563 sites of IL-6 gene may not be related to frailty susceptibility in Dali Bai people. Differences in frailty mechanisms among other populations at the gene level, which are of enormous significance for the prevention and treatment of frailty, require further research with larger samples and more gene loci.
Acute effects of muscle vibration on elbow joint position sense in healthy young men: A randomized trial
Authors: Alghadir Ahmad H. , Zafar Hamayun , Khan Masood
Published: September 2023

Background:

The study aimed to investigate and compare the acute effects of 2 local vibration frequencies (63 Hz vs 42 Hz frequencies) applied to the biceps brachii muscles on the elbow joint position sense (JPS) in healthy young men.

Methods:

A 3-arm parallel-group design with randomization of participants was used. Forty-five healthy young men aged 19 to 30 years were randomly assigned to 3 groups: to receive 63 Hz (n = 15) in experimental group 1 (EG1) or 42 Hz (n = 15) in experimental group 2 (EG2) or sham vibration in the control group (n = 15). Participants in the EG1 and EG2 received 5 bouts of 1-minute vibration exposure to the biceps brachii muscle, with a 1-minute rest between the bouts. In control group, sham vibration was applied with the same duration and interval as in EG1 and EG2. The active elbow joint position error was selected as an outcome measure to assess elbow JPS. The target angle and the angle reproduced were measured using a Universal Goniometer. The difference between the target and the reproduced angles was calculated to determine active elbow joint position error. Measurements were made before the vibration application and right after it.

Results:

No statistically significant difference was observed in the JPS of the elbow joint over time in any group (P = .625). No statistically significant differences were observed between the 33 groups in the JPS of the elbow (P = .075).

Conclusion:

There was no acute effect of vibration of the biceps brachii muscle at 63 and 42 Hz on active elbow JPS in healthy adults.