bluuebunny/crossref_metadata_2025 huggingface dataset:
Long Term Use of Anti-Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration
Authors: Begaj Tedi , Jeong Daeun , Park Jong G. , Runner Margaret M. , Capone Antonio , Dass A. Bawa , Drenser Kimberly A. , Faia Lisa J. , Farley Nathan D. , Garretson Bruce. R. , Hassan Tarek S. , Mahmoud Tamer H. , Margherio Alan , Raphaelian Paul V. , Randhawa Sandeep , Ruby Alan J. , Sneed Scott , Rao Prethy , Wolfe Jeremy D. , Williams George A.
Published: October 2023

Purpose:

While pivotal trials have demonstrated efficacy of anti-vascular endothelial growth factor (VEGF) therapy in neovascular age-related macular degeneration (nAMD), there is a paucity of clinical data about the long term (>5 years) treatment.

Methods:

Retrospective analysis of all patients with nAMD who were actively treated, had received >40 anti-VEGF injections, and were followed for ≥5 years. Snellen corrected visual acuity (SCVA), initial drug choice, and times elapsed between treatment were collected. Rates of endophthalmitis and outcomes of submacular hemorrhage were also evaluated.

Results:

A total of 88 patients (162 eyes) met the inclusion criteria: the average patient was 86.3 years with an average follow up period of 7.6 years. The average total number of injections per eye was 69 (18.0 std dev); a total of 11,208 injections were given throughout the study period and 6 (0.05%) cases of endophthalmitis were observed. Overall, there was a clinical and statistical difference in average SCVA at injections #2,#3, #4, #5, #6, #10 and #20, as compared with baseline (p=0.03, p<0.01, p=0.02, p<0.01, p=0.01, p=0.01, p<0.01, respectively). Patients in the SCVA 20/20-20/40 subgroup maintained vision until injection #30. Seven eyes experienced a visually significant submacular hemorrhage.

Conclusions:

The nAMD cohort herein received on average 8 anti-VEGF injections per year for approximately 8 years; eyes with good (≥20/40) initial baseline vision maintained their VA while eyes with worse SCVA (≤20/50) had a robust initial improvement that diminished with time. Most patients were maintained on the same initial drug of choice and the rate of endo11phthalmitis was low.
Presentations & factors affecting outcome of rhegmatogenous retinal detachment with choroidal detachment – An Indo-Taiwanese study
Authors: Dave Vivek Pravin , Chou Hung-Da , Kiri Hardik , Ieng Fok Chak , Hwang Yih-Shiou , Wu Wei-Chi , Chen Kuan-Jen , Das Anthony Vipin , Pathengay Avinash , Pappuru Rajeev Reddy , Lai Chi-Chun
Published: October 2023

Objective

To report the clinical settings, management and factors associated with outcomes of rhegmatogenous retinal detachment with concurrent choroidal detachment (RRDCD)

Methods

Retrospective, consecutive, multicenter case series from January 2014 to January 2021 were included. Cases were from a tertiary eye care center in India and Taiwan.

Results

Overall 303 eyes were included. Mean age was 43.72±20.64 years (median 46). Best-corrected presenting visual acuity was 1.79±0.92 logMAR (median 2.10) (Snellen 20/1233). Forty-four patients (17.91%) received pre-operative steroids. Final visual acuity was 1.33±0.94 logMAR (median 1.10) (Snellen 20/427). Favorable anatomic outcome was seen in 200/303 (66%) while favorable functional outcome was seen in 128/303 (42.20%). Factors predicting favorable anatomic outcome were absence of phakic lens status (OR 2.76) absence of PVR worse than grade A (OR 7.69), use of pre-operative steroids (OR 4.50) and use of an encircling band (3.85). Factors predicting favorable functional outcome were better presenting visual acuity (OR 3.03), absence of phakic lens status (OR 4.93), absence of PVR worse than grade A (OR 10.41) and use of pre-operative steroids (OR 7.24).

Conclusions

Administration of pre-operative steroids, use of an encircling band during surgery and pseudophakic status of the eye were found to have better outcomes in RRDCD.
Association of metformin use with risk of newly onset neovascular age-related macular degeneration development
Authors: Khanna Saira , Shaw Lincoln , Hyman Max J. , Zhang Jason , Hariprasad Seenu , Soo Jackie , Flores Andrea , Skondra Dimitra
Published: October 2023

Purpose:

To investigate if metformin use reduces the odds of developing new neovascular AMD (nAMD).

Methods:

This is a case-control study of 86,930 subjects with new diagnoses of nAMD and 86,918 matched controls using the Merative™ Marketscan® Research Databases. Subjects were analyzed using multivariable conditional logistic regression to identify the risks of various exposures on developing nAMD. A subgroup analysis of 22,117 diabetic cases and 21,616 diabetic controls was also performed.

Results:

Metformin use was associated with reduced odds ratio (OR) of developing nAMD (OR 0.95, 95% confidence interval 0.91-0.98) in full sample and diabetic cohort particularly in patients without any diabetic retinopathy (DR) —an effect that persisted after Bonferroni correction. In the diabetic cohort without DR, reduced OR was observed at 24-month cumulative doses of 1 to 300g, 301 to 630g, and 631 to 1080g.

Conclusions:

Metformin use was associated with reduced OR of nAMD, particularly in patients without DR. The protective effect was noted for 24-month cumulative doses below 1080g. Metformin may be a novel preventive strategy for nAMD.
Retinal Optical Coherence Tomography Imaging Biomarkers: A Review of the Literature
Authors: Pandya Bhadra U. , Grinton Michael , Mandelcorn Efrem D. , Felfeli Tina
Published: October 2023

Purpose:

This literature review aims to summarize novel optical coherence tomography (OCT) imaging biomarkers that have recently been described in the literature and are frequently encountered clinically.

Methods:

The literature was reviewed to identify novel OCT biomarkers reported to date. A descriptive summary of all terms and representative illustrations were provided to highlight the most relevant features.

Results:

37 OCT terminologies were identified. The vitreomacular interface disorders group included the four stages of ERM, macular pseudohole, tractional LH, degenerative LH, cotton ball sign, and foveal crack sign. The AMD group included outer retinal tubulation, multi-layered pigment epithelial detachment, pre-choroidal cleft, onion sign, double-layer sign, complete outer retinal atrophy, complete RPE and outer retinal atrophy, and reticular pseudodrusen. Uveitic disorders group consisted of bacillary layer detachment, syphilis placoid, rain cloud sign, and pitchfork sign. The disorders relating to toxicity group included flying saucer sign and MEK inhibitor-associated retinopathy. The disorders associated with systemic conditions group included choroidal nodules and needle sign. The pachychoroid spectrum group included pachychoroid and brush border pattern. The vascular disorders group included pearl necklace sign, diffuse retinal thickening, disorganization of retinal inner layers, INL microcysts, hyperreflective retinal spots, paracentral acute middle maculopathy, and acute macular neuroretinopathy. The miscellaneous group included omega sign (ω), macular telangiectasia (type 2), and omega sign (Ω).

Discussion:

37 OCT terminologies were summarized and detailed illustrations consolidating the features of each biomarker were included. A nuanced understanding of OCT biomarkers and their clinical significance is essential due to their predictive and prognostic value.
Neuronal–immune axis alters pain and sensory afferent damage during dental pulp injury
Authors: Erdogan Ozge , Michot Benoit , Xia Jinya , Alabdulaaly Lama , Yesares Rubi Pilar , Ha Vivian , Chiu Isaac M. , Gibbs Jennifer L.
Published: October 2023

Dental pulp tissue is densely innervated by afferent fibers of the trigeminal ganglion. When bacteria cause dental decay near the pulpal tissue, a strong neuronal and immune response occurs, creating pulpitis, which is associated with severe pain and pulp tissue damage. Neuroimmune interactions have the potential to modulate both the pain and pathological outcome of pulpitis. We first investigated the role of the neuropeptide calcitonin gene-related peptide (CGRP), released from peptidergic sensory afferents, in dental pain and immune responses by using Calca knockout (Calca−/−) and wild-type (Calca+/+) mice, in a model of pulpitis by creating a mechanical exposure of the dental pulp horn. We found that the neuropeptide CGRP, facilitated the recruitment of myeloid cells into the pulp while also increasing spontaneous pain-like behavior 20% to 25% at an early time point. Moreover, when we depleted neutrophils and monocytes, we found that there was 20% to 30% more sensory afferent loss and increased presence of bacteria in deeper parts of the tissue, whereas there was a significant reduction in mechanical pain response scores compared with the control group at a later time point. Overall, we showed that there is a crosstalk between peptidergic neurons and neutrophils in the pulp, modulating the pain and inflammatory outcomes of the disease.
Transplant center variability in utilizing nonstandard donors and its impact on the transplantation of patients with lower MELD scores
Authors: Goldberg David S. , McKenna Gregory J.
Published: October 2023

There is a subset of patients with lower MELD scores who are at substantial risk of waitlist mortality. In order to transplant such patients, transplant centers must utilize “nonstandard” donors (eg, living donors, donation after circulatory death), which are traditionally offered to those patients who are not at the top of the waitlist. We used Organ Procurement and Transplantation data to evaluate center-level and region-level variability in the utilization of nonstandard donors and its impact on MELD at transplant among adult liver-alone non-status 1 patients transplanted from April 1, 2020, to September 30, 2022. The center-level variability in the utilization of nonstandard donors was 4-fold greater than the center-level variability in waitlisting practices (waitlistings with a MELD score of <20). While there was a moderate correlation between center-level waitlisting and transplantation of patients with a MELD score of <20 (p = 0.58), there was a strong correlation between center-level utilization of nonstandard donors and center-level transplantation of patients with a MELD score of <20 (p = 0.75). This strong correlation between center-level utilization of “nonstandard” donors and center-level transplantation of patients with a MELD score of <20 was limited to regions 2, 4, 5, 9, and 11. Transplant centers that utilize more nonstandard donors are more likely to successfully transplant patients at lower MELD scores. Public reporting of these data could benefit patients, caregivers, and referring providers, and be used to help maximize organ utilization.
Evaluation of adrenal masses using 18F-FDOPA PET/CT in patients suspected with pheochromocytoma
Authors: Kim Soo Jeong , Park Cheol-Young , Kwon Hyemi , Kim Young Hwan
Published: October 2023

Objective

Pheochromocytomas (PHEOs) are chromaffin cell-derived adrenal tumors. 6-[18F]-L-fluoro-L-3, 4-dihydroxyphenylalanine (18F-FDOPA) is a radiotracer taken up in neuroendocrine chromaffin cells via the L-type amino-acid transporter. 18F-FDOPA is useful in patients with PHEO. However, more information about the use of 18F-FDOPA PET/CT scan is needed. Thus, the current study investigated various PET parameters on preoperative 18F-FDOPA PET/CT scan.

Methods

The 18F-FDOPA PET/CT scan findings of 29 patients who underwent adrenalectomy after PET/CT scans were evaluated according to their pathologic diagnosis. Thereafter, the patients were classified under different risk groups which were compared based on the Grading System for Adrenal Pheochromocytoma and Paraganglioma (GAPP).

Results

In terms of histopathologic results after surgery, 24 patients presented with PHEO. The remaining 5 patients were diagnosed with adrenal cortical adenomas or adrenal medullary hyperplasia. The maximum standardized uptake value, mean standardized uptake value, tumor-to-liver ratio, and tumor-to-contralateral adrenal gland ratio of PHEOs on preoperative 18F-FDOPA PET/CT scan were higher than those of other tumors. The metabolic tumor volume (MTV) and total lesion uptake of PHEOs in the intermediate-risk group (n = 19) were higher than those in the low-risk group (n = 5). The MTV and total lesion uptake were significantly correlated with the GAPP score.

Conclusion

Preoperative 18F-FDOPA PET/CT is helpful to identifying PHEOs. In addition, imaging interpretation using the standardized uptake value of the suspected tumor or the tumor-to-liver/contralateral adrenal gland ratio can be effective. The metabolic parameters of PHEOs are positively correlated with the GAPP score.
Should we reconsider blocking the thyroid for 123I-Ioflupane studies in elderly patients: quantifying radiation dose to the unblocked thyroid and implications for clinical practice
Authors: Morton D. William A. , Vennart Nicholas , Slinger Harry , Gannon Mark , Razvi Salman , Bartholomew Peter
Published: October 2023

Objectives

To measure the absorbed dose to the thyroid in patients injected with 123I-Ioflupane where the thyroid was not blocked with prophylaxis to investigate whether thyroid blocking should be limited to younger patients. This risk from the additional absorbed dose to the thyroid was then compared to the risk from iodine overdose through ingestion of the iodide prophylaxis, resulting in iodine-induced hyper/hypothyroidism (IIH).

Methods

A cohort of patients (n = 30) who did not receive thyroid prophylaxis underwent static thyroid imaging 3 h after 123I-Ioflupane administration. The measured thyroidal uptake of free 123I was then extrapolated to peak uptake time (24 h post-administration). This value was used to calculate cumulated activity in the thyroid and thus thyroid-thyroid absorbed dose D(r

thy

←r

thy
) using the relevant S-value in the MIRD method.

Results

Mean D(r

thy

←r

thy
) was found to be 13.6 mGy with an SD of 8.8 mGy; this would contribute an additional 0.5 mSv to the effective dose.

Conclusion

ARSAC recommends in its Notes for Guidance prophylactic thyroid blocking if the absorbed dose to the thyroid is >50 mGy; the maximum thyroid dose in this study cohort was 36.3 mGy. With risk from IIH and its associated cardiac complications increasing with age, this study suggests that iodide prophylaxis with 123I-Ioflupane should be reconsidered for elderly patient.
A new simpler image quality index based on body size for FDG-PET/CT
Authors: Sagara Hiroaki , Inoue Kazumasa , Yaku Hideki , Ohsawa Amon , Mano Chikara , Morita Takahiro , Hiyama Takashi , Muramatsu Yoshihisa , Inaki Anri , Fujii Hirofumi
Published: October 2023

Noise equivalent count density (NECdensity) is often used to evaluate the image quality of whole-body fluorodeoxyglucose tomography tests. However, this index is calculated using the patient volume, which is difficult to obtain at every facility. In this study, we proposed new image quality indices that can be evaluated at all facilities. In total, 94 patients were enrolled in the study. The correlations of patients’ body weight and BMI with volume were examined. New image quality indices normalized by body weight and BMI were defined as NECbw and NECbmi, respectively. Correlations between NECbw, NECbmi, and NECdensity were examined. Further, the correlations between these two new indices and visual scores were evaluated. Good correlations were observed between volume and body weight (r = 0.861, P < 0.001) and between volume and BMI (r = 0.728, P < 0.001). NECbw and NECbmi correlated well with NECdensity (r = 0.954 for NECbw and r = 0.897 for NECbmi, P < 0.001). These correlations improved when the examined bed positions were set to the same number. Additionally, the correlations of visual scores with NECbw and NECbmi were similar to those between the visual score and NECdensity. Our investigation indicated that the newly proposed image quality metrics, NECbw and NECbmi, were easily calculated and as useful as NECdensity for evaluating image quality when subjects had similar physiques.
Medicinal grade opium tincture for severe diarrhea: effect revisited in observational study
Authors: Dahlgren David , Hellström Per M.
Published: October 2023

Purpose of review

Chronic diarrhea is a common disorder that interferes with normal daily activities and results in poor quality of life. Fecal urgency and incontinence often necessitate clinical consultation, but the pathophysiological mechanisms are difficult to differentiate in a clinical setting. Therefore, drugs targeting the opioid receptors, such as diphenoxylate and loperamide, are typically used, as they reduce both gut motility and secretion.

Recent findings

For severe diarrhea, morphine-containing extemporaneous opium tincture drops have recently been reprofiled to a pharmaceutical. The drug is indicated for severe diarrhea in adults when other antidiarrheals do not give sufficient fecal emptying control. The pronounced effect is due to the liquid formulation with rapid onset as a drug dissolution step is avoided. A recent prospective, noninterventional study (CLARIFY) of patients treated with opioid drops demonstrates a rapid and sustained therapeutic effect. Tolerance does not develop for the antidiarrheal effect and no dependence was observed after discontinuation.

This mini-review discusses the use of opium derivates for treatment of diarrhea, with an emphasis on opium drops as a new medicinal grade opium for the use as additional treatment of severe diarrhea, emphasizing its mechanism of action and evaluation of the risk—benefit ratio in the clinical setting.
Comparing the effect of tissue adhesive and suturing material on collagen I/III ratio in abdominal skin wounds: an experimental study
Authors: Sofii Imam , Fauzi Aditya Rifqi
Published: October 2023

Background:

The skin closure procedure should be technically simple, acceptable, quick, and cost-effective. Sutures remain the technique’s mainstay, however tissue adhesive is becoming more used in clinical practice. Collagen ratios of types I and III play a significant role as postoperative wound healing parameters. Here, the authors aim to examine the collagen I/III ratio of tissue adhesive vs. non-absorbable sutures for abdominal skin closure in Wistar albino rats.

Material and methods:

The authors allocated 20 rats into four experimental groups. Wounds in groups 1 and 3 were sealed with tissue adhesive (cyanoacrylate), while those in groups 2 and 4 were closed using suture material (monofilament non-absorbable nylon). Groups 1 and 2 were sacrificed on postoperative day (POD) 4, while those in groups 3 and 4 were euthanized on POD 7. Skin samples (1×0.5 cm) were collected for analysis, and the collagen I/III ratios were determined using immunohistochemistry staining techniques.

Results:

The levels of collagen I and III expression did not exhibit statistically significant differences between tissue adhesive and nylon suture groups at either POD 4 (P=0.052, P=0.513) or POD 7 (P=0.125, P=0.80). Similarly, the collagen I/III ratio did not significantly differ between the two groups at POD 4 (1.23±2.26 vs. 0.70±0.24; P=0.47) or POD 7 (0.68±0.96 vs. 0.77±1.22; P=0.857).

Conclusions:

There were no statistical significance difference in collagen I/III ratio between the tissue adhesive and suture material groups, suggesting that the choice of wound closure material may not influence the abdominal skin closure.
Application of green mussel (Perna viridis) shells hydroxyapatite on osteocalcin levels and osteoblast cells in rabbit femur bone defect
Authors: Putra Rafika Syah , Widyastiti Nyoman Suci , Budijitno Selamat , Muniroh Muflihatul , Novriansyah Robin , Alwi Luqman , Adiputra Putu Anda Tusta
Published: October 2023

Background:

Bovine hydroxyapatite (HA) used for bone grafts is relatively expensive, necessitating the development of alternative sources. Alternative HA materials derived from green mussel shells with smaller molecular sizes are inexpensive and abundantly available throughout Indonesian waters. The purpose of this study is to investigate the effect of green mussel shells HA on bone healing.

Methods:

This post-test-only experimental research used male rabbits with femoral defects divided into three groups randomly: K (no treatment), P1 (bovine HA treatment), and P2 (green mussel shell HA treatment). The osteocalcin level was assessed biochemically while osteoblast cells were histopathologically at the second, fourth, and sixth weeks. Statistic tests were used to assess differences between groups and periods with statistical significance P<0.05.

Results:

Nine rabbits in each group showed significant differences between groups K, P1, and P2 in term osteocalcin levels at week 2 (2.60, 4.53±0.12, 4.47±0.23; P=0.046), week 4 (5.13±0.12, 8.53±0.12, 7.47±0.12; P=0.025), and week 6 (8.20, 11.93±0.23, 10.93±0.31, P=0.023), while in term osteoblast cells only at week 6 (16.33±3.46, 26.10±3.52, 30.40±3.29; P=0.006). The osteocalcin level and osteoblast increased significantly between groups K and P1/P2 from the initial trial until the last week. Osteoblast cells in the groups P1/P2 increased significantly, especially at week 6.

Conclusion:

Green mussel shell HA has the biochemical effectiveness of osteocalcin and can increase osteoblast cells comparable to bovine HA, which can enhance bone healing.
Ocular manifestations in COVID-19 infections: a case series
Authors: Khalayli Naram , Haider Ghina , Hodifa Yara , Kudsi Maysoun , Naman Nada
Published: October 2023

Introduction:

The prevalence of ocular abnormalities of COVID-19 is different according to different reports. However, currently available evidence on the presence of this virus in ocular secretions and its association with conjunctivitis is not well established.

Objective:

To reveal the ocular features among COVID-19 patients and to describe them with the findings of clinical data, inflammatory markers, and respiratory support therapy.

Methods:

Ocular symptoms were evaluated and recorded in 494 COV19 patients through questionnaire-style interviews, and an ophthalmologic examination. Data including age, sex, disease severity, and nasopharyngeal swab results were collected. Laboratory test values were reviewed. Patients with COVID-19 infections were classified into severe cases and mild cases.

Results:

The prevalence of ocular features was (2.83%). The most common features were conjunctival hyperaemia, epiphora, and foreign body sensation with itching. Patients with ocular manifestations on CPAP support therapy had higher rates of itching, lower rates of foreign body sensation. No differences were found in the levels of inflammatory marker. Meanwhile, patients used respiratory-aid therapy revealed higher values of white blood cells, platelet counts, erythrocyte sedimentation rate, C-reactive protein, ferritin, and lactate dehydrogenase.

Discussion:

Ocular involvement in COVID-19 and possibility of disease transmission through ocular tissues and secretions, has been registered in some reports, with a prevalence of 2–32%. The external and internal ocular parts are involved.

Conclusion:

Ocular features are not infrequent in COVID-19 patients.
The impacts of anxiety and depression on outcomes in orthopaedic trauma surgery: a narrative review
Authors: Weinerman Jonathan , Vazquez Arianna , Schurhoff Nicolette , Shatz Connor , Goldenberg Brandon , Constantinescu David , Hernandez Giselle M.
Published: October 2023

Introduction:

The impact of anxiety and depression on outcomes in orthopaedic trauma surgery is a topic of growing research interest.

Patients and methods:

Orthopaedic trauma patients often experience high rates of psychiatric disorders, with anxiety and depression being the most prevalent. Mental health disorders have been shown to increase the risk of negative surgical outcomes and morbidity. This narrative review seeks to summarize the current literature surrounding the impacts of anxiety and depression on orthopaedic trauma surgery outcomes.

Discussion:

There is a bidirectional relationship between chronic pain and mental health disorders, involving overlapping brain regions and neurotransmitter pathways. Anxiety and depression have been identified as predictors of negative surgical outcomes in orthopaedic trauma patients. Screening tools like the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-7 (GAD-7), and Medical Outcomes Study 36-item Short Form (SF-36) can assess mental health status and help tailor interventions. Psychological distress, chronic pain, and traumatic limb amputation are factors that contribute to adverse mental health outcomes in orthopaedic trauma patients. Opioid use for pain management is common in orthopaedic surgery, but it can worsen symptoms of depression and lead to dependency. Non-opioid pain management strategies may improve postoperative outcomes by reducing the impact of opioid-exacerbated depression.

Conclusion:

Mental health interventions, both preoperative and postoperative, are crucial in optimizing surgical outcomes and improving patient quality of life. Multidisciplinary approaches that address both physical and mental health are recommended for orthopaedic trauma patients. Further research is needed to develop effective interventions for improving mental health outcomes in this patient population.
Neutropenic enterocolitis in aplastic anemia – a case report from Nepal
Authors: Sharma Jagdish , Adhikari Anshumala , Basnet Ashik , Gelal Dharana , Singh Shivani , Mishra Aavash
Published: October 2023

Introduction and importance:

Neutropenic enterocolitis (NE) is a life-threatening necrotizing enterocolitis, particularly in neutropenic patients.

Case presentation:

We are presenting a case of a 22-year-old male who presented chief complaints of abdominal pain, reddish black stool, abdominal distention, and low-grade fever with laboratory and bone marrow findings suggestive of aplastic anemia. Computed tomography scan of the abdomen and pelvis with contrast was used to establish the diagnosis of necrotizing enterocolitis. Nonsurgical management including broad-spectrum antimicrobials, bowel rest, nasogastric suction, fluid and nutritional support, and blood product support, helped this patient to recover.

Clinical discussion:

NE is a life-threatening inflammatory condition of the small and large intestines. Typical symptoms of NE include diffuse abdominal pain, fever, and watery or bloody diarrhea. Diagnosis of NE is done by clinical and imaging findings. Management of the primary disease is important to improve the ultimate survival of the disease.

Conclusion:

Early identification and management of neutropenic enterocolitis help to reduce mortality.
Acalvaria: the first case report from Nepal
Authors: K.C. Kusha , Baral Abal
Published: October 2023

Introduction and importance:

Acalvaria is a rare congenital malformation in which the flat bones of the cranial vault, dura mater, and associated muscles are absent while the central nervous system usually remains unaffected. It is an extremely rare congenital anomaly with only a handful of cases being reported in literature.

Case presentation:

The authors report a case of a 2-month-old male infant with acalvaria who was delivered at home and brought to our centre with the complaint of an abnormally soft skull. He was evaluated in a primary centre in rural Nepal. Parietal bones were missing bilaterally but no other abnormalities were found during the physical examination and investigations. Major differential diagnoses like anencephaly, cephalocele, osteogenesis imperfecta type II, and hypophosphatasia were ruled out with the help of history, physical examination, and available investigations and the case was diagnosed as acalvaria.

Clinical discussion:

Acalvaria is a post-neurulation defect which is associated with anomalies of various organ systems. Radiological diagnosis, with supportive laboratory investigations, is the most reliable method of antenatal diagnosis.

Conclusion:

Acalvaria is known to have a dismal prognosis and all the living cases with long-term follow-up are mentally retarded and physically disabled. Early and reliable antenatal diagnosis can reduce the economic, physical, and psychological burden associated with this fatal disease, especially in low-income countries.
Recurrent paradoxical cerebral embolism caused by a thrombus entrapped in a patent foramen ovale: a case report
Authors: Do Anh Phuong , Nguyen Hung Minh , Thi Thu Nguyen Hoai , Ta Cuong Manh , Bui Son Tran Thanh , Pham Hung Manh
Published: October 2023

Introduction:

A thrombus straddling the patent foramen ovale (PFO) is a very rare clinical entity. Optimal management remains unclear due to the availability of various therapeutic options; thus, an individualized approach is recommended.

Case presentation:

The authors describe a case presenting with recurrent cerebral embolism and a large and mobile thrombus straddled in the PFO. Historically, cardiac surgery, thrombolysis or anticoagulation were possible management options for this patient. However, there are no guidelines on what the optimal treatment is. Our patient was a poor surgical candidate because of advanced age and multiple comorbidities. Furthermore, she had a recent ischaemic stroke which was a relative contraindication to thrombolysis. After consulting the Heart Team, medical treatment alone with systemic anticoagulation was administered. Subsequent transthoracic echocardiography (TTE) after 1 week showed complete thrombus resolution. After 4 months, the PFO was successfully occluded with an Amplatzer device. The patient received rehabilitation therapy and had good functional recovery.

Clinical discussion:

Anticoagulant therapy alone was chosen because of high risk for surgery. Complete thrombus resolution was achieved after 1 week although the initial thrombus size was quite large. Nevertheless, this approach may not be applicable to every patient. In addition to TTE, multimodality imaging using transesophageal echocardiography and cardiac magnetic resonance is helpful to identify the mechanism of stroke, which in our case is a thrombus-straddled PFO, and to make early treatment decisions. Serial TTEs help assess the response to anticoagulation. An individualized approach should be made with a multidisciplinary Heart Team.

Conclusion:

Echocardiography plays an important role in the diagnosis and treatment evaluation for patients with a thrombus straddling a PFO. An individualized approach to manage the patient should be made with a multidisciplinary Heart Team.
The top 100 most-cited studies on monkeypox: a brief bibliometric analysis
Authors: Zheng Li , Yuan Yuan , Zhang Kaihua , Wang Yan , Min Xianjun
Published: October 2023

Background:

A plethora of monkeypox papers have been published; however, pinpointing key and pivotal studies can be challenging amongst the ever-expanding literature. Bibliometric analyses are helpful in identifying the most influential articles and their impact pertinent to this field, which has helped mould the recognition and management of monkeypox.

Methods:

The Web of Science Core Collection (WoSCC) was searched on 27 October 2022. The top 100 most-cited articles on monkeypox were identified and evaluated by author, country, institution, type of articles, theme, journal of publication, keywords, and citations.

Results:

The top 100 most-cited studies were published between 1997 and 2022, and the 5-year period with the largest number of articles was 2007–2011. The median number of citations among the top 100 most-cited articles was 78.23. Of the top 100 most-cited studies, 91 were original articles, and nine were reviews, the median of annual citations was significantly higher in the review group than the original group, 7.86 (4.20–13.80) versus 4.50 (3.07–7.59; P=0.023). The 100 articles were classified into different research theme, with the top three being Immunology (31%), Infectious Diseases (30%), and Virology (26%), respectively. The keywords with the highest co-occurrence frequency were “monkeypox”, “smallpox,” and “smallpox virus.” The largest number of articles in the top 100 were published in Emerging Infectious Diseases (n=13), followed by Journal of Virology (n=11), Journal of Infectious Diseases (n=5), and PLoS One (n=5). The authors identified 711 different authors from 195 institutions and 28 countries in the top 100 most-cited articles, with the majority based in the USA.

Conclusion:

The top 100 most-cited studies provide an important insight into the historical developments of monkeypox. The authors should strengthen the recognition and management of monkeypox worldwide and strengthen research cooperation among scholars in order to better respond to the ongoing or future outbreak.
Effect of Guided Imagery on Patient Comfort, Vital Signs, Pain, Anxiety, and Satisfaction in Cancer Patients Undergoing Port Catheterization With Local Anesthesia
Authors: Acar Kadriye , Ersöz Hasan
Published: October 2023

Background

Port catheter placement is usually an operation performed under local anesthesia. Being conscious during the interventions performed with local anesthesia can lead to anxiety and stress.

Objective

The aim of this study was to determine the effect of guided imagery performed before and during the procedure on vital signs and comfort, pain, anxiety, and satisfaction levels in patients with cancer undergoing port catheterization with local anesthesia.

Methods

A total of 80 patients were included in the study. Patients in the intervention group received standard treatment and nursing care, as well as a guided imagery intervention once before and once during the procedure. Patients in the control group received only standard treatment and nursing care.

Results

Patients in the guided imagery group reported lower pain and anxiety scores, higher patient satisfaction, and increased comfort compared with patients in the control group. Patients in the guided imagery group showed significantly lower respiratory rate and heart rate than the control group by the end of the procedure. There was no significant difference in blood pressure.

Conclusion

Practicing guided imagery before and during a procedure performed under local anesthesia reduced cancer patients’ pain, increased patient satisfaction and comfort, and had a positive effect on their respiratory and heart rates.

Implications for Practice

We recommend guided imagery as a practical, low-cost complementary therapy for patients receiving local anesthesia.
Patient-Reported Outcomes Measurement Information System Pediatric Symptom Profiles of Children With Cancer in China
Authors: Liu Yanyan , Li Danyu , Shen Nanping , Zhang Wen , Zhou Fen , Yuan Changrong
Published: October 2023

Background

Unpleasant symptoms are common in children with cancer. However, research identifying subgroups of children with cancer who experience similar levels of self-reported symptoms in China is limited.

Objectives

This study aimed to classify the symptom profiles of children with cancer and detect the possible predictors of the profiles and their effect on children’s quality of life (QoL).

Methods

A total of 272 children aged 8 to 17 years completed the Chinese version of the Pediatric Patient-Reported Outcomes Measurement Information System short form measures, the Pediatric QOL Inventory general core and cancer modules. Latent profile analysis was used to identify symptom profiles, and ordinal logistic regression and analysis of variance were used to examine predictors of symptom profile membership and profile differences on QoL.

Results

The best fit was a 3-profile model: low, moderate, and severe symptom distress. Children who had been inpatients in the past 7 days and were currently under treatment are more likely to have severe symptoms. Participants in the low symptom distress profile reported significantly greater QoL than those in the other profiles.

Conclusions

Children with cancer are heterogeneous in their experience of symptoms. Children’s characteristics, such as inpatient history and treatment status, are predictors of profiles; different symptom profiles are associated with QoL.

Implications for Practice

This study identified distinct groups of patients who predictably experience higher symptoms and their predictors, which could help to place children within a profile and perhaps allow nurses to provide targeted supportive care to match children’s specific symptom profile.
Utility of Immunohistochemistry With Antibodies to SS18-SSX Chimeric Proteins and C-Terminus of SSX Protein for Synovial Sarcoma Differential Diagnosis
Authors: Lasota Jerzy , Chłopek Małgorzata , Kaczorowski Maciej , Natálie Klubíčková , Ryś Janusz , Kopczyński Janusz , Sulaieva Oksana , Michal Michael , Kruczak Anna , Harazin-Lechowska Agnieszka , Szczepaniak Magdalena , Koshyk Olena , Hałoń Agnieszka , Czapiewski Piotr , Abdullaev Zied , Kowalik Artur , Aldape Kenneth D. , Michal Michal , Miettinen Markku
Published: October 2023

Synovial sarcoma is a relatively common soft tissue tumor characterized by highly specific t(X;18)(p11;q11) translocation resulting in the fusion ofSS18with members ofSSXgene family. Typically, detection ofSS18locus rearrangement by fluorescence in situ hybridization orSS18::SSXfusion transcripts confirms the diagnosis. More recently, immunohistochemistry (IHC) for SS18-SSX chimeric protein (E9X9V) and C-terminus of SSX (E5A2C) showed high specificity and sensitivity for synovial sarcoma. This study screened a cohort of >1000 soft tissue and melanocytic tumors using IHC and E9X9V and E5A2C antibodies. Three percent (6/212) of synovial sarcomas were either negative for SS18-SSX or had scattered positive tumor cells (n=1). In these cases, targeted RNA next-generation sequencing detected variants ofSS18::SSXchimeric transcripts. DNA methylation profiles of 2 such tumors matched with synovial sarcoma. A few nonsynovial sarcoma tumors (n=6) revealed either focal SS18-SSX positivity (n=1) or scattered positive tumor cells. However, targeted RNA next-generation sequencing failed to detectSS18::SSXtranscripts in these cases. The nature of this immunopositivity remains elusive and may require single cell sequencing studies. All synovial sarcomas showed positive SSX IHC. However, a mosaic staining pattern or focal loss of expression was noticed in a few cases. Strong and diffuse SSX immunoreactivity was also seen in epithelioid sclerosing osteosarcoma harboringEWSR1::SSX1fusion, while several sarcomas and melanocytic tumors including cellular blue nevus (5/7, 71%) revealed focal to diffuse, mostly weak to intermediate SSX staining. The SS18-SSX and SSX IHC is a useful tool for synovial sarcoma differential diagnosis, but unusual immunophenotype should trigger molecular genetic testing.
Mpox
Authors: Jafari Kaileen , Woodward George A.
Published: October 2023

Human mpox (formerly known as monkeypox) is a zoonotic disease that causes a smallpox-like infection in humans. The mpox virus, the causative agent of mpox, was first reported to cause human disease in a 9-month-old infant in the Democratic Republic of the Congo in 1970. Since that time, periodic outbreaks in primarily endemic regions have occurred, typically secondary to transmission from wildlife reservoirs. However, in May 2022, after a rapid rise in worldwide cases in largely nonendemic countries, the World Health Organization declared mpox a Public Health Emergency of International Concern. As of January 2022, more than 80,000 cases of mpox in nonendemic countries have occurred, and more than 25,000 cases in the United States alone. Most of these cases occurred in adults, with the highest frequency among men who had sex with men. Children and adolescents represented only 0.3% of US cases as of September 2022, with most infections in young children the result of direct contact with an infected household member. Although infection remains uncommon in US children and teens, pediatric emergency and urgent care providers should be aware of the clinical features, treatment, and prophylaxis of this important emerging infectious disease.
A Pilot, Single-Blind, Randomized Controlled Study Evaluating the Use of Platelet-Rich Plasma for Hand Skin Rejuvenation
Authors: Pincelli Thais , Zawawi Suha , Shapiro Shane , Heckman Michael G. , Hochwald Alexander P. , Desmond Cheryl , Arthurs Jennifer , Tolaymat Leila , Forte Antonio , Bruce Alison
Published: October 2023

Background:

The presence of various growth factors in platelets makes platelet-rich plasma (PRP) a powerful tool in the stimulation of collagen regeneration in aging skin. The main objective of this study was to determine efficacy and safety of PRP compared with saline solution in women with aging skin of the hands.

Methods:

In this prospective, randomized clinical trial, 18 women with hand aging received PRP injections every 4 weeks into the unilateral dorsal hand for 12 weeks total; with saline injections into the contralateral hand in a randomized, controlled, single-blind fashion. Physician assessment, photographs, and quality-of-life questionnaires were used for assessment at baseline and at 12-week and 24-week follow-up.

Results:

The majority of patients reported pain and discomfort along with a burning/stinging sensation in both PRP- and saline-treated hands, with no significant differences noted in any patient outcome measures between the 2 treatments (all P ≥ 0.25). No differences were reliably detected between the treatment hands by a blinded investigator comparing before-and-after clinical photographs of the hands.

Conclusions:

Three injections of PRP spaced 4 weeks apart did not appear to be effective for treatment of aging skin of the hands in women, with no noted difference as compared with baseline, or saline injection. Although age older than 45 years may be a factor accounting for nonresponse (ie, subtle skin changes are difficult to appreciate, and possible limited platelet regenerative capacity in advanced age), it appears that PRP is not a reliable cosmetic option for management of hand aging.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Overactive Bladder in Late Pregnancy to 1 Year After First Vaginal Delivery
Authors: Hendrickson Whitney K. , Allshouse Amanda A. , Nygaard Ingrid E. , Swenson Carolyn W.
Published: October 2023

Importance

Understanding overactive bladder (OAB) during pregnancy and postpartum may increase our knowledge of pathophysiology.

Objectives

The purpose of this study was to understand the prevalence and severity of OAB during pregnancy through 1 year postpartum as well as the associated factors.

Study Design

This is a secondary analysis of a prospective cohort study evaluating primiparous women with a singleton term vaginal delivery assessed at the third trimester, 8 weeks postpartum, and 1 year postpartum. Overactive bladder was defined as urinary urgency plus nocturia or frequency, or urgency urinary incontinence (UUI). Overactive bladder severity was defined using average visual analog scores (0–100) from OAB symptoms on the Epidemiology of Prolapse and Incontinence Questionnaire. We evaluated associations with OAB at each time point using logistic regression.

Results

Among 579 participants, mean age was 29 years. Overactive bladder prevalence was higher at 8 weeks postpartum (23%) than at the third trimester (18%,P= 0.03) and 1 year postpartum (19%,P= 0.03). Overactive bladder severity was higher at the third trimester (42.2) than at 8 weeks postpartum (23.3,P= 0.008), but not at 1 year postpartum (29.1,P= 0.1). In those with OAB, UUI severity was higher at 1 year postpartum compared with that at the third trimester (P= 0.02). Younger age was associated with third trimester OAB. At 8 weeks postpartum, OAB was associated with older age, urinary tract infection after delivery, birth weight ≥3,500 g, and third trimester OAB. At 1 year postpartum, OAB was associated with birth weight ≥3,500 g and third trimester OAB.

Conclusions

Overactive bladder affects 1 in 5 primiparous women during pregnancy or after vaginal delivery. The increased severity of UUI postpartum and the association between higher birth weight and OAB postpartum suggest an effect of delivery.
Impact of Pretransplant Diabetes on Outcomes After Liver Transplantation: An Updated Meta-analysis With Systematic Review
Authors: Tang Ansel Shao Pin , Tan Caitlyn , Lim Wen Hui , Ng Cheng Han , Tan Darren Jun Hao , Zeng Rebecca , Xiao Jieling , Ong Elden Yen Hng , Cho Elina , Chung Charlotte , Lim Wei Shyann , Chee Douglas , Nah Benjamin , Tseng Michael , Syn Nicholas , Bonney Glenn , Liu Ken , Huang Daniel Q. , Muthiah Mark , Siddiqui Mohammad Shadab , Tan Eunice XX
Published: October 2023

Background.

Preliver transplant diabetes mellitus (pre-LT DM) is a common comorbidity in LT recipients associated with poorer post-transplant survival. However, its relationship with other important outcomes, including cardiovascular and renal outcomes, remains unclear. This meta-analysis aims to provide an updated analysis of the impact of pre-LT DM on key post-LT outcomes.

Methods.

A search was conducted in Medline and Embase databases for articles comparing the post-transplant outcomes between patients with and without pre-LT DM. Pairwise analysis using random effects with hazard ratios (HRs) was used to assess the longitudinal post-LT impacts of pre-LT DM. In the absence of HR, pooled odds ratios analysis was conducted for secondary outcomes.

Results.

Forty-two studies involving 77,615 LT recipients were included in this analysis. The pooled prevalence of pre-LT DM amongst LT recipients was 24.79%. Pre-LT DM was associated with significantly lower overall survival (HR, 0.65; 95% confidence interval, 0.52-0.81; P<0.01) and significantly increased cardiovascular disease-related mortality (HR, 1.78; 95% confidence interval, 1.11-2.85; P=0.03). Meta-regression of other patient characteristics identified Asian ethnicity and hypertension to be significant predictors of worse overall survival, whereas African-American ethnicity was associated with significantly improved overall survival in patients with pre-LT DM. Further analysis of secondary outcomes revealed pre-LT DM to be a significant predictor of post-LT cardiovascular events and end-stage renal disease.

Conclusions.

The present study illustrates the impact of pre-LT DM on post-LT survival, and cardiovascular and renal outcomes and provides a sound basis for revision of preoperative management of pre-LT DM.