bluuebunny/crossref_metadata_2025 huggingface dataset:
ML-11 Tirabrutinib treatment for recurrent or refractory PCNSL
Authors: Ohka Fumiharu , Yamaguchi Junya , Motomura Kazuya , Aoki Kosuke , Nishikawa Tomohide , Kibe Yuji , Yamazaki Shintaro , Natsume Atsushi , Saito Ryuta
Published: December 2021

Since 2020, tirabrutinib which is a Bruton’s tyrosine kinase (BTK) inhibitor has been available for recurrent or refractory PCNSL cases. The number of studies reporting efficiency and adverse effect of tirabrutinib treatment for recurrent or refractory PCNSL has been limited yet. In this study, we investigated clinical course of eight refractory or recurrent PCNSL cases treated with tirabrutinib in our institute.

Eight PCNSL cases treated with tirabrutinib included four recurrent cases and four refractory cases. Five cases obtained CR or PR after 26.8 days administration of tirabrutinib and other two cases also exhibited obvious improvement of clinical symptoms after 23.5 days administration of tirabrutinib. Among three cases exhibiting intraocular lesions, two cases revealed improvement of visual dysfunction and the other case obtained SD status of intraocular lesion. The most frequently found adverse effect was the skin rash. CTCAE grade 2 (n=2) or 3 (n=2) rash was found after mean 16 days or 94 days of tirabrutinib administration, respectively. Two cases with grade 3 rash could start taking the low-dose tirabrutinib after improvement of rash. Althouth one case experienced shingles, no other case experienced serious adverse effects.

Although adverse effect of rash was frequently found, we could obtain high response rate of tirabrutinib treatment for recurrent or refractory PCNSL cases. We need to establish quantitative assessment method for analysis of treatment response of tirabrutinib for intraocular lesions.
MET-4 Clinical investigation of the cases recurred as dissemination after postoperative local irradiation for metastatic brain tumors
Authors: Hashiba Tetsuo , Ueno Katsuya , Naito Nobuaki , Yamamura Natsumi , Komori Yumiko , Isozaki Haruna , Lee Ichi , Kamei Takamasa , Takeda Junnichi , Yoshimura Kunikazu , Nonaka Masahiro , Asai Akio
Published: December 2021

Last year, the authors examined the outcome of the patients with metastatic brain tumor (MBT)treated by whole-brain irradiation (WBRT)or local irradiation (LRT)after surgery. As a result, it was shown that the overall survival (OS) was same but the recurrence pattern was different. Furthermore, it was shown that there were some cases with disseminated recurrence in the LRT group. One year has passed, cases showing disseminated recurrence after LRT were examined. The subjects were 28 patients for whom LRT was selected as post-surgical irradiation since December 2017, with an average age of 66.2 years and a male-female ratio of 19: 9. Non-small cell lung cancer was the most in 17 cases. During the observation period, recurrence was observed in 12 cases, new outbreaks at other sites in 8 cases, disseminated recurrence in 4 cases, and no local recurrence. There was no clear difference in kinds of carcinoma and removal fashion between disseminated recurrence cases and other cases. Disseminated recurrence occurred between 3–10 months after surgery, 2 presented with headache, 1 with convulsions, 1 confirmed during follow-up of images, and all underwent WBRT. The lesions shrank after irradiation, but they were easy to re-grow, and the prognosis was poor. On the other hand, 10 cases died in 24 cases other than disseminated recurrence, but all cases died of primary cancer. Although LRT after surgery is non-inferior to WBRT in terms of OS and has the advantage of maintaining cognitive function, this study shows that there is a considerable risk of disseminated recurrence regardless of the removal fashion or kinds of carcinoma. It was also shown that prognosis after disseminated recurrence was poor. It is desirable to select postoperative irradiation after explaining the recurrence pattern, and when LRT is adopted, it is necessary to consider setting a short observation interval immediately after irradiation.
MET-8 Chemotherapy alone for brain metastases from small cell lung cancer -comparison with EGFR-TKI-
Authors: Iuchi Toshihiko , Syngyoji Masato , Ashinuma Hironori , Mizuno Satoko , Hasegawa Yuzo , Setoguchi Taiki , Hosono Junji , Sakaida Tsukasa
Published: December 2021

Background: Because of the invasive nature of small cell lung cancer (SCLC), the effectiveness of local therapy for brain metastases (BM) from SCLC had been limited. In this article, we retrospectively evaluated the efficacy of chemotherapy against non-treated BM from SCLC (SCLC-CHT) in compared with TKI for BM from EGFR-mutated NSCLC (EGFR-TKI).Materials and Methods: Un-treated 218 BM, including 58 SCLCs and 160 EGFR-mutated NSCLCs were enrolled. The primary endpoints were maximum response of BM and the duration of effect, and the secondary endpoints were times to the first and maximum responses, patterns of progression and overall survival after the diagnosis of BM.Results: The objective response rate (69%) and disease control rate (92%) of BM after SCLC-CHT were inferior to those after EGFR-TKI (85%, 97%), but were sufficiently satisfactory. Both the times to the first response (0.8m, 95% CI:0.6–0.9) and to the maximum effect after treatment(1.6m, 0.9–1.9) with SCLC-CHT were shorter than with EGFR-TKI (0.9m,0.9–1.0, P=0.011, and 2.4m, 1.9–2.8, P=0.004), but the duration of the response was conversely shorter with SCLC-CHT (5.1m, 4.2–5.6) than with EGFR-TKI (12.3m,9.2–15.1, P<0.0001). The dominant pattern of recurrence was local progression in the both groups. The risk of local progression after SCLC-CHT was higher than after EGFR-TKI (Fine-Gray HR:2.44, 1.56–3.83, P<0.0001), although the risk of new BM was not different between these two groups (0.94, 0.49–1.82, P=0.86). The risk of non-CNS death was higher after SCLC-CHT than after EGFR-TKI (1.8, 1.2–2.7, P=0.004), but the risk of CNS death was not different (0.92, 0.45–1.89,P=0.83).Conclusions: BM from SCLC well and quickly responded to CHT, but the duration of response was short. These responses of BM against CHT was comparable to that of extracranial disease. For the better control of BM and survival of patients, ingenuity to prolong the effect of CHT is required.
CS-7 A case of Lymphomatoid granulomatosis with skin, lung, and intracranial lesions due to multicentric development
Authors: Komaki Satoru , Furuta Takuya , Negoto Tetsuya , Moritsubo Mayuko , Nakamura Hideo , Sugita Yasuo , Morioka Motohiro
Published: December 2021

Introduction: LYG is very rare tumor and composed of large EB-positive B cells and reactive T cells. In this study, we experienced a case of LYG with multiple intracranial, cutaneous, and pulmonary masses. We report the pathogenesis and pathophysiology of LYG, including a discussion of the literature. case: A 69-year-old female presented with a growing lump in her lower back that had been present for several years. Six months later, she was found to have multiple masses in her lungs and intracranial region and underwent surgical removal for diagnostic purposes. Intraoperative findings: The tumor was substantial, reddish to grayish-white in color, and the margins of the tumor were whitish and hard, with some areas that could not be detached. Pathological findings: There were no atypical lymphocytes, and a small number of EBER-positive cells were observed. IgVH PCR: IgVH PCR was performed on the skin lesions and intracranial lesions, and bands of different sizes were detected, suggesting that the IgVH clone was present in the polyclonal region. Finally, we diagnosed LYG grade 1. discussion: EB-associated lymphoproliferative disease can lead to polyclonal reactive growth or monoclonal neoplastic growth depending on the balance between morphology and host immunity. The results of IgVH PCR suggest that the skin lesions did not cause multiple metastases, but rather that the enlargement of the skin lesions triggered intracranial and pulmonary lesions in an allo-centric manner. The results of IgVH PCR suggested that the skin lesions did not cause multiple metastases, but rather that the skin lesions grew to cause intracranial and pulmonary involvement in an other-centric manner.
COT-1 Clinical Questions and Answers about Glioma-Related Epilepsy (GRE): Real-world data in Wakayama Medical University Hospital
Authors: Fukai Junya , Sasaki Takahiro , Yamoto Toshikazu , Nakai Yasuo , Ishii Masamichi , Kitayama Mari , Nishibayashi Hiroki , Mori Kanji , Kanemura Yonehiro , Nakao Naoyuki
Published: December 2021

Introduction: In glioma patients, epilepsy not infrequently occurred and anti-epileptic drugs (AEDs) are commonly used. In this study, we revealed the real-world data on clinical practice of glioma-related epilepsy in Wakayama Medical University Hospital (WMUH). Methods. We collected clinical and molecular data of glioma patients operated at WMUH from January 1996 to December 2020 and analyzed the data to answer clinical questions as follows: 1) location/histology related GRE, 2) molecular features related GRE, 3) prophylactic AEDs and postoperative seizure, 4) tumor progression and convulsion, 5) GRE and survival. Results. Fifty-five of 113 glioma patients (49%) presented with seizure. CQ1. In tumors located at frontal, temporal and parietal lobe, the occurrence rate of GRE was 27/39 (69%), 13/19 (69%) and 9/14 (64%), respectively. Patients with glioblastoma, astrocytic tumors and oligodendroglial tumors presented with GRE at the rate of 26/54 (48%), 14/30 (47%) and 12/13 (92%), respectively. CQ2. GRE occurred in tumors with IDH mutated (16 cases, 29%), TERT mutated (32 cases, 58%) and MGMT methylated (32 cases, 58%). CQ3. Seizure in peri- or postoperative period occurred in 14 cases (12%); 4 cases in AED(+) group (4/29, 14%) and 10 cases in AED(-) group (10/84, 12%). CQ4. Tumor progression became apparent at the time of seizure in 12 cases (12/55, 22%). CQ5. According to the prognostic IDH/TERT classification of diffuse glioma cases (n = 94), overall survival (OS) times of GRE(+) cases tended to be longer than that of GRE(-) ones, especially in IDH wildtype/TERT mutated group (22.7 months vs. 8.3 months, p = 0.0397). Conclusion. GRE is likely associated with specific clinical and molecular features. Seizure in glioma patients can occur in specific situation regardless of the use of AEDs. Possible better prognosis of GRE(+) cases requires further investigation.
Assessing research excellence: Evaluating the Research Excellence Framework
Authors: Pinar Mehmet , Horne Timothy J
Published: December 2021

Performance-based research funding systems have been extensively used around the globe to allocate funds across higher education institutes (HEIs), which led to an increased amount of literature examining their use. The UK’s Research Excellence Framework (REF) uses a peer-review process to evaluate the research environment, research outputs and non-academic impact of research produced by HEIs to produce a more accountable distribution of public funds. However, carrying out such a research evaluation is costly. Given the cost and that it is suggested that the evaluation of each component is subject to bias and has received other criticisms, this article uses correlation and principal component analysis to evaluate REF’s usefulness as a composite evaluation index. As the three elements of the evaluation—environment, impact and output—are highly and positively correlated, the effect of the removal of an element from the evaluation leads to relatively small shifts in the allocation of funds and in the rankings of HEIs. As a result, future evaluations may consider the removal of some elements of the REF or reconsider a new way of evaluating different elements to capture organizational achievement rather than individual achievements.
Salivary gland ultrasonography in patients with connective tissue diseases: a multi-centre observational study
Authors: Lesturgie-Talarek Manon , Goossens Julia , Berkani Sabryne , Forien Marine , Juge Pierre-Antoine , Ebstein Esther , Palazzo Elisabeth , Borie Raphael , Crestani Bruno , Dieudé Philippe , Ottaviani Sébastien
Published: December 2021

Objective

US of salivary glands (SGUS) is a non-invasive tool that allows for diagnosing primary SS (pSS) or secondary SS (sSS). However, little is known about the prevalence of US findings of SS in other CTDs. The aim of this multi-centre observational study was to evaluate, in CTD patients with or without SS, the prevalence of abnormal SGUS findings and the possible association of the findings with clinical or biological phenotypes.

Methods

B-Mode SGUS was performed by one operator blinded to clinical data. Each SG was semi-quantitatively rated on a scale from 0 to 4 according to the Jousse-Joulin score; a score ≥2 was considered pathological.

Results

Data for 194 patients were analysed (pSS, n = 30; sSS, n = 39; other CTDs, n = 77; controls, n = 48). SGUS findings were abnormal in 80%, 67%, 25% and 2% of patients, respectively. Independent of the underlying disease, age and sex, abnormal SGUS findings were significantly associated with presence of anti-SSA antibodies (P < 0.001), pSS (P < 0.001) and sSS (P < 0.01). Among SS patients, abnormal SGUS findings were associated with the presence of hypergammaglobulinemia, anti-SSA antibodies, objective eye dryness and increased anti-nuclear antibody level, with no difference in EULAR SS Disease Activity Index.

Conclusion

Abnormal SGUS findings were associated with anti-SSA antibody positivity independent of the underlying disease. In SS patients, abnormal findings were associated with immunologic features and mouth involvement. Among CTD patients, SGUS changes may be associated with a particular immune profile.
Genomic Analyses of Rose Crown Gall-Associated Bacteria Revealed Two New Agrobacterium Species: Agrobacterium burrii sp. nov. and Agrobacterium shirazense sp. nov.
Authors: Mafakheri Hamzeh , Taghavi S. Mohsen , Khezerpour Kamran , Kuzmanović Nemanja , Osdaghi Ebrahim
Published: December 2021

Agrobacterium tumefaciens species complex contains a set of diverse bacterial strains, most of which are well known for their pathogenicity on agricultural plants causing crown gall diseases. Members of A. tumefaciens species complex are classified into several taxonomically distinct lineages called “genomospecies” (13 genomospecies until early 2021). Recently, two genomospecies, G19 (strains RnrT, Rew, and Rnw) and G20 (strains OT33T and R13) infecting Rosa sp. plants in Iran, were described based on biochemical and molecular-phylogenetic data. Whole genome sequence-based core-genome phylogeny followed by average nucleotide identity (ANI) and digital DNA-DNA hybridization (dDDH) calculations performed in this study suggested that genomospecies G19 and G20 could be described as two novel and standalone species. In the phylogenetic tree, these two new genomospecies were clustered separately from other genomospecies/species of A. tumefaciens species complex. Moreover, both ANI and dDDH indices between the G19/G20 strains and other Rhizobiaceae members are clearly below the accepted thresholds for prokaryotic species description. Hence, Agrobacterium burrii sp. nov. is proposed to encompass the G19 strains, with RnrT = CFBP 8705T = DSM 112541T as type strain. Agrobacterium shirazense sp. nov. is also proposed to include G20 strains, with OT33T = CFBP 8901T = DSM 112540T as type strain.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Hopelessness in New York State Physicians During the First Wave of the COVID-19 Outbreak
Authors: Johnson Alexander A. , Wallace Brendan K. , Xu Qianhui , Chihuri Stanford , Hoven Christina W. , Susser Ezra S. , DiMaggio Charles , Abramson David , Andrews Howard F. , Lang Barbara H. , Ryan Megan , Li Guohua
Published: December 2021

Background:

In the United States, New York State’s health care system experienced unprecedented stress as an early epicenter of the coronavirus disease 2019 (COVID-19) pandemic. This study aims to assess the level of hopelessness in New York State physicians working on the frontlines during the first wave of the COVID-19 outbreak.

Methods:

A confidential online survey sent to New York State health care workers by the state health commissioner’s office was used to gather demographic and hopelessness data as captured by a brief Hopelessness Scale. Adjusted linear regression models were used to assess the associations of physician age, sex, and number of triage decisions made, with level of hopelessness.

Results:

In total, 1330 physicians were included, of whom 684 were male (51.4%). Their average age was 52.4 years (SD=12.7), with the majority of respondents aged 50 years and older (55.2%). Almost half of the physician respondents (46.3%) worked directly with COVID-19 patients, and 163 (12.3%) were involved in COVID-19-related triage decisions. On adjusted analysis, physicians aged 40 to 49 years had significantly higher levels of hopelessness compared with those aged 50 years or more (μ=0.441, SD=0.152, P=0.004). Those involved in 1 to 5 COVID-19-related triage decisions had a significantly lower mean hopelessness score (μ=−0.572, SD=0.208, P=0.006) compared with physicians involved in none of these decisions.

Conclusion:

Self-reported hopelessness was significantly higher among physicians aged 40 to 49 years and those who had not yet been involved in a life or death triage decision. Further work is needed to identify strategies to support physicians at high risk for adverse mental health outcomes during public health emergencies such as the COVID-19 pandemic.
A Tale of Two Supercities: Early COVID-19 Outcomes Reflect Social Vulnerability in New York City and San Francisco
Authors: Eisler Lisa , Genziano Justin , Naus Claire , Brentjens Tricia E. , Gropper Michael A.
Published: December 2021

In this narrative review, anesthesiologists at 2 large hospital systems in New York City and San Francisco compare early coronavirus disease 2019 (COVID-19) public health outcomes while considering the role played by social vulnerability and relevant approaches in their 2 cities. An iterative search process allowed for a broad review of medical and public policy research, as well as newspaper reports, expert opinion, and multimedia sources, with the goal of exploring the importance of crowding, the labor force, and social identity in pandemic experiences. Related struggles, pitfalls, and successful interventions in both locales are summarized. Although technology in the form of vaccination will likely play an outsize role in the next phase of the pandemic, our review concludes that we must carefully consider how social vulnerabilities have and will continue to inform equitable and effective access to life-saving resources.
Insights into Fibrinogen-Mediated COVID-19 Hypercoagubility in Critically Ill Patients
Authors: Miltiades Andrea , Houck Philipp J. , Monteleone Matthew , Harrison Neil L. , Cabrera-Garcia David , Roh David , Wagener Gebhard
Published: December 2021

Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability that may cause thromobembolic complications. We describe our recent studies investigating the mechanisms of hypercoagulability in patients with severe COVID-19 requiring mechanical ventilation during the COVID-19 crisis in New York City in spring 2020. Using rotational thombelastometry we found that almost all patients with severe COVID-19 had signs of hypercoagulability compared with non–COVID-19 controls. Specifically, the maximal clot firmness in the fibrin-based extrinsically activated test was almost twice the upper limit of normal in COVID patients, indicating a fibrin-mediated cause for hypercoagulability. To better understand the mechanism of this hypercoagulability we measured the components of the fibrinolytic pathways. Fibrinogen, tissue plasminogen activator and plasminogen activator inhibitor-1, but not plasminogen levels were elevated in patients with severe COVID-19. Our studies indicate that hypercoagulability in COVID-19 may be because of decreased fibrinolysis resulting from inhibition of plasmin through high levels of plasminogen activator inhibitor-1. Clinicians creating treatment protocols for anticoagulation in critically ill COVID-19 patients should consider these potential mechanisms of hypercoaguability.
Open-wedge osteotomy for thumb radial angulation in Apert syndrome using a bone-graft substitute
Authors: Shintani Kosuke , Kazuki Kenichi , Nakagawa Keisuke , Hosomi Ryo , Kitano Toshio
Published: December 2021

A short thumb with radial angulation causes loss of hand function in patients with Apert syndrome. Although past reports have described various procedures for the correction of the thumb, there has been no consensus on the best procedure. This study aimed to assess the clinical and radiographic results of a surgical technique for the correction of a thumb radial angulation deformity: open-wedge osteotomy using a bone-graft substitute. Ten patients (18 thumbs) who underwent open-wedge osteotomy on the proximal phalange using a bone-graft substitute were evaluated retrospectively. The open-wedge osteotomies had been performed at the center of the proximal phalanx. Thumb radial angles and thumb lengths were measured on radiographs, and the clinical results were investigated, including bone union and complications. The median patient age at the time of surgery was 5.8 years, and the average follow-up period was 6.7 years. The average thumb radial angle was 57.3° preoperatively, 6.5° immediately postoperatively, and 19.8° at the most recent follow-up. The average thumb length was 12.1 mm preoperatively, 18.1 mm immediately postoperatively, and 22.3 mm at the most recent follow-up, indicating an extension effect of more than 50% immediately postoperatively. In all cases, the artificial bone had been absorbed and developed into autologous bone, and there were no complications such as infection and skin necrosis. These findings suggest that open-wedge osteotomy with an artificial bone substitute is simple and effective for treating radial-angulation deformities in patients with Apert syndrome. Level of evidence: Level IV – retrospective case series.
The Financial Burden of Nonoperatively Treated Pediatric Distal Radius Fractures: Medical Debt in Privately Versus Publicly Insured Patients
Authors: Xu Amy L. , Prasad Niyathi , Lee R. Jay
Published: December 2021

Background:

Patients with public health insurance have greater difficulty obtaining orthopaedic care than their privately insured counterparts because of lower reimbursements. However, the relationship between insurance status and financial burden for patients and treating institutions is unknown. We compared patient medical debt and uncompensated hospital costs by insurance type for pediatric patients who received nonoperative treatment for distal radius fractures (DRFs).

Methods:

We reviewed medical records of 100 pediatric patients (above 18 y) treated nonoperatively at our US academic hospital for DRFs from 2016 to 2020. Patients were grouped according to insurance type at the time of treatment: preferred-provider organization (PPO), n=30; health maintenance organization (HMO), n=29; Medicaid, n=28; and uninsured, n=13. These groups were matched by number of encounters, total original charge, and total number of charges. The primary outcomes were patient medical debt and uncompensated costs to the hospital, comprising unpaid balance, uncollectible debt, and self-adjustments offered by the hospital. χ2 tests and analysis of variance were used to compare financial outcomes among subgroups (alpha=0.05).

Results:

Patient medical debt (ie, uncollectible debt) was generated by 20% of PPO, 7.7% of uninsured, and 6.9% of HMO patients (P=0.06). Medicaid patients generated no patient medical debt, whereas PPO patients generated a mean (±SD) of $15±$39 and HMO patients generated $26±$130, which was not significantly different than that of uninsured patients ($25±$89) (P<0.0001). Uncompensated costs were generated by 54% of uninsured, 20% of PPO, 6.9% of HMO, and 0% of Medicaid patients (P<0.0001). Uncompensated costs were the same as uncollectible debt for privately insured and Medicaid patients, whereas uninsured patients generated an additional $550±$600 from self-adjustments (P<0.0001).

Conclusion:

Unlike the Medicaid group, the privately insured and uninsured groups incurred patient medical debt and uncompensated costs after nonoperative DRF treatment. Thus, orthopaedic providers should be cost conscious with privately insured patients, while publicly insured patients may provide more consistent—albeit lower—reimbursement for the hospital.

Level of Evidence:

Level III.
Association between gastric cancer and the family history of gastric cancer: a cross-sectional study using Korean Genome and Epidemiology Study data
Authors: Choi Hyo Geun , Chun Wook , Jung Kuk Hyun
Published: December 2021

Objective

The risk of gastric cancer based on a family history of gastric cancer remains unclear. The purpose of this study was to investigate the relationship between gastric cancer and family history of gastric cancer within a large cohort in Korea.

Methods

In total 211 708 participants were recruited in the Korean Genome and Epidemiology Study during 2001–2013, and divided into a group with a self-reported personal history of gastric cancer (n = 930) and a 1:40 matched control group (n = 37 200). We examined the family history of gastric cancer in first-degree relatives for cross-sectional analysis. Logistic regression was used to estimate the odds ratios (ORs) of gastric cancer according to family history, using four models that were adjusted for different confounding variables, including the interaction among a family history of gastric cancer.

Results

After matching the two groups for age and sex, the gastric cancer group had a significantly higher proportion of family history in each relative than the controls (P < 0.001). In the adjusted model, the ORs [95% confidence interval (CI)] for gastric cancer with a history of an affected father, mother and sibling were 1.80 (1.38–2.34), 1.95 (1.42–2.69) and 2.98 (2.31–3.83), respectively, compared with those in the control group. There was no statistically significant interaction among a family history of gastric cancer in each relative.

Conclusion

A history of gastric cancer in siblings, among first-degree relatives, is strongly associated with an increased risk of gastric cancer. Regular follow-up and early treatment are recommended for those with a family history of gastric cancer.
Shared Decision-Making in Cardiovascular Practice
Authors: Klein Lloyd W. , Anderson H. Vernon , Cigarroa Joaquin
Published: December 2021

Clinical decisions are optimally made collaboratively, with patients and clinicians working together to review all available information and treatment options. A comprehensive dialogue that identifies and brings into focus individual patient goals within the context of the evidence base is the ideal approach. Shared decision-making (SDM) is essential to making choices about treatment preferences and characterizes the optimal practice of evidence-based medicine and good patient care. By supporting patient autonomy and engagement, the patient and family become partners in their health care. Decisions surrounding whether or not to proceed with diagnostic and therapeutic procedures after fully discussing appropriate alternatives are best made considering both the evidence base and patient goals. The central feature of SDM is that a clinician and a patient engage in a dialogue to jointly make decisions, with reciprocated sharing of information that both find beneficial to reach the best decision. SDM entails much more than patient education or informed consent: there must be bidirectional transfer of knowledge, discussion of patient preference, and a process of deliberation reaching consensus. Patient decision aids have been shown to improve patient understanding of options and risks, enhance the patient’s involvement, and focus their comprehension of treatment preferences. Patient decision aids also may be of value in strengthening the physician-patient relationship. The need to emphasize SDM should be integrated into the quality process at every level to make it meaningful, not an apparently arbitrary obstacle that requires discovery of a shrewd work-around. A more patient-oriented consideration of the benefits of symptom relief and improved quality of life, in addition to survival and freedom from adverse events, could only be beneficial.
Protective effect of aqueous leaf extracts of Chromolaena odorata and Tridax procumbens on doxorubicin-induced hepatotoxicity in Wistar rats
Authors: Ikewuchi Catherine C. , Ikewuchi Jude C. , Ifeanacho Mercy O. , Jack Damiete P. , Ikpe Caleb N. , Ehiosun Samuel , Ajayi Tosin B.
Published: December 2021

Background:

The liver is one of the organs affected by doxorubicin toxicity. Therefore, in this study, the potential protective role of aqueous leaf extracts of Chromolaena odorata and Tridax procumbens against doxorubicin-induced hepatotoxicity was investigated.

Methods:

In order to achieve this, their impact on hepatic biomarkers of oxidative stress, lipid and electrolytes’ profile, and plasma biomarkers of liver functions/integrity were monitored in doxorubicin treated rats. The animals were treated with either metformin (250 mg/kg body weight orally for 14 days) or the extracts (50, 75, and 100 mg/kg orally for 14 days) and/or doxorubicin (15 mg/kg, intraperitoneal, 48 h before sacrifice).

Results:

The hepatic malondialdehyde, cholesterol, calcium, and sodium concentrations, and plasma activities of alanine and aspartate transaminases and alkaline phosphatase, as well as plasma albumin to globulin ratio of test control were significantly (P < .05) higher than those of all the other groups. However, the plasma albumin, total protein, globulin, and total bilirubin concentrations; hepatic concentrations of ascorbic acid, chloride, magnesium, and potassium; and hepatic activities of catalase, glutathione peroxidase, and superoxide dismutase of test control were significantly (P < .05) lower than those of all the other groups.

Conclusions:

Pretreatment with the extracts and metformin prevented to varying degrees, doxorubicin-induced hepatic damage, as indicated by the attenuation of doxorubicin-induced adverse alterations in hepatic biomarkers of oxidative stress, lipid and electrolyte profiles, and plasma biomarkers of hepatic function/integrity, and keeping them at near-normal values.
Extracorporeal Membrane Oxygenation Blood Flow and Blood Recirculation Compromise Thermodilution-Based Measurements of Cardiac Output
Authors: Russ Martin , Steiner Elvira , Boemke Willehad , Busch Thilo , Melzer-Gartzke Christoph , Taher Mahdi , Badulak Jenelle , Weber-Carstens Steffen , Swenson Erik R. , Francis Roland C.E. , Pickerodt Philipp A.
Published: December 2021

The contribution of veno-venous (VV) extracorporeal membrane oxygenation (ECMO) to systemic oxygen delivery is determined by the ratio of total extracorporeal blood flow (

) to cardiac output (

). Thermodilution-based measurements of

may be compromised by blood recirculating through the ECMO (recirculation fraction; Rf). We measured the effects of

and Rf on classic thermodilution-based measurements of

in six anesthetized pigs. An ultrasound flow probe measured total aortic blood flow (

) at the aortic root. Rf was quantified with the ultrasound dilution technique.

was set to 0–125% of

and

was measured using a pulmonary artery catheter (PAC) in healthy and lung injured animals. PAC overestimated

(

) at all

settings compared to

. The mean bias between both methods was 2.1 L/min in healthy animals and 2.7 L/min after lung injury. The difference between

and

increased with an

of 75–125%/

compared to QEC <50%/

. Overestimation of

was highest when

resulted in a high Rf. Thus, thermodilution-based measurements can overestimate cardiac output during VV ECMO. The degree of overestimation of

depends on the

EC/

ratio and the recirculation fraction.
Telehealth in chronic obstructive pulmonary disease: before, during, and after the coronavirus disease 2019 pandemic
Authors: Sculley Jennifer A. , Musick Hugh , Krishnan Jerry A.
Published: December 2021

Purpose of review

Many healthcare systems rapidly implemented telehealth as a substitute for in-person care during the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this review is to describe the evidence base supporting the use of telehealth for chronic obstructive pulmonary disease (COPD) prior to the COVID-19 pandemic, discuss the barriers to implementing telehealth during the pandemic, and share our opinion about the future of telehealth in COPD.

Recent findings

The evidence from randomized clinical trials in COPD completed prior to the COVID-19 pandemic indicate that the effectiveness of telehealth interventions compared to in-person usual care on clinical outcomes is inconclusive. Recent experience during the COVID-19 pandemic indicates that telehealth may increase access to healthcare and satisfaction with care when delivered in addition to usual in-person care. While some reimbursement-related barriers to telehealth have been alleviated during the COVID-19 pandemic, several patient, provider, and health-system barriers to implementation remain.

There is a need to further evaluate the delivery of telehealth services as an adjunct to traditional in-person models of COPD care. Standardization and reporting of core clinical, satisfaction, accessibility, and quality of care outcomes are needed to promote cross-study learning and more rapid translation of research evidence into practice.
Ranibizumab and conbercept for treating wet age-related macular degeneration in China
Authors: Pengfei Jiang , Hanyu Tan , Qinghua Peng
Published: December 2021

Background:

This study aimed to evaluate the therapeutic effects of ranibizumab and conbercept on wet age-related macular degeneration.

Methods:

Randomized controlled trials comparing ranibizumab and conbercept in the treatment of wet age-related macular degeneration were searched in the PubMed, Medline, EMbase, Cochrane Library, China National Knowledge Infrastructure, Wanfang databases, and Weipu Journal. Two reviewers independently extracted the data and assessed the methodological quality. Data analysis was performed using Rev Man 5.3 software for statistical analysis.

Results:

A total of 16 randomized controlled trials, including 1018 patients, were included, and the results showed that the effect of ranibizumab on uncorrected visual acuity was not significantly different from that of conbercept (Mean difference [MD] = -.03, 95% Confidence interval [CI] [-.10-.05], P = .47), and there was no significant difference between the two drugs in the effect on best-corrected visual acuity (MD = .00, 95% CI [-.02-.03], P = .73). The effect of conbercept on intraocular pressure was better than that of ranibizumab (MD = 1.61, 95% CI [1.05-2.17], P < .001). The effect of ranibizumab on central macular thickness was not significantly different from that of conbercept (MD = 1.31, 95% CI [-3.81-6.43], P = .62). Conbercept had a better inhibitory effect on choroidal neovascularization than ranibizumab (MD = .49, 95% CI [.32-.76], P = .001).

Conclusion:

The effects of ranibizumab on uncorrected visual acuity, best corrected visual acuity, and central macular thickness were not significantly different from those of conbercept. Conbercept is associated with a lower risk of increased intraocular pressure and regression of choroidal neovascularization compared with ranibizumab.
Recovery of visual field defects following vitrectomy for proliferative diabetic retinopathy
Authors: Lo Kang-Jung , Yang Jin-Han , Cheng Hui-Chen , Chang Hsin-Yi , Lin Tai-Chi
Published: December 2021

Rationale:

Proliferative diabetic retinopathy (PDR) may lead to severe visual impairment, and visual field (VF) loss in such patients has been reported. Vitrectomy is performed in PDR cases complicated with either vitreous hemorrhage or tractional retinal detachment to restore their visual acuity. However, its effect on VF defects is limited in data. Herein, we report the recovery of VF defects following vitrectomy in a patient with PDR.

Patient concerns:

A 25-year-old female with bilateral PDR and vitreous hemorrhage received 2 monthly intravitreal injections of aflibercept in both eyes. Six months after her last injection, she presented with fibrovascular membrane formation in both eyes and VF defects of −9.02 dB and −20.05 dB in the right and left eye, respectively.

Diagnoses:

Proliferative diabetic retinopathy in both eyes.

Interventions:

The patient underwent vitrectomy for her left eye.

Outcomes:

Although her visual acuity did not improve as expected, results from the Humphrey visual field analyzer showed notably improvement of her left eye (−9.05 dB) after the surgery.

Lessons:

Vitrectomy potentially allows recovery of VF defects in patients with PDR.
Gender difference in the clinical outcomes of patients with out-of-hospital cardiac arrest
Authors: Lee Gun Tak , Hwang Sung Yeon , Jo Ik Joon , Kim Tae Rim , Yoon Hee , Cha Won Chul , Sim Min Seob , Shin Sang Do , Shin Tae Gun , Choi Jin-Ho
Published: December 2021

We explored gender differences in the characteristics and outcomes of patients with out-of-hospital cardiac arrest (OHCA) in Korea.

We retrospectively analyzed a nationwide multicenter registry of out-of-hospital cardiac arrest patients that prospectively collected from January to December 2014, and explored the clinical outcomes of 670 successfully resuscitated adult patients with OHCA who were transferred to 27 hospitals. The effect of gender on the 30-day neurologically favorable survival (cerebral performance category 1 or 2) was analyzed after propensity score matching (PSM) of each patient in terms of clinical characteristics.

We included 670 patients with OHCA, of whom 482 (72%) were male and 182 (28%) were female. The frequency of witnessed arrests and proportion of home arrests were similar between men and women (73.7% vs 71.3%, P = .59, and 55.0% vs 60.6% P = .21, respectively). Women were older than men (mean age, 65.9 vs 59.7 years, P < .001) and less likely to present with an initial shockable rhythm (27.7% vs 45.0%, P < .001). Women were less likely to undergo targeted temperature management (19.1% vs 35.9%, P < .001), coronary angiography (14.9% vs 36.1%, P < .001), or revascularization (7.4% vs 19.3%, P < .001). Compared with men, women exhibited poorer 30-day neurologically favorable survival (69.7% vs 83.0%, P = .001). However, the gender difference was not significant on PSM or inverse probability of treatment weighting (IPTW) analyses (P = .48 and P = .63, respectively).

Female patients with OHCA exhibited poorer clinical characteristics and were less likely to receive treatment than men. After accounting for these differences, clinical outcomes did not differ by gender.
Non-islet cell tumor hypoglycemia caused by breast tumor
Authors: Zhou Zhibing , Wei Wensong , Tu Jianhong , Jiang Qihua
Published: December 2021

Introduction:

Non-islet cell tumor hypoglycemia (NICTH) generally refers to hypoglycemia caused by tumors other than islet cell tumors. Although hypoglycemia is a common clinical emergency, NICTH rarely occurs in patients with breast cancer.

Patient concerns:

A 47-year-old woman presented with repeated hypoglycemia hypoglycemia caused by a lobulated breast tumor.

Diagnoses:

Hypoglycemic symptoms occurred many times during fasting and in the early morning. Insulin and C-peptide levels were decreased; insulin-like growth factor (IGF)-II: IGF-I was greater than 10. Postoperative pathology revealed a lobulated tumor in the breast. After excluding other causes of hypoglycemia, the patient was diagnosed with NICTH due to breast cancer.

Interventions:

Total mastectomy of right breast was performed.

Outcomes:

After 3 years of follow-up, hypoglycemia did not recur.

Conclusion:

Patients with breast cancer may experience recurrent hypoglycemia. After exclusion of insulinomatous and pancreatic origin of hypoglycemia, the possibility of NICTH should be considered, and surgical resection of the primary tumor should be performed as soon as possible.
Risk factors of intracranial infection in patients after intracranial aneurysm surgery
Authors: Guo Xiaohong , Fang Junkang , Wu Yi
Published: December 2021

Postoperative intracranial infection after intracranial aneurysm is relatively common in clinical setting; it is necessary to analyze the clinical risk factors of postoperative intracranial infection, to provide reliable evidence to the management of aneurysm.

Patients with intracranial aneurysm admitted from January 1, 2016, to November 30, 2020, are included. We collected the patient's personal and treatment data, and analyzed the risk factors of intracranial infection by multivariate logistic regression analysis. We compared the cerebrospinal fluid (CSF) indicators and serological indicators and analyzed their correlation with intracranial infection by spearman analysis.

A total of 236 patients with intracranial aneurysm were included; the incidence of postoperative intracranial infection was 12.71%. There were significant differences in the diabetes, intraoperative aneurysm rupture, intraoperative CSF leakage, duration of surgery, and estimated blood loss between infection and non-infection group. Logistic regression indicated that diabetes [odds ratio (OR) 2.053, 95% confidence interval (95% CI) 1.092∼3.385], intraoperative aneurysm rupture (OR 2.239, 95% CI 1.173∼4.312), intraoperative CSF leakage (OR 2.168, 95% CI 1.033∼3.451), duration of surgery ≥360 minutes (OR 1.926, 95% CI 1.108∼2.655), and estimated blood loss ≥125 mL (OR 2.459, 95% CI 1.854∼3.447) were the independent risk factors of postoperative intracranial infection in patients with aneurysm surgery (all P < .05). Klebsiella pneumoniae, Escherichia coli, and Staphylococcus epidermidis were the top 3 commonly seen pathogens. Spearman analyses indicated that PCT, CRP, LA, LDH were all correlated with intracranial infection (all P < .05).

There are multiple factors for the postoperative intracranial infection in patients with aneurysm. Coping strategies should be formulated targeted on those risks to improve the prognosis of patients.
Expression and clinical significance of BDH1 in liver cancer
Authors: Liu Zhicheng , Li Yanqing , Liu Ying , Yang Dingquan , Jiao Yan , Liu Yunpeng
Published: December 2021

Liver cancer is a deadly disease with generally poor patient outcomes. BDH1 is a key enzyme that regulates the metabolism and synthesis of ketone bodies. This study sought to explore the prognostic relevance of BDH1 mRNA expression in liver cancer.

We utilized the Cancer Genome Atlas datasets to analyze the relationship between BDH1 expression and clinical outcomes. We used Kaplan–Meier curves and Cox analyses to explore the relevance of BDH1 mRNA levels to patient prognosis. Further gene set enrichment analysis was conducted as a means of comparing differences in gene expression as a function of BDH1 expression.

Liver cancer samples exhibited significantly decreased BDH1 mRNA expression, and that this downregulation was correlated with a number of clinicopathological variables including gender, histologic grade, stage, TNM classification, and both overall and relapse-free survival. We further determined that BDH1 mRNA expression was an independent predictor of liver cancer patient prognosis. A subsequent gene set enrichment analysis found genes affected by BDH1 expression to be those enriched in pathways relating to MYC and wnt/β-catenin signaling.

Our preliminary findings demonstrate for the first time that low expression of BDH1 mRNA is a potentially valuable independent prognostic indicator for liver cancer detection.
The effects of a pharmacist-led medication review in a nursing home
Authors: Liou Wen-Shyong , Huang Shih-Ming , Lee Wei-Hsin , Chang Yen-Lin , Wu Ming-Fen
Published: December 2021

Background:

In this study, an intensive review of pharmaceutical care for elderly patients was conducted in a Veterans Administration nursing home in Taiwan and its effects were evaluated.

Methods:

One hundred participants were enrolled in this randomized controlled study with even distribution. The inclusion criteria were age 65 years or older, prescriptions for at least 5 oral medicines daily, and ≥2 chronic diseases, for the period May 2013 to October 2014. Subjects were excluded if they had previously been included in an intensive medication review conducted by a pharmacist. The primary outcomes were numbers of drugs prescribed, potential inappropriate medications, and numbers of drug-related problems. The secondary outcomes were self-reported medical usages, measurements of quality of life, results of a satisfaction survey, and health status.

Results:

A total of 80 cases (42 in the intervention group with medication reconciliation and 38 in the control group without medication reconciliation) completed the study. Baseline characteristics were not statistically different between the 2 groups. The overall prevalence of potential inappropriate medication was 74.3%. There were no differences between the 2 groups, with the exception of “medical problems,” which showed a significantly higher prevalence in the intervention group (P < .05). The intervention group reported greater satisfaction regarding pharmacist visits and medication compliance (P < .01). The mean number of drug-related problems was significantly lower after the intervention (P < .01).

Conclusion:

In this study, the intensive review of the elderly patients’ medications revealed that the only significant effect of pharmaceutical care was on “all outcomes.” A possible reason for this is the rather advanced ages of some patients who needed a considerable number of medications to treat several chronic diseases. Another reason may be the small sample size. However, participants who received the pharmacist intervention did have higher satisfaction with medication reconciliation and fewer drug-related problems.