bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial intelligence and telemedicine in the field of anaesthesiology, intensive care and pain medicine
Authors: Bignami Elena Giovanna , Russo Michele , Bellini Valentina , Berchialla Paola , Cammarota Gianmaria , Cascella Marco , Compagnone Christian , Sanfilippo Filippo , Maggiore Salvatore Maurizio , Montomoli Jonathan , Vetrugno Luigi , Boero Enrico , Cortegiani Andrea , Giarratano Antonino , Pelosi Paolo , De Robertis Edoardo
Published: August 2023

BACKGROUND

The potential role of artificial intelligence in enhancing human life and medical practice is under investigation but the knowledge of the topic among healthcare providers is under-investigated.

OBJECTIVES

To investigate knowledge of artificial intelligence in physicians working in the field of anaesthesiology, intensive care, and pain medicine. As secondary outcomes, we investigated the main concerns on the implementation of artificial intelligence.

DESIGN

Online survey.

SETTING

Anaesthesiology, intensive care and pain medicine.

VOLUNTEERS

We invited clinicians specialised in anaesthesia, resuscitation, intensive care and pain medicine who were active members of the European Society of Anaesthesiology and Intensive Care (ESAIC).

INTERVENTION

Online survey from 28 June 2022 to 29 October 2022.

MAIN OUTCOME MEASURES

Primary outcome was to investigate knowledge of artificial intelligence and telemedicine of participants.

RESULTS

A total of 4465 e-mails were sent and 220 specialists, age 46.5 ± 10.2; 128 men (58.2%) responded to the survey. In general, some knowledge of artificial intelligence and machine learning was reported by 207 of 220 (94.1%) and 180 of 220 (81.8%) members, respectively. In anaesthesiology, 168 of 220 (76.4%) and 151 of 220 (68.6%) have heard of artificial intelligence and machine learning. In intensive care, 154 of 220 (70.0%) and 133 of 220 (60.5%) had heard of artificial intelligence and machine learning, while these figures were much lower in pain medicine [artificial intelligence: only 70/220 (31.8%) and machine learning 67/220 (30.5%)]. The main barriers to implementing these tools in clinical practice were: lack of knowledge of algorithms leading to the results; few validation studies available and not enough knowledge of artificial intelligence. Knowledge of telemedicine was reported in 212 of 220 (96.4%) members.

CONCLUSION

Most anaesthesiologists are aware of artificial intelligence and machine learning. General thinking about the application of artificial intelligence in anaesthesiology, intensive care and pain management was positive overall, with most participants not considering this tool as a threat to their profession.
Twin charts should be the standard reference to assess growth in twin pregnancy
Authors: Prasad Smriti , Khalil Asma
Published: August 2023

Purpose of review

Twin pregnancies are characterized by slower growth velocity compared with singletons, especially during the third trimester and, therefore, tend to be smaller than singletons. Growth surveillance is instrumental in the identification of twin pregnancies at risk of adverse outcomes. Whether the phenomenon of slow growth is an adaptive physiological response or represents pathological growth lag, is controversial. In this review, we focus on the evidence related to the types of growth charts employed for twin pregnancies.

Recent findings

Consistent evidence has emerged over the past few years from large independent cohorts in different countries suggesting that twin-specific standards perform better in identifying growth-restricted twin pregnancies at risk of adverse perinatal outcomes, without resulting in an increase in interventions or iatrogenic prematurity.

The current evidence supports the use of twin-specific reference charts. Concerted efforts should be made to derive prospective evidence from large multicentre studies on various aspects of the implementation of twin-specific standards.
Proximal aorta dilatation in hypertension
Authors: Zuo Xianghao , Liu Lu , Liu Kai , Zhang Xin , Ye Runyu , Yang Changqiang , Ma Jun , Jia Shanshan , Yang Xiangyu , Liu Xueting , Sun Lirong , Huo Xingwei , Chen Xiaoping
Published: August 2023

Dilation of the proximal aorta is a common clinical manifestation in hypertensive patients. Although it is straightforward to link hypertension with proximal aortic dilation, previous studies on their interrelation have yielded controversial results. Cross-sectional design, methodology of blood pressure assessment, confounding factors like medications, and inconsistent reference values may lead to the paradoxical conclusions. Recently, advances have been made in the exploration of determinants and clinical value of proximal aortic dilatation. Thus, we reviewed these findings and summarized that aortic dilatation may be the consequence of hemodynamic and nonhemodynamic co-factors’ combined action. Moreover, proximal aortic dilatation tends to be a predictor for aortic aneurysm dissection or rupture, hypertensive target organ damage as well as cardiovascular events. The present review contributes to a comprehensive understanding of the pathological process of proximal aortic dilatation in hypertension.
Resistance training reduces platelet activation in hypertensive women: the role of purinergic signaling
Authors: Cardoso Andréia Machado , Aneli Nyasmin Mendes , Lammers Mônica , Mânica Aline , Zanini Daniela , Maciel Sarah Franco Vieira de Oliveira , Sévigny Jean , Corralo Vanessa da Silva , De Sá Clodoaldo Antônio
Published: August 2023

Background and aim:

Essential arterial hypertension is a risk factor for stroke, myocardial infarction, heart failure, and arterial aneurysm, which are related to the activation of platelets. Purinergic signaling has a central role in platelet aggregation. Although ATP and ADP can act as a proaggregant agent, adenosine inhibits platelet aggregation and reduces vascular injury. Physical exercise exhibits antiaggregant properties and can modulate purinergic system. The aim of this study was to evaluate the effect of 6 months of resistance training on purinergic system components in platelets and on platelet activation, hemodynamic and anthropometric parameters in hypertensive woman.

Method:

A total of 31 hypertensive and 28 normotensive middle-aged sedentary women were submitted to 6 months of resistance training. Purinergic enzymes activities were assessed in platelets; ATP and Tromboxane B2 (TXB2) levels were measured in serum. Blood pressure (BP), BMI, and body fat were also measured. All variables were statistically analyzed, considering P value less than 0.05.

Results:

Six months of resistance training was able to significantly reduce BP, ATP, and TXB2 levels as well as NTPDase, ecto-5’nucleotidase, and ADA activities in hypertensive group. After 6 months of resistance training, purinergic system components and TXB2 of hypertensive group were similar to normotensive group in platelets, demonstrating that resistance training was able to modulate platelet activation. A positive correlation was found between BP, enzyme activities, and levels of ATP and TXB2.

Conclusion:

Our findings demonstrated the relationship between purinergic signaling and platelet activation in hypertension and suggests that resistance training serve as tool to reduce platelet aggregation in hypertensive woman by modulating purinergic system.
Impact of corrected refractive power on the corneal denervation and ocular surface in small-incision lenticule extraction and LASIK
Authors: Liu Chang , Lin Molly Tzu-Yu , Lee Isabelle Xin Yu , Mehta Jodhbir S. , Liu Yu-Chi
Published: August 2023

Purpose:

To evaluate the impact of corrected refractive power on the corneal denervation and ocular surface in small-incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK).

Setting:

Singapore National Eye Center, Singapore.

Design:

Prospective study.

Methods:

88 eyes undergoing SMILE or LASIK were divided into low-moderate (manifest refractive spherical equivalent [MRSE] <−6.0 diopters [D]) and high myopic (MRSE ≥−6.0 D) groups. In vivo confocal microscopy and clinical assessments were performed preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively.

Results:

In SMILE, high myopic treatment presented with significantly greater reduction in the corneal nerve fiber area (CNFA) and nerve fiber fractal dimension (CFracDim) compared with low-moderate myopic treatment (both P < .05). There was a significant and negative correlation between the corrected MRSE and the reduction in corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length, CNFA, and CFracDim after SMILE (r = −0.38 to −0.66, all P < .05). In LASIK, a significant correlation between the MRSE and the changes in CNBD, corneal nerve fiber total branch density, CNFA (r = −0.37 to −0.41), and corneal nerve fiber width (r = 0.43) was observed (all P < .05). Compared with SMILE, LASIK had greater reduction in CNBD and CNFA for every diopter increase in the corrected MRSE. High myopic SMILE, compared with low-moderate myopic SMILE, resulted in significantly lower tear break-up time at 1 and 6 months (both P < .05). The changes in CNFA and CFracDim were significantly associated with Schirmer test values (both P < .001).

Conclusions:

Postoperative corneal denervation was related to corrected refractive power in both SMILE and LASIK. With the same refractive correction, LASIK led to more prominent corneal denervation.
Cataract surgical training in Europe: European Board of Ophthalmology survey
Authors: Ní Dhubhghaill Sorcha , Sanogo Massira , Lefebvre François , Aclimandos Wagih , Asoklis Rimvydas , Atilla Huban , Creuzot-Garcher Catherine , Curtin Denise , Cvenkel Barbara , Flanagan Lisa , Kivelä Tero T. , Maino Anna , Martinez Costa Rafael , Priglinger Siegfried , Prior Filipe Helena , Stopa Marcin , Strong Brendan , Sturmer Joerg , Tassignon Marie José , Ivekovic Renata , Bourcier Tristan
Published: August 2023

Purpose:

To survey recently graduated European ophthalmologists concerning cataract surgery (CS) training opportunities.

Setting:

Countries affiliated to the European Board of Ophthalmology (EBO).

Design:

Cross-sectional study of anonymous survey results.

Methods:

A 23-question online survey was emailed to candidates who sat the EBO Diploma Examination as residents between 2018 and 2022.

Results:

821 ophthalmologists from 30 countries completed the survey. The mean residency duration was 4.73 (SD 0.9) years. The mean reported number of entire CS procedures performed was 80.7 (SD 100.6) at the end of residency, but more than 25% of respondents (n = 210) had received no live CS training during their residency. The self-confidence (scale, 1 to 10) to perform a simple case or challenging case, manage posterior capsular rupture, and realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and self-reported confidence to perform CS between European trainees. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (P < .05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (P < .001). The importance of fellowships to complete surgical education was rated 7.7 out of 10.

Conclusions:

CS training across European countries lacks harmony. Female ophthalmology trainees continue, as in other specialties, to experience apparent gender bias. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and promote post-residency fellowship training programs.
Continuity of Care Versus Language Concordance as an Intervention to Reduce Hospital Readmissions From Home Health Care
Authors: Squires Allison , Engel Patrick , Ma Chenjuan , Miner Sarah M. , Feldman Penny H. , McDonald Margaret V. , Jones Simon A.
Published: August 2023

Background:

Language concordance between health care practitioners and patients have recently been shown to lower the risk of adverse health events. Continuity of care also been shown to have the same impact.

Objective:

The purpose of this paper is to examine the relative effectiveness of both continuity of care and language concordance as alternative or complementary interventions to improve health outcomes of people with limited English proficiency.

Design:

A multivariable logistic regression model using rehospitalization as the dependent variable was built. The variable of interest was created to compare language concordance and continuity of care.

Participants:

The final sample included 22,103 patients from the New York City area between 2010 and 2015 who were non–English-speaking and admitted to their home health site following hospital discharge.

Measures:

The odds ratio (OR) average marginal effect (AME) of each included variable was calculated for model analysis.

Results:

When compared with low continuity of care and high language concordance, high continuity of care and high language concordance significantly decreased readmissions (OR=0.71, 95% CI: 0.62–0.80, P<0.001, AME=−4.95%), along with high continuity of care and low language concordance (OR=0.80, 95% CI: 0.74–0.86, P<0.001, AME=−3.26%). Low continuity of care and high language concordance did not significantly impact readmissions (OR=1.04, 95% CI: 0.86–1.26, P=0.672, AME=0.64%).

Conclusion:

In the US home health system, enhancing continuity of care for those with language barriers may be helpful to address disparities and reduce hospital readmission rates.
Matrikines in kidney ageing and age-related disease
Authors: Eckersley Alexander , Yamamura Tomohiko , Lennon Rachel
Published: August 2023

Purpose of review

Matrikines are cell-signalling extracellular matrix fragments and they have attracted recent attention from basic and translational scientists, due to their diverse roles in age-related disease and their potential as therapeutic agents. In kidney, the matrix undergoes remodelling by proteolytic fragmentation, so matrikines are likely to play a substantial, yet understudied, role in ageing and pathogenesis of age-related diseases.

Recent findings

This review presents an up-to-date description of known matrikines with either a confirmed or highly anticipated role in kidney ageing and disease, including their point of origin, mechanism of cleavage, a summary of known biological actions and the current knowledge which links them to kidney health. We also highlight areas of interest, such as the prospect of matrikine cross-tissue communication, and gaps in knowledge, such as the unexplored signalling potential of many kidney disease-specific matrix fragments.

We anticipate that knowledge of specific matrikines, and their roles in controlling processes of kidney pathology, could be leveraged for the development of exciting new future therapies through inhibition or even with their supplementation.
Does cooled dialysate still have a role in reducing intradialytic stress? Implications of the MyTEMP trial
Authors: Hull Katherine L. , McIntyre Chris , Burton James O.
Published: August 2023

Purpose of review

There is an excess of cardiovascular morbidity and mortality in the maintenance haemodialysis population. Targeting traditional risk factors (e.g. hypercholesterolaemia) do not improve cardiovascular outcomes. Repeated myocardial stunning during haemodialysis is an important nontraditional risk, resulting in pathological cardiac remodelling and fibrosis. This review explores dialysate cooling as a management strategy to promote haemodynamic stability, reduce myocardial injury, and improve cardiovascular disease outcomes for individuals receiving maintenance haemodialysis.

Recent findings

Observational data and small interventional studies demonstrate dialysate cooling has the potential to reduce end-organ damage and provide cardioprotection, renal protection and neuroprotection compared with standard care. These data are limited by the small sample sizes, short follow-up times and lack of long-term patient important outcomes. The MyTEMP study, a multicentre pragmatic randomized controlled trial, demonstrated cooled dialysate (0.5°C below body temperature) vs. standard care did not improve cardiovascular outcomes for prevalent haemodialysis patients.

Dialysate cooling has been widely adopted into routine clinical practice; the MyTEMP study challenges the unit-level approach to implementing dialysate cooling. Due to methodological limitations, the absence of other important patient outcome measures, and lack of granularity of patient-level data, dialysate cooling should not be hastily removed from all dialysis care and warrants further research.
Giant staghorn stone causing inferior vena cava compression: a novel case report
Authors: Alghafees Mohammad A. , Abdul Rab Saleha , Raheel Hiba M. , Sabbah Belal N. , Maklad Ahmed E. , El Sarrag Mazin I. , Abouelkhair Ahmed E. , Aljurayyad Abdulaziz , Alotaibi Tariq , Alotaibi Mohammed T. , Alomar Mohammad
Published: August 2023

Introduction and Importance:

Staghorn calculi (SC) are defined as large kidney stones that fill the renal pelvis and at least one renal calyx. They represent 10–20% of all renal stones in developing countries and require prompt diagnosis and management. Massive SC (over 5 cm) are treated exclusively via open surgery, despite percutaneous nephrolithotomy (PCNL) being the gold standard treatment for large stones. Descriptions of PCNL for massive SC are very limited in the literature.

Case Presentation:

We report a case of a 63-year-old male who presented with chronic abdominal pain, hepatosplenomegaly, and normal renal function. He was later diagnosed with polycythemia vera. Computed tomography of the abdomen revealed massive, bilateral staghorn stones measuring 7.3×5.5 cm and 1.8×4.5 cm on the right and left, respectively. Additionally, the right stone was found to be compressing the inferior vena cava (IVC). The patient was promptly scheduled for right-sided PCNL and the target of 80% stone fragmentation was successfully attained.

Discussion:

We present the first case of a stone of such size in the Middle East, as well as the first known case of a renal stone compressing the IVC. Unlike previous reports, the stone was successfully fragmented via PCNL – a procedure that has not been described for stones of such size.

Conclusion:

This report highlights that ultrasound-guided PNCL without any other intervention is sufficient for the successful treatment of giant SC. Greater research is needed on the potential utility of using ultrasound-guided PCNL for the fragmentation of stones sized over 5 cm.
Systemic sclerosis with interstitial lung disease and myocardial infarction: a case report
Authors: Adhikari Sagar , Poudel Priyanka , Pathak Sujan
Published: August 2023

Introduction and importance:

Systemic sclerosis (SSc) is a rare autoimmune connective tissue disorder that causes fibrosis due to an accelerated inflammatory response. One of the most frequent co-morbidities with SSc is interstitial lung disease (ILD), which is also one of the biggest killers among SSc patients.

Case presentation:

The authors present a rare case of diffuse SSc with ILD and myocardial infarction having a history of Raynaud phenomenon, skin thickening, and shortness of breath. Antinuclear antibody and antitopoisomerase antibody tests were positive. The patient was managed medically and the condition of patient is improving.

Clinical discussion:

SSC can affect the skin as well as other organs, with the lungs being the most frequently involved and seriously impacted. SSc patients can have multiple organ involvement like the skin, lungs, heart, kidneys, and gastrointestinal tract. Because ILD is the leading cause of death among people with SSC, early diagnosis and high suspicion of lung involvement can reduce mortality.

Conclusion:

The mortality rate for SSC associated with ILD is extremely high. Even though ILD is common in SSc, it might be difficult to identify and detect early for which a high-resolution CT scan can be used. In SSc patients, heart involvement can coexist with ILD.
Immunohistochemical expression of beta-catenin in ampullary adenocarcinoma: a cross-sectional retrospective study
Authors: Mirza Sazan Abdulwahab , Hilmi Mohammed N. , Al jaleeli Azza N.
Published: August 2023

Introduction:

Ampullary carcinomas are uncommon malignant tumours of the digestive system, they usually are adenocarcinomas presenting histologically as three types: intestinal, pancreaticobiliary and mixed. β-catenin is a multifunctional protein involved in physiological homoeostasis and intracellular adhesion. Abnormal nuclear accumulation of β-catenin has been described in many malignancies such as colon, breast, liver and others. The relationships between the immunohistochemical expression of β-catenin and the subtype, the grade and the stage of ampullary carcinoma are studied.

Material and methods:

A cross-sectional retrospective study was done on 25 formalin-fixed paraffin-embedded blocks of ampullary carcinoma: Cases were collected from the archives of the pathology department in the Gastroenterology and hepatology teaching hospital, medical city/ Baghdad from January 2019 to March 2022. The data of the patients and the characteristics of the tumour were derived from the pathological reports; additional sections from the block were stained with β-catenin immunohistochemically.

Results:

25 paraffin blocks from patients with ampullary carcinoma (12 males, 13 females) were included in the study. 64% of the cases are classified as pancreaticobiliary, 20% as mixed, 12% as intestinal and 4% as adenosquamous type. Eighty-four percent of the cases are moderately differentiated, and the remaining is poorly differentiated. Most cases show strong β-catenin membranous staining and 80% express 3+ staining of cytoplasmic β-catenin. Regarding nuclear β-catenin staining, 56% has negative staining.

Conclusion:

No significant association was found between the cytoplasmic and the nuclear expression of β-catenin and the tumour type, size and lymph node status. The grade of the tumour showed a significant correlation with the cytoplasmic expression; while, no correlation was noted with the nuclear expression. This study results do not support the use of beta-catenin as a diagnostic marker or prognostic marker in ampullary cancers.
Reinforced technique of tension band wiring for tibial tuberosity fracture in adolescents: a case report for surgical technique
Authors: Park Yong-Geun , Yoo Seung J. , Kim Yong-Beom , Jang Youjeong , Lim Chaemoon
Published: August 2023

Introduction and importance:

Most of the fractures had been previously treated with open reduction and internal fixation. Although there are a number of fixation methods, a consensus on the treatment options has not been reached yet.

Case presentation:

We demonstrated the reinforced technique of tension band wiring and its surgical outcomes in the tibial tuberosity fracture of a 14-year-old male basketball player. For the modified technique, the wire was inserted between the patellar tendon and tibial tuberosity (insertion site of patellar tendon) and passed distally through the 2-mm-sized predrill cortical hole. Tightening the figure of the eight loops draws the fractured fragments together and anatomically reduces under appropriate compression. This technique can achieve the reduction and fixation of the fracture simultaneously. We confirmed the fixation stability with a range of knee joint motions. The patient was able to return back to the pre-injury level of sports activity at postoperative 2 months.

Clinical discussion:

The original technique of tension band wiring utilized the Kirschner wire to make a figure-of-eight loop. However, we used the patellar tendon and its insertion site of the tibial tuberosity for making a figure-of-eight loop. Moreover, the reduction and fixation of fracture were achieved simultaneously by tightening the tension band wire. This reinforced technique was firm enough for postoperative rehabilitation.

Conclusion:

The most certain advantage of this technique was to be able to reduce anatomically and fixate firmly with appropriate compression simultaneously. We recommend open reduction internal fixation with the reinforced technique of tension band wiring for displaced tibial tuberosity fracture in adolescent athletes.
Evaluation of IL-17F A7488G polymorphism in Helicobacter pylori-infected patients: a case–control study
Authors: Hormati Ahmad , Mirtalebi Roknabadi Fateme S. , Aghaali Mohammad , Shams Saeed
Published: August 2023

Objective:

Interleukin 17 (IL-17) plays an important role in the inflammation of the gastric mucosa and, in severe cases, the development of gastric cancer. Thus, the authors aimed to evaluate the IL-17F A7488G polymorphism in Helicobacter pylori (H. pylori) patients.

Patients and methods:

A total of 86 adults (in two H. pylori-positive and H. pylori-negative groups) were included in the study. To identify the infection, rapid urease test and polymerase chain reaction (PCR) were performed. The cagA gene was also evaluated as a bacterial virulence factor. PCR–restriction fragment length polymorphism was used to investigate the IL-17F A7488G polymorphism in gastric biopsies using the NlaIII enzyme.

Results:

96.5% of patients in both groups did not show any mutation and had AA genotype, and only three patients infected with cagA-carrying H. pylori strains had polymorphism in the IL-17F A7488G gene, which included AG (one case) and GG (two cases) patterns. No significant relationship was found between these polymorphisms in the two groups of H. pylori-positive and H. pylori-negative patients, while, interestingly, a significant difference was observed between the polymorphisms and the presence of the cagA gene.

Conclusion:

This report is one of the first to demonstrate the association of IL-17F A7488G polymorphism with H. pylori infection and the presence of the cagA gene. Although no significant association between IL-17F polymorphism and H. pylori infection was found in the population of this study, the patients with mutated genotypes were positive for the cagA gene, which was statistically significant. Therefore, the possibility of the role of pathogenic strains in causing mutations in cytokine genes is more conceivable.
Polypharmacy among patients with hypertension attending primary healthcare centres
Authors: Alsanosi Safaa M. , Mousa Ahmed H. , Ahmadini Hind A. , Qadhi Rawabi S. , Ikram Nadeem , Felemban Alaa H. , Alqashqri Hamsah S. , Hariri Nahla H. , Alhindi Yosra Z. , Ayoub Nahla
Published: August 2023

Introduction:

Saudi Arabia has several hypertensive patients who require close attention and specialised care for their medications. Polypharmacy is one of the reasons for the failure of patient compliance with antihypertensive medications. Therefore, this study aims to gain a better perspective on polypharmacy in hypertensive patients attending primary healthcare (PHC) centres in Makkah, Saudi Arabia.

Methods:

This was an observational, cross-sectional, descriptive study of hypertensive patients followed up at 10 PHC centres in Makkah, Saudi Arabia, from 1 July 2019 to 30 June 2022. Frequencies and percentages were used to present categorical data, and Pearson’sχ2test was used to measure differences. APvalue less than 0.05 was considered statistically significant.

Results:

A total of 506 patients were included in this study. The mean age of the patients was 60 years, and more than half (69%) were females. Regarding antihypertensive medication use, 64% were on antihypertensive combination therapy, 76% on dual therapy, 21% on triple therapy, and 3% on quadruple therapy. Moreover, 21% of the hypertensive patients were exposed to polypharmacy. There was a significant relationship (P<0.001) between the overall number of chronic medications used per day and the duration of hypertension.

Conclusion:

More clinical research is needed to identify the impact of polypharmacy on the quality of healthcare in PHC centres in general and hypertensive patients specifically in different regions of Saudi Arabia.
Spontaneous liver rupture after uncomplicated delivery: medical case report
Authors: Merbouh Manal , El Aidouni Ghizlane , Bkiyar Houssam , Housni Brahmin
Published: August 2023

Introduction and importance:

Spontaneous hepatic rupture is an uncommon and fatal complication that most often occurs in the setting of severe pre-eclampsia.

Case presentation:

In this article, the authors describe a case of spontaneous liver rupture occurring on the sixth day of an uncomplicated pregnancy in postpartum.

Discussion:

According to the literature, liver rupture in the obstetrical setting is mostly linked to pre-eclampsia and HELLP syndrome.

Conclusion:

A collaborative multidisciplinary approach is required to define adequate medical and surgical management when there is suspicion of liver rupture in pregnant women.
Use of midodrine in heart failure: a review
Authors: Gautam Sudarshan , Lamichhane Saral , Sharma Nava R. , KC Prabal , Basnet Arjun , Kansakar Sajog , Pokhrel Madalasa , Shetty Vijay , Moskovits Norbert
Published: August 2023

Heart failure is a global health concern, affecting millions of individuals worldwide. Midodrine, an alpha-1 receptor agonist, might be a potential treatment option for patients with heart failure and concurrent hypotension. This review provides a comprehensive summary of the existing literature on the use of midodrine in heart failure patients, focusing on its pharmacology, epidemiology, and public health impact. Guideline-directed medical therapy (GDMT) is essential in heart failure management, but hypotension may limit its initiation or up-titration. Studies have shown that midodrine can improve blood pressure, reduce the need for vasopressor support, and enable the prescription of GDMT in patients who are intolerant to it due to hypotension. However, there are concerns over increased all-cause mortality in some studies, small sample sizes, and nonrandomized study designs in others. Further research, including large-scale randomized controlled trials and long-term follow-up studies, is needed to better understand the risks and benefits of midodrine use in heart failure patients, particularly in relation to GDMT. Clinicians should consider the potential advantages of midodrine against the limited evidence and potential risks before incorporating it into their clinical practice for heart failure treatment.
ZC3H7B-BCOR Fusion High-grade Endometrial Stromal Sarcoma With Morphologic Features of Low-grade Endometrial Stromal Sarcoma. A Case Report and Review of Literature
Authors: Zhao Longmei , Cheng Yu-Wei , Policarpio-Nicolas Maria Luisa C.
Published: August 2023

High-grade endometrial stromal sarcomas with ZC3H7B-BCOR fusion are rare. They are predominantly located in the endomyometrium, with morphologic features characterized as haphazardly arranged fascicles of spindle cells with mild to moderate atypia, abundant myxoid matrix, high mitotic index, and tongue-like/pushing patterns of myometrial invasion. Furthermore, conventional or variant low-grade endometrial stromal sarcomas are often not present. Clinically, they present at a higher stage and are associated with worse prognosis compared with low-grade endometrial stromal sarcoma. Given the limited number of reported cases, we describe the case of a ZC3H7B-BCOR fusion high-grade endometrial stromal sarcoma initially diagnosed on the hysterectomy specimen as low-grade endometrial stromal sarcoma based on an endometrial stromal tumor showing tongue-like myometrial and lymphovascular invasion, minimal cytologic atypia, low-mitotic activity (0–1/10 high-power field), round/spindle cell component and immunohistochemical stain results (positive for CD10, estrogen receptor, progesterone receptor, and focally positive for cyclin D1). At the time of pathologic diagnosis, she was Stage Ia and managed conservatively. Subsequent molecular analysis revealed a ZC3H7B (exon 10)-BCOR (BCL-6 corepressor) (exon 7) gene fusion. On follow-up, she showed no evidence of disease at 37 months from the time of diagnosis. This case report expands the morphologic spectrum of ZC3H7B-BCOR fusion high-grade ESS, which includes an intramural location, morphologic and immunophenotypic features similar to LG-ESS, as well as the presence of round and spindle cell components. This case also underscores the value of molecular analysis in the proper classification of ESS.
Programmed Death Ligand-1 (PD-L1) Expression in Cervical Squamous Cell Carcinoma: Does it Correlate With Outcomes?
Authors: Monsrud Ashley L. , Avadhani Vaidehi , Mosunjac Marina B. , Flowers Lisa , Krishnamurti Uma
Published: August 2023

Cervical cancer is one of the most common gynecological malignancies. Upregulation of programmed death ligand-1 (PD-L1), an immunoregulatory protein, is associated with an adverse outcomes in several malignancies. Most studies evaluating PD-L1 expression in cervical squamous cell carcinoma (CSCC) lack data on outcomes. In this study, we correlate PD-L1 expression with clinicopathologic factors and clinical outcomes in invasive CSCC. Seventy-three cases of CSCC from 2010 to 2018 were immunostained for PD-L1. A combined positive score (CPS) of ≥1 and ≥10 was correlated with age, stage, and survival outcomes. Kaplan-Meier curves for progression-free survival and overall survival were plotted and compared using the log-rank test. Cox regression analysis was performed to identify significant prognostic factors (2-tailed P<0.05 was considered statistically significant). With CPS ≥1 or ≥10 as the cut-off, PD-L1 was positive in 52/73 (71.2%) and 23/73 (31.5%) of cases, respectively. PD-L1 positive patients present at a higher stage of disease, especially those with CPS ≥10. With CPS of ≥10 as the cut-off, the 5-yr progression-free survival and 5-yr overall survival were significantly lower (P = 0.034 and 0.012, respectively). Only stage was statistically significant for worse overall survival on multivariate analysis. PD-L1 positive patients present at a higher stage of disease, and stage is an independent prognostic indicator for adverse outcomes in CSCC. This study highlights the potential of PD-L1 targeted therapy in patients with CSCC.
Big data, big consortia, and pain: UK Biobank, PAINSTORM, and DOLORisk
Authors: Hébert Harry L. , Pascal Mathilde M.V. , Smith Blair H. , Wynick David , Bennett David L.H.
Published: August 2023

Chronic pain (CP) is a common and often debilitating disorder that has major social and economic impacts. A subset of patients develop CP that significantly interferes with their activities of daily living and requires a high level of healthcare support. The challenge for treating physicians is in preventing the onset of refractory CP or effectively managing existing pain. To be able to do this, it is necessary to understand the risk factors, both genetic and environmental, for the onset of CP and response to treatment, as well as the pathogenesis of the disorder, which is highly heterogenous. However, studies of CP, particularly pain with neuropathic characteristics, have been hindered by a lack of consensus on phenotyping and data collection, making comparisons difficult. Furthermore, existing cohorts have suffered from small sample sizes meaning that analyses, especially genome-wide association studies, are insufficiently powered. The key to overcoming these issues is through the creation of large consortia such as DOLORisk and PAINSTORM and biorepositories, such as UK Biobank, where a common approach can be taken to CP phenotyping, which allows harmonisation across different cohorts and in turn increased study power. This review describes the approach that was used for studying neuropathic pain in DOLORisk and how this has informed current projects such as PAINSTORM, the rephenotyping of UK Biobank, and other endeavours. Moreover, an overview is provided of the outputs from these studies and the lessons learnt for future projects.
Pain associated with COVID-19 vaccination is unrelated to skin biopsy abnormalities
Authors: Di Stefano Giulia , Falco Pietro , Galosi Eleonora , De Stefano Gianfranco , Di Pietro Giuseppe , Leone Caterina , Litewczuk Daniel , Tramontana Lorenzo , Strano Stefano , Truini Andrea
Published: August 2023

Introduction:

Previous clinical observations raised the possibility that COVID-19 vaccination might trigger a small-fibre neuropathy.

Objectives:

In this uncontrolled observational study, we aimed to identify small fibre damage in patients complaining of generalized sensory symptoms and pain after COVID-19 vaccination.

Methods:

We collected clinical data, including a questionnaire for assessing autonomic symptoms (Composite Autonomic Symptom Score-31), and investigated quantitative sensory testing (QST) and skin biopsy in 15 prospectively enrolled patients with generalized sensory symptoms and pain after COVID-19 vaccination. Nine patients complaining of orthostatic intolerance also underwent cardiovascular autonomic tests.

Results:

We found that all patients experienced widespread pain, and most of them (11 of 15) had a fibromyalgia syndrome. All patients had normal skin biopsy findings, and in the 9 patients with orthostatic intolerance, cardiovascular autonomic tests showed normal findings. Nevertheless, 5 patients had cold and warm detection abnormalities at the QST investigation.

Conclusions:

In our study, most patients complaining of generalized sensory symptoms and pain after COVID-19 vaccination had clinical and diagnostic test findings compatible with a fibromyalgia syndrome. Although the abnormal QST findings we found in 5 patients might be compatible with a small-fibre neuropathy, they should be cautiously interpreted given the psychophysical characteristics of this diagnostic test. Further larger controlled studies are needed to define precisely the association between small fibre damage and COVID-19 vaccination.
Changes in short-term (in-ICU and in-hospital) mortality following Intensive Care Unit admission in adults Living with HIV: 2000–2019
Authors: Kanitkar Tanmay , Dissanayake Oshani , Bakewell Nicholas , Symonds Maggie , Rimmer Stephanie , Adlakha Amit , Lipman Marc C.I. , Bhagani Sanjay , Sabin Caroline A. , Agarwal Banwari , Miller Robert F.
Published: August 2023

Objective:

Limited data suggest intensive care unit (ICU) outcomes have improved in people with HIV (PWH). We describe trends in in-ICU/in-hospital mortality among PWH following admission to ICU in a single UK-based HIV referral centre, from 1 January 2000 to 31 December 2019.

Methods:

Modelling of associations between ICU admission and calendar year of admission was done using logistic regression with adjustment for age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, CD4+ T-cell count and diagnosis of HIV at/within the past 3 months.

Results:

Among 221 PWH (71% male, median [interquartile range (IQR)] age 45 years [38–53]) admitted to ICU, median [IQR] APACHE II score and CD4+ T-cell count were 19 [14–25] and 122 cells/mm3 [30–297], respectively; HIV-1 viral load was ≤50 copies/ml in 46%. The most common ICU admission diagnosis was lower respiratory tract infection (30%).

In-ICU and in-hospital, mortality were 29% and 38.5%, respectively. The odds of in-ICU mortality decreased over the 20-year period by 11% per year [odds ratio (OR): 0.89 (95% confidence interval (CI): 0.84–0.94)] with in-hospital mortality decreasing by 14% per year [0.86 (0.82–0.91)]. After adjusting for patient demographics and clinical factors, both estimates were attenuated, however, the odds of in-hospital mortality continued to decline over time [in-ICU mortality: adjusted OR: 0.97 (0.90–1.05); in-hospital mortality: 0.90 (0.84–0.97)].

Conclusion:

Short-term mortality of critically ill PWH admitted to ICU has continued to decline in the ART era. This may result from changing indications for ICU admission, advances in critical care and improvements in HIV-related immune status.
Improvement in CD4 count among people with HIV in New York City, 2007-2021: a serial cross-sectional analysis
Authors: Xia Qiang , Farovitch Lorne , Bertolino Daniel , Romano Anthony , Huang Jamie , Misra Kavita , Torian Lucia V.
Published: August 2023

Background:

A higher CD4 count among people with HIV (PWH) is associated with improved immune function and reduced HIV-related morbidity and mortality. The purpose of this analysis is to report the trend in CD4 count among PWH in New York City (NYC).

Methods:

We conducted a serial cross-sectional analysis using the NYC HIV registry data and reported the proportion of PWH with a CD4 count of 500 cells/mm3 or above, overall and by sex, race or ethnicity, and age.

Results:

The overall proportion of PWH in NYC with a CD4 count of 500 cells/mm3 or above increased from 38.1% in 2007 to 63.8% in 2021. Among males, the proportion increased from 36.7% in 2007 to 62.3% in 2021 with an annual percentage change (APC) of 6.6% (95% CI: 5.8, 7.5) in 2007–2013 and 2.6% (95% CI: 0.7, 4.4) in 2013–2017, and no changes in 2017–2021 (APC: 0.0%; 95% CI: -1.1, 1.0); among females, the proportion increased from 41.0% in 2007 to 67.6% in 2021 with an APC of 7.5% (95% CI: 5.2, 9.8) in 2007–2010, 4.5% (95% CI: 3.5, 5.4) in 2010–2015, and 0.8% (95% CI: 0.4, 1.2) in 2015–2021. White people had a higher proportion than other racial/ethnic groups, 70.9%, 59.3%, 60.9%, and 61.7%, respectively, among White, Black, Latino/Hispanic, and Asian/Pacific Islander males, and 69.8%, 68.0%, 66.3%, and 69.3%, respectively, among White, Black, Latina/Hispanic, and Asian/Pacific Islander females in 2021.

Conclusions:

CD4 count among PWH in NYC improved during 2007–2021, but the improvement slowed in recent years.
Vaginal microbiome, antiretroviral concentrations, and HIV genital shedding in the setting of hormonal contraception initiation in Malawi
Authors: Lantz Alyssa M. , Cottrell Mackenzie L. , Corbett Amanda H. , Chinula Lameck , Kourtis Athena P. , Nelson Julie AE. , Tegha Gerald , Hurst Stacey , Gajer Pawel , Ravel Jacques , Haddad Lisa B. , Tang Jennifer H. , Nicol Melanie R.
Published: August 2023

Objective:

To understand how vaginal microbiota composition affects antiretroviral concentrations in the setting of hormonal contraception initiation.

Methods:

Cervicovaginal fluid (CVF) concentrations of tenofovir, lamivudine, and efavirenz from 73 Malawian women living with HIV were compared before and after initiation of depot-medroxyprogesterone acetate (DMPA) or levonorgestrel implant. We evaluated antiretroviral concentrations and vaginal microbiota composition/structure in the context of contraception initiation and predicted genital shedding using multivariable repeated measurements models fit by generalized estimating equations.

Results:

Mean lamivudine CVF concentrations decreased 37% 1 month after contraception initiation. Subgroup analyses revealed a 41% decrease in women 1 month after initiating levonorgestrel implant, but no significant difference was observed in DMPA group alone. Tenofovir, lamivudine, and efavirenz CVF concentrations were positively correlated with anaerobic bacteria associated with non-optimal vaginal microbiota. Risk of genital HIV shedding was not significantly associated with tenofovir or lamivudine CVF concentrations (tenofovir RR: 0.098, p = 0.75; lamivudine RR: 0.142, p = 0.54). Lack of association between genital HIV shedding and efavirenz CVF concentrations did not change when adjusting for vaginal microbiota composition, and lamivudine/tenofovir CVF concentrations (RR: 1.33, p = 0.531).

Conclusion:

No effect of hormone initiation on genital shedding provides confidence that women with HIV on either DMPA or levonorgestrel implant contraception will not have compromised ART efficacy. The unexpected positive correlation between antiretroviral CVF concentrations and certain bacterial taxa relative abundance requires further work to understand the mechanism and clinical relevance.
A Case of Corticobasal Syndrome and Posterior Cortical Atrophy With Biomarkers of Alzheimer Disease
Authors: Sugimura Yoko , Baba Toru , Ezura Michinori , Kikuchi Akio , Hasegawa Takafumi , Nagano Isao , Suzuki Kyoko , Takeda Atsushi
Published: August 2023

Corticobasal syndrome is a clinical entity characterized by asymmetric akinetic rigidity and a variety of higher cortical dysfunction. Predicting background pathology of corticobasal syndrome is rather challenging; however, clinical and neuroimaging findings may provide a clue to its etiopathological origin. Visuospatial dysfunction of posterior cortical atrophy and logopenic-type language impairment indicate the presence of Alzheimer’s disease-related pathology, and they provide useful information in distinguishing Alzheimer’s disease from other types of corticobasal syndrome. Here we describe a case of corticobasal syndrome who showed characteristic visuospatial symptoms with imaging evidence of Alzheimer’s disease supported by amyloid-PET and tau/astrogliosis-PET. Early, accurate diagnosis based on clinical features and predictable biomarkers is mandatory to the success of early intervention in corticobasal syndrome associated with Alzheimer’s disease.
Awareness of Disease and Its Domains in Young-onset and Late-onset Dementia
Authors: Baptista Maria Alice Tourinho , Lacerda Isabel Barbeito , Belfort Tatiana , Nogueira Marcela Moreira Lima , de Oliveira Silva Felipe , Dourado Marcia Cristina Nascimento
Published: August 2023

Introduction:

Executive function (EF) involves a general cognitive process linked to strategic organization and control of complex goal-oriented tasks. In young-onset dementia (YOD), especially Alzheimer’s disease, the symptoms that stand out in the initial stage are deficits in attention, visual-spatial function, praxis, and language. The present study aims to investigate what components of EF differ in young and late-onset dementia (LOD) and its impact on awareness and its domains.

Methods:

Using a cross-sectional design, we included 44 people with YOD and 70 with LOD. We assessed awareness and its domains, cognition, dementia severity, EF, functionality, and neuropsychiatric symptoms.

Results:

The YOD group was more impaired in general cognition (P=0.017) and had a worse performance in Wechsler Digit Span Backward (DSB) (P=0.007) and Phonemic fluency task (FAS) (P=0.046) tests. In the LOD group, deficits in EF had a greater impact on awareness and on most domains (awareness total score, cognitive functioning and health condition, functional activity impairments and social function).

Conclusions:

Our study findings support the heterogeneity of awareness, not only with regard to the difference between the domains and the measures of EF, but also to the groups studied.