bluuebunny/crossref_metadata_2025 huggingface dataset:
Roles, Responsibilities, and Expectations of Medical Students on Surgical Subinternships: A Modified Delphi Consensus Study
Authors: Rhodin Kristen E. , Thornton Steven W. , Leraas Harold J. , Beckhorn Catherine B. , Alseidi Adnan , Greenberg Jacob A. , Shah Kevin N. , Migaly John , Tracy Elisabeth ,   the SubI Working Group
Published: August 2024

Purpose

Surgical subinternships are important rotations for students preparing for a career in general surgery; however, these rotations often vary by institution and service. This modified Delphi study was conducted to reach a consensus set of roles, responsibilities, and expectations of fourth-year medical students on their surgical subinternships.

Method

Candidate statements on roles, responsibilities, and expectations of subinterns were categorized into 7 domains: rotation structure, rounding and patient care, operating room conduct, technical skills, knowledge base, clinic, and professionalism. Expert panels were assembled of key stakeholders: program directors, clerkship directors, other education faculty, trainees, and recent subinterns. Three Delphi rounds were conducted from January to April 2023 to reach consensus defined a priori as a Cronbach α ≥ 0.8 and 80% or greater panel agreement.

Results

Forty-six expert panelists were recruited to participate in Delphi rounds, with 100%, 95.7%, and 97.8% response rates in the first, second, and third rounds, respectively. By the third round, 67 statements reached consensus as essential roles, responsibilities, and expectations of surgical subinterns. Key themes from these 67 statements included subinterns approximating the role of an intern with respect to work hours, patient care responsibilities, basic technical skills, and knowledge base. Panelists rated rounding and patient care as the most important domain, followed closely by professionalism. Additional key domains for evaluation in descending order were knowledge base, operating room conduct, clinic, and technical skills. By the third round, notable disagreements in the Delphi process included technical skills and rounding and patient care (93.3% and 88.9% agreement, respectively).

Conclusions

This study provides a national consensus on core roles, responsibilities, and expectations for medical students completing surgical subinternships. Students can use these recommendations to prepare for subinternships, whereas faculty as well as residents and fellows can use them to evaluate applicants for general surgery residency positions.
WellNest: A Medical Student–Run Housing Support Program
Authors: Dalapati Trisha , George Ian A. , Tracey Skye , Chukrun Tamar , Brown Madeline , Biederman Donna J.
Published: August 2024

Problem

Being unhoused and facing housing insecurity contribute to poor health outcomes. Medical school curricula may include social determinants of health (SDOH) topics. However, experiential learning opportunities allow students to better contextualize how SDOH impact patients. The WellNest Housing Support Program (WellNest) was conceived and developed by Duke University medical students to learn from and support community members with a history of housing insecurity.

Approach

Under the supervision of community organizations providing housing assistance services, WellNest was created in April 2020. Medical student–volunteers (MSVs) call clients, who are referred to WellNest by the community organizations, to plan move-ins. Local experts provide trainings on topics relevant to health care for individuals experiencing loss of housing. MSVs source and move furniture and clients’ belongings into the new homes. Following move-in, MSVs are paired with clients to provide longitudinal tenancy support for at least 1 year. Student-volunteers contemplate their experiences and learning takeaways through debriefing sessions and an optional online survey.

Outcomes

From fall 2021 to spring 2023, 83 student-volunteers from across the university participated in WellNest. Student-volunteers were generally medical students (37, 45%), and 16 MSVs served on the leadership team. WellNest facilitated 29 move-ins, and 26 clients requested to be paired with MSVs for longitudinal tenancy support. Following participation in WellNest, student-volunteers reported increased comfort, awareness, knowledge, and motivation related to caring for, discussing, and advocating for individuals experiencing housing insecurity.

Next Steps

As students from other programs are also interested in WellNest, there is potential for interprofessional education. Student-volunteers will be encouraged to participate in additional opportunities for reflection and advocacy activities. The impact of WellNest on clients will be explored through a questionnaire and narrative interviews. Long-term financial support was secured from community donations and partnering community organizations.
Is There a Problem With Evidence in Health Professions Education?
Authors: Ellaway Rachel H. , O’Brien Bridget C. , Sherbino Jonathan , Maggio Lauren A. , Artino Anthony R. , Nimmon Laura , Park Yoon Soo , Young Meredith , Thomas Aliki
Published: August 2024

What constitutes evidence, what value evidence has, and how the needs of knowledge producers and those who consume this knowledge might be better aligned are questions that continue to challenge the health sciences. In health professions education (HPE), debates on these questions have ebbed and flowed with little sense of resolution or progress. In this article, the authors explore whether there is a problem with evidence in HPE using thought experiments anchored in Argyris’ learning loops framework.

From a single-loop perspective (“How are we doing?”), there may be many problems with evidence in HPE, but little is known about how research evidence is being used in practice and policy. A double-loop perspective (“Could we do better?”) suggests expectations of knowledge producers and knowledge consumers might be too high, which suggests more system-wide approaches to evidence-informed practice in HPE are needed. A triple-loop perspective (“Are we asking the right questions?”) highlights misalignments between the dynamics of research and decision-making, such that scholarly inquiry may be better approached as a way of advancing broader conversations, rather than contributing to specific decision-making processes.

The authors ask knowledge producers and consumers to be more attentive to the translation from knowledge to evidence. They also argue for more systematic tracking and audit of how research knowledge is used as evidence. Given that research does not always have to serve practical purposes or address the problems of a particular program or institution, the relationship between knowledge and evidence should be understood in terms of changing conversations and influencing decisions.
The Efficacy of GLP-1 Agonists in Treating Substance Use Disorder in Patients: A Scoping Review
Authors: Shen Mary R. , Owusu-Boaitey Kwadwo , Holsen Laura M. , Suzuki Joji
Published: August 2024

Substance use disorder (SUD) continues to be a leading cause of morbidity and mortality with limited treatments. There is interest in expanding the use of GLP-1 agonists in treating SUD. However, evidence for safety and efficacy in humans is limited. This review aims to bridge the existing knowledge gap by establishing a baseline of literature in this area to inform future trials and clinical practice. Our inclusion criteria were English peer-reviewed manuscripts reporting on use of GLP-1, GIP, and/or glucagon receptor agonists in treatment of SUDs, excluding case studies. The literature search was performed in accordance to PRISMA guidelines. Five studies were included in this review examining the use of this medication in tobacco use disorder, alcohol use disorder, and cocaine use disorder. No studies regarding substance withdrawal syndrome were identified. The included studies varied widely in terms of patient selection, dose/formulation of GLP-1 agonists, and follow-up. The results of this scoping review are mixed, with 3 studies demonstrating positive results and 2 studies finding no efficacy of this medication on SUD outcomes. It is premature to prescribe this medication off-label to patients. Further research is needed to determine the efficacy of GLP-1 agonists in treating SUD.
Bibliometric Patent Review of Minimally Invasive Spine Surgery
Authors: Zaidat Bashar , Ahmed Wasil , Song Junho , Maza Noor , Shrestha Nancy , Rajjoub Rami , Etigunta Suhas , Kim Jun S. , Cho Samuel K.
Published: August 2024

Study Design:

This study analyzes patents associated with minimally invasive spine surgery (MISS) found on the Lens open online platform.

Objective:

The goal of this research was to provide an overview of the most referenced patents in the field of MISS and to uncover patterns in the evolution and categorization of these patents.

Summary of Background Data:

MISS has rapidly progressed, with a core focus on minimizing surgical damage, preserving the natural anatomy, and enabling swift recovery, all while achieving outcomes that rival traditional open surgery. While prior studies have primarily concentrated on MISS outcomes, the analysis of MISS patents has been limited.

Methods:

To conduct this study, we used the Lens platform to search for patents that included the terms “minimally invasive” and “spine” in their titles, abstracts, or claims. We then categorized these patents and identified the top 100 with the most forward citations. We further classified these patents into 4 categories: Spinal Stabilization Systems, Joint Implants or Procedures, Screw Delivery System or Method, and Access and Surgical Pathway Formation.

Results:

Five hundred two MISS patents were identified initially, and 276 were retained following a screening process. Among the top 100 patents, the majority had active legal status. The largest category within the top 100 patents was Access and Surgical Pathway Formation, closely followed by Spinal Stabilization Systems and Joint Implants or Procedures. The smallest category was Screw Delivery System or Method. Notably, the majority of the top 100 patents had priority years falling between 2000 and 2009, indicating a moderate positive correlation between patent rank and priority year.

Conclusions:

Thus far, patents related to Access and Surgical Pathway Formation have laid the foundation for subsequent innovations in Spinal Stabilization Systems and Screw Technology. This study serves as a valuable resource for guiding future innovations in this rapidly evolving field.
Pinch Grafts Versus Second Intention Wound Healing for Mohs Micrographic Surgery Defects Below the Knee: A Prospective Randomized Trial
Authors: Willenbrink Tyler J. , Brodland David G.
Published: August 2024

BACKGROUND

The surgical management of leg wounds following skin cancer extirpation is challenging. Pinch grafting (PG) is a technique that has been rarely described in the reconstruction of acute surgical wounds.

OBJECTIVE

The purpose of this study was to evaluate whether PG resulted in faster healing times for below the knee wounds following Mohs micrographic surgery (MMS) when compared with second intention healing (SIH).

MATERIALS AND METHODS

This was a prospective randomized trial of patients with post–Mohs micrographic surgical wounds of the lower extremity who were randomized either to receive pinch grafts or to heal by second intention. Patients were followed through a combination of in-person and virtual visits until their wounds were completely reepithelialized.

RESULTS

Median time to wound healing was 36 days in the PG group versus 56 days for the SIH group, representing a 56% improvement in healing time. There were no differences in complications between the 2 groups with trends toward decreased rates of pain and infection in the PG group.

CONCLUSION

PG is an effective simple method to hasten the healing of lower extremity wounds following MMS.
Unraveling Interactions Between Gut Epithelium and Microbiota Using Models of Intestinal Organoids
Authors: Huang Yi , He Kangxin , Chen Yanfei
Published: August 2024

Intestinal microbiota is an indispensable part of intestinal homeostasis and is closely related to human health. Intestinal microbiota participates in the development of a variety of intestinal diseases in a complex and diverse manner. Previous results have confirmed microbiota dysbiosis in a variety of diseases, while the mechanism is not clear. It is valuable to unravel these complex mechanisms, which would guide future therapies. A limiting factor of studies exploring interaction mechanisms between gut epithelium and microbiota was a lack of an in vitro organ model. The development of organoids has provided an indispensable tool for gastrointestinal studies. Here, we review the applications of organoids in exploring the roles of gut microbiota and its metabolites in diseases, summarize the advantages and limitations of organoid models, and discuss future prospective and challenges in this area.
Interventions to achieve environmentally sustainable operating theatres: an umbrella systematic review using the behaviour change wheel
Authors: Almukhtar Aws , Batcup Carys , Bowman Miranda , Winter Beatty Jasmine , Leff Daniel , Demirel Pelin , Judah Gaby , Porat Talya
Published: August 2024

Introduction:

The healthcare sector is a major contributor to the climate crisis and operating theatres (OTs) are one of the highest sources of emissions. To inform emissions reduction, this study aimed to (i) compare the outcomes of interventions targeting sustainable behaviours in OTs using the Triple Bottom Line framework, (ii) categorise the intervention strategies using the five Rs (reduce, recycle, reuse, refuse, and renew) of circular economy, and (iii) examine intervention functions (IFs) using the Behaviour Change Wheel (BCW).

Methods:

Medline, Embase, PsychInfo, Scopus, and Web of Science databases were searched until June 2023 using the concepts: sustainability and surgery. The review was conducted in line with the Cochrane and Joanna Briggs Institution’s recommendations and was registered on PROSPERO. The results were reported in line with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) (Supplemental Digital Content 1, http://links.lww.com/JS9/D210) guidelines.

Results:

Sixteen reviews encompassing 43 life-cycle analyses, 30 interventions, 5 IFs, and 9 BCW policy categories were included. 28/30 (93%) interventions successfully led to sustainability improvements; however, the environmental outcomes were not suitable for meaningful comparisons due to their using different metrics and dependence on local factors. The ‘reduce’ strategy was the most prolific and commonly achieved through ‘education’ and/or ‘environmental restructuring’. However, single-session educational interventions were ineffective. Improving recycling relied on ‘environmental restructuring’. More intensive strategies such as ‘reuse’ require multiple intervention functions to achieve, either through a sustainability committee or through an intervention package.

Conclusion:

Policymakers must examine interventions within the local context. Comparing the outcomes of different interventions is difficult and could potentially be misleading, highlighting the need for a tool integrating diverse outcomes and contextual factors. ‘Reduce’ strategy guarantees environmental and financial savings, and can be achieved through ‘Education’ and/or ‘environmental restructuring’.
Protective effect of sevoflurane on myocardial ischemia-reperfusion injury: a systematic review and meta-analysis
Authors: Nasiri-Valikboni Amirhossein , Rashid Mohamad , Azimi Amir , Zarei Hamed , Yousefifard Mahmoud
Published: August 2024

Background:

Myocardial ischemia-reperfusion (I/R) injury significantly impacts recovery in both cardiac and noncardiac surgeries, potentially leading to severe cardiac dysfunction. Sevoflurane, a volatile anesthetic, is reputed for its protective effects against myocardial I/R injury, although evidence remains inconclusive. This systematic review and meta-analysis aim to clarify the cardioprotective efficacy of sevoflurane.

Methods:

The systematic search of databases including Medline, Embase, Scopus, and Web of Science, was supplemented with a manual search to retrieve studies using rat or mouse models of myocardial I/R injury, comparing sevoflurane pretreatment (≥24 h before I/R), preconditioning (within 24 h before I/R), or postconditioning (after I/R) against nontreated controls. The outcomes were cardiac function, myocardial infarct size, apoptosis, inflammation, oxidative stress, and cardiac biomarkers. Using the random effects model, standardized mean differences (SMD) were pooled to perform meta-analyses.

Results:

Fifty-one studies, encompassing 8189 subjects, were included in the meta-analysis. Pretreatment with Sevoflurane significantly reduced infarct size. Sevoflurane preconditioning exhibited positive effects on left ventricular parameters and ejection fraction, and reduced infarct size, apoptosis, and oxidative stress. Postconditioning with Sevoflurane demonstrated improvements in cardiac function, including enhanced left ventricular parameters and reduced infarct size, apoptosis, inflammation, oxidative stress, and cardiac biomarkers.

Conclusion:

Sevoflurane demonstrates a significant protective effect against myocardial I/R injury in animal models. These findings support the potential clinical utility of sevoflurane as an anesthetic choice in preventing and managing myocardial I/R injury during surgeries.
Community experience and awareness regarding foreign body aspiration in Asir region, Kingdom of Saudi Arabia
Authors: Alshaikh Ayoub Ali , Alhelali Abdullah , Hassan Abdulrahim Ali , Asiri Mohammed Yahya Althwabi , Bukhari Lujain Khaled T. , Hassan Abduaelah Ali H. , Hassan Abeer Ali H. , Alqahtani Reem Saud H. , AlQahtani Raghad Yahya , Ghazy Ramy Mohamed
Published: August 2024

Foreign body aspiration (FBA) is a serious preventable pediatric health problem and one of the main causes of accidental death in children. Although unusual in adults, it is often overlooked as a cause of airway obstruction with serious consequences. This study assessed awareness and previous FBA experiences in the Asir community, Kingdom of Saudi Arabia. Using validated questionnaire, an annonymous online survey was conducted among 870 people aged 18 years and above. The questionnaire was used to collect data about the personal and sociodemographic characteristics of the respondents, as well as their experiences with FBA, and participants’ knowledge and perceived seriousness of FBA. The level of knowledge was deemed good if the score ranged between 60% and 100%, and bad if the score fell below 60%The level of knowledge was deemed good if the score ranged between 60% and 100%, and bad if the score fell below 60%. The majority of the participants (79.7%) were females, 48.1% were aged 18 to 30 years, 72.9% had university degree, 30.6% were students, 26.9% worked in the educational sector, 43.6% reported monthly income of <5000 Saudi Riyals and 19.8% of them identified themselves as healthcarepractitioners. Although the community experience with FBA was considerably high (70.6%) among the study participants, their awareness levels about FBA were deficient. Only 24.7% of the respondents had good knowledge of FBA. Older age, being a health practitioner, and perceiving FBA as a serious incident were significantly associated with good knowledge (P < .001). The findings of this study indicate an urgent need to raise community awareness of FBA. To reduce FBA morbidity and mortality, health education efforts in community and healthcare settings are required to educate people about the seriousness and importance of early diagnosis and management of the condition.
Development of huge keloid at donor site and recurrent keloid at graft site after excision of pubic keloid followed by split-thickness skin graft: A case report
Authors: Lee Jun Yong , Kim Su Ram , Yoo Gyeol , Baek Sang Oon
Published: August 2024

Introduction:

Keloids are the result of abnormal tissue scarring that occur after skin injuries leading to pain, psychological distress, and impaired quality of life. Despite the high recurrence rate after surgical treatment, excision is often inevitable for symptom control.

Patient concerns:

A 32-year-old female presented with a huge keloid on the pubic area accompanied by severe pain, pruritus, and infectious discharge. She also had multiple keloids on her chest and shoulders, indicating a strong predisposition to keloid formation.

Interventions:

While high potential for recurrence was anticipated, surgical excision was inevitable for symptom control. Complete keloid excision followed by split-thickness skin graft was performed.

Diagnosis:

Pathological report revealed keloid accompanied by ruptured epidermal inclusion cyst.

Outcomes:

Although postoperative care was highly recommended for prevention of keloid recurrence, the patient refused any additional management due to her financial difficulties. At postoperative 8 months, mild degree of keloid or hypertrophic scar at marginal area of the graft was observed, suggesting the potential sign of keloid recurrence. The patient voluntarily discontinued the outpatient follow-up for 2 years, and then returned with huge keloid not only at the graft site but also at the donor site.

Conclusion:

Keloid with inflamed epidermal inclusion cyst can cause severe pain where surgical excision is unavoidable, regardless of the high potential for recurrence. Additional postoperative care is necessary to prevent recurrence. Furthermore, attempts to minimize new keloid formation at the donor site after split-thickness skin graft, such as thin skin harvest or selecting the scalp as the donor site, should be considered.
SMARCA4-deficient undifferentiated tumor with high quality of life and far exceeding predicted survival: A case report
Authors: Lin Juan , Ren Qi , Liu Binbin
Published: August 2024

Rationale:

SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a recently reported rare malignancy that can rapidly metastasize to tissues and organs throughout the body. The tumor is characterized by a lower response to platinum-based chemotherapy. More regrettably, the mean survival time of patients with this disease after diagnosis is only 4 to 7 months.

Patient concerns:

A 58-year-old man was admitted to a hospital for fatigue, sudden syncope, and a mass-like shadow of his left upper lobe demonstrated by a pulmonary computed tomographic. Based on his subsequent clinical and pathological features, he was highly suspected of SMARCA4-UT.

Diagnoses:

Combined with next-generation sequencing genetic testing and immunohistochemical examination results, the patient was diagnosed with SMARCA4-UT.

Interventions:

The patient received a left upper lobectomy and lymph node dissection, four-course chemotherapy divided into 8 sessions with the use of paclitaxel simply, and a proper post-discharge self-care.

Outcomes:

The patient’s operation and chemotherapy were all successful and he maintained a high quality of life after surgery that far exceeded his predicted survival.

Lessons:

Early diagnosis, higher education level, attention to the disease and complications, reducing chemotherapy damage, adequate nutrient intake, relieving symptoms, controlling depression, and maintaining immunity and the ability to perform activities of daily living may all be the positive factors that can prolong the survival of patients with SMARCA4-UT.
Combination therapy of acupuncture and herbal medicine for heart failure: A systematic review and meta-analysis
Authors: Jeong Seong Hoon , Lee Han-Gyul , Kim Gyeongmuk , Kwon Seungwon , Cho Seung-Yeon , Jung Woo-Sang , Park Seong-Uk , Moon Sang-Kwan , Park Jung-Mi , Ko Chang-Nam
Published: August 2024

Background:

Heart failure (HF) is characterized by functional or structural dysfunction of the heart, resulting in impaired blood ejection or ventricular filling. Conventional Western Medicine (CWM) remains the mainstay of treatment for HF; however, the occurrence of adverse events (AEs) necessitates the exploration of alternative treatments. Herbal medicine and acupuncture are adjunctive therapies for HF and have shown potential for improving heart function. This systematic review and meta-analysis aimed to assess the effectiveness and safety of acupuncture and herbal medicine in treating HF.

Methods:

PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Citation Information by National Institute of Informatics, KoreaMed, Research Information Sharing Service, and DBpia were searched for randomized controlled trials (RCTs) evaluating the effects of acupuncture and herbal medicine along with CWM as adjunctive treatments for HF, published from inception to May 31, 2024. Treatment effectiveness was determined by evaluating the left ventricular ejection fraction as the primary metric, along with the measurement of the total effective rate, brain natriuretic peptide level, N-terminal prohormone of brain natriuretic peptide level, left ventricular end-diastolic volume, and left ventricular end-systolic volume; the administration of the Minnesota Living with Heart Failure Questionnaire; and the conduct of a 6-minute walk test. Treatment safety was evaluated based on the incidence of AEs. The methodological quality of all included RCTs was assessed using the Cochrane risk of bias tool. A meta-analysis was performed using Review Manager, version 5.4.1.

Results:

Of the 133 publications identified, 8 RCTs met the inclusion criteria. The meta-analysis showed significant improvements in left ventricular ejection fraction, brain natriuretic peptide levels, N-terminal prohormone of brain natriuretic peptide levels, left ventricular end-systolic volume, left ventricular end-diastolic volume, and 6-minute walk test results. Additionally, significant differences were observed in the total effective rate and Minnesota Living with Heart Failure Questionnaire responses. No significant medication-related AEs occurred in the intervention group. Conversely, 7 control patients developed well-known AEs associated with CWM.

Conclusion:

Acupuncture combined with herbal medicine and CWM is more effective than CWM alone, indicating a safe treatment approach. Consequently, the proactive administration of acupuncture alongside herbal medicine to patients with HF can be undertaken without concerns regarding AEs.
The efficacy of low/lactose-free milk powder in the treatment of lactose intolerance in infants: A protocol for systematic review and meta analysis
Authors: Aierken Kalibinuer , Xu Zhiwei , Ma Jianbao , Kawuli Gulibahaer
Published: August 2024

Background:

The aim of this study was to evaluate the efficacy and safety of formula milk powder in the treatment of lactose intolerance in children, and to provide an evidence-based medicine basis for the rational use of drugs in children with lactose intolerance caused by various reasons by meta-analysis.

Methods:

Use computers to search major databases, including Web of Science, PubMed, CNKI, Wanfang Data Knowledge Service Platform, and other databases, the retrieval time is from the establishment of the database to April 2023. The collected literatures were screened, data extracted and processed, and then meta-analysis was performed by Review-Manager 5.4 statistical software.

Results:

A total of 10 randomized controlled trials were included, with 1112 patients, including 562 patients in the treatment group and 550 patients in the control group. The control group was treated with conventional therapy, and the treatment group was treated with lactose-free/low-lactose milk powder on the basis of conventional therapy. The results of the meta-analysis showed that the clinical efficacy of the treatment group was significantly better than that of the control group [odds ratio=6.01, 95% confidence interval (CI): 3.94–9.18, P<0.00001], the course of disease in the treatment group was shorter than that in the control group (mean difference=−1.45, 95% CI: −1.76 to −1.13, P<0.0001). The antidiarrhea time of the treatment group was shorter than that of the control group, and the difference between the 2 groups was statistically significant (mean difference=−1.41, 95% CI: −1.67 to −1.15, P<0.0001).

Conclusion:

Low/lactose-free milk powder can improve clinical efficacy and shorten the course of treatment in infants with lactose intolerance, which can be demonstrated by further large-scale clinical studies.
Unveiling the causal relationship between circulating levels of micronutrients and risk of facial aging: A Mendelian randomization study
Authors: Zhu Lijiao , Cai Xueyao , Cai Yuchen , Shi Wenjun , Jiang Yiyuan
Published: August 2024

Facial aging involves a continuous sequence of complex, interrelated events that impact numerous facial tissues. The aim of the study was to elucidate the casual relationship between circulating micronutrients and risk of facial aging. A two-sample Mendelian randomization analysis was performed using genetic data from genome-wide association studies. The inverse-variance weighted method is used for causal effect estimation, and additional tools such as Mendelian randomization-Egger, weighted median, simple mode, and weighted mode were used to refine the analysis. We conducted an in-depth examination of the correlation between several micronutrient blood levels and the risk of facial aging, and identified 3 key micronutrients (selenium, carotene, and iron) that may have a significant impact on skin health. Inverse-variance weighted results indicate that selenium levels were positively correlated with the risk of facial aging (odds ratio [OR] 1.005, P = .027), while a negative causal effect of carotene (OR 0.979, P = .024) and iron (OR 0.976, P = .009) on age-related facial alterations was observed. This study offers a new and insightful perspective on the current understanding of antiaging strategies, particularly the importance of appropriate consumption of essential micronutrients to maintain healthy skin condition.
Treatments for pathogen infection rescued 2 patients with renal artery rupture after kidney transplantation: A case report
Authors: Lian Xin , Liu Si , Zhang Jie , Pang Lei , Yi Xuemei , Wang Gang
Published: August 2024

Rationale:

Renal artery rupture due to allograft infection, especially by fungi, is a serious clinical complication that can occur after kidney transplantation, and may lead to graft loss and death.

Patient concerns:

Two kidney recipients from China who developed renal artery rupture at our hospital on 5 days (47-year-old female) and 45 days (39-year-old male) after surgery.

Diagnoses:

The male had immunoglobulin A nephropathy as a primary disease, and experienced a postoperative attack of vascular rejection and mixed infection by Mucor and bacteria. The female had chronic glomerulonephritis as a primary disease, and experienced renal artery rupture near the anastomosis site with infection by fungi and other pathogens.

Interventions:

The male received resection of the implanted kidney and antibiotic therapy with intravenous vancomycin (0.5 g, 2 days) and amphotericin B (530 mg in 33 days). The female received replacing the segment of renal arterial and internal iliac artery by saphenous vein, as well as antibiotic therapy with amphotericin B (320 mg in 8 days).

Outcomes:

The male was recovered and received a second transplantation, while the female was discharged on postoperative day 19.

Lessons:

In both patients, prompt surgery and aggressive treatment with an antifungal drug (amphotericin B) and antidrugs led to successful rescue.
Delayed diagnosis of TAFRO syndrome: A case report
Authors: Qiao Yumeng , Zhang Xin , Xu Rong , Jia Xiaoyu , Wang Qian
Published: August 2024

Rationale:

TAFRO syndrome is a systemic inflammatory disorder, manifesting as thrombocytopenia (t), anasarca (a), fever (f), reticulin myelofibrosis/renal insufficiency (r), and organomegaly (o), and considered as a unique clinical subtype of idiopathic multicentric Castleman disease (iMCD). Such syndrome gave rise to a clinical picture similar to that of either a connective tissue disease or an autoimmune disease.

Patient concerns:

A Chinese young female initially presenting with arthralgia, Raynaud phenomenon, generalized edema, and a positive anti-small nuclear ribonucleoprotein particle antibody was diagnosed as mixed connective tissue disease. The kidney biopsy showed thrombotic microangiopathy. Bone marrow smear showed bone marrow hyperplasia and biopsy revealed suspected light chain restricted expression, megakaryocyte proliferation, and moderate to severe bone marrow fibrosis. A lymph node biopsy was conducted and the histopathological findings were consistent with the subtype of mixed Castleman disease. The clinical symptoms were relieved after regular chemotherapy.

Diagnoses:

After above examination results and clinical manifestations, the final diagnoses was TAFRO syndrome.

Intervention:

The she was started on chemotherapy with bortezomib, cyclophosphamide, and dexamethasone.

Outcome:

After chemotherapy, symptoms such as thrombocytopenia, hematuria and proteinuria disappeared, lymphadenopathy and VEGF level decreased, and bone marrow fibrosis relieved.

Lessons:

Our case illustrated the first cases of shared characteristics of mixed connective tissue disease and iMCD-TAFRO syndrome. Cytokines may play a role in the shared pathogenicity of the iMCD-TAFRO syndrome and systemic autoimmune diseases. Therapy directly against inflammatory factors such as corticosteroids or chemotherapy have an important therapeutic implication.
Effects of body mass index on mortality in elderly patients with hip fractures
Authors: Park Chan-Hee , Lee Seung-Hoon , Lee Rim , Kim Dong-Young , Cho Myung-Rae , Song Suk-Kyoon
Published: August 2024

Hip fractures remain a substantial health concern, particularly among elderly individuals with osteoporosis, leading to high global mortality rates. This study aimed to analyze the association between body mass index (BMI) and postoperative mortality in patients who underwent surgery for hip fractures. A total of 680 patients treated at a single institution between January 2018 and December 2022 were included. Factors such as age, BMI, sex, Charlson Comorbidity Index (CCI), preoperative hemoglobin levels, American Society of Anesthesiologists score, anesthesia method, duration of surgery, and time from injury to surgery were assessed. Underweight status, male sex, higher CCI, and general anesthesia were significantly associated with 1-year and in-hospital mortality. Notably, underweight individuals exhibited a higher risk of mortality than normal-weight individuals, and female patients had lower mortality rates. This study underscores the importance of considering BMI, along with other demographic and clinical factors, in predicting postoperative mortality among patients with hip fractures, aiding the development of tailored management strategies to improve outcomes and reduce complications in this vulnerable patient population.
Coronary angiography was used to assess the effect of diabetes on off-pump coronary artery bypass graft patency
Authors: Zeng Caiwu , Li Xiaomi , Zhou Ye , Liu Nan
Published: August 2024

This study aimed to examine the influence of diabetes on the left internal mammary artery (LIMA) and saphenous vein (SV) graft failure for 5-year follow-up. We enrolled 202 patients who underwent isolated off-pump coronary artery bypass grafting (CABG) surgery in 2014, angiographic follow-up occurred at 5 years after surgery. Angiographic outcomes in patients with or without diabetes were analyzed. Multivariate logistic regression analysis was used to identify independent predictors of graft dysfunction. A total of 66 (32.7%) patients had diabetes. Five-year rates of LIMA and SV graft failure were similar in patients with and without diabetes. In addition, in diabetics, the proportion of complete graft failure was significantly lower in the LIMA grafts (12/66, 18.2%) than in the SV grafts (57/133, 42.9%) (P = .001). In nondiabetic, the proportion of complete graft failure was also significantly lower in the LIMA grafts (28/136, 20.6%) than in the SV grafts (105/275, 38.2%) (P < .001). Multivariate logistic regression analysis showed that mean graft flow (MGF) was an independent predictor factor for LIMA (odds ratio = 1.186, 95% CI = 1.114–1.263, P < .001) and SV (odds ratio = 1.056, 95% CI = 1.035–1.077, P < .001) graft failure. Diabetes did not influence the patency of LIMA or SV grafts over a 5-year follow-up. LIMA grafts should be maximized in patients undergoing off-pump CABG surgery. Diabetes does not affect the patency of grafts CABG. Using angiography, our study proved that diabetes does not affect the patency of grafted vessels after CABG for 5 years.
Central lung adenocarcinoma in a young male mimicking pneumonia with nonrecurrent polyserous effusions of negative cytology: A case report
Authors: Aljuba Ayat A. , Shawer Balqis Mustafa , Aljuneidi Roa’a M. , Halman Safa , Jobran Afnan W.M. , Abdulrazzak Mohammed , Al Fallah Orwa , Al Jebrini Nidal E.M. , Bakri Izzeddin A. , Abu Asbeh Yousef
Published: August 2024

Introduction and Importance:

Lung adenocarcinoma may resemble the clinical presentation of an infectious or inflammatory lung disease. The coexistence of lung cancer, and polyserous effusions is uncommon, which may cause a diagnostic challenge. However, any polyserous effusions at a young age must always be suspicious for malignancy.

Case presentation:

We report a case of 38-year-old male patient with polyserous effusions and pneumonia who was treated accordingly and showed clinical improvement with a significant reduction of pericardial and pleural effusions. Subsequent testing and a biopsy resulted in the histopathological diagnosis of an adenocarcinoma of the lung.

Clinical Discussion:

Nonrecurrent polyserous effusions in lung adenocarcinoma are uncommon, and negative cytology results may not exclude malignancy due to the moderate sensitivity of pleural and pericardial fluid cytology. Clinicians should remain vigilant for false-negative results, especially in younger patients. Malignancy should not be ruled out because pleural and pericardial fluid cytology have a sensitivity of 60% and 92%, respectively.

Conclusion:

Our case highlights the diagnostic challenges posed by atypical presentations of lung adenocarcinoma and emphasizes the importance of considering malignancy in the differential diagnosis of polyserous effusions, even when initial cytology results are negative. Clarifying the rationale for this study enhances its relevance and impact.
Kawasaki disease with shock as the primary manifestation: How to distinguish from toxic shock syndrome?: A case report and literature review
Authors: Wang Weijuan , Wang Huixia , Wang Huijiao , Cheng Jun
Published: August 2024

Rationale:

Kawasaki disease (KD) is a vasculitis syndrome of small to medium-sized arteries that has typical clinical characteristics such as fever, rash, cervical lymphadenopathy, conjunctivitis, and mucosal changes. Cardiac manifestations, including coronary artery aneurysms, myocarditis, myocardial infarction, and sudden cardiac death, are the most serious complications observed in KD. On rare occasions, it may accompanied with reduced organ perfusion due to systolic hypotension, a condition known as Kawasaki disease shock syndrome (KDSS). KDSS is a serious complication that can be presented to the emergency department as an initial feature when typical clinical symptoms of KD have not be detected.

Patient concerns:

We report the case of a 12-year-old boy admitted with prolonged fever, bilateral non-purulent conjunctivitis, and signs of shock such as hypotension and tachycardia. Laboratory findings showed elevated inflammatory markers, hypoalbuminemia, and sterile pyuria. He was initially treated with intravenous cefotaxime and vancomycin considering the possible diagnosis of toxic shock syndrome, while the treatment was not effective. Subsequent chest computerized tomography and ultrasound identified pulmonary consolidation and polyserous effusion. Echocardiography revealed mild biatrial dilatation and mild valvular regurgitation with preserved left ventricular function.

Diagnosis:

After a multidisciplinary consultation, a diagnosis of KDSS was made.

Interventions:

To prevent coronary artery lesions and other severe complications, the patient immediately received immunoglobulin, corticoid, and acetylsalicylic acid.

Outcomes:

Soon afterwards, he showed significant improvement, with the temperature dropped to normal and hypotension corrected about 24 hours post-intravenous immunoglobulin therapy. Polyserous effusions also disappeared before discharge. Follow-up echocardiography revealed normal results.

Lessons:

Clinicians should maintain a high index of suspicion for KD and consider pulmonary involvement and polyserous effusions as potential complications. For children with KD, any symptoms pointing to infection should be carefully considered. When there is no etiologic evidence, antibiotics should be used with caution. Our case also highlights the importance of considering KDSS as a differential diagnosis in children presenting with prolonged fever and shock. Early recognition, timely treatment, and close monitoring are key to preventing severe complications and ensuring favorable outcomes in patients with KDSS.
Sulfasalazine’s potential in managing rheumatoid nodules: Insights from a case report
Authors: Alaswad Mohammed , Hamsho Suaad , Sultan Enas , Al-Ibrahim Muhammad , Merza Ahmed , Al-Baroudi Yamen
Published: August 2024

Rationale:

Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by joint inflammation and various extra-articular manifestations, including rheumatoid nodules (RNs). This case study aims to explore the effectiveness of alternative treatments for RNs, particularly highlighting the therapeutic potential of sulfasalazine.

Patient concerns:

A 52-year-old male with established RA presented with worsening joint pain and firm nodules on his elbows, feet, and fingers.

Diagnoses:

The patient fulfilled the diagnostic criteria for RA and was diagnosed with methotrexate-induced RNs based on their temporal association with methotrexate initiation.

Interventions:

Methotrexate was discontinued and a combination of leflunomide and sulfasalazine was initiated. Sulfasalazine led to improvement in both joint pain and nodule size. However, due to cost concerns, the patient discontinued sulfasalazine, resulting in a resurgence of both symptoms and nodule enlargement. Reintroduction of methotrexate resulted in significant improvement in joint inflammation, and notably, no new nodules developed at 6 months follow-up.

Outcomes:

Sulfasalazine demonstrated efficacy in managing RA nodules, suggesting a potential alternative therapy.

Lessons:

The case highlights the complex etiology of nodules in RA and emphasizes the importance of individualized treatment approaches and close monitoring for optimal management.
Mapping Competencies and Recommendations for Educating Nursing Students (CARES)
Authors: Cross Lisa A. , Lee Bertha , Adams Katherine
Published: August 2024

The Competencies and Recommendations for Educating undergraduate Nursing Students (CARES) was originally designed for nursing students’ palliative and end-of-life care education. The competencies were later revised to align with the 2021 American Association of Colleges of Nursing Essentials core competencies for baccalaureate nursing education. This project aimed to (1) review the courses in an accelerated baccalaureate nursing program for alignment with CARES, (2) determine any gaps, and (3) make program recommendations. The CARES competencies and Essentials were mapped according to the nursing program’s 12 core curriculum courses and evaluated. Three CARES competencies were not met, and 12 were partially met. Areas of improvement were identified across the curriculum. Results of the mapping included palliative concepts needing earlier program introduction, reflective journaling was recommended for clinical practice courses, and incorporation of palliative care simulations was proposed to bridge the gaps.
Rehabilitation systems: trauma centers Asia–Pacific (Australia and Japan)
Authors: Landale Keith , Sonntag Jesper , Kitada Shimpei , Miyamoto Takashi , Balogh Zsolt J.
Published: August 2024

Rehabilitation systems in Australia and Japan represent a multidisciplinary team approach that have similarities and differences. Treatment is based on a goal-driven, holistic, patient-centered approach. This article provides an overview of the structure of the rehabilitation systems in Australia and Japan, including written guidelines, in-hospital programs, and postdischarge options.
Tear α-synuclein as a biomarker for Parkinson's disease: A systematic review and meta-analysis
Authors: Akowuah Prince Kwaku , Owusu Ebenezer , Totoe David
Published: August 2024

BACKGROUND

Parkinson's disease symptoms mostly manifest after significant and irreversible neuropathology. Hence, there is a need to identify biomarkers that can provide indications of disease before significant neuronal degeneration occurs.

OBJECTIVE

To estimate the difference in the concentration of α-synuclein protein in tears between individuals with Parkinson's disease and healthy controls.

DATA SOURCES

PubMed, Scopus, and Web of Science. The last database search was on December 20, 2023.

STUDY ELIGIBILITY CRITERIA

Primary prospective studies in humans measuring the level of α-synuclein in tears and clinical outcomes reported using mean or median.

PARTICIPANTS AND INTERVENTIONS

Individuals with Parkinson's disease and healthy controls.

STUDY APPRAISAL AND SYNTHESIS METHODS

The risk of bias was assessed using the Newcastle-Ottawa Scale. The I
2 statistic was used to estimate heterogeneity. The outcome measure was the difference in tear total and oligomeric α-synuclein. Mean difference (MD) was used to assess the outcome. The certainty of evidence was rated following the Grading of Recommendations Assessment and Development and Evaluation (GRADE) system.

RESULTS

Three hundred twenty-seven Parkinson's disease and 312 healthy control subjects from five studies and 177 Parkinson's disease and 166 healthy control subjects from two studies were included in total α-synuclein levels and oligomeric α-synuclein levels analysis, respectively. Total α-synuclein level was not different between Parkinson's disease and healthy controls (MD = 0.02 ng/mL [95% confidence interval {CI}: 0.00 to 0.05 ng/mL; I
2 = 90%; Z = 1.79; p=0.07; number of studies = 5; GRADE rating = very low]). Stratifying the data based on disease duration, total α-synuclein was higher in subjects with Parkinson's disease duration ≥7 years compared with healthy controls (MD = 0.04 ng/mL [95% CI: 0.03 to 0.05 ng/mL; I
2 = 0%; Z = 8.24, p<0.00001; number of studies = 2; GRADE rating = low]) but not different between the two groups (MD = −0.12 ng/mL (95% CI: −0.38 to 0.15 ng/mL; I
2 = 93%; Z = 0.84, p=0.40; number of studies = 3; GRADE rating = very low]). Oligomeric α-synuclein level was higher in Parkinson's disease compared with controls (MD = 6.50 ng/mL [95% CI: 2.79 to 10.20 ng/mL; I
2 = 94%; Z = 3.44; p=0.0006; number of studies = 2; GRADE rating = very low]).

LIMITATIONS

High heterogeneity between studies. Potential sources of heterogeneity could not be explored due to the limited number of studies.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Tear α-synuclein has the potential to be a noninvasive biomarker for Parkinson's disease. Studies are, however, needed to increase certainty in the biomarker and establish how the protein's changes in tears correlate with Parkinson's disease progression and severity.