bluuebunny/crossref_metadata_2025 huggingface dataset:
Traumatic pediatric bear injury resulting in cerebrospinal fluid leakage
Authors: Kropp Lopez Amalie K , Lopez Richard A
Published: August 2024

Cerebrospinal fluid (CSF) leakage is a known sequela of open traumatic skull fractures within the pediatric traumatic brain injury population. Black bears are a known entity within the region of northeast Pennsylvania. It is plausible to have a bear–human interaction resulting in significant bodily injury. A 15-month-old male presented in May 2023 as a level 1 trauma alert for a concerning wound at the base of the skull leaking clear fluid; suspicious for CSF. As a result of this interaction, significant bodily injury can occur, such as CSF leaks and traumatic skull fractures. Living in a region within a known bear population poses a minimal risk of injury. Pediatric populations are usually at a low risk for traumatic CSF leaks. Most of the CSF leaks will resolve spontaneously, without acute surgical intervention, as was seen in our patient after a traumatic bear mauling.
Intrahepatic subcapsular hematoma after laparoscopic cholecystectomy in a male patient: a case report
Authors: Aliabusunoon Mamoun , Baroom Abdulrahman , Abdulghafar Hossam , Alssied Hala
Published: August 2024

A 41-year-old male, with a clear medical background, underwent laparoscopic cholecystectomy for uncomplicated acute cholecystitis. No complications were observed intraoperatively. Second day after operation, the patient developed intense right upper quadrant pain, dizziness, and hypotension with a hemoglobin drop to 8.8 g/dl. Subsequently, an urgent computed tomography was done, which identified subcapsular hepatic with an intraparenchymal hematoma, and therefore, the diagnosis of intrahepatic subcapsular hematoma (ISH) was made. After fluid resuscitation and blood transfusion, the hemodynamic status became stable with no further hemoglobin decline noted. Further serial imaging was conducted and showed no signs of expansion nor intra-abdominal hemorrhage and the conservative line of management was carried on. Nine days later, the patient was discharged home. This report emphasizes the importance of close monitoring of patients who undergo LC and the possibility of ISH, although being rare, in those who report acute abdominal pain and hemodynamic instability after LC.
On the Sages of Königsberg and Down: Rethinking Darwin’s Relationship to Kant
Authors: Stowell John
Published: August 2024

The aim of this essay is to provide a comprehensive account of the intellectual links between Darwin and Kant, bringing clarity to their relationship on both a historical and philosophical register. Understanding how and what Darwin knew of Kant’s philosophy provides a way to reconceptualize far more than their direct relationship. This case study allows us to rethink Kant’s legacy in British thought, the possible uses of Kant for later German writers, and the important role of the natural theological tradition in British aesthetics. First, I explore the sources through which Darwin encountered Kant during the 1830s and 40s, detailing Darwin’s response to various texts and assessing their impact on the development of his theory during these formative years. Secondly, I explore how British and German contemporaries understood the possible links between Darwin and Kant. I examine Darwin’s strategy in answering their views, and how Kant was thereby incorporated into Darwin’s later work. Finally, I discuss the use of Kantian philosophical resources by present-day historians to understand Darwin’s thought. Via a brief historical exploration of Darwin’s theory of beauty, I argue for a corrective reading, claiming we should reframe the habitual deployment of Kantian philosophemes in recent approaches to Darwin’s thought through the terms of a largely forgotten natural theological tradition to which both Darwin and Kant were, in divergent ways, equivalently disruptive heirs.
Single-plant-omics reveals the cascade of transcriptional changes during the vegetative-to-reproductive transition
Authors: Redmond Ethan J , Ronald James , Davis Seth J , Ezer Daphne
Published: August 2024

Plants undergo rapid developmental transitions, which occur contemporaneously with gradual changes in physiology. Moreover, individual plants within a population undergo developmental transitions asynchronously. Single-plant-omics has the potential to distinguish between transcriptional events that are associated with these binary and continuous processes. Furthermore, we can use single-plant-omics to order individual plants by their intrinsic biological age, providing a high-resolution transcriptional time series. We performed RNA-seq on leaves from a large population of wild-type Arabidopsis (Arabidopsis thaliana) during the vegetative-to-reproductive transition. Though most transcripts were differentially expressed between bolted and unbolted plants, some regulators were more closely associated with leaf size and biomass. Using a pseudotime inference algorithm, we determined that some senescence-associated processes, such as the reduction in ribosome biogenesis, were evident in the transcriptome before a bolt was visible. Even in this near-isogenic population, some variants are associated with developmental traits. These results support the use of single-plant-omics to uncover rapid transcriptional dynamics by exploiting developmental asynchrony.
Prevalence and prognostic relevance of electrocardiographic abnormalities among patients with ANCA-associated vasculitis
Authors: Nygaard Louis , Liboriussen Caroline Hundborg , Carlson Nicholas , Nelveg-Kristensen Karl Emil , Kristensen Salome , Andersen Mikkel Porsborg , Christensen Helle Collatz , Kragholm Kristian , Graff Claus , Torp-Pedersen Christian , Ivarsen Per , Svensson My , Gregersen Jon Waarst , Polcwiartek Christoffer ,   Danvas Investigators
Published: August 2024

Objectives

Current guidelines provide limited evidence for cardiovascular screening in ANCA-associated vasculitis (AAV). This study aimed to investigate the prevalence of ECG abnormalities and associations between no, minor or major ECG abnormalities with cardiovascular mortality in AAV patients compared with matched controls.

Methods

Using a risk-set matched cohort design, patients diagnosed with granulomatosis with polyangiitis or microscopic polyangiitis with digital ECGs were identified from Danish registers from 2000 to 2021. Patients were matched 1:3 to controls without AAV on age, sex and year of ECG measurement. Associated hazards of cardiovascular mortality according to ECG abnormalities were assessed in Cox regression models adjusted for age, sex and comorbidities, with subsequent computation of 5-year risk of cardiovascular mortality standardized to the age- and sex-distribution of the sample.

Results

A total of 1431 AAV patients were included (median age: 69 years, 52.3% male). Median follow-up was 4.8 years. AAV was associated with a higher prevalence of left ventricular hypertrophy (17.5% vs 12.5%), ST-T deviations (10.1% vs 7.1%), atrial fibrillation (9.6% vs 7.5%) and QTc prolongation (5.9% vs 3.6%). Only AAV patients with major ECG abnormalities demonstrated a significantly elevated risk of cardiovascular mortality [HR 1.99 (1.49–2.65)] compared with controls. This corresponded to a 5-year risk of cardiovascular mortality of 19.14% (16–22%) vs 9.41% (8–11%).

Conclusion

Patients with AAV demonstrated a higher prevalence of major ECG abnormalities than controls. Notably, major ECG abnormalities were associated with a significantly increased risk of cardiovascular mortality. These results advocate for the inclusion of ECG assessment into routine clinical care for AAV patients.
Clinical Impact of Standardized Interpretation and Reporting of Multimodality Neuromonitoring Data
Authors: Luna Rudy , Basil Barbara , Ewbank Davis , Kasturiarachi Brittany M. , Mizrahi Moshe A. , Ngwenya Laura B. , Foreman Brandon
Published: August 2024

OBJECTIVE:

Evaluate the consistency and clinical impact of standardized multimodality neuromonitoring (MNM) interpretation and reporting within a system of care for patients with severe traumatic brain injury (sTBI).

DESIGN:

Retrospective, observational historical case-control study.

SETTING:

Single-center academic level I trauma center.

INTERVENTIONS:

Standardized interpretation of MNM data summarized within daily reports.

MEASUREMENTS MAIN RESULTS:

Consecutive patients with sTBI undergoing MNM were included. Historical controls were patients monitored before implementation of standardized MNM interpretation; cases were defined as patients with available MNM interpretative reports. Patient characteristics, physiologic data, and clinical outcomes were recorded, and clinical MNM reporting elements were abstracted. The primary outcome was the Glasgow Outcome Scale score 3–6 months postinjury. One hundred twenty-nine patients were included (age 42 ± 18 yr, 82% men); 45 (35%) patients were monitored before standardized MNM interpretation and reporting, and 84 (65%) patients were monitored after that. Patients undergoing standardized interpretative reporting received fewer hyperosmotic agents (3 [1–6] vs. 6 [1–8]; p = 0.04) and spent less time above an intracranial threshold of 22 mm Hg (22% ± 26% vs. 28% ± 24%; p = 0.05). The MNM interpretation cohort had a lower proportion of anesthetic days (48% [24–70%] vs. 67% [33–91%]; p = 0.02) and higher average end-tidal carbon dioxide during monitoring (34 ± 6 mm Hg vs. 32 ± 6 mm Hg; p < 0.01; d = 0.36). After controlling for injury severity, patients undergoing standardized MNM interpretation and reporting had an odds of 1.5 (95% CI, 1.37–1.59) for better outcomes.

CONCLUSIONS:

Standardized interpretation and reporting of MNM data are a novel approach to provide clinical insight and to guide individualized critical care. In patients with sTBI, independent MNM interpretation and communication to bedside clinical care teams may result in improved intracranial pressure control, fewer medical interventions, and changes in ventilatory management. In this study, the implementation of a system for management, including standardized MNM interpretation, was associated with a significant improvement in outcome.
Linear Correlation Between Mean Arterial Pressure and Urine Output in Critically Ill Patients
Authors: Lichter Yael , Gal Oz Amir , Adi Nimrod , Nini Asaph , Angel Yoel , Nevo Andrey , Aviram Daniel , Moshkovits Itay , Wald Ron , Stavi Dekel , Goder Noam
Published: August 2024

OBJECTIVE:

Mean arterial pressure (MAP) plays a significant role in regulating tissue perfusion and urine output (UO). The optimal MAP target in critically ill patients remains a subject of debate. We aimed to explore the relationship between MAP and UO.

DESIGN:

A retrospective observational study.

SETTING:

A general ICU in a tertiary medical center.

PATIENTS:

All critically ill patients admitted to the ICU for more than 10 hours.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

MAP values and hourly UO were collected in 5,207 patients. MAP levels were categorized into 10 groups of 5 mm Hg (from MAP < 60 mm Hg to MAP > 100 mg Hg), and 656,423 coupled hourly mean MAP and UO measurements were analyzed. Additionally, we compared the UO of individual patients in each MAP group with or without norepinephrine (NE) support or diuretics, as well as in patients with acute kidney injury (AKI).

Hourly UO rose incrementally between MAP values of 65–100 mm Hg. Among 2,226 patients treated with NE infusion, mean UO was significantly lower in the MAP less than 60 mm Hg group (53.4 mL/hr; 95% CI, 49.3–57.5) compared with all other groups (p < 0.001), but no differences were found between groups of 75 less than or equal to MAP. Among 2500 patients with AKI, there was a linear increase in average UO from the MAP less than 60 mm Hg group (57.1 mL/hr; 95% CI, 54.2–60.0) to the group with MAP greater than or equal to 100 mm Hg (89.4 mL/hr; 95% CI, 85.7–93.1). When MAP was greater than or equal to 65 mm Hg, we observed a statistically significant trend of increased UO in periods without NE infusion.

CONCLUSIONS:

Our analysis revealed a linear correlation between MAP and UO within the range of 65–100 mm Hg, also observed in the subgroup of patients treated with NE or diuretics and in those with AKI. These findings highlight the importance of tissue perfusion to the maintenance of diuresis and achieving adequate fluid balance in critically ill patients.
Free Flap Failure and Contracture Recurrence in Delayed Burn Reconstruction: A Systematic Review and Meta-analysis
Authors: Liu Hilary Y. , Alessandri-Bonetti Mario , Kasmirski Julia A , Stofman Guy M , Egro Francesco M.
Published: August 2024

Background:

Free tissue transfer is often considered a last resort in burn reconstruction due to its complexity and associated risks. A comprehensive review on free flap outcomes in delayed burn reconstruction is currently lacking. The study aimed to evaluate the available evidence on the failure and contracture recurrence rates in free flap delayed burn reconstruction.

Methods:

A systematic review and meta-analysis was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The protocol was registered on PROSPERO (CRD42023404478). The following databases were accessed: Embase, PubMed, Web of Science, and Cochrane Library. The measured outcomes were free flap loss and contracture recurrence rate.

Results:

Of the 1262 retrieved articles, 40 qualified for inclusion, reporting on 1026 free flaps performed in 928 patients. The mean age was 29.25 years [95% confidence interval (CI), 24.63–33.88]. Delayed burn reconstruction was performed at an average of 94.68 months [95% CI, − 9.34 to 198.70] after initial injury, with a follow-up period of 23.02 months [95% CI, 4.46–41.58]. Total flap loss rate was 3.80% [95% CI, 2.79–5.16] and partial flap loss rate was 5.95% [95% CI, 4.65–7.57]. Interestingly, burn contracture recurrence rate was 0.62% [95% CI, 0.20–1.90].

Conclusions:

This systematic review provides a comprehensive evaluation of the free flap outcomes in delayed burn reconstruction. The flap loss rate was relatively low, given the complexity of the procedure and potential risks. Furthermore, burn contracture rate was found to be extremely low. This study demonstrates that free flaps are a safe and effective option for delayed burn reconstruction.
Imaging the Nerve “Allograft to Muscle Target” Technique in Neuroma Management
Authors: Hale Eva S. , Tadisina Kashyap Komarraju , Jose Jean , Xu Kyle Y.
Published: August 2024

Neuroma management has gained significant attention in the peripheral nerve literature in the past decade. Alongside techniques such as targeted muscle reinnervation and regenerative peripheral nerve interface, another technique known as the “allograft to nowhere” has emerged. This approach involves the placement of an extended allograft at the end of a nerve, creating a regrowth zone in cases where muscle or nerve targets are not available. Although technique and outcomes research has been performed regarding the above techniques, there is a lack of imaging studies to examine postoperative outcomes. The authors present a case of recurrent neuroma management using a combined nerve allograft to nowhere + muscle target, supported by postoperative imaging.
Fecal calprotectin as an inflammatory biomarker in small bowel Crohn disease
Authors: Sousa Maria I. , Dias Emanuel , Andrade Patrícia , Macedo Guilherme
Published: August 2024

Background:

Small bowel capsule endoscopy (SBCE) is an essential tool for evaluation of small bowel (SB) Crohn disease (CD). Fecal calprotectin (FC) represents an important biomarker of intestinal inflammation, widely used in ulcerative colitis and CD. Our aim was to evaluate the role of FC for diagnosing inflammatory activity in patients with isolated SB CD and how it correlates with SBCE findings.

Methods:

This is a retrospective study conducted in a tertiary inflammatory bowel disease referral center that included patients with SB CD who underwent SBCE between January 2017 and February 2023. FC value was obtained from the closest stool examination to SBCE.

Results:

One hundred ninety-six patients were included: 123 were women (63%) with a mean age of 44.2 years. In the SBCE, 127 (65%) patients had a Lewis Score ≥135 and, among the 94 patients with FC >200 μg/g, 23 had LS <135, 36 had LS between 135 and 790, and 35 had LS ≥790. FC levels were predictive of endoscopic lesions in SBCE, with significant correlation between FC level and total LS (Pearson correlation coefficient 0.43, P<.001). The sensitivity and specificity were calculated for each cut-off value being respectively 78% and 45% for FC = 100 μg/g, 69% and 59% for FC = 150 μg/g and 67% and 67% for FC = 200 μg/g.

Conclusion:

FC showed moderate correlation with endoscopic findings in SBCE in SB CD. It is, therefore, a reasonable marker for predicting significant inflammatory lesions in SBCE; however, none of the cut-off had a high sensitivity or specificity.
Antihyperlipidemic drugs mitigate the elevated incidence of peptic ulcer disease caused by hyperlipidemia: A cohort study
Authors: Chen Pei-Hsien , Tsai Chiu-Lin , Hsieh Yow-Wen , Cho Der-Yang , Tsai Fuu-Jen , Lin Cheng-Li , Liao Hsien-Yin
Published: August 2024

Background:

Several risk factors for peptic ulcer disease (PUD) have been identified; however, the recurrence rate of PUD remains high even with standard ulcer treatments. High cholesterol levels have been proposed as a risk factor for PUD, but clinical evidence remains limited. Therefore, this database study investigated whether hyperlipidemia increases PUD risk and whether antihyperlipidemic drugs reduce this risk.

Methods:

A long-term cohort design was adopted, and Taiwan’s National Health Insurance Research Database was used to enroll patients diagnosed with hyperlipidemia between 2000 and 2016. Patients without hyperlipidemia were randomly matched based on variables such as age and gender to establish a comparison cohort at a 1:1 ratio. Another cohort study was conducted to determine whether antihyperlipidemic drugs or red yeast rice prescriptions can reduce the incidence of PUD in patients with hyperlipidemia.

Results:

The overall incidence of PUD was 1.48 times higher in the hyperlipidemia cohort (203,235 patients) than in the nonhyperlipidemia cohort (adjusted hazard ratio, 1.48; 95% CI, 1.46-1.50; p < 0.001). Among the patients with hyperlipidemia, those who used antihyperlipidemic drugs with or without red yeast rice prescriptions exhibited a lower risk of developing PUD relative to those who did not use them; the adjusted hazard ratios were 0.33 (95% CI, 0.21-0.52) and 0.81 (95% CI, 0.78-0.84), respectively. When the cumulative exposure to antihyperlipidemic drugs and red yeast rice prescriptions increased, the risk of developing PUD showed a decreasing trend, which was statistically significant for antihyperlipidemic drugs but not for red yeast rice.

Conclusion:

Hyperlipidemia is associated with a higher risk of PUD, which can be reduced through the administration of antihyperlipidemic drugs with or without red yeast rice prescriptions.
Clinicopathologic and prognostic implications of HOXA gene and its associated long-noncoding RNAs expression in non-small cell carcinoma: A meta-analysis
Authors: Yang Yanhui , Huang JinYang , Wang Qi , Li Ji , Yu Lei , Xie Xiaoyang
Published: August 2024

Background:

We conducted an investigation into the correlation between HOXA and associated long-noncoding RNAs, along with their clinicopathologic and prognostic features in non-small cell lung cancer (NSCLC).

Methods:

A comprehensive search across multiple electronic databases, including PubMed and the Web of Science, was conducted to identify relevant studies. The association between HOXA, clinicopathologic parameters, and prognosis was assessed using relative risk (RR) and hazard ratio (HR) with a 95% confidence interval (CI). Data compilation was performed using STATA 12.0 software.

Results:

A total of 11 trials involving 2058 patients with NSCLC were included in our study. Significant correlations were observed between HOXA-AS2 and TNM stage (III-IV) (RR=2.173, 95% CI: 1.386–5.437, P< 0.05) and HOTTIP and age (≥60-year-old) (RR=2.628, 95% CI: 1.185–5.829, P< 0.05) and non-smoking (RR=0.387, 95% CI: 0.156–0.959, P< 0.05). The combined results indicated a significant association between HOXA5 and increased overall survival (HR = 0.69, 95% CI = 0.57–0.84, P < .001). Additionally, HOXA-AS2, HOXA11 and HOTTIP were identified as potential independent predictors for poorer OS (HOXA-AS2: HR =3.48, 95% CI = 1.95 to 6.21, P < 0.05; HOXA11: HR=1.39, 95%CI = 1.08 to 1.79, P < 0.05; HOTTIP: HR=2.44, 95%CI = 1.10 to 5.42, P < 0.05). The prognostic significance of HOXA1, HOXA3 and HOXA4 was uncertain (HOXA1: HR=1.40, 95% CI =0.28 to 7.06, P > 0.05; HOXA3: HR=1.20, 95% CI = 0.96 to 1.50, P > 0.05; HOXA4: HR=0.97, 95% CI = 0.77 to 1.23, P > 0.05).

Conclusions:

The HOXA gene family has some potential to emerge as a novel prognostic factor for NSCLC and is correlated with some clinicopathological parameters such as the TNM stage, age and smoking. However, further meticulously designed prospective studies are warranted to substantiate these findings.
Understanding the influence of social media on COVID-19 vaccine acceptance in a war-torn Syria: A cross-sectional study
Authors: Kahwaji Areej , Alaryan Thurya , Alhelwani Hani , Salem Moath , Alsuliman Tamim
Published: August 2024

Social media has become a source of disseminating information to the public during the COVID-19 outbreak which has been a great advantage for healthcare centers. However, foreign anti-vaccination campaigns on social media increased the disbelief in vaccine safety. To our knowledge, the effects of social media on COVID-19 vaccine acceptance are not well-studied in low-income countries. The primary objective of this survey is to investigate Syrians’ dependence on social media platforms to get information about vaccines, and to what extent it affects their vaccination decision. A web-based cross-sectional study was conducted in Syria from May 26th to July 26th, 2022 using an online questionnaire as Google Form posted on various social media platforms. The questionnaire consisted of 53 questions related to each of the socio-demographic characteristics, beliefs, and knowledge about COVID-19 vaccination, willingness to get vaccinated, and social media frequency use and its effects. Univariate and multivariate logistic regression was performed to identify factors associated with vaccination behavior. A total of 780 questionnaires were completed; around 42.2% of study participants did not get the vaccine, and 24% would take it only under compulsory rules. Also, only 3.08% of the participants answered correctly on the knowledge-evaluation questions. Results of the univariate analysis showed that being female, living in an urban residential area, and having good vaccine knowledge were positive predictors of vaccine receiving. The unvaccinated group had a higher likelihood of being college students, not trusting in the vaccine, knowing relatively less about the vaccine, and not having previously been exposed to the virus. No significant correlation between vaccination status and using social media was shown in our investigation. However, our results show the importance of social media information in health-related decisions in war-torn countries and emphasize further investigations to confirm causality and determine the best health policy choice.
Anatomical differences of the vertebrobasilar artery between normal subjects and patients with cerebral infarction
Authors: Park Geo-seong , Park Jung-soo
Published: August 2024

Previous studies have reported various anatomical differences in the cerebral artery between healthy subjects and patients with posterior circulation cerebral infarction. In particular, basilar artery angulation has been associated with posterior circulation cerebral infarction. We compared anatomical variations and the degree of anterior and lateral vertebrobasilar artery angulation and deviation to compare the incidence of cerebral infarction of healthy subjects and patients with posterior circulation cerebral infarction. We compared basilar artery anatomy using brain magnetic resonance angiography in 97 patients who underwent brain magnetic resonance angiography during health checkups at our hospital and in 92 patients diagnosed with posterior circulation cerebral infarction between 2012 and 2022. Anatomical variations, including fetal-type posterior cerebral artery, hypoplastic P1 segment, vertebrobasilar dolichoectasia, and dominant vertebral artery, as well as the degree of anterior and lateral deviation and angulation, were evaluated. Correlations between these variations and the occurrence of cerebral infarction were analyzed. The prevalence of hypoplastic P1 was significantly differences in patients with posterior circulation cerebral infarction (odds ratio: 5.655). Furthermore, patients with posterior circulation cerebral infarction exhibited more acute anterior and lateral angulation, as well as lateral deviation. Hypoplastic P1 and more acute anterior or lateral angulation of the vertebrobasilar artery are associated with increased frequency of cerebral infarction.
Biochemical study of the effect of lead exposure in nonobese gasoline station workers and risk of hyperglycemia: A retrospective case-control study
Authors: Numan Ahmad Tarik , Jawad Nada Kadum , Fawzi Hayder Adnan
Published: August 2024

Evaluate the relationship between blood lead (Pb) levels and other biomedical markers and the risk of diabetes in gasoline station workers. The participants were separated into 2 groups: group A consisted of 26 workers from gasoline filling stations, while group B comprised 26 healthy individuals. Serum levels of malondialdehyde, IL-1β, visfatin, insulin, fasting blood sugar, and vitamin D were assessed. Mean Pb level was significantly higher in group A compared to group B (almost 2.9 times higher levels) (14.43 ± 1.01 vs 5.01 ± 1.41, µg/dL). The levels of visfatin (23.19 ± 0.96 vs 3.88 ± 0.58, ng/mL), insulin (22.14 ± 1.31 vs 11.26 ± 0.75, mU/L), fasting blood sugar (118.4 ± 26.1 vs 82.7 ± 9.2, gm/dL), malondialdehyde (6.40 ± 0.27 vs 1.62 ± 0.21, nmol/mL), and IL-1β (330.25 ± 10.34 vs 12.35 ± 1.43, pg/mL) were significantly higher in group A, meanwhile; vitamin D (11.99 ± 1.55 vs 35.41 ± 3.16, ng/mL) were significantly lower in group A. A positive association exists between blood Pb levels and increased inflammatory markers. Lead exposure increases serum insulin and fasting blood sugar, which suggests that it is diabetogenic and that increased inflammation is a possible cause.
Association of baseline muscle mass with functional outcomes in intensive care unit survivors: A single-center retrospective cohort study in Korea
Authors: Lim Sung Yoon , Park Jong Sun , Cho Young-Jae , Lee Jae Ho , Lee Choon-Taek , Lee Yeon Joo
Published: August 2024

In critical care settings, ultrasound (US) of the quadriceps muscle and Bioelectrical Impedance Analysis (BIA) are noninvasive and widely available tools to evaluate muscle mass. We studied whether baseline muscle mass affects physical function in intensive care unit (ICU) survivors after discharge. This retrospective review of a prospective cohort enrolled 30 patients admitted to the medical ICU between April 2016 and June 2018. On ICU admission, quadriceps muscle thickness and skeletal muscle mass were measured using US and BIA, respectively. Muscle strength and physical function were measured using handgrip dynamometry, the 6-min walk test, and the Barthel index questionnaire survey during every clinic visit at 1, 3, 6, and 12 months after hospital discharge. Skeletal muscle mass at ICU admission was statistically correlated with the 6-min walk distance (6MWD) and Barthel index score. The segmental lean mass of the right arm was also positively correlated with handgrip muscle strength at 6 months after discharge. Likewise, the correlation between quadriceps muscle thickness at ICU admission and 6MWD at 6 months after discharge was positive and statistically significant. Multivariate regression analysis showed that skeletal muscle mass was associated with a reduced 6MWD, but the length of ICU stay was not. The segmental lean mass of the right arm also showed a significant association with handgrip strength after discharge. Low muscle mass on ICU admission is associated with reduced muscle strength, causing impaired physical function after hospital discharge in ICU survivors.
Association between 24-hour blood pressure parameters and 90-day functional outcome in acute ischemic stroke patients with early anticoagulation
Authors: Hu Lan , Jin Donggan , Qiao Zhenguo , Hu Wenze , Xu Yuan , Shi Yun
Published: August 2024

This study aimed to examine the relationship between blood pressure (BP) and blood pressure variability (BPV) during the first 24 hours from admission with 90-day functional outcomes in acute ischemic stroke (AIS) patients whose onset within 24 hours and receiving early argatroban treatment. The study recruited 214 AIS patients. BP was monitored using a cuff at 1-hour fixed intervals, and BP/BPV parameters [standard deviation (SD), coefficient of variation (CV), successive variation (SV), and average real variability (ARV)] were collected. Age, the National Institutes of Health Stroke Scale (NIHSS) score at admission, previous history of diabetes mellitus (DM), and infarction site (located in anterior circulation) were identified as independent factors affecting 90-day outcomes in multiple logistic regression. After adjusting for confounding variables, association between BP/BPV and 90-day modified Rankin Scale (mRS) was assessed using logistic regression models. In model 1 (adjusted for age and NIHSS score at admission), mean-systolic blood pressure (SBP) showed association with 90-day outcomes [1.068 (1.008, 1.131), P = .025]. In model 2 (adjusted for age, NIHSS score at admission, previous history of DM), mean-SBP [1.061 (1.001, 1.123), P = .045] and max-SBP [0.951 (0.906, 0.998), P = .040] showed relatively weak association with outcomes. In model 3 [adjusted for age, NIHSS score at admission, previous history of DM, infarct site (located in anterior circulation)], all BP values were not related with outcomes, meanwhile, none of the BPV parameters calculated from SBP, diastolic blood pressure and mean arterial pressure showed association with 90-day outcomes. Future prospective studies are required to assess the relationship between early BP/BPV parameters with 90-day outcomes and further clarify the reference values for BP parameters. This is important for effective BP/BPV management and improved patient prognosis.
Efficacy of fidaxomicin versus vancomycin in the treatment of Clostridium difficile infection: A systematic meta-analysis
Authors: Zhao Zihan , Wu Yarui , Geng Xuhua , Yuan Congrui , Fu Yi , Yang Guibin
Published: August 2024

Purpose:

To compare the efficacy, recurrence rate, adverse event rate and mortality of fidaxomicin compared with vancomycin in treating different types of Clostridium difficile infection (CDI).

Methods:

A systematic search was conducted on PubMed, Embase, Web of Science, Cochrane Library and clinical trial registration databases for research on fidaxomicin versus vancomycin in the treatment of CDI and the retrieval period extended from the establishment of the database to July 22, 2022. A total of 15 studies were included, including 8 RCTs and 7 retrospective cohort studies.

Results:

Results showed that there was no significant difference in the overall efficacy of the treatment between fidaxomicin and vancomycin, and results in the subgroups of CDI hypervirulent strains and recurrent CDI were obtained, but vancomycin was more effective than fidaxomicin in the treatment of severe CDI (RR = 0.94, 95% CI: 0.90–0.98, P < .01). Results showed that fidaxomicin is superior to vancomycin in terms of 40-day recurrence rate (RR = 0.52, 95% CI: 0.38–0.70, P < .01), 60-day recurrence rate (RR = 0.38, 95% CI: 0.21–0.69, P < .01) and 90-day recurrence rate (RR = 0.62, 95% CI: 0.50–0.77, P < .01). For the recurrence rate of the treatment in CDI hypervirulent strains, severe CDI and recurrent CDI, there was no significant difference between the 2 groups. In addition, there was no significant difference in the incidence of clinical adverse reactions, and same outcomes appeared in all-cause mortality at 40-day, severe CDI and recurrent CDI, but fidaxomicin was superior to vancomycin in all-cause mortality over 60-day (RR = 0.57, 95% CI: 0.34–0.96, P = .03).

Conclusion:

There were no significant differences between fidaxomicin and vancomycin in the treatment of CDI in therapeutic effectiveness and adverse reactions, while fidaxomicin was superior to vancomycin in terms of recurrence rate and long-term mortality, and vancomycin is more effective in treating severe CDI.
Effect of improving asymmetry through self-myofascial release in adolescent soccer player with hypomobility syndrome hip: A randomized controlled trial
Authors: Yan Shuren , Jiang Quan , Song Munku
Published: August 2024

Background:

Hypomobility syndrome (HMS), or limited hip range of motion (ROM), is often reported in adolescents who train heavily. This study was aimed to investigate the impact of traditional static stretching (STR) and self-myofascial release (MFR) in adolescents with HMS hip.

Methods:

This study was a randomized controlled trial. Adolescent athletes with HMS hip were grouped as 23 STR and 23 MFR. Foam rolling was employed as the training method for MFR. Both interventions were performed twice a day for 20 minutes in 6 weeks. The training was filmed and distributed via the mobile video. Self-assessed Copenhagen Hip & Groin Outcome Score, ROM, strength, and hop tests were measured before and after the interventions. The healthy side without limitations was designated as non-HMS (nHMS) and taken as reference value.

Results:

The study participants had limitations in flexion (FLX), abduction (ABD), internal rotation (IR), and external rotation (ER). The ROM of STR group was recovered to nHMS level. The FLX and ABD of MFR group was also recovered, however the IR and ER had lower angles compared to nHMS. MFR FLX, ABD, ER strength, and single hop test were restored like that of nHMS, however STR group was substantially lower than nHMS despite the improvements. Both groups depicted lower pre-intervention Copenhagen Hip & Groin Outcome Score subscale activities daily living, sport, and physical activity compared to nHMS. Activities daily living and physical activity were improved to healthy levels after the intervention, however sport was lower than that of nHMS.

Conclusion:

Both STR and MFR had impact on hip mobility and hip self-assessment score. Furthermore, MFR had strength improvements in FLX, ABD, and ER. However, the improvements in MFR group regarding triples, crossover hops, and self-assessed sports were limited. Therefore, STR and MFR are effective in improving not only ROM but also muscle function asymmetry in HMS hip.
Clinical evolution of bladder carcinosarcoma: A case report and literature review
Authors: Wu Shuo , Wang Xiaolong , Zuo Yuliang , Wang Kuan , Ye Meihong , Wang Chaoming
Published: August 2024

Rationale:

Bladder carcinosarcoma (BC) is a malignant tumor composed of a mixture of malignant epithelial and stromal components. Carcinosarcoma mostly occurs in the upper respiratory tract and upper gastrointestinal tract and is less common in the urinary system. The incidence of malignant tumors of the urinary system is <3%. It rarely occurs in the bladder and accounts for approximately 0.31% of all malignant bladder tumors. A literature review and this report will help to further improve our understanding, diagnosis, and treatment of bladder carcinosarcoma (BC).

Patient concern:

We describe the case of an 80-year-old female patient who was admitted to the hospital with a history of intermittent hematuria for 3 years. Furthermore, total cystectomy was refused when a BC was diagnosed. Palliative resection surgery was necessary because of the recurrent hematuria and abdominal pain.

Diagnoses:

Pathologically confirmed BC after surgery.

Interventions:

The patient’s first transurethral resection of bladder tumor (TURBT) was diagnosed as BC. However, the patient refused a total cystectomy. Two months after intravesical treatment with epirubicin, bladder tumor recurrence was observed during follow-up cystoscopy. The patient underwent a second TURBT for hemostatic treatment due to persistent hematuria. Due to hematuria and abdominal pain, a third TURBT was performed to reduce tumor size and stop bleeding. Finally, tumor recurrence resulted in bilateral hydronephrosis, and the patient underwent bilateral renal catheter drainage guided by B-ultrasound.

Outcomes:

Bladder carcinosarcoma caused uremia, electrolyte imbalance, and sepsis. Approximately 19 months after the discovery of the tumor, the patient died.

Lessons:

Radical bladder resection is recommended once a BC is diagnosed. By reporting the cases and reviewing the literature in the database, we will summarize the epidemiology, origin, etiology, clinical features, existing treatments, and prognostic factors of BC, and propose new prospects for BC therapy.
MR imaging diagnosis of small-cell carcinoma of the ovary, hypercalcemic type: A case report and literature review
Authors: Li Xinyu , Liu Zhuolin , Chen Jiake , Hao Huifen , Fan Dongmei , Huang Wenbin
Published: August 2024

Rationale:

Small-cell carcinoma of the ovary, hypercalcemic type (SCCOHT), is a rare and aggressive gynecological tumor. We retrospectively analyzed the clinical manifestations and imaging findings of this patient and analyzed the relevant literature, with the aim of improving the ability of radiologists to differentiate SCCOHT from other ovarian tumors.

Patient concerns:

We report a case of 36-year-old woman who was diagnosed with SCCOHT. MRI suggested a malignant tumor of the left ovary. The immunohistochemical markers shows SMARCA4 negativity. Notably, hypercalcemia was not detected. Microscopically, it was consistent with the large-cell variants.

Lessions:

Despite its rarity, SCCOHT should still be considered in the differential diagnosis of ovarian malignancies. When a young female patient presents with a large unilateral tumor on MRI with a predominant solid component and significant enhancement on the contrast enhanced scans, along with hypercalcemia, SCCOHT should be considered.
Pharmacokinetic variability of everolimus and impact of concomitant antiseizure medications in patients with tuberous sclerosis complex: A retrospective study of therapeutic drug monitoring data in Denmark and Norway
Authors: Kirkeby Kjersti , Cockerell Ine , Christensen Jakob , Hoei-Hansen Christina Engel , Holst Lotte , Fredriksen Mikkel G. , Lund Caroline , Johannessen Landmark Cecilie
Published: August 2024

The mTOR-inhibitor everolimus is a precision drug with antiepileptogenic properties approved for treatment of epilepsy in persons with tuberous sclerosis complex (TSC) in combination with other antiseizure medications (ASMs). However, the pharmacokinetic variability of everolimus is scarcely described, and the available information on pharmacokinetic interactions is scarce. The purpose of this study was to investigate pharmacokinetic variability of everolimus in patients with TSC, and the impact of age, sex and comedication. In this retrospective observational study we used anonymized data from medical records of patients with TSC using everolimus in Norway and Denmark, 2012 to 2020. Long-term therapeutic drug monitoring (TDM) identified inter-patient and intra-patient variability. The study included 59 patients, (36 females (61%)), median age 22 (range 3–59 years). Polytherapy was used in 50 patients (85%). The most frequently used ASMs were lamotrigine (n = 21), valproate (n = 17), and levetiracetam (n = 13). Blood concentrations of everolimus were measured in all patients. Pharmacokinetic variability of everolimus between patients was extensive, as demonstrated by a 24-fold variability from minimum–maximum concentration/dose (C/D)-ratios. The coefficient of variation (CV) for intra-patient (n = 59) and inter-patient variability (n = 47, ≥3 measurements) was 40% and 43%, respectively. The C/D-ratio of everolimus was 50% lower in 13 patients (22%) using enzyme-inducing ASMs compared to the 30 patients who did not (0.7 vs 1.4 ng/mL mg, P < .05). Age and sex were not significantly associated with changes in C/D-ratios of everolimus. Long-term TDM identified extensive variability in concentrations over time for everolimus both within and between patients, where comedication with enzyme-inducing ASMs was an important contributing factor. The findings suggest a need for TDM in patients with TSC treated with everolimus.
Evaluating the efficacy of cognitive restructuring and exposure therapies on secondary school chemistry students’ test anxiety: A randomized trial
Authors: Eya Ngozi M. , Anumudu Juliet I. , Nweze Bernardine N. , Dave-Ugwu Priscillia O. , Egbo Joy J. , Chukwunwogor Eunice O. , Okebanama Cliff I. , Omeje Cynthia O. , Aikoye Joshua E. , Ngwainmbi Desmon , Ibrahima Ngom N. , Ugwuanyi Christian Sunday
Published: August 2024

Background:

This study explored how cognitive restructuring (CR) and cognitive exposure therapy (CET) impacted test anxiety in chemistry students from Nsukka, Enugu State. Three research questions and hypotheses guided the investigation.

Method:

A quasi-experimental design with a pretest, posttest, and 2 experimental groups was employed. The study involved 154 SSII chemistry students from 4 purposefully chosen schools within Nsukka. The Chemistry Test Anxiety Scale, Cognitive Restructuring Chemistry Treatment Package, and Cognitive Exposure Chemistry Treatment Package served as the data collection instruments. The Chemistry Text Anxiety Scale’s internal consistency, measured by Cronbach alpha, was found to be 0.86, indicating good reliability. Descriptive statistics (mean and standard deviation) addressed the research questions, while Analysis of Covariance tested the hypotheses at a 0.05 significance level.

Results:

Results showed that the students who were exposed to CR therapy had pretest mean test anxiety score of M̄ = 78.31, standard deviation (SD) = 8.63 and posttest mean test anxiety of mean [M] = 27.06, SD = 5.71, while those exposed to cognitive exposure had a pretest mean test anxiety score of M = 77.39, SD = 8.68 and a posttest mean test anxiety score of M = 32.62, SD = 11.04. The reduction in text anxiety scores of −51.25 and −44.77 for the students exposed to CR and cognitive exposure respectively. The students exposed to CR therapy had lesser posttest mean test anxiety score than those exposed to CET. The results revealed that students receiving CR therapy displayed lower posttest anxiety scores compared to those receiving CET. Additionally, no significant interaction between treatment and gender on test anxiety was found.

Conclusion:

It was concluded that CR therapy is better than CET in the management of test anxiety among chemistry students. Based on these findings, it was recommended that cognitive behavioral therapists should be invited periodically to educate students on the negative effects of irrational thoughts on academic performance.
Cervical metastasis of breast cancer: A case report and literature review
Authors: Zhang Lu , Yang Xi , Zhang Yuanyuan , Wen Yaru , Huang Manni , An Jusheng
Published: August 2024

Rationale:

Cervical metastasis of breast cancer is rare and its clinical manifestations are similar to those of primary cervical cancer. It is thus easy to misdiagnose, with diagnosis mainly depending on pathology and immunohistochemistry. There have been few studies on its treatment and there is thus no standard treatment plan.

Patient concerns:

This is a 64-year-old female patient presented with a 2-month history of abnormal postmenopausal vaginal discharge, who had previous history of breast cancer.

Diagnoses:

Based on the gynecological examination, imaging results, pathology, and immunohistochemical results, a diagnosis of metastatic carcinoma of the cervix and breast cancer was confirmed.

Interventions:

She received computed tomography-guided 3-dimensional high-dose-rate brachytherapy in combination with chemotherapy.

Outcomes:

She achieved complete response locally. This case provides a new local treatment option for patients with inoperable localized cervical metastases.

Lessons:

We hope that this report and the accompanying review help to enrich the literature pertaining to the treatment of rare cervical metastases, providing a foundation for the improved survival of affected patients.
Acute myeloid leukemia with gastric carcinoma: A case report of a double malignancy
Authors: Wan Qiuxia , Chen Yongzhen , Wang Suyun
Published: August 2024

Rationale:

Multiple primary cancers (MPC) are malignant tumors that manifest as multiple primary tumors diagnosed in the same patient, either simultaneously or sequentially. Billroth first proposed the concept in 1889. Here, we report a rare case of untreated acute myeloid leukemia (AML) and adenocarcinoma of the cardia.

Patient concerns:

A 58-year-old male with muscle and joint pain for >1 month was admitted to the hospital with severe chest pain for 3 hours on July 14, 2023. The patient had chest tightness, shortness of breath, and dyspnea. The skin, mucosa, and lips of the patient were slightly pale and the sternum had mild tenderness. Other systemic examinations did not reveal any obvious abnormalities. The results of routine blood tests on admission were as follows: white blood cells, 7.46 × 109/L; red blood cells, 2.32 × 1012/L; hemoglobin, 90 g/L; and platelets, 62 × 109/L.

Diagnosis:

The patient was diagnosed with acute myeloid leukemia (FLT3, DNMT3A, U2AF1, and SMC3 mutations; KMT2A amplification; high-risk) and adenocarcinoma of the cardia.

Interventions:

The patient was treated with azacitidine + Veneckla chemotherapy, and through precise regulation, the patient survived the period of bone marrow suppression. He was unable to achieve complete relief and finally underwent allogeneic hematopoietic stem cell transplantation in February 2024.

Outcomes:

Bone marrow cytology and minimal residual disease analysis indicated complete relief on April 22, 2024, with the bone marrow exhibiting complete chimerism (99.63%). The patient and his family members decided to seize the opportunity to perform radical surgical treatment for gastric cancer on May 16, 2024.

Lessons:

The development of medicine, especially in oncology, has led to an increased possibility of developing multiple cancers. Clinically, some doctors may not be aware of the existence of multiple primary cancers, especially simultaneous carcinomas, which can be easily missed or misdiagnosed.