bluuebunny/crossref_metadata_2025 huggingface dataset:
Insulin Management for Gestational and Type 2 Diabetes in Pregnancy
Authors: Valent Amy M. , Barbour Linda A.
Published: June 2024

Insulin is preferred as the first-line agent for glucose management of gestational diabetes mellitus and type 2 diabetes in pregnancy when nutritional and lifestyle modifications are unable to achieve pregnancy-specific glucose targets. Individual heterogeneity in defects of insulin secretion or sensitivity in liver and muscle, unique genetic influences on pregnancy glycemic regulation, and variable cultural and lifestyle behaviors that affect meal, activity, sleep, and occupational schedules necessitate a personalized approach to insulin regimens. Newer insulin preparations have been developed to mimic the physiologic release of endogenous insulin, maintaining appropriate basal levels to cover hepatic gluconeogenesis and simulate the rapid, meal-related, bolus rise of insulin. Such physiologic basal–bolus dosing of insulin can be administered safely, achieving tighter glycemic control while reducing episodes of hypoglycemia. Insulin initiation and titration require understanding the pharmacodynamics of different insulin preparations in addition to a patient's glycemic profiles, effect of variable nutritional intake and mealtimes, physical activity, stress, timing of sleep cycles, and cultural habits. Educating and empowering patients to learn how their glucose responds to insulin, portion and content of meals, and physical activity can increase personal engagement in therapy, flexibility in eating patterns, and improved glycemic control. This Clinical Expert Series article is focused on optimizing insulin management (initiation, dosing, and titration) of gestational and type 2 diabetes in pregnancy.
Predicting Endometrial Hyperplasia and Endometrial Cancer on Recurrent Abnormal Uterine Bleeding
Authors: Veeranaraphanit Unyamanee , Saeaib Nungrutai , Srisintorn Wisarut
Published: June 2024

OBJECTIVE:

To develop predictive models for endometrial hyperplasia and endometrial cancer in patients with recurrent abnormal uterine bleeding (AUB).

METHODS:

This retrospective cohort study analyzed patients with recurrent AUB who had previous endometrial sampling that showed benign results between January 2013 and December 2021. A model was constructed from the significant factors associated with endometrial hyperplasia and endometrial cancer using multivariate logistic regression. Risk scores were calculated from the log odds of each significant predictive factor and were subsequently subcategorized into risk groups. The overall performance and internal validation of the model were assessed with the area under the receiver operating characteristic curve (AUC) and bootstrap methods.

RESULTS:

Of the total 456 patients with recurrent AUB, endometrial hyperplasia and endometrial cancer were detected in 8.3% and 2.2% of cases, respectively. The average interval between the first and second endometrial samplings was 25.1 months. Factors significantly associated with endometrial hyperplasia and endometrial cancer included age older than 45 years (odds ratio [OR] 2.86, 95% CI, 1.31–7.03), nulliparity (OR 3.50, 95% CI, 1.76–6.85), a history of endometrial polyp (OR 3.69, 95% CI, 1.93–7.05), and an interval of less than 12 months between sampling (OR 2.36, 95% CI, 1.25–4.42). Predictive factors were scored and categorized into three groups: 0–3, 5–8, and 9–11 points. The corresponding risks for endometrial hyperplasia and endometrial cancer in these groups were 4.7%, 15.5%, and 57.1%, respectively. The AUC was 73.1%, with a mean absolute error of 0.01.

CONCLUSION:

Endometrial hyperplasia and endometrial cancer occur at low incidence among one-fifth of patients with AUB who experience recurrent bleeding. Older age, nulliparity, a history of endometrial polyps, and an interval of less than 12 months between samplings are predictive factors for endometrial hyperplasia and endometrial cancer in this cohort.
Cigarettes and waterpipe use and risk of colorectal cancer in Iran: the IROPICAN study
Authors: Collatuzzo Giulia , Rashidian Hamideh , Hadji Maryam , Naghibzadeh Ahmad , Alizadeh-Navaei Reza , Boffetta Paolo , Zendehdel Kazem
Published: June 2024

We aimed to investigate the association between cigarettes and waterpipe use and colorectal cancer (CRC) in an Iranian population. We analyzed data from a multicenter hospital-based case–control study in Iran (IROPICAN). Data on tobacco smoking, including cigarettes, and waterpipe smoking, were collected in detail. Multivariate logistic regressions estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between cigarette and waterpipe smoking and CRC, accounting for confounders including age, sex, socioeconomic status, opium use, marital status, family history of cancer, red meat, fiber, body shape at age 15 and perceived physical workload, and each other of the two exposures. The study population consisted of 3215 controls and 848 cases, including 455 colon and 393 rectum cancers. We found no association between CRC and cigarette smoking (OR, 0.8; 95% CI, 0.6–1.0) or waterpipe smoking (OR, 1.1; 95% CI, 0.9–1.5). Analysis by categories of cigarette pack-year and frequency of waterpipe smoking (head-year) did not show associations. We observed an inverse association between colon cancer and cigarette smoking (OR, 0.6; 95% CI, 0.5–0.9). There was, however, no significant association by pack-year categories. Cigarette and waterpipe smoking was not associated with CRC in the Iranian population. Further studies are needed to better understand the role of waterpipe on CRC.
Compliance and satisfaction with BRCA surveillance in specialized clinics versus community follow-up
Authors: Vortman Rita , Echar Moran , Singer Amihood , Sagi-Dain Lena
Published: June 2024

Objective

To assess adherence to medical follow-up protocols among BRCA1/2 carriers and compare outcomes between dedicated carrier clinics and community healthcare settings.

Methods

This cross-sectional study was conducted by distributing an anonymous questionnaire within the ‘Good BRCA Genes – Support and Information Group for BRCA Carriers’ association. The questionnaire assessed adherence to recommended surveillance and satisfaction with various aspects of the follow-up.

Results

Of the 682 BRCA carriers surveyed, 68.5% reported fully adhering to recommended medical follow-up. Those not fully adhering cited bureaucracy challenges, scheduling difficulties, timing uncertainties, and difficulty remembering examination dates. Less than 50% were satisfied with appointment availability, scheduling, contact persons, and general practitioners’ knowledge of BRCA carrier risks and follow-up. The 417 women monitored in dedicated breast clinics reported notably higher optimal adherence to recommended surveillance (78.3 vs. 53.6%, P < 0.0001). In addition, they noted greater satisfaction with appointment availability (63.7 vs. 25.0%, P < 0.0001), appointment scheduling process (58.1 vs. 24.7%, P < 0.0001), availability of breast surgeons/gynecology specialists (67.4 vs. 50.8%, P < 0.0001), and availability of a contact person for consultations between appointments (53.5 vs. 20.8%, P < 0.0001).

Discussion

Our findings highlight the advantages of surveillance in dedicated BRCA1/2 clinics, including closer monitoring and increased satisfaction. Given the limited availability of such clinics and the growing number of BRCA1/2 carriers, the opening of additional dedicated clinics and the consideration of alternative surveillance-enhancing solutions, such as training healthcare professionals, using digital tools, and employing artificial intelligence, are essential.
Management of patients with CHB outside the guidelines: Insights from Egyptian cohort with long-term follow-up
Authors: Shiha Gamal , Soliman Riham , Hassan Ayman , Farahat Ahmed , Salem Ahmed , Taha Amr , Sabry Ramy , Geith Ahmed , Elshawaf Ahmed , Mikhail Nabiel
Published: June 2024

It is alarming that globally, only 2.2% (6.6 million) of patients with chronic hepatitis B (CHB) received treatment in 2019. One contributing factor to this low treatment rate is the complexity and restrictive nature of clinical practice guidelines. Since 1998, we have adopted a “treat-all” approach to patients with CHB. A retrospective study was conducted involving patients with CHB who received treatment from 1998 to 2020 at 2 institutions in Egypt. These patients underwent evaluation through various clinical and laboratory methods, which included testing for liver enzymes and HBV DNA. The study analyzed 1825 patients with HBV, finding that 27.4% had viremia levels under 2000 IU/mL. Most (88%) were HBeAg-negative, with 12% positive. A large portion (77.6%) had normal alanine aminotransferase levels, though 5.6% exceeded twice the upper limit of normal. About 14.2% were diagnosed with liver cirrhosis, and 9.6% with F3 stage fibrosis at enrollment. Notably, 2% (25 cases) lost HBsAg over a median of 52 months. Patients with HBV DNA <2000 IU/mL had a higher HBsAg loss rate (4.2%) compared to those with levels >2000 IU/mL (1.3%). During follow-up, 9.5% (117 patients) experienced decompensation, with a higher incidence in those with HBV DNA <2000 IU/mL (16.8%) than those >2000 IU/mL (7.1%). HCC developed in 5.2% of patients with lower HBV DNA and 2.6% with higher levels, showing significant differences. Liver-related deaths occurred in 2.8% of the cohort, with a slightly higher rate in those with lower initial HBV DNA levels (3.5% vs. 2.5%). The findings suggest a paradigm shift in CHB management toward early and broader eligibility for antiviral therapy. This could improve patient outcomes and address the global treatment gap in CHB management, especially in regions with high CHB prevalence.
Diversity Drives Representation: An Internal Audit of Gender Representation in Citation Practices of a Single Surgical Laboratory
Authors: Fioranelli Gabriela A. , Lo Yunee , Jesch Anna K. , Laluzerne Matthew J. , Donnelly D’Andrea , Lyon Sarah M. , Dingle Aaron M.
Published: June 2024

Background:

Large-scale retrospective studies have identified implicit gender bias in citation behaviors across multiple medical fields. There are minimal resources to directly assess one’s own citation behavior before publication at a laboratory level. In this study, we performed an internal audit of our own citation practices and behavior, looking at the representation of authors by gender in our own bibliographies.

Methods:

Bibliographies were collated from our laboratory’s publications between 2015 and 2022 with a single senior author, who was excluded from participating in this study. Bibliographies were run through a simulation originally constructed and used by authors from the University of Pennsylvania that categorized authors of each article by gender: man or woman, according to external database records.

Results:

Of the 1697 citations, the first and last authorship sequences displayed to be 60.8% male/male, 10.1% male/female, 16.3% female/male and 12.8% female/female. Men-led articles within our laboratory cited 67.4% male/male articles in their bibliographies compared with women-led articles citing 53.9%. All laboratory bibliographies consisted of 77.1% male senior authors compared with 22.9% female senior authors.

Conclusions:

Our data confirm that a gender bias in citation practices exists at the laboratory level. Promisingly, these data also indicate that diversity within an individual laboratory group leads to diversity in representation; therefore, diversifying a team of researchers is prone to improve the overall work and success of the laboratory. We encourage laboratory groups to challenge their own biases by replicating their own results and discovering how these biases might be impacting their publications.
Pain-relieving Effects of Autologous Fat Grafting in Breast Cancer Surgery: A Scoping Review
Authors: Sowa Yoshihiro , Nakayama Ichiro , Toyohara Yoshihiro , Higai Shino , Yoshimura Kotaro
Published: June 2024

Background:

Chronic pain is relatively common after breast cancer surgery, including breast reconstruction. Autologous fat grafting (AFG) has gained attention as a novel method for breast reconstruction, and recent clinical studies have also shown effects of AFG on alleviation of chronic pain after breast cancer surgery. Our objective was to conduct a scoping review of studies that have examined these effects with clearly defined clinical outcomes.

Methods:

A literature search was conducted using three databases: PubMed, MEDLINE, and Google Scholar, following PRISMA guidelines and the Arkesy and O’Malley framework. The search focused on clinical studies of the effects of AFG on chronic pain after breast cancer surgery. All studies reporting functional outcomes, return to work, and secondary surgery in a repeat operation were identified.

Results:

Of the 148 studies identified in the search, 11 studies with a total of 684 patients were included in the review. The average volume of fat grafted was approximately 128 mL over an average of 1.6 sessions. The most common time point for assessment was 1 year post-AFG. In all studies with an evidence level of 3 or lower, AFG showed positive results in alleviating pain after breast cancer surgery. However, one of the three randomized controlled trials did not show clinically significant effects.

Conclusions:

Most of the studies examined in this review suggested pain-relieving effects of AFG. However, there was one randomized controlled trial in which these effects were not confirmed, indicating a need for further accumulation of cases and performance of new, well-designed randomized controlled trials.
Integration of Virtual and Traditional Medical Education: Scholarship Pivots from the COVID-19 Pandemic
Authors: Berberoglu Ipek , Tang Sherry Y. Q. , Kozlow Jeffrey H. , Sezgin Billur , Sandhu Gurjit , Cederna Paul S.
Published: June 2024

Background:

The coronavirus disease 2019 (COVID-19) pandemic required an unprecedented transformation of medical education, shifting from traditional, in-person learning to distanced, online learning. This study aimed to review changes to medical education and describe the advantages and disadvantages of virtual medical education experienced by medical students during the pandemic.

Methods:

An online survey study was conducted at two medical schools, University of Michigan Medical School in the United States and Koc University School of Medicine in Turkey. Medical students completed questionnaires regarding their educational experience before and during the pandemic. Survey instruments were designed to assess differences in the educational curriculum, study methods, clinical skills self-evaluations, perceptions of the quality of in-person and online learning, and overall satisfaction.

Results:

A total of 184 medical students completed the survey. There was an increase in the use of online study tools since the pandemic. There was no statistically significant difference in self-reported assessments of clinical preparedness and overall clinical competence during surgical clerkship. The percentage of students interested in pursuing a career in surgery has nearly doubled from 34% to 63%. A majority of students (83%) believed that the time available for self-study and research increased during the pandemic. Fifty-two percent of students believed that online education is less efficacious than in-person education, but 86% of students still preferred a blended approach.

Conclusions:

Medical schools have continued to update their curricula following the COVID-19 pandemic. This study illustrates the transformations in medical education to ensure that the most effective and suitable teaching is delivered.
Association of Sarcopenia and Oxygen Uptake Efficiency Slope in Male Patients With Heart Failure
Authors: Bispo Henrique Nunes , Rondon Eduardo , dos Santos Marcelo Rodrigues , de Souza Francis Ribeiro , da Costa Marcel José Andrade , Pereira Rosa Maria Rodrigues , Negrão Carlos Eduardo , Carson Brian P. , Alves Maria-janieire de Nazaré Nunes , da Fonseca Guilherme Wesley Peixoto
Published: June 2024

Purpose:

Sarcopenia, the loss of muscle mass and function, is a common comorbidity in patients with heart failure (HF). The skeletal muscle modulates the respiratory response during exercise. However, whether ventilatory behavior is affected by sarcopenia is still unknown.

Methods:

We enrolled 169 male patients with HF. Muscle strength was measured by a handgrip dynamometer. Body composition was measured with dual-energy X-ray absorptiometry. Sarcopenia was defined by handgrip strength <27 kg and appendicular lean mass divided by height squared (ALM/height2) <7.0 kg/m2. Oxygen uptake efficiency slope (OUES), ventilation (VE), oxygen uptake (VO2), and carbon dioxide output (VCO2) were measured by a cardiopulmonary exercise test.

Results:

Sarcopenia was identified in 29 patients (17%). At the first ventilatory threshold, VE/VO2 (36.9 ± 5.9 vs 32.7 ± 6.5; P = .003) and VE/VCO2 (39.8 ± 7.2 vs 35.3 ± 6.9; P = .004) were higher in patients with sarcopenia compared to those without sarcopenia. At the exercise peak, compared to patients without sarcopenia, patients with sarcopenia had lower OUES (1186 ± 295 vs 1634 ± 564; P < .001), relative VO2 (16.2 ± 5.0 vs 19.5 ± 6.5 mL/kg/min; P = .01), and VE (47.3 ± 10.1 vs 63.0 ± 18.2 L/min; P < .0001), while VE/VCO2 (42.9 ± 8.9 vs 38.7 ± 8.4; P = .025) was increased. OUES was positively correlated with ALM/height2 (r = 0.36; P < .0001) and handgrip strength (r = 0.31; P < .001). Hemoglobin (OR = 1.149; 95% CI, 0.842-1.570; P = .038), ALM/height2 (OR = 2.166; 95% CI, 1.338-3.504; P = .002), and VO2peak (OR = 1.377; 95% CI, 1.218-1.557; P < .001) were independently associated with OUES adjusted by cofounders.

Conclusions:

Our results suggest that sarcopenia is related to impaired ventilatory response during exercise in patients with HF.
Parent Perspectives of Early Childhood Special Education Transition
Authors: Gaspar Catherine R. , Jahromi Laudan B.
Published: June 2024

The transition from early childhood special education into school-based special education services is often the first major educational change for children with special needs. Parents are critical to children’s successful transitions. This systematic review compiled parent-reported data from 20 peer-reviewed quantitative and qualitative empirical studies to identify consistent themes regarding parents’ experiences during the early childhood special education transition. Themes for parents’ reported experiences reflected three ecological contexts of children’s development: family, school, and the special education system. Parents reported challenges relating to communication with their new schools and confusion navigating special education procedures but relied on support from their early childhood service providers. These experiences were differentially related to parents employing advocacy strategies for their child or taking a passive role in the process. Findings suggest a need for improved parent resources to support families’ adjustment and their roles in their child’s education in this transition period.
Joint association of physical activity and dietary quality with survival among US cancer survivors: a population-based cohort study
Authors: Wei Xiaoyuan , Min Yu , Xiang Zhongzheng , Zeng Yuanyuan , Wang Jun , Liu Lei
Published: June 2024

Background:

Limited studies have explored the joint effect of physical activity (PA) and dietary quality (DQ) on the mortality outcomes of the cancer population. The authors aim to investigate the separate and joint prognostic effect of PA and DQ on the survival of US cancer survivors.

Methods:

Data of cancer survivors (n=3007, representing 22 million cancer survivors) were from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. PA was assessed using the self-reported Global Physical Activity Questionnaire (GPAQ) and DQ was evaluated through the Health Eating Index-2015 (HEI-2015). Kaplan–Meier (KM) curves and the Cox proportional hazard model were used to evaluate the associations between separate and joint prognostic effects of PA and DQ with mortality outcomes among cancer survivors.

Results:

In the joint analyses, cancer survivors with sufficiently active PA (≥600 MET-min/week) and qualified DQ (≥60) presented reduced risks of all-cause mortality (HR 0.45, 95% CI: 0.35–0.59) as compared with each lifestyle intervention separately. Meanwhile, the joint effects of either insufficiently or sufficiently active PA (>0 MET-min/week) and qualified DQ (≥60) were associated with lower risks for cancer (HR 0.60, 95% CI: 0.40–0.90) and noncancer mortality (HR 0.43, 95% CI: 0.32–0.59).

Conclusions:

Our study highlights the combination of active PA and qualified DQ was strongly associated with reduced mortality risk of cancer survivors. Our findings might help to refine the lifestyle intervention recommendations for this population.
Thyroid cancer-specific mortality during 2005–2018 in Korea, aftermath of the overdiagnosis issue: a nationwide population-based cohort study
Authors: Kim Kyeong Jin , Choi Jimi , Park Sue K. , Park Young Joo , Kim Sin Gon
Published: June 2024

Background:

Thyroid cancer (TC) has underwent notable changes in its diagnosis and treatments following the concerns regarding overdiagnosis and overtreatment. However, there is little research on evaluating the effects of these alterations on TC-specific mortality.

Materials and methods:

This population-based cohort study included 434 228 patients with TC using Korean National Health Insurance Service-National Health Information Database. The age-standardized and sex-standardized mortality rates of TC per 1000 person-years were calculated considering the number of patients diagnosed with TC in 2013 per our database to evaluate the TC-specific mortality trends according to the year of TC diagnosis.

Results:

The authors enrolled 434 228 patients with TC, including 352 678 women and 81 550 men, with a mean age of 48.6±12.5 years and a median follow-up duration of 7.4 (interquartile range: 4.5–10.1) years. TC incidence increased from 2005 to 2012, with a standardized rate of 91.9 per 100 000 people in 2012, decreased rapidly to 50.6 in 2015, and remained stable until 2018. However, TC-specific age-standardized and sex-standardized mortality rates decreased from 1.94 per 1000 person-years in 2005 to 0.76 per 1000 person-years in 2013 and then increased to 2.70 per 1000 person-years in 2018. The TC-specific age-standardized and sex-standardized mortality rates of patients who had undergone hemithyroidectomy or subtotal thyroidectomy remained steady during 2005–2018, but increased in patients who had undergone total thyroidectomy or not undergone thyroidectomy between 2013 and 2018.

Conclusions:

The TC-specific mortality rates among patients with TC diagnosed since 2015 have increased, in contrast to the significant decline in TC incidence during the same period. This underscores the importance of appropriate diagnosis and treatment in patients with TC at high-risk of progression, simultaneously emphasizing efforts to reduce overdiagnosis and overtreatment in those with low-risk TC.
WTAP participates in neuronal damage by protein translation of NLRP3 in an m6A-YTHDF1-dependent manner after traumatic brain injury
Authors: Chen Yuhua , Long Tianlin , Chen Junhui , Wei Hong , Meng Jiao , Kang Meili , Wang Juning , Zhang Xin , Xu Quanhua , Zhang Chi , Xiong Kun
Published: June 2024

Background

Traumatic brain injury (TBI) is a common complication of acute and severe neurosurgery. Remodeling of N6-methyladenosine (m6A) stabilization may be an attractive treatment option for neurological dysfunction after TBI. In the present study, the authors explored the epigenetic methylation of RNA-mediated NLRP3 inflammasome activation after TBI.

Methods

Neurological dysfunction, histopathology, and associated molecules were examined in conditional knockout (CKO) WTAP[flox/flox, Camk2a-cre], WTAPflox/flox, and pAAV-U6-shRNA-YTHDF1-transfected mice. Primary neurons were used in vitro to further explore the molecular mechanisms of action of WTAP/YTHDF1 following neural damage.

Results

The authors found that WTAP and m6A levels were upregulated at an early stage after TBI, and conditional deletion of WTAP in neurons did not affect neurological function but promoted functional recovery after TBI. Conditional deletion of WTAP in neurons suppressed neuroinflammation at the TBI early phase: WTAP could directly act on NLRP3 mRNA, regulate NLRP3 mRNA m6A level, and promote NLRP3 expression after neuronal injury. Further investigation found that YTH domain of YTHDF1 could directly bind to NLRP3 mRNA and regulate NLRP3 protein expression. YTHDF1 mutation or silencing improved neuronal injury, inhibited Caspase-1 activation, and decreased IL-1β levels. This effect was mediated via suppression of NLRP3 protein translation, which also reversed the stimulative effect of WTAP overexpression on NLRP3 expression and inflammation.

Conclusions

Our results indicate that WTAP participates in neuronal damage by protein translation of NLRP3 in an m6A-YTHDF1-dependent manner after TBI and that WTAP/m6A/YTHDF1 downregulation therapeutics is a viable and promising approach for preserving neuronal function after TBI, which can provide support for targeted drug development.
Long-term outcomes of active vaccination against de novo hepatitis B among pediatric recipients of living donor liver transplantations with anti-HBc (+) grafts: a retrospective case–control study
Authors: Yong Chee-Chien , Lin Yu-Hung , Espinosa Wendell Z. , Chen I-Hsuan , Wang Shih-Ho , Chan Yi-Chia , Chen Chao-Long , Lin Chih-Che
Published: June 2024

Background:

Active vaccination has been utilized to prevent de novo hepatitis B virus infection (DNHB) in anti-HBc (+) grafts after liver transplantation. However, the long-term efficacy of active vaccination and graft/patient outcomes of anti-HBc (+) grafts have yet to be comprehensively investigated.

Materials and methods:

Among 204 pediatric patients enrolled in the study, 82 recipients received anti-HBc (+) grafts. For DNHB prevention, active vaccination was repeatedly administered prior to transplant. Antiviral therapy was given to patients with pretransplant anti-HBs <1000 IU/ml (nonrobust response) for 2 years and discontinued when post-transplant patients achieved anti-HBs >1000 IU/ml, while antiviral therapy was not given in patients with an anti-HBs titer over 1000 IU/ml. The primary outcome was to investigate the long-term efficacy of active vaccination, while the secondary outcomes included the graft and patient survival rates.

Results:

Among the 82 anti-HBc (+) transplant patients, 68% of recipients achieved a robust immune response, thus not requiring antiviral therapy. Two patients (2.4%) developed DNHB infection, one of which was due to an escape mutant. With a median follow-up of 150 months, the overall 10-year patient and graft survival rates were significantly worse in recipients of anti-HBc (+) grafts than those of anti-HBc (-) grafts (85.2 vs 93.4%, P=0.026; 85.1 vs 93.4%, P=0.034, respectively). Additionally, the 10-year patient and graft outcomes of the anti-HBc (+) graft recipients were significantly worse than those of the anti-HBc (-) graft recipients after excluding early mortality and nongraft mortality values (90.8 vs 96.6%, P=0.036; 93.0 vs 98.3%, P=0.011, respectively).

Conclusion:

Our long-term follow-up study demonstrates that active vaccination is a simple, cost-effective strategy against DNHB infection in anti-HBc (+) graft patients, whereby the need for life-long antiviral therapy is removed. Notably, both the anti-HBc (+) grafts and patients exhibited inferior long-term survival rates, although the exact mechanisms remain unclear.
Association between magnesium depletion score and the prevalence of kidney stones in the low primary income ratio: a cross-sectional study of NHANES 2007–2018
Authors: Wang Jiahao , Xiao Yunfei , Yang Yaqing , Yin Shan , Cui Jianwei , Huang Ke , Wang Jia , Bai Yunjin
Published: June 2024

Introduction:

To explore the association between magnesium depletion score (MgDS) and the prevalence of kidney stones in the low primary income ratio (PIR).

Method:

A cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey 2007–2018. Within the low PIR, people aged ≥20 years with complete information on MgDS and kidney stones questionnaires were enrolled. Multivariable logistic regression and stratified logistic regression analyses were performed to examine the association between MgDS and the prevalence of kidney stones and the recurrence of kidney stones by confounding factors adjusted. Stratified and interaction analysis was conducted to find whether some factors modified the association. In addition, sensitive analyses were also conducted to observe the stability. The work has been reported in line with the strengthening the reporting of cohort, cross-sectional, and case–control studies in surgery (STROCSS) criteria (Supplemental Digital Content 1, http://links.lww.com/JS9/C781).

Result:

A total of 7600 adults were involved in the study, and the individuals were classified into four groups: 0 points for MgDS (n=3814), 1 point for MgDS (n=2229), 2 points for MgDS (n=1020), and ≥3 points for MgDS (n=537). The multivariable logistic regression suggested that a positive association between MgDS and the prevalence of kidney stones (OR=1.123, 95% CI: 1.019–1.238) in the fully adjusted model. Compared with the lowest group, people with ≥3 points of MgDS had a significant relationship with kidney stones (OR=1.417, 95% CI: 1.013–1.983). No significant association was observed between the recurrence of kidney stones and MgDS. The result of the sensitive analysis showed the robustness of the main analysis.

Conclusion:

The prevalence of kidney stones is positively correlated with MgDS, which suggests that maintaining a higher MgDS is accompanied by higher prevalence rates of kidney stones in the low PIR.
Enhancing WHO prescription writing guideline adherence through an educational intervention: a quality improvement study of Azad Jammu and Kashmir
Authors: Ahmed Mushood , Ahsan Areeba , Selal Zia Muhammad , Tul Ain Qura , Khurshid Salwa , Basit Jawad , Ahmad Tagwa Kalool Fadlalla
Published: June 2024

Background:

Prescription writing is an important component of healthcare delivery and can directly influence patient safety and treatment outcomes. Prescription errors are common in developing countries because of the lack of national guidelines. This two-cycle clinical audit assessed the impact of educational interventions on improving prescription writing practices.

Methods:

A cross-sectional prospective clinical audit was conducted in the Out Patients Department (OPD) of the District Head Quarters (DHQ) Hospital in Bhimber, Azad Jammu, and Kashmir. A total of 100 randomly selected prescriptions were reviewed for each cycle from July to August 2023. The authors recorded compliance with WHO guidelines for prescription writing before and after the educational intervention. Microsoft Excel and SPSS version 25.0 were used for statistical analysis. Categorical variables were analyzed using frequencies and percentages.

Results:

An improvement in compliance was observed during the second audit cycle, after the educational intervention. The greatest improvement was observed in documenting the allergic status of patients (62%) and the direction of drug administration (40%). The authors also observed improvements in the treatment duration (>10%), patient weight, physician registration number, diagnosis, and follow-up advice. The legibility of prescriptions also improved during the second audit cycle.

Conclusion:

This study shows that integrating an educational intervention into a clinical audit can improve prescription writing practices and ultimately result in a better quality of care for patients.
Comprehensive deep learning-based assessment of living liver donor CT angiography: from vascular segmentation to volumetric analysis
Authors: Oh Namkee , Kim Jae-Hun , Rhu Jinsoo , Jeong Woo Kyoung , Choi Gyu-Seong , Kim Jongman , Joh Jae-Won
Published: June 2024

Background:

Precise preoperative assessment of liver vasculature and volume in living donor liver transplantation is essential for donor safety and recipient surgery. Traditional manual segmentation methods are being supplemented by deep learning (DL) models, which may offer more consistent and efficient volumetric evaluations.

Methods:

This study analyzed living liver donors from Samsung Medical Center using preoperative CT angiography data between April 2022 and February 2023. A DL-based 3D residual U-Net model was developed and trained on segmented CT images to calculate the liver volume and segment vasculature, with its performance compared to traditional manual segmentation by surgeons and actual graft weight.

Results:

The DL model achieved high concordance with manual methods, exhibiting Dice Similarity Coefficients of 0.94±0.01 for the right lobe and 0.91±0.02 for the left lobe. The liver volume estimates by DL model closely matched those of surgeons, with a mean discrepancy of 9.18 ml, and correlated more strongly with actual graft weights (R-squared value of 0.76 compared to 0.68 for surgeons).

Conclusion:

The DL model demonstrates potential as a reliable tool for enhancing preoperative planning in liver transplantation, offering consistency and efficiency in volumetric assessment. Further validation is required to establish its generalizability across various clinical settings and imaging protocols.
Neurorehabilitation in a Pediatric Stroke Patient Supported on a CentriMag
Authors: Kwong Joann , Rizzuto Sandra , Hollander Amanda M. , Rivera Jennifer , Dykes John C. , Jahadi Ozzie , Murray Jenna , Hollander Seth A.
Published: June 2024

Patients supported on ventricular assist devices (VADs) benefit from rehabilitation while awaiting heart transplantation to recover from surgery, prevent deconditioning, and, in most cases, optimize transplant candidacy. With bleeding and neurological dysfunction as the most common VAD complications, the importance of rehabilitation dramatically increases when a patient on a VAD also suffers from a neurological injury. The rehabilitation needs for cardiac conditioning and neurological reeducation are not the same. Patients with severe neurological deficits require intense rehabilitation that often includes base-of-support challenges, usage of bolsters and balls, partial weight-bearing treadmill training, and assumption of various body positions in prone, kneeling, or quadruped for neuromotor reeducation. However, some devices are more conducive to rehabilitation than others. For children supported by the CentriMag in particular, rehabilitation is challenged by short cannula tubing, an external motor, a large interface, and an intensive care unit (ICU) admission. We report a safe and successful physical therapy course of a pediatric stroke patient with a diagnosis of Ebstein’s anomaly supported by a CentriMag right VAD (RVAD) while awaiting heart transplant in the ICU.
Clinical study of dance art therapy on hospitalized patients with chronic schizophrenia
Authors: Kong Yan , Min Haiying , Zhu Xiaochun , Zhang Lei , Hu Jianjun
Published: June 2024

Background:

To explore the effect of dance art on the treatment of hospitalized patients with chronic schizophrenia.

Methods:

In a prospective randomized controlled study conducted from June 2019 to June 2020, 120 patients from Shanghai Pudong New Area Mental Health Center were divided into intervention (n = 60) and control (n = 60) groups using a random number table. Control patients received standard drug treatment and nursing care, while the intervention group underwent dance art therapy sessions for 90 minutes twice weekly, in addition to standard care. Treatment outcomes after 6 and 12 weeks were measured using the positive and negative symptom scale (PANSS), Wisconsin Card Sorting Test (WCST), Montreal Cognitive Assessment Scale (MoCA), and body mass index (BMI).

Results:

This study involved 120 male patients with chronic schizophrenia, aged 30 to 60 years. After 6 and 12 weeks, the intervention group showed a greater reduction in PANSS scores (intervention group: from 49.02 ± 2.53 to 37.02 ± 1.83, control group: from 49.08 ± 2.59 to 44.91 ± 2.35, P < .05). In the WCST, the intervention group exhibited a higher increase in classification completion and correct answers, and a greater decrease in errors (P < .05). MoCA scores improved significantly in the intervention group compared to the control group (P < .05). BMI decreased in both groups, with a more pronounced reduction in the intervention group (intervention group: from 26.47 ± 1.05 kg/m² to 22.87 ± 0.73 kg/m², control group: from 26.50 ± 1.03 kg/m² to 26.22 ± 0.80 kg/m², P < .05).

Conclusion:

Based on routine drug treatment and routine nursing care, dance art has a better clinical effect in treating hospitalized patients with chronic schizophrenia, which can improve cognitive function, alleviate clinical symptoms, and reduce BMI.
Summary of the effect of an exercise intervention on elderly with mild cognitive impairment: A systematic review and meta-analysis
Authors: Liu Xiaotang , Liu Lanjuan , Liu Cheng
Published: June 2024

Background:

Many randomized controlled trials have demonstrated that exercise benefits cognitive function in patients with mild cognitive impairment (MCI), but less attention has been paid to the development of exercise programs in this population.

Objective:

This study aimed to assess the effect of exercise intervention for elderly with MCI and provide the most effective exercise intervention plan.

Methods:

We searched 4 international databases (PubMed, EMBASE, Web of Science, Cochrane Library) and 4 Chinese databases (Chinese National Knowledge Infrastructure, VIP database and Wanfang database) for studies on exercises associated with MCI up to September 25, 2022. The resulting standardized mean differences (SMD) and 95% confidence intervals were statistically analyzed using Review Manager 5.3 software.

Results:

A total of 20 RCTs were comprised in this meta-analysis, including 1393 participants. The results of the meta-analysis revealed that exercise had positive effects on cognitive function in elderly with MCI and was statistically significant (SMD = 1.25, 95%CI: [0.88,1.62], P < .00001). Subgroup analysis showed that the most significant factor was the Peterson 2004 criteria, multi-exercise, 35 to 50 minutes/times, <3 times/3 to 5 times per week, >16 weeks and medium intensity.

Conclusion:

Exercise intervention can significantly alleviate cognition in elderly with MCI. The best exercise program for exercise intervention for MCI is: multi-exercise, 35 to 50 minutes/times, 3 to 5 times/week, and exercise cycle for more than 16 weeks with medium intensity, has the best effect. Plus, more RCTs with larger sample sizes will be required in the future to demonstrate the link between exercise duration, intensity, and cognitive function.
Comparative study of choline alfoscerate as a combination therapy with donepezil: A mixed double-blind randomized controlled and open-label observation trial
Authors: Lee Wankiun , Kim Manho
Published: June 2024

Background:

Choline alfoscerate (alpha-glycerylphosphorylcholine) is a phospholipid that includes choline, which increases the release of acetylcholine. The ASCOMALVA trial, a combination of donepezil and choline alfoscerate, slowed cognitive decline in Alzheimer disease. This study aims to replicate the effect by combining donepezil with other nootropics currently used in South Korea.

Methods:

The 119 patients with cognitive decline who were eligible to use donepezil, with an mini-mental state examination (MMSE) score of 26 or less, were assigned to: donepezil alone (DO); donepezil and choline alfoscerate (DN); donepezil and acetyl-l-carnitine (DA); or donepezil and ginkgo biloba extract (DG). Cognitive evaluations such as MMSE, clinical dementia rating, Alzheimer disease assessment scale-cognitive subscale (ADAS-Cog), and Alzheimer disease assessment scale-noncognitive subscale were performed at the 12th and 24th weeks from the baseline time point.

Results:

At the 12th week, the MMSE score increased 3.52% in the DN group, whereas it increased by 1.36% in the DO group. In the DA + DG group, it decreased by 2.17%. At the 24th week, the MMSE score showed an increase of 1.07% in the DO group and 1.61% in the DN group, but decreased by 5.71% in the DA + DG group. ADAS-Cog decreased by 0.9% in the DO group, while it improved by 13.9% in the DN group at the 12th week. At the 24th week, ADAS-Cog showed improvement in the DN group by 18.5%, whereas it improved by 9.4% in the DO group. Alzheimer disease assessment scale-noncognitive subscale also revealed better performance in the DN group than in the DO group at the 12th and 24th weeks.

Conclusion:

Choline alfoscerate exhibits additional cognitive improvement in both cognitive and noncognitive domains, supporting the findings of the ASCOMALVA trial.
An outline of the management and prevention of postoperative ileus: A review
Authors: Iskander Othman
Published: June 2024

Postoperative ileus (POI) is a prevalent surgical complication, which results in prolonged hospitalization, patient distress, and substantial economic burden. The literature aims to present a brief outline of interventions for preventing and treating POI post-surgery. Data from 2014 to 2023 were gathered from reputable sources like PubMed, PubMed Central, Google Scholar, Research Gate, and Science Direct. Inclusion criteria focused on studies exploring innovative treatments and prevention strategies for POI, using keywords such as novel POI treatments, non-pharmacological prevention, POI incidence rates, POI management, and risk factors. The findings revealed that integration of preventive measures such as coffee consumption, chewing gum, probiotics, and use of dikenchuto within enhanced recovery programs has significantly reduced both the frequency and duration of POI, without any adverse effects, with minimally invasive surgical approaches showing promise as an additional preventive strategy. While treatment options such as alvimopan, NSAIDs, and acupuncture have demonstrated efficacy, the use of lidocaine has raised concerns due to associated adverse effects. The ongoing exploration of novel therapeutic strategies such as targeting the mast cells, vagal nerve stimulation and tight junction protein, and prokinetic-mediated instigation of the cholinergic anti-inflammatory trail not only holds promise for enhanced treatment but also deepens the understanding of intricate cellular and molecular pathways underlying POI. POI presents a complex challenge in various surgical specialties, necessitating a multifaceted management approach. The integration of preventive and treatment measures within enhanced recovery programs has significantly reduced POI frequency and duration.
A bibliometric analysis from 2013 to 2024 reveals research hotspots and trends in the connection between atrial fibrillation and cryoballoon: An observational study
Authors: Lu Jing , Zhang Nan , Yang Fan , Gao Yu , Ren Yan , Ma Dengfeng
Published: June 2024

Using bibliometric analysis, this study attempted to provide an overview of the current state of research and key findings regarding the relationship between atrial fibrillation (AF) and cryoballoons in general. We gathered the literature from the Web of Science (WOS) database covering the last 11 years (2013–2024) pertaining to AF and cryoballoons, and we used Citespace to evaluate the mapping of knowledge. The findings demonstrated that there were 1986 articles concerning AF and cryoballoons, with a faster growth after 2018. The United States, Vrije Universiteit Brussel, and Chierchia, Gian-Battista are the nation, organization, and writer with the highest number of publications. Kuck KH (2016) is the most frequently mentioned reference as well (488). We know that Vrije Universiteit Brusse in the Belgium has emerged as 1 of this discipline’s leading research forces based on a 10-year bibliometric investigation. Prominent universities and developed nations form the finest alliances for research on cryoballoons and AF.
Efficacy of early integrated rehabilitation therapy on treatment outcomes and limb functional recovery in patients with cerebral embolism: An observational study
Authors: Ban Weigu , Qing Peng , Teng Xiuying , Lu Lina , Qi Hui
Published: June 2024

Cerebral embolism presents a significant challenge for recovery of motor and neurological function. Early integrated rehabilitation therapy (EIRT) has been proposed as a beneficial approach, yet its efficacy requires thorough evaluation. This retrospective study, conducted from January 2020 to January 2023, involved 117 patient’s post-cerebral embolism, divided into an EIRT group (n = 56) receiving EIRT and a control group (n = 61) receiving standard care. The Fugl-Meyer Assessment (FMA) and the National Institutes of Health Stroke Scale (NIHSS) were used to evaluate motor and neurological functions, while muscle strength was categorized from Level 0 (complete paralysis) to Level V (normal strength) to assess physical recovery. Eligibility centered on confirmed cerebral embolism diagnosis, timing of poststroke admission, and baseline functional status. The study adhered to strict ethical standards, with informed consent obtained from all participants. The EIRT group showed substantial improvements in both FMA and NIHSS scores compared to the control group, indicating better motor and neurological recovery. Significant differences were found in the posttreatment FMA (P < .01) and NIHSS scores (P < .01). Muscle strength analysis further confirmed the positive impact of EIRT with more patients in the EIRT group achieving higher levels of muscle strength at discharge. The study demonstrates the potential of EIRT to significantly improve motor and neurological outcomes for patient’s post-cerebral embolism. The marked improvements in the observation group suggest that EIRT should be considered for broader application in stroke rehabilitation to enhance recovery and improve quality of life.
Study of the cement implantation syndrome: A review
Authors: Yang Yunze , Meng Xianyu , Huang Yiran
Published: June 2024

Bone cement implantation syndrome (BCIS) is a critical and potentially life-threatening condition that manifests during implantation. Characterized by a constellation of symptoms, including hypoxemia, hypotension, cardiac arrhythmias, elevated pulmonary vascular resistance, and occasionally cardiac arrest, BCIS typically ensues shortly after cement introduction, albeit with rare instances of delayed onset. Primarily attributed to the exothermic reaction of bone cement implantation, this syndrome is caused by local tissue damage, histamine and prostaglandin release, and microemboli formation, ultimately triggering a systemic immune response that culminates in respiratory and circulatory failure. The current hypotheses regarding BCIS include embolism, allergic reactions, and cement autotoxicity. BCIS management emphasizes preventative strategies, encompassing meticulous patient risk assessment, comprehensive preoperative and intraoperative evaluations, and precise cement application techniques. Treatment primarily involves symptomatic therapy and life-support measures to address the systemic effects of the syndrome.