bluuebunny/crossref_metadata_2025 huggingface dataset:
Increasing Prevalence of Pediatric Community-acquired UTI by Extended Spectrum β-Lactamase-producing E. coli: Cause for Concern
Authors: Collingwood Joshua D. , Yarbrough April H. , Boppana Suresh B. , Dangle Pankaj P.
Published: January 2023

Background:

Antimicrobial resistance and emerging spectrum-β-lactamase (ESBL) infections are a rising concern in public health. Despite the increasing prevalence of community-acquired (CA) ESBL-E. coli UTIs, there is little data on the antibiotic resistance profiles of this bacterial strain in the pediatric population. We review antibiotic resistance profile and rising trend in pediatric ESBL-E. coli UTI presentation at our pediatric hospital.

Methods:

This retrospective study reviewed data drawn from the infectious disease database at our pediatric hospital for all patients whose urine culture grew ESBL-E. coli from 01/2015 to 01/2021. Demographic information and antimicrobial susceptibility test results for ESBL-E. coli isolates from CA-UTIs were collected. Annual changes in resistance to antimicrobial agents and average annual percent change in ESBL-E. coli UTI presentation over the study period are reported.

Results:

From 01/2015 to 01/2021, 6403 urine cultures at our hospital grew E. coli. Of these, 169 urine cultures from 135 children grew ESBL-E. coli. The study population was 57% male (77) with a mean age of 6.9 ± 6.2 years and multiethnic. CA-UTI by ESBL-producing E. coli accounted for 2.62% of total E. coli UTIs within the study period and increased from 0.97% in 2015 to 3.54% in 2020 by an average of 0.51% each year.

Conclusions:

These findings demonstrate an increase in CA-ESBL E. coli UTIs in children. We observed most isolates demonstrated multidrug resistance. As CA-ESBL E. coli UTIs are associated with prolonged hospitalization and increased morbidity, our findings highlight the rising trend in pediatric CA-ESBL E. coli UTI.
Considerations to Improve Pediatric HIV Testing and Close the Treatment Gap in 16 African Countries
Authors: Gross Jessica , Medley Amy , Rivadeneira Emilia , Battey Katherine , Srivastava Meena , Grillo Michael , Wolf Hilary , Simmons Paige , Hast Marisa , Patel Monita
Published: January 2023

Background:

In 2019, South Africa, Nigeria, Tanzania, Democratic Republic of Congo, Uganda, Mozambique, Zambia, Angola, Cameroon, Zimbabwe, Ghana, Ethiopia, Malawi, Kenya, South Sudan and Côte d’Ivoire accounted for 80% of children living with HIV (CLHIV) not receiving HIV treatment. This manuscript describes pediatric HIV testing to inform case-finding strategies.

Methods:

We analyzed US President’s Emergency Plan for AIDS Relief monitoring, evaluation, and reporting data (October 1, 2018 to September 30, 2019) for these 16 countries. Number of HIV tests and positive results were reported by age band, country, treatment coverage and testing modality. The number needed to test (NNT) to identify 1 new CLHIV 1–14 years was measured by testing modality and country. The pediatric testing gap was estimated by multiplying the estimated number of CLHIV unaware of their status by NNT per country.

Results:

Among children, 6,961,225 HIV tests were conducted, and 101,762 CLHIV were identified (NNT 68), meeting 17.6% of the pediatric testing need. Index testing accounted for 13.0% of HIV tests (29.7% of positive results, NNT 30), provider-initiated testing and counseling 65.9% of tests (43.6% of positives, NNT 103), and universal testing at sick entry points 5.3% of tests (6.5% of positives, NNT 58).

Conclusions:

As countries near HIV epidemic control for adults, the need to increase pediatric testing continues. Each testing modality – PITC, universal testing at sick entry points, and index testing – offers unique benefits. These results illustrate the comparative advantages of including a strategic mix of testing modalities in national programs to increase pediatric HIV case finding.
Comparison of 18F-FDG PET/CT imaging with different dual time 18F-FDG PET/CT with forced diuresis in clinical diagnosis of prostate cancer
Authors: Yu Longhua , Huang Shiming , Wu Siyu , Yue Jianlan , Yin Liang , Lin Zhichun
Published: January 2023

The aim of this study was to compare the capability of different dual time (interval 1, 2, 3, or 4 hours) 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) with forced diuresis to diagnose prostate cancer (PCa). A retrospective review of 273 male patients from March 2009 to June 2019, with any focal 18F-FDG uptake in the prostate gland during PET/CT imaging. Early PET/CT imaging was performed 60 minutes after FDG injection. Delayed imaging was performed 1 to 4 hours after diuretic injection. For prostate lesions with increased 18F-FDG uptake, a spheroid-shaped volume of interest was drawn, including the entire lesion, and the maximum standard uptake value (SUVmax) of the lesion was measured. The SUVmax > 2.5 after delayed imaging and the retention index > 15% were used as the diagnostic criteria for PET/CT in the diagnosis of PCa. Otherwise, it was diagnosed as the benign prostate disease. The final diagnosis was based on histological examination, associated imaging studies, or/and clinical follow-up. The results of inter-group comparison showed that the SUVmax of 1-, 2-, 3-, and 4-hour delayed imaging after diuresis in PCa group was significantly higher than that in control group (P < .05), but there was no statistical difference in SUVmax of early imaging between PCa and control group (P > .05). And the retention index of PCa group that delayed 1, 2, 3, and 4 hours after diuresis were significantly higher than those of control group, respectively (P < .05). The diagnostic sensitivity of imaging delayed 1, 2, 3, and 4 hours after diuresis was 68.8%, 81.2%, 85.7 %, and 71.4%, the specificity was 52.5%, 74.5%, 70.6%, and 65.0%, and the accuracy was respectively 58.2%, 77.4%, 76.4%, and 67.6%, the positive predictive values were 44.0%, 68.9%, 64.3%, and 58.8%, and the negative predictive value were 75.6%, 85.4%, 88.9%, and 76.5%, respectively. 18F-FDG PET/CT imaging as an imaging tool lacks certain specificity in the diagnosis of PCa, regardless of whether the imaging is delayed. The main advantage of delayed diuretic imaging in PCa is that it can significantly improve the sensitivity, especially the diagnostic effect delayed 2 hours after diuresis is better.
Isolated splenic metastases from rectal carcinoma 5 years after surgery: Case report
Authors: Xu Jie , He Yanan , Cai Yu , Huang Yi , He Yuanyang
Published: January 2023

Introduction:

Splenic malignancies are mostly lymphocytic tumors and splenic metastases are rarer.[1] According to reports, the most common source of splenic metastases include melanoma, tumors of the breast, lung, ovary, colon, stomach, and pancreas.[2,3]

Patient concerns:

This paper reports a 41-year-old male patient who underwent a successful resection of low rectal cancer in our hospital 5 years ago.

Diagnosis:

Three months ago, computed tomography scan revealed a tumor in the spleen, considered as an isolated metastasis.

Interventions:

The patient underwent splenectomy and postoperative pathological examination confirmed metastatic adenocarcinoma.

Outcomes:

The patient was followed up for 3 months after surgery, there was no abdominal metastasis or recurrence.

Conclusion:

The splenic metastasis from rectal carcinoma 5 years after surgery is rare. If it is a solitary splenic metastasis, splenectomy can effectively improve the prognosis of patients. We review the literature and report this case.
Robotic-assisted combined transposition of left renal vein and gonadal vein as a novel treatment option for renal nutcracker syndrome: A case report
Authors: Wang Hua , Huang Zhansen , Hu Cheng , Wu Jieying , Huang Qunxiong , Li Tengcheng , Di Jinming
Published: January 2023

Rationale:

Renal nutcracker syndrome is a rare phenomenon that often causes various disability symptoms. The treatment protocol has been explored for a long time, but no consensus has been reached.

Patient concerns:

Here, we report the case of a 19-year-old male suffering with nutcracker syndrome, including left-sided flank pain and intermittent gross hematuria.

Diagnoses:

The patient was diagnosed with renal nutcracker syndrome, and the pressure gradient between the left renal vein and inferior vena cava was >5 mm Hg.

Interventions:

The patient underwentrobotic-assisted combined transposition of left renal vein and gonadal vein.

Outcomes:

Flank pain and gross hematuria ceased spontaneously after surgery without occurrence.

Lessons:

Robotic-assisted combined transposition of the left renal vein and gonadal vein is a safe and promising option for this condition.
Study on predictive factors of blood culture results in leukemia patients with fever during chemotherapy
Authors: Liu Mengjia , Wu Ying , Qi Peijing , Zhang Ruidong
Published: January 2023

Infection is a common complication of leukemia patients undergoing chemotherapy. Blood culture results are often needed to guide clinical use, but repeated sampling is often necessary to improve the positive rate and eliminate contamination. The purpose of this paper is to find predictive factors of blood culture results among clinical and laboratory indicators and try to establish a prediction model, so as to better choose the time of blood culture examination, predict the results, and better guide clinical treatment. We retrospectively collected clinical and laboratory data of febrile acute leukemia patients undergoing chemotherapy. The samples were randomly assigned to the training set and the validation set, and the prediction model was constructed from the training set. The calibration curve was made in the validation set and the Hosmer-Lemeshow test was performed to evaluate the prediction performance of the prediction model. A total of 229 patients were included. Univariate and multivariate analyses suggested that temperature at fever and procalcitonin were variables of significant difference between positive and negative blood culture patients. The sensitivity of the 2 variables for predicting blood culture results was high, but the specificity was low. In the process of external validation, the predictive ability of the constructed prediction model to the blood culture results was low. This study identified clinical and laboratory parameters associated with blood culture outcomes, but the predictive model established has low predictive accuracy in external validation.
Comparison of predictive value of FRAX, trabecular bone score, and bone mineral density for vertebral fractures in systemic sclerosis: A cross-sectional study
Authors: Lee Kyung-Ann , Kim Hyun-Joo , Kim Hyun-Sook
Published: January 2023

Assessing fracture risk is important for managing patients with systemic sclerosis (SSc). Vertebral fracture (VF) is the most common fracture and is associated with future VF and non-VF. We aimed to evaluate the predictive value of FRAX, trabecular bone score (TBS), and bone mineral density (BMD) for VFs, compared to rheumatoid arthritis (RA) patients and postmenopausal women, and to identify risk factors for VFs in SSc. In this cross-sectional study, prevalent VFs, 10-year probability of major osteoporotic fracture by FRAX (FRAX-MOF), TBS, and BMD were assessed in women with SSc (n = 69) and RA (n = 58), and postmenopausal women (n = 38). Risk factors for osteoporosis, modified Rodnan total skin score (mRSS), organ involvement, and patterns of nailfold capillaroscopy (NFC) were also evaluated. The accuracy of BMD (T-score ≤ −2.5), TBS and FRAX-MOF, with and without TBS adjustment, to detect prevalent VF was assessed by determining the area under the receiver operating characteristic (ROC) curve. Patients with SSc (14.5%) and RA (17.2%) had significantly more VFs than postmenopausal women (0%) (P = .031). Non-significant differences were observed in TBS and BMD of all groups. The FRAX-MOF were higher in RA (9.2%) than SSc group (6.1%) and postmenopausal women (5.5%) (P < .001). Based on the ROC curve, TBS-adjusted FRAX-MOF (0.803) showed largest area under curve (AUC) to detect the prevalent VFs, followed by FRAX-MOF (0.796), TBS (0.765), and BMD (0.588) in the SSc group. In the RA group, FRAX-MOF had the largest AUC (0.896), followed by TBS-adjusted FRAX-MOF (0.863), TBS (0.736), and BMD (0.686). The cutoffs for FRAX-MOF and TBS-adjusted FRAX-MOF for detecting VFs were 8.95% and 9.7% for SSc, and 14.5% and 14% for RA. No association between VFs and SSc subtypes, organ involvement, mRSS or NFC patterns was found. FRAX-MOF, with or without TBS, had better predictive value for VFs than BMD and TBS in SSc. However, FRAX-MOF underestimated the probability of VFs in SSc compared with RA.
Treatment outcomes of modified argon laser photocoagulation for conjunctivochalasis
Authors: Han Jisang , Lee Shin-Hyo , Choi Chul Young , Shin Hyun Jin
Published: January 2023

To determine the effectiveness of conjunctivoplasty using a modified argon laser photocoagulation method on patients with conjunctivochalasis (CCh). This study included 25 cases of symptomatic inferior CCh. After staining the surface of a redundant conjunctiva using a dark-purple marker, low-energy argon laser photocoagulation (500 μm spot size for 0.5 seconds at power 300 mW) was applied under topical anesthesia for a mean of 80 times. The patients were aged 67.6 ± 7.1 years (mean ± standard deviation). During a mean follow-up period of 7.8 months (range of 6–12 months), the CCh grades of 21 eyes (84%) decreased after laser conjunctivoplasty. Calculated reduction rates of grades 1, 2, and 3 were 90%, 75%, and 67%, respectively. Patient subjective symptoms were improved in 80% of cases. No postoperative complications such as conjunctival scarring or persistent ocular irritation were observed. Our modified argon laser photocoagulation method employs staining the conjunctival surface to increase the thermal laser energy absorbed by the target. This novel technique is simple and effective for treating mild-to-moderate-grade CCh in outpatient clinics.
Off-label use of an iliac branch device and a reversed iliac limb for a patient with a unilateral common iliac artery aneurysm and a narrow distal aorta: A case report
Authors: Hwang Deokbi , Yun Woo-Sung , Kim Hyung-Kee , Huh Seung
Published: January 2023

Introduction:

Current bifurcated aortic endografts are unsuitable for patients with a narrow distal aorta except AFX2, which is unavailable in South Korea. An iliac branch device (IBD) was introduced to exclude iliac aneurysms while preserving the pelvic circulation. With advancements in endovascular techniques, various attempts for outside instructions for use have been reported to be practicable in certain patients.

Patient concerns:

A 58-year-old man was referred to our emergency room with an incidentally found left common iliac artery aneurysm (CIAA) in a general checkup.

Diagnoses:

Computed tomography angiogram showed a narrow distal aorta that tapered from 20 mm just below the renal artery to 13 mm at aortic bifurcation and a left isolated CIAA with a maximal diameter of 40 mm and 70 mm in length.

Interventions:

After left hypogastric artery embolization, the Cook IBD was placed at the aortic bifurcation, and the Bard Covera Plus stent-graft was deployed from the IBD cuff to the left external iliac artery. Then, a reversed Medtronic Endurant iliac limb was implanted into the infrarenal aorta down to the proximal IBD.

Outcomes:

The stent grafts were patent without endoleak at the 6-month follow-up.

Lessons:

In selected patients with an isolated CIAA with a narrow distal aorta, IBD can be used as a main body at the aortic bifurcation for successful aneurysm exclusion. However, considering the application of outside instructions for use, special attention and careful planning must be taken before the procedure.
Efficacy of ultrasound-guided acupotomy for knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials
Authors: Lin Sixiong , Lai Chuanshi , Wang Jinxin , Lin Yating , Tu Yinyong , Yang Yuanfang , Zhang Renpan
Published: January 2023

Background:

This systematic review aimed to evaluate the effectiveness and safety of ultrasound-guided acupotomy (UGAT) therapy in the treatment of patients with knee osteoarthritis (KOA).

Methods:

We conducted online researches in the databases including PubMed, the Cochrane Library, EMBASE, China national knowledge infrastructure, China biomedical literature database, and Wan Fang data. All data were collected until January 1, 2022. Relevant randomized controlled trials on the effectiveness of UGAT for the treatment of KOA were included. Meta-analyses were carried out by RevMan 5.3 software. Evidence quality was evaluated by the grading of recommendations, assessment development, and evaluation.

Results:

Eight studies including 543 participants were analyzed in this study. The pooled analysis indicated that UGAT was significantly more efficient than the control group in decreasing the visual analogue scale score (mean difference = −0.81, 95% confidence interval (CI) = [−1.15, −0.47], P < .00001, 8 studies), improving knee function on the Lysholm knee score (mean difference = 8.26, 95% CI = [1.56, 14.97], P = .02, 2 studies), and increasing clinical effective rate (relative risk = 1.14, 95% CI = [1.06, 1.23], P = .0005, 6 studies). For adverse events, UGAT was also associated with lower incidence of adverse event (odds ratio = 0.27, 95% CI = [0.12, 0.63], P = .002, 4 studies) compared to traditional acupotomy.

Conclusion:

Current evidence suggested that UGAT therapy was effective and safe in the clinical treatments of KOA, thus could be suggested in the clinical managements of KOA. However, considering the unsatisfactory quality of the available trials, more large-scale, and better quality randomized controlled trials were recommend in future.
Predictors of intracranial hemorrhage after mechanical thrombectomy using a stent-retriever for anterior circulation ischemic stroke: A retrospective study
Authors: Lee In-Hyoung , Ha Sung-Kon , Lim Dong-Jun , Choi Jong-Il
Published: January 2023

Intracranial hemorrhage (ICH) after mechanical thrombectomy (MT) is a potentially catastrophic complication. We aimed to identify predictors of hemorrhagic complications following MT using a stent-retriever (SR) for acute ischemic stroke (AIS) patients due to large vessel occlusion of anterior circulation. In consecutive AIS patients, the clinical and procedural variables were retrospectively analyzed. ICH was evaluated on computed tomography performed 24 hours following MT and dichotomized into asymptomatic ICH and symptomatic intracranial hemorrhage (SICH) depending on the presence of neurological deterioration. Using univariate and multivariate analyses, the predictors of ICH and SICH were identified. The optimal cutoff value for predicting SICH was determined by receiver operating characteristic (ROC) analysis. Among 135 patients, ICH was detected in 52 (38.5%), and 17 (12.6%) were classified as having SICH. We found that serum glucose level (odds ratio [OR] 1.016, P = .011) and number of SR passes (OR 2.607, P < .001) were significantly correlated with ICH. Independent predictors of SICH included the baseline Alberta stroke program early computed tomography score (ASPECTS) (OR 0.485, P = .042), time from stroke onset to groin puncture (OTP) (OR 1.033, P = .016), and number of SR passes (OR 2.342, P = .038). In ROC analysis, baseline ASPECTS ≤ 7, OTP > 280 minutes, and SR passes > 3 were the optimal cutoff values for predicting SICH. In conclusion, serum glucose level and SR pass serve as predictors for any form of ICH in large vessel occlusion-induced AIS patients undergoing MT. Moreover, patients with lower ASPECTS, prolonged OTP, and multiple SR passes are more vulnerable to SICH.
Anti-carbonic anhydrase II antibody reflects urinary acidification defect especially in proximal renal tubules in patients with primary Sjögren syndrome
Authors: Jin Yue-Bo , Dai Yi-Jun , Chen Jia-Li , Li Jing , Zhang Xia , Sun Xiao-Lin , He Jing
Published: January 2023

Primary Sjögren syndrome (pSS) is a systemic autoimmue disease featured by excessive autoantibody production. It has been demonstrated that anti-carbonic anhydrase II (anti-CA II) antibody is correlated with renal tubular acidosis in pSS; however, no further details about urinary acidification defect have been reported, and the antibody’s relationship with other organ impairments remains unknown. This case-control study aimed to examine anti-CA II antibody levels in relation to various systemic complications in pSS, and evaluate its potential role as a organ-specific biomarker in a Chinese cohort.

Serum anti-CA II antibody levels were determined using ELISA in 123 patients with pSS and 72 healthy controls. The medical records of the patients were collected, and the correlation between serum anti-CA II antibody and clinical/immunological parameters was investigated.

Serum anti-CA II antibody level and its positive rate were significantly increased in pSS patients compared with controls, and ANA-positive patients presented even higher titers of the antibody. In anti-CA II positive group, remarkably higher urine pH and bicarbonate, as well as lower urine titratable acid and serum potassium were observed, which indicated renal tubular acidification dysfunction both involving bicarbonate reabsorption and acid secretion. In addition, platelet count and complement 3, complement 4 levels decreased, whereas serum IgG, IgA and γ-globulin levels increased notably in accord with a higher EULAR SS disease activity index score in these patients. Further analysis showed that anti-CA II antibody was most elevated in patients with defect in bicarbonate reabsorption, reflecting proximal renal tubular injury, rather than in patients with distal renal tubular acidosis as previously reported.

In conclusion, anti-CA II antibody reflects renal (especially proximal renal tubular) and hematologic impairment as well as increased disease activity in pSS. It may act as a serum biomarker of systemic damage of pSS.
Clinical determinants of apathy and its impact on health-related quality of life in early Parkinson disease
Authors: Choi Seong-Min , Cho Soo Hyun , Choe Youngshik , Kim Byeong C.
Published: January 2023

Apathy is a common non-motor symptom of Parkinson disease (PD) that can affect the health-related quality of life (HRQoL) of patients and caregivers. This study aimed to investigate the clinical determinants of apathy and its impact on HRQoL in patients with early PD.

We enrolled 324 patients with early PD with modified Hoehn–Yahr stages 1 to 3 and a disease duration ≤5 years. Demographic information was obtained, and motor and non-motor symptoms were evaluated with relevant scales.

Apathy was present in 110 of 324 (33.9%) patients. Compared with patients with non-apathetic PD, those with apathetic PD had significantly higher modified Hoehn–Yahr stage, Unified Parkinson’s Disease Rating Scale-II (UPDRS-II) score, Non-Motor Symptoms Scale (NMSS) total score, Beck Depression Inventory (BDI) score, and Parkinson’s Disease Questionnaire-8 (PDQ-8) score. Clinical variables independently associated with the Apathy Evaluation Scale (AES) score were NMSS domain 3 score and BDI score. The univariate regression analysis revealed that the PDQ-8 score was significantly associated with age; disease duration; formal education duration; and UPDRS-III, UPDRS-II, NMSS total, Mini-Mental Status Examination, BDI, Beck Anxiety Inventory, and AES scores. Independent predictors of the PDQ-8 score in the multivariate regression analysis were UPDRS-III, UPDRS-II, NMSS total, NMSS domain 3, Beck Anxiety Inventory, and AES scores.

In the present study, apathy was an independent predictor of HRQoL in patients with early PD. Therefore, identifying and managing apathy could help improve HRQoL in patients with early PD.
Comparison of adenoma detection rate between high-definition colonoscopes with different fields of view: 170 degrees versus 140 degrees
Authors: Moon Sang Yi , Lee Jong Yoon , Lee Jong Hoon
Published: January 2023

In newer generation colonoscopes, the field of view (FOV) varies approximately between 170° and 140°, depending on the type of colonoscopy. To the best of our knowledge, no study has investigated whether the visual field difference of the colonoscope affects quality indicators, such as the adenoma detection rate (ADR), without using additional devices to expand the FOV in colonoscopes with the same resolution. This study aimed to investigate the difference in quality indicators, such as ADR, between 170° and 140° FOV in colonoscopes with the same high-definition resolution. We retrospectively analyzed the medical records of patients who underwent screening or surveillance colonoscopy at the Dong-A University Hospital in Busan, South Korea, between March 2021 and February 2022. We calculated the overall ADR ratios for patients who underwent colonoscopy with 140° and 170° FOV. Polyp detection rate (PDR), sessile serrated PDR, and advanced neoplasia detection rate were calculated for each group. Factors associated with adenoma detection were identified using a logistical regression analysis. A total of 1711 patients were included in the study (838 patients in the 170° group and 873 patients in the 140° group). ADR (43.79 vs 41.92%, P = .434) did not significantly differ between the 2 groups. The generational differences were not statistically significant either for PDR (56.44 vs 53.49%, P = .220), sessile serrated PDR (1.19 vs 0.92%, P = .575), or advanced neoplasia detection rate (5.00 vs 4.58%, P = .735). Multivariate regression analysis revealed that, age, male sex, and long withdrawal time were the most significant factors affecting adenoma detection. This study revealed that there were no differences in ADR while employing high definition colonoscopes with a 170° FOV and a 140° FOV.
3M microfoam™ surgical tape prevents nasal pressure injury associated with nasotracheal intubation: A randomized double-blind trial
Authors: Hashimoto Mayumi , Sato (Boku) Aiji , Sento Yoshiki , Kamimura Yuji , Kako Eisuke , Okuda Masahiro , Tachi Naoko , Okumura Yoko , Kuroda Izumi , Hoshijima Hiroshi , Ito Hidekazu , Sobue Kazuya
Published: January 2023

Background:

3M microfoam™ surgical tape (3ST: 3M Japan Limited) is used for pressure wound control of medical equipment. It is cushioned and can be fitted to any body part. Here we investigated whether 3ST prevents nasal pressure injury associated with nasotracheal intubation (NTI).

Methods:

We conducted a prospective, randomized double-blind study, enrolling 63 patients aged 20 to 70 years, who underwent general anesthesia with NTI. They were divided into 2 groups; those treated with 3ST (group S; n = 31) and control (group C; n = 31). After NTI and before securing the nasotracheal tube, a 35 × 25 mm 3ST was used to protect the nasal wing in group S, and the nasotracheal tube was fixed in place after NTI without protection in group C. The primary outcome was the presence or absence of nasal pressure injury after extubation. The Chi-Square test was used to assess the association between the 2 categorical variables.

Results:

Nasal pressure injury was observed in 7 and 19 patients from groups S and C, respectively, representing a significant difference between the 2 groups (24.1% vs 67.8%, P = .001). Remarkably, none of the patients developed ulcers.

Conclusion:

3ST prevents nasal pressure injury associated with NTI.
Observation of complications assessed by Clavien-Dindo classification in different endoscopic procedures of benign prostatic hyperplasia: An observational study
Authors: Pan Ting-ting , Li Sheng-Qun , Dai Ya , Qi Jia-Xian
Published: January 2023

The Clavien-Dindo classification (CDC) was widely used in the assessment of surgical complications, but some inconsistencies always existed in urological literature. This study was aimed to report complications of the transurethral resection of the prostate (TURP), plasmakinetic resection of the prostate (PKRP), and holmium laser enucleation of the prostate (HoLEP) by using a more detailed way under the framework of CDC. A total of 623 eligible cases underwent endoscopic procedures from January 2018 and December 2020 were divided into the TURP group (212 cases), the PKRP group (208 cases), and the HoLEP group (203 cases) according to the surgical type. Patients’ surgical complications assessed by the CDC were compared among the 3 groups. The operation time, intraoperative irrigation volume, postoperative irrigation time and volume, decrease in hemoglobin and sodium, postoperative catheterization time, visual analogue scale, hospital stay of the PKEP group and the HoLEP group were significantly less than those of the TURP group, and the decrease in hemoglobin and visual analogue scale in the HoLEP group were significantly lower than those in the PKEP group (all P < .05). The electrolyte disturbance, urinary tract irritation, and patients with grade II of CDC in the PKRP group were significantly lower than those in the TURP group; The electrolyte disturbance, lower abdominal pain, urinary tract irritation, intraoperative hemorrhage, secondary hemorrhage, clot retention, patients with grade I, II, III of CDC in the HoLEP group were significantly lower than those in the TURP group, and the urinary tract irritation, grade I, II of CDC in the HoLEP group was significantly lower than that in the PKRP group (all P < .05). The CDC should be recommended because of the enhanced insight into surgical complications, and the HoLEP should be given a priority for Benign prostatic hyperplasia (BPH) surgical treatment in terms of the merits in surgical characteristics and complications.
Inpatient Physical Therapy After Orthopedic Lower Extremity Surgery in Children With Cerebral Palsy
Authors: Bailes Amy F. , Mangeot Colleen , Murphy Natalie J. , Richardson Zachary , McCarthy James , McManus Beth M.
Published: January 2023

Purpose:

To characterize and examine the variability in receipt of inpatient (IP) physical therapy after lower extremity (LE) orthopedic surgery for individuals with cerebral palsy (CP) across hospital-level (region, bed size) and individual characteristics (gender, age, race/ethnicity, insurance type, technology dependency, and surgical burden).

Methods:

We retrospectively analyzed physical therapy billing data of children with CP who had LE orthopedic surgery from October 1, 2015, through September 30, 2017, from the Pediatric Health Information Services (PHIS) database.

Results:

Seventy-five percent of individuals received IP physical therapy during the hospital stay. Individuals from the South and West and those who were technology dependent were less likely to receive IP therapy. Those at large hospitals, aged 11 to 14 years, and with a high surgical burden were more likely to receive therapy.

Conclusions:

Results provide a starting point for future research on the discrepancies of acute physical therapy services in children diagnosed with CP. (Supplemental digital content video abstract available at: http://links.lww.com/PPT/A420)
Comparison of Gross Motor Outcomes Between Children With Cerebral Palsy From Appalachian and Non-Appalachian Counties
Authors: Bican Rachel , Noritz Garey , Heathcock Jill
Published: January 2023

Purpose:

This study evaluated gross motor outcomes between children with cerebral palsy from non-Appalachian and Appalachian counties in the United States.

Methods:

For this retrospective, matched-case controlled study, data were sourced from electronic medical record and compared between groups. Groups were matched by age and Gross Motor Function Classification System (GMFCS) level.

Results:

Children from Appalachian counties had significantly higher Gross Motor Function Measure, 66 (GMFM-66) scores and had a cerebral palsy diagnosis reported in the electronic medical record significantly later compared with children from non-Appalachian counties, controlling for age and GMFCS level.

Conclusion:

Although it has been documented that families and children from Appalachian counties have poorer overall health outcomes, motor development may not be affected. Our study found that children with cerebral palsy from Appalachian counties scored significantly higher on the GMFM-66 across GMFCS levels.
Factors Associated With Short-Term Recovery Following Single-Event Multilevel Surgery for Children With Cerebral Palsy
Authors: Lennon Nancy , Gerry Grace , Biermann Isabel , Beaman Jason , Mamula Nicole , Gilmore Abigail , Niiler Tim , Shrader M. Wade , Owens Laura L.
Published: January 2023

Purpose:

To examine the role of multiple factors, including therapy dose, on recovery of mobility function during post–single-event multilevel surgery (SEMLS) rehabilitation in youth with cerebral palsy.

Methods:

Several factors expected to influence postoperative change in Gross Motor Function Measure (GMFM) were examined: age, Gross Motor Function Classification System (GMFCS) level, cognition, number of osteotomies, surgical complications, medical comorbidities, number of therapy sessions, and preoperative measures of gait, balance, and gross motor function.

Results:

Sixty-nine youth with cerebral palsy, GMFSC levels I-IV, who had undergone SEMLS and rehabilitation had on average 2.6 osteotomies and 89 postoperative therapy sessions. Fewer osteotomies, higher therapy dose, higher preoperative GMFM, and lower GMFM at postoperative admission were significant in determining GMFM change.

Conclusions:

The most relevant factors on post-SEMLS recovery were therapy dose, surgical burden, and level of gross motor function immediately before and after surgery.
Mimicker of Osteoblastic Skeletal Metastasis on 18F-FDG PET/CT Scan in a Case of Primary Mediastinal Germ Cell Tumor
Authors: Rungta Rachita , Pereira Melvika , Shivdasani Divya , Roy Debdip , Dang Shreya , Jaiswal Himanshu , Wagle Aishwarya , Singh Natasha
Published: January 2023

Primary mediastinal germ cell tumors are uncommon tumors, of which the nonseminomatous type is more likely to metastasize than the seminomatous type. Primary mediastinal germ cell tumors may also present with superior vena cava obstruction. Here, we present this case of primary mediastinal germ cell tumor with superior vena cava obstruction causing dilatation of collaterals in dorsal intravertebral venous plexus, which strongly mimics sclerotic skeletal lesions/metastasis on a Contrast-enhanced CT scan and also appears FDG avid on PET scan. Herein, we can differentiate the two by just a simple review of plain CT scan image.
MYOSIN LIGHT CHAIN KINASE DELETION WORSENS LUNG PERMEABILITY AND INCREASES MORTALITY IN PNEUMONIA-INDUCED SEPSIS
Authors: Chihade Deena B. , Smith Prestina , Swift David A. , Otani Shunsuke , Zhang Wenxiao , Chen Ching-Wen , Jeffers Lauren A. , Liang Zhe , Shimazui Takashi , Burd Eileen M. , Farris Alton B. , Staitieh Bashar S. , Guidot David M. , Ford Mandy L. , Koval Michael , Coopersmith Craig M.
Published: January 2023

Increased epithelial permeability in sepsis is mediated via disruptions in tight junctions, which are closely associated with the perijunctional actin-myosin ring. Genetic deletion of myosin light chain kinase (MLCK) reverses sepsis-induced intestinal hyperpermeability and improves survival in a murine model of intra-abdominal sepsis. In an attempt to determine the generalizability of these findings, this study measured the impact of MLCK deletion on survival and potential associated mechanisms following pneumonia-induced sepsis. MLCK−/− and wild-type mice underwent intratracheal injection of Pseudomonas aeruginosa. Unexpectedly, survival was significantly worse in MLCK−/− mice than wild-type mice. This was associated with increased permeability to Evans blue dye in bronchoalveolar lavage fluid but not in tissue homogenate, suggesting increased alveolar epithelial leak. In addition, bacterial burden was increased in bronchoalveolar lavage fluid. Cytokine array using whole-lung homogenate demonstrated increases in multiple proinflammatory and anti-inflammatory cytokines in knockout mice. These local pulmonary changes were associated with systemic inflammation with increased serum levels of IL-6 and IL-10 and a marked increase in bacteremia in MLCK−/− mice. Increased numbers of both bulk and memory CD4+ T cells were identified in the spleens of knockout mice, with increased early and late activation. These results demonstrate that genetic deletion of MLCK unexpectedly increases mortality in pulmonary sepsis, associated with worsened alveolar epithelial leak and both local and systemic inflammation. This suggests that caution is required in targeting MLCK for therapeutic gain in sepsis.
Accuracy of Visual Assessment of Urimeter Bag Volumes: The Whiz Quiz
Authors: Margulies Samantha L. , Osment Anna E. , Schroeder Michelle N. , Geller Elizabeth J.
Published: January 2023

Importance

Although visual estimate of urine output via urimeter bag is common, data on accuracy are limited.

Objective

This study aimed to assess the accuracy of a visual estimate of urine output in standard urimeter bags by health care workers.

Study Design

This is a prospective observational study. Perioperative health care workers were asked to visually estimate fluid volumes in 5 standard urimeter bags. Actual volumes were 50, 150, 350, 500, and 750 mL. Visual estimates were recorded. The primary outcome was accuracy, defined as estimated visual volume within 20% of actual volume. Secondary outcomes included effect of health care provider type, specialty, experience, sex, and age on accuracy.

Results

A total of 159 responses were analyzed. There were 55 (35.3%) registered nurses, 19 (12.2%) certified registered nurse anesthetists, 18 (11.5%) advanced practice providers not identified as a certified registered nurse anesthetist, and 64 (41%) physicians. Mean estimated volumes (in milliliters) ± standard deviation and accuracy for the bags were as follows: (a) actual volume of 50 mL and estimated volume of 66 ± 29 mL (45% accuracy), (b) actual volume of 150 mL and estimated volume of 149 ± 43 mL (46% accuracy), (c) actual volume of 350 mL and estimated volume of 356 ± 74 mL (76% accuracy), (d) actual volume of 500 mL and estimated volume of 452 ± 77 mL (85% accuracy), and (e) actual volume of 750 mL and estimated volume of 675 ± 108 mL (85% accuracy). There was reasonable accuracy for individual volume estimates, but accuracy across all 5 urimeter bags was low: 22 of 159 (13.8%). There were no significant differences in accuracy based on health care provider type, specialty, experience, sex, or age.

Conclusions

Consistent accuracy of visual assessment of calibrated urimeter bag volumes was low and not influenced by health care provider characteristics.
Comparison of the Perineal Body Between Chinese Women With Pelvic Organ Prolapse and Women With Normal Support by Magnetic Resonance Imaging With 3-Dimensional Reconstruction
Authors: Wang Wei , Chen Chunlin , Liu Yunlu , Xu Liqun , Wen Ting , Liu Ping
Published: January 2023

Objective

This study aimed to determine whether the perineal body (PB) is different between women with and without prolapse and to analyze its association with prolapse.

Methods

This cross-sectional observational study was performed in a tertiary-level urology department and included patients with stage II–IV pelvic organ prolapse (POP) and normal controls with all points 1 cm or more above the hymen. The patients underwent supine midsagittal magnetic resonance imaging (MRI) at rest and during the maximum Valsalva maneuver. Perineal mobility and PB length, height, perimeter, and area were measured; in addition, the genital hiatus and PB were measured according to the definition of the Pelvic Organ Prolapse Quantification system. Univariate associations of POP with characteristics were assessed using the chi-square test or Fisher exact test for categorical variables and the t test for continuous variables. Multivariate logistic regression analysis was used to estimate the adjusted odds ratios and 95% confidence intervals.

Results

Seventy-two controls and 130 patients were analyzed. The PB length, height, and area measurements were significantly lower in the POP group. The perineal mobility in different directions was significantly higher in the POP group. Multivariate analysis demonstrated that the PB area and perineal mobility in the ventral-dorsal and cranio-caudal directions were associated with POP.

Conclusions

Our data suggest that a smaller PB area and greater dorsal or caudal mobility are associated with prolapse.
Contemporary Clinical Research in the Management of Pelvic Organ Prolapse in the United States: A Systematic Review
Authors: Sandozi Arshia , Kaplan-Marans Elie , Polland Allison
Published: January 2023

Importance

Pelvic organ prolapse (POP) can cause bothersome symptoms that negatively affect quality of life. Management strategies include observation, conservative management, and surgery.

Objective

The purpose of this study was to evaluate the current focus of research in POP.

Study Design

We queried clinicaltrials.gov, a registry of clinical research studies maintained by the U.S. National Library of Medicine, for active, recruiting, and enrolling studies involving POP.

Results

A total of 104 unique clinical trials were included for analysis. Investigators most commonly specialized in obstetrics and gynecology (obstetrician-gynecologists [ob-gyns]; n = 66, 57.9%); urologists numbered 5 (4.4%). The most common subspecialty was urogynecology (n = 46, 40.4%). Seventy-six percent of clinical research involved surgical intervention. The second most common field of research was diagnostic evaluation of POP (8.4%). Only 12.1% of clinical research focused on conservative measures, and 2.8% investigated medications. Objective outcome measures were used more often than subjective or mixed measures (42.3%, 22.3%, and 32.7%, respectively). The most common outcome measure was Pelvic Organ Prolapse Quantification (14.5%), followed by the mixed measure, “composite success” (8.7%).

Conclusions

Urologists are less involved in POP research than ob-gyns. Urogynecologists from either background are most involved. Most clinical research involves surgical management of POP, despite the fact that less than 20% of women pursue surgical correction. Despite dubious concordance with quality of life, objective outcome measures are used more often than subjective or mixed measures to assess severity of POP. Clinical research in POP should be directed to better align with the needs and preferences of patients.
Comparative evaluation of serum lithium estimation in serum samples using plain glass vial and serum clot activator vacutainer by reflectance photometry principle
Authors: Sahu Prabesh kumar , Sahoo Sibasish , Chatterjee Namrata , Majhi Jitendra , Dutta Atanu Kumar , Goswami Kalyan , Pal Amit
Published: January 2023

Background

The collection of blood samples in different vacutainers can affect the result of serum lithium estimation due to the presence of distinct additives added in the blood collection vacutainer for enhancing the clot formation process. The presence of these additives has proven to interfere with laboratory results of biochemical analytes. In this case, both the pre-analytical and the analytical phases have a significant impact on the accuracy and precision of the test result. Thus, it has become a challenge for the lab physician to estimate lithium in any clinical laboratory setup.

Materials and Methods

In total, 100 patient samples were collected and paired into clot activator vacutainers and plain glass vials. Both the paired collecting tubes after centrifugation were processed immediately via Vitros 4600 analyzer working on the principle of reflectance photometry. Both the paired tubes were stored at 2-8 degrees centigrade and were further analyzed, at 24 and 48 hours respectively, from the time of their collection. The statistical analysis was done in IBM® SPSS® software version 23.

Results

There was a significant difference in the lithium values obtained from clot activator vacutainers in comparison to glass vial. The difference between the measurements of the lithium levels was statistically tested by ‘t’ test where it was observed that the lithium measurements by the two different collecting tubes differed significantly with a Confidence Interval of 0.03 to 0.06 implying the level of agreement of both the methods are not similar. But there was no statistical difference in the lithium values estimated at 24 hours and 48 hours of collection.

Conclusion

In this study, lithium levels measured by clot-activated vacutainers are found to be low as compared to lithium levels measured through glass vials. There is no apparent change in lithium values obtained at 1hr, 24hrs & 48hrs from their collection, when measured from the glass vials and the clot-activated vacutainers respectively, by the Vitros 4600 dry chemistry analyzer.

Summary Statement

Serum Lithium estimation in clincal laboratory may be done different methodologies, but the result may vary due to change in principle of investigation and the pre analytical and analytical interferences.
Ketolysis is Required for the Proper Development and Function of the Somatosensory Nervous System
Authors: Enders Jonathan , Jack Jarrid , Thomas Sarah , Lynch Paige , Lasnier Sarah , Cao Xin , Taylor Swanson M , Ryals Janelle M , Thyfault John P. , Puchalska Patrycja , Crawford Peter A. , Wright Douglas E
Published: January 2023

Ketogenic diets are emerging as protective interventions in preclinical and clinical models of somatosensory nervous system disorders. Additionally, dysregulation of succinyl-CoA 3-oxoacid CoA-transferase 1 (SCOT, encoded byOxct1), the fate-committing enzyme in mitochondrial ketolysis, has recently been described in Friedreich’s ataxia and amyotrophic lateral sclerosis. However, the contribution of ketone metabolism in the normal development and function of the somatosensory nervous system remains poorly characterized. We generated sensory neuron-specific, Advillin-Cre knockout of SCOT (Adv-KO-SCOT) mice and characterized the structure and function of their somatosensory system. We used histological techniques to assess sensory neuronal populations, myelination, and skin and spinal dorsal horn innervation. We also examined cutaneous and proprioceptive sensory behaviors with the von Frey test, radiant heat assay, rotarod, and grid-walk tests. Adv-KO-SCOT mice exhibited myelination deficits, altered morphology of putative Aδ soma from the dorsal root ganglion, reduced cutaneous innervation, and abnormal innervation of the spinal dorsal horn compared to wildtype mice. Synapsin 1-Cre-driven knockout ofOxct1confirmed deficits in epidermal innervation following a loss of ketone oxidation. Loss of peripheral axonal ketolysis was further associated with proprioceptive deficits, yet Adv-KO-SCOT mice did not exhibit drastically altered cutaneous mechanical and thermal thresholds. Knockout ofOxct1in peripheral sensory neurons resulted in histological abnormalities and severe proprioceptive deficits in mice. We conclude that ketone metabolism is essential for the development of the somatosensory nervous system. These findings also suggest that decreased ketone oxidation in the somatosensory nervous system may explain the neurological symptoms of Friedreich’s ataxia.