bluuebunny/crossref_metadata_2025 huggingface dataset:
The bird tear-drinking moths of the genus Hemiceratoides (Lepidoptera: Erebidae)
Authors: Zilli Alberto , Barbut Jérôme , Dorward Leejiah J , Lees David C
Published: May 2024

New footage confirms Hemiceratoides moths to be bird tear-drinking. Bionomics of Hemiceratoides is updated, and its taxonomy revised, with descriptions of Hemiceratoides ornithopotissp. nov. and H. avimolestumsp. nov., while Cynisca thysbe, type species of Siccyna (= Cynisca), is recombined as H. thysbecomb. nov. (thus Hemiceratoides = Siccynasynon. nov.), whereas another Siccyna, originally Cynisca reichi, is found to be conspecific with Devena atomifera(synon. nov.). We highlight the striking proboscis modifications in Hemiceratoides compared to non-calpine erebids that may perhaps be incidental eye frequenters. Hemiceratoides sittaca has remarkable, sexually dimorphic labial palps, which are fang-like in males, probably assisting in tear feeding. Hemiceratoides also features unusual valval processes, an asymmetric whip- or stick-like juxta, and sclerotizations surrounding the ostium bursae. A phylogenetic tree reconstructed with eight nuclear genes as well as COI for the subfamilies Hypocalinae + Calpinae confirms the prior finding that Hemiceratoides belongs to tribe Ophiderini, not to Calpini, and supports previously held relationships between calpine genera, except that (Miniodes + Phyllodes) do not form a sister group relationship with (Hemiceratoides + Eudocima). We thus discuss the controversy over the evolution of the unusual feeding habits in Hemiceratoides. Finally, Calyptra canadensiscomb. rev. is updated due to a newly established synonymy Calyptra = Percalpesynon. nov.
Hereditary angioedema: current therapeutic management and future approaches
Authors: Lamacchia Donatella , Nappi Emanuele , Marzio Valentina , Locatelli Francesca , Messina Maria Rita , Heffler Enrico
Published: May 2024

Purpose of review

The aim of this review is to provide an account of the focus of therapeutic strategies for hereditary angioedema (HAE), give a brief overview of those used in the past and set aside and toughly discuss those currently available as first line. Further research is ongoing and the future therapeutic approaches that are still in different phases of study will be reviewed as well.

Recent findings

In the last two decades, major research advancements on HAE pathophysiology and management were made and numerous novel therapeutic options are now available. Compared to the past, drugs available nowadays are more effective, well tolerated, and possibly have a more convenient administration route. Moreover, numerous other drugs with innovative mechanisms of action are under development.

HAE is a rare genetic disease that if not promptly treated, it can lead to death from asphyxiation. Furthermore, due to its disfiguring and painful manifestations, HAE implies an important burden on the quality of life. Recently, following great research progresses on HAE therapy, evidence-based guidelines on HAE management were released. The therapeutic landscape of HAE is still under florid development, and it is possible novel treatments will remarkably revolutionize HAE management in the future.
Application of machine learning in the analysis of multiparametric MRI data for the differentiation of treatment responses in breast cancer: retrospective study
Authors: Wang Jinhua , Wang Liang , Yang Zhongxian , Tan Wanchang , Liu Yubao
Published: May 2024

Objective

The objective of this study is to develop and validate a multiparametric MRI model employing machine learning to predict the effectiveness of treatment and the stage of breast cancer.

Methods

The study encompassed 400 female patients diagnosed with breast cancer, with 200 individuals allocated to both the control and experimental groups, undergoing examinations in Shenzhen, China, during the period 2017–2023. This study pertains to retrospective research. Multiparametric MRI was employed to extract data concerning tumor size, blood flow, and metabolism.

Results

The model achieved high accuracy, predicting treatment outcomes with an accuracy of 92%, sensitivity of 88%, and specificity of 95%. The model effectively classified breast cancer stages: stage I, 38% (P = 0.027); stage II, 72% (P = 0.014); stage III, 50% (P = 0.032); and stage IV, 45% (P = 0.041).

Conclusions

The developed model, utilizing multiparametric MRI and machine learning, exhibits high accuracy in predicting the effectiveness of treatment and breast cancer staging. These findings affirm the model’s potential to enhance treatment strategies and personalize approaches for patients diagnosed with breast cancer. Our study presents an innovative approach to the diagnosis and treatment of breast cancer, integrating MRI data with machine learning algorithms. We demonstrate that the developed model exhibits high accuracy in predicting treatment efficacy and differentiating cancer stages. This underscores the importance of utilizing MRI and machine learning algorithms to enhance the diagnosis and individualization of treatment for this disease.
Early life manganese exposure and reported attention-related behaviors in Italian adolescents
Authors: Schildroth Samantha , Bauer Julia Anglen , Friedman Alexa , Austin Christine , Coull Brent A. , Placidi Donatella , White Roberta F. , Smith Donald , Wright Robert O. , Lucchini Roberto G. , Arora Manish , Horton Megan , Claus Henn Birgit
Published: May 2024

Background:

Manganese (Mn) is an essential nutrient and neurotoxicant, and the neurodevelopmental effects of Mn may depend on exposure timing. Less research has quantitatively compared the impact of Mn exposure on neurodevelopment across exposure periods.

Methods:

We used data from 125 Italian adolescents (10–14 years) from the Public Health Impact of Metals Exposure Study to estimate prospective associations of Mn in three early life exposure periods with adolescent attention-related behaviors. Mn was quantified in deciduous teeth using laser ablation-inductively coupled plasma-mass spectrometry to represent prenatal (2nd trimester-birth), postnatal (birth ~1.5 years), and childhood (~1.5–6 years) exposure. Attention-related behavior was evaluated using the Conners Behavior Rating Scales in adolescence. We used multivariable linear regression models to quantify associations between Mn in each exposure period, and multiple informant models to compare associations across exposure periods.

Results:

Median tooth Mn levels (normalized to calcium) were 0.4 area under the curve (AUC) 55Mn:43Ca × 104, 0.1 AUC 55Mn:43Ca × 104, and 0.0006 55Mn:43Ca for the prenatal, postnatal, and childhood periods. A doubling in prenatal tooth Mn levels was associated with 5.3% (95% confidence intervals [CI] = −10.3%, 0.0%) lower (i.e., better) teacher-reported inattention scores, whereas a doubling in postnatal tooth Mn levels was associated with 4.5% (95% CI = −9.3%, 0.6%) and 4.6% (95% CI = −9.5%, 0.6%) lower parent-reported inattention and attention deficit/hyperactivity disorder index scores, respectively. Childhood Mn was not beneficially associated with reported attention-related behaviors.

Conclusion:

Protective associations in the prenatal and postnatal periods suggest Mn is beneficial for attention-related behavior, but not in the childhood period.
MEG3 in hematologic malignancies: from the role of disease biomarker to therapeutic target
Authors: Zhang Chunlan , Qin Yun , Tang Yun , Gu Mingyu , Li Zhengyan , Xu Heng
Published: May 2024

Maternally expressed gene 3 (MEG3) is a noncoding RNA that is known as a tumor suppressor in solid cancers. Recently, a line of studies has emphasized its potential role in hematological malignancies in terms of tumorigenesis, metastasis, and drug resistance. Similar to solid cancers, MEG3 can regulate various cancer hallmarks via sponging miRNA, transcriptional, or posttranslational regulation mechanisms, but may regulate different key elements. In contrast with solid cancers, in some subtypes of leukemia, MEG3 has been found to be upregulated and oncogenic. In this review, we systematically describe the role and underlying mechanisms of MEG3 in multiple types of hematological malignancies. Particularly, we highlight the role of MEG3 in drug resistance and as a novel therapeutic target.
Implant Texture and Capsular Contracture: A Review of Cellular and Molecular Pathways
Authors: Wells Hannah J. , Yang Jenny C.C. , Edelstein-Keshet Leah , Isaac Kathryn V.
Published: May 2024

Background:

Capsular contracture (CC) is a leading cause of morbidity in implant-based breast surgery. Implant surface texture has been implicated in CC development, yet its etiopathogenesis remains unclear. We conducted a systematic review to determine the influence of implant surface texture on cellular and molecular mechanisms involved in the etiopathogenesis of CC.

Methods:

A systematic review of the MEDLINE, Embase, Web of Science, and Scopus databases was completed to examine the influence of implant texture on cellular and molecular pathways leading to CC. Excluded articles were reviews and those examining solely the clinical presentation of CC.

Results:

Development of CC includes prolonged inflammation, increased myofibroblast density, parallel arrangement of collagen fibers, and biofilm formation. When compared with textured implants, smooth implants are associated with reduction in parallel collagen, capsule thickness, and sheer frictional force. Microtextured implants trigger a reduced macrophage response and decreased fibroblast activation as compared with smooth and macrotextured surfaces. Bacterial counts on microtextured and smooth surfaces are significantly lower than that of macrotextured surfaces. Both micro- and macrotextured implants have increased matrix metalloproteinases and activation of tumor necrosis factor α pathway, with increased activation of the transforming growth factor β1 pathway relative to smooth implants.

Conclusions:

Implant surface texture alters the cellular and molecular mechanisms in the chronic inflammatory process leading to CC. Given the complex biological system of cellular and molecular events in CC, a mathematical model integrating these influences may be optimal to deduce the etiopathogenesis.
Pilot Process Evaluation of the Supporting Older Adults at Risk Model: A RE-AIM Approach
Authors: Trotta Rebecca L. , Shoemaker Anne E. , Greysen S. Ryan , Boltz Marie
Published: May 2024

Despite evidence supporting transitional care models, hospitals report challenges implementing and sustaining them. The Discharge to Assess (D2A) Model is an innovative solution to this problem but required translation from a national health system context to an U.S.-based context. We translated the central tenets of the D2A model to establish the Supporting Older Adults at Risk (SOAR) Model, which unfolds in three phases: Prepare, Transition, and Support. The purpose of this project was to conduct a process evaluation of the SOAR Model in practice using the RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Forty patients completed all SOAR Model components for a Reach of 21%. Patients averaged 80 years of age, 53% were female, and 64% Black/AA. SOAR significantly improved discharge before noon, time to first home visit, and use of the in-house pharmacy. SOAR also improved length of hospital stay, emergency department visits, and readmissions. Twenty-one of the 26 Implementation measures unfolded with 75% or greater fidelity. Sixteen of the 24 Adoption measures unfolded with 75% or greater fidelity. COVID-19 limited Maintenance. Given the model unfolds across settings over time, requiring adoption from interprofessional team members, patients, and families, future work should focus on improving reach and adoption.
A Survey for Charting Intake, Output, and Body Weight in the Electronic Medical Record
Authors: Tao Jianling , May Sara , Li Mingyi , Monahan Marianne , Phanumas Donna , Seelig Charles
Published: May 2024

Background:

The accuracy of documentation of body weight and fluid balance in hospitalized patients is frequently questioned.

Methods:

We conducted a survey to understand provider perceptions of the accuracy of intake, output, and weight charting in the electronic medical record. We sent a six-item questionnaire to nurses and physicians who provide inpatient service in a community-based teaching hospital of the Northeastern United States. We compared the response difference between nurses and physicians by Fisher exact test.

Results:

One hundred eight nurses and 39 physicians participated in the survey. Both nurses and physicians responded that the accuracy of documentation is crucial. However, only 25.7% of participating physicians and 38.3% of participating nurses considered that documentation in the electronic medical record is reliable. Both physicians and nurses assumed that the nurses are too busy to collect and document the data, and the variability of non-patient weight and variations in body weight measurement under different conditions account for inaccuracies in the documented body weight.

Conclusions:

Assessing the accuracy of documenting intake, output, and body weight in the electronic medical record is warranted. Providers believe that educating patients about fluid balance and volume assessment help to improve the accuracy in charting intake, output, and body weight in the electronic medical record.
Molecular characteristics of early-onset compared with late-onset colorectal cancer: a case controlled study
Authors: Tang Junwei , Peng Wen , Tian Chuanxing , Zhang Yue , Ji Dongjian , Wang Lu , Jin Kangpeng , Wang Fufeng , Shao Yang , Wang Xiaowei , Sun Yueming
Published: May 2024

Background:

Early-onset colorectal cancer (EOCRC) is associated with a poorer prognosis relative to late-onset colorectal cancer (LOCRC), and its incidence has witnessed a gradual escalation in recent years. This necessitates a comprehensive examination of the underlying pathogenesis and the identification of therapeutic targets specific to EOCRC patients. The present study aimed to delineate the distinct molecular landscape of EOCRC by juxtaposing it with that of LOCRC.

Methods:

A total of 11 344 colorectal cancer patients, diagnosed between 2003 and 2022, were enrolled in this study, comprising 578 EOCRC cases and 10 766 LOCRC cases. Next-generation sequencing technology was employed to assess the tumor-related mutation and tumor mutation burden (TMB) in these patients. PD-L1 expression was quantified using immunohistochemistry. Microsatellite instability (MSI) was determined via capillary electrophoresis (2B3D NCI Panel).

Results:

Upon comparing LOCRC with EOCRC patients, the latter group demonstrated a tendency towards advanced TNM stage, lower tumor differentiation, and less favorable histological types. Among LOCRC patients, those with MSI-H status were found to have an earlier TNM stage compared to those with MSI-L/MSS status. Significantly, the incidence of MSI-H was notably higher in EOCRC (10.2%) compared to LOCRC (2.2%). Mutations in the 7-gene panel (ARID1A, FANCI, CASP8, DGFRA, DPYD, TSHR, and PRKCI) were more prevalent in LOCRC. Within the EOCRC cohort, patients with the MSI-H subtype displayed an earlier TNM stage but concurrently exhibited poorer tissue differentiation and a higher frequency of mucinous adenocarcinoma. Among EOCRC patients, FBXW7, FAT1, ATM, ARID1A, and KMT2B mutations were significantly enriched in the MSI-H subgroup. A comparative analysis of MSI-H patients revealed heightened mutation frequencies of FGFBR2, PBRM1, RNF43, LRP1B, FBXW7, ATM, and ARID1A in the EOCRC group. Furthermore, EOCRC patients demonstrated a higher overall TMB, particularly in the MSI-H subtype. PD-L1 expression was elevated in EOCRC and positively associated with MSI status.

Conclusions:

This study revealed a significantly higher MSI-H distribution rate in EOCRC, and EOCRC exhibits a distinct mutational signature coupled with higher PD-L1 expression. These findings hold promise in guiding personalized therapeutic strategies for improved disease management in EOCRC patients.
Effects of COVID-19 Status on Hip Fracture Surgical Outcomes: An ACS NSQIP Study
Authors: Shim Esther H. , Ghodasara Satyam K. , Roskam Justin S. , Gaccione Amanda G. , DiFazio Louis T. , Lombardo Gary , Nemeth Zoltan H.
Published: May 2024

BACKGROUND:

Studies have indicated that patients infected with the SARS-CoV-2 virus fare worse clinically after a traumatic injury, especially those who are older and have other comorbidities.

OBJECTIVE:

This study aims to understand the effects of Corona Virus Disease 19 (COVID-19) diagnosis on patients undergoing surgery for hip fractures.

METHODS:

This is a retrospective review of the 2021 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Targeted Hip Fracture database for patients who underwent surgery. Two cohorts were formed based on patients’ preoperative COVID-19 status, as tested within 14 days prior to the operation. Several clinical factors were compared.

RESULTS:

The COVID-positive cohort consisted of 184 patients, all of whom had a laboratory-confirmed or clinically suspected SARS-CoV-2 infection, while the COVID-negative cohort consisted of 12,211 patients with no infection. A lower proportion of COVID-positive patients had an emergent operation compared to the COVID-negative cohort (58.70% vs. 73.09%, p < .001). Preoperatively, the COVID-positive cohort showed higher rates of coagulopathy/bleeding disorders (22.83% vs. 14.12%), congestive heart failure (16.30% vs. 9.84%), diabetes mellitus (28.26% vs. 19.24%), and dementia (42.39% vs. 28.07%), with p ≤ .005 for all. Postoperatively, a higher proportion of COVID-positive patients died (9.78% vs. 5.40%) or had pneumonia (8.70% vs. 3.65%), hospital readmission within 30 days (10.87% vs. 6.76%), and pressure sores (8.15% vs. 4.55%), with p ≤ .033 for all.

CONCLUSION:

The diagnosis of COVID-19 in hip fracture patients was associated with higher rates of postoperative complications, including mortality, when compared to COVID-negative patients, indicating the severity of the viral infection.
Impact of Bedside Laparotomy Simulation and Microlearning on Trauma Nurse Role Clarity, Knowledge, and Confidence
Authors: Messing Jonathan A. , Russell-Babin Kathleen , Baker Deborah , D’Aoust Rita
Published: May 2024

BACKGROUND:

The care of patients undergoing low-volume, high-risk emergency procedures such as bedside laparotomy (BSL) remains a challenge for surgical trauma critical care nurses.

OBJECTIVES:

This study evaluates simulation and microlearning on trauma nurse role ambiguity, knowledge, and confidence in caring for patients during emergency BSL.

METHODS:

The study is a single-center, prospective pretest–posttest design conducted from September to November 2022 at a Level I trauma center in the Mid-Atlantic United States using simulation and microlearning to evaluate role clarity, knowledge, and confidence among surgical trauma intensive care unit (STICU) nurses. Participants, nurses from a voluntary convenience sample within a STICU, attended a simulation and received three weekly microlearning modules. Instruments measuring role ambiguity, knowledge, and confidence were administered before the simulation, after, and again at 30 days.

RESULTS:

From the pretest to the initial posttest, the median (interquartile range [IQR]) Role Ambiguity scores increased by 1.0 (1.13) (p < .001), and at the 30-day posttest, improved by 1.33 (1.5) (p < .001). The median (IQR) knowledge scores at initial posttest improved by 4.0 (2.0) (p < .001) and at the 30-day posttest improved by 3.0 (1.75) (p< .001). The median (IQR) confidence scores at initial posttest increased by 0.08 (0.33) (p = .009) and at the 30-day posttest improved by 0.33 (0.54) (p = .01).

CONCLUSIONS:

We found that simulation and microlearning improved trauma nurse role clarity, knowledge, and confidence in caring for patients undergoing emergency BSL.
Elements of an Advanced Trauma Education Program for Emergency Nurses: A Modified Delphi Approach
Authors: Wolf Lisa , Delao Altair , Kolbuk Monica Escalante , Simon Claire
Published: May 2024

BACKGROUND:

Basic trauma education for emergency department (ED) staff is available, but there are currently no advanced trauma nursing practice standards for ED nurses.

OBJECTIVE:

The purpose of this study was to identify consensus-based elements of an advanced trauma nursing program for ED nurses.

METHODS:

We used a modified Delphi process with three rounds of online survey data collection to ensure a large group of geographically diverse experts. Data were collected from February 2023 to May 2023. The sample for Round 1 was recruited from members of the Emergency Nurses Association reporting job titles, including trauma coordinator, trauma nursing core course instructor, and vice president of trauma services (n = 829). Participants in subsequent rounds were drawn from respondents to the initial invitation to participate (n = 131). Members of an emergency nursing research council with clinical and research expertise reviewed the results and provided expert input.

RESULTS:

An initial sample of 131 experts identified 17 elements that were assigned a median score equivalent to “agree/strongly agree” (i.e., median 4/5 or 5/5) in Round 2 (n = 69). These elements were presented in Round 3 (n = 43) to determine a rank order. Critical thinking/clinical judgment was the overall priority, followed by assessment/reassessment and early recognition of trauma.

CONCLUSIONS:

Emergency department trauma care experts identified priority content for advanced trauma education. Heterogeneity in the final ranking of components for this advanced trauma course, specifically differences by facility, regional, or demographic characteristics, suggests that training and education may not conform to a one-size-fits-all model.
Nurse-Initiated Protocol to Improve Timely Antibiotic Administration in Pediatric Open Fractures
Authors: Scallon Kylie , Lee Jessica , Spencer Meghan , Schissel Makayla , Timmons Zebulon , Hanna Angela , Sneller Hannah
Published: May 2024

BACKGROUND:

Early administration of antibiotics in the presence of open fractures is critical in reducing infections and later complications. Current guidelines recommend administering antibiotics within 60 min of patient arrival to the emergency department, yet trauma centers often struggle to meet this metric.

OBJECTIVES:

This study aims to evaluate the impact of a nurse-initiated evidence-based treatment protocol on the timeliness of antibiotic administration in pediatric patients with open fractures.

METHODS:

A retrospective pre–post study of patients who met the National Trauma Data Standard registry inclusion criteria for open fractures of long bones, amputations, or lawn mower injuries was performed at a Midwestern United States Level II pediatric trauma center. The time of patient arrival and time of antibiotic administration from preimplementation (2015–2020) to postimplementation (2021–2022) of the protocol were compared. Patients transferred in who received antibiotics at an outside facility were excluded.

RESULTS:

A total of N = 73 participants met the study inclusion criteria, of which n = 41 were in the preimplementation group and n = 32 were in the postimplementation group. Patients receiving antibiotics within 60 min of arrival increased from n = 24/41 (58.5%) preimplementation to n = 26/32 (84.4%) postimplementation (p< .05).

CONCLUSIONS:

Our study demonstrates that initiating evidence-based treatment orders from triage helped decrease the time from arrival to time of antibiotic administration in patients with open fractures. We sustained improvement for 24 months after the implementation of our intervention.
A Bibliometric study of the top 100 most-cited papers in high tibial osteotomy
Authors: Ye Ling-Chen , Zhang Jing-Yu , Jiang Ying-Ying , Xu Ren-Jie
Published: May 2024

Background:

High tibial osteotomy (HTO) is a well-established surgical procedure employed to treat medial compartment knee osteoarthritis by modifying the mechanical axis of the lower limb, thereby reducing the load on the affected joint. It has gained increased attention in recent years, resulting in numerous research advancements in this field.

Methods:

The top 100 most-cited papers on HTO, published between 1970 and 2023, were identified by searching the Web of Science Core Collection database. Data, including the title, author, keywords, journal, publication year, country, and institution, were extracted. Subsequently, a bibliometric analysis was performed.

Results:

The 100 papers collectively garnered a total of 15 833 citations, with a median of 122 and an average of 158.33 citations per article. Since the onset of the 21st century, there has been a significant increase in the number of publications and citations. Lobenhoffer authored the most published papers. The majority of papers originated from the USA. Hannover Medical School produced the most papers. Analysis of keywords in the articles revealed several research hotspots, including open-wedge osteotomy, biomechanical study, tibial slope, patellar height, Puddu plate, TomoFix plate, stability, complications, and accuracy.

Conclusion:

This study offers bibliometric insights into HTO, underscoring that the USA is a prominent leader in this field. HTO has garnered increasing attention since the onset of the 21st century and is expected to remain a significant research area in the future. Concurrently, the authors advise focusing on potential research hotspots, such as the navigation system, to augment the accuracy of the correction.
A rare case of aortitis presenting as chest pain: a case report and literature review
Authors: Ahmed Hasaan , Ismayl Mahmoud , Palicherla Anirudh , Mathew Kalathil Ruth Ann , Vaza Shivani , Kabach Amjad , Goldsweig Andrew M. , Aboeata Ahmed
Published: May 2024

Introduction and importance:

Chest pain is a frequent reason patients seek medical attention. The broad spectrum of potential etiologies makes determining the underlying cause of chest pain complex. Among cardiovascular etiologies, aortitis is a rare but life-threatening possibility that should be considered in the differential diagnosis.

Case presentation:

A 53-year-old female with a history of smoking presented with progressively worsening chest and epigastric pain over several weeks. She had seen multiple physicians previously for the same symptoms with unremarkable work-ups. Physical examination was notable for severe tenderness upon palpation of her lower abdomen. The electrocardiogram and troponins were unremarkable. Computed tomography of the abdomen revealed aneurysmal dilatation of the abdominal aorta, soft tissue thickening, and surrounding inflammatory stranding, consistent with aortitis. Infectious and autoimmune work-ups were unremarkable. Intravenous steroids were initiated, and her symptoms improved significantly. Her aortitis was attributed to inflammation secondary to chronic smoking.

Clinical discussion:

Aortitis is a rare condition with varied clinical presentations. Etiologies of aortitis include infection and non-infectious inflammation. Diagnosis of aortitis requires a thorough clinical assessment and prompt imaging of the aorta, with computed tomography being the preferred imaging modality.

Conclusion:

Evaluation for cardiovascular chest pain must extend beyond an electrocardiogram and troponin level. Imaging should be considered in patients with atypical symptoms. Aortitis is a rare but important diagnosis requiring immediate treatment.
Revolutionary breakthrough: FDA approves CASGEVY, the first CRISPR/Cas9 gene therapy for sickle cell disease
Authors: Singh Ajeet , Irfan Hamza , Fatima Eeshal , Nazir Zainab , Verma Amogh , Akilimali Aymar
Published: May 2024

Sickle cell disease (SCD) is a hereditary hemoglobinopathy resulting from a β-globin chain mutation that causes abnormal hemoglobin (HbS) polymerization and leads to severe complications. Current treatment options primarily focus on symptom management, with limited curative potential. Recently, Casgevy, the first CRISPR/Cas9-based gene therapy for SCD, has received breakthrough FDA approval. Clinical trials have shown that Casgevy administered to patients aged older than or equal to 12 years enables precise modifications in hematopoietic stem cells, resulting in elevated fetal hemoglobin (HbF) levels and a significant reduction in vaso-occlusive events. Unlike conventional treatments, this therapy offers a curative approach and eliminates the need for recurrent transfusions and transplants, thereby improving the quality of life of patients with SCD. Casgevy has emerged as a beacon of hope for SCD patients and signifies a potential paradigm shift in SCD management due to its safety, curative potential, and transformative impact, positioning it as a groundbreaking intervention. Nevertheless, ethical considerations surrounding CRISPR technology and regulatory frameworks must be addressed to ensure responsible application and equitable access to this one-time gene editing therapy. As the authors celebrate this scientific advancement, sustained interdisciplinary collaboration and ethical scrutiny are essential to navigating the evolving landscape of CRISPR technology in medicine. This review aims to provide a detailed insight into the application of Casgevy, challenges associated with its application, future prospects of this therapy, and its comparison with existing treatment options for SCD.
The results of femoral lengthening using domestic unilateral external fixation and then plating: the first case series in Vietnam
Authors: Van Nguyen Luong , Nguyen Gioi Nang
Published: May 2024

Introduction and importance:

This study aimed to assess the results of femoral lengthening using an external fixator and then plating.

Case presentation:

This prospective case series study enrolled 11 patients who underwent femoral lengthening and then plating (LATP) between January 2019 and April 2023. The average age of patients was 14.45 ± 7.54 years. One patient with a femur was lengthened and plated, and one tibia was lengthened over a nail simultaneously. The average femoral lengthening was 8.41 ± 1.35 cm.

Clinical discussion:

The femoral healing result was excellent in seven femurs and good in four femurs; the functional outcome was excellent in five patients and good in six patients. Pin-track infection occurred in all patients. A limited range of motion of knee flexion occurred in eight patients. Femoral varus and procurvatum deviation occurred during distraction in four and two patients. Femoral LATP was considered an attractive alternative to intramedullary lengthening nails in a low-income country.

Conclusion:

Our research suggests that femoral LATP was an effective method. However, the most common complications were pin-site infection and extensive knee contracture. Further research should be done with a larger sample size and longer follow-up time.

Level of evidence:

Level IV—prospective observational case series study.
Hypervascular gastrointestinal stromal tumor: a rare case report
Authors: Khana Firas , Katerji Abdulrahman , Sawas Taher , Zambakjian Jack , Kafa Dima , Abdullah Abdulmonem , Moussa Maen , Lbabidi Nour , Al-Najjar Zakaria , Ghazal Ahmad
Published: May 2024

Introduction and importance:

To document a case of an ileal gastrointestinal stromal tumor that caused a massive lower gastrointestinal hemorrhage.

Case presentation:

A 55-year-old man presented with multiple episodes of melena and decreased hemoglobin levels. Computed tomography angiography (CTA) revealed a hypervascularized ileal mass.

Clinical discussion:

The mass was surgically excised, and the patient’s hemoglobin levels stabilized. Histopathological findings confirmed it to be a low-grade gastrointestinal stromal tumor (G1 GIST).

Conclusion:

GISTs are infrequent clinical entities that should be kept in mind when managing patients with gastrointestinal hemorrhage of unknown origin. Using proper imaging modalities is essential for the accurate diagnosis of such tumors, with CTA proving to be particularly effective in identifying hypervascularized tumors.
Blood purification therapy in chronic renal failure and its impact on renal index, serological index, and inflammatory factors
Authors: Butt Batool , Mushtaq Adnan , Hameed Fatima Abdul , Abbasi Muhammad Sajid Rafique , Tariq Maham , Akbar Amna , Jadoon Sarosh Khan , Tasneem Sabahat , Ahmad Mumtaz , Zeb Anam , Alvi Sarosh
Published: May 2024

Introduction:

This study aimed to explore the clinical effects of blood purification therapy in patients with chronic renal disease, measured by renal function index and inflammation.

Methodology:

Data were collected from a tertiary care hospital in Pakistan between June 2022 and September 2023. Eighty-four patients undergoing maintenance hemodialysis for chronic renal failure were retrospectively included in this cohort.

Results:

Age, sex, BMI, course of disease, primary disease, and educational level were not related to the response to blood purification treatment. Blood purification therapy positively affected renal function, serological indices, and inflammatory factors (P<0.05).

Conclusion:

Blood purification therapy can improve toxin clearance and renal function and reduce inflammation. Therefore, the authors can conclude that this is an effective therapy for our population.
Ultrasound-Guided Peripheral Venipuncture Decreases the Procedure’s Pain and Positively Impacts Patient’s Experience: The PRECISE Randomized Clinical Trial
Authors: Junges Marina , Hansel Leandro Augusto , Santos Marina Scherer , Hirakata Vânia Naomi , Nascimento Ceratti Rodrigo do , Czerwinski Gabriela Petró Valli , Saffi Marco Aurélio Lumertz , Ferro Eduarda Bordini , Jacobsen Daniele Volkmer , Rabelo-Silva Eneida Rejane
Published: May 2024

This study aimed to compare patients’ experience of pain during ultrasound (US)-guided peripheral venipuncture versus conventional peripheral venipuncture. This randomized clinical trial was conducted at a public university hospital in 2021. Adult patients with indication for intravenous therapy compatible with peripheral intravenous catheters (PIVCs) were included: intervention group (IG), US peripheral venipuncture executed by specialist nurses; control group (CG), conventional peripheral venipuncture executed by clinical practice nurses. The primary outcome was patient experience of pain during the procedure and patient experience related to the PIVC placement method. Sixty-four patients were included, 32 for each group. The pain experienced was none-to-mild in the IG for 25 patients (78.1%) and moderate-to-severe in the CG for 21 patients (65.7%; P < .001). The overall pain rating was 2 (1-3) in the IG and 4 (3-6) in the CG (P < .001). The recommendation of the procedure in IG (net promoter score [NPS] + 90.6%) versus CG (NPS + 18.8%) was considered excellent and good, respectively (P < .001). Patients had less pain and significantly recommended the US-guided procedure. Patient experience with US-guided PIVC, performed by a specialist nurse, was superior to that of conventional peripheral venipuncture.
Countering Calcium Blooming With Personalized Contrast Media Injection Protocols
Authors: McDermott Michael C. , Sartoretti Thomas , Stammen Lion , Martens Bibi , Jost Gregor , Pietsch Hubertus , Gutjahr Ralf , Schmidt Bernhard , Flohr Thomas G. , Alkadhi Hatem , Wildberger Joachim E.
Published: May 2024

Objective

Photon-counting detector computed tomography (PCD-CT) enables spectral data acquisition of CT angiographies allowing for reconstruction of virtual monoenergetic images (VMIs) in routine practice. Specifically, it has potential to reduce the blooming artifacts associated with densely calcified plaques. However, calcium blooming and iodine attenuation are inversely affected by energy level (keV) of the VMIs, creating a challenge for contrast media (CM) injection protocol optimization. A pragmatic and simple rule for calcium-dependent CM injection protocols is investigated and proposed for VMI-based coronary CT angiography with PCD-CT.

Materials and Methods

A physiological circulation phantom with coronary vessels including calcified lesions (maximum CT value >700 HU) with a 50% diameter stenosis was injected into at iodine delivery rates (IDRs) of 0.3, 0.5, 0.7, 1.0, 1.5, 2.0, 2.5, and 3.0 g I/s. Images were acquired using a first-generation dual-source PCD-CT and reconstructed at various VMI levels (between 45 and 190 keV). Iodine attenuation in the coronaries was measured at each IDR for each keV, and blooming artifacts from the calcified lesions were assessed including stenosis grading error (as % overestimation vs true lumen). The IDR to achieve 300 HU at each VMI level was then calculated and compared with stenosis grading accuracy to establish a general rule for CM injection protocols.

Results

Plaque blooming artifacts and intraluminal iodine attenuation decreased with increasing keV. Fixed windowing (representing absolute worst case) resulted in stenosis overestimation from 77% ± 4% at 45 keV to 5% ± 2% at 190 keV, whereas optimized windowing resulted in overestimation from 29% ± 3% at 45 keV to 4% ± 1% at 190 keV. The required IDR to achieve 300 HU showed a strong linear correlation to VMI energy (R
2 = 0.98). Comparison of this linear plot versus stenosis grading error and blooming artifact demonstrated that multipliers of 1, 2, and 3 times the reference IDR for theoretical clinical regimes of no, moderate, and severe calcification density, respectively, can be proposed as a general rule.

Conclusions

This study provides a proof-of-concept in an anthropomorphic phantom for a simple pragmatic adaptation of CM injection protocols in coronary CT angiography with PCD-CT. The 1-2-3 rule demonstrates the potential for reducing the effects of calcium blooming artifacts on overall image quality.
Surgical Treatment Strategies for Residual or Recurrent Intracranial Aneurysms Following Endovascular Embolization
Authors: Zhao Haijun , Gao Kaiming , Shi Minggang , Shang Yanguo , Tong Xiaoguang
Published: May 2024

Objective:

To explore how to effectively manage the residual or recurrent intracranial aneurysms after embolization.

Methods:

The authors retrospectively reviewed our experience of endovascular interventional therapy, surgical clipping, and cerebrovascular bypass surgery in the treatment of residual or recurrent aneurysms after embolization at the authors’ institution from 2018 to 2022.

Results:

The Glasgow Outcome Scale of 28 patients after the procedure and at discharge showed that 24 recovered well, 3 had severe disability, and 1 died. During the 24-month follow-up, 26 had a good recovery, 1 suffered from disability, and 1 died. Two cases of aneurysm recurrence were detected, and both were treated through endovascular therapy. Among them, 1 case underwent a repeat endovascular embolization, and 1 case was switched to surgical clipping. No residual aneurysms were observed in the remaining patients who underwent bypass surgery, and their bypass grafts were all patent.

Conclusion:

Based on the clinical status of patients, aneurysmal characteristics, surgical risk, and possibility of rerupture of aneurysms, an individualized strategy was proposed for residual or recurrent aneurysms after embolization. The use of endovascular interventional therapy or surgical clipping can be safely and effectively managed, and cerebrovascular bypass surgery can effectively manage complex aneurysms.
Validating the Supraorbital Notch-Nasion-Supraorbital Notch Angle as a Marker for Metopic Craniosynostosis Severity
Authors: Romeo Dominic J. , Becerra Santiago Lopez , Barrero Carlos E. , Massenburg Benjamin B. , Du Steven , Ng Jinggang J. , Wu Meagan , Swanson Jordan W. , Taylor Jesse A. , Bartlett Scott P.
Published: May 2024

Objective:

Metopic craniosynostosis (MCS) can be difficult to differentiate from metopic ridge (MR) or normal frontal morphology. This study assess whether the supraorbital notch-nasion-supraorbital notch (SNS) angle can help identify MCS.

Methods:

Records of 212 patients with preoperative three-dimensional computed tomography scans were examined. The SNS angles, surgeon craniofacial dysmorphology rankings, and CranioRate metopic severity scores (MSSs) were compared with the Spearman rank correlation coefficient. Receiver operating characteristic (ROC) curves with Youden J-statistic and cross-validation of regression models assessed the ability of these measures to predict surgery.

Results:

A total of 212 patients were included, consisting of 78 MCS, 37 MR, and 97 controls. Both the mean SNS angle (MCS: 111.7 ± 10.7 degrees, MR: 126.0 ± 8.2 degrees, controls: 130.7 ± 8.8 degrees P < 0.001) and MSS (MCS: 5.9 ± 2.0, MR: 1.4 ± 1.9, controls: 0.2 ± 1.9, P < 0.001) were different among the cohorts. The mean SNS angle (111.5 ± 10.7 versus 129.1 ± 8.8, P < 0.001) was lower in those who had surgery and CranioRate score (5.9 ± 2.1 versus 0.8 ± 2.2, P < 0.001) was higher in those who underwent surgery. SNS angles were positively correlated with surgeon craniofacial dysmorphology rankings (r = 0.41, P < 0.05) and CranioRate MSS (r = 0.54, P < 0.05). The ROC curve requiring high sensitivity revealed an SNS angle of 124.8 degrees predicted surgery with a sensitivity of 88.7% and a specificity of 71.3%. A ROC curve using the CranioRate MCC values ≥3.19 predicted surgery with 88.7% sensitivity and 94.7% specificity.

Conclusion:

Orbital dysmorphology in patients with MCS is well captured by the supraorbital-nasion angle. Both the SNS angle and CranioRate MSS scores accurately predict surgical intervention.
Recurrent Auricular Keloid After Childbirth in a Patient With von Willebrand Disease
Authors: Kang Daihun , Park Tae Hwan
Published: May 2024

The authors present a case of a 34-year-old female patient with von Willebrand disease who developed a recurrent right auricular keloid after childbirth. The patient had previously undergone surgical excision of the keloid in 2017, which led to the diagnosis of von Willebrand disease due to uncontrolled bleeding. After a successful pregnancy in 2023, the patient experienced keloid recurrence. Surgical excision and radiotherapy were performed in April 2023, followed by DDAVP administration to control postoperative bleeding. At 1-year follow-up, no recurrence was observed. This case highlights the potential impact of pregnancy on keloid recurrence and the challenges of managing keloids in patients with bleeding disorders.
Characterizing Vitamin B12 Deficiency in Neurology Outpatients: A Retrospective Observational Study
Authors: Zhou Li , Bai Xue , Wu Bowen , Tan Yongjun , Li Mengxia , Yang Qin
Published: May 2024

Objectives

Clinical manifestations of vitamin B12 deficiency are varied and may result in missed or delayed diagnosis. This investigation explores the diverse clinical manifestations and demographic characteristics of vitamin B12 deficiency in neurology outpatients, aiming to enhance timely diagnosis and outcomes.

Methods

The severity of vitamin B12 deficiency was classified as absolute (≤150 pg/mL) or borderline deficiency (150–300 pg/mL). We conducted a retrospective analysis of 165 outpatients with vitamin B12 deficiency at the department of neurology between May 2020 and May 2021.

Result

Absolute vitamin B12 deficiency was found in 23.0% of the patients. The most common age range was 50–60 years, the most common cause was vegetarianism, and the most common symptom was headache. Epileptiform symptoms were more likely to occur in younger patients (<20 years old) with vitamin B12 deficiency, whereas psychiatric symptoms were more likely to occur in older patients (>70 years old). Vegetarians, salivation, and nonmegaloblastic anemia were more obvious in patients with absolute vitamin B12 deficiency, whereas headaches often showed borderline B12 deficiency.

Conclusions

The clinical characteristics of vitamin B12 deficiency are complex and nonspecific. The diagnosis should be based on multiple factors.
Building an implementation strategy for community-based rehabilitation for mental health in Colombia
Authors: Agudelo-Hernández Felipe , Rojas-Andrade Rodrigo , Giraldo Alvarez Ana Belén
Published: May 2024

Introduction:

Scientific evidence indicates that the community-based rehabilitation (CBR) model is recommended for recovery from mental disorders. However, this approach encounters barriers and often lacks implementation strategies.

Aim:

The aim of this study was to create a strategy for the implementation of CBR for mental health in Colombia through the identification of barriers and facilitators, together with the expected outcomes, from the perspective of mental health decision-makers in Colombia.

Methods:

This study adopts a qualitative descriptive approach, using focus group data collection methods and thematic analysis to code and analyze the data.

Results:

A total of 208 individuals participated in the study, including mental health decision-makers and health care professionals. Intersectoral collaboration, contextualization, financial resources, and community commitment and autonomy were identified as barriers and facilitators. The element that was considered a priority for successful implementation was the contextualization of strategies.

Conclusions:

CBR needs to be strengthened through implementation science if these strategies are to be successfully developed and implemented in various contexts.

Spanish abstract:

http://links.lww.com/IJEBH/A210
Clinical presentation and outcome of enteric fever in adult patients with cancer: a perspective from Pakistan
Authors: Aslam Seemal , Abbas Salma , Nizamuddin Summiya , Shehbaz Muhammad , Parveen Azra , Sultan Faisal , Raza Aun
Published: May 2024

Introduction. Enteric fever is a significant health concern in endemic countries. While extensive research has been conducted to understand its presentation and outcomes in non-cancer patients, limited data exist on its impact on cancer patients. This descriptive study aims to investigate the clinical presentation and outcome in cancer patients.

Methodology. This retrospective observational study analysed 90 adult cancer patients from a single centre in Pakistan from January 2017 to December 2022. Inclusion criteria involved documented blood culture infections with Salmonella typhi or paratyphi A, B, or C. We examined clinical presentation, laboratory parameters, antimicrobial resistance, complications, and outcomes. Additionally, we explored the effects of chemotherapy, comorbidities, type of malignancy, and patient age on complications and mortality.

Results.
Salmonella typhi was the most prevalent organism (72.2 %), followed by Salmonella paratyphi A (22.2 %) and B (5.5 %). Variably-resistant isolates constituted 51.5 %, multi-drug resistant (MDR) isolates accounted for 20 %, extensively drug-resistant (XDR) for 14.4 % and ESBL-producers for 15.5 %, of all enteric fever infections. Enteric fever-associated complications were observed in 21.1 % of cases. Chemotherapy in the preceding month did not affect mortality, nor did age, gender, or malignancy type. However, comorbidities were statistically significant for mortality (p-value 0.03). A total of 8.8 % of patients required ICU care, and the all-cause 30 day mortality rate was 13.3 %

Conclusion. Enteric fever remains prevalent in our geographical region. Unlike non-typhoidal Salmonella (NTS), enteric fever does not behave differently in an immunocompromised population, including cancer patients.
Microbiota of healthy dogs demonstrate a significant decrease in richness and changes in specific bacterial groups in response to supplementation with resistant starch, but not psyllium or methylcellulose, in a randomized cross-over trial
Authors: Salavati Schmitz Silke , Salgado Jorge Perez-Accino , Glendinning Laura
Published: May 2024

Graphical abstract

Microbiota of healthy dogs demonstrate significant changes in specific bacterial groups in response to supplementation with resistant starch (but not psyllium or methylcellulose) in this randomized cross-over trial.