bluuebunny/crossref_metadata_2025 huggingface dataset:
Wearable Nanocomposite Sensor System for Motion Phenotyping Chronic Low Back Pain: A BACPAC Technology Research Site
Authors: Baker Spencer A , Billmire Darci A , Bilodeau R Adam , Emmett Darian , Gibbons Andrew K , Mitchell Ulrike H , Bowden Anton E , Fullwood David T
Published: February 2023

Chronic low back pain (cLBP) is a prevalent and multifactorial ailment. No single treatment has been shown to dramatically improve outcomes for all cLBP patients, and current techniques of linking a patient with their most effective treatment lack validation. It has long been recognized that spinal pathology alters motion. Therefore, one potential method to identify optimal treatments is to evaluate patient movement patterns (ie, motion-based phenotypes). Biomechanists, physical therapists, and surgeons each utilize a variety of tools and techniques to qualitatively assess movement as a critical element in their treatment paradigms. However, objectively characterizing and communicating this information is challenging due to the lack of economical, objective, and accurate clinical tools. In response to that need, we have developed a wearable array of nanocomposite stretch sensors that accurately capture the lumbar spinal kinematics, the SPINE Sense System. Data collected from this device are used to identify movement-based phenotypes and analyze correlations between spinal kinematics and patient-reported outcomes.

The purpose of this paper is twofold: first, to describe the design and validity of the SPINE Sense System; and second, to describe the protocol and data analysis toward the application of this equipment to enhance understanding of the relationship between spinal movement patterns and patient metrics, which will facilitate the identification of optimal treatment paradigms for cLBP.
“Electronic Church” 2.0: Are Virtual and In-Person Attendance Associated with Mental and Physical Health During the COVID-19 Pandemic?
Authors: Upenieks Laura , Hill Terrence D , Acevedo Gabriel , Koenig Harold G
Published: February 2023

Over the past four decades, studies have consistently shown that regular attendance at religious services is associated with better mental and physical health. At the onset of the COVID-19 pandemic, many congregations paused in-person religious services and moved their worship rituals online. The ways that churches have responded to the threat of infectious disease require new conceptualizations and operationalizations of religious attendance and novel comparisons of the causes and consequences of virtual and in-person attendance. Analyses of data collected from a national probability sample of Americans (n = 1,717) show that while in-person religious attendance is associated with better mental and physical health, virtual attendance is unrelated to both outcomes in fully adjusted models. Taken together, these findings suggest that the association between religious attendance and health during a global pandemic may be contingent on physical proximity and the nature of the social and experiential aspects of religious worship.
Long-Term Effects of Increasing Buprenorphine Treatment Seeking, Duration, and Capacity on Opioid Overdose Fatalities: A Model-based Analysis
Authors: Stringfellow Erin J. , Lim Tse Yang , DiGennaro Catherine , Zhang Ziyuan , Paramasivam Pritika , Bearnot Benjamin , Humphreys Keith , Jalali Mohammad S.
Published: February 2023

Objectives

Because buprenorphine treatment of opioid use disorder reduces opioid overdose deaths (OODs), expanding access to care is an important policy and clinical care goal. Policymakers must choose within capacity limitations whether to expand the number of people with opioid use disorder who are treated or extend duration for existing patients. This inherent tradeoff could be made less acute with expanded buprenorphine treatment capacity.

Methods

To inform such decisions, we used a validated simulation model to project the effects of increasing buprenorphine treatment-seeking, average episode duration, and capacity (patients per provider) on OODs in the United States from 2023 to 2033, varying the start time to assess the effects of implementation delays.

Results

Results show that increasing treatment duration alone could cost lives in the short term by reducing capacity for new admissions yet save more lives in the long term than accomplished by only increasing treatment seeking. Increasing provider capacity had negligible effects. The most effective 2-policy combination was increasing capacity and duration simultaneously, which would reduce OODs up to 18.6% over a decade. By 2033, the greatest reduction in OODs (≥20%) was achieved when capacity was doubled and average duration reached 2 years, but only if the policy changes started in 2023. Delaying even a year diminishes the benefits. Treatment-seeking increases were equally beneficial whether they began in 2023 or 2025 but of only marginal benefit beyond what capacity and duration achieved.

Conclusions

If policymakers only target 2 policies to reduce OODs, they should be to increase capacity and duration, enacted quickly and aggressively.
Examining the Relationships Among Treatment, Pain, and Physical Function in Patients With Osteoarthritis
Authors: Abraham Lucy , Dworkin Robert H. , Turk Dennis C. , Markman John D. , Williams David A. , Bushmakin Andrew G. , Hall Jerry A. , Semel David C. , Cappelleri Joseph C. , Yang Ruoyong
Published: February 2023

Objectives:

To better understand the relationships among treatment, pain, and physical function (PF).

Methods:

Data were collected from 2 published randomized clinical trials of osteoarthritis patients who received tanezumab or a placebo. PF was measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) PF domain. Pain (WOMAC pain domain) was a mediator of the effect of treatment on PF. A set of mediation models were investigated. Variables were treatment (tanezumab vs placebo), WOMAC pain domain, and WOMAC PF domain. Cross-sectional mediation models were assessed separately at different weeks. Longitudinal mediation models used data from all weeks simultaneously. Results could identify a steady-state period.

Results:

The cross-sectional and longitudinal mediation models showed a stable indirect effect of treatment through the pain on PF across time, indicating that a pseudo-steady-state model was appropriate. Therefore, the longitudinal steady-state mediation models were used with all available data assuming relationships among variables in the model being the same at all time points; results showed that the indirect effect of the treatment on PF was 77.8% in study 1 (NCT02697773) and 74.1% in study 2 (NCT02709486), both P <0.0001, whereas the direct effect was 22.2% for study 1 (P = 0.0003) and 25.9% for study 2 (P = 0.0019).

Discussion:

At least 75% of the treatment effect of tanezumab on physical functioning can be explained by the improvements in pain. However, tanezumab had an additional effect on physical functioning (~25%) that, was independent of improvements in pain. Such independent effects are of considerable interest and require further research to determine their mechanisms.
A Comparison of Prognostic Models to Facilitate Surgical Decision-Making for Patients With Spinal Metastatic Disease
Authors: Wick Joseph B. , Kalistratova Venina S. , Jr Dagoberto Piña , Fine Jeffrey R. , Boozé Zachary L. , Holland Joseph , Vander Voort Wyatt , Hisatomi Lauren A. , Villegas Alex , Conry Keegan , Ortega Brandon , Javidan Yashar , Roberto Rolando F. , Klineberg Eric O. , Le Hai V.
Published: February 2023

Study Design.

Retrospective cohort.

Objective.

Compare the performance of and provide cutoff values for commonly used prognostic models for spinal metastases, including Revised Tokuhashi, Tomita, Modified Bauer, New England Spinal Metastases Score (NESMS), and Skeletal Oncology Research Group model, at three- and six-month postoperative time points.

Summary of Background Data.

Surgery may be recommended for patients with spinal metastases causing fracture, instability, pain, and/or neurological compromise. However, patients with less than three to six months of projected survival are less likely to benefit from surgery. Prognostic models have been developed to help determine prognosis and surgical candidacy. Yet, there is a lack of data directly comparing the performance of these models at clinically relevant time points or providing clinically applicable cutoff values for the models.

Materials and Methods.

Sixty-four patients undergoing surgery from 2015 to 2022 for spinal metastatic disease were identified. Revised Tokuhashi, Tomita, Modified Bauer, NESMS, and Skeletal Oncology Research Group were calculated for each patient. Model calibration and discrimination for predicting survival at three months, six months, and final follow-up were evaluated using the Brier score and Uno’s C, respectively. Hazard ratios for survival were calculated for the models. The Contral and O’Quigley method was utilized to identify cutoff values for the models discriminating between survival and nonsurvival at three months, six months, and final follow-up.

Results.

Each of the models demonstrated similar performance in predicting survival at three months, six months, and final follow-up. Cutoff scores that best differentiated patients likely to survive beyond three months included the Revised Tokuhashi score=10, Tomita score=four, Modified Bauer score=three, and NESMS=one.

Conclusion.

We found comparable efficacy among the models in predicting survival at clinically relevant time points. Cutoff values provided herein may assist surgeons and patients when deciding whether to pursue surgery for spinal metastatic disease.

Level of Evidence.

4.
Postoperative Use of the Muscle Relaxants Baclofen and/or Cyclobenzaprine Associated with an Increased Risk of Delirium Following Lumbar Fusion
Authors: Perez Eli A. , Ray Emanuel , Gold Colin J. , Park Brian J. , Piscopo Anthony , Carnahan Ryan M. , Banks Matthew , Sanders Robert D. , Olinger Catherine R. , Mueller Rashmi N. , Woodroffe Royce W.
Published: February 2023

Study Design.

Retrospective, single-center, cohort study

Objective.

Investigate whether the incidence of postoperative delirium in older adults undergoing spinal fusion surgery is associated with postoperative muscle relaxant administration

Summary of Background Data.

Baclofen and cyclobenzaprine are muscle relaxants frequently used for pain management following spine surgery. Muscle relaxants are known to cause central nervous system side effects in the outpatient setting and are relatively contraindicated in individuals at high-risk for delirium. However, there are no known studies investigating their side effects in the postoperative setting.

Methods.

Patients over 65 years of age who underwent elective posterior lumbar fusion for degenerative spine disease were stratified into two treatment groups based on whether postoperative muscle relaxants were administered on postoperative day 1 as part of a multimodal analgesia regimen. Doubly robust inverse probability weighting (IPW) with cox-regression for time-dependent covariates was used to examine the association between postoperative muscle relaxant use and the risk of delirium while controlling for variation in baseline characteristics.

Results.

The incidence of delirium was 17.6% in the 250 patients who received postoperative muscle relaxants compared to 7.9% in the 280 patients who did not receive muscle relaxants (P=0.001). Multivariate analysis to control for variation in baseline characteristics between treatment groups found patients who received muscle relaxants had a 2.00 (95% CI: 1.14-3.49) times higher risk of delirium compared to controls (P=0.015).

Conclusion.

Postoperative use of muscle relaxants as part of a multi-modal analgesia regimen was associated with an increased risk of delirium in older adults after lumber fusion surgery. Although muscle relaxants may be beneficial in select patients, they should be used with caution in individuals at high risk for postoperative delirium. Additional work is needed to further examine the risks and benefits of postoperative muscle relaxant administration.

Level of Evidence.

3
Response to Chemoimmunotherapy Is Associated With Expansion of Systemic Antitumor CD4+ Th1 Response in Metastatic Non–Small Cell Lung Cancer
Authors: Wespiser Mylène , Marguier Amélie , Lecoester Benoît , Richard Thibault , Boullerot Laura , Malfroy Marine , Kumar Abhishek , Laheurte Caroline , Adotévi Olivier
Published: February 2023

Limited data have reported the evolution of antitumor immune responses under chemoimmunotherapy (chemo-IO) in patients with metastatic non–small cell lung cancer. In this concise study, we performed dynamic monitoring of antitumor CD4+ T helper 1 (Th1) response in peripheral blood from 12 patients receiving a first-line chemo-IO. Tumor-reactive CD4+ Th1 cells were assessed within blood lymphocytes using interferon-gamma enzyme-linked immunospot assay to detect telomerase (TERT)-specific T cells at baseline, 3 and 12 months after treatment. An induction of circulating anti-TERT CD4+ Th1 response were found in 6 of 12 patients at 3 months after chemo-IO. In contrast, 3 patients had a substantial decrease in their preexisting response and 3 remained nonimmune responders. Among patients with chemo-IO-induced immune response, half achieved an objective clinical response and had long-lasting circulating anti-TERT CD4+ Th1 cells detected for at least 1 year. In contrast, no objective response was documented in nonimmune responders and a link between the loss of anti-TERT CD4+ Th1 responses were observed in patients with progressive disease. This preliminary work supports a relationship between the efficacy of combinatorial chemo-IO and circulating anti-TERT CD4+ Th1 responses and highlights the interest to implement blood-based monitoring of tumor-reactive CD4+ T cells that could be additional help for patient management.
The Use of a Dehydrated Complete Human Placental Membrane Allograft for Mohs Surgical Defects of the Nose
Authors: Wilmas Kelly M. , Patel Jigar , Silapunt Sirunya , Doan Hung Q. , Migden Michael R.
Published: February 2023

BACKGROUND

Repair options for Mohs surgical defects include primary closure, flap or graft, or healing by second intention. These options may not be optimal in all cases. A dehydrated complete human placental membrane (dCHPM) allograft may serve as an alternative repair option.

OBJECTIVE

To assess the aesthetic and functional outcomes of an alternative repair technique for Mohs surgical defects of the nose.

METHODS

Twenty patients with Mohs surgical defects of the nose repaired with a dCHPM allograft were retrospectively identified. Photographs were used to demonstrate surgical technique and outcomes. Two blinded observers evaluated final outcomes using the Patient and Observer Scar Assessment Scale.

RESULTS

Observers rated the scar outcome a combined mean score of 8.4 ± 3.2 (scale 5–50). Patients rated their outcomes a mean of 12.6 ± 7.4 (scale 6–60). The mean “Overall Opinion score” was 2.5 ± 1.8 by patients and 1.9 ± 1.3 by observers (scale 1–10).

Limitations

This was a single institution study with a small sample size.

CONCLUSION

Our study demonstrates that dCHPM allografts are a viable alternative repair option for Mohs surgical defects of the nose.
Highly Purified Microdroplet Liquid Injectable Silicone for the Treatment of Acne Scars in Lighter and Darker Skin Types: A Retrospective Review
Authors: Salame Nicole , Brody Harold J.
Published: February 2023

BACKGROUND

Treatment of acne scarring in darker skin types is fraught with challenges. Highly purified liquid injectable silicone (LIS) is effective in the treatment of acne scars, although its use in darker skin types has yet to be evaluated.

OBJECTIVE

Retrospective evaluation of the safety and efficacy of highly purified LIS for the treatment of acne scars in lighter and darker skin types.

MATERIALS AND METHODS

A retrospective chart review of patients who received highly purified LIS for acne scars between July 2010 and March 2021.

RESULTS

Two hundred six total treatments in 96 patients, 32.29% (n = 31) of whom were Fitzpatrick skin type IV (n = 20, 20.83%) and V (n = 11, 11.46%), with depressed and both broad-based and shallow acne scarring were reviewed. Mean age was 50.77 years (SD 16.77), and 83% were female. Complications such as granuloma formation, migration, extrusion of silicone, hyperpigmentation, hematoma, or infection were not observed. The average follow-up time was 6.31 years (SD 3.02).

CONCLUSION

Highly purified LIS is a safe and effective permanent treatment for acne scars in all skin types. Injection of highly purified LIS using small volume microdroplet technique at 6- to 8-week intervals did not yield any complications, including in patients with darker skin types.
Efficacy and Safety of the Micro-insulated Needle Radiofrequency Device for Reduction of Submental Fat
Authors: Kim Bo Ri , Kim Minjae , Kim Jee Woo , Shin Jung-Won , Na Jung-Im , Huh Chang-Hun
Published: February 2023

BACKGROUND

Recently, it has been reported that a micro-insulated needle radiofrequency (RF) system is effective at achieving subcutaneous fat reduction; however, no study has yet applied this technique to reduce submental fat.

OBJECTIVE

To evaluate the efficacy and safety of a fractional RF device with a micro-insulated needle to reduce submental fat.

MATERIALS AND METHODS

In this prospective, single-blinded, pre–post comparative study, 24 adults with excess submental fat were treated once using a micro-insulated needle RF device. Outcomes included efficacy (submental fat rating by an independent investigator, fat volume quantified with a 3-dimensional camera, and patient satisfaction), assessed 1 and 2 months after the procedure, and safety (adverse events), assessed throughout the study.

RESULTS

The patients' Physician-Assisted Submental Fat Rating Scale score significantly decreased after 1 month and further decreased after 2 months. The average volume of submental fat was significantly decreased after 2 months (20.44 ± 5.53 cc to 16.41 ± 4.58 cc, p < .001). Patient satisfaction was high. Transient and mild local skin reactions without long-term sequelae were observed in 4 patients.

CONCLUSION

The micro-insulated needle RF device is beneficial for the reduction of submental fat and has tolerable safety profiles.

Trial registration

ClinicalTrials.gov Identifier: NCT05517824.
Airway Edema after Keloid Resection and Superficial Radiation: Unexpected Event in an Unusual Location
Authors: Bailey Virginia Elizabeth , Knowles Ariel , Glass Donald , Albuquerque Kevin , Nagarkar Purushottam
Published: February 2023

Postoperative radiation therapy has been shown to significantly reduce recurrence rates of keloids after surgical excision. Adverse effects of radiation therapy in this setting are generally minimal because the radiation utilized quickly dissipates below the skin, and the radiation effects on the internal organs are usually negligible. This case report describes a patient who underwent excision of a wide anterior neck keloid and received postoperative external beam radiation therapy of the incision. She presented with extensive upper airway edema, dyspnea, and dysphagia requiring readmission and steroids. Re-evaluation of the radiation protocol revealed an inadvertent intersection of the multiple abutting radiation fields at the supraglottic region, resulting in tripling of the dose in the area, and likely leading to her complication. She did well with conservative management with IV steroids, and did not require intubation. She has had no long-term sequelae and no recurrence at 6 months postoperative.
Retrospective Detection Sensitivity for GPS-based Gamma Radiation Surveys
Authors: Alecksen Tyler , Whicker Randy
Published: February 2023

A probabilistic method for a priori calculation of the expected minimum detectable concentration of a contaminant radionuclide in soil while scanning (“scan MDC”) with a GPS-based gamma radiation survey system has previously been described. This paper presents supporting evidence for the validity of respective use of a statistical minimum detectable count rate (MDCR) as described in the Multi-Agency Radiation Survey and Site Investigation Manual (MARSSIM) and builds on related concepts to develop a technical basis for a posteriori estimation of MDCR and scan MDC sensitivity metrics for geospatially rendered datasets. Nearest-neighbor averaging of multiple data points from a geospatial population of gamma survey data permits retrospective quantification of MDCR values based on statistical reductions in the variance in both background and source data distributions. A retrospective MDCR can be used to calculate a posteriori scan MDCs based on detection efficiencies modeled with the probabilistic method for various radionuclides, source dimensions, detector heights, and scan speeds.
A Telestroke Nurse and Neuroradiologist Model for Extended Window Code Stroke Triage
Authors: Helms Anna Maria , Yang Hongmei , Karamchandani Rahul R. , Williams Laura , Singh Sam , DeFilipp Gary J. , Asimos Andrew W.
Published: February 2023

BACKGROUND: Distinguishing features of our stroke network include routine involvement of a telestroke nurse (TSRN) for code stroke activations at nonthrombectomy centers and immediate availability of neuroradiologists for imaging interpretation. On May 1, 2021, we implemented a new workflow for code stroke activations presenting beyond 4.5 hours from last known well that relied on a TSRN supported by a neuroradiologist for initial triage. Patients without a target large vessel occlusion (LVO) were managed without routine involvement of a teleneurologist, which represented a change from the preimplementation period. METHODS: We collected data 6 months before and after implementation of the new workflow. We compared preimplementation process metrics for patients managed with teleneurologist involvement with the postimplementation patients managed without teleneurologist involvement. RESULTS: With the new workflow, teleneurologist involvement decreased from 95% (n = 953) for patients presenting beyond 4.5 hours from last known well to 37% (n = 373; P < .001). Compared with patients in the preimplementation period, postimplementation patients without teleneurologist involvement experienced less inpatient hospital admission and observation (87% vs 90%; unadjusted P = .038, adjusted P = .06). Among the preimplementation and postimplementation admitted patients, there was no statistically significant difference in follow-up neurology consultation or nonstroke diagnoses. A similar percentage of LVO patients were transferred to the thrombectomy center (54% pre vs 49% post, P = .612), whereas more LVO transfers in the postimplementation cohort received thrombectomy therapy (75% post vs 39% pre, P = .014). Among LVO patients (48 pre and 41 post), no statistical significance was observed in imaging and management times. CONCLUSION: Our work shows the successful teaming of a TSRN and a neuroradiologist to triage acute stroke patients who present beyond an eligibility window for systemic thrombolysis, without negatively impacting care and process metrics. This innovative partnering may help to preserve the availability of teleneurologists by limiting their involvement when diagnostic imaging drives decision making.
A fatal retroperitoneal bleeding from iliolumbar artery following open reduction and internal fixation of an unstable pelvic ring injury: A case report
Authors: Song Suk-Kyoon , Park Jinkyu , Lee Sungho
Published: February 2023

Rationale:

Retroperitoneal bleedings are the result of injury to parenchymal tissue or vascular structures within retroperitoneal cavity. This may arise spontaneously, as a result of trauma or iatrogenically. Patients usually do not manifest clinically apparent signs and symptoms until a substantial amount of blood loss has occurred. Therefore, it is associated with high morbidity and mortality. Herein we present and discuss a case of fatal iatrogenic retroperitoneal bleeding following open reduction and internal fixation of an unstable pelvic ring injury.

Patient concerns:

A 66-year-old female patient presented to the Level I regional trauma center with severe pelvic pain after a pedestrian collision by a car.

Diagnoses:

In initial radiography and computed tomography, she was diagnosed with unstable pelvic ring injury.

Interventions:

Definitive surgery for open reduction and internal fixation through the anterior approach to the sacroiliac joint and anterior intrapelvic approach was performed on the 8th day after the injury.

Outcomes:

Patient died 3 days after the surgery due to a massive retroperitoneal bleeding from iliolumbar artery.

Lessons:

Insidious retroperitoneal bleeding from the small vessel may lead to fatal massive retroperitoneal hematoma. Therefore, active retroperitoneal bleeding should be suspected in cases of unexplained unstable hemodynamic status following orthopedic pelvic and acetabular surgery.
Offer of integrative and complementary health practices for the elderly in health services: A protocol for systematic review and meta analysis
Authors: Diniz Nathália Priscilla Medeiros Costa , da Silva José Felipe Costa , Sampaio Ana Tânia Lopes , Torres Gilson de Vasconcelos , Schveitzer Mariana Cabral , Nobre Thaiza Teixeira Xavier
Published: February 2023

Introduction:

Integrative and complementary health practices (ICHP) question the hegemony of the biomedical, technical and hospital paradigm, as they are an important axis in the process of redefining the health care model. Understanding how ICHP are offered to the elderly population can help to improve the production of changes in care and in the daily life of health services.

Objective:

To identify and summarize the scientific evidence on the provision of ICHP for the elderly in health services.

Methods:

This is a research protocol for a scoping review following the recommendations of the Extension for Scoping Reviews method proposed by the Joanna Briggs Institute. Studies will be collected in the following databases, Latin American and Caribbean Health Sciences Literature, Web of Science, Scopus, Scielo, Online System for Searching and Analyzing Medical Literature (MEDLINE), Embase, Virtual Library in Health and gray literature. Two independent reviewers will perform screening, data extraction, and risk of bias assessment using the Joanna Briggs Institute Critical Assessment Checklist. For the quality of evidence, the Grading of Recommendations, Assessment, Development and Evaluation analysis will be used.

Results:

This review will provide information on the provision of ICHP for the elderly population in health services.

Conclusions:

This scoping review will provide evidence to help health professionals, managers and users to recognize more effective therapeutic inventions for promoting, preventing and protecting comprehensive health at different levels of care.
Axenfeld–Rieger syndrome combined with ectropion uveae and pigment dispersion syndrome: A case report
Authors: Li Yang , Liu Jie , Tian Qingmei , Ma Xianzhen , Zhao Yuhui , Bi Hongsheng
Published: February 2023

Background:

In January 2021, we found one case of Axenfeld–Rieger syndrome combined with pigment dispersion syndrome (PDS), and this patient additionally manifested a symptom of ectropion uveae. The co-existence of both 2 syndromes is very rare and has not been reported in any literature yet.

Case presentation:

A 34-year-old female truck driver presented to our institution with a dimness of vision in her right eye. The patient had obvious posterior embryotoxons at bitamporal, and peripheral anterior synechia could be visualized by the slit lamp. The dispersion of pigment granules was observed behind the cornea. The pupil was slightly shifted upwards the nose, with 360° ectropion uveae. Gonioscopy revealed pigment accumulation on the trabecular meshwork. The patient underwent cataract surgery on her right eye, during which, flaky pigmentation around the posterior capsule was observed. These signs were consistent with Axenfeld–Rieger syndrome and PDS.

Conclusions:

We report a rare case of Axenfeld–Rieger syndrome with PDS and uveal eversion. Although the patient did not present with glaucoma, follow-up should be noted. Besides, the correlation between these 2 syndromes needs to be demonstrated by more cases or further evidence.
Pulmonary embolism in COVID-19, risk factors and association with inflammatory biomarkers
Authors: Yousaf Muhammad , Thomas Merlin Marry , Almughalles Salah , Hameed Mansoor Ali , Alharafsheh Ahmad , Varikkodan Irfan , Waseem Ali , Babikir Mona , Chengamaraju Dinesh , Khatib Mohamad Yahya
Published: February 2023

The coronavirus disease 2019 (COVID-19) pandemic affected millions of people worldwide resulting in a substantial number of hospitalizations. Venous thromboembolism including pulmonary embolism is a known complication of COVID-19 pneumonia although its incidence in such patients is unclear. In this multicenter retrospective cohort study, we looked at the incidence of pulmonary embolism in COVID-19 patients and its associations with various risk factors including demographics, comorbidities, inflammatory markers and coagulation profiles. We analyzed data from 193 patients of mixed ethnicity with a mean age of 51, mostly South Asians (62%) and Arabs (29%). Diabetes and hypertension were the most prevalent comorbidities accounting for 46% (N = 88) and 36% (N = 71) respectively. Critical COVID-19 illness was diagnosed in 67% of patients. The frequency of COVID-19 related pulmonary embolism was 21.8% (N = 42). We found no association of pulmonary embolism with demographic, comorbid or inflammatory variables. Only a raised D-Dimer was found to be associated with pulmonary embolism. Having a pulmonary embolism had no impact on the length of stay, critical illness, or mortality. Receiving steroids or being on standard thromboprophylaxis or weight/D-Dimer adjusted thromboprophylaxis also had no impact on the frequency of pulmonary embolism. Nine incidents of major bleeding were recorded independent of therapeutic anticoagulation. Patients admitted to the hospital for COVID-19 pneumonia had a relatively high incidence of pulmonary embolism. D-dimer was the only associated laboratory parameter associated with pulmonary embolism. However, further research is needed to evaluate its predictive and prognostic utility, particularly in an older population.
Immediate hypersensitivity reaction to intravitreal injection of triamcinolone acetonide following treatment by pars plana vitrectomy: A case report
Authors: Zhang Wei , Liao Mengyu , Yan Hua
Published: February 2023

Rationale:

Hypersensitivity reactions to intravitreal injection of triamcinolone acetonide (TA) were very rare and had been infrequently reported. In this study, we reported the clinical features of hypersensitivity reactions of TA, explored its management, and analyze the relative factors.

Patient concerns, diagnosis, interventions, and outcomes:

We described a case of an immediate hypersensitivity reaction to intravitreal injection of TA following the treatment by pars plana vitrectomy. A 27-year-old man was reported with an immediate hypersensitivity reaction following an intravitreal injection of TA. 0.1 mL TA (40 mg/mL) was injected into the vitreous cavity and then white punctate edema appeared on the surface of the retina. Three days later, the visual acuity was 20/500 and white punctate edema disappeared on the surface of the retina without specific treatment.

Conclusions and importance:

Hypersensitivity reaction must be considered in cases of intravitreal injection of TA that may resolve without specific treatment. The clinical intravitreal injection of TA requires filtration to remove excipients.
Successful chemotherapy with continuous immunotherapy for primary pulmonary endovascular epithelioid hemangioendothelioma: A case report
Authors: Guo Wenliang , Zhou Daibing , Huang Houquan , Chen Haiming , Wu Xiaofeng , Yang Xin , Ye Huiling , Hong Cheng
Published: February 2023

Rationale:

Epithelioid hemangioendothelioma (EHE) is a rare, low to moderate-grade malignancy, even less in pulmonary endovascular neoplasm. Patients with pulmonary EHE have no optimal treatment, resulting in poor prognoses.

Patient concerns:

We reported a 42-year-old man with multiple mild metabolic uptakes in pulmonary endovascular filling defect with a maximum standardized uptake value of 4.5 by 18-fluorodeoxyglucose/fibroblast associated protein inhibitor-positron emission tomography/ computed tomography. Anticoagulant treatment was not effective with the diagnosis of acute pulmonary embolism.

Diagnoses:

A primary endovascular EHE pulmonary endovascular epithelioid hemangioendothelioma was diagnosed by endovascular biopsy with positive stains for molecular CD31, CD34 and CAMTA1, and it had low proliferative capacity characterized by Ki-67 of 5%. The mutation gene MSH2 (p.Y656 in exon 12) (mutation abundance of 0.07%) from peripheral blood indicates the potential benefit of an immune checkpoint inhibitor, pembrolizumab.

Interventions and outcomes:

The patient was treated with tri-weekly paclitaxel (175mg/m2) and carboplatin (AUC 5) chemotherapy regimen. He exerted a remarkable response after 5 cycles (21 days per cycle) and Pembrolizumab (200mg once monthly) as maintenance treatment.

Lessons:

This case highlights the diagnostic challenge of differentiating endovascular lesions and optimal therapy for pulmonary EHE. Importantly, it indicated that the mutation gene MSH2 (p.Y656) might influence the pathogenesis of EHE.
Durable response of tislelizumab plus cisplatin, nab-paclitaxel followed by concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: A case report
Authors: Tang Haifeng , Yang Donghong , Luo Guoqing , He Jiaqi , Yi Guihua , Chen Zihong , Li Haiwen , Luo Qianbing , Huang Ningxin , Luo Haiqing
Published: February 2023

Rationale:

Limited patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) have achieved complete response (CR) from induction chemotherapy (IC). Neoadjuvant immunotherapy combined with chemotherapy has marked therapeutic effects in some locoregionally advanced solid tumors. However, its efficacy and safety of NPC have not been reported so far. The rapid response of neoadjuvant tislelizumab combined with chemotherapy on LA-NPC may be associated with long-term survival benefit.

Patient concerns:

A 57-year-old male patient presented with a 2-month history of bloody nasal discharge and right neck mass for 2 weeks.

Diagnosis:

The patient was eventually diagnosed with nasopharyngeal nonkeratinizing undifferentiated cell carcinoma (stage IVA).

Interventions:

The patient received tislelizumab combined with nanoparticle albumin-bound paclitaxel (nab-paclitaxel) nab-paclitaxel plus cisplatin for 4 cycles, followed by cisplatin-based concurrent chemoradiotherapy (CCRT).

Outcomes:

A partial response (PR) was achieved after 2 cycles of tislelizumab and nab-paclitaxel plus cisplatin, and CR was achieved after 4 cycles of neoadjuvant treatment. The duration of response lasted 24 months, and the patient was still in CR as of November 2022. The patient had no serious adverse event (AEs) during the treatment.

Lessons:

This case report showed that tislelizumab combined with cisplatin plus nab-paclitaxel followed CCRT for treatment of patients with LA-NPC may receive a fast and durable response with a manageable safety profile and long-term survival.
The effectiveness of motherwort injection in preventing postabortion hemorrhage after induced abortion: A protocol for systematic review and meta-analysis
Authors: Xiang Yanjie , Wang Xiaohan , Gong Yongqian , Xiang Jianfeng
Published: February 2023

Background:

Unintended pregnancy is a problem that women encounter throughout their reproductive age. Excessive and prolonged uterine bleeding is one of the most common and critical adverse reactions of induced abortion, for it increases the risk of anemia and intrauterine infection. To provide reliable clinical evidence, we performed a protocol for systematic review and meta-analysis to evaluate the hemostatic effect of motherwort in postabortion.

Methods:

This review protocol has been registered in the international prospective register of systematic reviews. The statement of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols will be used as guidelines for reporting present review protocol. Original clinical randomized controlled trials assessing the beneficial effects and safety of motherwort on induced abortion will be included. Databases searched include China National Knowledge Infrastructure, Chinese Scientific Journals Database, Wanfang Database, China Biological Medicine Database, PubMed, and EMBASE Database and Cochrane Central Register of Controlled Trials. Cochrane collaboration tool is used to assess the risk of bias of included randomized controlled trials. All calculations are carried out with Stata 11.0 (The Cochrane Collaboration, Oxford, United Kingdom).

Results:

This systematic review and meta-analysis will provide a detailed summary of the current evidence related to the efficacy of motherwort injection preventing postabortion hemorrhage after induced abortion.

Conclusion:

This evidence will be useful to practitioners, patients, and health policy-makers regarding the use of motherwort injection in induced abortion.
Hem coagulase induced cerebral venous sinus thrombosis in patients with uterine fibroids surgery
Authors: Sun Bei , Liu Tingting , Xu Bingchao , Zhang Guanghui , Xie Kang
Published: February 2023

Background:

Cerebral venous sinus thrombosis (CVST) is a rare, high-risk, and easily misdiagnosed disease. Currently, there are case reports of hem coagulase-induced thrombotic events, but no reports of CVST being associated with hem coagulase.

Case summary:

A 35-years-old woman presented to the outpatient clinic with a severe headache and sudden memory loss with intravenous hem coagulase for postoperative bleeding after uterine fibroids surgery. Abnormal neurological signs included slowed reactions, poor memory, and decreased numeracy. Magnetic resonance imaging and computed tomography scan showed multiple cerebral infarcts, and the infarct area was non-arterial. Brain magnetic resonance venography showed obstruction of the left sigmoid sinus. High-resolution magnetic resonance imaging of the left sigmoid sinus showed abnormally high signal. The patient was treated with a subcutaneous Low-Molecular-Weight Heparin Sodium injection 0.4 ml, twice a day (7 days), and oral Warfarin Sodium 3 mg, once a day, while monitoring the international normalized ratio, adjust the warfarin sodium dosage according to the international normalized ratio level. One month later, the patient had no neurological symptoms and her cognitive function returned to normal.

Conclusion:

hem coagulase may be a contributing factor to CVST in patients undergoing uterine fibroids surgery and should be administered intravenously with caution.
Impact of age for overall survival in head and neck sarcoma
Authors: Suzuki Hidenori , Takano Gaku , Tsukushi Satoshi , Ando Masashi , Yatabe Yasushi , Kodaira Takeshi , Nishikawa Daisuke , Beppu Shintaro , Hasegawa Yasuhisa , Hanai Nobuhiro
Published: February 2023

The purpose to the present study is to research the association between age at surgery and survival outcomes of patients with sarcoma in head and neck. Twenty-six patients with head and neck sarcoma who underwent by surgery from 2003 to 2017 were enrolled in the present observation study. Patients who did not undergo chemotherapy were significantly older age at surgery by Mann–Whitney U test. Fifty-five was the cutoff age that predicted death by receiver operating curve analysis. Shorter survival rates of overall, disease-specific, local recurrence-free and disease-free were associated with older age by log-rank test. Age (≥55 years/<55 years) was correlated with shorter overall survival by multivariate analysis of Cox’s proportional hazards model adjusting with chemotherapy (absence/presence). In conclusion, older age predicts worse overall survival in head and neck sarcoma.
A novel heterozygous mutation of the NPHS1 gene in a Chinese child with congenital nephrotic syndrome: A case report
Authors: Xie Dan , Wu Jiangfen , Zhang Wenyi , Jin Tingting , Wu Peng , An Banquan , Huang Shengwen
Published: February 2023

Rationale:

Congenital nephrotic syndrome (CNS) is a heterogeneous disorder in which massive proteinuria, hypoproteinemia, and hyperlipidemia and marked edema are the main manifestations before 3 months-of-age. Here, we present a case involving the genetic diagnosis of a child with CNS.

Patient concerns:

A 31-day-old male infant with diarrhea for 25 days and generalized edema for more than 10 days. There was no family history of kidney disease. On proband whole exome sequencing, a compound heterozygous mutation of the NPHS1 gene was identified, including a novel in-frame mutation in exon 14 (c.1864_1866dupACC p. T622dup) and a missense mutation in exon 8 (c.928G>A p. D310N).

Diagnoses:

Based on the clinical and genetic findings, this patient was finally diagnosed with CNS.

Interventions:

The main treatment options for the patient were 2-fold: anti-infective treatment and symptomatic treatment.

Outcomes:

The patient died in follow-up 2 months later; the specific reason for death was unclear.

Lessons:

Whole exome sequencing and Sanger sequencing confirmed that the infant had CNS. Our study identified a novel mutation in an infant, thus expanding the gene-mutation spectrum of the NPHS1 gene, thus providing an efficient prenatal screening strategy and early genetic counseling.
Efficacy of blood urea nitrogen-to-albumin ratio for predicting prognostic outcomes of inpatients with COVID-19: A meta-analysis
Authors: Hung Kuo-Chuan , Li Yu-Yu , Huang Yen-Ta , Liu Ping-Hsin , Hsu Chih-Wei , Ho Chun-Ning , Hung I-Yin , Chang Fu-Sheng , Sun Cheuk-Kwan
Published: February 2023

Background:

The associations between blood urea nitrogen (BUN)/albumin ratio and poor prognosis in patients with diagnosis of coronavirus disease 2019 (COVID-19) remain to be clarified.

Methods:

A search based on 4 electronic databases (i.e., EMBASE, Google scholar, MEDLINE, and Cochrane Library) was performed on June 23, 2022. The association of BUN/Albumin ratio with poor prognostic outcomes, defined as patients with mortality/severe illnesses, were analyzed.

Results:

Results from analysis of 7 cohort studies (3600 individuals with COVID-19) published between 2020 and 2022 showed a higher BUN/Albumin ratio in the poor-prognosis group (Mean difference:  = 2.838, 95% confidence interval: 2.015–3.66, P < .001, I
2 = 92.5%) than the good-prognosis group. Additional investigation into the connection between BUN/Albumin ratio as a binary variable (i.e., high or low) and the risk of poor outcome also supported an association between a higher BUN/Albumin ratio and a poor prognostic risk (odd ratio = 3.009, 95% confidence interval: 1.565–5.783, P = .001, I
2 = 93.7%, 5 studies). Merged analysis of poor prognosis produced a sensitivity of 0.76, specificity of 0.72, and area under curve of 0.81.

Conclusion:

This meta-analysis demonstrated a positive correlation between BUN/albumin ratio and poor outcome in patients with COVID-19. Additional large-scale prospective studies are needed to verify our findings.
Microsurgical complication associated with vaccine-induced immune thrombotic thrombocytopenia (VITT): A case report
Authors: Hung Chen-Ting , Hsu Honda
Published: February 2023

Rationale:

The use of ChAdOx1 nCoV-19 (Astra Zeneca) vaccine has proven beneficial, but in a limited number of the general population, it was found to be associated with vaccine-induced immune thrombotic thrombocytopenia (VITT). However, there have been no reports of this complication occurring in a microsurgical free tissue transfer.

Patient concerns:

A 49-year-old man developed an acute myocardial infarction 3 weeks after receiving his first dose of ChAdOx1 nCoV-19 in June 2021. Three months later, he presented with right third toe wet gangrene with extension into the plantar foot nine days after receiving his second dose of ChAdOx1 nCoV-19 vaccine.

Diagnosis:

Based on recent exposure to vaccination, the timing of inoculation before the development of his symptoms, and serology tests (platelet, D-dimer, and anti-PF4 antibodies), the patient was diagnosed with VITT.

Interventions:

Fasciectomy and sequestrectomy were performed for wound bed preparation. Limb salvage was done using free vastus lateralis muscle flap and skin graft for reconstruction.

Outcome:

The flap was complicated by persistent microthrombi leading to superficial necrosis without vascular pedicle compromise. Repeated debridement of the superficial necrosis was done. Three months after the development of VITT, no further new superficial necrosis was seen. A well-contoured flap was seen 5 months after the initial surgery.

Lessons:

We believe this is the first case describing microthrombi in the free flap due to VITT after microsurgical reconstruction. Patients and surgeons should be advised of this possible risk when contemplating microsurgery once VITT has developed after ChAdOx1 nCoV-19 administration.
Abrocitinib for the Treatment of Moderate-to-Severe Atopic Dermatitis
Authors: Villegas Susan C. , Dima Lorena
Published: February 2023

Background:

Atopic dermatitis (AD) is ranked as the third most prevalent skin condition with a worldwide prevalence of 2.4%. Atopic dermatitis is a common form of eczema. It develops in infancy or childhood and continues into adulthood with symptoms ranging from mild to severe. Pruritis and inflammation are the hallmark symptoms of AD.

Mechanism of Action, Pharmacodynamics, and Pharmacokinetics:

Abrocitinib is a JAK1 selective inhibitor; inhibition results in a decreased interleukin (IL) 4 activation and decreased pruritis in a patient with AD. Abrocitinib is hepatically metabolized by multiple cytochrome P450 enzymes, and dose modification may be required when administered with concurrent medications.

Clinical Trials:

At least 6 JAK1 Atopic Dermatitis Efficacy and Safety (JADE) trials were conducted evaluating Investigator's Global Assessment and Eczema Area and Severity Index score for efficacy. All JADE trials showed abrocitinib 100 mg and 200 mg doses efficacious when compared with placebo. Common adverse reactions were related to gastrointestinal disturbances, headache, and acne. Serious adverse reactions to assess risk for include serious infections, malignancy, major adverse cardiovascular events, and venous thromboembolisms.

Therapeutic Advance:

Abrocitinib provides a valuable treatment option for patients with moderate-to-severe AD unresponsive to other therapies for those candidates without a high risk for significant adverse reaction associated with its use.
Atypical Case of Fractal Wood Burning
Authors: Rohrer Charles T. , Kallan Jamie E.
Published: February 2023

Fractal wood burning is a form of pyrography that uses high-voltage electricity to burn branching, Lichtenberg-type patterns into a wooden canvas. This process often uses electrical transformers salvaged from household appliances, such as microwave ovens, to amplify available voltage to potentially lethal levels. In this case, 2 individuals were found dead inside their burned residential garage. Initially, law enforcement was suspicious of a double homicide with subsequent arson. However, postmortem examination showed the decedents had neither fatal antemortem trauma nor significant natural disease. Findings consistent with smoke inhalation were absent, suggesting that the victims were deceased before the fire. Interestingly, one decedent had jumper cables in their hand, and their recent computer activity included fractal wood burning–related content. Upon further scene investigation, 2 microwave ovens were identified in the garage, one of which had been disassembled with its transformer found adjacent to the bodies. The decedents likely died from high-voltage electrocution with ignition of the wooden canvas starting the structural fire. Since the first reported case in 2016, there have been 33 reported deaths attributed to fractal wood burning. The current study would be the first to report multiple fatalities due to a single fractal wood burning event.