bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcatheter aortic valve replacement before to breast cancer management: case report and literature review
Authors: Aquino-Bruno Heberto , Muratalla-González Roberto , Garcia-Garcia Juan F , Morales-Portano Julieta D , Meléndez-Ramírez Gabriela , Ahu-Chandomi Yusihey , Merino-Rajme Jose A , Alcantara-Meléndez Marco A
Published: September 2024

Background

The coexistence of aortic stenosis (AS) and neoplastic pathology are common due to shared risk factors with atherosclerotic disease, such as diabetes, inflammatory conditions, and smoking. Severe AS in patients with cancer requires careful assessment in order to select the appropriate therapeutic choices and their timing (i.e. valve treatment first vs. cancer treatment first).

Case summary

A 66-year-old woman with a history of smoking was admitted to our centre due to heart failure (HF). During her hospitalization, severe AS with severe ventricular dysfunction and cancer were documented. Because of her severe heart disease, she was unable to receive antineoplastic treatment. Therefore, she underwent percutaneous surgery to treat the aortic valve. After that, the management of cancer became possible, which included bilateral radical mastectomy and chemotherapy.

We are presenting a case of cancer coexisting with aortic stenosis and reduced left ventricle ejection fraction. In this case, we performed Transcatheter Aortic Valve Replacement (TAVR) with the aim of improving the ejection fraction, followed by chemotherapy.

Discussion

Cancer patients may be further disadvantaged by AS if it interferes with their treatment by increasing the risk associated with oncologic surgery and compounding the risks associated with cardiotoxicity and HF. Clinical trials and guidelines on TAVR exclude cohorts with limited life expectancy. Hence, the correct and optimal care for cancer patients with severe AS is complex. The TAVR, for cancer patients with severe AS, can more frequently be the best clinical choice by avoiding cardiopulmonary bypass, minimal invasiveness, and therefore, shorter recovery time.
Gender and ethnicity bias in generative artificial intelligence text-to-image depiction of pharmacists
Authors: Currie Geoffrey , John George , Hewis Johnathan
Published: September 2024

Introduction

In Australia, 64% of pharmacists are women but continue to be under-represented. Generative artificial intelligence (AI) is potentially transformative but also has the potential for errors, misrepresentations, and bias. Generative AI text-to-image production using DALL-E 3 (OpenAI) is readily accessible and user-friendly but may reinforce gender and ethnicity biases.

Methods

In March 2024, DALL-E 3 was utilized to generate individual and group images of Australian pharmacists. Collectively, 40 images were produced with DALL-E 3 for evaluation of which 30 were individual characters and the remaining 10 images were comprised of multiple characters (N = 155). All images were independently analysed by two reviewers for apparent gender, age, ethnicity, skin tone, and body habitus. Discrepancies in responses were resolved by third-observer consensus.

Results

Collectively for DALL-E 3, 69.7% of pharmacists were depicted as men, 29.7% as women, 93.5% as a light skin tone, 6.5% as mid skin tone, and 0% as dark skin tone. The gender distribution was a statistically significant variation from that of actual Australian pharmacists (P < .001). Among the images of individual pharmacists, DALL-E 3 generated 100% as men and 100% were light skin tone.

Conclusions

This evaluation reveals the gender and ethnicity bias associated with generative AI text-to-image generation using DALL-E 3 among Australian pharmacists. Generated images have a disproportionately high representation of white men as pharmacists which is not representative of the diversity of pharmacists in Australia today.
CD8+T cell infiltration–associated barrier function of brain endothelial cells is enhanced by astragalus polysaccharides via inhibiting the PI3K/AKT signaling pathway
Authors: Zhao Yan , Lu Qijin , Ma Jinyun , Ding Guiqing , Wang Xiaohan , Qiao Xi , Wang Yuanhua , Cheng Xiaodong
Published: September 2024

Pathogenic CD8+T cells play an essential role in neuroinflammation and neural injury, which leads to the progression of inflammatory neurological disorders. Thus, blocking the infiltration of CD8+T cells is necessary for the treatment of neuroinflammatory diseases. Our previous study demonstrated that astragalus polysaccharide (APS) could significantly reduce the infiltration of CD8+T cells in experimental autoimmune encephalomyelitis mice. However, the mechanism by which APS suppresses CD8+T cell infiltration remains elusive. In this study, we further found that APS could reduce the CD8+T cell infiltration in experimental autoimmune encephalomyelitis and lipopolysaccharide (LPS)-induced neuroinflammatory model. Furthermore, we established the mouse brain endothelial cell (bEnd.3) inflammatory injury model by interleukin-1β or LPS in vitro. The results showed that APS treatment downregulated the expression of vascular cell adhesion molecule1 to decrease the adhesion of CD8+T cells to bEnd.3 cells. APS also upregulated the expression of zonula occludens-1 and vascular endothelial cadherin to reduce the transendothelial migration of CD8+T cells. The PI3K/AKT signaling pathway might mediate this protective effect of APS on bEnd.3 cells against inflammatory injury. In addition, we demonstrated the protective effect of APS on the integrity of brain endothelial cells in an LPS-induced neuroinflammatory model. In summary, our results indicate that APS can reduce peripheral CD8+T cell infiltration via enhancing the barrier function of brain endothelial cells; it may be a potential for the prevention of neuroinflammatory diseases.
Plastic Resilience: Rethinking Resilience in Illness with Catherine Malabou
Authors: Ó Fathaigh Cillian
Published: September 2024

Drawing on Catherine Malabou’s notion of plasticity, this article argues for a conception of resilience as plastic. Resilience has proven an important concept in health care, describing how we manage life-changing illnesses. Yet, resilience is not without its critics, who suggest it neglects a political, social, or personal dimension in illness. In this article, I propose that a concept of plastic resilience can address these criticisms. On this account, success should not be based on a return to function, but rather on how actively we are involved in the formation of a new self after illness. I address some approaches that can benefit from “plastic resilience,” namely, art therapy, expert companionship, and shared decision-making. In each case, I underline how we should help patients thematize and engage with their new selves, while also being constantly vigilant for how these changes might impact our current assumptions around their preferences for treatment.
The Requisite Legal Standard of the Digital Markets Act’s Designation Process
Authors: Ribera Martínez Alba
Published: September 2024

Moving away from the effects-based approach in EU competition law, the Digital Markets Act introduces renewed requisite legal standards that differ from probabilistic standards of proof. Ideally, this concept should also shape the European Commission’s initial enforcement actions and its judicial review in the EU courts.

The paper critically examines the legal standards that the European Commission established in its first set of designation decisions issued in September 2023. It spotlights two significant actions by the Commission: the delineation of core platform services and the consideration of the undertakings’ rebuttals of the presumption of a gatekeeper position deriving from the application of the quantitative thresholds. The paper reveals a disjointed approach by the Commission building upon the idea of the regulation’s plasticity.
Younger age for the oldest magnetic white dwarfs
Authors: Ginzburg Sivan
Published: September 2024

Sufficiently old white dwarfs cool down through a convective envelope that directly couples their degenerate cores to the surface. Magnetic fields may inhibit this convection by stiffening the criterion for convective instability. We consistently implemented the modified criterion in the stellar evolution code mesa, and computed the cooling of white dwarfs as a function of their mass and magnetic field B. In contrast to previous estimates, we find that magnetic fields can significantly change the cooling time t even if they are relatively weak $B^2\ll 8\pi P$, where P is the pressure at the edge of the degenerate core. Fields $B\gtrsim 1\textrm {~MG}$ open a radiative window that decouples the core from the convective envelope, effectively lowering the luminosity to that of a fully radiative white dwarf. We identified a population of observed white dwarfs that are younger by $\Delta t\sim$ Gyr than currently thought due to this magnetic inhibition of convective energy transfer – comparable to the cooling delay due to carbon–oxygen phase separation. In volume-limited samples, the frequency and strength of magnetic fields increase with age. Accounting for magnetic inhibition is therefore essential for accurate cooling models for cosmic chronology and for determining the origin of the magnetic fields.
Nab-paclitaxel plus S-1 followed by gemcitabine-oxaliplatin as first-line alternating sequential treatment of pancreatic ductal adenocarcinoma
Authors: Li Zhiwei , Fan Xiaona , Jiang Dan , Li Qingwei , Liu Chao , Wang Dan , Li Na , Li Hengzhen , Chen Zhuo , Tang Hongzhen , Lou Changjie , Xu Haitao , Zhan Chao , Dong Yuandi , Ma Zhigang , Wang Guangyu , Zhang Chunhui , Lu Haibo , Zheng Tongsen , Zhang Yanqiao
Published: September 2024

Background

Alternating sequential administration of drugs may be a promising approach to overcome chemotherapy resistance in advanced pancreatic ductal adenocarcinoma (PDAC).

Methods

This study was an open-label, single-arm, and prospective trial included patients with untreated advanced PDAC. They received 2 cycles of NS regimen (nab-paclitaxel:125 mg/m2, intravenously injected on days 1 and 8, plus S-1:40-60 mg, orally twice per day for 1-14 days) followed by 2 cycles of GemOx regimen (gemcitabine, intravenously injected on days 1 and 8, and oxaliplatin: 130 mg/m2, intravenously injected on day 1). The primary efficacy endpoint was a progression-free survival rate at 6 months (PFSR-6m). The secondary efficacy endpoints included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs). Specific mRNA transcripts were used to explore survival associated genes.

Results

Forty-two patients received a minimum of one treatment cycle, and of these, 30 patients completed one alternating treatment consisting of 4 cycles. The PFSR-6m was 71% (95% CI = 58%-87%). The median PFS and OS were 6.53 months (95% CI = 6.03-8.43) and 11.4 months (95% CI = 9.8-14.4), respectively. Common grades 3-4 hematological AEs included neutropenia 30.9%, leukopenia 26.2%, anemia 2.4%, and thrombocytopenia in 11.9%. Patients with OS > 10 months showed high expression of HLA-DQA2 while melanoma-associated antigen genes (MAGE) were notably upregulated in patients with OS < 10 months.

Conclusion

The alternating sequential administration of the NS and GemOx regimens may be a novel approach for first-line chemotherapy in patients with advanced PDAC requiring further study (ClinicalTrials.gov Identifier: ChiCTR1900024867).
In reply: espying sarcopenia in gastric cancer: squaring the circle
Authors: Chan Wing-Lok
Published: September 2024

This letter to the editor continues the discussion on sarcopenia in gastric cancer.
Table-mounted Versus Self-retaining Retraction
Authors: Zavras Athan G. , Vucicevic Rajko S. , Federico Vincent P. , Nolte Michael T. , Sayari Arash J. , Shepard Nicholas A. , Colman Matthew W.
Published: September 2024

Study Design:

Retrospective study.

Objective:

To determine whether there are significant differences in postoperative dysphagia when using table-mounted versus self-retaining retractor tools.

Summary of Background Data:

Retraction of prevertebral structures during anterior cervical spine surgery (ACSS) is commonly associated with postoperative dysphagia or dysphonia. Retractors commonly used include nonfixed self-retaining retraction devices or fixed table-mounted retractor arms. However, there is a paucity of literature regarding differences in dysphagia between retractor types.

Methods:

Patients who underwent ACSS and adhered to a minimum of 6-month follow-up were retrospectively evaluated. Patient-reported outcomes (PROs) were compared between table-mounted and self-retaining retractor groups at the preoperative and final postoperative time points, including the SWAL-QOL survey for dysphagia. Categorical dysphagia was assessed using previously defined values for the minimum clinically important difference (MCID).

Results:

Overall, 117 and 75 patients received self-retaining or table-mounted retraction. Average follow-up was significantly longer in the self-retaining cohort (14.8±15.0 mo) than in the table-mounted group (9.4±7.8, P=0.005). No differences were detected in swallowing function (P=0.918) or operative time (P=0.436), although 3-level procedures were significantly shortened with table-mounted retraction (P=0.005). Multivariate analysis trended toward worse swallow function with increased operative levels (P=0.072) and increased retraction time (P=0.054), although the retractor used did not predict swallowing function (P=0.759). However, categorical rates of postoperative dysphagia were lower with table-mounted retraction (13.3% vs. 27.4%, P=0.033).

Conclusions:

There was no significant difference observed in long-term swallowing dysfunction between patients who underwent ACSS with self-retaining and table-mounted retractors, although the rate of dysphagia was lower with table-mounted retraction. In addition, the greater number of operated levels per case in the table-mounted group at a similar time suggests improved efficiency.
Cardiovascular death risk in patients with solid tumors: a population-based study in the United States
Authors: Gao Shuaijie , Zhu Hao , Chang Xinyu , Cao Xiting , Wang Zhenwei , Chu Xiaoxuan , Zhang Lu , Wang Xinhua , Lu Jie
Published: September 2024

Background

Previous studies have focused on the risk of cardiovascular disease (CVD)-specific death in hematological cancers and in some single anatomical tumor sites, there remains a paucity of data on systematic analyses in solid tumors.

Objective

The objective of this study is to evaluate the distribution, risk, and trends of CVD-specific death in patients with solid tumors.

Methods

A total of 2 679 293 patients with solid tumors diagnosed between 1975 and 2019 were screened from the Surveillance, Epidemiology and End Results (SEER) program across 15 anatomical sites. Standardized mortality ratios (SMRs) and absolute excess risks (AERs) were used to describe the intensity of CVD-specific death, competing risk regression models were used to assess the risk of CVD-specific death, and restricted cubic spline analyses were employed to investigate the potential linear or nonlinear relationship between age and CVD death.

Results

CVD-specific death in patients with solid tumors accounted for 48.95% of non-cancer deaths. Compared with the general population, patients with solid tumors had higher SMR and AER of CVD death (SMR: 1.15; AER: 21.12), heart disease-related death (SMR: 1.13; AER: 13.96), and cerebrovascular disease-related death (SMR: 1.20; AER: 4.85). Additionally, the SMR exhibited a decreasing trend with increasing time to diagnosis. Furthermore, a nonlinear relationship was observed between age and CVD-specific death in patients with solid tumors of different systems.

Conclusion

CVD-specific death accounted for a large proportion of the cause of non-cancer deaths. Patients with solid tumors exhibit an elevated risk of CVD-specific death. Screening for CVD death and optimizing risk management in patients with solid tumors throughout anticancer treatment may be beneficial in preventing CVD death.
Suicidality Trajectory, Hopelessness, Resilience, and Self-Efficacy Among Patients With Treatment-Resistant Depression in Vietnam
Authors: PHAM Thi Thu Huong , WU Chia-Yi , LEE Ming-Been , NGUYEN Van Tuan , PHAM Thi Thu Hien , DANG Thanh Tung , VU Son Tung , NGUYEN Thi Son
Published: September 2024

Background

Patients with treatment-resistant depression (TRD) have higher rates of suicidal ideation and a higher suicide attempt prevalence than patients with other types of depression.

Purpose

This study was designed to study the suicidality trajectory and relationships between hopelessness, resilient coping, and self-efficacy, respectively, and suicidal ideation and suicide attempts in patients with TRD during hospitalization and at 3 months after discharge.

Methods

A longitudinal survey of 53 psychiatric inpatients with TRD was conducted. Suicidality, hopelessness, resilient coping, self-reported medication adherence, and self-efficacy were assessed at Weeks 1 and 2 (T0 and T1) after hospitalization and Week 1 and Months 1 and 3 after discharge. Data were analyzed using a Cox regression model.

Results

Suicidality varied across the five time points, with a downward trend observed between T0 and T1 (reflecting the initial effects of inpatient treatment) and an upward trend observed across the 3-month follow-up. Antidepressant overdose was the most common method used for suicide. The risk of high suicidal ideation during follow-up was 1.63, 2.63, and 1.14 times higher, respectively, in participants with a high level of hopelessness, low level of resilient coping, and low self-efficacy. Also, having a higher level of hopelessness and being younger in age increased the risk of attempting suicide by 3.07 times and over 6 times, respectively, compared to older participants.

Conclusions/Implication for Practice

Suicidality was shown to fluctuate between the in-hospital treatment phase and the first 3 months following discharge in this sample of patients with TRD. Younger age, feelings of hopelessness, low resilience, and low self-efficacy were the top four factors contributing to postdischarge suicide risk. These findings highlight the need for regular patient monitoring and assessment to identify those with TRD who are at high risk of suicide as well as the importance of focusing on hopelessness, resilience, and self-efficacy as predictors of suicide ideation and attempts. Nurses should help patients with TRD, especially those who are younger, and improve and maintain their hope, resilience, and self-efficacy both during hospitalization and shortly after discharge.
A case of multiples liver metastases from a grade 2 brain meningioma: a rare entity with comprehensive literature review
Authors: Borni Mehdi , Kammoun Brahim , Taallah Marouen , Mzid Yosra , Boudawara Ons , Boudawara Mohamed Zaher
Published: September 2024

Introduction and importance:

Meningiomas are primary benign extra-axial central nervous system neoplasms that originate in meningothelial cells. Extra-neurological metastases are quite rare and occur in 0.1% of cases. The main metastatic sites are usually the lungs, bones, pleura, mediastinum and lymph nodes. Hepatic locations are quite rare and account for ~3% of all extracranial metastases. The dissemination route is still a subject of debate. Suggested routes of dissemination include the venous system, lymph nodes, or even cerebrospinal fluid. The treatment is based on complete surgical excision or on radiosurgery and adjuvant radiotherapy in case of subtotal resection.

Case presentation:

The authors present the following clinical case of a 31-year-old healthy male patient with surgical history of meningioma excisions, who presents, 3 years later, evidence of liver masses on tomography and confirmed diagnosis of liver metastases from brain meningioma after biopsy with favorable outcomes after chemotherapy.

Clinical discussion:

The overall incidence of extra-neurological metastases of meningiomas remains low. The vast majority of these metastases concern those of high grade, namely WHO grade 2 and 3 as it was reported in our case. Hepatic metastases remain quite rare and account for ~3% of all extracranial locations. Due to these characteristics of having low recurrence and its rare frequency of metastasis to extracranial sites, the authors, through their case, will dig into the literature to dissect this rare entity.

Conclusion:

In the report of liver lesions, the first differential diagnosis in mind should be metastatic lesions, if there is a prior clinical history of primary tumors.
Prediction of hospitalization time probability for COVID-19 patients with statistical and machine learning methods using blood parameters
Authors: Motarjem Kiomars , Behzadifard Mahin , Ramazi Shahin , Tabatabaei Seyed A. H.
Published: September 2024

Objectives:

Coronavirus disease 2019 (COVID-19) may induce life-threatening complications and lead to death in the patients.

Method:

The aim of this study was to describe a predictive model for the disease outcome (length of hospitalization and mortality) by using blood parameters results at the admission time of 201 patients with positive RT-PCR test for the infection. Variables including; age, sex, comorbidity risk factors, the length of hospitalization, and 25 blood parameters results at the time of admission were considered.

Results:

After analyzing the data, it was observed that several factors, such as hypocalcemia, hyponatremia, red blood cell microcytosis, monocytopenia, thrombocytosis, comorbidity risk factors (diabetes, dialysis, cardiovascular diseases, and hypertension), and age over 50 years had a significant impact on the length of hospitalization and mortality of the patients (P<0.05).

Conclusion:

Based on the data analysis, the authors found that the proportional hazard assumption was not established. Therefore, the authors opted to use the accelerated failure time model for our analysis. Among the various models considered, the log-normal model provided the best fit. Considering the analysis of laboratory results at the time of admission, the authors propose that thrombocytosis, red blood cell microcytosis, monocytopenia, hypocalcemia, hyponatremia, comorbidity factors, and age over 50 years can serve as predictive markers for estimating hospitalization length and mortality. These findings suggest that these factors may play a significant role in predicting patient outcomes.
The effect of median household income on the prognosis of lung adenocarcinoma: A SEER analysis
Authors: Wang Ruina , Lai Xiaofan , Huang Binying , Ning Xiaohua , Zhang Tingting
Published: September 2024

Background:

Lung cancer is the main cause of death related to malignant tumors. Since cause-specific mortality can guide clinical decision-making, this study employed the Fine–Gray model based on the Surveillance, Epidemiology, and End Results (SEER) database to identify significantly how socio-economic status influences initial treatment decisions and survival outcomes in patients with lung adenocarcinoma.

Objective:

The aim of this study was to identify the predictors of lung adenocarcinoma.

Methods:

The U.S. Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients diagnosed with lung adenocarcinoma between 2000 and 2018. Seventeen thousand four hundred forty-one patients with lung adenocarcinoma were subdivided in four socio-economic tertiles, based on median household income. Cox regression modeling explored the relationship between race, surgery, grading, and median household income on survival outcomes. The study also assessed patient demographic characteristics, age at diagnosis, and surgical interventions.

Results:

Among 17 441 patients with primary lung adenocarcinoma, the age distribution was as follows: less than 45 years (n=202, 1.16%), between 45 and 54 years (n=1121, 6.43%), 55 and 64 years (n=4252, 24.38%), 65 and 74 years (n=6357, 36.45%), 75 and 84 years (n=4426, 25.38%), and more than 84 years (n=1083, 6.2%). The adjusted hazard ratio (aHR) with 95% CI for ages 65–74 years, 75–84 years, and older than or equal to 85 years were 0.25 (0.11,1.29), 0.40 (0.11,1.50), and 0.72 (0.11,2.05), respectively. Multifactorial Cox regression indicated that the aHR for tumor metastasis was 0.93 (0.03, 2.54), and for patients who did not undergo surgery, it was 1.46 (0.03, 4.31). Grade IV patients exhibited the lowest survival rate [0.66(0.11, 1.93)]. A notable correlation existed between median household income and survival, with distinctly lower survival rates observed in low-income groups.

Conclusion:

Older patients, especially those who did not undergo surgery and had a higher tumor grade, had significantly reduced survival. Moreover, survival rates for black patients in lower-income brackets were worse than those for white patients in the same financial category.

Implications for practice:

The quality of life of lung cancer patients is affected by low-income family.
Intestinal microbiome as a diagnostic marker of coronary artery disease: a systematic review and meta-analysis
Authors: Dean Yomna E. , Shebl Mohamed A. , Doma Mohamed , Elmezayen Rafeek W. , Loayza Pintado Jose J. , Rouzan Samah S. , Hassan Noheir Ashraf Ibrahem Fathy , Yaqout Yasmeen E. , Tokunaga Akiko , Anozie Chukwuebuka , ElKoumi Omar , Elawady Sameh S. , Mady Tamer , Nizam Sana N. , Etman Yasser , Nizam Rayees , Hazimeh Yusef , Alazmy Mohamed , Aiash Hani
Published: September 2024

Background:

The intestinal microbiome has been recently linked to several metabolic and chronic disorders, one of which is coronary artery disease (CAD). Our study aimed to analyze the intestinal microbiome of CAD patients and assess the eligibility of dysbiosis as a diagnostic marker of CAD.

Methods:

PubMed, Scopus, Embase, and Web of Science were searched using terms, such as ‘CAD’ and ‘microbiome’. Only observational controlled studies were included. R version 4.2.2 was used for the analysis.

Results:

A significant association was found between the CAD group and increased Simpson and Shannon Indices compared with the control group (MD=0.04, 95% CI=0.03–0.05, and MD=0.11, 95% CI=0.01–0.22, respectively). Our analysis yielded a statistically significant association between the CAD group and increased Prevotella genus (MD=13.27, 95% CI=4.12–22.42, P-value=0.004), Catenibacterium genus (MD=0.09, 95% CI=0.09–0.10), Pseudomonas genus (MD=0.54, 95% CI=0.29–0.78, P-value), and Subdoligranulum (MD=−0.06, 95% CI=−0.06 to −0.06) compared with the control group. Another significant association was detected between the CAD group and decreased Bacteroides vulgatus and Bacteroides dorei (MD=−10.31, 95% CI=−14.78 to −5.84, P-value <0.00001).

Conclusion:

Dysbiosis is an acceptable diagnostic marker of CAD. Decreased B. dorei and B. vulgatus among CAD patients suggests a protective role of these bacteria. Future clinical trials are necessary to investigate the potential benefit of supplementation of these bacteria in treating or preventing CAD.
A complex case of PASH syndrome: pyoderma gangrenosum, acne, suppurative hidradenitis, and Crohn’s disease in a 36-year-old smoker
Authors: Abdul Rahman Noura , Jazmati Aya , Roumi Jamal Bakri , Darwish Israa , Kouja Doaa , Ishkhanian Silva
Published: September 2024

Introduction and importance:

PASH syndrome, is autoinflammatory condition driven by immune system dysfunction, resulting in elevated interleukin 1 levels and subsequent production of proinflammatory cytokines and chemokines. The clinical progression of PASH typically starts with acne conglobate in adolescence, followed by hidradenitis suppurativa, and pyoderma gangrenosum. Diagnosis relies on recognizing these hallmark features, but treatment remains a challenge despite current understanding. Conventional immunosuppressive therapies have shown limited efficacy in managing PASH syndrome.

Case presentation:

The authors present a 36-year-old man with a complex combination of pyoderma gangrenosum, acne, suppurative hidradenitis, obesity, and Crohn’s disease. The patient’s symptoms began in adolescence with acne and recurrent furuncles, evolving into painful skin ulcers and fistulas over time. Histological examination confirmed the diagnosis of pyoderma gangrenosum. Despite various treatment modalities, including isotretinoin, cyclosporine, azathioprine, and adalimumab, the patient experienced only partial improvement until receiving Infliximab, which led to remarkable improvement.

Discussion:

PASH syndrome, a rare neutrophilic dermatosis linked to autoinflammatory conditions like Braun Flaco, is characterized by Pyoderma gangrenosum, acne, and suppurative hidradenitis. This clinical entity presents diagnostic challenges due to its unique features and association with obesity and bowel diseases, such as Crohn’s disease. Treatment options, including TNF-α blockers like Infliximab, have shown promising results in controlling cutaneous manifestations. Our case study underscores the complexity of treating PASH syndrome and highlights the importance of personalized therapeutic approaches for optimal outcomes.

Conclusion:

PASH syndrome presents significant diagnostic and treatment challenges due to its complex symptomatology and associations with conditions like Crohn’s disease. The case of a 36-year-old man demonstrates the partial efficacy of conventional therapies and highlights the promising results of infliximab. This underscores the need for personalized treatment strategies and ongoing research to improve outcomes for patients with this rare and intricate syndrome.
Advancing life: innovative approaches to enhance survival in sickle cell anemia patients
Authors: Obeagu Emmanuel Ifeanyi , Adias Teddy Charles , Obeagu Getrude Uzoma
Published: September 2024

Sickle cell anemia (SCA) is a severe genetic disorder characterized by the production of abnormal hemoglobin S, leading to the formation of sickle-shaped red blood cells that cause chronic anemia, pain, and organ damage. This review explores recent innovative strategies aimed at improving survival rates and quality of life for SCA patients. Genetic therapies, particularly gene editing with CRISPR-Cas9 and gene therapy using lentiviral vectors, have shown significant potential in correcting the genetic defects responsible for SCA. Clinical trials demonstrate that these approaches can reduce sickle cell crises and minimize the need for blood transfusions by enabling the production of healthy red blood cells. Novel pharmacological treatments such as voxelotor, crizanlizumab, and L-glutamine provide additional mechanisms to prevent hemoglobin polymerization, reduce vaso-occlusive episodes, and decrease oxidative stress, respectively. These therapies offer new hope for patients, particularly those who do not respond adequately to existing treatments. Improved blood transfusion protocols, including automated red cell exchange and advanced donor-matching techniques, have enhanced the safety and efficacy of transfusions, reducing complications like alloimmunization. Comprehensive care models, integrating multidisciplinary care teams, patient education, and telemedicine, have further contributed to better disease management. By providing holistic care that addresses both medical and psychosocial needs, these models improve patient adherence to treatment and overall health outcomes. This review highlights the importance of these innovative strategies and calls for continued research and development to sustain and expand these advancements in SCA care.
Unanticipated diagnosis of Swyer syndrome: a case report
Authors: Giri Kanti Prabha , Thapa Sumana , Rawat Rohit , Rouniyar Sangam
Published: September 2024

Introduction and importance:

Swyer syndrome or complete/pure gonadal dysgenesis, a rare genetic disorder, presents with a female phenotype despite a 46, XY karyotype. The case highlights the importance of early diagnosis and management in XY females to prevent gonadal malignancy and facilitate proper growth of secondary sexual characteristics of the patient by initiating hormone replacement therapy (HRT).

Case presentation:

A 15-year-old female presented with lower abdominal pain, seeking an investigation, ultrasonography revealed the non-visualization of the uterus. Further examination with MRI revealed a hypoplastic uterus and non-visualization of ovaries. Clinical examination and diagnostic laparoscopy along with karyotype analysis confirmed the diagnosis of Swyer syndrome, prompting bilateral Salpingo-oophorectomy and initiation of HRT after the surgery. Follow-up showed improvement in the growth of the uterus and secondary sexual characteristics.

Clinical discussion:

Case discussion explores into the unique clinical findings of Swyer syndrome, emphasizing the importance of differentiating it from other disorders of sex development (DSD) like Mayer–Rokitansky–Küster–Hauser syndrome and androgen insensitivity syndrome. Genetic and hormonal aspects of the condition are also explored in relation to the patient’s presentation and management.

Conclusion:

The case highlights the significance of early diagnosis and comprehensive management of Swyer syndrome. It emphasizes the need for multidisciplinary care, including fertility counseling and psychological support, in addressing the complexities of rare genetic disorders like Swyer syndrome. The key message includes the importance of considering Swyer syndrome in cases of primary amenorrhea, the benefits of early surgical intervention, and the necessity of psychological support for patients.
A case of hypertensive crisis following administration of nonionic low molecular weight contrast in hemorrhagic stroke patient: a case report
Authors: Akkash Nour , Alshutaihi Mohamad S.
Published: September 2024

Introduction:

Radiocontrast agents can be iodinated or noniodinated. Iodinated agents are further divided into low and high molecular weights. In recent decades, LOCM has largely replaced the use of HOCM due to safety concerns, but an increasing number of severe side effects cases have been reported.

Case presentation:

A 62-year-old woman presented with acute right hemiparesis. A CT scan revealed ICH with IVH. A contrasted CTA was ordered, during which Iohexol was administered. Shortly after the injection, she developed a hypertensive crisis. She was transferred to the ICU, intubated, and given labetalol. Repeated CT scan showed increased IVH with posterior edema. Her family declined surgical intervention. Unfortunately, she died.

Discussion:

This represents a unique adverse effect of a low molecular weight contrast agent that has been rarely reported before, particularly in pheochromocytoma patients. Nevertheless, our patient had subtle hypertension that was revealed during hospital admission but without pheochromcytoma.

Conclusion:

This case represents an unusual instance of a severe adverse. It suggests that the malignant rise in blood pressure may not be catecholamine-induced.
Fatal aconite poisoning in a rural Nepali traditional healer: clinical challenges and management strategies
Authors: Adhikari Pratik
Published: September 2024

Introduction and importance:

Aconite, also known as Aconitum spp., is a group of highly toxic flowering plants used historically in traditional medicine despite their potent neurotoxic and cardiotoxic effects. In rural Nepal, where traditional healing practices are prevalent, accidental ingestion of Aconite remains a significant public health concern due to its resemblance to medicinal herbs.

Case presentation:

The authors present a case of severe Aconite poisoning in a 45-year-old male traditional healer from rural Nepal. Following ingestion of a homemade herbal tea containing Aconitum species, the patient developed rapid-onset symptoms, including paresthesia around the mouth, severe abdominal pain, and progressive weakness. Upon admission, he exhibited signs of cardiovascular compromise and metabolic acidosis. Despite aggressive management, including gastric lavage, fluid resuscitation, and symptomatic treatment, the patient succumbed to cardiovascular collapse within 12 h of admission.

Clinical discussion:

Aconite poisoning manifests with early neurological symptoms and progresses to severe gastrointestinal and cardiovascular complications. Its toxicity is attributed to aconitine, which disrupts cellular function by binding to voltage-gated sodium channels. Management focuses on supportive care and symptomatic treatment, given the absence of a specific antidote and challenges in rural healthcare settings.

Conclusion:

This case underscores the critical need for awareness among healthcare providers and the public regarding the dangers of Aconite. Improved education, healthcare infrastructure, and early intervention are essential in mitigating the morbidity and mortality associated with Aconite poisoning in resource-limited settings.
Barbie Deformity after Edge Labiaplasty: Classification and Repair Algorithm
Authors: Xia Zenan , Zhang Xinran , Kang Yuanbo , Chang Guojing , Zhu Lin , Long Xiao
Published: September 2024

Background:

Influenced by the popularity of the “Barbie” labia minora shape, edge labiaplasty has become the preferred option among patients and surgeons alike. However, excessive or inappropriate resection of labial free edges may lead to morphologic deformities and dysfunctional symptoms, termed the “Barbie deformity.” This study aimed to classify the Barbie deformity and provide a repair algorithm to help surgeons select appropriate surgical methods.

Methods:

A total of 216 patients with Barbie deformity were classified into 3 groups. Among these, 119 patients underwent repair operations using different methods based on the degree of deformity. The surgical outcomes of 87 patients were assessed by means of follow-up questionnaires. Preoperative and postoperative levels of general psychological distress and self-esteem were compared for 46 patients using standard scales.

Results:

Barbie deformity was identified on 338 sides: 158 were grade I, 106 were grade II, 74 were grade III, and 187 had vestibular mucosa exposure. Repair operations were performed on 189 sides: 53 by means of edge trimming, 99 by means of wedge excision, 32 with an island clitoral hood flap, and 5 with the Gress composite method. The complication rate was 4.8%. Genital appearance was improved in 96.6%, preoperative discomfort was resolved or significantly reduced in 74.2%, and overall satisfaction was 86.2%. The general psychological distress and self-esteem scores also improved significantly after surgery.

Conclusions:

The goals of repairing the Barbie deformity are to improve the appearance of the genitals and restore the position and function of the mucosa. Preventing Barbie deformity is much more important than repairing it.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Changes in HIV preexposure prophylaxis awareness and use among men who inject drugs who have sex with men by sexual identity in 19 US urban areas
Authors: Eustaquio Patrick C. , Burnett Janet , Prejean Joseph , Chapin-Bardales Johanna , Cha Susan
Published: September 2024

Background:

Men who inject drugs who have sex with men (MWIDSM) may acquire HIV through injecting drugs or sex. Interventions to increase awareness of HIV preexposure prophylaxis (PrEP) have focused on gay/bisexual MSM and may not be reaching heterosexual-identifying men or people who inject drugs (PWID). We explored changes in PrEP awareness and use among MWIDSM from 2018 to 2022 by sexual identity.

Methods:

We used data from the 2018 and 2022 National HIV Behavioral Surveillance among PWID recruited via respondent-driven sampling in 19 urban areas in the US. We examined changes in PrEP awareness and use over time by sexual identity among HIV-negative men who inject drugs and who had sex with another man in the past 12 months using log-linked Poisson regression models with robust standard errors with an interaction term between year and sexual identity.

Results:

Among 758 HIV-negative MWIDSM (463 in 2018; 295 in 2022), nearly all sample participants were likely indicated for PrEP (94.2 and 92.9%, respectively). PrEP awareness increased from 2018 to 2022 among gay/bisexual-identifying MWIDSM [45.5 to 65.5%; aPR = 1.49, 95% confidence interval (95% CI) = 1.30–1.70] but remained stable for heterosexual-identifying MWIDSM (39.4 to 40.8%; aPR = 1.01, 95% CI 0.75–1.36). PrEP use remained low among all MWIDSM (2.5 to 7.7%, among heterosexually identifying; 15.3 to 10.2% among gay/bisexual-identifying).

Conclusion:

PrEP awareness increased among gay/bisexual-identifying MWIDSM but not among heterosexual-identifying. PrEP use was low for all MWIDSM. Public health initiatives catered to MWIDSM should focus on improved campaigns and expanding PrEP accessibility in existing healthcare, harm reduction, and social services.
Diffusion Tensor Imaging
Authors: Chaker Sara C. , Reddy Anvith Palla , King Daniella , Manzanera Esteve Isaac V. , Thayer Wesley P.
Published: September 2024

Peripheral nerve injuries (PNIs) represent a complex clinical challenge, necessitating precise diagnostic approaches for optimal management. Traditional diagnostic methods often fall short in accurately assessing nerve recovery as these methods rely on the completion of nerve reinnervation, which can prolong a patient's treatment. Diffusion tensor imaging (DTI), a noninvasive magnetic resonance imaging (MRI) technique, has emerged as a promising tool in this context. DTI offers unique advantages including the ability to quantify nerve recovery and provide in vivo visualizations of neuronal architecture. Therefore, this review aims to examine and outline DTI techniques and its utility in detecting distal nerve regeneration in both preclinical and clinical settings for peripheral nerve injury.
Evaluating Board Certification Within the Aesthetic Marketplace
Authors: Chen Shirley , Lineaweaver William C.
Published: September 2024

Background

Unlike most health care sectors, patients can select an aesthetic surgery provider without considering insurance coverage. Patients therefore must be able to make informed choices regarding provider selection. Surgeon qualifications are part of the data patients evaluate in their decision making. To characterize the provider landscape that patients face, this study compares the certification requirements of various boards within the aesthetic marketplace.

Methods

Four boards were identified for analysis based on a Google search of “board of plastic surgery”: the American Board of Plastic Surgery (ABPS), the American Board of Cosmetic Surgery (ABCS), the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS), and the American Board of Facial Cosmetic Surgery (ABFCS). Information on certification requirements was obtained from each board's official website.

Results

ABPS requires that diplomates complete an Accreditation Council for Graduate Medical Education (ACGME)–accredited plastic surgery residency, pass a written and oral examination that includes a case collection, and meet continual standards to maintain certification. ABCS and ABFCS both require an American Academy of Cosmetic Surgery (AACS) cosmetic surgery fellowship and passage of a written and oral examination. Neither board has case collection or continuing certification requirements. ABFPRS requires completion of either an ACGME-accredited otolaryngology or plastic surgery residency. Its examination process includes written and oral components as well as a case log. ABFPRS has enacted continuing certification requirements for diplomates credentialed in 2001 and later. ABPS is the only board that is a member of the American Board of Medical Specialties (ABMS).

Conclusions

ABPS stands apart as the only board within the aesthetic marketplace with rigorous standards for precertification training, demonstrating competency through examinations and case logs, and maintaining certification. Being an ABMS member board also contributes to ABPS being the preeminent organization for identifying physicians who practice safe, effective aesthetic surgery.
Thirty-Day Complication Rates After Gender-Affirming Bottom Surgery
Authors: Goldman Jennifer , Hu Anna , Hammer Adam , Akiska Yagiz Matthew , Gombaut Cindy , Ranganath Bharat , Chao Jerry
Published: September 2024

Purpose

Gender-affirming bottom surgeries (GABS) play a central role in treating gender dysphoria to improve quality of life for transgender and nonbinary (TGNB) patients. However, there exists limited data on operative risks and outcomes for patient populations undergoing GABS. The goal of this study is to identify sociodemographic and clinical risk factors for determining 30-day postoperative complications in patients undergoing GABS.

Methods

The ACS-NSQIP database from 2010 to 2020 was used to identify patients undergoing gender affirmation surgery (GAS) using Current Procedural Terminology (CPT) codes included in transfeminine and transmasculine bottom surgery. IBS-SPSS software was used to perform a multivariate analysis to determine risk factors for increased 30-day postoperative complications including unplanned reoperation and readmission rates.

Results

A total of 1809 GABS were performed in the NSQIP database from 2010 to 2020. There was an upward trend in GABS procedures throughout the years, with 2017 having the most GABS (n = 629). Transmasculine patients with a BMI of 29 and over were at a greater risk for wound complications (P < 0.05). Diabetic transfeminine patients were also at a greater risk for wound complications (P < 0.05).

Conclusions

This study identified that several sociodemographic and clinical risk factors, such as BMI and diabetes mellitus type 2, had increased postoperative complications for patients undergoing gender-affirming bottom surgeries. Wound care management and patient education are essential in GABS to prevent long-term complications. Physician awareness of risk factors and social determinants of health can help prevent and improve postoperative care education and patient compliance.
Challenges of Imaging the Greater Occipital Nerve Using Magnetic Resonance Imaging
Authors: Reddy Anvith , Saad Mariam , Kassis Salam , Assi Patrick , Thayer Wesley P. , Esteve Isaac V. Manzanera
Published: September 2024

Migraine headaches are a significant global health concern, frequently managed with varying levels of success. Compression of the greater occipital nerve (GON) is hypothesized to contribute to pathology in some migraine patients, making extracranial nerve decompression surgery a potential intervention for refractory cases. However, accurate methods to image the GON along its tortuous course still need to be explored. Our group has developed magnetic resonance imaging sequences to track the GON. Yet, many challenges were met, which included navigating the GON's complex anatomy, understanding anatomical variants, and designing advanced magnetic resonance imaging sequences and coils to image the posterior scalp. Addressing these hurdles is vital to capture and understand GON pathology and guide potential interventions.