bluuebunny/crossref_metadata_2025 huggingface dataset:
Massage therapy can effectively relieve cancer pain: A meta-analysis
Authors: Zhang Yueyue , Wang Shaotong , Ma Xiaomin , Yuan Yang , Cheng Hui , Lin Lu , Tian Li
Published: July 2023

Background:

To critically evaluate the effects of massage therapy on cancer pain.

Methods:

Nine Chinese and English databases (PubMed, Cochrane Library, Embase, SCOPUS, Web of Science core, China Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang, and VIP) were systematically searched from the inception of databases to November 2022 for randomized controlled trials. According to Cochrane Collaboration, 2 reviewers independently assessed the risk of bias and extracted data from the included studies. All analyses were performed with Review Manager 5.4.

Results:

Thirteen randomized controlled trials were included in the meta-analysis, containing 1000 patients (498 in the massage therapy group and 502 in the control group). Massage therapy could significantly relieve cancer pain in patients (standardized mean difference = −1.16, 95% confidence interval [−1.39, −0.93], P < .00001), especially those in the perioperative period and those with hematological malignancies. Foot reflexology and hand acupressure had a moderate effect on cancer pain relief, with hand acupressure being more effective. Massage duration of 10 to 30 minutes and a program length of ≥1 week had a better effect and could significantly relieve pain. The occurrence of adverse events was reported in 4 of the 13 studies, all of which were no adverse events.

Conclusions:

Massage therapy can be used as a complementary alternative therapy to relieve cancer pain in patients with hematological malignancies, breast cancer, and cancers of the digestive system. It is suggested that chemotherapy patients use foot reflexology, and perioperative period patients use hand acupressure. A massage duration of 10 to 30 minutes and a program length of ≥1 week is recommended to achieve better effects.
Progressive pseudorheumatoid dysplasia involving a novel WISP3 mutation and sacroiliac and hip arthritis: A case report and literature review
Authors: Wang Weitao , Xiao Guangzhi , Han Qing , Ding Jin , Xie Ronghua , Jia Junfeng , Leng Nan , Zheng Zhaohui
Published: July 2023

Introduction:

Progressive pseudorheumatoid dysplasia (PPRD) is a rare autosomal recessive genetic disease caused by mutations in the Wnt1-inducible signaling pathway protein 3 gene. PPRD is considered a noninflammatory disease, and involvement of the sacroiliac joint and hip arthritis have not been reported previously.

Patient concerns:

We report a case of PPRD in an 11-year-old boy, who presented with bilateral pain and swelling in the knees, elbows, and ankles, and bilateral pain without swelling in the shoulders, wrists, knuckles, and proximal and distal interphalangeal joints for the past 5 years. He had been misdiagnosed with juvenile idiopathic arthritis for more than 6 years.

Diagnosis:

The correct PPRD diagnosis was made using whole-exome sequencing for Wnt1-inducible signaling pathway protein 3 gene mutations (c.589 + 2T>C and c.721T>G; both mutations have rarely been reported) and magnetic resonance imaging examination; moreover, the latter showed inflammation of the sacroiliac joint and hip joint.

Intervention:

The patient was administered supplemental calcium, active vitamin D, and glucosamine sulfate.

Outcome:

The patient experienced alleviation of joint pain following treatment initiation; however, joint motion improvement was not obvious. Above all, the long-term use of biologic or targeted synthetic disease-modifying antirheumatic drugs in the future was avoided.

Conclusion:

The findings of the inflammatory aspects in PPRD will enrich our understanding of this rheumatological disease.
Quality of life in adult patients using dialyzable leukocyte extract for allergic rhinitis
Authors: Homberg Toni Angela , Lara Ivan , Andaluz Consuelo , Cervantes-Trujano Edgar , Hernández-Martínez Pedro Martín , Pérez-Tapia Sonia Mayra , Jiménez-Martínez María Carmen
Published: July 2023

Allergic rhinitis (AR) has considerable impact on the general health of individuals. Therefore, treatment trials should include an evaluation of quality of life. We aimed to determine changes in the quality of life of moderate/severe AR patients treated with standard treatment in addition to dialyzable leukocyte extract (DLE), a peptide-based immunomodulator. In a prospective, non-controlled trial, DLE was added to the standard treatment regimen for patients with moderate/severe AR. DLE was administered orally at 2 mg per day for 5 days, followed by 4 mg per week for 5 weeks, and then 2 mg per week for 5 weeks. The primary endpoints were overall improved Standardized Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores, domain scores, and individual item scores of 0.5 points or higher. Statistical significance was defined as P < .05. Thirty patients (50% female) aged 14 to 60 years old (33.4 ± 11.9) were enrolled in this study. The mean overall basal quality of life score was 3.41 ± 1.22. After 11 weeks, the mean RQLQ score was 1.74 ± 1.09 (P < .0001; 95% confidence interval [CI], 1.05-2.33), and all the domain scores improved (daily activities P < .001, 95% CI 0.91–2.15, sleep P < .001, 95% CI 0.9–2.26, non-hay fever symptoms P = .001, 95% CI 0.51–1.82, practical problems P < .001, 95% CI 1.55–2.85, nasal symptoms P < .001, 95% CI 1.36–2.67, ocular symptoms P < .001, 95% CI 1.05–2.17, emotional P < .001, 95% CI 1.23–2.55). Each of the 28 individual item scores on the RQLQ showed clinical (minimal important difference [MID] ≥ 0.5) and statistical (P < .05) improvements. DLE might be a beneficial adjuvant treatment for AR. Our results provide preliminary data for future research.

Clinical trials registration ID: NCT02506998
Marginal resection as a potential curative treatment option of infantile fibrosarcoma with good response after chemotherapy: A case report of an ETV6-NTRK3 positive infantile fibrosacroma of the distal tibia
Authors: Weber Markus , von Kunow Frederik , Hillmann Axel
Published: July 2023

Rationale:

The infantile fibrosarcoma (IFS) is a non-rhabdomyosarcoma soft tissue sarcoma with locally aggressive properties. State of the art therapy consists of neoadjuvant chemotherapy followed by wide resection according to the criteria of the musculoskeletal tumor society.

Diagnoses:

An ETV6-NTRK3 positive IFS of the distal tibia in a 21-months old child showed good response to chemotherapy.

Interventions:

Due to refusal of amputation marginal resection completing the margins with a high speed drill and filling the space with bone cement was performed.

Outcomes:

At latest follow-up 10 years after surgery, no recurrence was observed.

Lessons:

An individual therapy for surgical treatment of IIFS is recommended. This comprises marginal resection in instead of the golden standard “wide resection” in selected cases.
Intervention for burnout and irrational beliefs in parents of couples seeking a divorce: A critical reflection of Igbo-African marital discord
Authors: Omeje Grace Ngozi , Ede Moses Onyemaechi , Amadi Kingsley , Ogbueghu Sylvester N. , Chinweuba Ngozi H. , Obeagu Emmanuel Ifeanyi , Eze Emmanuel , Areji Anthony Chukwudi , Agbo Christian Onuorah , Ekwueme Francis O.
Published: July 2023

Background:

Looking at the sociocultural dimension of marriage in the sub-region of Nigeria like Igbo, parents allow their sons and daughters to marry so that they can have homes. The expectation is for them to have permanent homes. If there is anything contrary to that such as divorce, parents usually frown at it. To some extent, the psychological effects of it may be deeply rooted in parents who hear that their children are seeking a divorce. Given this reason, this study investigated the effect of rational emotive family health therapy (REFHT) on burnout and irrational beliefs in parents of couples seeking a divorce.

Methods:

This is a pretest-posttest randomized control group research. Two instruments were used to measure 73 participants who were assigned to treatment and control arms. the intervention group received 12 sessions of counseling that aimed to decrease the level of burnout and irrational beliefs. At the end of the sessions and assessments, the data were analyzed using repeated measures, cross-tabulation, and univariate statistics.

Results:

the finding indicated that REFHT was highly effective in decreasing the high parental burnout orchestrated by irrational belief. Comparing the mean scores of the participants exposed to the intervention and those in the control group after time 1 and 2 assessments, the mean reduction of burnout and irrational beliefs further showed a positive treatment outcome. There was no significant influence of gender, time, and group.

Conclusion:

This study suggests that REFHT is significant in improving the psycho-emotional wellness of parents of couples seeking a divorce. Thus, additional research is required to validate the impact of REFHT in decreasing burnout in other populations.
The effect of progressive muscle relaxation technique and myofascial release technique on premenstrual symptoms, blood circulation, and quality of life in women with premenstrual syndrome: A single-blind randomized controlled study
Authors: Demiralp Ovgun Cisel , Tuzun Emine Handan
Published: July 2023

Background:

Premenstrual syndrome (PMS) is a common condition in women of reproductive age. It is characterized by a range of behavioral, physical, and psychological symptoms. The aim of this study is to investigate the effects of progressive relaxation and myofascial release technique (MRT) on premenstrual symptoms, blood flow rate, pain, sleep quality and quality of life, in women with PMS.

Method:

The study will conduct as a single-blind randomized controlled trial. Study registered at the ClinicalTrial.gov Protocol ID: NCT05836454. The volunteers will be randomized using allocation software to be divided into 3 groups: the progressive muscle relaxation group, the MRT group, and the control group. Assessments will be conducted by another physical therapist who is blinded to the groups. The assessments will include the Premenstrual Syndrome Severity Score, Blood Flow Measurements, Short Form McGill Pain Questionnaire, the Pittsburgh Sleep Quality Index and Short Form-36 Health Survey.

Discussion:

Since both methods provide relaxation, improve symptoms and quality of life, they have not been compared to each other in the literature. This prompt to us to plan this study.
Abundant infiltration of B cells and plasma cells in brain biopsy of a male patient with severe anti-NMDA receptor encephalitis: A case report
Authors: Wei Linfei , Lu Zhengjuan , Du Zunguo , Wang Yin , Guan Hongzhi
Published: July 2023

Rationale:

Anti-N-methyl-D-aspartate receptor (NMDAR) is the most common type of autoimmune encephalitis mediated by NMDAR antibodies. The pathological process remains unclear, especially in patients without tumors or infections. Autopsy and biopsy studies have rarely been reported because of the favorable prognosis. Pathological findings generally demonstrate mild-to-moderate inflammation. This case report presents severe anti-NMDAR encephalitis in a 43-year-old man without any identified triggers. The biopsy in this patient showed extensive inflammatory infiltration with evident B cell accumulation, which enriches the pathological study of male anti-NMDAR encephalitis patients without comorbidities.

Patient concerns:

A 43-year-old previously healthy man presented with new-onset seizures with recurrent jerks. The initial autoimmune antibody test with serum and cerebrospinal fluid yielded negative results. After ineffective treatment for viral encephalitis, based on the imaging results indicating the possibility of diffuse glioma, the patient underwent a brain biopsy in the right frontal lobe to rule out malignancy.

Diagnosis:

The immunohistochemical study showed extensive inflammatory cell infiltration, consistent with the pathological changes in encephalitis. Cerebrospinal fluid and serum samples were then retested and tested positive for IgG antibodies against NMDAR. Therefore, the patient was diagnosed with anti-NMDAR encephalitis.

Interventions:

The patient was administered intravenous immunoglobulin (0.4 g/kg/d for 5 days), intravenous methylprednisolone (1 g/d for 5 days, 500 mg/d for 5 days, subsequently reduced to oral administration), and intravenous cyclophosphamide cycles.

Outcomes:

The patient developed refractory epilepsy 6 weeks later and required mechanical ventilation. Despite brief clinical improvement after extensive immunotherapy, the patient died from bradycardia and circulation.

Lessons:

Anti-NMDAR encephalitis cannot be ruled out even if the initial autoantibody test result is negative. For progressive encephalitis of unknown etiology, it is necessary to recheck cerebrospinal fluid for anti-NMDAR antibodies.
The influence of psychological factors on coronary heart disease: A review of the evidence and implications for psychological interventions
Authors: Xu Weize , Fang Lingyan , Bai Hemanyun , Ke Kangling , Li Weiyan , Huang Haitao , Liang Xiao , Chen Can
Published: July 2023

This article reviews the evidence on the influence of psychological factors on coronary heart disease (CHD) and discusses the implications of these findings for psychological interventions. The review focuses on the role of work stress, depression, anxiety, and social support in the impact of CHD, as well as the effects of psychological interventions on CHD. The article concludes with recommendations for future research and clinical practice.
Influence of gut microecology in the development of malignant tumors and its potential therapeutic application: A review
Authors: Qian Jin-Ping , Jiang Bing , Lei Xu-Dong , Tian Le-Le , Zhou Ying , Teng Jing-Quan , Yue Jia , Li Jin-Juan , Zhang Yan
Published: July 2023

A microbial ecosystem is a complex community of multiple bacterial interactions. The potential role of gut microbiota in human health has already attracted the attention of many researchers. Dysregulation of the gut microbial community has been suggested to be closely associated with the progression of various chronic diseases. Malignant neoplasms represent a major global health burden and are now the leading cause of death. The formation of tumors is often thought to be influenced by genetic and environmental factors. Recent research advances have indicated that multiple malignancies may also be attributed to the gut microbiota. In this review, we highlight the complex interactions between gut microbes and their metabolites, as well as the potential impact of gut microecology on the occurrence and development of tumors. In addition, potential strategies for targeted therapy of tumors using gut microecology are discussed. In the near future, intestinal microecology is likely to be used for early screening of tumors and subsequent clinical treatment.
Prognostic value of sarcopenic visceral obesity in hepatocellular carcinoma treated with TACE
Authors: Li Yuxuan , Hou Juan , Chen Rongfeng
Published: July 2023

Although Transartial chemoembolization (TACE) is one of the recommended treatments for hepatocellular carcinoma (HCC), there is always a dispute on the selection of the best beneficiary for treatment. We studied the prognostic value of nutritional markers, obesity, visceral obesity and sarcopenia on survival outcomes under single and different combinations. In a retrospective cohort of 235 patients with HCC at different stages, more accurate comprehensive prognostic factors were obtained by combining and comparing the multifactor hazard ratios (HR) of various parameters, including skeletal muscle index (SMI) and visceral fat index (VFI) obtained by computer tomography, laboratory index albumin-to-globulin (A/G) ratio, anthropometric body mass index (BMI) and other parameters. The study cohort was dominated by men (73.6%), with a median age of 54 years. According to the survival outcome of HCC patients, we obtained the ideal sex cutoff value of VFI: ≥40.54 cm2/m2 for males (the receiver operating characteristic curve [ROC] = 0.764, P < .001) and ≥ 43.19 cm2/m2 for females (ROC = 0.718, P < .05). According to the results of multifactor analysis, sarcopenic visceral obesity (HR = 8.35, 95% confidence intervals [CI] = [4.96, 14.05], P < .001) is more effective than any single or combined prognosis assessment, including sarcopenic dystrophy (HR = 2.70, 95% CI = [1.85, 3.95], P < .001), sarcopenic obesity (HR = 5.23, 95% CI = [3.41, 8.02], P < .001), sarcopenia (HR = 5.74, 95% CI = [3.61, 9.11], P < .001) and visceral obesity (HR = 3.44, 95% CI = [2.24, 5.27], P < .001). Sarcopenic visceral obesity, defined by SMI and VFI, is a more objective and accurate prognostic indicator of HCC.
The effect of aminolevulinic acid hydrochloride topical powder photodynamic therapy versus nocardia rubra cell wall skeleton and observers group in the treatment of cervical low-grade squamous intraepithelial lesions with human papillomavirus infection: A non-randomized study, controlled pilot study
Authors: Jiang SuZhen , Nan XiaoMei , Pan XiangLian , Zhang JiaYing , Tang LiYan , Gong HongXia
Published: July 2023

There are insufficient studies comparing the efficacy of aminolevulinic acid hydrochloride topical powder (ALA) photodynamic therapy (PDT) against Nocardia rubra cell wall skeleton (Nr-CWS) therapy in the treatment of cervical low-grade squamous intraepithelial lesion (LSIL) with human papillomavirus (HPV), especially for long-term efficacy. Patients with cervical LSIL and HPV infection were divided into 3 treatment groups based on their own choice. All patients had a follow-up test including HPV testing, cytology and colposcopy at 4 to 6 months and 12 months after the treatment. Among142 patients, patients received 51 ALA PDT and 41 patients received Nr-CWS. Another 50 patients who refused treatment were included in the Observers group. Four to six months or 12 months after treatment, there was significant difference between 3 groups in the clearance rate of HR-HPV infection and the complete remission (CR) rates of cervical LSIL; the CR rates of cervical LSIL in the ALA PDT group was significantly higher than the Nr-CWS group; but there was no significant difference between 2 groups in the clearance rate of HPV infection. The CR rates of cervical LSIL and the clearance rate of HPV infection in the ALA PDT group was significantly higher than the Observers group; the CR rates of cervical LSIL and the clearance rate of HPV infection in the Nr-CWS group was significantly higher than the Observers group; there was no significant difference in the recurrence rates in ALA PDT and Nr-CWS group after 12 months. Both of ALA PDT and Nr-CWS group had lower recurrence rate than the Observers group. The effect of ALA PDT is similar to Nr-CWS in the clearance rate of HR-HPV infection. Compared to the Nr-CWS group, the CR rates of cervical LSIL were considerably greater in the ALA PDT group. The effect of ALA PDT in the clearance rate of HPV infection and CR rates of cervical LSIL was significantly higher than the follow-up group; Both of ALA PDT and Nr-CWS group had lower recurrence rate than the Observers group. For cervical LSIL with HPV infection, ALA PDT is a very successful therapeutic method that is noninvasive.
Star-shaped incision technique for gingiva patients treated with implant-supported fixed prosthesis
Authors: Luo Wen , Kuang Huifang , Sun Honglan , Huang Yuqi , Wang Jinrong , Zheng Kaiyue , Li Zhixin , Qu Yili , Man Yi , Wu Yingying
Published: July 2023

To evaluate the modified star-shaped incision on gingival sulcus for reducing horizontal food impaction around implant-supported restoration. Total 24 patients receiving bone-level implant placement were enrolled, a star-shaped incision was made on the gingiva sulcus before the placement of zirconia crown. Follow-up examination was carried out 3 and 6 months after final restoration, respectively. Assessment of soft tissue includes papilla height, modified plaque index, modified sulcus bleeding index, periodontal depth, gingival biotype and gingival margin level. Marginal bone level was measured on periapical radiographs. Only 1 patient complained about the horizontal food impaction. Both the mesial and distal papilla almost filled the entire proximal space, in good harmony with the adjacent papillae. No recession of the gingival margin was found around the crown even in the patients with thin gingival biotype. Other parameters of soft tissue including modified plaque index, modified sulcus bleeding index and periodontal depth remained low during the whole follow-up visit. The resorption of marginal crestal bone was less than 0.6 mm during the first 6 month, and there was no significant difference among baseline, 3-month and 6-month visit. The modified star-shaped incision on the gingiva sulcus maintained the gingival papilla height and reduced the occurrence of horizontal food impaction, and no recession of the gingiva margin was found around implant-supported restoration.
An effective salivation-facilitating method for COVID-19 testing: An experimental study
Authors: Higashijima Misako , Shiozu Hiroyasu , Sakai Tomoya , Matsuo Moemi
Published: July 2023

Background:

Simple tools, such as antigen test kits, are readily available for determining coronavirus disease 2019 infection at hospitals and homes. However, it is challenging for elderly people who are prone to dry mouth and other diseases. The main objective of this study was to investigate whether the presence or consumption of a plum pickle can facilitate salivation during coronavirus disease 2019 testing.

Method:

Twenty healthy adult women participated in the study. The participants were allocated to 2 groups: presentation and non-presentation (n = 10; with and without presentation of a plum pickle, respectively), and eating and non-eating (n = 10; with and without consumption of plum pickle, respectively). We recorded the number of saliva swallows in 1 minute under each condition, using a swallowing test device, which attached film sensors to the hyoid bone and thyroid cartilage.

Results:

There was a significant difference in the number of swallows between the non-presentation and presentation groups (P < .01, r = 0.89, Z = −2.82) as well as between the non-eating and eating groups (P < .01, r = 0.85, Z = −2.68).

Conclusions:

The strength of 3 factors, namely: direct stimulation with citric acid, saliva buffer capacity, and motor learning, may have affected the results. Our study suggests that saliva collection using the plum pickle is an effective complementary method for facilitating salivation. This technique may be useful in avoiding the risk associated with citric acid intake and for efficient specimen collection during coronavirus disease 2019 testing. In the future, we need to verify this method in elderly participants in a clinical setting.
Updates in food allergen immunotherapy
Authors: Szafron Vibha , Rana Ruchit , Anvari Sara
Published: July 2023

Purpose of review

Food allergies are on the rise. Though allergen avoidance and management of acute reactions have been the backbone of therapy, complete avoidance and timely acute care is often not feasible. Food allergen immunotherapy (FAIT) is a novel and evolving treatment option intended to induce desensitization and potential sustained unresponsiveness (SU) to food allergens. This review addresses the methods, mechanisms, efficacy, and adverse effects of oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) for food allergens in the published literature.

Recent findings

Single FAIT has been most extensively studied in peanut, milk, and hen's egg allergic patients and has been successful in achieving desensitization in treated individuals through various modalities. Long-term data regarding SU is limited; however, current data suggests subsets of patients may be more likely to achieve SU compared to others. Other studies are actively assessing multifood AIT and novel FAIT protocols with adjunctive therapies.

Food allergy constitutes a prevalent problem with far-reaching consequences. The emergence of FAIT may mitigate the burden of food allergy. Current evidence is promising for specific allergens and pediatric patient populations. Future studies are needed to further assess efficacy between different modalities of immunotherapy for food allergens across an age continuum.
Managing Older Adults' Chronic Pain
Authors: Arnstein Paul , Shade Marcia , Herr Keela A. , Young Heather M. , Fishman Scott M.
Published: July 2023

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.

This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Arnstein, P., et al. Managing Older Adults' Chronic Pain: Lower-Risk Interventions. Am J Nurs 2023; 123 (2): 46-52.
The Impact of Assistive Technology on Quality of Life of Home-Dwelling People with Parkinson's Disease
Authors: Collins Tracey L. , Cardella Alexa , Gordon Sarah
Published: July 2023

Parkinson's disease (PD) is the fastest growing neurological disease worldwide with more than 8.5 million people diagnosed. Assistive technologies for people with PD support the user to maximize independence. The purpose of this integrative literature review was to critique and synthesize the literature on the impact of assistive technologies on quality of life of home-dwelling individuals with PD. A literature search for studies on assistive technologies for people with PD with a primary outcome measure of quality of life was conducted. Of 156 articles screened for eligibility, 6 met selection criteria, including 4 quantitative studies, 1 qualitative study, and 1 mixed-method. Levels of evidence were scored as a percentage of quality criteria met, from 60% to 100% using the Mixed Methods Appraisal Tool. Using home monitoring devices was associated with significant improvements in walking, especially during freezing of gait. Evidence supports the use of assistive technologies including voice-activated technology, home automation, and home monitoring devices. Further research is needed to determine the effect of assistive technology on quality of life.
Aquatic Cycling for a Child With Hemiplegic Cerebral Palsy: A Case Report
Authors: Conklin Ashley , Van Wingerden Anita
Published: July 2023

Introduction and Purpose:

Cerebral palsy (CP) causes multisystem deficits including abnormalities in muscle tone, motor control, postural control, and balance, which lead to functional limitations. Research demonstrates that aquatic physical therapy (APT) aids in mitigating negative effects of CP in children. Land-based adapted cycling (LBADC) programs use adapted bicycles to facilitate movement, strength, and endurance, with promising results in children with CP. Aquatic cycling (AC), using a stationary bicycle submerged in water, posits benefits in adults. No study has investigated the combination of APT and cycling for children. The purpose of this case report is to present the outcomes of an AC program for a child with CP.

Case Description:

The patient was a 9-year-old boy diagnosed with hemiplegic CP, Gross Motor Function Classification System level II presenting with hypertonicity, and decreased motor control and strength throughout his right side, resulting in limitations in endurance and functional mobility. AC sessions consisted of 20 minutes of stationary AC, with a 5-minute warm-up and cooldown.

Outcomes:

A total of 10 AC sessions yielded improvements in strength and functional ability. Timed Up and Go test scores improved by 1.3 seconds, exceeding the minimal clinically important difference of 1.2 seconds. The 6-Minute Walk Test score increased by 284 ft, exceeding the minimal detectable change (MDC). Strength improvements were obtained at the right hip abductors and ankle dorsiflexors and bilateral knee flexors, exceeding the MDC of 1.7 lb.

Discussion:

This is the first study to investigate the effect of AC for a child with CP. Results indicate that AC sessions were beneficial in improving the patient's strength, endurance, and gait efficiency and may be an effective way to engage children with CP in therapeutic exercise.
Male-killer symbiont screening reveals novel associations in Adalia ladybirds
Authors: Archer Jack , Hurst Gregory D. D. , Hornett Emily A.
Published: July 2023

While male-killing bacteria are known to infect across arthropods, ladybird beetles represent a hotspot for these symbioses. In some host species, there are multiple different symbionts that vary in presence and frequency between populations. To further our understanding of spatial and frequency variation, we tested for the presence of three male-killing bacteria:

Wolbachia

,

Rickettsia

and

Spiroplasma

, in two Adalia ladybird species from a previously unexplored UK population. The two-spot ladybird, A. bipunctata, is known to harbour all three male-killers, and we identified

Spiroplasma

infection in the Merseyside population for the first time. However, in contrast to previous studies on two-spot ladybirds from continental Europe, evidence from egg-hatch rates indicates the

Spiroplasma

strain present in the Merseyside population does not cause embryonic male-killing. In the related ten-spot ladybird, A. decempunctata, there is only one previous record of a male-killing symbiont, a

Rickettsia

, which we did not detect in the Merseyside sample. However, PCR assays indicated the presence of a

Spiroplasma

in a single A. decempunctata specimen. Marker sequence indicated that this

Spiroplasma

was divergent from that found in sympatric A. bipunctata. Genome sequencing of the

Spiroplasma

-infected A. decempunctata additionally revealed the presence of cobionts in the form of a Centistes parasitoid wasp and the parasitic fungi Beauveria. Further study of A. decempunctata from this population is needed to resolve whether it is the ladybird or wasp cobiont that harbours

Spiroplasma

, and to establish the phenotype of this strain. These data indicate first that microbial symbiont phenotype should not be assumed from past studies conducted in different locations, and second that cobiont presence may confound screening studies aimed to detect the frequency of a symbiont in field collected material from a focal host species.
HAEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS AFTER INTRAVESICAL BCG ADMINISTRATION FOR BLADDER CANCER PRESENTING WITH MULTIORGAN FAILURE
Authors: Liatsos GD , Manousopoulou Georgia , Poulaki Aikaterini , Iliaki Agapi , Mariolis Ilias , Vassilopoulos Dimitrios
Published: July 2023

Bacillus Calmette-Guérin (BCG), is administered intravesically as an adjuvant immunotherapy for the treatment of non-muscle invasive bladder cancer. Minor non-infectious complications such as fever, malaise, and bladder irritation occurring a few hours after intravesical BCG administration are very common (up to 85%) and self-limited (resolving within 48 hours). However, in ~1-5% of patients severe local and systemic complications may occur. We report the case of a patient with superficial bladder cancer who after intravesical BCG instillation developed multiorgan failure including kidney and liver with subsequent haemophagocytic lymphohistiocytosis. Our report illustrates the first reported combination of secondary haemophagocytic lymphohistiocytosis with renal and liver failure after BCG immunotherapy for bladder carcinoma. Treatment strategy is discussed.
Rhodococcus antarcticus sp. nov., isolated from a till sample of Collins glacier front, Antarctica
Authors: Sun Mingjing , Zhu Baolin , Liu Jia , Qin Kun , Peng Fang
Published: July 2023

A pink-coloured, Gram-stain-positive, aerobic and rod-shaped strain, designated 75T, was isolated from Collins glacier front till, Antarctica. Strain 75T was non-motile and non-spore-forming. Growth was observed at pH 6.0–9.0 (optimum, pH 7.0), at 4–45 °C (optimum, 20 °C) and with 0–9 % (w/v) NaCl (optimum, 1%). Phylogenetic analyses based on 16S rRNA gene sequences showed that strain 75T belongs to the genus

Rhodococcus

, and is related to

Rhodococcus gannanensis

DSM 104003T,

Rhodococcus aerolatus

KCTC29240T and

Rhodococcus agglutinans

KCTC 39118T (96.1, 96.0 and 95.7 % sequence similarity, respectively). The main polar lipids were identified as diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, phosphatidylinositol, phosphatidylinositol mannoside and a phosphoglycolipid. The major cellular fatty acids were identified as C16 : 0, iso- C16 : 0, 10-methyl C17 : 0 and C17 : 1
 ω8c. MK-7 and MK-8(H4) were found to be the dominant menaquinones. Whole-cell hydrolysates contained meso-diaminopimelic acid, ribose, galactose, glucose and rhamnose. The genome of strain 75T is 3.82 Mb long in size with a G+C content of 73.1 mol%. On the basis of phenotypic, molecular and chemotaxonomic characteristics, strain 75T is considered to represent a novel species of the genus

Rhodococcus

, for which the name Rhodococcus antarcticus sp. nov. is proposed. The type strain is 75T (=CCTCC AA 2019032T=KCTC 49334T).
Resting-state background features demonstrate multidien cycles in long-term EEG device recordings
Authors: Ojemann William K.S. , Scheid Brittany H. , Mouchtaris Sofia , Lucas Alfredo , LaRocque Joshua J. , Aguila Carlos , Ashourvan Arian , Caciagli Lorenzo , Davis Kathryn A. , Conrad Erin C. , Litt Brian
Published: July 2023

Background

Longitudinal EEG recorded by implanted devices is critical for understanding and managing epilepsy. Recent research reports patient-specific, multi-day cycles in device-detected epileptiform events that coincide with increased likelihood of clinical seizures. Understanding these cycles could elucidate mechanisms generating seizures and advance drug and neurostimulation therapies

Objective/Hypothesis

We hypothesize that seizure-correlated cycles are present in background neural activity, independent of interictal epileptiform spikes, and that neurostimulation may disrupt these cycles.

Methods

We analyzed regularly-recorded seizure-free data epochs from 20 patients implanted with a responsive neurostimulation (RNS) device for at least 1.5 years, to explore the relationship between cycles in device-detected interictal epileptiform activity (dIEA), clinician-validated interictal spikes, background EEG features, and neurostimulation.

Results

Background EEG features tracked the cycle phase of dIEA in all patients (AUC: 0.63 [0.56 - 0.67]) with a greater effect size compared to clinically annotated spike rate alone (AUC: 0.55 [0.53-0.61], p < 0.01). After accounting for circadian variation and spike rate, we observed significant population trends in elevated theta and beta band power and theta and alpha connectivity features at the cycle peaks (sign test, p < 0.05). In the period directly after stimulation we observe a decreased association between cycle phase and EEG features compared to background recordings (AUC: 0.58 [0.55-0.64]).

Conclusions

Our findings suggest that seizure-correlated dIEA cycles are not solely due to epileptiform discharges but are associated with background measures of brain state; and that neurostimulation may disrupt these cycles. These results may help elucidate mechanisms underlying seizure generation, provide new biomarkers for seizure risk, and facilitate monitoring, treating, and managing epilepsy with implantable devices.

Highlights

Background EEG features track multidien cycles in RNS dIEA

dIEA linked EEG features are patient-specific and may differ with cortical structure

Responsive neurostimulation suppresses EEG-dIEA coupling
The Challenges of Surveying Heavy-tail Distributions for Use in Infectious Disease Dynamics
Authors: DeWitt Michael E , Kortessis Nicholas , Sanders John W , McNeil Candice J.
Published: July 2023

Sexual networks often have heavy-tails, where a small number of exceptional individuals in a population have many more sexual partners than the average (e.g., more than five standard deviations). Heavy-tails pose challenges when surveying this group, as these exceptional individuals are uncommon in the population (and so hard to detect), but have disproportionate impact on epidemiological questions, such as those related to the spread of sexually transmitted diseases. In essence, omitting these individuals is a severe error. In this modeling study, we use prior estimates of the distribution of sexual partners amongst men who have sex with men to explore the implication of different sample sizes on survey estimates. We find that even large surveys consistently fail to capture the variance of the sexual network. Surveys of heavy-tailed sexual networks should be designed with this high variance in mind so as not to underestimate the disease dynamics. The failure to adequately capture the variance within a heavy-tailed network has strong implications for infectious disease dynamics and modeling as disease dynamics are often driven by the heavy-tail.
Performance of Thrombectomy-Capable, Comprehensive, and Primary Stroke Centers in Reperfusion Therapies for Acute Ischemic Stroke: Report from the Get With The Guidelines Stroke Registry
Authors: Raychev Radoslav , Sun Jie-Lena , Schwamm Lee , Smith Eric E. , Fonarow Gregg C. , Messé Steven R. , Xian Ying , Chiswell Karen , Blanco Rosalia , Grory Brian Mac , Saver Jeffrey L.
Published: July 2023

Background

The thrombectomy-capable stroke center (TSC) is a recently introduced intermediate tier of accreditation for hospitals caring for patients with acute ischemic stroke (AIS). The comparative quality and clinical outcomes of reperfusion therapies at TSCs, primary stroke centers (PSCs), and comprehensive stroke centers (CSCs) has not been well delineated.

Methods

We conducted a retrospective, observational, cohort study from 2018-2020 that included patients with AIS who received endovascular (EVT) and/or intravenous (IVT) reperfusion therapies at CSC, TSC, or PSC. Participants were recruited from Get With The Guidelines–Stroke registry. Study endpoints included timeliness of IVT and EVT, successful reperfusion, discharge destination, discharge mortality, and functional independence at discharge.

Results

Among 84,903 included patients, 48,682 received EVT, of whom 73% were treated at CSCs, 22% at PSCs, and 4% at TSCs. The median annual EVT volume was 76 for CSCs, 55 for TSCs, and 32 for PSCs. Patient differences by center status included higher NIHSS, longer onset-to-arrival time, and higher transfer-in rates for CSC/TSC/PSC, respectively. In adjusted analyses, the likelihood of achieving the goal door-to-needle time was higher in CSCs compared to PSCs (OR 1.39; 95% CI 1.17-1.66) and in TSCs compared to PSCs (OR 1.45; 95% CI 1.08-1.96). Similarly, the odds of achieving the goal door-to-puncture time were higher in CSCs compared to PSCs (OR 1.58; 95% CI 1.13-2.21). CSCs and TSCs also demonstrated better clinical efficacy outcomes compared to PSCs. The odds of discharge to home or rehabilitation were higher in CSCs compared to PSCs (OR 1.18; 95% CI 1.06-1.31), while the odds of in-hospital mortality/discharge to hospice were lower in both CSCs compared to PSCs (OR 0.87; 95% CI 0.81-0.94) and TSCs compared to PSCs (OR 0.86; 95% CI 0.75-0.98). There were no significant differences in any of the quality-of-care metrics and clinical outcomes between TSCs and CSCs.

Conclusions

In this study representing national US practice, CSCs and TSCs exceeded PSCs in key quality-of-care reperfusion metrics and outcomes, whereas TSCs and CSCs demonstrated similar performance. Considering that over one-fifth of all EVT procedures during the study period were conducted at PSCs, it may be desirable to explore national initiatives aimed at facilitating the elevation of eligible PSCs to a higher certification status.
Unique Geographical Features of Out-of-Hospital Cardiac Arrest Patients within urban area: A Bayesian Spatial Analysis
Authors: Senda Atsushi
Published: July 2023

Background

The advantages of urban areas for patients with out-of-hospital cardiac arrest (OHCA), attributable to their extensive medical resources, are well recognized. However, whether a greater abundance of these resources directly improves patient outcomes is unclear. Moreover, it is important to clarify this because of the ongoing global trend of urbanization. Therefore, this study aimed to investigate this issue and shed light on the potential challenges specific to urban environments.

Methods

This retrospective observational study was conducted to evaluate the correlation between the geographical features of patients with shockable OHCA and neurological outcomes. Data of patients who were transported to Tokyo Medical and Dental University Hospital between June 1, 2016, and May 30, 2022, were extracted from electronic review board records. The Glasgow-Pittsburgh Cerebral Performance Category Scale was utilized to evaluate the neurological results. The study employed Bayesian spatial modeling and analyzed the results using the Integrated Nested Laplace Approximation and Stochastic Partial Differential Equation methods.

Results

Paradoxically, a region with the highest concentration of advanced medical facilities exhibited the poorest neurological outcomes. This area was characterized by an extended duration of on-site emergency medical service activity, which strongly correlated with a negative impact on patients’ neurological outcomes.

Conclusions

The abundance of healthcare resources in urban areas does not necessarily correlate with improved outcomes for patients with OHCA. A strategic approach to medical control that considers these factors can potentially enhance the outcomes of patients with OHCA in urban areas.

Clinical Perspectives

What is new?

In a retrospective geographical analysis of patients with shockable Out-of-Hospital Cardiac Arrest (OHCA), it was found that the region with the highest concentration of advanced medical facilities paradoxically exhibited the poorest neurological outcomes. Additionally, there was a noticeable extension in the duration of on-site emergency medical service activity in this area.

What are the clinical implications?

The abundance of healthcare resources in urban areas does not necessarily equate to improved outcomes for patients with OHCA. Therefore, a strategic approach to medical resource management should be considered to effectively utilize these resources and enhance the outcomes of patients in urban areas.
Intracardiac Thrombus in COVID-19 Inpatients: A Nationwide Study of Incidence, Predictors and Outcomes
Authors: Agrawal Ankit , Bajaj Suryansh , Bhagat Umesh , Chandna Sanya , Arockiam Aro Daniela , Chan Nicholas , Haroun Elio , Gupta Rahul , Badwan Osamah , Shekhar Shashank , Ramu Shivabalan Kathavarayan , Nayar Divya , Jaber Wael , Griffin Brian P , Wang Tom Kai Ming
Published: July 2023

Background

COronaVIrus Disease 2019 (COVID-19) has been observed to be associated with a hypercoagulable state. Intracardiac thrombosis is a serious complication but has seldom been evaluated in COVID-19 patients. We assessed the incidence, associated factors, and outcomes of COVID-19 patients with intracardiac thrombosis.

Methods

COVID-19 inpatients during 2020 were retrospectively identified from the national inpatient sample (NIS) database, and data retrieved regarding clinical characteristics, intracardiac thrombosis, and adverse outcomes. Multivariable logistic regression was performed to identify the clinical factors associated with intracardiac thrombosis and in-hospital mortality and morbidities.

Results

A total of 1,683,785 COVID-19 inpatients were identified in 2020 from NIS, with a mean age of 63.8 ± 1.6 years, and 32.2% females. Intracardiac thrombosis was present in 0.001% (1,830) patients. Overall, in-hospital outcomes include all-cause mortality 13.2% (222,695/1,683,785), cardiovascular mortality 3.5%, cardiac arrest 2.6%, acute coronary syndrome (ACS) 4.4%, heart failure 16.1%, stroke 1.3% and acute kidney injury (AKI) 28.3%. The main factors associated with intracardiac thrombosis were a history of congestive heart failure and coagulopathy. Intracardiac thrombosis was independently associated with a higher risk of in-hospital all-cause mortality (OR: 3.32, 95% CI: 2.42-4.54, p<0.001), cardiovascular mortality (OR: 2.95, 95% CI: 1.96-4.44, p<0.001), cardiac arrest (OR: 2.04, 95% CI: 1.22-3.43, p=0.006), ACS (OR: 1.62, 95% CI: 1.17-2.22, p=0.003), stroke (OR: 3.10, 95% CI: 2.11-4.56, p<0.001), and AKI (OR: 2.13 95% CI: 1.68-2.69, p<0.001), but not incident heart failure (p=0.27).

Conclusion

Although intracardiac thrombosis is rare in COVID-19 inpatients, its presence was independently associated with higher risks of in-hospital mortality and most morbidities. Prompt investigations and treatments for intracardiac thrombosis are warranted when there is a high index of suspicion and a confirmed diagnosis respectively.
Outcomes of Cardiac Resynchronization Therapy by New York Heart Association Class: A Patient-Level Meta-Analysis
Authors: Shivakumar Nishkala , Friedman Daniel J. , Fudim Marat , Abraham William T. , Cleland John G. F. , Curtis Anne B. , Gold Michael R. , Kutyifa Valentina , Linde Cecilia , Young James , Tang Anthony , Olivas-Martinez Antonio , Inoue Lurdes Y.T. , Sanders Gillian D. , Al-Khatib Sana M.
Published: July 2023

Data on the benefits of cardiac resynchronization therapy (CRT) in patients with severe heart failure (HF) symptoms are limited. We investigated the relative effects of CRT in patients with ambulatory NYHA IV vs. III functional class at the time of device implantation. In this meta-analysis, we pooled patient-level data from the MIRACLE, MIRACLE-ICD, and COMPANION trials. Outcomes evaluated were time to the composite endpoint of first HF hospitalization (HFH) or all-cause mortality and time to all-cause mortality alone. The association between CRT and outcomes was evaluated using a Bayesian Hierarchical Weibull survival regression model. We assessed if this association differs between NYHA III and IV groups by adding an interaction term between CRT and NYHA class as a random effect. A sensitivity analysis was performed by including data from the RAFT trial. Our pooled analysis included 2309 patients. Overall, CRT was associated with a longer time to HFH or all-cause mortality (adjusted hazard ratio [aHR] 0.79, 95%CI 0.64 – 0.99, p = 0.044), with a similar association with time to all-cause mortality (aHR 0.78, 95% CI 0.59 – 1.03, p = 0.083). Associations of CRT with outcomes were not significantly different for those in NYHA III and IV classes (ratio of aHR 0.72, 95% CI 0.30 – 1.27, p = 0.23 for HFH/mortality; ratio of aHR 0.70, 95% CI 0.35 – 1.34, p = 0.27 for all-cause mortality alone). The sensitivity analysis, including RAFT data, did not show a significant relative CRT benefit between NYHA III and IV classes. Overall, there was no significant difference in the association of CRT with either outcome for patients in NYHA functional class III compared with functional class IV.