bluuebunny/crossref_metadata_2025 huggingface dataset:
Astragalus membranaceus formula for moderate-high risk idiopathic membranous nephropathy: A meta-analysis
Authors: Wang Dan , Wang Lijuan , Zhang Mingrui , Li Ping , Zhang Qinghua , Bao Kun
Published: March 2023

Background:

Idiopathic membranous nephropathy (IMN) is a noninflammatory autoimmune glomerulonephropathy. Based on the risk stratification for disease progression, conservative nonimmunosuppressive and immunosuppressive therapy strategies have been recommended. However, there remains challenges. Therefore, novel approaches to treat IMN are needed. We evaluated the efficacy of Astragalus membranaceus (A membranaceus) combined with supportive care or immunosuppressive therapy in the treatment of moderate-high risk IMN.

Methods:

We comprehensively searched PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure, the Database for Chinese Technical Periodicals, Wanfang Knowledge Service Platform, and SinoMed. We then performed a systematic review and cumulative meta-analysis of all randomized controlled trials assessing the two therapy methods.

Results:

The meta-analysis included 50 studies involving 3423 participants. The effect of A membranaceus combined with supportive care or immunosuppressive therapy is better than that of supportive care or immunosuppressive therapy along in regulating for improving 24 hours urinary total protein (MD = −1.05, 95% CI [−1.21, −0.89], P = .000), serum albumin (MD = 3.75, 95% CI [3.01, 4.49], P = .000), serum creatinine (MD = −6.24, 95% CI [−9.85, −2.63], P = .0007), complete remission rate (RR = 1.63, 95% CI [1.46, 1.81], P = .000), partial remission rate (RR = 1.13, 95% CI [1.05, 1.20], P = .0004).

Conclusions:

Adjunctive use of A membranaceus preparations combined with supportive care or immunosuppressive therapy have a promising treatment for improving complete response rate, partial response rate, serum albumin, and reducing proteinuria, serum creatinine levels compared to immunosuppressive therapy in people with MN being at moderate-high risk for disease progression. Given the inherent limitations of the included studies, future well-designed randomized controlled trials are required to confirm and update the findings of this analysis.
Surgery and postoperative radiotherapy affect the prognosis of esophageal cancer: A SEER analysis
Authors: Yang Wenwen , Yang Yanjiang , Ma Xiang , Ma Minjie , Han Biao
Published: March 2023

The principal treatment modalities for esophageal cancer are radiation, chemotherapy and surgery or a combination of them. In some sense, technological advances have tremendously heightened patients’ survival rates. Nevertheless, the debate on the prognostic value of postoperative radiotherapy (PORT) has never ceased. On that account, this study made an effort to probe deep into the effects of PORT and surgery on the prognosis of stage III esophageal cancer. Our study included patients diagnosed with stage III esophageal cancer between 2004 and 2015 through the Surveillance, Epidemiology, and End Results (SEER) program. We performed propensity score matching (PSM) on the basis of whether surgery was carried out and whether PORT conducted. We identified the independent risk factors by multivariate Cox regression and constructed a nomogram model. In this research, we included 3940 patients, and the median follow-up is 14 months: 1932 cases without surgery; 2008 cases with surgery, and 322 cases of them underwent PORT. In the postPSM patient cohort, patients who underwent surgery had a median overall survival rate (OS) of 19.0 (95% confidence interval [CI] 17.2–20.8) and a median cancer-specific survival rate (CSS) of 23.0 (95% CI 20.6–25.3) months, which were remarkably higher than those without surgery (P < .001). The OS（P < .05）and CSS（P < .05）of the patients who underwent PORT were lower than those who did not. Similar results were obtained in the groups of N0 and N1. This study revealed surgery can heighten patients’ survival rate, while PORT could not elevate patients’ survival rate in stage III esophageal cancer patients.
Effect of summer acupoint application treatment (SAAT) on gut microbiota in healthy Asian adults: A randomized controlled trial
Authors: Zhou Jie , Zhou Bangmin , Kou Xiaoyue , Jian Tao , Chen Limei , Lei Xinghua , Jia Shijian , Xie Xiaoying , Wu Xianbo
Published: March 2023

Acupoint application has served as an important complementary and adjunctive therapy in China. The purpose of this study is to explore the impact of summer acupoint application treatment (SAAT) on the abundance and biological structure of gut microbiota in healthy Asian adults. Based on the CONSORT guidelines, 72 healthy adults were included in this study, randomly divided into 2 groups, receiving either traditional (acupoint application within known relevant meridians, Group A) or sham (treated with placebo prepared by mixing the equal amount of starch and water, Group B) SAAT. SAAT stickers include extracts from Rhizoma Corydalis, Sinapis alba, Euphorbia kansui, Asari Herba, and the treatment group received 3 sessions of SAAT for 24 months, administered to BL13 (Feishu), BL17 (Geshu), BL20 (Pishu), and BL23 (Shenshu) acupoints. Fecal microbial analyses via ribosomal ribonucleic acid (rRNA) sequencing were performed on donor stool samples before and after 2 years of SAAT or placebo treatment to analyze the abundances, diversity, and structure of gut microbiota. No significant baseline differences were present between groups. At the phylum level, the baseline relative abundance ofFirmicutes, Bacteroidetes, Proteobacteria, Actinobacteria, andFusobacteriawas identified in fecal samples collected from each group. After treatment, the relative abundance ofFirmicuteswas significantly increased in both groups (P< .05). Notably, a significant decrease in the relative abundance ofFusobacteriawas observed in the SAAT treatment group (P< .001), while the abundance ofBacteroideteswas decreased significantly in the placebo group (P< .05). At the genus level, the relative abundance ofFaecalibacteriumandSubdoligranulumspecies in the 2 groups were all significantly increased (P< .05). In addition, a significant reduction in the relative abundance ofBlautia, Bacteroides, andDoreain Group A (P< .05) andEubacterium halliigroup andAnaerostipes (P< .05) in Group B was observed after treatment. Our findings indicated SAAT substantially influenced the bacterial community structure in the gut microbiota of healthy Asian adults, which might serve as potential therapeutic targets for related diseases, and provided a foundation for future studies aimed at elucidating the microbial mechanisms underlying SAAT for the treatment of various conditions such as obesity, insulin resistance, irritable bowel syndrome.
Antiepileptic therapy in a patient with star fruit intoxication: A case report
Authors: Li Aixun , Chen Baoxin , Jin Xianglan , Bai Yu , Zhang Jingfeng , Zhang Chengcheng , Cheng Miaomiao , Guo Chunyan , Zhang Yu , Zhou Jing
Published: March 2023

Rationale:

It is rare for uremia patients to have epileptic seizures after eating star fruit, only a dozen cases are reported worldwide. Such patients usually have poor prognoses. Few patients had good prognoses, all of them were treated with expensive renal replacement therapy. At present, there is no report on the addition of drug therapy to these patients based on the initial renal replacement therapy.

Patient concerns:

A 67-year-old male patient with star fruit intoxication who had a history of diabetic nephropathy, hypertension, polycystic kidney, and chronic kidney disease in the uremic phase, and regular hemodialysis 3 times a week for 2 years. Initial clinical manifestations include hiccups, vomiting, speech disturbances, delayed reactions, and dizziness, which gradually progress to hearing and visual impairment, seizures, confusion, and coma.

Diagnoses:

This patient was diagnosed with seizures caused by star fruit intoxication. The experience of eating star fruit and the electroencephalograms can prove our diagnosis.

Interventions:

We performed intensive renal replacement therapy according to the recommendations in the literature. However, his symptoms did not improve significantly until he received an extra dose of levetiracetam and resumed his previous dialysis schedule.

Outcomes:

The patient was discharged after 21 days without neurologic sequelae. Five months after discharge, he was readmitted due to poor seizure control.

Lessons:

To improve the prognosis of these patients and to reduce their financial burden, the use of antiepileptic drugs should be emphasized.
Effectiveness of web-based mindfulness program on college students with social network addiction
Authors: Yang Li , Na Lv , Xiang Rui Jia
Published: March 2023

Aims:

In this study a web-based mindfulness cultivation program was implemented to investigate its effectiveness on the addiction symptoms and negative emotions of college students with social network addiction.

Methods:

A total of 66 students were recruited and randomly divided into the intervention group or the control group. Participants in the intervention group received a web-based mindfulness cultivation program including the group training and self-cultivating. The primary outcome was addiction level, and the secondary outcome was anxiety, depression and perceived stress. Repeated measures analysis of variance were utilized to analyze the differences between the control and intervention group over the course of the intervention and the follow-up.

Results:

There were significant interaction effects on addiction level (F = 39.39, P < .00), anxiety (F = 31.17, P < .00), depression (F = 37.93, P < .00) and perceived stress (F = 22.04, P < .00).

Conclusion:

A web-based mindfulness cultivation program could improve the addiction level and negative emotions of college students with social network addiction.
The effects of Bacillus coagulans MTCC 5856 on functional gas and bloating in adults: A randomized, double-blind, placebo-controlled study
Authors: Majeed Muhammed , Nagabhushanam Kalyanam , Paulose Shaji , Arumugam Sivakumar , Mundkur Lakshmi
Published: March 2023

Background:

Gut microbiome dysbiosis is a major cause of abdominal gas, bloating, and distension. Bacillus coagulans MTCC 5856 (LactoSpore) is a spore-forming, thermostable, lactic acid-producing probiotic that has numerous health benefits. We evaluated the effect of Lacto Spore on improving the clinical symptoms of functional gas and bloating in healthy adults.

Methods:

Multicenter, randomized, double-blind, placebo-controlled study at hospitals in southern India. Seventy adults with functional gas and bloating with a gastrointestinal symptom rating scale (GSRS) indigestion score ≥ 5 were randomized to receive B coagulans MTCC 5856 (2 billion spores/day, N = 35) or placebo (N = 35) for 4 weeks. Changes in the GSRS-Indigestion subscale score for gas and bloating and global evaluation of patient’s scores from screening to the final visit were the primary outcomes. The secondary outcomes were Bristol stool analysis, brain fog questionnaire, changes in other GSRS subscales, and safety.

Results:

Two participants from each group withdrew from the study and 66 participants (n = 33 in each group) completed the study. The GSRS indigestion scores changed significantly (P < .001) in the probiotic group (8.91–3.06; P < .001) compared to the placebo (9.42–8.43; P = .11). The median global evaluation of patient’s scores was significantly better (P < .001) in the probiotic group (3.0–9.0) than in the placebo group (3.0–4.0) at the end of the study. The cumulative GSRS score, excluding the indigestion subscale, decreased from 27.82 to 4.42% (P < .001) in the probiotic group and 29.12 to 19.33% (P < .001) in the placebo group. The Bristol stool type improved to normal in both the groups. No adverse events or significant changes were observed in clinical parameters throughout the trial period.

Conclusions:

Bacillus coagulans MTCC 5856 may be a potential supplement to reduce gastrointestinal symptoms in adults with abdominal gas and distension.
KRAS, NRAS, BRAF signatures, and MMR status in colorectal cancer patients in North China
Authors: Lian Shen-Yi , Tan Lu-Xin , Liu Xin-Zhi , Yang Lu-Jing , Li Ning-Ning , Feng Qing , Wang Ping , Wang Yue , Qiao Dong-Bo , Zhou Li-Xin , Sun Ting-Ting , Wang Lin , Wu Ai-Wen , Li Zhong-Wu
Published: March 2023

We assessed the clinicopathological features and prognostic values of KRAS, NRAS, BRAF, and DNA mismatch repair status in colorectal cancer (CRC) to provide real-world data in developing countries. We enrolled 369 CRC patients and analyzed the correlation between RAS/BRAF mutation, mismatch repair status with clinicopathological features, and their prognostic roles. The mutation frequencies of KRAS, NRAS, and BRAF were 41.7%, 1.6%, and 3.8%, respectively. KRAS mutations and deficient mismatch repair (dMMR) status were associated with right-sided tumors, aggressive biological behaviors, and poor differentiation. BRAF (V600E) mutations are associated with well-differentiated and lymphovascular invasion. The dMMR status predominated in young and middle-aged patients and tumor node metastasis stage II patients. dMMR status predicted longer overall survival in all CRC patients. KRAS mutations indicated inferior overall survival in patients with CRC stage IV. Our study showed that KRAS mutations and dMMR status could be applied to CRC patients with different clinicopathological features.
Case report and literature review on a large MBC with ulceration
Authors: Luo Qin-Qin , Luo Na-Na
Published: March 2023

Rationale:

Metaplastic breast cancer (MBC) is a rare tumor of the breast, and skin ulceration of breast tumors is a difficult clinical problem that reduces the patient’s quality of life.

Patient concerns:

There are currently no Standard Treatment Guidelines for MBC at present, and the treatment for the skin ulceration of breast tumors is limited in clinics.

Diagnosis:

Here, we report the case of a patient with a large MBC and skin ulceration, accompanied by exudation and odor.

Intervention:

The combined treatment of albumin paclitaxel and carrelizumab (anti-PD-1 immunotherapy) was effective in reducing the tumor, but it increased the severity of the skin ulceration. After taking traditional Chinese medicine, the skin ulceration healed completely. Then the patient underwent a mastectomy and radiotherapy.

Outcomes:

The patient has a high quality of life and was in good condition after the comprehensive treatment.

Lessons:

This suggests that traditional Chinese medicine may have a good auxiliary therapeutic effect on the skin ulceration of MBC.
Factors associated with non-home discharge of patients hospitalized for hip fracture: A nationwide retrospective study using the Japanese diagnostic procedure combination database
Authors: Moriwaki Mutsuko , Hayashida Kenshi , Ogata Yasuko
Published: March 2023

In Japan, the length of stay in acute care hospitals has been shortened, home medical care has been promoted following national policy. However, many issues remain in promoting home medical care. The aim of this study was to clarify the profiles of patients with hip fractures, aged ≥ 65 years, who were hospitalized in acute care institutions at the time of discharge and the influence on nonhome discharge. This study used data from patients who satisfied all the following conditions: Patients aged ≥ 65 years who were hospitalized and discharged between April 2018 and March 2019; Patients with hip fractures, and; Patients who were admitted from home. The patients were classified into the home discharge and nonhome discharge groups. Multivariate analysis was conducted by comparing socio-demographic status, patient background factors, patient status at discharge, and hospital function. This study included 31,752 patients (73.7%) and 11,312 patients (26.3%) in the nonhome discharge group and home discharge group, respectively. Overall, the proportions of males and females were 22.2% and 77.8%, respectively. The average (standard deviation) age of the patients was 84.1 years (7.4) and 81.3 years (8.5) in the nonhome discharge and home discharge groups, respectively (P < .01). The following factors affected nonhome discharge: 75 to 84 years (odds ratio [OR] = 1.81, 95% confidence interval [CI] = 1.68–1.96), ≥85 years (OR = 2.17, 95% CI = 2.01–2.36), electrocardiography or respiratory treatment “(Factor A3) (OR = 1.44, 95% CI = 1.23–1.68), level of assistance with activities of daily living “(Factor B1)” (OR = 4.56, 95% CI = 4.22–4.92), and hospital where the patient-to-nurse ratio is 7:1 (OR = 2.12, 95% CI = 1.91–2.35). The results suggested that support from activities of daily living caregivers and implementing medical treatments such as respiratory care are required to advance home medical care. This study’s method enables analysis focusing on aspiration pneumonia and cerebral infarction, which are common among older adults. Furthermore, specific measures for promoting home medical care for patients who are highly dependent on medical and long-term care may be developed.
Age as a risk factor for orthostatic hypotension induced by the levodopa challenge test in patients with Parkinson’s disease: Results from a single-center trial
Authors: Su Dan , Su Yanling , Xu Baolei , Chhetri Jagadish K. , Chan Piu
Published: March 2023

Background:

Hypotension can occur in patients receiving levodopa (L-dopa) treatment for parkinsonism. However, only few studies have focused on the characteristics of orthostatic hypotension (OH) induced by the L-dopa challenge test (LCT). This study aimed to investigate the characteristics and influencing factors of LCT-induced OH in a relatively large sample of patients with Parkinson’s disease (PD).

Methods:

Seventy-eight patients with PD without a previous diagnosis of OH underwent the LCT. Blood pressure (BP) in the supine and standing positions was measured before and 2 hours after the LCT. If diagnosed with OH, the patients’ BP was monitored again 3 hours after the LCT. The clinical features and demographics of the patients were analyzed.

Results:

Eight patients were diagnosed with OH 2 hours after the LCT (median dose of 375 mg L-dopa/benserazide; incidence = 10.3%). One patient without symptoms had OH 3 hours after the LCT. Compared with patients without OH, patients with OH had lower 1- and 3-minutes standing systolic BP and 1-minute standing diastolic BP at baseline and 2 hours after the LCT. Patients in the OH group were of older age (65.31 ± 4.17 years vs 59.74 ± 5.55years) and had lower Montreal Cognitive Assessment scores (17.5 vs 24) and higher L-dopa/benserazide levels (375 [250, 500] mg vs 250 [125, 500] mg). Older age markedly increased the odds of having LCT-induced OH (odds ratio, 1.451; 95% confidence interval, 1.055–1.995; P = .022).

Conclusions:

LCT increased the odds of OH in non-OH PD, causing symptomatic OH in 10.3% of patients in our study, thereby raising safety concerns. Increase in age was observed to be a risk factor for LCT-induced OH in PD patients. A study with a larger sample size is warranted to confirm our results.

Trial registration number:

Clinical Trials Registry under ChiCTR2200055707.

Date of registration:

January 16, 2022.
Socioeconomic determinants of asthma health
Authors: Simoneau Tregony , Gaffin Jonathan M.
Published: March 2023

Purpose of review

The current review provides an assessment of the recent pediatric literature evaluating socioeconomic drivers of asthma incidence and morbidity. The review addresses the specific social determinants of health related to housing, indoor and outdoor environmental exposures, healthcare access and quality, and the impact of systematic racism.

Recent findings

Many social risk factors are associated with adverse asthma outcomes. Children living in low-income, urban neighborhoods have greater exposure to both indoor and outdoor hazards, including molds, mice, second-hand smoke, chemicals, and air pollutants, all of which are associated with adverse asthma outcomes. Providing asthma education in the community – via telehealth, school-based health centers, or peer mentors – are all effective methods for improving medication adherence and asthma outcomes. The racially segregated neighborhoods created by the racist ‘redlining’ policies implemented decades ago, persist today as hotspots of poverty, poor housing conditions, and adverse asthma outcomes.

Routine screening for social determinants of health in clinical settings is important to identify the social risk factors of pediatric patients with asthma. Interventions targeting social risk factors can improve pediatric asthma outcomes, but more studies are needed related to social risk interventions.
Prevention and management of urinary tract infections after cystectomy
Authors: Berndl Florian , Frerichmann Jana , Berndl Thomas
Published: March 2023

Purpose of review

To give an overview of the most relevant recent literature about urinary tract infections (UTI) after radical cystectomy and to discuss them in the context of new individualized therapy approaches and possible preventive measures.

Recent findings

UTI following radical cystectomy is a common complication associated with significant morbidity and readmission risk. Recent literature focuses on the identification of risk factors and the optimization of management. The risk factors most commonly associated with increased risk for UTI were perioperative blood transfusions and orthotopic neobladder (ONB). Furthermore, the effect of perioperative antibiotic regimens on rates of postoperative infections has been studied, but no consistent significant changes in UTI rates have yet been identified. Guidelines should be based on urologic studies and, wherever appropriate, should be uniform in design to encourage more frequent adherence. Furthermore, understanding the pathomechanisms leading to the development of UTI after radical cystectomy needs to be more central to discussions.

Uniform definition of UTI, characteristics of bacterial pathogens involved, and type and duration of antibiotics used and identification of clinical risk factors must be the focus of well designed prospective studies to enable reduction of the most common complication after radical cystectomy.
Early sigmoid perforation involving left inguinal hernia mesh repair: a case report
Authors: Salimi Fatemeh , Narayan Prabhat , Salimi Zahra
Published: March 2023

Injury to the underlying bowel is a serious potential complication following inguinal hernia mesh repair. Here the authors describe a rare case of a 69-year-old gentleman who initially presented with a deep collection in the retroperitoneum, which extended into the extraperitoneal space on the anterior abdominal wall 3 weeks following left inguinal hernioplasty. Early sigmoid perforation involving the inguinal hernia mesh repair was diagnosed, and he underwent a successful Hartmann’s procedure with mesh removal.
Close, but no cigar: an unfortunate case of primary angiitis of the central nervous system
Authors: Ireifej Branden , Kanevsky Julie , Song David , Almas Talal , Alsubai Abdulla K. , Hadeed Sebastian , Aldhaheri Khaled S.O. , Ali Hussein Khan , Huang Helen , Ghaw Olivia
Published: March 2023

Introduction:

Primary angiitis of the central nervous system (PACNS) is an uncommon and misunderstood disease, where little is known regarding its immunopathogenesis and appropriate treatment. Due to the constellation of nonspecific clinical features and imaging findings, PACNS is a diagnostic conundrum for clinicians and can be very difficult to treat.

Case Presentation:

A 64-year-old male with a history of prostate cancer presented to the emergency department with expressive aphasia and severe headache. Previously, he was diagnosed with ischemic strokes at outside hospitals and was subsequently initiated on anticoagulation medication but was later readmitted with a new onset of nontraumatic subarachnoid hemorrhage and later was found to have ischemic changes in the right temporoparietal lobe. He was suspected to have hypercoagulability of malignancy, as he was unresponsive to a wide variety of anticoagulants and his symptoms continued to deteriorate. On presentation, the physical examination was significant for right homonymous hemianopia, with positive antinuclear antibodies and notable erythrocyte sedimentation rate. The results from the full serologic workup was negative. Subsequent imaging of the brain revealed multifocal stenoses in multiple arteries. On further examination, digital subtraction angiography was concerning for vasculopathy, and was initiated on corticosteroids and cyclophosphamide.

Discussion:

This is one of the first cases of PACNS in which recurrent strokes were the presenting symptom for PACNS. Vasculitis should be a considered differential in patients with recurrent ischemic strokes and failed anticoagulant therapy. It is important to rule out malignancy and infectious causes due to the wide spectrum of conditions that cause central nervous system vasculitis.
Futility considerations in surgical ethics
Authors: Udwadia Farhad R. , Zhu Jane , Khan Haaris M. , Das Sunit
Published: March 2023

The topic of futility has been intensely debated in bioethical discourse. Surgical futility encompasses considerations across a continuum of care, from decision-making during initial triage, to the choice to operate or refrain from operating on the critically ill, to withdrawal of life-supporting care. Determinations over futility may result in discord between providers and patients or their families, who might insist that treatment be provided at all costs to sustain life. In this manuscript, we will explore some of the possible sources for and manifestations of these disputes, and describe approaches by which to resolve them. Part I will briefly address some of the reasons that families ask for life-sustaining measures against medical advice in the surgical setting. These include variable determinations of both the quality of life and the inherent value of life (stemming from religious, cultural, and personal beliefs). Part II will detail some general instances in which physicians and surgeons can override requests to provide futile treatment, namely: instances of resource scarcity, interventions which carry a high probability of harm, and those that carry significant moral distress. To conclude, Part III will provide concrete guidelines for navigating futility, making an argument for individual case-based communication models in surgical decision-making.
Postpartum Guillain–Barré syndrome: a case report
Authors: Bhusal Amrit , Shrestha Anu , Muskan Vitasta , Bhattarai Sashank , Subedi Priza , Yadav Ajay K.
Published: March 2023

Introduction and Importance:

Guillain–Barré syndrome (GBS) is an immune-mediated disorder of the central nervous system presenting as symmetrical, progressive weakness and areflexia. The incidence of GBS is very low during pregnancy, but the risk increases in the postpartum period. The management is done by intravenous immunoglobulin or conservatively.

Case Presentation:

Case of 27 years female with parity 1, living 1, on postpartum day 20 presented to the emergency department (ED) with weakness over legs and hands since 20 days following emergency lower segment cesarean section for her delivery. The weakness prevailed over the lower extremities and progressed to the upper extremities in 4–5 days, affecting her grip strength and ability to stand alone. No history of prior diarrheal or respiratory illness. Cerebrospinal fluid analysis revealed albuminocytologic dissociation. A nerve conduction study showed in-excitable bilateral radial, median, ulnar, and sural nerves. Intravenous immunoglobulin was administered at the rate of 0.4 g/kg once daily for 5 days. Patient was discharged after 2 weeks with regular physiotherapy follow-up.

Conclusion:

GBS in the postpartum period is very rare. There must be a high degree of suspicion among physicians for GBS if a pregnant female or a woman during her postpartum period presents with ascending muscle paralysis, even if there is no recent antecedent history of diarrheal episodes or respiratory illness. An early diagnosis with multidisciplinary supportive measures helps improve the prognosis for both the mother and the fetus.
A pancreatic metastasis of anaplastic thyroid carcinoma: a rare case report
Authors: Zarg el Ayoun Radhwen , Chtourou Mohamed F. , Beji Hazem , Kchaou Majdi , Belfekih Houda , Chelbi Emna , Mighri Mohamed M. , Touinsi Hassen
Published: March 2023

Background:

Anaplastic thyroid carcinoma (ATC) is a rare malignancy with a poor prognosis. It is characterized by abrupt development with local and distant metastases. Metastases are essentially present in the lung. Pancreatic metastasis is extremely rare. The authors report that, to their knowledge, this is the first reported case of a patient who developed metachronous pancreatic metastasis related to ATC.

Case Presentation:

A 65-year-old woman, with a history of thyroidectomy, 2 years prior, for an anaplastic thyroid tumor presented in his regular follow-up computed tomography scan a hypodense lesion of the head of the pancreas. Definite diagnosis of neoplasm was difficult following the computed tomography-guided fine-needle aspiration biopsy. The patient had a cephalic duodenopanceatectomy with an uneventful recovery. Histopathology concluded in a pancreatic metastasis of ATC metastasis. The patient had uneventful outcomes with a follow-up of 3 months without tumor recurrence.

Conclusion:

Pancreatic metastases of thyroid carcinomas are extremely rare, particularly for ATC. The diagnosis of metastases is based on a regular follow-up. The prognosis is poor despite curative surgery.
Bilateral Page kidney in a postpartum female: a case report
Authors: Regmi Pradeep , Shrestha Suraj , Poddar Elisha , Sharma Deewakar
Published: March 2023

Introduction and Importance:

Page kidney results from external compression of the kidney by a subcapsular hematoma and is one of the rare but treatable causes of secondary hypertension. The majority are traumatic or iatrogenic and often unilateral. Spontaneous bilateral Page kidney is rare.

Case Presentation:

A 35-year P1 with gestational hypertension presented with a persistent postpartum elevation of blood pressure (BP). Imaging studies revealed bilateral renal subcapsular hematoma (left>right). She was managed with an angiotensin receptor blocker initially and ultrasound-guided percutaneous drainage of the collection for the optimal control of elevated BP.

Clinical Discussion:

Ultrasonography and computed tomography of the kidneys are the most frequently used for diagnosing a Page kidney. Medical management with antihypertensive and regular follow-ups form the first line of treatment in Page kidneys. Percutaneous drainage, surgical decortication, laparoscopic intervention, and nephrectomy are necessary in cases of organized late hematomas.

Conclusion:

Spontaneous bilateral Page kidney is a rare but potentially treatable and curable form of hypertension. Percutaneous drainage is an effective method to drain the hematoma and control elevated BP.
A cross-sectional survey of consistent rehabilitation through long-term care insurance in Japan: a questionnaire survey
Authors: Asaeda Makoto , Mikami Yukio , Nishimura Yukihide , Shimokawa Toshio , Shinohara Hiroshi , Kawasaki Takashi , Kouda Ken , Ogawa Takahiro , Okawa Hiroyuki , Uenishi Hiroyasu , Kuroda Rumi , Mikami Yasuo , Tajima Fumihiro , Kubo Toshikazu
Published: March 2023

Background:

There seems to be a lack of consistency of maintenance/community-based rehabilitation through long-term care insurance. We aimed to clarify whether consistent rehabilitation can be performed through long-term care insurance by questionnaires.

Materials and Methods:

This study was a cross-sectional study in a nationwide survey among rehabilitation staff and care recipients who completed disease-specific rehabilitation and required maintenance/community-based rehabilitation through long-term care insurance. Consistency of rehabilitation was compared using Fisher’s exact tests. The concordance of the rehabilitation evaluation and treatment conducted under medical and long-term care insurance was assessed using the κ coefficient.

Results:

Six hundred questionnaires from care recipients and staff were analyzed. Of the rehabilitation staff, 264 (44%) obtained rehabilitation plans from medical institutions. There was a significant difference between the responses of “referral from the same medical corporation” and “obtaining the rehabilitation plan” by Fisher’s exact test (odds ratio: 3.242; P<0.001). Most rehabilitation treatments under medical insurance comprised walking or training with parallel rods/canes [498 patients (83%)], and 454 patients (76%) received stretching and range-of-motion training for the limbs and spine for long-term care insurance. Muscle strength evaluation was the most frequently conducted under medical and long-term care insurance [383 (73%) and 487 (83%), respectively]. The concordance of the evaluation and treatment content, except for disease-specific evaluation, was low (κ coefficient≤0.6).

Conclusions:

The rate of provision of rehabilitation plans was low, and evaluation and treatment content under medical and long-term care insurance was inconsistent. Our results draw attention to the need for consistent rehabilitation plans between disease-specific and maintenance/community-based rehabilitation.
Trans-sinus dental implants, for immediate placement when insufficient alveolar height is present: an alternative to zygomatic implants – surgical case series
Authors: Aalam Alexandre A. , Krivitsky-Aalam Alina , Zelig David , Oh Simon , Holtzclaw Dan , Kurtzman Gregori M.
Published: March 2023

Low maxillary bone density associated with physiological bone remodeling and resorption accelerated by the presence or history of periodontal disease can prevent implant placement without either ridge and/or sinus augmentation in atrophic maxillary edentulous cases. As an alternative to avoid bone grafting and provide immediacy in restorative treatment care for the patient, remote anchorages to the basal bones of the maxilla of the patient are being used with zygomatic or pterygoid implants. The trans-sinus implant, when indicated can offer a reliable alternative to the zygomatic dental implant in that treatment of the severely edentulous maxilla. This approach is suggested in Bedrossian zones I and II atrophy and when an ‘L’ (or concave) anterior sinus wall anatomy is present. This approach will be discussed utilizing two case examples on how trans-sinus implants may be considered in treating the maxillary arch.
An accidental finding of a retroperitoneal desmoid tumor: case report and review of the literature
Authors: Mousa Ahmed H. , Nukaly Houriah Y. , Ahmed Ruqayyah A. , Zubair Talha M. , Merdad Mahmoud J. , Rahman Moshiur , Shmailah Elaf A. , Bondogji Raghad , Alshanberi Asim M. , Khaled Islam
Published: March 2023

Retroperitoneal desmoid-type fibromatosis is a rare benign mesenchymal neoplasm that develops as a result of fibroblastic proliferation within the musculoaponeurotic stroma. The authors present the case of a 41-year-old male patient who was referred for a retroperitoneal neoplasm. A mesenteric mass core biopsy was done, and it revealed a low-grade spindle cell lesion consistent with desmoid fibromatosis.
Ninety-day all-cause emergency room use among coronary artery bypass grafting patients associated with near-infrared fluorescence imaging: a retrospective cohort study
Authors: Sosa Michelle P. , McNicholas Deirdre G. , Bebla Arbelina B. , Emont Seth , Cao Zhun , Lipkin Craig , Ajmani Vivek , Muehrcke Derek D.
Published: March 2023

Background:

Reducing emergency room (ER) use may indicate the improved quality of patient care at index hospitalization. The aim of this study is to determine whether the use of near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) during coronary artery bypass grafting (CABG) surgery is associated with a lowered 90-day all-cause ER use.

Materials and Methods:

This retrospective cohort study included adult patients with inpatient hospitalizations between January 2016 and June 2020 for an isolated CABG procedure at a US hospital. Propensity score matching was used to create matched cohorts to address the differences in patient, payer type, hospital, and clinical characteristics. A multivariable regression analysis was conducted to determine the association of NIRF imaging with ICG on ER use within 90 days of discharge after controlling for patient, payer type, hospital, and clinical covariates.

Results:

In total, 230 506 adult patients underwent an isolated CABG procedure. Less than 1% (n=1965) were assessed with NIRF imaging using ICG. There were differences in patient demographic and hospital characteristics between the treatment group (i.e. NIRF with ICG) and the comparison group (i.e. no NIRF with ICG). After controlling for covariates, a statistically significant lower 90-day all-cause ER use was documented among the treatment group (adjusted odds ratio=0.84, 95% confidence interval=0.73–0.96,P<0.009). Reasons associated with ER use were similar between the two groups.

Conclusion:

Routine intraoperative graft patency assessment with NIRF imaging using ICG may help to improve a patient’s care experience and reduce subsequent resource utilization. Intraoperative graft patency assessment with NIRF imaging using ICG is associated with a 90-day all-cause ER use reduction among CABG patients. Further studies are needed to compare the ER usage among centers that used this technique versus those that did not to determine if associated reductions in ER use are a center or technique-specific phenomenon.
Early pyeloplasty and excision of a multicystic kidney in a neonate with a complicated nephrostomy: A case report
Authors: Raslan Hasan , Danial Aghyad K. , khallouf Fatima , Hamsho Ola , Abdullatif Shahd , Assaf Ragheb
Published: March 2023

Introduction and Importance:

The association of multicystic renal dysplasia with ureteropelvic junction obstruction is noteworthy in newborn. However, the possibility of conservative management is still a primary requirement, unless there are complications that suggest surgery. The authors are studying a case of a newborn in which an incorrect nephrostomy led to complications that required emergency surgery.

Case Presentation:

A newborn girl with left-side ureteropelvic junction obstruction and an enlarged and multicystic right kidney was operated on at an early age by unexpert hands, leading to complications. Was monitored daily, and an emergency procedure was done. Following up shows the success of the emergency operation.

Clinical Discussion:

The age and the precise timing of intervention are controversial. In this case, several postnatal diagnostic tests were made due to the severity of the hydronephrosis in the antenatal period, which resulted in the implementation of percutaneous nephrostomy.

Conclusion:

Authors suggest that it is better to not operate as long as the patient’s condition is stable
Artificial intelligence and machine learning in pain research: a data scientometric analysis
Authors: Lötsch Jörn , Ultsch Alfred , Mayer Benjamin , Kringel Dario
Published: March 2023

The collection of increasing amounts of data in health care has become relevant for pain therapy and research. This poses problems for analyses with classical approaches, which is why artificial intelligence (AI) and machine learning (ML) methods are being included into pain research. The current literature on AI and ML in the context of pain research was automatically searched and manually curated. Common machine learning methods and pain settings covered were evaluated. Further focus was on the origin of the publication and technical details, such as the included sample sizes of the studies analyzed with ML. Machine learning was identified in 475 publications from 18 countries, with 79% of the studies published since 2019. Most addressed pain conditions included low back pain, musculoskeletal disorders, osteoarthritis, neuropathic pain, and inflammatory pain. Most used ML algorithms included random forests and support vector machines; however, deep learning was used when medical images were involved in the diagnosis of painful conditions. Cohort sizes ranged from 11 to 2,164,872, with a mode at n = 100; however, deep learning required larger data sets often only available from medical images. Artificial intelligence and ML, in particular, are increasingly being applied to pain-related data. This report presents application examples and highlights advantages and limitations, such as the ability to process complex data, sometimes, but not always, at the cost of big data requirements or black-box decisions.
Chondrolaryngoplasty with Endoscopic Direct Visualization of the Vocal Cords: Demonstration of Technique.
Authors: Hamidian Jahromi Alireza , Ferraro Jennifer , Arnold Sydney H. , Schechter Loren S. , Dorafshar Amir H.
Published: March 2023

Chondrolaryngoplasty is a surgical procedure that reduces a prominent thyroid cartilage. Demand for chondrolaryngoplasty has significantly increased over recent years in transgender women and non-binary individuals and has been shown to alleviate gender dysphoria and improve quality of life. When performing chondrolaryngoplasty, surgeons must carefully balance the desire for maximal cartilage reduction with the potential for damage to surrounding structures (i.e., the vocal cords) which may result due to over-aggressive or imprecise resection. Our institution has adopted the technique of direct vocal cord endoscopic visualization using a flexible laryngoscopy for increased safety. Briefly, surgical steps include dissection and preparation for trans-laryngeal needle placement, endoscopic visualization of the needle placed above the level of the vocal cords, marking of the corresponding level, and resection of the thyroid cartilage. The following article and supplemental video provide further detailed descriptions of these surgical steps as a resource for training and technique refinement.
“A Comparative Study of Wrap-Around versus Anterior Coverage Placement of Acellular Dermal Matrix in Prepectoral Breast Reconstruction”
Authors: Han Woo Yeon , Han Seong John , Eom Jin Sup , Kim Eun Key , Han Hyun Ho
Published: March 2023

Background:

Prepectoral direct-to-implant insertion with acellular dermal matrix (ADM) is the currently preferred surgery for breast reconstruction. There are different placements of ADM, which are largely classified as wrap-around placement or anterior coverage placement. Since there is limited data comparing these two placements, this study aimed to compare the outcomes of these two methods.

Methods:

This was a retrospective study of immediate prepectoral direct-to-implant breast reconstructions performed by a single surgeon between 2018 and 2020. Patients were classified depending on the ADM placement type utilized. Surgical outcomes and breast shape changes using nipple position during follow-up were compared.

Results:

A total of 159 patients were included in the study, with 87 in the wrap-around group and 72 in the anterior coverage group. Demographics were similar between the two groups, excluding ADM usage amount (154.1 cm 2 vs. 137.8 cm 2, P=0.01). There were no significant differences in the overall rate of complications between the two groups including seroma (6.90% vs. 5.56%, P=1.0), total drainage amount (762.1 mL vs. 805.9 mL, P=0.45) and capsular contracture (4.6% vs. 1.39%, P=0.38). The wrap-around group had a significantly longer distance change than that of the anterior coverage group in the sternal notch-to-nipple distance (4.44% vs. 2.08 %, P=0.03) and mid-clavicle-to-nipple distance (4.94% vs. 2.64%, P=0.04).

Conclusion:

Wrap-around and anterior coverage placement of ADM in prepectoral direct-to-implant breast reconstruction showed similar complication rates including seroma, drainage amount and capsular contracture. However, wrap-around placement can make the breast more ptotic in shape compared to anterior coverage placement.
Chordicoccus furentiruminis, gen. nov., sp. nov., a novel succinic acid producing bacterium isolated from a steer on a high grain diet
Authors: Gaffney James , Embree Jordan , Gilmore Sean , Embree Mallory
Published: March 2023

This study presents MP1D12T (=NRRL B-67553T=NCTC 14480T), an isolate from the ruminal content of an Angus steer fed a high grain diet. Phenotypic and genotypic traits of the isolate were explored. MP1D12T was found to be a strictly anaerobic, catalase-negative, oxidase-negative, coccoid bacterium that frequently grows in chains. Analysis of metabolic products as a result of carbohydrate fermentation showed succinic acid as the major organic acid produced with lactic acid and acetic acid as minor products. Phylogenetic analysis of MP1D12T based on 16S rRNA nucleotide sequence and amino acid sequences from the whole genome presents a divergent lineage from other members in the family

Lachnospiraceae

. 16S rRNA sequence comparison, whole genome average nucleotide identity digital DNA–DNA hybridization and average amino acid identity results suggest that MP1D12T represents a novel species in a novel genus within the family

Lachnospiraceae

. We propose the creation of the genus Chordicoccus in which MP1D12T represents the type strain for the novel species Chordicoccus furentiruminis.
Likelihood-based docking of models into cryo-EM maps
Authors: Millán Claudia , McCoy Airlie J. , Terwilliger Thomas C. , Read Randy J.
Published: March 2023

Optimized docking of models into cryo-EM maps requires exploiting an understanding of the signal expected in the data to minimize the calculation time while maintaining sufficient signal. The likelihood-based rotation function used in crystallography can be employed to establish plausible orientations in a docking search. A phased likelihood translation function yields scores for the placement and rigid-body refinement of oriented models. Optimized strategies for choices of the resolution of data from the cryo-EM maps to use in the calculations and the size of search volumes are based on expected log-likelihood-gain scores computed in advance of the search calculation. Tests demonstrate that the new procedure is fast, robust and effective at placing models into even challenging cryo-EM maps.