bluuebunny/crossref_metadata_2025 huggingface dataset:
Immune checkpoint inhibitors for the treatment of non-small cell lung cancer brain metastases
Authors: Wei Yuxi , Xu Yan , Wang Mengzhao
Published: April 2023

Lung cancer has the highest risk of brain metastasis (BM) among all solid carcinomas. The emergence of BM has a significant impact on the selection of oncologic treatment for patients. Immune checkpoint inhibitors (ICIs) are the most promising treatment option for patients without druggable mutations and have been shown to improve survival in patients with non-small cell lung cancer (NSCLC) BM in clinical trials with good safety. Moreover, ICI has shown certain effects in NSCLC BM, and the overall intracranial efficacy is comparable to extracranial efficacy. However, a proportion of patients showed discordant responses in primary and metastatic lesions, suggesting that multiple mechanisms may exist underlying ICI activity in BM. According to studies pertaining to tumor immune microenvironments, ICIs may be capable of provoking immunity in situ. Meanwhile, systematic immune cells activated by ICIs can migrate into the central nervous system and exert antitumor effects. This review summarizes the present evidence for ICI treatment efficacy in NSCLC BM and proposes the possible mechanisms of ICI treatment for NSCLC BMs based on existing evidence.
Facial Anthropometric Norms of the Young Black South African Woman
Authors: Wilson Stephen P. , Medapati Vengal , Segwapa Kenneth
Published: April 2023

Background:

Ethnic pride and the push toward preservation of ethnicity in all areas of aesthetic and reconstructive medicine has created the need for normative facial anthropometric data specific to localized geographical populations. This study aimed to gather a set of soft tissue anthropometric norms for the young Black South African woman and to compare this with international data and neoclassical anthropometric maxims.

Methods:

In total, 156 Black female students from Sefako Makgatho University between 18 and 25 years of age, with a normal dental occlusion and a normal body mass index were included in the study. Computer-based photographic analysis of participants’ faces in anterior, lateral, and basal views was undertaken under strict studio conditions and compared with international studies.

Results:

Facial height proportions tended toward a smaller upper facial third in comparison with mid and lower facial thirds. Nasal width was greater than other populations, and exceeded the neoclassical canon of one-fifth of facial width. Nasal tip projection was greater than Congolese and African American counterparts. Vermilion height ratios approximated a ratio of 1:1 with lip protrusion beyond the classical Rickets E-line.

Conclusions:

The “classical” anthropometric measurements most often quoted in academic literature, although important in their own right, do not consider the distinct differences in facial anthropometric norms between population and racial groups. These differences must be taken into consideration to preserve ethnic traits and optimize aesthetic outcomes.
Eliminating hypertension disparities in U.S. non-Hispanic black adults: current and emerging interventions
Authors: Ferdinand Keith C. , Charbonnet Rachel M. , Laurent Jodie , Villavaso Chloe D.
Published: April 2023

Purpose of review

Hypertension in non-Hispanic black (NHB) adults in the United States has an earlier onset, higher prevalence, and increased severity compared with other racial/ethnic populations. Uncontrolled hypertension is responsible for the increased burden of cardiovascular disease (CVD) morbidity and mortality and decreased longevity in NHB adults. Unfortunately, eliminating the persistent hypertension-associated disparities and the white/black mortality gap, worsened by the COVID-19 pandemic, has been challenging. Overcoming the social determinants of health (SDOH), implementing therapeutic lifestyle changes (TLC), and using intensive guideline-directed medical therapy are required. Moreover, novel approaches, including community-based interventions and self-measured blood pressure (SMBP) monitoring, may mitigate U.S. disparities in hypertension.

Recent findings

In this review, we discuss recent data regarding the U.S. NHB adult disparate hypertension control and CVD morbidity and mortality. We note current approaches to address disparities, such as TLC, evidence-based pharmacotherapy, community-based interventions and SMBP. Finally, we explore future research and initiatives to seek hypertension-related health equity.

In the final analysis, longstanding, unacceptable hypertension and CVD morbidity and mortality in U.S. NHB adults must be addressed. Appropriate TLC and evidence-based pharmacotherapy benefit all populations, especially NHB adults. Ultimately, novel community-based interventions and SMBP may help overcome the SDOH that cause hypertension disparities.
Secondary hypertension: evaluation and management
Authors: Tandan Nitin , Lavie Carl J. , Stewart Merrill H. , Milani Richard V. , Ventura Hector O.
Published: April 2023

Purpose of review

Hypertension (HTN) that can be attributed to a particular source is known as secondary HTN (SH). Often, SH is difficult to control and thus referred to as resistant HTN, although the two terms are not mutually exclusive.

Recent findings

A common theme across several contributors to SH are coactivation of the sympathetic drive and hormonal changes, independent of hormonal axis activation. The key to effective management of SH is early recognition and treatment to avoid catastrophic cardiovascular disease effects and mortality.

This review article provides a contemporary summary of the conditions associated with SH and briefly reviews diagnostics and management.
Impact of perinatal factors on biomarkers of cardiovascular disease risk in preadolescent children
Authors: Mansfield Roshni , Cecula Paulina , Pedraz Carmen Traseira , Zimianiti Ioanna , Elsaddig Malaz , Zhao Rebecca , Sathiyamurthy Sundar , McEniery Carmel M. , Lees Christoph , Banerjee Jayanta
Published: April 2023

Background:

This review aims to summarize associations of the perinatal environment with arterial biophysical properties in childhood, to elucidate possible perinatal origins of adult cardiovascular disease (CVD).

Methods:

A systematic search of PubMed database was performed (December 2020). Studies exploring associations of perinatal factors with arterial biophysical properties in children 12 years old or less were included. Properties studied included: pulse wave velocity; arterial stiffness or distensibility; augmentation index; intima–media thickness of aorta (aIMT) or carotids; endothelial function (laser flow Doppler, flow-mediated dilatation). Two reviewers independently performed study selection and data extraction.

Results:

Fifty-two of 1084 identified records were included. Eleven studies explored associations with prematurity, 14 explored maternal factors during pregnancy, and 27 explored effects of low birth weight, small-for-gestational age and foetal growth restriction (LBW/SGA/FGR). aIMT was consistently higher in offspring affected by LBW/SGA/FGR in all six studies examining this variable. The cause of inconclusive or conflicting associations found with other arterial biophysical properties and perinatal factors may be multifactorial: in particular, measurements and analyses of related properties differed in technique, equipment, anatomical location, and covariates used.

Conclusion:

aIMT was consistently higher in LBW/SGA/FGR offspring, which may relate to increased long-term CVD risk. Larger and longer term cohort studies may help to elucidate clinical significance, particularly in relation to established CVD risk factors. Experimental studies may help to understand whether lifestyle or medical interventions can reverse perinatal changes aIMT. The field could be advanced by validation and standardization of techniques assessing arterial structure and function in children.
Relationship Between Degree of Neonatal Physiologic Desquamation and Skin Barrier Function
Authors: Yonezawa Kaori , Haruna Megumi
Published: April 2023

Background/Objectives:

This study examined the relationship between degree of neonatal physiologic desquamation and skin barrier functionality. In addition, we identified factors associated with neonatal desquamation.

Methods:

This cross-sectional study assessed 4-day-old newborns. The desquamation level was evaluated and placed in one of the following categories based on the severity of the desquamation: no desquamation, a small amount, and severe (including cracked or bleeding). Skin barrier function was assessed by evaluating transepidermal water loss, stratum corneum hydration, skin pH, and sebum secretion.

Results:

Among study participants, 67 (39.9%) showed no desquamation, 82 (48.8%) displayed a small amount, and 19 (11.3%) had severe desquamation. The group with severe desquamation had significantly elevated facial transepidermal water loss levels and reduced levels of stratum corneum hydration throughout the body, indicating skin barrier dysfunction, than other groups. In addition, the group with severe desquamation had a significantly longer gestational age, lower temperature and humidity level, smaller vernix caseosa, and tended to be born during winter.

Conclusions:

To our knowledge, this is the first report indicating that infants with severe desquamation had worsened skin barrier function versus those with moderate and no desquamation. Future research should consider what kind of care should be provided to newborns with severe desquamation.
Late-Onset Hyponatremia in Premature Infants
Authors: Marin Terri , Dowell Samuel H. , Wright Kristen , Mansuri Asifhusen , Mann Paul C.
Published: April 2023

Late-onset hyponatremia (LOH) frequently affects premature infants 2 or more weeks of age due to inadequate sodium intake and excessive kidney loss. Late-onset hyponatremia typically occurs in infants who are physiologically stable and is defined as serum sodium of 132 mEq/L or less or between 133 and 135 mEq/L if receiving sodium supplementation. Recent evidence suggests that spot urine sodium levels may improve the recognition of LOH, as low levels of excreted urine reflect a total body sodium deficit and negative balance. Untreated LOH may result in poor somatic growth, neurodevelopmental delay, higher incidence of bronchopulmonary dysplasia, and more severe retinopathy of prematurity. The primary prevention of LOH is to maintain serum sodium between 135 and 145 mEq/L; however, there are currently no formal protocols guiding sodium supplementation. The purpose of this article is to present on overview of LOH pathophysiology and its effect on somatic growth, neurodevelopment outcomes, and other related sequelae. We further discuss general management strategies and describe a protocol for sodium supplementation that is presently undergoing an evaluation for effectiveness.
The association of hepcidin, reticulocyte hemoglobin equivalent and anemia-related indicators on anemia in chronic kidney disease
Authors: Gao Zhaoli , Hu Yingying , Gao Yanxia , Ma Xiaotian , Hu Zhao
Published: April 2023

Hepcidin is an essential regulator of iron homeostasis in chronic kidney disease (CKD) anemia, reticulocyte hemoglobin equivalent (RET-He) can be used to evaluate the availability of iron for erythropoiesis. Previous research has found that hepcidin indirectly regulates RET-He. This study aimed to investigate the association of hepcidin, RET-He and anemia-related indicators on anemia in chronic kidney disease. A total of 230 individuals were recruited, including 40 CKD3-4 patients, 70 CKD5 patients without renal replacement therapy, 50 peritoneal dialysis patients, and 70 hemodialysis patients. The serum levels of hemoglobin (Hb), reticulocyte, RET-He, serum iron, serum creatinine, serum ferritin, total iron binding capacity, hepcidin-25, high sensitivity C-reactive protein, transferrin, erythropoietin, intrinsic factor antibody, soluble transferrin receptor and interleukins-6 (IL-6) were measured. Hepcidin-25 was positively associated with IL-6, and negatively with total iron binding capacity, intrinsic factor antibody, and transferrin. Reticulocyte Hb equivalent was associated positively with Hb, serum ferritin, serum iron, transferrin saturation, and negatively with serum creatinine, reticulocyte, IL-6, STfR. Hepcidin-25 was not associated with RET-He, while IL-6 was independently associated with hepcidin-25 and RET-He, suggesting that hepcidin has no effffect on the iron dynamics of reticulocytes in CKD, may be related to IL-6, indicate a likelihood of a threshold for stimulation of hepcidin-25 expression by IL-6 in order to indirectly regulates RET-He.
Effects of continuous positive air pressure on intraocular pressure in patients with obstructive sleep apnea during the split-night study: An open-label randomized controlled trial
Authors: Fukutome Takero , Kuze Manami
Published: April 2023

Background:

Intraocular pressure (IOP) is known to increase at midnight, when continuous positive airway pressure (CPAP) is initiated in split-night CPAP titration (SN-CPAP titration), in patients with obstructive sleep apnea (OSA); therefore, possible excessive increase in the IOP should be investigated. However, related studies on this topic are scarce. OSA causes increases and decreases in the IOP; however, its fluctuation during sleep remains unclear. Therefore, we determined the timing of these fluctuations in the IOP during sleep at night.

Methods:

This study included 25 patients with OSA. A 7-hour period of night sleep was divided into first (Sleep-1) and second halves (Sleep-2). Patients were randomly divided into the SN (natural breathing during Sleep-1, CPAP applied during Sleep-2) and C (without CPAP) groups. IOP was measured using the iCare Pro before Sleep-1 and after Sleep-1 and Sleep-2. The main hypothesis was that IOP would be significantly higher in the SN group than in the C group. The sub-hypothesis was that the effects of OSA on IOP are manifested at different times. The correlation is shown as Pearson’s r for normally distributed data or Spearman’s rho for non-normally distributed data. The difference between the SN and C groups in the time course of IOP during the night’s sleep was analyzed using repeated-measures analysis of variance. A P value of <.05 was considered significant.

Results:

No significant difference was found in IOP between the groups, but the SN group showed a significantly increased IOP during Sleep-2 (post hoc Bonferroni test). The apnea–hypopnea index inversely correlated with IOP changes in Sleep-1 and positively correlated with those in Sleep-2.

Conclusion:

This study does not support our main hypothesis that SN-CPAP titration promotes the effect of CPAP in increasing IOP. However, an expected range of the effect of increased CPAP on IOP has also been suggested. IOP-lowering and IOP-raising effects were predominant in the first and second halves of sleep in OSA, thereby providing a new perspective on measured IOP and supporting the subhypothesis.
Network pharmacology and bioinformatics to identify molecular mechanisms and therapeutic targets of Ruyi Jinhuang Powder in the treatment of monkeypox
Authors: Zhang Xi , Yu Xinping , Yu Zhichao , Fan Chengcheng , Li Yueming , Li Huan , Shen Yingkai , Sun Zijin , Zhang Shuo
Published: April 2023

Monkeypox outbreaks across the globe has aroused widespread concern. Ruyi Jinhuang Powder (RJP), a common formula in Chinese medicine, is used to treat pox-like illnesses. This study aimed to identify the molecular mechanisms and therapeutic targets of RJP for the treatment of monkeypox using network pharmacology and bioinformatics techniques. The bioactive substances and potential targets of each component of RJP were retrieved from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP). The differentially expressed genes (DEGs) of the monkeypox virus (MPXV) were identified from the GSE24125 by GEO2R. Key signaling pathways, bioactive components, and potential targets were obtained by bioinformatics analysis, including gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG), disease ontology (DO), and protein-protein interactions (PPI) analyses. Finally, molecular docking was used to predict the interaction between active compounds and core targets. A total of 158 active ingredients and 17 drug-disease-shared targets of RJP were screened. Bioinformatics indicated that wogonin and quercetin might be potential drug candidates. Potential therapeutic targets were identified. Immune-related mechanisms that exerted antiviral effects included signaling pathways like TNF, age-rage, and c-type lectin receptor pathways. Our results illustrated the good therapeutic effect of RJP on monkeypox in terms of biological activity, potential targets, and molecular mechanism. This also offered a promising strategy to reveal the scientific basis and therapeutic mechanism of herbal formulas used to treat the disease.
Thyroid hormone resistance resulting from a novel mutation in the THRB gene in a Chinese child: A case report
Authors: Feng Jinhua , Lin Shuangzhu , Wang Wei , Chen Qiandui , Wang Wanqi , Li Jiayi , Wang Xinyao
Published: April 2023

Introduction:

Thyroid hormone resistance (RTH) (mim # 188570) is a rare autosomal dominant genetic disorder characterized by reduced thyroid hormone response in target tissues. The clinical manifestations of RTH vary from no symptoms to symptoms of thyroid hormone deficiency to symptoms of thyroid hormone excess.

Patient concern and clinical findings:

A 24-month-old girl presented with growth retardation, tachycardia, and persistently elevated thyroid hormones despite antithyroid treatment.

Diagnosis/Intervention/Outcomes:

The patient was diagnosed with RTH, after whole exon gene sequencing, found a de novo missense mutation (c.1375T > G,p.Phe459Val) in a novel locus of the thyroid hormone receptor beta gene. She had only mild growth retardation, so the decision was made to monitor her development without intervention. At her last follow-up at 5 years and 8 months of age, she continued to show growth retardation (−2 standard deviation below age-appropriate levels), in addition to delayed language development. Her comprehension ability and heart rate have remained normal.

Conclusions:

We report a mild case of RTH caused by a novel thyroid hormone receptor beta gene mutation. RTH should be considered in the differential diagnosis of abnormal serum thyroxine levels during neonatal screening.
Health literacy status among community in the protected area: A protocol for systematic review and meta-analysis
Authors: Abd Kadir Nor Aziah , Azzeri Amirah , Mohd Noor Mohd Iqbal , Kefeli Zurina , Abdullah Muhammad Fuad , Ramlee Mohd Noor Afiq , Jaafar Mohd Hafiz
Published: April 2023

Background:

Adequate health literacy is necessary for individuals as it enables them to readily acquire information, process it, and apply it to health-related decisions. Various factors including geographical area will determine the disparity in health literacy status. Communities living in protected areas have limited health literacy and health status owing to a lack of access to infrastructure and medical facilities. Existing studies have discussed health literacy among various populations disproportionately affected by certain diseases. However, research remains underdeveloped, and the causal factors are largely untested. This research aims to better understand how population living conditions especially those who are living in protected areas are affected and exposed to limited health literacy.

Method:

This study will comprehensively review full-text papers published between 2013 and 2023. We will search 3 databases, PubMed, SCOPUS, and Web of Science, using the keyword search strategy to find articles related to the issue. Preferred Reporting Items for Systematic Reviews and Meta-Analyses will be used to guide the selection of relevant studies. The results will then be assessed using the standard Cochrane Quality assessment method. The outcome is addressed in light of a narrative synthesis that utilizes a theme category and focuses on each component’s main conclusions.

Result:

This protocol describes the planned scope and methodology for the systematic review and meta-analysis that will provide current evidence on; The status of health literacy among the community in protected areas and; The effect of Protected Areas on health literacy according to their types and characteristics.

Conclusion:

Meta-analysis of low-to-high health literacy status will benefit the development of policy recommendations for protected areas.
Associations between prehospital defibrillation and outcomes of out-of-hospital cardiac arrests presumed to be caused by hypothermia: A nationwide observational study with epidemiological analysis
Authors: Ushimoto Tomoyuki , Murasaka Kenshi , Wato Yukihiro , Inaba Hideo
Published: April 2023

This study aimed to clarify the epidemiology of out of-hospital cardiac arrest (OHCA) cases caused by hypothermia. The associations between the presence/absence of shockable initial electrocardiography rhythm, prehospital defibrillation and the outcomes of OHCA were also investigated. This study involved the retrospective analysis of prospectively collected, nationwide, population-based data for OHCA cases caused by hypothermia. One thousand five hundred seventy-five emergency medical service (EMS)-confirmed OHCA cases with hypothermia, recorded between 2013 and 2019, were extracted from the Japanese nationwide database. The primary outcome was neurologically favorable 1-month survival, defined as cerebral performance category 1 or 2. The secondary outcome was 1-month survival. OHCA cases with hypothermia occurred more frequently in the winter. In approximately half (837) of the hypothermic OHCA cases, EMS was activated in the morning (6:00 am to 11:59 am). Shockable initial electrocardiogram rhythms were recorded in 30.8% (483/1570) of cases. prehospital defibrillation was attempted in 96.1% (464/483) of cases with shockable rhythms and 25.8% (280/1087) of cases with non-shockable initial rhythms. EMS-witnessed cases, prolonged transportation time intervals and prehospital epinephrine administration were associated with rhythm conversion in cases with non-shockable initial rhythms. Binominal logit test followed by multivariable logistic regression revealed that shockable initial rhythms were associated with better outcomes. prehospital defibrillation was not significantly associated with better outcomes, regardless of the type of initial rhythm (shockable or non-shockable). Transportation to high-level emergency hospitals was associated with better outcomes (adjusted odds ratio: 2.94, 95% confidence interval: 1.66–5.21). In hypothermic OHCA, shockable initial rhythm but not prehospital defibrillation is likely to be associated with better neurologically favorable outcomes. In addition, transport to a high-level acute care hospital may be appropriately considered despite prolonged transport. Further investigation, including core temperature data in analyses, is necessary to determine the benefit of prehospital defibrillation in hypothermic OHCA.
Thrombospondin-2 acts as a critical regulator of cartilage regeneration: A review
Authors: Niu Jing , Liu Yanli , Wang Junjun , Wang Hui , Zhao Ying , Zhang Min
Published: April 2023

The degeneration of articular cartilage tissue is the most common cause of articular cartilage diseases such as osteoarthritis. There are limitations in chondrocyte self-renewal and conventional treatments. During cartilage regeneration and repair, growth factors are typically used to induce cartilage differentiation in stem cells. The role of thrombospondin-2 in cartilage formation has received much attention in recent years. This paper reviews the role of thrombospondin-2 in cartilage regeneration and the important role it plays in protecting cartilage from damage caused by inflammation or trauma and in the regenerative repair of cartilage by binding to different receptors and activating different intracellular signaling pathways. These studies provide new ideas for cartilage repair in clinical settings.
Mortality and risk factors associated with peptic ulcer bleeding among adult inpatients of Damascus Hospital, Syria: A cross-sectional study
Authors: Alhalabi Marouf Mouhammad
Published: April 2023

Peptic ulcer bleeding is associated with significant morbidity and mortality, while monitoring mortality is extremely beneficial to public health, and the latest estimates date back to 2010 for the Syrian population. This study aims to estimate the in-hospital mortality rate and risk factors associated with peptic ulcer bleeding among adult inpatients at Damascus Hospital, Syria. A cross-sectional study with systematic random sampling. Sample size (n) was calculated using the proportional equation: [n = Z
2
P (1 − P)/d
2], with the following hypothesis: Z = 1.96 for the 95% confidence level, P = .253 for mortality in patients hospitalized with complicated peptic ulcers, a margin of error (d) = 0.05, 290 charts were reviewed, and the Chi-square test (χ2 test) was used for categorical variables, and the t test for continuous data. We reported the odds ratio in addition to mean and standard deviation with a 95% confidence. A P value less than .05 was considered statistically significant. Data were analyzed using a statistical package for the social sciences (SPSS). The mortality rate was 3.4%, and the mean age was 61.76 ± 16.02 years. The most frequent comorbidities were hypertension, diabetes mellitus, and ischemic heart disease. The most commonly used medications were NSAIDs, aspirin, and clopidogrel. 74 patients (25.52%) were using aspirin with no documented indication P < .01, odds ratio = 6.541, 95% CI [2.612–11.844]. There were 162 (56%) Smokers. Six patients (2.1%) suffered from recurrent bleeding, and 13 (4.5%) needed surgery. Raising awareness about the risks of using non-steroidal anti-inflammatory drugs may reduce the occurrence of peptic ulcers and, as a result, peptic ulcer complications. Larger, nationwide studies are needed to estimate the real mortality rate in complicated peptic ulcer patients in Syria. There is a lack of some critical data in the patients’ charts, which necessitates action to correct.
A comparative study of magnifying endoscopy with narrow-band image and endocytoscopy in the diagnosis of gastric neoplasm: a pilot study
Authors: Yoo In Kyung , Park Jun Chul , Lee Hyuk , Yeniova Abdullah Ozgur , Lee Jeong Hoon , Yon Dong Keon , Cho Joo Young , Lee Wan-Sik
Published: April 2023

Background/aims

Endoscopic technologies have recently advanced to optimize the detection and diagnosis of gastric lesions. Endocytoscopy aids in the virtual realization of histology. Herein, we aimed to investigate gastric lesions using single-stain endocytoscopy and compare them using magnifying endoscopy with narrow-band imaging (ME-NBI) in terms of diagnostic yield in vivo.

Methods and methods

In the present prospective study, we registered 24 patients with gastric neoplasms and retrospectively reviewed their images. Three endoscopists reviewed the images of gastric neoplasms using white light, ME-NBI, and endocytoscopy. The diagnostic yield of endocytoscopy in early gastric cancer (EGC) was assessed using histopathology as the gold standard.

Results

Endocytoscopy was performed in 24 patients with gastric neoplasms. Of these, 15 patients had adenocarcinomas, while nine patients had low-grade dysplasia. The sensitivity, specificity, and accuracy of endocytoscopy for EGC detection were reported as 80.0% [95% confidence interval (CI), 51.9–95.7], 66.7% (95% CI, 58.4–91.9), and 75.0% (95% CI, 53.3–90.2) by endoscopist A; 80.0% (95% CI, 51.9–95.7), 44.4% (95% CI, 13.7–78.8), and 66.7% (95% CI, 44.7–84.4) by endoscopist B; and 93.3% (95% CI, 68.1–99.8), 55.6% (95% CI, 21.2–86.3), and 79.2% (95% CI, 57.9–92.8) by endoscopist C; these findings were not inferior to NBI. The inter-observer agreement, κ statistic = 0.67 (95% CI, 0.43–0.90) was favorable.

Conclusion

Endocytoscopy aid in the diagnosis of EGC because of its better sensitivity and accuracy compared to NBI or white-light imaging. However, further large-scale studies are required to confirm our findings.
Safety, hesitancy of coronavirus disease 2019 vaccination and pandemic burden in patients with inflammatory bowel disease: data of a national study (ESCAPE-IBD)
Authors: Principi Mariabeatrice , Macaluso Fabio Salvatore , Todeschini Alessia , Facciotti Federica , Contaldo Antonella , Castiglione Fabiana , Nardone Olga Maria , Spagnuolo Rocco , Doldo Patrizia , Riguccio Gaia , Conforti Francesco Simone , Viganò Chiara , Ascolani Marta , Fiorino Gionata , Correale Carmen , Bodini Giorgia , Milla Monica , Scardino Giulia , Vernero Marta , Desideri Federico , Caprioli Flavio , Mannino Mariella , Rizzo Giuseppe , Orlando Ambrogio ,   Italian Group for the study of Inflammatory Bowel Disease (IG-IBD)
Published: April 2023

Background and aims

The purpose of this study was to present data on the safety of anti- severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in a cohort of inflammatory bowel disease (IBD) patients of an ongoing multicenter study (ESCAPE-IBD) sponsored by the Italian Group for the study of Inflammatory Bowel Disease (ClinicalTrials.gov Identifier: NCT04769258).

Methods

Anti-SARS-CoV-2 vaccination was administrated to 809 IBD patients. Interviews were conducted to report adverse events related to vaccination. Of these 809, 346 patients were surveyed on the pandemic burden and the main reason for hesitancy in coronavirus disease 2019 vaccination. The chi-square test was used to compare categorical variables. Logistic regression was used to assess the relationship between disease-related characteristics and the onset of adverse events.

Results

About 45% of patients had at least one side effect, following the first dose (10%), the second (15%), and both doses (19%). All the adverse events were mild and lasted only a few days. Logistic regression analysis revealed that female sex (P < 0.001), younger age (P = 0.001), seroconversion (P = 0.002), and comorbidity (P < 0.001) were significantly associated with adverse events. The survey showed that the main concerns were the possibility of adverse event (33%). Almost all patients (99%) felt safer having been vaccinated at their IBD reference center.

Conclusion

The vaccine reactions experienced in IBD patients were mostly self-limited. We found high acceptance and good safety of SARS-CoV-2 vaccination in our cohort.
Pathogenic factors of cognitive dysfunction after liver transplantation: an observational study
Authors: Zhou Yongpeng , Huang Jun , Si Zhongzhou , Zhou Qin , Li Liwen
Published: April 2023

Objectives

Neurocognitive complications significantly reduce long-term health-related quality of life in patients undergoing liver transplantation; however, few studies have focused on their perioperative cognitive status. The authors designed a prospective observational study to determine the incidence and risk factors of posttransplant cognitive dysfunction.

Methods

This study included patients with end-stage liver disease who were on the liver transplantation waiting list. We performed an investigation with a neuropsychological battery before and 1 week after the successful transplant, analyzed the changes, and further explored the complicated perioperative factors that contribute to cognitive dysfunction.

Results

A total of 132 patients completed all the investigations. Compared with healthy controls and preoperative cognitive performance, 54 patients experienced deterioration, 50 patients remained unchanged, and 28 patients showed rapid improvement. Logistic regression analysis showed that age [odds ratio (OR) = 1.15, 95% confidence interval (CI, 1.07–1.22), P < 0.001], the model for end-stage liver disease (MELD) score [OR = 1.07, 95% CI (1.03–1.13), P = 0.038], systemic circulation pressure [OR = 0.95, 95% CI (0.91–0.99), P = 0.026] within the first 30 min after portal vein opening, and total bilirubin concentration [OR = 1.02, 95% CI (1.01–1.03), P = 0.036] on the seventh day post-transplant were closely related to the deterioration of cognitive function.

Conclusion

The incidences of deterioration, maintenance, and improvement in cognitive function were 40.9%, 37.9%, and 21.2%, respectively. Increasing age, higher MELD score, lower perfusion pressure in the early stage of the new liver, and higher total bilirubin concentration postoperatively may be independent pathogenic factors.
Administration of maximum dose of mucolytic solution before upper endoscopy – a double-blind, randomized trial
Authors: Stepan Michal , Fojtík Petr , Psar Robert , Hanousek Martin , Sabol Marek , Zapletalova Jana , Falt Premysl
Published: April 2023

Objective

The aim of the study was to demonstrate that an administration of mucolytic solution with a maximum dose of simethicone and n-acetylcysteine before upper endoscopy improves mucosal visibility compared to a group without administration of mucolytic solution or water.

Methods

This study was a double-blind, randomized controlled trial. Patients were randomized into four groups, with the administration of 100 ml of water + 600 mg n-acetylcysteine + 400 mg simethicone, 100 ml of water + 400 mg n-acetylcysteine + 20 mg simethicone, 100 ml of water, and without any water or mucolytic solution. During the examination, a total of 10 images were taken in the defined areas. The overall visibility score was given by the sum of the 0–5 scores of the five areas and was assessed by the endoscopist performing the procedure and the blinded endoscopists using static images.

Results

A total of 129 patients were randomized. The group of patients did not differ in age, sex distribution, and indications significantly. The overall visibility score as assessed by the endoscopist performing the procedure was significantly higher in the group with the maximum dose of mucolytic solution compared to the group without solution or water (18.9 ± 2.9 vs. 16.6 ± 3.3, P = 0.023). This difference was not evident by the blinded evaluation of static photographs.

Conclusion

Administration of mucolytic solution with a maximum dose of n-acetylcysteine and simethicone before upper endoscopy improved mucosal visibility in the upper gastrointestinal tract compared with the group without any preparation while evaluated by performing endoscopist.
Comparison of the role of 18F-fluorodeoxyglucose PET/computed tomography and 68Ga-labeled FAP inhibitor-04 PET/CT in patients with malignant mesothelioma
Authors: Güzel Yunus , Kömek Halil , Can Canan , Kaplan İhsan , Kepenek Ferat , Ebinç Senar , Büyükdeniz Mehmet Perver , Gündoğan Cihan , Oruç Zeynep
Published: April 2023

Objective

In this study, we aimed to compare the role of 68Ga-labeled FAP inhibitor (68Ga-FAPI)-04 PET/computed tomography (CT) and 18F-fluorodeoxyglucose (18F-FDG) PET/CT in the evaluation of primary tumor and metastases in patients diagnosed with malignant mesothelioma.

Materials and methods

Our prospective study included 21 patients with histopathological diagnosis of malignant mesothelioma who underwent both 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT imaging between April 2022 and September 2022. Maximum standardized uptake value (SUVmax), metabolic tumor volume, total lesion glycolysis, tumor-to-background ratio (TBR) and highest SUVpeak (HPeak) values and lesion numbers were calculated from primary and metastatic lesions on FDG and FAPI PET/CT images. Findings obtained from FAPI and FDG PET/CT were compared.

Results

More lesions were detected in 68Ga-FAPI-04 PET/CT compared to 18F-FDG PET/CT in primary tumor and lymph node metastases. Statistically significantly higher SUVmax and TBR values were found with FAPI PET/CT (primary lesion SUVmax and TBR, P = 0.001 and P < 0.001, respectively; lymph node SUVmax and TBR, P = 0.016 and P = 0.005, respectively). With FAPI PET/CT, upstage was observed according to tumor-node-metastasis staging in a total of seven patients including three patients with pleural origin, three patients with peritoneal origin and one patient with pericardial origin.

Conclusion

In addition to the stage change with 68Ga-FAPI-04 PET/CT in malignant mesothelioma patients, a statistically significant superiority was observed in SUVmax, TBR and volumetric parameters in primary tumors and metastases.
Correlation between metabolic uptake of F-18-FDG-PET/computed tomography and thyroglobulin level in differentiated thyroid cancer patients with suspected recurrence
Authors: Askar Hebatallah A.A. , Farghali Rana M. , Mekkaway Mohamed A. , Bashank Nahla M.
Published: April 2023

Objective

Our objective is to determine if there is correlation between serum thyroglobulin and SUVmax of the main lesion detected in F18-FDG-PET/CT scan, in differentiated thyroid cancer (DTC) patients with suspected recurrence.

Methods

All DTC patients enrolled in this prospective study, received at least one dose of radioactive iodine. During follow-up, they are suspected to have a recurrence due to elevated tumor markers although negative iodine whole-body scans. For all patients, F18-FDG-PET/CT scanning was performed. A 3D volume of interest was generated over the liver and main lesion to obtain maximum standardized uptake value (SUVmax). We calculated the lesion/liver ratio. Follow-up and/or histopathological examination were the gold standard. Pearson’s correlation coefficient was calculated between thyroglobulin and SUVmax of the main lesion.

Results

Sixty-eight patients were recruited in this study. F18-FDG-PET/CT identified suspicious malignant lesions in 42 patients, equivocal in 18 patients, while 8 patients showed no abnormal findings. Fifty-two, 6, 8, and 2 patients were true positive, true negative, false positive, and false negative respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 72%, 57% 87%, 35%, and 69% respectively. The median SUVmax and lesion/liver ratio were significantly higher in the malignant lesions than that of benign lesions (3.9 vs. 1.3 and 1.45 vs. 0.54 respectively). We found that the main lesion SUVmax and lesion/liver ratio have a positive moderate correlation with thyroglobulin (0.338 and 0.325 respectively).

Conclusion

In DTC patients with suspected recurrence, SUVmax of F18-FDG-PET/CT lesion showed a moderate positive correlation with serum thyroglobulin.
Dropped nucleus postintravitreal injection with intact anterior capsule: a case report
Authors: Al-Latayfeh Motasem M. , Shehada Reham
Published: April 2023

Introduction and importance:

The aim was to describe a case of inadvertent posteriorly dislocated lens nucleus after intravitreal injection (IVI) for diabetic retinopathy, highlighting the importance of adherence to the standard protocol of IVI.

Case presentation:

A 58-year-old female with uncontrolled type 2 diabetes mellitus presented with decreased vision bilaterally. At presentation, the anterior segment of both eyes showed nuclear sclerosis +2. Fundus examination of the left eye was not visible due to diffuse vitreous hemorrhage, for which an intravitreal ranibizumab injection was given. She presented for follow-up 3 weeks later; an aphakic left eye was discovered during the examination. A dropped nucleus was diagnosed, and the patient underwent an uneventful pars plana vitrectomy with removal of the dropped nucleus and implantation of a sulcus three-piece intraocular lens. Postoperatively, the vision had improved from hand motion to 6/18. Clinical discussion: this case presentation reports an unusual complication of a dropped lens nucleus after IVI. It highlights the possibility of inadvertent lens trauma in such a procedure and the importance of proper adherence to standards to avoid such a complication.

Conclusion:

This rare complication highlights the importance of carefully following IVI guidelines in the hands of experienced ophthalmologists and the need for meticulous supervision for ophthalmology residents because it is not a risk-free procedure.
Microvascular proliferation in arteriovenous malformation of the hand worsens during pregnancy: a case report
Authors: Utami Amalia M. , Horbach Sophie E.R. , Meijer-Jorna Lorine B. , Waas Ingeborg S.E. , de Boer Onno J. , van der Wal Allard C. , van der Horst Chantal M.A.M.
Published: April 2023

Introduction and Importance:

Arteriovenous malformations (AVMs) are rare congenital disorders characterized by episodes of disproportionate growth that can cause pain and severe bleeding, with microvascular proliferation (MVP) associated with these episodes. Hormonal influences can also worsen the symptoms in patients with AVM.

Case presentation:

This case report presents a female patient with congenital vascular malformations of the left hand since birth, whose symptoms worsened during puberty and pregnancy, ultimately leading to amputation of the left hand due to unbearable pain and loss of function. Pathologic analysis revealed substantial MVP activity within the tissues of the AVM, with an expression of receptors for estrogen, growth hormone, and follicle-stimulating hormone in the vessels of the AVM, including MVP areas. Resected materials not related to pregnancy revealed chronic inflammation and fibrosis but hardly any MVP.

Discussion and conclusion:

These findings suggest a role for MVP in the progressive growth of AVM during pregnancy, with a potential role for hormonal influences. The case highlights the relationship between AVM symptoms and size during pregnancy and the pathological findings of MVP areas within the AVM with hormone receptor expression on proliferating vessels in resected materials.
Washout-Computed Tomography Discriminates Pulmonary “Fat-poor” Hamartomas From Neuroendocrine Neoplasms
Authors: Volterrani Luca , Perrella Armando , Bagnacci Giulio , Di Meglio Nunzia , Di Martino Vito , Bertelli Paolo , Bellan Cristiana , Mazzei Maria A. , Luzzi Luca
Published: April 2023

Purpose:

Pulmonary hamartomas (HAs) and neuroendocrine neoplasms (NENs) are often impossible to discriminate using high-resolution computed tomography (CT) as they share morphologic features. This challenge makes differential diagnosis crucial as HAs are invariably benign, whereas NENs must be considered malignant, thus requiring them to be evaluated for surgical excision.

Our aim was, therefore, to develop a simple method to discriminate between pulmonary “fat-poor” HAs and NENs using contrast-enhanced CT (CECT).

Materials and Methods:

Between September 2015 and December 2021, 95 patients with a histologically proven diagnosis of lung NENs (74) and HAs (21) and who underwent a preoperative CECT scan were initially identified through a review of our pathologic and radiologic databases. Among these, 55 cases (18 HAs and 37 NENs), which have been studied with biphasic CECT, were ultimately selected and reviewed by 3 radiologists with different levels of experience, analyzing their morphologic and enhancement features.

The enhancement analysis was performed by placing a region of interest within the lesion in noncontrast (NCp), postcontrast (PCp, 55 to 65 s after intravenous contrast injection), and delayed phases (Dp, 180 to 300 s). A subgroup of 35 patients who underwent 18FDG-PET/CT was evaluated in a secondary analysis.

Results:

HU values were significantly different between NENs and HAs in the PCp (P<0.001). NCp and Dp attenuation values did not show significant differences in the 2 groups. Differences in values of HUs in PCp and Dp allowed to discriminate between NENs and HAs.

Conclusion:

Wash-out analysis, ΔHU (PCp-Dp), can perfectly discriminate pulmonary “fat-poor” HAs from NENs.
Comparison of Total and Nontotal Endoscopic Transaxillary Breast Augmentation Techniques
Authors: Yan Wen-Hui , Zeng Ang , Li Gao-Feng , Liu Hui , Mang Jian-Bo , Ren Li-Li , Gao Ji-Dong
Published: April 2023

Background

The aim of this retrospective study was to compare the clinical outcomes of total endoscopic transaxillary (TET) breast augmentation with those of non-TET (NTET) breast augmentation. For the purposes of this study, the term NTET refers to the combination of blunt dissection and endoscopic techniques, whereas TET did not involve blunt dissection.

Methods

We conducted a retrospective review of 119 consecutive cases of primary breast augmentation from May 1, 2020, to August 31, 2020. The primary outcomes were the number of drainage days and pain scores as assessed using the visual analog scale on the first postoperative day. The secondary outcomes were the daily drainage volume recorded during the postoperative drainage days, the presence of postoperative daily pain that required the administration of tramadol for relief, reoperation rate, and operative time.

Results

The number of drainage days was significantly lower in the TET group than in the NTET group (TET vs NTET: 2.56 ± 0.57 vs 3.78 ± 1.30 days, P = 0.000). The visual analog scale score on the first postoperative day was significantly lower in the TET group than in the NTET group (TET vs NTET: 4.96 ± 0.63 vs 5.93 ± 0.93, P = 0.000).

Conclusions

We observed that the major outcomes of the TET group were more favorable than those of the NTET group. Based on our results, we recommend the avoidance of blunt dissection during endoscopic transaxillary breast augmentation.

Level of Evidence

III
Research and Innovation in Organ Donation: Recommendations From an International Consensus Forum
Authors: Escoto Manuel , Issa Fadi , Cayouette Florence , Consolo Henrietta , Chaudhury Prosanto , Dhanani Sonny , Jiang Wenshi , Oniscu Gabriel C. , Murphy Nicholas , Rockell Karen , Weiss Matthew J. , Dieudé Mélanie
Published: April 2023

Background.

This report provides recommendations from the Research and Innovation domain as part of the International Donation and Transplantation Legislative and Policy Forum (hereafter the Forum) to provide expert guidance on the structure of an ideal organ and tissue donation and transplantation system. The recommendations focus on deceased donation research and are intended for clinicians, investigators, decision-makers, and patient, family, and donor (PFD) partners involved in the field.

Methods.

We identified topics impacting donation research through consensus using nominal group technique. Members performed narrative reviews and synthesized current knowledge on each topic, which included academic articles, policy documents, and gray literature. Using the nominal group technique, committee members discussed significant findings, which provided evidence for our recommendations. The Forum’s scientific committee then vetted recommendations.

Results.

We developed 16 recommendations in 3 key areas to provide stakeholders guidance in developing a robust deceased donor research framework. These include PFD and public involvement in research; donor, surrogate, and recipient consent within a research ethics framework; and data management. We highlight the importance of PFD and public partner involvement in research, we define the minimum ethical requirements for the protection of donors and recipients of both target and nontarget organ recipients, and we recommend the creation of a centrally administered donor research oversight committee, a single specialist institutional review board, and a research oversight body to facilitate coordination and ethical oversight of organ donor intervention research.

Conclusions.

Our recommendations provide a roadmap for developing and implementing an ethical deceased donation research framework that continually builds public trust. Although these recommendations can be applied to jurisdictions developing or reforming their organ and tissue donation and transplantation system, stakeholders are encouraged to collaborate and respond to their specific jurisdictional needs related to organ and tissue shortages.