bluuebunny/crossref_metadata_2025 huggingface dataset:
Disparities in Perinatal and Emergency Care Receipt Among Women With Perinatal Opioid Use Disorder in Medicaid, 2007 to 2012
Authors: Landis Rachel K. , Stein Bradley D. , Griffin Beth Ann , Saloner Brendan K. , Terplan Mishka , Faherty Laura J.
Published: June 2023

Objectives

This study aimed to better understand receipt of perinatal and emergency care among women with perinatal opioid use disorder (OUD) and explore variation by race/ethnicity.

Methods

We used 2007–2012 Medicaid Analytic eXtract (MAX) data from all 50 states and the District of Columbia to examine 6,823,471 deliveries for women 18 to 44 years old. Logistic regressions modeled the association between (1) OUD status and receipt of perinatal and emergency care, and (2) receipt of perinatal and emergency care and race/ethnicity, conditional on OUD diagnosis and controlling for patient and county characteristics. We used robust SEs, clustered at the individual level, and included state and year fixed effects.

Results

Women with perinatal OUD were less likely to receive adequate prenatal care (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.44–0.46) and attend the postpartum visit (aOR, 0.46; 95% CI, 0.45–0.47) and more likely to seek emergency care (aOR, 1.48; 95% CI, 1.45–1.51) than women without perinatal OUD. Among women with perinatal OUD, Black, Hispanic, and American Indian and Alaskan Native (AI/AN) women were less likely to receive adequate prenatal care (aOR, 0.68 [95% CI, 0.64–0.72]; aOR, 0.86 [95% CI, 0.80–0.92]; aOR, 0.71 [95% CI, 0.64–0.79]) and attend the postpartum visit (aOR, 0.85 [95% CI, 0.80–0.91]; aOR, 0.86 [95% CI, 0.80–0.93]; aOR, 0.83 [95% CI, 0.73–0.94]) relative to non-Hispanic White women. Black and AI/AN women were also more likely to receive emergency care (aOR, 1.13 [95% CI, 1.05–1.20]; aOR, 1.12 [95% CI, 1.00–1.26]).

Conclusions

Our findings suggest that women with perinatal OUD, in particular Black, Hispanic, and AI/AN women, may be missing opportunities for preventive care and comprehensive management of their physical and behavioral health during pregnancy.
A Novel Screening Method for Scoliosis Using A Bodysuit and 3-dimensional Imaging
Authors: Ito Yusuke , Doi Toru , Ohtomo Nozomu , Fujii Yuki , Ono Kengo , Kojima Eri , Yamada Takayasu , Tran Huy Hoang , Goffinet Francois , Endo Yui , Kato So , Matsubayashi Yoshitaka , Tanaka Sakae , Oshima Yasushi , Taniguchi Yuki
Published: June 2023

Study Design.

A single-center prospective observational study.

Objective.

To clarify the usefulness of a novel scoliosis screening method using a 3-dimensional (3D) human fitting application and a specific bodysuit.

Summary of Background Data.

Several scoliosis screening methods, such as scoliometer and Moiré topography, are available for detecting scoliosis. In the present study, a novel screening method for scoliosis using a 3D human fitting application and a specific bodysuit was developed.

Methods.

Patients with scoliosis or suspected scoliosis, non-scoliosis patients, and healthy volunteers were enrolled. They were divided into Non-Scoliosis and Scoliosis groups. The Scoliosis group was further subdivided into Mild-, Moderate-, and Severe-Scoliosis. Patients’ characteristics and Z values, which were calculated by a 3D virtual human body model created by a 3D human fitting application and a specific bodysuit to evaluate trunk asymmetry caused by scoliosis, were compared between the Non-Scoliosis and Scoliosis groups or among the Non-, Mild-, Moderate- and Severe-Scoliosis groups. Finally, the optimal cutoff of the Z value was determined to detect moderate to severe scoliosis using receiver operating characteristics (ROC) curve analysis.

Results.

A total of 101 patients were included. The Non-Scoliosis group consisted of 47 patients, and the Scoliosis group included 54 patients, with 11, 31, and 12 patients in the Mild-, Moderate-, and Severe-Scoliosis groups, respectively. The Scoliosis group showed a significantly higher Z value than the Non-Scoliosis group. The Moderate- or Severe-Scoliosis group had a significantly higher Z value than the Non- or Mild-Scoliosis group. The ROC curve analysis revealed that the optimal cutoff of the Z value was 19.9 mm (sensitivity, 95.3%; specificity, 58.6%).

Conclusion.

A novel scoliosis screening method consisting of a 3D human fitting application and a specific bodysuit may be useful for detecting moderate to severe scoliosis.
Risk Factors for Unexpected Conversion From Ambulatory to Inpatient Admission Among One-level or Two-level ACDF Patients
Authors: Tani Soji , Okano Ichiro , Dodo Yusuke , Camino-Willhuber Gaston , Caffard Thomas , Schönnagel Lukas , Chiapparelli Erika , Amoroso Krizia , Tripathi Vidushi , Arzani Artine , Oezel Lisa , Shue Jennifer , Zelenty William D. , Lebl Darren R. , Cammisa Frank P. , Girardi Federico P. , Hughes Alexander P. , Sokunbi Gbolabo , Sama Andrew A.
Published: June 2023

Study Design/Setting.

A retrospective observational study.

Objective.

The aim of this study was to investigate the factors associated with the conversion of patient status from ambulatory anterior cervical discectomy and fusion (ACDF) to inpatient.

Summary of Background Data.

Surgeries are increasingly performed in an ambulatory setting in an era of rising healthcare costs and pressure to improve patient satisfaction. ACDF is a common ambulatory cervical spine surgery, however, there are certain patients who are unexpectedly converted from an outpatient procedure to inpatient admission and little is known about the risk factors for conversion.

Materials and Methods.

Patients who underwent one-level or two-level ACDF in an ambulatory setting at a single specialized orthopedic hospital between February 2016 to December 2021 were included. Baseline demographics, surgical information, complications, and conversion reasons were compared between patients with ambulatory surgery or observational stay (stay <48 h) and inpatient (stay >48 h).

Results.

In total, 662 patients underwent one-level or two-level ACDF (median age, 52 yr; 59.5% were male), 494 (74.6%) patients were discharged within 48 hours and 168 (25.4%) patients converted to inpatient. Multivariable logistic regression analysis demonstrated that females, low body mass index <25, American Society of Anesthesiologists classification (ASA) ≥3, long operation, high estimated blood loss, upper-level surgery, two-level fusion, late operation start time, and high postoperative pain score were considered independent risk factors for conversion to inpatient. Pain management was the most common reason for the conversion (80.0%). Ten patients (1.5%) needed reintubation or remained intubated for airway management.

Conclusions.

Several independent risk factors for prolonged hospital stay after ambulatory ACDF surgery were identified. Although some factors are unmodifiable, other factors, such as procedure duration, operation start time, and blood loss could be potential targets for intervention. Surgeons should be aware of the potential for life-threatening airway complications in ambulatory-scheduled ACDF.
Applying the Project ECHO Model to Support Implementation and Sustainment of Cognitive Behavioral Therapy for Psychosis
Authors: Kopelovich Sarah L. , Blank Jennifer , McCain Chris , Hughes MacKenzie , Strachan Eric
Published: June 2023

Introduction:

Project Extension for Community Healthcare Outcomes (ECHO) is a teleconsultation model that leverages technology to sustain specialized interventions in underresourced settings. We present the application of the ECHO model to longitudinal training and consultation for community behavioral health providers learning to deliver cognitive behavioral therapy for psychosis, an evidence-based psychotherapy for individuals with psychotic disorders that has poorly penetrated the US mental health system.

Methods:

We analyzed within-group change over practitioners' 6-month ECHO participation cycle using the Expanded Outcomes Framework. We evaluated outcomes associated with participation, satisfaction, knowledge acquisition, performance, patient symptom severity, and functional impairment.

Results:

In the first 3 years, the cognitive behavioral therapy for psychosis ECHO Clinics supported 150 providers from 12 community agencies. Forty percent did not complete the 6-month ECHO calendar, most commonly due to separation from their agency. Participants reported high degrees of satisfaction. Declarative and procedural knowledge increased over the 6-month period. Of the 24 providers who received a fidelity review, 87.5% met or exceeded the competency benchmark within the 6-month period. Clinical outcomes reflected reductions in hallucinations, negative symptoms, depression, mania, and functional impairment, but no reductions were detected in delusions, disorganized speech, or abnormal psychomotor behavior.

Discussion:

ECHO Clinics offer a mode of providing continuous access to expert instruction, peer-to-peer consultation, and case-based learning that other workforce training models lack. Our evaluation suggests that the ECHO model supports continuous professional development for practitioners, most of whom had indicated inadequate preparation for their role. We observed improved learner and select patient outcomes.
Elements and Definitions of Continuing Professional Development Leadership: A Scoping Review
Authors: Paton Morag , Do Victor , Jeyakumar Tharshini , Maniate Jerry M. , Tavares Walter , Schneeweiss Suzan , Wiljer David
Published: June 2023

Introduction:

Leaders are being asked to transform the way that continuing professional development (CPD) is delivered to focus on better, safer, and higher quality care. However, there is scarce literature on CPD leadership. We set out to study what CPD leadership means and describe the competencies required for CPD leadership.

Methods:

A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-analyses extension guidelines for scoping reviews guidelines was conducted. With librarian support, four databases were searched for publications related to leadership, medical education, and CPD. Publications were screened by two reviewers and three reviewers extracted data.

Results:

Among 3886 publications, 46 were eligible for a full-text review and 13 met the final inclusion criteria. There was no agreed upon definition of CPD leadership and variable models and approaches to leadership in the literature. Contextual issues shaping CPD (eg, funding, training, and information technology) are evolving. We identified several attitudes and behaviors (eg, strategic thinking), skills (eg, collaboration), and knowledge (eg, organizational awareness) important to CPD leadership, but no established set of unique competencies.

Discussion:

These results offer the CPD community a foundation on which competencies, models, and training programs can build. This work suggests the need to build consensus on what CPD leadership means, what CPD leaders do, and what they will need to create and sustain change. We suggest the adaptation of existing leadership frameworks to a CPD context to better guide leadership and leadership development programs.
A Novel Approach to Reducing Splash Exposure in Pulsatile Lavage
Authors: Ward Candace L. , Kozian Leonardo , Bartolacci Joseph , Krupp James C. , Karadsheh Murad J. , Weiss Eric S. , Patel Sameer A.
Published: June 2023

Pulsatile lavage is utilized to copiously irrigate contaminated wounds; however, the current devices can cause significant splashing and increase the risk of contaminated fluid exposure to healthcare professionals. To create a larger splash guard for the standard pulsatile lavage device, we use heavy scissors to remove the end of a plastic light handle. We then place the nozzle of the lavage device through the open end to create a larger splash guard. This method provides a quick, accessible way to decrease the risk of splash exposure due to pulsatile lavage irrigation.
Is This Going to Hurt, Doc? Predicting Pain with Corticosteroid Injections for Upper Extremity Conditions
Authors: Wagner Ryan D. , Kilmartin Catherine , Behar Britany J. , Chhabra Abhinav Bobby , Freilich Aaron M. , DeGeorge Brent R.
Published: June 2023

Background:

Corticosteroid injections (CSIs) are used in a wide variety of upper extremity pathologies for both diagnostic and treatment purposes. Many patients ask about pain associated with the procedure before agreeing to proceed. The purpose of this study was to correlate perceived pain tolerance and resilience with patient-reported injection pain during and immediately after injection.

Methods:

One-hundred patients indicated for a CSI for an upper extremity condition were recruited for the study. Patients completed a Brief Resilience Scale, Patient-Reported Outcomes Measurement Information System pain interference form, and assessment of pain tolerance before injection. Physicians predicted pain tolerance and resilience for each patient. Immediately after the procedure, patients completed a second survey, assessing pain during and 1 minute after injection.

Results:

Physician-predicted patient resilience and pain tolerance was lower than that self-reported by patients. Pain with injection was inversely correlated with physician-predicted pain tolerance and resilience but not with patient-reported pain tolerance. Injection pain ratings did not correspond with patients’ willingness to undergo subsequent injections.

Conclusions:

Procedural pain is an important consideration for many patients, especially in awake procedures. Appropriate counseling is crucial to support informed consent and enhance patient outcomes. This study demonstrated that a physician’s clinical experience can be used to predict a patient’s pain with CSI and should be considered when counseling patients.
Pushing the DIEP Envelope with ERAS: 24 Hour Discharge is Safe in Appropriately Selected Patients
Authors: Fracol Megan , Teven Chad M. , Selimos Brianna , Wier Sylvia , Stockslager Caitlin , Schoenfeldt Joseph , Connors Paul , Monahan Denise , Dumanian Gregory A. , Howard Michael A.
Published: June 2023

Background:

Enhanced recovery after surgery protocols have become increasingly adopted for autologous breast reconstruction, demonstrating improved quality of care and reduced hospital stays. Despite this, average length of stay remains over 3 days. We have found, in appropriately selected patients, hospital length of stay can be safely reduced to less than 48 hours.

Methods:

Retrospective review was performed of patients who underwent microsurgical breast reconstruction by the senior author (M.H.) from April 2019 to December 2021. Demographics, operative details, length of stay, and postoperative complications are reported to assess for safety of discharge within 48 hours, with the primary outcome measure being flap loss.

Results:

In total, 188 flaps were performed on 107 patients. Average age was 51.4 years (SD 10.1 years) with average BMI 26.6 kg/m2 (SD 4.8 kg/m2). Average length of stay was 1.97 days (SD 0.61 days), and 96 patients (89.7%) were discharged within 48 hours. Six flaps (3.2%) required operative takebacks. Five of the six (83.3%) takebacks occurred on postoperative days zero or one, and all five of these flaps were salvaged. There were four breast hematomas (2.1%), four breast seromas (2.1%), eight breast infections (4.3%), 13 breasts (6.9%) with wound dehiscence, four flaps (2.1%) with partial flap loss, and 24 breasts (12.8%) with mastectomy flap necrosis. One hundred fifty flaps (79.8%) had no complications. Overall success rate of flap reconstruction was 99.5%.

Conclusion:

Hospital discharge in 24–48 hours is safe in appropriately selected patients undergoing autologous tissue breast reconstruction.
Obinutuzumab Versus Rituximab Immunochemotherapy in Previously Untreated iNHL: Final Results From the GALLIUM Study
Authors: Townsend William , Hiddemann Wolfgang , Buske Christian , Cartron Guillaume , Cunningham David , Dyer Martin J.S. , Gribben John G. , Phillips Elizabeth H. , Dreyling Martin , Seymour John F. , Grigg Andrew , Trotman Judith , Lin Tong-Yu , Hong Xiao-Nan , Kingbiel Dirk , Nielsen Tina G. , Knapp Andrea , Herold Michael , Marcus Robert
Published: June 2023

The phase III GALLIUM trial assessed the safety and efficacy of obinutuzumab-based versus rituximab-based immunochemotherapy in patients with previously untreated follicular lymphoma (FL) or marginal zone lymphoma (MZL). At the primary analysis, the trial met its primary end point, demonstrating improvement in investigator-assessed progression-free survival (PFS) with obinutuzumab-based versus rituximab-based immunochemotherapy in patients with FL. We report the results of the final analysis in the FL population, with an additional exploratory analysis in the MZL subgroup. Overall, 1202 patients with FL were randomized 1:1 to obinutuzumab- or rituximab-based immunochemotherapy followed by maintenance with the same antibody for up to 2 years. After a median 7.9 (range, 0.0–9.8) years of follow-up, PFS remained improved with obinutuzumab- versus rituximab-based immunochemotherapy, with 7-year PFS rates of 63.4% versus 55.7% (P = 0.006). Time-to-next antilymphoma treatment was also improved (74.1% versus 65.4% of patients had not started their next antilymphoma treatment at 7 y; P = 0.001). Overall survival was similar between the arms (88.5% versus 87.2%; P = 0.36). Irrespective of the treatment received, PFS and OS were higher in patients with a complete molecular response (CMR) versus those with no CMR (P < 0.001). Serious adverse events were reported in 48.9% and 43.4% of patients in the obinutuzumab and rituximab arms, respectively; there was no difference in the rate of fatal adverse events (4.4% and 4.5%, respectively). No new safety signals were reported. These data demonstrate the long-term benefit of obinutuzumab-based immunochemotherapy and confirm its role as a standard-of-care for the first-line treatment of advanced-stage FL, taking into account patient characteristics and safety considerations.
Cognitive fatigue weakens the effects of distraction on pain
Authors: Vogel Todd A. , Desjardins Sophie , Chabot Bianca , Otto A. Ross , Falk Carl F. , Roy Mathieu
Published: June 2023

Perceived pain can be viewed because of a competition between nociceptive inputs and other competing goals, such as performing a demanding cognitive task. Task performance, however, suffers when cognitively fatigued. We therefore predicted that cognitive fatigue would weaken the pain-reducing effects of performing a concurrent cognitive task, which would indicate a causal link between fatigue and heightened pain sensitivity. In this study, 2 groups of pain-free adults performed cognitive tasks while receiving painful heat stimuli. In 1 group, we induced cognitive fatigue before performing the tasks. We found that fatigue led to more pain and worse performance when the task was demanding, suggesting that fatigue weakens one's ability to distract from pain. These findings show that cognitive fatigue can impair performance on subsequent tasks and that this impairment can lower a person's ability to distract from and reduce their pain.
Excellent Clinical Outcomes and Return to Dance of 6 Active, Professional Ballet Dancers Aged Younger Than 40 Years at Total Hip Arthroplasty Through Direct Anterior Approach With a Custom Stem: A Case Report
Authors: Nogier Alexis , Tourabaly Idriss , Ramos-Pascual Sonia , Barreau Xavière , Baraduc Elodie , Saffarini Mo , Courtin Cyril
Published: June 2023

Objective:

To report clinical outcomes and return to dance after total hip arthroplasty (THA) by direct anterior approach (DAA) using custom stems in young, active, professional ballet dancers.

Design:

Case report.

Setting:

Tertiary.

Patients:

Six active, professional ballet dancers younger than 40 years who intended to resume ballet after THA.

Interventions:

Primary THA by muscle-sparing DAA using custom stems.

Main Outcome Measures:

Return to dance, Oxford hip score (OHS), forgotten joint score (FJS), and satisfaction with surgery and pain using numeric rating scale (NRS). CTs were acquired 2 days after surgery to assess implant position. Descriptive statistics were used.

Results:

The cohort comprised 4 women and 2 men aged 15 to 39 years. At 2.5 to 5.1 years of follow-up, all patients returned to professional ballet dance. Time to return to dance was 3 to 4 months for 3 patients and 12 to 14 months for 3 patients. Clinical scores were excellent, except for FJS in 1 patient who had considerable pain at her spine and ipsilateral foot. All patients were satisfied with surgery (NRS = 10). There were no complications, reoperations, or revisions. CTs confirmed that stems and cups were correctly positioned.

Conclusions:

All 6 young, active, professional ballet dancers who underwent THA by muscle-sparing DAA using custom stems returned to professional ballet dance and were completely satisfied with surgery. At >2 years of follow-up, 5 patients had excellent clinical outcomes and reported their dancing level to be as expected or better, whereas 1 patient had a lower FJS and was unable to return to her expected dance level.
Effect of Bariatric Surgery on Disease Outcomes in Patients With Inflammatory Bowel Disease
Authors: Desai Aakash , Hashash Jana G. , Baker Gianna , Farraye Francis A. , Waghray Nisheet , Kochhar Gursimran S.
Published: June 2023

Introduction and Aim:

A growing body of evidence suggests a negative impact of obesity on the disease activity of inflammatory bowel disease (IBD). The primary aim of the study was to evaluate disease outcomes of IBD in patients after bariatric surgery (BS).

Methods:

Patients with IBD and morbid obesity who underwent BS were compared with patients with IBD and morbid obesity without BS in a retrospective, propensity-score matched cohort study using TriNetX, a multi-institutional database. The primary aim was to assess the 2-year risk of a composite of disease-related complications, which included intravenous steroid use or IBD-related surgery. Risk was expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results:

In all, 482 patients (3.4%) with IBD and morbid obesity underwent BS (mean age 46.9±11.2 y old, mean BMI 42.1±7.72 kg/m2, Crohn’s disease 60%). After propensity-score matching, the BS cohort had a lower risk (aOR 0.31, 95% CI 0.17-0.56) of a composite of IBD-related complications compared with the control cohort. After propensity-score matching, the BS cohort with sleeve gastrectomy had a decreased risk (aOR 0.45, 95% CI 0.31-0.66) of a composite of IBD-related complications. There was no difference in the risk (aOR 0.77, 95% CI 0.45–1.31) of a composite of IBD-related complications between the BS cohort with Roux-en-Y gastric bypass (RYGB) compared with the control cohort.

Conclusion:

Sleeve gastrectomy but not Roux-en-Y gastric bypass is associated with improved disease-specific outcomes in patients with IBD and morbid obesity.
Influence of Colorectal Cancer Risk Factors on Predictive Value of a Positive Multitarget Stool DNA Test
Authors: Narayani Kaden R. , Narayani Raj I.
Published: June 2023

Goals:

We analyzed if the predictive value of multitarget stool-based DNA (mt-sDNA) varied when patients had pre-existing known colorectal cancer (CRC) risk factors.

Background:

mt-sDNA test is approved for CRC screening in average-risk patients. Whether patients with a personal history of adenomatous colon polyps or a family history of CRC (CRC risk factors) benefit from mt-sDNA testing is unknown.

Study:

We reviewed charts for all positive mt-sDNA referrals between 2017 and 2021. Diagnostic colonoscopy adherence rates were calculated. In those who had colonoscopy, we compared detection rates for any colorectal neoplasia (CRN), multiple (3 or more) adenomas, sessile serrated polyps (SSP), advanced CRN, and CRC between patients with and without known CRC risk factors.

Results:

Of 1297 referrals for positive mt-sDNA, 1176 (91%) completed a diagnostic colonoscopy. The absence of neoplasia was noted in 27% of colonoscopy exams. When neoplasia was identified, findings were as follows: any CRN (73%), multiple adenomas (34%), SSP (23%), advanced CRN (33%), and CRC (2.5%). One or more CRC risk factors were present in 229 (19%) of cases. In the CRC risk factor subgroup, patients having a prior history of adenomatous polyps or a family history of CRC were no more likely to have any CRN, multiple adenomas, SSP, advanced CRN, or CRC compared to average-risk patients when mt-sDNA was positive.

Conclusions:

In this real-world analysis of positive mt-sDNA referrals, adherence to subsequent diagnostic colonoscopy recommendations was high. The presence of pre-existing CRC risk factors did not affect the positive predictive value of mt-sDNA.
The role of dietary prehabilitation on anastomotic healing
Authors: Alverdy John C.
Published: June 2023

Purpose of review

As the microbiome takes center stage in biomedical research and emerging medical treatments, here we review the scientific basis and role of dietary modulation to prevent anastomotic leakage.

Recent Findings

It is becoming increasingly clear that dietary habits have a profound influence on an individual's microbiome and that the microbiome plays a key and causative role in anastomotic leak etiology and pathogenesis. A review of recent studies indicates that the gut microbiome can become significantly shifted in composition, community structure and function within an extremely short time period of 2 or 3 days simply by changing one's diet.

From a practical standpoint to improve outcome from surgery, these observations, when paired with next generation technology, suggest that it is now possible to manipulate the microbiome of surgical patients to their advantage prior to surgery. This approach will allow surgeons to modulate the gut microbiome with the endpoint of improving the outcome from surgery. Thus a new emerging field termed ‘dietary prehabilitation’ is now gaining popularity and similar to smoking cessation, weight loss and exercise, may be a practical method to prevent postoperative complications including anastomotic leak.
Understanding the gut microbiota in cancer cachexia
Authors: Rocha Ilanna Marques , Fonseca Danielle Cristina , Torrinhas Raquel Susana Matos , Waitzberg Dan Linetzky
Published: June 2023

Purpose of review

Cachexia is a complex, multifactorial syndrome primarily characterized by weight loss, muscle wasting, anorexia, and systemic inflammation. It is prevalent in cancer patients and is associated with a poor prognosis, including lower resistance to intervention toxicity, quality of life, and survival, compared to patients without the syndrome. The gut microbiota and its metabolites have been shown to influence host metabolism and immune response. Our article reviews the current evidence suggesting a role of gut microbiota in the development and progression of cachexia, while discussing the potential mechanisms involved. We also describe promising interventions targeting gut microbiota aiming to improve outcomes related to cachexia.

Recent findings

Dysbiosis, an imbalance in gut microbiota, has been associated with cancer cachexia through pathways involving muscle wasting, inflammation, and gut barrier dysfunction. Interventions targeting gut microbiota, such as probiotics, prebiotics, synbiotics, and fecal microbiota transplantation, have shown promising results in managing this syndrome in animal models. However, evidence in humans is currently limited.

Mechanisms linking gut microbiota and cancer cachexia need to be further explored, and additional human research is necessary to evaluate the appropriate dosages, safety, and long-term outcomes of prebiotic and probiotic use in microbiota management for cancer cachexia.
Caloric restriction and fasting-mimicking diets in the treatment of cancer patients
Authors: Arends Jann
Published: June 2023

Purpose of review

Different forms of caloric restriction for patients with cancer are widely advertised in lay circles, based mainly on promising preclinical experiments, while evidence from clinical trials is still preliminary. This review aims to present physiological responses to fasting and update knowledge on recently accumulated evidence from preclinical models and clinical trials.

Recent findings

Like other mild stressors, caloric restriction induces hormetic changes in healthy cells, which increase the tolerance to subsequent more severe stressors. While protecting healthy tissues, caloric restriction sensitizes malignant cells to toxic interventions because of their deficiencies in hormetic mechanisms, especially control of autophagy. In addition, caloric restriction may activate anticancer-directed immune cells and deactivate suppressive cells, thus increasing immunosurveillance and anticancer cytotoxicity. These effects may combine to increase the effectivity of cancer treatments while limiting adverse events. Though evidence obtained from preclinical models is promising, clinical trials in cancer patients so far have been preliminary. In clinical trials it will remain essential to avoid inducing or aggravating malnutrition.

Based on physiology and evidence from preclinical models, caloric restriction is a promising candidate as a potential combination partner for clinical anticancer treatment. However, large randomized clinical trials investigating effects on clinical outcome in patients with cancer are still lacking.
Nutritional interventions in patients with graft-versus-host disease
Authors: Seguy David , Hueso Thomas
Published: June 2023

Purpose of review

This review aims to highlight the benefits of nutrition before and during graft-versus-host disease (GvHD) and the promising precision medicine approach that should be offered to prevent and mitigate GvHD.

Recent findings

The intestinal damage induced by preconditioning/conditioning chemotherapies is the main trigger of GvHD. Impaired nutritional status and decreased plasma citrulline level, which is the most sensitive biomarker of intestinal barrier health, predict the occurrence of acute GvHD after allogeneic hematopoietic cell transplantation (allo-HCT). Optimal oral and/or enteral nutrition and a lack of vitamin D deficiency limit this intestinal damage. As intestinal dysbiosis plays an important role in GvHD, probiotics and prebiotics supplementation could be a promising therapy. Diverting enterostomy combined with parenteral nutrition saves the lives of patients with severe steroid-refractory gastrointestinal GvHD.

Regardless of age, healthy nutritional status and a healthy gut barrier are protective factors against GvHD in patients undergoing allo-HCT, and above all, these are closely dependent on adequate oral and/or enteral intake. Therefore, maintaining gut barrier integrity through adequate oral nutrition before allo-SCT and early first-line enteral nutrition after allo-HCT are of critical importance, not forgetting vitamin D supplementation. In the future, probiotics and prebiotics are expected to play a growing role for replenishing the commensal microbiota given the impact of gut dysbiosis on GvHD. Parenteral nutrition remains the only nutritional support that can be used in the event of severe gastrointestinal GvHD.
The diagnostic value of BI-RADS grade 3 to 5 for breast masses is correlated with the expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2
Authors: He Tiejun , Shi Tiemei , Luo Wendong , Ju Yabo , Li Ran
Published: June 2023

Background:

The breast imaging-reporting and data system (BI-RADS) grading has a great advantage in diagnosing breast diseases, but with some limitations.

Aims:

The study analyzed the value of ultrasound-guided core needle biopsy (CNB) in diagnosing BI-RADS grades 3, 4, and 5 breast cancer.

Methods:

Breast cancer patients at BI-RADS grades 3 to 5 received breast ultrasonography, ultrasound-guided CNB and immunohistochemical examination. Receiver operating characteristic (ROC) curve was made to test diagnostic efficiency of regression model.

Results:

Calcification was positively correlated with expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER)-2. The areas of 4 ROC curves were 0.752, 0.805, 0.758, and 0.847, and the 95%CI was 0.660 to 0.844, 0.723 to 0.887, 0.667 to 0.849, and 0.776 to 0.918, respectively. BI-RADS grades 3 to 5 were positively correlated with expression of ER, PR and human epidermal growth factor receptor-2 (HER-2). Statistical significance existed between grade 5 and expression of ER, PR and HER-2, and between grade 4 and expression of HER-2.

Conclusions:

The study demonstrates that BI-RADS can be used as an effective evaluation method in the diagnosis of breast diseases before invasive operation, and it has higher diagnostic accuracy if combined with pathological examinations.
Comparison of thyroid fine needle aspiration biopsy and ultrasonography results
Authors: Keskin Lezzan , Karahan Doğu , Yaprak Bülent
Published: June 2023

Thyroid nodules are one of the most common health problems in the community. Although most of the nodules are benign, Fine needle aspiration biopsy (FNAB) is requested due to malignancy concerns. In this research, the aim was to make a comparison of the results of thyroid ultrasonography (USG) and FNAB for thyroid nodules. This study was conducted retrospectively on the data of 532 patients. Detail Edu ultrasonographic assessment was conducted before the FNAB procedure and FNAB was performed by an endocrinology specialist. FNAB results and Thyroid USG features were compared, and thyroid FNAB results were graded using the classification of World Health Organization Bethesda-2017. The average age of the individuals included in the research was 49.99 ± 13.65 (min = 18-max = 97). According to the 2017 Bethesda classification, 74.6% of FNAB results were benign, 16% follicular lesion of undated mined significance or A type of undated mined significance, 0.9% were malignant, and 1.1% were suspicious for malignancy. When USG findings were compared according to FNAB results, it was found that malignant lesions were significantly higher in single nodules (non- cystic and non- mixed lesions). Lesions with a single nodule on USG were found to be 3.6 times more likely to be malignant (OR 95% CI: 1.172–11.352). The gold standard method for the diagnosis the presence of thyroid nodules is thyroid fine needle aspiration biopsy with ultrasound guidance. Taking samples from the correct nodule and component increases its value. The presence of a single nodule from the thyroid USG features was found to be an important predictor of malignancy according to the biopsy results.
Evaluation of usefulness of tongue pressure measurement device for dysphagia associated with treatment of patients with head and neck cancer (ELEVATE)
Authors: Tanaka Akihisa , Uemura Hirokazu , Kimura Takahiro , Nishimura Ari , Aoki Kumiko , Otsuka Shintaro , Ueda Keita , Kitahara Tadashi
Published: June 2023

Introduction:

Dysphagia is often caused by radiotherapy (RT) in patients with head and neck cancer (HNC), and reduced tongue pressure (TP) is often associated with swallowing dysfunction in the oral stage. However, the evaluation of dysphagia by measuring TP has not yet been established in HNC patients. Herein, we conducted a clinical trial to evaluate the usefulness of TP measurement using a TP-measuring device as an objective indicator of dysphagia induced by RT in HNC patients.

Methods and Analysis:

This ELEVATE trial is a prospective, single-center, single-arm, non-blind, non-randomized trial to evaluate the usefulness of a TP measurement device for dysphagia associated with the treatment of HNC. Eligible participants include patients with oropharyngeal or hypopharyngeal cancer (HPC) undergoing RT or chemoradiotherapy (CRT). The TP measurements are conducted before, during, and after RT. The primary endpoint is the change in the maximum TP values from before RT to 3 months after RT. Moreover, as secondary endpoints, the correlation between the maximum TP value and the findings of video-endoscopic and video-fluoroscopic examinations of swallowing will be analyzed at each evaluation point, as well as changes in the maximum TP value from before RT to during RT and at 0, 1, and 6 months after RT.

Discussion:

This trial aimed to investigate the usefulness of evaluation by measuring TP for dysphagia associated with HNC treatment. We expect that an easier evaluation for dysphagia will improve rehabilitation programs for dysphagia. Overall, we expect this trial to contribute to the improvement of patients’ quality of life (QOL).
The diagnostic value of lncRNA HOTAIR for cervical carcinoma in vaginal discharge and serum
Authors: Liu Ming-Yan , Li Na
Published: June 2023

There is a lower incidence of cervical carcinoma compared with other common carcinomas, however, the mortality rate of cervical carcinoma is higher, suggesting that the treatment and prognosis of cervical carcinoma are relatively poor. Therefore, cervical carcinoma patients urgently need to find new diagnostic markers for early detection and treatment. One hundred and fifty cervical carcinoma and 100 benign cervical disease patients from 2019 January to 2021 December in Tianjin Central Hospital of Gynecology Obstetrics were selected and 100 healthy women were as normal group. The expression of HOX transcript antisense RNA (HOTAIR) in cervical carcinoma and paracancerous tissue, serum sample was measured by realtime PCR assay. The receiver operating characteristic of HOTAIR for cervical carcinoma was analyzed. The study found that the expression level of HOTAIR in primary cervical carcinoma is closely related to tumor metastasis and prognosis. The expression level of HOTAIR in paracancerous tissue was significantly lower than that in cancer tissue, and the expression level of HOTAIR in vaginal discharge and serum was higher than that in cervical carcinoma patients which was positively correlated with tumor malignancy, meanwhile, HOTAIR was significantly reduced after surgery 3 months both in vaginal discharge and serum. In order to examine the diagnostic efficiency of HOTAIR for cervical carcinoma, we found that the area under curve of vaginal discharge was 0.9723, sensitivity was 92%, specificity was 98%, the area under curve of serum was 0.8518, sensitivity was 79%, and specificity was 94% by receiver operating characteristic analysis. The accuracy were 92.7% and 89.3% in vaginal discharge and serum via certified by cervical carcinoma and benign cervical disease patient and healthy people. The above results show that the diagnostic performance of HOTAIR in vaginal discharge is higher than that of serum, and it is expected to become a marker for cervical carcinoma diagnosis and treatment.
Health-promoting behaviors among middle-aged breast cancer survivors compared with matched non-cancer controls: A KNHANES VI-VII (2013–2018) study
Authors: Jeong Ju-Ri , Choe Yu-Ri
Published: June 2023

This study aimed to compare health-promoting behaviors between middle-aged breast cancer survivors and matched non-cancer controls. We conducted a retrospective, cross-sectional, matched case-control study using data from Korean National Health and Nutrition Examination Surveys (KNHANES) VI-VII (2013–2018) to compare health-promoting behaviors. We selected breast cancer survivors aged 40 to 65 who completed the surveys, and each case was matched with 5 non-cancer controls (1:5) based on propensity scores. With multivariable logistic regression, middle-aged breast cancer survivors were compared with controls in terms of their last screening for a second primary cancer (SPC), current smoking status, alcohol consumption, aerobic physical activity (PA), sedentary time, and self-reported diet control. The final study sample consisted of 117 middle-aged breast cancer survivors and 585 non-cancer controls after propensity score matching (PSM). In the multivariable analysis, middle-aged breast cancer survivors were less likely to consume alcohol (odds ratio [OR] 0.58, 95% confidence interval [CI], 0.35–0.95), more likely to engage in aerobic PA (OR, 1.60; 95% CI, 1.01–2.54), and more likely to self-report diet control (OR, 2.12; 95% CI, 1.27–3.53). There were no significant intergroup differences in SPC screening uptake within 2 years, smoking status, or sedentary times. There is a need to educate middle-aged breast cancer survivors about SPC screening, smoking cessation, and minimizing sedentariness to reduce the risks of associated with breast cancer recurrence, SPCs, and comorbid chronic diseases.
The relationship between VEGF-460(T>C) polymorphism and cancer risk: A systematic review and meta-analysis based on 46 reports
Authors: Qin Haoran , Xiao Qiang , Xie Yufen , Li Dan , Long Xiaozhou , Li Taiping , Yi Siqing , Liu Yiqin , Chen Jian , Xu Foyan
Published: June 2023

Background:

Extensive studies on the link between single nucleotide polymorphisms (SNPs) in vascular endothelial growth factor (VEGF) and various malignancy risks produced conflicting results, notably for VEGF-460(T/C). To evaluate this correlation more comprehensively and accurately, we perform a meta-analysis.

Methods:

Through retrieving 5 databases (Web of Science (WoS), Embase, Pubmed, Wanfang database (Wangfang), and China National Knowledge Infrastructure (CNKI)) and applying hand search, citation search, and gray literature search, 44 papers included 46 reports were enrolled. To evaluate the relationship between VEGF-460 and cancer risk, we pooled odds ratios (ORs) and 95% confidence intervals (CIs).

Results:

Our results indicated that the VEGF-460 polymorphism is not related to malignancy susceptibility (dominant model, OR = 0.98, 95% CI = 0.87–1.09; recessive model, OR = 0.95, 95% CI = 0.82–1.10; heterozygous model, OR = 0.99, 95% CI = 0.90–1.10; homozygous model, OR = 0.92, 95% CI = 0.76–1.10; additive model, OR = 0.98, 95% CI = 0.90–1.07). While, in subgroup analysis, this SNP may reduce the risk of hepatocellular carcinoma.

Conclusion:

this meta-analysis indicated that VEGF-460 was irrelevant to overall malignancy risk, but it might be a protective factor for hepatocellular carcinoma.
Decision-making for intensive rehabilitation in patients with Trousseau syndrome: Insights from a case series
Authors: Takeshima Shinichi , Kawate Nobuyuki
Published: June 2023

Rationale:

Patients with Trousseau syndrome, a common complication of advanced cancer, typically have poor survival. For that reason, there is a need to determine the effectiveness of rehabilitation treatment and develop a comprehensive treatment strategy earlier than that in the general stroke population. We investigated the relationship between physical function and its outcome 1 month after the start of intensive rehabilitation treatment in patients with Trousseau syndrome, to obtain insights for determining the indications for intensive rehabilitation in these patients.

Patient concerns:

The development of Trousseau syndrome may worsen the performance status (PS), often necessitating a reevaluation of the indications for treatment of the primary cancer. Furthermore, the primary cancer may progress during rehabilitation therapy.

Diagnoses:

These patients were diagnosed with Trousseau syndrome.

Interventions:

All patients underwent training under the supervision of a therapist for 2 to 3 hours per day, 7 days per week, with a focus on exercise therapy. The functional independence measure (FIM) 1 month after admission to the convalescent rehabilitation ward, modified Rankin scale (mRS) score on admission and on the date of last assessment, and its outcome was examined.

Outcomes:

The time from stroke onset to admission to rehabilitation ranged from 22 to 60 days. Primary cancers were lung, bladder, prostate, ovarian, uterine, and unknown primary. Four patients had advanced cancer with distant metastasis. Two patients were discharged to home with independent activities of daily living (ADL) status. Two patients were transferred to palliative care, and 3 patients died. The 2 patients with independent ADL status had a mean motor score of 90 and a mean cognitive score of 30 on FIM, while the other 5 patients had a mean motor score of 29 and a mean cognitive score of 21 at 1 month of admission. Patients with mRS > 3 on admission did not have independent ADL status at 1 month.

Lessons:

Intensive rehabilitation therapy may be indicated for patients with Trousseau syndrome who are expected to improve physical function after approximately 1 month of rehabilitation. Palliative care should be considered if recovery is inadequate.
A novel epithelial–mesenchymal transition-related lncRNA signature predicts prognosis and immune status in endometrioid endometrial cancer
Authors: Jin Yichao , Qiu Yixuan , Li Yujing , Jiang Ziwei , Hu Siwen , Dai Huihua
Published: June 2023

The pathogenesis and progression of endometrial cancer (EC) are associated with epithelial–mesenchymal transition (EMT) and long noncoding RNAs (lncRNAs). In the present study, we aimed to identify an EMT-related lncRNA signature and evaluate its prognostic value in EC. We obtained the expression profile of lncRNAs and clinical information of patients with endometrioid EC from The Cancer Genome Atlas database (N = 401). We identified a signature of 5 EMT-related lncRNAs and calculated the risk score of each patient. Next, we validated the independence of the prognostic value of the EMT-related lncRNA signature. Furthermore, we performed Gene Set Enrichment Analysis to identify potential molecular function and Kyoto Encyclopedia of Genes and Genomes pathways related to the EMT-related lncRNA signature. Tumor microenvironment analysis and immune checkpoint blockade (ICB) response prediction were also assessed. Survival analysis revealed that the high-risk group, based on the EMT-related lncRNA signature, had a poorer prognosis than the low-risk group in the training, testing, and entire sets. The predictive value of the EMT-related lncRNA signature was independent of age, The International Federation of Gynecology and Obstetrics stage, tumor grade, and body mass index. Time-dependent receiver operating characteristic curves also demonstrate the prognostic accuracy of this risk model. Gene Set Enrichment Analysis showed that cytokine-cytokine receptor interaction, glycolysis/gluconeogenesis, and IL-17 signaling pathway were significantly enriched. Furthermore, tumor microenvironment analysis indicated a significant negative correlation between the immune score and EMT-related lncRNA signature risks core, while the low-risk group was more likely to respond to ICB therapy than the high-risk group. A reliable EMT-related lncRNA signature of endometrioid EC was identified that could be utilized as an independent prognostic biomarker to predict patient survival outcomes and provide references for the option of ICB therapy.
Association between pregnant women with rheumatoid arthritis and preeclampsia: A systematic review and meta-analysis
Authors: Tian Lv , Zhang Zhiyuan , Mao Yuting , Zong Minru
Published: June 2023

Background:

To examine the association between pregnant women with rheumatoid arthritis (RA) and the risk of preeclampsia.

Methods:

This study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42022361571. The primary outcome was preeclampsia. Two evaluators independently reviewed the included studies, assessed their risk of bias, and extracted the data. Unadjusted and adjusted ratios with 95% confidence intervals and 95% prediction intervals were calculated. Heterogeneity was quantified using the І
2 statistic, where І
2 ≥ 50% indicated the presence of significant heterogeneity. Subgroup and sensitivity analyses were performed to test the robustness of the overall findings.

Results:

A total of 8 studies, including 10,951,184 pregnant women, of whom 13,333 were diagnosed with RA, met the inclusion criteria. Meta-analysis revealed that pregnant women with RA were significantly more likely to develop preeclampsia than those without RA (pooled odds ratio, 1.66; 95% confidence interval, 1.52–1.80; P < .001; І
2 < .001).

Conclusion:

RA during pregnancy is associated with higher odds of preeclampsia.