bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Lobar Emphysema
Authors: Sinton Jamie W.
Published: March 2023

Respiratory distress is common among newborns and has many potential etiologies. It may also be the first sign of neonatal lobar emphysema (NLE). NLE is characterized by hyperinflation with progressive air trapping and respiratory distress. Initial goals in management are to make an accurate diagnosis (as chest roentgenogram appearance is similar to simple pneumothorax) and prevent further enlargement of the lobe and its consequent mass effect on cardiorespiratory structures. This can be accomplished by maintenance of spontaneous ventilation and avoidance of positive pressure. Management is surgical with a lobectomy of the affected lung lobe (usually left upper). Outcomes are acceptable; however, controversy exists surrounding the optimal surgical technique, namely, open versus thoracoscopic.
Myelomeningocele
Authors: Karroum Rami Edward
Published: March 2023

Spinal dysraphism is a group of congenital defects involving the midline structures of the back. Myelomeningocele is the most common type. It is usually diagnosed with fetal ultrasound during pregnancy. It presents surgical urgency and needs to be performed within 24 hours after delivery to prevent infection and reduce the progression of neurological damage. Hydrocephalus due to Chiari malformation type 2 is a common association. Patients can develop latex allergy later in life; therefore, all centers recommend a latex-free environment from birth. Anesthetic considerations are focused on proper positioning during induction to facilitate intubation and prevent the rupture of the sac. Prone positioning for the procedure is another anesthetic challenge. Maintaining normothermia and normovolemia is another important objective for anesthesia.
Musculoskeletal Disease
Authors: Sinton Jamie W.
Published: March 2023

The spectrum of musculoskeletal disease varies widely. Ambiguity in diagnosis or presentation to the operating room without a definitive diagnosis provides a common challenge to the anesthesiologist. Children with musculoskeletal disease may be uniquely vulnerable to malignant hyperthermia, anesthesia-induced rhabdomyolysis, covert cardiac dysfunction, or respiratory embarrassment. Children with skeletal disorders present unique airway and ventilatory challenges. Postoperative disposition may require escalation in respiratory care with multispecialty input. Finally, analgesia in any child with musculoskeletal disease requires careful consideration regarding risks and benefits of regional analgesics and opioids. This chapter focuses on Duchenne muscular dystrophy, spinal muscular atrophy, and osteogenesis imperfecta. Neither malignant hyperthermia nor cerebral palsy is addressed here.
Developmental Delay, Autism, and Cerebral Palsy
Authors: Berkelhamer Maura C.
Published: March 2023

This chapter examines a constellation of neurologic disorders producing atypical patterns of human development that impact cognitive and motor abilities. Patients affected with these conditions present with a wide spectrum of neurologic impairment. Disorders of other organ systems and comorbidities exist in these patients as a result of their motor and cognitive impairment, including respiratory insufficiency, gastroesophageal reflux, obstructive sleep apnea, hypothalamic dysfunction, growth failure, and growth abnormalities. Understanding typical child developmental milestones is important for comparison. Delivery of anesthesia, beginning with induction, must consider the cognitive and behavioral abilities of the patient affected with developmental disabilities. The patient’s neurologic abnormalities can impair respiratory function and impact the pharmacodynamics of anesthetic drugs. This makes perioperative planning for these patients and their caregivers essential to ensure a safe hospital and postoperative course.
Childhood Obesity
Authors: Salik Irim
Published: March 2023

Childhood obesity is one of the direst medical and public health concerns of our generation. This chapter reviews the etiology, prevalent comorbidities, clinical interventions for treatment, and anesthetic implications of childhood obesity. The prevalence of childhood obesity is unacceptably high, and the rate of increase in severe obesity continues to grow. Because of its complex etiology stemming from the interaction of genetic, biological, environmental, and ecological factors, it has been difficult to manage. The serious medical comorbidities associated with childhood obesity necessitate effective treatment modalities, utilizing a staged approach to management. Children with poor responses to primary care management strategies should utilize a multidisciplinary team with expertise in pediatric obesity. Pharmacotherapy and/or bariatric surgery should be considered if there is no response to structured weight management. Although significantly more research is needed to optimize management strategies, interventions at the level of the primary care provider, family, school, and government have shown success in the prevention of childhood obesity. There are a number of anesthetic implications in obese children, most important of which is the increased incidence of perioperative adverse respiratory events in this population as opposed to normal weight controls. Anesthesiologists should be well versed and adequately prepared to manage airway complications as they arise in obese children.
Malignant Hyperthermia in Children
Authors: Edjiu Narbeh , Gutstein Howard B.
Published: March 2023

Malignant hyperthermia (MH) is a life-threatening autosomal dominant disorder of skeletal muscle. Exaggerated calcium release within skeletal muscle results in a severe hypermetabolic state when susceptible individuals are exposed to volatile inhaled anesthetics and/or succinylcholine. A mutation in the ryanodine receptor (RYR1) gene is responsible for most cases. Several congenital myopathies have increased MH susceptibility. Children account for approximately 50% of documented reactions. Early clinical signs include muscle rigidity (particularly masseter spasm), hypercarbia, and tachycardia. Later, hyperthermia, electrolyte abnormalities, severe acidosis, and rhabdomyolysis can develop. Differential diagnosis includes sepsis; thyroid storm; pheochromocytoma; overheating; neuroleptic malignant syndrome (NMS); serotonin syndrome; overdose of abused drugs (cocaine, “ecstasy”); and sudden hyperkalemic cardiac arrest. The caffeine-halothane contracture test (CHCT) remains the most reliable diagnostic test. Dantrolene is the treatment of choice and has reduced mortality to under 20%. This chapter outlines the management of MH susceptibility and episodes in pediatric patients.
Maternal Physiology
Authors: Shah Nimit K. , Al-Jindi Piotr
Published: March 2023

Pregnancy affects almost every organ system in a parturient’s body. Various anatomical and physiological changes in pregnancy that have significant implications for an anesthesiologist caring for a pregnant patient. Pregnant patients are more likely to present with a difficult airway and a high risk of aspiration during anesthesia. The incidence of difficult mask ventilation and difficult intubation is higher than in nonpregnant patients. All patients should be considered as having a full stomach from 16 weeks of pregnancy to 48 hours postpartum. There are significant cardiovascular changes, such as supine hypotension syndrome, which mandates left uterine displacement when a parturient is supine. There is an increase in plasma volume more than red cell volume, resulting in physiological anemia of pregnancy and an increase in both cardiac output and heart rate with a decrease in systolic and diastolic blood pressures—all changes designed for coping with blood loss during delivery. There is a reduction in functional residual capacity (FRC) due to the gravid uterus pushing the diaphragm up. The increased oxygen consumption, along with reduced FRC, can lead to faster desaturation, and adequate preoxygenation is vital. Pregnancy is also a hypercoagulable state meant for minimizing blood loss during delivery, and the incidence of deep vein thrombosis and pulmonary embolism is higher than for nonpregnant patients, so these patients will routinely receive thromboprophylaxis. The minimum alveolar concentration 50 is reduced by about 30%–40% in pregnant patients, and the dose of local anesthetic for neuraxial blocks should be reduced by 25%–40%.
Labor Analgesia
Authors: Uzodinma Ifomachukwu , Al-Jindi Piotr
Published: March 2023

The treatment of labor pain consists of multiple therapies to reduce maternal discomfort while maintaining fetal well-being. Visceral, somatic, and sympathetic contributions lead to the pain experienced by the parturient during labor. Neuraxial modalities provide superior analgesia for the laboring patient. Spinals provide rapid analgesia, epidurals provide maintenance of labor analgesia, while the combined spinal-epidurals offer the benefits of rapid onset and good anesthetic maintenance. Epidural delivery systems have had many changes over the years. Early methods of epidural medication administration started with intermittent boluses by anesthesia providers, progressing to continuous epidural infusions and patient-controlled epidurals. Recent technologies have found that the use of programmed intermittent epidural boluses provides superior analgesia for labor pain based on the concept that bolus dosing of local anesthetics provides improved epidural spread and improved sensory blockade.
Systemic Medications
Authors: Uzodinma Ifomachukwu , Al-Jindi Piotr
Published: March 2023

Systemic medications have been used in the management of labor analgesia since the late 1840s. Inhalational and parenteral medications offer a viable alternative to neuraxial analgesia. The pharmacokinetics of different opioids determine the agent that may be ideal to manage labor pain while limiting the deleterious effects on the parturient and fetus. Morphine and meperidine are opioids with potent metabolites that have long half-lives. When used in the later phases of labor, morphine-6-glucoronide and normeperidine will often result in respiratory alterations and decreased Apgar scores in the neonate. Most recently, remifentanil has been used in patient-controlled analgesia systems for labor analgesia. Remifentanil is a beneficial agent due to its rapid onset of analgesia; it should be used judiciously as it increases maternal respiratory depression. Inhaled nitrous oxide is a popular option used to treat labor pain and may help mitigate anxiety. Despite the variable pain relief offered by nitrous oxide, maternal satisfaction scores are often high due to their increased independence during the childbirth experience. Optimal scavenging systems should always be employed when using nitrous oxide in order to reduce adverse effects to the anesthesia provider.
Complications of Obstetric Anesthesia
Authors: Lampert Peter , Schroeder Kristopher M.
Published: March 2023

Obstetric anesthesia can be both highly rewarding and equally litigious as patient expectations are high; the implications of anesthetic complications can profoundly impact both mother and infant, and anesthetic interventions are frequently performed in an urgent fashion. The complications that can arise during the anesthetic management of obstetric patients are not unique to this patient population. However, the physiologic and anatomic changes associated with pregnancy can impact the incidence and severity of these complications. Understanding and conveying the risks of these complications is an essential component of the informed consent process. In addition, rapid diagnosis and management of these complications should increase the likelihood of a favorable outcome. Frequently encountered complications include postdural puncture headaches and neurologic complications consisting of peripheral nerve palsies. Fortunately, the complications are generally self-limited, but the severity and implications of these complications may prompt patients to seek expedited treatment of these symptoms.
Hazards and Complications
Authors: Naftalovich Rotem , Shah Manan Nimish
Published: March 2023

Anesthesia for ear, nose, and throat surgery necessitates unique considerations for hazards from surgical complications that can jeopardize the airway, preexisting conditions with potential to render difficulty in oxygenation and ventilation, and intraoperative field avoidance. A mass in close proximity to the airway may best be managed by securing the airway in the awake state because general anesthesia and paralysis result in loss of muscle tone that may otherwise be maintaining airway patency. Rigid bronchoscopy, reinforced endotracheal tubes, and emergent proning are potential life-saving options. The nature of aspirated material is a consideration in management. Maintaining spontaneous ventilation is an important consideration with foreign body aspiration since positive pressure ventilation can push the object further downstream in the airway, and so can the endotracheal tube itself. If pooling blood compromises visualization of the vocal cords, air bubbles emitting from the trachea with external stomach compression may clue the provider to the tracheal opening. Edematous tissue is often friable and bleeds easily, which can compromise the airway. Epinephrine is commonly used to decrease bleeding and improve visualization; this often leads to iatrogenic hemodynamic changes, which can easily be misdiagnosed with poor communication. If throat packing is used, it is crucial that removal is not forgotten prior to extubation.
Intraoperative Thyroid and Parathyroid Function Monitoring
Authors: Lacourrege Kelsey E. , Kaye Alan D.
Published: March 2023

Thyroid and parathyroid surgeries are performed for a variety of reasons, including cancer and noncancer. Appreciating the anatomic location and normal physiologic function of both the thyroid and parathyroid glands is imperative to appreciate the potential consequences and complications from surgery in this region. There are a number of safeguards that have become common to minimize complications, including monitoring of the recurrent laryngeal nerve and serial measurement of the parathyroid hormone and calcium levels. In both surgeries, good judgment and careful practice are required to achieve the best outcome. Hematoma and bleeding around the airway can result in morbidity and mortality. This chapter highlights perioperative concerns and practices with added focus on physiology and pathophysiologic states.
Carbon Monoxide Poisoning
Authors: Aquino Ben
Published: March 2023

Carbon monoxide (CO) is a byproduct of a significant number of chemical and biological processes. In high amounts, it can be fatal because of its ability to bind to the hemoglobin (Hb) molecule with an affinity more than 200 times that of oxygen (O2), creating a carboxyhemoglobin (COHb) molecule. This reduces the number of hemoglobin molecules available to bind oxygen and decreases the blood oxygen content. CO also changes the conformation of the hemoglobin molecule in a way that reduces its ability to release bound O2, creating a leftward shift in the oxyhemoglobin dissociation curve. Anesthesiologists need to be mindful of CO because under certain conditions it can build up in the anesthesia circuit and cause dangerously high patient carboxyhemoglobin levels. Carbon monoxide poisoning is difficult to detect because CO is a colorless and odorless gas, and early symptoms of poisoning in an awake patient, like headaches and fatigue, are very nonspecific. No single sign or symptom is pathognomonic for CO poisoning, which puts the onus on the clinician to suspect, diagnose, and treat it properly.
Drowning
Authors: Covington Derek Brady , Giordano Christopher
Published: March 2023

An estimated 500,000 deaths occur from drowning worldwide each year. A drowning happens when a person is submerged or immersed in fluid that subsequently blocks the airway and inhibits respiration. Drownings are labeled as witnessed or nonwitnessed for prognostic value. Regardless of whether the victim lives or dies in this process, they are considered to be involved in a drowning incident. Although shallow-water blackout may result in drowning, it occurs secondary to a specific sequence of events leading to hypoxia and subsequent loss of consciousness in shallow water (i.e., less than 15 feet deep). When someone is initially submerged in fluid during a drowning, they hold their breath until the carbon dioxide accumulates to a level that triggers inhalation. Because there is no surrounding air to inspire, the surrounding liquid is inhaled and laryngospasm may occur, leading to additional breath holding. The victim eventually becomes hypercarbic, hypoxemic, and unconscious. The ultimate mechanism of death is secondary to extreme and irreversible hypoxia. Cardiac arrest during drowning is due primarily to lack of oxygen. Consequently, it is important that cardiopulmonary resuscitation (CPR) follows the traditional airway-breathing-circulation, or ABC, sequence and starts with five initial rescue breaths. Two risk factors associated with a higher incidence of death or severe neurologic impairment include time of submersion longer than 10 minutes and CPR for longer than 25 minutes. Early initiation of basic life support/advanced cardiac life support (BLS/ACLS) and time of submersion of less than 5 minutes are associated with improved outcomes.
Radiological Procedures
Authors: Siddiqui Shahla
Published: March 2023

Radiological cases that require anesthesiology support can be challenging. The hazards of performing general anesthesia or sedation procedures in remote areas include the fact that the providers may not have adequate support and backup personnel and equipment in the case of an emergency. The usual causes of challenge can be in providing anesthesia, airway support, sedation, and hemodynamic support to unstable cases in remote areas; transporting such patients to and from the intensive care unit; and recovering patients in remote areas. Preparation and communication can be vital in such scenarios. Special preparation is required if the patient is COVID-19 positive.
Radiotherapy Planning
Authors: Ajithkumar Thankamma
Published: March 2023

Radiotherapy treatment is still based on the immutable principles of physics and biology and the fundamental approaches of logical thinking, audit, and appropriate analysis of treatment outcomes, including patterns of failure, research, and collaborative working must still underpin practice. This handbook is a guide to modern radiotherapy practice which is firmly based on unchanging principles. Describing advanced radiotherapy techniques as well as simpler field-based arrangements, this handbook provides sufficient information for clinical practice even in regions with limited resources. The site-specific chapters present the underlying principles of current treatment approaches to ensure the handbook will remain appropriate and useful despite future changes. In addition, it provides a discussion of the most important clinical trials which have informed the current approaches to treatment. It also includes imaging features of different tumours to enable clinicians to choose appropriate images for target volume delineation. This handbook will give an accessible introduction to new trainees in the specialty.
Removing barriers to accessing medical cannabis for paediatric patients
Authors: Huntsman Richard J , Elliott Jesse , Lewis Evan , Moore-Hepburn Charlotte , Alcorn Jane , Mansell Holly , Appendino Juan P , Bélanger Richard E , Corley Scott , Crooks Bruce , Denny AnneMarie M , Finkelstein Yaron , Finley Allen , Fung Ryan , Gilpin Andrea , Litalien Catherine , Jacobs Julia , Oberlander Timothy F , Palm Ashley , Palm Jacob , Polewicz Monika , Quinn Declan , Rassekh S Rod , Repetski Alexander , Rieder Michael J , Robson-McKay Amy , Seifert Blair , Shackelford Alan , Siden Hal , Szafron Michael , ‘t Jong Geert , Vaillancourt Régis , Kelly Lauren E
Published: March 2023

Medical cannabis (MC) may offer therapeutic benefits for children with complex neurological conditions and chronic diseases. In Canada, parents, and caregivers frequently report encountering barriers when accessing MC for their children. These include negative preconceived notions about risks and benefits, challenges connecting with a knowledgeable healthcare provider (HCP), the high cost of MC products, and navigating MC product shortages. In this manuscript, we explore several of these barriers and provide recommendations to decision-makers to enable a family-centered and evidence-based approach to MC medicine and research for children.
Cannabis Use and Symptomatic Relapse in First Episode Schizophrenia: Trigger or Consequence? Data From the OPTIMISE Study
Authors: Levi Linda , Bar-Haim Mor , Winter-van Rossum Inge , Davidson Michael , Leucht Stefan , Fleischhacker Wolfgang W , Park Jinyoung , Davis John M , Kahn Renè S , Weiser Mark
Published: March 2023

Background and Hypothesis

This analysis examined the relationship between cannabis use, compliance with antipsychotics and risk for relapse in patients in remission following a first episode of schizophrenia, schizophreniform, or schizoaffective disorder.

Study Design

Analyses were performed on data from a large European study on first episode of schizophrenia, schizophreniform, or schizoaffective disorder (OPTiMiSE). After 10 weeks of antipsychotic treatment, 282/446 patients (63%) met criteria for symptomatic remission; of whom 134/282 (47.5%) then completed a 1-year follow-up. Cross-lagged models and mediation models investigated the temporal relationships between cannabis use, compliance with antipsychotics, social functioning, and symptomatic worsening/relapse.

Study Results

Compared to nonusers, cannabis use increased risk for relapse, adjusted hazard ratio (HR) = 3.03 (SE = 0.32), P < .001, even in patients who were compliant with antipsychotic medication, adjusted HR = 2.89, (SE = 0.32), P < .001. Cannabis use preceded symptomatic worsening and was followed by worsening of Positive and Negative Syndrome Scale total score at the 1-year end-point (standardized β = 0.62, SE = 0.19, P = .001) and by worsening of social functioning (coef = −0.66, P ≤ .001).

Conclusions

In patients in remission from their first episode of schizophrenia, schizophreniform, or schizoaffective disorder, cannabis use increases the rate of relapse in both compliant and noncompliant individuals. Importantly, the temporal relationship between cannabis and relapse was that cannabis use preceded later relapse, noncompliance, and decrease in social functioning, and not that patients began to relapse, then used cannabis. Further research with a precision psychiatry approach might identify those patients in particular danger of relapse when using cannabis.
Safety and effectiveness of laparoscopic appendectomy in patients undergoing abdominal surgery
Authors: Tazeoglu Deniz , Benli Sami , Esmer Ahmet Cem
Published: March 2023

Background

Although laparoscopic appendectomy is the criterion-standard treatment method for acute appendicitis, the decision on laparoscopic or conventional technique is usually made according to individual perspectives. The reasons affecting this individual point of view include whether the disease is complicated, the infrastructure of the hospital, the patient's comorbid factors, and previous intra-abdominal operations. This cross-sectional retrospective study aimed to evaluate the safety of laparoscopic appendectomy in patients with a possible diagnosis of “appendicitis” in patients who had undergone previous abdominal surgery.

Methods

Patients who were operated on with the diagnosis of acute appendicitis in our clinic between March 2021 and March 2022 were retrospectively analyzed. Patients were grouped as those with a history of abdominal surgery (group 1) and without (group 2). In addition, demographic data of the patients (age, sex), body mass index, presence of comorbid disease, history of abdominal surgery, operation time, rate of conversion to open surgery, postoperative hospital stay, complications, and radiological and pathological appendix size were recorded.

Results

A total of 181 patients were included in the study. The mean age was 32.51 ± 15.89 years. Seventy (38.7%) of the patients were female, and 111 (61.3%) were male. Thirty-four patients (18.8%) were in group 1, and 111 patients (81.2%) were in group 2. The mean age, body mass index, and operation time in group 1 were statistically higher than in group 2 (P < 0.001). However, there was no difference between the groups regarding postoperative hospital stay, radiological and pathological appendix size, conversion to open surgery, and presence and severity of complications (P > 0.05).

Conclusion

In line with the data the authors have shown in their study, a laparoscopic appendectomy can be performed safely in patients who have undergone abdominal surgery. Therefore, surgeons should not stray from a laparoscopic appendectomy when they see an abdominal incision.
Increased blood flow of spinal cord lesion after decompression improves neurological recovery of degenerative cervical myelopathy: an intraoperative ultrasonography-based prospective cohort study
Authors: Chen Guoliang , Lin Chengkai , Zhu Zhengya , Tong Kuileung , Li Shiming , Chen Hongkun , Xu Zuofeng , Chen Ningning , Liu Xizhe , Liu Shaoyu
Published: March 2023

Introduction:

Surgical decompression is a highly effective therapy for degenerative cervical myelopathy (DCM), but the mechanisms of neurological recovery following decompression remain unclear. This study aimed to evaluate the spinal cord blood flow status after sufficient decompression by intraoperative contrast-enhanced ultrasonography (CEUS) and to analyze the correlation between neurological recovery and postdecompressive spinal cord blood perfusion in DCM.

Materials and methods:

Patients with multilevel DCM were treated by ultrasound-guided modified French-door laminoplasty using a self-developed rongeur. Neurological function was evaluated using the modified Japanese Orthopaedic Association (mJOA) score preoperatively and at 12 months postoperatively. Spinal cord compression and cervical canal enlargement before and after surgery were assessed by magnetic resonance imaging and computerized tomography. The decompression status was evaluated in real time by intraoperative ultrasonography, while the spinal cord blood flow after sufficient decompression was assessed by CEUS. Patients were categorized as favourable (≥50%) or unfavourable (<50%) recovery according to the recovery rate of the mJOA score at 12 months postoperatively.

Results:

Twenty-nine patients were included in the study. The mJOA scores were significantly improved in all patients from 11.2±2.1 preoperatively to 15.0±1.1 at 12 months postoperatively, with an average recovery rate of 64.9±16.2%. Computerized tomography and intraoperative ultrasonography confirmed adequate enlargement of the cervical canal and sufficient decompression of the spinal cord, respectively. CEUS revealed that patients with favourable neurological recovery had a greater increased blood flow signal in the compressive spinal cord segment after decompression.

Conclusions:

In DCM, intraoperative CEUS can clearly reflect spinal cord blood flow. Patients with increased blood perfusion of the spinal cord lesion immediately after surgical decompression tended to achieve greater neurological recovery.
The three-dimensional weakly supervised deep learning algorithm for traumatic splenic injury detection and sequential localization: an experimental study
Authors: Cheng Chi-Tung , Lin Hou-Shian , Hsu Chih-Po , Chen Huan-Wu , Huang Jen-Fu , Fu Chih-Yuan , Hsieh Chi-Hsun , Yeh Chun-Nan , Chung I-Fang , Liao Chien-Hung
Published: March 2023

Background:

Splenic injury is the most common solid visceral injury in blunt abdominal trauma, and high-resolution abdominal computed tomography (CT) can adequately detect the injury. However, these lethal injuries sometimes have been overlooked in current practice. Deep learning (DL) algorithms have proven their capabilities in detecting abnormal findings in medical images. The aim of this study is to develop a three-dimensional, weakly supervised DL algorithm for detecting splenic injury on abdominal CT using a sequential localization and classification approach.

Material and methods:

The dataset was collected in a tertiary trauma center on 600 patients who underwent abdominal CT between 2008 and 2018, half of whom had splenic injuries. The images were split into development and test datasets at a 4 : 1 ratio. A two-step DL algorithm, including localization and classification models, was constructed to identify the splenic injury. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Grad-CAM (Gradient-weighted Class Activation Mapping) heatmaps from the test set were visually assessed. To validate the algorithm, we also collected images from another hospital to serve as external validation data.

Results:

A total of 480 patients, 50% of whom had spleen injuries, were included in the development dataset, and the rest were included in the test dataset. All patients underwent contrast-enhanced abdominal CT in the emergency room. The automatic two-step EfficientNet model detected splenic injury with an AUROC of 0.901 (95% CI: 0.836–0.953). At the maximum Youden index, the accuracy, sensitivity, specificity, PPV, and NPV were 0.88, 0.81, 0.92, 0.91, and 0.83, respectively. The heatmap identified 96.3% of splenic injury sites in true positive cases. The algorithm achieved a sensitivity of 0.92 for detecting trauma in the external validation cohort, with an acceptable accuracy of 0.80.

Conclusions:

The DL model can identify splenic injury on CT, and further application in trauma scenarios is possible.
A case study of myopericarditis due to immune checkpoint inhibitor therapy: Proposed surveillance and management
Authors: Kuhnly Nicole M. , Coviello Jessica Shank
Published: March 2023

Immune checkpoint inhibitor (ICI) therapy is a treatment modality used in many types of cancer. Immune-related adverse events are relatively common. Cardiovascular adverse events are uncommon, but carry a high mortality rate of 25–50%. They require cessation of therapy. There is currently no universal screening before initiation of ICI therapy to identify patients with cardiovascular risk. There is also no ongoing screening to identify myocarditis and treatment is driven by symptoms. This article provides a case study of a patient who developed myopericarditis and the patient's clinical course. Furthermore, it proposes surveillance for patients before and during ICI therapy to swiftly identify potential cases of myocarditis. There is currently no universal baseline screening for cardiovascular risk in patients planned for ICI therapy. A proposed baseline cardiac evaluation, as well as scheduled surveillance therapy, is outlined in this article. With further education and training, immune-related cardiac adverse events may be more promptly detected, leading to better patient outcomes.
Investigating the effect of history of fractures and hypertension on the risk of all-cause death from osteoporosis: A retrospective cohort study
Authors: Chen Xiao , He Binbin , Zhou Youliang , Zhang Xinguo , Zhao Liang
Published: March 2023

To assess the coexistence effect between history of fractures and hypertension on the all-cause death risk of osteoporosis. In this retrospective cohort study, some characteristics of osteoporosis patients aged ≥ 20 years were extracted from the National Health and Nutrition Examination Survey (NHANES) database (2005–2010, 2013–2014), such as age, gender, smoking, drinking, the history of diabetes, cardiovascular and cerebrovascular diseases, fractures and hypertension. The outcome of this study was defined as all-cause death of osteoporosis. These patients were followed up until 2015 with an average follow-up time of 62.00 ± 34.79 months. Univariate and multivariate logistic regression was utilized to evaluate the association of history of fractures and hypertension on all-cause death risk of osteoporosis, respectively. The death risk factors were presented by using relative risk (RR) and 95% confidence interval (CI). The attributable proportion (AP) to explore the interaction between history of fractures and hypertension on the all-cause death risk of osteoporosis. Of the total 801 osteoporosis patients, 227 died. After adjusting age, gender, marital status, education background, annual household income, diabetes, the prior use of prednisone or cortisone medication, cardiovascular and cerebrovascular diseases, the history of fractures (RR = 1.502, 95% CI: 1.035–2.180), spine fracture (RR = 2.944, 95% CI: 1.244–6.967), hip fracture (RR = 2.033, 95% CI: 1.066–3.875) was significantly associated with the increased death risk of osteoporosis. However, there was no significant difference between hypertension and the all-cause death risk of osteoporosis (P > .05). Additionally, there was a significant interaction between the history of fractures and hypertension on the all-cause death risk of osteoporosis, and the interaction was an enhancement effect (AP = 0.456, 95% CI: 0.005–0.906). The co-existence of the history of fractures and hypertension could increase the all-cause death risk of osteoporosis, which indicated that osteoporosis patients with the history of fractures should actively monitor blood pressure levels and prevent the occurrence of hypertension.
The clinical value of DCE-MRI for differentiating secondary laryngeal cartilage lesions
Authors: Yu Jinfen , Xu Wei , Wang Linsheng , Jiang Nan , Dou Weiqiang , Li Chuanting , Sun Lixin
Published: March 2023

To explore the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the assessment of laryngeal cartilage lesions. In this study, 3 groups of cases were selected, including 16 cases benign lesions of the laryngopharynx as the benign group, 17 cases malignant lesions of laryngopharynx as the malignant group and 23 healthy adults as the control group. Conventional magnetic resonance imaging and DCE-MRI were performed with a 3.0 T MR scanner. cutoff, sensitivity, specificity and area under the curve values were calculated via receiver operating characteristic curve analysis based on the pathologic findings of surgically resected specimens. There were significant differences in the values of the volume transfer constant (K
trans), the rate constant between the extravascular extracellular space and blood plasma (K
ep) and The extravascular extracellular space fractional volume (V
e) between the control, benign and malignant groups (P < .005). Among the 3 groups, the malignant group had the highest K
trans and V
e values (0.8681 ± 0.3034 and 0.6186 ± 0.2405, respectively), and the benign group had the highest K
ep value (2.445 ± 0.7346). The cutoff points of the K
trans, K
ep, and V
e values of the control, benign and malignant groups were 0.39, 1.261, and 0.195; 0.471, 0.964, and 0.235; and 0.706, 2.005, and 0.659, respectively. The K
trans, K
ep, and V
e values obtained via DCE-MRI may enable differentiating laryngeal cartilage lesions. DCE-MRI can be used to evaluate laryngeal cartilage lesions accurately and quantitatively.
A case of chronic eosinophilic pneumonia associated with rheumatoid arthritis in glucocorticoid-free remission with JAK inhibitor: A case report
Authors: Yamane Takashi , Hashiramoto Akira
Published: March 2023

Rationale:

Chronic eosinophilic pneumonia (CEP) presents eosinophil infiltrations in the lung due to allergic reactions. Most CEP patients continue to take glucocorticoids, and their prolonged use induces various side effects. In this case report, based on the efficacy of baricitinib in patients with rheumatoid arthritis (RA) and CEP, we aimed to show that the administration of Janus kinase (JAK) inhibitors, when RA is complicated by an allergic disease, can stabilize the disease state and help avoid the adverse effects of long-term systemic glucocorticoid administration.

Patients concerns:

A 56-year-old woman developed RA at the age of 19 years. Treatment of the arthritis was initiated, but the joint destruction had progressed. At the age of 42, she developed eosinophilic pneumonia, which was relieved by glucocorticoid therapy. Since then, maintenance therapy has been continued with the diagnosis of CEP. She was treated with concomitant tacrolimus for persistent arthritis, and the prednisolone (PSL) dose was reduced to 3 mg/day after 10 years. However, around this time, an increase in peripheral blood eosinophil counts and respiratory symptoms was observed.

Diagnosis:

The peripheral blood eosinophil count was 4000/µL and computed tomography revealed multiple ground-glass opacities in the peripheral lung fields. As interstitial pneumonia due to infection or other causes was ruled out, CEP relapse was diagnosed.

Interventions:

Pneumonia rapidly recovered when the PSL dose was increased to 15 mg/day, and asymptomatic eosinophilic infiltrates reappeared in the lung field along with a relapse of arthritis when the PSL dose was reduced to 5 mg/day. Concomitant use of methotrexate and baricitinib has been introduced to suppress allergic reactions to pneumonia.

Outcomes:

After starting combination therapy with baricitinib and methotrexate, both arthritis and eosinophilia improved, and glucocorticoid-free remission was achieved.

Lessons:

Recently, inhibition of IL-5 signaling via JAK2 has been reported to be effective in bronchial asthma and atopic dermatitis. Although complications of RA and CEP are not common, the actions of baricitinib are useful not only in arthritis but also in allergic diseases. The efficacy of some JAK inhibitors should be actively tested in patients with RA and these complications.
A case report of T cell/histiocyte-rich large B cell lymphoma misdiagnosed as lymphomatoid papulosis
Authors: Kim Taekwoon , Kim Jisung , Park Joonsoo
Published: March 2023

Rationale:

T cell/histiocyte-rich large B cell lymphoma (THRLBCL) is an uncommon B cell lymphoma characterized by < 10% large neoplastic B cells in a background of abundant T cells and frequent histiocytes. If a skin lesion is the first clinical sign of lymphoma, the diagnosis might be difficult and misdiagnosed.

Patient concerns:

A 60-year-old woman presented with multiple erythematous umbilicated nodules on her left upper back for 3 months.

Diagnoses:

Through punch biopsy of the back lesion and additional excisional right inguinal lymph node biopsy, the patient was diagnosed with cutaneous metastasis of THRLBCL.

Interventions:

The patient was referred to the Hemato-oncology Department for chemotherapy.

Outcomes:

R-CHOP chemotherapy is currently in progress, and some skin lesions show improvement.

Lessons:

Skin lesions might be the first clinical sign of THRLBCL and when THRLBCL is suspected, careful further evaluation is essential for accurate diagnosis and treatment.
An obvious antinomy, superior sagittal sinus thrombosis in a patient with immune thrombocytopenia: Case report and a review of literatures
Authors: Wang Yuhui , Zhang Ge , Ding Jinggang
Published: March 2023

Rationale:

Immune thrombocytopenia (ITP) is an autoimmune disease with an increased risk of bleeding. However, in recent years, it has been reported that patients with this hemorrhagic disease have the risk of thrombosis and embolism.

Patient concerns and diagnosis:

The patient, in this case, was a young female who was diagnosed with ITP. When the platelet count was low, she had skin, mucosa, internal organs, and intracranial hemorrhage. In the process of ITP and hemostatic treatment, superior sagittal sinus thrombosis occurred when she was still bleeding.

Interventions:

She was given treatments for reducing intracranial pressure and controlling epilepsy.

Outcomes:

And then the embolectomy operation failed. It was suggested in this case that ITP patients with severe thrombocytopenia and bleeding tendency also have a risk of having thrombotic disease. We reviewed literatures regarding the mechanism of the simultaneous occurrence of 2 antinomy diseases and cerebral venous thrombosis.

Lessons:

There are many factors for ITP patients to have thrombosis involving ITP itself, its treatment and the patients’ constitution, medical history, and former medication. ITP is not only a hemorrhagic disease but also a thrombotic disease. Clinicians should be alert to the risk of thrombotic diseases in ITP treatment. Therefore thrombus monitoring and screening should be carried out, and early prevention or appropriate anticoagulant treatment should be selected, especially for patients with high risk.
Prognostic disparities in young patients based on breast cancer subtype: A population-based study from the SEER database
Authors: Chen Bing , Zhang Xiaojuan , Liu Yi , Wang Chuandong
Published: March 2023

Triple-negative breast cancer (TNBC) is associated with younger age and worse long-term survival. However, the characteristics and prognosis of different subtypes of breast cancer (BC) in young (<40 years) patients have not yet been elucidated. The present population-based study explored the clinical and pathological characteristics of young TNBC patients and investigated their long-term survival. We enrolled patients from the Surveillance, Epidemiology, and End Results database younger than 40 years of age with primary BC. Cases were defined as patients with TNBC (hormone receptor [HR]−/human epidermal growth factor receptor 2 [HER2]−), and controls were patients with other subtypes of BC (HR−/HER2+, HR+/HER2−, and HR+/HER2+). Demographic, pathological, and radiotherapy, chemotherapy, and surgery data were extracted and the overall survival was the primary endpoint. We enrolled 14,234 young patients with BC in the present study, of whom 2798 (19.7%) had TNBC and 11,436 (80.3%) had another BC subtype. A higher proportion of TNBC patients than non-TNBC patients had a more advanced tumor-node-metastasis stage (II–IV 80.5% vs 73.1%, P < .001), and smaller proportions underwent radiotherapy (50.0% vs 53.3%, P = .002) and surgery (91.8% vs 92.9%, P < .001). TNBC was associated with significantly lower 5-year survival rates than other subtypes among patients with regional node positivity (0, 1–3, 4–9, ≥10: 54.2% vs 57.7%, 44.2% vs 55.9%, 31.0% vs 52.0%, and 27.7% vs 38.8%, P < .001) and those with different lymph node ratios (low, intermediate, high: 50.9% vs 56.0%, 34.6% vs 53.6%, and 24.8% vs 44.8%, P < .001). Our research is the first to investigate the relevant characteristics of young TNBC patients in comparison with those of young non-TNBC patients based on the surveillance, epidemiology, and end results database. We found that young TNBC patients have a higher pathological stage and worse long-term survival than young patients with other BC subtypes. These findings have implications in identifying young patients with TNBC for aggressive therapy and further investigations should be performed to explore new multimodal treatments for such patients.
Vitamin D can ameliorate premature ovarian failure by inhibiting neutrophil extracellular traps: A review
Authors: Chen Menglu , Li Lailai , Chai Yihui , Yang Yuqi , Ma Sibu , Pu Xiang , Chen Yunzhi
Published: March 2023

The etiology of premature ovarian failure (POF) is mainly related to inflammatory diseases, autoimmune diseases, and tumor radiotherapy and chemotherapy; however, its specific pathogenesis has not been clarified. Vitamin D (VD), a fat-soluble vitamin, is an essential steroid hormone in the human body. Neutrophil extracellular traps (NETs) are meshwork structures that are formed when neutrophils are stimulated by inflammation and other factors and are closely associated with autoimmune and inflammatory diseases. Notably, VD inhibits NET formation and intervenes in the development of POF in terms of inflammatory and immune responses, oxidative stress, and tissue fibrosis. Therefore, this study aimed to theorize the relationship between NETs, VD, and POF and provide new ideas and targets for the pathogenesis and clinical treatment of POF.
Novel mutation in the SETD1A gene in a newborn patient associating with congenital airway and heart defeats: A case report
Authors: Jin Long , Mo Wendi , Yan Yu , Wang Ying
Published: March 2023

Rationale:

Congenital malformations are commonly associated with genetic disorders in infants and children.

Patient concerns:

A 13-day-old male infant was admitted to our hospital presenting with aggravated dyspnea and characteristic facial and body features. Examinations during hospitalization found congenital bronchomalacia and heart defects including atrial septal defect, patent ductus arteriosus, and pulmonary hypertension, congenital laryngeal stridor, and tracheal stenosis.

Diagnosis:

Considering complicated clinical manifestations, the Trio Whole Exon Sequencing test was run to screen for any hereditary diseases and found a heterozygous pathogenic mutation in SET domain containing 1A (SETD1A) gene (c.2096T > A; p. Leu699Ter, 1099), which was a de novo mutation.

Intervention:

The patient was given amoxicillin clavulanate potassium for antibiotic, fibro bronchoscope lavage and other symptomatic support therapy, and referred to the department of Cardiac Surgery for arterial catheter ligation.

Outcomes:

The patient was discharged after postoperative recovery without shunt. In the following 2 years, he was admitted to hospital multiple times during to infectious pneumonia.

Lessons:

SETD1A gene mutation is commonly associated with neuropsychiatric disorders. This is the first reported case with a novel mutation of SETD1A gene along with new associated phenotypes. Our results broaden the genotypic and phenotypes spectrum of SETD1A gene mutation in infant patients.
Leadership Elements in Veterans Affairs All Employee Survey
Authors: Perla Lisa Y. , Barry Erin S. , Grunberg Neil E.
Published: March 2023

Purpose/Objectives:

Veterans Affairs (VA) case managers assist and advocate for veterans navigating VA and civilian health care systems. However, government reports indicate repeated dissatisfaction with veteran care coordination. Several case management publications suggest that VA case managers lead, as well as manage, but do not indicate exactly what this means. Few published articles address leadership, specifically, among VA case managers.

The VA All Employee Survey (AES) is an annual survey of VA employees, including case managers, to gather information about their attitudes toward workplace characteristics, relationships, and leadership. The present study utilized a conceptual Leader–Follower Framework (LF2) to assess questions on the annual VA AES to determine which leadership elements are addressed, which leadership elements are not addressed, and whether there are any leadership elements that do not fit within the LF2.

Primary Practice Setting:

Case managers work in a variety of clinical settings including more than1,400 facilities throughout the United States. VA case managers advocate for safe, effective, and equitable patient care according to their scope of practice.

Findings/Conclusions:

All eight leadership elements from the LF2—Character, Competence, Context, Communication, Personal, Interpersonal, Team, and Organizational—were represented among the AES questions, and no leadership elements outside of the framework were identified. However, the leadership elements were unevenly represented within the AES questions, with communication and personal elements occurring frequently whereas context and team were underrepresented.

Implications for Case Management Practice:

These results indicate the LF2 can be used to evaluate the responses of VA employees, including those providing case management, and to address questions of interest related to leadership and may be considered in the development of future case management surveys.