bluuebunny/crossref_metadata_2025 huggingface dataset:
Study on serum vitamin A level in patients with type 1 diabetes: A systematic review and meta-analysis
Authors: Yuanyuan Guan , Wang Dongjun , Hao Yang , Guan Yun , Bu Huaien , Wang Hongwu
Published: October 2024

Background:

There is controversy about the relationship between type 1 diabetes and vitamin A (VA) levels in the body. Through meta-analysis, the results of related studies can be aggregated to more accurately estimate the relationship between type 1 diabetes mellitus (T1DM) patients and the level of VA in the body.

Methods:

Our purpose is to review the study to investigate VA levels in type T1DM patients and to provide recommendations for future studies. Until January 2024, we searched the National Library of Medicine (PubMed), Cochrane Library, Embase Databases, Web of Sciences, Scopus, China National Knowledge Infrastructure (CNKI), VIP databases (VIP) and WAN FANG databases. After a systematic search, 8 case-control studies were included in our meta-analysis. In the process of data inclusion and extraction, the 2 reviewers selected literature independently of each other. In this study, RevMan5.3 software was used for meta-analysis.

Results:

Eight case-control studies involving 689 participants were screened. The results after meta-analysis showed that there was a significant difference in serum VA between the patients with T1DM and the control group (standardized mean difference [SMD] = −0.82, 95% CI [−1.29, −0.36], P < .001, random effects model) with significant heterogeneity among these studies (P < .001, I
2 = 84%). Similarly, the difference in the high-performance liquid chromatography (HPLC) subgroup on serum VA (SMD = −0.99, 95% CI [−1.60, −0.38], P = .002) as well as the difference in the countries of Asia and Europe subgroup on serum VA (SMD = −0.60, 95% CI [−1.15, −0.05], P = .03; SMD = −1.06, 95% CI [−1.88, −0.24], P = .01) were suggested to be statistically significant. A significant result was also observed in the National Diabetes Data Group (NDDG) criteria subgroup (SMD = −0.48, 95% CI [−0.85, −0.12]).

Conclusion:

Serum VA levels seem to have decreased in T1DM patients. Further research is needed to strengthen this finding and clarify possible impact mechanisms.
Deciphering a hydrogen sulfide-related signature to supervise prognosis and therapeutic response in colon adenocarcinoma
Authors: Chen Jinbiao , Zhang Yingchun
Published: October 2024

Hydrogen sulfide (H2S) is a critical molecule that participates in various molecular, physiological, and pathophysiological processes in biological systems. Emerging evidence has revealed that H2S is implicated in the progression of colon cancer and immune escape. Against this backdrop, the present study aimed to construct a prognostic risk feature for colon adenocarcinoma (COAD) by leveraging hydrogen sulfide-related genes (HSRG). Transcriptomic data and corresponding clinical-pathological information of colon cancer were obtained from The Cancer Genome Atlas and gene expression omnibus databases. Univariate Cox regression analysis was employed to assess the prognostic relevance of HSRG. Consensus clustering was utilized to perform molecular subtyping of COAD, followed by comparison of immune cell infiltration, drug sensitivity, and immune therapy response between subtypes. Differential expression gene and gene set enrichment analyses were conducted between subtypes. Univariate, lasso, and multivariate Cox regression analyses were applied to construct a prognostic model derived from HSRG. A nomogram model for predicting COAD prognosis was constructed and evaluated. In this study, we identified 12 HSRGs that were associated with COAD prognosis. Consensus clustering analysis revealed 3 COAD molecular subtypes that exhibited significant differences in terms of prognosis, tumor immune cell infiltration, drug sensitivity, and immune therapy response. Gene set enrichment analysis demonstrated that immunoregulatory processes were significantly suppressed in the poor-prognosis subtype while Wnt-related pathways and processes were significantly upregulated. Based on the differentially expressed genes between subtypes, we constructed a risk model comprising 11 genes that effectively distinguished high-risk patients from low-risk patients with significant associations with patient survival outcomes, drug treatment, pathological staging, and T staging. The HSRG-derived risk feature was an independent prognostic factor for COAD in drug treatment and pathological staging and could be integrated into a nomogram for prognosis prediction. Calibration curve, receiver operating characteristic curve, and decision curve analysis demonstrated excellent performance of the nomogram in evaluating COAD prognosis. Our study systematically assessed the prognostic significance of HSRG in COAD, identified HSRG-based molecular subtypes and risk features, and highlighted their potential utility in predicting prognosis and treatment response.
What factors influencing surgical nurses’ competence in implementing person-centered care in the perioperative period?: A cross-sectional study
Authors: Shen Lu , Xu Dongju , Zhang Xiumei
Published: October 2024

Strengthening the capability of clinical surgical nurses to provide person-centered care (PCC) requires a thorough analysis of several related factors. This study used a descriptive cross-sectional design to investigate the factors that influence surgical nurses’ perioperative competency in the performance of PCC in Anhui, China. A convenience sampling was implemented to administer a questionnaire survey to 437 nurses with more than 1 year of experience working in surgical wards. A web-based cross-sectional questionnaire evaluated the participant’s general sociological information, empathy, job burnout, and nursing competence. The questionnaire were designed and published through the online platform Questionnaire Stars, and the link was distributed through the Internet and WeChat media by the nursing department of their hospital. Data were collected from June to September 2023 and processed by descriptive, correlation, and stepwise multiple regression analyses. Participants with high levels of empathy (β 
= 0.502, P < .001), low levels of job burnout (β 
= −0.288, P < .001), humanistic nursing training (β 
= 0.167, P < .001), and personnel agency (β 
= 0.083, P < .001) showed better PCC competence. The regression model analysis showed that 4 influencing factors explained 59.2% of the variance (F = 158.930, P < .001, adjusted R
2 = 0.592). These findings suggest that steps should be taken to strengthen the key factors, such as improving empathy, minimizing job burnout, offering more humanities training, and enhancing personalities, to reinforce PCC competency.
Incidence of respiratory depression between ciprofol and propofol after anesthesia: A systematic review and meta-analysis
Authors: Zeng Jinfang , Cao Qian , Hong Aonan , Gu Zhen , Jian Jinjin , Liang Xiao
Published: October 2024

Background:

Respiratory depression is a common complication during operative procedures, meanwhile, ciprofol can provide effective sedation for surgical operations. However, there is not enough evidence to prove the advantage of ciprofol in reducing respiratory depression. So, this meta-analysis aimed to assess the efficacy of ciprofol on the incidence of respiratory depression compared with propofol.

Methods:

Two individual researchers conducted searches for randomized controlled trials in PubMed, Embase, and Cochrane Central Register of Controlled Trials. The meta-analysis was performed using Review Manager software.

Results:

Seven trials with a total of 1408 patients were included in this meta-analysis. The results showed that ciprofol could reduce the incidence of respiratory depression compared with propofol (risk difference [RD] = −0.09, 95% confidence interval [CI]: −0.15 to −0.04). Ciprofol significantly reduced the incidence of respiratory depression when the method of administration was intravenous injection (RD = −0.06, 95% CI: −0.10 to −0.03), or continuous infusion (RD = −0.30, 95% CI: −0.45 to −0.15). Meanwhile, ciprofol significantly reduced the incidence of respiratory depression with the dosage not only greater than or equal to 0.4 mg/kg (RD = −0.11, 95% CI: −0.20 to −0.02), but also <0.4 mg/kg (RD = −0.08, 95% CI: −0.13 to −0.02). And ciprofol significantly reduced the incidence of hypoxemia (risk ratio [RR] = 0.47, 95% CI: 0.28 to 0.80), injection pain (RD = −0.32, 95% CI: −0.46 to −0.17), body movement (RR = 0.60, 95% CI: 0.43 to 0.84), dizziness (RR = 0.75, 95% CI: 0.62 to 0.90). Finally, ciprofol did not increase awakening time (standard mean difference [SMD] = 0.15, 95% CI: −0.02 to 0.31).

Conclusion:

From this meta-analysis, it is demonstrated that ciprofol might reduce the incidence of respiratory depression and injection pain. These benefits are important in surgery to ensure safe and rapid postoperative recovery. So, ciprofol may be a safe and appropriate drug with fewer adverse effects used in clinical anesthesia.
Estimation of the muscle force by perineural intramuscular electrical stimulation in healthy volunteers
Authors: Kim Jae Min , Kim Tae-Woo , Park Hye Jung , Lee Se Won , Yoo Yeun Jie , Yoon Mi-Jeong , Chang So-youn , Won Sun Jae
Published: October 2024

The present study aimed to evaluate the elbow flexor force induced by perineural intramuscular stimulation compared with surface electrical stimulation (ES) and maximal voluntary contraction. Thirty nondominant arms of healthy volunteers were evaluated. Isometric elbow flexion force was evaluated using a surface electrode stimulation at the biceps brachii muscle, a perineural intramuscular stimulation around the musculocutaneous nerve, and maximum voluntary contraction. The elbow flexion force was measured at the wrist volar area in a 90° elbow flexion posture, fixed with a rigid elbow orthosis. Pain and discomfort associated with ES were evaluated using a numeric rating scale. The mean maximum elbow flexion force was 16.6 ± 4.1 kgf via voluntary contraction. The mean elbow flexion force by ES was 2.9 ± 2.0 kgf, stimulation intensity was 24.8 ± 5.5 mA, and the numeric rating scale was 5.0 ± 2.5 via surface electrode stimulation and 3.1 ± 2.0 kgf, 5.0 mA, and 3.8 ± 1.9 via perineural stimulation, respectively. ES provides 16% to 18% of the maximal voluntary contraction force in elbow flexion, which corresponds to a fair grade of muscle force. Perineural intramuscular stimulation can generate an equivocal contraction force with less discomfort in elbow flexion than surface electrode stimulation.
A MR-PheWAS and bidirectional Mendelian randomization study: Exploring for causal relationships of pancreatic cancer
Authors: Guan Aiyu , Li Zeming , Guo Xingren
Published: October 2024

It is unknown what causes pancreatic cancer. We conducted a phenome-wide Mendelian randomization analysis (MR-pheWAS), a bidirectional Mendelian study, and a systematic review of research in order to thoroughly investigate any causal association between pancreatic cancer and Atlas. We used phenome-wide Mendelian randomization analysis to test for associations between pancreatic cancer and 776 phenotypes (n = 452,264) of Atlas in the UK Biobank. Causality is confirmed by two-sample Mendelian randomization (MR) analysis using correlation found by false discovery rate correction. Simultaneously, a comprehensive evaluation of pancreatic cancer MR studies was conducted in order to complement our findings and harmonize the existing evidence. According to the inverse-variance-weighted model, a total of 41 out of 776 phenotypes had a nominal significance level (P < .05) genetic prediction association with pancreatic cancer. Only genetically predicted pancreatic cancer was shown to be linked with elevated eosinophil counts following false discovery rate correction (P = .031) when several tests were taken into account. Pancreatic cancer and eosinophils were shown to be positively causally associated to one another, establishing a self-loop, according to two-sample MR validation in the IEU database (OR = 1.011, 95% CI: 1.002–1.020, P = .010) (OR = 1.229, 95% CI: 1.037–1.458, P = .017). Although MR-pheWAS found a strong causal relationship between eosinophils and pancreatic cancer, it also found a negative exclusion value for each phenotype and a significant number of suggestive association phenotypes that offered guidance for further research.
Primary bilateral macronodular adrenal hyperplasia: A rare case report of Cushing syndrome and review of literature
Authors: Ghanbari Boroujeni Mohammad Reza , Meftah Elahe , Zarimeidani Fatemeh , Rahmati Rahem , Esfahanian Fatemeh
Published: October 2024

Rationale:

Primary bilateral macronodular adrenal hyperplasia (PBMAH) is a rare cause of ACTH-independent Cushing syndrome (CS), accounting for <2% of CS cases. Diagnosing PBMAH can be difficult and challenging for clinicians.

Patient concerns:

We report a 52-year-old female, a patient with a history of intermittent fever for 3 years. She presented with nausea, headache, and dizziness for several days, along with fatigue, myalgia, muscle weakness, exertional dyspnea, hoarseness, spontaneous bruising over the past several months, and long-term psychological complaints. Additionally, we observed periorbital and facial edema, right lower quadrant tenderness, and abdominal striae during the examination.

Diagnoses:

Her laboratory results showed increased cortisol and suppressed ACTH, and an abdominal CT scan revealed 2 heterogeneous masses in the adrenal glands. These findings led us to the diagnosis of PBMAH in this patient. The existence of aberrant receptors was evaluated, and the tests were negative.

Interventions:

The patient underwent left adrenalectomy and corticosteroid therapy after the surgery. Her clinical complaints improved after the surgery.

Outcomes:

However, her dependency on corticosteroids was not transient after unilateral adrenalectomy, and she still needs glucocorticoid supplementation 1 year after surgery.

Lessons:

This patient is a case of PBMAH who presented with fever and CS symptoms and underwent unilateral adrenalectomy. Interestingly, she had suppressed cortisol levels for at least 1 year after the unilateral adrenalectomy. Therefore, we suggest further research on the most effective treatment strategies for PBMAH.
Ligament reconstruction for distal radioulnar joint instability with the biomechanical analysis: A case report
Authors: Zhang Baiyang , Liu Xilin , Sun Hongbin
Published: October 2024

Rationale:

The aim of the study is to evaluate the clinical effects and feasibility on chronic distal radioulnar unstable joint (DRUJ) under wrist arthroscope triangular fibrocartilage complex (TFCC) repair and reconstruction. The biomechanical characteristics of the recovery process after treatment were analyzed using finite element modeling.

Patient concerns:

A patient with chronic DRUJ instability was treated with reconstruction of the distal radioulnar ligament using the Adams Berger method. Piano sign and forearm rotation tests were used to evaluate the function of the DRUJ. Grip power, range of motion, and visual analog scale scores were recorded at the last follow-up. Joint function was evaluated by the disability of the arm, shoulder, and hand score. A geometric model for the surgical repair of TFCC damage, meshing in finite element simulation, and stress distribution of the repaired ligament during forearm rotation were analyzed by finite element simulation.

Diagnoses:

The diagnosis was confirmed as chronic DRUJ instability.

Interventions and outcomes:

The patient had no postoperative complications and was followed-up for 6 months. Stability was achieved in all patients. The results of the stress and forearm rotation tests are negative. At the last follow-up, the grip power, disability of the arm, shoulder, and hand score, visual analog scale score, and range of motion of the wrist were significantly improved compared with the preoperative values (P < .05).

Lessons:

TFCC repair and reconstruction under wrist arthroscopy can effectively treat chronic DRUJ and improve wrist function. Our study established a three-dimensional finite element model of the entire DRUJ, which provided a digital visual platform for simulating the biomechanical features of the TFCC, DRUJ, and other structures in different states. This study demonstrated that the rotation angle of the wrist joint should be confined within 75° for a short period after surgery to avoid tearing the tendon as a result of excessive force. It also provides an intuitive simulation tool for the design of TFCC repair and the evaluation of curative effects.
Gastric and small bowel metastases from lung adenocarcinoma: A case report
Authors: Wang Yan , Xu Li , Wu Jun-Lei , Wang Chao-Qun
Published: October 2024

Rationale:

Metastatic tumors in the stomach and small bowel are rare. This article reports a case of lung adenocarcinoma metastasizing to the stomach and small bowel.

Patient concerns:

This case study presents the medical history of a 41-year-old male construction worker with a 1-month-long cough and slight chest discomfort. Imaging revealed a tumor in the right middle lobe of the lung, with metastasis to lymph nodes in the mediastinum and right hilar region, as well as a mass in the stomach’s greater curvature and multiple lymph node metastases in the abdomen. Thirty-five days after the initial consultation, the patient exhibited worsening symptoms of vomiting and melena. A follow-up computed tomography scan revealed small bowel metastasis, leading to secondary intestinal obstruction and intussusception.

Diagnoses:

Biopsies confirmed poorly differentiated adenocarcinoma in the lung and stomach, with immunohistochemistry supporting a diagnosis of lung adenocarcinoma. Genetic testing showed no mutations or amplification in various genes.

Interventions:

The patient received interventional hemostatic treatment; however, the efficacy of the intervention was poor.

Outcomes:

The patient experienced worsening gastrointestinal symptoms. Despite attempted intervention, the patient ultimately died 78 days after seeking medical attention.

Lessons:

The case of lung cancer metastasizing to the stomach and small bowel presented in this article demonstrates high invasiveness and rapid progression. Combined with literature reports, this type of metastasis often indicates a poor prognosis for patients. The long-term benefits of surgical resection remain unclear, and further analysis will be needed with more cases and data in the future.
Pregnancy-associated triple-negative breast cancer: A case report and literature review
Authors: Bao Weichao , Ma Xiaolin , Xue Yuan , Zou Xin , Guo Ying
Published: October 2024

Rationale:

The incidence of pregnancy-associated breast cancer (PABC) is relatively low, but it has been increasing in recent years. The onset of PABC causes serious harm to the fetus and the mother due to the unique physiological characteristics of pregnancy, which poses a particular challenge to clinicians. This article reports a case of pregnancy-associated triple-negative breast cancer and describes the patient characteristics and systematic treatment of this type of breast cancer.

Patient concerns:

A 33-year-old woman was admitted to hospital with a left breast mass that had appeared more than a year earlier. She was a second-time pregnant woman with a single live intrauterine fetus at 23 + 4 weeks of gestation. During the examination of the left breast, a 6 by 8 cm sized mass can be observed on the upper outer quadrant.

Diagnosis:

Pregnancy-associated triple-negative breast cancer.

Intervention:

The patient underwent a breast ultrasound which showed a left breast mass and the diagnosis was confirmed by a puncture biopsy of the left breast mass. The pregnancy was terminated after multidisciplinary discussion, taking into account the wishes of the patient and her family. After termination of the pregnancy, all treatments were given according to the standard triple-negative breast cancer (TNBC) treatment protocol. The patient was treated with neoadjuvant chemotherapy with epirubicin in combination with docetaxel (TE) in cycles of 21 days. After 3 cycles of TE, a modified radical mastectomy for left breast cancer was performed, and the appropriate radiotherapy and chemotherapy treatments were carried out in sequence.

Outcomes:

After the surgery, the disease-free survival for the patient was 3 months until local metastases were diagnosed. Thus the radiotherapy and chemotherapy were carried out, and then the patient was in good general condition with no recurrence or metastases.

Lessons:

Clinicians need more research into the diagnosis, treatment and prognosis of PABC. Improving the rate of early diagnosis and using standardized and individualized comprehensive treatment plans will minimize fetal damage and improve survival and quality of life for patients.
Can the sports apps using play an intervening role in the process of college students’ exercise motivation affecting mental health by exercise adherence?
Authors: Li Jun , Wang Lingjie , Xia Feng , Shao Yuekun , Ma Xinyi
Published: October 2024

The continuous increase in college students’ use of the Internet and their mental health problems caused by a sedentary lifestyle, lack of exercise, and obesity have gradually attracted researchers’ attention. There is still more work to be done to understand “how” and “under what circumstances” exercise motivation effects mental health, despite the fact that many of these studies have demonstrated that it has a significant impact on it. Four hundred forty-three college students in China were selected to participate in this study in order to explore the impact of exercise motivation on mental health. The mediating role of exercise adherence and the moderating role of sports apps using in this relationship. The results show that exercise motivation has a significant positive impact on college students’ mental health; exercise adherence partially mediates the relationship between exercise motivation and mental health; and the relationship between exercise motivation and exercise adherence is moderated by sports apps using. Specifically, the relationship between exercise motivation and exercise adherence is stronger for college students with high sports apps using. This study is based on the Internet using to promote physical exercise to college students, thereby alleviating their psychological problems caused by a sedentary lifestyle, lack of exercise, and obesity in the Internet era. New ideas are also provided for intervention in college students’ mental health.
Comprehending symmetry in epidemiology: A review of analytical methods and insights from models of COVID-19, Ebola, Dengue, and Monkeypox
Authors: Shanmugam Siva Nanthini , Byeon Haewon
Published: October 2024

The challenge of developing comprehensive mathematical models for guiding public health initiatives in disease control is varied. Creating complex models is essential to understanding the mechanics of the spread of infectious diseases. We reviewed papers that synthesized various mathematical models and analytical methods applied in epidemiological studies with a focus on infectious diseases such as Severe Acute Respiratory Syndrome Coronavirus-2, Ebola, Dengue, and Monkeypox. We address past shortcomings, including difficulties in simulating population growth, treatment efficacy and data collection dependability. We recently came up with highly specific and cost-effective diagnostic techniques for early virus detection. This research includes stability analysis, geographical modeling, fractional calculus, new techniques, and validated solvers such as validating solver for parametric ordinary differential equation. The study examines the consequences of different models, equilibrium points, and stability through a thorough qualitative analysis, highlighting the reliability of fractional order derivatives in representing the dynamics of infectious diseases. Unlike standard integer-order approaches, fractional calculus captures the memory and hereditary aspects of disease processes, resulting in a more complex and realistic representation of disease dynamics. This study underlines the impact of public health measures and the critical importance of spatial modeling in detecting transmission zones and informing targeted interventions. The results highlight the need for ongoing financing for research, especially beyond the coronavirus, and address the difficulties in converting analytically complicated findings into practical public health recommendations. Overall, this review emphasizes that further research and innovation in these areas are crucial for addressing ongoing and future public health challenges.
The application effect of a pulmonary rehabilitation program based on empowerment theory for patients with COPD combined with heart failure
Authors: Zhang Yue , Gu Chunfang , Sun Lin , Hai Huang
Published: October 2024

Background:

Chronic obstructive pulmonary disease (COPD) and heart failure are often coexisting conditions that can severely impact patients’ cardiopulmonary function and quality of life. Pulmonary rehabilitation programs, particularly those based on empowerment theory, may improve clinical outcomes by enhancing self-efficacy and promoting patient engagement.

Methods:

A total of 70 patients with COPD and heart failure admitted to our hospital’s respiratory department from January 1, 2023, to April 31, 2024, were randomly assigned to either a control group (n = 35) or an observation group (n = 35). The control group received routine care, while the observation group underwent an empowerment-based pulmonary rehabilitation program in addition to routine care for 4 weeks. Lung function (forced vital capacity, forced expiratory volume in 1 second, maximum voluntary ventilation), arterial blood gas levels (partial pressure of carbon dioxide, partial pressure of oxygen, and arterial oxygen saturation), cardiac function (left ventricular ejection fraction and serum brain natriuretic peptide), cardiopulmonary function (heart rate, respiratory rate, and 6-minute walk test), self-efficacy, and rehabilitation compliance were measured before and after the intervention.

Results:

There were no significant differences between the groups before the intervention (P > 0.05). After the intervention, the observation group exhibited significant improvements in lung function, arterial blood gas levels, cardiac and cardiopulmonary function, and self-efficacy scores compared with the control group (P < 0.05). Rehabilitation compliance was also significantly higher in the observation group (P < 0.05).

Conclusion:

An empowerment-based pulmonary rehabilitation program effectively improves rehabilitation compliance, lung and heart function, and self-efficacy in COPD patients with heart failure, suggesting it has strong potential for clinical application.
The prognostic value and immunological role of calcium/calmodulin dependent protein kinase kinase 2 (CAMKK2) in pan-cancer study
Authors: Jin Senjun , Wang Yanyan , Hu Sheng’an , Yan Guangzhao
Published: October 2024

A thorough assessment of calcium/calmodulin dependent protein kinase kinase 2 (CAMKK2) in pan-cancer studies is currently absent. We integrate multi-omics and clinical data to conduct a molecular landscape of CAMKK2. Gene variation results revealed abnormal high frequency mutations of CAMKK2 in uterine corpus endometrial carcinoma, while expression level analysis demonstrated relatively high expression of CAMKK2 in prostate adenocarcinoma. The aberrant expression of CAMKK2 was found to be predictive of survival outcomes in several cancer types. Additionally, we identified potential regulators of CAMKK2 expression, including miRNAs such as miR.129.1.3p, as well as small-molecule drugs such as EPZ004777, which significantly correlated with CAMKK2 expression. Single-cell transcriptome analysis of kidney renal clear cell carcinoma further revealed a significantly higher expression of CAMKK2 in and monocyte and macrophage M1. Furthermore, in the kidney renal clear cell carcinoma IMvigor210 cohort, patients ongoing immunotherapy with higher CAMKK2 expression experienced a significantly longer median overall survival, but it was observed that in bladder urothelial carcinoma GSE176307 and skin cutaneous melanoma GSE78220 cohorts, CAMKK2 might significantly prolong overall survival. Briefly, CAMKK2 emerges as a promising molecular biomarker that holds potential implications for prognostic evaluation and predicting the effectiveness of immunotherapy across cancers.
Re-evaluation of the role of endoscopic submucosal dissection in the treatment of early gastric cancer based on additional gastrectomy results
Authors: Im Dong Won , Chung Jae Hun , Ryu Dae-Gon , Choi Cheol Woong , Kim Su Jin , Hwang Sun-Hwi , Lee Si-Hak
Published: October 2024

Endoscopic submucosal dissection (ESD) plays a pivotal role in treating early gastric cancer (EGC). Some patients require additional gastrectomy because of non-curative ESD. This study aimed to analyze the clinical factors associated with non-curative ESD and to re-evaluate the role of ESD according to its indication criteria. Altogether, 134 patients who had undergone additional gastrectomy with lymphadenectomy for non-curative ESD based on the pathological results of ESD specimens were included. Their data including pre-ESD diagnosis, reasons for requesting additional gastrectomy, and surgical outcomes were analyzed retrospectively. Of the 134 patients with EGC in the final pathology of ESD specimens, 56 underwent staging ESD for a diagnostic approach, of whom 28 were diagnosed with atypical glands and 28 with high-grade dysplasia (HGD) prior to ESD. The remaining 78 patients of the 134 were identified to have EGC and received ESD for therapy. Based on the pathological results of ESD specimens, additional gastrectomy was commissioned with non-curative ESD because of one or more causes such as deep submucosal invasion, lymphatic invasion, positive vertical margin, undifferentiated histology, positive lateral margin, and venous invasion. Regarding surgical specimens, 13 patients had lymph node metastasis (LNM) and 9 had local residual tumor; one of them had both LNM and a local residual tumor. In patients with atypical glands, 4 had LNM and 3 had a local residual tumor; one of them had both LNM and a local residual tumor, and then died of multiple organ metastasis. In patients with HGD, 4 had LNM and 1 had a local residual tumor. Additionally, 4 patients who were absolutely indicated for ESD had LNM, of whom 2 had atypical glands, and the other 2 had HGD. Similarly, in 6 patients with a local residual tumor absolutely indicated for ESD, 2 had atypical glands and 1 had HGD. Positive vertical margin, lymphatic invasion, and deep submucosal invasion were identified as independent risk factors for LNM. ESD may play diagnostic and therapeutic roles in determining the optimal treatment of EGC when the diagnosis is equivocal or insufficient in endoscopic assessments for gastric cancer screening.
Pediatric dermatologic emergencies
Authors: Gruver Juliana R. , Kirkorian A. Yasmine
Published: October 2024

Purpose of review

Provide an overview of recent findings and recommendations for the presentation, diagnosis, and management of pediatric dermatologic emergencies.

Recent findings

Updated information on optimal diagnosis and treatments for pediatric dermatologic emergencies because of infection, reactive infectious mucocutaneous eruption, and serious cutaneous adverse reactions are covered.

Pediatric dermatologic emergencies require prompt diagnosis and management. This review covers new agents and techniques for management and diagnosis.
Mullerian and vaginal anomalies
Authors: Etskovitz Haley , Nandivada Prathima , Hsi Dickie Belinda
Published: October 2024

Purpose of review

To provide a comprehensive resource for pediatric surgeons and pediatricians caring for patients with Mullerian and vaginal anomalies, with a focus on recent changes in practice.

Recent findings

Herein, we provide a foundation for understanding the anatomy, presentation, and work up of Mullerian and vaginal anomalies. We review how to approach management of these anomalies when in isolation or when associated with anorectal malformations. We discuss the evolution of the management of neovaginal discussion with a current emphasis on patient-centered and directed care.

Review of current understanding of and approach to Mullerian and vaginal anomalies in children.
The biologic landscape and therapeutic implications of upper tract urothelial cancer
Authors: Vlachou Evangelia , Hoffman-Censits Jeannie , Singla Nirmish
Published: October 2024

Purpose of review

Management of upper tract urothelial cancer (UTUC) has been largely extrapolated from bladder cancer due to its rarity; however, unique biological and clinical differences between UTUC and bladder cancer have been uncovered. The purpose of this review is to present the current therapeutic landscape of UTUC with an emphasis on biologically driven rationale.

Recent findings

Prospective trials for patients with high-risk localized UTUC have shown improved outcomes with adjuvant and neoadjuvant platinum-based chemotherapy. However, the timing of therapy relative to nephroureterectomy may impact platinum eligibility due to renal functional decline following surgery. In recent years, emerging therapeutic classes including immune checkpoint inhibition, antibody drug conjugates, and targeted therapies have emerged as tolerable alternatives to platinum-based chemotherapy in treating metastatic disease. Biomarker-selected therapies, including those targeting HER2 and FGFR3, have shown encouraging results and are relevant to UTUC based on increased expressions of these targets; however, no prospective study to date has been powered to assess the effect of these modern treatments on patients with UTUC specifically.

Unique biological insights into UTUC pathogenesis and risk factors have expanded the therapeutic landscape for these patients beyond conventional platinum-based chemotherapeutic approaches. Novel therapeutic classes have emerged to guide more precise approaches in treating patients with urothelial cancer, with a need for further trials powered specifically to the UTUC population.
Short-term Outpatient Parenteral Antimicrobial Therapy Administration in the Pediatric Emergency Department
Authors: Bin Salleeh Hashim M. , Ahmad Syed Amir , Ahmadi Tahani Al , Kashif Uzma Y. , Bamogaddam Israa Y. , AlFakhri Lama H. , AlSaeed Abdullah F.
Published: October 2024

Objectives

The practice of administration of intravenous (IV) antimicrobial therapy in outpatient settings (OPAT) is a low-cost alternative to in-patient admission and treatment. There is, however, limited evidence supporting OPAT management protocols for children. The primary objective of this study was to describe the use of pediatric emergency-based OPAT, as well as the safety of this practice.

Methods

The study was a prospective, observational study conducted in pediatric emergency department of a tertiary care hospital. Children younger than 14 years who required pediatric emergency department-based OPAT were included in the study.

Results

Three hundred and ninety-two children were included in the study. The mean duration of OPAT was 3.5 days. Ceftriaxone was the most frequently used antimicrobial. Chest infection was the commonest indication, followed by sickle cell disease with fever and soft tissue infections. There were no major intravenous line-related complications over course of treatment. Most of the patients (89.5%) completed the OPAT course successfully. Only 10.4% patients required subsequent hospital admission, with failure to improve on the OPAT protocol being the main reason patients for admission. None of the admitted patients required intensive care settings or faced unexpected morbidity.

Conclusions

Our results affirm that pediatric emergency-based OPAT is a safe yet effective practice in children with good clinical outcome. We believe that a reduction in admissions translates to better hospital resource utilization
Knowledge and Practices Regarding Prevention of Central Venous Catheter Removal-Associated Air Embolism: A Survey of Nonintensive Care Unit Medical and Nursing Staff
Authors: Karlinskaya Maria , Scharf Liad , Sarid Nadav
Published: October 2024

Introduction

Air embolism is a potentially serious complication of central venous catheter (CVC) use. While CVC insertion is usually performed by a trained specialist, extraction is frequently the responsibility of junior staff members. This complication can be easily prevented by following several simple measures described in common guidelines.

Aim

We conducted a single-center survey to assess knowledge and practices concerning the prevention of air embolism associated with CVC removal among healthcare workers from nonintensive care units.

Methods

The correct answers to the questionnaire were determined according to best-practice recommendations for CVC removal. Based on a comparison of the total sum of correct answers between the categories of groups, factors that predicted the level of knowledge were identified using an independent sample t test.

Results

Of the 156 respondents, one-third were unfamiliar with air embolism as a complication of CVC extraction. Almost 80% were unaware of the existence of a CVC removal protocol. Almost half of respondents did not follow guidelines regarding patient position when removing a CVC, 72% did not ask the patient to perform the Valsalva maneuver during the procedure, and 54% did not ask the patient to remain supine after the procedure. Adherence to the protocol was correlated with professional experience, with a lower level among those with experience of less than 1 year and, particularly, among interns.

Conclusions

Our survey revealed inappropriately low awareness of CVC removal-associated air embolism risk and low familiarity with CVC removal best-practice recommendations among nonintensive care unit healthcare workers. Staff members with experience of less than 1 year, including interns, were found to have a lower level of knowledge. These findings emphasize the importance of development and distribution an internal hospital protocol and the integration of educational intervention into a preliminary internship program.
Diagnostic Accuracy of PSMA PET-Guided Prostate Biopsy in Prostate Cancer—A Systematic Review and Meta-analysis
Authors: Aggarwal Piyush , Gunasekaran Vinisha , Singh Harmandeep , Kumar Rajender , Satapathy Swayamjeet , Mittal Bhagwant Rai
Published: October 2024

Purpose

Early diagnosis and treatment of prostate cancer (PC) are crucial for effective management and improved patient outcomes. Newer imaging modalities like prostate-specific membrane antigen PET have shown superior diagnostic performance in detecting PC and clinically significant PC (csPC). This systematic review and meta-analysis aims to synthesize evidence on the diagnostic performance of PSMA PET-guided prostate biopsy in detecting PC and csPC.

Patients and Methods

The study followed the PRISMA-DTA guidelines. Using a predefined search strategy, 3 databases (PubMed, Embase, and Web of Science) were systematically searched using appropriate keywords. A meta-analysis was conducted using diagnostic accuracy parameters of the included studies. Risk of bias assessment was done using the QUADAS-2 tool.

Results

Out of 378 articles, 20 were assessed for full-text screening and 10 articles with 874 patients were finally included. Eight studies reported a pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of 0.90 (95%confidence interval [CI], 0.82–0.95), 0.93 (95% CI, 0.57–0.99), 12.3 (95% CI, 1.5–98.9), 0.10 (95% CI, 0.05–0.20), and 117 (95% CI, 12–1178), respectively, for detecting PC using PSMA PET-guided prostate biopsy with an area under the summary receiver operating characteristics curve of 0.94 (95% CI, 0.92–0.96). Similarly, 6 studies reported a pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of 0.89 (95% CI, 0.82–0.94), 0.65 (95% CI, 0.49–0.79), 2.6 (95% CI, 1.6–4.1), 0.17 (95% CI, 0.09–0.31), and 15 (95% CI, 6–41), respectively, for detecting csPC using PSMA PET-guided prostate biopsy with area under summary receiver operating characteristics curve of 0.86 (95% CI, 0.82–0.88).

Conclusions

PSMA PET-guided prostate biopsy has a high diagnostic accuracy in detecting PC and csPC in patients with clinical suspicion of PC, and provides a 1-stop solution for early diagnosis and staging of PC.
177Lu-PSMA-617 Radioligand Therapy in Patient With Prostate Cancer Sciatic Nerve Metastasis
Authors: Tonnelet David , Edet-Sanson Agathe , Augusto Laetitia , Cabourg Marine , Thureau Sébastien
Published: October 2024

Patients with metastatic castration-resistant prostate cancer usually have lymph nodes and bone metastasis. We present a rare case of a 51-year-old patient with metastatic castration-resistant prostate cancer who complained of left truncated sciatica and diffuse bone pain and who was referred for 177Lu-prostate-specific membrane antigen (PSMA) screening. Pretreatment 68Ga-PSMA showed left sciatic nerve and multiple bone uptake. Patient underwent stereotactic radiotherapy on the sciatic nerve metastasis (30 Gy in 6 fractions of 5 Gy) before 7.4 GBq of 177Lu-PSMA infusions. Left truncated sciatica disappeared after stereotactic radiotherapy. No additional toxicity was added to the sciatic nerve from 177Lu-PSMA after stereotactic radiotherapy.
Mutant KRAS in Circulating Tumor DNA as a Biomarker in Localized Pancreatic Cancer in Patients Treated with Neoadjuvant Chemotherapy
Authors: Vitello Dominic J. , Shah Dhavan , Wells Amy , Masnyk Larissa , Cox Madison , Janczewski Lauren M. , Abad John , Dawravoo Kevin , D’Souza Arlene , Suh Grace , Bayer Robert , Cristofanilli Massimo , Bentrem David , Liu Yingzhe , Zhang Hui , Santana-Santos Lucas , Jennings Lawrence J. , Zhang Qiang , Chawla Akhil
Published: October 2024

Objective:

The primary objective was to determine the prognostic significance of circulating tumor DNA (ctDNA) in patients receiving neoadjuvant chemotherapy (NAC) for localized pancreatic ductal adenocarcinoma (PDAC) using digital droplet polymerase chain reaction (ddPCR).

Summary and Background Data:

Increasingly, ctDNA is being used for clinical decision-making in a variety of solid malignancies. However, the detection and prognostic value of KRAS ctDNA as assessed by ddPCR during NAC has yet to be characterized.

Methods:

Patients with localized PDAC eligible to receive NAC were prospectively enrolled. Peripheral blood samples were obtained at diagnosis, after NAC, and after resection and analyzed for ctDNA using ddPCR. Log-rank tests and Cox proportional hazards model were used to assess for association with OS.

Results:

84 patients were included in the analysis. Mutant KRAS ctDNA was detected in 49.3% of patients at diagnosis, 69.6% of patients after NAC, and 69.7% of patients after resection, respectively. There were 15 (17.9%) patients that cleared mutational ctDNA over the course of treatment. Clearance of ctDNA during NAC was associated with improved overall survival (OS) (18.4 mo. vs NR, P<0.05). Detection of mutant KRAS G12V after NAC and resection was associated with shorter OS (18.0 versus NR months, P<0.031). Detection of the KRAS G12V mutation after resection was associated with reduced OS (aHR 36.75, 95% CI 2.93-461.38).

Conclusions:

Throughout treatment, KRAS ctDNA is detectable by ddPCR in patients with localized PDAC treated with NAC. Detection of mutant KRAS G12V after resection was associated with reduced OS.
Population-Based Cohort Study on Treatment and Overall Survival of Patients Clinically Diagnosed With T1 Ampullary Cancer
Authors: de Wilde Anouk J. , de Jong Evelien J.M. , Bruno Marco J. , Besselink Marc G. , van der Geest Lydia G.M. , Geurts Sandra M.E. , Groot Koerkamp Bas , de Hingh Ignace H.J.T. , de Meijer Vincent E. , Miclea Razvan L. , Poley Jan-Werner , Samarska Iryna V. , van Santvoort Hjalmar C. , Stommel Martijn W.J. , Voermans Rogier P. , Olde Damink Steven W.M. , de Vos-Geelen Judith , Bouwense Stefan A.W. ,   for the Dutch Pancreatic Cancer Group
Published: October 2024

Objective:

To evaluate treatment outcomes, overall survival (OS), and prognostic factors for OS in patients diagnosed with T1 ampullary cancer.

Background:

Ampullary cancer is a rare gastrointestinal malignancy with limited data from large cohorts, especially regarding T1 disease.

Methods:

Patients diagnosed with clinical (c) T1 ampullary cancer and patients with pathological (p) T1 in the case of cTx were included from the Netherlands Cancer Registry (2014-2021). Primary endpoint was OS, analyzed using the Kaplan-Meier estimator. Multivariable Cox proportional hazards regression was used to identify OS predictors.

Results:

Overall, 244 patients with cT1 ampullary cancer were included, of whom 75% (n=184) underwent resection. Among these, 68% (n=125) were upstaged to a higher pathologically T classification (pT2:40%, pT3:22%, pT4:5%). Similarly, cN0 was upstaged to pN1 in 47% of patients (n=87). Next, 100 patients with pT1 and cTx ampullary cancer were included, making a total of 159 patients with pT1 tumor. 92% (146/159) underwent pancreatoduodenectomy while 8% (13/159) underwent endoscopic or local surgical resection. The 1- and 5-year OS for cT1N0 ampullary cancer were 72% and 36%, while for pT1N0 they were 94% and 75%. Independent poor prognostic factors for OS were pN1 classification (HR 2.12; 95%CI 1.15–3.94, P=0.017), pNx classification (i.e. locally resected patients) (HR 2.82; 95%CI 1.22–6.55, P=0.016), and poorly differentiated tumors (HR 4.05; 95%CI 1.33–12.40, P=0.014).

Conclusion:

In patients with cT1 ampullary cancer, more than two-thirds had a pathologically higher T classification, and almost half had a pathologically higher N classification. These findings suggest that pancreatoduodenectomy is recommended for cT1 ampullary cancer.
Fall prevention among psychiatric patients in an Iranian hospital: a best practice implementation project
Authors: Kabiri Neda , Alizadeh Mahasti , Ranjbar Fatemeh , Hajebrahimi Sakineh , Soleimanpour Hassan , Oladbaniadam Khatereh , Marjani Karim , Amini Behrouz , Soleimanpour Maryam
Published: October 2024

Introduction:

Falls are the main cause of disability among psychiatric patients, as well as being the most common adverse event in hospitals.

Aim:

The aim of this evidence implementation project was to improve fall prevention and management among psychiatric patients in a neurology ward in an Iranian tertiary psychiatric hospital.

Methods:

This project used the JBI Evidence Implementation Framework, which recommends an audit, feedback, and re-audit strategy. A baseline audit was conducted to evaluate current fall prevention practices among 50 psychiatric patients and 20 health care professionals. The baseline audit was used to identify gaps in compliance. After the implementation of improvement strategies, a follow-up audit was conducted to measure any changes in practice.

Results:

The baseline and follow-up audits revealed that compliance with best practices improved in ward transfer fall risk assessment (Criterion 2: 87% to 90%), patient participation in fall risk assessment (Criterion 3: 95% to 96%), revising patient fall risk status (Criterion 9: 50% to 86%), and person-centered education of health care providers (Criterion 11: 78% to 96%). Other audit criteria remained unchanged. However, for Criterion 6 on patient engagement in goal-setting and treatment planning, compliance dropped from 100% at baseline to 94% at follow-up.

Conclusions:

This project successfully increased evidence-based practices regarding fall prevention and management, as well as providing mechanisms for sustaining the practice changes. Future audits are required to further improve outcomes.

Spanish abstract:

http://links.lww.com/IJEBH/A267