bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding Medication Nonadherence in Crohn’s Disease Patients: A Qualitative Evaluation
Authors: Brady Robert E , Salwen-Deremer Jessica K , Tunnell Natalie C , Winter Michael W
Published: December 2023

Background

Immune-modifying medications are widely available and recognized as valuable by most gastroenterologists. However, approximately 40% of patients with Crohn’s disease (CD) do not comply with regimens using these medications, resulting in complications, hospitalization, and surgeries. We sought to identify factors that motivate adherence or nonadherence with medication recommendations for CD.

Methods

We conducted qualitative interviews with patients living with CD who were identified as adherent or nonadherent to immune-modifying medication recommendations by their treating gastroenterologist. Semistructured interview guides were developed based on an established framework for understanding health behaviors. We conducted content analysis of the resulting qualitative data using an inductive-deductive approach to identify emergent themes that influence medication decision-making.

Results

Twenty-five patients with CD completed interviews for this study. Interviews were independently coded and analyzed for thematic content. Two broad domains emerged comprising (1) themes reflected in the Theoretical Domains Framework and (2) novel themes specific to medication decision-making in CD. Adherent patients conveyed a sense of trust in science and healthcare provider expertise, while nonadherent patients were more likely to express beliefs in their ability to self-manage CD, concern about risks associated with medication, and a general ambivalence to treatment.

Conclusions

There are clear cognitive, behavioral, and relational factors that guide patients’ medication-related decision-making. Several of the factors share features of other behavioral change and decision-making processes, while others are specific to the experience of patients with CD. A fuller understanding of these factors is essential to developing effective behavioral interventions to improve adherence to evidence-based treatment recommendations.
Aortic growth after arch reconstruction with patch augmentation: a 2-decade experience
Authors: Recco Dominic P , Kizilski Shannen B , Ghosh Reena M , Piekarski Breanna , Prakash Ashwin , Hoganson David M
Published: December 2023

OBJECTIVES

Optimal aortic sizing during aortic arch reconstruction remains unknown. Negative effects of arch under- or oversizing are well-published. We aimed to characterize longitudinal aortic growth after patch-augmented arch reconstruction to identify the initial reconstructed arch size that results in normal mid-term arch dimensions.

METHODS

Single-centre, retrospective review of infants undergoing Damus-Kaye-Stansel (DKS) or non-DKS patch-augmented aortic arch reconstruction between 2000 and 2021. Ascending aorta, proximal and distal transverse arch, aortic isthmus (AIsth) and descending aorta dimensions were measured in postoperative echocardiograms (<3 months from index operation) and cross-sectional imaging (>12 months). Longitudinal changes to aortic dimensions and z-scores were analysed. Secondary outcomes included reintervention, valve and ventricular function, mortality and transplantation.

RESULTS

Fifty-four patients (16 DKS, 38 non-DKS) were included. At 6.3 [2.2, 12.0]-year follow-up, all aortic segments grew significantly in both groups, while z-scores remained unchanged except for non-DKS proximal and distal transverse arch z-scores, which significantly increased (P < 0.05 each). When stratified by initial postoperative z-score (z < −1, −1 ≤ z ≤ 1, z > 1), non-DKS patients with initial AIsth z-score <−1 had a final z-score significantly smaller than both the targeted z-score zero (P = 0.014) and final z-score in a group with initial postoperative z-score ±1 (P = 0.009). Valve and ventricular function remained stable. Eighteen patients required reintervention, 1 died and 1 underwent transplant.

CONCLUSIONS

Over mid-term follow-up, aortic growth after arch reconstruction with patch augmentation was proportional when repaired to normal z-score dimensions, aside from proximal transverse arch, which disproportionately dilated. AIsth undersizing prevailed mid-term and trended towards a higher reintervention rate. Initial reconstruction between z-score 0 and +1 resulted in maintenance of that z-score size at mid-term follow-up. Overall, it is crucial to achieve targeted aortic sizing at index operation to maintain appropriate aortic dimensions over time and reduce reintervention risk with specific focus on the AIsth.
Measuring prognostic awareness in patients with advanced cancer: a scoping review and interpretive synthesis of the impact of hope
Authors: Mathews Jean , Merchant Shaila , Galica Jacqueline , Palmer Michael J , O’Donnell Jennifer , Koven Rachel , Booth Christopher , Brundage Michael
Published: December 2023

Background

Assessment of prognostic awareness (PA) in patients with advanced cancer is challenging because patient responses often indicate their hopes. The objectives of this scoping review were to summarize studies that measured PA in patients with advanced cancer and to synthesize data about how PA was measured and whether hope was incorporated into the measurement.

Methods

MEDLINE and Embase databases were searched from inception to December 14, 2021. Data regarding the impact of hope on assessment of PA were extracted when studies reported on patients’ beliefs about prognosis and patients’ beliefs about their doctor’s opinion about prognosis. An interpretive synthesis approach was used to analyze the data and to generate a theory regarding the incorporation of hope into the assessment of PA.

Results

In total, 52 studies representing 23 766 patients were included. Most were conducted in high-income countries and measured PA based on the goal of treatment (curable vs incurable). Five studies incorporated hope into the assessment of PA and reported that among patients who responded that their treatment goal was a cure, an average of 30% also acknowledged that their doctors were treating them with palliative intent. Interpretive synthesis of the evidence generated a trinary conceptualization of PA patients who are aware and accepting of their prognosis; aware and not accepting; and truly unaware. Each of these groups will benefit from different types of interventions to support their evolving PA.

Conclusion

The trinary conceptualization of PA may promote understanding of the impact of hope in the assessment of PA and guide future research.
On the anisotropic distribution of clusters in the local Universe
Authors: Schaller Matthieu
Published: December 2023

In his 2021 lecture to the Canadian Association of Physicists Congress, P.J.E. Peebles pointed out that the brightest extragalactic radio sources tend to be aligned with the plane of the de Vaucouleur Local Supercluster up to redshifts of z = 0.02 ($d_{\rm MW}\approx 85~\rm {Mpc}$). He then asked whether such an alignment of clusters is anomalous in the standard Lambda cold dark matter (ΛCDM) framework. In this letter, we employ an alternative, absolute orientation agnostic, measure of the anisotropy based on the inertia tensor axial ratio of these brightest sources and use a large cosmological simulation from the flamingo suite to measure how common such an alignment of structures is. We find that only 3.5 per cent of randomly selected regions display an anisotropy of their clusters more extreme than the one found in the local Universe’s radio data. This sets the region around the Milky Way as a 1.85σ outlier. Varying the selection parameters of the objects in the catalogue, we find that the clusters in the local Universe are never more than 2σ away from the simulations’ prediction for the same selection. We thus conclude that the reported anisotropy, whilst noteworthy, is not in tension with the ΛCDM paradigm.
CHLOROPLAST UNUSUAL POSITIONING 1 is a plant-specific actin polymerization factor regulating chloroplast movement
Authors: Kong Sam-Geun , Yamazaki Yosuke , Shimada Atsushi , Kijima Saku T , Hirose Keiko , Katoh Kaoru , Ahn Jeongsu , Song Hyun-Geun , Han Jae-Woo , Higa Takeshi , Takano Akira , Nakamura Yuki , Suetsugu Noriyuki , Kohda Daisuke , Uyeda Taro Q P , Wada Masamitsu
Published: December 2023

Plants have unique responses to fluctuating light conditions. One such response involves chloroplast photorelocation movement, which optimizes photosynthesis under weak light by the accumulation of chloroplasts along the periclinal side of the cell, which prevents photodamage under strong light by avoiding chloroplast positioning toward the anticlinal side of the cell. This light-responsive chloroplast movement relies on the reorganization of chloroplast actin (cp-actin) filaments. Previous studies have suggested that CHLOROPLAST UNUSUAL POSITIONING 1 (CHUP1) is essential for chloroplast photorelocation movement as a regulator of cp-actin filaments. In this study, we conducted comprehensive analyses to understand CHUP1 function. Functional, fluorescently tagged CHUP1 colocalized with and was coordinately reorganized with cp-actin filaments on the chloroplast outer envelope during chloroplast movement in Arabidopsis thaliana. CHUP1 distribution was reversibly regulated in a blue light- and phototropin-dependent manner. X-ray crystallography revealed that the CHUP1-C-terminal domain shares structural homology with the formin homology 2 (FH2) domain, despite lacking sequence similarity. Furthermore, the CHUP1-C-terminal domain promoted actin polymerization in the presence of profilin in vitro. Taken together, our findings indicate that CHUP1 is a plant-specific actin polymerization factor that has convergently evolved to assemble cp-actin filaments and enables chloroplast photorelocation movement.
Radio galaxy zoo: towards building the first multipurpose foundation model for radio astronomy with self-supervised learning
Authors: Slijepcevic Inigo V , Scaife Anna M M , Walmsley Mike , Bowles Micah , Wong O Ivy , Shabala Stanislav S , White Sarah V
Published: December 2023

In this work, we apply self-supervised learning with instance differentiation to learn a robust, multipurpose representation for image analysis of resolved extragalactic continuum images. We train a multi-use model which compresses our unlabelled data into a structured, low dimensional representation which can be used for a variety of downstream tasks (e.g. classification, similarity search). We exceed baseline supervised Fanaroff–Riley classification performance by a statistically significant margin, with our model reducing the test set error by up to half. Our model is also able to maintain high classification accuracy with very few labels, with only $7.79{{\ \rm per\ cent}}$ error when only using 145 labels. We further demonstrate that by using our foundation model, users can efficiently trade off compute, human labelling cost and test set accuracy according to their respective budgets, allowing for efficient classification in a wide variety of scenarios. We highlight the generalizability of our model by showing that it enables accurate classification in a label scarce regime with data from the new MIGHTEE survey without any hyperparameter tuning, where it improves upon the baseline by $\sim 8{{\ \rm per\ cent}}$. Visualizations of our labelled and un-labelled data show that our model’s representation space is structured with respect to physical properties of the sources, such as angular source extent. We show that the learned representation is scientifically useful even if no labels are available by performing a similarity search, finding hybrid sources in the RGZ DR1 data set without any labels. We show that good augmentation design and hyperparameter choice can help achieve peak performance, while emphasizing that optimal hyperparameters are not required to obtain benefits from self-supervised pre-training.
Enabling novel paradigms: a biological questions-based approach to human chemical hazard and drug safety assessment
Authors: Berridge Brian R , Bucher John R , Sistare Frank , Stevens James L , Chappell Grace A , Clemons Meredith , Snow Samantha , Wignall Jessica , Shipkowski Kelly A
Published: December 2023

Throughput needs, costs of time and resources, and concerns about the use of animals in hazard and safety assessment studies are fueling a growing interest in adopting new approach methodologies for use in product development and risk assessment. However, current efforts to define “next-generation risk assessment” vary considerably across commercial and regulatory sectors, and an a priori definition of the biological scope of data needed to assess hazards is generally lacking. We propose that the absence of clearly defined questions that can be answered during hazard assessment is the primary barrier to the generation of a paradigm flexible enough to be used across varying product development and approval decision contexts. Herein, we propose a biological questions-based approach (BQBA) for hazard and safety assessment to facilitate fit-for-purpose method selection and more efficient evidence-based decision-making. The key pillars of this novel approach are bioavailability, bioactivity, adversity, and susceptibility. This BQBA is compared with current hazard approaches and is applied in scenarios of varying pathobiological understanding and/or regulatory testing requirements. To further define the paradigm and key questions that allow better prediction and characterization of human health hazard, a multidisciplinary collaboration among stakeholder groups should be initiated.
The Creation and Validation of an Ankle Bone Age Atlas and Data Predicting Remaining Ankle Growth
Authors: Pennock Andrew T. , Bomar James D. , Pedowitz Jason M. , Carveth Stephen L.
Published: December 2023

Background:

The purpose of the current study was 2-fold: (1) to create and validate an ankle bone age atlas spanning the pediatric and adolescent years and (2) to utilize this atlas in conjunction with distal tibia/fibular growth data as measured on serial radiographs to develop a predictive growth model for the lower extremity.

Methods:

Radiographs were surveyed to identify distinguishable, reproducible, radiographic features. Radiographic features of the tibia, fibula, hindfoot, and midfoot from 270 patients were identified and a “standard” for each age/sex was selected to create an atlas. A separate cohort of 90 ankle radiographs was selected to validate the atlas. A subcohort of 41 patients with left-hand radiographs within 3 months of ankle imaging was used to compare the 2 bone age approaches. Harris growth lines were evaluated in 304 serial images of the distal tibia to determine the remaining growth.

Results:

The distal tib/fib ossification centers provided the best age assessment for early childhood (male age: 1 to 8 y; female age: 1 to 4 y). The ossification/fusion of the calcaneal apophysis provided the best age assessment in the preadolescent stage (male age: 6 to 14 y; female age: 5 to 12 y). The closure of the distal tib/fib physes best determined skeletal maturity (male age: 14 to 16 y; female age: 12 to 14 y). The ankle atlas had excellent interobserver and intraobserver reliability (intraclass correlation coefficient=0.993, P<0.001 and 0.998, P<0.001), respectively. We found an excellent correlation between the patient’s chronologic age and ankle bone age (r=0.984; P<0.001). Ankle bone age assessment and Greulich and Pyle were correlated (r
s=0.822, P<0.001). We found that males with a bone age of ≥15 years and females with a bone age of ≥13 years had ≤2 mm of residual growth of the distal tibia/fibula physes.

Conclusions:

bone age can be determined using ankle films ordered to assess/treat ankle injuries. This tool, along with our growth remaining table, may have important clinical implications when managing patients with ankle trauma with premature physeal closure.

Level of Evidence:

IV
Executive Summary of the American Radium Society Appropriate Use Criteria for Neoadjuvant Therapy for Nonmetastatic Pancreatic Adenocarcinoma
Authors: Jethwa Krishan R. , Kim Ed , Berlin Jordan , Anker Christopher J. , Tchelebi Leila , Abood Gerard , Hallemeier Christopher L. , Jabbour Salma , Kennedy Timothy , Kumar Rachit , Lee Percy , Sharma Navesh , Small William , Williams Vonetta , Russo Suzanne
Published: December 2023

For patients with locoregionally confined pancreatic ductal adenocarcinoma (PDAC), margin-negative surgical resection is the only known curative treatment; however, the majority of patients are not operable candidates at initial diagnosis. Among patients with resectable disease who undergo surgery alone, the 5-year survival remains poor. Adjuvant therapies, including systemic therapy or chemoradiation, are utilized as they improve locoregional control and overall survival. There has been increasing interest in the use of neoadjuvant therapy to obtain early control of occult metastatic disease, allow local tumor response to facilitate margin-negative resection, and provide a test of time and biology to assist with the selection of candidates most likely to benefit from radical surgical resection. However, limited guidance exists regarding the relative effectiveness of treatment options. In this systematic review, the American Radium Society multidisciplinary gastrointestinal expert panel convened to develop Appropriate Use Criteria evaluating the evidence regarding neoadjuvant treatment for patients with PDAC, including surgery, systemic therapy, and radiotherapy, in terms of oncologic outcomes and quality of life. The evidence was assessed using the Population, Intervention, Comparator, Outcome, and Study (PICOS) design framework and “Preferred Reporting Items for Systematic Reviews and Meta-analyses” 2020 methodology. Eligible studies included phases 2 to 3 trials, meta-analyses, and retrospective analyses published between January 1, 2012 and December 30, 2022 in the Ovid Medline database. A summary of recommendations based on the available literature is outlined to guide practitioners in the management of patients with PDAC.
The Assessment of Radial Peripapillary Capillary Vessel Density in Adult Children of Patients With Primary Open Angle Glaucoma
Authors: Bayraktar Serdar , Hondur Gözde , Şekeroğlu Mehmet Ali , Altaş Fatma Büşra , Yeşilyaprak Nurtaç , Çevik Seda , Şen Emine , Elgin Ufuk
Published: December 2023

Précis:

The observed decrease in radial peripapillary capillary vessel density among adult children of individuals with primary open angle glaucoma, in comparison to controls, suggests the possibility of early microvascular alterations in the eyes of these at-risk individuals.

Purpose:

To compare the radial peripapillary capillary vessel density (RPCVD) and peripapillary retinal nerve fiber layer (RNFL) thickness values of eyes between healthy adults with a maternal or paternal history of primary open angle glaucoma (POAG) and age-matched healthy controls without a family history of POAG.

Materials and Methods:

RPCVD values and RNFL thicknesses in the peripapillary region and 4 quadrants (superior, inferior, nasal, and temporal) were evaluated using optical coherence tomography angiography among 30 adult children of patients with POAG and 30 age-matched healthy controls without a family history of POAG.

Results:

The mean whole image RPCVD (51.6±1.7% vs. 49.8±1.7%, P=0.0006) and average RPCVD (54.7±1.7% vs. 53.2±2.1%, P=0.006) values were significantly lower in the adult children of patients with POAG compared with age-matched healthy controls without a family history of POAG. There was no difference in terms of RNFL thickness values in any region.

Conclusion:

Despite having similar RNFL thickness values to the control group, the observation of lower RPCVD in the eyes of adult children of POAG patients may indicate potential early vascular alterations. The result of the present study encourages further longitudinal studies to determine the potential importance of the underlying vascular alterations in these high-risk individuals.
Difficult decisions, filtration surgery, and the heartbreak of the numerator
Authors: Samuelson Thomas W. , De Francesco Ticiana , Ahmed Iqbal Ike K. , Gedde Steven J. , Paranjpe Vikram R. , Singh Kuldev , Brubaker Jacob W. , Grover Davinder S. , Fellman Ronald L. , Zhang Amy D. , Barton Keith
Published: December 2023

A 70-year-old man had progressive and severe glaucoma in each eye. He was intolerant to dorzolamide, brimonidine, and netarsudil. Each eye had prior selective laser trabeculoplasty (SLT) as well as phacoemulsification plus minimally invasive glaucoma surgery (MIGS) 6 years before current presentation (iStent [Glaukos Corp.] in the right eye and Cypass [Alcon Laboratories, Inc.] in the left eye). Postoperative acuities were 20/20 and 20/25 in the right and left eyes, respectively.

When his left eye progressed with loss of central acuity despite peak intraocular pressures (IOPs) in the middle to upper teens, neuro-ophthalmology consultation was obtained (Figure 1

JOURNAL/jcrs/04.03/02158034-202401000-00017/figure1/v/2023-12-22T124801Z/r/image-tiff

). That workup included magnetic resonance imaging scan and hematologic screening, but all results were negative, and the neuro-ophthalmic consultant concluded that the vision loss was likely on the basis of glaucoma. Accordingly, a trabeculectomy was performed in the left eye achieving consistent IOPs in the range of 7 to 10 mm Hg without medications, rending the left eye stable since the filtration surgery nearly 2 years previously.

The right eye continued to progress both subjectively and objectively, and on recent examination, the IOP measured 20 mm Hg and 09 mm Hg in the right and left eyes, respectively (Figure 2

JOURNAL/jcrs/04.03/02158034-202401000-00017/figure2/v/2023-12-22T124801Z/r/image-tiff

). Medications included timolol and latanoprostene bunod in the right eye only. Central corneal thickness was 526 μm and 527 μm in the right and left eyes, respectively. The visual acuity now measured 20/25 in the right eye and 20/250 in the left eye. The vertical cup-to-disc ratio was 0.9 in the right eye and 1.0 in the left eye. Gonioscopy revealed a wide open angle in each eye with a patent sclerostomy superiorly in the left eye. The conjunctiva and sclera were healthy and without scarring in the right eye. The bleb in the left eye was diffuse, lightly vascularized, and seidel negative. Axial length (AL) was 26.88 μm in the right eye and 26.77 μm in the left eye. The patient was in good health and was not anticoagulated.

An extensive discussion ensued about the best course of action for the right eye.

How would you proceed in managing definite progression in this individual's right eye, knowing that he had lost fixation in his left eye at similar pressures?
Endoscopic atticotomy for attic cholesteatomas using piezosurgery
Authors: Chen Chin-Kuo , Ho Che-Fang , Chien Chen-Yu , Yang Hsin-Ting , Hsieh Li-Chun
Published: December 2023

Background:

Attic cholesteatomas can be exenterated by transcanal endoscopic ear surgery (TEES). In the limited operative field of exclusive transcanal endoscopic atticotomy, surgeons use either a piezosurgery scalpel or a drilling system to remove the posterior lateral bony wall of the epitympanum. We aimed to investigate the feasibility of using piezosurgery or microdrill for endoscopic atticotomy during exenteration of attic cholesteatomas.

Methods:

This study is a retrospective chart review of patients diagnosed with attic cholesteatoma, who were treated by exclusive TEES. The superior and posterior external auditory canal bones were excised using a piezosurgery scalpel or microdrill. Preoperative and postoperative hearing thresholds were measured by pure-tone audiometry.

Results:

The postoperative follow-up duration varied from 6 to 37 months. There were no significant differences in age, sex, laterality of the affected ear, and preoperative bone conduction thresholds between the piezosurgery scalpel and microdrill groups. The operative duration was longer in the piezosurgery group than in the microdrill group (135.6 ± 19.5 minutes vs 117.3 ± 29.1 minutes, p = 0.042). Seven of 30 (23.3%) patients in the microdrill group, but none in the piezosurgery group, had a friction injury from the drilling. Postoperative testing at higher frequencies of 2000, 3000, and 4000 Hz showed no deterioration in the bone conduction threshold in the piezosurgery group.

Conclusion:

Endoscopic atticotomy performed using a piezosurgery scalpel is potentially safer but slower than using a microdrill for exenteration of attic cholesteatomas.
Investigation of effects of Circadian Rhythm in Sport: A bibliometric analysis
Authors: Wang Jie , Xia Lina
Published: December 2023

Purpose:

This study conducted a bibliometric analysis of the literature on circadian rhythms and sports to identify research trends, knowledge gaps, and future directions.

Methods:

A total of 301 manuscripts, including 245 articles and 56 reviews, were extracted from the Web of Science Core Collection (WoSCC) database, and the bibliometric analysis was performed using VOSviewer 1.6.16.

Results:

The analysis revealed a continuous increase in the volume of literature on circadian rhythms and sports over the past 38 years, with a focus on the effects of circadian rhythms on physical performance, sleep quality, and jet lag. The study identified 1107 authors who have contributed to this field, with the highest number of publications from Reilly T, Chtourou H, and Atkinson G. The publications were from 512 institutions in 59 countries/regions, with Liverpool John Moores University, University of Sfax, and Manouba University being the leading institutions. The USA, UK, and Australia had the largest number of publications. The top 3 journals were Chronobiology International, Biological Rhythm Research, and Sports Medicine.

Conclusion:

Despite the increase in research, there are still several underexplored areas, such as the effects of circadian rhythms on cognitive and emotional processes in sports, the role of individual differences in circadian rhythms on sports outcomes, and the potential applications of circadian interventions for sports performance optimization. Future research should address these gaps to advance our understanding of the complex relationship between circadian rhythms and sports.
Diagnosis of invasive pulmonary fungal infections by a real-time panfungal PCR assay in non-neutropenic patients
Authors: Chen Feifei , Chen Yubao , Chi Yin , Gao Tianyi , Zhao Youcai , Shao Hongtao
Published: December 2023

This study explored the utility of quantitative real-time panfungal PCR assay in diagnosing invasive pulmonary fungal diseases (IPFD) in non-neutropenic patients. Panfungal PCR assay was performed on respiratory tract specimens from patients whose clinical signs could not exclude fungal infection. At the same time, the samples were subjected to bacterial and fungal culture, microscopic examination and galactomannan antigen (GM) test in order to find the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the 4 diagnostic methods in proven and probable cases. 518 specimens were collected while 63 respiratory tract specimens tested by PCR had positive results. According to diagnostic criteria, 40 patients were diagnosed with IPFD, with 12 proven, 20 probable and 8 possible cases. Among these, 33 patients of PCR results were positive, most of which were from BALF samples (44.12%). 23 cases were caused by Aspergillus species, with Aspergillus fumigatus was the major cause. Other Aspergillus species, including Aspergillus flavus, Aspergillus terreus and Aspergillus nidulans were found in 1 sample respectively. Candida species were found in 5 samples, Pneumocystis jeroveci pneumonia (PJP) in 4 samples and Mucormycosis in 1 sample. An analysis of proven/probable diagnosis showed a sensitivity of 78.13%, specificity of 92.18%, PPV of 39.68% and NPV of 98.46% for PCR and 50%, 85.27%, 35.7%, 95.65% for GM test respectively. The Ct value difference between proven/probable and possible cases had no statistical significance (P = .824). Fungal culture showed a sensitivity of 17.5% while microscopic examination sensitivity of 32.5%. Through stratified analysis, no apparent correlation was found between the Ct value of the PCR assay and GM value (r: 0.223, P = .294). But a conjunction of the 2 tests raised the PPV of Aspergillus to 90%. As shown in this study, the panfungal RT-PCR assay has high sensitivity and consistency with serological test and culture. Its high PPV in the detection of Aspergillus and PJP were also evident.
Association between periodontal disease and hypertriglyceridemia: Propensity score matching analysis using the 7th Korea National Health and Nutrition Examination Survey
Authors: Kim Eun-Kyong , Cho Ju-Yeon , Park Eun Young
Published: December 2023

The prevalence of periodontitis and dyslipidemia continues to increase, and several studies have reported an association between the 2. Therefore, we assessed the relationship between periodontitis and hypertriglyceridemia using propensity score matching to efficiently address confounding factors, as well as complex sample analysis with data from Korea National Health and Nutrition Examination Survey VII (2016–2018). To match the 1:1 ratio between the groups with and without periodontitis, the propensity scores of covariates, such as age, sex, education, income, smoking, drinking, obesity, and diabetes mellitus, were calculated using logistic regression. Both results of logistic regression analysis using complex sample design for whole and matched sample after propensity score matching demonstrated a significant association between hypertriglyceridemia and periodontitis, of which the adjusted odds ratio was 1.28 (95% confidence interval = 1.10–1.50) and 1.29 (95% confidence interval = 1.09–1.52), respectively. Our findings suggest that dental healthcare workers can help raise awareness among patients with periodontitis regarding the association between periodontitis and hypertriglyceridemia, which may help them manage the condition and receive treatment.
Vitamin D knowledge, awareness and practices of female students in the Southwest of Saudi Arabia: A cross-sectional study
Authors: Kambal Nahla , Abdelwahab Siddig , Albasheer Osama , Taha Sara , Abdelrahman Nusayba , Bani Ibrahim , Alsayegh Abdulrahman , Shammaky Eithar , Duwayri Nawal , Alhazmi Alaa , Mahzari Maryam , Hakami Nasser
Published: December 2023

Vitamin D deficiency is a common health problem among adults in Saudi Arabia, particularly females. Vitamin D deficiency is associated with many diseases, including cardiovascular diseases, diabetes, autoimmune diseases, neurological disorders, and cognitive decline. This study aimed to assess the knowledge, awareness and practice of vitamin D deficiency among female students in Jazan University as well as to determine the sociodemographic related factors. A cross-sectional study was conducted among 204 female undergraduate and postgraduate students (18 years of age and older) in March 2022 from Saudi Arabia. Students completed a web-based survey about vitamin D and their demographic characteristics. Statistical analyses were conducted using Statistical Package for the Social Sciences software. Descriptive statistics, the Chi-squared test of homogeneity, and univariate and multivariate logistic regression were used. The results revealed that the participants had limited knowledge related to vitamin D normal level (49.5%), and the recommended daily amount of vitamin D (26.5%). Most of the participants were unaware of its benefits for vision, muscle integrity, weakness, and fatigue. Most of them recognized the importance of sunlight for maintaining suitable levels of vitamin D (94.1%). However, only 43.1% identified that decreased intake of foods rich in vitamin D is a cause of vitamin D deficiency. Participants (33.7%) preferred exposure to sunlight to improve their vita-min D levels, and 32.4% used vitamin D supplements. However, only 39.2% had ever examined their vitamin D status. Univariate and multivariate logistic regression models demonstrated a significant association between knowledge, and residence, and source of information (odds ratios = 3.48 and 2.79, respectively, P < .05). Most respondents had a basic understanding of vitamin D, vitamin D insufficiency, and the environmental and dietary factors contributing to it. Given the findings obtained, cognitive interventions need to be carried out.
The niche of dermal graft to reconstruct a complex pressure injury wound in sacral region: A case report
Authors: Cheng Te-Wei , Lin Yun-Nan , Lee Su-Shin , Kuo Yur-Ren
Published: December 2023

Rationale:

Pressure ulcers are a common health issue, particularly among elderly and bedridden patients who are vulnerable to pressure injuries in the sacral region. Currently, free flap and local flap surgeries are the gold standard procedures for the reconstruction of such injuries. However, the recurrence rate of flap surgery appears to be high. In this context, we presented a case involving a sacral pressure ulcer reconstructed with dermal grafting.

Patient concerns:

A 59-year-old male with a medical history of hepatitis C, brain hemorrhage, hydrocephalus, and multiple fractures presented with a sacral ulcer. Owing to the patient’s history of recurrent pressure injuries and the challenges associated with postoperative wound care, the patient and his family were hesitant to proceed with flap surgery.

Diagnoses:

The patient was diagnosed with a stage IV pressure ulcer measuring 4 cm × 4 cm in size in the sacral region, according to the National Pressure Ulcer Advisory Panel staging system.

Interventions:

Before surgery, the patient received standard wound care with dressing for 4 months, along with short-term oral antibiotics due to a positive wound culture for Pseudomonas aeruginosa. During the surgery, a dermal graft with a size of 35 cm2 and a thickness of 0.014 inches was harvested from the patient’s left thigh. The graft was then secured to the wound bed.

Outcomes:

Although the dermal graft failed with sloughing after 1 week, the wound bed showed improvement with granulation. After 1.5 months, the wound area had decreased to half of its original size, and the wound eventually healed after 3.5 months.

Lessons:

Dermal grafts have a niche in reconstructing pressure injury wounds in the sacral region, because of the relative ease of wound care and additional benefits even in cases where the graft fails.
Primary pulmonary synovial sarcoma with delayed diagnosis in a 69-year-old man: A case report
Authors: Kim Chan Seop , Cho Hye Soo , Lee Ok Jun , Ahn Su Yeon , Yoo Jin Young
Published: December 2023

Rationale:

Primary pulmonary synovial sarcoma is a rare malignant pulmonary tumor accompanied by calcifications in approximately 15% of cases. These calcifications usually have a fine, stippled appearance; coarse shapes have seldom been reported. Moreover, the presence of coarse calcifications often suggests benign tumors, which vastly differ in treatment. We present a rare case of primary pulmonary sarcoma with coarse intratumoral calcifications, the diagnosis of which was delayed because of its radiologic appearance.

Patient concerns:

A computed tomography (CT) scan of a 69-year-old man with right upper quadrant (RUQ) pain revealed an incidental mass at the base of the right lower lobe, the margin of which was not well described with respect to the liver, and intratumoral coarse calcification was noted. Initially, the lesion was believed to be hepatic, and magnetic resonance imaging (MRI) was performed. Based on its imaging features, the mass was thought to be a pulmonary lesion, and a preliminary diagnosis of a benign lesion, such as a hamartoma or granuloma, was made. Four months after the initial CT scan, the patient’s RUQ pain had aggravated; however, no change in the mass was observed on follow-up CT.

Diagnosis:

The final diagnosis was primary pulmonary sarcoma, proven by surgical biopsy.

Interventions:

Wedge resection of the right lower lobe was performed, and the patient received adjuvant chemotherapy.

Outcomes:

The patient’s RUQ pain improved, and no recurrence or metastasis has been reported to date.

Lessons:

This case describes a rare presentation of a primary pulmonary synovial sarcoma with coarse intratumoral calcifications and the MRI features of the lesion. Intratumoral coarse calcifications often suggest benign lesions, such as hamartomas or post-inflammatory granulomas; however, as malignant lesions cannot be completely excluded, other radiologic and clinical features should be considered carefully. Focal areas of enhancement and eccentric calcification distribution might suggest malignant lesions such as primary pulmonary synovial sarcoma. Furthermore, despite not being used routinely, MRI scans might be helpful because advanced MRI techniques, such as diffusion-weighted imaging, can help distinguish malignant lesions from benign lesions. If the clinical course of a patient suggests malignancy, a more aggressive biopsy strategy should be considered.
Efficacy and safety of oral traditional Chinese medicine combined with conventional anti-osteoporosis drugs for osteoporosis and fractures: A meta-analysis of randomized controlled trials
Authors: Chi Kede , Yan Jianqiang , Zhu Yingying , Wu Junzhe
Published: December 2023

Objective:

To evaluate the efficacy and safety of oral traditional Chinese medicine combined with conventional anti-osteoporosis drugs in the treatment of osteoporosis and fractures.

Methods:

The database of China national knowledge infrastructure, China Science and Technology Journal Database, Wangfang (WANGFANG DATA), ChineseBioMedicalLiteratureDatabase, PubMed, Embase, and Cochrane Library databases were searched from inception to June 1st, 2023 for randomized controlled trials on oral Chinese medicine combined with conventional anti-osteoporosis drugs for the treatment of osteoporosis and fractures. Quality assessment was performed using the Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0. STATA 15.0 software was used for meta-analysis. Outcome measures included overall response rate, adverse events, T-score, bone mineral density, Oswestry Disability Index score, fracture healing time, and visual analog scale score.

Results:

A total of 72 studies were included, involving 7847 participants. Different treatment options showed different advantages in the adjuvant treatment of osteoporosis and fractures. The total response rate, complication reduction, Oswestry Disability Index and visual analog scale score reduction, bone mineral density improvement and fracture healing time were all superior to drug therapy alone. The differences were statistically significant, but the improvement in T-score was not significant.

Conclusion:

The combination of oral traditional Chinese medicine and conventional anti-osteoporosis drugs is more effective and safer than Western medicine alone in the treatment of osteoporosis and fractures, which indicated that the treatment of integrated Chinese and western medicine can promote the healing of osteoporosis and fracture. This approach had a promising clinical application prospect. Due to the limitations of included studies, the ranking results should be interpreted with caution. In the next step, we will further conduct subgroup data based on factors, such as conventional Western medicine treatment regimens, whether surgical treatment was performed, fracture locations.
Radiologic foot alignment and clinical outcome after percutaneous drilling for symptomatic accessory navicular in skeletally immature children
Authors: Minokawa So , Yoshimura Ichiro , Kanazawa Kazuki , Hagio Tomonobu , Ishimatsu Tetsuro , Sugino Yuki , Shibata Yozo , Izaki Teruaki , Yamamoto Takuaki
Published: December 2023

Various surgical treatments are available for a symptomatic AN, including percutaneous drilling (PD). PD is reportedly effective for ANs in skeletally immature children. However, no reports have described the foot alignment after PD in skeletally immature children. This study was performed to compare the radiographic parameters between the preoperative period and the final follow-up after PD for symptomatic ANs in skeletally immature children. From October 2013 to December 2020, PD was performed on 13 feet in 10 skeletally immature children. The patients comprised 5 boys and 5 girls with a mean age at surgery of 11.9 years. The mean follow-up period was 14.8 months. We measured 5 radiographic findings preoperatively and at the final follow-up: calcaneal pitch angle (CPA), talocalcaneal angle (TCA), talonavicular coverage angle (TNCA), anteroposterior talo-first metatarsal angle (ATMA), and lateral talo-first metatarsal angle (LTMA). Ten feet were assessed as excellent, 1 as fair, and 2 as poor. Ten unions (76.9%) were achieved among the 13 feet. The mean CPA improved from 16.4 ± 4.1 degrees preoperatively to 18.2 ± 3.4 degrees at the final follow-up, the TCA improved from 43.0 ± 3.7 to 45.2 ± 4.4 degrees, and the TNCA improved from 19.9 ± 4.4 to 15.4 ± 5.0 degrees (P < .05). The ATMA and LTMA were not significantly different between the preoperative period and final follow-up. We found that PD for symptomatic ANs in skeletally immature children was effective treatment, and some radiographic parameters showed significant differences between the preoperative period and final follow-up.
Fulminant ACTH decrease following diabetic ketoacidosis induced by immune checkpoint inhibitor combination therapy with nivolumab and ipilimumab: A case report
Authors: Iesaka Hiroshi , Kameda Hiraku , Miya Aika , Nomoto Hiroshi , Cho Kyu Yong , Nakamura Akinobu , Abe Takashige , Shinohara Nobuo , Atsumi Tatsuya
Published: December 2023

Rationale:

The increasing use of immune checkpoint inhibitors (ICIs) for treating malignant tumors result in the concomitant rise of immune-related adverse events (irAEs). This case report may provide useful insight to understanding the etiology of ICI-induced hypophysitis, a severe irAE leading to potentially fatal secondary adrenal insufficiency.

Patient concerns:

An 81-year-old Japanese man was hospitalized for diabetic ketoacidosis following 4 courses of ICI combination therapy with nivolumab and ipilimumab for metastatic renal cell carcinoma.

Diagnosis:

Insulin secretion was depleted, leading to diagnosis of fulminant type 1 diabetes. Adrenocorticotropic hormone (ACTH) and cortisol levels were very high (60.8 pmol/L and 1575 nmol/L, respectively) upon admission. ACTH and cortisol returned to normal ranges on the 2nd day. On the 8th day, an ACTH loading test showed intact cortisol response (peak value 519 nmol/L). However, on the 14th day, there was a sharp decrease in ACTH and cortisol levels (10.5 pmol/L and 47 nmol/L, respectively) accompanied by fatigue and a drop in blood pressure to 97/63 mm Hg. As secondary adrenal insufficiency was suspected, hydrocortisone replacement was initiated. An ACTH loading test on the 17th day revealed low cortisol peak (peak value 232 nmol/L), indicating sudden disruption of adrenal function. Magnetic resonance imaging showed no abnormal findings and there was no other pituitary hormone deficiency. These findings, along with the patient clinical course, suggest that secondary adrenal insufficiency was caused by acute ACTH producing cell destruction as an irAE associated with ICI therapy.

Interventions:

The patient hyperglycemia and ketoacidosis were treated using extracellular fluid and insulin therapy. After development of adrenal insufficiency, hydrocortisone 20 mg was started, and the patient symptoms improved.

Outcomes:

He was continued on insulin therapy, hydrocortisone, and reinitiated nivolumab.

Lessons:

This case provides a detailed course of the fulminant onset of ACTH deficiency during ICI administration, emphasizing the importance of close monitoring.
Focal hemolymphangioma of the rectum: A case report and literature review
Authors: Li Wei , Jiang Binghu , Zhou Lifeng , Liao Wenhua
Published: December 2023

Rationale:

Gastrointestinal hemolymphangiomas are very rare, especially in the rectum. Only 3 cases of rectal hemolymphangioma, all of which are diffuse lesions, have been reported in the English literature on PubMed. Our case is the first focal lesion of the rectum. It is important for radiologists to correctly identify the imaging features of rectal hemolymphangiomas.

Patient concerns:

A 51-year-old woman visited our hospital because of intermittent constipation for 3 years.

Diagnoses:

Colonoscopy revealed a prominent lesion on the left anterior wall of the lower rectum. Transvaginal color Doppler ultrasonography showed that the posterior vaginal wall area had a mixed-echo mass, and blood flow signals of the dots and stripes could be seen. Pelvic magnetic resonance imaging showed that the cystic space-occupying lesion in the region between the left anterior wall of the lower rectum and the posterior wall of the middle and lower vagina had a clear boundary.

Interventions:

The patient underwent surgery to remove the rectal lesions. The surgical specimen was finally diagnosed as local hemolymphangioma by pathological analysis.

Lessons:

Localized hemolymphangioma of the rectum is very rare, and imaging examination is essential for the diagnosis and evaluation of the extent of lesion invasion.
Meta-analysis of the therapeutic effect of acupuncture on dysphagia in patients with Parkinson disease
Authors: Jiayu Liu , Minmin Wu , Zhu Luwen
Published: December 2023

Objective:

To systematically evaluate the therapeutic effect of acupuncture on dysphagia in patients with Parkinson disease (PD).

Method:

We searched CNKI, WF, VIP, CBM, Cochrane Library, and Web of Chinese Biomedical Literature Randomized controlled trials on the efficacy of acupuncture in the treatment of dysphagia in patients with PD was retrieved from Science, Embase, and PubMed databases from establishment to October 2022. Outcome indicators included clinical efficacy, swallowing function, hemoglobin, and serum albumin. Literature screening and data extraction of included literature were conducted independently by 2 reviewers, and literature quality was evaluated according to the standards of the Cochrane Collaboration network. Data analysis was performed using Review Manager 5.3 and Stata14.0 software.

Results:

466 patients were included in 7 literature, 234 in the observation, and 232 in the control groups. The results of the meta-analysis showed the clinical efficacy in the observation group [odd ratio = 0.25, 95% confidence interval (95%CI) (0.15, 0.40), P < .01]. Swallowing function [standardized mean difference (SMD) = −0.96, 95%CI (−1.24, −0.68), P < .01]; hemoglobin index level [SMD = −0.72, 95%CI (−1.25, −0.20), P < .01]; serum albumin index level [SMD = −1.25, 95%CI (−2.19, −0.31), P < .01].

Conclusion:

Acupuncture has a specific curative effect on dysphagia in patients with PD, and the therapeutic effect is more significant than that in the control group, which can improve the dysphagia function and nutrition level in patients with PD more effectively.