bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of potential C1-binding sites in the immunoglobulin CL domains
Authors: Yanaka Saeko , Kodama Atsuji , Nishiguchi Shigetaka , Fujita Rina , Shen Jiana , Boonsri Pornthip , Sung Duckyong , Isono Yukiko , Yagi Hirokazu , Miyanoiri Yohei , Uchihashi Takayuki , Kato Koichi
Published: April 2024

Immunoglobulin G (IgG) molecules that bind antigens on the membrane of target cells spontaneously form hexameric rings, thus recruiting C1 to initiate the complement pathway. However, our previous report indicated that a mouse IgG mutant lacking the Cγ1 domain activates the pathway independently of antigen presence through its monomeric interaction with C1q via the CL domain, as well as Fc. In this study, we investigated the potential interaction between C1q and human CL isoforms. Quantitative single-molecule observations using high-speed atomic force microscopy revealed that human Cκ exhibited comparable C1q binding capabilities with its mouse counterpart, surpassing the Cλ types, which have a higher isoelectric point than the Cκ domains. Nuclear magnetic resonance and mutation experiments indicated that the human and mouse Cκ domains share a common primary binding site for C1q, centred on Glu194, a residue conserved in the Cκ domains but absent in the Cλ domains. Additionally, the Cγ1 domain, with its high isoelectric point, can cause electrostatic repulsion to the C1q head and impede the C1q-interaction adjustability of the Cκ domain in Fab. The removal of the Cγ1 domain is considered to eliminate these factors and thus promote Cκ interaction with C1q with the potential risk of uncontrolled activation of the complement pathway in vivo in the absence of antigen. However, this research underscores the presence of potential subsites in Fab for C1q binding, offering promising targets for antibody engineering to refine therapeutic antibody design.
Interprofessional education in antimicrobial stewardship, a collaborative effort
Authors: Chetty Sarentha , Swe-Han Khine Swe , Mahabeer Yesholata , Pillay Ashendri , Essack Sabiha Y
Published: April 2024

Introduction

Antimicrobial stewardship (AMS) education and interprofessional collaboration are integral to the success of a stewardship programme. An interactive interprofessional AMS workshop, designed to encourage workplace interprofessional collaboration was piloted in a tertiary hospital.

Objectives

To obtain feedback to determine the suitability and sustainability of the AMS workshop.

Methods

Feedback was elicited through a predesigned questionnaire containing both open-ended and closed questions on the content and structure of the workshop.

Results

The survey had a 70% (n = 16) overall response rate. All participants agreed that the goals of the workshop were met and that the knowledge and skills gained from the workshop would help them in their AMS roles. All participants indicated that the workshop content, and the level at which it was pitched, met their expectations and that it had improved their knowledge and skills. All agreed that they found it advantageous and enjoyed learning as an interprofessional group. Open feedback showed that the workshop was found to be useful and would potentially result in improved patient care, dissemination of knowledge, improved teamwork and organizational culture.

Conclusions

The positive feedback and changes made following the workshop demonstrated that a targeted AMS educational workshop adds value to an antimicrobial stewardship programme.
Genetically guided precision medicine clinical decision support tools: a systematic review
Authors: Johnson Darren , Del Fiol Guilherme , Kawamoto Kensaku , Romagnoli Katrina M , Sanders Nathan , Isaacson Grace , Jenkins Elden , Williams Marc S
Published: April 2024

Objectives

Patient care using genetics presents complex challenges. Clinical decision support (CDS) tools are a potential solution because they provide patient-specific risk assessments and/or recommendations at the point of care. This systematic review evaluated the literature on CDS systems which have been implemented to support genetically guided precision medicine (GPM).

Materials and Methods

A comprehensive search was conducted in MEDLINE and Embase, encompassing January 1, 2011–March 14, 2023. The review included primary English peer-reviewed research articles studying humans, focused on the use of computers to guide clinical decision-making and delivering genetically guided, patient-specific assessments, and/or recommendations to healthcare providers and/or patients.

Results

The search yielded 3832 unique articles. After screening, 41 articles were identified that met the inclusion criteria. Alerts and reminders were the most common form of CDS used. About 27 systems were integrated with the electronic health record; 2 of those used standards-based approaches for genomic data transfer. Three studies used a framework to analyze the implementation strategy.

Discussion

Findings include limited use of standards-based approaches for genomic data transfer, system evaluations that do not employ formal frameworks, and inconsistencies in the methodologies used to assess genetic CDS systems and their impact on patient outcomes.

Conclusion

We recommend that future research on CDS system implementation for genetically GPM should focus on implementing more CDS systems, utilization of standards-based approaches, user-centered design, exploration of alternative forms of CDS interventions, and use of formal frameworks to systematically evaluate genetic CDS systems and their effects on patient care.
Breast Hemangiomas: Imaging Features With Histopathology Correlation
Authors: Dhami Alysha , Hao Meng , Waheed Uzma , Dashevsky Brittany Z , Bean Gregory R
Published: April 2024

Breast hemangiomas are rare benign vascular lesions. In a previously performed review of approximately 10,000 breast surgical pathology results, roughly 0.15% (15/~10 000) were hemangiomas. Hemangiomas are more frequent in women and have a documented age distribution of 1.5 to 82 years. They are most often subcutaneous or subdermal and anterior to the anterior mammary fascia but may rarely be seen in the pectoralis muscles or chest wall. On imaging, breast hemangiomas typically present as oval or round masses, often measuring less than 2.5 cm, with circumscribed or mostly circumscribed, focally microlobulated margins, equal or high density on mammography, and variable echogenicity on US. Calcifications, including phleboliths, can be seen. Color Doppler US often shows hypovascularity or avascularity. MRI appearance can vary, although hemangiomas are generally T2 hyperintense and T1 hypointense with variable enhancement. Pathologic findings vary by subtype, which include perilobular, capillary, cavernous, and venous hemangiomas. If core biopsy pathology results are benign, without atypia, and concordant with imaging and clinical findings, surgical excision is not routinely indicated. Because of histopathologic overlap with well-differentiated or low-grade angiosarcomas, surgical excision may be necessary for definitive diagnosis. Findings that are more common with angiosarcomas include size greater than 2 cm, hypervascularity on Doppler US, irregular shape, and invasive growth pattern.
Impaired kidney function, cerebral small vessel disease and cognitive disorders: the Framingham Heart Study
Authors: Kelly Dearbhla M , Pinheiro Adlin A , Koini Marisa , Anderson Christopher D , Aparicio Hugo , Hofer Edith , Kern Daniela , Blacker Deborah , DeCarli Charles , Hwang Shih-Jen , Viswanathan Anand , Gonzales Mitzi M , Beiser Alexa S , Seshadri Sudha , Schmidt Reinhold , Demissie Serkalem , Romero Jose R
Published: April 2024

Background and hypothesis

It remains unclear whether the relation of chronic kidney disease (CKD) with cognitive dysfunction is independent of blood pressure (BP). We evaluated kidney function in relation to premorbid BP measurements, cerebral small vessel disease (CSVD), and incident mild cognitive impairment (MCI) and dementia in Framingham Offspring Cohort participants.

Methods

We included Framingham Offspring participants free of dementia, attending an examination during midlife (exam cycle 6, baseline) for ascertainment of kidney function status, with brain magnetic resonance imaging late in life (exam cycles 7–9), cognitive outcome data, and available interim hypertension and BP assessments. We related CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2) and albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) to CSVD markers and cognitive outcomes using multivariable regression analyses.

Results

Among 2604 participants (mean age 67.4 ± 9.2, 64% women, 7% had CKD, and 9% albuminuria), albuminuria was independently associated with covert infarcts [adjusted OR, 1.55 (1.00–2.38); P = 0.049] and incident MCI and dementia [adjusted hazard ratio (HR), 1.68 (1.18–2.41); P = 0.005 and 1.71, (1.11–2.64); P = 0.015, respectively]. CKD was not associated with CSVD markers but was associated with a higher risk of incident dementia [HR, 1.53 (1.02–2.29); P = 0.041]. While albuminuria was predictive of the Alzheimer's disease subtype [adjusted HR = 1.68, (1.03–2.74); P = 0.04), CKD was predictive of vascular dementia [adjusted HR, 2.78 (1.16–6.68); P = 0.023].

Conclusions

Kidney disease was associated with CSVD and cognitive disorders in asymptomatic community dwelling participants. The relation was independent of premorbid BP, suggesting that the link between kidney and brain disease may involve additional mechanisms beyond BP-related injury.
Glyphosate Residues in Soil and Phosphate Fertilizer Affect Foliar Endophytic Microbial Community Composition and Phytohormone Levels in Potato
Authors: Mathew Suni Anie , Jeevannavar Aditya , Helander Marjo , Tamminen Manu , Puigbò Pere , Rainio Miia , Saikkonen Kari , Fuchs Benjamin
Published: April 2024

Glyphosate, the active ingredient of glyphosate-based herbicides (GBHs), controls the growth of weeds by inhibiting the shikimate pathway, thereby interrupting amino acid biosynthesis in plants. However, several microbes have the shikimate pathway, and the effect of glyphosate on these non-target organisms is ignored. The action of GBHs is further complicated when used with other agrochemicals, such as phosphate fertilizers, often varying their mode of action depending on soil type or plant species. To address the impact of GBHs and phosphate fertilizers, we simulated agricultural application of GBHs and phosphate fertilizers in a field study, investigating the composition of endophytic microbial communities and correlation of phytohormone concentrations with the microbial diversity of potato ( Solanum tuberosum). In leaves, glyphosate residues in soil from GBH treatment alone and in combination with phosphate significantly shifted the bacterial community, whereas phosphate alone and in combination with glyphosate significantly altered the composition of the fungal community. There were no significant changes in microbial communities in roots and tubers. Plants treated with GBHs showed higher ratios of potentially glyphosate-resistant bacteria, with Xanthomonadaceae and Moraxellaceae being more abundant. Additionally, phytohormone concentrations showed various correlations with bacterial and fungal diversity in different treatments. The study highlights the impact of GBH residues in soil, particularly in combination with phosphate fertilizers, on the composition of plant-associated microbial communities. Together with changes in phytohormone concentrations, plant health may be affected. Future studies could provide insights into whether these agrochemicals influence the plant microbiome, leading to changes in phytohormones or vice versa.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Ensuring Continuity of Health Professions Training Amid a Global Pandemic: Lessons From the Uganda Safe Schools Initiative
Authors: Balizzakiwa Thomas , Achanga Pius , Ahaisibwe Bonaventure , Kerry Vanessa , Duhaga Irene Atuhairwe , Semakula Daniel , Sewankambo Nelson , Masood Kiran Mitha
Published: April 2024

Uganda experienced 2 COVID-19 waves that challenged health professional education. All health professions training institutions (HPTIs) in Uganda closed in March 2020. Cognizant of the threat to quality education and the frontline workforce, the National Council for Higher Education (NCHE) and Seed Global Health partnered to examine the risks and benefits of HPTI reopening through the Safe Schools Initiative (SSI). This article described the processes to unify stakeholders in health professions education and the outcomes from these discussions during the COVID-19 pandemic in Uganda.

During the first COVID-19 wave, the SSI conducted consultative meetings with key stakeholders. The SSI developed guidelines around student welfare and issued standard operating procedures (SOPs) for HPTI reopening. The NCHE recommended in-person learning for final-year students and online learning for junior years, resulting in HPTIs being the first academic institutions to reopen in the country. During the second COVID-19 wave, schools closed again. The SSI utilized recently published literature and quantitative data to inform decision making in addition to expert consensus. The NCHE recommended immediate phased reopening for students in clinical years, blended learning for nonclinical years, and prioritizing health professions education in future lockdowns. Consequently, HPTIs reopened within a month of closure. The SSI demonstrated that national advocacy for health professions education can be effective when engaging stakeholders to build consensus around difficult decisions.

Key lessons learned from the SSI include the following: (1) collaborating across sectors in health professions education can amplify change, (2) occupational health guidelines must include health professions students, (3) investing in online education and simulation has value in outbreak-prone areas, and (4) systemic inequities in health professions education will require persistence and advocacy to correct. Future pandemic preparedness must prioritize HPTIs to ensure quality education and continuity of a frontline workforce.
How a Team Effectiveness Approach to Health Systems Science Can Illuminate Undergraduate Medical Education Outcomes
Authors: Kim Jung G. , Gonzalo Jed D. , Chen Isabel , Vo Anne , Lupi Carla , Hyderi Abbas , Haidet Paul , DeWaters Ami , Blatt Barbara , Holmboe Eric , Thompson Lindsey R. , Jimenez Jazmin , Madigosky Wendy , Chung Paul J.
Published: April 2024

Health care delivery requires physicians to operate in teams to successfully navigate complexity in caring for patients and communities. The importance of training physicians early in core concepts of working in teams (i.e., “teaming”) has long been established. Over the past decade, however, little evidence of team effectiveness training for medical students has been available. The recent introduction of health systems science as a third pillar of medical education provides an opportunity to teach and prepare students to work in teams and achieve related core competencies across the medical education continuum and health care delivery settings. Although educators and health care system leaders have emphasized the teaching and learning of team-based care, conceptual models and evidence that inform effective teaming within all aspects of undergraduate medical education (including classroom, clinical, and community settings) are needed to advance the science regarding learning and working in teams. Anchoring teaming through the core foundational theory of team effectiveness and its operational components could catalyze the empirical study of medical student teams, uncover modifiable factors that lead to the evidence for improved student learning, and improve the link among competency-based assessments between undergraduate medical education and graduate medical education. In this article, authors articulate several implications for medical schools through 5 conceptual areas: admissions, the design and teaching of team effectiveness in health systems science curricula, the related competency-based assessments, and course and program evaluations. The authors then discuss the relevance of the measurable components and intended outcomes to team effectiveness in undergraduate medical education as critical to successfully prepare students for teaming in clerkships and eventually residency and clinical practice.
The Experience of Survivors of Firearm Suicide Attempts: A Retrospective Case Series
Authors: Savarino Jeffrey R. , Rubin Emily , Masiakos Peter T. , McLellan Rachel , Rolle Myron L. , Nanda Pranav , Stapleton Christopher J. , Sacks Chana A.
Published: April 2024

Objective:

We sought to identify people who survived firearm suicide attempts to describe the acute stressors, substance use, and mental health conditions related to the attempt.

Background:

Most firearm deaths in the United States are the result of suicide. Because firearm suicide attempts have a case fatality rate of approximately 90%, little is known about the precipitating factors that lead to firearm suicide attempts.

Methods:

We conducted a retrospective case series of patients admitted to a large hospital system between 2000 and 2019 who survived intentional, self-inflicted gunshot wounds to the head. Through the electronic medical record, we collected information about acute stressors, substance use, and mental health diagnoses before or at the time of the suicide attempt.

Results:

Thirty-four patients were included in the study cohort. Patients were predominantly White (74%) and male (88%), with a mean age of 44 (range, 14–82). Nineteen (56%) patients were acutely intoxicated with alcohol upon hospitalization and 17 (50%) patients had a positive urine drug screen. Acute stressors involving interpersonal relationships (53%), work/school (32%), and legal disputes (18%), among others, were documented in 82% of patients. Most patients (65%) had been diagnosed with depression before their index hospitalization. Most patients were discharged to an acute rehabilitation center (41%) or an inpatient psychiatric facility (41%).

Conclusions:

Acute stress and alcohol intoxication were common in this cohort of patients who attempted suicide using firearms. These data offer an ability to learn from the experience of survivors of firearm suicide attempts, a rare population.
Addition of Ketorolac to Local Anesthesia for Wound Infiltration in Multilevel Posterior Lumbar Spinal Fusion
Authors: Chaibhuddanugul Nattharut , Weerakul Santi , Laoruengthana Artit , Varakornpipat Panapol , Sudbanthad Pawin , Mahatthanatrakul Akaworn
Published: April 2024

Study Design.

Randomized double-blind controlled trial.

Objective.

The purpose of this study was to determine the efficacy of pain control and opioid consumption after administration of ketorolac directly to paraspinal muscle after spinal fusion.

Summary of Background Data.

Ketorolac is added to multimodal analgesia regimens to improve pain control, reduce opioid consumption following orthopaedics and spine surgery. However, evidence of the efficacy of adding ketorolac to local anesthesia for intrawound infiltration after spine surgery is still limited.

Materials and Methods.

The patients who underwent multilevel lumbar decompression and posterolateral fusion were recruited and randomized to the control group which received 0.5% bupivacaine hydrochloride injected into paraspinal muscles before wound closure, and the ketorolac group which received 30 mg ketorolac in addition to 0.5% bupivacaine hydrochloride. Postoperative numerical rating scale (NRS) for back pain, leg pain, morphine consumption, and adverse events were recorded.

Results.

A total of 47 patients were randomized (24 in the ketorolac group and 23 in the control group). The mean age was 60.9±6.9 years old. The mean NRS for back pain at 6 hours after surgery was 5.8±3.0 points for the control group and 3.3±2.1 points for the ketorolac group (P<0.01). The ketorolac group consumed lesser morphine than the control group by 9.1 mg in the first 24 hours, 13.8 mg at 48 hours, 14.3 mg at 72 hours, and 13.9 mg at 96 hours after the surgery (P<0.05). Postoperative complications were not different between the two groups.

Conclusions.

The addition of ketorolac to bupivacaine for wound infiltration after posterior lumbar spine decompression and fusion reduces early postoperative pain and total morphine consumption as compared with bupivacaine alone.
Omega Plate Fixation of Comminuted Olecranon Fractures: Technique and Case Series
Authors: Khanna Ankur , Clark Clarence J. , Yuan Brandon J. , Tangtiphaiboontana Jennifer , Barlow Jonathan D.
Published: April 2024

Fixation of olecranon fractures, especially those with minimal proximal bone and those that present with significant comminution, can be technically challenging. Current open reduction and internal fixation (ORIF) methods, such as tension band wire (TBW) constructs, plate fixation (PF), and intramedullary screws (IMSF), have demonstrated high rates of reoperation and symptomatic implants. We present the omega plate technique, which utilizes a mini-fragment plate passed under the triceps tendon insertion, allowing maximal implant surface area contact with small, proximal olecranon fracture fragments. The mini-fragment plate is not placed on the dorsal subcutaneous border of the ulna, which allows it to capture medial and lateral fragments of cortical comminution and may contribute to less soft tissue irritation.
The Relationship Between Self-Efficacy and Functional Capacity Among Discharged Heart Failure Patients in Jordan
Authors: Abusafieh Ahmad Moh’d , Shajrawi Abedalmajeed Methqal , Al-Smadi Ahmed Mohammad , Saleh Akram , Masa'deh Rami , Ismaile Samantha , Abdelhaq Mohammad Jamil
Published: April 2024

Background

Self-efficacy is an important factor associated with healthy lifestyle changes in heart failure treatment. Functional capacity testing of heart failure patients (HFPs) can stratify prognosis. Reduced functional capacities in HFPs are linked to a poor heart failure prognosis. Limited research has examined the potential relationship between self-efficacy and functional capacity.

Aim

The aims of this study were to assess self-efficacy level and functional capacity among HFPs after hospitalization, and examine whether there is a relationship between them.

Methods

A descriptive correlational design was used. A convenience sample of 220 HFPs was recruited from 2 hospitals in Jordan. The Arabic version of Cardiac Self-Efficacy Questionnaire was used to assess self-efficacy, the 6-Minute Walking Test (6-MWT) was used to assess functional capacity, and the Borg rating of perceived exertion scale (Borg Scale) was used to assess exertion during 6-MWT.

Result

The sample included 46.8% male (n = 103) and 53.2% female (n = 117). The mean age was 52.66 ± 8.91 years. Most of the HFPs were categorized based on New York Heart Association classification as class I, 35.9% (n = 79), and class II, 41.4% (n = 91). The mean ejection fraction was 41.46±9.44. The global self-efficacy was moderate (32.98 ± 9.92), and the mean score for the 6-MWT was 494.35 ± 143.37. The Borg Scale mean was 10.94±3.34. In addition, there was a positive relationship between self-efficacy and 6-MWT (r= 0.63, n = 220,P= .01).

Conclusion

This study provides baseline data for further research on treatment of HFPs, and the development of evidence-based tailored health interventions to maintain and improve self-efficacy and functional capacity among these service users. Moreover, replicated researches can test the study results considering different methodologies, such as using objective functional capacity tool and longer follow-up periods.
Management Strategies for Malignant Left-Sided Colonic Obstruction: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials and Propensity Score Matching Studies
Authors: McHugh Fiachra T. , Ryan Éanna J. , Ryan Odhrán K. , Tan Jonavan , Boland Patrick A. , Whelan Maria C. , Kelly Michael E. , McNamara Deirdre , Neary Paul C. , O’Riordan James M. , Kavanagh Dara O.
Published: April 2024

BACKGROUND:

The optimal treatment strategy for left-sided malignant colonic obstruction remains controversial. Emergency colonic resection has been the standard of care; however, self-expanding metallic stenting as a bridge to surgery may offer short-term advantages, although oncological concerns exist. Decompressing stoma may provide a valid alternative, with limited evidence.

OBJECTIVE:

To perform a systematic review and Bayesian arm random effects model network meta-analysis comparing the approaches for management of malignant left-sided colonic obstruction.

DATA SOURCES:

A systematic review was conducted from inception to August 22, 2023, of PubMed, Embase, Cochrane Library, and Google Scholar databases.

STUDY SELECTION:

Randomized controlled trials and propensity score matched studies.

INTERVENTIONS:

Emergency colonic resection, self-expanding metallic stent, decompressing stoma.

MAIN OUTCOME MEASURES:

Oncologic efficacy, morbidity, successful minimally invasive surgery, primary anastomosis, and permanent stoma rates.

RESULTS:

Nineteen articles from 5225 identified met our inclusion criteria. Stenting (risk ratio 0.57, 95% credible interval: 0.33, 0.79) and decompressing stomas (risk ratio 0.46, 95% credible interval: 0.18, 0.92) both resulted in a significant reduction in the permanent stoma rate. Stenting facilitated minimally invasive surgery more frequently (risk ratio 4.10, 95% credible interval: 1.45, 13.13) and had lower overall morbidity (risk ratio 0.58, 95% credible interval: 0.35, 0.86). A pairwise analysis of primary anastomosis rates showed an increase in stenting (risk ratio 1.40, 95% credible interval: 1.31, 1.49) as compared with emergency resection. There was a significant decrease in the 90-day mortality with stenting (risk ratio 0.63, 95% credible interval: 0.41, 0.95) when compared with resection. There were no differences in disease-free and overall survival rates, respectively.

LIMITATIONS:

There is a lack of randomized controlled trial and propensity score matching data comparing short and long-term outcomes for diverting stomas compared to self-expanding metallic stents. Two trials compared self-expanding metallic stents and diverting stomas in left-sided malignant colonic obstruction.

CONCLUSION:

This study provides high-level evidence that bridge-to-surgery strategy is safe for the management of left-sided malignant colonic obstruction, and may facilitate minimally invasive surgery, increase primary anastomosis rates, and reduce permanent stoma rates and postoperative morbidity as compared to emergency colonic resection.
Management of coagulopathy among patients with cirrhosis undergoing upper endoscopy and paracentesis: Persistent gaps and areas of consensus in a multispecialty Delphi
Authors: Tapper Elliot B. , Warner Matthew A. , Shah Rajesh P. , Emamaullee Juliet , Dunbar Nancy M. , Sholzberg Michelle , Poston Jacqueline N. , Soto Robin J. , Sarwar Ammar , Pillai Anjana , Reyner Karina , Mehta Shivang , Ghabril Marwan , Morgan Timothy R. , Caldwell Stephen
Published: April 2024

Patients with cirrhosis have abnormal coagulation indices such as a high international normalized ratio and low platelet count, but these do not correlate well with periprocedural bleeding risk. We sought to develop a consensus among the multiple stakeholders in cirrhosis care to inform process measures that can help improve the quality of the periprocedural management of coagulopathy in cirrhosis. We identified candidate process measures for periprocedural coagulopathy management in multiple contexts relating to the performance of paracentesis and upper endoscopy. An 11-member panel with content expertise was convened. It included nominees from professional societies for interventional radiology, transfusion medicine, and anesthesia as well as representatives from hematology, emergency medicine, transplant surgery, and community practice. Each measure was evaluated for agreement using a modified Delphi approach (3 rounds of rating) to define the final set of measures. Out of 286 possible measures, 33 measures made the final set. International normalized ratio testing was not required for diagnostic or therapeutic paracentesis as well as diagnostic endoscopy. Plasma transfusion should be avoided for all paracenteses and diagnostic endoscopy. No consensus was achieved for these items in therapeutic intent or emergent endoscopy. The risks of prophylactic platelet transfusions exceed their benefits for outpatient diagnostic paracentesis and diagnostic endosopies. For the other procedures examined, the risks outweigh benefits when platelet count is >20,000/mm3. It is uncertain whether risks outweigh benefits below 20,000/mm3 in other contexts. No consensus was achieved on whether it was permissible to continue or stop systemic anticoagulation. Continuous aspirin was permissible for each procedure. Clopidogrel was permissible for diagnostic and therapeutic paracentesis and diagnostic endoscopy. We found many areas of consensus that may serve as a foundation for a common set of practice metrics for the periprocedural management of coagulopathy in cirrhosis.
Examining Tear Film Dynamics Using the Novel Tear Film Imager
Authors: Mangwani-Mordani Simran , Baeza Drew , Acuna Kelly , Antman Gal , Harris Alon , Galor Anat
Published: April 2024

Purpose:

The purpose of this study was to examine Tear Film Imager (TFI, AdOM, Israel) generated parameters across controls and dry eye (DE) subgroups and examine the changes in TFI parameters with contact lens (CL) placement.

Methods:

The retrospective study (n = 48) was conducted at the Miami Veterans Hospital. Symptoms were assessed through validated questionnaires and signs of tear function by tear break-up time and Schirmer scores. Participants were grouped as 1) healthy, 2) evaporative, 3) aqueous deficient, and 4) mixed DE based on tear function. Seventeen individuals had a baseline scan and a repeat scan following CL placement. Descriptives were compared across groups and over time.

Results:

The median age was 27 years, 74% self-identified as White, 45% as male, and 51% as Hispanic. Subjects in the aqueous deficiency category had lower muco-aqueous layer thickness (MALT) (2672 vs. 3084 nm) but higher lipid layer thickness (47.5 vs. 38.3 nm), lipid break-up time (4.4 vs. 2 seconds), and interblink interval (13.9 vs. 5.4 seconds) compared with the evaporative group. Subjects in the evaporative group had the highest MALT values (3084 vs. 2988, 2672, 3053 nm) compared with healthy, aqueous-deficient, and mixed groups. Symptoms were not significantly correlated with TFI parameters. CL placement significantly decreased MALT values (2869 → 2175 nm, P = 0.001).

Conclusions:

The TFI provides unique information regarding the dynamic function of the tear film not captured by clinical examination. TFI generated metrics demonstrate a thinner aqueous layer in individuals with aqueous deficiency but highlight a thicker aqueous layer in those with evaporative DE.
The Efficacy of Fibrin Sealant in Sutureless Deep Sclerectomy—Preliminary Outcomes
Authors: Baxant Alina-Dana , Pencak Martin , Vranova Jana , Netukova Magdalena , Urbaniova Katarina , Holubova Lucie , Pluhovsky Patrik , Rosina Jozef , Studeny Pavel
Published: April 2024

Précis:

Deep sclerectomy (DS) with fibrin adhesive can constitute a safe alternative to the classic procedure using sutures, providing nonallergenic, nontoxic, and secure adhesion with no sign of aqueous humor outflow obstruction postoperatively.

Objective:

To evaluate short and medium-term postoperative results of DS with a fibrin sealant.

Patients and Methods:

This prospective, noncomparative, interventional case series involves 12 eyes of 12 patients with uncontrolled open angle glaucoma who underwent DS with Esnoper (Clip or V2000) implant between February 2021 and March 2022. A novel method of wound closure (sclera, Tenon fascia, and conjunctiva) employing fibrin glue was used instead of classic sutures. Surgical outcomes assessed include: intraocular pressure and glaucoma therapy reduction, best-corrected visual acuity changes, and number of complications registered peri and postoperatively. All measurements were performed preoperatively, as well as at 1 day, at 1 and 2 weeks, and at 1, 2, 3, 6, 9, and 12 months after surgery.

Results:

The mean intraocular pressure decreased from 24.0 ± 9.1 mm Hg to 13.8 ± 6.3 mm Hg at 1 year postoperatively (P < 0.001). Kaplan-Meier survival analysis revealed complete and qualified success rates of 83.3% and 91.7%. The mean glaucoma therapy decreased from 3.2 ± 1.1 to 0.8 ± 1.3 drugs 12 months after surgery (P < 0.001). Nd:YAG goniopunture was performed in 2 eyes at 1 and 12 months postoperatively. No significant best-corrected visual acuity changes were registered. Perioperatively, we noted a trabeculo-descemet microperforation in 1 eye, transient hypotony in 5 eyes, and mild hyphema in 2 eyes.

Conclusions:

Fibrin adhesive provided an effective closure in sutureless DS in the patients included in our study. This modification of classical DS may simplify the surgical technique, ensure secure wound adaptation, optimize healing, and lower the risk of inflammation and fibrosis postoperatively.
G2 and S phase-expressed protein 1 is a biomarker for poor prognosis in lung adenocarcinoma
Authors: Yang Xitong , Zhu Xiaoling
Published: April 2024

Studying the regulatory mechanism and clinical application of G2 and S phase-expressed protein 1 (GTSE1) genes in lung adenocarcinoma (LUAD). LUAD data was obtained from The Cancer Genome Atlas (TCGA) database, and differentially expressed genes (DEGs) were derived by analyzing expression data using R software. Survival analysis was performed to identify genes associated with LUAD, and among them, a target gene for LUAD was identified. Further analysis of the gene expression profiling interactive analysis database revealed differences in gene expression between normal and tumor tissues of LUAD patients. Disease free survival (DFS) and overall survival (OS) of the GTSE1 genes in LUAD were compared. The study conducted a GSEA analysis of GTSE1 expression and further investigated the relationships between GTSE1 expression and the survival time of LUAD patients at different pathological stages. The correlations between OS and GTSE1 gene expression were explored based on different treatments. Additionally, the correlation between the GTSE1 gene and immune infiltration was analyzed. The results indicated that the expression of GTSE1 was significantly higher in tumor tissues of LUAD compared to normal tissues. Furthermore, patients with high GTSE1 expression had significantly lower survival rates for OS and DFS compared to patients with low expression of GTSE1. The GSEA analysis of GTSE1 revealed its involvement in LUAD through the Reactome unwinding of DNA and Biocarta ranms pathway. In patients with LUAD at the pathological T2 stage, low expression of GTSE1 was associated with longer survival time. Furthermore, LUAD patients with low GTSE1 expression who underwent surgery without chemotherapy exhibited a longer survival time. The GTST1 gene, identified as a target gene of LUAD, was validated through cell experiments and pathological sections. GTSE1 can be used as a marker and therapeutic target for LUAD. The survival of LUAD patients can be improved by reducing the expression of GTSE1.
Impact of stress coping strategy in modifying perceptions of school stress among adult learners enrolled in Home Economics and Indigenous Textiles Education in Nigerian Universities
Authors: Nwadi Calister Lebechukwu , Ede Moses Onyemaechi , Nwakpadolu Glory Mmachukwu , Okoro Joy Oluchukwu , Onu Eucharia Amaka , Emeghebo Udochukwu M. , Ezeanwu Amaka Bibian , Ogbonna Kingsley Asogu , Agu Patricia U. , Nkemjika Ogechi , Nwosu Nneka , Okereke Godwin Keres , Onah Sebastian O. , Uba Mercy Benedette Ifeoma , Obeagu Emmanuel Ifeanyi
Published: April 2024

Background/Objective:

Studying some professions is so demanding that if not well managed it leads to severe stress, withdrawal, burnout, and other health-related problems. Hence, practical engagement and exhibition of catering, cooking, and home management are so tasking as they are time-consuming and very intensive. Many students in the specialties experience excess academic loads and internal and external demands. Given these, this study tested the impact of cognitive behavior coping strategy on school stress among adult learners enrolled in Home Economic and Indigenous Textile Education.

Methods:

A pretest-posttest randomized control group design was applied. Ninety-five students (43 [45.3%] males; 52 [54.7%] females) participated in the current study. Stress assessment was induced and then students were randomly allocated to the cognitive behavior coping strategy group and the waitlist conditions. Later, students on the waitlist received the cognitive behavior coping strategy contents. Data collected were analyzed using analysis of covariance.

Results:

Results showed that at pretest, there was no significant difference among the participants in the 2 groups as measured by Educational Stress Scale and Perceived Stress Scale scores. However, the post-intervention test result showed a long-term impact of cognitive behavior coping strategy in improving the management of school stress among students.

Conclusion:

This study suggests that cognitive behavior coping strategy has a long-term impact on modifying the students’ perception of school stress in a sample of adult learners enrolled in Home Economic and Indigenous Textile Education.
Thrombectomy for delayed thromboembolism in a recurrent cerebral aneurysm previously treated with coiling: A case report
Authors: Shao Ya , Yang Yuan , Huang Haidong , Wang Ting , Li Jinglun , Jiang Yushan , Yuan Ziwei , Tang Jiayi , Wang Dihu , Xiang Zerui , Zeng Xue , Yu Zhou , He Zhongchun , Yuan Zhengzhou
Published: April 2024

Rationale:

Giant intracranial aneurysms pose a significant threat due to high mortality rates upon rupture, prompting interventions such as neurosurgical clipping or endovascular coiling.

Patient Concerns:

We present a rare case involving a 47-year-old female with a history of successfully treated ruptured giant intracranial aneurysms. Six months post-surgical clipping, she developed symptoms of acute ischemic stroke, prompting the decision for neurosurgical coiling and stent-assisted aneurysm coil embolization due to recurrent intracranial aneurysms.

Diagnoses:

Subsequently, occlusion occurred at the previously implanted stent site during embolization, necessitating exploration of alternative therapeutic options. Digital subtraction angiography confirmed stent occlusion in the right middle cerebral artery.

Interventions:

Despite an initial unsuccessful attempt using a direct aspiration first-pass technique, the patient underwent successful mechanical thrombectomy with a retrievable stent, leading to successful reperfusion. This study aims to highlight the challenges and therapeutic strategies in managing delayed cerebral vascular occlusion following stent-assisted coil embolization, emphasizing the significance of exploring alternative interventions to enhance patient outcomes.

Outcomes:

The patient achieved successful reperfusion, and the study underscores the importance of recognizing and addressing delayed cerebral vascular occlusion after stent-assisted coil embolization for recurrent cerebral aneurysms.

Lessons:

Our findings suggest that retrievable stent mechanical thrombectomy may serve as a viable therapeutic option in challenging scenarios, emphasizing the need for further exploration of alternative interventions to enhance patient care.
A comparative study of anxiety and depression among healthcare workers and non-healthcare workers in Johor, Malaysia during the Covid-19 era
Authors: Wong Jing Wen , Tan Jun Hui , Abraham Ruth Elizabeth , Jauhar Ali Shareen Nisha , Kok Si Yin , Tan Henry Chor Lip , Tan Jih Huei , Ni Han
Published: April 2024

The outbreak of Coronavirus disease 2019 (Covid-19) has a significant impact on the mental health of the global population. Updates are needed regarding the mental health status among the local population since limited studies were done so far. This research compared the prevalence of anxiety and depression symptoms among HCWs and non-HCWs. We also evaluated the factors associated with anxiety and depression symptoms among these 2 groups. This was a cross-sectional study conducted between September to December 2022. Online questionnaire was distributed to HCWs from 2 tertiary government hospitals. Non-HCWs from various occupational fields were recruited randomly. Generalised Anxiety Disorder 7 (GAD-7) and Patient Health Questionnaire 9 (PHQ-9) were used to screen for anxiety and depression symptoms respectively. Data were analyzed using IBM SPSS version 28.0. 200 questionnaires were distributed to HCWs and non-HCWs respectively. The response rate was 74.5% from HCWs and 82.5% from non-HCWs (P = .07). A total of 236 individuals (105 HCWs and 131 non-HCWs) were included in the study. Majority were female, married, highly educated and worked more than 8 hours per day. There was no significant difference for the prevalence of anxiety (37.2% vs 44.3%, P = .34) and depression symptoms (37.3% vs 35.1%, P = .75) between HCWs and non-HCWs. Among HCWs, poor workplace support (P = .009) and low income (P = .04) were associated with anxiety symptoms. Younger age (P = .02), single status (P = .01) and poor workplace support (P = .006) were associated with depression symptoms. More non-HCWs with a higher educational level were having anxiety and depression symptoms. Single status (P = .03), working away from home (P = .02), poor family support (P = .03) and quarantine as Covid-19 close contact (P = .04) were also associated with depression symptoms among non-HCWs. There is no significant difference between HCWs and non-HCWs experiencing possible anxiety or depressive symptoms in this study. However, attention should be paid to address associated factors identified among each group to promote good mental health.
Pregnancy- and lactation-associated osteoporosis: A case series of 6 patients
Authors: Qian Ying , Wang Jingming , Wu Aifang , Huang Weimin
Published: April 2024

Rationale:

There is still information about pregnancy- and lactation-associated osteoporosis, which is a type of osteoporosis that occurs in women with normal bone in the late pregnancy or lactation period.

Patient concerns:

Six cases of pregnancy- and lactation-associated osteoporosis diagnosed in our Endocrinology and Orthopedics Departments from January 2018 to June 2020 were retrospectively studied. The baseline characteristics, clinical features, laboratory findings, radiological manifestations, and follow-up outcomes were analyzed and compared with previous reports.

Diagnoses:

All six patients underwent magnetic resonance imaging scans and vertebral compressive fractures were detected in four patients.

Outcomes:

All six patients received conservative treatment and no surgical intervention. After a mean follow-up of 27.3 months (range 24–31 months), the symptoms of the six patients were significantly relieved, although four patients still had low back pain to varying degrees.
The efficacy and safety of using a combination of rocuronium and sugammadex for awake craniotomy anesthesia: A randomized clinical trial
Authors: Chen Yun , Yang Ruixin , Sun Mei , He Huan , Lin Yuanyuan , Bai Hongming , Xiong Ming , Xu Bo
Published: April 2024

Background:

Awake craniotomy (AC) is a neurosurgical method for the resection of brain lesions located in eloquent areas to achieve maximal and safe resection. A patient’s arousal quality is essential for the success of the operation. This study compared the arousal time and quality after AC achieved by 2 different drug combinations: rocuronium with sugammadex and propofol with remifentanil.

Methods:

This prospective, randomized, controlled trial included 42 adult patients undergoing AC with a laryngeal mask, who were randomly assigned to either a rocuronium-sugammadex group (RS; n = 21) or a propofol-remifentanil without muscle relaxant group (nRS; n = 21). The primary outcomes were the arousal time and arousal quality. The secondary outcomes included the number of laryngeal mask airway (LMA) adjustments and diaphragmatic excursion length.

Results:

This study included 42 participants. The median (IQR) arousal time was 13.5 minutes (7–20) in the RS group and 21 minutes (16.5–26.5) in the nRS group (P = .005). There was no significant difference in arousal quality between the 2 groups (P = .229). LMA adjustments were significantly less frequent in the nRS group than in the RS group [0.25 times (±0.62) vs 1.26 times (±1.17), P = .001]. Adverse events, such as spontaneous movements and brain swelling, were more frequent in the nRS group than in the RS group.

Conclusions:

Using a combination of rocuronium and sugammadex with propofol and remifentanil may shorten the awakening time, reduce the duration of laryngeal mask adjustment, and do not affect the arousal quality and postoperative outcomes for patients undergoing awake craniotomy, compared to propofol and remifentanil alone.
Iatrogenic aortic dissection in patients undergoing coronary artery bypass grafting surgery: A systemic review of published literatures
Authors: Yuan Xi , Sun Yanting , Chen Huaqiu , Lan Qiqing , Wu Wen , Yao Yuntai ,   The Evidence in Cardiovascular Anesthesia (EICA) Group
Published: April 2024

Background:

Iatrogenic aortic dissection (IAD) is a rare but highly lethal complication that may occur following coronary artery bypass grafting (CABG) surgery. Aortic dissection (AD) is often asymptomatic, making early detection difficult. We aimed to optimize preoperative evaluation strategies of CABG surgery for minimizing the incidence of IAD and assess early recognition and management of IAD for improving outcomes.

Methods:

Electronic databases were searched to identify all case reports of patients undergoing CABG surgery who developed IAD. Clinical characteristics, operative information, perioperative management, and patient outcomes were compiled and analyzed.

Results:

Nineteen case reports involving 27 patients aged 50 to 81 were included. Patients were from Europe (n = 23) and Asia (n = 4), mostly men (n = 25). The aorta was described as normal, abnormal, and unmentioned (n = 8, 5, and 14, respectively). Sixteen patients had a bypass with more than 3 grafts. Most patients (n = 25) experienced type A dissection. There were intraoperative (n = 12) and postoperative (n = 15) cases. Surgery (n = 19) was the most common treatment, with 9 patients selecting deep hypothermic circulatory arrest. Eighteen patients were restored to health, while 9 patients died (3 died before treatment).

Conclusions:

Our study focused on patients with IAD and developed a recommended management protocol for patients undergoing CABG surgery.