bluuebunny/crossref_metadata_2025 huggingface dataset:
Mining of clinical and prognosis related genes in the tumor microenvironment of endometrial cancer: A field synopsis of observational study
Authors: Li Wenxue , Qin Yujing , Chen Xiujuan , Wang Xiaolei
Published: June 2023

Endometrial cancer (EC) is the sixth most common malignant tumor in women worldwide, and its morbidity and mortality are on the rise. The purpose of this study was to explore potential tumor microenvironment (TME)-related biomarkers associated with the clinical features and prognosis of EC. The Estimating Stromal and Immune Cells in Malignancy Using Expression Data (ESTIMATE) algorithm was used to calculate TME immune and stromal scores of EC samples and to analyze the relationship between immune/stromal scores, clinical features, and prognosis. Heat maps and Venn maps were used to screen for differentially expressed genes (DEGs). The ESTIMATE algorithm revealed immune score was significantly correlated with overall survival and tumor grade in patients with EC. A total of 1448 DEGs were screened, of which 387 were intersecting genes. Gene Ontology (GO) analysis revealed that the biological processes (BP) related to intersecting genes mainly included T cell activation and regulation of lymphocyte activation. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that the intersecting genes were closely related to immune-related signaling pathways. Thirty core genes with more than 7 nodes were identified using protein–protein interaction (PPI) analysis. Six independent prognostic genes of EC were identified using Kaplan–Meier survival analysis and multivariate Cox analysis, namely CD5, BATF, CACNA2D2, LTA, CD52, and NOL4, which are all immune-infiltrating genes that are closely related to clinical features. The current study identified 6 key genes closely related to immune infiltration in the TME of EC that predict clinical outcomes, which may provide new insights into novel prognostic biomarkers and immunotherapy for patients with EC.
Cyberbullying in teenagers – a true burden in the era of online socialization
Authors: Borka Balas Reka , Meliț Lorena Elena , Sarkozi Daniel , Ghiga Dana Valentina , Mărginean Cristina Oana
Published: June 2023

Cyberbullying represents a major concern worldwide, especially among teenagers with major negative psychological impact. We performed a prospective online questionnaire-based study on 316 teenagers in order to assess the prevalence of cyberbullying in Romania, evaluate its psychosocial consequences, and examine the factors that may predispose them to bullying. Almost 50% of the responders stated that they have been previously bullied, with females having a higher risk of being harassed (P = .0043). Most of the victims were bullied on Facebook, Instagram, and video games. More than 53% of the victims included in our study benefit from help. We found that subjects who have been cyberbullied had a significantly higher risk of having bullied friends (P < .0001). Also, we identified a significant association between the teenagers’ relationship with the parents and the incidence of bullying (P = .002). Domestic violence and the male gender were significant risk factors for committing cyberbullying (P = .0014/0.0020). Cyberbullying had a negative impact also on the harasser, and previous victims of cyberbullying had a significantly higher risk of becoming bullied (P < .0001). Also, we found a significant association between the type of substance and the perpetration of aggression (P < .0001). Further studies should focus on designing effective strategies in order to decrease the incidence of this harmful online act of bullying.
WeChat-based remote follow-up management reduces the burden of home care and anxiety on parents of children with refractory epilepsy: A randomized controlled study
Authors: Huang Xiaofen , Kang Yueming , Wang Meixin , Liu Qianqian , Wang Feng , Zeng Mingzhu
Published: June 2023

Objective:

The present research was designed to study the effect of WeChat-based remote follow-up management on the burden of home care and anxiety on parents of children with refractory epilepsy.

Methods:

161 refractory epileptic children were included in this study. They were divided into control group and WeChat group according to their management protocols after discharge, namely, control group with traditional follow-up (n = 81) and WeChat group with remote follow-up based on WeChat (n = 81). We evaluated home care burden by family caregiver task Inventory (FCTI) scale and zarit burden interview (ZBI) scale, and evaluated negative emotion by self-rating anxiety Scale (SAS) scale and self-Rating depression scale (SDS) scale.

Results:

There was no significant difference in the demographic characteristics of epileptic children and their parents and the scores of FCTI, ZBI, SAS and SDS before treatment between the 2 groups (all P > .05), and the score of FCTI (20.86 ± 4.26), ZBI (39.63 ± 4.46), SAS (44.49 ± 4.15) and SDS (50.02 ± 4.13) in WeChat group were all significantly lower than the score of FCTI (25.25 ± 3.71), ZBI (45.47 ± 4.61), SAS (52.75 ± 4.93) and SDS (54.51 ± 6.59) in control group (all P < .05).

Conclusion:

WeChat-based remote follow-up management reduces the burden of home care and anxiety on parents of children with refractory epilepsy.
A patient with the highly suspected B cell lymphoma accompanied by the erythrocytes cold agglutination: Case report
Authors: Lin Huijun , Feng Dujin , Tao Shuting , Wu Jianguo , Shen Yan , Wang Weizhong
Published: June 2023

Rationale:

Cold agglutinins are related with B cell lymphoproliferative disorder and lymphoma, and can agglutinate red blood cells (RBCs) at an optimum temperature of 3–4°C, which is the undergoing cause of RBCs cold agglutination. RBC cold agglutination may lead to an extreme abnormality of RBC parameters of complete blood count (CBC).

Patient concerns:

The present study reports a case of an old patient with severe infectious fever and anemia presenting extremely abnormal levels of RBC parameters in CBC and a sand-like appearance of blood on tube wall. The validating tests indicated the presence of the RBCs cold agglutination and the highly suspected B cell lymphoma.

Diagnoses:

The 37°C-incubation corrected the CBC results of the patient, and the microscopic observation and flow cytometry analysis of blood and marrow indicated many abnormal B lymphocytes. Subsequently, the patient was diagnosed with a highly suspected B-cell lymphoma.

Interventions:

The blood with a sand-like appearance was reanalyzed to validate the cold agglutination by 37°C-water incubation. The smears of peripheral blood and marrow were made for morphological observation by using optical microscopy. Moreover, the clusters of differentiation of the white blood cells were analyzed to confirm the type of abnormal white blood cells with a flow cytometer.

Outcomes:

The RBCs cold agglutination was validated, and the highly suspected B cell lymphoma was proved as the undergoing cause.

Lessons:

This case focuses on the discovery and solutions of RBCs cold agglutination, and emphasizes the importance of microscopic observation in the exploration of undergoing causes of cold agglutination.
Recurrent intestinal ulcer with bloody stool for >10 years in an adolescent boy of 15 years: A case report
Authors: Li Wei , Wang Yang , Wang Yufang , Yang Chuan , Lu Zhen , He Zhaoxia , Peng Lan
Published: June 2023

Rationale:

Infectious diseases, autoimmune diseases and vascular diseases can lead to intestinal ulcers, and inflammatory bowel disease is typically suspected as the underlying cause of ulcer and bleeding from the intestinal ulcers leading to bloody stool, and malnutrition. Here we report a rare case of successfully treated case of intestinal ulcer, bloody stool, and malnutrition by dietary modification and avoidance of long term barbecued spicy food and carbonated drinks.

Patient concerns:

A 15-year-old male patient had repeated symptoms of blood in the stool for >10 years. Treatment for Chron’s disease was not successful. An exhaustive investigation failed to confirm the diagnosis.

Diagnosis interventions:

Through changing diet structure, avoiding spicy food, and supplementing enteral nutrition and recurrent glutamine.

Outcomes:

The patient’s symptoms improved significantly, and the intestinal ulcer healed under endoscope.

Lessons:

Pay attention to healthy diet in life and avoid long-term consumption of spicy food and carbonated drinks.
Case series: Noninfectious myositis of temporal muscle: a report of 2 cases
Authors: Kong Mi-Sun , Huh Kyung-Hoe , Kho Hong-Seop
Published: June 2023

Background:

Noninfectious myositis (NIM) of the masticatory muscles is uncommon local myalgia disorder persisted by a centrally-mediated neurogenic mechanism. Due to the rarity of this condition and the lack of appropriate data regarding it, diagnosing this pathology when it affects the temporal muscle (TM) is challenging.

Case presentation:

Clinical signs and symptoms, diagnostic process, and treatment outcome of 2 rare cases of NIM of the TM were presented. The signs and symptoms of the patients were not pathognomonic. There were restrictions on the mouth opening and lateral excursion of the mandible. The duration of the symptoms may not be chronic. The findings of clinical evaluation may indicate the diagnosis of anterior disc displacement (DD) without reduction of the temporomandibular joint (TMJ) and/or local myalgia. Swelling of the involved muscle could be evident and identified on palpation depending on the involved site of myositis. The axial T2-weighted magnetic resonance (MR) imaging was important for the accurate diagnosis of this rare condition. Application of non-surgical conservative treatment modalities such as administration of non-steroidal anti-inflammatory analgesics for a sufficient period of time, control of oral parafunctional habits, and jaw exercises were effective for the management of NIM of the TM.

Conclusion:

A thorough clinical examination and MR imaging including the axial T2-weighted view are required for accurate diagnosis and effective management of NIM of the TM.
Tocilizumab-induced mucosal injury in the terminal ileum mimicking intestinal Behçet’s disease: A case report
Authors: Ozaka Sotaro , Fukuda Masahide , Takahashi Haruhiko , Tsutsumi Koshiro , Iwao Masao , Hirashita Yuka , Fukuda Kensuke , Okamoto Kazuhisa , Arakawa Mie , Ogawa Ryo , Endo Mizuki , Mizukami Kazuhiro , Kamiyama Naganori , Kobayashi Takashi , Kodama Masaaki , Murakami Kazunari
Published: June 2023

Rationale:

Tocilizumab, a humanized anti-interleukin-6 (IL-6) receptor monoclonal antibody, is used for the treatment of adult-onset Still disease (AOSD). Despite its efficacy in many clinical situations, concerns have been raised regarding intestinal mucosal injury in patients receiving tocilizumab.

Patient concerns:

A 64-year-old woman with a history of AOSD was admitted to our hospital with hematochezia. She had AOSD for 15 years and underwent treatment with biweekly tocilizumab 9 months prior to admission. Colonoscopy revealed a large punched-out ulcer in the terminal ileum. On pathological evaluation, nonspecific enteritis with lymphocytes and eosinophils were seen. Based on the location and shape of the lesion, we suspected intestinal Behçet’s disease. However, the ulcer reduced in size over time by discontinuation of tocilizumab without additional drug treatment, indicating that it was a drug-induced ulcer.

Diagnosis:

The patient was diagnosed with tocilizumab-induced small intestinal ulcer.

Interventions:

The patient treated with the discontinuation of tocilizumab.

Outcomes:

The discontinuation of tocilizumab resulted in ulcer scarring. There was no recurrence of hematochezia.

Lessons:

Tocilizumab can cause deep ulcerative lesions in the terminal ileum, which may resemble intestinal Behçet’s disease. It is important to continuously monitor abdominal symptoms during tocilizumab therapy and aggressively perform colonoscopy when hematochezia or abdominal pain is observed.
Diagnosis and treatment of traumatic Descemet’s membrane detachment: A case series
Authors: Li Zhao , Gao Wen , Yang Yongli , Liang Weilin
Published: June 2023

Rationale:

The Descemet layer is a dense layer of tissue that does not detach under normal circumstances. Descemet layer detachment may occur after intraocular surgery, but the Descemet layer spontaneously detached after trauma in this child, which is relatively rare. After looking for the cause, we found that the child was diagnosed with congenital glaucoma, and the trauma induced the Descemet’s membrane detachment.

Patient concerns:

The parents of the patient expected the child to recover the normal shape of the cornea as soon as possible, improve vision, and solve the problem of congenital glaucoma.

Diagnoses:

The patient was diagnosed with Descemet's membrane detachment of the left eye and congenital glaucoma in both eyes.

Interventions:

During operation, inflation gas is injected into the anterior chamber, the Descemet’s membrane is reset, and glaucoma surgery is performed.

Outcomes:

The Descemet’s membrane in the child’s eye was reset, and after glaucoma surgery, the intraocular pressure of the child was normal.

Lessons:

The analysis of the disease is not only to solve the problems seen but also to deeply analyze the internal causes and pathological changes in combination with the symptoms and signs, so as to discover the essence of the problem and solve the fundamental problem of the patient.
Efficacy of acupuncture on acute pharynx infections: A systematic review and meta-analysis
Authors: Zhang Shuo , Cui Yang , Zhou Xinyu , Wang Delong , Yin Jiantao , Meng Xiangyue , Cao Yu , Li Quan , Yin Hongna
Published: June 2023

Background:

Several clinical reports have focused on acupuncture for the treatment of acute pharyngeal infections. However, the efficacy and safety of acupuncture for the treatment of acute pharyngeal infections are controversial. To systematically assess the efficacy and safety of acupuncture in treating acute pharynx infections, thus providing a reference for clinical decision-making.

Methods:

We searched PubMed, CENTRAL, Embase, Web of Science, China National Knowledge Infrastructure, China Biomedical, clinical research registration platforms, gray literature, and reference lists of the selected studies from inception to October 30, 2022. The risk of bias assessment was performed using RevMan. The meta-analysis was performed using STATA with the Hedges’gvalue. We also performed a subgroup analysis, meta-regression, and publication bias detection using Harbord’s and Egger’s tests.

Results:

We included 19 randomized controlled trials comprising 1701 patients, of which only one study had a high risk of bias. The primary outcome, i.e., the response rate, revealed that acupuncture was more effective than antibiotics. The secondary results revealed that the differences in the reduction of VAS scores, sore throat duration, and white blood cell counts were statistically significant in the acupuncture group compared with the antibiotic group. However, the difference in the modulation of the neutrophil percentage and C-reactive protein levels was insignificant. Moreover, the acupuncture treatment resulted in a lower incidence of adverse events than the antibiotic treatment.

Conclusions:

Thus, acupuncture therapy for acute pharyngeal infections is safe and its response rate is superior to that of antibiotics. Acupuncture showed positive outcomes for alleviating the sore throat symptoms, shortening the sore throat duration, and improving the immune inflammation index. Nevertheless, owing to the limitations of this study, our conclusions should be interpreted with caution. More high-quality trials are warranted in the future for improving the methodology and reporting quality.
Group B Streptococcus infection-induced ovarian vein thrombosis identified during cesarean section: A case report and a literature review
Authors: Li Jianqiong , Zhou Meifang , He Chaoman , Liang Fengbing
Published: June 2023

Rationale:

Ovarian vein thrombosis (OVT) is a rare yet potentially life-threatening condition associated with thromboembolic events. Group B Streptococcus (GBS) is a type of β-hemolytic Gram-positive bacterium known for asymptomatic colonization in the lower genital and gastrointestinal tracts. Here we reported a 35-year-old multiparous woman with gestational diabetes who suffered from placental abruption, stillbirth, OVT, septic shock, and renal failure due to severe GBS infection.

Patient concerns:

A 35-year-old woman with gestational diabetes presented with acute and sustained lower abdominal cramping, vaginal bleeding, and fever at 35 gestational weeks.

Diagnoses:

Based on preoperative ultrasound and intraoperative findings, the patient was diagnosed with placental abruption, intrauterine fetal demise, and right OVT. GBS was cultured from the amniotic fluid obtained during cesarean section.

Interventions:

The patient underwent a right adnexectomy during a cesarean section and received intravenous antibiotics. Subsequently, an ultrasound-guided uterine curettage was performed due to recurrent fever.

Outcomes:

After a prolonged course of intravenous antibiotics for over a month, the patient recovered and was discharged from the hospital.

Lessons:

This case underscores the need for early initiation of anticoagulant protocols in cases of OVT, particularly when GBS infection is identified as a predisposing factor. Further research and awareness are warranted to better understand the relationship between GBS infection and OVT and to optimize management strategies in such cases.
Cerebral venous thrombosis after high-dose steroid in patient with multiple sclerosis: A case report
Authors: Zhu Manmin , Cui Wenxiu , Huang Wei , Liu Zheng , Xu Zucai , Huang Hao
Published: June 2023

Rationale:

Multiple sclerosis (MS) is a central nervous system disease mainly mediated by immunity, which is one of the most common causes of neurological dysfunction in young people worldwide. In the acute phase, high-dose steroid therapy is effective. There are few reports about cerebral venous thrombosis (CVT) after high-dose steroid therapy.

Patient concerns:

We present a case of a 19-year-old female diagnosed with MS who developed a headache after high-dose steroid therapy was diagnosed with CVT. Headache symptoms improved after anticoagulant treatment.

Diagnoses:

MS comorbid CVT.

Interventions:

Anticoagulant therapy was added and hormone therapy was reduced.

Outcomes:

Clinical symptoms such as headache, limb numbness, and involuntary tremors in the right hand were improved, and the muscle strength of the right limb recovered to grade 4. The patient did not suffer from headaches after discharge and no abnormality in the computed tomography (CT) scan of the cephalic vein at the 5-months follow-up.

Lessons:

High-dose steroid therapy may be a risk factor for CVT in patients with MS. MS patients who develop headaches during high-dose steroid therapy should undergo further cranial CTV to rule out CVT.
Efficacy and safety of intravenous tranexamic acid in urologic surgery: A systematic review and meta-analysis of randomized controlled trials
Authors: Lin Yu-Hui , Lee Kuo-Chang , Hsu Chien-Chin , Chen Kuo-Tai
Published: June 2023

Background:

This meta-analysis compared the effects of intravenous Tranexamic acid (TXA) and a placebo on hemostasis, hospital course, and complications in adult patients undergoing various urologic surgeries.

Methods:

The literature was extensively searched using various databases. The primary outcomes were standardized mean differences (SMDs) of intraoperative blood loss and odds ratios (ORs) of necessary blood product transfusion. The secondary outcomes included SMDs of operative time, SMDs of decreased hemoglobulin levels at 24 hours after surgery, and ORs of thromboembolic events.

Results:

The meta-analysis included 13 randomized controlled trials (RCT) comprising 1814 participants in total. The SMD of intraoperative blood loss for TXA versus placebo was −0.705 (95% confidence interval [CI]: −1.113 to −0.297). The pooled ORs of transfusion in the TXA group compared with the placebo group was 0.426 (95% CI: 0.290–0.625). These findings indicated a significantly lower intraoperative blood loss and a reduced need for transfusion following intravenous TXA. The pooled ORs of thromboembolic events in the TXA group compared with the placebo group was 0.664 (95% CI: 0.146–3.024).

Conclusions:

Intravenous TXA can reduce intraoperative blood loss, decrease the need for transfusion, and shorten operative time, and it does not increase the risk of thromboembolic events.
Age-stroke related dysfunction interaction associated with home discharge of stroke inpatients in the rehabilitation ward
Authors: Fujita Takaaki , Yamane Kazuhiro , Yamamoto Yuichi , Sone Toshimasa , Ohira Yoko , Otsuki Koji , Iokawa Kazuaki
Published: June 2023

The purpose of this study was to investigate whether interactions exist among cognitive and physical functions and activities of daily living (ADL) associated with home discharge of stroke patients in the rehabilitation ward. The subjects were 231 patients with a first stroke. Age, gender, affected side, the stroke impairment assessment set, ADL and discharge destination were collected from the medical record. Using a decision tree, a combination of variables that might have an interaction effect associated with home discharge was extracted. The existence of an interaction between the extracted variables was confirmed by logistic regression analysis. A combination of total score of the stroke impairment assessment set (≤27 points) and age (>76.5 years) at admission was extracted from the decision tree. As a result of the logistic regression analysis, this interaction term was significantly associated with home discharge. The findings of the present study suggest that there is an interaction between age and stroke-related dysfunction related to home discharge. Stroke patients aged over 76.5 years with the stroke impairment assessment set score of 27 or less at admission to the rehabilitation ward may need rehabilitation program considering the difficulty of home discharge.
Twenty years of intrathecal baclofen therapy in Slovenia: a retrospective single-center analysis of complications
Authors: Benedičič Mitja , Groleger Sršen Katja , Grabljevec Klemen , Majdič Neža , Haber Barbara
Published: June 2023

Since the first implantation in July 2001, the intrathecal baclofen (ITB) therapy for patients with generalized spasticity has been used in Slovenia for 20 years. The aim of this retrospective study was to evaluate the rates of different complications, especially if catheter-related complications were less frequent after the introduction of the coated catheter type in February 2013, and the potential correlation between higher baclofen doses and the incidence of complications. We retrospectively collected data from all patients in the registry during the period from 3 July 2001 to 31 December 2021. Among 138 patients (48 females), 120 patients had the first ITB system implanted at the University Medical Centre Ljubljana. Forty-three complications were reported in 38 patients (27%), with a total complication rate of 0.203/1000 days or 0.074/pump year. The most frequent was catheter-related (0.083/1000 days or 0.030/pump year), followed by skin-related (0.063/1000 days or 0.023/pump year) and pump-related complication (0.026/1000 days or 0.009/pump year). The incidence of catheter-related complications decreased significantly since the use of Ascenda type catheter: 14/7 complications per 88/147 implantations (P = 0.008). Patients with complications had a statistically significantly higher dose of baclofen: median 400 µg/24h vs. median 300 µg/24h (P = 0.016). Our retrospective analysis confirmed a significant decrease of catheter-related complications after the implementation of Ascenda type catheter in February 2013. Patients with a higher ITB dose had a statistically significantly higher incidence of complications. The total complication rate was a bit higher as previously reported in other studies, which is consistent with a long follow-up time.
Pendulum test parameters are useful for detecting knee muscle hypertonia and quantifying response to an intrathecal baclofen bolus injection
Authors: Chow John W. , Stokic Dobrivoje S.
Published: June 2023

Our objective was to determine which pendulum test parameters are useful for detecting hypertonia in the knee muscles and assessing the group and individual responses to intrathecal baclofen (ITB) bolus injection among prospective pump recipients. We included 15 neurological patients with lower limb hypertonia (mainly spinal cord injury, n = 7) and collected data the day before (baseline), and 2.5 and 5.0 h after the 50-µg ITB bolus injection. For comparison, data were collected in 15 healthy controls. The average over six test repetitions was obtained for the number of oscillations, swing time (SwingT), amplitudes of the first flexion and extension, maximum angular velocities of the first flexion (F1V) and extension (E1V), relaxation index, and damping coefficient (DampC). Across the patient group, all pendulum parameters indicated a significant decrease in hypertonia from baseline to postinjection (analysis of variance P ≤ 0.004), except DampC. On the basis of the cutoffs from the receiver operating characteristic curve, all parameters were good or excellent discriminators of hypertonia in patients from normotonia in controls (area under the curve ≥0.85), with the highest sensitivity for SwingT and E1V (≥93%). Furthermore, all parameters except F1V revealed a significant shift from preinjection hypertonia to postinjection normotonia among patients (McNamar test P ≤ 0.002, DampC excluded due to missing data), with the greatest responsiveness for E1V and relaxation index (≥73%). The results confirm the overall usefulness of pendulum test parameters in this patient population and indicate that some parameters are better at detecting hypertonia (SwingT, E1V) whereas others (E1V, relaxation index) are more responsive to the ITB injection.
Characteristics and healthcare utilization of COVID-19 rehabilitation patients during the first and second waves of the pandemic in Toronto, Canada
Authors: Wasilewski Marina B. , Szigeti Zara , Simpson Robert , Minezes Jacqueline , Mayo Amanda L. , Robinson Lawrence R. , Lung Maria , Hitzig Sander L.
Published: June 2023

The objective of this study is to describe the healthcare utilization, and clinical and sociodemographic features of a cohort of 74 coronavirus disease 2019 (COVID-19) patients admitted to a tertiary rehabilitation hospital in Toronto, Canada. A retrospective chart review was performed using 74 charts from patients admitted to a COVID-19 rehabilitation unit between 11 April 2020 and 30 April 2021. Measures of central tendency, SDs, interquartile ranges, frequencies, and proportions were calculated to analyze clinical and sociodemographic data. A total of 74 patients were included in this study, including 33 males and 41 females. The mean age was 72.8 years, with Wave 1 patients being younger than Wave 2 patients. Sixty-six percent of total patients experienced hypertension. Mean functional independence measure score across both waves was 78 at admission and 100 at discharge. Mean length of stay was 14.6 days in Wave 1 and 18.8 days in Wave 2. This study represents some of the first data on the characteristics and outcomes of COVID-19 patients admitted to inpatient rehabilitation in Toronto, Canada across the initial waves of the COVID-19 pandemic.
Accelerating Detection and Intervention for Sepsis in Skilled Nursing Facilities Using a Sepsis Pathway
Authors: Ahmed Asma M. , Macapili Efy , Brenner Michael J. , Pandian Vinciya
Published: June 2023

Background:

Early detection of sepsis decreases mortality in hospitals, but recognition of sepsis is often delayed in skilled nursing facilities (SNFs).

Local Problem:

A local SNF in the northeastern United States sought to use a standardized sepsis pathway to prevent hospital readmissions due to sepsis.

Methods:

A pre-/postimplementation design was used for this project. Outcome measures included sepsis detection and treatment, length of stay in the SNF, sepsis-related hospital transfer rate, mortality rate, and predictors of clinical outcomes.

Interventions:

A SNF sepsis pathway was developed based on current sepsis detection tools. The pathway incorporated a sepsis screening tool and a sepsis bundle. Implementation of the pathway involved education of nurses and certified nursing assistants on the pathway.

Results:

A total of 178 patients were included in data analysis (81 preimplementation and 97 implementation). Sepsis recognition increased from 56% to 86% (P < .001), and sepsis-related hospital transfers decreased from 68% to 44% (P = .07). Laboratory testing for lactate, white blood cell count, and blood cultures increased, and sepsis intervention rates significantly improved (P < .001).

Conclusions:

Implementing a modified SNF sepsis pathway accelerated identification of sepsis and improved clinical outcomes.
Effectiveness of a Modified Nurse-Led COUGH Bundle for Obese Patients After Bariatric Surgery
Authors: Yang Jumei , Turner Barbara S. , Teh Aline Hooi Ming , Liew Geoffrey Haw Chieh
Published: June 2023

Background:

Obesity commonly affects postsurgical pulmonary outcomes and is associated with increased oxygen usage, length of recovery and hospital stay, discharge to high levels of care, cost, morbidity, and mortality.

Local Problem:

No standardized pulmonary care bundle for obese patients after bariatric surgery was available in the postanesthesia care unit (PACU) at a hospital in Singapore.

Methods:

This quality improvement project was a prospective, single-cohort, pre- and posttest intervention design with 151 patients recruited.

Interventions:

Teaching and implementation of a modified nurse-led COUGH bundle was carried out on obese patients after their bariatric surgery.

Results:

Postbariatric surgery patients with the nurse-led COUGH bundle had significantly less consumption of oxygen in the PACU and step-down units. The PACU and hospital length of stay were also reduced.

Conclusions:

The modified nurse-led COUGH bundle can reduce patients' oxygen usage and hospital stay after their bariatric surgery.
Nonsurgical Rhinoplasty in Patients of African Descent: A Retrospective Review
Authors: Harb Ayad , Abdul-Razzak Amane
Published: June 2023

Background:

There is a paucity of research on nonsurgical rhinoplasty in the population of African descent. In this group, underlying anatomy and aesthetic ideals vary, necessitating differences in the consultation process and in treatment. The authors present a case series from a single clinician’s practice performing nonsurgical rhinoplasty on patients of African descent.

Methods:

A retrospective chart review was completed on eligible patients who underwent nonsurgical rhinoplasty treatment with hyaluronic acid filler injections performed by the first author (A.H.) from March of 2018 to February of 2021. Demographic variables, indications for treatment, patient-reported outcomes, and adverse events were reviewed. The authors also share the first author’s technique for nonsurgical rhinoplasty in this patient cohort.

Results:

A total of 487 patients of African descent or mixed race including African descent were included in this study. The most common indications for treatment were lack of bridge definition (63.9%), excessive alar width (61.6%), and a bulbous tip (61.6%). Median filler volume was 0.6 mL (range, 0.3 to 2.1 mL) at the initial treatment visit. There were no reported cases of infection, vascular occlusion, or necrosis.

Conclusions:

This study is the first to illustrate the effectiveness and safety profile of nonsurgical rhinoplasty in a population of African descent. Anatomical variations and the desire for racially congruent results must be acknowledged to ensure satisfactory outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Prevalence and incidence of stroke among people with HIV
Authors: Du Min , Wang Yaping , Qin Chenyuan , Mi Donghua , Liu Min , Liu Jue
Published: June 2023

Objective:

We aimed to obtain more precise estimates of stroke to address the wide variation of stroke burden among people with HIV (PWH) in different clinical settings.

Design:

Systematic review and meta-analysis.

Methods:

We systematically searched PubMed, EMBASE, and Web of Science for original articles reporting the prevalence and incidence of stroke among PWH up to November 23, 2022. Der Simonian-Laird random effects were used to obtain pooled estimates and 95% confidence intervals (CIs).

Results:

We included 17 observational studies covering 1 749 003 PWH on estimation of prevalence, and 17 cohort studies covering 249 606 PWH on estimation of incidence. The pooled prevalence of stroke was 1.30% (95% CI: 1.01%, 1.59%) for PWH aged at least 15 years, and 3.98% (95% CI: 2.45%, 5.51%) for PWH aged at least 50 years. The pooled incidence of stroke was 17.86 per 10 000 person-years (95% CI: 15.96, 19.76), meanwhile, the pooled incidence of ischemic stroke (31.50 per 10 000 person-years; 95% CI: 11.11, 51.89) was higher than hemorrhagic stroke (4.43 per 10 000 person-years; 95% CI: 1.95, 6.91) among PWH aged at least 15 years.

Conclusion:

The prevalence of stroke was nearly one per hundred among PWH aged ≥15 years, and reached four per hundred for those aged ≥50 years. The occurrence of stroke is common during HIV progression, particularly ischemic stroke. Therefore, more efforts should be made on implementing policies, strategies, and programs aimed at identifying the risk factors, improving treatment, and facilitating rehabilitation for stroke to reduce the disease burden among PWH.
A Case of Adenomyosis Showing Size Reduction in a Follicular Lymphoma Patient Receiving Chemotherapy With R-Bendamustine
Authors: Seo Minjung , Lee Yoo Jin , Choi Hyung Jin , Jo Jae Cheol , Park Seol Hoon
Published: June 2023

We describe a case of adenomyosis that reduced in size in a patient with lymphoma on receiving chemotherapy. A 48-year-old woman with worsening left flank pain was diagnosed with follicular lymphoma. [18F]FDG PET/CT revealed multiple hypermetabolic lymph nodes in the bilateral cervical, axillary, mediastinal, mesenteric, retroperitoneal, iliac, and inguinal regions. In addition, adenomyosis with mild hypermetabolism was demonstrated on [18F]FDG PET/CT. The size and metabolism of adenomyosis decreased after chemotherapy with R-bendamustine; in addition, along with decrease in estradiol levels, the patient experienced amenorrhea and hot flushes. The patient was diagnosed with chemotherapy-induced early menopause.
Prognosis-Guided Reconstruction of Scalp and Skull Defects in Neurosurgical Patients
Authors: Meyers Abigail , Krebs Jillian , Xia Thomas , Kshettry Varun R. , Angelov Lilyana , Nagel Sean , Rampazzo Antonio , Bassiri Gharb Bahar
Published: June 2023

Background

This study aimed to formulate reconstructive recommendations for neurosurgical patients presenting with scalp and/or skull defects based on outcomes in a large series of patients.

Methods

An institutional review board-approved retrospective review of patients who underwent scalp and/or calvarial reconstruction was conducted. Complications were divided into minor and major; early, intermediate, and late. Univariate logistic regression models were conducted to identify independent predictors of complications. Mann-Whitney U tests were used to compare survival time. Kaplan-Meier curves were developed to compare exposure of titanium and bone cranioplasties.

Results

One hundred seventy-one patients who underwent 418 procedures were included (median 1 [1–3] surgeries per patient). Average age was 55 ± 15 years; 53% of patients were male. Median follow-up was 25.5 months [13.9–55.6 months], and 57 patients (33%) were deceased. Complications occurred following 48% of procedures; most common were titanium hardware exposure (36%), nonhealing wounds (23%), and infection (9%). Titanium cranioplasties became exposed 0.47 months [0.3–4.0 months] postoperatively. Frontal defect location was an independent predictor of major complications (odds ratio, 1.59; 95% confidence interval, 1.06–2.39; P = 0.026). Mortality rate for malignant intracranial neoplasms was 68.4% (median survival, 4.3 months), 39.1% for malignancies of both scalp and skull (7.0 months), 37.5% for scalp cancers (16.0 months), and 16.7% for meningiomas (28.2 months).

Conclusions

Neurosurgical patients requiring scalp and/or skull reconstruction are a complex population undergoing multiple procedures with high complication rates. Given high exposure rate of titanium hardware shortly after reconstruction, titanium cranioplasty is recommended for patients with a prognosis less than 2 to 8 months.
Seroma After Breast Reconstruction With Tissue Expanders
Authors: Ozturk Cemile Nurdan , Ozturk Can , Magner William J. , Ali Adil , Diehl Jeremy , Sigurdson S. Lynn
Published: June 2023

Background

Seroma is a relatively common complication after breast reconstruction with tissue expanders. The main risk in the presence of seroma is development of periprosthetic infection, which can lead to implant loss. Our goals were to identify risk factors for seroma, and to describe our protocol for managing fluid accumulation.

Patients and Methods

An IRB approved breast reconstruction database was reviewed to identify patients who underwent tissue expander reconstruction. Patient characteristics, details of surgery, outcomes and treatment were recorded.

Results

Two hundred nineteen tissue expander reconstructions were performed in 138 patients. Twenty-eight reconstructions developed seroma (12.8%), and 75 were identified to have prolonged drains (34.2%). Seroma was more common in patients with lymph node surgery (P = 0.043), delayed reconstruction (P = 0.049), and prepectoral reconstruction (P = 0.002). Seroma and/or prolonged drains were more commonly noted in patients with higher body mass index (P = 0.044) and larger breast size (P = 0.001). Aspiration was the most common intervention (85.7%), which was performed in the clinic utilizing the expander port site. There was no difference in infection or explantation rate between seroma and no-seroma patients (P = 0.546 and 0.167), whereas patients with any fluid concern (seroma and/or prolonged drains) were more prone to developing infection and undergoing explantation (P = 0.041 and P < 0.005).

Conclusion

We recommend that prolonged drain placement longer than 3 weeks should be avoided, and patients should be screened for fluid accumulation after drain removal. Serial aspiration via expander port site and continuation of expansion provide a safe and effective method to manage seromas to avoid infection and expander loss.
Retinal and Choriocapillaris Vascular Changes in Early Alzheimer Disease Patients Using Optical Coherence Tomography Angiography
Authors: Di Pippo Mariachiara , Cipollini Virginia , Giubilei Franco , Scuderi Gianluca , Abdolrahimzadeh Solmaz
Published: June 2023

Background:

Alzheimer disease (AD) is a neurodegenerative disorder characterized by ß-amyloid accumulation in the brain. A simple and reliable biomarker for AD that is not invasive is urgently needed, particularly in the preclinical and early stages of the disease. The retina shares with the brain, the same embryologic origins and it is affected by similar vascular changes. The aim of this study was to analyze the characteristics of the retinal and choriocapillaris vascular structure through optical coherence tomography-angiography (OCTA) evaluation in patients with early AD.

Methods:

Eighteen patients with early AD (study group) and 18 healthy age-matched subjects (control group) were enrolled in the study. All patients underwent full neurologic and ophthalmologic examination, and OCTA scans.

Results:

We found a significant reduction in flow area of choriocapillaris in the study group compared with the control group (P-value: 0.006), suggesting an impairment of choriocapillaris circulation in patients with early AD.

Conclusions:

OCTA provides accumulative evidence on the microvasculature changes of the retina and choriocapillaris in patients with AD. Further studies and improved OCTA software are necessary to better evaluate the role of vascular changes shown with OCTA as potential biomarkers in early disease.
There Is No Such Thing as Too Soon: Long-Term Outcomes of Early Cholecystectomy for Frail Geriatric Patients with Acute Biliary Pancreatitis
Authors: Nelson Adam C , Bhogadi Sai Krishna , Hosseinpour Hamidreza , Stewart Collin , Anand Tanya , Spencer Audrey L , Colosimo Christina , Magnotti Louis J , Joseph Bellal
Published: June 2023

BACKGROUND:

Early cholecystectomy (CCY) for acute biliary pancreatitis (ABP) is recommended but there is a paucity of data assessing this approach in frail geriatric patients. This study compares outcomes of frail geriatric ABP patients undergoing index admission CCY vs nonoperative management (NOM) with endoscopic retrograde cholangiopancreatography (ERCP).

STUDY DESIGN:

Retrospective analysis of the Nationwide Readmissions Database (2017). All frail geriatric (65 years or older) patients with ABP were included. Patients were grouped by treatment at index admission: CCY vs NOM with endoscopic retrograde cholangiopancreatography. Propensity score matching was performed in a 1:2 ratio. Primary outcomes were 6-month readmissions, mortality, and length of stay. Secondary outcomes were 6-month failure of NOM defined as readmission for recurrent ABP, unplanned pancreas-related procedures, or unplanned CCY. Subanalysis was performed to compare outcomes of unplanned CCY vs early CCY.

RESULTS:

A total of 29,130 frail geriatric patients with ABP were identified and 7,941 were matched (CCY 5,294; NOM 2,647). Patients in the CCY group had lower 6-month rates of readmission for pancreas-related complications, unplanned readmissions for pancreas-related procedures, overall readmissions, and mortality, as well as fewer hospitalized days (p < 0.05). NOM failed in 12% of patients and 7% of NOM patients were readmitted within 6 months to undergo CCY, of which 56% were unplanned. Patients who underwent unplanned CCY had higher complication rates and hospital costs, longer hospital lengths of stay, and increased mortality compared with early CCY (p < 0.05).

CONCLUSIONS:

For frail geriatric patients with ABP, early CCY was associated with lower 6-month rates of complications, readmissions, mortality, and fewer hospitalized days. NOM was unsuccessful in nearly 1 of 7 within 6 months; of these, one-third required unplanned CCY. Early CCY should be prioritized for frail geriatric ABP patients when feasible.
Sex-specific clinical characteristics and treatment responses in delirium management: findings from a prospective cohort study in elderly patients
Authors: Hildenbrand Florian F. , Boettger Soenke , Spiller Tobias , Schubert Maria , Ernst Jutta , von Känel Roland , Zipser Carl M.
Published: June 2023

Delirium incidence and phenotype differ between sexes. Sex differences in the selection of treatment strategies remain elusive. We evaluated sex-specific responses to non- and pharmacological management. In this observational prospective cohort study conducted at the University Hospital Zurich, Switzerland, 602 patients managed for delirium were analyzed. Remission and benefit ratios of treatments were calculated using Cox regression models. Baseline characteristics were similar in both sexes. Overall, 89% of all patients (540/602) received pharmacological management for delirium, most (77%) with one or two different medications. An equal number of male and female patients had either no medication (P = 0.321) or three and more medications (P = 0.797). Men had two different medications more often (P = 0.009), while women more frequently received one medication (P = 0.037). Remission rates within 20 days were higher in non-pharmacological treatment and similar between sexes, with odds of 1.36 in females, and 2.3 in males. Non-pharmacological treatment was equally efficacious in both sexes. Women who received supportive treatment and monotherapy had equal odds of remission. Men fared better with supportive care compared to pharmacologic therapies. Remission rates with different management strategies were similar between sexes. No sex differences were found regarding phenotypes, clinical course, and response to therapy.
The Gordian knot of the immune-redox systems’ interactions in psychosis
Authors: Karanikas Evangelos
Published: June 2023

During the last decades the attempt to enlighten the pathobiological substrate of psychosis, from merely focusing on neurotransmitters, has expanded into new areas like the immune and redox systems. Indeed, the inflammatory hypothesis concerning psychosis etiopathology has exponentially grown with findings reflecting dysfunction/aberration of the immune/redox systems’ effector components namely cytokines, chemokines, CRP, complement system, antibodies, pro-/anti-oxidants, oxidative stress byproducts just to name a few. Yet, we still lie far from comprehending the underlying cellular mechanisms, their causality directions, and the moderating/mediating parameters affecting these systems; let alone the inter-systemic (between immune and redox) interactions. Findings from preclinical studies on the stress field have provided evidence indicative of multifaceted interactions among the immune and redox components so tightly intertwined as a Gordian knot. Interestingly the literature concerning the interactions between these same systems in the context of psychosis appears minimal (if not absent) and ambiguous. This review attempts to draw a frame of the immune-redox systems’ interactions starting from basic research on the stress field and expanding on clinical studies with cohorts with psychosis, hoping to instigate new avenues of research.
A statistical method for image-mediated association studies discovers genes and pathways associated with four brain disorders
Authors: He Jingni , Antonyan Lilit , Zhu Harold , Li Qing , Enoma David , Zhang William , Liu Andy , Cao Bo , MacDonald M. Ethan , Arnold Paul D. , Long Quan
Published: June 2023

Brain imaging and genomics are critical tools enabling characterization of the genetic basis of brain disorders. However, imaging large cohorts is expensive, and may be unavailable for legacy datasets used for genome-wide association studies (GWAS). Using an integrated feature selection/aggregation model, we developed Image-Mediated Association Study (IMAS), which utilizes borrowed imaging/genomics data to conduct association mapping in legacy GWAS cohorts. By leveraging the UK Biobank image-derived phenotypes (IDPs), IMAS discovered genetic bases underlying four neuropsychiatric disorders and verified them by analyzing annotations, pathways, and expression Quantitative Trait Loci (eQTLs). A cerebellar-mediated mechanism was identified to be common to the four disorders. Simulations show that, if the goal is identifying genetic risk, IMAS is more powerful than a hypothetical protocol in which the imaging results were available in the GWAS dataset. This implies the feasibility of reanalyzing legacy GWAS datasets without conducting additional imaging, yielding cost-savings for integrated analysis of genetics and imaging.