bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis
Authors: Amonker Sachin , Houshmand Aryo , Hinkson Alexander , Rowe Ian , Parker Richard
Published: April 2023

Background:

Alcohol-associated liver disease (ALD) is a common cause of morbidity and premature mortality. To date, there has been no systematic synthesis of the prevalence of ALD. This systematic review was done with the aim of reporting the prevalence of ALD across different health care settings.

Methods:

PubMed and EMBASE were searched for studies reporting the prevalence of ALD in populations subjected to a universal testing process. Single-proportion meta-analysis was performed to estimate the prevalence of all ALD, alcohol-associated fatty liver, and alcohol-associated cirrhosis, in unselected populations, primary care, and among patients with alcohol-use disorder (AUD).

Results:

Thirty-five studies were included reporting on 513,278 persons, including 5968 cases of ALD, 18,844 cases of alcohol-associated fatty liver, and 502 cases of alcohol-associated cirrhosis. In unselected populations, the prevalence of ALD was 3.5% (95% CI, 2.0%–6.0%), the prevalence in primary care was 2.6% (0.5%–11.7%), and the prevalence in groups with AUD was 51.0% (11.1%–89.3%). The prevalence of alcohol-associated cirrhosis was 0.3% (0.2%–0.4%) in general populations, 1.7% (0.3%–10.2%) in primary care, and 12.9% (4.3%–33.2%) in groups with AUD.

Conclusions:

Liver disease or cirrhosis due to alcohol is not common in general populations and primary care but very common among patients with coexisting AUD. Targeted interventions for liver disease such as case finding will be more effective in at-risk populations.
The integrated analysis strategy of unstable hypoxanthine, a potential quality marker in Shuxuetong injection based on standard addition method and multi-level pharmacokinetics by LC-MS/MS
Authors: Xing Yanchao , Wang Xiaoming , Wang Xianrui , Zhao Xizi , Guo Yaqing , Huang Yuhong , Teka Tekleab , Han Lifeng , Pan Guixiang
Published: April 2023

Objective:

As an injection made from traditional Chinese medicine, Shuxuetong (SXT) injection is used for the treatment of ischemic stroke. Hypoxanthine is regarded as one of its potential quality markers. The purpose of this study is to lay the foundation for the quality control of SXT injection by the analysis of the quantitation and pharmacokinetic behavior for hypoxanthine.

Methods:

A quantitative method of hypoxanthine in SXT injection based on standard addition method by liquid chromatography-tandem mass spectrometry (LC-MS/MS) was established for the first time. On the other hand, a determination method of hypoxanthine in rat plasma samples after administration of SXT was also successfully established based on LC-MS/MS.

Results:

It was found that the content of hypoxanthine was higher using conventional liquid-mass spectrometry technology compared to the application of LC-MS/MS combined standard addition method in the same batch of SXT injection. The ratio of low, medium and high dose of intravenous SXT were 1: 2: 4, and the AUC0-t was 848.34 ± 324.53, 1483.94 ± 497.74, and 3074.84 ± 910.29 μg·h/L, respectively. AUC0-t shows good linear dose-dependent relationship.

Conclusions:

The influences of endogenous substance tend to be eliminated through calibrating the concentration level of the target compound by the introduction of standard addition method. The added allopurinol could inhibit the conversion of the target compound, and ensure the accuracy of the detection during the pharmacokinetic studies. “Blank biological matrix” obtained from pretreatment of blank plasma successfully distinguished endogenous and drug-derived hypoxanthine. There is a good linear relationship between the blood concentration of intravenous hypoxanthine and the dosage of administration. Similarly, there was no drug accumulation in the multiple medium-dosage group, which is similar to the pharmacokinetic characteristics of the single medium-dosage group.
Using Collaborative Online International Learning to Support Global Midwifery Education
Authors: Saftner Melissa A. , Ayebare Elizabeth
Published: April 2023

Background and Local Problem:

The COVID-19 pandemic created a gap in global health learning, requiring creative solutions to bridge the divide. Collaborative online international learning (COIL) is a program between universities located in different geographic areas that aims to build cross-cultural learning and collaboration.

Intervention:

Faculty members from Uganda and the United States worked collaboratively to plan a 2-session COIL activity for nursing and midwifery students. Twenty-eight students from the United States and Uganda participated in the pilot quality improvement project.

Measures:

Students completed a 13-question REDCap survey measuring satisfaction, time commitment for the activity, and increase in knowledge about differently resourced healthcare systems. Students also were asked to provide qualitative feedback in that survey.

Results:

Survey results indicate a high level of satisfaction and an increased understanding of a new healthcare system. The majority of students wanted more scheduled activity times, the opportunity to meet face to face, and/or more robust sessions in the future.

Conclusion:

This COIL activity between students in the United States and Uganda was a no-cost activity that provided global health learning opportunities for students during the global pandemic. The COIL model is replicable, adaptable, and customizable for a variety of courses and time spans.
Bibliometric Analysis of the Role of Pyroptosis in Sepsis
Authors: Gu Bowen , Wu Meifen , Wang Han , Zhuang Jian , Xiong Weiping , Xiao Yingkai , Lei Liming
Published: April 2023

Background:

Emerging evidence has demonstrated that pyroptosis plays a vital role in the development of sepsis. However, few studies have examined this field systemically. We performed the first bibliometric analysis to draw conclusions from and visualize related publications to determine the trends and hotspots in pyroptosis research on sepsis.

Methods:

A total of 267 publications were retrieved from the Web of Science Core Collection from January 1, 2007 to December 21, 2021. Then, VOSviewer and CiteSpace were used for further analysis.

Results:

The publications in this field showed an upward trend annually, especially after 2014. Most of the articles were authored by Chinese and American scholars and published in Frontiers in Immunology. Timothy R Billiar published the most related articles, while Shi JJ was cited the most frequently. Co-citation analysis showed that the top 5 co-cited references in this field were in Nature and JAMA's leading co-cited journals. The keywords in this field revolve around the mechanisms of pyroptosis. Guanylate binding protein might be the hotspot, however, based on cluster analysis.

Conclusion:

The growing interest of researchers in pyroptosis in sepsis reflects the increasing understanding of its underlying mechanisms and the discovery of more clinical effects. These findings suggest that pyroptosis may hold significant potential as a therapeutic target for various diseases.
Digital Health: A New Frontier
Authors: Barracca Antonio , Ledda Stefano , Mancosu Gianmaria , Pintore Giovanni , Quintaliani Giuseppe , Ronco Claudio , Kashani Kianoush B.
Published: April 2023

The Food and Drug Administration defines digital health (DH) as “a convergence of people, information, technology, and connectivity to improve health care and health outcomes”. Information and communication technologies are categorized under the DH umbrella. While still in their infancy, these technologies have great potential to revolutionize the clinical approaches to bedside management and overall health care. Over the past few decades, there has been a substantial improvement in the technology in smart wearable devices that enabled them to enhance their abilities to collect patient-related data, including physiological and behavioral information in the Internet of things. This has resulted in implementing several controlled clinical trials that have confirmed their validity and safety. These digital diagnostics have led to the expansion of digital therapies and specialized software (for example, apps) capable of effectively and measurably guiding patients’ progress toward improving their clinical condition. These technologies are clinically validated treatments for many diseases with particular effectiveness in pathological conditions related to behavior and psychological factors. In this review paper, we describe the outlines of some of the recent progress made in this field.
Obstructive sleep apnea and ambulatory blood pressure abnormalities in children with chronic kidney disease
Authors: Kumar Suryendru , Goyal Abhishek , Atlani Mahendra , Malik Shikha , Pakhare Abhijit , Maheshwari Mahesh , Kumar Amber , Raina Rupesh , Bhatt Girish Chandra
Published: April 2023

Background

Obstructive sleep apnea (OSA) and hypertension are common complications in children with chronic kidney disease (CKD). Progression of CKD can aggravate OSA and hypertension whereas worsening sleep apnea can make hypertension difficult to treat in CKD patients. We, therefore, conducted a prospective study to evaluate the association between OSA and hypertension in pediatric patients with CKD.

Method

In this prospective observational study consecutive children with CKD stage 3–5 (nondialysis dependent) underwent overnight polysomnography and 24-h ambulatory blood pressure monitoring (ABPM). The detailed clinical features and investigations were recorded in a prestructured performa.

Results

Twenty-two children completed overnight polysomnography and 24-h ABPM was performed within 48 h of performing polysomnography. The median (IQR) age of the study population was 11 (8.5–15.5) years, with an age range of 5–18 years. Moderate-severe OSA defined as apnea-hypopnea index (AHI ≥5) was seen in 14 (63.6%) children, periodic limb movement syndrome in 20 (91%) and poor sleep efficacy in 9 (40.9%) children. Ambulatory blood pressure was abnormal in 15 (68.2%) children with CKD. Of them, 4 (18.2%) had ambulatory hypertension, 9 (40.9%) had severe ambulatory hypertension and 2 (9.1%) had masked hypertension. A statistically significant correlation of sleep efficiency with nighttime DBP SD score/Z score (SDS/Z) (r = −0.47; P = 0.02); estimated glomerular filtration rate with SBP loads (r = −0.61; P < 0.012); DBP loads (r = −0.63; P < ) and BMI with SBP load (r = 0.46; P = 0.012) was found.

Conclusion

Our preliminary findings suggest that ambulatory blood pressure abnormalities, OSA, periodic limb movement syndrome and poor sleep efficiency are highly prevalent in children with CKD stages 3–5.
Establishment of a scoring model for the differential diagnosis of white coat hypertension and sustained hypertension
Authors: Cai Peng , Lin Qingshu , Lv Dan , Zhang Jing , Wang Yan , Wang Xukai
Published: April 2023

Objectives

This study aimed to establish a scoring model for the differential diagnosis of white coat hypertension (WCH) and sustained hypertension (SHT).

Methods

This study comprised 553 adults with elevated office blood pressure, normal renal function, and no antihypertensive medications. Through questionnaire investigation and biochemical detection, 17 parameters, such as gender and age, were acquired. WCH and SHT were distinguished by 24 h ambulatory blood pressure monitoring. The participants were randomly divided into a training set (445 cases) and a validation set (108 cases). The above parameters were screened using least absolute shrinkage and selection operator regression and univariate logistic regression analysis in the training set. Afterward, a scoring model was constructed through multivariate logistic regression analysis.

Results

Finally, six parameters were selected, including isolated systolic hypertension, office systolic blood pressure, office diastolic blood pressure, triglyceride, serum creatinine, and cardiovascular and cerebrovascular diseases. Multivariate logistic regression was used to establish a scoring model. The R
2 and area under the ROC curve (AUC) of the scoring model in the training set were 0.163 and 0.705, respectively. In the validation set, the R
2 of the scoring model was 0.206, and AUC was 0.718. The calibration test results revealed that the scoring model had good stability in both the training and validation sets (mean square error = 0.001, mean absolute error = 0.014; mean square error = 0.001, mean absolute error = 0.025).

Conclusion

A stable scoring model for distinguishing WCH was established, which can assist clinicians in identifying WCH at the first diagnosis.
Traditional versus distal radial access for coronary angiography: a meta-analysis of randomized controlled trials
Authors: Barbarawi Mahmoud , Barbarawi Owais , Jailani Mohamed , Al-abdouh Ahmad , Mhanna Mahammed , Robinson Peter
Published: April 2023

Radial artery occlusion (RAO) is a well known complication that occurs after traditional radial artery (TRA) intervention and limits the radial artery as a future access site, as well as an arterial conduit. Distal radial artery (DRA) access has emerged recently as an alternative approach with a potential lower incidence of RAO. Database search of Pubmed/MEDLINE, Cochrane Library, and EMBASE was conducted by two authors from inception through 1 October 2022. Randomized trials that compared TRA with the DRA approach to perform coronary angiography were included. Two authors extracted pertinent data into predefined data collection tables. The risk ratios and 95% confidence intervals (CIs) were reported. Eleven trials were included (5700 patients) in the study. The mean age was 62.0 ± 10.9 years. Compared with DRA, vascular access through the TRA was associated with a higher incidence of RAO (risk ratio 3.05, 95% CI, 1.74–5.35, P < 0.01); however, arterial access by using the TRA was associated with a lower incidence of access failure leading to a crossover compared with the DRA approach (risk ratio 0.35; 95% CI, 0.21–0.57, P < 0.01). The incidence of radial artery spasm and access site-associated hematoma was not significant in the group treated with TRA compared with the DRA approach (P > 0.05). The DRA approach was associated with a lower incidence of RAO compared with the TRA approach but this was at the expense of a higher crossover rate.
Aberrant serum and tissue levels of Beclin1 and mechanistic target of rapamycin (mTOR) proteins in epithelial ovarian cancer
Authors: Lu Huixia , Hu Hong , Yang Zhihong , Li Shaobo
Published: April 2023

Beclin1 and mechanistic target of rapamycin (mTOR) can be used as tumor markers of epithelial ovarian cancer. This study aimed to assess the association of Beclin1 and mTOR expression with clinicopathological and prognostic data in epithelial ovarian cancer patients. Serum and tissue samples from 45 epithelial ovarian cancer patients and 20 controls were analyzed by enzyme-linked immunosorbent assay and immunohistochemistry for Beclin1 and mTOR expression. The online datasets from gene expression profiling interactive analysis (n = 426), Kaplan–Meier plotter (n = 398), cBioPortal (n = 585), and UALCAN (n = 302) were also analyzed. Beclin1 expression was associated with low-grade differentiation (P = .003), earlier clinical stage (P = .013), fewer local lymph node metastases (P = .02) and lower serum Beclin1 level (P = .001). mTOR expression was associated with high-grade differentiation (P = .013), advanced clinical stage (P = .021), ascites (P = .028), and higher serum mTOR level (P = .001). The online datasets showed that a high mTOR expression level (HR = 1.44; 95% CI = 1.08–1.92; P = .013) was associated with a poor overall survival of 426 patients. Beclin1 was mutated in 1.8% and mTOR was mutated in 5% of epithelial ovarian cancer patients. Serum Beclin1 and mTOR levels were able to predict tumor differentiation, clinical stage, lymph node metastasis, and ascites in epithelial ovarian cancer patients.
A prognostic model for bladder cancer based on cytoskeleton-related genes
Authors: Peng Chunting , Guo Sufan , Yang Zheng , Li Xiaohong , Su Qisheng , Mo Wuning
Published: April 2023

Background:

A typical cancerous growth in the urinary tract, bladder cancer (BLCA) has a dismal survival rate and a poor chance of being cured. The cytoskeleton has been shown to be tightly related to tumor invasion and metastasis. Nevertheless, the expression of genes associated with the cytoskeleton and their prognostic significance in BLCA remain unknown.

Methods:

In our study, we performed differential expression analysis of cytoskeleton-related genes between BLCA versus normal bladder tissues. According to the outcomes of this analysis of differentially expressed genes, all BLCA cases doing nonnegative matrix decomposition clustering analysis be classified into different molecular subtypes and were subjected to Immune cell infiltration analysis. We then constructed a cytoskeleton-associated gene prediction model for BLCA, and performed risk score independent prognostic analysis and receiver operating characteristic curve analyses to evaluate and validate the prognostic value of the model. Furthermore, enrichment analysis, clinical correlation analysis of prognostic models, and immune cell correlation analysis were carried out.

Results:

We identified 546 differentially expressed genes that are linked to the cytoskeleton, including 314 up-regulated genes and 232 down-regulated genes. All BLCA cases doing nonnegative matrix decomposition clustering analysis could be classified into 2 molecular subtypes, and we observed differences (P < .05) in C1 and C2 immune scores about 9 cell types. Next, we obtained 129 significantly expressed cytoskeleton-related genes. A final optimized model was constructed consisting of 11 cytoskeleton-related genes. Survival curves and risk assessment predicted the prognostic risk in both groups of patients with BLCA. Survival curves and receiver operating characteristic curves were used to evaluate and validate the prognostic value of the model. Significant enrichment pathways for cytoskeleton-associated genes in bladder cancer samples were explored by Gene set enrichment analysis enrichment analysis. After we obtained the risk scores, a clinical correlation analysis was performed to examine which clinical traits were related to the risk scores. Finally, we demonstrated a correlation between different immune cells.

Conclusion:

Cytoskeleton-related genes have an important predictive value for BLCA, and the prognostic model we constructed may enable personalized treatment of BLCA.
Tailored versus conventional surgical debridement in complex facial lacerations in emergency department: A retrospective study
Authors: Park Byeong Kwon , Min Jin Hong , Park Jung Soo , You Yeon Ho , Jeong Won Joon , Cho Yong Chul , Oh Se Kwang , In Yong Nam , Ahn Hong Joon , Kang Chang Shin , Kyung Hyun woo , Kim Joo Hak , Yang Ho Jik , Lee Byung Kook , Yoo Heon Jong
Published: April 2023

Surgical debridement is an essential step in treating complex facial lacerations (CFL). As the CFL severity increases, conventional surgical debridement (CSD) of wound edges becomes difficult and may be insufficient. Because the severity and shape of each CFL vary, it is necessary to tailor the customized pre-excisional design, that is, tailored surgical debridement (TSD), for each case before performing surgical debridement. The use of TSD can enable effective debridement of CFL with higher severity. This study aimed to compare the cosmetic outcomes and complication incidence of CSD versus TSD according to CFL severity. In this retrospective observational study, eligible patients with CFL who visited the emergency department between August 2020 and December 2021 were examined. CFL severity was graded as Grades I and II. The outcomes of CSD and TSD were compared using the scar cosmesis assessment and rating (SCAR) scale, wherein a good cosmetic outcome was defined as a SCAR score of ≤ 2. The percentage of good cosmetic outcomes between the 2 groups was compared. The SCAR score and percentage of good cosmetic outcomes between the 2 groups were compared overall and by severity. For analyzing complication incidence, asymmetry, infection, and dehiscence incidence were compared. In total, 252 patients were enrolled [121 (48.0%) CSD and 131 (52.0%) TSD]. The median SCAR scores were 3 (1–5) and 1 (0–2) in all enrolled patients (P < .001), 2 (0–4), and 1 (0–1) in Grade I patients (P < .01), and 5 (4–6) and 1 (1–2) in Grade II patients (P < .001) in the CSD and TSD groups, respectively. The percentage of good cosmetic outcomes was 46.3% and 84.0% overall (P < .001), 59.6% and 85.0% in Grade I patients (P < .01), and 9.4% and 83.5% in Grade II patients (P < .001) in the CSD and TSD groups, respectively. The incidence of complications was significantly higher in the CSD group than in the TSD group, but this was limited to asymmetry. No significant difference was noted in infection or dehiscence. Compared with CSD, TSD can lead to an objectively good cosmetic prognosis at higher CFL severity and can reduce facial asymmetry occurrence.
Correlation between spasticity and corticospinal/corticoreticular tract status in stroke patients after early stage
Authors: Cho Min Jye , Yeo Sang Seok , Lee Sung Jun , Jang Sung Ho
Published: April 2023

We investigated the correlation between spasticity and the states of the corticospinal tract (CST) and corticoreticular tract (CRT) in stroke patients after early stage. Thirty-eight stroke patients and 26 healthy control subjects were recruited. The modified Ashworth scale (MAS) scale after the early stage (more than 1 month after onset) was used to determine the spasticity state of the stroke patients. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), fiber number (FN), and ipsilesional/contra-lesional ratios for diffusion tensor tractography (DTT) parameters of the CST and CRT after the early stage were measured in both ipsi- and contra-lesional hemispheres. This study was conducted retrospectively. The FA and FN CST-ratios in the patient group were significantly lower than those of the control group (P < .05), except for the ADC CST-ratio (P > .05). Regarding the DTT parameters of the CRT-ratio, the patient group FN value was significantly lower than that of the control group (P < .05), whereas the FA and ADC CRT-ratios did not show significant differences between the patient and control groups (P > .05). MAS scores showed a strong positive correlation with the ADC CRT-ratio (P < .05) and a moderate negative correlation with the FN CRT-ratio (P < .05). We observed that the injury severities of the CST and CRT were related to spasticity severity in chronic stroke patients; moreover, compared to the CST, CRT status was more closely related to spasticity severity.
Bioinformatics analysis and identification of hub genes associated with female acute myocardial infarction patients by using weighted gene co-expression networks
Authors: Jiao Kun , Su Ping , Feng Yubao , Li Changqing
Published: April 2023

To explore potential biomarkers of acute myocardial infarction (AMI) in females by using bioinformatics analysis. In this study, we explored potential biomarkers of AMI in females using bioinformatics analysis. We screened a total of 186 differentially expressed genes from the Gene Expression Omnibus. In the study, we found that weighted gene co-expression network analysis explored the co-expression network of genes and identified key modules. Simultaneously, we chose brown modules as key modules related to AMI. In this study, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis revealed that genes in the brown module were mainly enriched in “heparin” and ‘complementation and coagulation cascade. Based on the protein-protein interaction network, we identified S100A9, mitogen-activated protein kinase (MAPK) 3, MAPK1, MMP3, interleukin (IL)-17A, and HSP90AB1 as hub gene sets. Whereas, polymerase chain reaction results showed that S100A9, MAPK3, MAPK1, MMP3, IL-17A, and HSP90AB1 were highly expressed compared with the control group. The IL-17 signaling pathway associated with an inflammatory response may be a potential biomarker and target for the treatment of women with myocardial infarction.
Identification of LncRNA-miRNA-mRNA ceRNA network in hypoxia-induced HTR-8/SVneo cells for preeclampsia
Authors: Liu Zhenzhen , Liu Haiyan , Wang Chengjie , Pei Jiangnan , Chu Nan , Peng Ting , Li Xiaotian , Gu Weirong , Tang Yao
Published: April 2023

Preeclampsia (PE) is a common pregnancy complication, and placental hypoxia is one of its causes. We aimed to identify the transcriptional profile and construct a long non-coding RNAs (lncRNA)-centered competing endogenous RNAs (ceRNA) network in hypoxia-induced HTR8/SVneo cells. We used datasets from the GEO database to identify important pathways in PE. We performed microarray profiling and functional analysis to identify differentially expressed long non-coding RNAs (lncRNAs), differentially expressed profiles of microRNA (miRNAs), and differentially expressed profiles of messenger RNA (mRNAs) in hypoxia-induced HTR8/SVneo cells. The candidates were validated using quantitative reverse transcription polymerase chain reaction. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes analyses were performed to understand the functional significance of differentially expressed genes. Finally, we constructed an lncRNA-centered ceRNA network. Several hub genes were validated both in placentas from PE and normal pregnancy, and in hypoxia-induced HTR8/SVneo cells. The hypoxic response pathway was involved in the pathophysiology of PE. Subsequently, we identified 536 differentially expressed profiles of lncRNAs (183 upregulated and 353 downregulated), 46 differentially expressed profiles of miRNAs (35 upregulated and 11 downregulated), and 2782 differentially expressed profiles of mRNAs (DEmRNAs) (1031 upregulated and 1751 downregulated) in hypoxia-induced HTR8/SVneo cells. Gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses revealed potential pathways affected by these genes, such as angiogenesis, the HIF-1 signaling pathway, and the PI3K-Akt signaling pathway. The ceRNA network comprised 35 lncRNAs, 11 miRNAs, 27 mRNAs, and 2 hub lncRNAs, which might play a vital role in placental functions and PE. Our results revealed the transcriptome profile and constructed an lncRNA-centered ceRNA network in hypoxia-induced HTR8/SVneo cells, thereby providing potential therapeutic targets for PE.
CT findings of glycogen storage disease I complicated with pancreatitis: A case report
Authors: Chen Shuo , Chen Feng , Cheng Fei , Xu Xiao
Published: April 2023

Rationale:

The incidence of glycogen storage disease type I (GSD I) in the overall population is 1/100,000.[1] Hyperlipidemia in patients with GSD I can induce pancreatitis. Three cases of GSD I complicated with pancreatitis have been reported.[2] Here, the computed tomography (CT) features of GSD I complicated with pancreatitis are reported for the first time

Patient concerns:

A 22-year-old female presents with growth retardation for 20 years and recurrent epigastric pain for 3 years. No abnormality in physical examination. Laboratory examination: GPT 81 U/L, GOT 111 U/L, DBIL 1.7 umol/L, TBIL 0.7 umol/L, Albumen 41.4 g/L, blood ammonia 54 umol/L, fasting blood glucose 3.02 mmol/L, G6PD 1829 U/L, lactic acid 7.9 mmol/L, triglyceride 18.79 mmol/L, TCH 9.46 mmol/L, uric acid 510 umol/L, urinary protein +++ (3.0) g/L.

Diagnosis:

The CT findings of the upper abdomen show that the liver is obviously enlarged, and the density of the liver is obviously uneven on plain scan. Unclear boundaries and increased blood vessels of the pancreas are found, especially in the head of the pancreas. The patient is diagnosed with GSD I complicated with pancreatitis.

Interventions:

The patient undergoes split liver transplantation and splenectomy under general anesthesia in our hospital.

Outcomes:

Upper abdominal CT is reexamined half a month and 2 and a half months after the operation. It is found that the transplanted liver is not enlarged and the density is not abnormal. The pancreas shrinks, its boundary is clear, and its blood vessels decrease, especially in the head of the pancreas

Lessons:

The density of the liver depends on the relative amount of glycogen and fat, which can be increased, normal, or decreased. Hyperlipidemia in patients with GSD I can induce pancreatitis.
Meta-analysis of the timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in patients with cholecystolithiasis and choledocholithiasis
Authors: Li Zhan , Xu Dong , Yu Hao , Jiang Honglei , Jin Junzhe
Published: April 2023

Endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy plays an important role in the treatment of cholecystolithiasis combined with choledocholithiasis; however, there is no unified standard for the interval of ERCP before laparoscopic cholecystectomy. We conducted a literature search, data extraction and meta-analysis on this topic. Twelve articles with 1142 patients were included, including 567 patients in the E-laparoscopic cholecystectomy group (laparoscopic cholecystectomy performed within 72 h after ERCP) and 575 patients in the D-laparoscopic cholecystectomy group (laparoscopic cholecystectomy performed 72 h after ERCP). The results showed that: compared with the D-laparoscopic cholecystectomy group, the duration of cholecystectomy was shorter in the E-laparoscopic cholecystectomy group [weighted mean difference (WMD) = −16.18, 95% confidence interval (CI) (−22.27 to −10.08), P < 0.00001], and the postoperative hospitalization was shorter [WMD = −1.24, 95% CI (−1.98 to −0.50), P < 0.0001]. There were fewer complications [odds ratio (OR) = 0.25, 95% CI (0.39–0.62), P < 0.0001], lower conversion rate [OR = 0.39, 95% CI (0.21–0.71), P = 0.002], lower high sensitivity C-reactive protein at 3 days after surgery [WMD = −8.76, 95% CI (−12.59 to −4.93), P < 0.00001], and fewer neutrophils in the ampulla of gallbladder specimen [WMD = −4.21, 95% CI (−4.55 to −3.88), P < 0.00001]. Therefore, in the treatment of cholecystolithiasis combined with choledocholithiasis by laparoscopic cholecystectomy within 72 h after ERCP, the degree of inflammation before and after surgery is less, the operation time and hospital stay are shortened, the postoperative complications and the conversion rate are reduced, which is a more appropriate time for surgery.
The value of a machine learning algorithm to predict adverse short-term outcome during resuscitation of patients with in-hospital cardiac arrest: a retrospective study
Authors: Dünser Martin W. , Hirschl David , Weh Birgit , Meier Jens , Tschoellitsch Thomas
Published: April 2023

Background and importance Guidelines recommend that hospital emergency teams locally validate criteria for termination of cardiopulmonary resuscitation in patients with in-hospital cardiac arrest (IHCA). Objective To determine the value of a machine learning algorithm to predict failure to achieve return of spontaneous circulation (ROSC) and unfavourable functional outcome from IHCA using only data readily available at emergency team arrival. Design Retrospective cohort study. Setting and participants Adults who experienced an IHCA were attended to by the emergency team. Outcome measures and analysis Demographic and clinical data typically available at the arrival of the emergency team were extracted from the institutional IHCA database. In addition, outcome data including the Cerebral Performance Category (CPC) score count at hospital discharge were collected. A model selection procedure for random forests with a hyperparameter search was employed to develop two classification algorithms to predict failure to achieve ROSC and unfavourable (CPC 3–5) functional outcomes. Main results Six hundred thirty patients were included, of which 390 failed to achieve ROSC (61.9%). The final classification model to predict failure to achieve ROSC had an area under the receiver operating characteristic curve of 0.9 [95% confidence interval (CI), 0.89–0.9], a balanced accuracy of 0.77 (95% CI, 0.75–0.79), an F1-score of 0.78 (95% CI, 0.76–0.79), a positive predictive value of 0.88 (0.86–0.91), a negative predictive value of 0.61 (0.6–0.63), a sensitivity of 0.69 (0.66–0.72), and a specificity of 0.84 (0.8–0.88). Five hundred fifty-nine subjects experienced an unfavourable outcome (88.7%). The final classification model to predict unfavourable functional outcomes from IHCA at hospital discharge had an area under the receiver operating characteristic curve of 0.93 (95% CI, 0.92–0.93), a balanced accuracy of 0.59 (95% CI, 0.57–0.61), an F1-score of 0.94 (95% CI, 0.94–0.95), a positive predictive value of 0.91 (0.9–0.91), a negative predictive value of 0.57 (0.48–0.66), a sensitivity of 0.98 (0.97–0.99), and a specificity of 0.2 (0.16–0.24). Conclusion Using data readily available at emergency team arrival, machine learning algorithms had a high predictive power to forecast failure to achieve ROSC and unfavourable functional outcomes from IHCA while cardiopulmonary resuscitation was still ongoing; however, the positive predictive value of both models was not high enough to allow for early termination of resuscitation efforts.
Inter-observer variability between readers in detection of bone metastases comparing different modalities; PET/CT, SPECT/CT and planar bone scintigraphy
Authors: Bashank Nahla , Hussein Aalaa , Mekawy Mohamed , Askar Hebatallah
Published: April 2023

Objective

To assess the inter-observer variability between readers in the detection of bone metastases for different modalities [planar bone scintigraphy (BS), single photon emission computed tomography/computed tomography (SPECT/CT), and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) (F-18 FDG PET/CT)].

Methods

Patients with known primary tumors referred for metastatic workup either by F-18 FDG PET/CT or conventional planar BS and SPECT/CT were enrolled in this prospective study. The three modalities (BS, SPECT/CT, and PET/CT) were acquired for each patient. Interpretation was done by two independent nuclear medicine physicians separately and blindly; reader 1 (R1) and reader 2 (R2). A three-point subjective scale was used (1 = negative for bone metastases, 2 = equivocal, and 3 = positive). The findings were compared to the final patient status based on clinical and radiological follow-up for at least 6 months. The Kappa test was used to assess the degree of agreement between readers in their interpretation of each modality.

Results

A total of 54 patients (39 females and 15 males, ages 26–76; mean: 54.7 ± 12) were eligible for this study. Fair agreement 0.372 between R1 and R2 in interpretation of BS was noticed that improved to 0.847 after addition of SPECT/CT. Perfect agreement was achieved between R1 and R2 while interpreting PET/CT images (kappa = 0.964, P < 0.001).

Conclusion

F-18 FDG PET/CT significantly improved the inter-observer variability between readers, allowing for better diagnosis of bone metastases in known cancer patients. Also, it was superior to BS and SPECT/CT in the detection of bone metastases.
A rare case of concomitant Klebsiella pneumonia and panophthalmitis in a poorly controlled diabetic patient: the first case report from Syria
Authors: Kashkash Mohamad F. , Douba Zain , Kaddour Samer H. , Khouri Abdulla
Published: April 2023

Introduction:

Diabetes mellitus is the most common endocrine metabolic disease. Uncontrolled diabetes affects almost all components of immunity. Diabetes mellitus patients have an increased susceptibility to infections which aggravates in the cases of uncontrolled hyperglycemia.

Case presentation:

The authors present the case of a 63-year-old female patient with a history of poorly controlled type 2 diabetes. She went to the ambulance complaining of fever, poor appetite, dyspnea, cough, fatigue, and asthenia. The chest computed tomography showed the presence of bilateral ovoid infiltration densities, mostly on the upper-right side. The initial diagnosis was community-acquired pneumonia in an immunocompromised host due to poorly controlled diabetes. A swelling was observed in the right cheek and around the right eye, along with ptosis of the right eyelid. The ophthalmologist indicated the presence of panophthalmitis of the entire right eye with optic neuritis and right orbital cellulitis. The bacterial culture of bronchoalveolar lavage showed Gram-negative bacteria known asKlebsiella. After 17 days of hospitalization, the patient was discharged from the hospital on treatment with oral fluconazole, oral ciprofloxacin, and intramuscular gentamicin.

Conclusion:

In conclusion, the case highlights the importance of early detection of systematic infection manifestations in diabetic patients, regarding their age, history, and other comorbidities. Ocular symptoms are highly recommended to be evaluated in this context ofKlebsiellainfection.
Management of pediatric Madelung’s deformity of the forearm due to physeal growth arrest of the distal ulna: a case report
Authors: Meirizal  , Muhammad Hilmi , Rukmoyo Tedjo , Angriawan Tedy
Published: April 2023

Introduction and importance:

The authors presented a treatment option for Madelung’s deformity due to physeal growth arrest of the distal ulna after Kirschner wire (K-wire) fixation for pediatric forearm fractures.

Case presentation:

A boy, 16 years old, suffered from a close fracture of the middle third of the left radius and ulna and was treated with open reduction and internal fixation (ORIF) pinning with intramedullary K-wires. Eight months after surgery, the implant was removed. There was no complaint for more than 10 years. Nevertheless, the patient complained of a bowing hand and was diagnosed with Madelung’s deformity of the left forearm due to physeal growth arrest 12 years ago. The authors treated this patient with the release of fibrous tissue of the distal ulna, Darrach’s procedure, and extensor carpi ulnaris (ECU) tenodesis, along with a close wedge osteotomy of the distal radius and an ORIF of the distal radius. Four months after surgery, the clinical and radiological results were satisfactory.

Clinical discussion:

Pinning across a physis has the potential to cause full or partial development to stop. Madelung’s deformity is usually treated conservatively or surgically, depending on the severity of the symptoms. Darrach’s procedure, ECU tenodesis, close wedge osteotomy, and ORIF of the distal radius are available options to treat Madelung’s deformity.

Conclusion:

The use of transphyseal K-wires may result in physeal growth interruption. The developed Madelung’s deformity can be satisfactorily managed by Darrach’s procedure, ECU tenodesis, in combination with a close wedge osteotomy and ORIF of the distal radius.
Cesarean section of a patient with combined severe mitral and aortic stenosis: a case report
Authors: Sheikh Haris , Samad Khalid , Mistry Akbar A.
Published: April 2023

Introduction and Importance:

Cardiovascular diseases during pregnancy are rare but account for complications that pose risks to the mother as well as the child. In patients with fixed cardiac output due to stenotic valvular lesion(s), the physiological changes during pregnancy carry high risk of morbidity and mortality.

Case Presentation:

Our patient was diagnosed with severe mitral and aortic stenosis at her first antenatal visit at 24 weeks of gestation. She was also diagnosed with intrauterine growth restriction and was therefore planned to be operated on at a gestational age of 34 weeks. After careful selection of monitoring and anesthetic regime, the patient was managed without any intraoperative or postoperative complications.

Clinical Discussion:

This case reports how the anesthetists, obstetricians, and cardiac surgeons devised a well-designed plan to operate on a patient with a relatively rare disease manifestation. Our patient had coexisting severe stenotic lesions of both mitral and aortic valves and posed a clinical dilemma regarding the choice of anesthesia and perioperative management. Regardless of the anesthetic technique, goals for a patient with the combined valvular disease include maintenance of adequate preload, systemic vascular resistance, cardiac contractility, sinus rhythm and avoidance of tachycardia, bradycardia, aortocaval compression, and anesthetic or surgery-induced hemodynamic changes.

Conclusion:

The course of management would give clinicians an idea of how to manage a patient with combined stenotic valvular lesions for cesarean section, ensuring a smooth course and a safe postoperative period.
A SCARE-compliant case report of recurrent meningioma in a 75-year-old patient after 10 years of surgical resection
Authors: Legmouz Maria , El Ouahabi Abdessamad , Boulbaroud Samira , Azzaoui Fatimazahra
Published: April 2023

Introduction and importance:

Meningiomas are intracranial extracerebral tumors derived from arachnoid cells of the neural crest. They represent ∼20% of primary intracranial tumors and are seen as more common in elderly patients and women. Recurrence of meningioma can be observed during the early years after surgical treatment, but their occurrence within 10 years is rare.

Case presentation:

In this report, the authors discuss a case of a 75-year-old patient with a recurrence of a frontal meningioma after 10 years of successful surgical resection. Our patient was a female who presented amnesia and memory lapses associated with several weeks of progressive heaviness of the lower limbs accompanied by speech heaviness, intense headaches, asthenia, consciousness disorder, and tonic–clonic convulsive seizures for 10 days. The patient had previously been treated for a benign meningioma by surgical excision. Imaging was performed, and recurrent frontal meningioma was retained as a final diagnosis. The patient underwent a successful total resection of her frontal tumor.

Clinical discussion:

Recurrent tumors after complete surgical removal of meningiomas are rare and may be associated with microscopic residues. The more radical the surgery, the lower the risk of observing a recurrence. Adjuvant radiotherapy can be proposed, but the evidence is still lacking. Careful follow-up of all patients with or without complete surgical resection is therefore recommended.

Conclusion:

This case illustrates the importance of suspecting recurrence of meningioma in adult patients after successful surgical excision, even after 10 years of free disease. Clinicians should be aware of long-term meningioma recurrence in this population, and imaging is key for a positive diagnosis.
Acute abdomen due to rupture of a hydatid cyst of the liver: a rare complication – a case report
Authors: Adhikari Subodh , Bhattarai Madhur , Gyawali Sushil , Subedi Sudhan , Bhattarai Abhishek , Awale Laligen , Kansakar Prasan B.S.
Published: April 2023

Introduction and importance:

Hydatid cyst is a parasitic disease that is transmitted from animals to humans caused by the larval stage Echinococcus, especially Echinococcus granulosus. A complication of a hydatid cyst of the liver is its rupture, either traumatic or spontaneously.

Case presentation:

A 19-year-old male presented with an acute abdomen for 12 h. After clinical assessment, contrast-enhanced computed tomography showed a rupture of the anterior wall of the hepatic hydatid cyst with intra-abdominal and pelvic dissemination. Exploratory laparotomy was performed with the evacuation of the daughter cyst and peritoneal lavage. The patient recovered well and was discharged with albendazole therapy.

Clinical discussion:

Hydatid cyst rupture is a rare but serious complication. Computed tomography has high sensitivity in demonstrating cyst rupture. The patient underwent laparotomy, where disseminated cysts were evacuated, and the anterior wall of the cyst was deroofed, along with the removal of a ruptured laminated membrane. Emergency surgery plus albendazole therapy are recommended protocols for cases like ours.

Conclusions:

A patient from an endemic region with acute presentation of right upper quadrant pain can have spontaneously ruptured hydatidosis as a differential diagnosis. Intraperitoneal rupture and dissemination of hydatid cysts of the liver can be life-threatening if intervention is delayed. Immediate surgery is life-saving and prevents complications.
A rare location of cardio hydatid cyst with multiple organ involvement: a case report
Authors: Ahmad Yara , Maree Gulan , Omar Sherawan , Alkhalaf Hussam
Published: April 2023

Introduction:

Cardiac cysts in hydatid cysts, a parasitic disease, are extremely rare, and left-atrial hydatid cysts are even more unusual. Therefore, the authors report herein a rare case of a hydatid cyst in the left atrium. According to them, this is the third documented case of left-atrial hydatid cysts.

Presentation of Case:

A 25-year-old male presented at the outpatient clinic with atypical chest pain, hacking cough, dyspnoea, nausea, and vomiting for 2 months. Echocardiography showed a left-atrial unilocular, well-delineated mass. The authors also found multiple liver cysts and spleen cysts.

Discussion:

The widespread distribution of the disease in our regions, the dog contact story of the patient, and the appearance on echocardiograms were strong reasons to diagnose a hydatid cyst in the left atrium, which may cause many symptoms (bundle branch conduction, arrhythmias, myocardial infarction) or unexpected death.

Conclusions:

The authors aimed to report this case due to the disease’s high probability of death, even asymptomatic patients with cardiac hydatid disease should all be referred for early surgery.
Leukemoid reaction in a patient with metastatic renal cell carcinoma—rare clinical presentation seen in Nepal: a case report
Authors: Khatiwada Pramit , Yadav Girendra , Guragain Prashant , Raut Pradip , Subedi Viplaw , Dulal Soniya
Published: April 2023

Introduction and importance:

Leukemoid reaction (increase in leucocyte count >50 ×109 cell/l) occurs due to reactive causes of bone marrow and is diagnosed after excluding the malignant haematological disorder. Leukemoid reaction is a rare clinical presentation in metastatic renal cell carcinoma and is said to have a rare prognosis. This case has had been reported in the line of SCARE criteria.

Case presentation:

A case of a 35-year-old female with no known previous co-morbidities presented with a history of abdominal pain in the right flank region for 2 months, fever and cough for 2 months. Physical examination showed palpable mass and tenderness in the right flank and investigations showed leukemoid reaction in peripheral blood smear. The patient was initially treated with strong intravenous antibiotics with suspicion of pyelonephritis in another centre, despite which the patient still had elevated leucocyte count and referred to our centre, where the patient was evaluated for elevated leucocyte count and with further investigations, ruled out any malignant haematological disorder. Final diagnosis of renal cell carcinoma was made by renal mass biopsy. The patient underwent targeted therapy with sunitinib. The patient expired and further investigation and follow-up were not possible.

Conclusion:

The lack of data and evidence of extensive diagnostic tests is the reason we are unable to assume leukemoid reaction as a poor prognostic factor in case of metastatic renal cell carcinoma. The presence of other paraneoplastic syndromes with renal cell carcinoma might have resulted in the poor prognosis that cannot be excluded.