bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative analysis of peri-intestinal lymph node metastasis using indocyanine green fluorescence imaging technology
Authors: Lin Weiyang , Li Qi , Sheng Jie , Zhao Yibing , Cui Wei
Published: August 2024

We evaluated the efficacy of indocyanine green fluorescence imaging compared to that of traditional nanocarbon dyes in assessing peri-intestinal lymph node metastasis in patients with colorectal cancer, which is a key prognostic factor. The relationship between indocyanine green fluorescence imaging and histopathological outcomes in patients with colon cancer has also been explored. A retrospective analysis was conducted on 30 patients with colon cancer (from May to October 2023) confirmed by surgical pathology. Tumors were marked with indocyanine green (ICG) or nanocarbon via colonoscopy 16 to 24 hours before surgery. Within 15 minutes after surgery, peri-intestinal lymph node fluorescence imaging and hematoxylin and eosin staining were used to assess the distribution of cancer foci. The correlation between cancer foci distribution, fluorescence intensity, and area under the receiver operating characteristic curve was measured. Among 243 metastatic lymph nodes from 30 patients, 18 were found. After the patients were divided into metastatic and nonmetastatic groups, significant differences in tumor differentiation and stage were noted (P < .001). The fluorescence intensity was strongly correlated with the presence and proportion of metastasis (area under the receiver operating characteristic curve = 0.931), whereas nanocarbon staining showed no significant correlation (P = .81). All P values were two-sided, with P < .05 indicating statistical significance. Lymph nodes with malignant intestinal tumor metastasis displayed weaker ICG fluorescence than did nonmetastatic nodes. Combining ICG and nanocarbon staining techniques enhances intraoperative lymph node dissection and postoperative analysis, indicating their potential utility in colorectal cancer surgery.
A case of H-type double gallbladder anomaly: A case report
Authors: Cheng Yingxue , Xi Zhe , Zhuang Aobo , Li Xi , Wang Yue , Yan Guangting , Zhang Geng , Zhang Chenhe , Chen Kun , Huang Yang Yang , Zhou Changsheng , Wang Qing , Li Wengang
Published: August 2024

Rationale:

Biliary system anomalies, such as duplicated gallbladders, are rare congenital conditions that present significant diagnostic challenges. Dr. Boyden’s classification system, especially the H-type anomaly, offers vital insight into these variations. Failure to detect these anomalies preoperatively can increase the risk of surgical complications, making early identification crucial for surgical planning.

Patient concern:

A 42-year-old male, asymptomatic, was incidentally found to have a gallbladder mass during routine imaging. An upper abdominal magnetic resonance imaging showed gallbladder wall thickening, gallstones, and a liver lesion. Despite the absence of symptoms, a laparoscopic cholecystectomy revealed an atrophied gallbladder with a cystic duct cyst, which was identified as an H-type double gallbladder anomaly. The surgery was completed without complications, and pathology confirmed the presence of gallstones and inflammation.

Diagnoses:

The patient was diagnosed with a duplicated gallbladder, classified as an H-type anomaly, following laparoscopic cholecystectomy. Preoperative imaging identified gallbladder wall thickening and gallstones, and further investigation during surgery confirmed the congenital anomaly.

Interventions:

The patient underwent laparoscopic cholecystectomy for the removal of the gallbladder, and during the procedure, an H-type double gallbladder anomaly was discovered. The surgery proceeded without incident, ensuring the complete excision of the gallbladders.

Outcomes:

The case highlights the diagnostic difficulty of identifying duplicated gallbladders and the importance of advanced imaging techniques in detecting atypical anatomical variations. The successful laparoscopic removal of both gallbladders illustrates the current capabilities of minimally invasive surgery. Postoperative recovery was uneventful, and the pathology confirmed gallstones and inflammation.

Lessons:

This case emphasizes the importance of recognizing biliary anomalies such as duplicated gallbladders to avoid complications during surgery. Preoperative identification, aided by imaging, and careful surgical planning are key to managing these rare conditions. The case contributes to the growing body of knowledge about biliary system anomalies and reinforces the need for comprehensive management strategies to ensure optimal patient outcomes.
The effect of Rebozo technique on perceived labour pain and childbirth experience: A randomized controlled trial
Authors: Tandoğan Özden , Oskay Ümran
Published: August 2024

Background:

Pain, stress, and anxiety experienced during childbirth can have detrimental effects on labor and delivery. The rebozo technique is an ancestral method used to minimize pain and enhance relief during gestation. This study aimed to investigate the effects of the rebozo technique on the birth process and its probable benefits on the birth experience.

Methods:

This survey was conducted from January to May 2021 in a randomized and controlled manner. A total of 113 pregnant women with their first children were surveyed. Women between 37 and 41 weeks of gestation without complications who were admitted to the delivery room with a cervical dilation of 4 cm or more were chosen as participants. In the Rebozo group, subjects were randomly selected by trained personnel to apply the standardized method, while the control group received a relaxing massage. Cervical dilation, fetal position, contraction patterns, and measures related to the birth experience were key indicators.

Results:

Women in the rebozo group had lower pain levels during birth and greater birth satisfaction. Mean cervical dilation in the latent phase was 5.61 cm in the rebozo group and 5.71 cm in the control group. In the active phase, cervical dilatation was 6.03 cm in the rebozo group and 6.68 cm in the control group, and this difference was statistically significant (P < .001). In the transition phase, the birth time was 46.29 minutes in the rebozo group and 68.71 minutes in the control group (P = <.007**). In the total birth experience score, the rebozo group received an average of 68.52 points, while the control group received 51.58 points (P < .001).

Conclusion:

This research has established that the use of the rebozo technique throughout labor helps enhance her feelings about being pregnant, as well as heightening fulfillment with delivery.
Efficacy and safety analysis of AKT inhibitor in triple-negative breast cancer: A meta-analysis and systematic review
Authors: Yang Minghao , Wang Chunxi , Chen Guoping , Zhang Haowen , Lin Junlong
Published: August 2024

Objective:

To determine the clinical benefit of monotherapy with AKT inhibitors in patients diagnosed with triple-negative breast cancer (TNBC).

Methods:

A systematic search was conducted in PubMed, Embase, and Cochrane Library for articles reporting treatment with AKT inhibitors in TNBC. The primary endpoint was progression-free survival and overall survival (OS). Secondary endpoints included the clinical benefit rate (CBR, included the proportion of patients with complete response, partial response, and stable disease), overall response rate (ORR, included the proportion of patients with complete response and partial response), all drug-related adverse events (AEs), and ≥3 grade drug-related grade AE.

Results:

We included 723 patients from 5 studies and observed a pooled progression-free survival of 0.80 (95% CI: 0.62–1.02; The Grading of Recommendations, Assessment, Development, and Evaluations [GRADE] assessment: moderate certainty) and OS of 0.7 (95% CI: 0.50–0.99; GRADE assessment: high certainty) in TNBC patients treated with AKT inhibitors. Regarding clinical benefit rate and overall response rate were 1.21 (95% CI 0.85–1.73; GRADE assessment: moderate certainty) and 1.26 (95% CI 0.91–1.73; GRADE assessment: low certainty). Only OS had a statistical difference. For the odd ratio of all grade AE and ≥3 grade AE in the therapeutic process was counted and pooled, 4.34 (95% CI 1.33–14.14; GRADE assessment: moderate certainty) and 1.76 (95% CI 1.28–2.41; GRADE assessment: moderate certainty), respectively.

Conclusions:

AKT inhibitors showed slightly better efficacy in the treatment of TNBC. However, further studies are needed to evaluate its long-term safety and optimal regimen, and caution should be exercised in patients with coexisting gastrointestinal disorders. The clinical characteristics of the patients and the choice of drugs should be considered on an individual basis.
Risk-factor analysis of the proximal tibia morphology for secondary ipsilateral injury after anterior cruciate ligament reconstruction: A retrospective cross-sectional study
Authors: Liu Wei , Wang Bin , Feng Zhiwei , Zhang He , Zhao Zhiguang , Han Shoujiang
Published: August 2024

Many studies have reported the risk factors associated with primary anterior cruciate ligament (ACL) injury. However, few studies have focused on the bony morphology of secondary ipsilateral injury after ACL reconstruction. This study aimed to investigate the morphological risk factors of the proximal tibia contributing to secondary ipsilateral injury after ACL reconstruction. Twenty patients who were selected from secondary ipsilateral injury after ACL reconstruction between January 2015 and May 2020 were included in the secondary injury group. They were matched in a 1:2 ratio to the control group, which underwent primary ACL reconstruction during the same period and did not experience reinjury at the minimum 2-year follow-up, based on age, gender, and body mass index. All parameters, including medial tibial posterior slope, lateral tibial posterior slope (LTPS), medial tibial plateau depth, and lateral tibial plateau height, were recorded by using magnetic resonance imaging. Binary logistic regression analysis and receiver operator characteristic curves were conducted to explore the risk factors for reinjury and determine the cutoff value for the significant parameter. The LTPS was significantly larger in the secondary injury group than in the control group (9.6 ± 1.5° to 7.0 ± 1.4°, P < .001), and there was no significant difference in the medial tibial posterior slope, medial tibial posterior slope, and lateral tibial plateau height between the 2 groups (P > .05). The LTPS was found to be an independent risk factor for secondary ipsilateral injury after ACL reconstruction (odds ratio = 3.220, 95% confidence interval = 1.904–5.446, P < .001). The cutoff value of the LTPS was 8.8°, with a sensitivity of 91.7% and a specificity of 81.2%. The LTPS could be a unique predictor of secondary ipsilateral injury after ACL reconstruction. Orthopedists should implement effective measurements during primary reconstruction when the LTPS is >8.8°.
Efficacy and safety of rectal chloral hydrate for pediatric procedural sedation: A systematic review and meta-analysis
Authors: Chen Zhe , Qin Fang , Zeng Linan , Zhang Lingli
Published: August 2024

Background:

To evaluate the efficacy and safety of rectal chloral hydrate (CH) in pediatric procedural sedation.

Methods:

Seven electronic databases and 3 clinical trials registry platforms were searched, and the deadline was August 2022. Randomized controlled trials evaluating the efficacy and safety of rectal CH in pediatric procedural sedation were included by 2 reviewers. The extracted outcomes included the success rate of sedation, sedation latency, sedation duration, and adverse events. The Cochrane risk of bias tool was used to assess the risk of bias. The outcomes were analyzed using Review Manager 5.3 software.

Results:

Forty-four randomized controlled trials with 8007 children were included in the meta-analysis. The success rate of sedation in the rectal CH group was significantly higher than that in the placebo group (risk ratio [RR], 2.60 [95% confidence interval [CI], 1.74–3.89]; P < .01; RR, 1.24 [95% CI, 1.01–1.54]; P = .04), oral CH group (RR, 1.12 [95% CI, 1.09–1.14]; I2 = 36%; P < .001; number needed to treat [NNT] = 10), diazepam group (RR, 1.21 [95% CI, 1.10–1.33]; I2 = 0%; P < .001; NNT = 6), phenobarbital group (RR, 1.24 [95% CI, 1.13–1.35]; I2 = 12%; P < .001; NNT = 6), and ketamine group (RR, 1.39 [95% CI, 1.20–1.60]; I2 = 20%; P < .001; NNT = 5). There was no significant difference in the success rate of sedation between the rectal CH group and the midazolam group (RR, 0.98 [95% CI, 0.86–1.11]; I2 = 51%; P > .05). The sedation latency was significantly shorter in rectal CH group than that in the oral CH group (mean difference [MD], −6.36 [95% CI, −7.04 to −5.68]; I2 = 49%; P < .001) and the phenobarbital group (MD, −7.64 [95% CI, −9.12 to −6.16]; P < .00001). The sedation duration in the rectal CH group was significantly longer than in the oral CH group (MD, 6.43 [95% CI, 4.39–8.47]; I2 = 0%; P < .001). The overall incidence of adverse events was significantly lower with rectal CH than with oral CH (RR, 0.21 [95% CI, 0.16–0.29]; I2 = 45%; P < .001) and ketamine (RR, 0.26 [95% CI, 0.12–0.60]; I2 = 0%; P = .001). There was no significant difference in the overall incidence of adverse events with rectal CH compared with intramuscular midazolam (RR, 0.55 [95% CI, 0.23–1.28]; P = .17) and intranasal midazolam (RR, 3.00 [95% CI, 0.66–13.69]; P = .16).

Conclusion:

The available evidence suggests that rectal CH cloud be an effective and safe sedative agent for pediatric procedural sedation.
Changes of oxidative stress in 3D film to be prepared for echocardiography: A randomized controlled study
Authors: Demir Emel , Duzguner Vesile , Yilmaz Nuh , Yengil Erhan
Published: August 2024

Background:

Echocardiography (ECHO) is a nonprocedure that causes acute stress in children. Fear, anxiety, and fluctuations in children’s blood pressure and heart rate can potentially lead to alterations in echocardiographic measurements. The insufficient research on virtual reality pediatric preparation applications, particularly in the context of echocardiographic procedures, underscores the necessity for additional studies focusing on pediatric patients. This study sought to assess the impact of virtual reality applications tailored explicitly for ECHO on children’s oxidative stress levels.

Methods:

This was a prospective, randomized, controlled experimental study. Forty-eight children (experimental/24, control/24) aged 7 to 12 years who had an ECHO appointment in the pediatric cardiology outpatient clinic in the 3 months from June to August 2019 participated in the study. Participants whose blood analyses showed hemolysis were eliminated, and the study was completed with 37 children in total: 16 children in the experiment and 21 children in the control. Post hoc power analysis was performed for sample adequacy, and the power of the study was found to be 0.99. A 3D film was prepared for the research and applied to the experimental group before the procedure. All children’s oxidative stress levels (cortisol, malondialdehyde, nitric oxide) and glutathione levels were checked after ECHO.

Results:

The stress hormone cortisol and malondialdehyde levels were lower in the 3D-applied experimental group than in the control group. As another crucial anti-stress antioxidant factor, glutathione level increased in the experimental group compared to the control group (P < .05).

Conclusion:

The research revealed that the 3D film used to prepare ECHO reduces the stress parameters associated with heart risk and may affect the ECHO measurements. At the same time, the study also proved the positive effect of 3D film preparation by increasing the anti-stress factor.
Are the tumor microenvironment characteristics of pretreatment biopsy specimens of colorectal cancer really effectively predict the efficacy of neoadjuvant therapy: A retrospective multicenter study
Authors: Li Bingbing , Chen Longjiao , Huang Yichun , Wu Meng , Fang Weilan , Zou Xin , Zheng Yihong , Xiao Qiuxiang
Published: August 2024

More and more studies had pointed out that the tumor microenvironment characteristics based on colorectal cancer (CRC) pretreatment biopsy specimens could effectively predict the efficacy of neoadjuvant therapy, but under hematoxylin and eosin (HE) staining, whether the tumor microenvironment characteristics observed by pathologists could predict the efficacy of neoadjuvant therapy remains to be discussed. We collected 106 CRC patients who received neoadjuvant treatment and surgical resection from 3 hospitals. The number of mitosis, inflammation degree, desmoplastic reaction (DR), necrosis, tumor-stroma ratio (TSR) and tumor budding (TB) of CRC pretreatment biopsy specimens were observed under HE staining, and the degree of tumor pathological remission of CRC surgical specimens after neoadjuvant treatment was evaluated. According to the tumor regression grade (TRG), patients were divided into good-responders (TRG 0–1) and non-responders (TRG 2–3). All data were analyzed with SPSS software (version 23.0) to evaluate the correlation between the number of mitosis, inflammation degree, DR, necrosis, TSR and TB in pretreatment biopsy samples and the treatment effect. In univariate analysis, mitosis (P = .442), inflammation degree (P = .951), DR (P = .186), necrosis (P = .306), TSR (P = .672), and TB (P = .327) were not associated with the response to neoadjuvant therapy. However, we found that for colon cancer, rectal cancer was more likely to benefit from neoadjuvant therapy (P = .024). In addition, we further analyzed the impact of mitosis, inflammation degree, DR, necrosis, TSR and TB on neoadjuvant therapy in rectal cancer, and found that there was no predictive effect. By analyzing the characteristics of tumor microenvironment of CRC pretreatment biopsy specimens under HE staining, such as mitosis, inflammation degree, DR, necrosis, TSR and TB, it was impossible to effectively predict the efficacy of neoadjuvant therapy for CRC.
Effect of ultrasound-guided nerve blocks on anesthesia and pulmonary function in patients undergoing distal radius fracture surgery
Authors: Hao Weihong , Zhang Chunmin , He Jiandong , Pei Ruomeng , Huo Haiyan , Liu Huihui
Published: August 2024

This study aimed to assess the impact of ultrasound (US)-guided nerve blocks (NBs) on anesthesia and their protective effect on pulmonary function (PF) in patients undergoing distal radius fracture (DRF) surgery. A total of 122 patients undergoing DRF surgery between April 2020 and June 2023 were included. According to the type of peripheral NB technique, these patients were randomized into a control group (CG; n = 60) receiving brachial plexus block (BPB) using blinded techniques, and an observation group (OG; n = 62) receiving US-guided supraclavicular BPB. Anesthetic effects, BPB-related indexes, adverse events, PF parameters (forced expiratory volume in 1 second, forced vital capacity, peak expiratory flow), and serum biochemical indexes (interleukin [IL]-6/10) were compared. The OG showed a relatively higher proportion of good anesthetic effects, shorter onset and completion times of block, and longer block duration compared to the CG, with a lower AE rate. Despite reductions in PF parameters and IL-10 levels after intervention, the OG maintained higher values than the CG. IL-6 levels increased significantly in the OG but remained lower than in the CG. In conclusion, US-guided NBs demonstrated significant anesthetic efficacy and apparently reduced anesthesia adverse events while also exerting a protective effect on PF in DRF surgery patients.
Association between wait time of central venous pressure and 28-day mortality in critically patients with acute pancreatitis: A restrospective cohort study
Authors: Lan Ying , Chen Lvlin , Yang Qilin , Zhu Bin , Lin Zhimei
Published: August 2024

Hemodynamic management is crucial in patients with acute pancreatitis. Central venous pressure (CVP) is widely used to assess volume status. Our aim was to determine the optimal time window for obtaining CVP measurements to prevent adverse outcomes in patients. This study utilized data from the Medical Information Mart for Intensive Care (MIMIC) IV database. The primary outcome under investigation was the 28-day mortality, while secondary outcomes included 90-day mortality and 1-year mortality. To categorize the study population, a CVP waiting time of 12 hours was employed as the grouping criterion, followed by the utilization of Cox regression analysis to compare the outcomes between the 2 groups. Our study included a total of 233 patients, among whom 154 cases (66.1%) underwent CVP measurements within 12 hours after admission to the Intensive Care Unit (ICU). Univariate and multivariate Cox regression analyses revealed a significantly increased risk of 28-day mortality in patients from the delayed CVP monitoring group compared to those who underwent early CVP measurements (HR = 2.87; 95% CI: 1.35–6.13; P = .006). Additionally, consistent results were observed for the risks of 90-day mortality (HR = 1.91; 95% CI: 1.09–3.35; P = .023) and 1-year mortality (HR = 1.84; 95% CI: 1.09–3.10; P = .023). In the ICU, an extended waiting time for CVP measurements in patients with acute pancreatitis was associated with an increased risk of 28-day mortality.
Resection of uterine arteriovenous fistula with temporary occlusion of the internal iliac arteries: Case series and literature review
Authors: Chen Jianmin , Huang Dong , Yang Jie , Zhang Songying
Published: August 2024

Rationale:

Uterine arteriovenous fistula (UAVF) is a rare vascular abnormality that can cause severe and potentially life-threatening hemorrhage. Uterine artery embolization is a common treatment that may affect ovarian and uterine perfusion and cause fertility problems. We herein report our experience treating 2 patients with UAVF who underwent resection after temporary occlusion of both internal iliac arteries.

Patient concerns:

Both patients presented with a large UAVF after incomplete miscarriages in the second trimester. Magnetic resonance imaging revealed a UAVF measuring 3.6 × 2.6 × 2.1 cm over the myometrium of the posterior uterine in case 1, and a UAVF of 7.1 × 4.1 × 4.5 cm was identified in case 2.

Diagnosis:

Uterine arteriovenous fistula, retained products of conception.

Interventions:

The patients underwent resection of UAVF with temporary occlusion of the internal iliac arteries and hysteroscopic removal of the retained products of conception.

Outcomes:

Intraoperative bleeding were minimal. Neither patient exhibited abnormal uterine bleeding at the 6-month follow-up. Follow-up ultrasonography and magnetic resonance imaging showed normal uterine myometrium and endometrium and no residual disease.

Lessons:

UAVF resection after temporary occlusion of the internal iliac arteries is a promising treatment approach for UAVF. This technique can reduce intraoperative bleeding and remove the potential hemorrhage-related lesion while preserving fertility.
Physical exercise on cortical brain activity in patients with mild cognitive impairment: A meta-analysis
Authors: Li Xiaomei , Cai Hejia , Li Fangcun , Tang Ke , Tang Gangjian
Published: August 2024

Background:

Physical exercise is recognized as a potential strategy to mitigate the cognitive decline associated with mild cognitive impairment (MCI). This systematic review aims to examine the specific effects of physical exercise on cortical brain activity in patients with MCI, an area that has not been thoroughly explored.

Methods:

We conducted a search across 9 electronic databases for randomized controlled trials assessing the impact of physical exercise on the cortical activity of patients with MCI. The search covered the period from database inception to September 2023. Literature screening, data extraction, and quality assessments were carried out by 2 independent researchers. Meta-analyses were conducted using RevMan 5.3, and publication bias was evaluated using STATA 17.0. This study primarily assessed P300 latency and amplitude, alongside cognitive evaluations using the mini-mental state examination and Montreal Cognitive Assessment.

Results:

Six high-quality randomized controlled trials, involving a total of 360 participants, were included. Compared to the control group, significant enhancements were observed in the amplitude of central midline electrode (mean difference [MD] = 1.64 [95% confidence interval [CI], 0.92–2.36]; P < .00001), frontal midline electrode (MD = 2.70 [95% CI, 2.02–3.38]; P < .00001), and parietal midline electrode (MD = 2.42 [95% CI, 0.44–4.41]; P = .02). Latency periods of the central midline electrode (MD = −32.40 [95% CI, −40.27 to −24.54]; P < .00001), frontal midline electrode (MD = −12.57 [95% CI, −30.83 to 5.69]; P = .18), and parietal midline electrode (MD = −12.57 [95% CI, −30.83 to 5.69]; P = .81) were also notably influenced. Moreover, overarching cognitive functions as measured by mini-mental state examination (MD = 1.02 [95% CI, 0.61–1.43]; P < .00001) and Montreal Cognitive Assessment (MD = 1.39 [95% CI, 0.67–2.12]; P = .0002) exhibited marked improvement.

Conclusion:

This meta-analysis suggests that physical exercise can augment the P300 amplitude, reduce the P300 latency period, and, overall, enhance cognitive functionality in individuals with MCI.
Integrated bioinformatic analysis of the molecular mechanisms between type 2 diabetes mellitus and osteoarthritis
Authors: Zhang Bao , Liu Deding
Published: August 2024

Type 2 diabetes mellitus (T2DM) is a metabolic syndrome that has been identified as an independent risk factor for osteoarthritis (OA) and may even trigger and exacerbate the progression of OA. However, the relationship between T2DM and OA is complex and has not yet been fully clarified by current research. In this study, we analyzed the potential mechanism of action between T2DM and OA by bioinformatics. Transcriptome sequencing data of T2DM (GSE25724) and OA (GSE55235) were downloaded from the gene expression omnibus. Differential expression analysis was performed for different subgroups to obtain differentially expressed genes. The protein–protein interaction network was constructed using overlapping genes and screened for hub targets. Then the enrichment analysis was performed separately for overlapping and hub targets. The GeneMANIA is used to predict functionally similar genes of hub genes. Differential expression analyses revealed that 184 genes are involved in both diseases together. The Kyoto Encyclopedia of Genes and Genomes pathway enrichment results showed that the overlapping genes were mainly involved in the advanced glycation end products-receptor of advanced glycation end products signaling pathway, the NF-kappa B signaling pathway, the mitogen-activated protein kinases signaling pathway, and the interleukin-17 signaling pathway in diabetic complications. The functions of genes similar to the hub genes are focused on cell chemotaxis, positive regulation of cell migration, positive regulation of RNA polymerase II transcription, regulation of leukocyte migration, epithelial cell proliferation, and integrated stress response signaling. The transcription factor Jun and C-X-C motif chemokine 8 may play an important role in the inflammatory response caused by advanced glycation end products. This study improves our understanding of T2DM complicating OA and helps to stimulate more effective treatments.
Acute effects of manual breathing assist technique on lung volume and dyspnea in individuals with severe chronic obstructive pulmonary disease: A quasi-experimental study
Authors: Tanaka Takako , Reid W. Darlene , Nonoyama Mika Laura , Kozu Ryo
Published: August 2024

Background:

Manual breathing assist technique (MBAT) is a common physical therapy technique used to facilitate airway clearance and improve ventilation and oxygenation. The effects during and immediately after intervention in individuals with chronic obstructive pulmonary disease (COPD) are unknown. This study aimed to investigate the acute effects and potential mechanisms of MBAT on lung volume, dyspnea, and oxygenation in individuals with COPD.

Methods:

This non-randomized quasi-experimental pre-test/post-test study included participants from pulmonary rehabilitation programs at Tagami Hospital (COPD group) and a community exercise program (Healthy group). During a single session, MBAT was applied during the expiration of every breath for 10 minutes. Dyspnea and lung volumes (tidal volume; V

T
, inspiratory capacity; IC, inspiratory reserved capacity; IRV, expiratory reserve capacity; ERV) were collected at baseline and after MBAT. Pulse oximetry (SpO2), skeletal muscle oxygenation (SmO2), and oxy- and deoxy-hemoglobin (O2Hb and HHb) using near-infrared spectroscopy (NIRS) were collected at baseline, during, and after MBAT. Between-group comparisons were conducted using the Mann-Whitney U-test and chi-square analyses. Within-group changes before and after MBAT were analyzed using the Wilcoxon signed-rank test. The Kruskal-Wallis test was used to detect differences in NIRS variables in each phase and over time.

Results:

Thirty participants with COPD, matched for age and sex, were included, with 15 individuals per group. The difference scores of V

T
, IRV, and IC were significantly higher in the Healthy group than in the COPD group, but improvements in dyspnea and SpO2 were significantly higher in the COPD group. Compared to baseline, ERV decreased significantly in both groups, with dyspnea and SpO2 improving significantly only in the COPD group. Inspiratory accessory muscle ΔO2Hb and ΔHHb were significantly higher and lower (respectively) during MBAT in the COPD group compared to the Healthy group. Additionally, only the COPD group had increased SmO2 during and after MBAT compared to baseline.

Conclusions:

MBAT in patients with COPD had acute physiological effects in reducing dyspnea by facilitating expiration and decreasing the recruitment of accessory respiratory muscles. MBAT may help individuals with COPD reduce dyspnea before exercise therapy in a pulmonary rehabilitation program.
Purse-string versus linear closure of the skin wound following stoma reversal: A meta-analysis with RCT and systematic review
Authors: Luo Jinlong , Liu Dan , Wu Junmei , Jiang Huaiwu , Chen Jin , Yang Hua , Yang Lie
Published: August 2024

Background:

Linear closure (LC) following stoma reversal is associated with a high risk of surgical site infection (SSI). Purse-string closure and LC were both positive for the closure of the skin wound following stoma reversal, and it was not yet possible to distinguish which one was more beneficial to the patient’s prognosis.

Methods:

We conducted a search in Embase, PubMed, Web of Science, and Cochrane Library and conducted a randomized controlled experiment from the inception of each database to July 2024. Among them, the SSI within 30 days, operation time, hospitalization time, incisional hernia, and wound healing time were all outcome indicators.

Results:

Eleven studies were included in this meta-analysis (506 patients in the purse-string closure group and 489 patients in the LC group). The pooled data showed that the SSI rate was significantly lower in the purse-string closure group than in the LC group (odds ratio, 0.15; 95% confidence interval, 0.09–0.24; P < .00001; I2 = 0%). The differences in operative time, hospitalization time, incision hernia, and wound healing time were not statistically significant.

Conclusion:

Overall, purse-string closure had a significantly lower SSI rate following stoma reversal than LC.
Study on the comprehensive treatment of migraine with traditional Chinese medicine based on the new pathophysiological mechanism: A review
Authors: Shen Yue , Li Zeguang , Wang Jing , Qiu Zitong
Published: August 2024

Migraine is a ubiquitous neurological disorder that affects approximately 1 billion people worldwide. Migraine is the second leading cause of illness in people of all ages worldwide. Uncertainty in migraine diagnosis leads to unnecessary testing and increases the treatment costs. To date, the pathogenesis of migraine is not fully understood, but it is generally believed that migraine involves the trigeminal nerve and its axonal projections to intracranial blood vessels. Pain signals from the trigeminal neurovascular system are transmitted to the brain, resulting in migraines. As an important component of complementary and alternative medicine, traditional Chinese medicine (TCM) has shown significant efficacy in the treatment of migraine, and has attracted increasing attention worldwide. This review is based on the pathophysiology of migraines in modern medicine. To explore the comprehensive treatment of migraine using TCM, acupuncture, and various other TCM treatments.
Challenging treatment of severe hypotension following tracheal intubation in a patient with primary hyperparathyroidism: A case report
Authors: Koyama Yuhei , Hamaguchi Shinsuke
Published: August 2024

Rationale:

Primary hyperparathyroidism (PHPT), which is characterized by increased parathyroid hormone secretion, typically manifests as hypercalcemia and hypertension. Here, we report a case of severe hypotension following tracheal intubation during anesthesia induction in a patient with PHPT, in contrast to the expected hypertensive response.

Patient concerns:

A 52-year-old man presented with nausea after eating, leg pain when walking, and headaches.

Diagnosis:

Based on the blood test and computed tomography results, he was diagnosed with PHPT.

Interventions:

The patient underwent parathyroidectomy under general anesthesia. After induction anesthesia and tracheal intubation, severe acute hypotension and tachycardia suddenly developed. To treat hypotensive shock, we immediately administered ephedrine and phenylephrine and infused Ringer solution.

Outcomes:

The symptoms of hypotensive shock were alleviated by this intervention.

Lessons:

We speculate that the cause of his severe hypotension was vasodilation due to the transient release of parathyroid hormone from mechanical stimulation by anesthetic procedures, such as tracheal intubation, combined with hypercalcemia-induced severe dehydration. Moreover, we speculate that fluid resuscitation stabilized his condition and helped achieve a successful surgical outcome. The possibility of severe hypotension after anesthesia induction should be anticipated, and management of cases with severe dehydration should be optimized during the anesthetic management of patients with PHPT.
Path analysis of COVID-19 cognition, social support, and mental health of pregnant women with interventional prenatal diagnosis during the COVID-19 pandemic based on structural equation modeling
Authors: Yang Hao , Wang Xihong , Luo Wanying , Wan Li , Zhu Hui , Peng Wentao , Guan Yujia
Published: August 2024

This study aims to investigate the relationship between Corona Virus Disease 2019 (COVID-19) cognition, social support, and mental health among pregnant women proposed for undergoing interventional prenatal diagnosis in Sichuan Province during the COVID-19 pandemic. A total of 2270 pregnant women (2232 valid) who were proposed to undergo interventional prenatal diagnosis at a tertiary hospital prenatal diagnosis center in Sichuan Province from January to December 2022 were selected by Convenience sampling and surveyed using a self-administered general information questionnaire, social support rating scale, mental health questionnaire (including: Self-Rating Anxiety Scale, Self-Rating Depression Scale), and self-administered COVID-19 cognition questionnaire. Structural equation modeling showed that social support negatively predicted anxiety (β = −0.34, t = −14.98, P < .001) and negatively predicted depressive status (β = −0.21, t = −9.57, P < .001); COVID-19 cognition negatively predicted anxiety (β = −0.76, t = −5.34, P < .001) and depression (β = −0.40, t = −2.99, P < .01); anxiety positively predicted anxiety (β = 0.73, t = 37.34, P < .001). The overall knowledge rate of COVID-19 cognition among 2232 pregnant women who were to undergo interventional prenatal diagnosis was 76.40%. The fit indices of the model were: CMIN/DF = 3.071, GFI = 0.999, AGFI = 0.993, CFI = 0.999, RMSEA = 0.030, NFI = 0.998, and TLI = 0.992, indicating that the model had a good fit and the model was scientifically valid. Pregnant women in Sichuan province who are to undergo prenatal interventional diagnosis have a medium level of COVID-19 awareness, and their level of COVID-19 awareness and social support will directly affect their anxiety and depression level, and their anxiety level will also affect their depression level. We should give more attention to pregnant women, especially those in particular situations such as advanced age, poor maternal history, family history of genetic disease, etc, they should be given adequate care and social support, and multiple channels and types of health education should be provided for the COVID-19 to improve the pregnant women’s knowledge of COVID-19, which is important for improving the mental health of pregnant women.
Clinical features and genetic analysis of 5 cases of infantile-type glycogen storage disease type II: Case reports
Authors: Feng Qi , Zhang Meng Qiao , Ba Chun Xiao , Zhang Ying Qian
Published: August 2024

Objective:

Clinical and genetic mutation analysis was performed on 5 infantile glycogen storage disease type II children in Chinese mainland.

Methods:

Clinical data of 5 children with infantile-type glycogen storage disease type II due to the acidic α-glucosidase (GAA) gene variants diagnosed and treated at Hebei Provincial Children’s Hospital from January 2018 to April 2020 were retrospectively analyzed.

Results:

Among the 5 cases, 1 was female and 4 were male, and the age at first diagnosis was from 2 months to 7 months. The first symptoms of all 5 cases showed progressive muscle weakness, hypotonia, and motor developmental backwardness, and all of them had abnormally elevated creatine kinase, and the echocardiograms suggested different degrees of myocardial hypertrophy, with ejection fractions ranging from 44% to 67%. Analysis of GAA gene variations: all 5 cases were compound heterozygous, and a total of 12 variant loci were detected, of which c.2024_2026delACA, c.2853G > A, c.1124G > T, c.574G > A, c.2509C > T, and c.2013G > A were new mutations that had not been reported.

Follow-up:

All 5 children died before 1 year of age, and the age of death ranged from 7 months to 11.5 months, with a mean survival time of 9.8 months.

Conclusion:

Peripheral blood GAA gene testing and alpha-glucosidase enzyme activity testing is an effective method for diagnosing this disease.
Evaluation of blood evacuation efficiency using 99mTc-RBC imaging: a comparative study of exsanguination tourniquet rings and Esmarch bandages
Authors: Liu Ninghu , Sun Binbin , Xu Jianjie , Xu Jianqiao , Zhao Keqi , Xu Shaonan , Su Xinhui , Zhou Weifeng
Published: August 2024

Objective

The objective of this study is to compare the effectiveness of the Esmarch bandage and exsanguination tourniquet rings (ETRs) in blood evacuation procedures using a controlled intra-subject design involving healthy volunteers.

Methods

A total of 20 healthy adult volunteers (12 males, 8 females) were recruited from the community. Participants underwent blood evacuation procedures on both legs, using the Esmarch bandage on one leg and the ETR on the other. The order of the procedures was randomized. Blood evacuation time, overall blood evacuation rate, and calf blood evacuation rate were measured using 99mTc-labeled red blood cell imaging. Paired t-tests were conducted to compare the effectiveness of the two methods.

Results

The ETRs demonstrated a significantly faster blood evacuation time compared to the Esmarch bandage (mean difference = −41.72 s, P < 0.0001). The overall blood evacuation rate was slightly higher for the ETRs (mean difference = 1.717%), though not statistically significant (P = 0.3680). The calf blood evacuation rate was significantly higher for the ETRs (mean difference = 6.86%, P = 0.0225). No significant discomfort or adverse reactions were reported by any participants.

Conclusion

ETRs are more efficient in terms of blood evacuation time and calf blood evacuation rate compared to the Esmarch bandage, without causing significant discomfort or adverse reactions. These findings suggest that ETRs could be a preferable option in clinical settings for blood evacuation procedures.
Implementation of a Standardized Screening Process to Increase Palliative Care Referrals in Primary Care
Authors: Smith Amy M.
Published: August 2024

Despite initiatives to increase palliative care awareness, referrals in primary care settings are still primarily based on provider judgment, causing a lack of appropriate referrals and disparities in access to palliative care resources. The purpose of this quality improvement project was to develop and implement an evidence-based, standardized palliative care referral protocol to increase the palliative care referral rate for eligible patients at a primary care clinic. The project used a preimplementation and postimplementation design with the use of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to successfully implement and evaluate the standardized referral process. Over the 10-month project period, the palliative care referral rate increased from 2% (4/193) preimplementation to 11% (16/147) postimplementation of the standardized referral process, which is an increase of 9%. Taking into consideration the potential impact of multiple extraneous variables, there was an overall decrease of 69% in emergency room visits and 73% in hospitalizations for patients who received a palliative care referral. These outcomes support expansion of the standardized referral process throughout other primary care clinics to increase palliative care referrals and sustain a high level of quality patient care.
International ISPRM Congress in Cartagena 2023: topics and recommendations
Authors: Lugo-Agudelo Luz Helena , Gimigliano Francesca , Fransisco Gerard E. , Gutiérrez-Godoy Jorge-Eduardo , Escobar-Giraldo Luz Marina , Giraldo-Prieto Mario
Published: August 2024

Background:

The International Society of Physical and Rehabilitation Medicine—ISPRM—is the pre-eminent scientific and educational society for medical specialists in rehabilitation. Its mission is to optimize functioning and health-related quality of life and minimize disability in persons with medical problems. The World Congress remains the society’s face-to-face meeting to update topics related to disability and rehabilitation. This manuscript describes the academic proposals and abstracts submitted and accepted after peer review, sorting them out according to the Standardized Abstract Topic List of the ISPRM World Congress bidding guidelines. It also aims to give recommendations for future congresses.

Methods:

This study is a cross-sectional descriptive study of academic proposals and abstracts submitted to the ISPRM2023 Congress in Cartagena. To structure the academic program, the Congress Scientific Committee (CSC) opened 2 calls for wide-open international participation: one for academic proposals (Scientific sessions and workshops led by top experts) and another for abstract submissions inviting rehabilitation professionals in general, according to the ISPRM Congress classification of topics. Six members of the CSC assessed the academic proposals to ensure the representation of diverse topics and geographic areas. The abstracts were peer-reviewed following predefined quality criteria and assigned to 3 international juries according to their expertise.

Results:

Participants submitted 142 proposals in English and 42 in Spanish from 6 continents: North and South America, Europe, Africa, Asia, and Oceania. The Clinical Sciences category (58.7%) out of 138 accepted proposals was the most common. Of 703 submitted abstracts, 692 got accepted to present their work, but only 418 were presented on-site: 127 (30.4%) oral and 291 poster presentations. The distribution of the submitted abstracts showed substantial interest in clinical science and therapeutics (73.9%), followed by engineering and technology (9.1%), biomedical sciences (4.5%), and health policy and systems (4.5%).

Conclusions:

We made 8 recommendations for future congresses. It will be essential to review the topics involving emerging ones in physical and rehabilitation medicine that are gaining relevance, such as infectious diseases (COVID-19), cardiopulmonary disorders, metabolic diseases (obesity, osteoporosis), diagnostic and therapeutic ultrasound, and electrodiagnosis.
Using A Disentangled Neural Network to Objectively Assess the Outcomes of Midfacial Surgery in Syndromic Craniosynostosis
Authors: Rickart Alexander J , Foti Simone , van de Lande Lara S , Wagner Connor , Schievano Silvia , Jeelani Noor ul Owase , Clarkson Matthew J , Ong Juling , Swanson Jordan W , Bartlett Scott P , Taylor Jesse A , Dunaway David J
Published: August 2024

Background:

Advancements in artificial intelligence and the development of shape models that quantify normal head shape and facial morphology provide frameworks by which the outcomes of craniofacial surgery can be compared. In this work, we will demonstrate the use of the Swap Disentangled Variational Autoencoder (SD-VAE) to objectively assess changes following midfacial surgery.

Materials and Methods:

Our model is trained on a dataset of 1405 3D meshes of healthy and syndromic patients which was augmented using a technique based on spectral interpolation. Patients with a diagnosis of Apert and Crouzon syndrome who had undergone sub- or trans-cranial midfacial procedures utilising rigid external distraction were then interpreted using this model as the point of comparison.

Results:

A total of 56 patients met our inclusion criteria, 20 with Apert and 36 with Crouzon syndrome. By using linear discriminant analysis to project the high-dimensional vectors derived by SD-VAE onto a 2D space, the shape properties of Apert and Crouzon syndrome can be visualised in relation to the healthy population. In this way, we are able to show how surgery elicits global shape changes in each patient. To assess the regional movements achieved during surgery, we use a novel metric derived from the Malahanobis distance to quantify movements through the latent space.

Conclusion:

Objective outcome evaluation, which encourages in-depth analysis and enhances decision making, is essential for the progression of surgical practice. We have demonstrated how artificial intelligence has the ability to improve our understanding of surgery and its effect on craniofacial morphology.