bluuebunny/crossref_metadata_2025 huggingface dataset:
Arsenic Induces GSK3β-Dependent p-Tau, Neuronal Apoptosis, and Cognitive Impairment via an Interdependent Hippocampal ERα and IL-1/IL-1R1 Mechanism in Female Rats
Authors: Gupta Keerti , Vishwakarma Jitendra , Garg Asmita , Pandey Rukmani , Jain Veena , Gupta Raksha , Das Uttara , Roy Somendu , Bandyopadhyay Sanghamitra
Published: August 2022

Arsenic is an environmental contaminant with potential neurotoxicity. We previously reported that arsenic promoted hippocampal neuronal apoptosis, inducing cognitive loss. Here, we correlated it with tau pathology. We observed that environmentally relevant arsenic exposure increased tau phosphorylation and the principal tau kinase, glycogen synthase kinase-3 beta (GSK3β), in the female rat hippocampal neurons. We detected the same in primary hippocampal neurons. Because a regulated estrogen receptor (ER) level and inflammation contributed to normal hippocampal functions, we examined their levels following arsenic exposure. Our ER screening data revealed that arsenic down-regulated hippocampal neuronal ERα. We also detected an up-regulated hippocampal interleukin-1 (IL-1) and its receptor, IL-1R1. Further, co-treating arsenic with the ERα agonist, 4,4',4″-(4-Propyl-[1H]-pyrazole-1,3,5-triyl)trisphenol (PPT), or IL-1R antagonist (IL-1Ra) resulted in reduced GSK3β and p-tau, indicating involvement of decreased ERα and increased IL-1/IL-1R1 in tau hyperphosphorylation. We then checked whether ERα and IL-1/IL-1R1 had linkage, and detected that although PPT reduced IL-1 and IL-1R1, the IL-1Ra restored ERα, suggesting their arsenic-induced interdependence. We finally correlated this pathway with apoptosis and cognition. We observed that PPT, IL-1Ra and the GSK3β inhibitor, LiCl, reduced hippocampal neuronal cleaved caspase-3 and TUNEL+ve apoptotic count, and decreased the number of errors during learning and increased the saving memory for Y-Maze test and retention performance for Passive avoidance test in arsenic-treated rats. Thus, our study reveals a novel mechanism of arsenic-induced GSK3β-dependent tau pathology via interdependent ERα and IL-1/IL-1R1 signaling. It also envisages the protective role of ERα agonist and IL-1 inhibitor against arsenic-induced neurotoxicity.
Genome-Informed Multiplex Conventional PCR for Identification and Differentiation of Xanthomonas citri pv. citri Subpathotypes, the Causal Agents of Asiatic Citrus Canker
Authors: Yasuhara-Bell Jarred , Santillana Gem , Robène Isabelle , Pruvost Olivier , Nakhla Mark , Mavrodieva Vessela
Published: August 2022

Asiatic citrus canker, one of the most important diseases of citrus, is caused by Xanthomonas citri pv. citri. It has high economic impact and can spread easily, and the disease is difficult to manage; it is a quarantine organism in many citrus-producing countries. X. citri pv. citri has been separated into three subpathotypes (A, A*, Aw) that differ in host range and geographical distribution, thus creating a need to differentiate subpathotypes for surveillance and disease management. Availability of useful diagnostic tools is the cornerstone of successful surveillance, quarantine, and eradication measures. In this study, a multiplex conventional PCR (cPCR) assay was developed for detection and subpathotype determination of X. citri pv. citri. Assay specificity was assessed by four different labs on a total of 146 X. citri pv. citri and 58 other Xanthomonas isolates. The assay demonstrated high analytical sensitivity, specificity, and selectivity. False negatives were observed with A Lineage 2 strains, and potential false positives were observed for X. citri pv. bilvae. Combined with a simple extraction protocol, the assay has been deployed successfully at the Plant Protection and Quarantine Plant Pathogen Confirmatory Diagnostics Laboratory. This assay has proven useful for differentiating Asiatic citrus canker subpathotypes from symptomatic citrus tissue.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Creating a Comprehensive Hospital-Based Skin and Wound Care Program to Improve Outcomes and Decrease Pressure Injuries
Authors: Capitulo Kathleen Leask
Published: August 2022

The author describes implementing a comprehensive skin and wound care program during her tenure as chief nurse executive to address challenges related to a lack of expert resources and knowledge of pressure injury (PI) prevention and treatment. This multifaceted program included the creation of a comprehensive, interprofessional, evidence-based skin and wound care committee; establishing a “Wound Board” for case presentations and expert consultation; providing educational programs; streamlining the processes for product evaluation, procurement, and use; decreasing costs; and hiring additional wound, ostomy, and continence nurse specialists. As a result, hospital-acquired PI incidence dropped significantly.
Tracheostomy Thursday: Journey of a Staff-driven COVID-19 Initiative to International Recognition
Authors: Gallagher Mary Anne , Torrieri Lisa Anne
Published: August 2022

OBJECTIVE

To use evidence-based practice and an interprofessional approach to improve outcomes for adult patients with tracheostomies and enhance staff knowledge during the COVID-19 pandemic.

METHODS

The core interprofessional Tracheostomy Thursday team included staff nurses, respiratory therapists, and nursing leadership who collaborated with surgeons and materials management staff at an urban academic medical center in New York, the epicenter of the COVID-19 pandemic in the US. The team implemented hospital-wide bedside rounds on all adults with tracheostomies. Skin and safety assessments were performed with peer-to-peer coaching. Data were collected and analyzed to understand areas of improvement.

RESULTS

After 6 months of hospital-wide rounding, implementation of a bedside tracheostomy safety checklist, and a continued interprofessional approach, safety measures increased by 48%, and preventive dressing use increased by 24% with improvement in preventing tracheostomy-related medical device-related pressure injuries. The team’s work was professionally recognized through institutional policy change, conference poster presentations, and Sigma’s international excellence award.

CONCLUSION

Bundling an interprofessional approach, staff education, bedside rounds, and standard preventive measures was key to the team’s success. A bedside safety checklist fostered team communication and supported direct care nurses in managing individuals with a new tracheostomy.
Simplifying neurologic assessment
Authors: Rank Wendi
Published: August 2022

It may be daunting at first, but your confidence will build with each neurologic examination you perform.
Serotonin syndrome
Authors: Saathoff Angela
Published: August 2022

Serotonin syndrome presents a variety of symptoms that can be difficult to diagnose. Use this information to help decipher diagnostic differentials.
Perioperative Neurofilament Light Plasma Concentrations and Cognition before and after Cardiac Surgery: A Prospective Nested Cohort Study
Authors: Brown Charles H. , Lewis Alexandria , Probert Julia , Parish Michelle , Tian Jing , Mandal Kaushik , Everett Allen , Colantuoni Elizabeth , Kamath Vidyulata , Hogue Charles , Moghekar Abhay
Published: August 2022

Background

Neurofilament light is a marker of neuronal injury and can be measured in blood. Postoperative increases in neurofilament light have been associated with delirium after noncardiac surgery. However, few studies have examined the association of neurofilament light changes with postdischarge cognition in cardiac surgery patients, who are at highest risk for neuronal injury and cognitive decline. The authors hypothesized that increased neurofilament light (both baseline and change) would be associated with worse neuropsychological status up to 1 yr after cardiac surgery.

Methods

This observational study was nested in a trial of cardiac surgery patients, in which blood pressure during bypass was targeted using cerebral autoregulation monitoring. Plasma concentrations of neurofilament light were measured at baseline and postoperative day 1. Neuropsychological testing was performed at baseline, 1 month after surgery, and 1 yr after surgery. Primary outcomes were baseline and change from baseline in a composite z-score of all cognitive tests.

Results

Among 167 patients, cognitive outcomes were available in 80% (134 of 167) and 61% (102 of 167) at 1 month and 1 yr after surgery, respectively. The median baseline concentration of neurofilament light was 18.2 pg/ml (interquartile range, 13.4 to 28.1), and on postoperative day 1 was 28.5 pg/ml (interquartile range, 19.3 to 45.0). Higher baseline log neurofilament light was associated with worse baseline cognitive z-score (adjusted slope, –0.60; 95% CI, –0.90 to –0.30; P < 0.001), no change in z-score from baseline to 1 month (0.11; 95% CI, –0.19 to 0.41; P = 0.475), and improvement in z-score from baseline to 1 yr (0.56; 95% CI, 0.31 to 0.81; P < 0.001). Whereas some patients had an improvement in cognition at 1 yr and others a decline, an increase in neurofilament light from baseline to postoperative day 1 was associated with a greater decline in cognition at 1 yr.

Conclusions

Higher baseline neurofilament light concentration was associated with worse baseline cognition but improvement in cognition at 1 yr. A postoperative increase in neurofilament light was associated with a greater cognitive decline at 1 yr.

Editor’s Perspective

What We Already Know about This Topic

What This Manuscript Tells Us That Is New
Reflections on the Complexity of Normalcy in Nursing and Health Care
Authors: Handberg Charlotte , Seibæk Lene , Thorne Sally , Beedholm Kirsten
Published: August 2022

Striving for normalcy plays an important role in patients' quality of life and illness experience. Normalcy is a powerful and complex idea, and the term can be used intentionally or unintentionally to various effects. We aimed to raise awareness of the complexity of this idea of normalcy and thus promote a more critically reflective understanding among nurses and other health professionals. By raising questions about how we use normalcy in our discourses and the potential impact that our professionally socialized interpretations of what constitutes normal might have on patient experience, we can encourage nurses and other health professionals to develop an intellectual curiosity about how the idea of normalcy works, and to be more critically reflective about how they integrate normalcy language into their practices and patient-centered communications. By unpacking the ideas that normal is always a good thing in the context of patient experience, and that normalizing can neutralize that which is bad in the health care world, we can qualify the language used and the metamessages conveyed for the ultimate benefit of patients.
Incisional and Surrounding Periarticular Soft Tissue Management With Negative Pressure Therapy
Authors: De Leon Jorge C. , Karia Ravi A.
Published: August 2022

Periarticular injuries of the lower extremity are known for wound healing and infection complications. The role for incisional negative pressure wound therapy for lower extremity periarticular fractures has expanded over the last 10 years in hopes of minimizing complications. To date, there is no standardized published protocol of how negative pressure wound therapy is best used in lower extremity periarticular fractures. A review of strategies to decrease complications associated with the operative management of lower extremity periarticular fractures to include the use of incisional negative pressure wound therapy is presented.
Evolution of Negative Pressure Wound Therapy in Orthopaedic Trauma
Authors: Agarwal Animesh
Published: August 2022

Negative Pressure Wound Therapy (NPWT) has evolved from open wound management to now include closed incision management. It has been a major advance in the management of open wounds and closed incisional wounds especially in orthopaedic trauma surgery. Because of the success of NPWT in the late 1990s and early 2000s, surgeons began using NPWT with adjuncts on closed incisions as a way to help prevent surgical wound dehiscence especially in at-risk patients for wound problems. It has been well established that obesity, diabetes, and smoking in addition to other comorbidities increase the risk of wound dehiscence and surgical site infections in orthopaedic patients. It is widely used for open wound management, often associated with open fractures, and in the mitigation of risk of surgical site infections over closed incisions (incisional negative pressure wound therapy). Newer systems allow the use of various topical wound solutions to be instilled in conjunction with NPWT, termed NPWTi-d. This has shown promising results in difficult wounds that may be resistant to standard NPWT. This article reviews the evolution and use of NPWT in orthopaedic trauma.
Spinal Post-traumatic Deformity
Authors: De Gendt Erin E.A. , Schroeder Greg D. , Joaquim Andrei , Tee Jin , Kanna Rishi M. , Kandziora Frank , Dhakal Gaurav R. , Vialle Emiliano N. , El-Sharkawi Mohammad , Schnake Klaus J. , Rajasekaran Shanmuganathan , Vaccaro Alex R. , Muijs Sander P.J. , Benneker Lorin M. , Oner F. Cumhur
Published: August 2022

Study Design:

Survey among spine experts.

Objective:

To investigate the different views and opinions of clinically relevant spinal post-traumatic deformity (SPTD).

Summary of Background Data:

There is no clear definition of clinically relevant SPTD. This leads to a wide variation in characteristics used for diagnosis and treatment indications of SPTD. To understand the current concepts of SPTD a survey was conducted among spine trauma surgeons.

Methods:

Members of the AO Spine Knowledge Forum Trauma participated in an online survey. The survey was divided in 4 domains: Demographics, criteria to define SPTD, risk factors, and management. The data were collected anonymously and analyzed using descriptive statistics, absolute, and relative frequencies. Consensus on dichotomous outcomes was set to 80% of agreement.

Results:

Fifteen members with extensive experience in treatment of spinal trauma participated, representing the 5 AO Spine Regions. Back pain was the only criterion for definition of SPTD with complete agreement. Consensus (≥80%) was reached for kyphotic angulation outside normative ranges and impaired function. Eighty-seven percent and 100% agreed that a full-spine conventional radiograph was necessary in diagnosing and treating SPTD, respectively. The “missed B-type injury” was rated at most important by all but 1 participant. There was no agreement on other risk factors leading to clinically relevant SPTD. Concerning the management, all participants agreed that an asymptomatic patient should not undergo surgical treatment and that neurological deficit is an absolute surgical indication. For most of the participants the preferred surgical treatment of acute injury in all spine regions but the subaxial region is posterior fixation.

Conclusion:

Some consensus exists among leading experts in the field of spine trauma care concerning the definition, diagnosis, risk factors, and management of SPTD. This study acts as the foundation for a Delphi study among the global spine community.
Advanced Triage Protocol: The Role of an Automated Lactate Order in Expediting Rapid Identification of Patients at Risk of Sepsis in the Emergency Department
Authors: Baum Andrew , Carr Brendan G. , Perman Sarah M. , Barger Jennifer , Goyal Munish , Gaieski David F.
Published: August 2022

OBJECTIVES:

We undertook a process improvement initiative to expedite rapid identification of potential sepsis patients based on triage chief complaint, vital signs, and initial lactate level.

DESIGN:

Prospective cohort study.

SETTING:

Seven hundred-bed tertiary care hospital with ≅65,000 patient visits/yr.

PATIENTS:

Patients presenting to emergency department (ED) triage who met the following criteria: greater than or equal to two of the three systemic inflammatory response syndrome criteria assessable in triage, a chief complaint suggestive of infection, emergency severity index 2 or 3, and ambulatory to ED.

INTERVENTIONS:

A computer-generated lactate order was created, staff education and resources increased, and point-of-care lactate testing was introduced.

MEASUREMENTS AND MAIN RESULTS:

Primary endpoints include the following: percent of patients having a lactate level drawn, percent of lactate samples resulting before room placement, and time intervals from triage to lactate blood draw and to lactate result. Secondary endpoints were percentage of patients admitted to the hospital, percentage admitted to the ICU, and in-hospital mortality. Six thousand nine hundred six patients were included: 226 historic controls (HCs) and 6,680 intervention group patients. The mean serum lactate level was 1.77 ± 1.18 mmol/L. The percentage of patients having a lactate resulted increased from 27.4% in the HC period to 79.6%. The percentage of these lactate results available while the patient was still in the waiting room increased from 0.4% during the HC period to 33.7% during Phase 5 (p < 0.0001). In the intervention period, time from triage to lactate result decreased (78.1–63.4 min; p < 0.0001) and time to treatment room decreased (59.3–39.6 min; p < 0.0001).

CONCLUSIONS:

Implementation of a computerized lactate order using readily available data obtained during ED triage, combined with point-of-care lactate testing, improves time to lactate blood draw and lactate result in patients at risk for severe sepsis. Initial lactate levels correlated with admission to the hospital, admission to the ICU, and in-hospital mortality.
Effect of Health Education via Mobile Application in Promoting Quality of Life Among Asthmatic Schoolchildren in Urban Malaysia During the COVID-19 Era
Authors: Al Raimi Abdulaziz Mansoor , Chong Mei Chan , Tang Li Yoong , Chua Yan Piaw , Al Ajeel Latifa Yahya
Published: August 2022

Bronchial asthma among children is a common chronic disease that may impact quality of life. Health education is one of the strategies to improve knowledge and quality of life. This study aims to assess the effect of health education via a mobile application in promoting the quality of life among schoolchildren with asthma in urban Malaysia during the COVID-19 era. A quasi-experimental, pre- and post-intervention design was used in this study involving a total of 214 students, randomly assigned into two groups (an intervention group and a control group). The control group received face-to-face health education, whereas the experimental group received health education via a mobile application. The findings showed that the total score of quality of life improved from a mean total score at pre-intervention of 5.31 ± 1.27 to post-intervention of 5.66 ± 1.28 for the control group, compared with the experimental group with a mean total score of quality of life at pre-intervention of 5.01 ± 1.36 and post-intervention of 5.85 ± 1.29. A comparison between the experimental and control groups using an independent t test showed statistically significant differences in their mean quality of life scores. The effect of health education via a mobile application showed a statistically significant improvement in the mean quality of life score from pre- to post-intervention (F
1,288 = 57.46, P < .01). As recommended, the use of mobile technology in health education improved the quality of life of schoolchildren with asthma as compared with the traditional methods of a face-to-face lecture and/or a handbook. Thus, educational modules using mobile applications do improve quality of life.
Predicting urine culture results in candidates for lithotripsy
Authors: Gofrit Ofer N. , Abudi Roey , Lorber Amitay , Duvdevani Mordechai
Published: August 2022

Background

Urological guidelines assert that “urine culture should be obtained” before surgical management of ureteral or kidney stones. Thus, many surgeries are delayed by 1–3 days until the results of urine culture are available. During this time, the patient frequently experience pain and possible kidney damage. We investigated the hypothesis that it is possible to predict the results of urine culture in candidates for surgical intervention using parameters that are accessible immediately upon admission.

Materials and methods

A database of 1000 patients who underwent either percutaneous nephrolithotomy (PCNL) or ureteroscopy/retrograde intrarenal surgery was analyzed. Eleven parameters potentially related to urinary infections and accessible to the clinician at the emergency department were correlated with the preoperative urine culture results.

Results

Of the patients, 234 (23.4 %) had positive cultures. On multivariate analysis, only sex, hydronephrosis grade, and history of previous nephrolithotomy were significantly associated with a positive preoperative urine culture. The risk of a positive culture can be easily determined from a simple table or an Excel-based calculator. This risk could be as low as 0.45% for a man without a history of PCNL and no hydronephrosis (4% in a woman with similar parameters) or as high as 79.5% in a man with a history of PCNL and hydronephrosis (85% in a woman with similar parameters).

Conclusions

The risk of preoperative positive urine culture can be predicted using 3 parameters that are accessible upon admission. In low-risk cases, prompt surgical treatment can be provided, eliminating the anticipation time for urine culture results.
Completion of Social Drivers of Health Screenings in Pediatric Practices Participating in a Quality Improvement Initiative
Authors: Brennan Luke , Evans Madeline , Michaeli Gabrielle , Pandita Pooja , Patel Shraya , Powell Kayla , Putnam-Johnson Hannah , Chong Alexander , Stelzner Sarah , Casavan Kara
Published: August 2022

Objectives:

The Indiana Chapter of the American Academy of Pediatrics (INAAP) participated in a national quality improvement project led by the AAP called Addressing Social Health and Early Childhood Wellness, which sought to screen for and address social drivers of health (SDoH), socioemotional development, and perinatal depression in pediatric practices through practice and system improvement. This project aims to evaluate positive SDoH screenings and subsequent referrals from participating Indiana practices.

Methods:

Ten pediatric practices in mid-central Indiana participated in this collaboration between July 2020 and July 2021 and submitted information about clinic resources, patient demographics, and process measures. Monthly chart reviews of well-child visits assessed completion of SDoH screenings, discussion of screening results with families, and referrals for positive screens. Composite measures of performance were developed from chart review.

Results:

Measures showed significant improvements in SDoH screening and identified opportunities for improvement in the care continuum. SDoH screenings of eligible patients significantly increased from 21% to 62% on average (p = 0.0002). Needed referrals fulfilled increased from 37% to 57% (p = 0.003) on average. Interestingly, no significant improvement was seen in referring patients who screened positive (81% vs 89%, p = 0.0949).

Conclusion:

This project provided a framework for successful development and efficient integration of screening and referral processes into clinic workflow. Implementing Plan-Do-Study-Act cycles, monthly chart reviews, and collaborative meetings facilitated increased documentation of screening, counseling, and referral for positive SDoH screens in participating practices. Future analysis should measure health outcomes and social and community capital derived by health systems and patients from such interventions.
Transcutaneous CO2 Pressure Monitoring Increases Salvage Rates after Free Tissue Transplantation for Extremity Reconstruction
Authors: Nakano Takahiko , Kudo Toshiya , Sano Yoshitomo , Minehara Hiroaki , Suzuki Masao , Aoki Kohei , Matsushita Takashi
Published: August 2022

Background:

Although free tissue transplantation (FTT) is an essential technique in extremity functional reconstruction, postoperative blood flow disturbance is one of the critical complications leading to transplanted tissue necrosis. Early detection of this complication may prevent tissue failure by prompt improvement of blood flow. The aim of this study was to determine whether transcutaneous carbon dioxide pressure (TcPCO2) monitoring increases the salvage rates after FTT.

Methods:

We retrospectively reviewed 75 consecutive patients who underwent FTT for extremity reconstruction with TcPCO2 monitoring postoperatively between December 2016 and September 2021.

Results:

Extremity reconstruction was performed in 53 cases due to trauma, 20 cases due to infection, and two cases due to tumor resection for tissue defects. The overall success rate of the FTT was 98.7%, with 13 complications. Of the 11 patients who underwent reoperation, nine had thrombosis and two had vascular strangulation. However, when reoperation was decided, none of the reoperation cases still exhibited any deterioration in the Doppler or clinical assessment. All reoperated cases were salvaged. Of the two patients who did not undergo reoperation, one had failed flaps and one had partial skin necrosis. With a TcPCO2 cutoff value of 70 mm Hg, the sensitivity and specificity for detecting complications due to impaired blood flow were 100% and 93.5%, respectively.

Conclusions:

TcPCO2 monitoring was performed after FTT for extremity reconstruction, and all cases of reoperation were salvaged. TcPCO2 monitoring can detect impaired postoperative blood flow critically earlier than clinical assessments and may increase salvage rates of transplanted tissue.
Perichondrial Arthroplasty Revisited: Technical Pearls
Authors: Lafreniere Ann-Sophie , Saayman Mariëlle , Lessard Antoine , Schrag Christiaan , Yeung Justin K.
Published: August 2022

Articular cartilage damage has been a longstanding challenge in hand surgery. Because of its limited ability to heal on its own and its predictable impact on bone resulting in degenerative osteoarthritis, surgical intervention is often mandated, through arthrodesis or implant arthroplasty. In this article, we revisit the perichondrial arthroplasty, a two-stage joint resurfacing technique using autologous rib perichondrium. It is indicated for posttraumatic osteoarthritic changes with or without stiffness and deviation, rheumatoid arthritis, and congenital joint malformation and/or ankylosis. This long-lasting method allows for a functional, pain-free joint that avoids both the immobility of arthrodesis and the long-term complications associated with implants.
Impact of Baseline Estimated Glomerular Filtration Rate Using CKD-EPI Equation on Long-term Prognosis of STEMI Patients: A Matter of Small Increments!
Authors: Sadre-Bafghi Seyed-Ali , Mohebi Mehrnaz , Hadi Fatemeh , Parsaiyan Hanieh , Memarjafari Mohammadreza , Tayeb Roya , Ghodsi Saeed , Sheikh-Sharbafan Reza , Poorhosseini Hamidreza , Salarifar Mojtaba , Alidoosti Mohammad , Haji-Zeinali Ali-Mohammad , Amirzadegan Alireza , Aghajani Hassan , Jenab Yaser , Hosseini Zahra
Published: August 2022

Background:

Baseline biomarkers including glomerular filtration rate (GFR) guide the management of patients with ST-segment elevation myocardial infarction (STEMI). GFR is a tool for prediction of adverse outcomes in these patients.

Objectives:

We aimed to determine the prognostic utility of estimated GFR using Chronic Kidney Disease Epidemiology Collaboration in a cohort of STEMI patients.

Methods:

A retrospective cohort was designed among 5953 patients with STEMI. Primary endpoint of the study was major adverse cardiovascular events. GFR was classified into 3 categories delineated as C1 (<60 mL/min), C2 (60–90), and C3 (≥ 90).

Results:

Mean age of the patients was 60.38 ± 5.54 years and men constituted 78.8% of the study participants. After a median of 22 months, Multivariate Cox-regression demonstrated that hazards of major averse cardiovascular event, all-cause mortality, cardiovascular mortality, and nonfatal myocardial infarction were significantly lower for subjects in C3 as compared with those in C1. Corresponding hazard ratios (HRs) for mentioned outcomes regarding C3 versus C1 were (95% confidence interval) were (HR = 0.852 [0.656–0.975]; P = 0.035), (HR = 0.425 [0.250–0.725]; P = 0.002), (HR = 0.425 [0.242–0.749]; P = 0.003), and (0.885 [0.742–0.949]; P = 0.003), respectively. Normal GFR was also associated with declined in-hospital mortality with HR of C3 versus C1: 0.299 (0.178–0.504; P < 0.0001).

Conclusions:

Baseline GFR via Chronic Kidney Disease Epidemiology Collaboration is associated with long-term cardiovascular outcomes following STEMI.
CLOSURE OF IDIOPATHIC FULL-THICKNESS MACULAR HOLE AFTER INTRAVITREAL C3F8 INJECTION WITHOUT VITREOMACULAR TRACTION RELEASE: A CASE REPORT AND REVIEW OF LITERATURE
Authors: Fazel Farhad , Rezaeian-Ramsheh Abdolreza , Fazel Mohammadreza , Ahmadieh Hamid
Published: August 2022

Background:

The purpose of this study was to describe a successful closure of macular hole without release of vitreomacular traction after intravitreal perfluoropropane (C3F8) gas injection.

Case Presentation:

A 54-year-old woman was referred to our clinic with the history of declined vision after a period of distorted vision in her right eye. After dilated fundus examination and performing optical coherence tomography, a V-shaped vitreomacular traction complicated by full-thickness macular hole was diagnosed and she underwent pneumatic vitreolysis using intravitreal C3F8 gas injection. After 12 weeks, her visual acuity was significantly improved and fundus examination and optical coherence tomography revealed that the macular hole was completely resolved despite persisted vitreomacular traction.

Conclusion:

Intravitreal gas injection would be a promising option to manage idiopathic macular holes not only by releasing the vitreous traction on the macula but also through some not proven or even unknown mechanisms.
A New Contact Lens Sensor System for Continuous Intraocular Pressure Monitoring: Evaluation of Safety and Tolerability
Authors: Zhang Yuning , Wei Yifan , Karunaratne I. K. , Lee Ching Hymn Christopher , Deng Mingjie , Chen Zidong , Yang Yangfan , Chong Iok Tong , Lam David C. C. , Yu Minbin
Published: August 2022

Purpose:

To assess the safety and tolerability of a new contact lens sensor (CLS) system for continuous 3- and 24-hr intraocular pressure (IOP) monitoring in human eyes.

Methods:

Twenty-five subjects were recruited for 3-hr IOP measurement by CLS. Corneal fluorescein staining (CFS) scores were evaluated before and after measurement. Then, 30 participants (10 normal subjects and 20 glaucoma patients) were recruited for 24-hr IOP monitoring. Ocular surface disease index (OSDI) was assessed before and one day after measurement. Contact lens dry eye questionnaire-8 was assessed immediately after measurement. Visual analog scale of discomfort was measured before, immediately after, and one day after measurement. Best-corrected visual acuity (BCVA), tear break-up time (TBUT), and CFS were assessed before, immediately after, and 1 day after measurement.

Results:

All participants completed 3- or 24-hr IOP measurement by CLS. Corneal fluorescein staining increased from 0.6±0.7 to 2.4±1.5 after 3-hr IOP measurement (P<0.001). For participants undergoing 24-hr IOP monitoring, OSDI increased from 9.1±9.7 to 18.0±12.4 (P=0.001). CLDEQ-8 score was 11.6±5.8. Visual analog scale increased from 11.1±14.2 to 35.2±21.8 after measurement (P<0.001) and decreased to 26.7±18.4 one day later (P<0.001 compared with baseline). BCVA decreased from 1.0±0.01 to 0.8±0.1 (P<0.001) and returned to 0.9±0.1 after one day (P<0.001 compared with baseline). TBUT decreased from 5.1±3.9 to 2.6±1.5 s (P=0.001) and returned to 4.8±2.5 s (P=0.465 compared with baseline). Corneal fluorescein staining increased from 0.7±0.9 to 4.3±0.8 (P<0.001) and dropped to 0.8±0.7 (P=0.599 compared with baseline). No significant difference was found for all variations of indicators between normal subjects and glaucoma patients (P>0.1 for all comparisons).

Conclusions:

The CLS shows a great potential for a safe and tolerable 24-hr IOP monitoring in normal subjects and glaucoma patients. Clinical attention to the worsening signs and symptoms after measurement is required.
A paraventricular hypothalamic nucleus input to ventral of lateral septal nucleus controls chronic visceral pain
Authors: Li Yong-Chang , Wang Qian , Li Meng-Ge , Hu Shu-Fen , Xu Guang-Yin
Published: August 2022

Irritable bowel syndrome is a functional gastrointestinal disorder characterized by chronic visceral pain with complex etiology and difficult treatment. Accumulated evidence has confirmed that the sensitization of the central nervous system plays an important role in the development of visceral pain, whereas the exact mechanisms of action of the neural pathways remain largely unknown. In this study, a distinct neural circuit was identified from the paraventricular hypothalamic (PVH) to the ventral of lateral septal (LSV) region. This circuit was responsible for regulating visceral pain. In particular, the data indicated that the PVH CaMKIIα-positive neurons inputs to the LSV CaMKIIα-positive neurons were only activated by colorectal distention rather than somatic stimulations. The PVH-LSV CaMKIIα+ projection pathway was further confirmed by experiments containing a viral tracer. Optogenetic inhibition of PVH CaMKIIα+ inputs to LSV CaMKIIα-positive neurons suppressed visceral pain, whereas selective activation of the PVH-LSV CaMKIIα+ projection evoked visceral pain. These findings suggest the critical role of the PVH-LSV CaMKIIα+ circuit in regulating visceral pain.
Sleep quality, latency, and sleepiness are positively correlated with depression symptoms of Brazilians facing the pandemic-associated stressors of COVID-19
Authors: Garbuio Ana Luíza Paula , Carvalhal Talita Albertin Oliveira , Tomcix Mariana Fatima Ribeiro , dos Reis Ivan Gustavo Masseli , Messias Leonardo Henrique Dalcheco
Published: August 2022

The severe acute respiratory syndrome coronavirus has implicated on mental health and psychopathological sequelae through viral infection. Suggestively, the pandemic-associated stressors (e.g., isolation, fear of illness, inadequate information and supply) may affect the sleep and feedback the depression symptoms, ultimately decreasing the immune system and offering further opportunities for severe acute respiratory syndrome coronavirus infection. Nevertheless, this association still requires investigation. Therefore, this study aimed to correlate the depression symptoms with sleep variables from subjects facing the restrictions of the ongoing pandemic in Brazil.

One hundred sixty-two volunteers (age = 31 ± 13 years; body mass = 69.8 ± 14.9 kg; height = 168 ± 9 cm) answered the Beck Depression Inventory, Pittsburgh Sleep Quality Index/Epworth Sleepiness Scale for determination of depression symptoms and sleep variables, respectively.

Significant and positive correlations were obtained between Beck score and sleep quality (r = 0.53; P = .000), sleep latency (r = 0.29; P = .000), and sleepiness (r = 0.22; P = .003), but not with sleep time (r = –0.10; P = .175).

This report concluded that Brazilians struggling with pandemic-associated stressors with high depression symptoms may have negative impacts on sleep, mainly regarding its quality, latency, and sleepiness.
Risk factors influencing COVID-19 mortality rate in OECD countries: A cross-sectional study
Authors: Lee Su-Jin , Kim Myung-Gwan , Kim Jung Hee , Park Chulyong , Kim Aeryoung , Hwang Jong-Moon
Published: August 2022

The coronavirus disease (COVID-19) has spread globally; however, the COVID-19 mortality rate varies largely across countries. The purpose of this study was to investigate the factors affecting mortality and increase in mortality rate by time trends in 30 member countries of the Organization for Economic Co-operation and Development (OECD). These countries have different national health and medical characteristics in terms of health care use, health equipment, health resource, health risk, and health status at different time points. The results revealed that the lower 25% of countries had an increase in the mortality rate of 27.21% which was higher than the upper 25% of countries’ increase in the mortality rate of 20.51%. Therefore, the affected countries should strengthen their medical infrastructure to prepare for such large-scale outbreaks in the future. It is imperative to reduce the health inequality between population groups and achieve health equity, regardless of the income gap, rather than vaccination of specific countries. This will require the management of non-communicable diseases, a solid health insurance system, a stable supply of medical supplies, and strengthening the competency of health care workers.
Correlation of TBK1, AR, and other serum cancer-related biomarkers in breast cancer patients: An observational study
Authors: Liu HanCheng , Li HuiMing , Zhang Jie , Meng QingLai , Ma LiHui
Published: August 2022

Breast cancer (BC) ranks first for incidence and mortality in gynecological malignant tumors. This study aims to investigate the diagnostic value of Tank-binding kinase 1 (TBK1) and its correlation with androgen receptor (AR) and other serum cancer-related biomarkers in BC patient. The present observational study included 451 female BC patients and 451 healthy controls. Serum levels of TBK1, AR and other cancer-related biomarkers were detected in all the patients and healthy controls. Patients’ demographic data and clinical data including age, body mass index (BMI), tumor node Metastasis (TNM), pathological type, tumor size and lymph node metastasis were collected. The follow-up lasted for 5 years.

The deceased group had higher rate of patients with TNM III~IV, lymph node metastasis or tumor diameter >2. Deceased group had much higher rate of patients with negative ER and positive Ki67. Besides, increased TBK1 was found in BC patients with positive correlation with AR, CA15-3, CA125, CEA, and CA19-9. Serum TBK1 was associated with the clinic outcomes of BC patients and those with high TBK1 had lower 5-year survival rate. Moreover, cutoff value of 13.95 ng/mL TBK1 showed AUC of 0.981 (93.6% for sensitivity and 86.3% for specificity) for diagnosing BC, and cutoff value of 22.65 ng/mL TBK1 had AUC of 0.996 (97.7% for sensitivity and 96.3% for specificity) for diagnosing the death of BC patients. Serum TBK1 was positively correlated with AR and other serum cancer-related biomarkers. In addition, high TBK1 predicted the poor prognosis and might be used for the diagnosis of BC.
Best cutoff score of cervical-pedicle thickness as a morphological parameter for predicting cervical central stenosis
Authors: Choi Jungho , Park Hyung-Bok , Lim Taeha , Yi Shin Wook , Lee Sooho , Park Sukhee , Park SoYoon , Yi Jungmin , Kim Young Uk
Published: August 2022

There are various factors for the cause of cervical central stenosis (CCS), such as osteophyte, cervical-disc degeneration, and cervical ligamentum flavum hypertrophy. However, the pedicle of the cervical vertebra has not yet been analyzed for its relationship with CCS. We created a new morphologic parameter called the cervical-pedicle thickness (CPT) to assess the association between CCS and the cervical pedicle.

We obtained morphological cases involving the CPT from 82 patients with CCS. There were also 84 in the normal group who underwent cervical spine magnetic resonance imaging (CS-MR) as part of routine health screening. We obtained the T2-weighted CS-MR axial images from group members, and assessed the CPT at the level of the C6 vertebra on CS-MR.

The mean CPT was 3.46 ± 0.57 mm in the normal group, 4.97 ± 0.75 mm in the CCS group, which thus had a significantly higher CPT (P < .01) than did the normal group. For the prognostic value of the CPT as a predictor of CCS, ROC analysis indicated that the best cutoff score for the CPT was 4.18 mm, with 93.9% sensitivity, 92.9% specificity, and AUC 0.97.

Greater CPT was highly associated with a possibility of CCS. This conclusion will be helpful for assessing the CCS patients.
Linezolid in the treatment of severe intraabdominal infection: A STROBE-compliant retrospective study
Authors: You Deyuan , Su Yuexiang , Sun Xuri , Wang Jianbao , Zheng Yuxin , Liu Yuqi
Published: August 2022

Safety concerns over bone marrow suppression and thrombocytopenia may inhibit the use of linezolid to treat intraabdominal infection (IAI). To evaluate the effectiveness, safety, and prognosis of linezolid in the treatment of severe IAI (SIAI). Patients were divided into a linezolid group and nonlinezolid group according to whether linezolid was prescribed. Subgroup analysis (thrombocytopenia treated with linezolid group (I), and thrombocytopenia treated with nonlinezolid group (II) also was performed. We evaluated the effectiveness of linezolid by analyzing the changes in white blood cells (WBC) and procalcitonin, evaluated safety by analyzing the changes in platelet counts, and evaluated patient outcomes by analyzing the length of hospital stay, the length of ICU stay, and the rates of clinical improvement. Sixty-six adult SIAI patients were treated with anti-gram-positive (G+) bacteria drugs for more than 7 days from January 1, 2014, to December 31, 2020. The length of hospital stay, the length of ICU stay, and the rates of clinical improvement were not significantly different between the linezolid group and nonlinezolid group. On the 15th day after anti-G + bacteria treatment, the WBC of the linezolid group was significantly lower than in the nonlinezolid group (9.00 ± 4.30 vs 13.1 ± 6.19, P < .05). The time for a statistical difference in the decrease of procalcitonin in the linezolid group was earlier than in the nonlinezolid group (day 6 vs day 7, P < .05). There was no statistically significant difference in the changes of platelet counts in the subgroup I (P > .05), but compared with the baseline data (day 0), the time for the statistical difference in the increase of platelets in thrombocytopenia treated with linezolid group was earlier (day 5 vs day 6, P < .05). There was no statistical difference in the changes of platelets in subgroup II (P > .05). In the treatment of severe intraabdominal infection in a single-center, retrospective study, linezolid was not inferior to other antibiotics in patient clinical outcomes or seral WBC and procalcitonin values. Linezolid also induced no evident bone marrow suppression or thrombocytopenia. Linezolid is a good choice for treatment of SIAI.
A randomized controlled trial to compare Helicobacter pylori eradication rates between the empirical concomitant therapy and tailored therapy based on 23S rRNA point mutations
Authors: Kim Su Jin , Jee Sam Ryong , Park Moo In , Jung Kyoungwon , Kim Gwang Ha , Lee Moon Won , Lee Jin , Jang Jin Seok , Koh Myeongseok
Published: August 2022

Background:

Increasing clarithromycin resistance has led to changes in several guidelines for treatment of Helicobacter pylori infections. We compared the H. pylori eradication rates of the empirical concomitant therapy (CoT) and a tailored therapy (TaT) using dual-priming oligonucleotide-based polymerase chain reaction to detect mutations in the 23S rRNA gene that are related to clarithromycin resistance.

Methods:

Between June 2020 and May 2021, 290 patients were enrolled and randomly assigned to 2 groups. In the CoT group, the patients received rabeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg twice daily for 14 days. In the TaT group, point mutation-negative patients received rabeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg twice daily for 14 days and point mutation-positive patients received rabeprazole 20 mg twice daily, metronidazole 500 mg thrice daily, and bismuth 120 mg and tetracycline 500 mg 4 times daily for 14 days.

Results:

A total of 290 and 261 patients were included in the intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. A2142G and/or A2143G point mutations were identified in 28.6% of the patients. No significant difference in eradication rates were observed between the 2 groups as per ITT (CoT, 82.8% and TaT, 85.5%, P = .520) and PP (CoT, 88.6% and TaT, 94.6%, P = .084) analyses. In point mutation-positive patients, the eradication rates in the CoT group were lower than those in the TaT group as per ITT (69.8% and 87.5%, respectively, P = .050) and PP (76.9% and 97.1%, respectively, P = .011) analyses.

Conclusion:

CoT and TaT showed similar overall eradication rates for H. pylori. However, CoT eradication rate was suboptimal, especially in point mutation-positive patients.
Endothelial dysfunction: The possible link between cardiovascular comorbidities and phenomenon of inflammaging from COPD
Authors: Tudorache Emanuela , Fira-Mladinescu Ovidiu , Traila Daniel , Marc Monica , Rajnoveanu Ruxandra Mioara , Tofolean Doina Ecaterina , Fildan Ariadna Petronela
Published: August 2022

Aging is a risk factor for many chronic noncommunicable diseases, including chronic obstructive pulmonary disease (COPD), which is often associated with cardiovascular disease (CVD). Moreover, aging is associated with a mild form of systemic inflammation. The aim of our study was to analyze the relationship between age, systemic and vascular inflammation, and the presence of CVD comorbidities in a stable COPD population. Forty COPD patients were divided into 2 age groups (<65 and ≥65 years of age), from which we collected the following inflammatory biomarkers: C-reactive protein, tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and endothelin-1 (ET-1). Elderly COPD patients had more frequent exacerbation events per year (2 vs 1, P = .06), a higher prevalence of CVD (3 vs 2, P = .04), more limited exercise tolerance (6-minute walking test distance, 343 [283–403] vs 434 [384–484]; P = .02), and mild systemic inflammation (TNF-α, 9.02 [7.08–10.96] vs 6.48 [5.21–7.76]; P = .03; ET-1, 2.24 [1.76–2.71] vs 1.67 [1.36–1.98] pg/mL; P = .04). A weak correlation between age and ET-1 (r = 0.32, P = .04) was observed. Mild systemic inflammation, characterized by a slightly increased level of TNF-α, and endothelial dysfunction, marked by elevated ET-1, could be liaisons between aging, COPD, and CVD comorbidities.
Efficacy and safety of pembrolizumab monotherapy in EGFR-mutant squamous cell lung cancer with PD-L1 over-expression: A case report
Authors: Liu Qiu-Xia , Wei Jian-Guo , Chen Yi-Yi , Wang Jian-Fang
Published: August 2022

Background:

Epidermal growth factor receptor (EGFR)-mutant nonsmall cell lung cancer (NSCLC) patients are less likely to be programmed death-ligand 1 (PD-L1)-positive compared with wild-type EGFR mutant tumors. Given the rarity of actionable driver genes in squamous cell lung cancer (SQCC), the frequency of SQCC patients simultaneously carrying EGFR driver gene mutation and having PD-L1 over-expression is extremely low. Studies on the effectiveness and safety of EGFR-TKIs or immune-checkpoint inhibitors (ICIs) in this subset of patients are lacking.

Patient concerns:

The patient suffered from coughing and chest pain for 1 month. A chest CT revealed a mass with a cavity in the right lung, enlarged mediastinal lymph nodes, diffuse pleural thickening in the right pleura, and pleural effusion of the right chest.

Diagnosis:

A pleural biopsy was performed using a video-assisted thoracoscope. The pathological examination revealed a poorly differentiated squamous cell carcinoma of lung. Further genetic testing identified exon 19 deletion mutation in EGFR with abundance of 0.27%. Meanwhile, immunohistochemical PD-L1 analysis showed a TPS of 90%.

Interventions:

The patient was initially resistant to EGFR-TKIs but exhibited a rapid and marked response to pembrolizumab.

Outcomes:

After 5 cycles of pembrolizumab monotherapy, the patient developed Grade 3 immune-related dermatitis, and ICI therapy was suspended.

Conclusions:

ICI monotherapy could be an effective therapy in SQCC patients with low-abundance of EGFR mutations and PD-L1 over-expression. However, close attention should be paid to immune-related adverse events.