bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacological Implications
Authors: Tinevez Dillon , Jani Jai
Published: March 2023

Inhaled anesthetics are used to provide anesthesia to patients undergoing surgery by acting primarily on the central nervous system. Volatile anesthetics decrease the cerebral metabolic rate of oxygen consumption but may increase cerebral blood flow and intracranial pressure at higher concentrations, while nitrous oxide causes an increase in both. Both volatile anesthetics and N2O decrease the amplitude and increase the latency of somatosensory evoked potentials (SSEPs) in a dose-dependent manner. All volatile anesthetics decrease mean arterial pressure, while nitrous oxide has little to no effect. Volatile anesthetics cause a decrease in tidal volume and an increase in respiratory rate; however, minute ventilation is preserved. All volatile anesthetics potentiate the activity of neuromuscular blocking drugs and are all known triggers of malignant hyperthermia. Fluoride production from the metabolism of other inhaled anesthetics such as sevoflurane shows no association with renal injury. There is a mild and severe form of liver injury that is associated with volatile anesthetics. The severe immune-mediated liver injury may follow any commonly used volatile anesthetic involving massive hepatic necrosis, resulting in fulminant liver failure. The mild form of liver injury caused by a volatile anesthetic follows the administration of halothane and is characterized by transient transaminitis.
Systemic Inflammatory Response Syndrome
Authors: Gorneva Maria , Tzonkov Anna
Published: March 2023

Systemic inflammatory response syndrome (SIRS) is an overactive defense response of the body to an external or internal stressor. The physiological goal is elimination of insult source via release of acute-phase reactants, leading to significant pro-inflammatory immunological changes. In certain individuals, this process leads to an overreactive “cytokine storm,” causing reversible or irreversible end-organ damage. The diagnosis of SIRS can be made by the presence of two or more of the following criteria: (1) body temperature over 38°C or under 36°C; (2) heart rate greater than 90 beats/min; (3) respiratory rate greater than 20 breaths/min or partial pressure of CO2 less than 32 mm Hg; and (4) leukocyte count greater than 12,000 or less than 4000/µL or over 10% immature forms or bands. Early diagnosis and intervention are the key points for improved morbidity and mortality. Interleukin 1, 6, and 8; tumor necrosis factor alpha (TNF-α); and γ-interferon are among the most important mediators. Management of SIRS focuses on treatment of underlying etiology and prevention of end-organ damage.
Ventilator-Associated Pneumonia
Authors: Owen Robert M. , Chung Kevin W.
Published: March 2023

Ventilator-associated pneumonia (VAP) is a serious nosocomial infection that is often encountered in the critical care setting. While there is no firm consensus on the “gold standard” of diagnosis; it is most broadly accepted to be a pneumonia that occurs more than 48 hours after endotracheal intubation. VAP can result in prolonged hospital stays, increased resource utilization, and significant morbidity and mortality. As VAP occurs in patients who already have critical illness, progression to acute respiratory distress syndrome (ARDS), empyema, sepsis, and septic shock are common. Several strategies have been implemented, often in the form of ventilator “bundles,” to prevent VAP as well as other ventilator-associated events. The most common causative organisms for VAP include Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacteriaceae members. Multidrug-resistant (MDR) pathogens are of increasing concern. Systemic antibiotics serve as the mainstay of treatment. Antibiotic choice should be driven not only from a desire to cover both methicillin-resistant S. aureus (MRSA) and Pseudomonas aeruginosa, but also by the institution’s local patterns of microbial flora and resistance.
Brain Death
Authors: Siddiqui Shahla
Published: March 2023

Since the 1950s, the diagnosis of brain death has come to mean death of the individual. There is a strict set of criteria that are validated and accepted globally as the diagnostic veracity of death. The criteria for such a determination largely remain clinical, including a battery of bedside tests. Knowledge of these clinical criteria as well as the need for ancillary tests for determination of brain death are important during residency training. In the United States, brain death criteria include irreversible coma, lack of brainstem criteria, and apnea. Determination of brain death (or determination of death of an individual) can be a crucial and a deeply emotional aspect of critical care.
Definitions
Authors: Hanna Joseph Salama , Saad Ramsey
Published: March 2023

Patient safety is a healthcare discipline that emerged with the evolving complexity in healthcare systems and the resulting rise of patient harm in healthcare facilities. It aims to prevent and reduce risks, errors, and harm that occur to patients during provision of healthcare. A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events. The occurrence of adverse events due to unsafe care is likely 1 of the 10 leading causes of death and disability in the world. In high-income countries, it is estimated that 1 in every 10 patients is harmed while receiving hospital care. The harm can be caused by a range of adverse events, with nearly 50% of them preventable. Each year, 134 million adverse events occur in hospitals in low- and middle-income countries (LMICs) due to unsafe care, resulting in 2.6 million deaths. This chapter reviews the key definitions, concepts, as well as examples of medication error and adverse and sentinel events.
Freud’s Contribution
Authors: Berman Carol W.
Published: March 2023

Sigmund Freud is considered the first psychiatrist. The oedipal complex (see Chapter 1) is a central tenet of his psychoanalytical theory. Many plays illustrate this complex, as it is an essential feature of family dynamics. Freud, aware of the basic themes of childhood sexuality, named the “Oedipus complex” after Sophocles’s play, Oedipus Rex. Freud also called the childhood aspect of female sexuality, in which the girl wants to eliminate her mother and marry her father, the Oedipus complex. It took Jung to consider another Sophocles play, Electra, and name the female oedipal complex the “Electra complex,” although now we use the Oedipus complex to include females and males alike.
Depression and Bipolar Disorder
Authors: Berman Carol W.
Published: March 2023

Depressed patients have problems eating and sleeping, and their moods are blue. They may have anhedonia and hopelessness. Many are irritable and guilty. The danger is they may commit suicide if their depressions are not treated. Depression is common and strikes fifteen to thirty percent of the population. It is not simply a down mood as many people believe. Chekhov’s Uncle Vanya provides a good example of a depressed character to whom the audience can relate because of his humor and humanity. Many times defenses like humor or sarcasm are used by depressed patients to hide their depressed moods. Bipolar patients can alternate from bouncing around in hypomania, like Chekhov’s Ivanov, or be depressed like Vanya. If a person swings back and forth between a down mood and an up mood, the person may very well have bipolar disorder.
Psychosis
Authors: Berman Carol W.
Published: March 2023

Psychosis is a break from reality in which patients may hallucinate and have delusions. Hallucinations usually involve seeing or hearing things that don’t exist. Delusions are fixed and false beliefs that are not based in reality. In The House of Blue Leaves by John Guare, Bananas, a main character, has a breakdown and has to be hospitalized. Tennessee Williams’s Laura in The Glass Menagerie is believed to be based on the playwright’s schizophrenic sister. Schizophrenia involves psychosis in specific ways. Patients suffering from schizophrenia have problems with thinking, behavior, and emotions. Laura’s glass figurines are objects on which she projects her psychotic fantasies.
Substance Abuse
Authors: Berman Carol W.
Published: March 2023

In Eugene O’Neill’s Long Day’s Journey Into Night, Mary, who is addicted to morphine, is the center of a dysfunctional family where drinking is also a problem. In The Iceman Cometh by O’Neill, a group of alcoholics try to deal with life and their longing for oblivion. Many other plays show us the outcome of alcoholism or drug addiction. Halfway Bitches Go Straight to Heaven, Stephen Adly Guirgis’s play is set in a women’s shelter that is filled with people who are addicted and mentally ill people. The playwright takes us into their psyches and steers us toward new pathways of thinking.
Paediatric, teenage, and young adult cancers
Authors: Ajithkumar Thankamma
Published: March 2023

Paediatric tumours are a varied spectrum of malignancies in children with different biology and clinical behaviour. The commonest paediatric malignancies are the leukaemias, followed by CNS tumours, lymphomas, and soft-tissue sarcomas. Approximately 70–80% of children with cancers are cured. However, >70% of survivors are affected by long-term sequelae of treatment. Radiotherapy is only used when it cannot be replaced effectively by surgery and chemotherapy. Currently up to 50% of children receive radiotherapy. This chapter discusses the clinical and imaging features of paediatric tumours where radiotherapy is used and practical details on radiotherapy planning. It also summarizes the evidence underpinning current clinical practice.
End-of-life care
Authors: Harwood Rowan H. , Huwez Farhad Umer , Guyler Paul , Alam Sajid , Gaynor Catherine
Published: March 2023

This chapter discusses end-of-life care. Many stroke patients die, some soon after their stroke, particularly when the stroke is severe. But for the most part, care focuses on survival and recovery, which can cause problems. According to the WHO, palliative care is an approach that improves the quality of life of patients and their families facing problems associated with a life-threatening illness. The key principles of palliative care are meticulous management of symptoms, open communication, minimizing treatment burden, planning for the future, and supporting patients and their families. The chapter describes how these can be applied in stroke care, including what to do when prognosis is uncertain.
Outcomes and prognosis
Authors: Harwood Rowan H. , Huwez Farhad Umer , Guyler Paul , Alam Sajid , Gaynor Catherine
Published: March 2023

This chapter covers outcomes and prognosis after a stroke. Prediction of outcome can help manage expectations and make informed decisions on rehabilitation potential. We can track neurological and functional recovery but defining prognosis is complicated by inexorable attrition due to death, recurrence, complications, and intercurrent illness. The chapter describes survival rates and recurrences of stroke patients. About 40% of stroke survivors discharged from the hospital need help with basic activities of daily living, but the disabilities from stroke decline-over time.
Cognitive impairment after stroke
Authors: Harwood Rowan H. , Huwez Farhad Umer , Guyler Paul , Alam Sajid , Gaynor Catherine
Published: March 2023

This chapter explores cognitive impairment after stroke. Cognition comprises memory, orientation, reasoning, communication, and other thinking functions. Cognitive impairment is seen in many neurological disorders, so healthcare professionals managing stroke patients should be confident in assessing, diagnosing, and managing cognitive impairment. The chapter describes different causes including delirium, and vascular dementia, and also describes specific neurological deficits like aphasia, apraxia, and executive dysfunction. Management is predominantly supportive and functional. Close family involvement and individualization are needed to treat people with delirium and dementia.
Structure transformation from Sierpiński triangles to chains assisted by gas molecules
Authors: Li Chao , Xu Zhen , Zhang Yajie , Li Jie , Xue Na , Li Ruoning , Zhong Mingjun , Wu Tianhao , Wang Yifan , Li Na , Shen Ziyong , Hou Shimin , Berndt Richard , Wang Yongfeng , Gao Song
Published: March 2023

Reversible transformations between fractals and periodic structures are of fundamental importance for understanding the formation mechanism of fractals. Currently, it is still a challenge to controllably achieve such a transformation. We investigate the effect of CO and CO2 molecules on Sierpiński triangles (STs) assembled from Fe atoms and 4,4″-dicyano-1,1′:3′,1″-terphenyl (C3PC) molecules on Au surfaces. Using scanning tunneling microscopy, we discover that the gas molecules induce a transition from STs into 1D chains. Based on density functional theory modeling, we propose that the atomistic mechanism involves the transformation of a stable 3-fold coordination Fe(C3PC)3 motif to Fe(C3PC)4 with an axially bonded CO molecule. CO2 causes the structural transformation through a molecular catassembly process.
Wastewater surveillance and an automated robot: effectively tracking SARS-CoV-2 transmission in the post-epidemic era
Authors: Ou Guanyong , Tang Yuxuan , Niu Shiyu , Wu Liwen , Li Shaxi , Yang Yang , Wang Jun , Peng Yun , Huang Chuanfu , Hu Wei , Hu Qinghua , Li Yinghui , Ping Yang , Lin Chao , Yu Boping , Han Qi , Hao Yabin , Luo Zhiguang , Tian Wende , Zhang Han , Liu Yingxia
Published: March 2023

Wastewater-based epidemiology (WBE) has exhibited great utility in the early and rapid identification of SARS-CoV-2. However, the efficacy of wastewater surveillance under China's previous strict epidemic prevention policy remains to be described. We collected the WBE data of wastewater treatment plants (WWTPs) in the Third People's Hospital of Shenzhen and several communities to determine the significant effectiveness of routine wastewater surveillance in monitoring the local spread of SARS-CoV-2 under tight containment of the epidemic. The results of 1 month of continuous wastewater surveillance showed that positive signals for SARS-CoV-2 RNA were detected in the wastewater samples, and a significant positive correlation was observed between the virus concentration and the number of daily cases. In addition, the community's domestic wastewater surveillance results were confirmed even 3 days before, or simultaneously with, the infected patient being confirmed as having the virus. Meanwhile, an automated sewage virus detection robot, ShenNong No.1 robot, was developed, showing a high degree of agreement with experimental data, offering the possibility of large-scale multi-point surveillance. Overall, our results illustrated the clear indicative role of wastewater surveillance in combating COVID-19 and provided a practical basis for rapidly expanding the feasibility and value of routine wastewater surveillance for future emerging infectious diseases.
Feasibility of using an app-based coaching intervention to improve provider communication about HPV vaccination
Authors: Grabert Brigid K , McRee Annie-Laurie , Henrikson Nora B , Heisler-MacKinnon Jennifer , Blasi Paula R , Norris Consuelo M , Nguyen Matthew B , Dunn John , McKeithen Mary Catharine , Gilkey Melissa B
Published: March 2023

Provider communication training is effective for increasing HPV vaccination rates among U.S. adolescents. However, such trainings often rely on in-person meetings, which can be burdensome for providers and costly to implement. To evaluate the feasibility of Checkup Coach, an app-based coaching intervention, to improve provider communication about HPV vaccination. In 2021, we offered Checkup Coach to providers in 7 primary care clinics in a large integrated delivery system. Participating providers (n = 19) attended a 1-h interactive virtual workshop that taught 5 high-quality practices for recommending HPV vaccination. Providers then had 3 months of access to our mobile app, which offered ongoing communication assessments, tailored tips for addressing parents’ concerns, and a dashboard of their clinic’s HPV vaccination coverage. Online surveys assessed pre-/post-intervention changes in providers’ perceptions and communication behaviors. Compared to baseline, more providers reported high-quality HPV vaccine recommendation practices at 3-month follow-up (47% vs. 74%, p < .05). Providers’ knowledge, self-efficacy, and shared commitment to improving HPV vaccination also improved (all p < .05). Although we found improvements in several other cognitions after the workshop, these changes did not retain statistical significance at 3 months. About three-quarters (78%) of providers used the mobile app, logging 2.3 sessions on average. Most providers agreed the app was easy to use (mean = 4.7/5.0), a convenient way to get vaccination data (mean = 4.6/5.0), and a tool they would recommend (mean = 4.3/5.0). Our app-based coaching intervention demonstrated feasibility and warrants additional evaluation as a novel mode for training providers to improve their HPV vaccine communication.
Integrating Text Messaging in a Low Threshold Telebuprenorphine Program for New York City Residents with Opioid Use Disorder during COVID-19: A Pilot Randomized Controlled Trial
Authors: Tofighi Babak , Badiei Beita , Badolato Ryan , Lewis Crystal Fuller , Nunes Edward , Thomas Anil , Lee Joshua D.
Published: March 2023

Background

Pragmatic innovations are needed to optimize clinical outcomes among people who use opioids initiating buprenorphine. This pilot randomized controlled trial assessed the feasibility of integrating text messaging in a low threshold telebuprenorphine bridge program for people who use opioids during the COVID-19 pandemic.

Methods

Eligible adult patients with opioid use disorder inducted on buprenorphine (N = 128) in the NYC Health+Hospitals Virtual Buprenorphine Clinic between May and November 2020 were randomized to an automated texting intervention based on the medical management model versus treatment as usual. A participant feedback survey was administered at 8 weeks (n = 18). Primary outcomes consisted of acceptability (eg, study enrollment, engagement with the intervention) and feasibility (eg, lack of phone number and/or mobile phone ownership) of integrating texting in clinical care. A secondary outcome included retention in treatment at week 8 (ie, active buprenorphine prescription within the prior 7 days).

Results

Nearly all eligible patients consented to enroll in the study (90.8%) and few were excluded because of lack of mobile phone ownership (n = 27, 14.6%). Requests to discontinue receipt of texts (n = 6, 9.4%) was attributed to excessive message frequency, perceived lack of relevancy, and reduced interest in the intervention. Respondents completing the follow-up feedback survey were generally satisfied with the frequency of software-generated messages (14/18, 77.8%) and half shared text content with peers (9/18, 50%). There were no perceived issues with privacy, intrusiveness, or ease of use. Retention did not differ between participants randomized to the texting (M = 5.23 weeks, SD = 3.41) and treatment as usual groups (M = 4.98 weeks, SD = 3.34) at week 8 (P = 0.676).

Conclusions

This pilot randomized controlled trial confirms high acceptability and feasibility of integrating an automated texting tool in a telebuprenorphine bridge program. Future studies should assess whether text messaging may be efficacious when combined with staff contact and content addressing social determinants of health.
A Peer Recovery Coach Intervention for Hospitalized Patients with Opioid Use Disorder: A Pilot Randomized Controlled Trial
Authors: Suzuki Joji , Martin Bianca , Loguidice Frank , Smelson David , Liebschutz Jane M. , Schnipper Jeffrey L. , Weiss Roger D.
Published: March 2023

Objectives

Patients with opioid use disorder (OUD) are increasingly being hospitalized for acute medical illnesses. Despite initiation of medications for OUD (MOUDs), many discontinue treatment after discharge. To evaluate whether a psychosocial intervention can improve MOUD retention after hospitalization, we conducted a pilot randomized controlled trial of a peer recovery coach intervention.

Methods

An existing peer recovery coach intervention was adapted for this trial. Hospitalized adults with OUD receiving MOUD treatment were randomized to receive either a recovery coach intervention or treatment-as-usual. For those in the intervention arm, the coach guided the participant to complete a relapse prevention plan, maintained contact throughout the 6-month follow-up period, encouraged MOUD continuation, and helped to identify community resources. Those receiving treatment-as-usual were discharged with a referral to outpatient treatment. Primary outcome was retention in MOUD treatment at 6 months. Secondary outcomes were the proportion of participants readmitted to the hospital and the number of days until treatment discontinuation and to hospital readmission.

Results

Twenty-five individuals who provided consent and randomized to the recovery coach intervention (n = 13) or treatment-as-usual (n = 12) were included in the analysis. No significant differences were found in the proportion of participants retained in MOUD treatment at 6 months (38.5% vs 41.7%, P = 0.87), proportion of participants readmitted at 6 months (46.2% vs 41.2%, P = 0.82), or the time to treatment discontinuation (log-rank P = 0.92) or readmission (log-rank P = 0.85).

Conclusions

This pilot trial failed to demonstrate that a recovery coach intervention improved MOUD treatment retention compared with treatment-as-usual among hospitalized individuals with OUD.
Membrane phospholipid remodeling modulates nonalcoholic steatohepatitis progression by regulating mitochondrial homeostasis
Authors: Tian Ye , Jellinek Matthew J. , Mehta Kritika , Seok Sun Mi , Kuo Shanny H. , Lu Wei , Shi Ruicheng , Lee Richard , Lau Gee W. , Kemper Jongsook Kim , Zhang Kai , Ford David A. , Wang Bo
Published: March 2023

Background and Aims:

NASH, characterized by inflammation and fibrosis, is emerging as a leading etiology of HCC. Lipidomics analyses in the liver have shown that the levels of polyunsaturated phosphatidylcholine (PC) are decreased in patients with NASH, but the roles of membrane PC composition in the pathogenesis of NASH have not been investigated. Lysophosphatidylcholine acyltransferase 3 (LPCAT3), a phospholipid (PL) remodeling enzyme that produces polyunsaturated PLs, is a major determinant of membrane PC content in the liver.

Approach and Results:

The expression of LPCAT3 and the correlation between its expression and NASH severity were analyzed in human patient samples. We examined the effect of Lpcat3 deficiency on NASH progression using Lpcat3 liver-specific knockout (LKO) mice. RNA sequencing, lipidomics, and metabolomics were performed in liver samples. Primary hepatocytes and hepatic cell lines were used for in vitro analyses. We showed that LPCAT3 was dramatically suppressed in human NASH livers, and its expression was inversely correlated with NAFLD activity score and fibrosis stage. Loss of Lpcat3 in mouse liver promotes both spontaneous and diet-induced NASH/HCC. Mechanistically, Lpcat3 deficiency enhances reactive oxygen species production due to impaired mitochondrial homeostasis. Loss of Lpcat3 increases inner mitochondrial membrane PL saturation and elevates stress-induced autophagy, resulting in reduced mitochondrial content and increased fragmentation. Furthermore, overexpression of Lpcat3 in the liver ameliorates inflammation and fibrosis of NASH.

Conclusions:

These results demonstrate that membrane PL composition modulates the progression of NASH and that manipulating LPCAT3 expression could be an effective therapeutic for NASH.
Acupuncture for swallowing disorder after recovery from COVID-19: A protocol for systematic review and meta analysis
Authors: Xiao Yao , Lin Yueqi , Chen Qiqi , Wang Runyi , Li Zuming , Chen Daman , Huang Yuxin , Peng Guiyuan
Published: March 2023

Background:

Swallowing disorder is a common sequela after recovery from COVID-19. Acupuncture is an important traditional therapy for treating swallowing disorder. However, the efficacy of acupuncture for swallowing disorder after recovery from COVID-19 lacks evidence-based medicine.

Methods:

All randomized controlled trials of acupuncture for swallowing disorder after recovery from COVID-19 will be retrieved and collected from December 2019 to November 2022 with no language restrictions. PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure Database, Chinese Biomedical Database, Chinese Science and Technology Journal Database (VIP), and the Wanfang Database will be searched. Two researchers will independently select studies, extract data, and evaluate study quality. The Cochrane risk of bias tool for randomized trials will be used to assess the risk of bias in the included studies. Statistical analyses will be performed using Review Manager version 5.3.

Results:

This study will provide a high-quality and convincing assessment of the efficacy and safety of acupuncture for swallowing disorder after recovery from COVID-19 and will be published in peer-reviewed journals.

Conclusion:

Our findings will provide a reference for future clinical decisions and guidance development.
A contemporary case series of Pseudomonas aeruginosa infective endocarditis
Authors: Walczak Andrew , McCarthy Kate , Paterson David L.
Published: March 2023

Pseudomonas aeruginosa infective endocarditis (IE) is a rare disease associated with high mortality and complications. Here, we describe a contemporary set of patients aiming to improve the understanding of risk factors, clinical features, treatments, and outcomes. This retrospective case series reviewed cases from 3 tertiary metropolitan hospitals between January 1999 and January 2019. prespecified data were collected for each case, with a review of risk factors, valve involvement, acquisition, treatment, and complications. Fifteen patients were identified over a 20 years period. All patients presented with fever, 5/15 had preexisting prosthetic valve with valvular heart disease in 7/15 patients making it the most common risk factor. Intravenous drug use (IVDU) was the source in only 6/15 cases with healthcare associated infection and left-sided valvular involvement being more common than previous reports both occurring in 9/15 cases. Complications occurred in 11/15 patients with a 30 days mortality of 13%. Surgery was performed in 7/15 patients and 9/15 patients received antibiotic combination therapy. One year mortality was higher in those with increasing age, comorbidities, left-sided valve involvement, presence of predefined complications, and antibiotic monotherapy. Development of resistance occurred in 2 cases that received monotherapy. P aeruginosa IE remains a rare disease with high mortality and secondary complications.
Biomarkers for predicting the prognosis of intrahepatic cholangiocarcinoma: A retrospective single-center study
Authors: Li Xueliang , Sun Zhaowei , Li Xiaoxiao , Wang Qinlei , Chen Menshou , Zhang Bingyuan , Feng Yujie , Han Bing , Hu Xiao , Guo Jingyun , Wang Maobing , Ma Kai
Published: March 2023

The aim of this retrospective study was to investigate the association between preoperative serological and clinical indicators and postoperative recovery in patients who had undergone resection of intrahepatic cholangiocarcinoma (ICC). We collected data form the medical records of patients who underwent operations for the treatment of ICC at Qingdao University Affiliated Hospital from 2015 to 2021. We analyzed the data to explore the independent predictors of disease prognosis after surgery for ICC. By univariate analysis, we found that the following factors were significantly associated with overall survival and tumor-free survival in patients with ICC: TNM stage; degree of vascular invasion; levels of hemoglobin, carcinoembryonic antigen, carbohydrate antigen 125, direct bilirubin, alkaline phosphatase, and albumin; prothrombin time; neutrophil to lymphocyte ratio; prothrombin time to albumin ratio; albumin to alkaline phosphatase ratio; albumin to gamma-glutamyl transferase ratio; prognostic nutrition Index, and incisional margin. However, only carbohydrate antigen 24-2 and glutamyl transpeptidase were correlated with overall survival in patients with ICC. However, only a positive history of biliary surgery was significantly associated with tumor-free survival in patients with ICC. Preoperative prothrombin time, vascular invasion, N-stage, incisal edge, and carcinoembryonic antigen levels may be simple predictors of disease progression in ICC after hepatectomy.
Study on the active ingredients and mechanism of action of Jiaotai Pill in the treatment of type 2 diabetes based on network pharmacology: A review
Authors: Chen Xiaona , Yang Zhao , Du Lin , Guan Yuxin , Li Yunfang , Liu Chenggang
Published: March 2023

To explore the potential active ingredients and related mechanisms of Jiaotai Pill in the treatment of Type 2 diabetes mellitus (T2DM) based on network pharmacology and molecular docking. The main active components of Jiaotai Pills were obtained by TCMSP and BATMAN-TCM database combined with literature mining, and the targets of the active components of Jiaotai Pills were predicted by reverse pharmacophore matching (PharmMapper) method. Verifying and normalizing the obtained action targets by using a Uniprot database. Obtaining T2DM related targets through GeneCards, the online mendelian inheritance in man, DrugBank, PharmGKB and therapeutic target databases, constructing a Venn diagram by using a Venny 2.1 online drawing platform to obtain the intersection action targets of Jiaotai pills and T2DM, and the protein–protein interaction network was constructed by String platform. Bioconductor platform and R language were used to analyze the function of gene ontology and the pathway enrichment of Kyoto Encyclopedia of Genes and Genomes. A total of 21 active components and 262 potential targets of Jiaotai Pill were screened by database analysis and literature mining, including 89 targets related to T2DM. Through gene ontology functional enrichment analysis, 1690 biological process entries, 106 molecular function entries and 78 cellular component entries were obtained. Seven pathways related to T2DM were identified by Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. Jiaotai Pill can achieve the purpose of treating T2DM through multiple active ingredients, multiple disease targets, multiple biological pathways and multiple pathways, which provides a theoretical basis for the clinical treatment of T2DM by Jiaotai Pill.
Nomogram to predict the prognosis of patients with AFP-negative hepatocellular carcinoma undergoing chemotherapy: A SEER based study
Authors: Wang Lei , Peng Jin-Lin , Wu Ji-Zhou
Published: March 2023

This study aimed to formulate reliable nomograms for predicting the outcomes of α-fetoprotein (AFP)-negative hepatocellular carcinoma (HCC) patients after chemotherapy. HCC patients with normal AFP expression who received chemotherapy were screened and evaluated from the surveillance, epidemiology, and end results database. The prognostic factors for predicting outcomes of HCC patients undergoing chemotherapy were chosen by analyzing the results of Cox analyses. Then, a nomogram integrating the prognostic factors was established. The discrimination ability of the nomogram was evaluated with computation of area under the curve (AUC) and calibration curve. A total of 2424 patients with AFP-negative HCC undergoing chemotherapy were identified. The median overall survival (OS) for HCC patients undergoing chemotherapy was 33 months. Age, race, pathologic grade, N stage, M stage, surgery, and lung metastases were significantly linked to OS. These relevant factors were incorporated into the nomogram. AUC values of the prognostic nomogram for 3- and 5-year OS were 0.696 and 0.706 in the training groups, which were superior to those of the tumor node metastasis (TNM) stage (0.641 and 0.671) in training groups. The calibration curves indicated a high consistency between the predicted probability of nomograms and the actual observation. The validation groups produced AUC values of 0.674 and 0.736 for 3- and 5-year OS, which were superior to those of the TNM stage (0.601 and 0.637) in validation groups. The results revealed significantly unfavorable OS in the high-risk group (P < .001). Nomograms to accurately predict the OS for AFP-negative HCC patients after chemotherapy were established and exhibited a more accurate predication than the conventional TNM staging system.
Auricular therapy for primary dysmenorrhea: A protocol for systematic review and meta-analysis of randomized controlled trials
Authors: Yu Qianhui , Cao Jiazhen , Chen Hongxiu , He Jing , Wang Xinyue , Liu Renming , Li Tie
Published: March 2023

Background:

Primary dysmenorrhea (PD) is a common problem among women. It is defined as any degree of perceived cramping pain during menstruation without any evident pathology. Auricular therapy (AT), a widely used alternative medical treatment method as part of traditional Chinese acupuncture, lacks reliable evidence to support its safety and effectiveness for PD. We aimed to conduct a meta-analysis to investigate the efficacy and safety of AT in PD and to investigate possible factors impacting the particular efficacy of AT in PD by meta-regression.

Methods:

This protocol followed the PRISMA guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. The following 9 sources will be searched for randomized control trials of AT for PD: the Cochrane Central Register of Controlled Trials, PubMed, Medline, Embase, Web of Science, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure, Chinese Science and Technology Periodicals (VIP) database and WanFang Database from inception to January 1, 2023. Primary outcomes include visual rating scales and clinical efficacy rates, while secondary outcomes include endocrine hormone indicators related to PD and adverse events. Two reviewers will work independently on study selection, data extraction, and coding, including the risk of bias assessment in the included studies. While conducting a meta-analysis, Review Manager version 5.3 will be employed. Otherwise, a descriptive analysis will be performed. The results will be displayed as a risk ratio with 95% confidence intervals for dichotomous data as well as weight mean difference or standardized mean difference with 95% confidence intervals for continuous data.

Results:

This study’s protocol will investigate the efficacy and safety of AT in the treatment of PD in a systematic way.

Conclusion:

This systematic evaluation will objectively and systematically assess the efficacy and safety of AT in PD based on the available evidence, as well as provides clinicians with evidence to support the treatment of the disease.
Caregiving experiences of stroke caregivers: A systematic review and meta-synthesis of qualitative studies
Authors: Wang Lingyu , Liu Jingyu , Wu Lingsha , Zhang Jing , Fang Haiyan
Published: March 2023

Background:

Caregivers of stroke patients have demanding caregiving tasks and roles, and they face multiple challenges and a variety of needs in their caregiving process. This study aimed to systematically integrate and evaluate qualitative research data to understand the care experiences of caregivers of stroke patients and to provide them with targeted assistance.

Methods:

We critically assessed the study using the Joanna Briggs Institute Critical Assessment Checklist for Qualitative Research. Extraction, summarization and meta-synthesis of qualitative data. Qualitative studies related to this study were searched in PubMed, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, China Biomedical Literature Database, and Wanfang Database by computer from the establishment of the database to February 2022. The method of tracing citations was used to find other articles that might be included to ensure the comprehensiveness of the search articles.

Results:

A total of 11 studies, including 167 participants, were included, and 40 research results were extracted, summarized into 8 new categories, and formed 2 meta-themes. Meta-theme 1: Caregivers had emotional struggles during caregiving but were still able to provide compassion and care for patients through positive coping. Meta-theme 2: caregivers faced many difficulties in the care process and were eager for support.

Conclusions:

Caregiving is a long and heavy process. Society, medical institutions, and families should pay full attention to the feelings and needs of stroke caregivers in the care process and provide appropriate support for them.
Plasma cell myeloma initially diagnosed as light-chain deposition disease on liver biopsy: A case report and literature review
Authors: Jeong Ji Yun , Yang Hyeon Tae , Cho Seung Hyun , Lee Yu Rim , Kim Jinhee , Kang Min Kyu , Hong Jihoon , Moon Joon Ho , Seo An Na
Published: March 2023

Rationale:

Light-chain deposition disease (LCDD) is a rare condition characterized by the abnormal deposition of monoclonal light chains (LCs) in multiple organs, leading to progressive organ dysfunction. Herein, we report a case of plasma cell myeloma initially diagnosed as LCDD on liver biopsy performed for prominent cholestatic hepatitis.

Patient concerns:

A 55-year-old Korean man complained of dyspepsia as the main symptom. On abdominal computed tomography performed at another hospital, the liver showed mildly decreased and heterogeneous attenuation with mild periportal edema. Preliminary liver function tests revealed abnormal results. The patient was treated for an unspecified liver disease; however, his jaundice gradually worsened, prompting him to visit our outpatient hepatology clinic for further evaluation. Magnetic resonance cholangiography revealed liver cirrhosis with severe hepatomegaly of unknown cause. A liver biopsy was performed for the diagnosis. Hematoxylin and eosin staining revealed diffuse extracellular amorphous deposits in perisinusoidal spaces with compressed hepatocytes. The deposits, which morphologically resembled amyloids, were not stained by Congo red but stained strongly positive for kappa LCs and weakly positive for lambda LCs.

Diagnoses:

Therefore, the patient was diagnosed with LCDD. Further systemic examination revealed a plasma cell myeloma.

Interventions:

Fluorescence in situ hybridization, cytogenetics, and next-generation sequencing tested in bone marrow showed no abnormalities. The patient initially received bortezomib/lenalidomide/dexamethasone as the treatment regimen for plasma cell myeloma.

Outcomes:

However, he died shortly thereafter because of coronavirus disease 2019 complications.

Lessons:

This case demonstrates that LCDD may present with sudden cholestatic hepatitis and hepatomegaly, and may be fatal if patients do not receive appropriate and timely treatment because of delayed diagnosis. Liver biopsy is useful for the diagnosis of patients with liver disease of unknown etiology.
High risk factors related to lymph node metastasis in early gastric cancer: A retrospective observational study
Authors: Fan Xiaoyuan , Shi Chihong , Lu Dewen
Published: March 2023

Lymph node metastasis (LNM) is a key factor affecting the prognosis of patients with early gastric cancer. This is a retrospective study, conducted between January 20, 2010 and January 30, 2019 and included 402 patients with early-stage gastric cancer who underwent radical gastrectomy at The Affiliated People Hospital of Ningbo University. Clinical and pathological data including patients’ gender, age, tumor location, gross typing, depth of invasion, tumor maximum diameter, type of differentiation, vascular invasion, presence or absence of signet ring cells, and LNM data were collected and analyzed. Univariate analysis identified positive relationships between patient gender, tumor invasion depth, tumor size, presence or absence of vascular involvement, and differentiation type with LNM (P < .05). Multivariate analysis subsequently confirmed tumor size (odds ratio [OR]: 2.38, 95% confidence interval [CI]:1.15–4.92, P = .02), vascular involvement (OR: 4.35, 95% CI: 2.00–9.47, P < .001), and depth of invasion (OR: 6.63, 95% CI: 2.19–20.06, P = .001) as independent risk factors for LNM (P < .05). Tumor size, vascular involvement, and depth of invasion are independent risk factors for LNM in cases of early-stage gastric cancer.
Marjolin’s ulcer in an ischial pressure sore presented with necrotizing soft tissue infection: A case report
Authors: Huang Ching-Yen , Hsieh Zhoa-Yu , Chang Ke-Chung , Chang Dun-Hao
Published: March 2023

Rationale:

Marjolin’s ulcer (MU) is a rare skin malignancy derived from a chronic wound. Pressure ulcer related MU possesses poor prognosis and high metastatic rate, and it is difficult to be differentiated, especially when superimposed infection.

Patient concerns:

Here we report a case with pressure ulcer related MU which presented as necrotizing soft tissue infection (NSTI) to demonstrate the manifestation, treatment, and prognosis of this rare disease.

Diagnoses:

A 45-year-old male patient had spinal cord injury at age 2 years. He presented ischial pressure sore complicated with NSTI initially. After serial debridements and antibiotic treatment, the infection subsided. For the persistent verruca-like skin lesion, he underwent wide excision which revealed well-differentiated squamous cell carcinoma. Further image studies showed localized residual tumor without distant metastasis.

Interventions:

He then underwent hip disarticulation and anterior thigh fillet flap reconstruction. Local recurrence developed 3 months later, and re-wide excision and inguinal lymph node dissection were performed. No lymph node metastasis was noted and adjuvant radiotherapy was given.

Outcomes:

He was followed for 34 months and no recurrence or metastasis was found. The patient can move with a wheelchair or a hip prosthesis, and is partially dependent for daily activities.

Lessons:

MU can masquerade as NSTI and one should be alert to its malignant potential. Due to its aggressive nature, limb sacrifice can be considered in circumstances of profound involvement. As for the reconstruction method, pedicled fillet flap provided good wound coverage.
How to Start an IV Drip Bar
Authors: Doran Michelle Dyment , Oxton Alison
Published: March 2023

The practice of administering intravenous (IV) vitamin infusions is going to increase in the future and medspas are already meeting this demand. Many practices are striving to create an IV drip bar that complements their aesthetic practice. In this article, we provide a blueprint for starting an IV drip bar. We break down the process into several easy steps designed to make any aesthetic practice successful.
Incorporating a Patient Education Video With Provider Consultation to Improve Patient Satisfaction and Reduce Consultation Time Among New Patients Seeking Cosmetic Injections
Authors: Hansen Darya A. , Stevenson Eleanor L. , Johnson Ragan , Teague Malinda
Published: March 2023

The field of aesthetics is expanding more rapidly than ever before, bringing with it an influx of new-to-aesthetics patients who lack industry knowledge. We investigated ways to bridge this gap in knowledge and provide patients with important procedural information and also increase their satisfaction and confidence. We implemented this project to improve the delivery of preprocedural patient education via the implementation of an educational video. We collected data over a 16-week period and analyzed the results of the pre- and post-video implementation. We found that implementing the educational video decreased the average time the provider spent consulting with new patients considering injectable neuromodulators or dermal fillers. We also found that using the video increased the patient's preprocedural confidence and postprocedural satisfaction. Based on the results of our quality improvement project, we concluded that implementing a patient education video before performing cosmetic injectable procedures improved patient confidence and satisfaction and decreased provider consultation times.
Somatic chromosome pairing has a determinant impact on 3D chromatin organization
Authors: Puerto Marta , Shukla Mamta , Bujosa Paula , Perez-Roldan Juan , Tamirisa Srividya , Solé Carme , Nadal Eulàlia de , Posas Francesc , Azorin Fernando , Rowley M. Jordan
Published: March 2023

In the nucleus, chromatin is intricately structured into multiple layers of 3D organization important for genome activity. How distinct layers influence each other is not well understood. In particular, the contribution of chromosome pairing to 3D chromatin organization has been largely neglected. Here, we address this question inDrosophila,an organism that shows robust chromosome pairing in interphasic somatic cells. The extent of chromosome pairing depends on the balance between pairing and anti-pairing factors, with the anti-pairing activity of the CAP-H2 condensin II subunit being the best documented. Here, we identify the zinc-finger protein Z4 as a strong anti-pairer that interacts with and mediates the chromatin binding of CAP-H2. We also report that hyperosmotic cellular stress induces fast and reversible chromosome unpairing that depends on Z4/CAP-H2. And, most important, by combining Z4 depletion and osmostress, we show that chromosome pairing reinforces intrachromosomal 3D interactions. On the one hand, pairing facilitates RNAPII occupancy that correlates with enhanced intragenic gene-loop interactions. In addition, acting at a distance, pairing reinforces chromatin-loop interactions mediated by Polycomb (Pc). In contrast, chromosome pairing does not affect which genomic intervals segregate to active (A) and inactive (B) compartments, with only minimal effects on the strength of A-A compartmental interactions. Altogether, our results unveil the intimate interplay between inter-chromosomal and intra-chromosomal 3D interactions, unraveling the interwoven relationship between different layers of chromatin organization and the essential contribution of chromosome pairing.