bluuebunny/crossref_metadata_2025 huggingface dataset:
SGLT-2 Inhibitors: Focus on Dapagliflozin
Authors: Siddiqui Zoya , Hadid Somar , Frishman William H.
Published: April 2024

Dapagliflozin (trade name FARXIGA) is a sodium-glucose cotransporter-2 (SGLT-2) inhibitor that has transcended its initial antidiabetic application to demonstrate benefits in cardiac and renal diseases. It was first approved by the food and department administration for type 2 diabetes in 2014. Since then, it has gained food and department administration approval for chronic kidney disease in 2021, heart failure with reduced ejection fraction in 2020, and heart failure with preserved ejection fraction in 2023. Thus, dapagliflozin plays a pivotal role in improving patient outcomes. By competitive binding to renal SGLT-2 cotransporters, dapagliflozin effectively prevents glucose and sodium reabsorption, leading to glucosuria. Its pharmacokinetic profile involves minimal cytochrome P450-induced metabolism, rapid absorption with an 18-hour duration of action, and stable effects. Clinical trials have revealed dapagliflozin’s efficacy in glycemic control without the risk of hypoglycemia, making it an advantageous choice for patients insufficiently managed on other antidiabetic drugs. Comparative analysis with other SGLT-2 inhibitors suggests dapagliflozin’s potential superiority in preventing heart failure. Compared to empagliflozin, it has more extended effects, contributing to stable sodium diuresis, reduced blood pressure fluctuations, and potentially lower cardiovascular disease risks. However, it leads to less urinary glucose excretion compared with canagliflozin. Dapagliflozin has specific contraindications, such as type 1 diabetes and end-stage chronic kidney disease. Adverse effects include an increased risk of genital infections, urinary tract infections, and Fournier’s gangrene. A nuanced understanding of dapagliflozin’s benefits and limitations is imperative for informed clinical decision-making in the management of diabetes and its complications.
Intravenous Iron Therapy in Heart Failure Patients With Iron Deficiency: Benefits, Safety, and Guidelines
Authors: Chand Swati , Garg Jasmine , Arsha Sanjana , Shah Sangam , Tripathi Ashish , Thapa Sangharsha , Frishman William H. , Aronow Wilbert S.
Published: April 2024

Iron deficiency is a common comorbidity in heart failure (HF) patients, with up to 50% of ambulatory patients with HF affected. Intravenous (IV) iron therapy has emerged as a promising treatment approach for HF patients with concomitant iron deficiency. This review summarizes the current literature on the use of IV iron therapy in HF patients, focusing on its benefits in improving quality of life, and exercise capacity, and reducing HF hospitalizations. However, concerns about the long-term cardiotoxic effects of IV iron, including the risk of iron overload, are also addressed. The review highlights the importance of a balanced approach to iron replacement and provides an overview of the 2022 American College of Cardiology/American Heart Association guidelines, which recommend IV iron therapy for eligible patients. Additionally, the review underscores the need for further research, particularly in HF patients with preserved ejection fraction and acute HF. While IV iron therapy shows promise, questions about its safety and specific formulations remain to be fully addressed.
The Interplay of Microbiome Dysbiosis and Cardiovascular Disease
Authors: Zaher Anas , Elsaygh Jude , Peterson Stephen J. , Weisberg Ilan S. , Parikh Manish A. , Frishman William H.
Published: April 2024

The intricate ecosystem of the mammalian gut, which hosts a diverse microbiome, plays a vital role in various physiological functions. Trillions of bacteria within the gut contribute to host metabolism, immune modulation, energy homeostasis, and more. Emerging research highlights the gut microbiota’s significant impact on cardiovascular diseases (CVDs), with intestinal dysbiosis identified as a risk factor for conditions such as obesity and diabetes, both linked to atherosclerosis. Chronic inflammation, pivotal in atherosclerosis, is influenced by the gut microbiome, where microbial signals, such as lipopolysaccharides, can translocate from the gut to trigger inflammatory responses. Diet has major effects on the gut microbiota, with the Western diet, rich in saturated fats, contributing to dysbiosis and elevated cardiovascular risks. Probiotics and prebiotics offer therapeutic potential in CVD management. Probiotics, or live microorganisms, exhibit antioxidant, anti-inflammatory, and cholesterol-lowering effects. Probiotics are most effective when given with prebiotics, with the former acting on the latter as substrate. Understanding the dynamic interplay between diet, gut microbiota, and CVD provides insights into preventive and therapeutic strategies.
Impact of Frailty on Survival and Neurological Outcomes After Cardiac Arrest: A Systematic Review and Meta-Analysis
Authors: Zhang Hailuo , Wang Aiping , Zhou Meifeng
Published: April 2024

To synthesize the evidence on the associations of frailty with the risk of mortality and neurological outcomes in patients with cardiac arrest undergoing cardiopulmonary resuscitation. We conducted a literature search on PubMed, EMBASE, and Scopus. We included observational studies on adult participants (18 years or older) with cardiac arrest. The eligible studies reported frailty assessments using standard tools, and the comparator group comprised nonfrail participants. We used random-effects models for all analyses and expressed pooled effect sizes as odds ratios (ORs) with 95% confidence intervals (CIs). We included data from 12 studies in our analysis. Individuals with frailty exhibited a significantly higher risk of in-hospital mortality (OR, 2.18; 95% CI, 1.62–2.94), and increased 30-day mortality (OR, 1.43; 95% CI, 1.12–1.84) and 12-month mortality (OR, 4.16; 95% CI, 2.32–7.47) than the nonfrail individuals. Frail individuals also displayed lower odds of achieving favorable neurological outcomes upon hospital discharge (OR, 0.32; 95% CI, 0.20–0.50) and at the 30-day follow-up (OR, 0.42; 95% CI, 0.23–0.78). Additionally, they had lower odds of return of successful spontaneous circulation (OR, 0.49; 95% CI, 0.34–0.72). The observed associations between frailty and a higher risk of mortality reduced odds of favorable neurological outcomes, and lower odds of return of successful spontaneous circulation underscore the value of identifying frailty in individuals to achieve more accurate prognoses. Our findings highlight the importance of including frailty assessments as a component of the management plan for patients experiencing cardiac arrest.
Clinical Characteristics, Management, and Outcomes in Cardiogenic Shock: Insights From a High-Volume Italian Cardiac Intensive Care Unit
Authors: Del Buono Marco Giuseppe , La Vecchia Giulia , D'Aiello Alessia , Pedicino Daniela , Pinnacchio Gaetano , Genuardi Lorenzo , Montone Rocco Antonio , Saponara Gianluigi , Di Renzo Antonio , Conte Cristina , Cribari Francesco , Moroni Francesco , Filomia Simone , Brecciaroli Mattia , Aurigemma Cristina , Liuzzo Giovanna , Trani Carlo , Burzotta Francesco , Sanna Tommaso
Published: April 2024

Cardiogenic shock (CS) is a life-threatening condition. The aim of this study is to evaluate the clinical characteristics, management, and complication rate of patients with CS admitted to a high-volume hospital in Italy. We retrospectively reviewed the clinical, echocardiographic, and laboratory data, therapeutic management, and outcomes of patients with CS admitted to the Policlinico Gemelli (Rome) between January 1, 2020, and January 1, 2023. We included 96 patients [median age 71 years, interquartile range 60–79; 65 (68%) males], of whom 49 patients (51%) presented CS secondary to acute myocardial infarction and 60 (63%) with a de novo presentation of CS. Dobutamine was the most frequently used inotrope and noradrenaline the most frequently used vasopressor (adopted in 56% and 82% of cases, respectively). Forty-five (47%) patients died during the hospitalization. Nonsurvivors were older and had a higher inflammatory burden at admission, elevated lactate levels, a greater increase in lactate levels, higher left ventricular filling pressures, and worse right ventricular function. C-reactive protein levels [odds ratio (OR) 1.03, 95% confidence interval (CI) (1.00–1.04),P= 0.027], lactate levels at admission (OR 3.49, 95% CI, 1.59–7.63,P= 0.02), and increase in lactate levels (OR 2.8, 95% CI, 1.37–5.75,P= 0.005) were independent predictors of in-hospital all-cause death. Our data contribute to the assessment of the regional variations in the management and outcomes of patients with CS. We observed a high mortality and complication rate. Lactate acidosis and C-reactive protein measured at admission may help in identifying patients at higher risk of adverse in-hospital outcomes.
Necrotizing Fasciitis after Panniculectomy Caused by Finegoldia magna
Authors: Breidung David , Delavari Sarina , Megas Ioannis-Fivos , Reichert Bert , Billner Moritz
Published: April 2024

Necrotizing fasciitis is a rare yet severe complication after body contouring surgery. We present a case of a 54-year-old woman with a complex medical history who developed necrotizing fasciitis 9 days after panniculectomy and epigastric hernia repair. Microbiological examination revealed Finegoldia magna as the causative agent, a rare pathogen in necrotizing fasciitis. Patients undergoing body contouring may be at increased risk of developing necrotizing fasciitis; therefore, increased attention should be paid to this differential diagnosis in case of postoperative signs of infection. This case report highlights the pivotal importance of early recognition, prompt surgical intervention, and comprehensive medical treatment to improve patient outcomes in necrotizing fasciitis.
Sex and gender in alcohol use disorder and alcohol-associated liver disease in the United States: A narrative review
Authors: Carlini Lauren E. , Fernandez Anne C. , Mellinger Jessica L.
Published: April 2024

Over the last 20 years, there has been an alarming increase in alcohol use and AUD prevalence among women, narrowing the historical gender gap. Concurrently, there has also been a significant rise in alcohol-associated liver disease (ALD) prevalence, severity, and mortality among women. Despite this, there are no recent reviews that have sought to evaluate both sex and gender differences at the intersection of AUD and ALD. In this narrative review, we address the escalating rates of ALD and AUD in the United States, with a specific focus on the disproportionate impact on women. Sex and gender play an important and well-known role in the pathogenesis and epidemiology of ALD. However, sex and gender are also implicated in the development and prevalence of AUD, as well as in the treatment of AUD, all of which have important consequences on the approach to the treatment of patients with ALD and AUD. A better understanding of sex and gender differences in AUD, ALD, and the intersection of the 2 is essential to enhance prevention, diagnosis, and management strategies. These data underscore the urgent need for awareness and preventive efforts to mitigate the potential long-term health consequences.
Neutron Activation Analysis Based on AB-BNCT Treatment Room
Authors: Cai Yunzhu , Gu Shaoxian , Wang Ningyu , Cui Fengjie , Liu Wei , Li Tianhang , Wu Zhangwen , Gou Chengjun
Published: April 2024

Boron neutron capture therapy (BNCT) is an ideal binary targeted radiotherapy for treating refractory tumors. An accelerator-based BNCT (AB-BNCT) neutron source has attracted more and more attention due to its advantages such as higher neutron yield in the keV energy region, less gamma radiation, and higher safety. In addition to 10B, neutrons also react with other elements in the treatment room during BNCT to produce many activation products. Due to the long half-life of some activation products, there will be residual radiation after the end of treatment and the shutdown of the accelerator, which has adverse effects on radiation workers. Therefore, the ambient dose equivalent rate in the treatment room needs to be evaluated. The AB-BNCT neutron source model proposed by Li is studied in this paper. Based on the Monte Carlo method, the Geant4 platform was used to simulate the dose induced by radionuclides near the Beam Shaping Assembly (BSA) of the source. It is concluded that the concrete wall contributed the most to the radiation dose. The dose rate of 2.45 μSv h−1 after 13 min of shutdown meets the dose rate limit of 2.5 μSv h−1, at which point it is safe for workers to enter the treatment room area.
Genetic Variants and Persistent Impairment Following Mild Traumatic Brain Injury: A Systematic Review
Authors: Feigen Chaim M. , Charney Molly F. , Glajchen Simone , Myers Cameron , Cherny Steven , Lipnitsky Ronni , Yang Wendy W. , Glassman Nancy R. , Lipton Michael L.
Published: April 2024

Objective:

The purpose of this review is to systematically assess primary research publications on known genetic variants, which modify the risk for symptoms or dysfunction persisting 30 days or more following mild traumatic brain injury (mTBI).

Summary of Review:

A search of PubMed and Embase from inception through June 2022 identified 42 studies that associated genetic variants with the presence of symptoms or cognitive dysfunction 30 days or more following mTBI. Risk of bias was assessed for each publication using the Newcastle Ottawa Scale (NOS). Fifteen of the 22 studies evaluating apolipoprotein E (APOE) ɛ4 concluded that it was associated with worse outcomes and 4 of the 8 studies investigating the brain-derived neurotrophic factor (BDNF) reported the Val66Met allele was associated with poorer outcomes. The review also identified 12 studies associating 28 additional variants with mTBI outcomes. Of these, 8 references associated specific variants with poorer outcomes. Aside from analyses comparing carriers and noncarriers of APOE ɛ4 and BDNF Val66Met, most of the reviewed studies were too dissimilar, particularly in terms of specific outcome measures but also in genes examined, to allow for direct comparisons of their findings. Moreover, these investigations were observational and subject to varying degrees of bias.

Conclusions:

The most consistent finding across articles was that APOE ɛ4 is associated with persistent post-mTBI impairment (symptoms or cognitive dysfunction) more than 30 days after mTBI. The sparsity of other well-established and consistent findings in the mTBI literature should motivate larger, prospective studies, which characterize the risk for persistent impairment with standardized outcomes in mTBI posed by other genetic variants influencing mTBI recovery.
Candidate selection for lung transplantation – considerations beyond the medical evidence
Authors: Holm Are Martin
Published: April 2024

Purpose of review

The scarcity of organs available for lung transplantation makes it necessary to develop consistent practices for candidate selection and organ allocation. Such policies are mainly built on prognostic estimations, which are again built on medical evidence. In addition, however, other factors also guide these practices. These factors are not always explicit. The purpose of this review is to discuss some of these factors.

Recent findings

While one candidate may be considered to be in need of a transplant, the extent to which this need is weighed up against other patients at need varies, depending on how societal responsibility is conceived at the transplant center. Individual survival benefit may be in conflict with the concept of a just distribution of life years (’fair innings’). Furthermore, the need to expand medical knowledge, and the perceived patient autonomy and right to choose may affect the selection and allocation practices. Finally, financial considerations and nationality may have great influence.

Although well trained in medical judgment, the clinicians’ candidate selection for lung transplantation is often influenced by factors beyond the medical evidence. These factors should be discussed just as transparently and accountably as the medical judgments.
Meta-analysis of modified Sijunzi decoction for the treatment of chronic atrophic gastritis
Authors: Huang Xue , Shao Shuling
Published: April 2024

Background:

Qi deficiency in the spleen and stomach is considered to be the fundamental pathogenesis of chronic atrophic gastritis (CAG) in Traditional Chinese medicine. Spleen strengthening and Qi replenishment are the basic treatment principles. Sijunzi Decoction serves as the fundamental remedy for spleen notification and Qi replenishment.

Methods:

The Cochrane Library, China National Knowledge Infrastructure China Biology Medicine disc, VIP, Wanfang Database, Web of Science, PubMed, and Embase were retrieved for related randomized controlled trials published from the inception of the databases to June 3, 2023. Literature screening and data extraction were executed by 2 independent investigators. The Cochrane Collaboration tool was leveraged to appraise the quality of included studies. Meta-analysis was implemented utilizing Stata 15.

Results:

This analysis incorporated 32 studies with 2780 patients. The analysis results unveiled that compared to Western medicine treatment, modified Sijunzi Decoction significantly enhanced the clinical efficacy (relative risk [RR] = 1.241, 95% confidence interval [95% CI] = 1.199–1.285, P < .0001), lowered symptom scores (standardized mean difference [SMD] = −1.846, 95% CI = −2.160 to −1.532, P < .00001) and gastroscopic pathological scores (SMD = −1.122, 95% CI = −1.492 to −0.752, P < .00001), ameliorated quality of life (SMD = 4.294, 95% CI = 2.982–5.606, P < .00001), increased the Helicobacter pylori eradication rate (RR = 1.297, 95% CI = 1.035–1.625, P < .001), pepsinogen I levels (SMD = 2.615, 95% CI = 2.344–2.886, P < .00001), pepsinogen I/II ratio (SMD = 3.107, 95% CI = 2.811–3.403, P < .00001), and gastrin-17 levels (SMD = 1.004, 95% CI = 0.794–1.215, P < .00001), and reduced the incidence of adverse reactions (RR = 0.361, 95% CI = 0.235–0.556, P < .01) in individuals with CAG, with statistically significant discrepancies.

Conclusion:

Modified Sijunzi Decoction exhibited superior efficacy to conventional Western medicine in treating CAG. It was shown to improve the Helicobacter pylori eradication rate, reduce symptom scores, enhance quality of life, and improve pepsinogen-related indicators with a high safety profile.
Adjacent vertebral fractures in the lumbar and thoracic spine after balloon kyphoplasty: A finite element analysis
Authors: Yamaguchi Yuichi , Kobayashi Takaomi , Todo Mitsugu , Hijikata Yasukazu , Mawatari Masaaki , Tsukamoto Masatsugu , Yoshihara Tomohito , Hirata Hirohito , Morimoto Tadatsugu
Published: April 2024

The purpose of the present study was to mechanically verify after vertebral augmentation (AVA) scores using a finite element method (FEM) with accurate material constants of balloon kyphoplasty (BKP) cement. Representative cases with AVA scores of 1 (case 1), 3 (case 2), and 5 (case 3) among patients with vertebral body fractures who underwent BKP were analyzed. A FEM model consisting of 5 vertebral bodies was created, including the injured vertebral body in each case. The amount of displacement for each load (up to 4000 N) between the upper and lower vertebral bodies of each model was measured. Young modulus of the BKP cement was calculated from actual measurements using the EZ-Test EZ-S (Shimadzu Corporation, Kyoto, Japan). In all cases, the number of shell elements (209,296–299,876), solid elements (1913,029–2417,671), and nodes (387,848–487,756) were similar, indicating that FEM modeling was comparable among the cases. Young modulus of BKP cement, calculated using EZ-Test EZ-S, was 572 MPa. Fractures were detected by compressive forces of 3300 N (upper) and 3300 N (lower), 3000 N (upper) and 3100 N (lower), and 1200 N (upper) and 1200 N (lower) in cases 1, 2, and 3, respectively. The AVA scoring system was mechanically verified using the accurate material constants of BKP cement. A multicenter survey and external validation are therefore required for the clinical implementation of the AVA score.
Brain radiotherapy and anlotinib control primary cardiac angiosarcoma with metastases: A case report
Authors: Ma Ying-Ying , Li Zhi-Ke , Liao Zi-Yi , Peng Yang , Zeng Li , Ma Dai-Yuan
Published: April 2024

Rationale:

Primary cardiac angiosarcoma (PCA) is a rare and fatal disease with a poor prognosis. Whether the survival of PCA patients can be prolonged with additional treatment following complete surgical excision is controversial.

Patient Concerns:

In this case study, a 52-year-old male complained of chest tightness and pain for 7 days before admission into the hospital. Subsequently, he revisited the hospital because of dizziness and headache.

Diagnoses:

Initially, the patient was diagnosed with PCA in the right atrium by thoracic computed tomography (CT). Palliative resection identified brain, lung, and liver metastases.

Intervention:

The patient accepted multimodal combination therapy, including first-line chemotherapy and then second-line anlotinib concurrent with brain radiotherapy and immunotherapy.

Outcome:

Although anlotinib combined with brain radiotherapy controlled the growth of intracranial lesions, progression-free survival (PFS) was only 5 months, and the overall survival (OS) was only 12 months.

Lesson:

The treatment for metastatic PCA needs an in-depth exploration.
Perforation of barium sulfate enterography in an infant: A case report
Authors: Lu Yixing , Mo Lixian , Chen Junhong , Peng Wei
Published: April 2024

Rationale:

Barium peritonitis is an inflammatory response that occurs when barium accidentally enters the abdominal cavity during a barium test. In extreme circumstances, it has the potential to harm various organs and even result in death.

Patient concerns:

A 3-month-old infant was diagnosed with multiple organ failure after severe barium peritonitis.

Diagnosis:

Multiple organ dysfunction is associated with barium peritonitis.

Interventions:

The infant underwent surgical intervention and received ventilator support, anti-infection therapy, myocardial nutrition, liver and kidney protection, rehydration, circulation stabilization, and other symptomatic supportive care.

Outcomes:

The patient experienced clinical death after treatment and resuscitation was unsuccessful.

Lessons:

Barium enema perforation complications are uncommon, but can lead to fatal injuries with a high mortality rate. This case highlights the importance of raising awareness among clinicians about the risks of gastroenterography in infants and children and actively preventing and avoiding similar serious complications. The mortality rate can be reduced by timely multidisciplinary consultation and joint management once a perforation occurs.
Adult obesity diagnostic tool: A narrative review
Authors: Liu Xiaolong , He Mengxiao , Li Yi
Published: April 2024

Obesity is a complex chronic metabolic disorder characterized by abnormalities in lipid metabolism. Obesity is not only associated with various chronic diseases but also has negative effects on physiological functions such as the cardiovascular, endocrine and immune systems. As a global health problem, the incidence and prevalence of obesity have increased significantly in recent years. Therefore, understanding assessment methods and measurement indicators for obesity is critical for early screening and effective disease control. Current methods for measuring obesity in adult include density calculation, anthropometric measurements, bioelectrical impedance analysis, dual-energy X-ray absorptiometry, computerized imaging, etc. Measurement indicators mainly include weight, hip circumference, waist circumference, neck circumference, skinfold thickness, etc. This paper provides a comprehensive review of the literature to date, summarizes and analyzes various assessment methods and measurement indicators for adult obesity, and provides insights and guidance for the innovation of obesity assessment indicators.
Continuing medical education for attending physicians in anesthesia: Feasibility of an innovative blended learning approach
Authors: Wang Tian , Zhou Yang , Xu Mao , Deng Ying
Published: April 2024

Continuing medical education plays a pivotal role in fostering and upholding the standard of excellence in medicine. Both SPOC (small private online course) and BOPPPS (bridge-in, learning objective, pretest, participatory learning, posttest, and summary) methodologies are rooted in the same educational and learning theories, emphasizing active student engagement, interaction, and feedback. Using ultrasound-guided spinal anesthesia as an exemplar, we aimed to investigate the feasibility of blended teaching (combination of BOPPPS and SPOC) for anesthesiology clinicians and explore trainees’ and trainers’ perspectives towards the innovative method. Twenty-seven attending anesthesiologists were randomly divided into experimental group (n = 14, blended teaching method) and control group (n = 13, traditional teaching method). The questionnaire was administered before and a week post-training. Their operative skills (measured by operation time) were assessed. The students’ cognitive evaluation of the blended teaching mode was conducted in the experimental group. The experimental group demonstrated notably higher theoretical scores compared to the control group [(46.42 ± 5.345) vs (41.92 ± 5.219), t = 2.213, P < .05]. The operation time in the experimental group was significantly shorter than that in the control group [(84.79 ± 28.450) seconds vs (114.23 ± 35.607) seconds, t = −2.383, P < .05]. Most participants preferred blended learning as it was more effective than traditional learning. Suggestions for enhancement included enhanced online interactivity with trainers and the inclusion of case analysis. Integration of blended teaching incorporating BOPPPS and SPOC methodologies holds promise for enhancing the efficiency of skill training among anesthesiologists. Blended learning may become a viable and well-received option among anesthesia clinicians in China.
Cerebrotendinous xanthomatosis with tremor as the main manifestation: A case report
Authors: Zhao Wei , Han Jie , Tao Dingbo , Zheng Hongliang
Published: April 2024

Introduction:

Cerebrotendinous xanthomatosis (CTX) is an autosomal recessive lipid metabolism disorder. It is caused by a defect in the sterol-27-hydroxylase gene, leading to the deposition of cholesteryl and bile alcohol in large amounts, causing a variety of clinical manifestations; however, tremor as the main manifestation of CTX has not been reported.

Patient’s concerns and clinical findings:

Herein, we report a 27-year-old woman, who developed head and body tremors at the age of 12 years. Many hospitals misdiagnosed her condition as idiopathic tremor and Parkinson disease, with a poor curative effect.

Primary diagnosis and intervention:

We diagnosed her with CTX and treated with chenodeoxycholic acid and clonazepam.

Conclusion:

The patient’s condition considerably improved. This case could help avoid misdiagnosis and mistreatment in clinical practice.
Diagnosis and treatment of malignant retroperitoneal mesothelioma: A case report
Authors: Tang Feihu , Cui Yong , Gao Yuan
Published: April 2024

Rationale:

Malignant peritoneal mesothelioma (MPM) is a rare clinical disease. Although there are several reports describing intraperitoneal mesothelioma of the lung, liver, and intestine, retroperitoneal mesothelioma is, to our knowledge, very rare and rarely reported. In recent years, our best clinical protocols for the treatment and diagnosis of retroperitoneal mesothelioma have not been proven and the diagnosis and treatment are challenging.

Patient concerns:

A 37-year-old Chinese woman complained of bilateral low back pain for a month, with obvious symptoms of low back pain on the left side. To treat low back pain, retroperitoneal masses were found during physical examination. The patient consulted a urological specialist for further treatment.

Diagnosis:

After the operation, pathological biopsy confirmed retroperitoneal epithelioid diffuse mesothelioma.

Interventions:

After exclusion of surgical contraindications, the patient underwent laparoscopic retroperitoneal lesion resection under tracheal intubation and general anesthesia, and the operation was successful.

Outcomes:

On the tenth day after surgery, the patient vital signs were stable, and he was discharged.

Lessons:

Patients with malignant peritoneal mesothelioma may have no typical clinical symptoms, and the diagnosis is based on pathological and immunohistochemical examination. In selected patients, surgical cell reduction and intraoperative intraperitoneal heat chemotherapy have become the first choice of treatment, which can achieve ideal therapeutic effects and prolong survival.
Acute puerperal uterine inversion with successful manual transvaginal repositioning: A case report
Authors: Gao Qianqian , Jiang Hong , Jia Mengmeng , Xiong Jinqiu
Published: April 2024

Rationale:

Uterine inversion is a rare medical condition that is categorized as puerperal and nonpuerperal. Repositioning of uterine involution can be done manually or surgically, the latter of which involves abdominal manipulation and disruption of the integrity of the uterine wall, which can lead to complications for the patient in subsequent pregnancies, such as uterine rupture.

Patient concerns:

We report a case of acute puerperal uterine inversion that was manually repositioned transvaginally. An ultrasonogram and reset schematic were also presented. A 23-year-old woman (gravida 1 para 0) was admitted to the hospital with a full-term pregnancy.

Diagnoses:

In the postpartum period, we found placental adhesions and uterine inversion into the uterine cavity, which was confirmed by bedside ultrasound.

Interventions and outcomes:

We administered analgesic, relieving uterine spasms, and antishock therapy along with manual stripping of the placenta and ultrasound-guided uterine repositioning. After successful repositioning the patient vaginal bleeding decreased rapidly and she was discharged 3 days after delivery.

Lessons:

Early recognition, antishock therapy and prompt repositioning are key in the management of puerperal uterine inversion. We hope that this case will enable clinicians to better visualize the ultrasound imaging of uterine inversion and the process of manual repositioning.
Hepatitis B Delta: assessment of the knowledge and practices of hepato-gastroenterologists practicing in non-academic settings in France
Authors: Cadranel Jean-François D. , Zougmoré Honoré T. , Efole Jean-René Ngele , Hanslik Bertrand , Causse Xavier , Rosa Isabelle , Lemaitre Caroline , Mokhtari Camélia , Baron Aurore , Thevenot Thierry , Medmoun Mourad , Smadhi Ryad , Fantognon Gildas , Remy André J. , Macaigne Gilles , Arondel Yves , Arpurt Jean-Pierre , Bellaiche Guy , Bourlière Marc , De Kerguenec Caroline , Heluwaert Frédéric , Verlynde Juliette , Halfon Philippe , Roulot Dominique , Carrier Paul , Loustaud-Ratti Véronique , Lemagoarou Tristan ,   ANGH and CREGG B-Delta Group
Published: April 2024

Background

Data on the management of Hepatitis B-Delta (HB-D) by hepatogastroenterologists (HGs) practicing in nonacademic hospitals or private practices are unknown in France.

Objective

We aimed to evaluate the knowledge and practices of HGs practicing in nonacademic settings regarding HB-D.

Methods

A Google form document was sent to those HGs from May to September 2021.

Results

A total of 130 HGs (mean age, 45 years) have participated in this survey. Among HBsAg-positive patients, Delta infection was sought in only 89% of cases. Liver fibrosis was assessed using FibroScan in 77% of the cases and by liver biopsy in 81% of the cases. A treatment was proposed for patients with >F2 liver fibrosis in 49% of the cases regardless of transaminase levels and for all the patients by 39% of HGs. Responding HGs proposed a treatment using pegylated interferon in 50% of cases, bulevirtide in 45% of cases and a combination of pegylated interferon and bulevirtide in 40.5% of cases. Among the criteria to evaluate the treatment efficacy, a decrease or a normalization of transaminases was retained by 89% of responding HGs, a reduction of liver fibrosis score for 70% of them, an undetectable delta RNA and HBsAg for 55% of them and a 2 log 10 decline in delta viremia for 62% of the cases.

Conclusion

Hepatitis Delta screening was not systematically performed in HBsAg-positive patients despite the probable awareness and knowledge of the few responders who were able to prescribe treatments of hepatitis delta.
Is there a relationship between somatosensory impairment and the perception of pain in stroke survivors? An exploratory study
Authors: Zahra Fatima-tul , Zoghi Maryam , Haslam Brendon , Carey Leeanne M.
Published: April 2024

Pain and somatosensory impairments are commonly reported following stroke. This study investigated the relationship between somatosensory impairments (touch detection, touch discrimination and proprioceptive discrimination) and the reported presence and perception of any bodily pain in stroke survivors. Stroke survivors with somatosensory impairment (N = 45) completed the Weinstein Enhanced Sensory Test (WEST), Tactile Discrimination Test, and Wrist Position Sense Test for quantification of somatosensation in both hands and the McGill Pain Questionnaire, visual analog scale and the Neuropathic Pain Symptom Inventory (NPSI) for reporting presence and perception of pain. No relationship was observed between somatosensory impairment (affected contralesional hand) of touch detection, discriminative touch or proprioceptive discrimination with the presence or perception of pain. However, a weak to moderate negative relationship between touch detection in the affected hand (WEST) and perception of pain intensity (NPSI) was found, suggesting that stroke survivors with milder somatosensory impairment of touch detection, rather than severe loss, are likely to experience higher pain intensity [rho = −0.35; 95% confidence interval (CI), −0.60 to −0.03; P = 0.03]. Further, a moderate, negative relationship was found specifically with evoked pain (NPSI) and touch detection in the affected hand (rho = −0.43; 95% CI, −0.72 to −0.02; P = 0.03). In summary, our findings indicate a weak to moderate, albeit still uncertain, association, which prevents making a definitive conclusion. Nevertheless, our findings contribute to our understanding of the complexities surrounding the experience of pain in survivors of stroke and provide direction for future studies.
Advance Care Planning
Authors: Kitt-Lewis Erin , Zheng Nanda , Loeb Susan J.
Published: April 2024

A person-centered approach to advance care planning is recognized as a fundamental need, yet its routine implementation remains a challenge across disparate settings, such as prisons. The purpose of this study was to gain the perspectives of people who are incarcerated about advance care planning. Four focus groups were conducted with people living in 1 men's and 1 women's state prison (n = 26). Handwritten field notes were taken, transcribed, deidentified, and verified before the completion of independent thematic analysis by 2 experienced qualitative researchers. Key themes regarding advance care planning were identified: components of advance care planning, initiation and continuation of advance care planning, barriers to implementing advance care planning, and facilitators to implementing advance care planning. Participants noted several key components related to the name, structure, and content of advance care planning programs. Insights about who should initiate the conversation, when to continue the conversation, and how to deliver education about advance care planning were obtained. Findings contribute to identifying best practices for infusing advance care planning into prisons. Best practices will inform the development of a toolkit of contextually relevant, person-centered approaches to advance care planning that are tailored to meet the unique needs of people who are incarcerated.
Vestibular Schwannoma Management: Patient Perspectives and Health Literacy
Authors: Casazza Julia A. , Yancey Kristen L. , Hunter Jacob B.
Published: April 2024

Objective:

To assess medical decision-making, reasons for attrition, and health literacy among vestibular schwannoma (VS) patients last seen in clinic more than 2 years ago.

Study Design:

Survey.

Setting:

Tertiary skull base center.

Patients:

Adults with sporadic VS last evaluated more than 2 years ago.

Methods:

Survey including Brief Health Literacy Screen (BHLS), a validated 3-question measure of health literacy, and open-ended questions on care; retrospective chart review.

Main Outcome Measures:

BHLS score, patient reasons for attrition.

Results:

Of 1011 patients contacted, 205 (20.3%) patients responded and met all criteria for analysis. At initial evaluation, mean patient age was 50.6 ± 12.8 years, roughly half (51.4%) were female, and the majority (80.2%) identified as White. At the time of the survey, 48 (23%) continued to observe their tumor. The remaining 160 (76.9%) patients previously underwent treatment (surgery and/or radiation). Of those treated, 34 (21.3%) underwent intervention elsewhere. Symptoms since the last patient visit did not differ between observed and treated patients. About 94.7% of the cohort displayed high health literacy (BHLS > 9), though rates of inadequate health literacy were higher among observed patients (12.5% versus 3.1% in those treated). The most common reasons for opting not to follow-up included counseling issues, personal decisions, and social/life stressors (including the COVID-19 pandemic).

Conclusions:

Despite being a highly health-literate cohort, patients cited multiple reasons for attrition. Regardless of whether they were observed or treated, patients described follow-up visits as burdensome and perceived them to be of minimal benefit.
Visual performance of optical films utilizing Spatio-Temporal Optical Phase technology
Authors: Fedtke Cathleen , Tilia Daniel , Ehrmann Klaus , Diec Jennie , Lahav-Yacouel Karen , Falk Darrin , Bakaraju Ravi C.
Published: April 2024

SIGNIFICANCE

Spatio-Temporal Optical Phase technology utilizes film pairs containing optical elements applied to standard single-vision spectacle lenses. This technology provides a dynamic optical cue that may have efficacy in reducing the rate of myopia progression, but the visual performance of this technology is unknown.

PURPOSE

This study aimed to assess the visual performance of film pairs containing optical elements (tests) and a film pair with no optical elements (control).

METHODS

In this randomized, single-masked, bilateral wear study, 42 participants aged 18 to 40 years wore four test designs (E, F-1, G, and F-2) and the control. Subjective data (subjective ratings [1 to 10 scale]: clarity of vision [far-away, intermediate, near] and vision [at night, while walking, overall satisfaction], and willingness to purchase [yes/no response]) were collected after 3 days. Visual acuity (VA)–based measures (monocular high/low-contrast VA [6 m], contrast sensitivity [6 m], and binocular high-contrast VA [6 m and 40 cm]) were collected at dispensing. Visual acuity–based measures were also collected while wearing spectacles with no film. Analyses were performed using linear mixed models and the χ
2 test. Significance was set at 5%.

RESULTS

The control performed better than any test for all subjective ratings (mean differences, 1.6 to 3.1 units: p<0.001), willingness to purchase (p<0.001), and designs F-1 and F-2 for binocular high-contrast VA at 40 cm (p=0.001 and p=0.01, respectively). Clarity of vision was significantly worse with F-2 compared with F-1 and G (p<0.001 and p=0.02, respectively). There were no differences between tests for any other subjective rating (p>0.1), willingness to purchase (p=0.11), or any VA-based measure (p>0.08). There were no differences between control and spectacles with no film for any VA-based measure (p>0.08).

CONCLUSIONS

All four test film pairs reduced visual performance compared with control to a degree comparable with other myopia management devices. There was no difference in visual performance between three of the four test film pairs.
Infantile nystagmus syndrome: An observational, retrospective, multicenter study
Authors: Fossataro Claudia , Pafundi Pia Clara , Mattei Roberta , Cima Valentina , De Rossi Francesca , Savino Gustavo
Published: April 2024

SIGNIFICANCE

This multicenter study assessed clinical and psychological aspects of infantile nystagmus syndrome (INS) focusing on its management and nonsurgical treatment.

PURPOSE

This study aimed to assess clinical features, management, relationship life, and psychological impact in a group of patients with nystagmus onset in pediatric age.

METHODS

This observational study included patients diagnosed with INS referred to two Italian centers from January 1, 2017, to December 31, 2020. Ophthalmologic and orthoptic features and impact of visual function on quality of life, according to nystagmus-specific nystagmus quality of life questionnaire, were analyzed within the overall sample and in any of INS subgroups.

RESULTS

Forty-three patients were included; 65.1% of them had idiopathic INS (IINS), and 34.9% had INS associated with ocular diseases (INSOD). The median age was 15.4 years (interquartile range [IQR], 10.4 to 17.3 years), significantly different between groups (median, 15.8 years among those with IINS vs. 12.3 years among those with INSOD; p<0.001). In the INSOD subgroup, strabismus was significantly more prevalent (93.3 vs. 57.1%; p=0.017). Binocular distance best-corrected visual acuity in primary position was significantly higher in the IINS subsample (p<0.001). Such behavior was further confirmed at anomalous head position evaluation (p<0.001). At near best-corrected visual acuity assessment, differences between groups were more remarkable in primary position (p<0.001) than in anomalous head position. Contrast sensitivity showed significantly higher values in the IINS subgroup (p<0.001). The nystagmus quality of life questionnaire disclosed a significantly lower score in IINS as compared with INSOD (median total score, 90.5 [IQR, 84 to 97] vs. 94 [IQR, 83.0 to 96.5]; p<0.001).

CONCLUSIONS

The IINS group showed significantly better ophthalmologic and orthoptic outcomes than the INSOD group. The psychological and quality-of-life impact was instead significantly greater in the IINS group. To the best of our knowledge, this is the first multicenter study investigating the clinical features of IIN and comparing the two main subgroups, IINS and INSOD.
The Grading System for Lung Adenocarcinoma: Brief Review of its Prognostic Performance and Future Directions
Authors: Mantilla Jose G. , Moreira Andre L.
Published: April 2024

Histologic grading of tumors is associated with prognosis in many organs. In the lung, the most recent grading system proposed by International association for the Study of Lung Cancer (IASLC) and adopted by the World Health Organization (WHO) incorporates the predominant histologic pattern, as well as the presence of high-grade architectural patterns (solid, micropapillary, and complex glandular pattern) in proportions >20% of the tumor surface. This system has shown improved prognostic ability when compared with the prior grading system based on the predominant pattern alone, across different patient populations. Interobserver agreement is moderate to excellent, depending on the study. IASLC/WHO grading system has been shown to correlate with molecular alterations and PD-L1 expression in tumor cells. Recent studies interrogating gene expression has shown correlation with tumor grade and molecular alterations in the tumor microenvironment that can further stratify risk of recurrence. The use of machine learning algorithms to grade nonmucinous adenocarcinoma under this system has shown accuracy comparable to that of expert pulmonary pathologists. Future directions include evaluation of tumor grade in the context of adjuvant and neoadjuvant therapies, as well as the development of better prognostic indicators for mucinous adenocarcinoma.
Fidelity in Academic Global Surgery and Research: Incorporating Trustworthiness in the Development of Research Partnerships, Infrastructure, and Policy
Authors: Sherif Youmna A , Erdene Sarnai , Khan Lubna , Rosengart Todd K , Asturias Simons Sabrina Marie , Davis Rachel W , Philipo Godfrey Sama
Published: April 2024

Academic global surgery consists of collaborative partnerships that address surgical inequities through research, training, education, advocacy, and diplomacy. It has been characterized by increased scholastic production through global surgery publications, dedicated global surgery sessions within scientific conferences, global surgery-specific research grants, database development to support global surgery research, global surgery research fellowships, and global surgery-based academic promotion paradigms. The increased emphasis on global surgery research has been accompanied by multiple ethical challenges. This article reviews critical ethical dilemmas presented by global surgery research efforts and proposes interventions on the partnership, infrastructural, and policy levels to enhance fidelity within research partnerships.
Hollow-fibre infection model: adaptations for the culture and assessment of fastidious organisms
Authors: Mead Andrew , Azzariti Stefano , Pelligand Ludovic
Published: April 2024

The Hollow-fibre Infection Model (HFIM) is a valuable in vitro platform for emulating antimicrobial drug (AMD) pharmacokinetic (PK) profiles. Despite its potential, standardized protocols for HFIM operation, especially concerning fastidious organisms, are lacking. This study addresses this gap by examining challenges in culturing Pasteurella multocida and Actinobacillus pleuropneumoniae, two fastidious organisms, in the HFIM.
Our findings reveal effective strategies to prevent system clogging, involving multiple freeze-thaw cycles of horse blood, centrifugation, and cell straining to enhance the clarity of the Mueller-Hinton fastidious (MH-F) medium defined by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Clinical and Laboratory Standards Institute (CLSI). Additionally, we propose that the provision of a CO2 atmosphere, along with the utilization of gas-permeable tubing and gas vent filters, significantly facilitates the growth of fastidious organisms. Remarkably, both P. multocida and A. pleuropneumoniae were sustained for a period of up to 10 days under these optimized conditions.
This study provides crucial insights into the modifications necessary to successfully culture fastidious organisms in the HFIM, paving the way for more accurate and representative in vitro models for antimicrobial drug testing. These advancements hold promise for advancing research in the field of antimicrobial pharmacokinetics and efficacy against challenging pathogens.
Evaluation of optimal agar medium for detecting hypervirulent Klebsiella pneumoniae using string test
Authors: Watanabe Naoki , Masuda Akari , Watari Tomohisa , Otsuka Yoshihito , Yamagata Kazufumi , Fujioka Miyuki
Published: April 2024

1. Abstract

The string test is a screening method for detecting hypervirulent Klebsiella pneumoniae (hvKp). Agar media are typically used for string test; however, the effect of media type on the test results remains unclear. We aimed to determine the optimal agar medium and cutoff value for the string test. We tested the string test for 99 Klebsiella strains using different agar media: sheep blood, chocolate, Drigalski's, and MacConkey. Diagnostic accuracy was calculated in concordance with the rmpA, rmpA2, or iuc gene levels. The diagnostic accuracy rates for sheep blood, chocolate, Drigalski's, and MacConkey agar were 0.79, 0.75, 0.73, and 0.64, respectively. When the cutoff was changed from 5 mm to 10 mm, the diagnostic accuracy rate for sheep blood agar decreased from 0.79 to 0.65. Our findings suggest that agar medium type affect the string test results and sheep blood agar with a cutoff of 5 mm is the optimal condition for detecting hvKp.