bluuebunny/crossref_metadata_2025 huggingface dataset:
The downregulation of HSP90‐controlled CRALBP expression is associated with age‐related vision attenuation
Authors: Chen Dan‐Dan , Liu Baixue , Wang Yuxuan , Jiang Mingjun , Shang Guohui , Xue Mengjiao , Jia Xiaolin , Lang YouFei , Zhou Guiling , Zhang Fengyan , Peng Xuyan , Hu Yanzhong
Published: February 2023

The dysfunction of CRALBP, a key regulator of the visual cycle, is associated with retinitis punctata albescens characterized by night vision loss and retinal degeneration. In this paper, we find that the expression of CRALBP is regulated by heat shock protein 90 (HSP90). Inhibition of HSP90α or HSP90β expression by using the CRISPR‐Cas9 technology downregulates CRALBP's mRNA and protein expression in ARPE‐19 cells by triggering the degradation of transcription factor SP1 in the ubiquitin–proteasome pathway. SP1 can bind to CRALBP's promoter, and inhibition of SP1 by its inhibitor plicamycin or siRNA downregulates CRALBP's mRNA expression. In the zebrafish, inhibition of HSP90 by the intraperitoneal injection of IPI504 reduces the thickness of the retinal outer nuclear layer and Rlbp1b mRNA expression. Interestingly, the expression of HSP90, SP1, and CRALBP is correlatedly downregulated in the senescent ARPE‐19 and Pig primary RPE cells in vitro and in the aged zebrafish and mouse retinal tissues in vivo. The aged mice exhibit the low night adaption activity. Taken together, these data indicate that the HSP90‐SP1 is a novel regulatory axis of CRALBP transcriptional expression in RPE cells. The age‐mediated downregulation of the HSP90‐SP1‐CRALBP axis is a potential etiology for the night vision reduction in senior people.
Local glucose elevation activates pyroptosis via NLRP3 inflammasome in ovarian granulosa cells of overweight patients
Authors: Xu Rui , Zhao Hanting , Qi Jia , Yao Guangxin , He Yaqiong , Lu Yao , Zhu Qinling , Wang Yuan , Ding Ying , Zhu Zhenyi , Li Xinyu , Vankelecom Hugo , Sun Yun
Published: February 2023

Overweight, with an increasing prevalence worldwide, significantly impairs the clinical outcomes following in vitro fertilization (IVF). Hyperglycemia, hyperlipidemia, and metabolic disorders are always accompanied by the majority of overweight patients. The association between granulosa cell function and metabolic alterations in follicular fluid including lipids, proteins, and growth factors has been extensively documented. However, the effects of higher glucose level on ovarian granulosa cells (GCs), remain largely unknown. In this study, we identified that overweight women had elevated follicular glucose level which profoundly activated NLRP3 inflammasome and pyroptosis. An in vitro correlation between follicular high glucose, NLRP3 inflammasome and pyroptosis was also established. More importantly, in granulosa cells of overweight patients, the activation of the NLRP3 inflammasome and pyroptosis induced by high glucose was involved in the dysregulation of estradiol synthesis. Our study may provide new options to interpretate and improve IVF outcomes in overweight women.
The impact of COVID-19 on the social media practices of orthopaedic surgery residency programs
Authors: Ohnoutka Cole J. , Oladeji Lasun O. , Cherian Nathan J. , Hogan Daniel W. , Crist Brett D.
Published: February 2023

Background:

Social media is a robust outreach tool that allows programs to outreach with prospective applicants while maintaining social distancing policies. The purpose of this study was to evaluate how the COVID-19 pandemic influenced the social media practices of ACGME accredited orthopaedic surgery residency programs.

Methods:

An analysis of orthopaedic surgery residency social media accounts was performed to identify changes in practices from July 2019 to December 2020. Social media participation was analyzed with respect to program type, location, size, geographical location, and Doximity ranking.

Results:

A total of 194 residency programs were included in this study. Twitter accounts increased from 56 (28.9%) in December 2019 to 87 (44.8%) in January 2021 while Instagram accounts increased from 16 (8.2%) to 107 (55.2%). Allopathic programs, programs with a higher Doximity Reputation Ranking, and those with more than 35 residents were significantly more likely to have an Instagram or Twitter account (P<0.05). There was a significant increase in the average number of Instagram posts per month in July and September 2020 (P<0.05) 2020 as compared to the same period in 2019.

Conclusions:

There was an increase in the prevalence of orthopaedic residency social media accounts during the Covid pandemic. Allopathic programs, programs with a higher Doximity Reputation Ranking, and larger programs were more likely to utilize social media. Social media offers another avenue for programs to communicate with applicants and an increasing number of programs are harnessing this tool to connect with the next generation of orthopaedic surgeons.

Level of Evidence:

Level IV.
Proximal row carpectomy of the wrist in the setting of midcarpal arthritis: Survivorship and associated complications in soft tissue interposition versus capitate resurfacing
Authors: Cheng Christopher , Acuña Alexander J. , Wang Joanne H. , Malone Kevin J.
Published: February 2023

Background:

Proximal row carpectomy (PRC) has been shown to be an effective treatment option for early stages of wrist arthritis. In the presence of midcarpal arthritis however, PRC has generally been contraindicated due to a high conversion rate to total wrist arthrodesis. Variations to PRC, including radio-capitate soft tissue interposition and capitate resurfacing, have been introduced to delay conversion and have demonstrated similar outcomes compared to standard PRC. Comparative outcomes between these technical variations have not been investigated however.

Methods:

Retrospective chart review was conducted for patients who underwent PRC with interposition or capitate resurfacing from 2009-2019. Patient demographics, pre- and post-operative range of motion, operative time, cost, and post-operative complications were collected. Descriptive statistics were expressed as means and standard deviations. Survivability was plotted on a Kaplan-Meier survival curve.

Results:

Final cohorts included ten patients who underwent PRC with interposition and six who underwent PRC with resurfacing. Resurfacing had longer average operative duration (51.3±18.3 vs. 79.0±16.5 min, P=0.009) and higher cost ($29,116±10,036 vs. $15,290±3,743, P=0.028). There was no significant difference in wrist ROM. Two of the six patients who underwent resurfacing experience complications requiring conversion to total wrist arthrodesis, however there was no significant difference in overall survivorship.

Conclusions:

In this observational comparative study, PRC with capitate resurfacing trended towards longer operative time, increased cost, and higher complication and conversion rate. Future larger and more standardized analyses are needed in order to evaluate the long-term outcomes of these procedures.

Level of Evidence:

Level IV – Case Series.
Persistently Elevated Soluble Triggering Receptor Expressed on Myeloid Cells 1 and Decreased Monocyte Human Leucocyte Antigen DR Expression Are Associated With Nosocomial Infections in Septic Shock Patients
Authors: Venet Matthieu , Bidar Frank , Derive Marc , Delwarde Benjamin , Monard Céline , Hengy Baptiste , Jolly Lucie , Rimmelé Thomas , Lukaszewicz Anne-Claire , Monneret Guillaume , Venet Fabienne
Published: February 2023

OBJECTIVES:

Sepsis-acquired immunosuppression may play a major role in patients’ prognosis through increased risk of secondary infections. Triggering receptor expressed on myeloid cells 1 (TREM-1) is an innate immune receptor involved in cellular activation. Its soluble form (sTREM-1) has been described as a robust marker of mortality in sepsis. The objective of this study was to evaluate its association with the occurrence of nosocomial infections alone or in combination with human leucocyte antigen-DR on monocytes (mHLA-DR).

DESIGN:

Observational study.

SETTING:

University Hospital in France.

PATIENTS:

One hundred sixteen adult septic shock patients as a post hoc study from the IMMUNOSEPSIS cohort (NCT04067674).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Plasma sTREM-1 and monocyte HLA-DR were measured at day 1 or 2 (D1/D2), D3/D4, and D6/D8 after admission. Associations with nosocomial infection were evaluated through multivariable analyses. At D6/D8, both markers were combined, and association with increased risk of nosocomial infection was evaluated in the subgroup of patients with most deregulated markers in a multivariable analysis with death as a competing risk. Significantly decreased mHLA-DR at D6/D8 and increased sTREM-1 concentrations were measured at all time points in nonsurvivors compared with survivors. Decreased mHLA-DR at D6/D8 was significantly associated with increased risk of secondary infections after adjustment for clinical parameters with a subdistribution hazard ratio of 3.61 (95% CI, 1.39–9.34;p= 0.008). At D6/D8, patients with persistently high sTREM-1 and decreased mHLA-DR presented with a significantly increased risk of infection (60%) compared with other patients (15.7%). This association remained significant in the multivariable model (subdistribution hazard ratio [95% CI], 4.65 [1.98–10.9];p< 0.001).

CONCLUSIONS:

In addition to its prognostic interest on mortality, sTREM-1, when combined with mHLA-DR, may help to better identify immunosuppressed patients at risk of nosocomial infections.
A Rapid Response Team (RRT) System at a Cancer Center
Authors: Buchholz Tara , Barzola Melissa , Tayban Yekaterina , Halpern Neil A
Published: February 2023

The Rapid Response Team (RRT) system at Memorial Sloan Kettering Cancer Center led by critical care medicine (CCM) advanced practice providers (APPs) expanded exponentially between 2009 and 2021. CCM-APPs are trained for care of critically ill patients as well as to oversee rapid response calls. The RRT is composed of a CCM-based RRT-APP, respiratory therapist, RRT-RN, and nursing supervisor. Since program inception, 11 RRT pathways and interventions have been developed and adjusted to improve multidisciplinary patient management. Pathways vary in complexity and require multidisciplinary collaboration. In some circumstances, the RRT patient may require transfer to outside facilities for services not provided at our oncology-based facility. RRT data are tracked across the hospital continuum with on-line reporting through RRT website dashboards. 2021 RRT data on electronic sepsis alerts, behavioral RRT and stroke alerts are presented. The RRT program is monitored through robust quality assurance. The APP-led RRT system's scope of care has been continuously expanded through the creation of RRT pathways to meet the increasingly complex medical needs of our patients.
A Multidisciplinary Approach to Increase Compliance With Spontaneous Awakening Trials and Spontaneous Breathing Trials in the Medical Intensive Care Unit
Authors: Jones Nicole , Shivji Rozmeen
Published: February 2023

Prolonged mechanical ventilation can lead to undesirable outcomes, including reduced 6-month survival, increased hospital mortality, intensive care unit (ICU) length of stay, and physiological stress. A large academic medical center currently has a Spontaneous Awakening Trials/Spontaneous Breathing Trials (SAT/SBT) protocol with an SAT/SBT compliance goal of 80%; however, the medical intensive care unit's (MICU) SAT/SBT compliance rate was only 33% for FY2020. The Define-Measure-Analyze-Improve-Control (DMAIC) framework was used to guide this quality improvement project. Current processes and root causes for noncompliance were analyzed through chart reviews, a preimplementation staff survey, and meetings with stakeholders. Compliance rates were compared before and after implementation. Interventions included education, reminder fliers, weekly chart audits, and individualized weekly emails to noncompliant RNs and RTs. To achieve project sustainability, 2 unit champions were selected to continue the weekly emails and chart audits. Data were collected from 216 patients and 1063 patient ventilator days from October 2020 to October 2021. The SAT/SBT compliance steadily increased throughout the 13-month implementation period, except for 3 months. The preimplementation monthly SAT/SBT compliance rate was 26% in September 2020. After 13 months of project implementation, the SAT/SBT compliance rate was 64% in October 2021. There was no significant change in patient ventilator days pre– and post–quality improvement project. A multi-intervention implementation strategy consisting of education in-services, weekly chart audits, weekly emails to staff with current compliance rates, and reminder fliers can successfully increase SAT/SBT compliance rates. Utilizing unit champions provides sustainability.
Nonalcoholic Fatty Liver Disease and Cardiovascular Disease: Causation or Association
Authors: Bali Atul D. , Rosenzveig Akiva , Frishman William H. , Aronow Wilbert S.
Published: February 2023

Nonalcoholic fatty liver disease (NAFLD) is a disease process that is gaining increasing recognition. The global prevalence of NAFLD is increasing in parallel with growing rates of risk factors for NAFLD such as hypertension, obesity, diabetes, and metabolic syndrome. NAFLD has been referred to as a risk factor for cardiovascular disease (CVD). As CVD is the leading cause of morbidity and mortality worldwide, there are constant efforts to describe and alleviate its risk factors. Although there is conflicting data supporting NAFLD as a causative or associative factor for CVD, NAFLD has been shown to be associated with structural, electrical, and atherosclerotic disease processes of the heart. Shared risk factors and pathophysiologic mechanisms between NAFLD and CVD warrant further explication. Pathologic mechanisms such as endothelial dysfunction, oxidative stress, insulin resistance, genetic underpinnings, and gut microbiota dysregulation have been described in both CVD and NAFLD. The mainstay of treatment for NAFLD is lifestyle intervention including physical exercise and hypocaloric intake in addition to bariatric surgery. Investigations into various therapeutic targets to alleviate hepatic steatosis and fibrosis by way of maintaining the balance between lipid synthesis and breakdown. A major obstacle preventing the success of many pharmacologic approaches has been the effects of these medications on CVD risk. The future of pharmacologic treatment of NAFLD is promising as effective medications with limited CVD harm are being investigated.
Compassionate Care Within Early Intervention Caregiver Coaching
Authors: D'Agostino Sophia R. , Douglas Sarah N. , Meadan Hedda
Published: February 2023

The practice of coaching caregivers requires early intervention (EI) providers to build relationships using compassionate care while implementing coaching practices to increase outcomes for caregivers and children. Coaching with compassion is highly valued and studied within other disciplines, yet investigations focused on interpersonal skills within the field of EI are just emerging. With the rise of families enrolled in Part C programs along with the increasing emphasis of caregiver coaching, it is critical to explore the approach of coaching with compassion. The aim of this study was to examine EI providers' perceptions and reported use of compassionate care competencies within caregiver coaching. We report findings from an online questionnaire that contained closed and open-ended questions. The results of this study indicate that most compassionate care competencies were ranked highly whereas some were not implemented as often and EI providers reported less confidence in using them. Early intervention providers also identified benefits and challenges to implementation. In addition, EI providers noted the importance of integrating compassionate care competencies into the practice of caregiver coaching. Results provide critical insights related to including compassionate care competencies into preparation for EI providers. Training recommendations and resources for EI providers are discussed.
Interventional Pulmonology Productivity, Compensation, and Practice Benchmarks
Authors: Wahidi Momen M. , Lamb Carla R. , Kovitz Kevin , Keyes Colleen , Bechara Rabih , Giovacchini Coral X. , French Kim , Shojaee Samira , Musani Ali , Eapen George , Ost David E.
Published: February 2023

Background:

Interventional pulmonology (IP) is a growing field that has not yet been recognized by the American Board of Medical Specialties or incorporated into national benchmark organizations. As a result, there is a lack of data on IP practice patterns, physicians’ compensation and productivity targets.

Methods:

We sent an anonymous survey to 647 current or past physician members of the AABIP. Domains included demographics, training background, academic rank, practice settings, work relative value unit (wRVU) targets, salary, and career satisfaction.

Results:

The response rate to the survey was 28.3%; 17.8% were female. The median salary for IP faculty in academic institutions was $320,000 for assistant professors, $338,000 for associate professors, and $350,000 for full professors. Salaries were lower for women than for men in academic practice, even after adjusting for the number of years in practice (mean salary difference after adjustment $57,175, 95% CI: $19,585-$94,764, P=0.003). The median salary for private practice was higher at $428,000. Among respondents that used wRVU targets, the median targets for academic and private practice were 5500 and 6300, respectively. The majority of IP physicians are satisfied with their career choice.

Conclusions:

Productivity targets in IP are used less than half the time, and when they are used, they are set in line with the lower wRVU of IP procedures. IP compensation is higher than that of general pulmonary medicine, as reported by national benchmark associations. In academic practices, gender differences in salaries were found.
Hypoalbuminemia and colorectal cancer patients: Any correlation?: A systematic review and meta-analysis
Authors: Christina Natalia Maria , Tjahyanto Teddy , Lie Jason Gunawan , Santoso Tiffanie Almas , Albertus Hans , Octavianus Daniel , Putri Derby Ayudhia Utami Iskandar , Andrew Johanes , Jatinugroho Yusuf Damar , Shiady Christian , Wijaya Jeremiah Hilkiah
Published: February 2023

Background:

In malnourished patients with colorectal cancer, hypoalbuminemia is common and was proposed to determine the postoperative outcome of colorectal surgery. Mounting articles published but have not been evaluated. We aim to assess the predictive value of preoperative hypoalbuminemia in patients undergoing colorectal surgery.

Methods:

We performed a literature search from PubMed, Euro PMC, and Cochrane with the terms serum albumin, hypoalbuminemia, prognosis, outcome, colorectal cancer, and neoplasm. We also hand-searched and included any relevant papers. Hypoalbuminemia is defined as plasma albumin level < 3.5 mg/dL. We restricted the included studies to English language and adults undergoing colectomy, laparotomy, laparoscopy, or abdominoperineal resection. Any types of articles were included, except an abstract-only publication and those that did not report the key exposure or outcome of interest. The key exposures were mortality, hospitalization time, and morbid conditions (thrombosis, surgical site infection, sepsis, and wound events). We pooled the odds ratio from each included literature as effect size. The Newcastle Ottawa scale and GRADE were used to determine the quality of each included study.

Results:

Hereof 7 observational studies (236,480 individuals) were included. Our meta-analysis found that preoperative hypoalbuminemia can predict the postoperative outcome in colorectal cancer patients. Individuals with hypoalbuminemia were not associated with 30-day mortality (risk ratio [RR] 2.05 [0.72, 5.86], P = .18, I
2 = 99%) but were associated with morbidity (RR 2.28 [1.78, 2.93], P < .00001, I
2 = 87.5%), surgical complication (RR 1.69 [1.34, 2.13], P < .00001, I
2 = 98%), and hospitalization (RR 2.21 [1.93, 2.52], P < .00001, I
2 = 0%). According to newcastle ottawa scale, the included studies are of moderate to sound quality.

Conclusions:

The current systematic review and meta-analysis showed that preoperative hypoalbuminemia was significantly associated with morbidity, length of stay, and surgical complication but not mortality.
Relationship between periodontal disease and dizziness in Taiwanese adults: A nationwide population-based cohort study
Authors: Huang Fu-Mei , Luo Ci-Wen , Lee Shiuan-Shinn , Ho Yung-Chuan , Li Yi-Ching , Chang Yu-Chao , Kuan Yu-Hsiang
Published: February 2023

Periodontal disease is often neglected and overlooking its initial symptoms can lead to tooth loss and systemic diseases. Patients with otitis media are at high risk of vestibular and balance dysfunction, consequently, and vertigo. Vertigo and dizziness are conditions with high reported incidences; they worsen with age and can burden health systems. The present study investigated whether periodontal disease causes dizziness. Research data covering 2008 through 2013 were retrieved from the National Health Insurance Research Database of Taiwan. Patients who were newly diagnosed as having periodontal disease or dizziness after at least 1 hospital admission or 3 outpatient visits were enrolled as participants. For our controls, we randomly selected individuals without periodontal disease who were sex- and age-matched with the investigated participants. In total, we enrolled 445 patients with periodontal disease and 1780 controls. The Kaplan–Meier curve indicated that the cumulative incidence of dizziness was significantly higher among the patients with periodontal disease relative to the controls. After adjustment for sex, age, income level, urbanization level, month of onset, and comorbidities, Cox proportional-hazards analysis revealed that patients with periodontal disease had an increased risk of dizziness (hazard ratio [HR]: 1.306, 95% confidence interval (CI): 1.155, 1.475). Compared with the controls, the risk of dizziness among patients with periodontal disease was higher for both female (HR: 1.439, 95%: 1.203, 1.720) and male patients (HR: 1.284, 95%: 1.123, 1.468); this risk was higher even when January (HR: 1.302, 95% CI: 1.145, 1.480), February (HR: 1.337, 95% CI: 1.178, 1.518), or March was excluded (HR: 1.308, 95% CI: 1.151, 1.487) and for patients without Ménière disease. Therefore, periodontal disease is not only a risk factor for dizziness but also an independent risk factor for dizziness. Future studies could clarify the mechanisms linking periodontal disease to dizziness.
Cognitive decline sensitivity by educational level and residential area: A descriptive study using long-term care insurance dementia registration data in South Korea
Authors: Park Dougho , Jang Chan Woong , Cho Han Eol , Kim Jong Hun , Kim Hyoung Seop
Published: February 2023

In South Korea Long-Term Care Insurance (LTCI) system, the special dementia rating (SDR) is a registration grading for dementia patients who do not have a physical disability or functional restrictions and is the first applicable registration following the diagnosis of dementia. We investigated the differences in age of registration of SDR and age of dementia diagnosis according to the educational level and residential area. This was a retrospective, cross-sectional study using the Korean National Health Insurance Service dataset. Applications for SDR between July 2014 and December 2016 were identified for participant selection, and 32,352 patients with dementia were included. Educational levels were defined as follows: the illiterate, only-reading, 1 to 6 years, 6 to 12 years, and ≥12 years. Urban residents were those who lived in the city, as ascertained from the Korean administrative district system. The primary outcomes were ages at the time of dementia diagnosis and SDR registration. A lower education level significantly correlated with a higher proportion of older adults, but a higher number of years of education significantly increased with the proportion of males and urban residents (P < .001 for all). A higher education level was inversely associated with the age at diagnosis of dementia (P < .001) and at the registration of SDR (P < .001). Urban residents were diagnosed with dementia at a significantly lower age and registered for SDR earlier than rural residents (P < .001 for both). Both urban and rural residents consistently showed that a higher educational level was associated with lower age at the dementia diagnosis and SDR registration. Patients who were highly educated and living in urban areas were diagnosed with dementia and registered on SDR when they were relatively younger, indicating that cognitive decline sensitivity and medical accessibility are related to earlier dementia diagnosis and registration.
An algorithmic approach of reconstruction for cranioplasty failure: A case series
Authors: Wang Yu-Chi , Wu Yi-Chia , Chang Chao-Wei , Chung Chia-Li , Lee Su-Shin
Published: February 2023

Rationale:

Cranioplasty is a surgical procedure used to repair cranial defects for both cosmetic and functional reasons. The complication rate of cranioplasty is between 10% and 50%. The failure of cranioplasty is associated with various factors, including etiologies, types of material, and the timing of cranioplasty. In this study, a case series of managing cranioplasty complications at a single institution.

Patient concerns:

Eighteen patients were identified who underwent craniofacial defect reconstruction due to the failure of their initial cranioplasty between January 2010 and May 2020. Five men (27.78%) and thirteen women (72.22%) were included. The mean age was 39.61 years old. The average follow-up duration was 5.94 years.

Diagnoses:

The indication for initial cranioplasty included previous decompressive craniectomy (77.78%, n = 14), traumatic cranial defects (16.67%, n = 3), and congenital cranial deformity (5.56%, n = 1). The reported complications were infection (50%, n = 9), implant exposure (50%, n = 9), wound dehiscence (22.22%, n = 4) and cranial deformity (11.11%, n = 2).

Interventions:

More than half of the materials used for initial cranioplasty were synthetic [titanium mesh: 44.44%, n = 8; polymethyl metacrylate: 5.56%, n = 1; titanium mesh and polymethyl metacrylate: 5.56%, n = 1], while 44.44% of the patients received autologous bone graft.

Outcomes:

Of all reconstructive procedures for cranioplasty failure, 55.56% was local flap with or without skin graft (n = 10), 16.67% was free flap (n = 3), 11.11% was skin graft only (n = 2), 5.56% was regional flap (n = 1). The free flap survival rate was 100% (3/3), and implant removal with sebsquent second cranioplasty was performed on 27.78% (n = 5) of the patients.

Lessons:

Management of cranioplasty failure can be challenging due to infection, refractory implant exposure, and wound dehiscence. The principles of management are based on adequate infection control and reconstructive ladder. Meanwhile, collaboration with plastic surgery and neurosurgery should be strengthened in order to achieve the best clinical outcomes.
Full recovery of lung tissue after severe viral pneumonia H1N1: A case report with 10 years follow-up
Authors: Kočan Ladislav , Firment Jozef , Pirníková Ingrid , Farkašová Iannaccone Silvia , Rybár Dušan , Gnoriková Juliána , Korček Ján , Kočanová Hana , Török Pavol , Rapčanová Simona , Vašková Janka
Published: February 2023

Rationale:

World healthcare frequently faced severe viral pneumonia cases in the last decades, due to pandemic situations such as H1N1, MERS-CoV, and SARS-COVID-19.

Patient concerns:

The impact of viral infection on lung structure, lung function, and overall mortality was significant. The quality of life and assumed life expectancy was decreased with the supposed development of lung fibrosis in involved survived patients.

Diagnoses:

We described the course and treatment of severe pneumonia H1N1 in a 30-year-old patient.

Interventions:

Patient was included in a study regarding the therapeutic efficacy of selenium ClinicalTrials.gov ID: NCT02026856 with 10 years follow-up with concurrently documented X-ray lung examinations and final histology of lung tissue after sudden death.

Outcomes:

All sequential examinations and histological findings show a healing trend with the final full recovery of lung tissue.
3D reconstruction of a gallbladder duplication to guide LC: A case report and literature review
Authors: Ye Yong Qing , Liang Qing , Li En Ze , Gong Jing Lin , Fan Jing Ming , Wang Ping
Published: February 2023

Rationale:

Gallbladder duplication is a congenital aberration of the biliary tree, which is rarely encountered in the abdomen. It is a challenge that can be encountered by surgeons and is associated with an increased risk of complications after cholecystectomy. More than 50% of gallbladder duplication cases were undetected on preoperative traditional imaging. In this study, a case of gallbladder duplication in a patient with mild abdominal pain detected using preoperative 3-dimensional (3D) reconstruction of the gallbladder was described for the first time.

Patient concerns and diagnosis:

We present a case of gallbladder duplication in a 32-year-old man who was referred to our hospital for recurrent right upper quadrant abdominal pain without any other significant history.

Interventions and outcomes:

He underwent a 3D reconstruction technique as a supplement for gallbladder duplication that could not be diagnosed using magnetic resonance cholangiopancreatography or other traditional tools. Compared with other diagnostic tools, 3D reconstruction is more visual and accurate for diagnosing gallbladder duplication and guiding laparoscopic cholecystectomy without ductal injuries or other complications.

Conclusion:

Gallbladder duplication is an extremely rare biliary anatomical anomaly; failure to recognize it perioperatively exposes the patient to an increased risk of bile duct injuries. We review 28 cases of missed gallbladder duplication and conclude that less 50% of gallbladder duplication cases were detected via preoperative traditional imaging. We present a case and find that the 3D reconstruction technique can be used as a supplement for gallbladder duplication that could not be diagnosed by using magnetic resonance cholangiopancreatography or other tools. The value of using 3D reconstruction of gallbladder duplication is feasible and innovative, and facilitates guiding to laparoscopic cholecystectomy.
Clinical application of Mycobacterium RT-PCR assay using various specimens for the rapid detection of lymph node tuberculosis: A diagnostic accuracy study
Authors: Zhong Fangming , Zhao Wuchen , Wang Linhua , Shen Yi
Published: February 2023

To evaluate the diagnostic accuracy of the Capital Bio Mycobacterium real-time polymerase chain reaction assay Capital Bio assay for lymph node (LN) tuberculosis (LNTB), and to further compare the effect of different types of LN specimens on the detection capability of the test. We retrospectively analyzed the medical records of LNTB patients who met the inclusion criteria. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of Capital Bio assay were calculated to evaluate its diagnostic accuracy compared with the final clinical diagnosis as reference standard. Three hundred sixty-four patients were included in the study. The overall sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of the Capital Bio assay for LNTB were 74.4%, 100.0%, 100.0%, 34.9%, and 0.87, respectively. For the pus specimens, these values for Capital Bio assay were 93.2%, 100.0%, 100.0%, 27.3%, 0.97, respectively. For the core needle biopsy specimens, these values were 65.9%, 100.0%, 100.0%, 33.3%, and 0.83, respectively. For the fine-needle aspiration specimens, these values were 60.0%, 100.0%, 100.0%, 53.9%, and 0.80, respectively. For the tissue, these values were 59.3%, 100.0%, 100.0%, 33.3%, 0.80, respectively. The Capital Bio assay had good effective for the diagnosis of LNTB. Compared to LN fine-needle aspiration and core needle biopsy specimens and tissue specimens, pus specimens were more suitable for molecular testing and had the best diagnostic efficacy.
Comparison of patients admitted to an inner-city intensive care unit across 3 COVID-19 waves
Authors: Venkatram Sindhaghatta , Dileep Arundhati , Fortuzi Ked , Allena Nishant , Diaz-Fuentes Gilda
Published: February 2023

To expand our limited knowledge of COVID-19-related outcomes in patients admitted to inner-city intensive care unit (ICU across multiple infection waves. This retrospective study compared patients admitted to the ICU in Bronx, NY, during 3 COVID-19 waves (March 2020 to February 2022). Outcomes included in hospital mortality, length of stay (LOS), use of mechanical ventilation, and discharge disposition. The study included 716 patients (343, 276, and 97 in the first, second, and third COVID-19 waves, respectively). The number of days on mechanical ventilation and LOS were lower in the first wave. Of the 345 discharged patients, 37% went home directly, whereas 11% were discharged to a skill nursing facility. More patients went home during the second and third waves. Mortality decreased from the first to the third waves (57%–37%; P < .001). Predictors of mortality included age, male gender, COPD, shock, acute kidney injury (AKI), dialysis requirement, and mechanical ventilation. The decreased mortality and better discharge disposition of these inner-city patients during the second and third waves is encouraging, as this population historically had a high COVID-19-related mortality risk.
Acupuncture for children with autism spectrum disorder: A systematic review and meta-analysis
Authors: Lun Tingting , Lin Shaoping , Chen Yuecai , Zhao Yunxuan , Wang Dexin , Li Li , Yu Jin
Published: February 2023

Background:

The aim of this study was to assess the efficiency and safety of acupuncture in core symptomatic improvement of children with autism spectrum disorder (ASD).

Methods:

We searched the following databases: Cochrane Library, PubMed, Embase, Medline, China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Science and Technology Periodical (VIP) and Chinese Biological Medicine (CBM), from 1 January 2012 to 25 September 2022. The Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), and Autism Treatment Evaluation Checklist (ATEC) were adopted as outcome indicators. Three reviewers independently assessed the risk of bias (ROB) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)assessment. Utilizing Review Manager (RevMan) 5.3 and Stata 12.0, data were analyzed.

Results:

A total of 38 trials were included, and 2862 participants participated in qualitative synthesis and meta-analysis. Only 1 trial was assessed as having a low ROB, and 37 trials were assessed as having an overall high ROB. The quality of evidence for most indicators were considered very low by the GRADE criteria. The results showed that acupuncture groups might have a higher clinical effective rate than nonacupuncture groups (relative risk [RR] = 1.33,95% confidence interval [CI] = 1.25–1.41; heterogeneity: x
2=18.15, P = .64, I
2 = 0%). Regarding changes in ABC scores, the acupuncture groups might exhibit greater decrease than nonacupuncture groups (MMD = −6.06, 95%CI = −7.25 to −4.87, P < .00001; heterogeneity: x
2 =73.37, P = .03, I
2 = 77%). In terms of changes in CARS score, acupuncture group may benefit more than nonacupuncture group (MMD = −3.93, 95%CI = 4.90 to −2.95, P < .00001; heterogeneity: x
2=234.47, P < .00001, I
2 = 90%). Additionally, in terms of ATEC score, acupuncture groups showed more benefit than nonacupuncture groups (MMD = −10.24, 95%CI = −13.09 to −7.38, P < .00001; heterogeneity: x
2=45.74, P = .04, I
2 = 85%). Both subgroup analysis and sensitivity analysis are existing heterogeneity. Only 1 RCT study involved adverse events with mild symptoms that did not interfere with treatment and evaluation.

Conclusion:

Children with ASD may benefit from acupuncture because of its effectiveness and safety. Nevertheless, given the low quality of the evidence for the assessed outcomes and the high ROB of analyzed trials, the results should be regarded with caution.
Diffuse large B cell lymphoma CD5-positive arising in an immune deficiency and immune dysregulation setting: A case report and brief review of the literature
Authors: Cristian Miruna , Baz Radu Andrei , Stoica Andreea Georgiana , Așchie Mariana , Ghinea Maria Mihaela , Deacu Mariana , Boșoteanu Madalina , Mitroi Anca Florentina , Dobrin Nicolae , Iordache Ionut Eduard , Bălțătescu Gabriela Izabela
Published: February 2023

Rationale:

In the era of antiretroviral therapy, lymphoma is the primary cause of cancer-related death among human immunodeficiency virus (HIV)-infected people and the most prevalent and aggressive non-Hodgkin lymphoma is diffuse large B cell lymphoma, which usually has an aggressive clinical course. CD5-positive diffuse large B cell lymphoma (DLBCL) is an insufficiently studied, relatively new entity, which accounts for 5% to 10% of the DLBCL population. The current study presents the clinicopathological features, diagnostic approach, and clinical outcomes of this HIV-related lymphoma and highlights the importance of the early diagnosis of CD5-positive DLBCL.

Patient concerns:

We present a case of a 30-year-old male patient, with a medical history of HIV-positive serology and antiviral treatment, presenting with diffuse abdominal pain and symptoms related to obstruction or perforation, followed by exploratory laparotomy and surgical resection of the small intestine with other areas of involvement. The surgical specimen was morphologically evaluated and immunohistochemical stained.

Diagnoses and Interventions:

Histopathologic examination revealed a diffuse neoplastic proliferation of large B lymphocytes within the small intestine, lacking features of other defined types of large B cell lymphoma. The diagnosis of CD5-positive DLBCL subtype was made after immunostaining with twelve monoclonal antibodies (CD3, CD5, CD10, CD20, CD23, CD30, CD68, Cyclin D1, MUM1, Bcl2, Bcl6, and Ki-67). The expression profile of immunohistochemical markers (CD10, Bcl6, and MUM1) established the cell of origin of this case of DLBCL by using the Hans algorithm.

Lessons:

The current report highlights the importance of early diagnosis of CD5-positive DLBCL because of its poor prognosis and calls attention to the critical importance to identify immunodeficiencies because doing so affects the types of treatments available. Although cell-of-origin is useful for predicting outcomes, the germinal center B cell like and activated-B cell like subtypes remain heterogeneous, with better, and worse prognostic subsets within each group.
Evaluation of efficacy and safety of lascufloxacin for nursing and healthcare associated pneumonia: single-arm, open-label clinical trial: A study protocol
Authors: Hosogaya Naoki , Takazono Takahiro , Ota Kenji , Kiya Rieko , Shirai Yumi , Kawasaki Rina , Yano Hiroshi , Morimoto Shinpei , Nakao Rumiko , Kanamaru Yumiko , Yoshino Yukari , Ishikawa Yasuyuki , Fukushima Chizu , Yamamoto Hiroshi , Izumikawa Koichi , Yanagihara Katsunori , Mukae Hiroshi
Published: February 2023

Background:

Lascufloxacin hydrochloride (LSFX) is a quinolone antibiotic that inhibits DNA gyrase and topoisomerase IV of bacteria, it is anticipated to minimize antibiotic resistance in bacteria. It exhibits antibacterial activity against a relatively wide range of bacterial species, including anaerobic bacteria, and its efficacy and safety against community-acquired pneumonia have been shown; however, its efficacy and safety against nursing and healthcare associated pneumonia (NHCAP) have not been verified.

Methods/Design:

Here, a single-arm, open-label, uncontrolled study was conducted in which LSFX was administered to patients with NHCAP at 24 facilities. The research subjects (77 cases) were orally administered 75 mg of LSFX once a day for 7 days. The primary endpoint was the clinical efficacy at the time of test of cure (TOC) (TOC; 5–10 days after the end of LSFX administration), while the secondary endpoints were the efficacy at the time of end of treatment, early clinical efficacy, microbiological efficacy at the time of TOC and end of treatment, and safety evaluation of LSFX.

Discussion:

NHCAP is a common pneumonia in clinical settings and a notable pneumonia whose mortality is high compared to community-acquired pneumonia. The present study showed the efficacy and safety of LSFX against NHCAP, which could lead to a larger number of therapeutic options for NHCAP.
Macrotrabecular-massive subtype-based nomogram to predict early recurrence of hepatocellular carcinoma after surgery
Authors: Yang Yong , Mao Shuqi , Fang Jiongze , Wang Gaoqing , Shan Yuying , Yu Xi , Lu Caide
Published: February 2023

Objectives

To analyze the predictive factors on early postoperative recurrence of hepatocellular carcinoma (HCC) and to establish a new nomogram to predict early postoperative recurrence of HCC.

Methods

A retrospective analysis of 383 patients who had undergone curative resection between February 2012 and September 2020 in our center was performed. The Kaplan–Meier method was used for survival curve analysis. Univariate and multivariate Cox regression were performed to identify independent risk factors associated with early recurrence, and a nomogram for predicting early recurrence of HCC was established.

Results

A total of 152/383 patients developed recurrence after surgery, of which 83 had recurrence within 1 year. Multivariate Cox regression analysis showed that preoperative alpha-fetoprotein level ≥400 ng/ml (P = 0.001), tumor diameter ≥5 cm (P = 0.009) and MVI (P = 0.007 and macrotrabecular-massive HCC (P = 0.003) were independent risk factors for early postoperative recurrence of HCC. The macrotrabecular-massive-based nomogram obtained a good C-index (0.74) for predicting early recurrence of HCC, and the area under the curve for predicting early recurrence was 0.767, which was better than the single American Joint Committee on Cancer T stage and Barcelona Clinic Liver Cancer stage.

Conclusions

The nomogram based on macrotrabecular-massive HCC can effectively predict early postoperative recurrence of HCC.
Fast-track pathway for early diagnosis and management of giant cell arteritis: the combined role of vascular ultrasonography and [18F]-fluorodeoxyglucose PET-computed tomography imaging
Authors: Ludwig Dalia R. , Vöö Stefan , Morris Vanessa
Published: February 2023

Giant cell arteritis (GCA) is a medical emergency, which can lead to irreversible blindness and other ischaemic vascular events if left untreated. Prompt access to specialist assessment, diagnostics in the form of a fast-track pathway (FTP) and access to appropriate treatment are key factors in preventing morbidity associated with this disease. Recent developments in vascular imaging prompted review of our management of GCA patients. Here, we present the newly implemented FTP in GCA at the University College London Hospital, with added vascular imaging in the form of temporal artery ultrasound (TAUS) and [18F]-fluorodeoxyglucose PET-computed tomography (18F-FDG PET-CT) with temporal artery biopsy. The initial pilot data on the FTP showed a significant negative predictive value of the combined TAUS and 18F-FDG PET-CT, and the vast majority of cases positive on imaging were confirmed by biopsy. Through the new FTP in GCA, the diagnosis was completed within 48–72 h, compared with the conventional pathway time of up to 2–3 weeks awaiting biopsy results. Prompt and accurate diagnosis of GCA enables commencement of corticosteroid (prednisolone) treatment in the appropriate patient population while avoiding unnecessary steroid exposure and toxicity in GCA-negative patients.
Role of textural analysis parameters derived from FDG PET/CT in differentiating hepatocellular carcinoma and hepatic metastases
Authors: Mishra Ajit , Ravina Mudalsha , Kote Rutuja , Kumar Amit , Kashyap Yashwant , Dasgupta Subhajit , Reddy Moulish
Published: February 2023

Introduction

Texture and radiomic analysis characterize the tumor’s phenotype and evaluate its microenvironment in quantitative terms. The aim of this study was to investigate the role of textural features of 18F-FDG PET/computed tomography (CT) images in differentiating hepatocellular carcinoma (HCC) and hepatic metastasis in patients with suspected liver tumors.

Methods

This is a retrospective, single-center study of 30 patients who underwent FDG PET/CT for the characterization of liver lesions or for staging a suspected liver tumor. The histological diagnosis of either primary or metastatic tumor was obtained from CT-guided biopsy, ultrasound-guided biopsy, or surgical removal of a liver lesion. The PET/CT images were then processed in commercially available textural analysis software. Region of interest was drawn over the primary tumor with a 40% threshold and was processed further to derive 42 textural and radiomic parameters. These parameters were then compared between HCC group and hepatic metastases group. Receiver-operating characteristic (ROC) curves were used to identify cutoff values for textural features with a P value <0.05 for statistical significance.

Results

A retrospective study of 30 patients with suspected liver tumors was done. After undergoing PET/CT, the histological diagnosis of these lesions was confirmed. Among these 30 patients, 15 patients had HCC, and 15 patients had hepatic metastases from various primary sites. Seven textural analysis parameters were significant in differentiating HCC from liver metastasis. Cutoff values were calculated for these parameters according to the ROC curves, standardized uptake value (SUV) Skewness (0.705), SUV Kurtosis (3.65), SUV Excess Kurtosis (0.653), gray-level zone length matrix_long zone emphasis (349.2), gray-level zone length matrix_long zone low gray-level emphasis (1.6), gray-level run length matrix_long run emphasis (1.38) and gray-level co-occurrence matrix_Homogeneity (0.406).

Conclusion

Textural analysis parameters could successfully differentiate HCC and hepatic metastasis non-invasively. Larger multi-center studies are needed for better clinical prognostication of these parameters.
A Clinical Nurse Leader-Guided Behavior Management Consult Team to Impact Workplace Violence Against Nurses
Authors: Smith Michelle A.
Published: February 2023

Background:

Violence against nurses is a growing problem. Minimizing violence against nurses will contribute to a safer clinical environment.

Local Problem:

An increase in violence against nurses was identified at a regional medical center in the Midwest.

Methods:

A clinical nurse leader (CNL)–led behavior management consult team was developed to support the clinical team with aggressive, disruptive, or violent patients. The team consulted, assigned interventions to address potential source(s) of agitation, provided clinical support and guidance, and developed clinical tools to manage future patients with similar behavior patterns.

Results:

Between April 2019 and January 2023, a total of 108 behavior management consults were completed. Staff appreciated the additional support from the team.

Conclusions:

Implementation of a CNL-led behavior management consult team was found to be beneficial; other health care systems should consider implementing a similar consult team.