bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and effectiveness for oral intake of carbohydrate-rich drink at preoperative 2 hours before painless colonoscopy
Authors: Xu Qing-qin , Zhu Wen-xiu , Xiong Hao-lan , Zeng Fan-li , Du Yun
Published: June 2023

The aim of this study was to evaluate the feasibility, safety, and optimal dose of oral intake of carbohydrate-rich drinks 2 hours before painless colonoscopy. All patients receiving painless colonoscopy were randomly divided into 3 groups: control group (no carbohydrate-rich drink, n = 33), low-dose group (5 mL/kg carbohydrate-rich drink, n = 30), and high-dose group (8 mL/kg carbohydrate-rich drink, n = 30). Use of vasoactive drugs, the visual analog scale including thirst and hunger, degree of satisfaction, the time required for Modified Post Anesthetic Discharge Scoring System scale, first urination time, electrolyte level (sodium, potassium, and calcium), and blood glucose level were also determined. A total of 93 patients were recruited in this study. No significant difference was observed in the cross-sectional area (CSA) of the gastric antrum area at T0 between low- and high-dose groups (P = .912). There was a significant difference in CSA of gastric antrum at 120 minutes after oral intake between the low- and high-dose groups (P = .015). No significant difference was observed in the CSA of gastric antrum at 0 minutes and 120 minutes in the low-dose group (P = .177). In the high-dose group, the CSA of gastric antrum significantly differed at 0 minutes and 120 minutes (P < .001). There was a significant difference in the visual analog scale scores of thirst and hunger at 4 and 5 hours after bowel preparation among 3 groups (P = .001, P = .029, P < .001, P = .001). The degree of satisfaction in low- and high-dose groups was significantly higher than that in the control group (both P < .001). In conclusion, it is feasible and safe to deliver an oral intake of 5 mL/kg carbohydrate-rich drink 2 hours before painless colonoscopy. The comfort level and degree of satisfaction of patients can be further improved.
Extramedullary plasmacytoma of the orbit with intracranial invasion: A case report
Authors: Kim Yoo Jin , Moon Sang Woong , Park , In-Ki , Shin Jae-Ho
Published: June 2023

Rationale:

Plasmacytoma is a disease caused by the proliferation of monoclonal immunoglobulin-producing plasma cells and divided into multiple myeloma, solitary bone plasmacytoma, and extramedullary plasmacytoma. We report a case of orbital extramedullary plasmacytoma invading the dura mater in a patient with exophthalmos and diplopia.

Patient concerns:

A 35-year-old female patient with exophthalmos in the right eye and diplopia visited the clinic.

Diagnoses:

The thyroid function tests showed nonspecific results. Orbital computed tomography and magnetic resonance imaging revealed a homogeneously enhancing orbital mass infiltrating the right maxillary sinus and adjacent brain tissue in the middle cranial fossa through the superior orbital fissure.

Interventions:

To diagnose and alleviate the symptoms, an excisional biopsy was performed, which revealed a plasmacytoma.

Outcomes:

One month after the surgery, the protruding symptoms and eye movement restriction in the right eye improved, and the visual acuity in the right eye was restored.

Lessons:

In this case report, we present a case of an extramedullary plasmacytoma that originated in the inferior wall of the orbit and invaded the cranial cavity. To our knowledge, no previous reports have described a solitary plasmacytoma that originated in the orbit, causing exophthalmos and invading the cranial cavity at the same time.
Effects of continuous bicycle ergometer and step exercises from admission to discharge in a patient with myelodysplastic syndrome undergoing myeloablative conditioning and hematopoietic stem cell transplantation: A case report
Authors: Kawanishi Makoto , Nishimura Yukihide , Kinoshita Tokio , Hashizaki Takamasa , Umemoto Yasunori , Nishiyama Kazunari , Tajima Fumihiro
Published: June 2023

Background:

In myelodysplastic syndromes (MDS), in addition to disease-related symptoms, many adverse events are associated with anticancer agents, myeloablative conditioning (MAC), and allogeneic hematopoietic stem cell transplantation (allo-HSCT). Isolation and bed rest in a clean room severely limit physical activity, resulting in cardiopulmonary and muscle weakness. In addition, post-transplant patients may experience general fatigue, gastrointestinal symptoms, and infections associated with a weakened immune system, as well as graft-versus-host disease, which causes further decline in physical function and activities of daily living (ADL). Most reports on the rehabilitation of patients with hematopoietic tumors involve interventions before and after chemotherapy or transplantation. However, an important issue is to establish effective and feasible exercise programs in a clean room setting, where activity is severely limited and physical function is most likely to decline.

Case report:

This case report describes the treatment progress of a 60-year-old man with MDS and thrombocytopenia scheduled to receive MAC and allo-HSCT, who continued bicycle ergometer and step exercises from admission to discharge. The patient was admitted for allo-HSCT, and on day 4, he started bicycle ergometer and step exercise in a clean room and continued until discharge. As a result, exercise tolerance and lower-extremity muscle strength were maintained at the time of hospital discharge. Furthermore, the patient was able to continue rehabilitation in a restricted environment without adverse events.

Conclusions:

The rehabilitation and treatment course of this case may provide valuable information for patients with MDS and thrombocytopenia.
The SERPINA5 coding variant E228Q does not contribute to clinicopathologic characteristics in Alzheimer’s disease: A cross-sectional study
Authors: Matchett Billie J. , Lincoln Sarah J. , Baker Matt , Tamvaka Nikoleta , Labuzan Sydney A. , Hicks Sirmans Tiffany N. , Moloney Christina M. , Helminger Jacqueline , Hinkle Kelly M. , Cabrera-Rodriguez Janisse , Wickland Daniel P. , Johnson Patrick W. , Heckman Michael G. , Reddy Joseph S. , Younkin Steven G. , Carrasquillo Minerva M. , Duara Ranjan , Graff-Radford Neill R. , Pottier Cyril , Ertekin-Taner Nilüfer , Ross Owen A. , Rademakers Rosa , Dickson Dennis W. , Murray Melissa E.
Published: June 2023

We previously demonstrated that increased expression of the SERPINA5 gene is associated with hippocampal vulnerability in Alzheimer’s disease (AD) brains. SERPINA5 was further demonstrated to be a novel tau-binding partner that colocalizes within neurofibrillary tangles. Our goal was to determine whether genetic variants in the SERPINA5 gene contributed to clinicopathologic phenotypes in AD. To screen for SERPINA5 variants, we sequenced 103 autopsy-confirmed young-onset AD cases with a positive family history of cognitive decline. To further assess the frequency of a rare missense variant, SERPINA5 p.E228Q, we screened an additional 1114 neuropathologically diagnosed AD cases. To provide neuropathologic context in AD, we immunohistochemically evaluated SERPINA5 and tau in a SERPINA5 p.E228Q variant carrier and a matched noncarrier. In the initial SERPINA5 screen, we observed 1 individual with a rare missense variant (rs140138746) that resulted in an amino acid change (p.E228Q). In our AD validation cohort, we identified an additional 5 carriers of this variant, resulting in an allelic frequency of 0.0021. There was no significant difference between SERPINA5 p.E228Q carriers and noncarriers in terms of demographic or clinicopathologic characteristics. Although not significant, on average SERPINA5 p.E228Q carriers were 5 years younger at age of disease onset than noncarriers (median: 66 [60–73] vs 71 [63–77] years, P = .351). In addition, SERPINA5 p.E228Q carriers exhibited a longer disease duration than noncarriers that approached significance (median: 12 [10–15]) vs 9 [6–12] years, P = .079). More severe neuronal loss was observed in the locus coeruleus, hippocampus, and amygdala of the SERPINA5 p.E228Q carrier compared to noncarrier, although no significant difference in SERPINA5-immunopositive lesions was observed. Throughout the AD brain in either carrier or noncarrier, areas with early pretangle pathology or burnt-out ghost tangle accumulation did not reveal SERPINA5-immunopositive neurons. Mature tangles and newly formed ghost tangles appeared to correspond well with SERPINA5-immunopositive tangle-bearing neurons. SERPINA5 gene expression was previously associated with disease phenotype; however, our findings suggest that SERPINA5 genetic variants may not be a contributing factor to clinicopathologic differences in AD. SERPINA5-immunopositive neurons appear to undergo a pathologic process that corresponded with specific levels of tangle maturity.
Global status and research trends of cuprotosis research: A bibliometrics study via CiteSpace
Authors: Xie Xiaoli , Liu Li
Published: June 2023

Cuproptosis, a novel copper ion-dependent cell death type being regulated in cells, has raised concerns but lacks scientific analysis. Therefore, this study aimed to analyze the global status and emerging trends in cuprotosis research using bibliometric methods. Publications related to cuprotosis were systematically retrieved from the Web of Science Core Collection and then screened according to the inclusion criteria. Next, CiteSpace and Microsoft Excel 2021 were used to measure and visualize annual publications, categories, journals, countries, institutions, authors, co-cited references, and keywords to identify future global status and trends. A total of 2776 publications on cuprotosis were included, and the overall trend in the number of publications exhibited a rapid increase over the years. Biochemistry and Molecular Biology is the most common category, whereas the Journal of Inorganic Biochemistry is the most active. The United States is the country that produces the most articles, and University of Melbourne in Australia is the core institution involved in this field. Furthermore, Chan Pak of Stanford University is the most prolific author. Oxidative stress and antioxidant, the toxicity of copper in vitro, anticancer mechanism, and brain injury in neurological diseases are hot topics. The research frontiers are copper complexes, anticancer activity, DeoxyriboNucleic Acid binding, inflammation, and nanoparticles. This study provides the current status and trends in cuprotosis research. It may help researchers to identify hot topics and get ideas for future research directions in this field, focusing on copper complexes, anticancer activity, DeoxyriboNucleic Acid binding, inflammation, and nanoparticles.
Difficult endotracheal intubation due to a large epiglottic cyst: A case report
Authors: Zhang Ran , Jiang Xian , Feng Jianguo
Published: June 2023

Rationale:

An epiglottic cyst is a type of benign tumor that is formed due to the obstruction of the mucinous duct and the retention of glandular secretion. In such cases, the glottis is not visible as it is covered by the enlarged epiglottic cyst. When conventional anesthesia is administered in such patients, they might have difficulty ventilation since the epiglottic cyst can easily form a flap and move with external pressure changes and can cause the blockage of the glottis due to the loss of consciousness and the relaxation of the throat muscles of the patient. If endotracheal intubation is not initiated and effective ventilation is not established, the patient may suffer from hypoxia and other accidents.

Patient concerns:

A 48-year-old male presented to the otolaryngology department with a foreign body sensation in the throat.

Diagnoses:

A large epiglottic cyst was diagnosed.

Interventions:

The patient was planned to undergo epiglottis cystectomy under general anesthesia. After induction of anesthesia, the cyst severely covered the glottis and made endotracheal intubation difficult. The anesthesiologist rapidly adjusted the position of the laryngeal lens; thus, the endotracheal intubation was successful under the visual laryngoscope.

Outcomes:

The endotracheal intubation was successful under the visual laryngoscope and the operation went well.

Lessons:

Patients with epiglottic cysts are more likely to have difficult airways after induction of anesthesia. Anesthesiologists should take preoperative airway assessment seriously, efficiently handle difficult airway and intubation failure, and make quick and correct choices to ensure patient safety.
An acquired BMF with FANCL gene heterozygous mutation: Case report
Authors: Zhang Nan , Wang Xiao , Miao Xiao-Juan , Zhang Xu-Pai , Xia Xin-Yu , Li Li , Sun Hao-Ping
Published: June 2023

Rationale:

Bone marrow failure (BMF) includes inherited and acquired BMFs. Acquired BMF can be secondary to various factors, such as autoimmune dysfunction, benzene, drugs, radiation, viral infection and so on. Fanconi anemia (FA) complementation group L (FANCL) is an E3 ubiquitin ligase that participates in the repair of DNA damage. Homozygous or compound heterozygous mutations of FANCL can lead to the onset of FA, which is one of the most common inherited BMFs.

Patient concerns and Diagnoses:

Here, we report a case of acquired BMF. This patient had a history of benzene exposure for half a year before the onset of the disease, and presented with progressive pancytopenia, especially the reduction of erythrocytes and megakaryocyte, without malformation. Interestingly, this patient and his brother/father had a heterozygous (non-homozygous/compound heterozygous) mutation (Exon9, c.745C > T, p.H249Y) in the FANCL gene.

Interventions and Outcomes:

The patient successfully underwent unrelated and fully compatible umbilical cord blood hematopoietic stem cell transplantation.

Lessons subsections:

We report for the first time an acquired BMF case with FANCL gene heterozygous mutation, and the mutation site (Exon9, c.745C > T, p.H249Y) has never been reported. This case suggests that heterozygous mutations in FANCL gene may be associated with increased susceptibility to acquired BMF. Based on current reports and this case, we speculate that heterozygous mutations in the FA complementation gene may exist in a certain proportion of tumor and acquired BMF patients, but have not been detected. We recommend routine screening for FA complementation gene mutations in tumor and acquired BMF patients in clinical practice. If positive results are found, further screening can be conducted on their families.
Interleukin-4 expression is increased in patients with tuberculosis: A systematic review and meta-analysis
Authors: He Jie , Song Lingmeng , Zheng Pengcheng
Published: June 2023

Background:

Interleukin-4 (IL-4) is an important cytokine in the Th2 differentiation of CD4+ T cells, which modulates immune responses and participates in host defense against Mycobacterium tuberculosis. The present study aimed to evaluate the significance of IL-4 concentration in patients with tuberculosis. Data from this study will be helpful in understanding the immunological mechanisms of tuberculosis and in clinical practice.

Method:

A data search was conducted from January 1995 to October 2022 in electronic bibliographic databases such as China National Knowledge Infrastructure, Wan Fang, Embase, Web of Science, and PubMed. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. Heterogeneity between the studies was assessed using I
2 statistics. Publication bias was determined by funnel plot, and Egger’s test was used to confirm the presence of publication bias. All qualified studies and statistical analyses were performed using Stata 11.0.

Results:

Fifty-one eligible studies comprising 4317 subjects were included in the meta-analysis. The results depicted a considerably increased level of serum IL-4 in patients with tuberculosis than in the controls (standard mean difference [SMD] = 0.630, [95% confidence interval (CI), 0.162–1.092]). However, there was no significant difference in plasma IL-4 levels between patients with TB and controls (SMD = 0.290, [95% CI, −0.430 to 1.010]). In addition, the infection status, TB focus location, drug resistance, race, research design type, and detection method divided the subjects into different subgroups for the meta-analysis. The results of the comparison of healthy controls and TB subjects showed that in the Asian population, the serum IL-4 level in patients with TB was higher than that in controls (SMD = 0.887, [95% CI, 0.202 to −1.573]) and patients with active TB as well as people with pulmonary TB showed increased serum IL-4 levels compared to controls (SMD = 0.689, [95% CI, 0.152–1.226]). In the case of the control group with latent TB, the active TB group had higher serum IL-4 levels than the control group (SMD = 0.920, [95% CI, 0.387–1.452]).

Conclusion:

The present meta-analysis showed that serum IL-4 varied in healthy individuals and patients with TB. Patients with active TB may also exhibit higher IL-4 concentrations.
Quantitative analysis with multiphase contrast-enhanced computed tomography to evaluate residual tumor activity of hepatocellular carcinoma after DEB-TACE
Authors: Hu Wenchao , Cao Guohong , Ye Shengli , Xu Jianfeng , Chen Jing , Shao Guoliang
Published: June 2023

Most hepatocellular carcinomas (HCC) treated by transcatheter arterial chemoembolization with drug-eluting beads (DEB-TACE) are characterized by coagulation necrosis; therefore, it is often difficult to distinguish enhancement in the arterial phase that would lead to false negative evaluation. This study aimed to evaluate the specificity and sensitivity of the difference value of multiphase contrast-enhanced computed tomography (CECT) in predicting residual tumor activity in HCC lesions after DEB-TACE. This retrospective diagnostic study analyzed CECT images of 73 HCC lesions in 57 patients 20 to 40 days (average 28 days) after DEB-TACE treatment at our Hospital from January to December 2019. Postoperative pathology or digital subtraction angiography images were used as references. Residual tumor activity after the first intervention was determined based on the presence of tumor staining in digital subtraction angiography or the postoperative pathological discovery of HCC tumor cells. A significant difference was observed between the active and inactive residual groups in ∆ HU difference between CT values of arterial phase and non-contrast scans (AN, P = .000), difference between CT values of venous phase and non-contrast scans (VN, P = .000), difference between CT values of delay phase and non-contrast scans (DN, P = .000), (difference between CT values of venous and arterial phase scans, P = .001), and (difference between CT values of delay and arterial phase scans, P = .005). No statistically significant difference was observed between the delayed and venous phases (difference between CT values of delay and venous phase scans, P = .361). The area under the curve (AUC) of the ROC curve showed that the diagnostic efficacies in difference in CT value of AN (AUC = 0.976), VN (AUC = 0.927), and DN (AUC = 0.924) were higher, and their cutoff values were 4.86, 12.065, 20.19 HU with their sensitivities of 93.3%, 84.4%, 77.8% and specificities of 100%, 96.4%, and 100%, respectively. difference in CT value values of AN, VN, DN, difference between CT values of venous and arterial phase scans and difference between CT values of delay and arterial phase scans can sensitively detect residual tumor activity 20-40 days after DEB-TACE. Thus, more sensitive active residual foci were detected using all 3 enhanced phases rather than only the arterial phase. Quantitative analysis of multiphase CECT can detect residual tumor activity in an early and noninvasive manner, which can provide time for patients to receive early follow-up treatment.
Laparoscopic versus open surgery for colonoscopic perforation: A systematic review and meta-analysis
Authors: Zhong Wu , Liu Chuanyuan , Fang Chuanfa , Zhang Lei , He Xianping , Zhu Weiquan , Guan Xueyun
Published: June 2023

Background:

The efficacy of laparoscopic surgery (LS) for the treatment of colonoscopic perforation is still controversial. The purpose of this meta-analysis was to evaluate the effectiveness and safety of LS versus open surgery (OS) for colonoscopic perforation.

Methods:

All clinical trials that compared laparoscopic with OS for colonoscopic perforation published in English were identified in PubMed, EMBASE, Web of Science, and Cochrane Library searches. A modified scale was used to assess the quality of the literature. We analyzed the age, sex ratio, aim of colonoscopy, history of abdominopelvic surgery, type of procedure, size of perforation, operation time, postoperative fasting time, hospital stay, postoperative complication morbidity, and postoperative mortality. Meta-analyses were performed using weighted mean differences for continuous variables, and odds ratios for dichotomous variables.

Results:

No eligible randomized trials were identified, but eleven nonrandomized trials were analyzed. In the pooled data of 192 patients who underwent LS and 131 OS, there were no significant differences in age, sex ratio, aim of colonoscopy, history of abdominopelvic surgery, perforation size, and operative time between the groups. LS group had shorter time of hospital stay and postoperative fasting time, less postoperative complication morbidity, but there were no significant difference in postoperative mortality rate between LS group and OS group.

Conclusions:

Based on the current meta-analysis, we conclude that LS is a safe and efficacious technique for colonoscopic perforation, with fewer postoperative complications, less hospital mortality, and faster recovery compared with OS.
Association of triglyceride-glucose index with major depressive disorder: A cross-sectional study
Authors: Jin Man , Lv Peiyuan , Liang Hao , Teng Zhenjie , Gao Chenyang , Zhang Xueru , Ni Aihua , Cui Xiaona , Meng Nan , Li Litao
Published: June 2023

The triglyceride-glucose (TyG) index has been proposed as a new marker for insulin resistance, which is associated with a risk of major depressive disorder (MDD). This study aims to explore whether the TyG index is correlated with MDD. In total, 321 patients with MDD and 325 non-MDD patients were included in the study. The presence of MDD was identified by trained clinical psychiatrists using the International Classification of Diseases 10th Revision. The TyG index was calculated as follows: Ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). The results revealed that the MDD group presented higher TyG index values than the non-MDD group (8.77 [8.34–9.17] vs 8.62 [8.18–9.01], P < .001). We also found significantly higher morbidity of MDD in the highest TyG index group than in the lower TyG index group (59.9% vs 41.4%, P < .001). Binary logistic regression revealed that TyG was an independent risk factor for MDD (odds ratio [OR] 1.750, 95% confidence interval: 1.284–2.384, P < .001). We further assessed the effect of TyG on depression in sex subgroups. The OR was 3.872 (OR 2.014, 95% confidence interval: 1.282–3.164, P = .002) for the subgroup of men. It is suggested that the TyG index could be closely associated with morbidity in MDD patients; thus, it may be a valuable marker for identifying MDD.
Age and CD4+ T cell counts are inversely associated with HIV drug resistance mutations in treatment naive female sex workers
Authors: Mulinge Martin M. , Oluoch Jeff O. , Abisi Hellen K. , Otieno Leon E. , Anzala Omu , Wamalwa Dalton C. , Nduati Ruth W. , Kimani Joshua , Herbeck Joshua , McKinnon Lyle
Published: June 2023

The increasing prevalence of human immunodeficiency virus (HIV) drug resistance mutations (HIVDRM) in untreated seropositive persons has consequences for future treatment options. This is extremely important in key populations such as female sex workers (FSWs), where the prevalence of pretreatment drug resistance (PDR) and associated risk factors are unknown. In this study, we analyzed PDR and associated risk factors in recently diagnosed and treatment-naive FSWs in Nairobi, Kenya. In this cross-sectional study, we used 64 HIV-seropositive plasma samples collected from FSWs between November 2020 and April 2021. To identify HIVDRM, the pol gene was amplified and genotyped using sanger sequencing. The effects of age, tropism, CD4+ T cell count, subtype, and location on HIVDRM counts were examined using Poisson regression. Overall, the prevalence of PDR was 35.9% (95% CI: 24.3–48.9), which was strongly influenced by K103N and M184V mutations, which confer resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) and nucleoside reverse transcriptase inhibitors (NRTI), respectively. Subtype A1 was predominant followed by subtype D with a notable increase in inter-subtype recombinants. We found statistically significant evidence that age was inversely related to HIVDRM. A FSW who is 1 year older had 12% less HIVDRM (incidence rate ratios [IRR]: 0.88; 95% CI: 0.82–0.95; P < .001), after adjusting for CD4+ T cell count, subtype, location, and tropism. Similarly, an increase in CD4+ T cell count by 1 unit, was associated with 0.4% fewer HIVDRM (IRR: 0.996; 95% CI: 0.994–0.998; P = .001), while controlling for the other variables. HIV-1 tropism was not associated with HIVDRM counts. In conclusion, our findings show a high prevalence of NNRTIs. Lower CD4+ T cell counts and younger age were significant risk factors that influenced HIVDRM loads. This finding underscores the relevance of targeted interventions and the importance of continuing to focus on FSWs as a way of addressing the HIV epidemic.
Women consuming oral contraceptives containing cyproterone acetate and ethinylestradiol show a higher risk of thyroid cancer than nonusers
Authors: Lai Pei-Hsuan , Chen Weishan , Hsu Chung Y. , Wang Jen-Hung , Ding Dah-Ching
Published: June 2023

This study explored whether the risk of thyroid cancer in Asian women is associated with consumption of oral contraceptives (Diane-35). We conducted a population-based, retrospective cohort study using the Taiwan National Health Insurance Research Database. From the database, 9865 women aged 18 to 65 years who were prescribed Diane-35 between 2000 and 2012 were included in the Diane-35 group, and 39,460 women who were not prescribed Diane-35 were included in the comparison group and were frequency-matched by age and index year. Both groups were followed until 2013 to calculate the incidence of thyroid cancer. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazard model. The median (standard deviation) follow-up duration was 7.08 (3.63) and 7.04 (3.64) years in the Diane-35 and the comparison group, respectively. The incidence of thyroid cancer was 1.80-fold higher in the Diane-35 group than in the comparison group (2.72 vs 1.51 per 10,000 person-years). The cumulative incidence of thyroid cancer was significantly higher in the Diane-35 group than in the comparison group (log-rank test, P = .03). An elevated hazard ratio of thyroid cancer was observed in the Diane-35 group than in the comparison group (HR: 1.91, 95% CI: 1.10–3.30). In subgroup analysis, patients aged 30 to 39 years showed a higher hazard ratio of developing thyroid cancer after consuming Diane-35 than those in the comparison group (HR: 5.58, 95% CI: 1.84–16.91). The study provides evidence that women aged 30 to 39 years consuming Diane-35 are at increased risk of thyroid cancer. Nevertheless, a larger population with a longer follow-up may be necessary to confirm causality.
Comparison of pipeline classic and flex embolization devices in endovascular performance for intracranial aneurysms
Authors: Li Li , Gao Bu-Lang , Wu Qiao-Wei , Li Tian-Xiao , Shao Qiu-Ji , Chang Kai-Tao
Published: June 2023

To investigate the endovascular performance of the Pipeline Classic embolization device (PED Classic) and PED Flex device (PED Flex) in the treatment of intracranial aneurysms. Fifty-three patients with intracranial aneurysms treated with the PED Classic were retrospectively enrolled into the PED Classic group, and 118 patients with intracranial aneurysms treated with the PED Flex were enrolled into the PED Flex group. The Procedure time, contrast dosage, fluoroscopy time, and perioperative complications were analyzed. The success rate of the stenting procedure was 100% in both groups. In the PED Classic group, 58 PED Classic devices were implanted, and 26 aneurysms underwent coil embolization. In the PED Flex group, 126 PED Flex devices were implanted, and 35 aneurysms underwent concomitant coil embolization. The procedure time was significantly (P < .001) greater in the PED Classic (159.0 ± 42.0 minutes) than in the PED Flex (121.9 ± 4.0 minutes) group. The dosage of contrast agent (156.4 ± 39.4 vs 110.1 ± 38.5 mL) and the total fluoroscopic time (34.7 ± 5.7 minutes vs 22.8 ± 7.6 minutes) were significantly (P < .001) greater in the PED Classic than in the PED Flex group. Peri-procedural complications occurred in 5 (9.4%) patients in the PED Classic group and in 3 (2.5%) patients in the Flex group, without a statistically significant (P = .11) difference. The performance of the PED Flex device may be safer and easier than that of the PED Classic device in the treatment of intracranial aneurysms despite some serious complications which remain to be prevented.
Triple Strut Concept for the Nasal Tip Projection in Small Lower Lateral Cartilages and Septum
Authors: Suh Jeongsoo , Suh Man-Koon , Choi Hongseo
Published: June 2023

Introduction:

This study aimed to evaluate the effectiveness of the triple strut graft technique for nasal tip projection in Asian patients with weak and small lower lateral cartilages and septum. The technique uses a combination of septal angle strut and, columellar strut grafts and lateral crural repositioning to provide support for the nasal tip.

Methods:

The study included 30 Asian patients who underwent primary rhinoplasty using this technique between January 2019 and December 2021. The surgical procedure involved making an open rhinoplasty incision and performing a scroll area release. A small triangular-shaped septal angle strut graft was then placed, and the lower lateral cartilages were suspended anteriorly and placed on the anterior end of the septal angle after a columellar strut graft was performed between both medial crura. The lateral crura of the lower lateral cartilages were transposed medially on top of the upper lateral cartilages and maintained in place by spanning sutures at the cephalic margins of both lateral crura.

Results:

The triple strut graft technique was shown to be effective in providing stable tip projection in Asian noses with weak and small lower lateral cartilages and septum. Statistically significant differences were found between the preoperative and postoperative values of the nasal tip projection ratio and Rhinoplasty Outcome Evaluation (P < 0.05).

Conclusions:

The triple strut graft tip projection technique can be an effective surgical option for Asian patients who have weak and small medial crura combined with a small septum, providing stability for the nasal tip projection.
The Effect of Trans-Sutural Distraction Osteogenesis on Nasal Bone, Nasal Septum, and Nasal Airway in the Treatment for Midfacial Hypoplasia in Growing Patients
Authors: Bao Xueer , Jin Mengying , Bai Yanjie , Xue Hongyu , Zhao Zhenmin
Published: June 2023

The purposes of this study were to analyze the effect of trans-sutural distraction osteogenesis (TSDO) on nasal bone, nasal septum, and nasal airway in the treatment of midfacial hypoplasia. A total of 29 growing patients with midfacial hypoplasia who underwent TSDO by a single surgeon were enrolled. The 3-dimensional measurement of nasal bone and nasal septum changes was performed using computed tomography (CT) images obtained preoperatively (T0) and postoperatively (T1). One patient was selected to establish 3-dimensional finite element models to simulate the characteristics of nasal airflow field before and after traction. After traction, the nasal bone moved forward significantly (P<0.01). The septal deviation angle was lower than that before traction (14.43±4.70 versus 16.86 ±4.59 degrees) (P<0.01). The length of the anterior and posterior margin of the vomer increased by 21.4% (P<0.01) and 27.6% (P<0.01), respectively, after TSDO. The length of the posterior margin of the perpendicular plate of ethmoid increased (P<0.05). The length of the posterior inferior and the posterior superior margin of the nasal septum cartilage increased (P<0.01) after traction. The cross-sectional area of nasal airway on the deviated side of nasal septum increased by 23.0% after traction (P<0.05). The analysis of nasal airflow field showed that the pressure and velocity of nasal airflow and the nasal resistance decreased. In conclusion, TSDO can promote the growth of the midface, especially nasal septum, and increase the nasal space. Furthermore, TSDO is conductive to improve nasal septum deviation and decrease nasal airway resistance.
Early-Onset Pancreatic Neuroendocrine Tumors
Authors: Pulvirenti Alessandra , Hauser Haley F. , Fiedler Laura M. , McIntyre Caitlin A. , Le Tiffany , Reidy-Lagunes Diane L. , Soares Kevin C. , Balachandran Vinod P. , Kingham T. Peter , D’Angelica Michael I. , Drebin Jeffrey A. , Jarnagin William R. , Raj Nitya , Wei Alice C.
Published: June 2023

Background:

Early-Onset (EO) pancreatic neuroendocrine tumor (PanNET) is a rare disease but whether is clinically different from late-onset (LO) PanNET is unknown. Our study aimed to evaluate clinical differences and disease outcomes between EO- and LO-PanNET and to compare sporadic EO-PanNET with those with a hereditary syndrome (HS).

Methods:

Patients with localized PanNET who underwent pancreatectomy at Memorial Sloan Kettering between 2000-17 were identified. Those with metastatic disease and poorly differentiated tumors were excluded. EO-PanNET was defined as <50 and LO-PanNET >50 years of age at the time of diagnosis. Family history, and clinical and pathology characteristics were recorded.

Results:

Overall 383 patients were included, 107 (27.9%) with EO-PanNET. Compared with LO-PanNET, EO-PanNET were more likely to have a hereditary syndrome (2.2% vs. 16%, P<0.001) but had similar pathology features such as tumor grade (P=0.6), size (2.2 Vs. 2.3 cm, P=0.5) and stage of disease (P=0.8). Among patients with EO-PanNET those with HS had more frequently a multifocal disease (65% vs. 3.3%, P<0.001). With a median follow-up of 70 months (range 0-238), the 5-year cumulative incidence of recurrence after curative surgery was 19% (95%CI 12-28%) and 17% (95%CI 13-23%), in EO- and LO-PanNET (P=0.3). Five-year disease-specific survival was 99% (95%CI 98-100%) with no difference with respect to PanNET onset time (P=0.26)

Conclusion:

In this surgical cohort, we found that EO-PanNET is associated with hereditary syndromes but has pathological characteristics and oncological outcomes similar to LO-PanNET. These findings suggest that patients with EO-PanNET can be managed similarly to those with LO-PanNET.
Resolution of Secondary Hyperparathyroidism after Kidney Transplantation and the Effect on Graft Survival
Authors: Wang Rongzhi , Price Griffin , Disharoon Mitchell , Stidham Gabe , McLeod M. Chandler , McMullin Jessica Liu , Gillis Andrea , Fazendin Jessica , Lindeman Brenessa , Ong Song , Chen Herbert
Published: June 2023

Objective:

Hyperparathyroidism (HPT) is nearly universal in patients with end-stage kidney disease. Kidney transplantation (KT) reverses HPT in many patients, but most studies have only focused on following calcium and not parathyroid hormone (PTH) levels. We sought to study the prevalence of persistent HPT post-KT at our center and its effect on graft survival.

Methods:

Patients who underwent KT from January 2015 to August 2021 were included and characterized by post-KT HPT status at the most recent follow-up: resolved (achieving normal PTH post-KT) versus persistent HPT. Those with persistent HPT were further stratified by the occurrence of hypercalcemia (normocalcemic versus hypercalcemic HPT). Patient demographics, donor kidney quality, PTH and calcium levels, and allograft function were compared between groups. Multivariable logistic regression and Cox regression with propensity score matching (PSM) were conducted.

Results:

Of 1554 patients, only 390 (25.1%) patients had resolution of renal HPT post-KT with a mean (±SD) follow-up length of 40±23 months. The median (IQR) length of HPT resolution was 5 (0-16) months. Of the remaining 1164 patients with persistent HPT post-KT, 806 (69.2%) patients had high PTH and normal calcium levels, while 358 (30.8%) patients had high calcium and high PTH levels. Patients with persistent HPT had higher parathyroid hormone (PTH) at the time of KT [403 (243 – 659) versus 277 (163 – 454) pg/mL, P<0.001] and were more likely to have received cinacalcet treatment before KT (34.9% vs. 12.3%, P<0.001). Only 6.3% of patients with persistent HPT received parathyroidectomy. Multivariable logistic regression showed race, cinacalcet use pre-KT, dialysis before KT, receiving an organ from a deceased donor, high PTH, and calcium levels at KT were associated with persistent HPT post-KT. After adjusting for patient demographics and donor kidney quality by PSM, persistent HPT (HR 2.5, 95% CI 1.1 – 5.7, P=0.033) was associated with a higher risk of allograft failure. Sub-analysis showed that both hypercalcemic HPT (HR 2.6, 95% CI 1.1 – 6.5, P=0.045) and normocalcemic HPT (HR 2.5, 95% CI 1.3-5.5, P=0.021) were associated with increased risk of allograft failure when compared to patients with resolved HPT.

Conclusion:

Persistent HPT is common (75%) after KT and is associated with a higher risk of allograft failure. PTH levels should be closely monitored after kidney transplantation so that patients with persistent HPT can be treated appropriately.
Research priorities in venous thromboembolism after trauma: Secondary analysis of the National Trauma Research Action Plan
Authors: Costantini Todd W. , Bulger Eileen , Price Michelle A. , Haut Elliott R. ,   the National Trauma Research Action Plan (NTRAP) Investigators Group
Published: June 2023

BACKGROUND

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality during recovery from injury and can result in significant health care costs. Despite advances in the past several decades in our approach to VTE prophylaxis after injury, opportunities exist to improve the delivery and implementation of optimal VTE prophylaxis. Here, we aim to identify consensus research questions related to VTE across all National Trauma Research Action Plan (NTRAP) Delphi expert panels to further guide the research agenda aimed at preventing VTE after injury.

METHODS

This is a secondary analysis of consensus-based research priorities that were collected using a Delphi methodology by 11 unique NTRAP panels that were charged with unique topic areas across the spectrum of injury care. The database of questions was queried for the keywords “VTE,” “venous thromboembo,” and “DVT” and then grouped into relevant topic areas.

RESULTS

There were 86 VTE-related research questions identified across 9 NTRAP panels. Eighty-five questions reached consensus with 24 rated high priority; 60, medium priority; and 1, low priority. Questions related to the timing of VTE prophylaxis (n = 17) were most common, followed by questions related to risk factors for the development of VTE (n = 16), the effects of tranexamic acid on VTE (n = 11), the approach to dosing of pharmacologic prophylaxis (n = 8), and the pharmacologic prophylactic medication choice for optimal VTE prophylaxis (n = 6).

CONCLUSION

National Trauma Research Action Plan panelists identified 85 consensus-based research questions that should drive dedicated extramural research funding opportunities to support quality studies aimed at optimizing VTE prophylaxis after injury.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
The Long Road to Develop Custom-built Livers: Current Status of 3D Liver Bioprinting
Authors: Cross-Najafi Arthur A. , Farag Kristine , Chen Angela M. , Smith Lester J. , Zhang Wenjun , Li Ping , Ekser Burcin
Published: June 2023

Although liver transplantation is the gold-standard therapy for end-stage liver disease, the shortage of suitable organs results in only 25% of waitlisted patients undergoing transplants. Three-dimensional (3D) bioprinting is an emerging technology and a potential solution for personalized medicine applications. This review highlights existing 3D bioprinting technologies of liver tissues, current anatomical and physiological limitations to 3D bioprinting of a whole liver, and recent progress bringing this innovation closer to clinical use. We reviewed updated literature across multiple facets in 3D bioprinting, comparing laser, inkjet, and extrusion-based printing modalities, scaffolded versus scaffold-free systems, development of an oxygenated bioreactor, and challenges in establishing long-term viability of hepatic parenchyma and incorporating structurally and functionally robust vasculature and biliary systems. Advancements in liver organoid models have also increased their complexity and utility for liver disease modeling, pharmacologic testing, and regenerative medicine. Recent developments in 3D bioprinting techniques have improved the speed, anatomical, and physiological accuracy, and viability of 3D-bioprinted liver tissues. Optimization focusing on 3D bioprinting of the vascular system and bile duct has improved both the structural and functional accuracy of these models, which will be critical in the successful expansion of 3D-bioprinted liver tissues toward transplantable organs. With further dedicated research, patients with end-stage liver disease may soon be recipients of customized 3D-bioprinted livers, reducing or eliminating the need for immunosuppressive regimens.
Cancer “Avatars”: Patient-Derived Xenograft Growth Correlation with Postoperative Recurrence and Survival in Pancreaticobiliary Cancer
Authors: Lynch Isaac T , Abdelrahman Amro M , Alva-Ruiz Roberto , Fogliati Alessandro , Graham Rondell P , Smoot Rory , Truty Mark J
Published: June 2023

BACKGROUND:

Pancreaticobiliary (PB) cancers are a diverse group of cancers with poor prognoses and high rates of recurrence after resection. Patient-derived xenografts (PDX), created from surgical specimens, provide a reliable preclinical research platform and high-fidelity cancer model from which to study these malignancies with consistent recapitulation of their original patient tumors in vivo. However, the relationship between PDX engraftment success (growth or no growth) and patient oncologic outcomes has not been well studied. We sought to evaluate the correlation between successful PDX engraftment and survival in several PB exocrine carcinomas, including the pancreatic and biliary tract.

STUDY DESIGN:

In accordance with IRB and Institutional Animal Care and Use Committee protocols and with appropriate consent and approval, excess tumor tissue obtained from surgical patients was implanted into immunocompromised mice. Mice were monitored for tumor growth to determine engraftment success. PDX tumors were verified to recapitulate their tumors of origin by a hepatobiliary pathologist. Xenograft growth was correlated with clinical recurrence and overall survival data.

RESULTS:

A total of 384 PB xenografts were implanted. The successful engraftment rate was 41% (158/384). We found that successful PDX engraftment was highly associated with both recurrence-free survival (p < 0.001) and overall survival (p < 0.001) outcomes. Successful PDX tumor generation occurs significantly in advance of clinical recurrences in their corresponding patients (p < 0.001).

CONCLUSIONS:

Successful PB cancer PDX models predict recurrence and survival across tumor types and may provide critical lead time to alter patients’ surveillance or treatment plans before cancer recurrence.
Going through phages: a computational approach to revealing the role of prophage in Staphylococcus aureus
Authors: Sweet Tyrome , Sindi Suzanne , Sistrom Mark
Published: June 2023

Prophages have important roles in virulence, antibiotic resistance, and genome evolution in

Staphylococcus aureus

. Rapid growth in the number of sequenced

S. aureus

genomes allows for an investigation of prophage sequences at an unprecedented scale. We developed a novel computational pipeline for phage discovery and annotation. We combined PhiSpy, a phage discovery tool, with VGAS and PROKKA, genome annotation tools to detect and analyse prophage sequences in nearly 10 011 

S

.

aureus

genomes, discovering thousands of putative prophage sequences with genes encoding virulence factors and antibiotic resistance. To our knowledge, this is the first large-scale application of PhiSpy on a large-scale set of genomes (10 011 

S

.

aureus

). Determining the presence of virulence and resistance encoding genes in prophage has implications for the potential transfer of these genes/functions to other bacteria via transduction and thus can provide insight into the evolution and spread of these genes/functions between bacterial strains. While the phage we have identified may be known, these phages were not necessarily known or characterized in

S. aureus

and the clustering and comparison we did for phage based on their gene content is novel. Moreover, the reporting of these genes with the

S. aureus

genomes is novel.
Purpura fulminans secondary to Capnocytophaga canimorsus bacteraemia following a dog bite: A case report and review of literature
Authors: Killington Kieran , Lee Nathaniel , Asher Radha , Farrant Olivia , Stone Neil
Published: June 2023

Introduction. Infection due to

Capnocytophaga canimorsus

may result in a wide variety of clinical presentations. We present a case of life-threatening

Capnocytophaga canimorsus

infection with evolution of ecchymosis to purpura fulminans.

Case description. We present a case of a 43-year-old male with a history of excessive alcohol consumption who presented with features of sepsis following a dog bite. This was associated with a striking, widespread purpuric rash. A causative pathogen,

C. canimorsus

was identified through blood culture and 16S RNA sequencing. His initially purpuric rash underwent bullous transformation and was diagnosed clinically as purpura fulminans, confirmed on skin biopsy. He made a full recovery with prompt antimicrobial therapy, initially with co-amoxiclav but escalated to clindamycin and meropenem due to clinical deterioration and concerns of beta-lactamase resistance.

Discussion. β-Lactamase producing

Capnocytophaga

strains are of increasing concern. This particular concern is reflected in our case as 5 days into treatment with β-lactamase inhibitor combination therapy the patients clinical condition deteriorated but demonstrably improved on switching to a carbapenem.

The development of biopsy proven purpura fulminans in this immunocompetent case is a rare severe manifestation of the previously reported manifestation of disseminated intravascular coagulation (DIC) in

Capnocytophaga

bacteraemia. The case reported describes characteristics common with other DIC presentations such as the presence of clinical risk factors (history of excessive alcohol consumption) and symmetrical involvement. However, an unusual feature in that initial purpuric lesions were followed by the development of a bullous appearance and peripheral necrotic features concerning for purpura fulminans and confirmed with skin biopsy.