bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Obstetrics and Gynecology in Shaping Gender-diverse Leadership in Medicine
Authors: Winkel Abigail Ford , Katz Nadine T.
Published: April 2024

Gender inequity persists in academic medicine. This article reviews the historical context, ongoing leadership challenges, and societal biases. The persistent barriers to gender equity in leadership roles, pay, and professional recognition are considered through the lens of obstetrics and gynecology where these issues persist despite a significant presence of women in the field. The impact of gender stereotypes, the role of intersectionality, and the need for systemic change are evident. Embracing diverse leadership styles and creating inclusive pathways to leadership will help actualize the potential benefits of a gender-diverse workforce, enhancing health care outcomes and fostering innovation.
County-Level Cardiac Rehabilitation and Broadband Availability
Authors: DeLara David L. , Pollack Lisa M. , Wall Hilary K. , Chang Anping , Schieb Linda , Matthews Kevin , Stolp Haley , Pack Quinn R. , Casper Michele , Jackson Sandra L.
Published: April 2024

Purpose:

Cardiac rehabilitation (CR) improves patient outcomes and quality of life and can be provided virtually through hybrid CR. However, little is known about CR availability in conjunction with broadband access, a requirement for hybrid CR. This study examined the intersection of CR and broadband availability at the county level, nationwide.

Methods:

Data were gathered and analyzed in 2022 from the 2019 American Community Survey, the Centers for Medicare & Medicaid Services, and the Federal Communications Commission. Spatially adaptive floating catchments were used to calculate county-level percent CR availability among Medicare fee-for-service beneficiaries. Counties were categorized: by CR availability, whether lowest (ie, CR deserts), medium, or highest; and by broadband availability, whether CR deserts with majority-available broadband, or dual deserts. Results were stratified by state. County-level characteristics were examined for statistical significance by CR availability category.

Results:

Almost half of US adults (n = 116 325 976, 47.2%) lived in CR desert counties (1691 counties). Among adults in CR desert counties, 96.8% were in CR deserts with majority-available broadband (112 626 906). By state, the percentage of the adult population living in CR desert counties ranged from 3.2% (New Hampshire) to 100% (Hawaii and Washington, DC). Statistically significant differences in county CR availability existed by race/ethnicity, education, and income.

Conclusions:

Almost half of US adults live in CR deserts. Given that up to 97% of adults living in CR deserts may have broadband access, implementation of hybrid CR programs that include a telehealth component could expand CR availability to as many as 113 million US adults.
Primary surgical prevention of lymphedema
Authors: Sun Jeremy Mingfa , Yamamoto Takumi
Published: April 2024

Lymphedema in the upper and lower extremities can lead to significant morbidity in patients, resulting in restricted joint movements, pain, discomfort, and reduced quality of life. While physiological lymphatic reconstructions such as lymphovenous anastomosis (LVA), lymphovenous implantation (LVI), and vascularized lymph node transfer (VLNT) have shown promise in improving patients’ conditions, they only provide limited disease progression control or modest reversal. As lymphedema remains an incurable condition, the focus has shifted toward preventive measures in developed countries where most cases are iatrogenic due to cancer treatments. Breast cancer–related lymphedema (BCRL) has been a particular concern, prompting the implementation of preventive measures like axillary reverse mapping. Similarly, techniques with lymph node-preserving concepts have been used to treat lower extremity lymphedema caused by gynecological cancers. Preventive lymphedema measures can be classified into primary, secondary, and tertiary prevention. In this comprehensive review, we will explore the principles and methodologies encompassing lymphatic microsurgical preventive healing approach (LYMPHA), LVA, lymphaticolymphatic anastomosis (LLA), VLNT, and lymph-interpositional-flap transfer (LIFT). By evaluating the advantages and limitations of these techniques, we aim to equip surgeons with the necessary knowledge to effectively address patients at high risk of developing lymphedema.
Cardiopulmonary functional capacity in Taiwanese children with atrial septal defects
Authors: Xue Yu-Hao , Huang I-Ching , Tuan Sheng-Hui , Cheng Cheng-Chang , Cheng Hsuan , Lu Yen-Sen , Chou Chia-Chun , Chang Yung-Liang , Lin Ko-Long
Published: April 2024

Background:

Most existing studies measure atrial septal defect (ASD) outcomes based on morbidity rates such as atrial arrhythmias and heart failure rather than the functional assessment of physical capacity postprocedure. Few studies have evaluated cardiopulmonary function in ASD children. This study represents the largest sample population in the current research, encompassing a total of 122 Taiwanese children with ASD who had undergone treatment, to evaluate cardiopulmonary functional capacity through the implementation of cardiopulmonary exercise testing (CPET), and to investigate whether variations in treatment may impact their cardiopulmonary function.

Methods:

This is a retrospective cohort study with the data collected from January 2010 to December 2021. All patients and controls (age-, sex-, and body mass index-matched) underwent CPET and pulmonary function testing.

Results:

In total, 122 ASD patients (surgically closed ASDs 27, transcatheter-closed ASDs 48, and follow-up unrepaired ASD 47) and 244 healthy controls were recruited. The ASD group exhibited lower peak metabolic equivalent (MET), peak oxygen consumption (VO2, p < 0.001), and peak minute ventilation (p = 0.028) along with MET and VO2 at the anaerobic threshold (AT) (p = 0.012) compared to the control group. No statistically significant differences were observed in the pulmonary function test. Among surgically closed, transcatheter closed and unrepaired ASD subgroups, no significant variances were seen in CPET and pulmonary function tests.

Conclusion:

Taiwanese ASD children exhibited diminished exercise capacity and cardiopulmonary performance compared to their healthy counterparts. Differences among specific ASD treatments in cardiopulmonary tests were non-significant.
Prevalence of Hearing Loss Among Noise-Exposed US Workers Within the Utilities Sector, 2010–2019
Authors: Masterson Elizabeth A. , Themann Christa L.
Published: April 2024

Objective

This study’s objective was to estimate hearing loss prevalence for noise-exposed US Utilities workers.

Methods

In this cross-sectional study of a retrospective cohort, audiograms were examined for 1.3 million workers (13,595 within utilities) from 2010–2019. Hearing loss prevalence and adjusted risk as compared with a reference industry were estimated.

Results

The hearing loss prevalence for noise-exposed Utilities workers (25%) was higher than for noise-exposed workers in all industries combined (20%). Some subsectors surpassed the prevalence for all industries combined and/or had adjusted risks significantly higher than the reference industry. The highest prevalence subsectors were Hydroelectric Power Generation (37%) and steam and Air-Conditioning Supply (29%).

Conclusions

While often overlooked, noise-exposed workers in this sector have among the highest prevalences of hearing loss and significantly higher risks. Increased attention and better hearing conservation strategies are needed.
Development and validation of a preoperative radiomics-based nomogram to identify patients who can benefit from splenic hilar lymphadenectomy: a pooled analysis of three prospective trials
Authors: Xu Bin-bin , Zheng Hua-Long , Chen Chun-sen , Xu Liang-liang , Xue Zhen , Wei Ling-hua , Zheng Hong-hong , Shen Li-li , Zheng Chao-Hui , Li Ping , Xie Jian-Wei , Lin Jian-xian , Zheng Yu-hui , Huang Chang-Ming
Published: April 2024

Background:

The authors aimed to use preoperative computed tomography images to develop a radiomic nomogram to select patients who would benefit from spleen-preserving splenic hilar (No.10) lymphadenectomy (SPSHL).

Methods:

A pooled analysis of three distinct prospective studies was performed. The splenic hilar lymph node (SHLN) ratio (sLNR) was established as the quotient of the number of metastatic SHLN to the total number of SHLN. Radiomic features reflecting the phenotypes of the primary tumor (RS1) and SHLN region (RS2) were extracted and used as predictive factors for sLNR.

Results:

This study included 733 patients: 301 in the D2 group and 432 in the D2+No.10 group. The optimal sLNR cutoff value was set at 0.4, and the D2+No.10 group was divided into three groups: sLNR=0, sLNR ≤0.4, and sLNR >0.4. Patients in the D2+No. 10 group were randomly divided into the training (n=302) and validation (n=130) cohorts. The AUCs value of the nomogram, including RS1 and RS2, were 0.952 in the training cohort and 0.888 in the validation cohort. The entire cohort was divided into three groups based on the nomogram scores: low, moderate, and high SHLN metastasis burden groups (LMB, MMB, and HMB, respectively). A similar 5-year OS rate was found between the D2 and D2+No. 10 groups in the LMB and HMB groups. In the MMB group, the 5-year OS of the D2+No. 10 group (73.4%) was significantly higher than that of the D2 group (37.6%) (P<0.001).

Conclusions:

The nomogram showed good predictive ability for distinguishing patients with various SHLN metastasis burdens. It can accurately identify patients who would benefit from SPSHL.
Impact of blood salvage therapy during oncologic liver surgeries on allogenic transfusion events, survival, and recurrence: an ambidirectional cohort study
Authors: Lugassy Liav , Marion Samuel , Balthazar Frédéric , Cheng Oviedo Sonia G. , Collin Yves
Published: April 2024

Introduction:

The use of autologous blood transfusions in oncologic surgeries is somewhat controversial due to the potential risk of disease dissemination through the salvage process. On the other hand, autologous blood transfusion can prevent the potential negative effects of allogenic blood transfusions and reduce use of valuable resources.

Methods:

This study included 106 adult patients who underwent oncologic liver surgery at our institution between December 2015 and June 2019. The patients were divided into two groups: the Cell Saver group (operated between January 2018 and June 2019) and the control group (operated between December 2015 and December 2017). The Cell Saver device was present in the operating room for the Cell Saver group, and blood was retransfused if a certain amount of blood loss occurred. Data analysis focused on outcomes such as blood transfusion requirements, overall survival, recurrence-free survival, hemoglobin levels, hospital stay, and complications. Patient records provided relevant information on demographics, surgery details, pathology, and outcomes for both groups.

Results:

Autologous blood transfusion was found to reduce the amount of blood units needed (4.0 units (control group) versus 0.4 units (Cell Saver group) P=0.029. Kaplan–Meier curves showed no difference for both overall survival 471.6 days (Cell Saver group) versus 468.3 days (control group) (P=0.219) and 488.9 days (Cell Saver group) versus 487.2 days (control group) (P=0.993) and disease-free survival (P=0.553) and (P=0.735) for primary hepatic tumors and hepatic metastasis respectively between the Cell Saver and control groups. Overall survival regardless of the type of tumor was similar to the control group (485.4 days vs. 481.9 days) (P=0.503). Survival was significantly lower for minor hepatectomies (516.0 days vs. 517.4 days) (P=0.050) in the Cell Saver group, major hepatectomies showed no difference in overall survival (470.2 days vs. 466.4 days) (P=0.868). No impact on disease recurrence was found between patients who received autologous blood transfusions versus those who did not.

Conclusion:

The use of Cell Saver should not be avoided in oncologic surgeries of the liver. Use of Cell Saver for major hepatectomies might be more beneficial as OS was significantly lower for the Cell Saver group for patients who underwent minor hepactomies. Further research is needed to explain this conflicting result. Nonetheless, the use of Cell Saver in autologous blood transfusions can reduce the use of valuable resources and the risks associated with allogenic blood transfusions.
A Novel Model for Xenograft Right Ventricle to Pulmonary Artery Conduit
Authors: Mitchell Chace B. , Wiggins Luke M. , Wells Winfield J. , Cleveland David C. , Cleveland John D.
Published: April 2024

The last 40 years have shown dramatic improvement in outcomes for neonatal cardiac surgery for a spectrum of congenital heart disease diagnoses. With more patients surviving into adulthood, the long-term impact of initial management strategies of these patients has come into focus. This is particularly true for patients with pediatric heart valve disease. Many patients born with right ventricular to pulmonary artery (RVPA) discontinuity require placement of a valved conduit in the neonatal period. Valved conduit options are limited in this patient population due to patient size and inability to respond to somatic growth. Genetically engineered porcine (GEP) donors may offer a xenograft conduit alternative that can grow with the patient. We have developed a model utilizing GEP donor RVPA conduits placed in infantile nonhuman primate (NHP) recipients. Our recipient is maintained on single-drug immunosuppression and demonstrates no evidence of pulmonary valve insufficiency or stenosis during short-term follow-up. Further studies and long-term outcomes are necessary to determine the utility of this technology in human application.
The association between monocyte-to-high-density lipoprotein ratio and hyperuricemia: Results from 2009 to 2018
Authors: Cao Lei , Wu Chunwei , Liu Miao , Zhang Wenlong , Chen Hailong , Wang Ruolin , He Ze
Published: April 2024

Previous research has suggested that the monocyte-to-high-density lipoprotein ratio (MHR), an emerging inflammatory biomarker, holds promise in predicting the prevalence of various cardiovascular and metabolic diseases. However, earlier investigations were constrained by the relatively modest sample sizes. This study endeavored to expand the sample size and conduct a more comprehensive exploration of the potential relationship between MHR and hyperuricemia. This cross-sectional study incorporated data from participants of the 2009 to 2018 National Health and Nutrition Examination Survey (NHANES) with complete and qualifying information. MHR was determined by calculating the ratio between monocyte count and high-density lipoprotein levels. Various statistical methodologies such as weighted multivariate logistic regression, subgroup analysis, smoothed curve fitting, and threshold analysis, have been used to explore the correlation between hyperuricemia and MHR. The study included a cohort of 17,694 participants, of whom 3512 were diagnosed with hyperuricemia. MHR levels were notably higher in the hyperuricemia group than in the normal group, aligning with an elevated body mass index (BMI). A comprehensive multivariate logistic analysis, accounting for all relevant adjustments, revealed a notable positive correlation between MHR and hyperuricemia (P < .001, OR = 1.98, 95% CI: 1.54–2.54). Subgroup analysis indicated that the MHR exhibited an enhanced predictive capacity for identifying hyperuricemia risk, particularly in females (P < .05). Curvilinear and threshold analyses revealed a nonlinear association between MHR and hyperuricemia prevalence, with a notable inflection point at 0.826. In the US population, a clear positive correlation was observed between the MHR and prevalence of hyperuricemia. Importantly, the MHR is a more robust predictor of hyperuricemia risk in females. Further investigations are required to confirm these findings.
Lateral lymph node metastasis in papillary thyroid cancer: Is there a difference between PTC and PTMC?
Authors: Ma Wenli , Guo Yehao , Hua Tebo , Li Linlin , Lv Tian , Wang Jiafeng
Published: April 2024

Papillary thyroid carcinoma (PTC) and papillary thyroid microcarcinoma (PTMC) are generally characterized as less invasive forms of thyroid cancer with favorable prognosis. However, once lateral cervical lymph node metastasis takes place, the prognosis may be significantly impacted. The purpose of this study was to evaluate whether there is a difference in the pattern of lateral lymph node metastasis between PTC and PTMC. A retrospective analysis was performed for PTC and PTMC patients that underwent central area dissection and unilateral lateral neck lymph node dissection (II–V area) between January 2020 and December 2021. Compared with PTMC group, the PTC group exhibited higher incidence of capsule invasion, extrathyroid invasion and lymphatic vessel invasion. Both the number and rate of central lymph nodes metastasis were elevated in the PTC group. While the number of lateral cervical lymph node metastasis was higher, the metastasis rate did not demonstrate significant difference. No significant differences were identified in the lymph node metastasis patterns between the 2 groups. The determination of the extent of lateral neck lymph node dissection solely based on the tumor size may be unreliable, as PTC and PTMC showed no difference in the number and pattern of lateral neck metastasis. Additional clinical data are warranted to reinforce this conclusion. For patients categorized as unilateral, bilateral, or contralateral cervical lymph node metastasis (including level I, II, III, IV, or V) or retropharyngeal lymph node metastasis who require unilateral lateral neck dissection, the size of the primary tumor may not need to be a central consideration when assessing and deciding the extent of lateral neck dissection.
Causal relationships between gut microbrome and digestive system diseases: A two-sample Mendelian randomization study
Authors: Ding Wenjing , Chen Liangliang , Xia Jianguo , Dong Gang , Song Biao , Pei Bei , Li Xuejun
Published: April 2024

Growing evidences of recent studies have shown that gut microbrome are causally related to digestive system diseases (DSDs). However, causal relationships between the gut microbiota and the risk of DSDs still remain unclear. We utilized identified gut microbiota based on class, family, genus, order and phylum information and digestive system diseases genome-wide association study (GWAS) dataset for two-sample Mendelian randomization (MR) analysis. The inverse variance weighted (IVW) method was used to evaluate causal relationships between gut microbiota and 7 DSDs, including chronic gastritis, colorectal cancer, Crohn’s disease, gastric cancer, gastric ulcer, irritable bowel syndrome and esophageal cancer. Finally, we verified the robustness of MR results based on heterogeneity and pleiotropy analysis. We discovered 15 causal associations with genetic liabilities in the gut microbiota and DSDs, such as genus Victivallis, genus RuminococcaceaeUCG005, genus Ruminococcusgauvreauiigroup, genus Oxalobacter and so on. Our MR analysis revealed that the gut microbiota is causally associated with DSDs. Further researches of the gut microbiota and the pathogenesis of DSDs are still significant and provide new methods for the prevention and treatment of DSDs.
Eosinophilic pulmonary disease with ulcerative colitis: A case report
Authors: Li Songtao , Fang Mingliang , Guo Hua , Yu Tian , Wang Jun , Li Weiming , Huang Yunong , Wang Xichuan , Wu Rongyi
Published: April 2024

Rationale:

Eosinophilic pulmonary disease (EPD) is a general term for a large group of diseases with complex etiology. Ulcerative colitis is an inflammatory bowel disease (IBD). Patients with IBD may have pulmonary involvement. We herein present a case of ulcerative colitis complicated with EPD.

Patient concerns:

A 34-year-old woman with ulcerative colitis presented with dry cough. She had peripheral eosinophilia and apical ground glass opacities on CT (computed tomography) of her chest. Antibiotic treatment was ineffective.

Diagnoses:

Lung biopsy revealed eosinophil infiltration in the alveolar space and interstitial space, so EPD was considered.

Interventions:

After oral administration of prednisone, the lung shadow on CT disappeared when the cough symptoms resolved. However, the symptoms recurred after drug withdrawal, and the lung shadow reappeared on imaging. The cough symptoms and lung shadow disappeared after oral prednisone was given again. Prednisone was slowly discontinued after 6 months of treatment.

Outcomes:

The patient stopped prednisone for half a year. No recurrence or abnormal CT findings were detected during the half-year follow-up.

Lessons:

The clinical manifestations of EPD are atypical, laboratory and imaging findings are not specific, and it is difficult to make a definite diagnosis before lung biopsy. The diagnosis depends on pathological examination. Glucocorticoid treatment is effective, but some patients may relapse after drug withdrawal. Active follow-up after glucocorticoid treatment is very important for identifying disease recurrence. Patients with IBD are relatively prone to developing EPD. The etiology of EPD is complex. In clinical practice, we need to make a diagnosis and differential diagnosis to clarify its etiology.
Comparative analysis of different therapeutic approaches in the management of protein-energy malnutrition: Case reports from a clinical setting
Authors: Elendu Chukwuka , Amaechi Dependable C. , Jingwa Klein A. , Elendu Tochi C.
Published: April 2024

Background:

Severe protein-energy malnutrition (PEM) presents a significant clinical challenge, often compounded by comorbidities such as type 2 diabetes. This case report aims to elucidate the intricacies of managing severe PEM in conjunction with type 2 diabetes, emphasizing the importance of personalized interventions and multidisciplinary collaboration in achieving optimal outcomes. By addressing the unique challenges this complex clinical scenario poses, this report contributes valuable insights to the medical literature and guides clinicians in effectively managing similar cases.

Methods:

The patient, pseudonymously identified as Emma Thompson, underwent a comprehensive diagnostic evaluation to assess her symptoms’ severity and underlying causes. This included a thorough physical examination, laboratory testing, imaging studies, and collaboration with specialists to formulate a tailored treatment plan. Interventions were meticulously administered, with dosages, strengths, and durations adjusted based on ongoing assessments and patient response.

Results:

Implementing multidisciplinary therapeutic interventions significantly improved the patient’s nutritional status, glycemic control, and overall well-being. Objective measures such as BMI, serum albumin levels, and physical functioning showed marked improvement throughout treatment. Patient-reported outcomes indicated enhanced quality of life, reduced fatigue, and increased energy levels, underscoring the comprehensive success of the integrated therapeutic approach.

Conclusion:

This case report highlights the efficacy of a holistic, patient-centered approach in managing severe PEM and comorbid type 2 diabetes. Optimal outcomes were achieved by addressing the complex interplay of medical conditions through tailored interventions and multidisciplinary collaboration. The lessons from this case underscore the importance of individualized care, ongoing assessment, and long-term follow-up in enhancing patient well-being and guiding future clinical practice.
Main mechanisms and clinical implications of alterations in energy expenditure state among patients with pheochromocytoma and paraganglioma: A review
Authors: Yang Yuqi , Zhou Tong , Zhao Xue , Cai Yunjia , Xu Yao , Gang Xiaokun , Wang Guixia
Published: April 2024

Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors with diverse clinical presentations. Alterations in energy expenditure state are commonly observed in patients with PPGL. However, the reported prevalence of hypermetabolism varies significantly and the underlying mechanisms and implications of this presentation have not been well elucidated. This review discusses and analyzes the factors that contribute to energy consumption. Elevated catecholamine levels in patients can significantly affect substance and energy metabolism. Additionally, changes in the activation of brown adipose tissue (BAT), inflammation, and the inherent energy demands of the tumor can contribute to increased resting energy expenditure (REE) and other energy metabolism indicators. The PPGL biomarker, chromogranin A (CgA), and its fragments also influence energy metabolism. Chronic hypermetabolic states may be detrimental to these patients, with surgical tumor removal remaining the primary therapeutic intervention. The high energy expenditure of PPGL has not received the attention it deserves, and an accurate assessment of energy metabolism is the cornerstone for an adequate understanding and treatment of the disease.
Does the ulnohumeral angle have a role in the aetiopathogenesis of lateral epicondylitis?
Authors: Yurteri Ahmet , Mercan Numan
Published: April 2024

The pathophysiology of lateral epicondylitis (LE) remains not fully elucidated, as it involves a complex interaction of anatomical structures. The primary objective of the research is to identify a potential relationship between LE and the ulnohumeral angle (UHA), which demonstrates the coronal alignment of the elbow. Patients diagnosed with LE between September 1st, 2020, and September 1st, 2023, were retrospectively examined. Demographic information and UHA measurements of patients meeting the inclusion criteria and a control group with similar criteria were collected. Measurements were independently conducted by 2 orthopedists at a 2-week interval and compared. Among 413 patients meeting the inclusion criteria and the control group comprising 420 patients, there were no significant differences in age, gender, and side (P = .447, P = .288, P = .159, respectively). The mean UHA for the LE group was 13.49 ± 4.24, while for the control group, it was 12.82 ± 9.19, showing a significant difference (P = .026). The inter-observer and intraobserver reliability of the angle measurements were both above 0.80. We hypothesize that the increase in UHA in patients with LE reflects an adaptive change secondary to compressive forces acting on the lateral aspect of the elbow. This study is the first to describe the relationship between LE and UHA based on anatomical-biomechanical foundations, suggesting a cause-and-effect relationship. Further studies are warranted to delve deeper into this relationship.
Identification of prognostic m6A modification patterns and score system in melanoma patients
Authors: Wang Feixiang , Chen Peijie , Ouyang Si , Xiong Kaixin , Liu Zichuan , Wang Yao
Published: April 2024

N6-methyladenosine (m6A) is the most common modification on RNAs and LncRNAs. It plays an important role in cancer stem cell differentiation, T cell differentiation, and immune homeostasis. In this study, we explored the potential roles of m6A modification of RNA in melanoma and investigated the immune cell infiltration in tumor microenvironment in diverse m6Aclusters and different m6Ascore groups. A consensus clustering algorithm determined m6A modification patterns based on 14 m6A regulators, and further explored the biological functions and the connection with TME. An m6A-related gene signature (m6Ascore) was constructed based on m6A-related genes using principal component analysis. Three m6A modification patterns were identified based on 14 m6A regulators, named as m6Aclusters A-C. The prognosis of m6Acluster A was more favorable than m6Aclusters B and C, and it was more closely associated with immune regulation. To quantify the m6A modification patterns of individual tumor, an m6Ascore was constructed, and patients were classified into high and low m6Ascore groups. The low m6Ascore group, which had a favorable prognosis, was more relevant to immunology. The expression of PD-L1 was higher and the immunophenoscore (IPS) revealed stronger response to immunotherapy in the low m6Ascore group. This study identified 3 m6A modification patterns with different immune characteristics and constructed an m6Ascore system to predict prognosis and immunogenicity of patients, which is conducive to clinical prognosis judgment and individual treatment.
The correlation between vitamin D3 and arginine metabolism levels in newborns with amino acid metabolism disorders
Authors: Zhang Yao , Han Yanjie , Hou Shikuan , Gu Suyan , Han Wei
Published: April 2024

This study aimed to explore the correlation between vitamin D3 and arginine (Arg) metabolism indicators in newborns with amino acid metabolism disorders. Based on clinical data, 30 newborns with amino acid metabolism diseases admitted to Shijiazhuang Fourth Hospital from June 2021 to June 2022 were selected as the disease group, and 30 healthy newborns from the same period were selected as the healthy group. After enrollment, blood samples were collected to measure the levels of Arg, Glycine (Gly), and vitamin D3 levels. The levels of Arg metabolism indicators and vitamin D3 levels in the 2 groups and the correlation between vitamin D3 levels and Arg metabolism indicators in the affected group were analyzed. The Arg level in the diseased group was higher than that in the healthy group, whereas the Gly and vitamin D3 levels were lower than those in the healthy group (P < .05). There was a significant negative correlation between vitamin D3 and Arg levels in the affected group, and a significant positive correlation with Gly levels (P < .05). Newborns with amino acid metabolism disorders have abnormally high Arg levels, significantly reduced Gly levels, and significantly decreased vitamin D3 levels. The degree of decline was closely related to the levels of indicators of Arg metabolism. Vitamin D3 supplementation can improve the Arg metabolism status of newborns with amino acid metabolism disorders.
A comparison of scoring systems and biomarkers to predict the severity of acute pancreatitis in patients referring to the emergency clinic
Authors: Vahapoğlu Ayşe , Çalik Mustafa
Published: April 2024

To investigate scoring systems and biomarkers for determining the severity and prognosis of acute pancreatitis (AP). Between January and July 2023, 100 patients with AP diagnosed and treated in the emergency department were included. AP was divided into 2 groups according to severity: mild AP and moderately severe AP (MSAP-SAP), according to the revised Atlanta Classification in 2012. Demographic characteristics, severity, intensive care unit (ICU) admission, white blood cell count (WBC), hematocrit, red cell distribution width from whole blood taken at admission and 48 hours later, C-reactive protein (CRP) and biochemistry values, Bedside Index for Severity in Acute Pancreatitis (BISAP), Pancreatitis Activity Scoring System (PASS), and harmless AP score scores were recorded retrospectively. Our variables, which were found to be significant in multiple logistic regression results, were found to increase MSAP-SAP expectation by 4.36-, 7.85-, 6.63 and 5.80 times in the presence of CRP > 47.10, WBC > 13.10, PASS > 0, and necrotizing computed tomography findings, respectively. It was detected that the risk factor which was found significant as a single variable affecting the ICU admission increased the risk of ICU requirement by 28.88 when PASS > 0, by 3.96 when BISAP > 1, and it increased the Atlanta score by 9.93-fold. We found that WBC and CRP values at the time of hospital admission and WBC, CRP, and red cell distribution width values after 48 had the highest accuracy in determining AP disease severity. BISAP, which was found to be significant in determining MSAP-SAP expectations, lost its significance in multiple logistic regression results, and PASS was found to be effective. The PASS is an important score in the clinical evaluation of patients with AP and in determining the need for ICU hospitalization.
Prognostic values of serum lactate-to-bicarbonate ratio and lactate for predicting 28-day in-hospital mortality in children with dengue shock syndrome
Authors: Nguyen Tat Thanh , Vo Hoang-Thien Nhu , Nguyen Tat Dat , Nguyen Phuc Hoang , Ho Lien Thi , Doan Duong Hung , Phan Dung Tuan , Duong Yen Nguyen-Hoang , Nguyen Truc Huynh , Nguyen Tuyet Kim , Dinh Ha Thi-Thu , Dinh Thuy Thi-Diem , Pham Anh Thi-Mai , Do Chau Viet , Trinh Tung Huu , Vo Thanh Luan
Published: April 2024

This study aimed to assess the clinical utility of blood lactate-to-bicarbonate (L/B) ratio, as a prognostic factor for 28-day in-hospital mortality in children with dengue shock syndrome (DSS), admitted to the pediatric intensive care unit (PICU). This single-center retrospective study was conducted at a tertiary children hospital in southern Vietnam from 2013 to mid-2022. Prognostic models for DSS mortality were developed, using a predefined set of covariates in the first 24 hours of PICU admission. Area under the curves (AUCs), multivariable logistic and Least Absolute Shrinkage and Selection Operator (LASSO) regressions, bootstrapping and calibration slope were performed. A total of 492 children with DSS and complete clinical and biomarker data were included in the analysis, and 26 (5.3%) patients died. The predictive values for DSS mortality, regarding lactate showing AUC 0.876 (95% CI, 0.807–0.944), and that of L/B ratio 0.867 (95% CI, 0.80–0.934) (P values of both biomarkers < .001). The optimal cutoff point of the L/B ratio was 0.25, while that of lactate was 4.2 mmol/L. The multivariable model showed significant clinical predictors of DSS fatality including severe bleeding, cumulative amount of fluid infused and vasoactive-inotropic score (>30) in the first 24 hours of PICU admission. Combined with the identified clinical predictors, the L/B ratio yielded higher prognostic values (odds ratio [OR] = 8.66, 95% confidence interval [CI], 1.96–38.3; P < .01) than the lactate-based model (OR = 1.35, 95% CI, 1.15–1.58; P < .001). Both the L/B and lactate models showed similarly good performances. Considering that the L/B ratio has a better prognostic value than the lactate model, it may be considered a potential prognostic biomarker in clinical use for predicting 28-day mortality in PICU-admitted children with DSS.
Immunohistochemistry of Lung Cancer Biomarkers
Authors: Beasley Mary Beth
Published: April 2024

Immunohistochemical (IHC) staining represents a comparatively inexpensive testing method that is attractive as a potential alternative to molecular sequencing methods or fluorescence in situ hybridization for pulmonary biomarker testing. While a variety of IHC tests directed at actionable genetic alterations have been developed and evaluated since the advent of targeted therapy, specific antibody clones for anaplastic lymphoma kinase, ROS-1, and potentially neurotrophic tropmyosin receptor kinase have been the primary antibodies that provide sufficiently robust results to be utilized as either a primary testing or screening method to direct targeted therapy. Antibodies for a variety of other targets such as epidermal growth factor receptors, for example, have lacked sufficient sensitivity and specificity to cover the range of mutations that may occur and are generally not recommended in lieu of molecular testing with the exception of limited resource settings. IHC is also used as a predictive marker for response to immunotherapy through evaluation of programmed death ligand 1 expression. In addition, multiple antibody-drug conjugates (ADCs) are under investigation, designed to deliver drugs directly to tumor cells through binding to specific target antigens. Some ADCs have already received accelerated FDA approval, and IHC was incorporated in many clinical trials evaluating ADC efficacy. As such, it is anticipated that ADCs may have a companion diagnostic IHC to guide patient selection.
Rapid Whole-Genome Sequencing and Clinical Management in the PICU: A Multicenter Cohort, 2016–2023*
Authors: Rodriguez Katherine M. , Vaught Jordan , Salz Lisa , Foley Jennifer , Boulil Zaineb , Van Dongen-Trimmer Heather M. , Whalen Drewann , Oluchukwu Okonkwo , Liu Kuang Chuen , Burton Jennifer , Syngal Prachi , Vargas-Shiraishi Ofelia , Kingsmore Stephen F. , Sanford Kobayashi Erica , Coufal Nicole G.
Published: April 2024

OBJECTIVES:

Analysis of the clinical utility of rapid whole-genome sequencing (rWGS) outside of the neonatal period is lacking. We describe the use of rWGS in PICU and cardiovascular ICU (CICU) patients across four institutions.

DESIGN:

Ambidirectional multisite cohort study.

SETTING:

Four tertiary children’s hospitals.

PATIENTS:

Children 0–18 years old in the PICU or CICU who underwent rWGS analysis, from May 2016 to June 2023.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A total of 133 patients underwent clinical, phenotype-driven rWGS analysis, 36 prospectively. A molecular diagnosis was identified in 79 patients (59%). Median (interquartile range [IQR]) age was 6 months (IQR 1.2 mo–4.6 yr). Median time for return of preliminary results was 3 days (IQR 2–4). In 79 patients with a molecular diagnosis, there was a change in ICU management in 19 patients (24%); and some change in clinical management in 63 patients (80%). Nondiagnosis changed management in 5 of 54 patients (9%). The clinical specialty ordering rWGS did not affect diagnostic rate. Factors associated with greater odds ratio (OR [95% CI]; OR [95% CI]) of diagnosis included dysmorphic features (OR 10.9 [95% CI, 1.8–105]) and congenital heart disease (OR 4.2 [95% CI, 1.3–16.8]). Variables associated with greater odds of changes in management included obtaining a genetic diagnosis (OR 16.6 [95% CI, 5.5–62]) and a shorter time to genetic result (OR 0.8 [95% CI, 0.76–0.9]). Surveys of pediatric intensivists indicated that rWGS-enhanced clinical prognostication (p < 0.0001) and contributed to a decision to consult palliative care (p < 0.02).

CONCLUSIONS:

In this 2016–2023 multiple-PICU/CICU cohort, we have shown that timely genetic diagnosis is feasible across institutions. Application of rWGS had a 59% (95% CI, 51–67%) rate of diagnostic yield and was associated with changes in critical care management and long-term patient management.
Effects of Chronic Pain Diagnoses on the Antidepressant Efficacy of Transcranial Magnetic Stimulation
Authors: Afshar Houtan Totonchi , Fishbein Joel N. , Martinez Erica J. , Chu Gage M. , Shenasa Mohammad A. , Ramanathan Dhakshin , Herbert Matthew S.
Published: April 2024

Objective

Major depressive disorder (MDD) and chronic pain are highly comorbid and bidirectionally related. Repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex is effective in treating MDD, but additional research is needed to determine if chronic pain interferes with rTMS for MDD.

Methods

Participants were 124 veterans (M
age = 49.14, SD = 13.83) scheduled for 30 sessions of rTMS across 6 weeks. Depression severity was monitored weekly using the Patient Health Questionnaire-9 (PHQ-9). Having any pain diagnosis, low back pain, or headache/migraine were assessed by chart review. We fit latent basis models to estimate total change by pain diagnosis in depression scores and quadratic latent growth models to examine differences in growth rates. Then, we computed χ
2 tests of group differences in response (PHQ-9 reduction ≥50%) and remission rates (final PHQ-9 < 5).

Results

A total of 92 participants (74%) had a documented pain diagnosis, 58 (47%) had low back pain, and 32 (26%) had headache/migraine. In growth models, depression scores initially decreased (linear slope estimate = −2.04, SE = 0.26, p < .0001), but the rate of decrease slowed over time (quadratic slope estimate = 0.18, SE = 0.04, p < .001). Overall change was not different as a function of any pain diagnosis (p = .42), low back pain (p = .11), or headache/migraine (p = .28). However, we found that low back pain was a negative predictor of response (p = .032).

Conclusions

These data support rTMS as a viable treatment option for comorbid populations. Although patients with comorbid chronic pain conditions are likely to receive benefit from rTMS for depression, adjunctive pain treatment may be indicated.
Unconscious Activation of Negative Emotional Memories Increases Pain Unpleasantness
Authors: Frisch Stephan , Walter Steffen , Rebhann Vanessa , Gruss Sascha , Geisel Daniela , Bär Karl-Jürgen , Gündel Harald , Lane Richard D. , Smith Ryan
Published: April 2024

Objective

The influence of unconscious emotional processes on pain remains poorly understood. The present study tested whether cues to forgotten unpleasant images might amplify pain (i.e., in the absence of conscious recall).

Methods

Seventy-two healthy female adults (19 to 34 years) performed an adapted Think/No-think paradigm (T/NT) using 72 combinations of neutral face images (cues) paired with 36 neutral and 36 unpleasant images. After completion of the T/NT task, cues associated with forgotten neutral or unpleasant images were identified. Cues to either neutral or unpleasant images from the NT condition were then presented in randomized order while participants received intermediate-level thermal pain stimulation on the left hand. Ratings of both pain intensity and unpleasantness were acquired after each trial.

Results

Mean pain unpleasantness ratings were greater during presentation of cues to forgotten negative versus neutral images (5.52 [SD = 2.06] versus 5.23 [SD = 2.10]; p = .02). This pattern was also present when comparing cues to remembered negative versus neutral images (5.62 [SD = 1.94] versus 5.04 [SD = 1.90]; p < .001). Mean pain intensity ratings were higher for cues to negative versus neutral images when remembered (5.48 [SD = 1.79] versus 5.00 [SD = 1.69]; p < .001), but not when forgotten (5.27 [SD = 1.96] versus 5.16 [SD = 1.93]; p = .30).

Conclusions

Using an adapted T/NT-Pain paradigm, this study demonstrated that cues to nonrecallable (but potentially unconsciously activated) negative emotional memories amplify pain unpleasantness, similar to known effects of conscious negative emotions.
Squamous Cell Carcinoma Arising From Epidermal Cyst
Authors: Kim Ji-Young , Min Sally , Park Joseph Kyu-hyung , Kim Sang Wha
Published: April 2024

Epidermal cysts are among the most common benign subcutaneous tumors. However, malignant transformation of benign epidermal cysts into squamous carcinomas has been reported. Owing to its low incidence rate, the clinical and pathological features of this condition are not well understood. This study aimed to analyze the clinical and pathological characteristics of the malignant transformation of epidermal cysts, which could suggest an appropriate treatment strategy. We conducted a retrospective study of 9 patients diagnosed with squamous cell carcinoma arising from epidermal cysts. All patients underwent surgical excision, and clinical information regarding patient demographics, tumor characteristics, treatment, and outcomes was analyzed. The average age at diagnosis was 57.3 years, with an average latency period of 15.4 years. Five patients had undergone prior cyst excision or drainage, with an average of 2.3 episodes of recurrence. Surgical excision was the primary treatment in all cases, and 2 patients with margin involvement at the final pathology underwent re-excision with additional resection margins. No recurrence was observed during the follow-up period. Four patients had immune dysregulation due to an underlying chronic kidney disease or cancer. Our study emphasizes the need for increased awareness of squamous cell carcinoma arising from epidermal cysts in patients with a history of cyst existence or recurrence, especially those with immune deficiencies. We expect these findings to contribute to early suspicion of malignant transformation and guide adequate clinical decision-making.
Optimal Treatment Order With Fibula-Free Flap Reconstruction, Oncologic Treatment, and Dental Implants: A Systematic Review and Meta-Analysis
Authors: Sriram Shreya , Njoroge Moreen W. , Lopez Christopher D. , Zhu Lily , Heron Matthew J. , Zhu Katherine J. , Yusuf Cynthia T. , Yang Robin
Published: April 2024

Head and neck cancer (HNC) patients benefit from craniofacial reconstruction, but no clear guidance exists for rehabilitation timing. This meta-analysis aims to clarify the impact of oncologic treatment order on implant survival. An algorithm to guide placement sequence is also proposed in this paper. PubMed, Embase, and Web of Science were searched for studies on HNC patients with ablative and fibula-free flap (FFF) reconstruction surgeries and radiotherapy (RTX). Primary outcomes included treatment sequence, implant survival rates, and RTX dose. Of 661 studies, 20 studies (617 implants, 199 patients) were included. Pooled survival rates for implants receiving >60 Gy RTX were significantly lower than implants receiving < 60 Gy (82.8% versus 90.1%, P=0.035). Placement >1 year after RTX completion improved implant survival rates (96.8% versus 82.5%, P=0.001). Implants receiving pre-placement RTX had increased survival with RTX postablation versus before (91.2% versus 74.8%, P<0.001). One hundred seventy-seven implants were placed only in FFF with higher survival than implants placed in FFF or native bone (90.4% versus 83.5%, P=0.035). Radiotherapy is detrimental to implant survival rates when administered too soon, in high doses, and before tumor resection. A novel evidence-based clinical decision-making algorithm was presented for utilization when determining the optimal treatment order for HNC patients. The overall survival of dental prostheses is acceptable, reaffirming their role as a key component in rehabilitating HNC patients. Considerations must be made regarding RTX dosage, timing, and implant location to optimize survival rates and patient outcomes for improved functionality, aesthetics, and comfort.
Optimizing the Management Strategies of Delayed Post-Pancreaticoduodenectomy Hemorrhage
Authors: Ma Tao , Qian Tao , Huang Kaiquan , Li Huiliang , Lin Wei-Chiao , Lao Mengyi , Gao Shunliang , Bai Xueli , Liang Tingbo
Published: April 2024

Objective:

To optimize the management strategies of delayed post-pancreaticoduodenectomy hemorrhage (PPH) by evaluating data from a high-volume pancreatic center.

Summary Background Data:

Delayed PPH is a potentially lethal complication. The management of delayed PPH remains controversial.

Methods:

Patients who underwent pancreaticoduodenectomy between July 2018 and June 2023 were identified from an institutional database. The clinical scenarios, management, and outcomes of patients with delayed PPH (>5 d postoperatively) were analyzed.

Results:

Out of the 2013 patients who underwent elective pancreaticoduodenectomy, 130 (6.5%) with delayed PPH were identified. The overall mortality was 15.4%. The success rates of endoscopy, angiographic intervention, and relaparotomy in treating delayed PPH were 54.5%, 56.5%, and 68.8%, respectively. For PPH from the hepatic arteries or their branches, complete blockade of the common or proper hepatic artery (C/PHA) was performed in 17 patients, either by coil embolization (n=7) or surgical ligation (n=10). Coil embolization of the C/PHA resulted in significant infarction of the left liver in 2 patients. No postoperative liver infarction occurred in patients who underwent ligation of the C/PHA during relaparotomy. Ten patients underwent suture repair of the C/PHA 13 times during relaparotomy. Arterial ligation achieved a significantly higher success rate of hemostasis than suture repair of the C/PHA during relaparotomy (100% vs. 30.8%, P<0.001).

Conclusions:

Angiography should be attempted first in managing hemodynamically stable delayed PPH. Arterial ligation was preferred for bleeding from the hepatic arteries during relaparotomy with minor consequences for the liver.