bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe varicella-zoster virus meningoencephalomyelitis coexisting with visceral disseminated varicella-zoster virus infection in a patient with lupus nephritis: A case report
Authors: Tao Tian , Chen Jun , Long Kunlan , Zhi Lijia , Zhang Song , Liu Shuqin , Ma Yuexian , Yan Hong , Lv Lizeyu , Xu Yue , Wu Ling , Zhao Liangbin , Gao Peiyang
Published: April 2023

Rationale:

Meningoencephalomyelitis and visceral dissemination infection are rare but life-threatening complications of either the primary infection or reactivation of varicella-zoster virus (VZV) in immunocompromised patients. To date, few studies have reported the co-existence of VZV meningoencephalomyelitis and the visceral dissemination of VZV infection.

Patient concerns:

A 23-year-old male was diagnosed with lupus nephritis class III and was being treated with oral prednisone and tacrolimus. The patient exhibited herpes zoster 21-day after the initiation of therapy and experienced unbearable abdominal pain and generalized seizures 11 days after the onset of a zoster rash. Magnetic resonance imaging showed progressive lesions in the cerebrum, brainstem, and cerebellum, as well as meningeal thickening and thoracic myelitis. Computed tomography showed pulmonary interstitial infiltration, partial intestinal dilatation, and effusion. Metagenomic next-generation sequencing revealed 198,269 and 152,222 VZV-specific reads in the cerebrospinal fluid and bronchoalveolar lavage fluid, respectively.

Diagnoses:

Based on the clinical and genetic findings, this patient was finally diagnosed with VZV meningoencephalomyelitis and visceral disseminated VZV infection.

Interventions:

The patient received intravenous acyclovir (0.5 g every 8 hours) combined with plasma exchange and intravenous immunoglobulin. Treatment against secondary bacterial and fungal infections, organ support therapy and rehabilitation training were given simultaneously.

Outcome:

The patient’s peripheral muscle strength did not improve and repeated metagenomic next-generation sequencing showed the persistence of VZV-specific reads in the cerebrospinal fluid. The patient finally abandoned therapy due to financial constraints at the 1-month follow-up.

Lessons:

Patients with autoimmune diseases receiving immunosuppressive therapy should be warned about the possibility of developing serious neurological infections and visceral disseminated VZV infections as side effects. Early diagnosis and the early initiation of intravenous acyclovir therapy are important for such cases.
Effects of physical activity level on quality of life, stress, and dietary behavior in people living with HIV/AIDS: A pilot study
Authors: Kim Sung-Hoon , Joo Chang-Hwa
Published: April 2023

The aim of this study was to analyze the daily physical activity and the relationship between the physical activity levels and psychological variables of Koreans with HIV. Twenty-two people with HIV participated in this study. The participants completed questionnaires, and we assessed the daily physical activity for 2 weeks. The daily physical activity level of most of the participants was low-intensity; high-intensity activities were only performed for approximately 1 minute. The participants had unhealthy dietary habits, such as eating 2 meals a day, eating irregularly, and skipping breakfast. Psychological well-being and environmental satisfaction were higher in the high-intensity group than in the medium- and low-intensity groups (P < .05). The overall stress level among the groups was statistically significantly different (P < .05), and the stress level was lower in the high-intensity group than in the low- and medium-intensity groups. Restraint eating was higher in the low-intensity group than in the medium- and high-intensity groups (P < .05). However, among the groups, the external eating variable was highest in the high-intensity group (P < .05). Daily physical activity during positively affects the physical and mental well-being of people living with HIV.
The effect of ginsenoside Rg3 combined with chemotherapy on immune function in non-small cell lung cancer: A systematic review and meta-analysis of randomized controlled trials
Authors: Gao Song , Fang Cancan , Wang Tiancheng , Lu Wenjie , Wang Nan , Sun Lingfeng , Fang Wenyou , Chen Yang , Hu Rongfeng
Published: April 2023

Background:

The occurrence and development of non-small cell lung cancer (NSCLC) are closely related to the immune status of the tumor-host. The immunosuppression caused by tumor cells and toxic side effects produced by chemotherapeutic drugs results in a decrease in immune function, ultimately leading to the failure of clinical chemotherapy treatment. Ginsenoside Rg3 has been clinically reported to have positive effects in enhancing immune function in patients. Thus, we screened and evaluated the quality of the evidence regarding the benefits of ginsenoside Rg3 and conducted a meta-analysis to assess the impact on improving immune function in NSCLC.

Methods:

The PubMed, EMBASE, Cochrane Library, CNKI, Weipu (VIP), and Wanfang databases were searched in this study, all from the time of library construction to January 2023.

Results:

In total,12 trials with a sample size of 1008 cases were included based on the eligible criteria. The results showed that compared with first-line chemotherapy alone, the combination of ginsenoside Rg3 and first-line chemotherapy could better improve level of the CD3+ T lymphocytes [mean difference (MD) = 4.72; 95% confidence intervals (CI): 3.92, 5.53; P < .00001], CD4+ T lymphocytes (MD = 4.93; 95% CI: 4.61, 5.26; P < .00001), CD8+ T lymphocytes (MD = 2.67; 95% CI: 0.93, 4.37; P = .003), CD4+/CD8+ T lymphocytes (MD = 0.20; 95% CI: 0.09, 0.32; P = .0006), increase the activity of nature killer cells (MD = 2.11; 95% CI: 0.58, 3.63; P = .007), recover the decline of the white blood cell count induced by chemotherapy, and improve the clinical efficacy for patients.

Conclusion:

This study confirmed that ginsenoside Rg3 has some efficacy advantages for improving immune function in patients with NSCLC.
The function of S100A4 in pulmonary disease: A review
Authors: Wang Ting
Published: April 2023

S100 protein family, which represents 25 relatively small calcium binding proteins, is involved in many intracellular and/or extracellular processes, including differentiation, apoptosis, migration/invasion, Ca2+ homeostasis, inflammation, and tissue repair. As an important member, S100A4 was reported to have an abnormal expression in several lung diseases, such as lung cancer, pulmonary hypertension, idiopathic pulmonary fibrosis (IPF), etc. For example, in lung cancer, S100A4 was demonstrated to be associated to metastatic tumor progression and epithelial to mesenchymal transition (EMT). In IPF, S100A4 was considered as a promising serum biomarker predicting disease progression. Various studies in recent years focused on the S100A4 function in lung diseases, showing researchers’ interests on this protein. It is necessary to focuses on relative studies, and make a comprehensive understanding of S100A4 in common pulmonary diseases. By doing this, this paper provides a review of the evidence for S100A4 in lung cancer, chronic obstructive pulmonary disease (COPD), asthma, IPF and pulmonary hypertension.
Comprehensive analyses of cuproptosis-related gene CDKN2A on prognosis and immunologic therapy in human tumors
Authors: Zhang Di , Wang Tao , Zhou Yi , Zhang Xipeng
Published: April 2023

Recent studies have identified a novel programmed cell death based on copper, named cuproptosis. However, as an anti-cuproptosis gene, the functional roles, definite mechanisms and prognostic value of CDKN2A in pan-cancer are largely unclear. The GEPIA2, cancer genome atlas (TCGA), the tumor immune estimation resource 2.0 and CPTAC databases were performed to validate the differential expression of CDKN2A in 33 tumors. The clinical features and survival prognosis analysis were conducted by GEPIA2 and UALCAN web tool. Genetic alteration analysis of CDKN2A in pan-cancer was also evaluated. Furthermore, the functional roles of CDKN2A were explored via DNA methylation analysis, tumor microenvironment, infiltration of immune cells, enrichment analysis and gene co-expression associated with cuproptosis and immune regulation. The CDKN2A expression, both at the transcriptional and translational level, was obviously upregulated in most cancer patients, which might lead to poor survival in certain cancer types. CDKN2A expression was significantly associated with tumor pathological stages in some cancer types. In adrenocortical carcinoma (ACC) and kidney renal clear cell carcinoma (KIRC), DNA methylation of CDKN2A was explored to induce poor clinical outcomes. Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis indicated that CDKN2A expression was closely related to several cancer-associated signaling pathways, such as the p53 signaling pathway, Cellular senescence, DNA replication and Cell cycle signaling pathways. Gene set enrichment analysis (GSEA) analysis suggested that aberrantly expressed CDKN2A took part in the cell cycle regulation, immune regulation and mitochondrial signaling pathways in certain cancer patients. In addition, aberrant CDKN2A expression was closely correlated to immune infiltration and the levels of immune-regulatory genes. The study deeply defined the concrete roles of cuproptosis-related gene CDKN2A in tumorigenesis. The results provided new insights and pieces of evidence for treatment.
Advances in the prevention and treatment of postoperative delirium by acupuncture: A review
Authors: Yang Jian-Bing , Wang Long-Fei , Cao Yun-Fei
Published: April 2023

Postoperative delirium is a common postoperative complication of neurocognitive dysfunction, especially in elderly surgical patients. Postoperative delirium not only damages patients’ recovery but also increases social costs. Therefore, its prevention and treatment has essential clinical and social significance. However, due to its intricate pathogenesis and limited pharmacological interventions, the effective prevention and treatment of postoperative delirium remains a thorny problem. As traditional acupuncture therapy has been shown to be an effective treatment in many neurological disorders, and in recent years, it has begun to be clinically used as an intervention for postoperative delirium. Although most clinical and animal studies confirm that multiple types of acupuncture interventions can alleviate or prevent postoperative delirium by relieving acute postoperative pain, reducing the consumption of anesthetics and analgesics, attenuating neuroinflammation and neuronal lesions, while more evidence-based medical evidence and clinical validation are needed for these encouraging effects.
Role of nutritional vitamin D in chronic kidney disease-mineral and bone disorder: A narrative review
Authors: Shen Yingjing
Published: April 2023

Chronic kidney disease-mineral and bone disorder has complex and diverse clinical manifestations, including the simplest abnormalities of calcium, phosphorus and parathyroid hormone detected in blood, abnormalities of bone transformation and mineralization in bone, and calcification of blood vessels or other soft tissues detected on imaging. Patients with CKD-MBD combined low bone mineral density and fragility fractures are referred to as CKD-MBD with low bone mineral density. Vascular calcification refers to ectopic deposition of calcium phosphate in the blood vessel walls and heart valves. The degree of vascular calcification was inversely proportional to bone mineral density. The more severe the degree of vascular calcification, the lower the bone mineral density, and the higher the risk of death, indicating that the bone-vascular axis exists. Activation and alteration of the Wnt signaling pathway are central to the treatment of vascular diseases in uremia. Vitamin D supplementation can prevent secondary hyperparathyroidism, activate osteoblasts, relieve muscle weakness and myalgia, and reduce vascular calcification. Nutritional vitamin D may improve vascular calcification in uremia patients by regulating Wnt signaling pathway.
Exploring the pharmacological and adverse reaction mechanism of a drug by network pharmacology strategy: Using colchicine to treat Behcet syndrome as an example
Authors: Li Shizhe , Wang Lei , Wang Yeming , Zhang Chaoqun
Published: April 2023

Colchicine (COLC) is a natural alkaloid used to treat Behcet syndrome (BS), but its adverse reactions limit its clinical application in treating BS. However, the adverse reaction mechanism of COLC in the treatment of BS remains unclear. Herein, a network pharmacology-based strategy was designed to analyze the pharmacological and adverse reaction mechanism of COLC in treating BS. The biological functions of COLC and BS pathogenesis were analyzed through a series of network construction and analysis. The data above predicted the pharmacological and adverse reaction mechanism of COLC in BS treatment. The pharmacological mechanism of COLC against BS was predicted to control inflammatory responses. Interleukin-8, interleukin-18, integrin alpha-4, integrin beta-2, and tubulin targets are crucial in treating BS. The adverse reactions of COLC in BS treatment were predicted as neurotoxicity and hepatotoxicity. The mechanism of hepatotoxicity may be related to the decrease of cytochrome P450 family 3 subfamily A activity caused by various factors, such as poor hepatic function, the dosage of COLC, and combination with inhibitors. The mechanism of neurotoxicity may be related to the disruption of microtubules in the nervous system by COLC transport across the blood-brain barrier. This study provided basic evidence for the medication safety management of COLC used in treating BS. Moreover, this study demonstrated that it is feasible to analyze the adverse reaction mechanisms of drugs using a network pharmacology strategy, which facilitates systematic drug safety management and evaluation.
Radical resection of trigeminal schwannoma at the cerebellopontine angle with support of the digital robotic exoscope Synaptive Modus V system: A case report and literature review
Authors: Chu Tan-Si , Chu Tan-Huy , Huynh Tri-Dung , Phan Van-Dinh , Dang Bao Ngoc , Tran Quoc Dat
Published: April 2023

Rationale and patient concerns:

We report on a 67-year-old woman who experienced drowsy mental status, facial numbness, and hearing loss on the right side; the symptom gradually worsened over the last 4 years. Brain magnetic resonance imaging revealed a 4.8 × 1.8 × 2.6 cm lesion located in the right cerebellopontine angle.

Interventions:

She underwent surgery with the retrosigmoid suboccipital approach and support from the digital robotic exoscope Synaptive Modus V system. To the best of our knowledge, this is the first reported case that used the robotic exoscope system in Vietnam, and also in Asia.

Diagnosis:

We performed radical resection of the tumor, the surgery position and the pathology result concluded the diagnosis was trigeminal schwannoma.

Outcomes:

After 30 months of follow-up, she fully recovered and the magnetic resonance imaging showed radical resection of the tumor.

Lessons:

The aim of this study is to share our experience with the robotic exoscope system, which can improve optical field and image resolution, hence creating an opportunity for surgery that otherwise is impossible. The application of this robotic exoscope system is a breakthrough in neurosurgery in developing countries, such as Vietnam.
Clinical characterization of polycythemia vera associated with IgA nephropathy in a single Chinese center: A case series
Authors: Wang Xia , Yang Nannan , Lu Chunyu , Xu Feng , Wang Jinquan
Published: April 2023

Background:

Polycythemia vera (PV) is a myeloproliferative neoplasm which is characterized by excessive production of erythrocytes as well as myeloid and megakaryocytic proliferation. PV associated with IgA nephropathy (IgAN) has rarely been reported in the literature. The long-term renal prognosis of these patients is unknown.

Methods:

Clinical and pathological characteristics of 7 patients with renal biopsy-proven IgAN associated with PV were retrospectively analyzed.

Results:

The 7 patients were all males, with a mean age of 49.1 ± 18.8 years when admitted to our hospital. Systemic symptoms include: hypertension in case 2, 3, 5, and 6, splenomegaly in case 2, 4, and 5, and multiple lacunar infarction in case 6. Bone marrow biopsy test revealed relative erythroid hyperplasia and atypical megakaryocyte proliferation which consistent with a chronic myeloproliferative neoplasm. All patients had JAK2V617F and BCR-ABL tested, and JAK2V617F positive in 2 patients. Mild mesangial proliferation was observed in 5 patients and moderate/severe mesangial proliferation in 2patients. Immunofluorescence mainly showed diffuse granular deposition of dominant IgA in mesangium. After follow-up of 56.7 ± 44.0 months, hemoglobin level was 144 ± 29 g/L and hematocrit lever was 0.470 ± 0.03, compared with 187 ± 29 g/L and 0.563 ± 0.087 respectively when admitted to our hospital. The urine protein was 0.85 ± 0.64 g/24 h compared with 3.97 ± 4.68 g/24 h. Case 3 progressed to end stage renal disease and had received hemodialysis for 5 years before renal transplantation.

Conclusions:

The results of this study showed that PV associated with IgAN mainly occurs in males and is often accompanied by hematuria and mild-to-moderate renal insufficiency. The long-term prognosis was good for most patients, and few progressed relatively quickly to end stage renal disease.
Esophageal achalasia, diagnosed through the repeated manometry, alleviated using benzodiazepine: A case report
Authors: Nishi Ryusei , Amitani Haruka , Hamada Kazumasa , Fukumoto Takamasa , Kato Ryuichi , Yamamoto Takako , Fuku Yuuki , Sagiyama Kenichiro , Asakawa Akihiro
Published: April 2023

Rationale:

Idiopathic achalasia is an esophageal peristaltic dysfunction of the lower esophageal sphincter (LES). The initial symptom is progressive dysphagia. However, due to its rarity, it is often misdiagnosed as an esophageal disorder. High LES pressure on esophageal manometry is an essential finding for the diagnosis.

Patient concerns:

A 55-year-old man was hospitalized with saliva-like vomitus, stuck-in-throat feeling of dysphagia, and weight loss.

Clinical findings:

On initial admission, gastrointestinal endoscopy, esophageal manometry, laboratory tests, and physical examination results were within normal limits.

Diagnoses, interventions, and outcomes:

Initially, the patient was diagnosed with globus sensation and recovered with medication. However, the symptoms recurred. He requested another examination on the second admission and was diagnosed with achalasia based on repeat esophageal manometry. The patient recovered after surgical treatment.

Lessons:

When patients still suffer from these symptoms, there is a need to reconsider achalasia, even if it is initially excluded from the differential diagnosis. Medication is not a radical treatment; however, it sometimes ameliorates symptoms. Moreover, the psychosomatic approach can be useful in such cases.
A novel treatment approach for a patient with advanced low rectal cancer: A case report and literature review
Authors: Jiang Xuejun , Zhou Feng , Yuan Fangjun , Lei Xinyi , Liu Cui , Ji Zujin
Published: April 2023

Rationale:

In the treatment of low rectal cancer (LRC), preserving the anal sphincter is increasingly attracting the attention of colorectal surgeons. Many patients refused to perform a colostomy. Here, we report a case of LRC in a middle-aged woman and the clinical implications of the symptom, the treatment process of LRC, and the complications.

Patient concerns:

A 46-year-old woman visited our department with a tumor found on her physical examination because of hemafecia. Then she refused to perform abdominoperineal resection.

Diagnosis:

The patient first completed a colonoscopy and then underwent a rectal biopsy. The tumor was diagnosed as a rectal adenocarcinoma after pathological evaluation. Then it was staged by magnetic resonance imaging and enhanced computed X-ray tomography.

Interventions:

The treatment consisted of chemoradiotherapy followed by cryoablation.

Outcomes:

The patient achieved a good oncological outcome and preserved the sphincter successfully. The post-cryoablation course of the patient was uneventful and he remained healthy at the 1-year follow-up.

Lessons:

The preservation of anal sphincters has attracted more and more attention from colorectal surgeons. From the patient's perspective, the preservation of the anal sphincter was a key part of her treatment. We should try to meet the wishes of patients on the basis of curing the disease.
Effect of dexmedetomidine and remifentanil infusion on postoperative sore throat after lumbar spine surgery in the prone position
Authors: Choi Eun Kyung , Baek Jongyoon , Kim Do Young
Published: April 2023

Background:

A sore throat is an adverse postoperative consequence of tracheal intubation under general anesthesia. Recently, dexmedetomidine, an anesthetic adjuvant, has shown beneficial effects in postoperative sore throat (POST). Herein, we compared the effects of dexmedetomidine and remifentanil on POST after spinal surgery in the prone position, which is a risk factor for developing POST.

Methods:

Ninety-eight patients were enrolled in the dexmedetomidine and remifentanil groups. Each drug was continuously infused using the following protocol: 1 μg/kg over 10 minutes followed by 0.2 to 0.8 μg/kg/h of dexmedetomidine, 3 to 4 ng/mL during induction followed by 1 to 3 ng/mL of remifentanil intraoperatively. The incidence and severity of POST were assessed serially at 24 hours postoperatively. Postoperative hoarseness, nausea, and pain scores were measured.

Results:

The incidence and severity of POST were significantly lower in the dexmedetomidine group than that in the remifentanil group. However, the incidence of hoarseness was comparable between the 2 groups. Postoperative nausea was lower in the dexmedetomidine group at 1 hour postoperatively; however, the postoperative pain score and analgesic requirements did not differ significantly.

Conclusions:

Dexmedetomidine infusion as an adjuvant during sevoflurane anesthesia significantly reduced the incidence and severity of POST in patients who underwent lumbar surgery 24 hours postoperatively.
The efficacy and influence factors analysis of Mifepristone combined with estrogen-progesterone in the treatment of incomplete abortion
Authors: Wang Kai , Zhuang Ling-Ling , Shen Hai-Lan , Su Rui-De , Luo Zhen-Yu , Wang Wen-Rong
Published: April 2023

To analyze the efficacy and influencing factors of Mifepristone combined with estrogen-progesterone sequential therapy (Femoston) in the treatment of incomplete abortion. This retrospective cohort study included 93 patients with incomplete abortion. All patients took 50 mg of Mifepristone 2 times a day for 5 days and then took Femoston once a day (starting with estradiol tablets/2 mg) for 28 days. Without any indication of intrauterine residue by ultrasonic examination was judged to be effective. According to statistical analysis, this study calculated the effective rate and analyzed its influencing factors. A 2-sided value of P < .05 was considered statistically significant. The total response rate of the treatment regimen was 86.67%. body mass index was a significant influencing factor for treatment outcome (OR 0.818, 95% confidence interval 0.668–0.991, P = .041). For patients with incomplete abortion, Mifepristone combined with estrogen-progesterone sequential therapy has a remarkable therapeutic effect. Patients with a lower body mass index may respond much more significantly to this treatment regimen.
Assessment of Factors Associated With the Evaluation of Children for Leukemia Predisposition Syndromes: A Retrospective Single-center Study
Authors: D’Aquila Kristen R. , Kessler Elena , Cooper Kristine L. , Durst Andrea , Meade Julia
Published: April 2023

Five to 10% of children with cancer are thought to have a cancer predisposition syndrome (CPS). Referral guidelines for leukemia predisposition syndromes are limited and vague, requiring the treating provider to determine whether patients should have a genetics evaluation. We evaluated referrals to the pediatric cancer predisposition clinic (CPP), the prevalence of CPS in those who elected to pursue germline genetic testing, and assessed for associations between a patient’s medical history and the diagnosis of a CPS. Data were obtained via chart review of children diagnosed with leukemia or myelodysplastic syndrome between November 1, 2017, and November 30, 2021. A total of 22.7% of pediatric leukemia patients were referred for evaluation in the CPP. Of the participants evaluated with germline genetic testing, the prevalence of a CPS was 25%. Our study was able to find a CPS in different malignancies, including acute lymphoblastic leukemia, acute myeloid leukemia, and myelodysplastic syndrome. We did not find associations between a participant with an abnormal CBC before diagnosis or hematology visit and the diagnosis of a CPS. Our study supports that a genetic evaluation should be available to all children with leukemia as medical and family history alone is not predictors of a CPS.
Effect of Imatinib Mesylate on Growth in Pediatric Chronic Myeloid Leukemia: A Systematic Review and Meta-analysis
Authors: Gupta Priyanka , Banothu Kiran Kumar , Haldar Partha , Gupta Aditya Kumar , Meena Jagdish Prasad
Published: April 2023

The outcomes of pediatric chronic myeloid leukemia (CML) have improved with the use of imatinib mesylate (IM). Multiple reports of growth deceleration with IM have raised concerns, necessitating careful monitoring and evaluation in children with CML. We systematically searched the databases of PubMed, EMBASE, Scopus, CENTRAL, and conferences-abstracts, reporting the effect of IM on growth among children with CML, and published in the English language from inception till March 2022. For observational studies, the modified Newcastle Ottawa Scale was used to assess the risk of bias. Pooled estimates were derived using a random-effects meta-analysis, and heterogeneity was assessed using Cochrane Q statistic test of heterogeneity and I
2 statistic. Of the 757 studies identified through electronic search, 15 (n=265) were included in the final analysis. Six studies (n=178) were included in the meta-analysis of the primary outcome. There was a significant deleterious effect of IM on height—standardized mean difference (SMD): −0.52 (95% CI: −0.76; −0.28) (I
2=13%). The adverse effect of IM on height was significant among studies with a follow-up period <3 years [SMD: −0.66 (95% CI: −0.93, −0.40), I
2=0%, P=0.59] but not in studies with follow-up period ≥3 years [SMD: −0.26 (95% CI: −0.63, 0.11), I
2=0, P=0.44], indicating that the effect of IM on height is a short-term effect. The effect of IM on height was not dependent upon pubertal status at the initiation of therapy. Prospective studies with adequate sample size are required to confirm the findings of the effect of IM on height in children with CML.
Hepatocellular Carcinoma in ADA-SCID Patient After Hematopoietic Stem Cell Transplantation
Authors: Ucku Duygu , Armutlu Ayse , Cipe Funda , Ersoy Gizem Zengin , Karakaya Afak Durur , Arikan Cigdem
Published: April 2023

Adenosine deaminase (ADA) deficiency is one of the most prevalent forms of severe combined immunodeficiency and results in the accumulation of toxic substrates which creates a systemic metabolic disease. It predisposes patients to the development of malignancies, most commonly lymphoma. We report an 8-month-old infant with ADA deficient severe combined immunodeficiency who developed progressive liver dysfunction and hepatocellular carcinoma after successful hematopoietic stem cell transplantation. This is the first case report of an ADA-deficient patient who presented with hepatocellular carcinoma and gives an insight into the complex etiology that can lie behind liver dysfunction in these patients.
Prognostic Values of Primary Tumor Textural Heterogeneity and Blood Biomarkers in High-risk Neuroblastoma
Authors: Vural Ozge , Aydos Uguray , Okur Arzu , Pinarli Faruk Güçlü , Atay Lütfiye Özlem
Published: April 2023

Purpose:

The aim of this study was to evaluate the prognostic value of textural parameters of primary tumors, serum lactate dehydrogenase (LDH), D-dimer, and ferritin in high-risk neuroblastoma patients.

Patients and Methods:

The imaging findings of 22 neuroblastoma patients (14 girls and 8 boys; age, 36.6 ± 34.2 [range: 5 to 138] months) who underwent 18-fluorodeoxyglucose positron emission tomography/computed tomography for primary staging before therapy between 2009 and 2020 were retrospectively evaluated. Positron emission tomography-derived metabolic data (maximum standard uptake value, mean standard uptake value, metabolic tumor volume, and total lesion glycolysis) and textural features of primary tumors were obtained. Serum LDH, D-dimer, and ferritin levels at the time of diagnosis were recorded. Univariate and multivariate Cox proportional hazards regression models were used to identify predictors for progression-free survival (PFS) and overall survival (OS). Survival curves were estimated by using the Kaplan-Meier method.

Results:

The median follow-up duration after diagnosis was 63 months (range: 5 to 141 mo). The median PFS and OS in all patients were 19 and 72 months, respectively. In multivariate Cox regression analyses with backward stepwise selection, grey level size zone matrix_size zone emphasis (GLSZM_SZE) was found as an independent predictor for both PFS and OS. Serum ferritin level was also found as an independent predictor for PFS. The Kaplan-Meier survival analysis showed that higher serum LDH, D-dimer, GLSZM_SZE, and zone size nonuniformity were significantly associated with shorter OS.

Conclusion:

Serum LDH, D-dimer, ferritin levels, and GLSZM_SZE of primary tumors may be used as prognostic biomarkers to identify patients with worse prognoses in high-risk neuroblastoma. GLSZM textural features showing higher tumor heterogeneity are significantly associated with shorter PFS and OS.
Effect of a Compassion Fatigue Resiliency Program on Nurse Managers' Professional Quality of Life, Stress, and Resilience
Authors: Pehlivan Sarıbudak Tuğba , Güner Perihan , Çepni Berrin
Published: April 2023

Background:

Compassion fatigue, stress, and burnout have an adverse impact on nurse managers.

Purpose:

To evaluate the impact of a compassion fatigue resiliency program on nurse managers and to obtain their views of the program.

Methods:

This mixed-methods study was conducted with 16 nurse managers. The compassion fatigue resiliency program was implemented; compassion fatigue, compassion satisfaction, burnout, perceived stress, and resilience were assessed before and after implementation of the program.

Results:

The mean compassion fatigue and perceived stress scores of nurses decreased significantly after the intervention. Four themes were identified from qualitative analysis, including awareness, coping with stress, effective communication skills in team management, and recommendations.

Conclusions:

The current study shows the training program reduced nurse managers' compassion fatigue and stress and enabled nurse managers to improve their coping skills and awareness.
From the ER to the OR: Initial Evaluation of Primary Central Nervous System Lymphoma
Authors: Baskaran Archit B. , Dixit Karan S. , Sonabend Adam W. , Horbinski Craig M. , Abutalib Syed Ali , Lukas Rimas V.
Published: April 2023

Background:

Primary central nervous system lymphoma (PCNSL) is a rare, often curable neoplasm, often initially presenting in acute care settings by nonneuroscience specialized physicians. Delays in the recognition of specific imaging findings, lack of appropriate specialist consultation, and urgent incorrect medication administration can delay necessary diagnosis and treatment.

Review Summary:

In this paper, the reader is moved quickly from the initial presentation to the diagnostic surgical intervention for PCNSL in a manner analogous to the experience of clinicians in the frontline setting. We review the clinical presentation of PCNSL, its radiographic features, the effect of prebiopsy steroids, and the role of a biopsy in the diagnosis. In addition, this paper revisits the role of surgical resection for PCNSL and investigational diagnostic studies for PCNSL.

Conclusion:

PCNSL is a rare tumor that is associated with high morbidity and mortality. However, with appropriate identification of clinical signs, symptoms, and key radiographic findings, the early suspicion of PCNSL can lead to steroid avoidance and timely biopsy for rapid administration of the potentially curative chemoimmunotherapy. Surgical resection presents the potential for improving outcomes for patients with PCNSL, however, this remains controversial. Further research into PCNSL presents the opportunity for better outcomes and longer livelihoods for patients.
Systemic Neoplastic Cryoglobulinemic Vasculitis Mimics Large Vessel Occlusion
Authors: Bisogno Antonio L. , Viaro Federica , Pieroni Alessio , Rinaldi Francesca , Corbetta Maurizio , Baracchini Claudio
Published: April 2023

Introduction:

We describe a systemic neoplastic cryoglobulinemic vasculitis presenting as a large vessel occlusion (LVO) syndrome. We focus on a rare presentation of a rare condition.

Case Report:

A 68-year-old man was admitted to the Stroke Unit of Padova with a right middle cerebral artery syndrome. A cerebrovascular event was suspected and protocol for revascularization treatment was performed. Neuroimaging provided no evidence for infarcted tissue or medium-large vascular occlusion but hypothesized a vasculitic involvement of the small vessels of the right hemisphere. Further diagnostics demonstrated a microangiopathic involvement of the heart, kidneys, and lungs. Blood tests showed circulating cryoglobulins and further hematological investigation identified a chronic lymphatic leukemia-like lymphoproliferative disorder. High-dose steroid therapy improved the patient’s clinical status and no neurological symptoms remained at discharge.

Conclusion:

We discuss the clinical-radiologic presentation of a small vessel vasculitis that mimics an LVO stroke. This case focuses on the relevance of concomitant multiorgan manifestations in the hyper-acute evaluation of LVO stroke, suggesting the clinical neurologist should consider alternative etiologies as these could provide important clinical implications.
Burnout and Wellness Strategies Utilized by Academic Physiatry Programs: An Analysis and Perspective from the AAP Chairs Council
Authors: Steinberg David P. , Faurot Keturah R. , Thompson Karla L. , Alexander Joshua J. , Braza Diane W. , Cuccurullo Sara , Herrera Joseph , Sliwa James , Weiss Lyn
Published: April 2023

Physiatrists are at elevated risk of burnout, a work-related exhaustion syndrome resulting from chronic stress associated with emotionally draining work demands. The high reported rate of burnout in Physical Medicine and Rehabilitation (PM&R) led the Association of Academic Physiatrists (AAP) Chair Council to convene a workgroup to address burnout among academic PM&R physicians. The Council recognizes that leaders of departments are accountable for all organizational stakeholders, including faculty, trainees, and staff. Department leaders are expected to understand and effectively manage the drivers of burnout among stakeholders. The workgroup identified several opportunities, including identifying and disseminating effective burnout mitigation across U.S. academic medical center PM&R programs. As a result, in 2019, a work group conducted a survey of U.S. academic PM&R program leaders to ascertain the use of strategies for reducing physician burnout. With the aim of identifying, educating, and advancing the development of effective interventions to address burnout among academic PM&R departments, the AAP Chair Council advocates for increased education and utilization of effective strategies aimed at promoting physician well-being across organizational levels (national, organizational, work unit, and individual).
Does spasticity correlate with motor impairment in the upper and lower limbs in ambulatory chronic stroke survivors?
Authors: Li Sheng , Ghuman Jaskiran , Gonzalez-Buonomo Javier , Huang Xinran , Malik Aila , Yozbatiran Nuray , Francisco Gerard E. , Wu Hulin , Frontera Walter R.
Published: April 2023

Objective

This study aimed to explore correlations between spasticity and motor impairments in the upper and lower limbs (UL and LL) in ambulatory chronic stroke survivors.

Design

We performed clinical assessments in 28 ambulatory chronic stroke survivors with spastic hemiplegia (female:12; male: 16; mean ages = 57.8 ± 11.8 yr; 76 ± 45 months after stroke).

Results

In the upper limb, spasticity index (SI_UL) and Fugl-Meyer Motor Assessment (FMA_UL) showed a significant correlation. SI_UL showed a significant negative correlation with handgrip strength of the affected side (r = -0.4, p = 0.035) while FMA_UL had a significant positive correlation (r = 0.77, p < 0.001). In the LL, no correlation was found between SI_LL and FMA_LL. There was a significant and high correlation between timed up and go test (TUG) and gait speed (r = 0.93, p < 0.001). Gait speed was positively correlated with SI_LL (r = 0.48, p = 0.01), and negatively correlated with FMA_LL (r = -0.57, p = 0.002). Age and time since stroke showed no association in analyses for both UL and LL.

Conclusions

Spasticity has a negative correlation on motor impairment in the upper limb but not in the lower limb. Motor impairment was significantly correlated with grip strength in the upper limb and gait performance in the lower limb of ambulatory stroke survivors.
Effectiveness of kinesio taping and night splinting along with physical therapy intervention on symptoms and functionality: A Double-Blind Randomized Controlled Trial for Moderate Carpal Tunnel Syndrome
Authors: ERASLAN Leyla , BALTACI Gul
Published: April 2023

Objective

To compare the effects of kinesio taping (KT) and night splinting (NS) along with physical therapy intervention on symptoms in patients with moderate carpal tunnel syndrome (CTS) undergoing rehabilitation.

Design

In this double-blind, randomized controlled trial, forty-five patients with moderate CTS were included and randomly assigned to three groups: KT Group (n = 15), NS Group (n = 15), and control group (CG) (n = 15). All patients received 20 physical therapy intervention sessions. The primary outcome was self-reported disability status measured by the Boston Carpal Tunnel Questionnaire, and secondary outcomes were pain and paresthesia (rest, activity, and night) measured by the Numeric Rating Scale. Outcomes were recorded at baseline and four weeks.

Results

All patients showed clinically meaningful improvements for all outcome measures over time (p < 0.05). The intergroup analysis revealed that the KT group demonstrated better results in all measures than the NS (p < 0.05) except for pain during activity (p = 0.054), at night (p = 0.191), and paresthesia at rest (p = 0.575). Additionally, the KT group showed better outcomes than the CG (p < 0.05) except for the activity pain (p = 0.022). However, there were negligible differences between NS and CG (p > 0.05).

Conclusion

Kinesio taping in combination with physical therapy intervention is more effective than NS in combination with physical therapy intervention or physical therapy intervention alone and may be recommended.
The profile of athletes with a vision impairment: Exploring demographics and ocular pathologies of athletes in three Paralympic sports
Authors: Zenk Franziska , Willmott Ashley G. B. , Fortin-Guichard Daniel , Austick Kizzy , Mann David L. , Winckler Ciro , Allen Peter M.
Published: April 2023

Objective

This study aimed to explore the profile of athletes with a vision impairment (VI) who compete in three Paralympic sports (goalball, VI judo and blind football).

Design

Descriptive and association analyses of the VI athletes’ profile were conducted.

Results

The typical athlete profile was a male (65.1%), aged 26-34 years (39.7%), from Europe (38.8%), representing a country with a high-income (46.1%) and was diagnosed with a retinal-related ocular pathology (38.9%). In all three sports, the ages of the athletes were similar. In goalball, most athletes were from Europe, represented countries with a high-income and were diagnosed with retinal-, globe-, or neurological-related pathologies. In VI judo, the majority of athletes were from Asia, represented countries with an upper-middle-income and were diagnosed with retinal-, global-, or neurological-related pathologies. In blind football, most athletes were from Europe, represented countries with an upper-middle-income, and were diagnosed with retinal-, neurological-related ocular pathologies, or glaucoma.

Conclusions

The homogeneity of the athletes’ profile suggests that an effort is needed to target other parts of the VI population to take part in VI sports. Differences in the athletes’ profiles across the sports provides information that may be useful for sport-specific talent identification.
Discontinuation and nonpublication analysis of chronic pain randomized controlled trials
Authors: Jacobsen Samuel M. , Moore Ty , Douglas Alexander , Lester Drew , Johnson Austin L. , Vassar Matt
Published: April 2023

Introduction:

The primary objective of this cross-sectional analysis is to evaluate rates of discontinuation and nonpublication of Randomized controlled trials (RCTs) of therapeutic interventions to treat chronic pain.

Methods:

Using ClinicalTrials.gov, a sample was obtained which included clinical trials pertaining to chronic pain. Trials were analyzed for publication status and completion status of each trial. If information was unavailable on the trial registry database, or could not be allocated through a systematic search, the corresponding trialist was contacted and data points were gathered.

Results:

In our final analysis of the 408 RCTs, we found that 281 (68.9%) were published in a peer-reviewed journal and 127 (31.1%) were unpublished trials. Of 112 discontinued trials, 59 (52.7%) reached publication. In addition, 221 of 296 completed trials (74.7%) were published, and 75 (25.3%) remained unpublished after trial completion. The most common listed reason for trial discontinuation was administrative recommendations (41 of 71 trials [57.7%]), while not receiving an email reply to our standardized email from the corresponding trialist was the most common result for trial nonpublication (49 of 88 trials [55.7%]). Clinical trials funded by nonindustry sponsors were more likely to reach publication than industry-funded clinical trials (unadjusted odds ratio 1.86 [95% CI, 1.18–2.95]; adjusted odds ratio 3.01 [95% CI, 1.76–5.14]).

Conclusion:

The rate of discontinuation of RCTs involving patients with chronic pain is concerning. Chronic pain affects many patients; thus, the importance of having quality data from clinical trials cannot be overstated. Our study indicates that chronic pain RCTs are frequently discontinued and their findings often go unpublished — all of which could provide crucial information to providers and patients regarding the treatment of chronic pain. We offer suggestions to enhance chronic pain RCT completion, thereby reducing the waste of resources in chronic pain research.
Magnetic Resonance Fingerprinting
Authors: Gaur Sonia , Panda Ananya , Fajardo Jesus E. , Hamilton Jesse , Jiang Yun , Gulani Vikas
Published: April 2023

Magnetic resonance fingerprinting (MRF) is an approach to quantitative magnetic resonance imaging that allows for efficient simultaneous measurements of multiple tissue properties, which are then used to create accurate and reproducible quantitative maps of these properties. As the technique has gained popularity, the extent of preclinical and clinical applications has vastly increased. The goal of this review is to provide an overview of currently investigated preclinical and clinical applications of MRF, as well as future directions. Topics covered include MRF in neuroimaging, neurovascular, prostate, liver, kidney, breast, abdominal quantitative imaging, cardiac, and musculoskeletal applications.
Standardization and Interpretation of RNA-sequencing for Transplantation
Authors: Thareja Gaurav , Suryawanshi Hemant , Luo Xunrong , Muthukumar Thangamani
Published: April 2023

RNA-sequencing (RNA-seq) is a technique to determine the order of nucleotides in an RNA segment. Modern sequencing platforms simultaneously sequence millions of RNA molecules. Advances in bioinformatics have allowed us to collect, store, analyze, and disseminate data from RNA-seq experiments and decipher biological insights from large sequencing datasets. Although bulk RNA-seq has significantly advanced our understanding of tissue-specific gene expression and regulation, recent advances in single-cell RNA-seq have allowed such information to be mapped to individual cells, thus remarkably enhancing our insight into discrete cellular functions within a biospecimen. These different RNA-seq experimental approaches require specialized computational tools. Herein, we will first review the RNA-seq experimental workflow, discuss the common terminologies used in RNA-seq, and suggest approaches for standardization across multiple studies. Next, we will provide an up-to-date appraisal of the applications of bulk RNA-seq and single-cell/nucleus RNA-seq in preclinical and clinical research on kidney transplantation, as well as typical bioinformatic workflows utilized in such analysis. Lastly, we will deliberate on the limitations of this technology in transplantation research and briefly summarize newer technologies that could be combined with RNA-seq to permit more powerful dissections of biological functions. Because each step in RNA-seq workflow has numerous variations and could potentially impact the results, as conscientious citizens of the research community, we must strive to continuously modernize our analytical pipelines and exhaustively report their technical details.
An Immune Atlas of T Cells in Transplant Rejection: Pathways and Therapeutic Opportunities
Authors: Short Sarah , Lewik Guido , Issa Fadi
Published: April 2023

Short-term outcomes in allotransplantation are excellent due to technical and pharmacological advances; however, improvement in long-term outcomes has been limited. Recurrent episodes of acute cellular rejection, a primarily T cell–mediated response to transplanted tissue, have been implicated in the development of chronic allograft dysfunction and loss. Although it is well established that acute cellular rejection is primarily a CD4+ and CD8+ T cell mediated response, significant heterogeneity exists within these cell compartments. During immune responses, naïve CD4+ T cells are activated and subsequently differentiate into specific T helper subsets under the influence of the local cytokine milieu. These subsets have distinct phenotypic and functional characteristics, with reported differences in their contribution to rejection responses specifically. Of particular relevance are the regulatory subsets and their potential to promote tolerance of allografts. Unraveling the specific contributions of these cell subsets in the context of transplantation is complex, but may reveal new avenues of therapeutic intervention for the prevention of rejection.