bluuebunny/crossref_metadata_2025 huggingface dataset:
High‐intensity interval training improves hypothalamic inflammation by suppressing HIF‐1α signaling in microglia of male C57BL/6J mice
Authors: Chen Yi , Zhang Siyan , Ye Liu , Chen Hong , Ma Ping , Wu Dandong
Published: July 2024

Repeated bouts of high‐intensity interval training (HIIT) induce an improvement in metabolism via plasticity of melanocortin circuits and attenuated hypothalamic inflammation. HIF‐1α, which plays a vital role in hypothalamus‐mediated regulation of peripheral metabolism, is enhanced in the hypothalamus by HIIT. This study aimed to investigate the effects of HIIT on hypothalamic HIF‐1α expression and peripheral metabolism in obese mice and the underlying molecular mechanisms. By using a high‐fat diet (HFD)‐induced obesity mouse model, we determined the effect of HIIT on energy balance and the expression of the hypothalamic appetite‐regulating neuropeptides, POMC and NPY. Moreover, hypothalamic HIF‐1α signaling and its downstream glycolytic enzymes were explored after HIIT intervention. The state of microglia and microglial NF‐κB signaling in the hypothalamus were also examined in vivo. In vitro by using an adenovirus carrying shRNA‐HIF1β, we explored the impact of HIF‐1 signaling on glycolysis and NF‐κB inflammatory signaling in BV2 cells. Food intake was suppressed and whole‐body metabolism was improved in exercised DIO mice, accompanied by changes in the expression of POMC and NPY. Moreover, total and microglial HIF‐1α signaling were obviously attenuated in the hypothalamus, consistent with the decreased levels of glycolytic enzymes. Both HFD‐induced microglial activation and hypothalamic NF‐κB signaling were significantly suppressed following HIIT in vivo. In BV2 cells, after HIF‐1 complex knockdown, glycolysis and NF‐κB inflammatory signaling were significantly attenuated. The data indicate that HIIT improves peripheral metabolism probably via attenuated HFD‐induced microglial activation and microglial NF‐κB signaling in the hypothalamus, which could be mediated by suppressed microglial HIF‐1α signaling.
Suture-Less and Glue-Less Amniotic Membrane Graft for Keratopathy and Early Keratinization in Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome
Authors: Lahoti Sejal , Shi Julia J. , Mohamed Mohamed , Waldrop William , Bowman R. Wayne
Published: July 2024

Purpose:

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome can cause significant keratopathy and lead to lasting visual effects. The main objective of this study was to describe an ocular presentation of DRESS treated with a modified suture-less and glue-less amniotic membrane graft technique. This study also provides a literature review of ocular DRESS manifestations and ocular management of the other severe cutaneous adverse reactions.

Methods:

This is a case review about an 82-year-old man with sepsis due to recent Mycobacterium tuberculosis, who presented with DRESS based on clinical findings.

Results:

The patient was treated with a modified suture-less and glue-less amniotic membrane graft technique along with a Prokera corneal bandage placement. The patient had significant improvement of visual acuity and symptoms with this technique.

Conclusions:

Patients with significant corneal and conjunctival involvement associated with DRESS, similar to Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), may benefit from more aggressive treatment with amniotic membrane transplantation and Prokera corneal bandage placement to prevent scarring and subsequent vision loss. The modified technique described in this article can be used for patients who may be poor candidates for the operating room.
Systemic Hodgkin Lymphoma with Presumed Intraocular Involvement
Authors: Marks Victoria A. , Vempuluru Vijitha S. , Shields Carol L.
Published: July 2024

Purpose:

We report a rare case of systemic Hodgkin lymphoma with presumed intraocular involvement that resolved following systemic chemotherapy.

Method:

Observational case report.

Results:

A 32-year-old woman with known stage II Hodgkin lymphoma presented with 3 months of photopsia and decreased vision in the left eye. Fundus examination demonstrated vitreous cells, more than 100 yellow choroidal infiltrates involving the entire fundus, and retinal pigment epithelial defects in the macular region of the left eye. Ultrasonography showed chorioretinal thickening and optical coherence tomography demonstrated vitreous opacities with outer retinal atrophy, irregular retinal pigment epithelial thickening, and hyper-transmission defects. A diagnosis of Hodgkin lymphoma with vitreoretinal involvement was considered. Fine needle aspiration biopsy was considered, but the patient preferred deferral as she was already on cycle 3 of systemic chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine). Following the fourth cycle of systemic treatment, the vitreous cells and choroidal lesions resolved.

Conclusion:

This case details a rare presentation of systemic Hodgkin lymphoma with presumed vitreoretinal and choroidal involvement that responded to anti-Hodgkin lymphoma chemotherapy.
Limitations of ChatGPT for Patient Education Regarding Frequently Searched Questions About Benign Prostatic Hyperplasia
Authors: Muraira Paolo M. , Chen Annie , Lerner Lori B. , Kaplan Steven A. , McVary Kevin T. , Muraira Franco M. , Gonzalez Ricardo R.
Published: July 2024

Purpose:

Generative Pre-Trained Transformer 4 (GPT-4) or ChatGPT, an artificial intelligence language generator, has been used in multiple applications in medicine. We seek to evaluate ChatGPT’s ability to generate appropriate responses consistent with guidelines when asked patient-generated questions regarding benign prostatic hyperplasia (BPH).

Methods:

GPT-4 (Open AI) was queried to answer 20 of the most frequently asked questions regarding BPH according to Google’s search engine. Questions were subclassified into 5 categories: pathophysiology, diagnosis, behavioral modification, procedural interventions, and medical treatments. These responses were graded by expert urologists involved in generating the AUA BPH Clinical Guidelines on 3 domains: accuracy, comprehensiveness, and contemporaneousness.

Results:

Of the responses generated, 70% were accurate, 73% were comprehensive, and 63% were contemporary. Seventeen percent of GPT-4 responses were inaccurate, incomprehensive, and noncontemporary. The highest scores were in diagnosis (88.9%), pathophysiology (83.3%), and relative medical treatment (70.4%) subcategories. The most inaccurate, incomprehensive, and noncontemporary category was procedural treatments (31.7%).

Conclusions:

When rated by guideline experts in management of male lower urinary tract symptoms attributed to BPH, GPT-4 has been shown to provide some accurate, comprehensive, and updated information exceeding 80% accuracy, comprehensiveness and contemporaneousness in the categories of diagnosis, and pathophysiology. GPT-4 can serve as an adequate revising tool for patients to learn the basics about BPH regarding diagnosis and pathophysiology, but the current version fails patients in other subcategories such as relative medical treatments and procedural treatments. Given the rise in GPT-4’s ubiquity, it is imperative that the urologic community critically examines all sources of patient information to identify areas of improvement.
Urinary Bladder Melanosis Diagnosed Simultaneously With Urothelial Carcinoma: A Case Report and Literature Review
Authors: Ellison Erin , Faber Lauren , Ice Carolyn , Glass Joseph , Ming Jessica , Martinez Michael J.
Published: July 2024

Melanosis is a rare entity described as brown-black tissue pigmentation secondary to melanin deposition. Presented here is the third reported case of melanosis diagnosed simultaneously with urothelial carcinoma of the bladder. This is only the sixth case associating melanosis with malignancy. The patient is a 78-year-old man who presented with lower urinary tract symptoms and on cystoscopy, was noted to have diffused brown-black bladder pigmentation. Initial pathology showed squamous cell carcinoma with melanosis present. The patient underwent robotic cystectomy with ileal conduit and on final pathology, had urothelial carcinoma with squamous differentiation. A literature review was performed for both benign-associated and malignant-associated melanosis. The review elucidated that melanosis may herald malignancy in 16% of available reported cases, suggesting even a patient with benign melanosis should undergo surveillance.
Pre-gestational diabetes mellitus, gestational diabetes mellitus, and its association with the MTHFR C677T polymorphism
Authors: Pham Nga Thi Ngoc , Huynh Chau Thi Ngoc , Nguyen Ai Thuy Thuy , Ho Chuong Quoc , Duong Linh My , Bui Dung The , Nguyen Ha Hong
Published: July 2024

Gestational diabetes mellitus (GDM) is a common condition during pregnancy and is associated with an increased risk of pre-eclampsia. The methylenetetrahydrofolate reductase (MTHFR) gene plays a crucial role in folate metabolism and has been implicated in GDM. To investigate the relationship between the MTHFR C677T gene polymorphism and the conditions of GDM and gestational prediabetes in pregnant women. A case-control study was conducted in 114 pregnant women with GDM and 96 pregnant women without GDM, from the first trimester to the prenatal examination at Can Tho Obstetrics Hospital. The pregnant women underwent a 1-hour (G1) and 2-hour (G2) oral glucose tolerance test (OGTT) and genetic polymorphism analysis based on real-time PCR technique. In pregnant women with GDM, weight, concentrations of G0, G1, G2, and folic acid were higher than those in the non-GDM group, with P < .05. When analyzing the subgroup without gestational diabetes, we found that the rate of prediabetes was 16.6% (16/96 pregnant women). In this group, blood glucose levels at 1 hour and 2 hours during the OGTT were higher compared to the normal glucose group (P < .05). A 2-hour post-OGTT glucose level of 7.78 mmol/L had a sensitivity of 93.8%, a specificity of 100%, and an area under the curve of 0.987 for diagnosing gestational prediabetes (P < .001). However, there were no statistically significant differences in the CC, CT, and TT polymorphisms of the MTHFR C677T gene among pregnant women with or without pre-gestational and GDM. Both fasting blood glucose and 2-hour glucose concentrations during the OGTT, as well as folic acid concentrations, were higher in both the pre-gestational and GDM groups compared to the non-gestational diabetes cohort. However, the analysis of MTHFR C677T polymorphisms revealed no statistically significant differences among the groups, highlighting the necessity for more extensive investigations to gain deeper insights into this relationship.
Gut microbiota-melatonin signaling axis in acute pancreatitis: Revealing the impact of gut health on pancreatic inflammation and disease severity in a case-control study
Authors: Li Chao , Wen Yangfen , Tong Qiwen , Peng Yi , Yu Dan , Rao Yisong , Zeng Yuehong
Published: July 2024

Acute pancreatitis (AP), a severe inflammatory condition affecting the pancreas requires investigation into its predictors. Melatonin, a compound with anti-inflammatory and antioxidant properties, has shown promise in managing AP. Additionally, the gut microbiota, a community of microorganisms residing in the intestines has been linked to AP development. This study aims to explore the correlation between melatonin and gut microbiota in predicting AP severity. This study involved 199 participants, with 99 diagnosed with AP and 100 serving as healthy controls. The AP patients were categorized into 2 groups based on the severity of their condition: mild AP (MAP) and severe AP (SAP). Serum melatonin levels were measured on Days 1, 3, and 5 of hospitalization, and gut microbiota composition was examined via 16S rRNA gene sequencing. Other parameters were evaluated, such as the Acute Physiology and Chronic Health Evaluation (APACHE) score, Ranson, and Acute Gastrointestinal Injury (AGI) scores. Melatonin levels were significantly lower in subjects with severe AP compared those with mild AP (18.2 ng/mL vs 32.2 ng/mL, P = .001), and melatonin levels decreased significantly in patients with AP on Days 3 and 5. The study also revealed that individuals with AP exhibited a significantly altered gut microbiota composition compared to control individuals, with a lower Shannon index and higher Simpson index. The AUCs for Simpson index and F/B ratio were significantly higher than those for other biomarkers, indicating that these gut microbiota markers may also be useful for AP prediction. The study proposes that there is a relationship between melatonin levels and the dynamics of gut microbiota profiles in relation to the severity of AP. As a result, the severity of the disease can be assessed by assessing the levels of serum melatonin and gut microbiota profiles.
Clinical effect of nursing methods integrating health belief models on self-care of maintenance hemodialysis patients: A retrospective study
Authors: Zhang Huajun , Xia Lihua
Published: July 2024

This study aimed to explore the clinical effectiveness of nursing methods that incorporate health belief models on the self-care practices of maintenance hemodialysis patients. The objective was to enhance patients’ health beliefs, strengthen their healthy behaviors and habits, improve their unhealthy daily behaviors, and provide robust theoretical and practical foundations for future nursing practices in this area. A retrospective analysis was conducted on 150 hemodialysis patients from our hospital, from January 2019 to February 2023. The participants were divided into 2 groups: a control group (N = 75) using routine nursing methods, and an experimental group (N = 75) using methods integrated with health belief models. Both groups were comparable in terms of demographic and baseline clinical characteristics such as gender, marital status, age, education level, total scores of self-care ability, and dialysis duration, with no significant differences observed (P > .05). Data collection tools included a general information questionnaire and a self-care ability scale, and clinical effectiveness was measured through specific indicators such as parathyroid hormone, blood phosphorus, urea, potassium, calcium, and IWGR%. Post-intervention, the experimental group demonstrated significant improvements in self-care capabilities across various dimensions and most clinical indicators compared to the control group, with the exception of parathyroid hormone and blood urea levels. The study concludes that integrating health belief models into nursing practices significantly enhances the self-care abilities of maintenance hemodialysis patients, improves several clinical parameters, and holds promise for fostering better patient outcomes and guiding future clinical nursing practices.
Evaluation of the impact of bundled nursing strategies on the prevention of venous thromboembolism in patients with cerebral hemorrhage
Authors: Hongfang Lu , Yangyang Tian , Lijuan Zhao , Na Sun
Published: July 2024

To investigate the effectiveness and value of bundled nursing strategies for venous thromboembolism prevention in nonsurgical patients with cerebral hemorrhage, 200 patients who underwent treatment for cerebral hemorrhage in our hospital from January 2023 to July 2023 were chosen as the study subjects. Patients were divided into control group and experimental group according to different treatment methods. For patients in the control group, regular care was used, while for patients in the observation group, bundled care was used for intervention. This study used a venous thromboembolism risk factor assessment form to assess the probability of patients suffering from venous thromboembolism. It used the incidence of venous thromboembolism, disease cognition level, coagulation function, fibrinolysis, changes in blood routine, exercise ability, improvement in quality of life, and patient satisfaction with nursing mode as detection indicators to obtain the changes in various indicator values and patient satisfaction scores under different nursing interventions. Prior to nursing intervention, the significant statistical differences did not exist (P > .05) between the control group and the observation group in terms of general information, number of venous thromboembolism risk levels, degree of disease cognition, coagulation function, blood routine, exercise ability, quality of life, and fibrinolysis indicators. After a period of nursing intervention, the significant statistical difference existed (P < .05) between the control group and the observation group in terms of general information, number of venous thromboembolism risk levels, degree of disease cognition, coagulation function, blood routine, exercise ability, quality of life, and fibrinolysis indicators. In the patient satisfaction score, the satisfaction scores of male and female patients with general care were 0.865 and 0.878, respectively, and the satisfaction scores for bundled care were 0.942 and 0.965, respectively. In conclusion, bundled care can better improve the coagulation status and blood routine indexes of nonsurgical patients with cerebral hemorrhage compared with ordinary care, thus contributing to better prevention of venous thromboembolism in nonsurgical patients with cerebral hemorrhage.
Causal relationship between inflammatory markers and left ventricle geometry and function: A 2-sample Mendelian randomization study
Authors: Lai Bolin , Huang Bin , Li Li
Published: July 2024

Studies have shown that some inflammatory markers can predict the risk of cardiovascular disease (CVD) and affect the structure and function of the heart. However, a causal relationship between inflammatory markers and the cardiac structure and function has not yet been established. Thus, we conducted a 2-sample Mendelian randomization (MR) study to explore the potential causal relationship between inflammatory markers and prognostically-related left ventricular (LV) parameters. Instrumental variables (IVs) for C-reactive protein (CRP), interleukin-6 (IL-6), and myeloperoxidase (MPO) levels were selected from the databases of large genome-wide association studies (GWAS). Summary statistics for LV parameters, including LV mass, ejection fraction, end-diastolic and systolic volumes, and the ratio of LV mass to end-diastolic volume, were obtained from cardiovascular magnetic resonance studies of the UK Biobank (n = 16923). The inverse-variance weighted (IVW) method was the primary analytical method used, and was complemented with the MR-Egger, weighted median, simple mode, weighted mode, and MR pleiotropy residual sum and outlier (MR-PRESSO) methods. Sensitivity analysis was performed to evaluate the robustness of the results. CRP was significantly associated with the LV mass in the IVW method (β = −0.13 g [95% confidence interval [CI], 0.78 g–1.00 g], P = .046). A higher standard deviation of genetically-predicted CRP levels was associated with a 0.13 ± 0.06 g lower LV mass. No causal relationships of IL-6 and MPO with LV parameters were found. No evidence of heterogeneity and pleiotropy was detected. Sensitivity analyses confirmed the robustness of the results. Two-sample MR analysis revealed a causal association between increased CRP level and decreased LV mass, whereas IL-6 and MPO levels did not influence the LV parameters. However, further research is required to validate our findings.
Dacomitinib overcomes acquired resistance to osimertinib in advanced NSCLC patients with EGFR L718Q mutation: A two-case report
Authors: Li Jielin , Jin Meizi , Diao Yuzhu , Li Xiaoling
Published: July 2024

Rationale:

Acquired resistance still inevitably occurs in patients treated with third-generation TKI osimertinib. Although the EGFR L718Q mutation has been reported as a scarce mechanism of osimertinib resistance, advanced therapeutic strategies are still in development. In this report, we included 2 cases of patients who acquired EGFR L858R/L718Q mutation after osimertinib and were overcome by dacomitinib.

Patient concerns:

Case 1: A 77-year-old woman was diagnosed with stage IV lung adenocarcinoma. Case 2: A 64-year-old woman was diagnosed with stage IV lung adenocarcinoma.

Diagnoses:

Case 1: The patient was diagnosed with adenocarcinoma with EGFR L858R mutation. Since then, treatment with gefitinib was administrated, leading to a progression-free survival of 18 months. The treatment was switched to osimertinib based on the detection of EGFR T790M mutation, resulting in a progression-free survival of 24 months. Subsequently, EGFR L718Q mutation was detected. Case 2: The patient was diagnosed with adenocarcinoma with EGFR L858R mutation. Icotinib was used as the first-line treatment for 7 months. Osimertinib was applied as the second-line treatment for 13 months based on the EGFR T790M mutation. Subsequently, EGFR L718Q mutation was detected.

Interventions:

Case 1: Dacomitinib was administered. Case 2: Dacomitinib was administered.

Outcomes:

Case 1:The progression-free survival was 8 months. Case 2: The progression-free survival was 3 months.

Lessons:

Dacomitinib is a potential treatment option for NSCLC patients with EGFR L718Q mutation after resistance to Osimertinib. Further research is needed to validate the efficacy of Dacomitinib in this context.
Harnessing technology for infectious disease response in conflict zones: Challenges, innovations, and policy implications
Authors: Ugwu Okechukwu Paul-Chima , Alum Esther Ugo , Ugwu Jovita Nnenna , Eze Val Hyginus Udoka , Ugwu Chinyere N , Ogenyi Fabian C , Okon Michael Ben
Published: July 2024

Epidemic outbreaks of infectious diseases in conflict zones are complex threats to public health and humanitarian activities that require creativity approaches of reducing their damage. This narrative review focuses on the technology intersection with infectious disease response in conflict zones, and complexity of healthcare infrastructure, population displacement, and security risks. This narrative review explores how conflict-related destruction is harmful towards healthcare systems and the impediments to disease surveillance and response activities. In this regards, the review also considered the contributions of technological innovations, such as the improvement of epidemiological surveillance, mobile health (mHealth) technologies, genomic sequencing, and surveillance technologies, in strengthening infectious disease management in conflict settings. Ethical issues related to data privacy, security and fairness are also covered. By advisement on policy that focuses on investment in surveillance systems, diagnostic capacity, capacity building, collaboration, and even ethical governance, stakeholders can leverage technology to enhance the response to infectious disease in conflict settings and, thus, protect the global health security. This review is full of information for researchers, policymakers, and practitioners who are dealing with the issues of infectious disease outbreaks in conflicts worn areas.
Role of anagliptin, a dipeptidyl peptidase-4 inhibitor, in managing type 2 diabetes: A systematic review and meta-analysis
Authors: Kamrul-Hasan A.B.M. , Dutta Deep , Nagendra Lakshmi , Sharma Meha , Patra Shinjan , Bhattacharya Saptarshi
Published: July 2024

Background:

No comprehensive meta-analysis has examined and consolidated the effectiveness and safety of anagliptin in treating type 2 diabetes mellitus (T2D). To bridge this knowledge gap, we undertook this meta-analysis.

Methods:

Randomized controlled trials involving patients with T2D receiving anagliptin were sought after through electronic databases. The control arm consisted of either an active comparator (active control group [ACG]) or a placebo (passive control group [PCG]). The primary outcome was glycated hemoglobin (HbA1c), with secondary outcomes including fasting plasma glucose (FPG) and lipid profiles and adverse events.

Results:

From the 226 articles first examined, 10 randomized controlled trials with 970 participants were analyzed. Reductions in HbA1c (mean difference [MD]: −0.03%, 95% confidence interval [CI]: −0.14 to 0.14, P = .51, I
2 = 9%) and FPG (MD: 0.03 mmol/L, 95% CI: −0.30 to 0.35, P = .87, I
2 = 42%) were similar in the anagliptin group and ACG. Anagliptin reduced FPG better than placebo (MD: −1.25 mmol/L, 95% CI: −1.87 to −0.64, P < .0001, I
2 = 0%). Sufficient data were unavailable to analyze the HbA1c lowering with anagliptin versus placebo. Among the lipid parameters, changes in total cholesterol, high-density lipoprotein cholesterol, apolipoprotein B48, and apolipoprotein B100 were identical between the anagliptin and control groups (PCG and ACG). Anagliptin was better than ACG at lowering low-density lipoprotein cholesterol but not as good at lowering triglyceride. Adverse events were infrequent and similar in the anagliptin and control groups (PCG and ACG).

Conclusion:

Anagliptin positively affects glucose control and is safe for managing T2D. Its low-density lipoprotein cholesterol-lowering effect warrants further investigation.
Relationship between admission blood urea nitrogen levels and postoperative length of stay in patients with hip fracture: A retrospective study
Authors: Fan Teng-di , Bei Di-kai , Wang Qi
Published: July 2024

To investigate the relationship between admission blood urea nitrogen (BUN) levels and postoperative length of stay (LOS) in hip fracture (HF) patients. This retrospective study retrieved related data from the MIMIC-IV database, of which the laboratory variables were taken preoperatively. The patients were divided into 4 groups according to the BUN quartile levels. After exploring the nonlinear relationship between BUN and LOS by generalized additive model, their connection was further analyzed using the generalized linear models, quantile regression models, and interaction analysis. Receiver operating characteristic curve analysis and decision curve analysis were performed to evaluate its value in predicting first intensive care unit admission and in-hospital mortality. Totally 1274 patients with HF were enrolled in the study. There was a nonlinear relationship between BUN and LOS (P < .05). Besides, BUN was an independent predictor for LOS after adjusting different covariates in 3 models (P < .05). Age served as a significant interactor in this relationship (P < .05). Moreover, receiver operating characteristic curve and decision curve analysis revealed the predictive value of BUN for intensive care unit admission and in-hospital mortality in HF. Admission BUN level as a cost-effective and easy-to-collect biomarker is significantly related to LOS in patients with HF. It helps clinicians to identify potential high-risk populations and take effective preventions before surgery to reduce postoperative LOS.
The dorsal muscle group area at the T12 vertebral level as a risk factor for tolerability of nintedanib in patients with idiopathic pulmonary fibrosis or other progressive fibrosing interstitial lung diseases
Authors: Ono Manabu , Kobayashi Seiichi , Masakazu Hanagama , Ishida Masatsugu , Sato Hikari , Okutomo Koji , Shirai Yusuke , Takahashi Kodai , Yamada Mitsuhiro , Fujino Naoya , Yamanda Shinsuke , Yanai Masaru
Published: July 2024

Nintedanib, a multi-intracellular tyrosine kinase inhibitor, reduces progression of idiopathic pulmonary fibrosis (IPF) and has been approved to use in other progressive fibrosing interstitial lung diseases (ILD) recently. However, the factors that affect the discontinuation of treatment due to adverse events is uncertain. The dorsal muscle group area at the T12 vertebral level (T12DMA) assessed on computed tomography (CT) images has been reported to be associated with mortality in chronic obstructive pulmonary disease (COPD) and other diseases. The relationship between T12DMA and the discontinuation of nintedanib remains unclear. Methods: 39 patients with IPF or other progressive fibrosing ILDs who started nintedanib at a regular dose (300 mg/day) were enrolled. We compared the characteristics between patients who stopped nintedanib at a regular dose before 6 months and/or continue to take nintedanib at a low dose (150 mg/day) and patients who were still taking nintedanib at a regular dose over 6 months. This study retrospectively investigated clinical parameters including T12DMA index (T12DMA/height2) to evaluate whether these parameters might serve as risk factor for the tolerability of nintedanib in patients with IPF and other progressive fibrosing ILDs. Results: Discontinuation or dose reductions of nintedanib due to adverse events were observed in 14 (35.8%) patients. A multiple logistic regression model showed T12DMA index to be the only significant risk factor for predicting for the early termination of nintedanib (odd rate, 0.549; 95% confidence interval, 0.327–0.922; P = .023). Conclusions: This study revealed that T12DMA index was a risk factor for the early termination of nintedanib. The initial dose of nintedanib adjusted to the differences in skeletal muscle mass and careful management of adverse events may contribute to the longer nintedanib treatment, which would lead to a better clinical outcome.
Assessing the effectiveness of ACS surgical risk calculator versus P-POSSUM in predicting mortality and morbidity for major hepatobiliary surgery: An observational study
Authors: Karabulut Ali , Umman Veysel , Oral Gunes , Erginoz Ergin , Carkman Mehmet Sinan
Published: July 2024

Risk assessment is difficult yet would provide valuable data for both the surgeons and the patients in major hepatobiliary surgeries. An ideal risk calculator should improve workflow through efficient, timely, and accurate risk stratification. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator (SRC) and Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM) are surgical risk stratification tools used to assess postoperative morbidity. In this study, preoperative data from 300 patients undergoing major hepatobiliary surgeries performed at a single tertiary university hospital were retrospectively collected from electronic patient records and entered into the ACS-SRC and P-POSSUM systems, and the resulting risk scores were calculated and recorded accordingly. The ACS-NSQIP-M1 (C-statistics = 0.725) and M2 (C-statistics = 0.791) models showed better morbidity discrimination ability than P-POSSUM-M1 (C-statistics = 0.672) model. The P-POSSUM-M2 (C-statistics = 0.806) model showed better differentiation success in morbidity than other models. The ACS-NSQIP-M1 (C-statistics = 0.888) and M2 (C-statistics = 0.956) models showed better mortality discrimination than P-POSSUM-M1 (C-statistics = 0.776) model. The P-POSSUM-M2 (C-statistics = 0.948) model showed better mortality differentiation success than the ACS-NSQIP-M1 and P-POSSUM-M1 models. The use of ACS-SRC and P-POSSUM calculators for major hepatobiliary surgeries offers quantitative data to assess risks for both the surgeon and the patient. Integrating these calculators into preoperative evaluation practices can enhance decision-making processes for patients. The results of the statistical analyses indicated that the P-POSSUM-M2 model for morbidity and the ACS-NSQIP-M2 model for mortality exhibited superior overall performance.
Autoimmune glial fibrillary acidic protein astrocytopathy with anti-NMDAR and sulfatide-IgG-positive encephalitis overlap syndrome: A case report and literature review
Authors: Cui Ruo-mei , Fan Fu-rong , Ma Shou-hong , Li Hua , Li Jin-chun , Wen Yu , Liu Ming-wei
Published: July 2024

Rationale:

Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is a rare autoimmune disease of the central nervous system that affects the meninges, brain, spinal cord, and optic nerves. GFAP astrocytopathy can coexist with a variety of antibodies, which is known as overlap syndrome. Anti-NMDAR-positive encephalitis overlap syndrome has been reported; however, encephalitis overlap syndrome with both anti-NMDAR and sulfatide-IgG positivity has not been reported.

Patient concerns:

The patient was a 50-year-old male who was drowsy and had chills and weak limbs for 6 months. His symptoms worsened after admission to our hospital with persistent high fever, dysphoria, gibberish, and disturbance of consciousness. Positive cerebrospinal fluid NMDA, GFAP antibodies, and serum sulfatide antibody IgG were positive.

Diagnoses:

Autoimmune GFAP astrocytopathy with anti-NMDAR and sulfatide-IgG-positive encephalitis overlap syndrome.

Interventions:

In addition to ventilator support and symptomatic supportive treatment, step-down therapy with methylprednisolone (1000 mg/d, halved every 3 days) and pulse therapy with human immunoglobulin (0.4 g/(kg d) for 5 days) were used.

Outcomes:

After 6 days of treatment, the patient condition did not improve, and the family signed up to give up the treatment and left the hospital.

Conclusions:

Patients with autoimmune GFAP astrocytopathy may be positive for anti-NMDAR and sulfatide-IgG, and immunotherapy may be effective in patients with severe conditions.

Lessons:

Autoimmune GFAP astrocytopathy with nonspecific symptoms is rarely reported and is easy to be missed and misdiagnosed. GFAP astrocytopathy should be considered in patients with fever, headache, disturbance of consciousness, convulsions, and central infections that do not respond to antibacterial and viral agents. Autoimmune encephalopathy-related antibody testing should be performed as soon as possible, early diagnosis should be confirmed, and immunomodulatory therapy should be administered promptly.
We Rely on Relationships
Authors: Anderson Amanda Joy , Bowen Elizabeth
Published: July 2024

Purpose of Study:

Care coordination occurring across multiple sectors of care, such as when professionals in health or social service organizations collaborate to transition patients from hospitals to community-based settings like homeless shelters, happens regularly in practice. While health services research is full of studies on the experiences of case management and care coordination professionals within health care settings, few studies highlight the perspective of nonclinical homeless service providers (HSPs) in coordinating care transitions.

Primary Practice Setting:

This study explores the experience of nonclinical HSPs, employed in a large homeless service agency in New York, United States, responsible for coordinating care transitions of patients presenting to a homeless shelter after hospitalization, with attention to COVID-19 impact.

Methodology and Sample:

Semi-structured interviews were conducted with providers at three hierarchical levels (frontline, managerial, and executive). The data were analyzed using qualitative content analysis. The implementation science framework Normalization Process Theory was used to structure semi-deductive coding categories.

Results:

The findings included three major themes that highlight promoting and inhibiting factors in care coordination, including a reliance on informal relationships, the impact of strong hierarchical structures, and a lack of collaborative cross-sector information exchange pathways. Altogether, findings offer insights from an infrequently studied professional group engaging in cross-sector care coordination for a high-risk population. Operational insights can inform future research to ensure that the implementation of interventions to improve cross-sector care coordination is evidence-based.

Implications for Case Management Practice:

This study of nonclinical HSPs facilitating care transitions demonstrates the importance of understanding this critical provider population. Opportunities for acute care case managers and administrators include the importance of relationships, reciprocal education on the differences in work settings, and the need for administrative structure to ensure complex clinical information is effectively translated.
Schatzker IV tibial plateau fractures: are they always unicondylar?
Authors: Vogel Michael , Hoffman Alexander , Revak Thomas
Published: July 2024

Objective:

The objectives of this study were to describe the incidence and morphology of medial tibial plateau fractures that extend into the lateral articular surface and to describe trends in their management.

Design:

Retrospective.

Setting:

Level I Urban Trauma Center.

Patients:

Seventy consecutive patients sustaining OTA/AO 41 B1 and B3 fractures.

Intervention:

Open reduction internal fixation of medial tibial plateau fractures.

Main Outcome Measurements:

Incidence of medial tibial plateau fractures that extend into the lateral articular surface. Secondary outcomes include localization of lateral articular surface depression, neurovascular injury, and trends in surgical management.

Results:

Seventy patients were included with 9 fractures (12.9%) isolated to the medial condyle (MC) and 61 fractures (87.1%) extending to the lateral condyle (LC). Compartment syndrome was present in 2 patients (2.9%), peroneal nerve palsy in 2 (2.9%), and arterial injury in 1 (1.4%). Initial external fixation was used more frequently in the LC group compared with the MC group (P = 0.028). Of the 61 fractures in the LC group, 49 (80.3%) included lateral articular surface depression which localized to the posteromedial quadrant of the lateral articular surface in 36 of 49 fractures (73.5%). Lateral articular surface depression depth ≥10.6 mm was associated with the use of dual incisions (P < 0.001).

Conclusions:

Schatzker IV fractures frequently extend to the lateral condyle and often present with depression of the posteromedial lateral articular surface. Fractures with lateral articular surface depression depth ≥10.6 mm were more likely to undergo fixation with dual incisions.

Level of Evidence:

Therapeutic level IV.
PRAME Expression in Merkel Cell Carcinoma
Authors: Miller Elisabeth , Biesemier Andrew , Coomes David M. , Raghavan Shyam S.
Published: July 2024

Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. Risk factors include extensive sun damage, infection with Merkel cell polyomavirus, and an immunocompromised state. PRAME, also known as preferentially expressed antigen in melanoma, is a cancer-testis antigen recently found to be a useful diagnostic tool in the workup of melanocytic neoplasms. However, the expression pattern of PRAME in Merkel cell carcinoma is unknown. In this study, we examine PRAME expression in Merkel cell carcinoma and explore its prognostic implications. The institutional archives at the University of Virginia were used to search for tumors classified as Merkel cell carcinoma from 2004 to 2022. All potential cases were reviewed to confirm the diagnosis, and electronic medical records were searched for clinical and demographic data. Tumors were subsequently immunostained for PRAME and Merkel cell polyomavirus. Cox proportional hazards regression models were used to estimate relative (all-cause) survival of PRAME positivity and MCPyV positivity in our study as well as MCC-specific survival of PRAME positivity. Univariate and multivariable models were created for each outcome related to all-cause survival. A total of 39 cases were included in the study. Twenty-eight percent (11 cases) demonstrated strong PRAME expression, and 27% of cases were positive for Merkel cell polyomavirus. There was no statistically significant correlation between PRAME expression and virus positivity. With respect to PRAME, the adjusted all-cause mortality hazard ratio was 11.4 (95% CI: 1.8, 70.8). The unadjusted MCC-specific hazard ratio was 4.6 (95% CI: 0.8, 27.5). The adjusted hazard ratio pertaining to Merkel cell polyomavirus infection was 0.25 (95% CI: 0.02, 2.96). In this limited cohort, PRAME expression appears to correlate with worse outcomes in Merkel cell carcinoma.
The Application of Lag Screws and Digital Positioning Guide in Treating Sagittal Split Fracture of the Mandible
Authors: Kim Minji , Ohe Joo-Young , Heo Cheolho , Jung Junho
Published: July 2024

Sagittal mandibular fractures are challenging to manage using traditional open reduction and internal fixation techniques due to the difficulty in manually reducing mandibular fragments and performing osteosynthesis on the lingual side. In addition, there is a risk of damaging dental roots with screws during fixation. In this case, the authors employed the lag screw technique combined with digitally guided surgery to effectively perform osteosynthesis on the fragments and avoid iatrogenic tooth and nerve injury.
Comparison of Clinical Outcomes and Postoperative Nutritional Status Between Early and Late Oral Feeding After Esophagectomy
Authors: Na Kwon Joong , Kang Chang Hyun , Kim Young Ran , Kang Mi Jin , Song Eun Hwa , Jang Eun Joo , Park Samina , Lee Hyun Joo , Park In Kyu , Kim Young Tae
Published: July 2024

Objective:

To compare nutritional and postoperative outcomes between early oral feeding and late oral feeding with jejunostomy feeding support after esophagectomy.

Background:

Esophagectomy is associated with substantial body weight loss and malnutrition, impacting the prognosis of esophageal cancer patients. Despite many studies on postesophagectomy nutritional support, optimal strategies remain elusive. This study investigates the impact of jejunostomy feeding with late oral feeding compared to conventional oral feeding on nutritional and postoperative outcomes.

Methods:

We performed a single-center prospective open-labelled randomized controlled trial between 2020 and 2022. Patients aged 18 to 75 years with resectable esophageal cancer were randomly assigned to undergo either early oral feeding (early group) or late oral feeding with jejunostomy feeding support (late group) after esophagectomy. The primary endpoint was body weight loss from preoperative body weight at postoperative 4 to 5 weeks and 4 months. Other perioperative and nutritional outcomes were also evaluated.

Results:

We randomly assigned 29 patients to the early group and 29 patients to the late group. The late group exhibited significantly less body weight loss at both postoperative 4 to 5 weeks (8.3% vs. 5.6%; P=0.002) and 4 months (15.0% vs. 10.5%; P=0.003). The total calorie intake and protein intake were higher in the late group for both postoperative 4 to 5 weeks (1800 kcal/day vs. 1100 kcal/day; P<0.001) and 4 months (1565 kcal/day vs. 1200 kcal/day; P=0.010). Sixty percentage of the early group changed to malnutrition state, while 40% of the late group changed to malnutrition. The complication rate and length of hospital stays were similar.

Conclusions:

The late group demonstrated prevention of significant body weight loss, enhanced nutritional intake, and reduced malnutrition without compromising short-term surgical outcomes.
A trauma expert consensus: Capabilities are required early to improve survivability from traumatic injury
Authors: Gurney Jennifer M. , Kotwal Russ S. , Holcomb John B. , Staudt Amanda M. , Eastridge Brian , Sirkin Max , Jensen Shane , Shackelford Stacy , Sonka Brian J. , Wilson Justin , Montgomery Harold , Gross Kirby , Warren Wendy , Mazuchowski Edward , Rohrer Andrew J.
Published: July 2024

BACKGROUND

Mortality reviews examine US military fatalities resulting from traumatic injuries during combat operations. These reviews are essential to the evolution of the military trauma system to improve individual, unit, and system-level trauma care delivery and inform trauma system protocols and guidelines. This study identifies specific prehospital and hospital interventions with the potential to provide survival benefits.

METHODS

US Special Operations Command fatalities with battle injuries deemed potentially survivable (2001–2021) were extracted from previous mortality reviews. A military trauma review panel consisting of trauma surgeons, forensic pathologists, and prehospital and emergency medicine specialists conducted a methodical review to identify prehospital, hospital, and resuscitation interventions (e.g., laparotomy, blood transfusion) with the potential to have provided a survival benefit.

RESULTS

Of 388 US Special Operations Command battle-injured fatalities, 100 were deemed potentially survivable. Of these (median age, 29 years; all male), 76.0% were injured in Afghanistan, and 75% died prehospital. Gunshot wounds were in 62.0%, followed by blast injury (37%), and blunt force injury (1.0%). Most had a Maximum Abbreviated Injury Scale severity classified as 4 (severe) (55.0%) and 5 (critical) (41.0%). The panel recommended 433 interventions (prehospital, 188; hospital, 315). The most recommended prehospital intervention was blood transfusion (95%), followed by finger/tube thoracostomy (47%). The most common hospital recommendations were thoracotomy and definitive vascular repair. Whole blood transfusion was assessed for each fatality: 74% would have required ≥10 U of blood, 20% would have required 5 to 10 U, 1% would have required 1 to 4 U, and 5% would not have required blood products to impact survival. Five may have benefited from a prehospital laparotomy.

CONCLUSION

This study systematically identified capabilities needed to provide a survival benefit and examined interventions needed to inform trauma system efforts along the continuum of care. The determination was that blood transfusion and massive transfusion shortly after traumatic injury would impact survival the most.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level V.
Mastering multicasualty trauma care with the Trauma Non-technical Skills Scale
Authors: Regev Stav , Mitchnik Ilan Y.
Published: July 2024

BACKGROUND

Multicasualty events present complex medical challenges. This is the first study to investigate the role of nontechnical skills in prehospital multicasualty trauma care. We assessed the feasibility of using the Trauma Nontechnical Skills Scale (T-NOTECHS) instrument, which has not yet been investigated to evaluate these scenarios.

METHODS

We conducted an observational study involving military medical teams with Israel Defense Forces Military Trauma Life Support training to assess the T-NOTECHS' utility in predicting prehospital medical team performance during multicasualty event simulations. These teams were selected from a pool of qualified military Advanced Life Support providers. Simulations were conducted in a dedicated facility resembling a field setting, with video recordings to ensure data accuracy. Teams faced a single multicasualty scenario, assessed by two instructors, and were evaluated using a 37-item checklist. The T-NOTECHS scores were analyzed using regression models to predict simulation performance.

RESULTS

We included 27 teams for analysis, led by 28% physicians and 72% paramedics. Interrater reliability for simulation performance and T-NOTECHS scores showed good agreement. Overall T-NOTECHS scores were positively correlated with simulation performance scores (R = 0.546, p < 0.001). Each T-NOTECHS domain correlated with simulation performance. The Communication and Interaction domain explained a unique part of the variance (β = 0.406, p = 0.047). Assessment and Decision Making had the highest correlation (R = 0.535, p < 0.001). These domains significantly predicted specific items on the simulation performance checklist. Cooperation and Resource Management showed the least correlation with checklist items.

CONCLUSION

This study confirms the T-NOTECHS' reliability in predicting prehospital trauma team performance during multicasualty scenarios. Key nontechnical skills, especially Communication and Interaction, and Assessment and Decision Making, play vital roles. These findings underscore the importance of training in these skills to enhance trauma care in such scenarios, offering valuable insights for medical team preparation.

LEVEL OF EVIDENCE

Diagnostic Tests or Criteria; Level III.