bluuebunny/crossref_metadata_2025 huggingface dataset:
#6282 MAKING DECISION OF VASCULAR ACCESS TYPE BASED ON UPPER ARM DOPPLER PARAMETERS AMONG INCIDENT HEMODIALYSIS PATIENTS: A SINGLE CENTER EXPERIENCE
Authors: Jankovic Aleksandar , Rajić Sofija , Davidovic Zeljko , Stopić Bojan , Djuric Petar , Pešić Snezana , Naumovic Radomir
Published: June 2023

Background and Aims

Functional vascular access (VA) remains one of the most important problems related to successful hemodialysis (HD) treatments. Pivotal issue related to inadequate vascular access is decision making process of which type of VA should be created at start. Therefore, the aim of our study is to examine possible impact of Doppler examination of upper arm on decision of VA type creation.

Method

During 5 year period (January 2018th- December 2022th), 260 patients started hemodialysis in our department. Among them, 18 died during the first three months after HD was started, 3 were transferred to other hospitals for chronic HD program and 5 have created vascular access in other hospitals. So, we analyzed data for 234 patients (No=150, 63.6% males, mean age 62.6±13.8) which vascular access were created in our Center. We have divided them into two groups (Group A-patients with arterio-venous fistula (AVF) as first created VA and group B-patients with arterio-venous graft (AVG) or permanent central venous catheter (pCVK) as first created VA. From medical records, we have collected demographic data, type of created vascular access, Doppler parameters of upper arm and laboratory findings.

Results

Out of 234 patients, in Group A were167 patients (male No=109, 65.2%, mean age 61.0 years±13.8), while in group B were 67 patients(male No=40, 59.7% mean age 66.8 years±13.2). In table 1, demographic, laboratory and Doppler data is presented. We found that in Group A patients are statistically younger (61.0 years ±13.8 vs 66.8 years ±13.2, P = .004) and their vena cephalica (2.9mm± 2.5 vs 1.9mm±0.1, P = .000) and arteria radialis (2.2mm±0.4 vs 1.9mm±0.1, P = .002) are with better diameters. Also, their protein levels were statistically lower (69±9 vs 78±3, P = .036) and CRP levels higher (21.2±35.3 vs 8.1±2.1, P = .000) compared to Group B. Binary logistic regression revealed that there are no statistically significant variables that could impact decision to create AVF, but larger diameter of vena cephalica increase this decision over 13 fold (OR 13.497, CI 0.706-257.868, P = .084), and diameter of arteria radialis 17 fold (OR 17.073, CI 0.372-784-182, P = .146).

Conclusion

Diameteres of vena cephalica and arteria radialis could be the main variables in the planning of type of vascular access.
#6463 IMPLEMENTATION OF CLINICAL ALARM SYSTEM IS ASSOCIATED WITH REDUCTION OF THE RISK OF INTRADIALYTIC HYPOTENSION
Authors: Lin Hsuanming , Liu Chi Yuan , Hu Hsiang Wei , Chen Kuanyu , Chu Jennie Ting Hsuan , Un Chi Hin , Wang Jian-An
Published: June 2023

Background and Aims

Intradialytic hypotension (IDH) plays an essential role in hemodialysis. IDH prevalence can be up to 8% to 40% [1], according to research. Furthermore, research shows that IDH positively correlates with severe complications such as non-occlusive mesenteric ischemia[2], critical limb ischemia[3] and tissue ischemia, which leads to irreversible damage, even increasing the chance of infection. Many causes and risk factors result in IDH, such as excessive weight gain during dialysis, cardiovascular dysfunction, and improper use of blood pressure-lowering drugs[1]. Therefore, it still relies on experienced medical professionals to monitor patients’ blood pressure to beware of the risk of developing IDH. However, this increases the workload on medical professionals and does not provide standard or more objective early warning indicators of hypotension for new medical professionals.

Method

Selection of experimental and control group: In this study, we included 81 subjects that received hemodialysis in Tainan City Municipal Annan Hospital from January 2021 to August 2022. The control group was retrospective data collected from January 2021 to August 2021. Then, from January 2022 to August 2022, we implemented our IDH predicting system and took subjects’ data from this interval as the experimental group to compare the incidence of IDH with the control group.

IDH prediction system monitoring interface: After integrating with the hemodialysis dataset, our prediction system will predict patients’ systolic pressure and the likelihood of IDH in the next 30 minutes. As soon as the system detects that the patient will encounter hypotension, it sends warning signals, blood pressure and IDH incidence probability predictions to the monitoring interface to alert medical professionals. Furthermore, our system also supports multi-bed monitoring, which can significantly increase the efficiency of monitoring during hemodialysis.

Results

After implementing the IDH prediction system, the outcome yielded an IDH incidence of 6.12% in August 2022. Compared to the control group, when the IDH system was not yet implemented, which yielded an IDH incidence of 9.34%, it showed a reduction of 34.5% in IDH cases. Furthermore, the average reduction in IDH rate each month was 12%.

Conclusion

The present study demonstrated that implementing the IDH predicting model may efficiently reduce the incidence of IDH. However, along with the IDH warning multi-bed monitoring interface, medical professionals must develop a standard procedure to deploy when noticing the warning signals. As a result, this may further reduce the incidence of IDH during hemodialysis sessions.
#6814 A NEW SORBENT DEVICE FOR MULTIPLE CLINICAL PURPOSES: CURRENT EVIDENCE AT A PRIVATE HOSPITAL IN MEXICO
Authors: Mier Jesus , Merino Ruben
Published: June 2023

Background and Aims

Adsorption is an extracorporeal technique utilized for blood purification, it also complements convection and diffusion for solute removal. Since 1991 we had used blood purification techniques, over the years, new adsorption cartridges had been developed, the new ones involving treatment for inflammatory conditions, chronic uremic symptoms and autoimmune diseases. HA130, HA230, and HA330 (Jafron, Zhuhai City, China) are among the widely used adsorption cartridges in China. We report highlights of the use of hemoperfusion using HA130 cartridges in the Mexican population cohorts in the context of multiple chronic inflammatory conditions in order to support evidence of effectiveness and safety.

Method

We retrospectively analyzed the medical records of 14 critically ill patients in the context of chronic inflammatory conditions such as acute kidney injury in chronic kidney disease, acute lung injury due to SARS-COV-2 infection and sepsis. Hemoperfusion in addition to standard therapy (fluid resuscitation, vasopressors, antimicrobial therapy and ventilatory support) resulted in the improvement of inflammatory substances levels when compared to standard therapy alone. Out of the 14 patients, 7 patients used HA130 cartridges and 7 patients with standard therapy alone.

Results

There were no significant side effects associated with HA130 cartridge use. HA 130 cartridges were found to be effective in reducing uremic symptoms in chronic hemodialysis patients, improvement of pruritus score and decreased parathyroid hormone and phosphate product (p<0.5) when compared to HD alone, creatinine (MARS: −24 μmol/L, −19.5 to −10.46, p < 0.001; SPAD: −2 μmol/L, −9.0 to +7.0/L, p = 0.314) and urea (MARS: −0.9 mmol/L, −318 to −0.189, p = 0.024; SPAD: −0.1 mmol/L, −1.0 to +0.68, p = 0.523). 66.6% of cost-effectiveness when compared to standard therapy.

Conclusion

In the group of patients that used HA130 cartridges we found statistically significant (p <0.05) reduction of pruritus score, PTH, phosphate product, creatine and urea when compared to the group of patients with standard therapy alone. The development in new cartridges technology allows more wide applications for renal patients. As we expand to involve other indications for this therapy there is cost-effectiveness improvement for the patients.More studies in different clinical settings are needed in order to achieve adsorption therapy national recommendations. We also found that the HA130 cartridges are effective in reducing uremic symptoms and microinflammatory status in acute kidney injury in chronic kidney disease patients due to the elimination of middle and small molecule uremic toxins and inflammatory mediators and endotoxins. This may translate as an improvement of quality of life and survive rates in patients with chronic hemodialysis, even though more studies are needed in order to prove this assumption.
Diel, seasonal and vertical changes in the abundance, biomass and community structure of pelagic polychaetes at the subtropical station S1 in the western North Pacific: comparison with the results from the subarctic station K2
Authors: Amei Kanako , Dobashi Ryo , Kitamura Minoru , Yamaguchi Atsushi
Published: June 2023

Information on pelagic polychaete community structure in the western North Pacific is available for the subarctic region (Station K2) but not for the subtropical region. Hence, we analyzed day–night vertically stratified samples collected in eight layers within the first 1000 m of the water column during four seasons in 1 year, using the same sampling method as St. K2, at the subtropical region (Station S1). At St. S1, 27 species of pelagic polychaetes belonging to 13 genera and six families were identified. The annual mean abundance was 35.0 ind. 1000 m−3 and the biomass was 17.3 mg WW 1000 m−3. At St. S1, the numbers of genera and species were higher and the annual mean abundance and biomasses were much lower than St. K2. The pelagic polychaetes often peaked in the mesopelagic layer at St. K2, with the carnivores and particle feeders peaking in the epipelagic and mesopelagic layers, respectively. At St.S1, the carnivorous species predominated throughout the entire water column, and were most abundant in the epipelagic layer. Thus, In the western Pacific Ocean, the subarctic pelagic polychaete community structure changed vertically with feeding ecology. On the other hand, the subtropical community may be adapted to conditions of high irradiance and light transmission.
When the construction of police legitimacy backfires? Emotion expression management in times of the erosion of the rule of law
Authors: Rak Joanna
Published: June 2023

Emotion management in relation to police legitimacy during the pandemic in Poland offers an illustrative case study of backfire mechanisms in times of the erosion of the rule of law. Grounded in social constructionism, the study uses qualitative frame analysis to determine: what emotion management strategies embedded in discursive frames were used by the police and the state to build and rebuild police legitimacy during the pandemic? Why did they backfire? Masking, a strategy negative in valence, backfired. Ignoring emotions experienced by officers in frames constructed to gain legitimacy widened the rift between police and ordinary people. For the latter, it was equivalent to losing another public institution to the ruling state. If masking is the only strategy in use, law enforcement will likely be perceived negatively, and citizens will resist, impairing the ability of the police to perform its duties.
Familiality of the Intelligence Quotient in First Episode Psychosis: Is the Degree of Family Resemblance Associated With Different Profiles?
Authors: Murillo-García Nancy , Soler Jordi , Ortiz-García de la Foz Victor , Miguel-Corredera Margarita , Barrio-Martinez Sara , Setién-Suero Esther , Papiol Sergi , Fatjó-Vilas Mar , Ayesa-Arriola Rosa
Published: June 2023

Background and Hypothesis

There is uncertainty about the relationship between the family intelligence quotient (IQ) deviation and the risk for schizophrenia spectrum disorders (SSD). This study tested the hypothesis that IQ is familial in first episode psychosis (FEP) patients and that their degree of familial resemblance is associated with different profiles.

Study Design

The participants of the PAFIP-FAMILIAS project (129 FEP patients, 143 parents, and 97 siblings) completed the same neuropsychological battery. IQ-familiality was estimated through the Intraclass Correlation Coefficient (ICC). For each family, the intra-family resemblance score (IRS) was calculated as an index of familial similarity. The FEP patients were subgrouped and compared according to their IRS and IQ.

Study Results

IQ-familiality was low-moderate (ICC = 0.259). A total of 44.9% of the FEP patients had a low IRS, indicating discordancy with their family-IQ. Of these patients, those with low IQ had more schizophrenia diagnosis and a trend towards poorer premorbid adjustment in childhood and early adolescence. Whereas FEP patients with low IQ closely resembling their family-IQ were characterized by having the lowest performance in executive functions.

Conclusions

The deviation from the familial cognitive performance may be related to a particular pathological process in SSD. Individuals with low IQ who do not reach their cognitive familial potential show difficulties in adjustment since childhood, probably influenced by environmental factors. Instead, FEP patients with high phenotypic family resemblance might have a more significant genetic burden for the disorder.
Researcher roles in collaborative governance interventions
Authors: Peltola Taru , Saarela Sanna-Riikka , Kotilainen Juha M , Litmanen Tapio , Lukkarinen Jani , Pölönen Ismo , Ratamäki Outi , Saarikoski Heli , Salo Miikka , Vikström Suvi
Published: June 2023

While societies are facing complex problems involving multiple stakeholders and interdependencies, interest in collaborative governance as a potential solution is rising. Research-based interventions in policy, planning, and management processes have been introduced to test different approaches and tools for collaboration. The nature of these processes, tools, and approaches varies substantially, as do researchers’ cultures of making contributions to and in collaboration with society. This paper outlines the various possibilities and means for researchers to intervene in and explore steps towards collaborative governance. It utilises literature-based descriptions of potential roles for researchers and draws on insight from Finnish collaborative governance interventions in environmental decision-making. The conventional role of researchers as providers of knowledge was complemented with roles needed to foster favourable conditions for collaboration. Tensions regarding these roles show that collaborative governance requires a reflexive position from researchers, enabling them to adapt their ideas about collaboration to specific governance settings.
Social Reproduction Gone Wrong? The Citizenship Revocation and Rehabilitation of Young European Women Who Joined ISIS
Authors: Korteweg Anna , Yurdakul Gökçe , Sunderland Jillian , Streppel Marloes
Published: June 2023

Some European women who joined the Islamic State during the 2010s have had their citizenship revoked, which leaves them in a liminal state in camps at the Syrian border. Others have been able to return home, where they face prosecution and potential pathways to “rehabilitation.” This article turns to media discussions of two cases that have been extensively discussed in the media: Shamima Begum, a British national whose citizenship was revoked, and Laura Hansen, a Dutch national who was rehabilitated. Our analysis homes in on the symbolic dimension of social reproduction, showing how media representations of these two women as mothers, wives, and daughters play a critical role in media justifications of revocation and rehabilitation. We argue that media discourses create a gendered, racialized, and class-based conceptualization of citizenship unattainable to those whose social reproductive labor is deemed a threat to the nation-state.
Key hydraulic traits control the dynamics of plant dehydration in four contrasting tree species during drought
Authors: Blackman Chris J , Billon Lise-Marie , Cartailler Julien , Torres-Ruiz José M , Cochard Hervé
Published: June 2023

Trees are at risk of mortality during extreme drought, yet our understanding of the traits that govern the timing of drought-induced hydraulic failure remains limited. To address this, we tested SurEau, a trait-based soil–plant–atmosphere model designed to predict the dynamics of plant dehydration as represented by the changes in water potential against those observed in potted trees of four contrasting species (Pinus halepensis Mill., Populus nigra L., Quercus ilex L. and Cedrus atlantica (Endl.) Manetti ex Carriére) exposed to drought. SurEau was parameterized with a range of plant hydraulic and allometric traits, soil and climatic variables. We found a close correspondence between the predicted and observed plant water potential (in MPa) dynamics during the early phase drought, leading to stomatal closure, as well as during the latter phase of drought, leading to hydraulic failure in all four species. A global model’s sensitivity analysis revealed that, for a common plant size (leaf area) and soil volume, dehydration time from full hydration to stomatal closure (Tclose) was most strongly controlled by the leaf osmotic potential (Pi0) and its influence on stomatal closure, in all four species, while the maximum stomatal conductance (gsmax) also contributed to Tclose in Q. ilex and C. atlantica. Dehydration times from stomatal closure to hydraulic failure (Tcav) was most strongly controlled by Pi0, the branch residual conductance (gres) and Q10a sensitivity of gres in the three evergreen species, while xylem embolism resistance (P50) was most influential in the deciduous species P. nigra. Our findings point to SurEau as a highly useful model for predicting changes in plant water status during drought and suggest that adjustments made in key hydraulic traits are potentially beneficial to delaying the onset of drought-induced hydraulic failure in trees.
Direct oral anticoagulants and their antagonists in perioperative practice
Authors: Levy Jerrold H. , Mamoun Negmeldeen
Published: June 2023

Purpose of review

Review management strategies for patients receiving nonvitamin K direct-acting oral anticoagulants (DOACs).

Recent findings

Updated clinical trials and guidelines continue to further define optimal management for patients on DOACs requiring emergency surgery or procedural interventions. In addition, specific bleeding management strategies that include either specific or nonspecific antagonists are becoming available.

Most currently used DOACs are factor Xa inhibitors and should be stopped for 24–48 h for elective surgical procedures in patients at risk for bleeding and potentially longer for dabigatran, depending on renal function. Idarucizumab, a specific dabigatran reversal agent, has been studied in surgical patients and is currently approved for use. For Xa inhibitors apixaban and rivaroxaban, although andexanet alfa is approved for medical bleeds, it is not approved for surgical patients, has a short duration of effect, and costs $12 500 per gram. When managing DOAC-treated patients requiring emergency surgery, when stopping the DOAC and delaying surgery is not feasible, standard approaches should include hemostatic, hemodynamic, and transfusional support. Due to higher risk associated with therapeutic agents used to manage DOAC-related bleeding, increasing data supports the potential off-label use of prothrombin complex concentrate (PCC).
Electroconvulsive therapy: recent advances and anesthetic considerations
Authors: Ninke Tobias , Groene Philipp
Published: June 2023

Purpose of review

This review summarizes the current indications and principles of ECT. Contemporary anesthetic considerations are described with a focus on the optimal use of hypnotic agents and providing ECT in pregnant patients.

Recent findings

ECT is useful in treatment-resistant major depression, bipolar disorders, and treatment-resistant schizophrenia. It is a well tolerated treatment in pregnant patients with treatment-resistant depression. Cognitive side effects may be attenuated by using unilateral placement of scalp electrodes, fewer treatment sessions, and the use of ultrabrief pulse width of the electrical charge. All modern hypnotics can be used for induction of anesthesia for ECT but should be titrated to effect. Etomidate is superior to Propofol in regarding seizure quality. The use of Ketamine shows good seizure quality and may alleviate cognitive impairment. Providing ECT for pregnant patients may prove challenging because of logistic difficulties and the physiologic changes during pregnancy. Although representing an effective treatment option in severely ill patients, ECT is underutilized because of stigmatization and ethnic and financial disparities.

ECT is effective in treating treatment-resistant psychiatric illnesses. Symptoms of cognitive impairment are the most common side effects but can be treated by modifying the technique of ECT. All modern hypnotics can be used for the induction of general anesthesia. Etomidate and Ketamine may be of special interest in patients with insufficient seizure duration. Treating pregnant patients with ECT requires a multidisciplinary approach, in order to provide a safe therapy for mother and unborn child. Stigmatization and social disparities are hindering the widespread use of ECT as an effective treatment for severely ill psychiatric patients.
Half-pin Breakage in Multiplanar External Fixators Used for Pediatric Deformity Correction
Authors: Bridges Callie S. , Taylor Tristen N. , Lee Tiffany , Moore Kevin , Shenava Vinitha R. , Hill Jaclyn F.
Published: June 2023

Background:

Pediatric patients with leg length discrepancies and complex deformities may require multiplanar external fixators for correction. We have encountered 4 cases of half-pin breakage with the Orthex hexapod frame. The purpose of this study is to report factors associated with half-pin breakage and compare various deformity correction characteristics between 2 hexapod frames – Taylor Spatial Frame (TSF) and Orthex.

Methods:

Pediatric patients with lower extremity deformities treated with an Orthex or TSF at a single tertiary children’s hospital between 2012 and 2022 were included for retrospective review. Variables compared between frame groups include frame configuration, half-pin/wire fixation, length achieved, angular correction, and frame time.

Results:

There were 23 Orthex frames (23 patients) and 36 TSF (33 patients) included. Four Orthex and zero TSF had proximal half-pin breakage. The Orthex group was younger on average (10 vs. 12 y, P=.04*) at the time of frame placement. The majority (52%) of Orthex frames were used for simultaneous lengthening and angular correction, while the majority (61%) of TSF was used for only angular correction. Orthex had more half-pins used for proximal fixation (median 3 vs. 2, P<0.0001*) and more frames with nonstandard configuration (7 (30%) vs. 1 (3%), P=0.004*). Orthex group had a longer total frame time (median 189 vs. 146 days, P=0.012*) and longer time required for regenerate healing (117 vs. 89 d, P=0.02*). There were no significant differences in length gained, angular correction, or healing index between Orthex and TSF. Nonstandard configuration, increased number of proximal half-pins, younger age at index surgery, and increased lengthening were associated with pin breakage.

Conclusions:

This is the first study to report half-pin breakage while using multiplanar frames in pediatric lower extremity deformity correction. The Orthex and TSF groups consisted of significantly different patients and frame configurations, making it difficult to identify any specific cause for pin breakage. This study shows that pin breakage is likely caused by multiple factors and is associated with the increased complexity of deformity correction.

Level of Evidence:

Level III—Retrospective Comparison Study.
Quality of Life of Sepsis Survivors*
Authors: Kurematsu Kumiko , Ikematsu Yuko
Published: June 2023

OBJECTIVE:

To determine the differences between the quality of life for sepsis and nonsepsis survivors, factors affecting the quality of life for sepsis survivors, and their changes over time.

DESIGN:

A prospective longitudinal study with a quantitative comparative design.

SETTING:

A university hospital in the greater Tokyo area of Japan.

PATIENTS:

The study included 41 and 40 patients in the sepsis and nonsepsis groups, respectively.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Health-related quality of life (HRQOL), independence in activities of daily living (ADL), stress levels, and spirituality were compared between the sepsis and nonsepsis groups at ICU discharge, hospital discharge, and 1 month after discharge. Comparison of HRQOL between the sepsis and nonsepsis groups showed significantly low HRQOL in the sepsis group compared with the nonsepsis group at ICU discharge and hospital discharge. Factors such as stress levels and spirituality affected the HRQOL in the nonsepsis group at ICU discharge. At discharge, stress and spirituality affected HRQOL in both the sepsis and nonsepsis groups. One month after discharge, ADL, stress, and spirituality affected HRQOL in both the sepsis and nonsepsis groups. In terms of changes over time, HRQOL at ICU discharge in the sepsis group was significantly lower than at discharge and 1 month after discharge. The two-way analyses of variance showed no interactions between the groups and time regarding HRQOL.

CONCLUSIONS:

HRQOL of sepsis survivors was significantly lower than that of nonsepsis survivors. ADL and stress influenced HRQOL. The study suggests the importance of ADL training and stress alleviation during the ICU stay.
Vogt-Koyanagi-Harada-like Syndrome Induced by Checkpoint Inhibitor Cemiplimab
Authors: Huang Ye , Khan Farid , Saraiya Nehali V. , Punjabi Omar S. , Gulati Vikas , Erickson Alan R. , Yeh Steven
Published: June 2023

Checkpoint inhibition targeting programmed cell-death protein 1 has demonstrated efficacy for a wide range of indications including cutaneous malignancy. However, immune-related adverse events (irAEs), including infrequent but visually impactful ocular irAEs, require careful consideration of treatment options, including medication withdrawal, local corticosteroids, or rarely immunomodulation. This case presents a 53-year-old woman who developed uveitis and mucous membrane ulcers after treatment for numerous cutaneous neoplasms, primarily squamous cell carcinoma, with the programmed cell-death protein 1 inhibitor cemiplimab. Ophthalmic examination revealed diffuse choroidal depigmentation consistent with a Vogt-Koyanagi-Harada-like syndrome. Topical and periocular steroids were used to treat the intraocular inflammation, and cemiplimab was discontinued. Because of ongoing severe uveitis, systemic corticosteroids and corticosteroid-sparing immunosuppression were initiated. Specifically, azathioprine and methotrexate were introduced, but each was stopped due to side effects, prompting the initiation of adalimumab (ADA) treatment. While ADA controlled intraocular inflammation, the squamous cell carcinomas were noted to progress, resulting in the discontinuation of ADA. However, a uveitis recurrence was observed. After a discussion of risks and benefits of biologic immunosuppressive therapy, including the risk of vision loss, ADA was restarted with successful disease quiescence at a 16-month follow-up. The cutaneous neoplasms were managed with topical and intralesional therapies, such as 5-fluorouracil. Recent dermatologic examinations suggested no new cutaneous lesions. This scenario presents the effective use of ADA in an ocular irAE that balances the management of sight-threatening ocular inflammation with the risk of promoting recurrent or de novo neoplastic disease.
A gut bacterial signature in blood and liver tissue characterizes cirrhosis and hepatocellular carcinoma
Authors: Effenberger Maria , Waschina Silvio , Bronowski Christina , Sturm Gregor , Tassiello Oronzo , Sommer Felix , Zollner Andreas , Watschinger Christina , Grabherr Felix , Gstir Ronald , Grander Christoph , Enrich Barbara , Bale Reto , Putzer Daniel , Djanani Angela , Moschen Alexander R. , Zoller Heinz , Rupp Jan , Schreiber Stefan , Burcelin Remy , Lass-Flörl Cornelia , Trajanoski Zlatko , Oberhuber Georg , Rosenstiel Philip , Adolph Timon E. , Aden Konrad , Tilg Herbert
Published: June 2023

Background:

HCC is the leading cause of cancer in chronic liver disease. A growing body of experimental mouse models supports the notion that gut-resident and liver-resident microbes control hepatic immune responses and, thereby, crucially contribute to liver tumorigenesis. However, a comprehensive characterization of the intestinal microbiome in fueling the transition from chronic liver disease to HCC in humans is currently missing.

Methods:

Here, we profiled the fecal, blood, and liver tissue microbiome of patients with HCC by 16S rRNA sequencing and compared profiles to nonmalignant cirrhotic and noncirrhotic NAFLD patients.

Results:

We report a distinct bacterial profile, defined from 16S rRNA gene sequences, with reduced α-and β-diversity in the feces of patients with HCC and cirrhosis compared to NAFLD. Patients with HCC and cirrhosis exhibited an increased proportion of fecal bacterial gene signatures in the blood and liver compared to NAFLD. Differential analysis of the relative abundance of bacterial genera identified an increased abundance of Ruminococcaceae and Bacteroidaceae in blood and liver tissue from both HCC and cirrhosis patients compared to NAFLD. Fecal samples from cirrhosis and HCC patients both showed a reduced abundance for several taxa, including short-chain fatty acid–producing genera, such as Blautia and Agathobacter. Using paired 16S rRNA and transcriptome sequencing, we identified a direct association between gut bacterial genus abundance and host transcriptome response within the liver tissue.

Conclusions:

Our study indicates perturbations of the intestinal and liver-resident microbiome as a critical determinant of patients with cirrhosis and HCC.
Population Health Management Approach to Depression Symptom Monitoring in Primary Care via Patient Portal: A Randomized Controlled Trial
Authors: Staab Erin M. , Franco Melissa I. , Zhu Mengqi , Wan Wen , Gibbons Robert D. , Vinci Lisa M. , Beckman Nancy , Yohanna Daniel , Laiteerapong Neda
Published: June 2023

Depression is undertreated in primary care. Using patient portals to administer regular symptom assessments could facilitate more timely care. At an urban academic medical center outpatient clinic, patients with active portal accounts and depression on their problem list or a positive screen in the past year were randomized to assessment during triage at visits (usual care) versus usual care plus assessment via portal (population health care). Portal invitations were sent regardless of whether patients had scheduled appointments. More patients completed assessments in the population health care arm than usual care: 59% versus 18%,P< 0.001. Depression symptoms were more common among patients who completed their initial assessment via the portal versus in the clinic. In the population health care arm, 57% (N = 80/140) of patients with moderate-to-severe symptoms completed at least 1 follow-up assessment versus 37% (N = 13/35) in usual care. A portal-based population health approach could improve depression monitoring in primary care.
Budd-Chiari Syndrome—A Single Center Experience From the United Kingdom
Authors: Mann J.P. , Ikram F. , Modin L. , Kelgeri C. , Sharif K. , Olliff S. , McGuirk S. , Gupte G.L.
Published: June 2023

Pediatric Budd-Chiari syndrome (BCS) is a rare cause of portal hypertension and liver disease in Europe and North America. In order to understand the long-term effect of radiological intervention on BCS we performed a single center retrospective review. Fourteen cases were identified; 6 of 14 (43%) had a congenital thrombophilia with many having multiple prothrombotic mutations. Two were managed with medical anticoagulation alone and two required super-urgent transplant for acute liver failure. The remaining 10 of 14 (71%) underwent radiological intervention: 1 of 14 thrombolysis, 5 of 14 angioplasty, and 4 of 14 transjugular intrahepatic portosystemic shunt (TIPS). Six of 14 (43%) patients required repeat radiological intervention (1 angioplasty, 5 TIPS) but none required surgical shunts or liver transplantation for chronic liver disease. The time between diagnosis and treatment did not predict the need for repeat radiological intervention. These data show that radiological intervention can be highly effective, and reduces the need for surgery, though it requires specialist multidisciplinary teams for monitoring.
Mycophenolate Mofetil Use in Pediatric Immune Thrombocytopenia Refractory to First-line Therapy: a Single-center Experience
Authors: Goldberg Tracie A. , Levy Carolyn Fein
Published: June 2023

Most children treated for immune thrombocytopenia remit during the first year following diagnosis. For the ∼40% who develop persistent or chronic disease, second-line treatment options include immunomodulation and thrombomimetic agents. While immunomodulators target the underlying mechanism, prolonged immunosuppression may increase the risk of infection. We report the use of the reversible immunomodulating agent mycophenolate mofetil (MMF) in 16 pediatric patients with immune thrombocytopenia refractory to first-line treatment. Using escalating doses up to 2400 mg/m2/d, MMF treatment resulted in a 73% response rate. Adverse events were mostly mild and tolerable. Complete responders have been successfully tapered off MMF with sustained responses.
Pediatric Thromboprophylaxis of Large Coronary Artery Aneurysm Using Rivaroxaban
Authors: Montanez Natalie , Sexson Tejtel Sara Kristen , Menon Neethu M.
Published: June 2023

Giant or large coronary artery aneurysms (CAA) are rare in children, most often secondary to Kawasaki disease, and anticoagulation is recommended to prevent thromboembolism. There are no published pediatric reports on the use of a direct oral anticoagulant for this indication. We describe the anticoagulation management of an 8-year-old boy with a dilated right CAA secondary to Kawasaki disease that has remained stable on rivaroxaban and aspirin, following bleeding complications on enoxaparin and challenges on warfarin. The use of rivaroxaban appears to be safe and effective in the prevention of thrombosis in a pediatric patient with CAA.
Early Postoperative Magnetic Resonance Imaging Findings Related to Electrocauterization for Cerebellar Reduction During Chiari Decompression Surgery
Authors: Ginat Daniel T. , Hooper Grayson W.
Published: June 2023

Background

Cerebellar tonsillar reduction or resection can be performed as part of the surgical management of Chiari type 1 malformation when it is accompanied by symptomatic brainstem compression or syringomyelia. The purpose of this study is to characterize the early postoperative magnetic resonance imaging (MRI) findings in patients with Chiari type 1 malformations who undergo cerebellar tonsillar reduction via electrocautery.

Methods

The extent of cytotoxic edema and microhemorrhages demonstrated on MRI scans obtained within 9 days following surgery was assessed and correlated with neurological symptoms.

Results

Cytotoxic edema was found on all postoperative MRI examinations included in this series, with superimposed hemorrhage in 12 of 16 patients (75%) and was primarily located along the margins of the cauterized inferior cerebellum. Cytotoxic edema was present beyond the margins of the cauterized cerebellar tonsils in 5 of 16 patients (31%) and was associated with new focal neurological deficits in 4 of 5 patients (80%).

Conclusion

Cytotoxic edema and hemorrhages along the cerebellar tonsil cautery margins can be expected findings in early postoperative MRI in patients who undergo Chiari decompression accompanied by tonsillar reduction. However, the presence of cytotoxic edema beyond these regions can be associated with new focal neurological symptoms.
Using Ultrahigh b-Value Diffusion-Weighted Imaging to Noninvasively Assess Renal Fibrosis in a Rabbit Model of Renal Artery Stenosis
Authors: Zhang Zhiping , Zha Tingting , Jiang Zhenxing , Pan Liang , Liu Yang , Dong Congsong , Chen Jie , Xing Wei
Published: June 2023

Objective

This study aimed to investigate the feasibility of diffusion-weighted imaging with ultrahigh b values (ubDWI) for the evaluation of renal fibrosis (RF) induced by renal artery stenosis (RAS) in a rabbit model.

Methods

Thirty-two rabbits underwent left RAS operation, whereas 8 rabbits received sham surgery. All rabbits underwent ubDWI (b = 0–4500 s/mm2). The standard apparent diffusion coefficient (ADCst), molecular diffusion coefficient (D), perfusion fraction (f), perfusion-related diffusion coefficient (D*) and ultrahigh apparent diffusion coefficient (ADCuh) were longitudinally assessed before operation and at weeks 2, 4, and 6 after operation. The degree of interstitial fibrosis and the expression of aquaporin (AQP) 1 and AQP2 were determined through pathological examination.

Results

In the stenotic kidney, the ADCst, D, f, and ADCuh values of the renal parenchyma significantly decreased compared with those at baseline (all P < 0.05), whereas the D* values significantly increased after RAS induction (P < 0.05). The ADCst, D, D*, and f were weakly to moderately correlated with interstitial fibrosis as well as with the expression of AQP1 and AQP2. Furthermore, the ADCuh negatively correlated with interstitial fibrosis (ρ = −0.782, P < 0.001) and positively correlated with AQP1 and AQP2 expression (ρ = 0.794, P < 0.001, and ρ = 0.789, P < 0.001, respectively).

Conclusions

Diffusion-weighted imaging with ultrahigh b values shows the potential for noninvasive assessment of the progression of RF in rabbits with unilateral RAS. The ADCuh derived from ubDWI could reflect the expression of AQPs in RF.
Effect of Deep Learning Reconstruction on Evaluating Cervical Spinal Canal Stenosis With Computed Tomography
Authors: Ohtake Yuta , Yasaka Koichiro , Hamada Akiyoshi , Fujita Nana , Abe Osamu
Published: June 2023

Objective

Magnetic resonance imaging (MRI) is commonly used to evaluate cervical spinal canal stenosis; however, some patients are ineligible for MRI. We aimed to assess the effect of deep learning reconstruction (DLR) in evaluating cervical spinal canal stenosis using computed tomography (CT) compared with hybrid iterative reconstruction (hybrid IR).

Methods

This retrospective study included 33 patients (16 male patients; mean age, 57.7 ± 18.4 years) who underwent cervical spine CT. Images were reconstructed using DLR and hybrid IR. In the quantitative analyses, noise was recorded by placing the regions of interest on the trapezius muscle. In the qualitative analyses, 2 radiologists evaluated the depiction of structures, image noise, overall image quality, and degree of cervical canal stenosis. We additionally evaluated the agreement between MRI and CT in 15 patients for whom preoperative cervical MRI was available.

Results

Image noise was less with DLR than hybrid IR in the quantitative (P ≤ 0.0395) and subjective analyses (P ≤ 0.0023), and the depiction of most structures was improved (P ≤ 0.0052), which resulted in better overall quality (P ≤ 0.0118). Interobserver agreement in the assessment of spinal canal stenosis with DLR (0.7390; 95% confidence interval [CI], 0.7189–0.7592) was superior to that with hybrid IR (0.7038; 96% CI, 0.6846–0.7229). As for the agreement between MRI and CT, significant improvement was observed for 1 reader with DLR (0.7910; 96% CI, 0.7762–0.8057) than hybrid IR (0.7536; 96% CI, 0.7383–0.7688).

Conclusions

Deep learning reconstruction provided better quality cervical spine CT images in the evaluation of cervical spinal stenosis than hybrid IR.
Imaging Features of Primary Intraosseous Meningiomas
Authors: Gao Lu , Chen Peiyao , Yang Lin , Li Yang , Han Fang , Liu Heng , Zhang Jiawen
Published: June 2023

Objective

To describe the imaging features of primary intraosseous meningiomas (PIMs) to aid an accurate diagnosis.

Methods

Clinical materials and radiological data for 9 patients with pathologically confirmed PIMs were reviewed comprehensively.

Results

Most lesions involved inner and outer plates of the calvaria and all were relatively well circumscribed. Upon computed tomography, portions of the solid neoplasm were hyperattenuated or isoattenuated. Hyperostosis was found in many lesions, but calcification was seen rarely. On magnetic resonance imaging, most neoplasms were hypointense on T1-weighted images, hyperintense on T2-weighted images, and heterogeneous on fluid-attenuated inversion recovery images. In most cases, the soft tissue of neoplasms showed hyperintense on diffusion-weighted imaging and hypointense on apparent diffusion coefficient. All lesions were obviously enhanced after gadolinium administration. Each patient accepted surgical treatment and recurrence was not observed during follow-up.

Conclusions

Primary intraosseous meningiomas are very rare tumors that occur usually in later life. They are well-defined and tend to involve the inner and outer plates of the calvaria, with a classic appearance of hyperostosis on computed tomography. Primary intraosseous meningiomas display hypointense on T1-weighted images, hyperintense on T2-weighted images, and hyperattenuated or isoattenuated on computed tomography. Hyperintense on diffusion-weighted imaging, hypointense on apparent diffusion coefficient can also be found. Obvious enhancement supplied additional information for an accurate diagnosis. A neoplasm with these features should raise the suspicion of a PIM.
Lymphoscintigraphy of the Lower Extremities
Authors: Mrhac Lubomir , Havel Martin , Kolacek Michal , Kraft Otakar , Bukovansky Kamil
Published: June 2023

We describe a 57-year-old man with prostate cancer. A radical prostatectomy with a pelvic lymphadenectomy was performed. After 2 years, a mild swelling of the lower extremities appeared, and the patient was referred for lower-limb lymphoscintigraphy. A lymphoscintigraphy of the superficial lymphatic system in the limbs showed prominent, dermal backflow in the area of the right hypogastrium. Lymphoscintigraphy of the deep lymphatic system showed reflux in the left hypogastrium. This discrepancy between the findings in the superficial and deep lower-limb lymphatic systems was explained by asymmetric sampling of the lymph nodes during the lymphadenectomy.
Upper Gastrointestinal Bleeding
Authors: Banigan Meghan , Kranenburg Laura , Vise Jennifer
Published: June 2023

Upper gastrointestinal bleeding is a common medical emergency that requires prompt diagnosis and intervention. Patients may be hemodynamically stable or unstable depending on bleeding severity and vital signs. Immediate resuscitation and timely diagnosis are paramount to reducing mortality in this extremely vulnerable patient population. Upper gastrointestinal bleeding can be classified into two categories: variceal bleeding and nonvariceal bleeding, both of which can be life-threatening. This article aids bedside practitioners in understanding the pathogenesis of an upper gastrointestinal bleed to identify potential diagnoses. Furthermore, to ensure the proper diagnostic tests are prescribed, the algorithm provides guidance on collecting a pertinent medical history, discusses common presenting symptoms, and identifies the top risk factors for several disease processes that might present as an upper gastrointestinal bleed. A diagnostic algorithm that includes a myriad of the most common differential diagnoses of an upper gastrointestinal bleed is presented as a tool for bedside clinicians to utilize when encountering this serious gastrointestinal phenomenon.
SUPPLEMENTATION WITH NICOTINAMIDE RIBOSIDE ATTENUATES T CELL EXHAUSTION AND IMPROVES SURVIVAL IN SEPSIS
Authors: Zhao Guang-ju , Yang Xi-yu , Zhang Chen , Dong Wei , Dong Fu-bo , Zhang Jie , Chen Xiao-Yan , Yao Ren-qi , Xiao Zhong , Chen Long-wang , Yao Yong-ming , Lu Zhong-qiu
Published: June 2023

T cell exhaustion is the main cause of sepsis-induced immunosuppression and is associated with the poor prognosis. Nicotinamide adenine dinucleotide (NAD+
) is well known for its anti-aging effect, but its role in sepsis-induced T cell exhaustion remains to be elucidated. In the present study, using a classic septic animal model, we found that the levels of NAD+ and its downstream molecule, which is sirtuins 1 (SIRT1), in T cells in sepsis were decreased. Supplementation with nicotinamide ribose (NR), the precursor of NAD+, right after cecal ligation and puncture significantly increased the levels of NAD+ and SIRT1. Supplementation with NR alleviated the depletion of mononuclear cells and T lymphocytes in spleen in sepsis and increased the levels of CD3+ CD4+ and CD3+ CD8+ T cells. Interestingly, both Th1 and Th2 cells were expanded after NR treatment, but the balance of Th1/Th2 was partly restored. Nicotinamide ribose also inhibited the regulatory T cells expansion and programmed cell death 1 expression in CD4+ T cells in sepsis. In addition, the bacteria load, organ damage (lung, heart, liver, and kidney), and the mortality of septic mice were reduced after NR supplementation. In summary, these results demonstrate the beneficial effect of NR on sepsis and T cell exhaustion, which is associated with NAD+/SIRT1 pathway.
Association Between Biliary Pathogens, Surgical Site Infection, and Pancreatic Fistula
Authors: Ellis Ryan J. , Brajcich Brian C. , Bertens Kimberly A. , Chan Carlos H.F. , Castillo Carlos Fernandez-del , Karanicolas Paul J. , Maithel Shishir K. , Reames Bradley N. , Weber Sharon M. , Vidri Roberto J. , Pitt Henry A. , Thompson Vanessa M. , Gonen Mithat , Seo Susan K. , Yopp Adam C. , Ko Clifford Y. , D’Angelica Michael I.
Published: June 2023

Objective:

Establish the association between bactibilia and postoperative complications when stratified by perioperative antibiotic prophylaxis.

Background:

Patients undergoing pancreatoduodenectomy (PD) experience high rates of surgical site infection (SSI) and clinically relevant postoperative pancreatic fistula (CR-POPF). Contaminated bile is known to be associated with SSI, but the role of antibiotic prophylaxis in mitigation of infectious risks is ill-defined.

Methods:

Intraoperative bile cultures (IOBC) were collected as an adjunct to a randomized phase 3 clinical trial comparing piperacillin-tazobactam with cefoxitin as perioperative prophylaxis in patients undergoing PD. After complication of IOBC data, associations between culture results, SSI, and CR-POPF were assessed using logistic regression stratified by the presence of a preoperative biliary stent.

Results:

Of 778 participants in the clinical trial, IOBC were available for 247 participants. Overall, 68 (27.5%) grew no organisms, 37 (15.0%) grew one organism, and 142 (57.5%) were polymicrobial. Organisms resistant to cefoxitin but not piperacillin-tazobactam were present in 95 patients (45.2%). The presence of cefoxitin-resistant organisms, 92.6% of which contained either Enterobacter or Enterococcus species, was associated with development of SSI in participants treated with cefoxitin (53.5% vs 25.0%; OR 3.44, 95%CI 1.50-7.91; P=0.004) but not those treated with piperacillin-tazobactam (13.5% vs 27.0%; OR 0.42, 95%CI 0.14-1.29; P=0.128). Similarly, cefoxitin-resistant organisms were associated with CR-POPF in participants treated with cefoxitin (24.1% vs 5.8%; OR 3.45, 95%CI 1.22-9.74; P=0.017) but not those treated with piperacillin-tazobactam (5.4% vs 4.8%; OR 0.92, 95%CI 0.30-2.80; P=0.888).

Conclusion:

Previously observed reductions in SSI and CR-POPF in patients that received piperacillin-tazobactam antibiotic prophylaxis are potentially mediated by biliary pathogens that are cefoxitin resistant, specifically Enterobacter spp and Enterococcus spp.