bluuebunny/crossref_metadata_2025 huggingface dataset:
Burosumab treatment of X-linked hypophosphatemia patients: interim analysis of the SUNFLOWER longitudinal, observational cohort study
Authors: Michigami Toshimi , Kang Hee Gyung , Namba Noriyuki , Ito Nobuaki , Kubota Takuo , Shintani Ayumi , Kabata Daijiro , Kanematsu Masanori , Nishida Yayoi , Fukumoto Seiji , Ozono Keiichi
Published: June 2024

X-linked hypophosphatemia (XLH) is a genetic disease that results in excessive FGF23, chronic hypophosphatemia, and musculoskeletal abnormalities, with affected patients experiencing symptoms such as bone pain, bone deformity, fracture, and pseudofracture. Burosumab is a fully human monoclonal antibody that binds to FGF23, improving lowered serum 1,25(OH)2D and phosphate levels in patients with XLH. There are insufficient data on the use of burosumab, its safety, and the outcomes of treated patients in a real-world setting. The SUNFLOWER (Study of longitUdinal observatioN For patients with X-Linked hypOphosphatemic rickets/osteomalacia in collaboration With Asian partnERs) study is an ongoing longitudinal, observational cohort study of patients with XLH in Japan and South Korea. Enrollment occurred between April 2018 and December 2020. This interim analysis compared the background characteristics of patients who received burosumab with those who did not, and assessed improvements in biomarkers, physical and motor function, health-related quality-of-life (HRQOL) and other patient-reported outcome (PRO) measures, as well as the safety of burosumab treatment in 143 Japanese patients from 15 institutions over 6 mo. The patients had a median [interquartile range] age of 17.5 [11.0, 38.8] yr and 98 (68.5%) were female. Among patients aged <18 and ≥18 yr, 40/73 (54.8%) and 25/70 (35.7%) received burosumab, respectively. More patients aged ≥18 who received burosumab had bone pain at baseline vs those not treated with burosumab (6/25, 24.0% vs 2/45, 4.4%, p=.021). Patients treated with burosumab had improved serum phosphate and 1,25(OH)2D levels; moreover, rickets severity and HRQOL/PRO measures, such as pain, appeared to improve over 6 mo of burosumab treatment, and no new safety concerns were identified. This study identified trends in the background characteristics of patients with XLH who receive burosumab in real-world clinical practice. Furthermore, the results support the use of burosumab therapy in real-world settings.
Cranial Ultrasound Findings in Infants With Congenital Cytomegalovirus Infection in a Universal Newborn Screening Study in Minnesota
Authors: Kruc Rebecca M , Osterholm Erin A , Holm Tara , Nestrasil Igor , Lanzieri Tatiana M , Schleiss Mark R
Published: June 2024

Background

Congenital cytomegalovirus (cCMV) is the most common infectious cause of neurodevelopmental deficits in US children. To inform patient management, it is important to define whether central nervous system (CNS) manifestations are present at birth. This study characterized neuroimaging findings in infants with cCMV identified by a universal screening study in Minnesota during February 2016–December 2022.

Methods

Newborns with cCMV infection (confirmed by urine CMV polymerase chain reaction [PCR] testing, obtained following a positive screening saliva and/or dried blood spot result) underwent a diagnostic evaluation that included a cranial ultrasound (cUS) exam, laboratory studies, ophthalmological, and audiological evaluation. Neuroimaging findings and cCMV disease classification were interpreted based on international consensus guidelines.

Results

Among 87 newborns with confirmed cCMV, 76 underwent cUS. Of these, 53/76 (70%) had normal examinations, while 23/76 (30%) exhibited cUS findings: for 5 infants, these were clearly cCMV disease-defining, while for 18 infants, there were findings of uncertain significance. Magnetic resonance imaging (MRI) results (n = 10 infants) aligned with cUS cCMV disease-defining findings in 2 infants, while cCMV-specific abnormalities were noted by MRI in 2 of 6 infants with nondiagnostic/incidental cUS findings. Of 9 infants who had both cUS and MRI examination, the average time interval between studies was 220 days (range, 2–1061). Excluding infants with cCMV CNS disease-defining cUS abnormalities, incidental findings were observed more commonly in infants with clinical/laboratory features described in cCMV disease classification guidelines (9/13) than in newborns with completely asymptomatic infections (9/58; P < .0001).

Conclusions

Among infants with cCMV identified in a universal screening study, the majority had a normal cUS. CNS disease-defining abnormalities were present in 7%, while 24% had findings of uncertain significance. We propose that many cUS findings are incidental, and not diagnostic of symptomatic cCMV infection. Although these findings may not be sufficient to define the presence of symptomatic cCMV disease involving the CNS, in our study they were more commonly observed in infants with other clinical and/or laboratory findings associated with symptomatic cCMV infection.
Advances of surgical robotics: image-guided classification and application
Authors: Li Changsheng , Zhang Gongzi , Zhao Baoliang , Xie Dongsheng , Du Hailong , Duan Xingguang , Hu Ying , Zhang Lihai
Published: June 2024

Surgical robotics application in the field of minimally invasive surgery has developed rapidly and has been attracting increasingly more research attention in recent years. A common consensus has been reached that surgical procedures are to become less traumatic and with the implementation of more intelligence and higher autonomy, which is a serious challenge faced by the environmental sensing capabilities of robotic systems. One of the main sources of environmental information for robots are images, which are the basis of robot vision. In this review article, we divide clinical image into direct and indirect based on the object of information acquisition, and into continuous, intermittent continuous, and discontinuous according to the target-tracking frequency. The characteristics and applications of the existing surgical robots in each category are introduced based on these two dimensions. Our purpose in conducting this review was to analyze, summarize, and discuss the current evidence on the general rules on the application of image technologies for medical purposes. Our analysis gives insight and provides guidance conducive to the development of more advanced surgical robotics systems in the future.
Silvery fullerene in Ag102 nanosaucer
Authors: Wang Zhi , Wang Yuchen , Zhang Chengkai , Zhu Yan-Jie , Song Ke-Peng , Aikens Christine M , Tung Chen-Ho , Sun Di
Published: June 2024

Despite the discovery of a series of fullerenes and a handful of noncarbon clusters with the typical topology of Ih-C60, the smallest fullerene with a large degree of curvature, C20, and its other-element counterparts are difficult to isolate experimentally. In coinage metal nanoclusters (NCs), the first all-gold fullerene, Au32, was discovered after a long-lasting pursuit, but the isolation of similar silvery fullerene structures is still challenging. Herein, we report a flying saucer-shaped 102-nuclei silver NC (Ag102) with a silvery fullerene kernel of Ag32, which is embraced by a robust cyclic anionic passivation layer of (KPO4)10. This Ag32 kernel can be viewed as a non-centered icosahedron Ag12 encaged into a dodecahedron Ag20, forming the silvery fullerene of Ag12@Ag20. The anionic layer (KPO4)10 is located at the interlayer between the Ag32 kernel and Ag70 shell, passivating the Ag32 silvery fullerene and templating the Ag70 shell. The tBuPhS− and CF3COO− ligands on the silver shell show a regioselective arrangement with the 60 tBuPhS− ligands as expanders covering the upper and lower of the flying saucer and 10 CF3COO− as terminators neatly encircling the edges of the structure. In addition, Ag102 shows excellent photothermal conversion efficiency (η) from the visible to near-infrared region (η = 67.1% ± 0.9% at 450 nm, 60.9% ± 0.9% at 660 nm and 50.2% ± 0.5% at 808 nm), rendering it a promising material for photothermal converters and potential application in remote laser ignition. This work not only captures silver kernels with the topology of the smallest fullerene C20, but also provides a pathway for incorporating alkali metal (M) into coinage metal NCs via M-oxoanions.
Equity issues associated with the widespread implementation of autonomous vehicles
Authors: Fatima Saba , Hsiu Lee Chieh , Dannenberg Andrew L
Published: June 2024

Autonomous vehicles (AVs), either shared or privately owned, are predicted to become a common transport mode used by the general population in coming decades. Policies governing the use of AVs may increase or decrease social inequities. This review synthesizes existing literature and provides policy recommendations to enhance equity as the use of AVs becomes more widespread. We identified nine areas in which AVs could impact equity: (i) assessment of community mobility needs and priorities, (ii) education and outreach, (iii) disparities in infrastructure quality, (iv) equitable distribution of customer services, (v) access to AVs by persons with low incomes, (vi) shared infrastructure services, (vii) barriers to shared AV use, (viii) access to AVs by persons with disabilities and (ix) disruption of existing transportation jobs. Recommendations for promoting equitable use of AVs include (i) policies governing how jurisdictions oversee AV implementation and (ii) policies addressing how jurisdictions issue permits to AV service providers. Oversight policies include ensuring input from disadvantaged communities, providing subsidies for low-income users, establishing ride-sharing rules to protect vulnerable populations, reviewing the equity implications of proposed AV infrastructure improvements, providing retraining opportunities for those who may lose jobs due to AV implementation and monitoring the impact of AV policies implemented. Permitting processes include ensuring equitable access to AVs for low-income, minority, and older users and persons with disabilities, ensuring equitable distribution of AV service areas and verifying that data from all communities are incorporated into the artificial intelligence algorithms used to guide AVs.
Effects of maternal methylparaben exposure on the offspring population dynamics varied between amictic and mictic mothers of the rotifer Brachionus calyciflorus
Authors: Bian Shijun , Niu Cuijuan
Published: June 2024

Maternal effect plays important role in adaptive evolution and population dynamics. Methylparaben (Mep) is a common organic pollutant exerting diverse impacts on aquatic organisms. However, the impact of maternal Mep exposure on offspring remains poorly understood. This study was designed to explore whether maternal Mep exposure can affect the offspring’s population performance, either by amictic mothers in parthenogenesis phase, or by mictic mothers in sexual reproduction phase of the rotifer Brachionus calyciflorus. Here, we exposed either amictic or mictic mothers from one clonal laboratory population to 20 mg/L Mep (T environment) until the offspring or resting eggs were collected. A parallel control group without Mep (C environment) was also set. Thereafter, offspring from amictic mothers or stem female from resting eggs of mictic mothers were treated similarly in T or C environment. Population growth, life history traits and antioxidant indices of the offspring were examined. The results demonstrated that maternal Mep exposure inhibited population performance of offspring in both life history phases, while the negative effects were markedly buffered in sexual reproduction phase. This study clarifies toxicity of Mep on rotifers and highlights the different response patterns of maternal Mep exposure in different life history phase.
Trends in obstructive sleep apnea disease severity over nearly two decades: update on the VA San Diego experience
Authors: Nokes Brandon , Zamora Tania , Velazquez Yzabel , Golshan Shah , Cervantes-Gomeros Cesar , Perrine Will , Barker Robert , Malhotra Atul , Sarmiento Kathleen F , Stepnowsky Carl
Published: June 2024

Study Objectives

The Sleep Program at the VA San Diego Healthcare System (VASDHS) started a patient database over twenty years ago for its home sleep apnea testing (HSAT) program. An analysis of ten years of diagnostic HSAT data was reported on over 12 500 patients in 2014. Over this time period, severe obstructive sleep apnea (OSA) decreased in frequency. In contrast, mild OSA increased in frequency and was the most frequently reported severity in our analysis. In more recent times, the 2021 continuous positive airway pressure (CPAP) crisis created difficulties in dispersing CPAP therapies to individuals including Veterans with OSA, prompting our group to reexamine the HSAT database.

Methods

A retrospective review was performed of the local clinical database of HSAT diagnostic testing of 8,928 sleep studies from 2018 to 2022.

Results

The overall mean apnea–hypopnea index (AHI) decreased from 40.4/hour (2004) to 24.3/hour (2022) (p < .001). The two time periods were examined separately. For 2004–2013, it was found that the mean AHI in 2004 was not significantly different from the mean AHI in 2005, 2006, or 2007 but was significantly different from the mean AHI in each year from 2008 (mean AHI = 30.7/h) to 2013 (mean AHI = 26.1/hour). For 2019–2022, the mean AHI did not significantly differ between the 4 years.

Conclusions

These findings have implications for OSA therapies. Additionally, the high prevalence of mild sleep apnea, which is typically associated with lesser adherence to PAP therapy, further highlights the importance of non-PAP alternatives to improve treatment effectiveness.
Development of an application programming interface to automate downloading and processing of precision livestock data
Authors: Brennan Jameson R , L. Parsons Ira , Harrison Meredith , Menendez Hector M
Published: June 2024

Advancements in technology have ushered in a new era of sensor-based measurement and management of livestock production systems. These sensor-based technologies have the ability to automatically monitor feeding, growth, and enteric emissions for individual animals across confined and extensive production systems. One challenge with sensor-based technologies is the large amount of data generated, which can be difficult to access, process, visualize, and monitor information in real time to ensure equipment is working properly and animals are utilizing it correctly. A solution to this problem is the development of application programming interfaces (APIs) to automate downloading, visualizing, and summarizing datasets generated from precision livestock technology (PLT). For this methods paper, we develop three APIs and accompanying processes for rapid data acquisition, visualization, systems tracking, and summary statistics for three technologies (SmartScale, SmartFeed, and GreenFeed) manufactured by C-Lock Inc (Rapid City, SD). Program R markdown documents and example datasets are provided to facilitate greater adoption of these techniques and to further advance PLT. The methodology presented successfully downloaded data from the cloud and generated a series of visualizations to conduct systems checks, animal usage rates, and calculate summary statistics. These tools will be essential for further adoption of precision technology. There is huge potential to further leverage APIs to incorporate a wide range of datasets such as weather data, animal locations, and sensor data to facilitate decision-making on time scales relevant to researchers and livestock managers.
Greenhouse Screening of Cotton Varieties Against Fusarium Wilt Complex
Authors: Dotray Jessica , Chagoya Jennifer , Wheeler Terry A. , Monclova-Santana Cecilia
Published: June 2024

Fusarium oxysporum f. sp. vasinfectum race 1 and 2 (FOV) and the Meloidogyne incognita (southern root-knot nematode, RKN) complex can cause severe losses in cotton, and management recommendations include using varieties that are resistant to RKN. The objective of this project was to test the response of different varieties to the Fusarium wilt complex with and without RKN resistance. Four greenhouse trials were conducted, where cultivars infested with RKN and FOV were evaluated on (i) leaf wilt symptoms rated every 3 to 4 days to calculate the area under disease progress curve (AUDPC) and (ii) visual ratings of root and stem necrosis at the end of each trial. RKN-resistant cultivars PHY 480 W3FE and DP 1747NR B2XF had statistically similar AUDPC, root necrosis, and stem necrosis as RKN-susceptible cultivars DP 1522 B2XF and DP 1646 B2XF in all trials. This demonstrated that RKN resistance does not correlate to FOV resistance, and RKN resistance alone is not sufficient to manage Fusarium wilt. Cultivar ST 4946GLB2, which carries both RKN and FOV resistance, statistically had the lowest AUDPC, root necrosis, and stem necrosis in all greenhouse trials.
Incidental Abdominal Wall Endometriosis in Plastic Surgery: Two Cases and Review of the Literature
Authors: Payton Jesse I. , Chiodo Michael V. , Webster Nicholas
Published: June 2024

Endometriosis is a common cause of pain and infertility. Abdominal wall endometriosis (AWE) is a form of extrapelvic endometriosis that can be encountered during abdominal surgery such as abdominoplasty or free flap harvest. We report two cases of AWE; one found intraoperatively in a 32-year-old woman desiring body contouring after undergoing cesarean section, and a second in a 36-year-old woman requiring resection and reconstruction of a left chondroid tenosynovial giant cell tumor of her temporomandibular joint. During free flap planning, she was found to have endometriosis of her right hemi-abdomen. Both patients underwent resection of their AWE and were referred to their obstetrics and gynecology physicians for consideration of menstrual suppression to decrease their risk of recurrence.
Pediatric Mandibular Fracture Management: Intraoperative Thermoplastic Splint Fabrication and Circummandibular Wires, without Maxillomandibular Fixation
Authors: Sudduth Jack D. , Byrd Richard , Marquez Jessica L. , Bautista Catherine H. , Chen Joanna , Battistini Andrea , Yamashiro Duane K. , Gociman Barbu
Published: June 2024

Management of mandibular fractures often involves the use of maxillomandibular fixation (MMF) to attain immobility of the fractured segments. This can be used as a primary treatment modality or as an adjunct in fracture management. This technique, however, has its drawbacks due to the great burden of care imposed on patients. In the following case, fixation of a pediatric open mandibular body fracture was attained without the use of MMF, and bone union was achieved. Due to age, safety concerns, long-distance travel, and parent’s preference, the routine management of this type of fracture with MMF using piriform aperture drop wires and circummandibular wires was not done. Instead, the fracture was reduced, and an intraoral mandibular impression was taken in the operating room, which was used to create a stone model. A 2-mm acrylic splint was designed and fabricated from the stone model, and two circummandibular wires were placed. The wires were tightened over the acrylic splint to achieve stabilization of the mandibular reduction. At 4 weeks postoperatively, the splint was removed, and the patient was maintained on a soft diet. At 6 weeks, bone union was appreciated clinically by immobility of the mandibular segments, and the patient was advanced to a regular diet. Occlusion was corrected to premorbid state by clinical findings and 6 months postoperative imaging. This technique represents an effective approach in managing pediatric mandibular fractures when MMF cannot be used.
Complex Scalp Reconstruction with Super Thin DIEP Free Flap
Authors: Stanneart Jordin , Holtrop John , Smith Christopher
Published: June 2024

Scalp reconstruction provides a unique challenge to the reconstructive surgeon, especially in terms of matching skin color and contour. We present a case of a 67-year-old man with a chronic scalp wound requiring soft tissue coverage after major debridement and coverage of a skull defect. We chose to use a super thin deep inferior epigastric perforator (DIEP) flap to provide good skin coverage along with good contour to the scalp. The use of a super thin DIEP flap, dissected above the superficial fascial plane, is a newer technique in the realm of free tissue transfers that has shown improved outcomes in wound contour. Although the DIEP flap has been popularized for breast reconstruction, the authors believe that it has the ability to provide good soft tissue and skin coverage to other areas of the body, including in head and neck reconstruction.
Distraction Osteogenesis for Frontosphenoidal Craniosynostosis: a Novel Surgical Treatment Modality of a Rare Suture Fusion
Authors: Chen Joanna , French Mackenzie M. , Holdaway Matthew G. B. , Jolley Tessa M. , Bautista Catherine H. , Collar Yagas Lucia , Gociman Barbu
Published: June 2024

Frontosphenoidal craniosynostosis (FSC) is a rare premature fusion of the frontosphenoidal suture that results in anterior plagiocephaly. When associated with severe cranial deformity, surgical treatment is beneficial. All previously reported cases of FSC correction have utilized fronto-orbital remodeling and advancement to achieve improved anatomy and increased intracranial volume. For patients with isolated synostosis deformities, we believe that distraction osteogenesis can be a viable option, with the additional benefit of quicker operating time, shorter hospital stays, and less irregularity in final head contour. This case illustrates the feasibility of using distraction osteogenesis in the management of FSC.
Ocular manifestations of mpox
Authors: Nguyen Minh , Doan Thuy , Seitzman Gerami D.
Published: June 2024

Purpose of review

To highlight the clinical features of mpox with an emphasis on ocular manifestations and to review treatment options for this re-emerging infectious disease.

Recent findings

Ocular involvement of mpox varies by clade. The most recent 2022 outbreak appears to be associated with fewer conjunctivitis cases compared to previous outbreaks. However, the ocular findings occurring during this newly emerging clade can be visually threatening and include cases of keratitis, rapidly progressing scleritis, and necrotizing periorbital rashes.

Ocular mpox is an important clinical feature of systemic mpox virus (MPXV) infection. Heightened clinical suspicion allows for a timely diagnosis and the initiation of antiviral treatment, when appropriate. Randomized clinical trials for mpox systemic and ocular treatment efficacy are lacking. Prior clinical experience with smallpox and in-vitro mpox data support the use of systemic antivirals such as tecovirimat, cidofovir, brincidofovir and topical use of trifluridine in ocular mpox management, though tr

eatment-resistant infection can occur and portend a poor prognosis.
Clinical characteristics, survival analysis and influencing factors of distant metastasis in patients with acromelanomas: A retrospective study
Authors: Fang Yan , Yongqian Zhu , Yin Lu , Li Min , Mei Zhang , Jing Yang , Di Wu
Published: June 2024

The prognosis of acromelanomas (AM) is worse. The objective of this study was to investigate the clinical features of distant metastasis of AM and the factors affecting the survival and prognosis of patients. In this study, a retrospective study was conducted to select 154 AM patients admitted to Nanjing Pukou People’s Hospital from January 2018 to April 2021 for clinical research. The clinical characteristics of distant metastasis were statistically analyzed, and the survival curve was drawn with 5-year follow-up outcomes. The median survival time of the patients was calculated, and the clinicopathological features and peripheral blood laboratory indexes of the surviving and dead patients were analyzed. Logistic regression model was used to analyze the risk factors affecting the prognosis of AM patients. In this study, 154 patients with AM were treated, including 88 males and 76 females, aged from 27 to 79 years old, with an average age of (59.3 ± 11.7) years old. Among them, 90 cases had distant metastasis. The main metastatic sites were lung (47.78%) and lymph nodes (42.22%). Among them, single site metastasis accounted for 41.11% and multiple site metastasis 58.89%. 89 cases survived and 65 cases died. The survival time was 22 months to 60 months, and the median survival time was 48.0 months. The Breslow thickness, stage at diagnosis, distant metastasis, site of metastasis and ulceration were compared between the survival group and the death group (P < .05). serum lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR) and lymphocyte monocyte ratio (LMR) were compared between the survival group and the death group (P < .05). The results of Logistic regression model showed that LDH ≥ 281 U/L, NLR ≥ 2.96, LMR ≤ 3.57, newly diagnosed stage > stage II, distant metastasis, multiple site metastasis and tumor ulcer were independent risk factors for poor prognosis of AM patients (P < .05). Patients with AM had a higher proportion of distant metastasis, mainly lung and lymph node metastasis. Increased LDH, increased NLR, decreased LMR, higher initial stage, distant metastasis, multiple site metastasis, and combined tumor ulcer were closely related to the poor prognosis of patients after surgery.
Efficacy and safety of EGFR-TKIs for non-small cell lung cancer: A meta-analysis of randomized controlled clinical trials
Authors: Lai Xiaoming , Zeng Jinlin , Xiao Zhijun , Xiao Junlan
Published: June 2024

Background:

We conducted this meta-analysis based on updated literature and research to compare the efficacy and safety of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) as treatments for patients with non-small cell lung cancer (NSCLC).

Methods:

A literature search was conducted using PubMed, Embase, Medline and Web of Science databases to perform a systematic literature search based on random control trials. In these articles, EGFR-TKIs were compared with placebos, chemotherapy, or whole-brain irradiation as treatments for NSCLC. In this research, a meta-analysis of the literature was performed to produce a combined risk ratio (RR) with a 95% confidence interval (CI) for progression-free survival (PFS), overall survival (OS), and adverse events. The data were synthesized with Review Manager 5.3 software, which was used to manage the process.

Results:

There were 15 random control trials included in the study, involving 4249 patients in total. There was evidence that EGFR-TKIs can significantly prolong OS (RR: 0.87, 95% CI: 0.75–1) and PFS (RR: 0.75, 95% CI: 0.66–0.86) in NSCLC patients. There was an increase in the incidence of adverse events after treatment with EGFR-TKI, including diarrhea (RR: 0.18, 95% CI: 0.10–0.26), infection (RR: 0.09, 95% CI: 0.02–0.16), and rash (RR: 0.37, 95% CI: 0.22–0.51).

Conclusions:

It has been shown that EGFR-TKIs prolong OS and PFS in patients with NSCLC. NSCLC patients may benefit from EGFR-TKIs as an important treatment option in order to prolong their survival.
A comprehensive practical review of acupoint embedding as a semi-permanent acupuncture: A mini review
Authors: Kazemi Amir Hooman , Adel-Mehraban Mohammad Sadegh , Jamali Dastjerdi Moein , Alipour Reihane
Published: June 2024

Since ancient times, acupuncture has been utilized in the treatment of lots of diseases, as a part of Traditional Chinese Medicine. Acupoint embedding (AEM) therapy, known as catgut embedding, is a development of acupuncture that consists of inserting catgut or surgical threads into specific acupoints to produce continuous acupoint stimulation based on the theory of Traditional Chinese Medicine. The remaining thread in the acupoint works as a semi-permanent acupuncture needle that results in decreasing the total time of the treatment which is required for continuous manual acupuncture sessions and increasing the treatment efficacy and patients’ satisfaction. In each session of AEM about twenty 1 to 2 cm-long threads—natural origin, synthetic polymer, or bioactive threads—will be inserted at the target acupoints and this process will be repeated every 3 to 4 weeks. Indications of AEM are somehow similar to manual acupuncture including obesity, pain, musculoskeletal inflammations, infertility, etc, and it cannot be performed on pregnant women and pediatrics. AEM demonstrates its therapeutic effects via modulating immune system function, alleviating body inflammatory conditions, affecting the neurohormonal system, and other mechanisms. Subcutaneous indurations, redness, bleeding, hematoma, and bruising are some adverse events reported following the AEM. In conclusion, the scientific literature suggests that AEM is a relatively safe and convenient therapy if performed by a professional skilled practitioner.
Determination of cotinine and 3-hydroxynicotinine in human serum by liquid chromatography-tandem mass spectrometry and its application
Authors: Wang Da-Guang , Du Ke-He , Shao Li-Jun , Ma Shi-Qiao , Yang Xiao-Feng , Liu Tian-Yi , Liu Qian , Wang Meng , Liu Hong-Jun , Wu Yi-Qun
Published: June 2024

In this study, we developed a method for determining cotinine and 3-hydroxycotinine in human serum and established a methodology for an in-depth study of tobacco exposure and health. After the proteins in the human serum samples were precipitated with acetonitrile, they were separated on a ZORBAX SB-Phenyl column with a mobile phase of methanol encompassing 0.3% formic acid-water encompassing 0.15% formic acid. The measurement was performed on an API5500 triple quadrupole mass spectrometer in the multiple reaction monitoring mode. Cotinine, 3-hydroxycotinine, and cotinine-d3 isotope internal standards were held for 2.56 minutes, 1.58 minutes, and 2.56 minutes, respectively. In serum, the linear range was 0.05 to 500 ng·mL−1 for cotinine and 0.50 to 1250 ng·mL−1 for 3-hydroxycotinine. The lower limit of quantification (LLOQ) was 0.05 ng·mL−1 and 0.5 ng·mL−1 for cotinine and 3-hydroxycotinine, respectively. The intra-day and inter-day relative standard deviations were <11%, and the relative errors were within ± 7%. Moreover, the mean extraction recoveries of cotinine and 3-hydroxycotinine were 98.54% and 100.24%, respectively. This method is suitable for the rapid determination of cotinine and 3-hydroxycotinine in human serum because of its rapidity, sensitivity, strong specificity, and high reproducibility. The detection of cotinine levels in human serum allows for the identification of the cutoff value, providing a basis for differentiation between smoking and nonsmoking populations.
Preparing interns for clinical practice through an institution-wide simulation-based mastery learning program for teaching central venous catheter placement
Authors: Yee Jennifer , Holliday Scott , Spitzer Carleen R. , Essandoh Michael , Way David P. , Panchal Ashish R.
Published: June 2024

Central venous catheter (CVC) placement is a challenging procedure with known iatrogenic risks. However, there are no residency program requirements to demonstrate baseline CVC procedural competency. Competency-based procedural education has been shown to decrease CVC-associated morbidity, but there has been limited literature about institution-wide efforts to ensure initial trainee competency for CVC placement. This study describes the implementation of a competency-based CVC curriculum for first-year interns across an institution before supervised clinical care. An institution-wide, simulation-based mastery training curriculum was designed to assess initial competency in CVC placement in first-year residents during 2021 and 2022. A checklist was internally developed with a multidisciplinary team. Using the Mastery–Angoff technique, minimum passing standards were derived to define competency levels considered appropriate for intern participation in supervised clinical care. Interns were trained through the competency-based program with faculty assessing intern performance using the CVC checklist to verify procedural competency. Over 2 academic cycles, 229 interns from 20 specialties/subspecialties participated. Overall, 83% of interns met performance standards on their first posttest attempt, 14% on the second attempt, and 3% on the third attempt. Interns from both cycles demonstrated significant improvement from baseline to posttest scores (P < .001). Overall, 10.5% of interns performed dangerous actions during assessment (malpositioning, retained guidewire, or carotid dilation). All interns ultimately achieved the passing standard to demonstrate initial competency in the simulation assessment. All participating interns demonstrated simulation-based competency allowing them to place CVCs under supervised clinical care. Dangerous actions, however, were not uncommon. Simulation-based teaching and learning frameworks were a feasible method to promote patient safety through an institutional-wide verification of preliminary procedural competency.
Clinical application of intracavitary electrocardiogram localization combined with ultrasound in central venous catheterization in critically ill patients: An observational study
Authors: Pan Zhenfei , Zhu Jinqiang , Jiang Zhenzhen , Chen Lili
Published: June 2024

To explore the clinical application value of intracavitary electrocardiogram (ECG) localization combined with ultrasound in central venous catheterization in critically ill patients. A total of 103 patients who were treated in the intensive care unit of our hospital from October 2020 to June 2023 were selected as the study subjects, and according to the differences in their central venous catheter placement methods, they were divided into study group (n = 52, receiving ultrasound combined with intracavitary ECG localization for catheterization) and control group (n = 51, receiving routine catheterization). The differences in the catheter placement accuracy, catheter depth, catheter placement duration, incidence of catheter-related complications, length of stay, and hospitalization expenses between the 2 groups were compared. The analysis utilizing X-ray for catheter tip positioning indicated that the catheter tip placement rate was higher in the study group than in the control group, and the catheter tip malposition rate was lower than in the control group (P < .05). There was no statistical significance in the catheter depth between study group and control group (P > .05), and the catheter placement duration of study group was significantly lower than that of control group, with statistical significance (P < .05). One case of partial catheter blockage, one case of catheter-related bloodstream infection, and one case of phlebitis were observed in study group, with an overall incidence of complications of 5.77% (3/52), which was significantly lower than 21.57% (11/51) of control group (P < .05). The length of stay and hospitalization expenses in study group were significantly lower than those in control group, with statistical significance (P < .05). The combined use of ultrasound and intracavitary ECG localization in critically ill patients undergoing central venous catheterization can help increase the success rate of catheter placement, shorten the catheter placement duration, reduce the incidence of various catheter-related complications, and also reduce the length of stay and hospitalization expenses.
Placement of a drainage tube in the ileac lumen following laparoscopic appendectomy: A case report and literature review
Authors: Dong Wei , Qiu Meng , Ma Xuhui , Zhou Shunchang , Chen Hao , Chu Haibo , Zhong Yuxu
Published: June 2024

Rationale:

Ileal perforation caused by the insertion of a drainage tube is a rare complication. Hence, the utilization of surgical drains in abdominal surgery remains controversial. At present, there is a trend to reduce the utilization of drains in abdominal surgery, although certain situations may necessitate their application.

Patient concerns:

A 25-year-old Chinese woman presented with a history of right lower abdominal pain persisting for 10 days. Imaging examinations, including abdominal computed tomography and ultrasound, identified low-density lesions measuring 10 × 8 × 8cm3 in the right lower abdomen, which are consistent with perforated appendicitis complicated by a peri-appendiceal abscess. A laparoscopic appendectomy was carried out. On the 5th postoperative day, the drainage fluid changed to a grass-green color (80mL). Imaging with retrograde contrast through the drainage tube revealed that the 26 Fr silicon rubber drainage tube tip was positioned 50cm away from the ileocecal junction within the ileum. Both the ileal and ileocecal regions appeared well-developed.

Intervention and outcomes:

Oral intake was suspended, and the patient received antacids, somatostatin, antibiotics, and total parenteral nutrition. On the 19th postoperative day, a follow-up imaging procedure using retrograde contrast through the drainage tube indicated that the tube tip was sealed. The treatment concluded on day 33 postoperatively, and the patient was discharged.

Discussion and conclusion:

Ileal perforation due to an abdominal drainage tube following laparoscopic appendectomy constitutes a rare but serious complication. However, due to the adhesion and inflammatory changes around the abscess, laparoscopic dissection becomes a challenging and risky process, and the surgical skills and experiences are particularly important. Removing the abdominal drainage tube promptly based on the characteristics of the drainage fluid is recommended. The findings provide valuable insights for surgeons navigating similar challenges.
Study on the value of Inhibin B in the diagnosis of nasopharyngeal carcinoma and its correlation with traditional Chinese medicine syndromes: An observational study
Authors: Ma Nuoya , Deng Xin , Liu Qing , Xu Fei , Guo Qi , Yan Kun , Yang Yan , Zou Guoying
Published: June 2024

To investigate the expression of Inhibin B between various clinical stages, Chinese medicine dialectic typing, and in nasopharyngeal carcinoma (NPC) tissues and serum, and to evaluate the potential of Inhibin B as a new biomarker for NPC. Paraffin specimens of pathologically confirmed NPC tissues and paracancerous tissues were retrospectively collected, and the expression of Inhibin α (INHA) and Inhibin βB (INHBB) was detected by SP method, and their relationship with clinicopathological indexes was analyzed; in addition, patients with NPC who had received radiotherapy were included as the study subjects, and Epstein–Barr virus DNA (EBV-DNA), INHA, and INHBB in patients were detected by using the fluorescence quantitative polymerase chain reaction, enzyme-linked immunosorbent assay, and chemiluminescent immuno-sandwiching method, respectively. EBV-DNA, EBV-viral capsid antigen-immunoglobulin A (VCA IgA), INHA, and INHBB were detected in the patients, respectively, and their relationships with traditional Chinese medicine (TCM) patterns were also analyzed. The expression of INHA and INHBB in NPC tissues was lower than that in paracancerous tissues, and the expression of INHA in NPC patients was correlated with lymphatic metastasis, clinical staging, and TCM staging; the levels of EBV-DNA and VCA IgA were higher than that of healthy populations in NPC patients and were higher than that of patients with stage III + IV than that of patients with stage I + II, and the levels of INHA and INHBB were lower than those of healthy populations and were lower than those of patients with stage III + IV than that of patients with stage I + II. The levels of INHA and INHBB in nasopharyngeal cancer patients were lower than those in healthy people, and the levels in stage III + IV patients were lower than those in stage I + II patients. The levels of EBV-DNA and VCA IgA in nasopharyngeal cancer patients were correlated with the Chinese medicine patterns, and had different patterns. The expression of Inhibin B may be related to the progression of NPC, and it has certain typing significance for different TCM syndromes of NPC, which is helpful for TCM typing diagnosis.
Value of sonoelastography for diagnosis of breast non-mass lesions and comparison with BI-RADS: A systematic review and meta-analysis
Authors: Li Hong , Cong Peng , Yu Ya-Na , Zhang Yun-Fei
Published: June 2024

Background:

Not all the breast lesions were mass-like, some were non-mass-like at ultrasonography. In these lesions, conventional ultrasonography had a high sensitivity but a low specificity. Sonoelastography can evaluate tissue stiffness to differentiate malignant masses from benign ones. Then what about the non-mass lesions? The aim of this study was to evaluate the current accuracy of sonoelastography in the breast non-mass lesions and compare the results with those of the American College of Radiology breast Imaging-Reporting and Data System (BI-RADS).

Methods:

An independent literature search of English medical databases, including PubMed, Web of Science, Embase & MEDLINE (Embase.com) and Cochrane Library, was performed by 2 researchers. The accuracy of sonoelastography was calculated and compared with those of BI-RADS.

Results:

Fourteen relevant studies including 1058 breast non-mass lesions were included. Sonoelastography showed a pooled sensitivity of 0.74 (95% CI: 0.70–0.78), specificity of 0.89 (95% CI: 0.85–0.91), diagnostic odds ratio (DOR) of 25.22 (95% CI: 17.71–35.92), and an area under the curve of 0.9042. Eight articles included both sonoelastography and BI-RADS. The pooled sensitivity, specificity, DOR and AUC were 0.69 versus 0.91 (P < .01), 0.90 versus 0.68 (P < .01), 19.65 versus 29.34 (P > .05), and 0.8685 versus 0.9327 (P > .05), respectively.

Conclusions:

Sonoelastography has a higher specificity and a lower sensitivity for differential diagnosis between malignant and benign breast non-mass lesions compared with BI-RADS, although there were no differences in AUC between them.
Exploring the role of personal quantification in alleviating generalized anxiety disorder among Chinese PhD students: A cross-sectional study
Authors: Li Guilong , Su Qiulan
Published: June 2024

Personal quantification plays a crucial role in preserving individual mental health. However, in previous research, its effectiveness in alleviating generalized anxiety disorder (GAD) has not been conclusively established. This study explores the impact of personal quantification on GAD among PhD students. The research data was obtained through questionnaires distributed to 308 PhD students across universities in China. Among these students, 118 anxiety-free participants were excluded, yielding valuable data from 190 students with GADs. We employed Python programming language and SPSS software for the empirical analysis. The results illustrated that personal quantification significantly and negatively impacted GAD (β = −0.148, P = .002), concurrently producing a significantly positive effect on self-efficacy (β = 0.359, P < .001). Further analysis showed that through 5000 sampling iterations and a 95% confidence level, self-efficacy significantly reduced certain symptoms of GAD (β = −0.1183; P = .026; 95% Cl: −0.2222 to −0.0144). Moreover, when the coefficient of self-efficacy was significantly negative, the impact of personal quantification on GAD remained statistically significant (β = −0.1056; P = .033; 95% Cl: −0.2025 to −0.0087). The findings indicated that personal quantification has a significant role in alleviating GAD among PhD students, which is partly mediated through self-efficacy. This study contributes valuable insights to the nonpharmacological alleviation of GAD in Chinese PhD students.
Automatic diagnosis of pediatric supracondylar humerus fractures using radiomics-based machine learning
Authors: Yao Wuyi , Wang Yu , Zhao Xiaobin , He Man , Wang Qian , Liu Hanjie , Zhao Jingxin
Published: June 2024

The aim of this study was to construct a classification model for the automatic diagnosis of pediatric supracondylar humerus fractures using radiomics-based machine learning. We retrospectively collected elbow joint Radiographs of children aged 3 to 14 years and manually delineated regions of interest (ROI) using ITK-SNAP. Radiomics features were extracted using pyradiomics, a python-based feature extraction tool. T-tests and the least absolute shrinkage and selection operator (LASSO) algorithm were used to further select the most valuable radiomics features. A logistic regression (LR) model was trained, with an 8:2 split into training and testing sets, and 5-fold cross-validation was performed on the training set. The diagnostic performance of the model was evaluated using receiver operating characteristic curves (ROC) on the testing set. A total of 411 fracture samples and 190 normal samples were included. 1561 features were extracted from each ROI. After dimensionality reduction screening, 40 and 94 features with the most diagnostic value were selected for further classification modeling in anteroposterior and lateral elbow radiographs. The area under the curve (AUC) of anteroposterior and lateral elbow radiographs is 0.65 and 0.72. Radiomics can extract and select the most valuable features from a large number of image features. Supervised machine-learning models built using these features can be used for the diagnosis of pediatric supracondylar humerus fractures.
Payment perception in the emergency department: The mediating role of perceived quality of healthcare and patient satisfaction
Authors: Abidova Alina , Alcântara da Silva Pedro , Moreira Sérgio
Published: June 2024

The aim of this research is to identify the main factors associated with patients’ payment perception and the effects of these factors on payment perception. Patients admitted between January and December 2016 at an emergency department of a public hospital in Lisbon, Portugal, were included in this study, with a representative sample size of 382 patients. A 5% margin of error and a 95% confidence interval were used, and all the data were collected between May and November 2017. To test the mediation models, stepwise multiple linear regression analysis was used. The effect of doctors on payment perception through satisfaction and through perceived quality of healthcare (PQHC) is explained by 3% and 4% of the variation, respectively, with statistically significant results (P < .01). Moreover, the effect of privacy and meeting expectations on payment perception through PQHC is explained by 4% and 4% of the variation, with statistically significant results (P < .01). Doctors play a crucial role in understanding the patients’ payment perception (with direct and indirect effects). Mediators, in turn, strengthen this effect, in which the contribution of PQHC is more significant than that of satisfaction.