bluuebunny/crossref_metadata_2025 huggingface dataset:
Tyrannosaurus rex runs again: a theoretical analysis of the hypothesis that full-grown large theropods had a locomotory advantage to hunt in a shallow-water environment
Authors: Blanco R Ernesto
Published: May 2023

Biomechanical analyses suggest that adult large theropods, such as Tyrannosaurus rex, could not run, and its top speed probably was at most 10 m/s. This probably implied a speed disadvantage of adult T. rex compared with some smaller potential prey. Living predators at a disadvantage owing to speed or manoeuvrability sometimes use the environment or special techniques to minimize those differences. Here, I made a theoretical analysis of the possibility that adult large theropods, such as T. rex, could occasionally pursue prey in water to take advantage of their body size. There are arguments based on scaling laws to support this hypothesis. To give an example, I applied a biomechanical model to estimate the speed in a shallow-water environment of adult T. rex and two smaller dinosaurs, a juvenile Edmontosaurus annectens and Struthiomimus sedens. I conclude that by wading or swimming, the adult T. rex would have been faster than smaller prey in water. I also suggest that in water, adult large theropods, such as T. rex, were able to use a running gait that was probably precluded on land. Finally, I propose a near-shore hunting scenario for adult T. rex and other full-grown large theropods.
Deletion of MGF‐110‐9L gene from African swine fever virus weakens autophagic degradation of TBK1 as a mechanism for enhancing type I interferon production
Authors: Ren Jingjing , Li Dan , Zhu Guoqiang , Yang Wenping , Ru Yi , Feng Tao , Qin Xiaodong , Hao Rongzeng , Duan Xianghan , Liu Xiangtao , Zheng Haixue
Published: May 2023

African swine fever (ASF) caused by African swine fever virus (ASFV) is a devastating disease for the global pig industry and economic benefit. The limited knowledge on the pathogenesis and infection mechanisms of ASF restricts progress toward vaccine development and ASF control. Previously, we illustrated that deletion of the MGF‐110‐9L gene from highly virulent ASFV CN/GS/2018 strains (ASFV∆9L) results in attenuated virulence in swine, but the underlying mechanism remains unclear. In this study, we found that the difference in virulence between wild‐type ASFV (wt‐ASFV) and ASFV∆9L strains was mainly caused by the difference in TANK Binding Kinase 1 (TBK1) reduction. TBK1 reduction was further identified to be mediated by the autophagy pathway and this degradative process requires the up‐regulation of a positive autophagy regulation molecule‐ Phosphatidylinositol‐4‐Phosphate 3‐Kinase Catalytic Subunit Type 2 Beta (PIK3C2B). Moreover, TBK1 over‐expression was confirmed to inhibit ASFV replication in vitro. In summary, these results indicate that wt‐ASFV counteracts type I interferon (IFN) production by degrading TBK1, while ASFVΔ9L enhanced type I IFN production by weakening TBK1 reduction, clarifying the mechanism that ASFVΔ9L present the attenuated virulence in vitro.
Wound Care Nursing Education in the Acute Care Setting
Authors: Heerschap Corey , Wiesenfeld Samantha
Published: May 2023

OBJECTIVE

To assess the feasibility of a survey study exploring how nurses in acute care prefer to be educated, particularly regarding wound management in the acute care setting.

METHODS

This pilot study utilized a cross-sectional survey design that included both open-ended and close-ended questions. Participants (N = 47) completed the Index of Learning Styles Questionnaire and provided information regarding their educational preferences related to wound management through use of an online survey.

RESULTS

Participants described the importance of varying educational techniques by topic, ensuring an appropriate time of day for education, and preferring smaller educational sessions over time. Most participants preferred one-on-one bedside education, and the most commonly reported learning styles were active, sensing, visual, and a balanced approach to sequential and global learning. There were few correlations between learning styles and choice of education method, only one of which was expected.

CONCLUSIONS

It would be beneficial to conduct this study on a larger scale to confirm results, improve understanding of the correlations, and determine further potential correlations between study variables.
The Effect of Assessments on Student Motivation for Learning and Its Outcomes in Health Professions Education: A Review and Realist Synthesis
Authors: Kusurkar Rashmi A. , Orsini Cesar , Somra Sunia , Artino Anthony R. , Daelmans Hester E.M. , Schoonmade Linda J. , van der Vleuten Cees
Published: May 2023

Purpose

In health professions education (HPE), the effect of assessments on student motivation for learning and its consequences have been largely neglected. This is problematic because assessments can hamper motivation and psychological well-being. The research questions guiding this review were: How do assessments affect student motivation for learning in HPE? What outcomes does this lead to in which contexts?

Method

In October 2020, the authors searched PubMed, Embase, APA PsycInfo, ERIC, CINAHL, and Web of Science Core Collection for “assessments” AND “motivation” AND “health professions education/students.” Empirical papers or literature reviews investigating the effect of assessments on student motivation for learning in HPE using quantitative, qualitative, or mixed methods from January 1, 2010, to October 29, 2020, were included. The authors chose the realist synthesis method for data analysis to study the intended and unintended consequences of this complex topic. Assessments were identified as stimulating autonomous or controlled motivation using sensitizing concepts from self-determination theory and data on context–mechanism–outcome were extracted.

Results

Twenty-four of 15,291 articles were ultimately included. Assessments stimulating controlled motivation seemed to have negative outcomes. An example of an assessment that stimulates controlled motivation is one that focuses on factual knowledge (context), which encourages studying only for the assessment (mechanism) and results in surface learning (outcome). Assessments stimulating autonomous motivation seemed to have positive outcomes. An example of an assessment that stimulates autonomous motivation is one that is fun (context), which through active learning (mechanism) leads to higher effort and better connection with the material (outcome).

Conclusions

These findings indicate that students strategically learned what was expected to appear in assessments at the expense of what was needed in practice. Therefore, health professions educators should rethink their assessment philosophy and practices and introduce assessments that are relevant to professional practice and stimulate genuine interest in the content.
TLIF is Associated with Lower Rates of Adjacent Segment Disease and Complications Compared to ALIF
Authors: Tao Xu , Matur Abhijith V. , Khalid Syed , Onyewadume Louisa , Garner Rebecca , McGrath Kyle , Owen Bryce , Gibson Justin , Cass Daryn , Mejia Munne Juan C. , Vorster Phillip , Shukla Geet , Gupta Sahil , Wu Andrew , Childress Kelly , Palmisciano Paolo , Duah Henry O. , Motley Benjamin , Cheng Joseph , Adogwa Owoicho
Published: May 2023

Study Design.

Retrospective cohort.

Objective.

To compare the rate of adjacent segment disease (ASD) in patients undergoing anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF) for treatment of degenerative stenosis and spondylolisthesis.

Summary of Background Data.

ALIF and TLIF are frequently used to treat Lumbar stenosis and spondylolisthesis. While both approaches have distinct advantages, it is unclear whether there are any differences in rates of ASD and postoperative complications.

Methods.

A retrospective cohort study of patients who underwent index 1-3 levels ALIF or TLIF between 2010-2022, using the PearlDiver Mariner Database, an all-claims insurance database (120 million patients). Patients with a history of prior lumbar surgery and those undergoing surgery for cancer, trauma, or infection were excluded. Exact 1:1 matching was performed using demographic factors, medical comorbidities, and surgical factors found to be significantly associated with ASD in a linear regression model. The primary outcome was a new diagnosis of ASD within 36 months of index surgery and secondary outcomes were all-cause medical and surgical complications.

Results.

Exact 1:1 matching resulted in two equal groups of 106,451 patients undergoing TLIF and ALIF. The TLIF approach was associated with a lower risk of ASD (RR 0.58, 95% CI 0.56-0.59, P < 0.001), and all-cause medical complications (RR 0.94, 95% CI 0.91-0.98, P=0.002). All-cause surgical complications were not significantly different between both groups.

Conclusion.

After 1:1 exact matching to control for confounding variables, this study suggests that for patients with symptomatic degenerative stenosis and spondylolisthesis, a TLIF procedure (compared to ALIF) is associated with a decreased risk of developing ASD within 36 months of index surgery. Future prospective studies are needed to corroborate these findings.

Level of Evidence.

III
Interbody Cage Placement Without Plate Supplementation Adjacent to Plated Segments in Multilevel Anterior Cervical Decompression and Fusion
Authors: Odate Seiichi , Shikata Jitsuhiko
Published: May 2023

Study Design.

A retrospective cohort study.

Objective.

To evaluate the clinical efficacy and safety of hybrid anterior cervical fixation, focusing on stand-alone segments.

Summary of Background Data.

In the treatment of multilevel cervical stenosis, the number of segments fixed using a plate is limited by placing an interbody cage without plate supplementation at one end of the surgical segment to reduce long plate-related problems. However, the stand-alone segment may experience cage extrusion, subsidence, cervical alignment deterioration, and nonunion.

Methods.

Patients who underwent three-segment or four-segment fixation for cervical degenerative disease and completed one-year follow-up were included in this study. Patients were divided into two groups: a cranial group, with stand-alone segments located at the cranial end adjacent to plated segments, and a caudal group, with stand-alone segments located at the caudal end. Differences in radiographic outcomes between the groups were evaluated. Fusion was defined using dynamic radiographs or computed tomography. To identify factors associated with nonunion in stand-alone segments, multivariable logistic regression analyses were performed. To identify factors associated with cage subsidence, multiple regression analyses were performed.

Results.

A total of 116 patients (mean age, 59±11 y; 72% male; mean fixed segments, 3.7±0.5 segments) were included in this study. No case showed cage extrusion or plate dislodgement. In stand-alone segments, the fusion rate was significantly lower in the caudal group than in the cranial group (76% vs. 93%, P=0.019). Change in the cervical sagittal vertical axis was worse in the caudal group than in the cranial group (2.7±12.3 mm vs. −2.7±8.1 mm, P=0.006). One caudal group patient required additional surgery because of nonunion at the stand-alone segment. Multivariable logistic regression indicated factors associated with nonunion included the location of the stand-alone segment (caudal end: OR 4.67, 95% CI, 1.29–16.90), larger pre-disk space range of motion (OR 1.15, 95% CI, 1.04–1.27), and lower preoperative disk space height (OR 0.57, 95% CI, 0.37–0.87). Multiple regression analysis indicated that higher cage height and lower pre-disk space height were associated with cage subsidence.

Conclusion.

Hybrid anterior cervical fixation with stand-alone interbody cage placement adjacent to plated segments may avoid long plate-related problems. Our results suggest that the cranial end of the construct may be more suitable for the stand-alone segment than the caudal end.
Variations in the Number of Vertebrae, Prevalence of Lumbosacral Transitional Vertebra and Prevalence of Cervical Rib Among Surgical Patients With Adolescent Idiopathic Scoliosis
Authors: Chiu Chee Kidd , Chin Tian Fu , Chung Weng Hong , Chan Chris Yin Wei , Kwan Mun Keong
Published: May 2023

Study Design.

Retrospective Study.

Objective.

This study aims to investigate variation in the number of thoracic and lumbar vertebrae, the prevalence of lumbosacral transitional vertebra (LSTV) and the prevalence of cervical ribs among surgical patients with adolescent idiopathic scoliosis (AIS).

Summary of Background Data.

Due to variation in the number of thoracic or lumbar vertebrae, inaccurate identification of vertebral levels has been found to be a contributory factor to wrong-level surgery.

Methods.

This was a retrospective study on AIS patients who underwent posterior spinal fusion. Demographic and anthropometric data (age, gender, height, weight, and body mass index), radiographic data (Lenke curve type, pre-operative Cobb angle, vertebra numbering of cervical, thoracic, and lumbar spine, presence of LSTV based on the Castellvi classification and the presence of cervical ribs) and clinical data were collected. Data were analysed and reported with mean and standard deviation for quantitative parameters and number and percentage for qualitative parameters. Multinomial logistic regression analyses were performed to identify factors associated with the outcomes of interest.

Results.

A total of 998 patients met inclusion criteria, of which 135 (13.5%) were males and 863 (86.5%) were females. The vertebrae number varied between 23 to 25 total vertebrae with 24 vertebrae considered as the typical number of vertebrae. The prevalence of atypical number of vertebrae (23 or 25) was 9.8% (98 patients). We found a total of 7 different variations in number of cervical, thoracic, and lumbar vertebrae (7C11T5L, 7C12T4L, 7C11T6L, 7C12T5L, 7C13T4L, 7C12T6L, and 7C13T5L) with 7C12T5L considered as the typical vertebrae variation. The total prevalence of patients with atypical vertebrae variation was 15.5% (155 patients). Cervical ribs were found in 2 (0.2%) patients while LSTV were found in 250 (25.1%) of patients. The odds of 13 thoracic vertebrae were higher in males (OR 5.17; 95% CI: 1.25, 21.39) and the odds of 6 lumbar vertebrae were higher in LSTV (OR 3.93; 95% CI: 2.58, 6.00).

Conclusion

In this series, we identified a total of 7 different variations in the number of cervical, thoracic, and lumbar vertebrae. The total prevalence of patients with atypical vertebrae variation was 15.5%. LSTV was found in 25.1% of the cohort. It is important to ascertain atypical vertebrae variations rather than the absolute number of vertebrae because variants such as 7C11T6L and 7C13T4L may still have typical numbers of vertebrae in total. However, due to the differences in the number of morphologically thoracic and lumbar vetrebrae, there may still be a risk of inaccurate identification.
Forecasting ICU Census by Combining Time Series and Survival Models
Authors: Murray Lori L. , Wilson John G. , Rodrigues Felipe F. , Zaric Gregory S.
Published: May 2023

OBJECTIVES:

Capacity planning of ICUs is essential for effective management of health safety, quality of patient care, and the allocation of ICU resources. Whereas ICU length of stay (LOS) may be estimated using patient information such as severity of illness scoring systems, ICU census is impacted by both patient LOS and arrival patterns. We set out to develop and evaluate an ICU census forecasting algorithm using the Multiple Organ Dysfunction Score (MODS) and the Nine Equivalents of Nursing Manpower Use Score (NEMS) for capacity planning purposes.

DESIGN:

Retrospective observational study.

SETTING:

We developed the algorithm using data from the Medical-Surgical ICU (MSICU) at University Hospital, London, Canada and validated using data from the Critical Care Trauma Centre (CCTC) at Victoria Hospital, London, Canada.

PATIENTS:

Adult patient admissions (7,434) to the MSICU and (9,075) to the CCTC from 2015 to 2021.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We developed an Autoregressive integrated moving average time series model that forecasts patients arriving in the ICU and a survival model using MODS, NEMS, and other factors to estimate patient LOS. The models were combined to create an algorithm that forecasts ICU census for planning horizons ranging from 1 to 7 days. We evaluated the algorithm quality using several fit metrics. The root mean squared error ranged from 2.055 to 2.890 beds/d and the mean absolute percentage error from 9.4% to 13.2%. We show that this forecasting algorithm provides a better fit when compared with a moving average or a time series model that directly forecasts ICU census. Additionally, we evaluated the performance of the algorithm using data during the global COVID-19 pandemic and found that the error of the forecasts increased proportionally with the number of COVID-19 patients in the ICU.

CONCLUSIONS:

It is possible to develop accurate tools to forecast ICU census. This type of algorithm may be important to clinicians and managers when planning ICU capacity as well as staffing and surgical demand planning over a short time horizon.
Broadly neutralizing antibodies for HIV treatment and cure approaches
Authors: Frattari Giacomo Schmidt , Caskey Marina , Søgaard Ole Schmeltz
Published: May 2023

Purpose of review

In recent years, clinical trials have explored broadly neutralizing antibodies (bNAbs) as treatment and cure of HIV. Here, we summarize the current knowledge, review the latest clinical studies, and reflect on the potential role of bNAbs in future applications in HIV treatment and cure strategies.

Recent findings

In most individuals who switch from standard antiretroviral therapy to bNAb treatment, combinations of at least two bNAbs effectively suppress viremia. However, sensitivity of archived proviruses to bNAb neutralization and maintaining adequate bNAb plasma levels are key determinants of the therapeutic effect. Combinations of bNAbs with injectable small-molecule antiretrovirals are being developed as long-acting treatment regimens that may require as little as two annual administrations to maintain virological suppression. Further, interventions that combine bNAbs with immune modulators or therapeutic vaccines are under investigation as HIV curative strategies. Interestingly, administration of bNAbs during the early or viremic stage of infection appears to enhance host immune responses against HIV.

While accurately predicting archived resistant mutations has been a significant challenge for bNAb-based treatments, combinations of potent bNAbs against nonoverlapping epitopes may help overcome this issue. As a result, multiple long-acting HIV treatment and cure strategies involving bNAbs are now being investigated.
Growing pains: strategies for improving ergonomics in minimally invasive gynecologic surgery
Authors: Lin Emily , Young Riley , Shields Jessica , Smith Katherine , Chao Lisa
Published: May 2023

Purpose of review

To evaluate factors contributing to the development of work-related musculoskeletal disorders (WMSDs) and review strategies for mitigating ergonomic strain in minimally invasive gynecologic surgery.

Recent findings

Factors associated with increased ergonomic strain and the development of WMSDs include increasing patient body mass index (BMI), smaller surgeon hand size, noninclusive design of instruments and energy devices and improper positioning of surgical equipment. Each type of minimally invasive surgery (laparoscopic, robotic, vaginal) confers its own ergonomic risk to the surgeon. Recommendations have been published regarding optimal ergonomic surgeon and equipment positioning. Intraoperative breaks and stretching are effective in reducing surgeon discomfort. Formal training in ergonomics has not yet been widely implemented, but educational interventions have been effective in reducing surgeon discomfort and can improve surgeon recognition of suboptimal ergonomics.

Considering the serious downstream effects of WMSDs on surgeons, it is imperative to implement strategies for WMSD prevention. Optimal positioning of the surgeons and operative equipment should be routine. Intraoperative breaks and stretching should be incorporated during procedures and between every case. Formal education in ergonomics should be provided to surgeons and trainees. Additionally, more inclusive instrument design by industry partners should be prioritized.
Surgical management of endometriosis to optimize fertility
Authors: Hamilton Kacey M. , VanHise Katherine , Truong Mireille D. , Wright Kelly N. , Siedhoff Matthew T.
Published: May 2023

Purpose of review

Surgery is an integral element of treatment for infertility caused by endometriosis. This review summarizes the purported mechanisms of infertility in endometriosis, as well as the impacts of surgery for endometriosis on fertility, including pregnancy achieved spontaneously and with assisted reproductive technology (ART).

Recent findings

Endometriosis’ effect on fertility is multifactorial. The sequela of increased inflammation resulting from endometriosis causes alterations in ovarian, tubal, and uterine function. Removing or destroying these lesions reduces inflammation. Surgical treatment of both early-stage endometriosis and deeply infiltrating endometriosis improves spontaneous pregnancy rates and ART pregnancy rates. Conventional or robotic laparoscopy is the preferred surgical approach.

Endometriosis has detrimental effects on fertility, including negative impacts on oocyte, tubal, and endometrial function. Laparoscopic surgery for endometriosis elevates both spontaneous and ART pregnancy rates above those achieved with expectant management alone. The resection or destruction of endometriosis implants reduces inflammation, which likely improves the multifactorial infertility related to endometriosis. This topic is complex and controversial; more research in the form of high-quality randomized control trials is needed.
Gynecologic counseling for patients undergoing bariatric surgery: a scoping review
Authors: Cook Elizabeth , Fajardo Olga , Walden Rachel Lane , Harvey Lara
Published: May 2023

Purpose of review

Obesity is associated with several gynecologic conditions. While bariatric surgery is regarded as the most effective treatment option for obesity, gynecologic counseling for patients planning bariatric surgery is limited and often focused on fertility. The goal of this scoping review is to investigate the current recommendations for gynecologic counseling prior to bariatric surgery.

Recent findings

A comprehensive search was conducted to find peer reviewed studies written in English discussing a gynecologic issue of patients who were planning or previously had bariatric surgery. All the included studies identified a gap in preoperative gynecologic counseling. The majority of the articles made specific recommendations for a multidisciplinary approach to preoperative gynecologic counseling with a call to involve gynecologists or primary care providers.

Patients deserve to receive appropriate counseling about how obesity and bariatric surgery impact their overall gynecologic health. We advocate that the scope of gynecologic counseling includes more than pregnancy and contraception counseling. We propose a gynecologic counseling checklist for female patients undergoing bariatric surgery. Offering patients a referral to a gynecologist from the patient's first entry to a bariatric clinic is imperative to facilitate appropriate counseling.
New treatment options for nonsurgical management of uterine fibroids
Authors: Lee SiWon , Stewart Elizabeth A.
Published: May 2023

Purpose of review

Uterine fibroids is a common problem in reproductive-age individuals, frequently causing abnormal uterine bleeding, bulk symptoms, and adverse reproductive outcomes. Traditionally, almost half of the women with symptomatic fibroids received surgery for definitive treatment. There are a growing number of nonsurgical options for treatment that have become available for patients who desire conservative treatment or those with contraindications to surgery.

Recent findings

The introduction of oral gonadotropin-releasing hormone antagonists in combination with low-dose physiologic hormonal therapy demonstrated improvement in heavy menstrual bleeding, pain, and quality of life with preservation of bone density and a modest reduction in uterine volume with few hypogonadal side effects. Magnetic resonance-guided focused ultrasound surgery and uterine artery embolization continue to be minimally invasive procedural alternatives to hysterectomy that are safe and effective.

As more options for conservative management of uterine fibroids became available, it is important to counsel patients on possible options based on the size, location, and number of the fibroids as well as severity of the symptoms, plans for pregnancy, how close they are to menopause and their treatment goals.
Mental stress affects the occurrence and development of psoriasis through neuroendocrine-immune regulation: a narrative review
Authors: Li Fei , Zhang Yin-Lian , Chen Xi , Zhang Jing-Yu , Fu Li , Chai Bao , Chen Hong-Xiang
Published: May 2023

Psoriasis is a systemic immune-mediated inflammatory disease that presents at any age and is characterized by excessive proliferation and abnormal differentiation of keratinocytes as well as infiltration of multiple inflammatory cells. It has been gradually attracting more attention because of not only the increased risk of cardiovascular, metabolic, and autoimmune-related diseases but also the accompanying depression, anxiety, self-affirmation impairments, dementia, sleep disorders, and other mental disorders that place a substantial psychosocial burden on society and individuals. Mental and psychological disorders are involved in the occurrence, development, outcome, recurrence, and treatment of psoriasis through the neuroendocrine-immune signaling network. This review summarizes the pathogenesis of psychological and psychological disorders in patients with psoriasis with the aim of deepening clinicians’ awareness of the mental and psychiatric comorbidities in patients with psoriasis.
Massive Transfusion Protocol Adherence: Relationship to Trauma Patient Outcomes
Authors: Margolin Alexander M. , Silva Susan G. , McLaughlin Kasey E. T. , Pereira Katherine C. , Flowe Adam M. , Poisson Jessica L.
Published: May 2023

BACKGROUND:

Ongoing evaluation of massive transfusion protocol adherence is critical to ensure better trauma patient outcomes.

OBJECTIVE:

This quality improvement initiative aimed to determine provider adherence to a recently revised massive transfusion protocol and its relationship to clinical outcomes among trauma patients requiring massive transfusion.

METHODS:

A retrospective, descriptive, correlational design was used to determine the association between provider adherence to a recently revised massive transfusion protocol and clinical outcomes in trauma patients with hemorrhage treated at a Level I trauma center from November 2018 to October 2020. Patient characteristics, provider massive transfusion protocol adherence, and patient outcomes were assessed. Patient characteristics and massive transfusion protocol adherence associations with 24-hr survival and survival to discharge were determined using bivariate statistical methods.

RESULTS:

A total of 95 trauma patients with massive transfusion protocol activation were evaluated. Of the 95, 71 (75%) survived the initial 24 hr following massive transfusion protocol activation and 65 (68%) survived to discharge. Based on protocol applicable items, the median massive transfusion protocol overall adherence rate per patient was 75% (IQR = 57.1–85.7) for the 65 survivors and 25% (IQR = 12.5–50.0) for the 21 nonsurvivors to discharge whose death occurred at least 1 hr after massive transfusion protocol activation (p < .001).

CONCLUSION:

Findings indicate the importance of ongoing evaluations of adherence to massive transfusion protocols in hospital trauma settings to target areas for improvement.
Do statins enhance the antitumor effect of trastuzumab emtansine (T-DM1)?: Real-life cohort
Authors: Akyildiz Arif , Guven Deniz Can , Yildirim Hasan Cagri , Ismayilov Rashad , Yilmaz Feride , Tatar Omer Denizhan , Chalabiyev Elvin , Kus Fatih , Yalcin Suayib , Aksoy Sercan
Published: May 2023

Human epidermal growth factor receptor 2 (HER2)-targeting therapies have become crucial in the management of HER2-positive breast cancer. Trastuzumab emtansine (T-DM1) is a microtubule inhibitor and HER2-targeted antibody conjugate. T-DM1 resistance is most likely influenced by factors involved in the biological mechanisms of T-DM1 action. This study aimed to examine the efficacy of statins, which influence HER-2-based therapies via the caveolin-1 (CAV-1) protein, in female breast cancer patients receiving T-DM1. Our study included 105 patients with HER2-positive metastatic breast cancer treated with T-DM1. The progression-free survival (PFS) and overall survival (OS) of patients who received statins concurrently with T-DM1 versus those who did not were compared. During the median 39.5 (95% confidence interval [CI]: 35.6–43.5) months of follow-up, 16 (15.2%) patients received statins, and 89 (84.8%) patients did not. Median OS was significantly higher in patients using statins than in patients not using statins (58.8 vs 26.5 months, P = .016). The association between statin use and PFS did not reach statistical significance (34.7 vs 9.9 months, P = .159). Multivariate Cox regression analysis showed that better performance status (hormone receptor [HR]: 0.30, 95% CI: 0.13–0.71, P = .006), use of trastuzumab plus pertuzumab prior to T-DM1 (HR: 0.37, 95% CI: 0.18–0.76, P = .007) and use of statins with T-DM1 (HR: 0.29, 95% CI: 0.12–0.70, P = .006) were independent factors that prolong OS duration. Our study showed that T-DM1 is more effective at treating HER2-positive breast cancer in people who receive statins concurrently with T-DM1 than those who do not.
Effectiveness of home-based conventional exercise and cryotherapy on daily living activities in patients with knee osteoarthritis: A randomized controlled clinical trial
Authors: MohammedSadiq Hawar Abdulrazaq , Rasool Mohammad Tahir
Published: May 2023

Background:

Knee osteoarthritis (KOA) is a prevalent joint condition associated with aging that causes pain, disability, loss of function, and a decline in quality of life. This study aimed to evaluate the effectiveness of home-based conventional exercise and cryotherapy on daily living activities in patients with KOA.

Methods:

In this randomized controlled clinical trial, the patients who were diagnosed with KOA were assigned to 3 groups: an experimental group (n = 18), the control group 1 (n = 16), and the control group 2 (n = 15). Control and experimental groups engaged in a 2-month home-based exercise (HBE) program. The experimental group received cryotherapy along with HBE. In contrast, the patients in the second control group received regular therapeutic and physiotherapeutic services at the center. The patients were recruited from the Specialized Center for Rheumatic and Medical Rehabilitation in Duhok, Iraq.

Results:

The patients in the experimental group had statistically significant better daily activity functions compared to the first and second control groups in pain (2.22 vs 4.81 and 12.7; P < .0001), stiffness (0.39 vs 1.56 and 4.33; P < .0001), physical function (5.72 vs 13.31 and 38.13; P < .0001), and the total score (8.33 vs 19.69 and 55.33; P < .0001) at 2 months. The patients in the experimental and the first control groups had statistically significantly lower balance scores compared to the second control group at 2 months, 8.56 versus 9.30. At 3 months, similar patterns were observed for the daily activity function and balance.

Conclusions:

This study showed that combining HBE and cryotherapy may be an effective technique to improve function among patients with KOA. Cryotherapy could be suggested as a complementary therapy for KOA patients.
Popliteal sciatic nerve block for high-risk patients undergoing lower limb angioplasty: A prospective double-blinded randomized controlled trial
Authors: Noikham Alif , Tivirach Wannapa , Pongraweewan Orawan , Suphathamwit Aphichat , Puangpunngam Nattawut , Jirativanont Tachawan
Published: May 2023

Background:

To assess the rate of conversion to general anesthesia, sedative and analgesic drug-sparing effects, and complications of popliteal sciatic nerve block (PSNB) compared with a sham block during lower limb angioplasty.

Methods:

A randomized, controlled, double-blinded trial of patients with chronic limb-threatening ischemia (CLTI) who receive PSNB with 0.25% levobupivacaine 20 mL compared with a sham block (control) during lower limb angioplasty. Pain scores, conversion rate to general anesthesia, amount of sedoanalgesia drug usage, complications, and satisfaction with the anesthesia technique by surgeons and patients were assessed.

Results:

Forty patients were enrolled in this study. Two of 20 (10%) control group patients were converted to general anesthesia, while none of the patients in the intervention group required general anesthesia (P = .487). Pain scores before PSNB did not differ between the groups (P = .771). After the block, pain scores in the block group were lower than those in the control group: 0 (0, 1.5) (median, interquartile range) and 2.5 (0.5, 3.5), respectively (P = .024). The analgesic effect persisted until immediately after the surgery (P = .035). There was no difference in pain scores at the 24-hours follow-up visit (P = .270). The total propofol and fentanyl dosage requirements, a number of patients who required propofol and fentanyl, side effects, and satisfaction were not different between the groups. No major complications were noted.

Conclusions:

PSNB provided effective pain relief during and immediately after lower limb angioplasty, but did not statistically affect the rate of conversion to general anesthesia, sedoanalgesia drug usage, or complications.
Secukinumab for the treatment of generalized pustular psoriasis: A case report
Authors: Li Jiayan , Gao Xue , Ma Lili , Fang Yimiao
Published: May 2023

Introduction:

Generalized pustular psoriasis (GPP) is a rare subtype of psoriasis that manifests as a generalized pustular eruption.

Patient concerns:

A 31-year-old female was admitted to the hospital in June 2021 with a widespread erythematous, itchy, and scaly rash for a week. The patient has a 10-year history of psoriasis vulgaris.

Diagnosis:

GPP complicated by a late-stage viral infection and early-stage renal damage.

Interventions:

Weekly subcutaneous injections of 300 mg of secukinumab for a month, followed by monthly (every 4 weeks) injections of 300 mg of secukinumab for 20 weeks.

Outcomes:

The symptoms of pustules and erythema were reduced, and the patient reported pain relief soon after the first injection. The patient had no serious adverse reactions during treatment and follow-up.

Conclusions:

Secukinumab might be an optional treatment strategy for GPP.
How to reduce the risk of cervicalgia and low back pain in obese individuals: A mendelian randomization study
Authors: Gou Li , Zheng Qiang
Published: May 2023

Obesity is associated with cervicalgia and low back pain (LBP), but the specific role and how to reduce the risk of neck pain and low back pain are not clear. The Mendelian randomization analysis was used to investigate the causal relationship between obesity and cervicalgia and LBP, as well as the effect of possible mediating factors. Then, causal associations were estimated using sensitivity analysis. Educational level (odds ratio (OR) = 0.30, 0.23) was negatively associated with cervicalgia and LBP; Heavy physical work (HPW) (OR = 3.24, 2.18), major depression (MD) (OR = 1.47, 1.32), body mass index (BMI) (OR = 1.36, 1.32), and waist circumference (WC) (OR = 1.32, 1.35) were positively associated with cervicalgia and LBP; Leisure sedentary behavior (LSB) (OR = 1.96), smoking (OR = 1.32), and alcohol intake frequency (OR = 1.34) were positively associated only with LBP, but not with cervicalgia. Ranked by mediated proportions of selected mediators, the largest causal mediator from BMI and WC to cervicalgia was educational level (38.20%, 38.20%), followed by HPW (22.90%, 24.70%), and MD (9.20%, 17.90%); However, the largest causal mediator from BMI and WC to LBP was LSB (55.10%, 50.10%), followed by educational level (46.40%, 40.20%), HPW (28.30%, 20.90%), smoking initiation (26.60%, 32.30%), alcohol intake frequency (20.40%, 6.90%), and MD (10.00%, 11.40%). For obese individuals, avoiding HPW and maintaining a stable mood may be an effective approach to prevent cervicalgia; Additionally, reducing LSB, avoiding HPW, quitting smoking and drinking, and maintaining a stable mood may be an effective approach to prevent LBP.
Inflammatory bowel disease and cannabis: key counseling strategies
Authors: Saidman Jakob , Rubin Samantha , Swaminath Arun
Published: May 2023

Purpose of review

Cannabis use is becoming more frequent in patients with inflammatory bowel disease (IBD). Because of the increased usage, gastroenterologists need to be cognizant of the benefits and risks associated with cannabis use in the IBD-patient population.

Recent findings

Recent studies have attempted to determine whether cannabis can improve biomarkers or endoscopic findings of inflammation in patients with IBD, but the results have been inconclusive. However, cannabis has been shown to have an impact on the symptoms and quality of life of individuals with IBD. Despite these benefits, the use of cannabis in IBD is not without risks, including the potential for systemic illness, toxin ingestion and significant drug interactions.

In this review article, we use a case-based approach to discuss the critical clinical data that informs us of the benefits and risks of cannabis use in IBD. The endocannabinoid system plays a crucial role in regulating various physiological functions including the gastrointestinal tract. Studies have investigated the impact of cannabis on various medical conditions, including IBD. Clinicians must be aware of the most recent data to properly educate their patients on the benefits and risks of its use.
Management of osteosarcoma of the head and neck
Authors: Sharin Florida , Pai Ameya , Mair Manish
Published: May 2023

Purpose of review

There is no clear consensus guideline that specifies the optimum course of treatment for adult head and neck osteosarcoma (HNO) because of its rarity. The review's goal is to examine the most recent research on the presentation, diagnosis, prognosis, and therapy of head and neck osteosarcoma.

Recent findings

Due to overlapping symptoms with various benign disorders of the lower jaw and midface bone, these patients present with a noticeable delay. The greatest results for these malignancies can be achieved with surgery with sufficient margins. However, it may not be able to achieve sufficient margins in tumours of the midface and skull base, and the significance of adjuvant radiation/chemotherapy needs to be investigated. The use of adjuvant radiation in instances with an advanced stage, poor prognostic indicators, and inadequate resection is supported by evidence. Nonetheless, there are divergent opinions regarding the advantages of chemotherapy in adjuvant and neoadjuvant conditions, and further multicentric randomized control trials are required to provide robust evidence.

Multimodality treatments seem to yield better results for advanced HNO with adverse features and incomplete resections.
The role of primary retroperitoneal lymph node dissection in the treatment of stage II seminoma
Authors: Sigg Silvan , Fankhauser Christian Daniel
Published: May 2023

Purpose of review

Stage II seminoma is responsive to chemo- or radiotherapy with a progression-free survival of 87–95% at 5 years but at the cost of short- and long-term toxicity. After evidence about these long-term morbidities emerged, four surgical cohorts investigating the role of retroperitoneal lymph node dissection (RPLND) as a treatment option for stage II disease were initiated.

Recent findings

Currently, two RPLND series have been published as a complete report, while data from other series have only been published as congress abstracts. In series without adjuvant chemotherapy, recurrence rates ranged from 13% to 30% after follow-ups of 21–32 months. In those receiving RPLND and adjuvant chemotherapy, the recurrence rate was 6% after a mean follow-up of 51 months. Across all trials, recurrent disease was treated with systemic chemotherapy (22/25), surgery (2/25), and radiotherapy (1/25). The rate of pN0 disease after RPLND varied between 4% and 19%. Postoperative complications were reported in 2–12%, while antegrade ejaculation was maintained in 88–95% of patients. Median length of stay ranged from 1 to 6 days.

In men with clinical stage II seminoma, RPLND is a safe and promising treatment option. Further research is needed to determine the risk of relapse and to personalize treatment options based on patient-specific risk factors.
An Atypical Presentation of Hodgkin Lymphoma Invading the Myocardium
Authors: Kligfeld Heather , Wynn Shannon M. , Hermanson Kristen , Ma Tehui Marsha , Suh Eugene , Hemenway Charles S.
Published: May 2023

Pericardial involvement by Hodgkin lymphoma has been found in up to 20% of children at presentation, but disease of the myocardium itself is rare. We describe an 18-year-old male with HL who presented with a large mediastinal mass, pericardial effusion, and tumor invasion of both atrial walls with intra-atrial extension. A PubMed search of publications between 1989 and 2022 was conducted and additional older references were identified among these publications. While pericardial disease is described in numerous case series, myocardial involvement by HL, diagnosed clinically rather than at autopsy, is distinctly unusual.
Prevalence and Outcomes of Carbapenem-resistant Bloodstream Infection in Children With Cancer
Authors: Nirmal Garima , Jithin TK , Gopakumar KG , Parthiban Rudrapathy , Nair Chandran
Published: May 2023

Introduction:

Carbapenem-resistant (CR) infections cause major morbidity and mortality. Data on CR infections in children with cancer are scarce, especially from the developing world. The aim of this study was to evaluate the characteristics and outcomes of bacteremia with CR organisms (CRO) compared with bacteremia with Carbapenem-sensitive organisms in children with cancer.

Methods:

This retrospective observational study was conducted in a tertiary pediatric oncology center in South India. Data on all bloodstream infections with Gram-negative organisms (CRO and Carbapenem sensitive-organisms) in children with malignancy ≤14 years of age from August 2017 to July 2021 were retrieved. The outcome was determined as survival and all-cause death 28 days after the date of Bloodstream infection (BSI) onset.

Results:

Sixty-four Gram-negative BSI were identified, with 24% (n=15) in the Carbapenem-Resistant Bloodstream Infection (CR-BSI) group and 76% (n=49) in the Carbapenem-sensitive-Bloodstream Infection group. The patients included 35 males (64%) and 20 females (36%), with ages ranging from 1 year to 14 years (median age: 6.2 y). The most common underlying disease was hematologic malignancy (92.2%, n=59). Children with CR-BSI had a higher incidence of prolonged neutropenia, septic shock, pneumoniae, enterocolitis, altered consciousness, and acute renal failure and were associated with 28-day mortality in univariate analysis. The most common carbapenem-resistant Gram-negative bacilli isolates were Klebsiella species (47%) and Escherichia coli (33%). All carbapenem-resistant isolates were sensitive to colistin, and 33% were sensitive to Tigecycline. The case-fatality rate was 14% (9/64) in our cohort. The overall 28 days mortality was significantly higher in patients with CR-BSI than in those with Carbapenem-sensitive Bloodstream Infection (28-day mortality: 43.8% vs. 4.2%, P=0.001).

Conclusions:

Bacteremia with CRO has higher mortality in children with cancer. Prolonged neutropenia, pneumoniae, septic shock, enterocolitis, acute renal failure, and altered consciousness were predictors of 28-day mortality in carbapenem-resistant septicemia.
Evaluation of the prognostic value of negative to positive lymph node ratio in gastric cancer: results from multi-institutional cohorts from western and eastern datasets – Cohort study
Authors: Wang Xinyu , Wang Pengliang , Wang Wei , Sun Zhe , Wang Zhenning , Zhang Rupeng , Xu Huimian , Zhou Zhiwei , Liang Han , Deng Jingyu
Published: May 2023

Introduction:

Lymph node (LN) stage is important for prognosis evaluation of gastric cancer (GC) patients. This study aimed to evaluate the prognostic value of the ratio of negative to positive LNs (Rnp) in GC.

Methods:

The authors evaluated the clinical significance of the Rnp stage in 7660 GC patients from three high-volume institutions in China. Meanwhile, the authors verified the value of the Rnp stage in 11 234 GC patients from the Surveillance, Epidemiology, and End Results (SEER) database.

Results:

The patients were stratified into different subgroups based on the N stage of the eighth edition of the TNM staging system, the ratio of positive to detected LNs (Rpd) and Rnp. The survival analysis showed clear differences between the three LN stages in both the China and Surveillance, Epidemiology, and End Results cohorts. In univariate and multivariate analyses, the Rnp stage provided smaller Akaike information criterion or Bayesian information criterion values and a larger likelihood ratio χ2 than the N or Rpd stages in both two cohorts. For patients with inadequate examined LNs (<16), the Rnp stage showed better prognostic evaluation performance than the other two stages. In addition, the 5-year disease-specific survival of GC patients showed a slight variation with increasing LNs in the same subgroup classified by the Rnp or Rpd stages compared to the N stage.

Conclusions:

Along with the higher prognostic value, the Rnp stage has excellent universality with GC patients compared to the N or Rpd stages. Studies with larger sample sizes are needed to predict the prognosis and provide more precise treatment for GC patients.
Implementing Home-Based Clinical Research for Caregivers and Persons with Stroke
Authors: Blanton Sarah , Dunbar Sandra , Caston Sarah , McLaughlin Theresa , Stewart Heather , Clark Patricia C.
Published: May 2023

Conducting research in the home environment presents challenges related to setting, study participants, methods, and researchers. Researchers should be aware of potential challenges to ensure rigor and improve planning for future studies. This paper describes difficulties experienced and lessons learned when conducting a two-group, randomized pilot study (n = 32) of a web-based intervention (Carepartner and Constraint-Induced Therapy [CARE-CITE]) designed to foster positive carepartner engagement in home-based activities to improve upper extremity function in persons with stroke. Challenges and issues included: 1) recruitment and referral, 2) data collection in the home setting, 3) participants' understanding of the rationale for adhering to constraint-induced movement therapy principles (wearing mitt on the less-affected limb), 4) tracking adherence of upper extremity practice time, 5) participant-driven goal setting, 6) potentially unsafe participant practice activities, 7) home visit safety, 8) encouraging versus controlling—using autonomy support, 9) participant needs beyond study scope, and 10) ethical safeguards for addressing depressive symptoms. Researchers can incorporate suggested strategies to support methodological rigor and facilitate interventions engaging carepartners in the rehabilitation process when planning for research in the home environment.