bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient-Reported Outcomes Following Anterior and Posterior Surgical Approaches for Multilevel Cervical Myelopathy
Authors: Lambrechts Mark J. , Brush Parker L. , Lee Yunsoo , Issa Tariq Z. , Lawall Charles L. , Syal Amit , Wang Jasmine , Mangan John J. , Kaye Ian David , Canseco Jose A. , Hilibrand Alan S. , Vaccaro Alexander R. , Kepler Christopher K. , Schroeder Gregory D.
Published: January 2023

Study Design.

Retrospective cohort.

Objective.

To compare health-related quality of life (HRQoL) outcomes between approach techniques for the treatment of multilevel degenerative cervical myelopathy (DCM).

Summary of Background Data.

Both anterior and posterior approaches for the surgical treatment of cervical myelopathy are successful techniques in the treatment of myelopathy. However, the optimal treatment has yet to be determined, especially for multilevel disease, as the different approaches have separate complication profiles and potentially different impacts on HRQoL metrics.

Materials and Methods.

Retrospective review of a prospectively managed single institution database of patient-reported outcome measures after 3 and 4-level anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) for DCM. The electronic medical record was reviewed for patient baseline characteristics and surgical outcomes whereas preoperative radiographs were analyzed for baseline cervical lordosis and sagittal balance. Bivariate and multivariate statistical analyses were performed to compare the two groups.

Results.

We identified 153 patients treated by ACDF and 43 patients treated by PCDF. Patients in the ACDF cohort were younger (60.1 ± 9.8 vs. 65.8 ± 6.9 yr; P < 0.001), had a lower overall comorbidity burden (Charlson Comorbidity Index: 2.25 ± 1.61 vs. 3.07 ± 1.64; P = 0.002), and were more likely to have a 3-level fusion (79.7% vs. 30.2%; P < 0.001), myeloradiculopathy (42.5% vs. 23.3%; P = 0.034), and cervical kyphosis (25.7% vs. 7.69%; P = 0.027). Patients undergoing an ACDF had significantly more improvement in their neck disability index after surgery (−14.28 vs. −3.02; P = 0.001), and this relationship was maintained on multivariate analysis with PCDF being independently associated with a worse neck disability index (+8.83; P = 0.025). Patients undergoing an ACDF also experienced more improvement in visual analog score neck pain after surgery (−2.94 vs. −1.47; P = 0.025) by bivariate analysis.

Conclusions.

Our data suggest that patients undergoing an ACDF or PCDF for multilevel DCM have similar outcomes after surgery.
Incidence of surgical site infection following lateral lumbar interbody fusion compared with posterior/transforminal lumbar interbody fusion: A propensity score-weighted study
Authors: Masuda Soichiro , Fukasawa Toshiki , Takeuchi Masato , Fujibayashi Shunsuke , Otsuki Bungo , Murata Koichi , Shimizu Takayoshi , Matsuda Shuichi , Kawakami Koji
Published: January 2023

Study Design.

Retrospective cohort study.

Objective.

The objective of this study was to compare the incidence of surgical site infection (SSI) after lateral lumbar interbody fusion (LLIF) and posterior/transforaminal lumbar interbody fusion (P/TLIF).

Summary of Background Data.

Previous studies have shown that LLIF can improve neurological symptoms to a comparable degree to P/TLIF. However, data on the risk of SSI after LLIF is lacking compared with P/TLIF.

Methods.

The study was conducted under a retrospective cohort design in patients undergoing LLIF or P/TLIF for lumbar degenerative diseases between 2013-2020 using a hospital administrative database. We used propensity score overlap weighting to adjust for confounding factors including age, sex, body mass index, comorbidities, number of fusion levels, hospital size, and surgery year. We estimated weighted odds ratios (ORs) and 95% confidence intervals (CIs) for SSI within 30 days postoperatively.

Results.

27,119 patients (2,874 in the LLIF group and 24,245 in the P/TLIF group) were included in this study. Compared with P/TLIF, LLIF was associated with a significantly lower risk of SSI (0.7% vs. 1.2%; weighted OR, 0.57; 95% CI, 0.36–0.92; P=0.02).

Conclusions.

In this large retrospective cohort study of adults undergoing lumbar interbody fusion, LLIF was associated with a significantly lower risk of SSI than P/TLIF. The small, but significantly, decreased risk of SSI associated with LLIF may inform decisions regarding the technical approach for lumbar interbody fusion.

We compared the risk of SSI between 2,874 patients who underwent LLIF and 24,245 patients who received P/TLIF

Patients who had received LLIF were significantly less risk of experiencing an SSI compared with those receiving P/TLIF (0.7% vs. 1.2%; weighted OR, 0.57; 95% CI, 0.36–0.92; P=0.02).

As a secondary outcome, patients who had received LLIF had less risk of transfusion (7.8% vs. 11.8%; weighted OR, 0.63; 95% CI, 0.54–0.73; P<0.001).
Clinical Nurses' Identification of a Wearable Universal Serial Bus Used for Pediatric Oncology Clinical Trial Participant Safety Management
Authors: Johnson Elizabeth A. , Rainbow Jessica G. , Carrington Jane M.
Published: January 2023

The expanded access to clinical trials has provided more patients the opportunity to participate in novel therapeutics research. There is an increased likelihood of a patient, as a pediatric oncology clinical trial participant, to present for clinical care outside the research site, such as at an emergency room or urgent care center. A novel wearable universal serial bus device is a proposed technology to bridge potential communication gaps, pertaining to critical information such as side effects and permitted therapies, between research teams and clinical teams where investigational agents may be contraindicated to standard treatments. Fifty-five emergency and urgent care nurses across the United States were presented, via online survey without priming to the context of clinical trials or the device, a picture of a pediatric patient wearing the novel wearable device prompted to identify significant, environmental cues important for patient care. Of the 40 nurses observing the patient photo, three identified the wearable device within Situational Awareness Global Assessment Tool formatted narrative response fields. Analysis of the narrative nurse-participant responses of significant clinical findings upon initial assessment of the pediatric patient photo is described, as well as the implications for subsequent prototyping of the novel universal serial bus prototype.
Cyanotic Congenital Heart Disease in Pregnancy: A Review of Pathophysiology and Management
Authors: Koziol Klaudia J. , Isath Ameesh , Aronow Wilbert S. , Frishman William , Ranjan Pragya
Published: January 2023

The advancement of medical treatment and surgical technique, along with the invention of cardiopulmonary bypass, has allowed for long-term survival of patients with cyanotic congenital heart disease (CHD)—with many women with CHD now reaching child-bearing age and wishing to become pregnant. Pregnancy in these women is a major concern as the physiologic adaptations of pregnancy, including an increased circulating volume, increased cardiac output, reduced systemic vascular resistance, and decreased blood pressure, place a substantial load on the cardiovascular system. These changes are essential to meet the increased maternal and fetal metabolic demands and allow for sufficient placental circulation during gestation. However, in women with underlying structural heart conditions, they place an additional hemodynamic burden on the maternal body. Overall, with appropriate risk stratification, pre-conception counseling, and management by specialized cardiologists and high-risk obstetricians, most women with surgically corrected CHDs are expected to carry healthy pregnancies to term with optimization of both maternal and fetal risks. In this article, we describe the current understanding of 5 cyanotic CHDs—Tetralogy of Fallot, Transposition of the Great Arteries, Truncus Arteriosus, Ebstein’s Anomaly, and Eisenmenger Syndrome—and explore the specific hemodynamic consequences, maternal and fetal risks, current guidelines, and outcomes of pregnancy in women with these conditions.
Assessment of Clinical Reasoning While Attending Critical Care Postsimulation Reflective Learning Conversation
Authors: Almomani Emad , Sullivan Jacqueline , Samuel Jisha , Maabreh Ahmed , Pattison Natalie , Alinier Guillaume
Published: January 2023

Background

The critical care environment is characterized with a high level of workload, complexity, and risk of committing practice mistakes. To avoid clinical errors, health care professionals should be competent with effective clinical reasoning skills. To develop effective clinical reasoning skills, health care professionals should get the chance to practice and be exposed to different patient experiences. To minimize safety risks to patients and health care professionals, clinical reasoning with a focus on reflective learning conversation opportunities can be practiced in simulated settings.

Objectives

To explore the most valid and reliable tools to assess clinical reasoning while attending adult critical care–related simulation-based courses in which reflective learning conversations are used.

Methods

A scoping review was conducted following Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews. Eight electronic databases were searched, and full-text review was completed for 26 articles.

Results

The search resulted in no studies conducted to measure clinical reasoning while attending adult critical care–related, simulation-based courses in which the reflective learning conversation method was embedded.

Discussion

This highlights the need to evaluate current available clinical reasoning tools or develop new tools within the context of adult critical care simulation where reflective learning forms a key part of the simulation procedures.
Sound and Light Levels in a General Intensive Care Unit Without Windows to Provide Natural Light
Authors: Lucchini Alberto , Giani Marco , Ferrari Katia , Di Maria Stefania , Galimberti Giulia , Zorz Alessandra , Iozzo Pasquale , Elli Stefano , Fumagalli Roberto , Bambi Stefano
Published: January 2023

Background

Appropriate levels and patterns of sound and light in an intensive care room help to maintain the patient's normal physiological functions. High sound levels can disrupt the patient's normal sleep architecture, cause hearing deficits, and induce the onset of delirium. Intensive care unit patients frequently report poor sleep, partly due to the environment.

Objectives

An observational pilot prospective study was designed to record sound pressure and light pollution levels in an Italian intensive care unit, without windows to provide natural light.

Method

Sound levels were measured in decibel A (dBA) every 10 seconds. Sound data were analyzed for sound peak, defined as the number of times sound levels exceeded 45, 50, 60, 65, 70, 75, 80, and 85 dBA. Light measures were taken every 10 seconds on a continuous basis. Light data were analyzed for light “peaks,” defined as the number of times light levels exceeded 100, 200, 300, 400, and 500 lux.

Results

The overall median sound level during the study period was equal to 54.60 (interquartile range [IQR], 51.70-57.70) dBA. The daytime median sound level was 56.00 (IQR, 53.00-59.50) dBA, and the nighttime median was 53.00 (IQR, 49.50-55.20) dBA (P< .001). The overall median light level was equal to 114 (IQR, 0-225) lux. The daytime median light level was 184 (IQR, 114-293) lux, and the nighttime median was 0 (IQR, 0-50) lux (P< .001). With respect to room lighting, rooms were observed to have “no lights on” 12.6% of daytime and 41% of nighttime.

Discussion

The sound levels recorded in our sample demonstrated that peaks >45 dBA during daytime and nighttime are, respectively, equal to 99.9% and 98.6% of all readings. The Environmental Protection Agency/World Health Organization recommended thresholds for both day (45 dBA) and night (35 dBA). Sound levels reached “toxic levels” when sound-generating activities were performed by nurses and physicians.
Spiritual Care in the Intensive Care Unit
Authors: Willemse Suzan , Smeets Wim , van Leeuwen Evert , Heldens Jeannette , ten Napel-Roos Nelleke , Foudraine Norbert
Published: January 2023

Background/Objective

To gain insight into both patients' and relatives' experiences with spiritual care (SC) in the intensive care unit (ICU).

Methods

Method used was qualitative interviewing. This was a thematic, topic-centered, biographical, and narrative approach, using semistructured interviews with thematic analysis. A purposive sampling method was used to select a sample of ICU patients and ICU patients' relatives. An interview guide facilitated individual, semistructured interviews. The interview data were recorded by means of note-taking and audio-recording. Verbatim transcripts were compiled for analysis and interpretation.

Results

All 12 participants—7 ICU patients and 5 family members of 5 other ICU patients—experienced ICU admission as an existential crisis. Participants would appreciate the signaling of their spiritual needs by ICU health care professionals (HCPs) at an early stage of ICU admission and subsequent SC provision by a spiritual caregiver. They regarded the spiritual caregiver as the preferred professional to address spiritual needs, navigate during their search for meaning and understanding, and provide SC training in signaling spiritual needs to ICU HCPs.

Discussion

Early detection of existential crisis signals with ICU patients and relatives contributes to the mapping of spiritual and religious needs. Spiritual care training of ICU HCPs in signaling spiritual needs by ICU patients and relatives is recommended. Effective SC contributes to creating room for processing emotions, spiritual well-being, and satisfaction with integrated SC as part of daily ICU care.
Standardization of the Definition and Surgical Management of the Splenic Flexure Carcinoma by an International Expert Consensus Using the Delphi Technique: Room for Improvement?
Authors: Benlice Cigdem , Parvaiz Amjad , Baca Bilgi , Hohenberger Werner , Miskovic Danilo , Stocchi Luca , Steele Scott , Kim Seon-Hahn , Holm Torbjörn , Spinelli Antonino , Gogenur Ismail , Panis Yves , Hasegawa Hirotoshi , Karachun Alexey , Uriburu Juan C Patron , Ito Masaki , Croner Roland , Kessler Hermann , Kuzu Mehmet Ayhan
Published: January 2023

BACKGROUND:

Surgical management of splenic flexure cancer remains controversial.

OBJECTIVE:

To establish an expert international consensus on splenic flexure cancer management.

DESIGN:

A 3-round online-based Delphi study was conducted between September 2020 and April 2021.

SETTING:

The first round included 18 experts from 12 different countries. For the second and third rounds, each expert in the first round was asked to invite 2 more colorectal surgeons from their region (n = 47). Out of 47 invited experts, 89% (n = 42) participated in the second and third rounds of the consensus.

INTERVENTIONS:

A total of 35 questions were created and sent via online questionnaire tool.

MAIN OUTCOME MEASURES:

Levels of recommendation based on voting concordance were graded as follows: more than 75% agreement was defined as strong, between 50-75% as moderate, and below 50% as weak.

RESULTS:

There was moderate consensus on the definition of splenic flexure (55%) as 10 cm from either side where the distal transverse colon turns into the proximal descending colon. Also, experts recommended abdominopelvic computerized tomography scan plus intraoperative exploration (moderate consensus, 72%) for tumor localization and cancer registry splenic flexure recording. Segmental colectomy was the preferred technique for management of splenic flexure cancer in the elective setting (72%). Moderate consensus was achieved on the technique of complete mesocolic excision and central vascular ligation principles for splenic flexure cancer (74%). Only strong consensus was achieved on the surgical approach for minimally invasive surgery (88%).

CONCLUSIONS:

This is the first internationally conducted Delphi consensus study regarding splenic flexure cancer. While we found moderate consensus on preoperative diagnostic modalities and surgical management, the definition of splenic flexure remains ambiguous. To more effectively compare oncologic outcomes among different cancer registries, guidelines need to be developed to standardize each domain and avoid arbitrary definitions. See Video Abstract at http://links.lww.com/DCR/C143.
Efficacy of Anal Sphincter Division During Fistulotomy in Anal Fissure Associated Fistula
Authors: Adams Evan D. , Mirocha James M. , Fleshner Phillip R. , Zaghiyan Karen N.
Published: January 2023

BACKGROUND:

A subset of chronic anal fissures beget focal infection, leading to concomitant fistula. The optimal management of fissure associated fistula is unknown.

OBJECTIVE:

We sought to characterize healing rates and effect of fistulotomy in fissure associated fistula.

DESIGN:

Retrospective study.

SETTING:

Urban tertiary center.

PATIENTS:

Adults who underwent fistulotomy for a fistula associated with a chronic anal fissure. Crohn’s disease, history of lateral internal sphincterotomy, and fistula not amenable to fistulotomy were excluded.

INTERVENTIONS:

Patients were managed with fistulotomy. Fissures were otherwise managed conservatively with a step-up approach.

MAIN OUTCOME MEASURES:

The primary endpoint was healing, defined as resolution of symptoms and both fistula and fissure wounds within one year. Subgroup analysis compared those who underwent subcutaneous fistulotomy (group A) versus fistulotomy involving anal sphincter fibers (group B).

RESULTS:

Twenty-four of 38 patients (63%) patients healed with a median overall follow-up of 6.6 months (4.2—14.1). The overall median time to healing was 4.4 months (2.2—6.0). No clinical or pathologic factors predicted healing. In subgroup analysis, overall subcutaneous fistulotomy healing rates were non-statically lower at 46% (6/13) compared to fistulotomy involving anal sphincter fibers at 72%, (18/25; p = 0.16). There was no difference in time to healing [Subcutaneous fistulotomy 6.7 months (5.2—8.4) vs. Fistulotomy involving sphincter 5.1 months (2.1—7.0); p = 0.36].

LIMITATIONS:

Treatment bias, with increased utilization of chemical sphincter relaxing agents in those who did not heal. Not applicable to complex fistulas, Crohn’s disease, or atypical fissures.

CONCLUSIONS:

Patients presenting with chronic fissure and associated subcutaneous, intersphincteric, or low transphincteric fistula are successfully managed with fistulotomy. Patients with a subcutaneous fistula tract exhibited non-statistically significant lower rates of healing. See Video Abstract at http://links.lww.com/DCR/C145.
Motivations for Seeking Cosmetic Enhancing Procedures of the Face: A Systematic Review
Authors: Martinez Michael J. , Dixit Dhaval , White Michael W. , Rieder Evan A.
Published: January 2023

BACKGROUND

Cosmetic enhancing procedures continue to grow in demand. Physicians should understand the complex factors that drive patient motivation for seeking such procedures.

OBJECTIVE

In contrast to a lens of psychopathology, this review reveals the driving power of everyday intrapersonal, social, and behavioral factors that motivate interest in elective facial cosmetic procedures.

MATERIALS AND METHODS

The review was conducted according to PRISMA guidelines and included studies with at least 50 adult patients seeking facial cosmetic enhancements between January 1, 2000, and July 1, 2022.

RESULTS

Among 1,239 identified publications, 21 studies with 9,005 participants were selected for inclusion. The review documents everyday factors as patient motivators for pursuing cosmetic enhancements of the face, with the majority of work focusing on intrapersonal factors (17 of 21 studies), such as preventing aging or negative appearance based self-appraisals. For studies reporting social factors (15 of 21 studies), the most common motivators were the patient's social network and a desire to promote social standing. Behavioral factors revealed that social media and media consumption impact patient motivation for cosmetic enhancements (5 of 21 studies).

CONCLUSION

In summary, this review demonstrates that patient motivations for facial cosmetic enhancements may be best understood through everyday intrapersonal, social, and behavioral factors.
Improved Margin Control of Microcystic Adnexal Carcinoma After Mohs Micrographic Surgery Compared With Wide Local Excision
Authors: Yerneni Sharmitha , Murad Fadi , Schmults Chrysalyne D. , Ruiz Emily S.
Published: January 2023

BACKGROUND

Microcystic adnexal carcinoma (MAC) is a locally aggressive and deeply infiltrative cutaneous tumor primarily treated with excision; however, there are limited data comparing outcomes by surgical approach.

OBJECTIVE

To compare surgical outcomes of MAC treated with Mohs micrographic surgery (MMS) and wide local excision (WLE).

METHODS

A 27-year retrospective cohort study of primary MAC was performed. Surgical (i.e. margin status after resection) and recurrence outcomes (including local recurrence [LR], nodal metastases [NM], and distance metastases [DM]) were analyzed by type of surgical approach (MMS and WLE).

RESULTS

Sixty-nine MACs were included, of which 34 (49.3%) were treated with MMS and 35 (50.7%) with WLE. All MMS-treated tumors had negative margins after the first surgery attempt. Twenty-one (60.0%) tumors treated with WLE had positive margins after the first surgical attempt and required additional procedures. More tumors treated with WLE developed LR, NM, or DM, although this did not meet statistical significance.

LIMITATIONS

Retrospective single institution study.

CONCLUSION

Greater than half of MAC tumors treated with WLE had positive margins after the initial surgery and required multiple procedures for complete removal. Real-time complete margin assessment is important for this locally aggressive and infiltrative tumor.
Adipose Tissue Transfer in Dynamic Definition Liposculpture PART III. The Arms: Biceps, Triceps, and Deltoids
Authors: Hoyos Alfredo E. , Stefanelli Matt , Perez Mauricio E. , Padilla Mauricio
Published: January 2023

Background:

Arm contouring usually represents a challenge for the surgeon due to zones with high risk of irregularities/asymmetries, the variable degree of skin laxity, and the differences between patient/gender preferences. In men, the bigger and muscular the arms the better, while women tend to prefer a slim and soft silhouette.

Methods:

We performed arm cadaveric dissections and also searched our records for patients who underwent fat grafting of the arm in addition to HD2, from January 2016 to May 2022 at a single center in Bogotá, Colombia.

Results:

Two hundred eighty-nine consecutive patients (275 men and 14 women) underwent high-definition lipoplasty/HD2 plus fat grafting of the biceps (72 muscles), the triceps (46 muscles), the deltoids (426 muscles), or a combination of them. Mean age was 39 and 36 years for men and women, respectively. Range of the fat graft volume was 30–150 ml. No major complications were reported. Follow-up period ranged from 2 to 24 months. Most patients were satisfied with the results.

Conclusions:

Men usually seek an overall well-toned and muscular extremity, while women tend to prefer a slim but also athletic contour. Such outcomes can be achieved through intramuscular fat grafting of the biceps, triceps, and deltoids. The proper recognition of the pedicles and a precise surgical technique will ensure both its safety and the reproducibility of the results.
Personalized Digital Health Information to Substantiate Human-Delivered Exercise Support for Adults With Type 1 Diabetes
Authors: Ash Garrett I. , Nally Laura M. , Stults-Kolehmainen Matthew , De Los Santos Melissa , Jeon Sangchoon , Brandt Cynthia , Gulanski Barbara I. , Spanakis Elias K. , Baker Julien S. , Weinzimer Stuart A. , Fucito Lisa M.
Published: January 2023

Objective:

Pilot-test personalized digital health information to substantiate human-delivered exercise support for adults with type 1 diabetes (T1D).

Design:

Single-group, 2-week baseline observation, then 10-week intervention with follow-up observation.

Setting:

Community-based sample participating remotely with physician oversight.

Participants:

Volunteers aged 18 to 65 years with T1D screened for medical readiness for exercise intervention offerings. N = 20 enrolled, and N = 17 completed all outcomes with 88% to 91% biosensor adherence.

Intervention:

Feedback on personalized data from continuous glucose monitoring (CGM), its intersection with other ecological data sets (exercise, mood, and sleep), and other informational and motivational elements (exercise videos, text-based exercise coach, and self-monitoring diary).

Main Outcome Measures:

Feasibility (use metrics and assessment completion), safety (mild and severe hypoglycemia, and diabetic ketoacidosis), acceptability (system usability scale, single items, and interview themes), and standard clinical and psychosocial assessments.

Results:

Participants increased exercise from a median of 0 (Interquartile range, 0-21) to 64 (20-129) minutes per week (P = 0.001, d = 0.71) with no severe hypoglycemia or ketoacidosis. Body mass index increased (29.5 ± 5.1 to 29.8 ± 5.4 kg/m2, P = 0.02, d = 0.57). Highest satisfaction ratings were for CGM use (89%) and data on exercise and its intersection with CGM and sleep (94%). Satisfaction was primarily because of improved exercise management behavioral skills, although derived motivation was transient.

Conclusions:

The intervention was feasible, safe, and acceptable. However, there is a need for more intensive, sustained support. Future interventions should perform analytics upon the digital health information and molecular biomarkers (eg, genomics) to make exercise support tools that are more personalized, automated, and intensive than our present offerings.
Effects of Medicare wellness visits on health promotion outcomes
Authors: Watkins Susan , Astroth Kim Schafer , Kim MyoungJin , Dyck Mary J.
Published: January 2023

Background:

The American older adult population has the highest historical prevalence of chronic disease and underuses wellness visit benefits. Little is known about how Medicare wellness visits (MWVs) affect health outcomes.

Purpose:

The aim of this retrospective case–control study was to examine how MWVs affect health outcomes by measuring two kinds of data for case and control groups at baseline versus 15 months: (1) the differences in blood pressure, fasting lipids, and glucose levels and (2) the completion frequencies for seven screenings and vaccinations.

Methodology:

Informed by Pender's Health Promotion Model, this design used purposively matched samples from a large American Midwestern Medicare population active between January 2013 and January 2016, with a total sample size of 252, consisting of the case group (N = 120) and control group (N = 132). The case and control group samples were matched according to gender, age, marital status, Charlson index scores, smoking status, and pharmaceutical classes. The two groups, case (MWV recipients) and matched control (MWV nonrecipients), were compared at different time points using a doubly multivariate repeated-measures analysis procedure. Descriptive statistics were computed to compare completion frequencies between groups.

Results:

A doubly repeated multivariate analysis of variance (MANOVA) and descriptive statistics revealed significant differences between the case and control group for three of the four health outcomes. The case group had increased completion frequencies in pneumococcal vaccination.

Conclusions:

Additional research controlling for more variables is warranted to better understand MWV efficacy on health outcomes.

Implications:

Primary care providers need to study how MWVs affect longitudinal health outcomes.
The Effects of Extracorporeal Cardiopulmonary Resuscitation According to Covariate Adjustment
Authors: Ko Kwangchul , Kim Yong Hwan , Lee Jun Ho , Lee Kyoung Yul , Hwang Seong Youn , Jin Mi Hyeon
Published: January 2023

This study compared the effects of extracorporeal cardiopulmonary resuscitation (ECPR) using propensity-score matching (PSM) analyses. A nationwide registry of out-of-hospital cardiac arrest (OHCA) patients in Korea between 2013 and 2016 was used. Patients with OHCA aged ≥15 years with cardiac etiology and resuscitation time >30 minutes were enrolled. Resuscitation-related variables before the initiation of ECPR were included. Two PSM analyses were performed separately, with and without post-ECPR variables. The primary outcome (PO) was a favorable neurologic outcome at hospital discharge. The rate of PO was 8.1% (13/161) in the ECPR group and 1.5% (247/16,489) in the conventional CPR (CCPR) group. In the matched cohort with post-ECPR variables, there was no significant difference in the rate of PO between the ECPR and CCPR groups (7.9% vs. 7.9%; p = 0.982). In the matched cohort without post-ECPR variables, the rate of PO was higher in the ECPR group than that in the CCPR group (8.3% vs. 3.6%; p = 0.012). PSM analysis without post-ECPR variables compared outcomes of all patients experiencing OHCA and treated with ECPR versus CCPR, which showed better neurologic outcomes for ECPR. PSM analysis with post-ECPR variables compared outcomes between ECPR survivors and CCPR survivors, which exhibited similar neurologic outcomes.
Association between monocyte to high-density lipoprotein ratio and coronary heart disease in US adults in the National Health and Nutrition Examination Surveys 2009–2018
Authors: Yan Shaoyi , Sha Shuo , Wang Di , Li Senjie , Jia Yongping
Published: January 2023

Background

Monocyte to high-density lipoprotein ratio (MHR) is associated with coronary heart disease (CHD) events. The purpose of this study was to analyze the correlation between MHR and CHD in American adults from 2009 to 2018 in the National Health and Nutrition Examination Surveys (NHANES) database.

Methods

A total of 25 862 persons in the NHANES from 2009 to 2018 were included in the cross-sectional analysis. The independent variable was MHR and the outcome variable was CHD. MHR was obtained by dividing the number of monocytes by the high-density lipoprotein concentration, and whether it is CHD is obtained through a questionnaire. Univariate analysis, stratified analysis, and a multivariate linear regression model were used to study the correlation between MHR and CHD.

Results

In each multivariate linear regression model, MHR was positively correlated with CHD, and this positive correlation was stable in both men and women [man odds ratio (OR): 1.54; 95% confidence interval (CI), 1.17–2.03; woman OR: 2.21; 95% CI, 1.40–3.50]. Our results show that the association between MHR and CHD was significant until MHR was less than 0.6 (OR: 7.2; 95% CI, 4.0–13.0); however, in cases where MHR was greater than 0.6, the results were negative but not significantly different (OR: 0.6; 95% CI, 0.3–1.2).

Conclusion

MHR has a clear association with CHD. Our prediction model and validation model show that MHR is highly predictive and robust as a predictor of CHD, therefore it can play an important role in the prediction of CHD.
Can increased intestinal permeability and low-grade endotoxemia be the triggering pathogenesis in isolated coronary artery ectasia?
Authors: Toprak Kenan , Kaplangoray Mustafa , Altiparmak İbrahim Halil , Taşcanov Mustafa Begenç , Güngören Fatih , Fedai Halil , İnanir Mehmet , Biçer Asuman , Demirbağ Recep
Published: January 2023

Purpose

Isolated coronary artery ectasia (ICAE) is a rare coronary artery disease (CAD) encountered during coronary angiography. Although many mechanisms have been suggested today that may be associated with ICAE, the underlying pathogenesis has not been fully understood. In this study, we aimed to reveal the possible relationship between intestinal permeability and ICAE.

Methods

Of the 12 850 patients who underwent coronary angiography, 138 consecutive patients with ICAE and 140 age- and sex-matched subjects with normal coronary arteries as the control group and 140 subjects with stenotic CAD were included in the study.

Results

Serum zonulin and lipopolysaccharide levels were significantly higher in patients with ICAE than in the control group and CAD group. Additionally, zonulin and lipopolysaccharide levels were significantly higher in the CAD group than in the ICAE group. In the correlation analysis, serum zonulin levels were correlated with the mean diameter and length of the ecstatic segment. In multivariate analysis, zonulin and lipopolysaccharide were identified as independent predictors for ICAE.

Conclusion

These results suggest that there may be a pathophysiological relationship between increased intestinal permeability and ICAE.
Changing epidemiology of dengue fever in children in South America
Authors: Fonseca Silvia Nunes Szente
Published: January 2023

Purpose of review

Dengue is the most important arthropod-borne viral disease of public health significance. Its geographic distribution includes 128 countries worldwide, affecting 390 million people every year causing significant morbidity and mortality in children and adults everywhere.

Recent findings

In the past, severe dengue affected mostly adults in the Americas; this scenario has changed and now cases of dengue, severe dengue, and dengue deaths have increased in children under 15 years in Brazil and in Colombia. Dengue and COVID-19 co-infections have been reported in South America, with increased hospitalization. A dengue vaccine for 9-year-old children and older children and adults who have serological evidence of previous dengue has been licensed in many countries; a different dengue vaccine trial for 4–16-year-old children has demonstrated decrease in clinical dengue and decrease in dengue hospitalizations.

There is no specific treatment of dengue, and a changing climate, insecticide resistance and urban expansion have permitted the vector's spread, making the vector control almost impossible. The hope for dengue control relies on vaccine development; there is important research on this area with one vaccine already licensed and another one showing promising results.
The role of cytoreductive nephrectomy in the immuno-oncological therapy era
Authors: Magee Diana E. , Helstrom Emma , Kutikov Alexander
Published: January 2023

Purpose of review

Cytoreductive nephrectomy has had a variable role in the management of metastatic renal cell carcinoma (RCC) through the different systemic therapy eras. Initially felt to be beneficial with interferon, the utility of cytoreductive nephrectomy was called into question in the tyrosine kinase inhibitor (TKI) era. However, with the advent of immunotherapy for metastatic RCC, the role of cytoreductive nephrectomy continues to be debated. This study sought to evaluate the recent literature and discuss cytoreductive nephrectomy within the context of an improved systemic therapy era.

Recent findings

The literature that exists on the use of cytoreductive nephrectomy with immunotherapy is retrospective in nature and largely derived from large, institutional databases. Although smaller, single-institution articles exist and provide more granular data, issues concerning selection bias and unmeasured confounders persist. Overall, the available studies demonstrate that patient selection is paramount, and cytoreductive nephrectomy should be reserved for patients with no more than one risk factor, those requiring palliation of local symptoms and for those patients with stable, low volume disease or with a complete response following systemic therapy exposure.

The optimal use of cytoreductive nephrectomy in metastatic RCC remains unclear, but certain subgroups of patients, on evaluation of post hoc and retrospective data, seem to benefit from surgical intervention.
A Malignant Hepatoblastoma Mimicking a Benign Mesenchymal Hamartoma: Lessons Learned
Authors: Singh Anuradha , Wong Kaitlyn , Nathan Paul C. , Shaikh Furqan , Ngan Bo-Yee , Sayed Blayne A. , Doria Andrea S.
Published: January 2023

Differentiating hepatoblastomas from other congenital benign hepatic tumors is key to surgical management. We, herein, present an unusual case of an antenatally diagnosed liver lesion assessed in the neonatal period. Because of its predominantly cystic ultrasound/MRI appearance and borderline alpha-fetoprotein serum levels the diagnosis of mesenchymal hamartoma was favored and protocol-based tumor resection was performed. Due to the intraoperative diagnosis of a fetal subtype of hepatoblastoma with positive resection margins the child had to undergo a second laparotomy. This report raises awareness to an unusual appearance of hepatoblastoma and discusses noninvasive imaging clues to consider atypical appearances of hepatoblastoma preoperatively as they can have profound implications in patient management.
When a Lump is More Than Just a Lump: Anaplastic Large Cell Lymphoma Presenting as a Pediatric Breast Mass
Authors: Xu Shuo , Duarte Laura Sofia , Baqir Agha Wajdan , Lyo Shawn , Gupta Raavi , Zhang Yaoping
Published: January 2023

Anaplastic large cell lymphoma (ALCL) is a rare non-Hodgkin T-cell lymphoma characterized by a cluster of differentiation-30 positivity. Subtypes are characterized by positive or negative anaplastic lymphoma kinase (ALK) expression. ALCLs account for about 10% to 15% of all pediatric non-Hodgkin lymphomas and more than 90% of the cases are ALK-positive. We report a rare case of pediatric systemic ALK-negative ALCL with an atypical presentation as a painful breast mass. Despite the general benign features of most pediatric breast masses, it is important to consider malignant systemic diagnoses like the one reported here.
Clinical Indicators of Effects of Yoga Breathing Exercises on Patients With Lung Cancer After Surgical Resection
Authors: Lu Han-Bing , Ma Rui-Chen , Yin Ying-Ying , Song Chun-Yu , Yang Ting-Ting , Xie Jiao
Published: January 2023

Background

Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients’ perioperative outcomes.

Objective

To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.

Methods

One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.

Results

Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients’ dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.

Conclusion

Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.

Implications for practice

Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.
High Interleukin-6 Levels Are Associated With Large-Artery Atherosclerotic Stroke
Authors: Li Cai , Wang Ying , Mei Peina , Tung Tao-Hsin , Wu Gang , Wang Feng , Wang En , Ni Hong , Zhu Xingrong , He Zhidi , Ke Shaofa
Published: January 2023

Objectives:

Interleukins (ILs) play several critical roles in modulating the occurrence and development of atherosclerosis-related diseases. We aimed to investigate the associations between ILs and the diagnosis, progress, and functional outcome in patients with large-artery atherosclerotic (LAA) stroke.

Methods:

Plasma levels of IL-2, IL-4, IL-6, and IL-10 were measured within 24 hours after stroke in 181 patients with first-time LAA stroke and on admission in 181 age-matched and sex-matched controls. NIHSS scores were recorded at admission and on Day 1, Day 2, Day 3, Day 4, and Day 5 after the stroke. Functional outcome was measured by the modified Rankin Scale at 3 months after stroke. Subgroup analyses were compared based on short-term progress within 5 days (ΔNIHSS ≥3) and 3-month unfavorable outcome (modified Rankin Scale >2). Logistic regression analysis adjusted for relevant confounders was performed.

Results:

IL-6 levels were higher in patients with LAA stroke than in controls [AOR (95% CI), 0.701 (95% CI 0.651–0.748, P<0.001], with an area under the receiver operating characteristic curve (AUC) of 0.701. Higher IL-6 levels were associated with short-term progression [AOR (95% CI), 1.070 (1.009, 1.135), P=0.025], with an AUC value of 0.720. Higher IL-6 levels were associated with unfavorable outcomes [AOR (95% CI), 1.075 (1.002, 1.153), P=0.040], with an AUC value of 0.658. No difference in IL-2, IL-4, or IL-10 was found between the groups.

Conclusions:

Plasma levels of IL-6 are higher in patients with LAA stroke and are independently associated with short-term progression and 3-month functional outcomes after stroke.
A Comparative Study of the Etiology of Intracranial Vertebral Artery Dissection and Carotid Artery Dissection
Authors: Zhang Xingwen , Han Jintao , Wang Jun , Yu Shengyuan
Published: January 2023

Background:

Both extrinsic (trauma or violent movement) and intrinsic (structural abnormality, atherosclerosis, or hemodynamic instability) factors may result in arterial dissection. The role of these factors in the origin or progression of dissection remains unclear. This study aimed to characterize the clinical features, radiologic features, and outcomes of intracranial vertebral artery dissection compared with carotid artery dissection and to determine the major causative factors.

Methods:

Consecutive patients with craniocervical dissection (n=127) were retrospectively analyzed. Patients with intracranial vertebral artery dissection (n=77) and those with carotid artery dissection (n=35) were compared with respect to patient age, sex, cerebrovascular risk factors, laboratory indices, and radiologic features.

Results:

Intracranial vertebral artery dissection was the most common craniocervical arterial dissection in our cohort (n=77, 60.6%). Body mass index in the intracranial vertebral artery dissection group was significantly greater than that in carotid artery dissection group. Clinical manifestations of intracranial vertebral artery dissection included ischemic stroke (37.7%), dizziness or vertigo (39.0%), and headache or neck pain (44.2%). Two patients had a definite history of trauma. The frontal and lateral tortuosity ratios of the vertebral basilar artery were significantly greater while the vertex angle was smaller in the intracranial vertebral artery dissection group compared with carotid artery dissection group. A positive correlation between the tortuosity ratios and subarachnoid hemorrhage and a significant inverse correlation between the tortuosity ratios and lipid parameters (high-density lipoprotein; apolipoprotein A1) were identified.

Conclusions:

Intrinsic causes may play a more important role in the development of intracranial vertebral artery dissection than carotid artery dissection.
Cremation Permit Review and COVID-19 Death Certificates
Authors: Prahlow Joseph A. , VanderVeen Madeline H. , Storer John D.
Published: January 2023

Data derived from death certificates (DCs) is an important resource for mortality statistics, disease surveillance, and the creation of public health policies. This study involved the review of COVID-19 DCs occurring during the normal course of DC review for cremation approval purposes in a medical examiner office. During the review process since the occurrence of the pandemic, it was noticed that a significant percentage of COVID-19 DCs being reviewed did not include any comorbid conditions as contributing to death, despite reports, both within the medical literature and within the media, that suggested that most deaths occur in people with known risk factors. The study involved medical record review for COVID-19 DCs that did not list any comorbid conditions. The results indicated that a vast majority of such cases did, in fact, have significant comorbid conditions, such that they should have been listed on the DCs.
Postcolectomy Enteritis in a Pediatric Patient With Ulcerative Colitis
Authors: Hawa Kathryn , Maltz Ross , Donegan Amy , Prasad Vinay , Dotson Jennifer L. , Boyle Brendan , Michel Hilary K.
Published: January 2023

Postcolectomy enteritis is characterized by diffuse small bowel inflammatory changes following colectomy for medically refractory ulcerative colitis. Symptoms may include abdominal pain, massive intestinal bleeding, intestinal perforation, and high stoma output. While the exact pathogenesis is unknown, immune dysregulation with increased cytokine and inflammatory cell response is suspected to lead to the inflammatory response. Therefore, immunosuppressive medications are the mainstay for treatment. All cases to date have been described in adult patients. We present a case of postcolectomy enteritis in a pediatric patient who improved without significant intervention.
Autosomal Recessive ACTG2-Related Visceral Myopathy in Brothers
Authors: Mori Mari , Clause Amanda R. , Truxal Kristen , Hagelstrom R. Tanner , Manickam Kandamurugu , Kaler Stephen G. , Prasad Vinay , Windster Jonathan , Alves Maria M. , Di Lorenzo Carlo
Published: January 2023

Objectives:

Pediatric intestinal pseudo-obstruction (PIPO) is a heterogeneous condition characterized by impaired gastrointestinal propulsion, a broad clinical spectrum, and variable severity. Several molecular bases underlying primary PIPO have been identified, of which autosomal dominant ACTG2-related visceral myopathy is the most common in both familial or sporadic primary PIPO cases. We present a family with autosomal recessive ACTG2-related disease in which both parents have mild gastrointestinal symptoms and sons have severe PIPO and bladder dysfunction.

Methods:

Clinical genome sequencing was performed on the patients and the mother. Immunohistochemistry was performed on intestinal tissue from the patients to show expression levels of the ACTG2.

Results:

Genome sequencing identified a 6.8 kb 2p13.1 loss that includes the ACTG2 gene and a maternally inherited missense variant p.Val10Met in the ACTG2 gene.

Discussion:

This case demonstrates that monoallelic hypomorphic ACTG2 variants may underly mild primary gastrointestinal symptoms, while biallelic mild variants can cause severe diseases. The Deletions of the noncoding ACTG2 exon can be an under-recognized cause of mild gastrointestinal symptoms unidentifiable by exome sequencing, explaining some instances of interfamilial variability with an apparent autosomal dominant inheritance. Genome sequencing is recommended as a genetic work-up for primary or idiopathic PIPO because of genetic heterogeneity.
Management of Enteritis Associated With Tricohepatoenteric Syndrome due to SKIV2L Mutation Using the Combination of JAK1/2 Inhibition and Azathioprine
Authors: Talbot Jonathan , Wiskin Anthony E. , Monaghan Marie , Goenka Anu , Rice Gillian , Roderick Marion
Published: January 2023

Tricohepatoenteric syndrome is a rare genetic disorder caused by mutations in SKIV2L or TTC37. An upregulation of type 1 interferon signaling is associated with the SKIV2L variation. Introduction of Baricitinib as a JAK1/ 2 kinase inhibitor alongside traditional immunosuppressive agents successfully reduced the symptoms of enteritis by blocking the inflammogenic effects of type 1 interferonopathy in a case of tricohepatoenteric syndrome diagnosed in a 5-year-old boy.