bluuebunny/crossref_metadata_2025 huggingface dataset:
A Randomized Noninferiority Trial to Compare Enteral to Parenteral Phosphate Replacement on Biochemistry, Waste, and Environmental Impact and Healthcare Cost in Critically Ill Patients With Mild to Moderate Hypophosphatemia*
Authors: Nguyen Chinh D. , Panganiban Haustine P. , Fazio Timothy , Karahalios Amalia , Ankravs Melissa J. , MacIsaac Christopher M. , Rechnitzer Thomas , Arno Lucy , Tran-Duy An , McAlister Scott , Ali Abdelhamid Yasmine , Deane Adam M.
Published: March 2024

OBJECTIVES:

Hypophosphatemia occurs frequently. Enteral, rather than IV, phosphate replacement may reduce fluid replacement, cost, and waste.

DESIGN:

Prospective, randomized, parallel group, noninferiority clinical trial.

SETTING:

Single center, 42-bed state trauma, medical and surgical ICUs, from April 20, 2022, to July 1, 2022.

PATIENTS:

Patients with serum phosphate concentration between 0.3 and 0.75 mmol/L.

INTERVENTIONS:

We randomized patients to either enteral or IV phosphate replacement using electronic medical record-embedded program.

MEASUREMENT AND MAIN RESULTS:

Our primary outcome was serum phosphate at 24 hours with a noninferiority margin of 0.2 mmol/L. Secondary outcomes included cost savings and environmental waste reduction and additional IV fluid administered. The modified intention-to-treat cohort comprised 131 patients. Baseline phosphate concentrations were similar between the two groups. At 24 hours, mean (sd) serum phosphate concentration were enteral 0.89 mmol/L (0.24 mmol/L) and IV 0.82 mmol/L (0.28 mmol/L). This difference was noninferior at the margin of 0.2 mmol/L (difference, 0.07 mmol/L; 95% CI, –0.02 to 0.17 mmol/L). When assigned IV replacement, patients received 408 mL (372 mL) of solvent IV fluid. Compared with IV replacement, the mean cost per patient was ten-fold less with enteral replacement ($3.7 [$4.0] vs. IV: $37.7 [$31.4]; difference = $34.0 [95% CI, $26.3–$41.7]) and weight of waste was less (7.7 g [8.3 g] vs. 217 g [169 g]; difference = 209 g [95% CI, 168–250 g]). CO
2 emissions were 60-fold less for comparable phosphate replacement (enteral: 2 g producing 14.2 g and 20 mmol of potassium dihydrogen phosphate producing 843 g of CO
2 equivalents).

CONCLUSIONS:

Enteral phosphate replacement in ICU is noninferior to IV replacement at a margin of 0.2 mmol/L but leads to a substantial reduction in cost and waste.
Prognostic Analysis and an Appropriate Antiplatelet Strategy for Patients With Percutaneous Coronary Intervention and High Bleeding Risk: Rationale and Protocol for a Multi-Center Cohort Study
Authors: Zhang Junyan , Chen Zhongxiu , Wang Hua , Wang Mian , Li Chen , He Sen , Peng Yong , Wei Jiafu , He Yong
Published: March 2024

Percutaneous coronary intervention (PCI) is an important treatment strategy for patients with coronary artery disease. However, bleeding after PCI significantly increases the mortality risk. The search for prognostic predictors and optimal antiplatelet therapy for patients with high bleeding risk (HBR) after PCI has been a much researched upon topic in current cardiovascular research. However, there is no widely accepted prognostic model or recommended antiplatelet therapy for patients with PCI-HBR. In this trial, based on prospective multi-center database building, we will analyze the adverse prognostic predictors for patients with PCI-HBR, observe the types of antiplatelet drugs and duration of dual antiplatelet therapy in PCI-HBR patients, and compare the safety and feasibility of different antiplatelet regimens and treatment courses. The prognostic analysis and an appropriate antiplatelet strategy for patients with PCI and high bleeding risk (PPP-PCI) trial will help analyze bleeding risk factors in PCI-HBR patients and explore the appropriate antiplatelet treatment options. This study is registered with ClinicalTrials.gov (NCT05369442). The Research Ethics Committee of West China Hospital authorized this study (2022 Review #269). The trial results will be published in peer-reviewed journals and at conferences.
Outdoor Artificial Light at Night and Reproductive Endocrine and Glucose Homeostasis and Polycystic Ovary Syndrome in Women of Reproductive Age
Authors: Fang Lanlan , Ma Cong , Wang Guosheng , Peng Yongzhen , Zhao Hui , Chen Yuting , Ma Yubo , Cai Guoqi , Cao Yunxia , Pan Faming
Published: March 2024

Background:

Artificial light at night, a well-recognized circadian clock disrupter, causes disturbances in endocrine homeostasis. However, the association of artificial light at night with polycystic ovary syndrome (PCOS) is still unknown. This study examines the effects of outdoor artificial light at night on sex hormones, glucose homeostasis markers, and PCOS prevalence in Anhui Province, China.

Methods:

We recruited 20,633 women of reproductive age from Anhui Medical University Reproductive Medicine Center. PCOS was diagnosed according to Rotterdam criteria. We estimated long-term (previous year) and short-term (previous month) artificial light at night values for residential addresses using 500 m resolution satellite imagery. We fitted multivariable models, using both linear and logistic regression, to estimate the association of artificial light at night with sex hormones, glucose homeostasis markers, and PCOS prevalence.

Results:

Both long-term and short-term exposure to outdoor artificial light at night were negatively associated with follicle-stimulating hormone and luteinizing hormone levels, while positively associated with testosterone, fasting insulin, homeostasis model assessment-insulin resistance, and homeostasis model assessment-insulin resistance-β levels. The second-highest quintile of artificial light at night was associated with increased PCOS prevalence (odds ratio [ORlong-term] = 1.4; 95% confidence interval [CI] = 1.2, 1.6 and ORshort-term = 1.3; 95% CI = 1.1, 1.5) compared with the lowest quintile. In addition, prevalence of PCOS was linearly associated with long-term exposure to artificial light at night, but nonlinearly associated with short-term exposure. This association was more evident in younger, obese or overweight, moderately educated, rural women, and for the summer and fall seasons.

Conclusion:

Outdoor artificial light at night may be a novel risk factor for PCOS.
NK-cell–elicited gasdermin-D–dependent hepatocyte pyroptosis induces neutrophil extracellular traps that facilitate HBV-related acute-on-chronic liver failure
Authors: Zhao Qiang , Chen Dong-Ping , Chen Hua-Di , Wang Ying-Zhe , Shi Wei , Lu Yi-Tong , Ren Yi-Zheng , Wu Yuan-Kai , Pang Yi-Hua , Deng Hong , He Xiaoshun , Kuang Dong-Ming , Guo Zhi-Yong
Published: March 2024

Background and Aims:

HBV infection is a major etiology of acute-on-chronic liver failure (ACLF). At present, the pattern and regulation of hepatocyte death during HBV-ACLF progression are still undefined. Evaluating the mode of cell death and its inducers will provide new insights for developing therapeutic strategies targeting cell death. In this study, we aimed to elucidate whether and how immune landscapes trigger hepatocyte death and lead to the progression of HBV-related ACLF.

Approach and Results:

We identified that pyroptosis represented the main cell death pattern in the liver of patients with HBV-related ACLF. Deficiency of MHC-I in HBV-reactivated hepatocytes activated cytotoxic NK cells, which in turn operated in a perforin/granzyme-dependent manner to trigger GSDMD/caspase-8-dependent pyroptosis of hepatocytes. Neutrophils selectively accumulated in the pyroptotic liver, and HMGB1 derived from the pyroptotic liver constituted an important factor triggering the generation of pathogenic extracellular traps in neutrophils (NETs). Clinically, elevated plasma levels of myeloperoxidase-DNA complexes were a promising prognostic biomarker for HBV-related ACLF. More importantly, targeting GSDMD pyroptosis-HMGB1 release in the liver abrogates NETs that intercept the development of HBV-related ACLF.

Conclusions:

Studying the mechanisms that selectively modulate GSDMD-dependent pyroptosis, as well as its immune landscapes, will provide a novel strategy for restoring the liver function of patients with HBV-related ACLF.
The future of liver transplantation
Authors: Feng Sandy , Roll Garrett R. , Rouhani Foad J. , Sanchez Fueyo Alberto
Published: March 2024

Over the last 50 years, liver transplantation has evolved into a procedure routinely performed in many countries worldwide. Those able to access this therapy frequently experience a miraculous risk-benefit ratio, particularly if they face the imminently life-threatening disease. Over the decades, the success of liver transplantation, with dramatic improvements in early posttransplant survival, has aggressively driven demand. However, despite the emergence of living donors to augment deceased donors as a source of organs, supply has lagged far behind demand. As a result, rationing has been an unfortunate focus in recent decades. Recent shifts in the epidemiology of liver disease combined with transformative innovations in liver preservation suggest that the underlying premise of organ shortage may erode in the foreseeable future. The focus will sharpen on improving equitable access while mitigating constraints related to workforce training, infrastructure for organ recovery and rehabilitation, and their associated costs. Research efforts in liver preservation will undoubtedly blossom with the aim of optimizing both the timing and conditions of transplantation. Coupled with advances in genetic engineering, regenerative biology, and cellular therapies, the portfolio of innovation, both broad and deep, offers the promise that, in the future, liver transplantation will not only be broadly available to those in need but also represent a highly durable life-saving therapy.
Analysis of Graft Detachments and Re-Bubblings After 450 Descemet Membrane Endothelial Keratoplasty Procedures
Authors: Massia Menkene Louise , Berger Tim , Safi Tarek , Hamon Loïc , Munteanu Cristian , Seitz Berthold , Daas Loay
Published: March 2024

Purpose:

To objectify the indication for re-bubbling by analyzing graft detachments (GDs) after Descemet membrane endothelial keratoplasty.

Methods:

In this retrospective monocentric observational study, re-bubbling cases of 450 Descemet membrane endothelial keratoplasties and the percentage of the residual gas filling (RGF) in the anterior chamber on the first postoperative day were collected. The number/location/extent of GDs and the corneal thickness above GDs were analyzed using anterior segment optical coherence tomography.

Results:

From a total of 450 grafts, 384 (85.3%) had at least a minimal degree GD. One hundred twenty-two of 450 grafts (27.1%) underwent at least 1 re-bubbling. The mean RGF was significantly lower in eyes with GD (67.7 ± 12.6%) than in eyes without GD (74.2 ± 11.3%). GDs occurred most frequently in the inferotemporal quadrant (46.0%). GDs were significantly more likely to require a re-bubbling when the central parts of the graft were affected (94.0% vs. 35.7%). The number of detachments per graft was directly proportional to the re-bubbling rate. The GDs which required a re-bubbling were on average 56 μm higher and 461 μm wider than the untreated ones. The cornea above the GDs that needed a re-bubbling was significantly thicker than above the untreated GDs (mean 988 ± 102 μm vs. 951 ± 99 μm).

Conclusions:

The RGF seems to be a major influencing factor for graft attachment. The most susceptible location of the GD is inferotemporal. The main factors that need to be investigated to decide if a re-bubbling is required are the number of detachments per graft, their dimensions, whether the central portions of the graft are involved, and the corneal thickness above GDs.
Conventional Epithelial-Off Corneal Crosslinking in Patients With Progressive Keratoconus: 10-Year Outcomes
Authors: Bordais Jérémy , Cassagne Myriam , Touboul David , Saunier Valentine , Butterworth Jacqueline , Malecaze François , Soler Vincent , Fournié Pierre
Published: March 2024

Purpose:

Corneal crosslinking (CXL) is the standard treatment of progressive keratoconus (KC). We evaluated the safety and 10-year outcomes of conventional “epithelial-off” CXL for progressive KC for the first time in a cohort in France.

Methods:

We conducted a retrospective review of patients undergoing conventional CXL (Dresden protocol) in our tertiary ophthalmology department from 2006 to 2011 with 10-year follow-up. The primary outcome was change in preoperative versus postoperative keratometry measured by maximum keratometry (Kmax), steep keratometry (K2), flat keratometry (K1), mean keratometry (Km), and topographic cylinder. Secondary outcomes were changes in visual and refractive outcomes. We report postoperative complications and adverse events.

Results:

Eighty-nine eyes from 76 patients (67% male patients, mean age 22.7 ± 7.6 years) were included. Mean Kmax (−2.31 ± 2.98 diopters (D); P < 0.00001), K2 (−2.07 ± 3.15 D; P < 0.00001), K1 (−1.00 ± 2.29 D; P = 0.00008), Km (−1.53 ± 2.47 D; P < 0.00001), and topographic cylinder (−1.15 ± 2.53 D; P = 0.00004) significantly decreased 10 years after CXL compared with preoperative baseline. Significant decreases were still observed between 5 and 10 years after for mean Kmax, mean K2, mean K1, and mean Km. Mean distance best spectacle-corrected visual acuity and mean manifest refraction spherical equivalent were significantly improved after 10 years versus before CXL. The 10-year rate of repeat CXL was n = 3/76 patients (4%) (all younger than 18 years at first CXL) and of loss of >3 lines in best spectacle-corrected visual acuity was n = 1/76 patients (1%).

Conclusions:

Progressive KC was effectively stabilized with a prolonged flattening and maintenance of functional vision improvements after 10 years. Repeat CXL was rare and only required among younger patients.
Clinical Characteristics of 118 Pediatric Patients With Acute Benign Myositis Associated With Influenza A Virus Infection
Authors: Jiang Shaoqun , Li Jieling , Cao Jie , Ou Yuexu , Duan Yuanhui , Gan Xiaoming
Published: March 2024

Objective:

The objective of this study was to investigate the clinical and laboratory features of acute benign myositis associated with influenza A virus infection in children.

Methods:

A retrospective analysis was performed on the clinical data of 118 children with acute benign myositis associated with influenza A virus infection who were admitted to the Children’s Hospital of Chongqing Medical University during the epidemic period of influenza A from February 2023 to May 2023.

Results:

(1) Most of the 118 children were preschool- or school-age. The most common symptom was sudden lower limb pain after fever, and bilateral calf myalgia was more common. The muscle enzyme spectrum ranged from 187.21 to 32191.00 μg/L (median: 3053 μg/L). Creatine kinase isoenzymes ranged from 5.15 to 749.7 μg/L (median 41.82 μg/L). Myoglobin ranged from 102.79 to 1200 μg/L (median 674.9 μg/L). (3) Examination: electromyography, muscle color Doppler ultrasound, radiograph and cardiac color Doppler ultrasound in Benign acute childhood myositis in children were rarely positive. (4) Treatment and prognosis: besides bed rest and a reduction of physical activity, oseltamivir treatment, drugs to improve energy metabolism, fluid replacement and alkalinization of symptomatic treatment. All children had a good prognosis without sequelae.

Conclusions:

This study summarized and analyzed the clinical characteristics of acute benign myositis associated with influenza A infection in children with the aim of allowing rapid and early diagnosis of the disease and reducing unnecessary diagnostic tests and treatments. Closely monitoring myalgia and the muscle enzyme spectrum is recommended to exclude other neuromuscular and metabolic diseases.
Significant Changes of Corneal Astigmatism After Levator Muscle Surgery for Acquired Blepharoptosis
Authors: Chen Po-Jui , Lee Yu-Kuei , Lai Chun-Chieh
Published: March 2024

Purpose:

To investigate the change of corneal astigmatism after the correction of blepharoptosis.

Methods:

This was a single-center retrospective cohort study conducted in Taiwan from 2017 to 2021. The medical records of patients with acquired blepharoptosis who had received levator muscle surgeries were collected. The differences in corneal astigmatism between the measurements before and at least 1 month after surgeries were investigated. Subgroup analysis of various severities of blepharoptosis and different types of corneal astigmatism was performed to determine their impacts on the axial changes after blepharoptosis surgeries.

Results:

A total of 120 eyes of 68 patients were enrolled in this study. The mean axial change of corneal astigmatism was 17.4° after blepharoptosis surgeries, and 55 eyes (45.8%) had a change of at least 10°. In the subgroup analysis, the eyes with against-the-rule, with-the-rule, and oblique astigmatism had 42.9%, 68.4%, and 91.7% with an axial change of at least 10° after surgeries, respectively. The averaged axial change of corneal astigmatism after surgeries was 22.7° in eyes with severe blepharoptosis (margin to reflex distance1 < 1 mm), whereas it was 12.0° in eyes with mild-to-moderate blepharoptosis (margin to reflex distance1 ≥ 1 mm).

Conclusions:

A high proportion of eyes had a crucial axial change in corneal astigmatism after blepharoptosis surgeries, especially in those with oblique astigmatism and severe blepharoptosis. For blepharoptosis patients needing refractive surgeries or astigmatism correction with toric intraocular lens implantation, a surgical correction of blepharoptosis may be considered beforehand.
The Effect of Supine Versus Upright Positioning on Eyelid Height in the Nonsurgical Patient
Authors: Wier Garrison P. , Legocki Alex T. , Radke Phillip M. A. , Sires Bryan S.
Published: March 2024

Purpose:

To directly compare margin-reflex distance 1, margin-reflex distance 2, and palpebral fissure in the upright versus supine positions in nonsurgical patients.

Methods:

A total of 43 patients (31 female, 12 male, and age range 26–96) were enrolled. Photos were taken in the clinic in the upright and supine position with a ruler placed vertically in the same plane as the eyelid, and the above computer-analyzed measurements were obtained.

Results:

Among the 86 eyes observed, the average upright margin-reflex distance 1 was 2.97 mm (95% confidence interval [CI], 2.70–3.24), while the average supine margin-reflex distance 1 was 2.38 mm (95% CI, 2.13–2.63). These differences were statistically significant (p < 0.001). Similarly, statistically significant differences were seen with margin-reflex distance 2 (p < 0.001), where upright measurements averaged 5.57 mm (95% CI, 5.33–5.81), and supine measurements averaged 5.01 mm (95% CI, 4.73–5.28). Finally, palpebral fissure showed similar significance (p < 0.001). Upright measurements averaged 8.54 mm (95% CI, 8.19–8.90), while supine measurements averaged 7.38 mm (95% CI, 7.00–7.76).

Conclusions:

Supine positioning provides a decrease in margin-reflex distance 1, margin-reflex distance 2, and palpebral fissure when compared with upright positioning in nonsurgical patients. This contradicts a previous study on intraoperative patients when lidocaine with epinephrine was used. This study helps us better understand the normal physiologic response to position changes with regard to eyelid height in the nonsurgical patient. As such, this study may function as a control for future studies comparing anesthetic/surgical parameter effects on intra- and post-operative eyelid heights.
Personal versus therapist perioperative music intervention: a randomized controlled trial
Authors: Jiang Fan , Wang Tingting , Hu Liqiong , Chen Shangui , Chen Lijian , Liu Xuesheng , Lu Yao , Gu Erwei , Ulloa Luis
Published: March 2024

Introduction:

Music interventions can alleviate patient anxiety and improve post-surgical satisfaction. However, it remains uncertain whether personal music preferences affect efficacy. The authors tested whether personal music intervention with patient-selected songs played ad libitum is more effective than standard therapist-designed treatment with classical music.

Methods:

A prospective, parallel-group, single-blinded, randomized controlled trial with 229 participants (aged 18–60 years) previously scheduled for elective surgery. Data analyses followed a modified intention-to-treat principle. The patients were randomized into three groups: Standard care without music (Control), therapist-designed classic music treatment (TT), or personal music intervention with patient-selected songs played ad libitum by the patient (PI). All patients received standard post-anaesthesia care, and music intervention was started upon arrival at the post-anaesthesia care unit. Primary outcomes were anxiety and overall satisfaction at discharge. In contrast, secondary outcomes were systolic blood pressure during music intervention, the sleep quality of the night after surgery, and the occurrence of postoperative nausea and vomiting within the first 24 h after surgery.

Results:

Compared with therapist-designed music treatment, personal intervention decreased systolic blood pressure (T0: 124.3±13.7, 95% CI:121–127.7; T20min: 117.6±10.4, 95% CI:115–120.1; T30min: 116.9±10.6, 95% CI:114.3–119.4), prevented postoperative nausea and vomiting (Control: 55.9%, TT: 64.6%, PI: 77.6%), including severe postoperative nausea (VAS score>4; Control: 44.1%; TT: 33.8%; PI: 20.9%) and severe emesis (Frequency≥3, Control: 13.2%; TT: 7.7%; PI: 4.5%). None of the treatments affected sleep quality at night after surgery (Median, Q1–Q3, Control: 3, 1–3; TT: 3, 1–4; PI: 3, 1–3.5). Personal, but not therapist, music intervention significantly prevented anxiety (Control: 36.4±5.9, 95% CI:35.0–37.9; TT: 36.2±7.1, 95% CI: 34.4-37.9; PI: 33.8±5.6, 95% CI: 32.4–35.2) and emesis (Control: 23.9%; TT: 23.4%; PI: 13.2%) and improved patient satisfaction (Median, Q1–Q3, C: 8, 6–8; TT: 8, 7–9; PI: 8, 7–9).

Conclusions:

Personal music intervention improved postoperative systolic blood pressure, anxiety, nausea, emesis, and overall satisfaction, but not sleep quality, as compared to therapist-designed classic intervention.
Outpatient mean arterial pressure: A potentially modifiable risk for acute kidney injury and death among patients with cirrhosis
Authors: Cullaro Giuseppe , Chiou Sy Han , Fenton Cynthia , Ge Jin , McCulloch Charles E. , Rubin Jessica , Shui Amy M. , Yao Frederick , Lai Jennifer C.
Published: March 2024

Mean arterial blood pressure (MAP), which decreases as portal hypertension progresses, may be a modifiable risk factor among patients with cirrhosis. We included adults enrolled in the Functional Assessment in Liver Transplantation study. We completed latent class trajectory analyses to define MAP trajectories. We completed time-dependent Cox-regression analyses to test the association between outpatient MAP and 3 cirrhosis-related outcomes: (1) stage 2 acute kidney injury (AKI), defined as a ≥200% increase in serum creatinine from baseline; (2) a 5-point increase in the MELD-Na score, defined as the incidence of increase from initial MELD-Na; (3) waitlist mortality, defined as death on the waitlist. For each outcome, we defined MAP cut points by determining the maximally selected Log-rank statistic after univariable Cox-regression analyses. Among the 1786 patients included in this analysis, our latent class trajectory analyses identified 3 specific outpatient MAP trajectories: “stable-low,” “stable-high,” and “increasing-to-decreasing.” However, >80% of patients were in a “stable-low” trajectory. We found in adjusted analyses that outpatient MAP was associated with each of our outcomes: Stage 2 AKI (adjusted hazard ratio 0.88 per 10 mm Hg increase in MAP [95% CI: 0.79–0.99]); 5-point increase in MELD-Na (adjusted hazard ratio: 0.91 [95% CI: 0.86–0.96]; waitlist mortality (adjusted hazard ratio: 0.89 [95% CI: 0.81–0.96]). For each outcome, we found that an outpatient MAP of 82 mm Hg was most associated with outcomes (p<0.05 for all). Our study informs the association between outpatient MAP and cirrhosis-related outcomes. These findings, coupled with the identification of specific thresholds, lay the foundation for the trial of targeted outpatient MAP modulation in patients with cirrhosis.
Sleep disturbances in chronic liver disease
Authors: Busebee Bradley , Watt Kymberly D. , Dupuy-McCauley Kara , DuBrock Hilary
Published: March 2024

Sleep disturbances are common in chronic liver disease and significantly impact patient outcomes and quality of life. The severity and nature of sleep disturbances vary by liver disease etiology and severity. While there is ongoing research into the association between liver disease and sleep-wake dysfunction, the underlying pathophysiology varies and, in many cases, is poorly understood. Liver disease is associated with alterations in thermoregulation, inflammation, and physical activity, and is associated with disease-specific complications, such as HE, that may directly affect sleep. In this article, we review the relevant pathophysiologic processes, disease-specific sleep-wake disturbances, and clinical management of CLD-associated sleep-wake disturbances.
Serum HSP70 and VEGF Levels Are Effective Predictive Factors of Chemoradiosensitivity and Prognosis of Pancreatic Cancer Patients
Authors: Xiong Liumei , Li Danming , Xiao Gui , Tan Sipin , Wen Jianbo , Wang Guiliang
Published: March 2024

Aim

The study is to evaluate serum HSP70 and VEGF for predicting the chemoradiosensitivity of the pancreatic cancer patients.

Materials and Methods

255 pancreatic cancer patients and 60 healthy subjects were measured for serum HSP70 and VEGF using ELISA for the pretreatment, during treatment, and postchemoradiotherapy timepoints.

Results

The serum HSP70 and VEGF were found to be elevated in pancreatic cancer patients as compared to healthy subjects. After chemoradiotherapy treatment, 179 patients showed effective clinical response while 76 patients showed ineffective clinical response. Serum HSP70 and VEGF were higher during chemoradiotherapy, and lower posttreatment in the effective group. However, serum HSP70 and VEGF were higher during and after treatment in the ineffective group. At any given timepoint, serum HSP70 and VEGF were higher in the ineffective group compared with the effective group. The overall survival and progression-free survival trends were as follows: HSP70 High/VEGFHigh < HSP70High/VEGFLow or HSP70Low/VEGFHigh < HSP70Low/VEGFLow. Serum HSP70 and VEGF were individually effective, and their combination was even more effective in predicting the chemoradiosensitivity of pancreatic cancer patients. HSP70 and VEGF were independent risk factors for overall survival and progression-free survival of pancreatic cancer patients.

Conclusions

Low levels of serum HSP70 and VEGF were associated with improved radiosensitivity and better prognosis of pancreatic cancer patients.
Lasting Impact of the COVID-19 Pandemic on Care and Prevention of Sexually Transmitted Infections in the Midwest
Authors: Patel Maya , Cardoza Nicholas , Weingarten Lawrence , Kolenchery Nebu , Trolard Anne , Cooper Benjamin , Reno Hilary
Published: March 2024

Background

The COVID-19 pandemic reduced the general accessibility of health services. Many sexually transmitted infection (STI) testing and treatment sites modified services (e.g., reduced hours, limited walk-in availability, decreased testing capacity), changes that may result in permanent change in STI service availability. At the same time, systems were driven to innovate in ways that could benefit patients. This study aimed to describe how the COVID-19 pandemic changed STI clinical services, with a focus on long-term impacts.

Methods

In July 2022, a phone survey was designed to assess services for STIs at the 105 STI testing and treatment providers in the St. Louis metropolitan statistical area. Sexually transmitted infection testing providers included STI clinics, primary care clinics that cater to a broad population, and community-based organizations, and excluded emergency departments and urgent care centers. In most cases, the survey was completed by a clinic manager, medical director, or nursing staff member.

Results

Of the 75 locations that were interviewed, 12 (16%) had not returned to prepandemic capacity and operations as of July 2022. Five sites had closed completely since the pandemic began, 3 of which are in the northwestern region of the metropolitan statistical area. Most (58.6%) of the open clinics had added telehealth appointments.

Conclusions

Sexually transmitted infection testing sites decreased during the pandemic with lasting impact in one area of the Midwest. Resources to support STI infrastructure should be expanded. Maintaining updated information on STI care providers in the region can aid future assessments.
Pulmonary Thromboemboli Due to Leiomyoma
Authors: Gongolli Julita , Vanderschaegen Anna , Renfrow Shannon , Collins Kimberly D. , Prahlow Joseph A.
Published: March 2024

Uterine leiomyomas are the most common pelvic tumor in women and the most frequent indication for hysterectomy. Although benign lesions, leiomyomas can cause dysfunctional uterine bleeding, pelvic pain or discomfort, infertility, and spontaneous abortion. Despite the fact that uterine leiomyomas can result in a significant amount of morbidity, it is relatively rare for these common tumors to lead to death. Here we present a case of fatal pulmonary thromboembolism that occurred due to pelvic vein thrombosis in the setting of leiomyomas.
Lymphomatoid Papulosis With T-cell Receptor–Gamma Delta Expression
Authors: Mark Erica , Kempf Werner , Guitart Joan , Pulitzer Melissa , Mitteldorf Christina , Hristov Alexandra , Torres-Cabala Carlos , Marchi Enrica , Cropley Thomas , Rodriguez Pinilla Socorro Maria , Griffin Teresa , Fernandez Rony , Pileri Stefano , Pileri Alessandro , Tabanelli Valentina , Borretta Lisa , Subtil Antonio , Plaza Jose Antonio , Piris Jose A. Miguel Angel , Feldman Andrew L. , Cerroni Lorenzo , Gru Alejandro A.
Published: March 2024

Lymphomatoid papulosis (LyP) has several histopathologic presentations. LyP featuring gamma-delta (γδ) T-cell receptor expression may masquerade as and may be misdiagnosed as aggressive cutaneous T-cell lymphoma, particularly primary cutaneous γδ T-cell lymphoma (PCGDTL) or γδ mycosis fungoides. We performed a clinicopathologic analysis of the largest series of LyP featuring γδ T-cell expression. We identified 26 patients with a diagnosis of LyP with γδ T cells from our institutions, as well as through a comprehensive review of the literature, and characterized these cases. Most cases were treated with topical steroids or not treated at all. The majority of cases showed a CD4-CD8+ phenotype and featured at least one cytotoxic marker. Histopathologic features included an intraepidermal or dermal infiltrate with large cells and frequent angiotropism. One case was initially misdiagnosed as PCGDTL, requiring further therapy. Our case series, the largest international cohort of γδ T cell predominant LyP cases, confirms marked clinicopathologic heterogeneity that may contribute to misdiagnosis, reasserting the need to identify classic clinical features, CD30+ T-cell components, and markers of cytotoxicity when dealing with this differential diagnosis. A limitation of this study includes somewhat limited follow-up, histologic, and immunophenotypic information for some cases.
Forecasting the effect of HIV-targeted interventions on the age distribution of people with HIV in Kenya
Authors: Schnure Melissa C. , Kasaie Parastu , Dowdy David W. , Genberg Becky L. , Kendall Emily A. , Fojo Anthony T.
Published: March 2024

Objectives:

To provide accurate forecasts of the age distribution of people with HIV (PWH) in Kenya from 2025 to 2040.

Design:

Development of a compartmental model of HIV in Kenya, calibrated to historical estimates of HIV epidemiology.

Methods:

We forecasted changes in population size and age distribution of new HIV infections and PWH under the status quo and under scale-up of HIV services.

Results:

Without scale-up, new HIV infections were forecasted to fall from 34 000 (28 000–41 000) in 2,025 to 29 000 (15 000–57 000) in 2,040; the percentage of new infections occurring among persons over 30 increased from 33% (20–50%) to 40% (24–62%). The median age of PWH increased from 39 years (38–40) in 2025 to 43 years (39–46) in 2040, and the percentage of PWH over age 50 increased from 26% (23–29%) to 34% (26–43%). Under the full intervention scenario, new infections were forecasted to fall to 6,000 (3,000–12 000) in 2,040. The percentage of new infections occurring in people over age 30 increased to 52% (34–71%) in 2,040, and there was an additional shift in the age structure of PWH [forecasted median age of 46 (43–48) and 40% (33–47%) over age 50].

Conclusion:

PWH in Kenya are forecasted to age over the next 15 years; improvements to the HIV care continuum are expected to contribute to the growing proportion of older PWH.
Inflammatory and Malignant Uptake Along Crohn Perianal Fistula on 18F-FDG
Authors: McKinley Spencer , Garuba Favour , Itani Malak , Deepak Parakkal , Ballard David H.
Published: March 2024

Inflammatory increased metabolic activity was discovered in the left anal canal on an 18F-FDG PET/CT scan performed for initial staging of anal squamous cell carcinoma in a patient with history of perianal Crohn disease. This increased uptake was due to a complex intersphincteric perianal fistula with supralevator extension, with a secondary, contiguous, superficial focus of squamous cell carcinoma at the anal verge that was identified on an MRI performed on the same day.
Significantly Elevated FDG Activity in Neurothekeoma
Authors: Amiruddin Raisa , Zhuang Hongming
Published: March 2024

Neurothekeoma is a very rare cutaneous lesion affecting mainly young patients. The lesion is generally benign. We report here that intense FDG activity on PET/CT was noted at the site of primary neurothekeoma of the right shoulder in a 16-year-old boy. Abnormal FDG activity was also seen in the metastatic neurothekeoma in the lung in the same patient 2 years later.
Application of System Nursing in the Prevention of Postoperative Nonstructural Scoliosis in Patients With Ear Reconstruction
Authors: Tian Mei , Zhuang Jun , Zhang Huiwen , Hu Jintian , Liu Na
Published: March 2024

Objective:

To evaluate whether early systematic nursing can reduce the occurrence of postoperative nonstructural scoliosis in patients undergoing ear reconstruction.

Methods:

A total of 136 patients with congenital microtia who underwent ear reconstruction surgery at the Department of Plastic Surgery, Chinese Academy of Medical Sciences from, January 2022 to July 2022 were included as study subjects. They were randomly divided into a routine nursing group and a systematic nursing group. After preoperative and postoperative education, as well as continuous follow-up intervention after surgery, spinal CT three-dimensional imaging examination was performed 6 months later to measure the Cobb angle and observe the occurrence of spinal scoliosis.

Results:

Compared with the routine nursing group, the incidence and severity of postoperative nonstructural scoliosis were significantly reduced in patients who received systematic nursing.

Conclusions:

Systematic nursing intervention for patients undergoing ear reconstruction can help prevent the occurrence of postoperative nonstructural scoliosis and has a positive effect on improving patient prognosis. It is worth promoting in clinical treatment.
What Factors Can Affect the Occurrence of Vertigo in Patients After Craniofacial Surgery in China?
Authors: Zhang Sainan , Zhuang Jun , Wu Wenhong , Huang Lan , Tian Mei , Guo Li , Sun Mengjin , Hu Jintian , Liu Na
Published: March 2024

Vertigo is a complication of craniomaxillofacial contour plastic surgery characterized by dizziness from hypovolemia in the cerebral hemispheres and brainstem. The authors analyzed the current status and influencing factors of postoperative vertigo in patients who undergo craniomaxillofacial contouring and discussed improvements in nursing strategies. The authors investigated 418 patients admitted to the authors’ hospital who underwent craniomaxillofacial contouring between November 2020 and October 2023 and divided them into asymptomatic and symptomatic groups based on syncopal precursors or vertigo. The authors screened the current status of vertigo in patients after craniomaxillofacial contouring and the factors affecting vertigo and determined nursing improvement strategies. After craniomaxillofacial contouring, 125 patients had vertigo symptoms. Postcraniomaxillofacial contouring syncope or vertigo was associated with age, patient vertigo history, family history, depression, weight loss, blood pressure at admission, feeding before getting out of bed, and the level of intraoperative hemorrhage Multifactorial logistic regression analysis revealed the association between postcraniomaxillofacial contouring syncope or vertigo and vertigo history, depression, weight loss, feeding before getting out of bed, and intraoperative bleeding volume. Vertigo precursor incidence after craniomaxillofacial contouring surgery is 29.90%. Its influencing factors are complex, suggesting that nurses need to improve the perioperative health education of craniomaxillofacial contouring surgery and optimize the nursing care, encourage patients to have a reasonable diet or provide parenteral nutritional support preoperatively, help patients get out of bed early postoperatively, encourage them to have multiple meals in little quantity before getting out of bed, and control the intraoperative bleeding, to ensure patient safety postoperatively.
Surgical Management of Complex Skull Base Tumor Using Preoperative Multimodal Image Fusion Technology
Authors: Jian zhi-heng , Chen peng , Li yu , Liao chang-chun , Yi xin-feng , Zhan run-gen , Chen gang
Published: March 2024

Objective:

To review our single-institution experience in the surgical management of complex skull base tumors using multimodal image fusion technology.

Methods:

From October 2019 to January 2022, 7 cases of complex skull base tumors that performed preoperative multimodal image fusion in Zhuhai People’s Hospital neurosurgery department were involved in this study. The image data were uploaded to the GE AW workstation. Corresponding image sequences were opened in the workstation to complete registration fusion and 3D reconstruction. We retrospectively reviewed the clinical and imaging data, and surgical strategy, respectively.

Results:

one case of recurrent C2 schwannoma, 1 case of recurrent spindle cell tumor of the left cranio-orbital communication, 1 case of lobular malignant tumor of the left infratemporal fossa, 1 case of central giant cell repairing granuloma, 1 case of mesenchymal malignant tumor in left pharyngeal process, 1 case of meningioma in jugular foramen, and 1 case of hemangioblastoma with vascular malformation in fourth ventricular. All cases underwent preoperative multimodal image fusion for the surgical plan and all cases had gross total resection. Except for one case of mesenchymal malignant tumor in left pharyngeal process that had dysphagia and one case of hemangioblastoma that had discoordination, others cases were without postoperative complication.

Conclusions:

Preoperative multimodal image fusion and surgical approach simulation benefit complex skull base tumor surgical treatment. Individually multiple image assessment of complex skull base tumors to determine the specific surgical strategy is more rational and should be recommended (Supplemental Digital Content 1, Supplementary Video, http://links.lww.com/SCS/F936).
The Association Between Craniofacial Fracture Patterns and Traumatic Optic Neuropathy
Authors: Hassan Bashar , Yoon Joshua , Elegbede Adekunle , Merbs Shannath L. , Liang Fan , Miller Neil R. , Manson Paul N. , Grant Michael P.
Published: March 2024

Traumatic optic neuropathy (TON) is a rare but potentially devastating complication of craniofacial trauma. Approximately half of patients with TON sustain permanent vision loss. In this study, we sought to identify the most common fracture patterns associated with TON. We performed a retrospective review of craniomaxillofacial CT scans of trauma patients who presented to the R Adams Cowley Shock Trauma Center from 2015 to 2017. Included were adult patients who had orbital fractures with or without other facial fractures. Patients diagnosed with TON by a formal ophthalmologic examination were analyzed. Craniofacial fracture patterns were identified. Bivariate analysis and multivariate logistic regression were performed to identify craniofacial fracture patterns most commonly associated with TON. A total of 574 patients with orbital fractures who met inclusion criteria [15 (2.6%)] were diagnosed with TON. The median [interquartile range (IQR)] age was 44 (28–59) years. Patients with optic canal fractures and sphenoid sinus fractures had greater odds of TON compared with patients who did not have these fracture types [adjusted odds ratio (aOR) 95% confidence interval (CI) 31.8 (2.6–>100), 8.1 (2.7–24.4), respectively]. Patients who sustain optic canal and sphenoid sinus fractures in the setting of blunt facial trauma are at increased odds of having a TON. Surgeons and other physicians involved in the care of these patients should be aware of this association.
Orbital Fracture Characteristics and Outcomes in Baltimore
Authors: Er Seray , Hassan Bashar , Yoon Joshua , Resnick Eric , Yusuf Cynthia , Lagziel Tomer , Liang Fan , Ptak Thomas , Redett Richard , Yang Robin , Grant Michael
Published: March 2024

Fracture characteristics and postoperative outcomes of patients presenting with orbital fractures in Baltimore remain poorly investigated. The purpose of our study was to determine the fracture patterns, etiologies, and postoperative outcomes of patients treated for orbital fractures at 2 level I trauma centers in Baltimore. A retrospective cohort study was conducted on patients who underwent orbital fracture repair at the R Adams Cowley Shock Trauma Center and the Johns Hopkins Hospital from January 2015 to December 2019. Of 374 patients, 179 (47.9%) had orbital fractures due to violent trauma, 252 (67.4%) had moderate to near-total orbital fractures, 345 (92.2%) had orbital floor involvement, and 338 (90.4%) had concomitant neurological symptoms/signs. Almost half of the patients had at least one postoperative ocular symptom/sign [n = 163/333 (48.9%)]. Patients who had orbital fractures due to violent trauma were more likely to develop postoperative ocular symptoms/signs compared with those who had orbital fractures due to nonviolent trauma [n = 88/154 (57.1%), n = 75/179 (41.9%); P = 0.006]. After controlling for factors pertaining to injury severity, there was no significant difference in patient throughput or incidence of any postoperative ocular symptom/sign after repair between the two centers. Timely management of patients with orbital fractures due to violent trauma is crucial to mitigate the risk of postoperative ocular symptoms/signs.
The Effect of Combined Spinal Epidural Anesthesia on Shoulder Pain in Laparoscopic Extraperitoneal Hernia Surgery
Authors: Guzey Deniz , Donmez Turgut , Karabulut Mehmet , Surek Ahmet , Emir Nalan Saygi , Cayirci Can Ertug , Kandemir Hande , Hatipoglu Engin
Published: March 2024

Background:

Shoulder pain is a condition that seriously discomforts patients and develops caused by a peritoneal tear in laparoscopic extraperitoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out on the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method to prevent shoulder pain in the TEP technique.

Methods:

The patients who operated with the TEP procedure were divided into 2 groups; SA (group 1) and CSEA (group 2). The 2 patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effects, intraoperative, and postoperative complications.

Results:

The number of patients in group 1 was 42 and group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2, respectively, which was statistically significantly shorter in group 1 (P<0.001). Postoperative pain was significantly less in group 2 for the 4th hour (P<0.0001) and the 12th hour (P=0.047). There was no difference between the 2 groups in terms of peritoneal tear (P=0.860). Intraoperative and postoperative shoulder pain was significantly less in group 2 (P=0.038, P=0015, respectively).

Conclusion:

CSEA is an effective and safe anesthesia method for preventing shoulder pain that develops after TEP surgeries.
Endotheliopathy of trauma in children: The association of syndecan-1 with injury and poor outcomes
Authors: Morgan Katrina M. , Abou-Khalil Elissa , Gaines Barbara A. , Leeper Christine M.
Published: March 2024

BACKGROUND

The contribution of the endothelium to trauma-induced coagulopathy has not been thoroughly investigated in injured children.

METHODS

This is a prospective cohort study of children (younger than 18 years) who presented with a potentially severe injury to an academic pediatric trauma center. Syndecan-1 level was collected on arrival and 24 hours following hospital arrival. Children were categorized as injured versus uninjured based on results of trauma evaluation. Demographics, injury characteristics, vital signs, and clinical laboratories were recorded. A composite clinical outcome was defined as death or blood product transfusion within 24 hours of hospital arrival. Statistical tests determined the impact of injury characteristics and therapeutics on syndecan-1 levels and assessed for associations between syndecan-1 level and outcomes.

RESULTS

A total of 121 subjects were included in the analysis: 96 injured (79%) and 25 uninjured (21%). There were no differences between groups in age (median [interquartile range (IQR)], 11 [4–14] years), sex, or race. The injured cohort had a median (IQR) Injury Severity Score of 16 (9–21), 75% had blunt mechanism, 26% were transfused within 6 hours, 3% had 24-hour mortality, and 6% had in-hospital mortality. Median (IQR) syndecan-1 level on admission was significantly higher in injured versus uninjured cohort (44 [21–75] vs. 25 [17–42]; p = 0.04). Admission base deficit was significantly correlated with syndecan-1 level (r = 0.8, p < 0.001); no association with traumatic brain injury or injury mechanism was seen. Children with elevated syndecan-1 on admission had significantly increased odds of poor outcome; every 10 ng/mL increase in syndecan-1 was associated with 10% increased odds of death or transfusion (p < 0.001). Transfusion with any blood product was associated with a significant decrease in syndecan-1 from arrival to 24 hours (Δ syndecan-1, −17 [−64 to −5] vs. −8 [−19 to +2]; p < 0001).

CONCLUSION

Elevated admission syndecan-1 level, suggestive of endotheliopathy, was associated with shock and poor outcomes in pediatric trauma. Larger cohort studies are required to fully describe the complexities of trauma-induced coagulopathy and investigate the benefit of therapies targeting endotheliopathy in children.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.