bluuebunny/crossref_metadata_2025 huggingface dataset:
52. The Association of Cardiovascular Risk Factors and Blood Pressure Changes after Exercise in Coronary Artery Disease Patients
Authors: Ikhsani Rizkania , Tiksnadi Badai Bhatara , Putra Agastya Prabhaswara
Published: April 2023

Background: Changes in blood pressure after exercise and factors affecting it specifically in CAD patients were poorly studied. This study aimed at investigating the association of cardiovascular risk factors and changes of blood pressure among CAD patients after exercise.

Methods: This retrospective study includes 87 CAD patients from cardiac rehabilitation center Dr. Hasan Sadikin General Hospital Bandung that have completed 12 sessions of moderate intensity exercise from December 2021 to November 2022. Blood pressure measured before and immediately after their training session. The change in blood pressure calculated as the mean of it during 12 sessions.

Results: Among 86 patients (95.3% men; mean age 55.93 + 9.9) included in this study, 57% had hypertension, 29.1% had diabetes mellitus (DM), 9.3% had dyslipidemia, and 82.6% had history of smoking. All patients have received at least one antihypertensive therapy. From 970 blood pressure data, the mean SBP and DBP changes after exercise were decreased 8.13mmHg and 3.54mmHg, respectively. Most patients has decreased both SBP and DBP (66 patients; 77%); decreased SBP increased DBP (12.6%); increased both SBP and DBP (5.7%); and increased SBP decreased DBP (4.6%), Sex is the only factor that has association with category of blood pressure changes (p 0.007), while the others (age, hypertension, dyslipidemia, DM, history of smoking) were not.

Conclusion: This study shows that most patients experience a decrease in blood pressure immediately after exercise. Men tend to have increasing blood pressure compared to women. However, other classic cardiovascular risk factors were not associated with the changes.
62. Effect of Dietary Pattern on the Incidence of Hypertension in Geriatric at Cawang, East Jakarta
Authors: Rantung N,H. , Suling F,R,W. , Gowa M. , Lumaksono M. , Widihastuti W. , Suling T,E
Published: April 2023

Background: Geriatrics is the high-risk population to develop hypertension due to their physiology changes. One of the hypertension risk factors in the geriatric population is dietary habits. Poor dietary habits, such as frequent intake of high calories, low-fiber, high-sodium, and low-potassium food can develop hypertension in the geriatric population.

Objectives: This study aims to investigate the effect of dietary patterns and the incidence of hypertension in geriatric living in Cawang, East Jakarta.

Methods: This study is a quantitative cross-sectional study with a random sampling technique and uses the Chi-Square method to analyze the correlation between dietary patterns and blood pressure in the elderly. Blood pressure data were obtained using a manual sphygmomanometer to measure blood pressure and the dietary pattern was evaluated by using the Food Frequency Questionnaire. Hypertension criteria in this study were based on JNC VIII.

Results: There are 65 elderly in Cawang selected by random sampling technique to be in this study. The amount of hypertension cases accounts for 78.5 percent of all subjects. The elderly with frequent and high sodium intake was identified to be 38 people (58.5%), high fat intake was identified in 36 people (55.4%), and low potassium intake was identified in 36 people (55.4%). The correlation between dietary sodium intake and hypertension is significantly shown by the p-value result (p = 0,000), between fat intake and hypertension (p = 0.023), and between potassium intake and hypertension (p = 0.004).

Conclusion: This study shows there is a significant correlation between dietary patterns and hypertension among geriatrics.
Delirium prevention and management in hospitalized older adults
Authors: Blodgett Thomas J.
Published: April 2023

Delirium is a common neurocognitive disorder among hospitalized older adults, and it can have devastating effects. The purpose of this article is to inform NPs in the hospital setting to recognize, prevent, and manage delirium in older adults. The roles of nonpharmacologic and pharmacologic interventions are described.
Melanoma risk prediction based on a polygenic risk score and clinical risk factors
Authors: Wong Chi Kuen , Dite Gillian S. , Spaeth Erika , Murphy Nicholas M. , Allman Richard
Published: April 2023

Melanoma is one of the most commonly diagnosed cancers in the Western world: third in Australia, fifth in the USA and sixth in the European Union. Predicting an individual’s personal risk of developing melanoma may aid them in undertaking effective risk reduction measures. The objective of this study was to use the UK Biobank to predict the 10-year risk of melanoma using a newly developed polygenic risk score (PRS) and an existing clinical risk model. We developed the PRS using a matched case–control training dataset (N = 16 434) in which age and sex were controlled by design. The combined risk score was developed using a cohort development dataset (N = 54 799) and its performance was tested using a cohort testing dataset (N = 54 798).

Our PRS comprises 68 single-nucleotide polymorphisms and had an area under the receiver operating characteristic curve of 0.639 [95% confidence interval (CI) = 0.618–0.661]. In the cohort testing data, the hazard ratio per SD of the combined risk score was 1.332 (95% CI = 1.263–1.406). Harrell’s C-index was 0.685 (95% CI = 0.654–0.715). Overall, the standardized incidence ratio was 1.193 (95% CI = 1.067–1.335). By combining a PRS and a clinical risk score, we have developed a risk prediction model that performs well in terms of discrimination and calibration. At an individual level, information on the 10-year risk of melanoma can motivate people to take risk-reduction action. At the population level, risk stratification can allow more effective population-level screening strategies to be implemented.
Apollo Rising: Acute Conjunctivitis Outbreak in India, 2022
Authors: Prajna Namperumalsamy Venkatesh , Prajna Lalitha , Teja Vishnu , Gunasekaran Ramesh , Chen Cindi , Ruder Kevin , Zhong Lina , Yu Danny , Liu David , Abraham Thomas , Ao Wendy , Deiner Michael , Hinterwirth Armin , Seitzman Gerami D. , Doan Thuy , Lietman Thomas M. ,   on behalf of the SCORPIO (Seasonal Conjunctivitis Outbreak Reporting for Prevention and Improved Outcomes) Study Group
Published: April 2023

Purpose:

The purpose of this study was to identify pathogens associated with the 2022 conjunctivitis outbreak in Tamil Nadu, India.

Methods:

This prospective study was conducted in November 2022. Patients with presumed acute infectious conjunctivitis presenting to the Aravind Eye Clinic in Madurai, India, were eligible. Anterior nares and conjunctival samples from participants were obtained and processed for metagenomic RNA deep sequencing (RNA-seq).

Results:

Samples from 29 patients were sequenced. A pathogen was identified in 28/29 (97%) patients. Coxsackie virus A24v, a highly infectious RNA virus, was the predominant pathogen and detected in 23/29 patients. Human adenovirus D (HAdV-D), a DNA virus commonly associated with conjunctivitis outbreaks, was detected in the remaining patients (5/29). Hemorrhagic conjunctiva was documented in both HAdV-D and Coxsackie virus A24v affected patients but was not the predominant clinical presentation. Phylogenetic analysis of Coxsackie virus A24v revealed a recent divergence from the 2015 outbreak.

Conclusions:

Coxsackie virus A24v and HAdV-D were cocirculating during the 2022 conjunctivitis outbreak in Tamil Nadu, India. Clinical findings were similar between patients with HAdV-D and Coxsackie virus A24v–associated conjunctivitis. As high-throughput sequencing technologies become more readily available and cost-effective, unbiased pathogen surveillance may prove useful for outbreak surveillance and control.
Research progress of viral sepsis: etiology, pathophysiology, diagnosis, and treatment
Authors: Li Jianping , Luo Yiqi , Li Hao , Yin Yunhong , Zhang Yi
Published: April 2023

Sepsis is a common systemic disease characterized by various physiological and pathological disorders. It can result from infection by various pathogens, such as bacteria, viruses, and fungi. The rate of culture-negative sepsis is almost 42%, indicating that most patients may have nonbacterial infections. With the outbreak of coronavirus disease 2019, viral sepsis has attracted growing attention because many critically ill patients develop sepsis. Viral sepsis can be caused by viral infections and combined with, or secondary to, bacterial infections. Understanding the common types of viral sepsis and the main characteristics of its pathogenesis will be helpful for effective diagnosis and treatment, thereby reducing mortality. Early identification of the causative agent of viral sepsis can help reduce the overuse of broad-spectrum antibiotics. In this article, we reviewed the common viruses of sepsis, their potential pathophysiology, targets of diagnosis, and remedies for viral sepsis.
Closed Incision Negative Pressure Therapy in Oncoplastic Breast Surgery: A Comparison of Outcomes
Authors: Wareham Carly M. , Karamchandani Manish M. , Ku Gabriel De La Cruz , Gaffney Kerry , Sekigami Yurie , Persing Sarah M. , Homsy Christopher , Nardello Salvatore , Chatterjee Abhishek
Published: April 2023

Background:

We aim to discern the impact of closed incision negative pressure therapy (ciNPT) on wound healing in the oncoplastic breast surgery population.

Methods:

A retrospective analysis was conducted on patients who underwent oncoplastic breast surgery with and without ciNPT in a single health system over 6 years. Oncoplastic breast surgery was defined as breast conservation surgery involving partial mastectomy with immediate volume displacement or replacement techniques. Primary outcomes were rates of clinically significant complications requiring either medical or operative intervention, including seroma, hematoma, fat necrosis, wound dehiscence, and infection. Secondary outcomes were rates of minor complications.

Results:

ciNPT was used in 75 patients; standard postsurgical dressing was used in 142 patients. Mean age (P = 0.73) and Charlson Comorbidity Index (P = 0.11) were similar between the groups. The ciNPT cohort had higher baseline BMIs (28.23 ± 4.94 versus 30.55 ± 6.53; P = 0.004), ASA levels (2.35 ± 0.59 versus 2.62 ± 0.52; P = 0.002), and preoperative macromastia symptoms (18.3% versus 45.9%; P ≤ 0.001). The ciNPT cohort had statistically significant lower rates of clinically relevant complications (16.9% versus 5.3%; P = 0.016), the number of complications (14.1% versus 5.3% with one complication, 2.8% versus 0% with >2; P = 0.044), and wound dehiscence (5.6% versus 0%; P = 0.036).

Conclusions:

The use of ciNPT reduces the overall rate of clinically relevant postoperative complications, including wound dehiscence. The ciNPT cohort had higher rates of macromastia symptoms, BMI, and ASA, all of which put them at increased risk for complications. Therefore, ciNPT should be considered in the oncoplastic population, especially in those patients with increased risk for postoperative complications.
Technical Feasibility of Whole-eye Vascular Composite Allotransplantation: A Systematic Review
Authors: Laspro Matteo , Chaya Bachar F. , Brydges Hilliard T. , Dave Nikhil , Thys Erika , Onuh Ogechukwu C. , Tran David , Kimberly Laura L. , Ceradini Daniel J. , Rodriguez Eduardo D.
Published: April 2023

Background:

There are over 43 million individuals in the world who are blind. As retinal ganglion cells are incapable of regeneration, treatment modalities for this condition are limited. Since first incepted in 1885, whole-eye transplantation (WET) has been proposed as the ultimate cure for blindness. As the field evolves, different aspects of the surgery have been individually explored, including allograft viability, retinal survival, and optic nerve regeneration. Due to the paucity in the WET literature, we aimed to systematically review proposed WET surgical techniques to assess surgical feasibility. Additionally, we hope to identify barriers to future clinical application and potential ethical concerns that could be raised with surgery.

Methods:

We conducted a systematic review of PubMed, Embase, Cochrane Library, and Scopus from inception to June 10, 2022, to identify articles pertaining to WET. Data collection included model organisms studied, surgical techniques utilized, and postoperative functional outcomes.

Results:

Our results yielded 33 articles, including 14 mammalian and 19 cold-blooded models. In studies performing microvascular anastomosis in mammals, 96% of allografts survived after surgery. With nervous coaptation, 82.9% of retinas had positive electroretinogram signals after surgery, indicating functional retinal cells after transplantation. Results on optic nerve function were inconclusive. Ocular-motor functionality was rarely addressed.

Conclusions:

Regarding allograft survival, WET appears feasible with no complications to the recipient recorded in previous literature. Functional restoration is potentially achievable with a demonstrated positive retinal survival in live models. Nevertheless, the potential of optic nerve regeneration remains undetermined.
Purine anabolism creates therapeutic vulnerability in hepatocellular carcinoma through m6A-mediated epitranscriptomic regulation
Authors: Hung Man Hsin , Chang Ching Wen , Wang Kathy Cheng , Chaisaingmongkol Jittiporn , Ruchirawat Mathuros , Greten Tim F. , Wang Xin Wei
Published: April 2023

Background and Aims:

Purines are building blocks for the cellular genome, and excessive purine nucleotides are seen in tumors. However, how purine metabolism is dysregulated in tumors, and impacting tumorigenesis remains elusive.

Approach and Results:

Transcriptomic and metabolomic analyses of purine biosynthesis and purine degradation pathways were performed in the tumor and associated nontumor liver tissues obtained from 62 patients with HCC, one of the most lethal cancers worldwide. We found that most genes in purine synthesis are upregulated, while genes in purine degradation are inhibited in HCC tumors. High purine anabolism is associated with unique somatic mutational signatures linked to patient prognosis. Mechanistically, we discover that increasing purine anabolism promotes epitranscriptomic dysregulation of DNA damage repairing (DDR) machinery through upregulating RNA N6-methyladenosine (m6A) modification. High purine anabolic HCC is sensitive to DDR-targeting agents but not to standard HCC treatments, correlating with the clinical outcomes in 5 independent HCC cohorts containing 724 patients. We further showed that high purine anabolism determines the sensitivity to DDR-targeting agents in 5 HCC cell lines in vitro and in vivo.

Conclusions:

Our results reveal a central role of purine anabolism in regulating DDR, which could be therapeutically exploited in HCC.
Topical Ripasudil for the Treatment of Segmental Corneal Edema: A Case Series
Authors: Tseng Michael , Feder Robert
Published: April 2023

Purpose:

Ripasudil, a rho-kinase inhibitor, has gained popularity as an adjunctive therapy after Descemet stripping only to hasten visual recovery. Ripasudil has been shown to increase corneal endothelial cell proliferation and intercellular adhesion, and decrease endothelial cell apoptosis. We present 4 cases in which persistent corneal edema after various anterior segment surgeries was successfully treated with topical ripasudil, and 1 case in which corneal edema did not improve with use of ripasudil.

Methods:

Retrospective chart review revealed 5 patients treated with topical ripasudil for persistent corneal edema that failed to improve with conventional, nonsurgical treatments.

Results:

In each case, the patient had symptomatic, persistent, focal corneal edema which followed a surgical procedure in the anterior segment. The various etiologies of corneal edema included graft failure after Descemet stripping endothelial keratoplasty, a failed penetrating keratoplasty, and 3 cases of pseudophakic corneal edema. These patients experienced improved vision and partial or complete resolution of corneal edema after 2 to 4 weeks of topical ripasudil administered 4 times daily. One patient with pseudophakic bullous keratopathy had edema that initially improved on topical ripasudil, but after cessation of the medication, developed progressive corneal edema and required endothelial keratoplasty.

Conclusions:

In patients with focal corneal edema resulting from surgical trauma to the endothelium who failed to clear over time with conservative measures, topical ripasudil was shown to be an effective treatment option that in most cases improved vision and helped reduce the need for endothelial transplantation.
The role of eye banking with cell-based therapies
Authors: Tran Lillian T. , Li Jennifer Y.
Published: April 2023

Purpose of review

Cell-based therapies are an exciting new frontier in managing corneal diseases. The introduction of these novel therapies may provide new alternatives to corneal transplantation and decrease the dependence on donor corneal tissue. These changes have the potential to significantly impact eye banking in the future.

Recent findings

The current article reviews current research involving cell-based therapy for treating corneal disorders, including cultivated limbal stem cell transplantation, limbal mesenchymal stem cells for stromal regeneration, and the use of human-cultivated endothelial cells. We will look at barriers to the development and implementation of these therapies.

As corneal surgery expands to include cell-based therapies; eye banks will need to redefine their role to support the everchanging landscape of corneal surgery and the decreased demand for corneal donor tissue.
Duloxetine for rehabilitation after total knee arthroplasty: a systematic review and meta-analysis
Authors: Yang Jia-Man , Wang Yi , Li Jun-Yi , Li Cong-Cong , Wang Zhen-Tao , Shen Zhen , Ou Liang , Chen Ze-Hua
Published: April 2023

Objective:

The aim was to evaluate the efficacy and safety of duloxetine for postoperative recovery after total knee arthroplasty.

Methods:

The following electronic databases were searched for eligible trials: PubMed, EMBASE, Web of Science, Cochrane Library, VIP, Wanfang Data, and China National Knowledge Infrastructure (CNKI). The search was performed from the inception dates to 10 August 2022. Data extraction and quality assessment were performed by two independent reviewers. Standard mean differences or mean differences with 95% CIs for pooled data were calculated. The primary outcomes were pain, physical function, and analgesic consumption. Secondary outcomes included range of motion (ROM) of the knee, depression, and mental health.

Results:

This meta-analysis included 11 studies, reporting on a total of 1019 patients. Results of analyses indicated that duloxetine showed a statistically significant reduction in pain at rest at 3 days, 1 week, 2, and 6 weeks and pain on movement at 5 days, 1 week, 2, 4, 6, and 8 weeks. However, there was no statistical significance in pain at rest and on movement at 24 h, 12 weeks, 6 months, and 12 months. Additionally, duloxetine had a significant improvement in physical function, ROM of the knee at 6 weeks, and emotional function (depression and mental health). Moreover, the cumulative opioid consumption at 24 h in the duloxetine groups was lower than in the control groups. But there was no statistical significance for the cumulative opioid consumption over 7 days between the duloxetine groups and controls.

Conclusions:

In conclusion, duloxetine might reduce pain mainly over a time span of 3 days–8 weeks and lower cumulative opioid consumption within 24 h. In addition, it improved physical function, ROM of the knee with a time span of 1–6 weeks and emotional function (depression and mental health).
The Inheritance and Development of Chinese Narrative Medicine Practice to the Philosophical Wisdom of Traditional Chinese Medicine
Authors: YANG Xiaolin
Published: April 2023

Starting from the inheritance and promotion of Chinese life philosophy and traditional Chinese medicine wisdom by Chinese narrative medicine practice, this paper discusses the inheritance and echo relationship between the “close textual reading ability” in Chinese narrative medicine practice and the “four diagnoses” in traditional Chinese medicine wisdom, narrative mediation and the “mind-body holistic philosophy” in traditional Chinese medicine, and narrative wisdom and Dao Sheng in Chinese life philosophy. Meanwhile, by analyzing the stories of contemporary doctors’ practice of narrative intelligence, this paper expounds that Chinese narrative medicine is a new model of medical education and clinical practice based on the absorption of Chinese traditional life wisdom and the essence of traditional Chinese medicine culture, and the integration of western narrative medicine concepts. It also advocates Chinese scholars to actively build the discipline of “narrative traditional Chinese medicine,” constantly translate the academic achievements to foreign countries, and create a good narrative ecology of traditional Chinese medicine.
Evolving trends in inpatient paediatric dermatology
Authors: Pineider Juliana , Oza Vikash S. , Cipriano Sarah D.
Published: April 2023

Purpose of review

This review provides updates in the evaluation and management of key dermatologic diseases encountered in the hospitalized child.

Recent findings

Our understanding of dermatologic disorders in children continues to evolve. Staphylococcal scalded skin syndrome (SSSS) is a potentially severe blistering disorder typically seen in children under the age of 4 with an incidence that is increasing in the United States. Recent research has highlighted that the majority of cases are due to methicillin-sensitive Staphylococcus aureus (MSSA) and most patients can be adequately managed with beta-lactams. Toxic epidermal necrolysis (TEN) is one of the most feared dermatologic disorders. Currently, there is a lack of consensus on the most efficacious first-line systemic therapy. Etanercept is increasingly being used based on studies showing a shorter time to re-epithelization and decreased mortality. Lastly, the COVID-19 pandemic introduced the novel inflammatory condition multisystem inflammatory syndrome in children (MIS-C) in which approximately three out of four children present with a mucocutaneous eruption. Early recognition of the dermatologic features of MIS-C is important in potentially establishing a diagnosis and differentiating it from the many other causes of childhood fever and rash.

There are no clear universal treatment guidelines for these rare diagnoses, and therefore, clinicians must remain informed of the latest findings in diagnosis and therapeutics.
Cardiac toxic effect of radiation therapy in patients receiving adjuvant trastuzumab treatment, as examined by LVEF of echocardiography: an experimental research
Authors: Khandoozi Reza , Gelvardi Mohsen S. , Khoshbin Khoshnazar Alireza
Published: April 2023

Background:

Radiation in breast cancer patients may result in cardiovascular disease affecting the pericardium, myocardium, and cardiac valves.

Objective:

This study aimed to evaluate the cardiotoxic consequences of radiotherapy in breast cancer patients who underwent adjuvant trastuzumab treatment by echocardiographic left ventricular ejection fraction (LVEF) measurement.

Methods:

In this retrospective study patients treated with postoperative breast irradiation with adjuvant trastuzumab were examined in terms of LVEF. Eithy five patients with age of 31–76 referred to the radiotherapy department of 5 Azar Hospital of Gorgan, Iran between years 2013 and 2020 were analyzed. Patients were divided into two left sided and right sided breast groups. Patients are routinely assessed every 3 months by echocardiocraphgy. LVEF values was measured at intervals of 3, 6, and 12 months after treatment onset.

Result:

On the left side, the average of LVEF immediately decreased after treatment, compared to before treatment (∆ LVEF= 0.021), which shows the impact of trastuzumab. The LVEF average 3 months after treatment onset showed a significant decrease (∆ LVEF= 0.043) indicating a synergistic effect of trastuzumab and radiotherapy. LVEF average 6 months and 1 year after treatment onset showed a decrease but not significant (∆ LVEF= 0.009 and 0.013, respectively).In the right breast LVEF average immediately 3 months after treatment showed a significant decrease (∆ LVEF= 0.011 and 0.057, respectively). Nevertheless, LVEF average does not show a significant decrease after 6 months and 1 year after treatment in the right side group (∆ LVEF= 0.0002 and 0.018, respectively).

Conclusion:

Our results showed LVEF changes within one year following treatment in left sided breast cancer was more than right side , but the difference was not significant ,which may be due to the short period of our study based on the protocol of our department. More changes in the left side must be due to placing of the heart in the path of radiation. The study showed that LVEF may be an indicative measure for assessing radiation and adjuvant treatment effects on cardiac function.
Impact of Phlebotomy Volume Knowledge on Provider Laboratory Ordering and Transfusion Practices in the Pediatric Cardiac ICU
Authors: LaCroix Gary A. , Danford David A. , Marshall Amanda M.
Published: April 2023

Objectives:

Phlebotomy can account for significant blood loss in post-surgical pediatric cardiac patients. We investigated the effectiveness of a phlebotomy volume display in the electronic medical record (EMR) to decrease laboratory sampling and blood transfusions. Cost analysis was performed.

Design:

This is a prospective interrupted time series quality improvement study. Cross-sectional surveys were administered to medical personnel pre- and post-intervention.

Setting:

The study was conducted in a 19-bed cardiac ICU (CICU) at a Children’s hospital.

Patients:

One hundred nine post-surgical pediatric cardiac patients weighing 10 kg or less with an ICU stay of 30 days or less were included.

Interventions:

We implemented a phlebotomy volume display in the intake and output section of the EMR along with a calculated maximal phlebotomy volume display based on 3% of patient total blood volume as a reference.

Measurements and Main Results:

Providers poorly estimated phlebotomy volume regardless of role, practice setting, or years in practice. Only 12% of providers reported the availability of laboratory sampling volume. After implementation of the phlebotomy display, there was a reduction in mean laboratories drawn per patient per day from 9.5 to 2.5 (p = 0.005) and single electrolytes draw per patient over the CICU stay from 6.1 to 1.6 (p = 0.016). After implementation of the reference display, mean phlebotomy volume per patient over the CICU stay decreased from 30.9 to 14.4 mL (p = 0.038). Blood transfusion volume did not decrease. CICU length of stay, intubation time, number of reintubations, and infections rates did not increase. Nearly all CICU personnel supported the use of the display. The financial cost of laboratory studies per patient has a downward trend and decreased for hemoglobin studies and electrolytes per patient after the intervention.

Conclusions:

Providers may not readily have access to phlebotomy volume requirements for laboratories, and most estimate phlebotomy volumes inaccurately. A well-designed phlebotomy display in the EMR can reduce laboratory sampling and associated costs in the pediatric CICU without an increase in adverse patient outcomes.
18F-FDG PET–Positive Large Pelvic Granuloma Mimicking Malignant Bladder Tumor
Authors: Altintas Taslicay Ceylan , Cam Isa , Civriz Aziz Hakki , Kara Onder , Demir Hakan
Published: April 2023

An 88-year-old man was admitted to our hospital with a recurrent lower urinary tract infection. He had a history of open prostatectomy for benign prostatic hyperplasia 15 years ago and smoking. A mass arising within a bladder diverticula was suspected on the left lateral wall of the bladder on ultrasonography. Although no mass was observed in the bladder lumen on the cystoscopy, abdominal CT detected a left-sided pelvic soft tissue mass. A hypermetabolic mass was detected on 18F-FDG PET/CT performed because of suspicion of malignancy, and it was excised. Granuloma secondary to chronic vasitis was diagnosed histopathologically.
Functional Magnetic Resonance Spectroscopy of Lactate in Alzheimer Disease: A Comprehensive Review of Alzheimer Disease Pathology and the Role of Lactate
Authors: Shirbandi Kiarash , Rikhtegar Reza , Khalafi Mohammad , Mirza Aghazadeh Attari Mohammad , Rahmani Farzaneh , Javanmardi Pouya , Iraji Sajjad , Babaei Aghdam Zahra , Rezaei Rashnoudi Amir Mohammad
Published: April 2023

Functional 1H magnetic resonance spectroscopy (fMRS) is a derivative of dynamic MRS imaging. This modality links physiologic metabolic responses with available activity and measures absolute or relative concentrations of various metabolites. According to clinical evidence, the mitochondrial glycolysis pathway is disrupted in many nervous system disorders, especially Alzheimer disease, resulting in the activation of anaerobic glycolysis and an increased rate of lactate production. Our study evaluates fMRS with J-editing as a cutting-edge technique to detect lactate in Alzheimer disease. In this modality, functional activation is highlighted by signal subtractions of lipids and macromolecules, which yields a much higher signal-to-noise ratio and enables better detection of trace levels of lactate compared with other modalities. However, until now, clinical evidence is not conclusive regarding the widespread use of this diagnostic method. The complex machinery of cellular and noncellular modulators in lactate metabolism has obscured the potential roles fMRS imaging can have in dementia diagnosis. Recent developments in MRI imaging such as the advent of 7 Tesla machines and new image reconstruction methods, coupled with a renewed interest in the molecular and cellular basis of Alzheimer disease, have reinvigorated the drive to establish new clinical options for the early detection of Alzheimer disease. Based on the latter, lactate has the potential to be investigated as a novel diagnostic and prognostic marker for Alzheimer disease.
CT Volumetry Can Be Used for Monitoring Liver Function Recovery in Auxiliary Partial Orthotopic Liver Transplantation
Authors: Kirchner Antoine , Ronot Maxime , Durand Francois , Dondero Federica , Lesurtel Mickael , Francoz Claire , Roux Olivier , Lebtahi Rachida , Vilgrain Valérie , Dioguardi Burgio Marco
Published: April 2023

Background.

Scintigraphy with a 99mTC-trimethyl-Br-IDA tracer (TBIDA) is used to monitor liver function regeneration after auxiliary partial orthotopic liver transplantation (APOLT) for acute liver failure (ALF). As computed tomography (CT) is also regularly performed during patient follow-up, CT volumetry could be used as an alternative to monitor native liver recovery after APOLT for ALF.

Methods.

This was a retrospective cohort study of all patients who underwent APOLT (October 2006–July 2019). Collected data included liver graft and native liver CT volumetry measurements (expressed as fractions), TBIDA scintigraphy results, and biological and clinical data including immunosuppression therapy after APOLT. Four follow-up time points were defined (baseline, discontinuation of mycophenolate mofetil, beginning of tacrolimus reduction, and tacrolimus discontinuation) for analysis.

Results.

Twenty-four patients (7 men; median age 28.5 y old) were included. The main etiologies of ALF were acetaminophen intoxication (n = 12), hepatitis B virus (n = 5), and amanita phalloides intoxication (n = 3). The median native liver function fractions on scintigraphy at baseline, at discontinuation of mycophenolate mofetil, at tacrolimus reduction, and at tacrolimus discontinuation were 22.0% (interquartile range 14.0–30.8), 30.5% (21.5–49.0), 32.0% (28.0–62.0), and 93.0% (77.0–100.0), respectively. The corresponding median native liver volume fractions on CT were 12.8% (10.4–17.3), 20.5% (14.2–27.3), 24.7% (21.3–48.4), and 77.9% (62.5–96.9), respectively. Volume and function were strongly correlated (r = 0.918; 95% confidence interval, 0.878–0.945; P < 0.01). Median time-to-immunosuppression discontinuation was 25.0 (17.0–35.0) mo. Estimated time-to-immunosuppression discontinuation was shorter in patients with acetaminophen-induced ALF (22 versus 35 mo; P = 0.035).

Conclusions.

In patients who receive APOLT for ALF, CT-based liver volumetry closely parallels native liver function recovery evaluated on TBIDA scintigraphy.
Assessment of ChatGPT in the preclinical management of ophthalmological emergencies – an analysis of ten fictional case vignettes
Authors: Knebel Dominik , Priglinger Siegfried , Scherer Nicolas , Siedlecki Jakob , Schworm Benedikt
Published: April 2023

Background/Aims

The artificial intelligence (AI) based platform ChatGPT (Chat Generative Pre-Trained Transformer, OpenAI LP, San Francisco, CA, USA) has gained an impressing popularity over the past months. Its performance on case vignettes of general medical (non-ophthalmological) emergencies has priorly been assessed with very encouraging results. The purpose of this study is to assess the performance of ChatGPT on ophthalmological emergency case vignettes in terms of the main outcome measures triage accuracy, appropriateness of recommended preclinical measures and overall potential to inflict harm to the user/patient.

Methods

We wrote ten short, fictional case vignettes describing different acute ophthalmological symptoms. Each vignette was entered into ChatGPT five times with the same wording and following a standardized interaction pathway. The answers were analysed in a standardised manner.

Results

We observed a triage accuracy of 87.2%. Most answers contained only appropriate recommendations for preclinical measures. However, an overall potential to inflict harm to users/patients was present in 32% of answers.

Conclusion

ChatGPT should not be used as a stand-alone primary source of information about acute ophthalmological symptoms. As AI continues to evolve, its safety and efficacy in the preclinical management of ophthalmological emergencies has to be reassessed regularly.
Bushfire-smoke trigger hospital admissions with cerebrovascular diseases: evidence from 2019-20 bushfire in Australia
Authors: Hasnain Md Golam , Garcia-Esperon Carlos , Tomari Yumi , Walker Rhonda , Saluja Tarunpreet , Rahman Md Mijanur , Boyle Andrew , Levi Christopher R , Naidu Ravi , Filippelli Gabriel , Spratt Neil J
Published: April 2023

Background

Exposure to ambient air pollution is strongly associated with increased cerebrovascular diseases. The 2019–20 bushfire season in Australia burnt 5.4 million hectares of land in New South Wales alone, with smoke so severe it affected cities in Argentina, 11,000 km away. We aimed to determine the effects of i) short-term air pollution triggered by bushfires and ii) high smoke days in increasing the daily number of hospital admissions with cerebrovascular diseases.

Methods

Hospitalisation data were accessed from the admitted patient dataset from seven local Government areas of Hunter New England Local Health District. The bushfire period was defined from 1 October 2019 to 10 February 2020, and a similar period from 2018-19 as the control. High bushfire smoke days were days when the average daily concentration of particulate matter was higher than the 95thpercentile of the control period. Poisson regression models and fixed effect meta-analysis were used to analyse the data.

Results

In total, 275 patients with cerebrovascular admissions were identified, with 147 (53.5%) during the bushfire (2019-20) and 128 (46.5%) in the control period (2018-19). There was no significant increase in daily cerebrovascular disease (Incidence Rate Ratio, IRR: 1.04; 95% CI: 0.98-1.05; p-value: 0.73) or ischemic stroke (IRR: 1.18; 95% CI: 0.87-1.59; p-value: 0.28) admissions over the entire bushfire period. However, the high bushfire smoke days were associated with increased ischaemic stroke-related hospital admissions with a lag of 0-1 days (IRR: 1.28; 95% CI: 1.01-1.62; I2=18.9%). In addition, during the bushfire period, particulate matter, both PM10and PM2.5(defined as particulates that have an effective aerodynamic diameter of 10 microns, and 2.5 microns, respectively), were also associated with increased ischaemic stroke admissions with a lag of 0 to 3 days.

Conclusion

The results suggested an association between particulate matter and high smoke days with increased hospital admissions due to cerebrovascular diseases during the recent Australian bushfire season.
Developing a context-relevant psychosocial stimulation intervention to promote cognitive development of children with severe acute malnutrition in Mwanza, Tanzania
Authors: Jensen C. L. , Sanga E. , Kitt H. , PrayGod G. , Kunzi H. , Setebe T. , Filteau S. , Webster J. , Gladstone M. , Olsen M. F.
Published: April 2023

More than 250 million children will not meet their developmental potential due to poverty and malnutrition. Psychosocial stimulation (PS) has shown promising effects for improving development in children exposed to severe acute malnutrition (SAM) but programs are rarely implemented. In this study, we used qualitative methods to inform the development of a PS programme to be integrated with SAM treatment in Mwanza, Tanzania. We conducted in-depth interviews with seven caregivers of children recently treated for SAM and nine professionals in early child development. We used thematic content analysis and group feedback sessions and organised our results within the Nurturing Care Framework. Common barriers to stimulate child development included financial and food insecurity, competing time demands, low awareness about importance of responsive caregiving and stimulating environment, poor father involvement, and gender inequality. Caregivers and professionals suggested that community-based support after SAM treatment and counselling on PS would be helpful, e.g. how to create homemade toys and stimulate through involvement in everyday chores. Based on the findings of this study we developed a context-relevant PS programme. Some issues identified were structural highlighting the need for programmes to be linked with broader supportive initiatives.

Key findings

Financial insecurity, competing time constraints, lack of awareness and poor father involvement are all barriers highlighted by families with children who have severe acute malnutrition (SAM) as negatively impacting their ability to promote nurturing care and child development.

Despite knowledge of the importance of good health and adequate nutrition as important contributors to child development, caregivers of children with SAM did not always have the resources to support this.

Caregivers interviewed were less familiar with the importance of responsive caregiving and opportunities for early learning as ways to support children’s development.

A context-relevant programme to support psychosocial development among young children treated for SAM should include clear linkages with community-based support after discharge, but also approaches to promote involvement of fathers in childcare, and counselling of caregivers on low-cost strategies to improve nutrition and development.

Other supporting social welfare initiatives in the community are needed to address the broader structural issues identified in this study.
Estimates of the global burden of Congenital Rubella Syndrome, 1996-2019
Authors: Vynnycky Emilia , Knapp Jennifer K , Papadopoulos Timos , Cutts Felicity T , Hachiya Masahiko , Miyano Shinsuke , Reef Susan E
Published: April 2023

Background

Many countries introduced rubella-containing vaccination (RCV) after 2011, following changes in recommended World Health Organization (WHO) vaccination strategies and external support. The full impact of these introductions is unknown as previous estimates of the global burden of Congenital Rubella Syndrome (CRS) considered the period 1996-2010.

Methods

We updated a previously-published literature review to identify rubella seroprevalence studies among unvaccinated populations. These were used in an age-structured transmission model, including routine and campaign vaccination coverage to estimate the CRS incidence during 1996-2019 in each country, each region and globally.

Findings

For 2019, the highest CRS incidence was estimated for the WHO African (AFR) and Eastern Mediterranean (EMR) regions (64 (95% CI: 24-123) and 27 (95% CI: 4-67) per 100,000 live births respectively), where nearly half of births occur in countries that have introduced RCV.. In regions elsewhere, where over 95% of births occurred in countries which had introduced RCV, the estimated CRS incidence was low (<1 (95% CI: <1-8) and <1 (95% CI: <1-12) per 100,000 live births in the South East Asian (SEAR) and Western Pacific (WPR) regions respectively, and similarly in Europe and the Americas). The estimated number of CRS births globally declined by approximately two thirds from 100,000 (95% CI: 54,000-166,000) in 2010 to 32,000 (95% CI: 13,000-60,000) by 2019, with the biggest falls in SEAR and WPR.

Interpretation

The introduction of RCV in SEAR and WPR led to dramatic regional and global reductions in the CRS incidence since 2010. Introducing RCV in the remaining countries and maintaining high RCV coverage can result in further reductions.

Funding

Gavi the Vaccine Alliance via the Vaccine Impact Modelling Consortium (VIMC). VIMC is jointly funded by Gavi the Vaccine Alliance and the Bill and Melinda Gates Foundation (BMGF grant number: OPP1157270).
A comparative national-level analysis of government food system resilience activities in preparation for future food system disruptions
Authors: Lloyd Jane , Moore E.R.H. , Dowell Lyndsey , Neff Roni
Published: April 2023

Background:The COVID-19 pandemic, extreme weather events, and the Russian invasion of Ukraine have highlighted global food system vulnerabilities and a lack of preparedness and prospective planning for increasingly complex disruptions. This has spurred an interest in food system resilience. Despite the elevated interest in food system resilience, there is a lack of comparative analyses of national-level food system resilience efforts. An improved understanding of the food system resilience landscape can support and inform future policies, programs, and planning.

Methods:We conducted a cross-country comparison of national-level food system resilience activities from Australia, Aotearoa (New Zealand), Sweden, and the United States. We developed upon and adapted the resilience framework proposed by Harris and Spiegel to compare actions derived from thirteen national food system resilience documents. We coded the documents based on how the governments determined actions by food system resilience attribute utilized, part of the food supply chain, specific shocks or stressors, implementation level, the temporal focus of action, and the expected impact on food security. We analyzed and compared countries’ coded categories, subcategories, and category combinations.

Results:The results showed that countries are using multi-pronged policy actions to address food system resilience issues and are focused on both retrospective reviews and prospective models of disruptive events to inform their decisions. Some work has been done towards preparing for climate change and other natural disasters, but not as much for other shocks or stressors.

Conclusions:The analysis identified potential gaps, concentrations, and themes in national food systems resilience. The framework can be applied to augment existing policy, create new policy, as well as to supplement and complement other existing frameworks.
Diagnostic Utility of Brain MRI in Spontaneous Intracerebral Hemorrhage: A Retrospective Cohort Study and Meta-Analysis
Authors: Wilson Mitch , Wang Jia-Yi , Andreev Alexander , Katsanos Aristeidis H. , Selim Magdy , Lioutas Vasileios-Arsenios
Published: April 2023

Background

The diagnostic yield of brain Magnetic Resonance Imaging (MRI) in spontaneous intracerebral hemorrhage (ICH) is unclear. We performed both an independent single-center retrospective cohort study and a meta-analysis to assess the detection rate of secondary lesions on MRI in patients with spontaneous ICH.

Methods

In the retrospective cohort study, we examined 856 consecutive patients with spontaneous ICH. Brain MRI scans on admission and follow-up were assessed for secondary lesions. We also examined clinical and CT radiographic variables associated with secondary lesions in univariable analysis. In the meta-analysis we searched PubMed and EMBASE for articles investigating the secondary lesion detection rate on brain MRI in spontaneous ICH. Random-effects models were used to calculate the pooled estimate of secondary lesion detection rate. The meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Of the 856 patients with ICH, 481 (56%) had at least one brain BRI performed [70±14 years, 270(56% male)]. 462(54%) had an admission MRI and 138(16%) had both admission and follow-up MRIs. The detection rate of secondary lesions on admission MRIs was 24/462(5.2%). 4/127(3.1%) patients with a negative admission MRI had a lesion identified on follow-up MRI. No clinical or radiographic variables were associated with a secondary lesion on MRI using univariable analysis. The meta-analysis included 5 studies total (4 identified in the PubMed and EMBASE searches as well as our own cohort study) comprising 1147 patients with spontaneous ICH who underwent brain MRI. The pooled detection rate of secondary lesions was 11% (95%CI: 7-16%).

Conclusions

No predictors of secondary lesion detection were identified in our cohort study. Prospective studies are required to better understand the diagnostic utility of MRI in spontaneous ICH.
AI-based histologic scoring enables automated and reproducible assessment of enrollment criteria and endpoints in NASH clinical trials
Authors: Iyer Janani S. , Pokkalla Harsha , Biddle-Snead Charles , Carrasco-Zevallos Oscar , Lin Mary , Shanis Zahil , Le Quang , Juyal Dinkar , Pouryahya Maryam , Pedawi Aryan , Hoffman Sara , Elliott Hunter , Leidal Kenneth , Myers Robert P. , Chung Chuhan , Billin Andrew N. , Watkins Timothy R. , Resnick Murray , Wack Katy , Glickman Jon , Burt Alastair D. , Loomba Rohit , Sanyal Arun J. , Montalto Michael C. , Beck Andrew H. , Taylor-Weiner Amaro , Wapinski Ilan
Published: April 2023

Clinical trials in nonalcoholic steatohepatitis (NASH) require histologic scoring for assessment of inclusion criteria and endpoints. However, guidelines for scoring key features have led to variability in interpretation, impacting clinical trial outcomes. We developed an artificial intelligence (AI)-based measurement (AIM) tool for scoring NASH histology (AIM-NASH). AIM-NASH predictions for NASH Clinical Research Network (CRN) grades of necroinflammation and stages of fibrosis aligned with expert consensus scores and were reproducible. Continuous scores produced by AIM-NASH for key histological features of NASH correlated with mean pathologist scores and with noninvasive biomarkers and strongly predicted patient outcomes. In a retrospective analysis of the ATLAS trial, previously unmet pathological endpoints were met when scored by the AIM-NASH algorithm alone. Overall, these results suggest that AIM-NASH may assist pathologists in histologic review of NASH clinical trials, reducing inter-rater variability on trial outcomes and offering a more sensitive and reproducible measure of patient therapeutic response.