bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Aspects of Fusiform and Saccular Extracranial Carotid Artery Aneurysms
Authors: Miksić K. , Flis V. , Košir G. , Pavlovič M. , Tetičkovič E.
Published: September 2024

The purpose of this paper is to analyse surgical aspects of aneurysms of the distal extracranial internal carotid artery. Nine cases of extracranial carotid artery aneurysm are reported. Five were fusiform, located at the carotid bifurcation, and four were saccular, confined to the internal carotid artery. An end-to-end plication technique and Dacron patch angioplasty were employed for all fusiform aneurysms. In three saccular lesions, resection and 4-mm polytetrafluoroethylene (PTFE) graft interposition were carried out. In one case with a high lesion, ligation of the carotid artery was performed. Ligation resulted in severe postoperative stroke and fatal outcome. One patient with a saccular lesion developed a transient ischaemic attack after the operation. In other patients no central neurological deficit was produced by the surgery itself. Transient cranial nerve damage occurred in four patients (two hypoglossal nerve; two superior laryngeal nerve). As demonstrated by these cases, synthetic material may be used in restoration of the carotid artery. It is concluded that, according to type, location of the aneurysm and adequacy of contralateral cerebral blood flow, selective management is necessary.
Admission to an Intensive Care Unit after Transvenous Implantable Cardioverter Defibrillator Implantation: Analysis of Risk Factors
Authors: Chalabi K. G. , Rastan A. , Herse B. , Dalichau H.
Published: September 2024

A retrospective review was undertaken of 90 patients admitted to the cardiothoracic intensive care unit and who comprised 47% of all transvenous implantable cardioverter defibrillator operations performed between March 1991 and August 1995. The review aimed to evaluate the necessity for routine postoperative intensive care unit (ICU) admission after implantable cardioverter defibrillator operation. Pre-, intra- and postoperative data were analysed. Eight of 90 patients (9%) subsequently required care unique to the ICU. None of the variables examined, including the Acute Physiology Score (APACHE II system), was helpful in identifying patients who required unique ICU services. Patients undergoing transvenous implantable cardioverter defibrillator surgery are identified as a low risk group requiring in over 90% of cases monitoring services rather than active therapy in an ICU. As no reliable predictors seem to exist to identify the necessity for postoperative ICU admission, cardioverter defibrillator implantations should only be performed in hospitals where adequate facilities are readily available.
Coronary Artery Bypass Surgery without Cardiopulmonary Bypass
Authors: Tezcaner T. , Çatav Z. , Yorgancioğlu C. , Moldibi O. , Süzer K. , Zorlutuna I.Y.
Published: September 2024

In the years 1994 and 1995, 1087 patients underwent coronary artery bypass grafting at our institution. Of these, 297 were operated on without cardiopulmonary bypass. 239 were male, and 58 were female. Their ages ranged from 28 to 81 years (54.43 ± 9.63). Of the total, 294 were operated on electively, two as a coronary reoperations, and one as an emergency after a failed percutaneous transluminal coronary angioplasty procedure. In all patients complete revascularization was the aim, and a cardiopulmonary bypass team was kept on standby. Median sternotomy was performed as the exposure in all patients, except a patient who underwent a coronary reoperation through a left thoracotomy incision. The average of the distal anastomoses was 1.51 ± 0.6, ranging from 1 to 3. The left internal thoracic artery was used in 292 operations, which was an individual graft in 284, a sequential graft in five, and a free graft in four. Major complications in the early postoperative period were noted in three patients as reoperation for excessive bleeding. One patient had reoperation for left internal thoracic artery spasm, and one patient had lower extremity ischemia caused by intraoartic balloon counterpulsation. Hospital mortality was 0.3% with one patient. It is our belief that in selected cases coronary artery bypass grafting without cardiopulmonary bypass is a safe procedure with the advantage of improvement in recovery during the postoperative period.
Management of Isolated Common Iliac Artery Aneurysms
Authors: Kasirajan V. , Hertzer N. R. , Beven E. G. , O'Hara P. J. , Krajewski L. P. , Sullivan T. M.
Published: September 2024

Purpose:

Since isolated common iliac artery aneurysms are rare and there is no consensus regarding some aspects of their management, we reviewed our recorded experience with common iliac artery aneurysms from 1977 through 1993.

Methods:

We were able to identify 25 patients having a total of 33 common iliac artery aneurysms on the basis of information maintained by our medical records staff, old surgical logs and a departmental registry that was implemented in 1989. Follow-up data were collected from outpatient charts and by telephone contact. New imaging studies were obtained for 14 patients who either underwent common iliac artery aneurysm repair without aortic replacement (aortic ultrasound scans, n = 7) or had no surgical treatment whatsoever (computerized tomography of the abdomen and pelvis, n = 7).

Results:

All 25 patients were men (mean age, 71 years). Eighteen patients (72%) had elective ( n = 14) or urgent ( n = 4) operations to repair common iliac artery aneurysms with mean diameters of 3.8 cm and 5.8 cm, respectively. There was one postoperative death (5.5%) in conjunction with complementary renal revascularization in a patient with preoperative renal insufficiency. During a mean follow-up period of 50 months, two (29%) of the seven patients who had not received bifurcation grafts at the time of their common iliac artery aneurysm procedures had developed infrarenal aortic aneurysms. Seven (28%) of the original 25 patients were observed without intervention for common iliac artery aneurysms measuring 2–2.5 cm in diameter. No common iliac artery aneurysm enlargement or new aortic aneurysms have been documented in any of these patients at a mean follow-up interval of 57 months.

Conclusions:

In our limited experience, the risk for spontaneous rupture appears to be concentrated among common iliac artery aneurysms exceeding 5 cm in diameter, while those that are less than 3 cm in diameter may fail even to enlarge under observation. Therefore, common iliac artery aneurysms measuring ≥ 3 cm in size probably warrant surgical treatment, at which time simultaneous aortic replacement also should be a serious consideration.
25th Annual Vascular Surgery Seminar and Meeting of the Society for Military Vascular Surgery
Authors: Rich Norman M.
Published: September 2024

The 25th Annual (Silver Anniversary) Vascular Surgery Seminar and Meeting of the Society for Military Vascular Surgery was held in the Jay P. Sanford Auditorium at the F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USUHS). 4–6 December 1997. This highly successful exchange included active duty military surgeons, military surgeons in the reserves, retired military officers continuing second careers in civilian vascular surgery, distinguished visiting professors from the United States and abroad. International Guest Scholars, USUHS Faculty as well as colleagues and friends. The emphasis continued to be directed to ensuring that military vascular surgery remains current, recognizing the rich heritage of contributions to vascular surgery in general that have come from surgeons serving on battlefields around the world, particularly in this 20th century.
Five-Year Experience with Endovascular Grafts for the Treatment of Aneurysmal, Occlusive and Traumatic Arterial Lesions
Authors: Ohki T. , Veith F. J.
Published: September 2024

Standard therapy for most aneurysmal, occlusive, and traumatic arterial lesions has historically consisted of surgical exposure and repair or placement of an interposition bypass graft. Endovascular grafting techniques are an alternative treatment. These techniques blend stent and graft technology and enable a vascular graft to be placed from a remote access site under fluoroscopic guidance to treat a variety of arterial lesions. The major advantage of this approach is its less invasive nature. During the last 5 years, 234 endovascular grafts have been implanted at Montefiore Medical Center to treat a variety of arterial lesions including aneurysms, occlusions and traumatic or iatrogenic injuries. Although many of these procedures were complex and difficult, results have improved steadily as appropriate devices, techniques and indications have been developed. These endovascular grafts have facilitated successful treatment in many patients and have permitted correction of limb- or life-threatening lesions in some patients who would otherwise be impossible or difficult to treat. Based on this 5-year experience, it is likely that endovascular grafts will play an important role in the future treatment of various types of arterial pathology. Although the value and limitations of endovascular graft for the treatment of aneurysmal and occlusive lesions in good-risk patients remains to be precisely defined, their usage in high-risk patients and in those with iliac aneurysms and central artery traumatic false aneurysms and arteriovenous fistula already appears justified.
Natural History of Congenital Arteriovenous Fistula
Authors: Blaisdell F. W. , Stein M.
Published: September 2024

There is no more difficult lesion to manage than congenital arteriovenous fistula. The advanced lesions are extremely vascular and unless they lend themselves to total excision, prompt recurrence is the rule. For the same reason, embolization is not successful and as the major feeding vessels are occluded, access to the tumor becomes more and more limited. In order to obliterate the tumor, it must be destroyed at the microvascular level. So far, only ethanol has proved effective in this regard, and this agent must be used conservatively to avoid excessive destruction of normal tissue and systemic damage.
Potential of a Hand-Held Ultrasound in Assessment of the Injured Patient
Authors: Wherry D. C.
Published: September 2024

Current studies indicate that portable ultrasound used by trained trauma surgeons in the emergency room can be performed using the focused abdominal sonogram for trauma technique in approximately 2 minutes to evaluate patients with blunt torso trauma. It has been shown to be as accurate as DPL and computed tomography (CT) in the detection of hemoperitoneum following abdominal trauma. It is also very accurate in detecting pericardial fluid and may have a role in the evaluation of penetrating injuries of the thorax, either from stab or gunshot wounds. The examination is best performed early on in the secondary survey of the injured patient. Miniaturization and hand-held ultrasound units are on the horizon. The faculty of the University of Washington in Seattle in conjunction with the Advanced Technology Laboratories in Seattle and the Advanced Research Project Agency of the Department of Defense are producing a battlefield hand-held ultrasound with the ultimate goal to have an ultrasound unit that will fit in the trauma surgeon's pocket. With the use of this new technology, the potential for early diagnosis of victims of trauma and prompt treatment is at hand. One of the greatest challenges remaining is that of training surgeons in the use of ultrasound. The author's experience in conducting ultrasound courses for surgeons at the Uniformed Services University of the Health Sciences is described.
Arterial Reconstruction with Vascular Clips is Safe and Quicker Than Sutured Repair
Authors: Pikoulis E. , Rhee P. , Nishibe T. , Leppäniemi A. K. , Fishback N. , Hufnagel H. V. , Wherry D. C. , Rich N. M.
Published: September 2024

Background:

Non-penetrating, arcuate-legged vascular-closure staple clips made of titanium were initially developed for microvascular anastomoses with little experience of their use in larger vessels. The purpose of this study was to compare vascular-closure staple clips to sutured anastomoses in common iliac arteries in a porcine model. Methods: In an experimental study, transected iliac arteries on both sides of 11 pigs were randomly assigned to end-to-end anastomosis performed with vascular-closure staple clips or interrupted 6–0 polypropylene sutures. Angiographic, macroscopic and microscopic results were assessed after 2 months.

Results:

There was no significant difference in the patency rate, tensile strength of the anastomoses, vessel diameter at the repair site, intimal thickness or wall thickness of the arteries after either method of closure. The mean (s.d.) clamp time was 19.8 (6.1) minutes for clip repair, and 36.0 (6.9) seconds for suture repair ( P < 0.001). The times required for the reconstruction of the anastomoses were 17.4 (6.1) and 35.S (7.1) minutes, respectively ( P < 0.001).

Conclusions:

Arterial anastomoses performed with vascular-closure staple clips are faster than sutured anastomoses, and result in comparable wound healing when assessed for patency, tensile strength, degree of narrowing and intimal reaction.
Autogenous Common Facial Vein or External Jugular Vein Patch for Carotid Endarterectomy
Authors: Sabharwal P. , Mukherjee D.
Published: September 2024

Background:

The purpose of this study was to determine whether common facial vein or external jugular vein are as good a vein patch as a saphenous vein for carotid patch angioplasty.

Method:

Retrospectively. 19 patients who underwent everted common facial vein or external jugular vein patch were compared with 199 patients who underwent saphenous vein patch carotid endarterectomy during 1989 to 1996. The two groups were compared clinically and by sonographic surveillance. The mean follow-up was 18 ± 4 months for common facial vein/external jugular vein patients and 48 ± 15 months for saphenous vein patch group.

Results:

No significant differences in mortality or morbidity were observed among patients in whom everted common facial vein or external jugular vein was used as compared with saphenous vein. No bleeding, thrombotic event, dilation of the patch or aneurysmal degeneration and perioperative deaths occurred in either of the two groups. Duplex surveillance studies showed no significant difference in recurrent moderate (50–79%) and severe (80–99%) stenosis.

Conclusion:

Everted common facial vein or external jugular vein patch was comparable to other vein patches. This eliminates the comorbidity of groin incision. Also, using everted common facial vein or external jugular vein as vein patch saves saphenous vein to be used for other vascular procedures, such as coronary artery or lower extremity bypass.
Anterior Tibial Artery Pseudoaneurysm after Ankle Arthroscopy
Authors: Salgado C. J. , Mukherjee D. , Quist M. A. , Cero S.
Published: September 2024

Arthroscopy of the ankle has dramatically expanded its role in diagnostic and therapeutic value afforded to the patient; however, it is not without complications. Although the majority of the complications described are neurological in origin, vascular injuries can occur. A case of a patient with normal coagulation parameters who underwent a purely diagnostic ankle arthroscopy and later developed a pseudoaneurysm of her distal anterior tibial artery is described. The pseudoaneurysm was resected without complications and early postoperative recovery has been uneventful.
Arresting Donor Hearts with Extracellular-Type Cardioplegia Prevents Vasoconstriction Induced by UW Solution
Authors: Tanoue Y. , Morita S. , Hisahara M. , Tominaga R. , Kawachi Y. , Yasui H.
Published: September 2024

The effects of arresting donor hearts with University of Wisconsin solution was investigated. Donor dogs were divided into two groups according to the technique used for arresting the heart. In group I ( n = 6) the heart was arrested with University of Wisconsin solution, whereas in group II ( n = 6) extracellular-type cardioplegia (K+ = 20 mmol/liter) was used to induce cardioplegic arrest. Aortic root pressure was measured during the infusion of solution at constant flow. In both groups, the hearts were then flushed and stored in cold University of Wisconsin solution for 6 h. The hearts were transplanted orthotopically and disconnected from cardiopulmonary bypass. Left ventricular function was evaluated by pressure—volume relations using a conductance catheter. Peak aortic root pressure during the infusion was significantly higher in group I than in group II, although post-transplant left ventricular function was similar in both groups. Although there was no difference in cardiac function after implantation, donor hearts should be arrested by extracellular-type cardioplegia to prevent coronary vasoconstriction associated with preservation in University of Wisconsin solution.
Long-Term Patency Rates, Complications and Cost-Effectiveness of Polytetrafluoroethylene (PTFE) Grafts for Hemodialysis Access: A Prospective Study That Compares Impra versus Gore-Tex Grafts
Authors: Hurlbert S. N. , Mattos M. A. , Henretta J. P. , Ramsey D. E. , Barkmeier L. D. , Hodgson K. J. , Sumner D. S.
Published: September 2024

Manufacturers of polytetraflouroethylene (PTFE) grafts used for chronic hemodialysis access describe specific advantages for their respective grafts, which presumably result in greater graft patency rates, reduced complications and decreased overall costs. There are few data available in the literature to support or contradict these alleged benefits. Therefore, this prospective study was undertaken to evaluate and compare patency rates, complications and costs between two of the leading brands of PTFE that are currently being marketed for use as hemodialysis access grafts. Totals of 190 primary PTFE grafts (100 Gore-tex (W. L. Gore and Associates, Flagstaff, AZ) and 90 Impra (C. R. Bard Inc., Tempe, AZ)) were implanted in 168 consecutive patients with end-stage renal disease. A policy of non-interventions was employed for patent grafts, as no attempt was made to assist primary patency. Grafts that occluded during follow-up underwent secondary revision to maintain patency. There was no difference in primary and secondary patency by life-table analysis between Gore-tex and Impra grafts at 2 years ( P > 0.53 and P > 0.13, respectively). There was also no significant difference between Gore-tex and Impra in the number of days before the first thrombectomy or in the number of thrombectomies or revisions per graft ( P > 0.50). Likewise, the incidence of complications was similar between the two grafts. The cost of graft implantation and maintenance of patency was not significantly different between Gore-tex and Impra grafts. It is concluded that either graft can be used for hemodialysis access with similar expected outcomes for at least 2 years following implantation.
Edward K. Barsky (1897–1975): Surgery, activism, and the Spanish Civil War
Authors: Jenkins Reed
Published: September 2024

Edward K. Barsky (1897–1975) was born and raised in New York City and became a surgeon at Beth Israel Hospital. During the political upheaval of the 1930s, Barsky became passionate about the cause of the Spanish Republic during the Spanish Civil War, as the democratically elected government came under siege by insurrectionists led by General Francisco Franco. Barsky transformed his beliefs into action as a founder of the American Medical Bureau to Aid Spanish Democracy, where he led a medical mission to the Spanish frontlines from 1937 to 1939. In Spain, Barsky organized American hospitals and operated under fire, contributing to significant advances in battlefield medicine. After the fall of the Republic in 1939, Barsky returned to the United States and his career as a surgeon in New York while also dedicating himself to the cause of Spanish refugees. His political activities, however, made him a target of political persecution by the House Un-American Activities Committee, and he ultimately lost both his freedom and his medical licence. Barsky was a surgeon, scientist, humanitarian, and activist, and his life illustrates the often complicated ties between politics and the practice of medicine.
Dr Kadambini Bose Ganguly (1861–1923): First Indian woman to practise Western medicine in India
Authors: Verma Nikhil , Roy Shubhajeet , Tewari Jay , Gupta Sanjiban , Suresh Timil
Published: September 2024

Dr Kadambini Bose Ganguly, BA, Graduate of Bengal Medical College (GBMC), LRCPE, LRCSE, LRFPSG, a woman of many firsts, defied social criteria to become one of the first women to graduate in medicine in India in the nineteenth century. She was also the first Indian female to pass an entrance examination to a medical school in India. Dr Ganguly went on to become the first Indian woman to graduate and practise Western medicine in India, and remains an important symbol of women's empowerment in India. She understood the struggles that women faced, supported the education of fellow female students and promoted childcare for working women. She demonstrated that a woman could perform responsibilities in both the professional and domestic domains. Dr Ganguly paved the path for the success of other women and helped achieve female representation in the delivery of healthcare. This paper examines her life and work for women's empowerment and medical education.
The Influence of Legal Nature on Executive Compensation in Brazil
Authors: Filho Leonardo Luiz Lopes , Siqueira Diego Dantas , Romão Bruno José Patrício , Monte Paulo Aguiar do
Published: September 2024

We analyzed the influence of legal nature (publicly traded or privately held companies) on executive compensation. For this purpose, we used data from the Annual Social Information Report (RAIS) of Brazilian publicly traded and privately held companies for the year 2019, totalling 15,397 observations. Through various econometric approaches, it was observed that legal nature has an impact on executive compensation. Using ordinary least squares regression, it was found that executives in publicly traded companies receive, on average, about 30% more than their counterparts in privately held companies. This difference was also evident in estimations using quantile regression, re-centred influence function (RIF)-regression and Oaxaca-RIF. However, the difference diminishes at higher levels of compensation. By means of the Oaxaca–Blinder decomposition, the average compensation difference due to legal nature was found to be 26.9% in favour of publicly traded companies. Of this difference, the largest portion is attributed to discretionary factors. When analyzing an economic, institutional and cultural context different from what is commonly researched, this research contributes to the discussion of results in emerging economies and provides new insights that can be valuable in the development of standards encouraging compensation linked to value creation for the company, as well as promoting greater transparency regarding the reasons behind high remuneration.
Machine Learning and Digital Twins-enabled Supply Chain Resilience: A Framework for the Indian FMCG Sector
Authors: Singh Devnaad , Sharma Anupam , Rana Prashant Singh
Published: September 2024

Disruptions highlight machine learning (ML)-powered digital twins as a significant technology to ensure supply chain resilience (SCR). The authors acquired supportive data by conducting semi-structured interviews with 37 fast-moving consumer goods supply chain professionals. Using open, axial and selective coding approaches, the authors mapped and discovered the themes that constitute the essential elements of ML-enabled SCR. The findings of the research underscore four principal capabilities in which ML is poised to enhance the resilience of supply chains, namely (a) visibility, (b) supply chain analytics, (c) managing levels of inventory and (d) consumer behaviour. The research implications employ empirical data to demonstrate how integrating ML with digital twins into the supply chain enhances resilience and presents a comprehensive framework utilizing ML to improve SCR. The research draws upon the dynamic capability view theory.
Application and Reliability of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC): An Institutional Study
Authors: Manoharan Elamathi , Krishnamurthy Suganthi , Menon Maya
Published: September 2024

Introduction:

Milan System for Reporting Salivary Gland Cytopathology (MSRGC) was introduced in the year 2015 to facilitate a standardised reporting format and to improve the overall effectiveness of fine-needle aspiration cytology (FNAC) in the preoperative evaluation of salivary gland lesions. Risk of malignancy (ROM) provided in each category guides the physician for appropriate clinical management. This study was performed prospectively for one year to evaluate the diagnostic utility and validate MSRSGC. Materials and Methods: The study included lesions in the salivary gland area, including intraparotid lymph node. Cytology material from both direct FNAC, which had rapid onsite evaluation (ROSE) for adequacy and ultrasonography-guided procedures, was included for analysis. Relevant clinical information and imaging findings were obtained. Slides were reviewed, and one of the six categories was applied using the Milan system. ROM and risk of neoplasm (RON) were calculated for each category.

Results:

The study included 62 cases of salivary gland FNAC of which 35.5% of the cases had surgical resection specimens. Category IVA formed the major group, and only 1.6% was given category III. The ROM and RON were calculated for each category and were statistically significant and compared with other studies.

Conclusion:

MSRSGC is the recent classification system, and it suggests less than 10% of cases under category III to avoid it’s over utilisation. MSRSGC is a reliable classification in our population, and it was best with category IVA lesions in our study.
A Prospective Clinicopathological Study of Cervical Lymphadenopathy in a Head and Neck Unit of a Tertiary Referral Centre
Authors: Preethi S  , Narayanan Nithya , Venkatakarthikeyan C
Published: September 2024

Background and Aims:

This study aims to investigate the clinicopathological profile of cervical lymphadenopathy in a tertiary referral centre. The findings will contribute to a deeper understanding of the disease spectrum, aid in accurate diagnosis, and help in improving patient treatment and outcomes.

Methodology:

This is a prospective study conducted in the Department of ENT, Head and Neck Surgery, Apollo Hospital, Chennai, between June 2022 and May 2023. The clinicopathological profile of all patients was analysed. The final histological diagnosis and the preoperative Fine Needle Aspiration Cytology (FNAC) were correlated. The primary tumour was identified in cases with metastatic secondary tumours in the neck.

Results:

Among the 80 patients in our study, 67% had a benign aetiology (most common was tuberculosis), and 33% had a malignant aetiology (most common was Hodgkin’s Lymphoma). Gender distribution was equal, with those between the ages of 35 and 60 more frequently affected. The nasopharynx (30%) was the most likely location of the occult primary, followed by the thyroid (20%) and larynx (20%). In detecting TB, FNAC had a sensitivity of 75.5% and a specificity of 98%; in detecting lymphomas, it was 64% and 100%; in detecting metastatic secondaries, it was 80% and 100%; and in detecting reactive lymphadenitis, it was 79% and 86%.

Conclusion:

Cervical lymphadenopathy is a common entity requiring careful evaluation and treatment. PET scans prove invaluable in detecting occult primary tumours. FNAC is an initial, cost-effective diagnostic tool. However, biopsy is indicated in specific conditions to obtain accurate diagnosis to enable prompt treatment.
Histopathological Correlation of Robotic-Assisted Radical Prostatectomy Specimen with Simultaneous 68GA-PSMA PET/MRI Findings in Cases of Adenocarcinoma Prostate
Authors: Kumar Sharwan , Jena Amarnath , Taneja Sangeeta , Kashyap Vikas , Singh Ashutosh Kumar , Sharma Ankur , Taneja Nilesh , Raheja Apeksha , Taneja Rajesh
Published: September 2024

Background and Aims:

68Ga-PSMA PET represents a reasonable biomarker for presence of cancer of prostate (CaP). 68Ga-PSMA PET combined with simultaneous ‘multiparametric MRI’ (mpMRI) has the potential to be used for the detection and localisation of primary prostate cancer. It is therefore essential to correlate the histopathological findings of robotic-assisted radical prostatectomy (RARP) specimens with pre-operative PSMA PET/MRI. In addition, imaging with PSMA could be useful in estimating the aggressiveness of CaP. The current study aims at the correlation of histopathologic findings of RARP specimens with pre-operative combined 68Ga-PSMA PET/MRI imaging.

Materials and Methods:

Specimens retrieved after RARP in 38 patients of localised CaP were synchronised with pre-operative images obtained with simultaneous 68Ga-PSMA PET/MRI. Maximum scores of individual parameters such as PI-RADS, Gleason’s score and PSMA uptake (in SUV) were taken for each sector and used for statistical analysis.

Results:

The positive predictive value (PPV) and negative predictive value (NPV) of simultaneous 68Ga-PSMA PET and MRI in detecting malignancy were found to be 84.23% (95% CI: 80.74%–87.18%) and 63.92% (95% CI: 57.77%–69.65%), respectively. Combining 68Ga-PSMA PET and mpMRI improves the sensitivity to 81.48% (95% CI: 76.70%–85.67%), but the specificity was found to be 68.24% (95% CI: 60.09%–75.64%). It was found that SUV max correlated with the severity of GS ( P value < .001).

Conclusion:

Prediction and localisation of histological malignancy in the prostate could be improved pre-operatively by adding 68Ga-PSMA PET to mpMRI imaging. The SUV of abnormal uptake of 68Ga-PSMA radiotracer is predictive of aggressiveness of tumour as reflected in the Gleason score.
Pharmacovigilance Consideration for Ayurvedic Medicines in Pediatric Practice: Developing Protocols for Documenting Clinical Safety
Authors: Subramanian Dinesh Karayil , Balakrishnan Geethu
Published: September 2024

Background

The rising global trend of traditional medicine and complementary and alternative medicine use necessitates a structured approach to ensure patient safety and efficacy. Due to its unique theoretical framework, directly applying modern pharmacovigilance principles to Ayurveda may be insufficient.

Purpose

This study aims to highlight the need for a collaborative approach that integrates traditional Ayurvedic knowledge with modern safety and efficacy evaluation methods. It critiques the limitations of current pharmacovigilance practices, especially in the context of Ayurveda, and proposes improvements to better capture the complexities of traditional medicine.

Methodology

An analysis of the “AyushSuraksha” program, a key initiative for the pharmacovigilance of Ayurveda, Siddha, Unani, and homoeopathy (ASU&H) medicines in India, was conducted. The program’s focus areas, including monitoring medications, specific materials, and procedure-based therapies, were reviewed in light of their efficacy and safety reporting mechanisms. Additionally, the applicability of current pharmacovigilance methodologies, particularly in the context of personalized Ayurveda treatments, was evaluated through case studies and literature reviews.

Results

The “AyushSuraksha” program, while focused on medication and therapy monitoring, overlooks the safety of food items used in Ayurveda. Current pharmacovigilance systems, designed for standardized medications, may be inadequate for Ayurveda, as demonstrated by positive outcomes in autism treatment despite the presence of microbiologically harmful products. Furthermore, existing pharmacovigilance proformas lack a distinction between physicians’ and end-users perspectives, limiting the reporting scope.

Conclusion

A transition to a holistic, evidence-based pharmacovigilance approach that incorporates Ayurvedic assessments and nonlinear herbal interactions is crucial. Separate proformas for physicians and end-users, along with disease-specific questions, are recommended to improve reporting accuracy. Expanding the scope of pharmacovigilance beyond standardized medication monitoring is essential for the evolution and refinement of Ayurvedic science.
Creating a mental health talanoa to promote a collaborative approach to wellbeing across Pacific peoples
Authors: Ravulo Jioji
Published: September 2024

Objective

Promoting holistic health and wellbeing is a shared conversation, or talanoa, requiring collaboration between individuals, their families and wider communities. This paper will explore various community-based initiatives privileging Pacific epistemologies and ontologies that promote and provide accessible resources improving mental health literacies.

Method

Three specific initiatives are discussed in this paper; Mental Health Talanoa (MHT), Open Worksheet and Wellbeing Talanoa. These provide a platform to understand practical ways to support Pacific peoples in various contexts.

Results

The MHT project offers a nuanced understanding of symptomatology related to common mental disorders amongst Pacific peoples, a nuanced understanding of the barriers and enablers to health literacies and help seeking behaviour, and a series of infographics, including the Pacific Mental Health Lexicons (PIMHL). The Open Worksheet is a dynamic tool underpinned by a dialogical and relationally driven way to understanding individual and familial narratives. The Wellbeing Talanoa supports a communally orientated opportunity to enhance a sense of connection to self and others whilst therapeutically reviewing social and welfare needs and solutions.

Conclusion

Developing and implemented Pacific approaches that are grounded in Pacific values and practices can lead to enhanced help seeking behaviour, engagement, service retention and provision.
Advance Care Planning in Nursing Homes: Comparing Characteristics and Outcomes of Participants and Non-Participants
Authors: Zhou Yi , Zailan Liyana Binte , Tan Laurence , Chung Salina Yee Hung Annaliese , Chua Alecia Qin Ying , Magpantay Gerlie Contreras , Sim Lai Kiow , Muthusamy Thilagavathy , Low James Alvin
Published: September 2024

Background

There is an increasing need to integrate Advance Care Planning (ACP) in nursing homes (NH) due to rapid aging and burden of multimorbidity. This study examines differences in the characteristics and outcomes of NH residents enrolled in a palliative care programme who have completed ACP and those who did not.

Method

We conducted a retrospective cohort analysis of 294 deceased residents enrolled into a palliative programme from 8 nursing homes in Singapore. Comparison was made between residents who completed an ACP and those who did not. Treatment preferences and place of death preferences were examined and concordance to these preferences were analyzed.

Results

ACP completion rate was 81% in the cohort. Residents opting for comfort measures only had high concordance (92%) for their preferred place of death (PPOD). However, residents opting for limited intervention showed lower PPOD concordance (77%), with many dying in hospitals despite a preference for dying in the NH. Residents with ACP were significantly more likely to die in NH (68.2% vs. 36.4%) and had a longer median programme enrolment duration (131 vs. 53 days) compared to those who did not complete ACP.

Conclusion

Despite high ACP completion rate in our cohort, challenges remain in aligning treatment preferences with actual care provided, particularly for residents opting for limited intervention. Future efforts should focus on increasing ACP participation and addressing systemic barriers to improve end-of-life care outcomes for NH residents.
Stochastic Publics: The Emergence and Ethics of AI-Generated Publics in Technical Communication
Authors: Littlefield Jamie
Published: September 2024

The concept of a public—a group of strangers drawn together through their mutual attention to a text—has historically been tied to the notion of human intentionality. The recent popularization of artificial intelligence (AI) large language models (such as ChatGPT) destabilizes this connection. When large language models generate text, they may inadvertently form stochastic publics—groups pulled together through the randomization of biased data patterns drawn from AI training material. This exploratory study draws on a three-phase dialogue with OpenAI's ChatGPT 4 to identify the risks of stochastic publics and suggest human-originated interventions grounded in feminist care ethics.
Improving Prediction of Complications Post-Proton Therapy in Lung Cancer Using Large Language Models and Meta-Analysis
Authors: Chao Pei-Ju , Chang Chu-Ho , Wu Jyun-Jie , Liu Yen-Hsien , Shiau Junping , Shih Hsin-Hung , Lin Guang-Zhi , Lee Shen-Hao , Lee Tsair-Fwu
Published: September 2024

Purpose

This study enhances the efficiency of predicting complications in lung cancer patients receiving proton therapy by utilizing large language models (LLMs) and meta-analytical techniques for literature quality assessment.

Materials and Methods

We integrated systematic reviews with LLM evaluations, sourcing studies from Web of Science, PubMed, and Scopus, managed via EndNote X20. Inclusion and exclusion criteria ensured literature relevance. Techniques included meta-analysis, heterogeneity assessment using Cochran’s Q test and I2 statistics, and subgroup analyses for different complications. Quality and bias risk were assessed using the PROBAST tool and further analyzed with models such as ChatGPT-4, Llama2-13b, and Llama3-8b. Evaluation metrics included AUC, accuracy, precision, recall, F1 score, and time efficiency (WPM).

Results

The meta-analysis revealed an overall effect size of 0.78 for model predictions, with high heterogeneity observed (I2 = 72.88%, P < 0.001). Subgroup analysis for radiation-induced esophagitis and pneumonitis revealed predictive effect sizes of 0.79 and 0.77, respectively, with a heterogeneity index (I2) of 0%, indicating that there were no significant differences among the models in predicting these specific complications. A literature assessment using LLMs demonstrated that ChatGPT-4 achieved the highest accuracy at 90%, significantly outperforming the Llama3 and Llama2 models, which had accuracies ranging from 44% to 62%. Additionally, LLM evaluations were conducted 3229 times faster than manual assessments were, markedly enhancing both efficiency and accuracy. The risk assessment results identified nine studies as high risk, three as low risk, and one as unknown, confirming the robustness of the ChatGPT-4 across various evaluation metrics.

Conclusion

This study demonstrated that the integration of large language models with meta-analysis techniques can significantly increase the efficiency of literature evaluations and reduce the time required for assessments, confirming that there are no significant differences among models in predicting post proton therapy complications in lung cancer patients.
Abnormal serum Magnesium Level is Associated with the Coagulopathy in Traumatic Brain Injury Patients
Authors: Wang Ruoran , Xu Jianguo , He Min
Published: September 2024

Background

Coagulopathy is associated with poor prognosis of traumatic brain injury (TBI) patients. This study is performed to explore the association between serum magnesium level and the risk of coagulopathy in TBI.

Methods

TBI patients from the Medical Information Mart for Intensive Care-III database were included for this study. Logistic regression analysis was performed to explore risk factors and develop a predictive model for coagulopathy in TBI. The restricted cubic spline (RCS) was utilized to analyze the association between serum magnesium level and the development of coagulopathy. Receiver operating characteristic curve was drawn to evaluate the performance of the predictive model for coagulopathy.

Results

The incidence of coagulopathy in TBI was 32.6%. The RCS indicated the association between magnesium and coagulopathy was U-shaped. Multivariate logistic regression confirmed age, coronary heart disease, cerebral vascular disease, chronic liver disease, GCS, ISS, epidural hematoma, hemoglobin, shock index and magnesium level were independently associated with the coagulopathy in TBI. Compared with patients of magnesium level between 1.7 and 2.3 mg/dL, those with magnesium level below 1.7 mg/dL or above 2.2 mg/dL had a higher risk of coagulopathy.

Conclusion

Both hypermagnesemia and hypomagnesemia are associated with higher risk of coagulopathy in TBI patients. Physicians should pay more attention on preventing coagulopathy in TBI patients with hypomagnesemia or hypermagnesemia.
Drug induced lupus associated with Trastuzumab emtansine in a patient with metastatic breast cancer
Authors: Yıldız Oğuzhan , Gürbüz Ali Fuat , Karakurt Eryılmaz Melek , Araz Murat , Aykut Talat , Şahin Özlem , Büyükboyacı Naciye Hilal , Çelik Zeliha , Artaç Mehmet
Published: September 2024

Introduction

Ado-trastuzumab emtansine (T-DM1) is employed in the treatment of patients with HER2-positive breast cancer. The most common side effects are fatigue, diarrhoea, anaemia, transaminase elevation and drug-induced thrombocytopenia. This report describes a patient with metastatic breast cancer who developed drug-induced lupus due to T-DM1.

Case Report

A 54-year-old woman was diagnosed with breast cancer in March 2018. She underwent modified radical mastectomy and axillary lymph node dissection (pT2N1aM0). Following supraclavicular lymph node metastasis in May 2018, she received 8 cycles of docetaxel, trastuzumab, and pertuzumab. In December 2020, the patient presented with axillary and intra-abdominal lymph node metastases, along with bone metastases observed on PET/CT scan. Treatment with T-DM1 and zoledronic acid was initiated. After 18 months on T-DM1, she developed drug-induced lupus. Her symptoms resolved with hydroxychloroquine treatment and discontinuation of T-DM1.

Discussion

Drug-induced lupus is a clinical syndrome that shares similar features with systemic lupus erythematosus (SLE). The majority of patients present with symptoms such as arthralgia and myalgia. Hydralazine and procainamide are high-risk drugs for drug-induced lupus. Symptoms usually develop after months or years of use, but may also develop suddenly. Our patient also received TDM-1 treatment for 18 months. We present a case of TDM-1-associated drug-induced lupus in a patient with metastatic breast cancer. This is the first case of TDM-1-related drug-induced lupus reported in the literature.
Identifying risk factors of dose reduction or treatment discontinuation due to fatigue or gastrointestinal symptoms in patients receiving lenvatinib treatment for hepatocellular carcinoma
Authors: Kimura Michio , Yamada Shiori , Go Makiko , Yasuda Satoshi , Toyoda Hidenori , Usami Eiseki
Published: September 2024

Introduction

Lenvatinib (LEN) is the standard treatment for hepatocellular carcinoma (HCC). In clinical practice, gastrointestinal (GI) symptoms such as fatigue and loss of appetite often lead to dose reduction or treatment discontinuation. This study aimed to identify the predictors of patients who will experience dose reduction or treatment discontinuation owing to fatigue or GI symptoms during LEN treatment for HCC.

Methods

We retrospectively identified 99 patients who received LEN at the Ogaki Municipal Hospital (Ogaki, Japan) between April 2018 and December 2023. To investigate the risk factors for treatment discontinuation or dose reduction due to fatigue or GI symptoms during LEN administration, patients were divided into two groups based on whether treatment discontinuation or dose reduction occurred due to fatigue or GI symptoms during LEN administration (37 patients) or not (62 patients). We compared baseline characteristics between the two groups.

Results

Multivariate analysis revealed that body weight (odds ratio 4.310, 95% confidence interval 1.380–13.500; P = 0.002) was an independent risk factor that significantly contributed to treatment discontinuation or dose reduction owing to fatigue or GI symptoms during LEN administration. The cut-off value calculated using the body weight curve was 55.0 kg. Using this cutoff value, the sensitivity and specificity of body weight to detect treatment discontinuation or dose reduction due to fatigue or GI symptoms during LEN administration were 83.9% and 56.8%, respectively.

Conclusion

In clinical practice, patients weighing less than 55 kg who start with a full dose will likely experience weight loss or discontinuation during treatment.
Feeling Out of Place and Creating Their Own Space: Young Queers of Colour in Sweden
Authors: Sotevik Lena , Stretmo Live
Published: September 2024

In this article, we explore the strategies and experiences of young queers of colour in Sweden. Drawing on semi-structured interviews with four young queers of colour, we discuss their experience in relation to belongingness, space and place. At the centre of our analysis is the notion of being ‘out of place’, that is, of not embodying the somatic norm of a specific position or space. The participants articulated how queer people of colour lack representation, both in mainstream society and in the queer community. According to the young participants, finding a community with other queers of colour was imperative for them to share experiences and feel belongingness. They strategically navigated and resisted heteronormative and racialized stereotypes in their everyday life. By claiming and creating their own spaces, these young people become social and political actors who are involved in renegotiating the meaning of a space and place.
The management of anticoagulated fragility femoral fracture patients
Authors: Farhan-Alanie Muhamed M , Eardley William G P
Published: September 2024

Approximately 20% of patients sustaining a fragility femur fracture use an anticoagulant, and over 30% use an antiplatelet medication, both of which can result in surgical delay. Previously confined to fractures of the proximal femur, performance assessment, outcome and surgical delay is now assessed for all fractures of the femur in older patients, including those involving implants. This narrative review draws together all literature pertaining to anticoagulation and antiplatelet management in older patients with a fracture of the femur to address 5 key points: prevalence of anticoagulant and antiplatelet use; analysis of management protocols; collation of national guidelines; comparison of perioperative management; timing of surgery and perioperative outcomes.

Our review found that the prevalence of fragility femur fracture patients taking anticoagulant and antiplatelet medication ranges from 20–40% and 25–35% respectively. More anticoagulated patients are taking direct oral anticoagulants compared to vitamin k antagonists with growing implications for variation in practice and delays to surgery.

Several national guidelines exist although these are characterised by marked variation, there is little standardisation, and none are generalised across all fragility femur fractures.

Expedited surgery within 36 hours of admission in patients taking an anticoagulant or antiplatelet medication is safe and has been demonstrated in fractures of the proximal femur across many small number studies although no such evidence exists in non-proximal femur fractures despite this population sharing similar characteristics. There is a need for all fractures of the femur in older people to be considered when researching and assessing performance in this population to prevent needless variation and delay.