bluuebunny/crossref_metadata_2025 huggingface dataset:
Hybridization and polyploidization generate evolutionary diversification of the genus Buddleja in the Sino-Himalayan region. A commentary on ‘Deciphering complex reticulate evolution of Asian Buddleja (Scrophulariaceae): insights into the taxonomy and speciation of polyploid taxa in the Sino-Himalayan region’
Authors: Chen Chunlin , Liu Jianquan
Published: August 2023

This article comments on:

Fengmao Yang, Jia Ge, Yongjie Guo, Richard Olmstead and Weibang Sun. Deciphering complex reticulate evolution of Asian Buddleja (Scrophulariaceae): insights into the taxonomy and speciation of polyploid taxa in the Sino-Himalayan region, Annals of Botany, Volume 132, Issue 1, 01 July 2023, Pages 15–28, https://doi.org/10.1093/aob/mcad022
Use of high- and low-value care among US adults by education levels
Authors: Park Sungchul , Nguyen Ann M
Published: August 2023

Background

Healthcare reform in the United States has focused on improving the value of health care, but there are some concerns about the inequitable delivery of value-based care.

Objective

We examine whether the receipt of high- and low-value care differs by education levels.

Methods

We employed a repeated cross-sectional study design using data from the 2010–2019 Medical Expenditure Panel Survey. Our outcomes included 8 high-value services across 3 categories and 9 low-value services across 3 categories. Our primary independent variable was education level: (i) no degree, (ii) high school diploma, and (iii) college graduate. We conducted a linear probability model while adjusting for individual-level characteristics and estimated the adjusted values of the outcomes for each education group.

Results

In almost all services, the use of high-value care was greater among more educated adults than less educated adults. Compared to those with no degree, those with a college degree were significantly more likely to receive all high-value services except for HbA1c measurement, ranging from blood pressure measurement (4.5 percentage points [95% CI: 3.9–5.1]) to colorectal cancer screening (15.6 percentage points [95% CI: 13.9–17.3]). However, there were no consistent patterns of the use of low-value care by education levels.

Conclusion

Our findings suggest that more educated adults were more likely to receive high-value cancer screening, high-value diagnostic and preventive testing, and high-value diabetes care than less educated adults. These findings highlight the importance of implementing tailored policies to address education-based inequities in the delivery of high-value services in the United States.
Parallel incorporation and public law
Authors: Edgar Andrew , Stack Kevin M
Published: August 2023

Over the past fifty years, domestic regulators have turned to standards developed by private organizations as a means of complying with international law commitments to eliminate barriers to trade. What impact does this phenomenon of parallel incorporation, in which regulators in different countries incorporate the same private standards, have on domestic administrative law and public law? Through a case study of US and Australian regulators’ adoption of the same standards in aviation, the article exposes how parallel incorporation exacerbates existing accountability deficits of administration, contributes to the hollowing out of public capacity to review these incorporations, defies conventional understandings of delegation, and breaches basic understanding of rulemaking processes in both the United States and Australia. Using conventional administrative processes to implement solutions compelled by international commitments strains and transforms these processes. In this context, trade law imperatives result in accommodations from domestic public law not the reverse.
A systematic review of economic evaluations of pharmacist services
Authors: Price Emilia , Shirtcliffe Andi , Fisher Thelma , Chadwick Martin , Marra Carlo A
Published: August 2023

Background

Challenges to the provision of health care are occurring internationally and are expected to increase in the future, further increasing health spending. As pharmacist roles are evolving and expanding internationally to provide individualised pharmaceutical care it is important to assess the cost-effectiveness of these services.

Objectives

To systematically synthesise the international literature regarding published economic evaluations of pharmacy services to assess their cost-effectiveness and clinical outcomes.

Methods

A systematic review of economic evaluations of pharmacy services was conducted in MEDLINE, EMBASE, PubMed, Scopus, Web of Science, CINAHL, IPA and online journals with search functions likely to publish economic evaluations of pharmacy services. Data were extracted regarding the interventions, the time horizon, the outcomes and the incremental cost-effectiveness ratio. Studies’ quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) statement.

Results

Seventy-five studies were included in the systematic review, including 67 cost-effectiveness analyses, 6 cost-benefit analyses and 2 cost-consequence analyses. Of these, 57 were either dominant or cost-effective using a willingness-to-pay threshold of NZ$46 645 per QALY. A further 11 studies’ cost-effectiveness were unable to be evaluated. Interventions considered to be most cost-effective included pharmacist medication reviews, pharmacist adherence strategies and pharmacist management of type 2 diabetes mellitus, hypertension and warfarin/INR monitoring. The quality of reporting of studies differed with no studies reporting all 28 items of the CHEERS statement.

Conclusions

There is strong economic evidence to support investment in extended pharmacist services, particularly those focussed on long-term chronic health conditions.
Genetic differentiation and species diversification of the Adoxophyes orana complex (Lepidoptera: Tortricidae) in East Asia
Authors: Tsai Cheng-Lung , Shih Li-Cheng , Yeh Wen-Bin , Byun Bong-Kyu , Jinbo Utsugi , Ning Fang-Yu , Sung I-Hsin
Published: August 2023

The Adoxophyes tea tortrix (Lepidoptera: Tortricidae) is a group of leaf rollers that cause enormous economic losses on tea and apple crops. In East Asia, taxonomic ambiguity of the Adoxophyes orana complex (AOC), which consists of A. orana, A. dubia, A. honmai, and A. paraorana, has persisted for decades because of vague diagnostic characters. In this study, differences in the AOC were examined to improve species identification, determine genetic variations, and develop control strategies. Analyses revealed that A. orana comprised 2 lineages, a widely distributed Palearctic lineage and an East Asian lineage that was nested with other Asian species. Genetic divergence of >3% is proposed to confirm the AOC species that would benefit subsequent taxonomic revision. The monophyletic Taiwanese A. sp. with 2.8–4% from other AOC species appeared to suggest it as an independent taxon, and low interspecific divergence between A. honmai and A. dubia of 0.3% indicated possibility of recent divergence or intraspecific variations. Our result further suggested that the Z9-14:Ac ratio of semiochemicals could be a reference for the reblending of pheromone attractants in Taiwanese tea plantations. Moreover, the AOC species appeared to have a tendency of specific geographic distributions, with A. dubia and A. honmai in Japan and China, A. paraorana in Korea, and A. sp. in Taiwan. Maintaining the unique genetic composition of Adoxophyes species in each geographic region and preventing the possible invasions into those AOC-free countries through the transportation of host plants are essential in managing the AOC in East Asia.
Trick of the Eye: Prospect Gazing, Illusion, and the University Novel
Authors: Bunzel Jordan Lewis
Published: August 2023

Literary critics often cast the English university novel as a traditionalist relic of the nineteenth century, one largely defensive of Oxbridge classics and masculinity. Yet the subgenre was a more subversive cultural nexus of sorts: an attempted reconciliation of novel form with the era’s emerging and optically illusive technologies. These Bildungsromane, largely or exclusively set at universities, value letting undergraduates stare at and learn to enjoy outdoor vistas. In turn, they frequently compare those college landscapes to illusory devices like panoramas and magic lanterns. The fictions thus represent a struggle to bridge conventional Oxbridge education with innovative outdoor learning, and Romantic natural aesthetics with a visual subjectivism more akin to the early modernists. The essay begins by linking the so-called visual turn of nineteenth-century studies with the fewer book-length accounts of university fiction. The paper’s second section then defines natural versus what I call illusory prospect gazing in English culture; where the former involved staring at outdoor vistas for pleasure, the latter offered this through indoor and often unsettlingly virtual landscapes. Finally, the essay turns to university novels, which combine both forms of prospect gazing for students’ educative benefits. While earlier fictions liken college grounds to panoramas, later ones grow fascinated with photographic, phantasmagoric, and kaleidoscopic vistas. We can begin to re-evaluate the university novel, then, as one of the era’s new optical technologies: it taught undergraduate characters and readers alike to visually enjoy and distrust their surroundings, and to confront the Romantic legacies and dizzying futures of novel form.
Clinical application of a real-time polymerase chain reaction test for CYP2C19 genotyping based on genotype distribution in a healthy Korean population
Authors: Park Kuenyoul , Yoo Soo Jin
Published: August 2023

Objective

With the recent reports of additional alleles of the CYP2C19 gene with decreased or no function, the clinical utility of real-time polymerase chain reaction (PCR)-based testing that detects only a small number of variant targets needs to be evaluated.

Method

We retrospectively reviewed 7-year data for real-time PCR test records from a single hospital and analyzed CYP2C19 genotypes from publicly available whole-genome or whole-exome data from a healthy Korean population.

Results

Of the 2327 test results in this hospital, the *1 allele was most common (60.5%), followed by *2 (28.0%), *3 (10.1%), and *17 (1.4%). Among 5305 healthy Korean individuals, the frequencies of the *2, *3, and *17 alleles were 28.6%, 9.9%, and 1.0%, respectively, which were not statistically different from those of the hospital data (P = .4439, P = .6025, and P = .1142, respectively). Interestingly, the total frequency of additional nonfunctional alleles (*4, *6, *22, and *24) that could not be detected using real-time PCR was only 0.1%, with a total allele count of 8.

Conclusion

Our study shows that the clinical utility of real-time PCR for CYP2C19 genotyping remains satisfactory. However, caution should be exercised because the test can miss patients with decreased CYP2C19 function.
A Critical Minority
Authors: Englund Heather M. , MacWilliams Brent , Mott Jason
Published: August 2023

AIM

The purpose of this study was to investigate the relationship between gender and marginalization in nursing academia.

BACKGROUND

Men continue to be significantly underrepresented in nursing academia because they experience numerous barriers to their integration and success in the profession.

METHOD

A descriptive cross-sectional design was implemented in this pilot study to investigate differences in perceived marginalization between male versus female faculty teaching in Commission on Collegiate Nursing Education-accredited colleges. Marginality was measured using the Englund Marginality Index (EMI).

RESULTS

Male nursing faculty participants reported higher scores on the EMI (M = 43.6, SD = 9.9) than female faculty (M = 37.2, SD = 9.6), t(1428) = 6.0, p < .001.

CONCLUSION

As the nursing faculty shortage continues to increase, it is imperative that leaders in nursing education steer their efforts toward attracting a more robust and diverse faculty population.
Using Virtual Remote Interpretation in Simulation for Clients With Limited English Proficiency
Authors: Marcus Jessica , Hendry Terri
Published: August 2023

Providing culturally responsive communication to clients with limited English proficiency (LEP) is important to achieve equitable care. Ensuring nurses are trained in effective communication using interpreters or interpretation devices can begin before licensure. Virtual remote interpretation (VRI) is commonly used in the absence of in-person interpretation for clients with LEP. The purpose of this simulation activity was to evaluate student performance and perceptions related to culturally responsive communication when using VRI in a prenatal care simulation of clients with LEP.
Integrating LGBTQI+ Content in Nursing Education Using Immersive Virtual Reality: Embodying Eden
Authors: Hannans Jaime
Published: August 2023

Teaching nursing students to understand LGBTQI+ health care perspectives is critical in providing safe and effective care. Nursing curricula often have limited LGBTQI+ content to prepare students, with clinical experiences too varied to ensure exposure to specific gender diversity learning opportunities. Immersive virtual reality is a promising strategy to offer rich learning experiences from the perspective of the LGBTQI+ community.
Addressing Nursing Students’ Understanding of Health Equity and Social Determinants of Health: An Innovative Teaching-Learning Strategy
Authors: Swan Beth Ann , Giordano Nicholas A.
Published: August 2023

Immersive learning opportunities across care settings enhance nursing students’ understanding of the environmental, social, cultural, and policy factors that influence patients’ health (e.g., social determinants of health) and care utilization. Hotspotting happens when care teams visit patients with frequent hospital admissions to coordinate outpatient care. However, geographic limitations may inhibit the delivery of hotspotting learning opportunities available to students. Delivering immersive hotspotting opportunities over virtual reality helps to overcome this barrier. This overview summarizes the design and implementation of a virtual reality hotspotting experience designed to aid students in understanding the impact of social determinants of health on care transitions.
Using a Flipped Classroom and Role-Play to Introduce Nursing Students to LGBTQIA+ Patient Care
Authors: Jordan Christina
Published: August 2023

This project used a flipped classroom method to introduce prelicensure baccalaureate nursing students to the concept of sexual orientation and gender identity and increase student knowledge and comfort in the care of these individuals. Teaching-learning strategies included self-instruction via video and classroom activities of group discussion and role-play. The educational activity used a pre- and posttest design to evaluate learning outcomes. After implementation, students reported a greater understanding of the needs of lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual (LGBTQIA+) patients. The results suggest that even a short introduction to the LGBTQIA+ patient’s needs could increase nursing students’ knowledge.
Executive Summary of the Lower Anogenital Tract Cancer Evidence Review Conference
Authors: Chelmow David , Cejtin Helen , Conageski Christine , Farid Huma , Gecsi Kimberly , Kesterson Joshua , Khan Michelle J. , Long Margaret , O'Hara Julia Sage , Burke William
Published: August 2023

The Centers for Disease Control and Prevention sponsored a project conducted by the American College of Obstetricians and Gynecologists to develop educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. For this final module, focusing on the cancers of the lower anogenital tract (vulva, vagina, and anus), a panel of experts in evidence assessment from the Society for Academic Specialists in General Obstetrics and Gynecology, ASCCP, and the Society of Gynecologic Oncology reviewed relevant literature and current guidelines. Panel members conducted structured literature reviews, which were then reviewed by other panel members. Representatives from stakeholder professional and patient advocacy organizations met virtually in September 2022 to review and provide comment. This article is the executive summary of the review. It covers prevention, early diagnosis, and special considerations of lower anogenital tract cancer. Knowledge gaps are summarized to provide guidance for future research.
Nonestrogen Therapies for Treatment of Genitourinary Syndrome of Menopause
Authors: Casiano Evans Elizabeth A. , Hobson Deslyn T. G. , Aschkenazi Sarit O. , Alas Alexandriah N. , Balgobin Sunil , Balk Ethan M. , Dieter Alexis A. , Kanter Gregory , Orejuela Francisco J. , Sanses Tatiana V. D. , Rahn David D.
Published: August 2023

OBJECTIVE:

To systematically review the literature and provide clinical practice guidelines regarding various nonestrogen therapies for treatment of genitourinary syndrome of menopause (GSM).

DATA SOURCES:

MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane databases were searched from inception to July 2021. We included comparative and noncomparative studies. Interventions and comparators were limited to seven products that are commercially available and currently in use (vaginal dehydroepiandrosterone [DHEA], ospemifene, laser or energy-based therapies, polycarbophil-based vaginal moisturizer, Tibolone, vaginal hyaluronic acid, testosterone). Topical estrogen, placebo, other nonestrogen products, as well as no treatment were considered as comparators.

METHODS OF STUDY SELECTION:

We double-screened 9,131 abstracts and identified 136 studies that met our criteria. Studies were assessed for quality and strength of evidence by the systematic review group.

TABULATION, INTEGRATION, AND RESULTS:

Information regarding the participants, details on the intervention and comparator and outcomes were extracted from the eligible studies. Alternative therapies were similar or superior to estrogen or placebo with minimal increase in adverse events. Dose response was noted with vaginal DHEA and testosterone. Vaginal DHEA, ospemifene, erbium and fractional carbon dioxide (CO2) laser, polycarbophil-based vaginal moisturizer, tibolone, hyaluronic acid, and testosterone all improved subjective and objective signs of atrophy. Vaginal DHEA, ospemifene, tibolone, fractional CO2 laser, polycarbophil-based vaginal moisturizer, and testosterone improved sexual function.

CONCLUSION:

Most nonestrogen therapies are effective treatments for the various symptoms of GSM. There are insufficient data to compare nonestrogen options to each other.
Intrastromal Corneal Ring Segment Implantation Followed by Simultaneous Topography-Guided Photorefractive Keratectomy and Corneal Cross-Linking for Contact Lens–Intolerant Keratoconus
Authors: Gupta Aanchal , Huang Sonia , Sun Michelle T. , Zamora-Alejo Katherine
Published: August 2023

Purpose:

This study aimed to evaluate the efficacy and safety of Keraring implantation followed by simultaneous topography-guided photorefractive keratectomy (TGPRK) and corneal cross-linking (CXL) in the management of keratoconus.

Methods:

This is a single-center, private practice, retrospective review. Patients with keratoconus who were intolerant to contact lens wear underwent implantation of the Keraring, followed by TGPRK with CXL from 2 to 36 months after implantation. Main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction (cylinder and spherical equivalent), keratometry (steep, maximum, and central), and central corneal thickness (CCT). Patients were followed up for 3 to 60 months postoperatively.

Results:

Fifty-seven eyes from 45 patients were included. The mean time between Keraring and TGPRK/CXL was 6.0 ± 6.0 months. Patients were followed up for a mean of 28.6 ± 20.1 months after Keraring insertion. At 12-month follow-up, there was a statistically significant improvement in mean UDVA (0.94 ± 0.49–0.35 ± 0.23,P< 0.01), CDVA (0.39 ± 0.26–0.17 ± 0.15,P< 0.01), cylinder (−4.97 ± 2.68 to −1.74 ± 1.25,P< 0.01), steep keratometry (51.25 ± 3.37–45.03 ± 2.27,P< 0.01), central keratometry (52.59 ± 4.98–46.99 ± 3.53,P< 0.01), and maximum keratometry (58.78 ± 4.22–50.76 ± 3.42,P< 0.01). These results were sustained at 48-month follow-up. CCT decreased at 12 months after TGPRK (461.84 ± 27.46–418.94 ± 45.62,P< 0.01) and remained stable at 60 months. Postoperatively, 2 eyes (3.51%) had corneal haze, resulting in decrease in CDVA; 1 was treated successfully with repeat PRK; and 1 patient (1.75%) had wound melt due to partial Keraring extrusion, which settled with repositioning.

Conclusions:

Keraring implantation followed by simultaneous TGPRK and CXL appears to be effective in the long term in improving UDVA, CDVA, cylinder, CCT, and keratometry in patients with keratoconus who are intolerant to contact lenses.
How is Aging Perceived to Affect Well-being in Women Older than 50 Years Living With HIV? A Qualitative Systematic Review
Authors: Conway Rebecca , Evangeli Michael
Published: August 2023

Advances in HIV treatment have led to more people with HIV living to 50 years and older. No reviews have qualitatively analyzed and synthesized the literature relevant to theory and practice for well-being specifically in Women living with HIV (WLWH) aged 50 years and older. Sixteen eligible qualitative studies were critically appraised and thematically synthesized to investigate how aging was perceived to affect well-being in WLWH aged 50 years and older. Six themes demonstrated how HIV-related stigmas negatively affected social well-being, and how adjusting to living and aging with HIV negatively affected psychological and physical well-being of older WLWH. Holding caring roles also negatively affected physical well-being of WLWH. Globally, majority women aging with HIV were found to experience additional stigmas. Further research could elucidate how HIV-related stigma affects the well-being of global majority women living and aging with HIV. Recommendations are made for future HIV-related clinical practice and theory development.
Efficacy of ranibizumab combined with photocoagulation for diabetic retinopathy: A meta-analysis study
Authors: Yin Hongli , Zhong Senquan
Published: August 2023

Background:

Ranibizumab addition may benefit to improve the efficacy in patients with diabetic retinopathy than only photocoagulation, and this meta-analysis aims to explore the impact of ranibizumab addition on efficacy for diabetic retinopathy.

Methods:

PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched, and we included randomized controlled trials assessing the effect of ranibizumab addition on patients with diabetic retinopathy for this meta-analysis.

Results:

Six randomized controlled trials were finally included in the meta-analysis. Overall, compared with control intervention for diabetic retinopathy, ranibizumab addition showed significantly increased number of neovascularization area reduction (OR = 4.20; 95% CI = 1.47–12.02; P = .007) and reduced fluorescein leakage (MD = −2.53; 95% CI = −3.31 to −1.75; P < .00001), but showed no obvious impact on neovascularization area (MD = −1.80; 95% CI = −3.68 to 0.08; P = .06), photocoagulation retreatment (OR = 1.03; 95% CI = 0.47–2.27; P = .94) or adverse events (OR = 1.45; 95% CI = 0.49–4.29; P = .50).

Conclusions:

Ranibizumab combined with photocoagulation is effective to improve efficacy for diabetic retinopathy.
Association between serum uric acid to high density lipoprotein-cholesterol ratio and arterial stiffness in a Japanese population
Authors: Wang Haidong , Ba Yudong , Gao Xuede , Zhuo Jinxiu , Li Yanan , Sun Jianhua , Zhang Shuxian
Published: August 2023

Uric acid (UA) and HDL-cholesterol (HDL-C) level are closely associated to the cardiovascular disease (CVD) morbidity. The UA/HDL-C ratio (UHR), a new parameter combination of serum UA and HDL-C, attracts attention for its association with metabolic and inflammatory conditions. There may exists the association between UHR and arterial stiffness. This study aims to explore the association between the UHR and brachial-ankle PWV (baPWV) and to determine whether or not UHR has effect on arterial stiffness. The present study included a total of 912 Japanese (592 men and 320 women), aged from 24 to 84, received a health medical checkup programme with an automatic waveform analyzer to measure baPWV and various standardized questionnaires in a medical center of Japan. Non-linear regression and threshold effect analysis were conducted to explore the association between UHR and baPWV. It was found that UHR was positively correlated with baPWV after adjusting for multiple confounders. A non-linear relationship (with a inflection point was 14.25) was found between UHR and baPWV. Subgroup analyses showed that the significant association between UHR and baPWV only existed in females group, no fatty liver group and normal BMI groups. This study revealed the nonlinear relationship between UHR and baPWV. A significant correlation between UHR and baPWV existed in females but not in males. Fatty liver status, BMI, and menopausal status may affect the above association.
Nomogram for predicting survival after lymphatic metastasis in esophageal cancer: A SEER analysis
Authors: Sun Shuo , Yang Wenwen , Yang Yanjiang , Fan Mengmeng , Wang Feng , He Li , Han Biao , Chen Chang
Published: August 2023

Lymphatic metastasis (LM) is a significant mechanism for the spread of esophageal cancer (EC) and predicts the poor prognosis of EC patients. This research aimed to assess the survival of patients with LM from EC by developing a nomogram. In this retrospective study, EC patients with LM from 2004 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were divided by year of diagnosis into a training cohort and a validation cohort. Univariate and multivariate Cox regression analyses were employed to determine the prognostic factors of LM, and a nomogram was constructed. The discrimination and calibration of the nomogram were compared by the C-index, area under the curve value, and calibration plots. The survival time difference was compared using Kaplan–Meier curves. A total of 11,695 patients with EC were included in this analysis. LM occurred in 56.5% (n = 6614) of EC patients. In the post-propensity score matching (PSM) cohort, patients with LM had significantly lower median overall survival (OS) than those without LM. Multivariate Cox regression was used to identify the eleven independent prognostic factors. The C-index was 0.709 in both the training and test sets, revealing the good predictive performance of the nomogram. Based on the results of calibration plots and the receiver operating characteristic (ROC) curve, we demonstrate the great performance of the prognostic model. The survival time of EC patients with LM was remarkably lower than that of EC patients without LM. The nomogram model established in this study can precisely predict the survival of EC patients with LM.
Follicular dendritic cell sarcoma arising in the stomach and abdominal cavity: A case report
Authors: Zhan Ting , Xing Shanshan , Lu Chunhua
Published: August 2023

Rationale:

Follicular dendritic cell sarcoma (FDCS) is a rare mesenchymal tumor that typically develops in lymph nodes; it is clinically uncommon and has only occasionally been documented in cases of soft tissue, liver and spleen, and retroperitoneum; it is also extremely uncommon to develop in the stomach.

Patient concerns:

A 64-year-old woman who discovered a lump in her left upper abdomen 6 months prior and was taken to the hospital due to excruciating abdominal pain.

Diagnosis:

An abdominal computed tomography scan showed a soft tissue mass around the cardia. The immunohistochemical and postoperative histopathology results were compatible with FDCS.

Interventions:

The patient underwent “radical total gastrectomy and esophagojejunostomy” (Roux-Y anastomosis).

Outcomes:

The patient recovered well 2 months after surgery.

Lessons:

We report a case of FDCS occurring in the stomach and abdominal cavity, which was unique in terms of clinical location, clinical presentation, and imaging signs. This case report aims to enhance clinicians’ understanding and diagnosis of FDCS in the stomach and abdominal cavity and reduce the rate of clinical misdiagnosis.
The diagnostic and prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio on gastric cancer patients
Authors: Nguyen Mai Ly Thi , Pham Chi , Le Quoc Vuong , Nham Phuong Linh Thi , Tran Doanh Hieu , Le Thanh Son , Hoang Van Tong , Can Van Mao , Nguyen Linh Toan , Bui Khac Cuong
Published: August 2023

Gastric cancer (GC) is the remaining concern of cancer-associated health burden. Valuable predictive and prognostic indicators support the early diagnosis and improve outcome. Immune escape and inflammation are important cancer hallmarks. The prognostic and diagnostic value of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) was reported in some cancers. But these cheap and convenient indexes are far from clinical use. Thus, investigation the alteration of those index on GC is needed to impose the use of those indexes in clinic. The study recruited seventy-seven hospitalized patients newly diagnosed with GC and 90 healthy individuals. The clinical and preclinical data of participants were collected from Hospital Information Management system. This study were approved by the Ethical Committee, Vietnam Military Medical University. The data were analyzed on STATA version 14.0 and GraphPad Prism 8.0. The alteration of immunological system was reported by significantly higher white blood cell count, neutrophils, platelets, PLR, and NLR as well as decreased lymphocytes on GC, compared to healthy individuals. Those indexes were elevated on advanced stage GC, compared to early stage GC. Our receiver operating characteristic curve analysis showed the significant specificity and sensitivity of PLR (cutoff 135.0) and NLR (cutoff 2.0) on GC diagnosis with respective area under receiver operating characteristic curve of 84.74% and 85.17%, P < .0001. Besides, our results reported the tendency of increased PLR and NLR and short time from clinical signs to being diagnosed. PLR and NLR have significant specificity and sensitivity in diagnosis and prognosis of GC.
Incompleteness trends of epidemiological variables in a Brazilian high complexity cancer registry: An ecological time series study
Authors: Grippa Wesley Rocha , Dell’Antonio Larissa Soares , Salaroli Luciane Bresciani , Lopes-Júnior Luís Carlos
Published: August 2023

Hospital Cancer Registries serve as a vital source of information for clinical and epidemiological research, allowing the evaluation of patient care outcomes through therapeutic protocol analysis and patient survival assessment. This study aims to assess the trend of incompleteness in the epidemiological variables within the Hospital Cancer Registry of a renowned oncology center in a Brazilian state. An ecological time-series study was conducted using secondary data from the Hospital Santa Rita de Cássia Cancer Registry in Espírito Santo between 2000 and 2016. Data completeness was categorized as follows: excellent (<5%), good (5%–10%), fair (10%–20%), poor (20%–50%), and very poor (>50%), based on the percentage of missing information. Descriptive and bivariate statistical analyses were performed using the free software RStudio (version 2022.07.2) and R (version 4.1.0). The Mann–Kendall test was used to assess temporal trends between the evaluated years, and the Friedman test was employed to evaluate quality scores across the years. Among the variables assessed, birthplace, race/color, education, occupation, origin, marital status, history of alcohol and tobacco consumption, previous diagnosis and treatment, the most important basis for tumor diagnosis, tumor-node-metastasis staging (TNM) staging, and clinical tumor staging by group (TNM) showed the highest levels of incompleteness. Conversely, other epidemiological variables demonstrated excellent completeness, reaching 100% throughout the study period. Significant trends were observed over the years for history of alcohol consumption (P < .001), history of tobacco consumption (P < .001), TNM staging (P = .016), clinical tumor staging by group (TNM) (P = .002), first treatment received at the hospital (P = .012), disease status at the end of the first treatment at the hospital (P < .001), and family history of cancer (P < .001), and tumor laterality (P = .032). While most epidemiological variables within the Hospital Santa Rita de Cássia Cancer Registry exhibited excellent completeness, some important variables, such as TNM staging and clinical staging, showed high levels of incompleteness. Ensuring high-quality data within Cancer Registries is crucial for a comprehensive understanding of the health-disease process.
Alterations in factors associated with diabetic retinopathy combined with thrombosis: A review
Authors: Wei Haiyan , Xiao Xiaoping , Zeng Shuqin , Liu Ye , Liu Xiaofang , Zeng Tianyu , Xu Pengxiang , Xia Wenyan , Guo Li , Hong Shihua , Lv Weiming , Chen Yijian , Xu Rong
Published: August 2023

Diabetic retinopathy (DR) is one of the most common and serious microvascular complications of diabetes mellitus, the incidence of which has been increasing annually, and it is the main cause of vision loss in diabetic patients and a common cause of blindness. It is now found that thrombosis plays a crucial role in the disease progression in DR patients, and the final vision loss in DR may be related to the occurrence of thrombosis in the retinal vessels, which is dominated by abnormal endothelial cell function, together with platelet dysfunction, imbalance of coagulation and fibrinolytic function, and related alterations of inflammatory factors leading to the main cause of thrombotic disease in DR patients. In this review, we examine the role between DR and thrombosis and the association of each factor, including endothelial dysfunction; platelet dysfunction; coagulation-fibrinolytic imbalance; and alterations in inflammatory factors.
Fortuitously detected primary ovarian carcinoid tumor: A case report
Authors: Choi Hwa Yeon , Pak Min Gyoung , Park Jung-Woo
Published: August 2023

Rationale:

Carcinoid tumors, derived from the cells of the disseminated neuroendocrine system, are rare, slow-growing neuroendocrine neoplasms that display a relatively indolent disease course. The majority of carcinoids are found within the gastrointestinal tract and bronchopulmonary system. Primary ovarian carcinoids are rare and account for merely 1% of all carcinoid tumors. We describe our experience of a rare case of primary ovarian carcinoid, presenting as chronic constipation, with no other carcinoid symptoms such as flushing, diarrhea, and wheezing.

Patient concerns:

A 51-year-old postmenopausal woman with chronic constipation visited the clinic for routine check-up of her preexisting uterine fibroids. She had undergone hemorrhoidectomy 3 years ago. Physical examination revealed a soft abdomen without direct or rebound tenderness. Transvaginal ultrasonography revealed two subserosal fibroids, which had increased in size compared with previous ultrasonographic findings. A 3 cm hyperechoic mass was also detected in the right ovary. Her blood and urine tests were unremarkable, with no ascites in the pelvic cavity. She had a normal CA-125 level of 5.5 units/mL.

Diagnosis, interventions, and outcomes:

The patient underwent a robot-assisted hysterectomy and right salpingo-oophorectomy because of enlarging fibroids and the right ovarian mass. Subsequently, based on the pathological and immunohistochemical findings, she was diagnosed with a primary ovarian carcinoid. The mass consisted of the insular and trabecular types of tumor cells. It was positive for pan-cytokeratin and synaptophysin, and the Ki-67 proliferation index was less than 1%. A follow-up positron emission tomography-computed tomography revealed no distant metastasis. Six months postoperatively, the patient was doing well without any signs of recurrence.

Lessons:

Primary ovarian carcinoids without teratoma components are rare. It is crucial to make an accurate diagnosis based on the immunohistochemical staining results. Diagnosis in the early stages of the disease are associated with a favorable prognosis, but regular follow-up is mandatory.
Cardiac tamponade due to eosinophilia treated with intravenous corticosteroid: A case report
Authors: Taniguchi Hiroaki , Kaneko Mayuko , Kiriu Nobuaki , Kiyozumi Tetsuro
Published: August 2023

Rationale:

Cardiac tamponade, a condition in which the heart is compressed by pericardial fluid retention, is easy to diagnose; however, identifying the cause may be challenging since it can be caused by a variety of conditions, including trauma and pericardial disease.

Patient concerns:

A 22-year-old man was admitted to the intensive care unit with respiratory failure. He had previously received allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia and developed chronic graft-versus-host disease (cGvHD) that was treated with a corticosteroid. At this time, he developed bilateral femur head necrosis and underwent surgery after discontinuation of the corticosteroid but developed respiratory failure postoperatively. The initial diagnosis was cardiac failure, which temporarily improved with treatment; however, eosinophilia and pericardial effusions became prominent.

Diagnoses:

Pericardial effusion gradually progressed, resulting in cardiac tamponade.

Interventions:

Pericardiocentesis was performed. Eosinophilia could be the cause of cardiac tamponade; thus, corticosteroid was administered.

Outcomes:

Pericardial effusion improved remarkably after corticosteroid administration. The corticosteroid dose was gradually tapered, and the patient was discharged.

Lessons:

This case presented with cardiac tamponade associated with eosinophilia, probably owing to graft-versus-host disease. This is an unusual condition associated with a history of hematologic neoplasms; although evaluation is challenging, appropriate assessment could help save the patient’s life.
Clinical benefits of FOLFOXIRI combined with bevacizumab for advanced-stage primary signet ring cell carcinoma of the appendix: A case report
Authors: Huang Nana , Lu Yishan , Wang Rui , Gao Ping , Liu Ge
Published: August 2023

Rationale:

Signet-ring cell carcinoma, which is an infrequent type of colorectal cancer. Abdominal pain is the primary presenting complaint of patients with acute appendicitis. It is difficult to diagnose patients with appendiceal carcinomas accompanying with symptoms of acute appendicitis.

Patient Concerns:

A 33-year-old female patient was admitted to our hospital, with chief complaints of “bilateral pelvic space-occupying lesions for 1 month, aggravated abdominal distension, and she accompanied with diarrhea for 3 days.”

Diagnosis:

The patient was with primary signet ring cell carcinoma of the appendix, presented with acute appendicitis, as well as bilateral ovarian metastasis and peritoneal implantation metastasis.

Interventions:

She was then treated with irinotecan, oxaliplatin, calcium folinate, 5-FU combined with bevacizumab, surgical treatment, and postoperative adjuvant treatment with oxaliplatin, capecitabine regimen to consolidate the efficacy.

Outcomes:

The patient is in good conditions, and postoperative adjuvant chemotherapy is in progress as well.

Conclusion:

The outcomes highlighted the importance of strict histopathologic assessment for appendiceal adenocarcinoma, and provided new ideas for the diagnosis and treatment of advanced-stage signet ring cell carcinoma of the appendix.
Intestinal perforation with systemic lupus erythematosus: A systematic review
Authors: Chen Ya Lan , Meng Jie , Li Cong
Published: August 2023

Intestinal perforation (IP) is a rare complication of systemic lupus erythematosus (SLE), and the timely diagnosis and treatment of IP are necessary to prevent death. In this study, the clinical features of IP in SLE were described in an attempt to enhance its understanding to reduce mortality. The clinical data of IP in SLE from 1984 to 2022 were retrospectively collected. A total of 18 patients were enrolled, and data on clinical symptoms, preoperative evaluation, surgical procedures, and postoperative outcomes were collected and retrospectively analyzed. The analysis included 15 females and 3 males, with a mean age of 49.2 years. Fifteen patients (83.3%) had a history of the disease for >5 years, and the SLE disease activity index score of 1 (5.6%) patient was <5 points and that of 17 (94.4%) patients was >10 points. A total of 9 (50%), 5 (27.7%), 3 (16.7%), and 1 (5.6%) patient had lesions in the rectum, colon, ileum, and both ileum and appendix, respectively. The cause of perforation in 12 (66.7%) patients was lupus mesenteric vasculitis and in 3 (16.7%) patients was chronic inflammation. Seven (38.9%) patients had other immune system diseases. All patients were treated with steroids and surgical treatment. However, 5 patients died after surgery. A disease duration of >5 years, SLE disease activity index score of >10, nonstandard use of steroids, and concomitant presence of other immune system diseases are the possible risk factors of IP in SLE. The most common site of perforation was the rectum, which was caused by lupus mesenteric vasculitis. The results suggest that the key to successfully manage such cases is early diagnosis, aggressive resuscitation, antibiotics, steroid therapy, and prompt surgical intervention.
Pulmonary sarcoidosis-like reactions induced by sintilimab in esophageal cancer: A case report
Authors: Li Haoqian , Mu Fengchun , Zou Bing , Wang Linlin
Published: August 2023

Rationale:

Esophageal cancer is one of the deadliest cancers in the world, with high incidence and mortality rates ranking among the top ten in China. The efficacy of conventional treatments is limited and often accompanied by severe adverse reactions, which results in unsatisfactory outcomes. The mechanism of immune checkpoint inhibitors (ICIs) is to activate cytotoxic T cells to kill tumor cells expressing tumor antigens. The application of ICIs has profoundly changed the mode of cancer treatment. However, the use of ICIs also induces a series of adverse reactions similar to autoimmune reactions, called immune-related adverse events (irAEs). Some ICIs can cause manifestations similar to those in the development of sarcoidosis, which are called sarcoidosis-like reactions or granulomatosis.

Patient concerns:

We report a 50-year-old Chinese male patient.

Diagnoses:

The patient had been diagnosed with advanced esophageal squamous cell carcinoma , and was confirmed to have pulmonary sarcoidosis-like reactions associated with sintilimab, a human programmed cell death protein 1 (PD-1) inhibitor.

Interventions:

The patient was administered corticosteroid treatment.

Outcomes:

After receiving steroid treatment, the patient’s systemic and pulmonary symptoms improved rapidly. To our knowledge, this is the first report of pulmonary sarcoidosis-like reaction in a patient with esophageal squamous cell carcinoma. The patient then continued to receive 1 year of follow-up antitumor treatment after the appearance of lung pulmonary sarcoidosis-like reactions. The prognosis was good and the patient’s condition is currently stable.

Lessons:

The diagnosis of ICI-induced sarcoidosis often requires comprehensive evaluation through clinical, pathological, and radiological assessment. A subset of patients with sarcoidosis-like reactions may not require treatment unless there is organ dysfunction or severe clinical symptoms, and these reactions generally respond well to treatment. The occurrence of sarcoidosis-like reactions after immunotherapy is positively correlated with the long-term prognosis of cancer patients. However, this hypothesis requires larger prospective studies for validation.
Risk factors of nonalcoholic fatty liver disease in healthy women
Authors: Guan Hui , Shao Guangrui , Cheng Fang , Ni Pingjuan , Wu Mei
Published: August 2023

We investigated the risk factors of nonalcoholic fatty liver disease (NAFLD) in healthy women. This is a cross-sectional study. Healthy women who underwent physical examination were enrolled. Their basic information and medical history [including age, height, weight, body mass index (BMI)], abdominal ultrasound results, and, serological indexes [including white blood cells, platelet count, fasting blood glucose, triglyceride (TG), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDLC), uric acid (UA), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and glutamyl transpeptidase] were collected. Univariate and multivariate regression analysis was carried out to screen the risk factors of NAFLD. ALT/AST ratio, and BMI were significantly independent risk factors for the occurrence and severity of NAFLD. In addition, TG/HDLC ratio, and UA level also had significant independent correlation with NAFLD. ALT/AST ratio, BMI, TG/HDLC ratio, and UA are independent risk factors for the occurrence and severity of NAFLD. It is suggested that obesity, hyperlipidemia, hyperuricemia and high transaminase value are closely related to NAFLD. People with such conditions should pay more attention to early screening of NAFLD to avoid disease aggravation and the occurrence and development of other complications. In clinical practice, ALT/AST, BMI, TG/HDLC, and UA level should be closely monitored, so as to facilitate the follow-up management of the disease.
Uncovering a new SASH1 mutation associated with dyschromatosis universalis hereditaria using whole-exome-sequencing: A case report
Authors: Yang Yue , Jiang Nan , Mai Jing Qun , Yang Shuo , Xiao Yuanyuan , Liu Shanling
Published: August 2023

Rationale:

Dyschromatosis universalis hereditaria (DUH) is an uncommon form of pigmented genodermatosis that is typically inherited autosomally and dominantly. In the previous study, the pathogenic genes of DUH have been identified in ATP-binding cassette subfamily B, member 6 and SASH1. However, the mutational screening of the causative gene remains incomplete and still lacks sufficient proof in the etiology.

Patient concerns:

A 2-generation Chinese family clinically diagnosed with DUH were enrolled. They showed pigmented spots from their childhood and came to the hospital for medical advice and genetic analysis. We found a novel mutation c.1757T > C (p.I586T) of SASH1 in 3 affected family members by whole-exome sequencing.

Diagnoses:

Genetic outcomes and clinical examinations confirmed the diagnosis of DUH in 3 family members with lentiginous syndrome.

Interventions and outcomes:

Using whole-exome sequencing and sanger sequencing technologies, we identified a novel mutation c.1757T > C (p.I586T) of SASH1 that co-segregated in 3 afflicted family members but not in the normal individuals. Significantly, c.1757T > C (p.I586T) is a novel mutation which had not been previously reported. The same codon position in SASH1 (c.1758C > G, p.I586M) has been reported in a Japanese man, and he showed identical phenotype compared to our study participants.

Lessons:

Our study broadens the spectrum of DUH mutations and provides more genetic characteristics of DUH in understanding its etiology. Furthermore, we demonstrated the diagnostic accuracy of whole-exome sequencing for inherited skin diseases and provided new information for etiological study.