bluuebunny/crossref_metadata_2025 huggingface dataset:
Granulocyte colony-stimulating factor combined with SOFA score for mortality prediction in patients with sepsis
Authors: Fu Xiaomeng , Zhang Ye , Wang Junyu , Liu Yugeng , Wei Bing
Published: December 2024

Background:

Sepsis in emergency departments is a prevalent occurrence characterized by high hospitalization rate and mortality. The granulocyte colony-stimulating factor (G-CSF) is an indicator for identifying patients with sepsis.

Methods:

A total of 171 patients with sepsis were included in our study who were admitted to the emergency department of Beijing Chaoyang Hospital affiliated with Capital Medical University from October 2020 to April 2021. Out of these patients, 122 did not survive on day 28. Laboratory tests, the sequential organ failure assessment (SOFA) score and the acute physiology and chronic health evaluation II (APACHE II) were calculated. Logistic regression and receiver operating characteristic curve were used to analyze the predictive value of G-CSF for 28-day mortality patients with sepsis.

Results:

There were significant differences in G-CSF, SOFA, APACHE II, systolic blood pressure (SBP), mean arterial pressure, lactate, and albumin between the survivor and non-survivor groups (P < .05). The multivariate regression analysis showed that G-CSF, SOFA, APACHE II, and SBP were independent risk factors for 28-day mortality in patients with sepsis. There was no comparative with significant differences in receiver operating characteristic curves of G-CSF, SOFA, and APACHE II for 28-day mortality in patients with sepsis (Z
1 = 1.381, P = .167; Z
2 = 0.095, P = .924).

Conclusions:

The G-CSF, SOFA, APACHE II, and SBP were identified as independent risk factors for mortality among patients with sepsis. Particularly, G-CSF and SOFA exhibited a high level of predictability for 28-day mortality in this population.
Bipolar sternocleidomastoid partial resection in pediatric patients case report: Technique and early outcomes
Authors: Obana Kyle K. , Myers Annika Y. , Bennett James T. , Siddiqui Ali A. , Fan Bensen B. , Andras Lindsay M. , Wren Tishya A.L. , Skaggs David L.
Published: December 2024

Rationale:

Congenital muscular torticollis (CMT) that is refractory to conservative therapy is often treated with unipolar or bipolar sternocleidomastoid (SCM) release. Prior texts and descriptions warn of overcorrection or defects, but these have not been encountered in our practice. However, recurrence and undercorrection have been observed, prompting us to transition to a bipolar release with partial resection of SCM. We will review the outcomes of this modified approach.

Patient concerns:

Nine patients (6 males and 3 females) failed a trial of physical therapy and all conservative measures.

Diagnoses:

All patients were diagnosed with CMT refractory to conservative therapy.

Interventions:

Nine patients were treated with unipolar SCM (6 right and 3 left). The mean age at the time of surgery was 9.3±3.4 years.

Outcomes:

There were no surgical complications. No patients required subsequent revision surgery. One patient had prior surgery on the SCM.

At final follow-up, 8 (88.9%) patients had a neutral head position. Rotation in the direction of the release significantly improved from preoperative to final follow-up (from 59.7±26.5 to 85.6±7.3 degrees, P = .01). Rotation in the opposite direction (away from the release) was maintained from preoperative to final follow-up (83.8±11.1 vs. 85.6±8.8 degrees, P = .71). No cases of overcorrection or defect in the area of the resection were observed.

Lessons:

Bipolar release with partial resection may be a promising form of treatment for CMT as head position was improved without overcorrection, defects, or other complications.
Systemic immune profiling analysis identifying M2-TAM related genes predicted colon cancer prognosis and chemotherapy responses
Authors: Liu Xiaopei , Liu Dan , Tan Cong’e , Wang Jiehong
Published: December 2024

Colon cancer (COAD) poses great challenges to clinical treatment due to its heterogeneity and complex immune microenvironment. M2-like macrophages significantly influence COAD’s onset, progression, and treatment. Yet, existing M2-like macrophage markers are limited in prognostic efficacy, prompting the exploration of new M2 signatures. Extensive data analysis aimed to unveil prognosis-associated M2-derived signatures. Bulk transcriptome, single-cell RNA sequencing, and clinical data from The Cancer Genome Atlas and Gene Expression Omnibus databases for patients with COAD were amassed. Cell-Type Identification by Estimating Relative Subsets of RNA Transcripts identified immune cell infiltration, and the Kaplan-Meier test identified crucial immune populations associated with prognosis. Genetic signatures linked to M2 tumor–associated macrophage were crafted utilizing weighted gene coexpression network analysis, least absolute shrinkage and selection operator, and Cox regression. The M2 tumor–associated macrophage gene signature was validated in GSE17536. The expression profile of the M2 gene signature was investigated in single-cell RNA sequencing dataset GSE166555. Systemic immune profile identified that M2-like macrophage has the most significant prognostic significance in The Cancer Genome Atlas-COAD. The core genes related to M2 macrophage infiltration were extracted by weighted gene coexpression network analysis. Least absolute shrinkage and selection operator-stepwise COX regression–derived M2-derived signatures (snail family zinc finger 1, gastrin-releasing peptide, gamma-aminobutyric acid type A receptor delta subunit, cluster of differentiation 1B, poly(A)-binding protein cytoplasmic 2, manic fringe, and death-associated protein kinase 1) as a risk model, which was confirmed as independent prognosis factors, validated by external dataset. This M2-based prognostic model reflected M2 macrophage infiltration. Mendelian randomization established cytotoxic T lymphocyte associate protein-4 and cluster of differentiation 274 immune checkpoints’ causality with COAD. In conclusion, our study developed novel markers for discriminating M2-like macrophages and predicting the prognosis of patients with COAD, offering fresh perspectives for clinical interventions.
COVID-19 induced thrombotic thrombocytopenic purpura in a patient with systemic lupus erythematosus: A rare case report
Authors: Gao Ou , Chen Yinghua , Xie Honglang
Published: December 2024

Rationale:

Thrombotic thrombocytopenic purpura (TTP) is a severe and rare disease, and its complexity increases in the presence of underlying autoimmune disease and COVID-19 infection, making differential diagnosis and treatment more challenging.

Patient’s concerns:

A 43-year-old patient presented with high fever, intermittent cough, and tea-colored urine.

Diagnoses:

The patient had a long-term history of systemic lupus erythematosus (SLE) and lupus nephritis (LN). The nasopharyngeal swab confirmed the diagnosis of COVID-19 by RT-PCR, and plasma ADAMTS-13 activity was completely deficient (0%). It was considered that COVID-19 infection occurred on the basis of SLE disease and was then complicated with TTP.

Interventions:

The patient was successfully treated with plasma exchange, followed by a combination of biologics and immunosuppressants.

Outcomes:

After 1 year of follow-up, the patient had completely recovered from COVID-19 infection and TTP, meeting the cure criterion. In addition, the LN was in remission, with an SLEDAI-2K score of 0, indicating a low disease activity state.

Lessons:

This article indicates that the patient suffers from both long-standing underlying diseases and the sudden occurrence of SARS-CoV-2 infection, which complicates the determination of the etiology and diagnosis of TTP. Consequently, after thorough analysis of the disease progression, clinical manifestations, laboratory results, and treatment outcomes, it was primarily concluded that COVID-19 was the catalyst for the onset of TTP in this patient.
Gene variant C3 glomerulonephritis with chronic urinary tract infection: A case report and literature review
Authors: Xu Chao , Fan Junfen
Published: December 2024

Rationale:

C3 glomerulonephritis (C3GN) is 1 type of C3 nephropathy which is a rare glomerular disease associated with abnormal regulation of the alternative complement pathway. This review reports a rare case of C3GN with repeated urinary tract infection and summarizes the clinical features, differential diagnosis, treatment, and outcome of patients with C3GN.

Patient concerns:

A 44-year-old woman was admitted to our hospital because of proteinuria increased for more than 8 years.

Diagnoses:

The patient was finally diagnosed with C3GN by renal biopsy and gene testing.

Interventions:

The patient was worried about the side effects of drugs and strongly refused to use glucocorticoids and immunosuppressants, so she was given angiotensin II receptor blocker monotherapy for glomerulonephritis and quinolones for urinary tract infection.

Outcomes:

Serum creatinine, proteinuria, and serum complement c3 levels remained stable. Our case is still under continuous follow-up.

Lessons:

Clinical diagnosis of C3GN is difficult to make as there are many differential diagnoses, especially post infection nephritis. This case emphasizes the importance of renal biopsy in the diagnosis of C3GN, but the relationship between gram-negative bacilli and C3GN is still unclear. In addition, gene mutation is also involved in the pathogenesis of C3GN, and the treatment of C3GN still needs to be explored.
Investigation of the relationship between hypertension and asymptomatic organ damage in patients with Sjogren’s disease
Authors: Bayraktar Muhammet Fatih , Toprak Güvenç , Taşçi Murat
Published: December 2024

The study aimed to compare the development of asymptomatic cardiovascular (CV) organ damage in hypertensive patients with and without Sjogren syndrome (SS), a condition characterized by inflammatory processes that lead to vascular damage. Forty hypertensive patients with SS (aged 18–65) and 40 age- and sex-matched hypertensive patients without this syndrome were included into the study. Carotid intima-media thickness was measured from area of 1 cm length proximal to both carotid bulbs. Left ventricular mass index was determined via echocardiography, and microalbuminuria was calculated from spot urine samples. Hypertensive retinopathy was assessed through fundoscopy. Asymptomatic organ damage was found in 51.2% of all participants: 61% in the Sjogren group and 39% in controls, with a statistically significant difference between groups and sexes (P = .041). Carotid intima-media thickness was higher in the Sjogren group (0.815 mm vs 0.607 mm in controls), and left ventricular mass index was significantly elevated in the Sjogren group (92.54 g/m² vs 83.07 g/m², P = .016). All patients with Sjogren disease had at least stage 1 hypertensive retinopathy, while 14 patients in the control group had not. Microalbuminuria values were higher in the Sjogren group but the difference was not statistically significant (P = .082). Hypertensive patients with SS exhibit more asymptomatic organ damage compared to those without the syndrome. Close monitoring and CV screening with measurement of tools which are reflecting subclinical atherosclerosis are recommended for prevention and early detection of overt CV diseases in this population.
Over-supplement of vitamin D may cause delirium, abdominal distension, and muscle weakness in the elderly: A case report and literature review
Authors: Yu Ching-Hsiang , Tseng Hsiang-Kuang , Chien Ding-Kuo , Liao En-Chih
Published: December 2024

Rationale:

Vitamin D deficiency is common among the elderly due to limited sunlight exposure, increasing osteoporosis risk. Over-supplementation poses risks, especially with caregiver involvement.

Patient concerns:

Rising vitamin D overdose cases underscore the need for better education on safe intake and monitoring practices to prevent toxicity, particularly hypercalcemia from excessive doses.

Diagnoses:

This case report details the clinical presentation and management of a woman who exhibited progressive lower limb weakness, delirium, and abdominal distension over a 3-day period. Initial assessments ruled out intracranial hemorrhage but revealed significant electrolyte imbalances, including hyponatremia, hypokalemia, hypomagnesemia, and severe hypercalcemia. Upon further inquiry, it was discovered that the patient had consumed an excessive amount of liquid Vitamin D3 over the preceding 3 weeks, surpassing the threshold for vitamin D intoxication.

Interventions:

Intravenous fluid hydration was initiated to promote calcium excretion. Bisphosphonates and calcitonin were administered to reduce serum calcium levels. Electrolyte imbalances, including hyponatremia, hypokalemia, and hypomagnesemia, were corrected. Continuous monitoring and supportive care were provided in the geriatric ward.

Outcomes:

After these treatments, the patient’s electrolyte levels stabilized, and her symptoms, such as confusion and muscle weakness, gradually improved, leading to a full recovery.

Lessons:

This case underscores the importance of recognizing hypercalcemia, particularly in the elderly, where symptoms may manifest nonspecifically. Additionally, it highlights the potential risks associated with medication errors and inadvertent overdoses, particularly in situations involving elderly spousal caregivers.
Epidemiology and outcome analysis of blast injury patients in Japan: An analysis of the nationwide trauma registry database
Authors: Madokoro Shunsuke , Hirano Yohei , Kondo Yutaka , Okamoto Ken
Published: December 2024

Blast injuries in safe countries like Japan are understudied. This study examines nationwide data to reveal unique patterns, hypothesizing differences from conflict zones, and provides baseline insights for improving trauma care and disaster preparedness globally. This retrospective cohort study was conducted between 2004 and 2017 using a nationwide trauma registry in Japan. Data on patients with blast injuries were extracted from the registry and divided into 3 age groups: 0 to 15 years; 16 to 64 years; and 65-years. Data on patient demographics including age, gender, time of injury, cause of injury, and severity such as abbreviated injury scale for each component of the body and injury severity score (ISS) were analyzed among the groups. The examinations, treatment, and mortality were also assessed. The primary outcome of the study was the in-hospital mortality rate. We also performed subgroup analysis of patients with or without inhalation injuries. A total of 523 blast injury patients were treated during the study period. Among these, 18 belonged to the 0–15 year age group, 414 to the 16 to 64 year age group, and 91 to the 65-year age group. Males accounted for 83.4% of all patients. Most injuries were unintentional (56.2%), with all pediatric injuries occurring accidentally. The skin was the most frequently injured body part (84.3%) and a mean injury severity score was 9. Severe injuries (abbreviated injury scale ≥ 3) mainly involved burns. Only a single body area was damaged in 81.5% of all cases. Focused assessment with sonography for trauma was not performed in 66.5% of cases, and computed tomography scanning was not conducted in 67.7%. No surgery was performed in 67.1% of the cases. The overall in-hospital mortality rate was 6.1%, and the emergency department mortality rate was 1.5%. Intensive care unit admission was common (77.4%). Inhalation injuries were present in 31.5% of patients. These patients had higher intensive care unit admission rates (92.1%) compared to those without inhalation injuries (70.7%), and more frequent tracheal intubations (36.4% vs 15.4%). The study clarified the characteristics of blast injuries in Japan.
Musculoskeletal ultrasound-guided needle knife therapy in the treatment of refractory nonspecific low back pain: A single-blind, randomized controlled trial
Authors: Li Xia , Zhang Hongkai , Zhang Sidi , Wu Mingqi , Wang Shiyun , Tang Zhanying , Xiao Jing
Published: December 2024

Background:

This clinical study aimed to evaluate the Numerical Rating Scale (NRS), Oswestry disability index (ODI), and Japanese Orthopedic Association (JOA) scores at 2, 4, 6, and 12 weeks, and the thickness of the 4th lumbar multifidus under ultrasound at 6 and 12 weeks, using musculoskeletal ultrasound (MU)-guided needle-knife loosening therapy for treating refractory nonspecific low back pain (RNSLBP) compared to usual care, to demonstrate the clinical efficacy of needle knife therapy for RNSLBP. This study used a single-blind, randomized controlled design.

Methods:

A total of 66 patients with RNSLBP who met the inclusion criteria were randomly divided into an observation group and a control group of 33 patients. The observation group underwent MU-guided needle knife release for RNSLBP, whereas the control group underwent low-frequency transcutaneous electrical nerve stimulation therapy, exercise therapy, and oral celecoxib capsules if necessary.

Results:

No statistically significant differences were observed in the baseline data (sex, age, body mass index, disease duration, NRS score, ODI score, JOA score, and 4th lumbar multifidus muscle thickness) (P > .05) between the 2 groups, with both groups having flat baseline and comparable indices. After 2, 4, 6, and 12 weeks of treatment, NRS and ODI scores decreased, while JOA scores increased in both groups, with statistically significant differences both within and between the 2 groups. The observation group showed better results than did the control group. The difference in multifidus muscle thickness between the 2 groups was not statistically significant after the final treatment; however, at the 12-week follow-up, the observation group showed significantly greater multifidus muscle thickness than the control group, with a statistically significant difference.

Conclusion:

This study demonstrated that MU-guided needle knife release effectively treats RNSLBP by reducing pain, improving lumbar spine function, and increasing the multifidus muscle thickness. It is efficient, safe, has a shorter treatment period, and causes fewer adverse reactions.
Saliva and serum biomarkers in oral diseases: A case–control study
Authors: Al Shaar Aliaa , Hamadeh Omar , Ali Ayman
Published: December 2024

Saliva stands out as an advantageous diagnostic fluid due to various reasons that make it a reliable and practical source for analysis. Its abundance facilitates easy and large-scale sample collection, enhancing its diagnostic utility. The simplicity of collecting and storing saliva samples, combined with its accessibility and cost-effectiveness compared to other body fluids, makes it an attractive choice for diagnostic purposes. This study aims to investigate and compare variations in salivary biomarkers with their serum counterparts in specific oral diseases such as recurrent aphthous stomatitis (RAS), lichen planus (LP), and oral cancer (OC). A case-control study was conducted in 55 individuals, including 15 patients with RAS, 13 patients with LP, 12 patients with OC, and a 15 individuals in the control group. Saliva and serum samples were collected after a specified fasting period, and various biomarker analyses immunoglobulin A (IgA), cortisol, lactate dehydrogenase (LDH) were conducted using laboratory techniques. In this study, an independent samples t-test was employed to investigate the significant differences between the experimental groups and the control group. The results indicated that there was a statistically significant difference in the salivary IgA levels, salivary cortisol levels, and salivary LDH levels (P = .000) (P = .016) (P = .001), respectively, as compared to the control group. However, no significant differences were observed in serum cortisol levels (P = .363) and serum IgA levels (P = .101) when compared to the control group. Interestingly, significant differences materialized when evaluating serum LDH levels (P = .048) in the OC group as compared to the control group. Overall, this research contributes to a deeper understanding of the utility of salivary biomarkers in diagnosing oral diseases and may pave the way for improved diagnostic and treatment strategies in the field of oral health.
First-line carboplatin-based chemotherapy may be beneficial for HER2-low advanced breast cancer: A retrospective analysis
Authors: Li Jingxin , Tang Yijing , Chen Qianying , Lei Sen , Lu Yongkui , Tan Aihua , Xie Weimin
Published: December 2024

For patients with human epidermal growth factor receptor 2 (HER2)-low advanced breast cancer who had failed to meet with anthracycline or taxane, the application of HER2-targeted antibody-drug conjugates as second-line therapy could improve patients' outcomes, but it is unclear whether carboplatin-based first-line therapy will benefit these patients. This retrospective study was designed to explore whether carboplatin based first-line treatment could improve outcomes in HER2-low advanced breast cancer, and to analyze potential factors affecting efficacy and prognosis. 103 patients with HER2-negative metastatic breast cancer were treated with carboplatin based first-line therapy. The differences in progression-free survival (PFS), objective response rate (ORR), and adverse events were analyzed in different HER2 expression subgroups. The risk ratio (HR) and 95% confidence interval (CI) for PFS were estimated using Cox proportional risk models. The ORR for the whole group was 42.72% and the median PFS (mPFS) was 7.93 months (m). The ORR of HER2-low patients was significantly higher than HER2-zero patients (56.4% vs 27.1%, P = .003), and HER2-zero was an independent risk factor of ORR (OR 3.478, 95%CI 1.516–7.977, P = .003), especially in the HR-negative subgroup. The mPFS was significantly longer in patients with low neutrophil-to-lymphocyte ratio (NLR) scores than those with high NLR scores (P < .001). Multivariate analysis showed that young breast cancer (age < 40) (P = .006) and high NLR values (P = .001) were prognostic risk factors affecting mPFS. The main grade 3 to 4 adverse reactions were neutropenia (15.53%), anemia (15.53%), and leukopenia (11.65%). The first-line carboplatin-based chemotherapy is quite active and tolerable in patients with HER2-low advanced breast cancer, that higher response rates can be achieved. In cases where CDK4/6 inhibitors are inappropriate for use due to resistance to endocrine therapy or the urgent need for short-term clinical response, chemotherapy remains important. When it is necessary to consider the accessibility of antibody-drug conjugates and the economics of patients, carboplatin-based chemotherapy may be provided to HER2-low patients as a more convenient, cost-effective and efficient option on the front line. Forecasting the efficacy and prognosis via inflammatory index such as NLR before the commencement of the treatment could enhance the precision and efficiency of carboplatin-based regimens.
Predictive value of platelet parameters for bronchopulmonary dysplasia in preterm infants: A systematic review and meta-analysis
Authors: Zhang Shunyou , He Yulin , Liu Chonghai
Published: December 2024

Background:

To systematically evaluate the predictive value of platelet (PLT) parameters for bronchopulmonary dysplasia (BPD) in preterm infants.

Methods:

PubMed, Embase, Cochrane Library, and Web of Science databases were searched for studies on PLT parameters predicting BPD in preterm infants from inception to December 2023. The Newcastle-Ottawa Scale was adopted to judge the article’s quality. RevMan 5.4 was utilized for Meta-analysis, and Stata/SE 15.1 was applied for sensitivity analysis and Egger regression test.

Results:

Ten studies were included, including 1637 preterm infants, of which 540 were diagnosed with BPD. Meta-analysis showed that PLTs (SMD = −0.98, 95% CI [−1.57, −0.38], P = .001), mean platelet volume (MPV) (SMD = 0.67, 95% CI [0.19, 1.15], P = .006), and PMI (SMD = −0.47, 95% CI [−0.65, −0.28], P < .00001) could assist in predicting BPD in preterm infants. Subgroup analyses showed that PLT parameters 3 days after birth had better predictive performance for BPD in preterm infants. Sensitivity analysis implied no significant change in the results after excluding the studies 1 by 1, suggesting robust results of meta-analysis. There was a significant publication bias in the enrolled studies (P < .001).

Conclusion:

PLT, MPV, and PMI have a predictive value for BPD in preterm infants.
Correlations of mucin 5B gene polymorphisms and expression levels with the risk of onset of coal workers’ pneumoconiosis
Authors: Yang Li , Deng Hao , Chen Hongyun , Wu Mali , Li Jun , Zhang Tao
Published: December 2024

This study investigates the correlations of mucin 5B (MUC5B) rs2672794, rs2075854, and rs868903 polymorphisms and MUC5B expression level with the risk of the onset of coal workers’ pneumoconiosis (CWP). Overall, 506 Han Chinese men were included in this study. Among them, 143 were healthy individuals, 132 were dust-exposed workers who underwent health monitoring periodically, and 231 were patients with CWP. The participants were categorized into the following groups based on health status: healthy, exposure, CWP stage I, and CWP stage II groups. Genotyping was performed using the MassARRAY platform, and gene expression levels were measured via real-time fluorescence quantitative polymerase chain reaction. Subsequently, the correlations of 3 single-nucleotide polymorphisms (rs2672794, rs2075854, and rs868903) and MUC5B gene expression with the risk of CWP onset were analyzed. Distributions of the rs2672794 (P = .82) and rs2075854 (P = .72) genotypes were not significantly different among the various groups. Frequencies of the CC and CT genotypes of single-nucleotide polymorphism rs868903 and the C allele of MUC5B were higher in patients with CWP than in the healthy group (P = .04). The MUC5B expression level of patients with CWP was significantly lower than those of the exposure and healthy groups (P < .001). Receiver operating characteristic curve analysis revealed that MUC5B in blood cells was a sensitive biomarker for CWP diagnosis. Significant differences were observed in MUC5B gene expression levels among different genotypes of rs868903 (P < .001), with individuals carrying the CC and CT genotypes exhibiting lower MUC5B gene expression levels than those with the TT genotype. The rs868903 polymorphism in the MUC5B gene could be associated with the susceptibility to CWP, and early monitoring would aid in identifying individuals at high risk. MUC5B might serve as a valuable early screening biomarker for CWP.
Social dilemma for 30 years: Progress, framework, and future based on CiteSpace analysis
Authors: Gao Juan , Geng Yuqing , Jiang Xinying , Li Jianyi , Yan Yan
Published: December 2024

Social dilemmas have been a popular research topic in the past 30 years, yet there is still a lack of interdisciplinary reviews. This study represents the first attempt to conduct a bibliometric analysis of social dilemma research over the past 30 years, aiming to identify the research status, research hotspots, and future trends in this domain. We conduct an interdisciplinary analysis of 3630 articles from 1993 to 2023 using CiteSpace software. We find that: (1) this research domain exhibits a fluctuating upward trend and possesses evident interdisciplinary characteristics. (2) Collaboration among authors, institutional and regional, is much more prevalent, especially in the evolutionary dynamics of human behavior, cooperation, and reinforcement learning. (3) The current hot trend in this field of research is to investigate the influencing factors and solutions for social dilemmas. Researchers have shown great interest in value orientation, social norms, fairness, punishment, and rewards in promoting cooperation. (4) In the future, this field will cover different disciplines, develop theoretical frameworks grounded in bounded rationality, explore the boundary conditions of effective strategies, and integrate emerging technologies. This study serves as a valuable reference for scholars seeking to navigate social dilemma research while also providing insights for managers aiming to devise practical solutions to social dilemmas.
The effect of frailty on postoperative recovery in patients with cardiovascular surgery
Authors: Zengin Hilal , Yildirim Nadide
Published: December 2024

This study aimed to examine the impact of frailty on postoperative morbidity and mortality in patients undergoing cardiovascular surgery, questioning the adequacy of the preoperative American Society of Anesthesiologists (ASA) as the sole assessment tool. In a cohort of 76 patients undergoing cardiovascular interventions, we analyzed demographic data, Edmonton Frail Scale (EFS), ASA scores, Charlson Comorbidity Index values, surgery and hospitalization durations, intraoperative blood pressures, inotropic needs, erythrocyte transfusions, and pre/postoperative hemoglobin levels. Pearson chi-squared and Spearman tests were performed. Correlation of postoperative intensive care unit (ICU) stay, extubation time, ward stay, discharge status, morbidity rates, and ASA and EuroSCORE II results with EFS scores. The demographic profile indicated a mean age of 59.67 ± 13.02 years, with a majority of male patients (59.2%). Frailty status varied, with 48.7% non-frail, 26.3% vulnerable, 18.4% mildly frail, and 6.6% moderately frail. Surgical data revealed an average duration of 300.93 minutes and a mean ICU stay of 54.48 ± 101.16 hours. Statistical analysis showed significant differences in frailty levels based on initial morbidity (χ2 = 10.612, P = .014) but not in ASA score distribution by morbidity status (χ2 = 1.634, P = .442). A negative correlation was observed between EFS scores and hemoglobin levels, along with a positive correlation between the EuroSCORE II score and the duration of intubation, extubation, and ICU stay. Frailty significantly contributes to increased morbidity and necessitates evaluation alongside preoperative ASA scores to inform the need for prehabilitation. The ultimate goal extends beyond patient survival, aiming to ensure recovery while maintaining the quality of life and functional independence.
Regional nerve block in postoperative analgesia after cesarean section: A narrative review
Authors: Qin Yongyi , Yang Yujiao , Qin Sulan , Xiong Zhaohui
Published: December 2024

Of all obstetric operations, cesarean section is one of the most common. The impact of postoperative pain on physical and mental health in women cannot be ignored. Moreover, effective postoperative analgesia is essential in women who have given birth. Traditional systemic analgesic methods (intravenous analgesia, oral analgesics, etc) are often accompanied by adverse reactions that are positively correlated with the drug dosage. Regional nerve block is an analgesic and anesthetic technique that temporarily blocks nerve conduction by injecting local anesthetics around the nerve roots, nerve trunks, nerve plexus, ganglia, or surgical area, thereby alleviating or eliminating pain. Currently, the regional block techniques used for postoperative analgesia following cesarean section include paravertebral nerve block, transversus abdominis plane block, rectus sheath block, quadratus lumborum block, ilioinguinal-iliohypogastric nerve block, erector spinae block, wound infiltration analgesia, and intraperitoneal infusion of local anesthetics. These regional block techniques hold great promise for providing effective postoperative analgesia after cesarean section, each with unique advantages. Moreover, regional blocks have a unique place in multimodal analgesia protocols following cesarean section and are increasingly used in clinical practice for analgesia after cesarean section. This review provides an overview of the regional nerve block techniques used for postoperative analgesia following cesarean section, discusses their benefits and drawbacks, and provides a reference for choosing postoperative pain management following cesarean delivery, offering a hopeful outlook for improved patient care.
The clinical and radiographic features of eastern equine encephalitis: A single-center retrospective case series
Authors: Garcia-Dominguez Maria A. , Moonis Majaz , Kipkorir Vincent , Srichawla Bahadar S.
Published: December 2024

Rationale:

This case series aims to describe the clinical and radiographic findings associated with eastern equine encephalitis (EEE) virus.

Patient concerns:

Patients in this series presented with a variety of neurological symptoms, including altered mental status, seizures, and focal neurological deficits. Common initial concerns included confusion, hemiparesis, fever, and flu-like symptoms. In all cases, the progression of neurological symptoms prompted urgent medical evaluation and hospitalization.

Diagnoses:

Diagnosis of EEE was confirmed in all 4 patients by detection of EEE-specific IgM antibodies in cerebrospinal fluid. Cerebrospinal fluid studies also showed elevated protein, red blood cells, normal or high glucose, and elevated white blood cells with lymphocytic or neutrophil predominance. Magnetic resonance imaging showed T2 hyperintensities in the basal ganglia, thalamus, and cortical regions. Two cases showed encapsulation as evidence by a hyperintense ring around the basal ganglia or thalamus. Electroencephalogram findings ranged from normal, focal irritability, and spikes to nonconvulsive status epilepticus. Clinical and/or electrographic evidence of seizure was seen in all 4 cases.

Interventions:

All patients received supportive care, including anticonvulsant therapy, often using levetiracetam. Two patients were treated with high-dose intravenous methylprednisolone and one with intravenous immunoglobulin (IVIG) to modulate the immune response. Empiric antibiotics and antivirals were initiated in most cases until the diagnosis of EEE was confirmed. Two patients required intubation and mechanical ventilation, one of which was due to seizure activity and nonconvulsive status epilepticus.

Outcomes:

We report a 1/4 (25%) mortality rate. The average hospital stay among survivors was 10 days. Two-fourth (50%) required intubation and mechanical ventilation. Two patients were discharged to rehabilitation facilities, one patient recovered fully with resolution of magnetic resonance imaging abnormalities at follow-up, and one patient experienced a fatal outcome after the family opted to withdraw care due to a poor prognosis.

Lessons:

This case series underscores the importance of maintaining a high clinical suspicion of EEE in patients with acute neurological symptoms, especially in endemic areas. Early diagnosis and treatment are crucial, but the variability in presentation and imaging findings complicates this process. Early use of high-dose steroids can improve outcomes.
Review of Point-of-Care Diaphragmatic Ultrasound in Emergency Medicine
Authors: Kharasch Sigmund J. , Salandy Sonja , Hoover Paloma , Kharasch Virginia
Published: December 2024

The diaphragm is the major muscle of inspiration accounting for approximately 70% of the inspired tidal volume. Point-of-care diaphragmatic ultrasound offers the ability to quantitatively assess diaphragmatic function, perform serial evaluations over time, and visualize structures above and below the diaphragm. Although interest in point-of-care ultrasound (POCUS) of the diaphragm is developing in the emergency medicine, assessment of the diaphragm and its function is not recognized as a core application by national organizations or expert guidelines. As a result, it is infrequently performed, and its potential value in research or clinical practice may not be fully appreciated. The purpose of this review is to describe the developmental aspects of the diaphragm as it pertains to POCUS, discuss the POCUS techniques for evaluating diaphragmatic function, address competency acquisition in this POCUS application, summarize relevant research in the ED, and provide a summary of recommendations for further research and clinical utilization of POCUS in diaphragm evaluation.
Risk and Mortality of Cardiovascular Diseases in Patients with Dupuytren’s Disease: A Nationwide Population-Based Cohort Study
Authors: Ryu Jeong Yeop , Park Tae Hwan , Lee Joon Seok , Choi Kang Young , Yang Jung Dug , Chung Ho Yun
Published: December 2024

Background:

Dupuytren’s disease (DD) is a type of fibroproliferative disease that involves the palmar aspect of the hand. Although many benign fibroproliferative diseases have been shown to increase the risk of cardiovascular disease, the relationship between DD and myocardial infarction (MI) or stroke has not been fully elucidated.

Methods:

A total of 35,909 patients with DD and a control cohort with 1,077,270 age- and sex-matched participants from the Korean National Health Insurance database were included. The incidence of MI, stroke, and survival after cardiovascular events, were compared between participants with DD and the control cohort.

Results:

Compared with the control cohort, the incidence rate ratio for cardiovascular diseases in DD was 1.51 (95% confidence interval, CI 1.44–1.58) for MI, 2.01 (CI 1.94–2.09) for ischemic stroke (IS), and 1.49 (CI 1.36–1.63) for hemorrhagic stroke (HS). After adjusting for other cardiovascular disease risk factors, DD was associated with an increased risk of IS. Based on the age-, sex-, and BMI-stratified analyses, an increased risk of MI was identified in the younger age group (<50 years) and thin subjects (BMI<18.5 kg/m2). Adjusted hazard ratios for mortality in subjects with DD who developed cardiovascular diseases were 0.51 (CI 0.43–0.60), 0.56 (CI 0.50–0.62), and 1.08 (CI 0.86–1.36), respectively.

Conclusions:

DD is associated with an increased risk of IS, independent of cardiovascular risk factors. DD is also associated with an increased risk of MI in individuals younger than 50 years of age. DD did not significantly aggravate mortality secondary to cardiovascular events.
Moving Towards the Outpatient DIEP Flap: Factors Influencing Early Discharge
Authors: Graziano Francis D. , Plotsker Ethan L. , Amakiri Uchechukwu O. , Shammas Ronnie L. , Vingan Perri S. , Mehrara Babak J. , Stern Carrie S. , Nelson Jonas A. , Matros Evan , Allen Robert J.
Published: December 2024

BACKGROUND:

Enhanced Recovery After Surgery (ERAS) protocols can reduce the length of stay (LOS) for surgical patients, including those undergoing unilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, allowing most patients to be discharged by postoperative day 2. However, some patients require a prolonged inpatient stay due to difficulty completing postoperative milestones. This study aims to identify factors associated with increased LOS after DIEP flap breast reconstruction and assess safety of earlier discharge.

METHODS:

A retrospective review was performed of all patients who underwent unilateral DIEP reconstruction between January 2021 and December 2022 at Memorial Sloan Kettering. We assessed patient characteristics, comorbidities, and complications to identify correlations with LOS and milestone completion after implementation of an ERAS protocol.

RESULTS:

A total of 278 patients were included; the median LOS was 2.25 days (interquartile range: 2.19,2.33). Factors associated with delayed discharge included increased age, increased operative time, history of diabetes, and history of immunologic disease. Increased operative time was the only variable associated with prolonged milestone completion. A sub-analysis of the safety of an earlier discharge goal of postoperative day 1 when compared to a goal of postoperative day 2 demonstrated no significant differences in complication rates.

CONCLUSIONS:

Discharge timing and milestone completion after unilateral DIEP flap reconstruction is variable and dependent on patient and operative characteristics. These insights can aid in patient optimization and may suggest ERAS protocol adjustments to enable earlier discharge for more patients. Furthermore, earlier discharge goals appear safe for appropriate patients.
225Ac-PSMA-617 Augmentation After Insufficient Response Under 177Lu-PSMA-617 Radioligand Therapy in mCRPC: Evaluation of Outcome and Safety From a Prospective Registry (REALITY Study)
Authors: Rosar Florian , Khreish Fadi , Nagel Lea Sophie , Blickle Arne , Burgard Caroline , Petto Sven , Bastian Moritz B. , Speicher Tilman , Bartholomä Mark , Maus Stephan , Schaefer-Schuler Andrea , Ezziddin Samer
Published: December 2024

Background

Even though the introduction of 177Lu-PSMA-617 RLT represents a major milestone in the treatment of mCRPC, there are still patients who do not respond adequately to this therapy and for whom there are only limited options left. Augmenting 177Lu-PSMA-617 RLT with the alpha-emitter 225Ac-PSMA-617 may present an escalating treatment option to increase efficacy. In this study, we aim to evaluate outcome and safety of 225Ac-PSMA-617 augmentation to 177Lu-PSMA-617 RLT in patients who present insufficient response to monotherapy with 177Lu-PSMA-617 RLT.

Patients and Methods

The study included n = 51 mCRPC patients enrolled in a prospective registry receiving 177Lu-PSMA-617 monotherapy and showing insufficient response, followed by initiation of 225Ac-PSMA-617 augmentation, with adjusted activities depending on individual patient characteristics. Biochemical response, progression-free survival, and overall survival were assessed. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE v.5.0).

Results

After initiation of 225Ac-PSMA-617 augmentation to 177Lu-PSMA-617 RLT, 24/51 patients (47.1%) exhibited partial remission, 16/51 (31.4%) stable disease, and 11/51 (21.6%) progressive disease. The median progression-free survival and overall survival rates were 6.3 months and 9.1 months, respectively. The majority of CTCAE gradings remained stable after initiating augmentation. Severe adverse events were rare, and no treatment termination due to side effects was recorded.

Conclusions

225Ac-PSMA-617 augmented 177Lu-PSMA-617 radioligand therapy seems to be an effective escalating treatment option in patients after failure of conventional 177Lu-PSMA-617 RLT and represents a promising approach balancing antitumor effect and tolerable side effects.
Advancing Healthcare AI Governance: A Comprehensive Maturity Model Based on Systematic Review
Authors: Hussein Rowan , Zink Anna , Ramadan Bashar , Howard Frederick M , Hightower Maia , Shah Sachin , Beaulieu-Jones Brett K
Published: December 2024

Artificial Intelligence (AI) deployment in healthcare is accelerating, yet comprehensive governance frameworks remain fragmented and often assume extensive resources. Through a systematic review of 22 frameworks published between 2019-2024, we identified seven critical domains of healthcare AI governance: organizational structure, problem formulation, external product evaluation, algorithm development, model evaluation, deployment integration, and monitoring maintenance. While existing frameworks provide valuable guidance, they frequently target only large academic medical centers, creating barriers for smaller healthcare organizations. To address this gap, we propose the Healthcare AI governance Readiness Assessment (HAIRA), a five-level maturity model that provides actionable governance pathways based on organizational resources and capabilities. HAIRA spans from Level 1 (Initial / Ad Hoc) suitable for small practices to Level 5 (Leading) for major academic centers, with specific benchmarks across all seven governance domains. This tiered approach enables healthcare organizations to assess their current AI governance capabilities and establish appropriate advancement targets. Our framework addresses a critical need for adaptive governance strategies that can support AI-enabled healthcare value across diverse settings and ensures that AI implementation delivers tangible benefits to healthcare systems of varying sizes and resource levels.
Weight Transfer in the Reinforcement Learning Model of Songbird Acquisition
Authors: Tran Khue , Koulakov Alexei
Published: December 2024

Song acquisition behavior observed in the songbird system provides a notable example of learning through trial- and-error which parallels human speech acquisition. Studying songbird vocal learning can offer insights into mechanisms underlying human language. We present a computational model of song learning that integrates reinforcement learning (RL) and Hebbian learning and agrees with known songbird circuitry. The song circuit outputs activity from nucleus RA, which receives two primary inputs: timing information from area HVC and stochastic activity from nucleus LMAN. Additionally, song learning relies on Area X, a basal ganglia area that receives dopaminergic inputs from VTA. In our model, song is first acquired in the HVC-to-Area X connectivity, employing an RL mechanism that involves node perturbation. This information is then consolidated into HVC-to-RA synapses through a Hebbian mechanism. The transfer of weights from Area X to RA takes place via the thalamus, utilizing a specific form of spike-timing-dependent plasticity (STDP). Thus, we present a computational model grounded in songbird circuitry in which the optimal policy is initially guided by RL and subsequently transferred to another circuit through Hebbian plasticity.
Effective Field Theory of Conformal Boundaries
Authors: Diatlyk Oleksandr , Khanchandani Himanshu , Popov Fedor K. , Wang Yifan
Published: December 2024

We introduce an effective field theory (EFT) for conformal impurity by considering a pair of transversely displaced impurities and integrating out modes with mass inversely proportional to the separation distance. This EFT captures the universal signature of the impurity seen by a heavy local operator. We focus on the case of conformal boundaries and derive universal formulas from this EFT for the boundary structure constants at high energy. We point out that the more familiar thermal EFT for conformal field theory is a special case of this EFT with distinguished conformal boundaries. We also derive, for general conformal impurities, nonpositivity and convexitylike constraints on the Casimir energy which determines the leading EFT coefficient.

Published by the American Physical Society
2024
Response Theory via Generative Score Modeling
Authors: Giorgini Ludovico Theo , Deck Katherine , Bischoff Tobias , Souza Andre
Published: December 2024

We introduce an approach for analyzing the responses of dynamical systems to external perturbations that combines score-based generative modeling with the generalized fluctuation-dissipation theorem. The methodology enables accurate estimation of system responses, including those with non-Gaussian statistics. We numerically validate our approach using time-series data from three different stochastic partial differential equations of increasing complexity: an Ornstein-Uhlenbeck process with spatially correlated noise, a modified stochastic Allen-Cahn equation, and the 2D Navier-Stokes equations. We demonstrate the improved accuracy of the methodology over conventional methods and discuss its potential as a versatile tool for predicting the statistical behavior of complex dynamical systems.

Published by the American Physical Society
2024