bluuebunny/crossref_metadata_2025 huggingface dataset:
Deep Learning Algorithm for Identifying Cervical Cord Compression Due to Degenerative Canal Stenosis on Radiography
Authors: Tamai Koji , Terai Hidetomi , Hoshino Masatoshi , Tabuchi Hitoshi , Kato Minori , Toyoda Hiromitsu , Suzuki Akinobu , Takahashi Shinji , Yabu Akito , Sawada Yuta , Iwamae Masayoshi , Oka Makoto , Nakaniwa Kazunori , Okada Mitsuhiro , Nakamura Hiroaki
Published: February 2023

Study design.

Cross-sectional study.

Objective.

Validate the diagnostic accuracy of a deep-learning algorithm for cervical cord compression due to degenerative canal stenosis on radiography.

Summary of Background Data.

The diagnosis of degenerative cervical myelopathy is often delayed, resulting in improper management. Screening tools for suspected degenerative cervical myelopathy would help identify patients who require detailed physical evaluation.

Materials and Methods.

Data from 240 patients (120 with cervical stenosis on magnetic resonance imaging and 120 age and sex-matched controls) were randomly divided into training (n = 198) and test (n = 42) data sets. The deep-learning algorithm, designed to identify the suspected stenosis level on radiography, was constructed using a convolutional neural network model called EfficientNetB2, and radiography and magnetic resonance imaging data from the training data set. The accuracy and area under the curve of the receiver operating characteristic curve were calculated for the independent test data set. Finally, the number of correct diagnoses was compared between the algorithm and 10 physicians using the test cohort.

Results.

The diagnostic accuracy and area under the curve of the deep-learning algorithm were 0.81 and 0.81, respectively, in the independent test data set. The rate of correct responses in the test data set was significantly higher for the algorithm than for the physician’s consensus (81.0% vs. 66.2%; P = 0.034). Furthermore, the accuracy of the algorithm was greater than that of each individual physician.

Conclusions.

We developed a deep-learning algorithm capable of suggesting the presence of cervical spinal cord compression on cervical radiography and highlighting the suspected levels on radiographic imaging when cord compression is identified. The diagnostic accuracy of the algorithm was greater than that of spine physicians.

Level of Evidence.

Level IV.
Identification of provider and patient characteristics associated with antibiotic prescription in the treatment of acute sinusitis
Authors: Thapa Anita , Champion Jane D.
Published: February 2023

Background:

Inappropriate antibiotic use contributes to the development of antibiotic resistance. Sinusitis is the fifth most common diagnosis responsible for antibiotic use. Appropriate antibiotic prescribing for acute sinusitis treatment is crucial to mitigate antibiotic resistance threats.

Purpose:

The purpose of this study was to identify patient and provider characteristics associated with antibiotic prescription and to assess provider adherence to antibiotic prescribing guidelines for acute sinusitis treatment.

Methodology:

Retrospective chart review including acute sinusitis cases diagnosed over 12 months, at two express care clinics in the Southwestern United States. Data extraction identified 371 cases meeting inclusion criteria (age >18 years). Descriptive statistical data analyses included Chi square tests.

Results:

A majority of cases received antibiotic prescriptions (90.8%, n = 337). Sociodemographic characteristics significantly associated with antibiotic prescription (p < .05) included race, ethnicity, insurance type, and smoking status. Patient-reported nature of symptoms, sinus tenderness, and erythema/edema nasal turbinates were also significantly associated with antibiotic prescription (p < .05). Antibiotic prescription and watchful waiting for acute sinusitis treatment were significantly associated with provider types (p < .05).

Conclusions:

A gap exists between current guidelines and clinical practice for acute sinusitis treatment in outpatient settings. Antibiotic prescription occurred, although not indicated, along with incorrect antibiotic choice, dose, and duration of therapy.

Implications:

Outpatient antimicrobial stewardship programs for acute sinusitis treatment with a focus on educational interventions for providers may reduce antibiotic overprescribing for acute sinusitis.
Prevalence of anemia and its predictors among patients with chronic kidney disease admitted to a teaching hospital in Ethiopia: A hospital-based cross-sectional study
Authors: Bishaw Filagot , Belay Woldemariam Maekel , Mekonen Gashahun , Birhanu Bezawit , Abebe Abinet
Published: February 2023

Anemia is a common complication of chronic kidney disease (CKD) and is associated with adverse patient outcomes. However, data on the prevalence of anemia in CKD patients is sparse, particularly in resource-limited settings. Therefore, this study aimed to assess the prevalence of anemia and its predictors among patients with CKD admitted to the Jimma medical center, southwest Ethiopia. A hospital-based prospective cross-sectional study was conducted from September 1 to November 30, 2020. All adult patients with CKD aged ≥18 years who fulfilled the inclusion criteria were consecutively recruited into the study. Data were entered into the Epi data manager version 4.4.1 and then exported to SPSS version 22 (IBM Corp., Armonk, NY) for analysis. The predictors of anemia were determined using multivariable logistic regression analysis. Statistical significance was set at P < .05. A total of 150 patients were included in this study. Of these, 64.67% were male, 56.67% had stage 5 CKD, 78% had a CKD duration of less than 1 year, and 74% had proteinuria. Hypertension (40.7%) and diabetes (14.7%) were the common causes of CKD. The prevalence of anemia was 85.33%. Of the patients, 28.67%, 40.67%, and 16% had mild, moderate, and severe anemia, respectively. On multivariate logistic regression, stage 4 CKD (adjusted odds ratio [AOR] 3.2, confidence interval [CI]: 1.78–12.91, P = .025), stage 5 CKD (AOR 4.03, CI: 1.17–13.73, P = .016), and CKD duration of less than 1 year (AOR 3, CI: 1.19–9.11, P = .007) were significantly associated with anemia. The prevalence of anemia among stage 3 to 5 CKD patients was very high. Anemia was significantly associated with the severity and duration of CKD. Therefore, serial follow-up of patients with a long duration and advanced stages of CKD may help prevent anemia and its adverse consequences.
Effects of amlodipine combined with atorvastatin on Th17/Treg imbalance and vascular microcirculation in hypertensive patients with atherosclerosis: A double-blind, single-center randomized controlled trial
Authors: Yang Gui , Qiu Youjiang
Published: February 2023

Objective:

Helper T cells 17 (Th17) and regulatory T cells (Treg), as CD4+T lymphocyte subsets, play an important role in the process of atherosclerosis. However, there are few studies on the regulation and efficacy of atorvastatin combined with amlodipine on Th17/Treg balance in hypertension combined with carotid atherosclerosis. Therefore, this study aims to verify the efficacy and immunomodulatory effects of atorvastatin combined with amlodipine in the treatment of hypertension combined with carotid atherosclerosis.

Methods:

A total of 260 patients with hypertension and carotid atherosclerosis were randomly divided into atorvastatin or combined treatment group. Inflammatory factors and Th17 and Treg levels were detected by enzyme-linked immunosorbent assay and flow cytometry. The messenger ribonucleic acid expression of retinoic acid receptor-related orphan receptor gamma and forkhead spiral transcription factor were detected by real-time quantitative polymerse chain reaction.

Results:

We found that the total effective rate in the treatment group was significantly higher than that in the control group. The levels of whole blood high shear viscosity, whole blood low shear viscosity, plasma specific viscosity and fibrin content in the 2 groups were significantly decreased after treatment, and the combined group was significantly lower than the control group (all P < .05). The improvement of endothelial function in the treatment group was also significantly higher than that in the control group (all P < .05). In addition, we found that there were statistically significant differences in Th17 percentage, Treg percentage and Treg/Th17 between the treatment group and the control group (P < .05). The messenger ribonucleic acid levels of retinoic acid receptor-related orphan receptor gamma and forkhead spiral transcription factor showed the same trend. Further detection of Th17-related inflammatory factors showed that the expression of interleukin (IL)-17, IL-6, IL-23 and tumor necrosis factor-α in the treatment group was significantly decreased, which was better than that in the control group (all P < .05).

Conclusion:

These data indicate that amlodipine combined with atorvastatin can improve Th17/Treg imbalance, vascular endothelial function and efficacy in patients with hypertension and atherosclerosis.
Inflammatory bowel disease and associated cardiovascular disease outcomes: A systematic review
Authors: Jaiswal Vikash , Batra Nitya , Dagar Mehak , Butey Swatika , Huang Helen , Chia Jia Ee , Naz Sidra , Endurance Evbayekha O. , Raj Nishchita , Patel Srushti , Maroo Dipansha , Ang Song Peng , Hanif Muhammed , Mukherjee Dattatreya , Sarfraz Zouina , Shrestha Abhigan Babu , Song David
Published: February 2023

Background:

There is limited and conflicting data available regarding the cardiovascular disease outcomes associated with inflammatory bowel disease (IBD).

Objective:

We aim to perform a systematic review to evaluate the cardiovascular outcomes and mortality associated with IBD patients.

Methods:

A systematic literature search has been performed on PubMed, Embase, Cochrane, and Scopus from inception till May 2022 without any language restrictions.

Results:

A total of 2,029,941 patients were included in the analysis from 16 studies. The mean age of the patients was 45.6 years. More females were found compared with males (57% vs 43%). The most common risk factors for cardiovascular disease (CVD) included smoking (24.19%) and alcohol (4.60%). The most common comorbidities includes hypertension (30%), diabetes mellitus (14.41%), dyslipidemia (18.42%), previous CVD (22%), and renal disease (10%). Among outcomes, all-cause mortality among IBD patients was 1.66%; ulcerative colitis (UC): 15.92%; and Crohn disease (CD): 0.30%. Myocardial Infarction (MI) among IBD patients were 1.47%, UC: 30.96%; and CD: 34.14%. CVD events among IBD patients were 1.95%. Heart failure events among IBD patients were 5.49%, stroke events among IBD patients were 0.95%, UC: 2.63%, and CD: 2.41%, respectively.

Conclusion:

IBD patients are at higher risk for adverse cardiovascular outcomes, especially in women. Although there remains a lack of concrete treatment algorithms and assessment parameters that better characterize IBD risk factors, nutritional modifications and physical activity should be at the forefront of CVD prevention in IBD.
Clinical application of improved VSD and VSD in the treatment of SSI after abdominal surgery: A retrospective randomized clinical study
Authors: Huang Tao , Liu Tong , Shang Mei , Han Gang
Published: February 2023

By comparing the efficacy and cost of improved vacuum-sealing drainage devices and vacuum-sealing drainage (VSD) devices in the treatment of postoperative abdominal surgical site infection, the clinical applicability and promotion of improved vacuum-sealing drainage devices were assessed. In our institution, between October 2019 and December 2021, 55 patients with surgical site infection after abdominal surgery were retrospectively analyzed, including 30 patients treated with improved VSD and 25 patients treated with VSD. The efficacy of wound healing, total dressing change cost throughout therapy, total hospital costs, hospital days, and bacterial culture results of wound secretions before and after treatment were compared between the 2 groups. Both groups achieved wound healing following vacuum sealing-drainage treatment, with no significant differences in wound healing time or secondary suture rate. However, the total hospitalization and dressing change costs in the improved VSD group were significantly lower than those in the VSD group. Similar to VSD, improved VSD is effective in the treatment of surgical site infections after abdominal surgery. Compared with VSD, the improved VSD device has lower dressing change costs and total hospitalization costs during the treatment process. The improved VSD has a wide range of applications and is suitable for clinical use and promotion.
The model of descriptive, diagnostic, predictive, and prescriptive analytics on 100 top-cited articles of nasopharyngeal carcinoma from 2013 to 2022: Bibliometric analysis
Authors: Hung Chung-Chia , Tu Mei-Yu , Chien Tsair-Wei , Lin Cheng-Yao , Chow Julie Chi , Chou Willy
Published: February 2023

Background:

Nasopharyngeal carcinomas (NPCs) are prevalent in southeast Asia. There is a need to systematically review the current trend and status of NPC research. However, most bibliometric analyses have tended to focus on descriptive and diagnostic analytics rather than predictive and prescriptive analyses. Thus, it is necessary to use the model of the 4 (called the descriptive, diagnostic, predictive, and prescriptive analytics [DDPP]) to derive insights from the data. This study aimed to apply the DDPP model to classify article themes and illustrate the characteristics of NPCs; compare NPC researcher achievements across countries, institutes, departments, and authors; determine whether the mean citations of keywords can be used to predict article citations; and highlight articles that are worthy of reading.

Methods:

The Web of Science Core Collection was searched for 100 top-cited articles and reviews related to NPCs published between 2013 and 2022. As part of Microsoft Office Excel 2019, Visual Basic for Applications was used to illustrate the number of publications and scientific productivity of authors over time and to generate network/temporal heatmaps, chord/Sankey diagrams, radar/impact beam plots, and scatter/pyramid charts about collaborations among countries. The DDPP model identifies institutions, authors, and hotspots of NPC research. The category, journal, authorship, and L-index (CJAL) score was applied to evaluate individual research achievements.

Results:

A total of 10,564 publications were extracted from Web of Science Core Collection and screened for 100 top-cited articles and reviews related to NPCs. Despite having the highest number of publications (36%), China lags slightly behind the US in CJAL scores. CJAL was higher at Sun Yat-Sen University, Radiat Oncol department, and author Jun Ma from China. The number of article citations was significantly correlated with the number of weighted keywords (F = 1791.17; P < .0001). Six articles with significantly increasing citations over the last 4 years were recommended.

Conclusion:

This bibliometric study utilizes the DDPP model to analyze the scientific progress of NPC over the past decade. The whole genome is a hot topic that may prove to be a promising research area in the future. A temporal heatmap may serve as a tool for providing readers with articles that are worth reading, which could lead to additional research in bibliometrics.
Treatment of paradoxical eczematous eruption in psoriasis treated with secukinumab: A case report
Authors: Xiao Yu , Peng Shanshan , Li Xiangjun , Mao Tianyi , Fang Muping , Hu Youhong , Ye Wenzheng
Published: February 2023

Rationale:

Eczematous eruption is an increasingly recognized form of drug-related eruption, typically reported in association with interleukin 17 (IL-17)A inhibitors. However, severe paradoxical eczematous eruption due to IL-17A inhibitors has been rarely reported. Herein, we reported a case of a man with severe psoriasis with erythematous scaly plaques on the scalp, trunk, and arms and legs after the administration of secukinumab was initiated.

Patient concerns:

We reported a case of a 20-year-old man with severe psoriasis with erythematous scaly plaques on the scalp, trunk, and arms and legs after the administration of secukinumab was initiated. A skin biopsy was performed. It revealed spongiotic dermatitis consistent with eczematous reaction. Direct and indirect immunofluorescence assays were negative.

Diagnoses:

He was diagnosed with eczematous eruption.

Interventions:

Discontinuation of secukinumab and administration of cyclosporine and prednisone were considered.

Outcomes:

Significant improvement was observed, with no adverse events.

Conclusion:

Our case shows that eczematous eruption can paradoxically occur in patients on IL-17A inhibitors and this report is expected to increase awareness of the rising number of cutaneous eruptions related to biological agents.
Gender-related differences in the coagulofibrinolytic responses and long-term outcomes in patients with isolated traumatic brain injury: A 2-center retrospective study
Authors: Tsuchida Takumi , Wada Takeshi , Nakae Ryuta , Fujiki Yu , Kanaya Takahiro , Takayama Yasuhiro , Suzuki Go , Naoe Yasutaka , Yokobori Shoji
Published: February 2023

Coagulation function differs by gender, with women being characterized as more hypercoagulable. Even in the early stages of trauma, women have been shown to be hypercoagulable. Several studies have also examined the relationship between gender and the prognosis of trauma patients, but no certain conclusions have been reached. Patients with isolated traumatic brain injury (iTBI) are known to have coagulopathy, but no previous studies have examined the gender differences in detail. This is a retrospective analysis of a prospective registry conducted at 2 centers. The study included adult patients with iTBI enrolled from April 2018 to March 2021. Coagulofibrinolytic markers were measured in each patient at 1 hour, 24 hours, 3 days, and 7 days after injury, and neurological outcomes were assessed with the Glasgow Outcome Scale Extended at 6 months. Subgroup analysis was also performed by categorizing patients into groups according to neurological prognosis or age at 50 years. Males (n = 31) and females (n = 21) were included in the analysis. In males, there was a significant difference in the levels of activated partial thromboplastin time (P = .007), fibrin/fibrinogen degradation products (P = .025), D-dimer (P = .034), α2-plasmin inhibitor (P = .030), plasmin-α2-plasmin inhibitor complex (P = .004) at 1 hour after injury between favorable and unfavorable long-term neurological outcome groups, while in females there was no significant difference in these markers between 2 groups. In the age group under 50 years, there were significant gender differences in fibrinogen (day 3: P = .018), fibrin/fibrinogen degradation products (1 hour: P = .037, day 3: P = .009, day 7: P = .037), D-dimer (day 3: P = .005, day 7: P = .010), plasminogen (day 3: P = .032, day 7: P = .032), and plasmin-α2-plasmin inhibitor complex (day 3: P = .001, day 7: P = .001), and these differences were not evident in the age group over 50 years. There were differences in coagulofibrinolytic markers depending on gender in patients with iTBI. In male patients, aggravation of coagulofibrinolytic markers immediately after traumatic brain injury may be associated with poor neurologic outcome 6 months after injury.
The clinical course of untreated CIN2 (HPV16/18+) under active monitoring: A protocol of systematic reviews and meta-analysis
Authors: Han Buwei , Yuan Mengke , Gong Yi , Qi Ding , Jiang Tong , Li Jian , Sun Yiming , Liu Li
Published: February 2023

Background:

Cervical cancer (CC) is one of the most prevalent and fatal cancers among women. Nearly all forms of CC are related to HPV, and 70% of invasive CCs are associated with HPV16 and HPV18. A histologically confirmed case of cervical intraepithelial neoplasia (CIN)2 or a more severe histological diagnosis is considered to be the demarcation point for treatment, but overtreatment will increases the risk of preterm birth in subsequent pregnancies. This study will evaluate the progress of CIN2 (progression, persistence, or regression) in HPV16/18+ CIN2 patients who were managed conservatively for 3 months.

Methods:

PubMed, Cochrane Library, China National Knowledge Infrastructure, Cumulative Index for Nursing and Allied Health Literature (CINAHL), and the Excerpta Medica Database will be searched. We will include studies reporting on women with CIN2 and HPV16/18+, conservative treatment for 3 to 60 months with disease outcomes including progression (CIN3 or worse), persistence (CIN2), and regression rates (CIN1 or less). The primary outcome will be the progress of CIN2. Two authors will search the relevant literature, extract the data, and assess the risk of bias. A funnel chart will be used to identify publication or other reporting biases, and the AHRQ guidelines will be used to assess the risk of bias in each included study. The I
2 statistic will be used to assess heterogeneity. If there is a high degree of heterogeneity between the studies, the random effects model will be used; otherwise, a fixed effects model will be used.

Results:

The results of this systematic review will be published in a peer-reviewed journal.

Conclusion:

This systematic review will evaluate the clinical development of patients with conservatively monitored histologically confirmed HPV16/18+ CIN2.
A case of misdiagnosed leiomyoma of the vulva: A case report
Authors: He Jing , Liu Wenhua , Wu Xiaoyu , Li Dingheng , Liu Yuanwei
Published: February 2023

Rationale:

Leiomyoma of the vulva is a rare, benign mass that is present on the vulva. Most commonly, they are described as painless, well-circumscribed, solitary tumors that are misdiagnosed as Bartholin cysts before surgery.

Patient concerns:

A 45-year-old woman presented with a case of vulvar leiomyoma misdiagnosed as Bartholin cyst preoperatively. A solitary swelling mass measuring 3 cm × 2 cm was found in the left labia majora at the Bartholin gland site on physical examination.

Diagnoses:

A vulvar mass extent and vascularity may be determined by imaging. A color doppler flow imaging of the posterior vaginal wall revealed abundant blood flow.

Intervention:

To confirm vulvar leiomyoma, surgery and histopathology were performed.

Outcome:

After 2 months of follow-up, there were no signs of recurrence in the patient.

Lessons:

Rare vulvar leiomyomas are often mistaken for Bartholin’s cysts. It is also difficult to distinguish benign from malignant forms, making vulvar leiomyoma a difficult diagnosis. As there are a few techniques used to differentiate between the nature of the tumor, excisional biopsy seems to be the best current procedure employed in addition to being the treatment of choice for such tumors.
Diagnostic value of ultrasound elastography in triple negative breast cancer: A meta-analysis
Authors: Wang Fei , Wang Hongjiang
Published: February 2023

Background:

The purpose of this study was to determine the value of ultrasound elastic imaging (UE) in the differential diagnosis of the 3 negative breast cancer (TNBC) and non-TNBC.

Methods:

We searched the PubMed, Cochrane Library, and CBM databases from inception to July 20, 2022 and used STATA version 14.0 and Meta-Disc version 1.4 software. We computed summary statistics for sensitivity (Sen), specificity, positive and negative likelihood ratio (LR+/LR−), diagnostic odds ratio, and summary receiver operating characteristic curves. Cochran Q-statistic and I2 test were used to assess potential heterogeneity between studies. Sen analysis was carried out to evaluate the effect of a single study on overall estimation. We also conducted a meta regression analysis to investigate potential sources of heterogeneity.

Results:

Nine studies that fulfilled all the criteria for acceptance were incorporated into the meta-analysis. TNBC 317 and non-TNBC 1055 cases were evaluated. All breast tumors were histologically confirmed. The pooled Sen was 0.78 (95% confidence interval [CI] = 0.58–0.90); the pooled specificity was 0.86 (95%CI = 0.78–0.91). The pooled LR+ was 5.46 (95%CI = 3.07–9.73); the pooled negative LR− was 0.26 (95%CI = 0.12–0.55). The pooled diagnostic odds ratio of UE was 21.00 (95% CI = 6.14–71.78). The area under the summary receiver operating characteristic curve was 0.89 (SE = 0.0378). No evidence was found to reveal bias (t = 0.10, P = .92).

Conclusion:

Our meta-analysis showed that UE could have high diagnostic accuracy in distinguishing TNBC and non-TNBC.
Physical function, nutritional status, and quality of life before and after chemotherapy in patients with malignant lymphoma
Authors: Jinbo Ryohei , Kasahara Ryuichi , Morishita Shinichiro , Kubota Junko , Takano Aya , Takahashi Shoko , Kisara Sayaka , Jinbo Kazumi , Yamamoto Yuichi , Kai Tatsuyuki , Shiga Yutaka , Kimura Hideo , Furukawa Miki , Fujita Takaaki
Published: February 2023

This study investigates the efficacy of and gender differences in exercise therapy in patients with malignant lymphoma undergoing chemotherapy. Twenty-six patients (13 men, 13 women) received physical therapy (based on the Borg Scale 13) during hospitalization. Physical function was measured using grip and knee extension strength, 6-minute walking distance, and body composition; nutritional status assessed via Mini Nutritional Assessment (MNA®); and serum albumin levels analyzed. Fatigue was evaluated using the Brief Fatigue Inventory, and health-related quality of life was assessed with the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36v2). The analysis of all patients indicated that the right grip strength, skeletal muscle mass, skeletal muscle index, and leg muscle mass significantly decreased, whereas the serum albumin level, MNA® score, and scores of many items of the SF-36v2 significantly increased after chemotherapy. In a gender-specific analysis, only men showed significant declines in the skeletal muscle mass and skeletal muscle index, and improvement in the MNA® score after chemotherapy. In the SF-36v2, there were significant improvements in general health and physical component summary scores among men, and general health and mental component summary scores among women. Exercise therapy at a Borg Scale intensity of 13 may not prevent muscle mass decline in patients with malignant lymphoma, especially male patients. In addition, this study revealed that there is a gender difference in the effect of exercise therapy on quality of life. Thus, gender should be considered in exercise therapy for patients with malignant lymphoma.
Additional malignancies shorten overall survival in chronic lymphocytic leukemia irrespective of chromosomal aberrations: A retrospective cohort study
Authors: Turan Erkek Esra , Aslan Eda
Published: February 2023

The aim of this study was to determine the incidence of other malignancies (OMs) in patients with chronic lymphocytic leukemia (CLL) and to identify parameters associated with the occurrence of OMs in addition to CLL. This retrospective cohort study was conducted by examining the records of CLL patients who applied to a tertiary hospital between January 2013 and December 2021. The cases were divided into 2 groups, CLL (n = 107) and CLL + OM (n = 25), according to the presence of additional malignancy. Lymphocyte count (P = .014), white blood cell count (P = .006), and hemoglobin (P = .034) were significantly higher in the CLL group. Rai stage IV percentage (P = .015), Binet stage B percentage (P = .043), progression, and sepsis percentages (P = .008) were significantly higher in the CLL + OM group. Overall survival time was significantly lower in the CLL + OM group (P = .032). Most OMs had been diagnosed before CLL (63.64%) in the no-treatment group, while the majority of OMs were diagnosed after CLL (78.57%) in the treatment group (P = .032). CLL patients with OM had a more advanced CLL stage, and survival was significantly shorter in these patients. In addition, CLL-associated OM appears to occur more frequently in the post-treatment period.
The enhanced recovery after surgery (ERAS) protocol in elderly patients with acute cholecystitis: A retrospective study
Authors: Yu Tianyang , Zhao Luwen , Zhao Hongtao , Fu Hua , Li Jian , Yu Aijun
Published: February 2023

Enhanced recovery after surgery (ERAS) protocol is a perioperative management theory aimed at reducing the injury of surgical patients and accelerating postoperative recovery. It has been widely recognized and applied in elective surgery. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. We collected medical data from 126 elderly patients with acute cholecystitis from October 2018 to August 2021. Among the 126 patients, 70 were included in the ERAS group and 56 in the traditional group. We analyzed the clinical data and postoperative indicators of the 2 groups. No significant differences were observed regarding the general characteristics of the 2 groups (P > .05). The ERAS group had significantly earlier time to first flatus, time to first ambulation, and time to solid intake, compared with the traditional group (P < .001); additionally, the ERAS group had significantly shorter stay and gentler feeling of postoperative pain (P < .001). Furthermore, the ERAS group had significant incidences of lower postoperative lung (P = .029) and abdominal cavity infection (P = .025) compared to the traditional group. No significant difference was observed regarding the incidences of other postoperative complications between the 2 groups (P > .05). The ERAS protocol helps reduce elderly patients’ stress reactions and accelerate postoperative recovery. Thus, it is effective and beneficial to implement the ERAS protocol during the perioperative period of elderly patients with acute cholecystitis.
The Charlson comorbidity index and short-term readmission in patients with heart failure: A retrospective cohort study
Authors: Wei Dongmei , Sun Yang , Chen Rongtao , Meng Yuanting , Wu Wei
Published: February 2023

The relationship between the Charlson comorbidity index (CCI) and short-term readmission is as yet unknown. Therefore, we aimed to investigate whether the CCI was independently related to short-term readmission in patients with heart failure (HF) after adjusting for other covariates. From December 2016 to June 2019, 2008 patients who underwent HF were enrolled in the study to determine the relationship between CCI and short-term readmission. Patients with HF were divided into 2 categories based on the predefined CCI (low < 3 and high > =3). The relationships between CCI and short-term readmission were analyzed in multivariable logistic regression models and a 2-piece linear regression model. In the high CCI group, the risk of short-term readmission was higher than that in the low CCI group. A curvilinear association was found between CCI and short-term readmission, with a saturation effect predicted at 2.97. In patients with HF who had CCI scores above 2.97, the risk of short-term readmission increased significantly (OR, 2.66; 95% confidence interval, 1.566–4.537). A high CCI was associated with increased short-term readmission in patients with HF, indicating that the CCI could be useful in estimating the readmission rate and has significant predictive value for clinical outcomes in patients with HF.
Balanced resuscitation: application to the paediatric trauma population
Authors: Georgette Nathan , Lipton Galina , Li Joyce
Published: February 2023

Purpose of review

Trauma is the leading cause of death in children over 5 years old. Early mortality is associated with trauma-induced coagulopathy (TIC), with balanced resuscitation potentially mitigating the effects of TIC. We review TIC, balanced resuscitation and the best evidence for crystalloid fluid versus early blood products, massive transfusion protocol (MTP) and the optimal ratio for blood products.

Recent findings

Crystalloid fluids have been associated with adverse events in paediatric trauma patients. However, the best way to implement early blood products remains unclear; MTP has only shown improved time to blood products without clear clinical improvement. The indications to start blood products are also currently under investigation with several scoring systems and clinical indications being studied. Current studies on the blood product ratio suggest a 1 : 1 ratio for plasma:pRBC is likely ideal, but prospective studies are needed to further support its use.

Balanced resuscitation strategies of minimal crystalloid use and early administration of blood products are associated with improved morbidity in paediatric trauma patients but unclear mortality benefit. Current evidence suggests that the utilization of MTPs with 1 : 1 plasma:pRBC ratio may improve morbidity, but more research is needed.
Recommendations and effects of rehabilitation programs in older adults after hospitalization for COVID-19: A scoping review
Authors: Araya-Quintanilla Felipe , Sepulveda-Loyola Walter , Cuyul-Vásquez Ivan , Alvarez-Bustos Alejandro , Gutiérrez-Espinoza Héctor , Suziane Probst Vanessa , Camp Pat G. , Rodríguez-Mañas Leocadio
Published: February 2023

The aim of this review was to identify studies on physical rehabilitation programs, and to describe the potential effects on functional outcomes in patients older than 60 years at discharge from acute care post-COVID-19. The literature search was conducted in the MEDLINE, Cochrane CENTRAL, EMBASE, PEDro, LILACS, CINAHL, SPORTDiscus, Web of Science, and The Living OVerview of Evidence (L-OVE) COVID-19 databases. Studies with patients older than >60 years, hospitalized with COVID-19, and admitted to a rehabilitation program after discharge from acute care were included. Ten studies were included with a total of 572 patients. The prevalence of patients that received post-intensive care rehabilitation was 53% (CI 95% 0.27–0.79; p = 0.001). The rehabilitation program included physiotherapy in nine studies, occupational therapy in three studies, and psychotherapy in two studies. The rehabilitation programs increased the aerobic capacity, functional independence in basic activities of daily living, muscle strength, muscle mass, dynamic balance, physical performance, pulmonary function, quality of life, cognitive capacity and mental health. Multidisciplinary rehabilitation programs are necessary for older adults after hospitalization for COVID-19, especially those coming from intensive care units, as rehabilitation has a positive effect on important clinical outcomes.

PROSPERO registration number: CRD42021259740
Key Modifiable Factors in Community Participation Among Adults With Lower Limb Amputation
Authors: Sions Jaclyn Megan , Seth Mayank , Pohlig Ryan Todd , Stauffer Samantha Jeanne , Horne John Robert , Sarlo Frank Bernard
Published: February 2023

Objective

The aim of the study is to identify factors that may predict community participation among adults with lower limb amputation.

Design

This study is a secondary analysis of a cross-sectional data set, including 126 community-dwelling adults, ≥1 yr after unilateral transfemoral- (n = 44; mean age = 59 ± 14 yrs) or transtibial-level amputation (n = 82; mean age = 59 ± 14 yrs) seen in an outpatient limb loss clinic. Participation was assessed with the Community Integration Questionnaire. Factors, that is, demographics, comorbidities, prosthesis use per the Houghton Scale, Socket Comfort Score, assistive device use, falls history, and activity level per General Practice Physical Activity Questionnaire were evaluated. Moreover, balance confidence per the Activities-Specific Balance Confidence Scale, mobility per the Locomotor Capabilities Index, fast and self-selected gait speed per 10-meter walk tests, and functional mobility via Timed Up and Go were also included.

Results

Community participation was correlated with several factors (P ≤ 0.050). Stepwise regression of correlated factors found absence of peripheral neuropathy and greater self-reported physical activity, balance confidence, and prosthesis use, as the strongest correlates, collectively explaining 50.1% of the variance in community participation post–lower limb amputation.

Conclusions

Findings identify key modifiable factors for consideration in future prospective research seeking to enhance community reintegration and participation among adults living with a unilateral transfemoral- or transtibial-level amputation.
Pulmonary Open, Robotic, and Thoracoscopic Lobectomy (PORTaL) Study
Authors: Kent Michael S. , Hartwig Matthew G. , Vallières Eric , Abbas Abbas E. , Cerfolio Robert J. , Dylewski Mark R. , Fabian Thomas , Herrera Luis J. , Jett Kimble G. , Lazzaro Richard S. , Meyers Bryan , Reddy Rishindra M. , Reed Michael F. , Rice David C. , Ross Patrick , Sarkaria Inderpal S. , Schumacher Lana Y. , Spier Lawrence N. , Tisol William B. , Wigle Dennis A. , Zervos Michael
Published: February 2023

Objective:

The aim of this study was to analyze overall survival (OS) of robotic-assisted lobectomy (RL), video-assisted thoracoscopic lobectomy (VATS), and open lobectomy (OL) performed by experienced thoracic surgeons across multiple institutions.

Summary Background Data:

Surgeons have increasingly adopted RL for resection of early-stage lung cancer. Comparative survival data following these approaches is largely from single-institution case series or administrative data sets.

Methods:

Retrospective data was collected from 21 institutions from 2013 to 2019. Consecutive cases performed for clinical stage IA–IIIA lung cancer were included. Induction therapy patients were excluded. The propensity-score method of inverse-probability of treatment weighting was used to balance baseline characteristics. OS was estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to evaluate association among OS and relevant risk factors.

Results:

A total of 2789 RL, 2661 VATS, and 1196 OL cases were included. The unadjusted 5-year OS rate was highest for OL (84%) followed by RL (81%) and VATS (74%); P=0.008. Similar trends were also observed after inverse-probability of treatment weighting adjustment (RL 81%; VATS 73%, OL 85%, P=0.001). Multivariable Cox regression analyses revealed that OL and RL were associated with significantly higher OS compared with VATS (OL vs. VATS: hazard ratio=0.64, P<0.001 and RL vs. VATS: hazard ratio=0.79; P=0.007).

Conclusions:

Our finding from this large multicenter study suggests that patients undergoing RL and OL have statistically similar OS, while the VATS group was associated with shorter OS. Further studies with longer follow-up are necessary to help evaluate these observations.
Recent advances in pharmacotherapy for epilepsy
Authors: Pong Amanda W. , Xu Kevin J. , Klein Pavel
Published: February 2023

Purpose of review

Epilepsy affects 70 million people worldwide and is a significant cause of morbidity and early mortality. The mainstay of therapy is oral medications. Epilepsy drug development is escalating, driven by continued drug resistance in up to a third of epilepsy patients. Treatment development now focuses on discovery of novel mechanisms of action and syndrome-specific therapies

Recent findings

Difficult-to-treat epilepsy related to conditions including tuberous sclerosis complex (TSC), Lennox Gastaut syndrome (LGS) and Dravet syndrome (DS) have been the target of recent developments. Disease-modifying therapy for epilepsy related to TSC with vigabatrin at onset of first electroencephalographic epileptiform changes, rather than after first clinical seizure, has demonstrated strongly positive seizure and developmental outcomes. Fenfluramine, approved for DS and, more recently, LGS, has robust data supporting efficacy, safety/tolerability, as well as mortality, quality of life and cognitive function. Rescue therapy has expanded to include better tolerated benzodiazepines in the form of nasal midazolam and valium. Cenobamate, a first-in-class inactivator of the persistent voltage-gated sodium channel and approved for adult partial onset epilepsy, has exceptional efficacy and tolerability and will be expanded to children and to generalized onset epilepsy in adults.

The repertoire of available and developmental therapies for epilepsy is rapidly expanding, and now includes disease-modifying vigabatrin in TSC and agents with extraordinary efficacy, fenfluramine and cenobamate.
Update on current animal models for schizophrenia: are they still useful?
Authors: Uliana Daniela L. , Gomes Felipe V. , Grace Anthony A.
Published: February 2023

Purpose of review

Schizophrenia is a psychiatric disorder that has a significant socioeconomic impact worldwide. Antipsychotic drugs targeting dopamine transmission alleviate psychotic symptoms but with limited efficacy and tolerability. Animal models have long proven useful for drug discovery. The continued need for new treatment highlights the importance of animal models to study schizophrenia. The lack of new therapeutic compounds combined with the shortcomings of clinical design studies potentially decreased the enthusiasm for animal model use.

Recent findings

In the current review, we discuss the central role of animal models for schizophrenia in providing new insights into neurobiological features and therapeutic development. The US National Institute of Mental Health released the Research Domain Criteria to guide preclinical model studies. Here, we point out the advances of this approach and debate its potential limitations when using animal models to study schizophrenia from the drug discovery perspective.

Cross-validated animal models for schizophrenia are crucial to comprehend the cause, pathophysiology, and behavioral and biological features of the disease, to advance prevention and treatment, and the need to carefully evaluate and select appropriate paradigms when investigating novel therapeutic targets.
Race, criminalization and urban mental health in the United States
Authors: Pamplin John R. , Kelsall Nora Clancy , Keyes Katherine M. , Bates Lisa M. , Prins Seth J.
Published: February 2023

Purpose of review

As efforts to increase policing and roll back criminal legal system reforms in major U.S. cities rise, the collateral consequences of increased criminalization remain critical to document. Although the criminalization of mental illness has been well studied in the U.S., the mental health effects of criminalization are comparatively under-researched. In addition, despite extreme racial disparities in U.S. policing, there is limited understanding of how criminalization may contribute to racial disparities in mental health.

Recent findings

Literature included in this review covers various types of criminalization, including direct and indirect impacts of incarceration, criminalization of immigration, first-hand and witnessed encounters with police, and the effects of widely publicized police brutality incidents. All forms of criminalization were shown to negatively impact mental health (depression, anxiety and suicidality), with evidence suggestive of disproportionate impact on Black people.

There is evidence of significant negative impact of criminalization on mental health; however, more robust research is needed to address the limitations of the current literature. These limitations include few analyses stratified by race, a lack of focus on nonincarceration forms of criminalization, few longitudinal studies limiting causal inference, highly selected samples limiting generalizability and few studies with validated mental health measures.
FEBRILE SEPSIS IN AN IMMUNOCOMPETENT PATIENT: FIRST REPORT OF HUMAN DISEASE DUE TO PAENIBACILLUS SILVAE
Authors: BENEDETTI PAOLO , Vecchia Ilaria Dalla , Fasan Daniele , Pegoraro Manuela
Published: February 2023

Introduction

Paenibacillus species are saprophytes widely distributed in nature and rarely associated with overt human infection. Most of cases have been described in people with important comorbidities and/or immunodepression. We report here what is, to the best of our knowledge, the first documented case of human disease due to P. silvae, so far considered an exclusively environmental micro-organism.

Case presentation

A 57-year-old female patient was referred to our Unit after a 2-month history of remittent fever. Upon admission, septic state and bacteraemia due to P. silvae was revealed. The patient became afebrile after 9 days of antibiotic treatment and was completely cured after a 2-week regimen with I.V. amoxicillin-clavulanate plus oral doxycycline.

Conclusion

The patient did not report any episode of infection occurred previously. None of the well-known risk factors to Paenibacillus bacteraemia, i.e., invasive procedures, use of intravenous drugs, immunosuppression, and foreign bodies could be revealed. We suggest that the isolation of bacteria belonging to the Paenibacillus genus should not be disregarded, since there is accumulating evidence that these organisms may cause disease even in immunocompetent subjects.
Fingerstick blood assay maps real-world NAD+ disparity across gender and age
Authors: Wang Pei , Chen Meiting , Hou Yaying , Luan Jun , Liu Ruili , Chen Liuqing , Hu Min , Yu Qiuliyang
Published: February 2023

NAD+level has been associated with various age-related diseases and its pharmacological modulation emerges as a potential approach for aging intervention. But human NAD+landscape exhibits large heterogeneity, and the lack of rapid, low-cost assays limits the establishment of NAD+baseline and the development of personalized therapies, especially for those with poor responses towards conventional NAD+supplementation. Here, we developed an automated NAD+analyzer for the rapid measurement of NAD+with 5 μL of capillary blood using a recombinant bioluminescent sensor protein and an automated optical reader. The minimal invasiveness of the assay allowed a frequent and decentralized mapping of real-world NAD+dynamics. We showed that sports and NMN supplementation can increase blood NAD+levels and that male on average has higher NAD+than female before the age of 50. We further revealed the long-term stability of human NAD+baseline over 100 days and identified the major real-world NAD+-modulating behaviors.