bluuebunny/crossref_metadata_2025 huggingface dataset:
CE: Using Smart IV Infusion Pumps Outside of Patient Rooms
Authors: Messing Emily G. , Abraham Renu S. , Quinn Nicholas J. , Duthie Elizabeth A.
Published: January 2022

The COVID-19 pandemic has created unique challenges for health care workers, who have demonstrated dedication, collaboration, and innovation in response. In this article, the authors describe an important nursing innovation they employed at Montefiore Medical Center in the Bronx, New York, during the spring 2020 COVID-19 surge: the relocation of smart IV infusion pumps outside of patient rooms. The goals of this innovation were to improve delivery of care, conserve personal protective equipment, limit the spread of the virus, and protect staff from exposure. The authors discuss the initial concerns that arose regarding the safety and efficacy of this practice; the research they conducted with other colleagues in nursing, pharmacy, infection control, and patient safety in the face of scant clinical literature relevant to the difficult circumstances the pandemic created; and the strategies they ultimately employed to ensure that this practice maintained safety and efficacy.
LONGITUDINAL FOLLOW-UP OF CHOROIDAL GRANULOMAS WITH INDOCYANINE GREEN ANGIOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Parrulli Salvatore , Invernizzi Alessandro , Monteduro Davide , Zicarelli Federico , Oldani Marta , Staurenghi Giovanni , Woodstock Elizabeth , Hay Steven , Neri Piergiorgio , Pichi Francesco
Published: January 2022

Purpose:

To investigate choroidal granulomas visualized by indocyanine green angiography (ICGA) and optical coherence tomography angiography (OCTA) in response to treatment.

Methods:

Ten eyes of eight patients with tubercular, sarcoid, or Vogt–Koyanagi–Harada-associated choroidal granulomas were evaluated in this multicentric study. All patients underwent ICGA and OCTA at baseline, 1, and 3 months after treatment onset. Granulomas were identified as hypofluorescent lesions on intermediate ICGA phases. Late ICGA behavior and OCTA visualization were assessed.

Results:

On baseline intermediate ICGA, 222 choroidal granulomas were detected. Overall, 174/222 granulomas were detected on baseline OCTA images. At 1 month, 28% of lesions were healed and 48 late ICGA hyperfluorescent lesions were identified. At 3 months, 63% of baseline lesions were healed, with 33 persistent late hyperfluorescent lesions. Optical coherence tomography angiography sensitivity was reduced at 1 and 3 months compared with baseline. Some flow-voids detected on OCTA at 1 and 3 months did not correspond to any visible lesion on ICGA.

Conclusion:

Different healing behaviors of choroidal granulomas were identified combining ICGA and OCTA analysis. Late ICGA hyper-fluorescent lesions may be the consequence of a possible fibrotic shift. Structural changes in the choroid may persist after active granulomas resolution resulting in persistent flow voids on OCTA.
NOVEL METHOD FOR VISUALIZING PERIPHERAL RETINAL STRUCTURES WITH MICROSCOPE-INTEGRATED OPTICAL COHERENCE TOMOGRAPHY
Authors: Brodie Frank L. , Feng Henry , Raynor William , Li Jianwei D. , Vajzovic Lejla , Izatt Joseph A. , McNabb Ryan P. , Toth Cynthia A.
Published: January 2022

Background/Purpose:

Visualization of peripheral retinal structures with optical coherence tomography (OCT) can be challenging but can offer valuable clinical information. We describe a method for intraoperative OCT of the peripheral retina.

Methods:

An investigational microscope-integrated OCT system with real-time 4D volumetric imaging was used in conjunction with a Goldmann style mirrored contact lens intraoperatively to capture peripheral images in three patients.

Results:

We identified retinoschisis, a retinal break, and areas of focal retinal detachment using our peripheral OCT method.

Conclusion:

Use of a Goldmann lens in conjunction with intraoperative OCT offers surgeons the ability to resolve peripheral pathology that cannot be easily evaluated with OCT otherwise.
PARACENTRAL ACUTE MIDDLE MACULOPATHY AS AN EARLY SIGN OF WALDENSTRÖM MACROGLOBULINEMIA
Authors: Passo Ross M. , Scruggs Brittni A. , Bailey Steven T.
Published: January 2022

Purpose:

To report a case of paracentral acute middle maculopathy as the earliest sign of an undiagnosed, life-threatening hyperviscosity syndrome.

Methods:

A 78-year-old man with an acute paracentral scotoma and examination findings of bilateral arteriolar tortuosity and unilateral paracentral acute middle maculopathy.

Results:

Work-up revealed anemia and elevated serum viscosity. Protein electrophoresis demonstrated an immunoglobulin M kappa monoclonal protein spike, and bone marrow biopsy confirmed an immunoglobulin M gammopathy consistent with Waldenström macroglobulinemia. Systemic chemotherapy was initiated.

Conclusion:

This case demonstrates typical optical coherence tomography findings of paracentral acute middle maculopathy, which led to the diagnosis of a rare lymphoproliferative disorder. This highlights the importance of a prompt work-up for paracentral acute middle maculopathy to detect underlying systemic diseases, including hyperviscosity syndromes.
Predictive Model of Self-management in Patients With Stroke Based on the Information-Motivation-Behavioral Skills Model
Authors: Kim Sung Reul , Kim Sunho , Kim Hye Young , Cho Kyung-Hee
Published: January 2022

Background

Patients who had a stroke are required to manage risk factors, and self-management for risk factor control in stroke is essential. Recent studies using the information-motivation-behavioral skills model reported that the model is effective for predicting and explaining self-management behavior in chronically ill patients.

Objectives

This study aimed to develop and verify the predictive model of self-management based on the information-motivation-behavioral skills model in patients with stroke.

Methods

This was a descriptive, cross-sectional study; path analysis was conducted to develop and verify the hypothesized predictive model. We recruited 242 patients who had a stroke using convenience sampling from the neurological outpatient clinic.

Results

The model's fit indices were adequate. Stroke self-management knowledge, social support, and self-efficacy had a direct effect on stroke self-management, and stroke self-management knowledge and attitude and social support had an indirect effect on stroke self-management, mediated by self-efficacy. Stroke self-management knowledge and attitude, social support, and self-efficacy explained 27.5% of the total variance in stroke self-management.

Conclusions

The information-motivation-behavioral skills model is potentially a predictive model for self-management for patients who had a stroke. Considering the level of stroke knowledge and attitude, social support, and self-efficacy together may help to understand the required level of self-management. In addition, using this model for the development of self-management interventions for patients who had a stroke could be a strategy for improving self-management in patients with stroke.
Implementation of an Electronic Health Record Integrated Clinical Pathway Improves Adherence to COVID-19 Hospital Care Guidelines
Authors: Sangal Rohit B. , Liu Rachel B. , Cole Kelsey O. , Rothenberg Craig , Ulrich Andrew , Rhodes Deborah , Venkatesh Arjun K.
Published: January 2022

Background:

During the COVID-19 pandemic, frequently changing guidelines presented challenges to emergency department (ED) clinicians. The authors implemented an electronic health record (EHR)-integrated clinical pathway that could be accessed by clinicians within existing workflows when caring for patients under investigation (PUI) for COVID-19. The objective was to examine the association between clinical pathway utilization and adherence to institutional best practice treatment recommendations for COVID-19.

Methods:

The authors conducted an observational analysis of all ED patients seen in a health system inclusive of seven EDs between March 18, 2020, and April 20, 2021. They implemented the pathway as an interactive flow chart that allowed clinicians to place orders while viewing the most up-to-date institutional guidance. Primary outcomes were proportion of admitted PUIs receiving dexamethasone and aspirin in the ED, and secondary outcome was time to delivering treatment.

Results:

A total of 13 269 patients were admitted PUIs. The pathway was used by 40.6% of ED clinicians. When clinicians used the pathway, patients were more likely to be prescribed aspirin (OR, 7.15; 95% CI, 6.2-8.26) and dexamethasone (10.4; 8.85-12.2). For secondary outcomes, clinicians using the pathway had statistically significant (P < 0.0001) improvement in timeliness of ordering medications and admission to the hospital. Aspirin, dexamethasone, and admission order time were improved by 103.89, 94.34, and 121.94 minutes, respectively.

Conclusions:

The use of an EHR-integrated clinical pathway improved clinician adherence to changing COVID-19 treatment guidelines and timeliness to associated medication administration. As pathways continue to be implemented, their effects on improving patient outcomes and decreasing disparities in patient care should be further examined.
Evaluating the impact of evidence-based nursing in combination with clinical nursing pathway for nursing care of patients with stroke
Authors: Ma Shao-Yan
Published: January 2022

Objectives:

Strokes are among the leading conditions that lead to disability and death. Currently, there is a lack of ideal nursing care for stroke patients. The aim of this study is to assess the effect of combining evidence-based nursing and clinical nursing pathway to establish a nursing model to provide care for patients who suffered a stroke.

Methods:

A comprehensive search of online-based databases will be carried out to identify relevant publications, the databases include EMBASE, Cochrane Library, PubMed, VIP databases, Chinese National Knowledge Infrastructure, and WanFang database. The search will consider all Randomized Controlled Trials, interrupted time series studies, and controlled before and after studies, all related to providing care for neurology and strokes by combining evidence-based nursing and clinical nursing pathway to elevate access and outcomes for patients with stroke. The language of publications will be restricted to English and Chinese. The author will select studies, extract data, and evaluate the quality of the involved articles. RevMan 5.3 software will be employed to perform all statistical analysis.

Results:

The outcomes of the proposed study will provide scientific evidence for the nursing care of evidence-based nursing combined with clinical nursing pathway for stroke patients.

Conclusion:

The planned systematic analysis will be first to examine the effect of combining evidence-based nursing and clinical nursing pathway to present a nursing model to treat stroke patients.

Registration number:

November 16, 2021.osf.io/6zr5a/. (https://osf.io/6zr5a/).
Clinical study on acupuncture treatment of COVID-19
Authors: Luo Wenjun , Zhai Yan , Sun Mi , Guo Dong , Xie Fang , Yu Zhou , Tang Zunhao
Published: January 2022

Background:

COVID-19 is an acute respiratory infectious disease, which makes people difficult to breathe; in addition, it is often accompanied by headache, olfaction, and taste disorders of the neurological manifestations. Acupuncture has been proved to have a therapeutic effect on various neurologic manifestations. This study is designed to evaluate the effectiveness and safety of acupuncture for the neurologic manifestations in COVID-19.

Methods:

Randomized controlled trials from December 2019 to July 2021 will be included without restrictions on language or publication date. PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Databases (CBM), China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database will be searched. Two researchers will independently select studies, extract data, and evaluate study quality. Cochrane risk of bias tool for randomized trials will be used to assess the risk of bias of included studies. Statistical analyses will be performed using the Review Manager V.5.3 and stata 14.0.

Ethics and dissemination:

This study will not involve personal information. Ethical approval will not be required. We will publish the results in a peer-reviewed journal.

PROSPERO Trial registration number:

CRD42021265699
A case of bronchial asthma as an immune-related adverse event of pembrolizumab treatment for bladder cancer
Authors: Hamada Kazuyuki , Yoshimura Kiyoshi , Oshinomi Kazuhiko , Hirasawa Yuya , Ariizumi Hirotsugu , Ohkuma Ryotaro , Shida Midori , Kubota Yutaro , Matsui Hiroto , Ishiguro Tomoyuki , Sambe Takehiko , Ishida Hiroo , Horiike Atsushi , Wada Satoshi , Iwamoto Sanju , Uchida Naoki , Ogawa Yoshio , Kobayashi Shinichi , Tsunoda Takuya
Published: January 2022

Rationale:

Bladder cancer is one of the most common cancers worldwide. The anti-programmed cell death protein 1 (PD-1) antibody pembrolizumab, which is an immune checkpoint inhibitor (ICI), has improved survival in bladder cancer. We report a case of bladder cancer that had a high antitumor effect with anti-programmed cell death PD-1 antibody pembrolizumab, an ICI, but asthma occurred an immune-related adverse event (irAE).

Patient concerns:

A 70-year-old female patient was diagnosed as unresectable bladder cancer who was indicated for ICI treatment.

Diagnosis:

After ICI administration as a treatment for bladder cancer, the patient had a grade 3 asthma attack. Cytotoxic T lymphocyte antigen 4 (CTLA-4) in CD4+ FOX3+ T cells was upregulated in the early phase before the development of asthma attacks. Moreover, T-cell immunoglobulin and mucin domain 3 (TIM-3) was upregulated in all memory T cells among CD4+ T cells. However, no change in the expression of TIM-3 was observed in any CD8+ T-cell subtype. In contrast, the proportion of CD161- T helper 17 cell (Th17) cells increased.

Interventions:

The patient was treated with betamethasone, montelukast, salbutamol nebulization, and a combination of salmeterol (50 μg) and fluticasone (500 μg) (SFC).

Outcomes:

The patient's wheezing resolved, and her peak flow rate reached 100% of the predicted value; therefore, the patient continued treatment with SFC and montelukast and was discharged from the hospital.

Conclusion:

Increases in CTLA-4 and TIM-3 expression in CD4+ T cells (not CD8+), as well as an increase in Th17 cells, may reflect asthma-related inflammation activity. Immune-related adverse events during immune checkpoint inhibitor administration may be predictive markers of antitumor efficacy.
Extensive pyomyositis secondary to paronychia-related MRSA infection
Authors: Wong Ying-Chi , Chen Hsi-Chih , Lai Chou-Cheng
Published: January 2022

Rationale:

Pyomyositis is characterized by an insidious and multifactorial inflammatory process, which is often caused by hematogenous pathogen. Predisposing risk factors include immunodeficiency, diabetes, malignancy, or trauma. The spectrum of clinical presentation depends on disease severity, typically presented by fever and hip pain. We hereby present a case with extensive pyomyositis secondary to chronic paronychia infection.

Patient concerns:

A 14-year-old immunocompetent male presented with fever and hip pain. The patient was initially surveyed for common infectious etiologies prior to the presentation of acute limping, which led to image confirmation of extensive pyomyositis.

Diagnosis:

The patient presented with acute pain in the right hip accompanied by headache, myalgia of the right leg, and intermittent fever for a week. Physical examination disclosed limping gait, limited range of motion marked by restricted right hip flexion and right knee extension, and chronic paronychia with a nail correction brace of the left hallux. Diagnosis of pyomyositis was confirmed by magnetic resonance image. Methicillin-resistant strains of Staphylococcus aureus was isolated from the patient's blood and urine cultures within 2 days of collection. The same strain was also isolated from the pus culture collected via sonography-guided aspiration.

Interventions:

Antibiotics treatment with oxacillin, teicoplanin, daptomycin, and fosfomycin were administered. Sonography-guided aspiration and computed tomography-guided pigtail drainage were arranged, along with nail extraction of his left hallux paronychia prior to discharge. Oral antibiotics fusidic acid was prescribed. Total antibiotics course of treatment was 4 weeks.

Outcomes:

The patient gradually defervesced and was afebrile after drainage. Followed limb doppler sonography showed regression of the abscess at his right lower limb. Gait and range of motion gradually recovered without sequelae.

Lessons:

Ambulation and quality of life are greatly affected by the inflammatory process of pyomyositis. Detailed evaluation of predisposing factors should be done, even in immunocompetent individuals. Timely diagnosis is vital to successful treatment.
Acupuncture treatment of hypertension with insomnia
Authors: Zhu Xun , Yan Luda , Dou Xuejiao , Zheng Yanping , He Guanglin , Liao Meiyan , Fu Wenbin
Published: January 2022

Introduction:

Hypertension patients often suffered from insomnia problems which lowered the quality of life. Studies have shown that acupuncture is effective to treat perimenopausal and cancer-related insomnia. However, there is a lack of randomized controlled trials to support the effectiveness of acupuncture on insomnia of hypertension patients.

Methods and analysis:

This study is a randomized, double-blind (patients and evaluators), and placebo-controlled clinical trial to investigate the effect of acupuncture in hypertension patients’ insomnia management. We will recruit 158 hypertension patients suffering from insomnia in Bao’an People's Hospital, Shenzhen and randomly assign them into treatment group (antihypertensive drugs + acupuncture) and control group (antihypertensive drugs + sham acupuncture) in a 1:1 ratio. The patients will receive acupuncture 3 times a week for 12 weeks, and then a 6-months follow-up will be conducted after the treatment. The primary outcome is the Pittsburgh Sleep Quality Index. The secondary outcomes include sleep parameters, blood pressure dropping, sleeping pill dosage, Rating Depression Scale score, and Self-Rating Anxiety Scale score. The primary outcome will be evaluated at baseline, 4, 8, and 12 weeks, and 1, 3, and 6 months following the end of treatment. The secondary outcomes will be assessed at baseline and 12 weeks of the treatment period.
Clinicopathological characteristics and treatment of patients with high-grade endometrial stromal sarcoma
Authors: Bai Huimin , Yuan Fang , Liang Bing , Sun Hengzi , Gao Yutao , Jin Mulan , Xing Xiaoming
Published: January 2022

To investigate the clinicopathological characteristics of patients with high-grade endometrial stromal sarcoma (HG-ESS).

The clinicopathological characteristics, treatments, and prognostic information of consecutive HG-ESS patients were collected from medical records and then evaluated.

A total of 40 women were included in the analysis. The immunohistochemical profiles indicated that HG-ESS tumors tend to be locally or weakly positive for vimentin (100%) and CD10 (72.0%) but mostly negative for desmin (7.7%) and AE1/AE3 (9.1%). The progression-free survival intervals and the clinical benefit rates of patients receiving radiotherapy and/or chemotherapy were slightly longer and higher than those receiving simple observation (progression-free survival: 6 and 5 months vs 2 months; clinical benefit rate: 83.3% and 75.0% vs 28.6%). The 1-year disease-specific survival (DSS) rate was 62.7%. Tumor size, myometrial invasion, lymphovascular space invasion, cervical involvement, Federation International of Gynecology and Obstetrics (FIGO) stage, and residual disease all significantly affected the DSS rate (P < .001, =.002, <.001, =.004, <.001, and <.001, respectively). For patients with stage I disease, the 1-year DSS rate was as high as 91.7%, in contrast to 66.7%, 26.7%, and 0% for those with stage II, III, and IV disease, respectively.

HG-ESS is associated with an adverse prognosis. FIGO stage could effectively predict the prognosis of patients with this lethal disease. Immunohistochemical markers, vimentin+/CD10+ (local or very weak), in combination with desmin-/AE1/AE3-, may be helpful for improving the diagnostic accuracy of this lethal condition. The therapeutic roles of adjuvant chemotherapy and radiotherapy warrant further investigation.
Programmed death 1 monoclonal antibody helped to treat mixed chimeric and reactivation of Epstein-Barr virus in a patient with adult-onset chronic active Epstein-Barr virus infection after allogeneic hematopoietic stem cell transplantation
Authors: You Yahong , Wang Jingshi , Wang Zhao
Published: January 2022

Rationale:

Systemic forms of chronic active Epstein-Barr virus infection (CAEBV) can predispose a patient to a protracted course of fulminant hemophagocytic lymphohistiocytosis, which has a poor prognosis. Epstein-Barr virus (EBV) infection may persist even after theoretically curative hematopoietic stem cell transplantation.

Patient concerns:

A female patient with CAEBV underwent chemotherapy followed by allogeneic hematopoietic stem cell transplantation from her human leukocyte antigen-matched sister. Neutrophil and platelet engraftment was observed on day +12 and +10. Full donor chimerism (DC) was achieved on Day +21.

Diagnoses:

From day +38, EBV-DNA in the blood was persistently positive, and DC declined. We attempted empirical interventions such as withdrawal of immune suppression, multiple donor lymphocyte infusion, stem cell boost, and interferon-α treatment. However, EBV-DNA copies continued to increase aggressively, whereas DC decreased rapidly and then reached a nadir of 63.27%.

Interventions:

Salvage programmed death 1 (PD-1) antibody treatment was administered as salvage therapy at +69 and +84.

Outcomes:

EBV-DNA was negative on day +97 and was ultimately undetectable. Equivalently, a full and stable DC was obtained at +97.

Lessons:

We summarize a case of PD-1 antibody used as salvage treatment in a post-transplant patient with CAEBV, which was eradicated and full DC was obtained. This case suggests that the PD-1 antibody appears to be a promising option for fighting EBV and mixed DCs.
Biliary atresia combined Wilson disease identified by whole exome sequencing in Vietnamese patient with severe liver failure
Authors: Hoa Nguyen Pham Anh , Lien Nguyen Thi Kim , Tung Nguyen Van , Lan Nguyen Ngoc , Mai Nguyen Thi Phuong , Huong Nguyen Thi Mai , Thach Hoang Ngoc , Hoang Nguyen Huy
Published: January 2022

Rationale:

Hepatobiliary diseases such as biliary atresia (BA), Wilson disease, and progressive familial intrahepatic cholestasis are common causes of morbidity and mortality in young children. Affected patients progress rapidly to end-stage cirrhosis and require liver transplantation or die. Mutations in many genes have been identified to play an important role in the pathogenesis of hepatobiliary diseases.

Patient concerns and diagnosis:

In this study, we identified mutations in an 8-year-old girl who had severe liver failure. The patient was first diagnosed with BA at 2.5 months of age and has undergone Kasai surgery to connect the umbilical cord and jejunum. After that, the patient suddenly had unusual developments with symptoms of jaundice, acute liver failure with hemolysis. She was tested and diagnosed with Wilson disease.

Interventions and outcomes:

She was treated according to the regimen for a patient with Wilson disease but had abnormal progress leading to severe liver failure. Genetic analysis was performed by whole exome sequencing and Sanger sequencing methods. The genetic analysis revealed that the patient had a homozygous mutation (p.Gly17Glyfs77∗) in the KRT18 gene, a double heterozygous mutation (p.Ser105∗ and p.Pro992Leu) in the ATP7B gene, and a homozygous variant (p.Val444Ala) in the ABCB11 gene. In silico prediction of mutations indicated that these mutations are the cause of the severe liver failure in the patient.

Lesson:

This is a rare clinical case of a BA patient combined with Wilson disease. Our results suggested that whole exome sequencing is an effective diagnostic tool and emphasizes the importance of early diagnosis and appropriate management to save lives and prevent serious complications in the patient.
Endovascular repair of an ilio-iliac arteriovenous fistula following rupture of common iliac artery aneurysm with an aortic extension cuff in common iliac vein
Authors: Yoo Young Sun
Published: January 2022

Rationale:

Common iliac artery aneurysm (CIAA) is complicated by ilio-iliac arteriovenous fistulas (IIAVF), which is rare but fatal and require prompt diagnosis and appropriate treatment. As open repair is associated with high morbidity and mortality, endovascular therapy is considered appropriate for treating an IIAVF.

Patient concerns:

A 76-year-old male patient who developed an IIAVF as a complication of ruptured CIAA, requiring immediate surgical repair presented to the hospital with hemodynamic instability.

Diagnosis:

Computed tomography angiography and conventional angiography revealed an IIAVF.

Intervention:

Endovascular therapy was selected to reduce the risk of morbidity and mortality. As the angiogram after the first endovascular aneurysm repair with stent-grafting showed contrast medium filling in the aneurysm sac, right common iliac vein, and the inferior vena cava, an aortic extension cuff was inserted into the right common iliac vein to close the orifice on the venous side.

Outcomes:

The right lower leg edema and discomfort were resolved immediately after the procedure, with the vital signs remaining stable. Computed tomography performed 6 months postoperatively showed patent stent-grafts of the artery and vein, with no evidence of IIAVF and endoleak.

Lessons:

IIAVF following CIAA rupture can be repaired successfully by stenting of the common iliac vein with an aortic extension cuff. For successful endovascular repair, the vein side of the fistula tract should be excluded with a stent-graft to block the backflow into the aneurysm sac.
Gastric neuroendocrine neoplasms and precursor lesions
Authors: Boeriu Alina , Dobru Daniela , Fofiu Crina , Brusnic Olga , Onişor Danusia , Mocan Simona
Published: January 2022

Rationale:

Gastric neuroendocrine neoplasms (g-NENs) represent a distinctive group of gastric tumors, stratified into different prognostic categories according to different histological characteristics, put forth in the 2018 World Health Organization classification system. The clinical presentations, as well as pathological features, represent important data in establishing the type of the tumor, in estimating the tumor behavior, and in selecting the best therapeutic strategy. In our case series we presented different clinical scenarios that may be encountered in practice regarding gastric NENs. We performed a literature review and discussed diagnostic strategy, current classification system, precursor lesions, and therapeutic options in g-NENs.

Patient concerns:

The first patient was a 41-year-old female with weight loss, persistent dyspeptic complaints and a history of pernicious anemia. In the second clinical case a 61-year-old man was admitted with heartburn, abdominal pain, diarrhea and mild iron deficiency anemia. The third patient was a 56-year-old male with a history of neoplasia, admitted for weight loss, dyspeptic complaints, and liver metastases.

Diagnosis:

All the 3 patients underwent upper endoscopy with targeted biopsies. Histopathological and laboratory evaluation, together with imagistic evaluation (abdominal ultrasound, endoscopic ultrasound, and magnetic resonance imaging) allowed the distinction between 3 different types of gastric tumors: type 1 enterochromaffin-like-cell G1 NET, type 2 enterochromaffin-like-cell G2 NET, and type 3 G2 NET with liver metastases.

Interventions:

Endoscopic polypectomy of the largest lesion was performed in patient with type 1 g-NET and autoimmune chronic atrophic gastritis, followed by regular endoscopic surveillance with biopsies. In type 2 g-NET associated with pancreatic gastrinoma, pancreaticoduodenectomy with total gastrectomy were performed. In type 3 g-NET, detected in metastatic stage, oncologic therapy was performed.

Outcomes:

The patients follow-up was selected according to tumor behavior, from regular endoscopic surveillance to oncology follow-up. The prognosis was good in case 1, whilst poorer outcomes were associated with more aggressive tumors in case 2 and case 3.

Lessons:

g-NENs are rare tumors with distinct clinical and histological features. Our case series emphasized the role of close collaboration between clinician and pathologist, as well as the importance of a detailed pathology report.
Effect of different intensity exercises intervention on cardiovascular functions and quality of life on patients with chronic heart failure
Authors: Bai Yan , Hua Bin , Zhang Fan , Zhou Wenqin , Deng Bing
Published: January 2022

Background:

Exercise training can improve exercise capacity, quality of life, and reduce hospitalization time in chronic heart failure (CHF) patients. Various training protocols have been studied in CHF, but there is no consensus on the optimal exercise intensity for the rehabilitation of cardiac patients. Therefore, systematic evaluation of the effects of different exercise intensities on the efficacy of cardiac function and quality of life in patients with CHF was done.

Methods:

Computer searches of PubMed, Web of Science, The Cochrane Library, Embase, SinoMed, the China National Knowledge Infrastructure, Wanfang, and VIP databases were conducted to collect randomized controlled trials of different exercise intensities applied to patients with CHF. Study selection and data extraction will be performed simultaneously by two independent reviewers, using the PEDro scale for quality assessment of the included literature. Publication bias will be assessed by funnel plot, and Begg and Egger tests. The I
2 statistic and the chi-square (χ
2) test will be used to assess heterogeneity. In addition, subgroup analyses will be performed for different left ventricular ejection fraction populations and different intervention cycles. All meta-analyses will be performed using Revman5.3 software.

Results:

The present study is a systematic review and meta-analysis program with no results. Data analysis will be completed after the program has been completed.

Conclusion:

This meta-analysis may provide more reliable, evidence-based evidence for the choice of exercise intensity in patients with CHF.

Registration number:

CRD42021276529
Accuracy of ultrasound in distinguishing pathology of malignant thyroid diseases
Authors: Qin Ling , Liu Qiyu , Sun Lipeng , Wang Hui
Published: January 2022

Background:

In recent years, the incidence rate of thyroid cancer is increasing. Meanwhile, with the development of medical technology, the detection rate of thyroid cancer by ultrasound has been greatly improved. Normally doctors can initially distinguish pathology of malignant thyroid diseases by their abundant experience. And it will bring assistance to follow-up treatment. However, the results of these studies have been contradictory. Therefore, this meta-analysis tested the hypothesis that ultrasound is accurate in distinguishing pathology of malignant thyroid diseases.

Methods:

We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the December 14, 2021, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis.

Results:

This systematic review will determine the accuracy of ultrasound in distinguishing pathology of malignant thyroid diseases.

Conclusion:

It is findings will provide helpful evidence for the accuracy of ultrasound in distinguishing pathology of malignant thyroid diseases.

Systematic review registration:

INPLASY2021120072.
Initial experience with intensity distribution analysis of hemodynamic parameters in the thoracic aorta using four-dimensional magnetic resonance imaging
Authors: Nishimura Takamasa , Sueyoshi Eijun , Koike Hirofumi , Uetani Masataka
Published: January 2022

The purpose of this study was to investigate whether there were significant differences in the intensity distributions of thoracic aorta hemodynamic parameters between groups with different ejection fractions (EF) using four-dimensional flow magnetic resonance imaging and to investigate the relationships between each parameter.

A total of 26 patients, 13 each with EF of >60% and <30%, underwent cardiac four-dimensional flow magnetic resonance imaging (EF >60%: mean age: 54 ± 11.6 years, EF <30%: mean age: 49.2 ± 17.2 years). The thoracic aorta was divided into the proximal and distal ascending aorta (AAo), aortic arch, and the proximal and distal descending aorta, and each section was further divided into the anterior wall, posterior wall, lesser curvature, and greater curvature. The intensity distributions of wall shear stress (WSS), energy loss (EL), and vorticity (Vort) (hemodynamic parameters) and the concordance rates between these distributions were analyzed.

The concordance rate between the intensity distributions of EL and Vort was high. Only the intensity distributions of EL and Vort in the distal AAo differed significantly between the groups (P < .001). In the EF >60% group, these intensity distributions showed higher values in the greater curvature of the AAo, whereas in the EF <30% group higher values were seen in the lesser curvature of the AAo.

Although there was no significant intergroup difference in the WSS intensity distribution, in the EF <30% group the WSS intensity distribution tended to exhibit higher values in the lesser curvature of the distal AAo, and the WSS intensity distribution values for the greater curvature tended to gradually increase from the arch to the proximal descending aorta.

The only significant differences between the EF groups were found in the intensity distributions of EL and Vort in the distal AAo. This suggests that the distributions of atherosclerosis may be EF-dependent.
Association of blood cobalt concentrations with dyslipidemia, hypertension, and diabetes in a US population
Authors: Wang Hongxin , Li Feng , Xue Jianghua , Li Yanshuang , Li Jiyu
Published: January 2022

Various heavy metal elements in the human body have been reported to be associated with dyslipidemia, hypertension, and diabetes. The role of cobalt in these conditions is unclear. The current study aimed to investigate the association of blood cobalt concentrations with dyslipidemia, hypertension, and diabetes.

Using the data collected from the National Health and Nutrition Examination Survey (2015-2018), we performed logistic regression to explore the association of blood cobalt concentrations with total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, hypertension, and diabetes.

A total of 6866 adults were included in this study. Participants with higher blood cobalt levels appeared to be older and have a lower body mass index and, were more likely to be female (P for trend < .05). After fully adjusting for demographic characteristics (Model 2), compared with the lowest quartile, the highest quartile of blood cobalt concentrations had lower odds ratios (ORs) for elevated TC [OR: 0.62, 95% confidential interval (CI): 0.53 to 0.72, P < .001], elevated LDL-C (OR: 0.65, 95% CI: 0.53-0.80, P < .001) and low HDL-C (OR: 0.81, 95% CI: 0.69-0.96, P = .013). The adjusted ORs for elevated TC, elevated LDL-C and low HDL-C were negatively correlated with increased blood cobalt concentrations (P for trend < .05). The adjusted ORs for hypertension and diabetes were not associated with blood cobalt concentrations (P > .05 and P for trend > .05).

In conclusion, higher blood cobalt concentrations were associated with a lower risk of dyslipidemia. However, blood cobalt concentrations were not associated with the risk of hypertension or diabetes.
The effects of swimming sports on the prevention and restoration of COVID-19 and its variant strains
Authors: Zeng Jing , Liu Qing , Wang Yang , Lei Zhengfang , Shang Yao , Yang Qunru
Published: January 2022

Introduction:

Since 2019, corona virus disease 2019 (COVID-19) has become a new round of “epidemic,” which has brought about a major crisis to the world from national development, to people's life safety and mental health. Faced with the constant variation of viruses, from COVID-19 to Delta to Omicron. How to curb its further deterioration and enhance human defense against viruses is the focus of scientific researchers. From previous studies, we found that in addition to basic medical treatment, swimming with a certain amount of load and intensity can promote the ventilator of the human body, thereby playing an auxiliary and preventive role in the treatment of COVID-19 and its variant strains.

Methods:

This study searched China knowledge network, Web of science, Google scholar, PubMed database to search for the relevant research on swimming prevention and treatment for COVID-19, and the deadline for searching was December 2021. Two researchers independently screened and extracted the literature, and evaluated the bias risk of the included studies. The methodological quality of the included literature was evaluated by the Chochrane bias risk assessment tool.

Result:

This study will provide new evidence for the prevention and recovery of COVID-19 and its variant strains by swimming.

Conclusion:

To provide a method to help the prevention and restoration of COVID-19 and its variant strains by swimming.

INPLASY registration number:

INPLASY2021120075.
Multiple evanescent white dot syndrome following vaccination for COVID-19
Authors: Inagawa Sayako , Onda Masahiro , Miyase Taishi , Murase Shiho , Murase Hiroki , Mochizuki Kiyofumi , Sakaguchi Hirokazu
Published: January 2022

Rationale:

Multiple evanescent white dot syndrome (MEWDS) is an acute, usually unilateral, retinal disorder of unknown etiology that predominantly occurs in healthy young women. We report a case of bilateral asymmetric MEWDS that developed following the first vaccination for coronavirus-19 and worsened after a second vaccination.

Patient concerns:

A 30-year-old Japanese woman was examined in an eye clinic for blurred vision in her left eye for 1 week duration. Thirteen days before her examination, she had received her first BNT162b2 mRNA SARS-CoV-2 vaccination. Her best-corrected visual acuity was 20/20 in both eyes. Fundus examination revealed multiple yellowish-white spots in the perifoveal area of both eyes. Visibility of the spots gradually decreased during the following week. She was then vaccinated with a second dose, and 3 days later, her vision worsened in her left eye. She was then referred to our hospital because of worsened vision and the appearance of white spots on other parts of the retina. Ophthalmological examination revealed a best-corrected visual acuity of 30/20 both eyes.

Diagnosis:

The flare value in the anterior chamber was elevated in both the eyes. Fundus examination showed multiple white spots in the perifoveal area of both eyes, but they were more prominent in the left eye. Fundus fluorescein angiography revealed early hyperfluorescent spots located circumferentially around the fovea in both eyes. We concluded that the patient had MEWDS, which was most likely due to mRNA COVID-19 immunization.

Interventions:

The patient was treated with topical betamethasone sodium phosphate/fradiomycin sulfate 0.1% thrice daily for 2 months.

Outcomes:

Two months after treatment, her blurry vision resolved with the disappearance of the fundus lesions.

Lesson:

Clinicians should be aware of potential adverse ocular events following similar vaccinations.
Long-term survival in a patient with advanced non-smoking lung adenocarcinoma and no EGFR mutation after comprehensive therapy with EGFR-TKI-based therapy
Authors: Zhang Qianyu , Liu Meiling , Zhong Yunchao , Zhang Kang
Published: January 2022

Rationale:

This is the first known report to describe a case of advanced non-smoking lung adenocarcinoma with no epidermal growth factor receptor mutation after comprehensive epidermal growth factor receptor-tyrosine kinase inhibitor-based therapy that survived for nearly 12 years.

Patient concerns:

A 48-year-old Chinese woman that came to our hospital with a left supraclavicular mass.

Diagnosis:

The final diagnosis was left lung adenocarcinoma with left supraclavicular lymph node metastasis, cT1N3M0 IIIB (International association for the Study of lung cancer 6th version).

Interventions:

After 4 months of 4 cycles of chemotherapy, gefitinib was administered alone for 5.5 years. Local radiotherapy (40GY/20F) was administered for 1 month, and osimertinib alone was followed for 4.5 years. A combination of pemetrexed with oxaliplatin and hyperthermia at the same time was administered for 4 cycles. Toripalimab and anlotinib were administered for 3 months. Since then, the patient had been taking a double dose of icotinib herself.

Outcomes:

The patient has survived for nearly 12 years since diagnosis of lung cancer.

Lessons:

Our case is of significant importance to clinicians involved in the treatment of patients with advanced nonsmoking lung adenocarcinoma and no epidermal growth factor receptor mutations.
A 6-Year Thematic Review of Reported Incidents Associated With Cardiopulmonary Resuscitation Calls in a United Kingdom Hospital
Authors: Beed Martin , Hussain Sumera , Woodier Nick , Fletcher Cathie , Brindley Peter G.
Published: January 2022

Background

Critical incident reporting can be applied to cardiopulmonary resuscitation (CPR) events as a means of reducing further occurrences. We hypothesized that local CPR-related events might follow patterns only seen after a long period of analysis.

Design

We reviewed 6 years of local incidents associated with cardiac arrest calls. The following search terms were used to identify actual or potential resuscitation events: “resuscitation,” “cardio-pulmonary,” “CPR,” “arrest,” “heart attack,” “DNR,” “DNAR,” “DNACPR,” “Crash,” “2222.” All identified incidents were independently reviewed and categorized, looking for identifiable patterns.

Setting

Nottingham University Hospitals is a large UK tertiary referral teaching hospital.

Results

A total of 1017 reports were identified, relating to 1069 categorizable incidents. During the same time, there were approximately 1350 cardiac arrest calls, although it should be noted that many arrest-related incidents were not associated with cardiac arrest call (e.g., failure to have the correct equipment available in the event of a cardiac arrest). Incidents could be broadly classified into 10 thematic areas: no identifiable incident (n = 189; 18%), failure to rescue (n = 133; 12%), staffing concerns (n = 134; 13%), equipment/drug concerns (n = 133; 12%), communication issues (n = 122; 10%), do-not-attempt-CPR decisions (n = 101; 9%), appropriateness of patient location or transfer (n = 96; 9%), concerns that the arrest may have been iatrogenic (n = 76; 7%), patient or staff injury (n = 43; 4%), and miscellaneous (n = 52; 5%). Specific patterns of events were seen within each category.

Conclusions

By reviewing incidents, we were able to identify patterns only noticeable over a long time frame, which may be amenable to intervention. Our findings may be generalizable to other centers or encourage others to undertake this exercise themselves.
The Compressed Sensing MP2RAGE as a Surrogate to the MPRAGE for Neuroimaging at 3 T
Authors: Trotier Aurélien J. , Dilharreguy Bixente , Anandra Serge , Corbin Nadège , Lefrançois William , Ozenne Valery , Miraux Sylvain , Ribot Emeline J.
Published: January 2022

Objectives

The magnetization-prepared 2 rapid acquisition gradient echo (MP2RAGE) sequence provides quantitative T1 maps in addition to high-contrast morphological images. Advanced acceleration techniques such as compressed sensing (CS) allow its acquisition time to be compatible with clinical applications. To consider its routine use in future neuroimaging protocols, the repeatability of the segmented brain structures was evaluated and compared with the standard morphological sequence (magnetization-prepared rapid gradient echo [MPRAGE]). The repeatability of the T1 measurements was also assessed.

Materials and Methods

Thirteen healthy volunteers were scanned either 3 or 4 times at several days of interval, on a 3 T clinical scanner, with the 2 sequences (CS-MP2RAGE and MPRAGE), set with the same spatial resolution (0.8-mm isotropic) and scan duration (6 minutes 21 seconds). The reconstruction time of the CS-MP2RAGE outputs (including the 2 echo images, the MP2RAGE image, and the T1 map) was 3 minutes 33 seconds, using an open-source in-house algorithm implemented in the Gadgetron framework.

Both precision and variability of volume measurements obtained from CAT12 and VolBrain were assessed. The T1 accuracy and repeatability were measured on phantoms and on humans and were compared with literature.

Volumes obtained from the CS-MP2RAGE and the MPRAGE images were compared using Student t tests (P < 0.05 was considered significant).

Results

The CS-MP2RAGE acquisition provided morphological images of the same quality and higher contrasts than the standard MPRAGE images. Similar intravolunteer variabilities were obtained with the CS-MP2RAGE and the MPRAGE segmentations. In addition, high-resolution T1 maps were obtained from the CS-MP2RAGE. T1 times of white and gray matters and several deep gray nuclei are consistent with the literature and show very low variability (<1%).

Conclusions

The CS-MP2RAGE can be used in future protocols to rapidly obtain morphological images and quantitative T1 maps in 3-dimensions while maintaining high repeatability in volumetry and relaxation times.
Vortioxetine-Induced Amenorrhea: A Case Report
Authors: Işik Mesut , Kurhan Faruk , Ülkevan Tuba , Özdemir Pinar Güzel
Published: January 2022

Background

Vortioxetine is a novel multimodal antidepressant for the treatment of major depressive disorders and is widely used in clinical practice. Vortioxetine has a safe profile. However, there are case reports of other adverse effects in the literature. In this article, a case of amenorrhea due to vortioxetine is presented.

Case

The patient is 36 years old, married, female, and is an anesthesiologist. She applied to the psychiatric outpatient clinic with symptoms of major depression. Vortioxetine was initiated at 10 mg/d and then gradually increased to 20 mg/d. She had regular menstruation until now. However, she did not menstruate after taking vortioxetine. The patient used vortioxetine for 3 months and never had a period. Pregnancy test and other tests to investigate organic etiology were normal. Two weeks after discontinuation of vortioxetine, the patient had a menstrual period.

Conclusions

Further research is needed on the relationship and possible mechanisms between vortioxetine and amenorrhea.