bluuebunny/crossref_metadata_2025 huggingface dataset:
Sequence variations affect the 5′ splice site selection of plant introns
Authors: Cheng Wenzhen , Hong Conghao , Zeng Fang , Liu Nan , Gao Hongbo
Published: July 2023

Introns are noncoding sequences spliced out of pre-mRNAs by the spliceosome to produce mature mRNAs. The 5′ ends of introns mostly begin with GU and have a conserved sequence motif of AG/GUAAGU that could base-pair with the core sequence of U1 snRNA of the spliceosome. Intriguingly, ∼ 1% of introns in various eukaryotic species begin with GC. This occurrence could cause misannotation of genes; however, the underlying splicing mechanism is unclear. We analyzed the sequences around the intron 5′ splice site (ss) in Arabidopsis (Arabidopsis thaliana) and found sequences at the GC intron ss are much more stringent than those of GT introns. Mutational analysis at various positions of the intron 5′ ss revealed that although mutations impair base pairing, different mutations at the same site can have different effects, suggesting that steric hindrance also affects splicing. Moreover, mutations of 5′ ss often activate a hidden ss nearby. Our data suggest that the 5′ ss is selected via a competition between the major ss and the nearby minor ss. This work not only provides insights into the splicing mechanism of intron 5′ ss but also improves the accuracy of gene annotation and the study of the evolution of intron 5′ ss.
Sickle cell disease and coronavirus disease-2019 (COVID-19) infection: a single-center experience
Authors: Devarashetty Sindhu P , Grewal Udhayvir S , Le Blanc Kimberly , Walton Jacqueline , Jones Tabitha , Shi Runhua , Master Samip R , Mansour Richard P , Ramadas Poornima
Published: July 2023

Purpose

Sickle cell disease (SCD) has been found to be associated with an increased risk of hospitalization and death from coronavirus disease-2019 (COVID-19). We sought to study clinical outcomes in patients with SCD and a diagnosis of COVID-19 infection.

Methods

We conducted a retrospective analysis of adult patients (>18 years) with SCD who were diagnosed with COVID-19 infection between 1 March 2020 and 31 March 2021. Data on baseline characteristics and overall outcomes were collected and analyzed using SAS 9.4 for Windows.

Results

A total of 51 patients with SCD were diagnosed with COVID-19 infection in the study period, out of which 39.3% were diagnosed and managed in the outpatient setting/emergency room (ER) and 60.3% in the inpatient setting. Disease-modifying therapy such as hydroxyurea did not impact inpatient vs outpatient/ER management (P > 0.05). Only 5.71% (n = 2) required intensive care unit admission and were mechanically ventilated and 3.9% (2 patients) died of complications of COVID-19 infection.

Conclusion

We identified a lower mortality (3.9%) rate among patients in our cohort in comparison to previous studies and a higher burden of inpatient hospitalizations as compared to outpatient/ER management. Further prospective data are needed to validate these findings.

Key messages What is already known on this topic COVID-19 has been shown to have a disproportionately unfavorable impact on African Americans, including longer hospital stays, higher rates of ventilator dependence, and a higher overall mortality rate. Limited data also suggest that sickle cell disease (SCD) is associated with an increased risk of hospitalization and death from COVID-19. What this study adds Our analysis did not show a higher mortality due to COVID-19 in patients with SCD. However, we identified a high burden of inpatient hospitalizations in this population. COVID-19-related outcomes did not improve with the use of disease-modifying therapies. How this study might affect research, practice, or policy These results will aid in decision making for triage of patients with COVID-19 and SCD and ensure the most appropriate use of healthcare resources. Our analysis underscores the need for more robust data to identify patients at higher risk of severe disease and/or mortality, necessitating inpatient hospitalization and aggressive management.
On the identification of radon areas as defined in art. 103 of Council Directive 2013/59/EURATOM
Authors: Salvi Francesco
Published: July 2023

Radon maps are one of the key tools for implementing a graded approach to reduce exposure due to radon. The Council Directive 2013/59/Euratom indicated how to identify the geographical areas of the country most exposed to indoor radon. Using annual average radon concentrations in 5000 dwellings in the Lazio region, located in central Italy, the expected number of dwellings with annual average radon concentrations above the reference level of 300 Bq per m3 within the 6 km grid squares was estimated. For the purpose of application, radon areas were identified by arbitrarily selecting grid squares with at least 10 expected dwellings per square kilometer above 300 Bq per m3. Since comprehensive measurements surveys must be conducted within the radon areas to identify all dwellings exceeding the reference level for the purpose of reducing radon concentration, quantitative economic considerations are reported.
Strategies for rate and rhythm control of atrial fibrillation in the ED
Authors: Zapata James , Akopian Erik , Yvanovich Anthony
Published: July 2023

Atrial fibrillation (AF) is one of the most common dysrhythmias managed in the ED and accounts for more than half a million visits a year in the United States. More than 6 out of 10 of these visits result in admissions. As the prevalence of AF has continued to increase in recent years, so has the presentation of patients with AF to the ED. For these reasons, clinicians in emergency settings must be knowledgeable of evidence-based rate and rhythm control strategies for stabilizing patients and preventing complications. This article discusses options, indications, contraindications, and safe implementation of rate and rhythm control strategies for ED clinicians. Recent studies have suggested that early rhythm control may benefit newly diagnosed patients, reducing stroke risk, cardiovascular deaths, and disease progression.
The Association of Relational Coordination and Faculty Members' Burnout and Job Satisfaction: A Preliminary Cross-Sectional Study
Authors: Wisdom Christina M.
Published: July 2023

Introduction.

The relational coordination theory describes the interaction between effective communication and high-quality relationships critical for coordinating and accomplishing tasks when multiple individuals and groups are involved.

Review of Literature.

Relational coordination is associated with improved worker performance, increased job satisfaction, and reduced burnout. The purposes of this paper were to examine the differences in physical therapist education program (PTEP) core faculty members' perceived relational coordination with other PTEP faculty members, staff, and administration and to examine the associations between PTEP core faculty members' perceived relational coordination and its subscales and their perceived burnout and job satisfaction.

Subjects.

Entry-level PTEP core faculty members.

Methods.

An online survey that included the Relational Coordination Survey, Oldenburg Burnout Inventory, and Job Satisfaction Survey was used. A 1-way analysis of variance was conducted to test whether there were differences in PTEP core faculty members' perceived relational coordination with other PTEP faculty members, staff, and administration. Several simple linear regressions were conducted to test the associations between PTEP core faculty members' perceived relational coordination and its subscales and their perceived burnout and job satisfaction.

Results.

A total of 103 responses were analyzed. The PTEP core faculty members' mean perceived relational coordination with core faculty members was significantly higher than the mean relational coordination with associated faculty members, administration, and staff. Physical therapist education program core faculty members' perceived relational coordination and all its subscales were negatively associated with perceived disengagement. Perceived problem-solving communication and mutual respect were negatively associated with perceived exhaustion. Physical therapist education program core faculty members' perceived relational coordination and all its subscales were positively associated with perceived job satisfaction.

Discussion and Conclusion.

The quality of communication and relationships between and among core faculty members, administrators, and staff may affect PTEP core faculty members' perceived burnout and job satisfaction.
Burnout among palliative care providers
Authors: Zogby Colleen Borden
Published: July 2023

Background:

Burnout among health care professionals contributes to high job turnover. Within the United States, burnout among specialty palliative care (PC) providers will accentuate provider shortage problems.

Objectives:

This systematic review was conducted to answer the question “what is known about burnout among specialty PC providers practicing in the United States?” More specifically, it was designed to identify the rate of burnout and factors that influence or mitigate it among PC nurse practitioners (NPs), physician assistants (PA), and physicians and to inform future research.

Data sources:

An electronic literature search of studies conducted in the United States between 2012 and September 2022 was completed in Embase, PubMed, CINAHL, and PsycINFO.

Conclusions:

Analysis of 14 studies showed that there are five primary themes related to burnout among PC providers: (1) the rate of burnout, (2) the physical, psychological, and clinical manifestations of burnout, (3) predictors of burnout, (4) factors of resiliency, and (5) interventions piloted to decrease burnout. The majority of studies have delineated the physician role but have failed to determine the rate and factors of burnout among PC NPs and PAs.

Implications for practice:

As NPs and PAs are integral to the PC provider workforce, future research should be designed to understand more clearly how burnout affects these two PC roles to inform efforts to sustain the PC workforce.
A multicenter, observational study to evaluate hemostasis following recombinant activated FVII treatment in patients in Japan with congenital factor VII deficiency
Authors: Seita Ikuo , Kinai Ei
Published: July 2023

Reports describing symptoms and treatment of patients with congenital factor VII (FVII) deficiency frequently relate to patients in Europe, while only a small number describe data from Asian countries.

This multicenter, prospective observational study (NCT01312636) collected data from 30 sites for 55% of patients registered in 2011 in Japan with congenital FVII deficiency treated with activated recombinant FVII (rFVIIa) for bleeding episodes and/or during surgery.

The mean follow-up in 20 eligible patients was 11 months (range 1–49 months). Of 348 bleeding episodes in seven patients, 170 (48.9%) were intra-articular bleeding and 62 (17.8%) were menorrhagia, of which 92.9% (158/170) and 100% (62/62) were in patients with baseline factor VII activity 20 IU/dl or less, respectively. The hemostatic effect after rFVIIa treatment was rated as excellent, effective or partially effective for 45.7, 33.6 and 18.4% of 348 bleeding episodes. Overall, hemostasis for bleeding events and surgery was achieved in nearly 2 days, with the majority of patients receiving two doses or less. The hemostatic effect after the recommended dose (15–30 μg/kg) of rFVIIa was rapid and effective treatment for all categories of bleeding and surgical procedure.

On the basis of data from routine clinical practice, no new safety signals were identified.

Trial Registration

NCT01312636
The predictive role of platelet count for bleeding in patients with hepatitis B virus and hepatitis C virus infection
Authors: Huang Cih-En , Chang Jung-Jung , Chen Chih-Cheng , Wang Ying-Hsuan , Lu Chang-Hsien , Chen Yi-Yang , Wang Ting-Yao , Chen Min-Chi
Published: July 2023

The impact of platelet count on bleeding in hepatitis B virus (HBV) and hepatitis C virus (HCV)-infected patients is unclear. We aimed to evaluate the relationship between platelet count and bleeding in patients with viral hepatitis.

We selected patients with HBV and HCV infection. All esophagogastroduodenoscopy, colonoscopy, and brain imaging reports were reviewed to document upper gastrointestinal bleeding (UGIB), lower gastrointestinal bleeding (LGIB), and central nervous system bleeding (CNSB), respectively. We analyzed risk factors for first bleeding events by using Cox proportional hazards models. Incidence rate ratios (IRRs) were used to compare bleeding incidences between viral types and platelet levels.

A total of 2522 HCV and 2405 HBV patients were enrolled. The HCV-to-HBV IRRs of UGIB, LGIB, and CNSB were significant at 1.797, 2.255, and 2.071, respectively. The common risk factors in both groups were thrombocytopenia, hypoalbuminemia, high alkaline phosphatase level, and cirrhosis for UGIB, whereas thrombocytopenia and hypoalbuminemia for LGIB. Hypoalbuminemia was the only risk for CNSB. After adjusting platelet count, the higher bleeding rates in the HCV patients diminished. Using a reference platelet count less than 100 x 109/l, bleeding risk elevated at platelet count less than 70 x 109/l and less than 40 x 109/l for UGIB and LGIB in the HCV patients, respectively, compared with less than 60 x 109/l for UGIB in the HBV patients. The incidence of CNSB was not related to platelet levels.

HCV patients had a higher risk for major bleeding. Thrombocytopenia was a significant predictor. Monitoring and management of thrombocytopenia in addition to cirrhotic status was important in these patients.
Avatrombopag increased platelet count in a patient with chronic immune thrombocytopenia refractory to multiple lines of treatment
Authors: Lebowa Weronika , Zdziarska Joanna , Sacha Tomasz
Published: July 2023

We present a case of a 30-year-old man suffering from chronic refractory immune thrombocytopenia (ITP) from early childhood. The patient was treated with all the therapeutic methods available in Poland, without platelet response: corticosteroids, intravenous immunoglobulins, splenectomy, cyclophosphamide, vinblastine, azathioprine, mycophenolate mofetil, rituximab, ciclosporin A, romiplostim, and eltrombopag. He continued to function persistently with deep thrombocytopenia, symptoms of hemorrhagic diathesis, and one episode of spontaneous subarachnoid bleeding. In April 2022, at the age of 29, the patient received avatrombopag. Within 4 weeks of starting avatrombopag 20 mg daily for 2 weeks and then 40 mg daily, he reached a platelet (PLT) count of 67 x 109/l. In the next month, platelets fell below 30 x 109/l, but subsequently the count increased to 47 x 109/l, then to 52 x 109/l, and remained stable. The symptoms of cutaneous hemorrhage diathesis have resolved completely since avatrombopag was introduced and did not reappear despite the decrease in PLT count.
Incidence of factor XII deficiency in critically ill patients with a prolonged activated partial thromboplastin time: a prospective observational study
Authors: Mishra Lipi , Lee David , Ho Kwok M.
Published: July 2023

Limited data is available on factor XII deficiency in critically ill patients with prolonged activated partial thromboplastin time (aPTT). The association of factor XII deficiency with an increased risk of thromboembolism is unclear. This prospective observational study assessed the incidence of factor XII deficiency among critically ill patients with prolonged aPTT (>40 s), whether factor XII deficiency manifesting as prolonged aPTT was associated with an increased risk of thromboembolism, and clotting time on a viscoelastic (ROTEM) test was useful to predict factor XII deficiency. Of the 40 included patients, 48% [95% confidence interval (CI) 33–63) had a factor XII deficiency (mean ± standard deviation of factor XII level of all patients: 54% ± 29%). Factor XII levels were not significantly correlated with the measured aPTT (r = −0.163, P = 0.315). Factor XII deficiency was significantly more common in patients who were less critically ill (P = 0.027), but it was not significantly related to Disseminated Intravascular Coagulation scores (P = 0.567). The incidence of symptomatic venous thromboembolism (P = 0.246), allogeneic blood transfusion (P = 0.816), and hospital mortality (P = 0.201) were not significantly different between those with and without factor XII deficiency. The clotting time on the viscoelastic test was not predictive of factor XII deficiency (area under the receiver-operating characteristic = 0.605, P = 0.264). Factor XII deficiency was common in critically ill patients with a prolonged aPTT. There was no association between factor XII deficiency and risk of thromboembolism. The clotting time on ROTEM was not predictive of the presence of factor XII deficiency.
Resolution of cardiac surgical bleeding with the combination of 4-factor prothrombin complex concentrate and fresh frozen plasma following lack of response to fresh frozen plasma alone in a patient with severe factor XI deficiency
Authors: Boateng Percy , Varma Mala , Chen Lilyanne , Kyaw Hein , Kyaw Nay Lin , Yoe Joseph
Published: July 2023

Factor XI deficiency is associated with a bleeding tendency in some patients. Factor XI helps to reduce fibrinolysis. Bleeding risk is increased in factor XI-deficient patients during surgeries with high fibrinolytic activity, including nasopharyngeal/oropharyngeal and genitourinary surgeries. Treatment options for factor XI-deficient patients include fresh frozen plasma (FFP), antifibrinolytics, recombinant factor VIIa, and factor XI concentrates (available in Australia, Canada, and some European countries). 4-factor prothrombin complex concentrate (4-factor PCC) is an extract of FFP comprised of unactivated factors II, VII, IX, and X, proteins C and S, and heparin. It has been used for cardiac surgical bleeding. We report the first case of a patient with severe factor XI deficiency and cardiac surgical bleeding, which resolved with the combination of 4-factor PCC and FFP after lack of response to FFP alone.
Dysfibrinogenemia: discrepant results following infusion of purified fibrinogen
Authors: Marin Maximo J. , Mathew Carol M. , Rajasekhar Anita , Zumberg Marc , Euliano Tammy Y. , Winter William E. , Pelletier J. Peter R. , Pruitt Heather D. , Harris Neil S.
Published: July 2023

Inherited dysfibrinogenemias are molecular disorders of fibrinogen that affect fibrin polymerization. The majority of cases are asymptomatic, but a significant proportion suffer from increased bleeding or thrombosis. We present two unrelated cases of dysfibrinogenemia, both of whom showed a characteristic discrepancy between fibrinogen activity and the immunologic fibrinogen. In one patient, the dysfibrinogenemia was confirmed by molecular analysis; in the other case, the diagnosis was presumptive based upon laboratory studies. Both patients underwent elective surgery. Both received a highly purified fibrinogen concentrate preoperatively and demonstrated a suboptimal laboratory response to the infusion. Three methods for determining fibrinogen concentration (Clauss fibrinogen, prothrombin-derived fibrinogen, and the viscoelastic functional fibrinogen) were utilized in the case of one patient, and these techniques showed discrepant results with the classic Clauss method giving the lowest concentration. Neither patient experienced excessive bleeding during surgery.

Although these discrepancies have been previously described in untreated patients, their manifestation after infusion of purified fibrinogen is less well appreciated.
Management of hypocalcaemia in the critically ill
Authors: Melchers Max , van Zanten Arthur Raymond Hubert
Published: July 2023

Purpose of review

To better understand the established associations between hypocalcaemia and clinical outcomes, we synopsize the mechanisms involved in hypocalcaemia in the critically ill. We also provide an overview of the current evidence on managing hypocalcaemia in critical illness.

Recent findings

Hypocalcaemia is reported to occur in 55–85% of ICU patients. It appears to be associated with poor outcomes, but it may be a marker rather than a direct cause of disease severity. The recommendations to correct calcium in major bleeding are found on weak evidence and require further exploration by a randomized controlled trial (RCT). Calcium administration in cardiac arrest has shown no benefit and may provoke harm. In addition, no RCT has assessed the risks and benefits of calcium supplementation in critically ill hypocalcemic patients. Several recent studies conclude that it may even harm septic ICU patients. These observations are supported by evidence that septic patients using calcium channel blockers may have better outcomes.

Hypocalcaemia is common in critically ill patients. Direct evidence that calcium supplementation improves their outcomes is lacking, and there is even some indication that it may be detrimental. Prospective studies are required to elucidate the risks and benefits, and the pathophysiological mechanisms involved.
Intestinal topical lidocaine spray improves the efficacy and safety of endoscopic sigmoid polypectomy
Authors: Lu Qin , Xiong Fei , Wang Xiang-Yin , Zeng Ting , Lin Da-Yong , Liu Wei-Hui
Published: July 2023

Background and aims

Endoscopic polypectomy can prevent colorectal cancer. Adequate surgical field visualization is crucial to complete resection. To prevent visual field loss caused by intestinal peristalsis, we investigated the efficacy and safety of topical lidocaine spraying during the endoscopic sigmoid polypectomy (ESP).

Methods

Retrospective analysis was performed on 100 ESP patients admitted from July 2021 to October 2021, among which 50 patients received lidocaine (case group) and other 50 patients received normal saline (control group). Lidocaine or saline was sprayed on the colonic mucosa within 5 cm above and below the polyps before polypectomy. The en-bloc resection rate (EBRR) and complete resection rate (CRR) were primarily evaluated. Secondary outcomes included EBRR for polyps located in the 5–11 o’clock position, sigmoid colon peristalsis frequency, degree of exposure to the surgical field, operative times, and adverse events.

Results

There were no significant differences in the basic demographic characteristics between the two groups. EBRR and CRR in the case group were 72.9% and 95.8%, and in the control group were 53.3% and 91.1%, respectively. The EBRR of sigmoid polyps located at the 5–11 o’clock positions was significantly higher in the case group (82.8%) than in the control group (56.7%) (P = 0.03). Sigmoid colonic peristalsis was significantly inhibited after lidocaine spraying (P < 0.01). There was no statistical difference in the operative times and adverse event rates between the two groups.

Conclusion

Topical spraying lidocaine around polyps can safely and effectively reduce intestinal peristalsis, thus improving the EBRR of sigmoid polypectomy.
Excellent outcome in patients with primary biliary cholangitis in Northwest Italy followed up for up to 30 years
Authors: Rigamonti Cristina , De Benedittis Carla , Labanca Sara , Vanni Ester , Morgando Anna , Manfredi Giulia Francesca , Azzolina Danila , Cittone Micol Giulia , Giannini Edoardo Giovanni , Saracco Giorgio Maria , Pirisi Mario
Published: July 2023

Objective

Primary biliary cholangitis (PBC) is a rare chronic autoimmune cholangiopathy, characterized by a variable course and response to treatment. We aimed to describe long-term outcomes of PBC patients referred to three academic centres in Northwest Italy.

Methods

This is an ambispective cohort study of PBC patients (retrospective component: diagnosis before 1 January 2019; prospective component: thereafter), including 302 patients: 101 (33%) followed up in Novara, 86 (28%) in Turin, 115 (38%) in Genoa. Clinical features at diagnosis, biochemical response to therapy and survival were analyzed.

Results

Among the 302 patients (88% women, median age 55 years, median follow-up 75 months), alkaline phosphatase (ALP) levels significantly decreased during treatment with ursodeoxycholic acid (UDCA, P < 0.0001) and obeticholic acid (P < 0.0001). At multivariate analysis, ALP at diagnosis was predictive of 1-year biochemical response to UDCA [odds ratio 3.57, 95% confidence interval (CI) 1.4–9, P < 0.001]. Estimated median survival free of liver transplantation and hepatic complications was 30 years (95% CI 19–41). Bilirubin level at diagnosis was the only independent risk factor for the combined outcome of death, transplantation or hepatic decompensation (hazard ratio, 1.65, 95% CI 1.66–2.56, P = 0.02). Patients presenting with total bilirubin at diagnosis ≥0.6 times the upper normal limit (ULN) had a significantly lower 10-year survival compared to those with bilirubin <0.6 times ULN (63% vs. 97%, P < 0.0001).

Conclusion

In PBC, both short-term response to UDCA and long-term survival can be predicted by simple conventional biomarkers of disease severity, obtained at diagnosis.
Transjugular intrahepatic portosystemic shunt for pyrrolidine alkaloids-induced hepatic sinusoidal obstruction syndrome: a retrospective cohort study
Authors: Huang Tongmin , Zhang Xingfen , Yan Kun , Lou Dandi , He Yujing , Dai Senjie , Zheng Dingcheng , Chen Ping , Wu Feng , Gu Lihu
Published: July 2023

Background

This study aimed to investigate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of patients with pyrrolidine alkaloids-induced hepatic sinusoidal obstruction syndrome (PA-HSOS).

Methods

Patients diagnosed with PA-HSOS and treated in Ningbo No.2 Hospital between November 2017 and October 2022 were enlisted in this retrospective cohort study.

Results

This cohort comprised a total of 22 patients with PA-HSOS, of which 12 patients received TIPS treatment and 10 patients experienced conservative treatment. The median follow-up duration was 10.5 months. Baseline characteristics existed with no significant difference between the two groups. No operation failures or any TIPS-associated intraoperative complications were observed after TIPS. In the TIPS group, the portal venous pressure was substantially decreased from 25.3 ± 6.3 mmHg to 14.4 ± 3.5 mmHg after TIPS (P = 0.002). Compared with preoperative, the ascites after TIPS were significantly subsided (P = 0.001) and there existed a considerable decrease in Child-Pugh score. At the end of follow-up, 5 patients died, involving 1 in the TIPS group and 4 in the conservative treatment group. The median survival time was 13 (3–28) months in the TIPS group and 6.5 (1–49) months in the conservative treatment group, respectively. The survival analysis demonstrated that the total survival time of TIPS group was longer than that of the conservative treatment group, no statistical significance was observed (P = 0.08).

Conclusion

TIPS may be a secure and effective therapeutic strategy for PA-HSOS patients who do not respond to conservative treatment.
Fatty pancreas was associated with a higher acute pancreatitis Systemic Inflammatory Response Syndrome score at hospital admission
Authors: Sbeit Wisam , Abu Elheja Fares , Msheiil Botros , Shahin Amir , Khoury Sharbel , Sbeit Moeen , Khoury Tawfik
Published: July 2023

Background

Pancreatic fat infiltration was shown to be linked with acute pancreatitis and probably its severity. These interesting findings merit more investigation to elucidate the effect of fatty pancreas on acute pancreatitis severity.

Methods

We performed a retrospective study of patients hospitalized with documented acute pancreatitis. Pancreatic fat was determined according to pancreas attenuation on computed tomography. Patients were divided into two groups, with and without fatty pancreas. The Systemic Inflammatory Response Syndrome (SIRS) score was compared.

Results

Overall, 409 patients were hospitalized with acute pancreatitis. Among them, 48 patients had fatty pancreas (group A), vs. 361 patients who did not (group B). The mean ± SD age in group A was 54.6 ± 21.3, vs. 57.6 ± 16.8 in group B (P = 0.51). Patients in group A, had a significantly higher rate of fatty liver, as compared to group B (85.4% vs. 35.5%, P < 0.001). There was no significant difference in the medical history among the two groups. Fatty pancreas was associated with more severe acute pancreatitis as assessed by SIRS score at admission. The mean ± SD of SIRS score was significantly higher in group A (0.92 ± 0.87), as compared to 0.59 ± 0.74 in group B (P = 0.009). Positive SIRS score was present in a significantly higher proportion of patients with fatty pancreas (25%), as compared to only 11.4% in group B (P = 0.02).

Conclusion

The occurrence of acute pancreatitis with higher SIRS score was significantly associated with fatty pancreas. Fatty pancreas may represent a predictor of acute pancreatitis severity.
Quantitative [123]I-Ioflupane DaTSCAN single-photon computed tomography-computed tomography in Parkinsonism
Authors: Missir Elena , Begley Patrick , Jessop Maryam , Singh Nitasha , Aplin Mark , McMeekin Helena , Parekh Puja , Raczek Malgorzata , Dizdarevic Sabina
Published: July 2023

Aim

[123]I-Ioflupane (DaTSCAN) binds to the presynaptic dopamine transporter (DAT) and with a lower affinity to the serotonin transporter (SERT). We aimed to develop a novel method to quantify absolute uptake in the striatal (predominantly DAT binding) and extra-striatal regions (mainly SERT binding) using single-photon computed tomography-computed tomography (SPECT-CT) DaTSCAN and to improve DaTSCAN image quality.

Method

Twenty-six patients with Parkinsonism underwent DaTSCAN SPECT-CT prospectively. The scans were visually analyzed independently by two experienced reporters. Specific binding ratios (SBRs) from Chang attenuation corrected SPECT were obtained using GE DaTQuant. Normalized concentrations and specific uptakes (NSU) from measured attenuation and modelled scatter-corrected SPECT-CT were obtained using HERMES Hybrid Recon and Affinity and modified EARL volumes of interest.

Results

Striatal NSU and SBR positively correlate (R = 0.65–0.88, P = 0.00). SBR, normalized concentrations, and NSU box plots differentiated between scans without evidence of dopaminergic deficit and abnormal scans. Interestingly, body weight inversely correlated with normalized concentrations values in extra-striatal regions [frontal (R = 0.81, P = 0.00); thalamus (R = 0.58, P = 0.00); occipital (R = 0.69, P = 0.00)] and both caudate nuclei [R = 0.42, P = 0.03 (Right), R = 0.52, P = 0.01 (Left)]. Both reporters noted improved visual quality of SPECT-CT versus SPECT images for all scans.

Conclusion

DaTSCAN SPECT-CT resulted in more accurate quantification, improved image quality, and enabled absolute quantification of extra-striatal regions. More extensive studies are required to establish the full value of absolute quantification for diagnosis and monitoring the progression of neurodegenerative disease, to assess an interplay between DAT and SERT, and to verify whether serotonin and DATs are potentially dysfunctional in obesity.
Direct Occipital Remodeling in Sagittal Synostosis Improves 2-Year Posterior Morphology after Modified Pi Procedure
Authors: Hopper Richard A. , Nguyen Andy N. , Massenburg Benjamin B. , Lee Amy , Mercan Ezgi
Published: July 2023

Background:

Modifications of the pi craniectomy technique are meant to address the occipital bullet deformity of sagittal synostosis, but it is not clear whether they result in persistent improvement. The authors’ purpose was to use morphometric analysis to determine whether a low occipital osteotomy with verticalization results in improved occipital shape after a modified pi procedure 2 years after surgery.

Method:

The authors performed a retrospective cohort study comparing modified pi technique with and without a low occipital osteotomy with verticalization immediately and 2 years after surgery relative to age-matched normal controls. The authors used anthropometric measures and population-level anatomical templates using the multivariate template construction script from advanced normalization tools for comparison between groups. A subgroup analysis was performed for severe occipital bullet deformity at presentation.

Results:

The authors observed stable improvement in the angle of the inferior occiput with the occipital remodeling modification that persisted 2 years after surgery. This improvement was seen in the entire cohort and was greater in the severe subgroup analysis. Complications and blood transfusion volumes were not different between the 2 techniques. The low occipital osteotomy group demonstrated improved posterior vertical height and cephalic index immediately after surgery, but these did not persist 2 years later.

Conclusions:

Occipital remodeling improves the bullet deformity but does not affect posterior vertical height 2 years after surgery. The authors recommend direct inferior occipital remodeling when using the pi technique for young patients with acute occipital incline angles and occipital constriction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Business practices efficiency: Impact of integrating digital technology on clinical P&O practices
Authors: Eshraghi Arezoo , Phillips Clara , Heim Winfried
Published: July 2023

Additive manufacturing (AM) is on the path to transforming the approach to Prosthetics and Orthotics (P&O) manufacturing. Although digitalization of limbs and other body parts is not new to the field, it has not been widely accepted by the industry for various reasons. However, the reliability and precision that AM can attain, and the availability of various materials is improving rapidly. This professional opinion article discusses the ways that AM has changed P&O services, with a specific focus on prosthetic socket manufacturing. Digitalizing P&O services will eventually change the business model used in clinics, which is further explored here.
Reconstruction of Acquired Defects of the External Genitalia
Authors: Weisberger Joseph S. , Park John B. , Cortes Ricardo , Pizzo Dane , Van Kouwenberg Emily A. , Agag Richard L. , Sinkin Jeremy C.
Published: July 2023

Purpose

Patients undergoing resection of the external genitalia are often faced with significant deformity and decreased quality of life. Plastic surgeons are tasked with the challenge of reconstructing these defects to minimize morbidity and increase patients' quality of life. The authors have set out to investigate the efficacy of local fasciocutaneous and pedicled perforator flaps in external genital reconstruction.

Methods

A retrospective review was conducted of all patients undergoing reconstruction of acquired defects of the external genitalia from 2017 to 2021. In total, 24 patients met inclusion criteria for the study. Patients were allocated into 2 cohorts: patients with defects reconstructed using local fasciocutaneous flaps (FF) versus patients with defects reconstructed using pedicled islandized perforator flaps (PF). Comorbid conditions, ablative procedures, operative times, flap size, and complications were compared across all groups. Fisher exact test was used to analyze differences in comorbidities, while independent t tests were used to analyze age, body mass index, operative time, and flap size. Significance was set at P < 0.05.

Results

Of the 24 patients included in the study, 6 underwent reconstruction with islandized PFs (either profunda artery perforator or anterolateral thigh), and 18 underwent reconstruction with FFs. The most common indication for reconstruction was vulvectomy for vulvar cancer, followed by radical debridement for infection, and lastly penectomy for penile cancer. The PF cohort had a significantly higher percentage of previously irradiated patients (50% vs 11.1%, P = 0.019). Although mean flap size was larger in the PF cohort, this difference did not reach statistical significance (176 vs 143.4 cm2, P = 0.5). Perforator flaps had significantly longer operative times when compared with FFs (237.33 vs 128.99 minutes, P = 0.003). Average length of stay was 6.88 days in FF and 5.33 days in PF (P = 0.624). Complication profile including flap necrosis, wound healing delays, and infection were similar between groups despite a significantly higher rate of prior radiation in the PF cohort.

Conclusions

Our data suggest that PFs such as profunda artery perforator and anterolateral thigh flaps are associated with longer operative times but may offer a suitable option for reconstruction of acquired defects of the external genital compared with local FFs, especially in the setting of prior radiation.
“Cutoff Clipping” Technique as a Tentative Clipping Alternative for Large Aneurysms: A Preliminary Study
Authors: Zhang Weihua , Huang Gaoming , Zhang Jian , Bai Zennan , Yang Kaichuang
Published: July 2023

Background:

Intraoperative rupture of an aneurysm is potentially devastating. The thin-walled regions (TIWRs) of an aneurysm are associated with rupture risk. This study aimed to describe the feasibility and concerns of the “cutoff clipping” technique for TIWRs disposition of certain complex aneurysms.

Methods:

Three cases were reported to illustrate the “cutoff clipping” technique which was applied to clip a large aneurysm. This study emphasized the exposure and clipping of the aneurysm fundus. The fundus was dissected according to the TIWRs size threshold the author proposed and was clipped transversely by a temporary clip to achieve size reduction and blood flow disconnection. The authors called this the “cutoff clipping” technique. After the cutoff clip was placed, the neck of the aneurysm was further dissected and clipped.

Results:

After successfully placing the cutoff clip, the surgeon achieved to reduce the size of the fundus, decrease the TIWRs proportion, and disconnect the blood flow from the neck to the distal thin-walled dome. Sequentially, three aneurysms were clip-ligated without complications.

Conclusion:

The “cutoff clipping” technique applied under suitable conditions is a potential choice to dissect and clip a complex aneurysm with an adhesive neck and thin-walled dome.
Endoscopic Transoral Odontoidectomy of Craniovertebral Junction Rheumatoid Arthritis With the Help of Real-Time Fluoroscopy and Intraoperative Computed Tomography
Authors: Zeynal Mete
Published: July 2023

Rheumatoid arthritis (RA) involvement in the craniovertebral junction (CVJ) is a rare condition after antirheumatoid medications, nevertheless still exists. Neurological deterioration of the patient makes surgery inevitable. Seventy-seven years old man without antirheumatoid treatment presented with progressive neurological deterioration and CVJ involvement of RA with severe cord compression with myelomalacia. The patient underwent endoscopic transoral odontoidectomy with real-time fluoroscopy and intraoperative computed tomography. Even though radiological improvement has been achieved the patient died because of pulmonary complications. Rheumatoid arthritis of CVJ is a life-threatening medical condition. Surgical procedures will be safer by using endoscopy and intraoperative radiological imaging techniques.
Correlation of Obesity and Clinical Characteristics in Drug-Naive First-Episode Patients With Schizophrenia
Authors: Li Na , Xue Hua , Li Yong , Gao Minglong , Yu Ming , An Cuixia , Wang Chaomin
Published: July 2023

Objectives

This study was aimed at investigating the prevalence of obesity in drug-naive first-episode (DNFE) patients with schizophrenia and its association with metabolic parameters, psychopathological symptoms, and cognitive function.

Methods

We collected general information on 411 DNFE schizophrenia patients and divided them into obese and nonobese groups according to body mass index (BMI). Glucolipid metabolic parameters of patients were collected. Positive and Negative Syndrome Scale was performed for assessing patients' psychopathological symptoms. Cognitive function was observed and evaluated in both groups. Pearson correlation analysis was applied to assess factors related to BMI, while we conducted multiple stepwise regression analysis for determining risk factors for obesity.

Results

Obesity occurred in 60.34% of DNFE patients with schizophrenia, whereas the obese group had notably higher BMI value and waist-to-hip ratio than the nonobese group (P < 0.05). Obese patients had markedly higher levels of blood glucose, insulin, apolipoprotein B, total triglycerides, low-density lipoprotein cholesterol, and total cholesterol versus nonobese patients (P < 0.05). Besides, the disease severity and cognitive function were dramatically lower in the obese group. Results of multiple stepwise regression analysis demonstrated negative symptoms, low-density lipoprotein cholesterol, triglycerides, and blood glucose levels as the risk factors for comorbid obesity in DNFE patients with schizophrenia.

Conclusions

The detection rate of obesity was high in DNFE patients with schizophrenia, and there was an intrinsic association between obesity and glucolipid metabolism, clinical symptoms, and cognitive function among them. Our study will provide a theoretical foundation for the diagnosis of obesity in DNFE patients with schizophrenia and the development of effective early interventions.
Amantadine for Refractory Tremor in Parkinson Disease and Other Indications: A Chart Review With Long-Term Follow-up
Authors: Friedman Joseph H.
Published: July 2023

Objectives

The aim of this study was to determine how amantadine was used in a movement disorders clinic and how effective it was.

Methods

A chart review over a 2-month period in 2022 of all patients in a movement disorders clinic who had ever taken amantadine was undertaken.

Results

One hundred six charts were included. Amantadine was initiated primarily for tremor and secondly for l-dopa–induced dyskinesias (LIDs). Sixty-two percent of tremor patients improved and tolerated amantadine; 74% of those with LID improved and tolerated the drug. Hallucinations occurred in 23%. Initiating amantadine as a syrup allowed a more conservative titration than other formulations, which is attractive given the high percentage of hallucinations that may occur. Patients who tolerated drug initiation were generally kept on the drug for many years.

Conclusions

Amantadine should be considered as adjunctive therapy in Parkinson disease patients with refractory tremor as well as for LIDs.
Metagenomics of culture isolates and insect tissue illuminate the evolution of Wolbachia, Rickettsia and Bartonella symbionts in Ctenocephalides spp. fleas
Authors: Beliavskaia Alexandra , Tan Kim-Kee , Sinha Amit , Husin Nurul Aini , Lim Fang Shiang , Loong Shih Keng , Bell-Sakyi Lesley , Carlow Clotilde K. S. , AbuBakar Sazaly , Darby Alistair C. , Makepeace Benjamin L. , Khoo Jing Jing
Published: July 2023

While fleas are often perceived simply as a biting nuisance and a cause of allergic dermatitis, they represent important disease vectors worldwide, especially for bacterial zoonoses such as plague (transmitted by rodent fleas) and some of the rickettsioses and bartonelloses. The cosmopolitan cat (Ctenocephalides felis) and dog (Ctenocephalides canis) fleas, as well as Ctenocephalides orientis (restricted to tropical and subtropical Asia), breed in human dwellings and are vectors of cat-scratch fever (caused by

Bartonella

spp.) and

Rickettsia

spp., including

Rickettsia felis

(agent of flea-borne spotted fever) and

Rickettsia asembonensis

, a suspected pathogen. These

Rickettsia

spp. are members of a phylogenetic clade known as the ‘transitional group’, which includes both human pathogens and arthropod-specific endosymbionts. The relatively depauperate flea microbiome can also contain other endosymbionts, including a diverse range of

Wolbachia

strains. Here, we present circularized genome assemblies for two C. orientis-derived pathogens (

Bartonella clarridgeiae

and

R. asembonensis

) from Malaysia, a novel

Wolbachia

strain (wCori), and the C. orientis mitochondrion; all were obtained by direct metagenomic sequencing of flea tissues. Moreover, we isolated two

Wolbachia

strains from Malaysian C. felis into tick cell culture and recovered circularized genome assemblies for both, one of which (wCfeF) is newly sequenced. We demonstrate that the three

Wolbachia

strains are representatives of different major clades (‘supergroups’), two of which appear to be flea-specific. These

Wolbachia

genomes exhibit unique combinations of features associated with reproductive parasitism or mutualism, including prophage WO, cytoplasmic incompatibility factors and the biotin operon of obligate intracellular microbes. The first circularized assembly for

R. asembonensis

includes a plasmid with a markedly different structure and gene content compared to the published plasmid; moreover, this novel plasmid was also detected in cat flea metagenomes from the USA. Analysis of loci under positive selection in the transitional group revealed genes involved in host–pathogen interactions that may facilitate host switching. Finally, the first

B. clarridgeiae

genome from Asia exhibited large-scale genome stability compared to isolates from other continents, except for SNPs in regions predicted to mediate interactions with the vertebrate host. These findings highlight the paucity of data on the genomic diversity of Ctenocephalides-associated bacteria and raise questions regarding how interactions between members of the flea microbiome might influence vector competence.
“Current Practices and Attitudes towards Magnetic Resonance Imaging Safety during Pregnancy in Egyptian Healthcare Facilities: A Survey Study”
Authors: Ibrahim Moataz
Published: July 2023

Introduction

Magnetic resonance imaging (MRI) is a widely used diagnostic tool, but its safety during pregnancy remains a topic of concern. This study aimed to assess the current practices and attitudes towards MRI safety during pregnancy in Egypt.

Methods

A survey was conducted among 41 MRI facilities across the country, with a response rate of 85%. The survey assessed patient load, safety protocols, screening procedures, administration of contrast agents, follow-up assessments, and consent requirements for MRI during pregnancy.

Results

The majority of facilities (45%) reported a patient load between 100 and 200 exams per month. Regarding safety protocols, only 28% of facilities had a written policy on the exposure of pregnant patients to magnetic fields, while a mere 12% had a written policy on the exposure of pregnant health workers to MRI. Although 86% of facilities had a special MRI screening form, 27% did not consistently inquire about pregnancy during the screening procedure. Only 32% of facilities administered MRI contrast agents to pregnant patients when necessary. None of the facilities conducted regular follow-up assessments for babies exposed to the magnetic field in utero. Approximately 62% of facilities required special consent for MRI during pregnancy, with the patient herself (38%) and the husband (28%) being the common signatories.

Conclusion

The study highlights the need for enhanced awareness and implementation of MRI safety guidelines during pregnancy in Egyptian healthcare facilities. Standardized protocols, improved screening procedures, regular follow-up assessments, and informed consent are crucial to ensure the safety and well-being of pregnant patients and healthcare workers. These findings provide a basis for future research and policy development to optimize MRI safety practices in Egypt.