bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of performance-based budgeting on quality outcomes in U.S. military health care facilities
Authors: Decker Kimberly L. , Schwab Stephen D. , Bazzoli Gloria J. , Chukmaitov Askar S. , Wernz Christian
Published: May 2023

Background

Performance-based budgeting (PBB) is a variation of pay for performance that has been used in government hospitals but could be applicable to any integrated system. It works by increasing or decreasing funding based on preestablished performance thresholds, which incentivizes organizations to improve performance. In late 2006, the U.S. Army implemented a PBB program that tied hospital-level funding decisions to performance on key cost and quality-related metrics.

Purpose

The aim of this study was to estimate the impact of PBB on quality improvement in U.S. Army health care facilities.

Approach

This study used a retrospective difference-in-differences analysis of data from two Defense Health Agency data repositories. The merged data set encompassed administrative, demographic, and performance information about 428 military health care facilities. Facility-level performance data on quality indicators were compared between 187 Army PBB facilities and a comparison group of 241 non-PBB Navy and Air Force facilities before and after program implementation.

Results

The Army’s PBB programs had a positive impact on quality performance. Relative to comparison facilities, facilities that participated in PBB programs increased performance for over half of the indicators under investigation. Furthermore, performance was either sustained or continued to improve over 5 years for five of the six performance indicators examined long term.

Conclusion

Study findings indicate that PBB may be an effective policy mechanism for improving facility-level performance on quality indicators.

Practice Implications

This study adds to the extant literature on pay for performance by examining the specific case of PBB. It demonstrates that quality performance can be influenced internally through centralized budgeting processes. Though specific to military hospitals, the findings might have applicability to other public and private sector hospitals who wish to incentivize performance internally in their organizational subunits through centralized budgeting processes.
Comparison of Long-Term Outcomes of DSEK and DMEK in Fuchs Endothelial Dystrophy
Authors: Fu Lanxing , Hollick Emma J.
Published: May 2023

Purpose:

This study aimed to compare the long-term endothelial cell loss, graft survival, and clinical outcomes in patients with Fuchs endothelial dystrophy (FED) after Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK) using a standardized surgical protocol.

Methods:

Three hundred and six consecutive DSEK and DMEK grafts of 223 patients with FED performed by 8 surgeons between January 2006 and August 2022 were analyzed. The primary outcome measures were graft survival, endothelial cell loss, and best spectacle-corrected visual acuity.

Results:

At 5 years, graft survival was 96% for both DSEK and DMEK eyes. The mean percentage of endothelial cell loss was 57.7 ± 17.1 in DSEK and 56.8 ± 15.2 in DMEK eyes (P = 0.430). The mean best spectacle-corrected visual acuity was 0.13 ± 0.14 logMAR in DSEK and 0.01 ± 0.18 logMAR in DMEK grafts (P <0.00001) at 5 years postoperatively. Rebubbling was performed in 7.8% DSEK and 2.1% DMEK grafts (P = 0.441). Cox regression identified rejection episodes (HR 6.5; 95% CI: 1.70–24.8; P = 0.0062) as a significant contributing factor for graft failure.

Conclusions:

DMEK had superior visual acuity outcomes compared with DSEK in these patients up to 5 years after surgery. At 5 years, there was no significant difference in graft survival or endothelial cell loss between DSEK and DMEK eyes with FED. We propose that our standardized technique reduces the need for rebubbling.
Association Between Fuchs Endothelial Corneal Dystrophy, Diabetes Mellitus, and Multimorbidity
Authors: Nealon Cari L. , Halladay Christopher W. , Gorman Bryan R. , Simpson Piana , Roncone David P. , Canania Rachael L. , Anthony Scott A. , Sawicki Rogers Lea R. , Leber Jenna N. , Dougherty Jacquelyn M. , Cooke Bailey Jessica N. , Crawford Dana C. , Sullivan Jack M. , Galor Anat , Wu Wen-Chih , Greenberg Paul B. ,   the Million Veteran Program, Lass Jonathan H. , Iyengar Sudha K. , Peachey Neal S.
Published: May 2023

Purpose:

The aim of this study was to assess risk for demographic variables and other health conditions that are associated with Fuchs endothelial corneal dystrophy (FECD).

Methods:

We developed a FECD case–control algorithm based on structured electronic health record data and confirmed accuracy by individual review of charts at 3 Veterans Affairs (VA) Medical Centers. This algorithm was applied to the Department of VA Million Veteran Program cohort from whom sex, genetic ancestry, comorbidities, diagnostic phecodes, and laboratory values were extracted. Single-variable and multiple variable logistic regression models were used to determine the association of these risk factors with FECD diagnosis.

Results:

Being a FECD case was associated with female sex, European genetic ancestry, and a greater number of comorbidities. Of 1417 diagnostic phecodes evaluated, 213 had a significant association with FECD, falling in both ocular and nonocular conditions, including diabetes mellitus (DM). Five of 69 laboratory values were associated with FECD, with the direction of change for 4 being consistent with DM. Insulin dependency and type 1 DM raised risk to a greater degree than type 2 DM, like other microvascular diabetic complications.

Conclusions:

Female sex, European ancestry, and multimorbidity increased FECD risk. Endocrine/metabolic clinic encounter codes and altered patterns of laboratory values support DM increasing FECD risk. Our results evoke a threshold model in which the FECD phenotype is intensified by DM and potentially other health conditions that alter corneal physiology. Further studies to better understand the relationship between FECD and DM are indicated and may help identify opportunities for slowing FECD progression.
Hazard Detection During Simulated Driving in Glaucoma Patients
Authors: Daga Fábio B. , Boer Erwin R. , Diniz-Filho Alberto , Elhosseiny Ahmed , Jammal Alessandro A. , Tavares Ivan M. , Medeiros Felipe A.
Published: May 2023

Précis:

In this cross-sectional study, glaucoma patients showed slower reaction times (RTs) to hazardous situations when compared with control subjects during simulated driving. Worse RTs were associated with a greater magnitude of visual field loss.

Purpose:

The purpose of this study was to evaluate the impact of different hazardous traffic conditions on driving performance in glaucoma patients using a high-fidelity driving simulator.

Methods:

The cross-sectional study was performed with 52 glaucoma patients and 15 control subjects. A series of hazard scenarios were presented, such as pedestrians crossing the street unexpectedly or vehicles suddenly pulling into the driver’s lane. RTs in seconds (s) from first the evidence of a hazard to the time it took the driver to take the foot off the gas pedal (“Gas Off”) and the time it took to depress the brake pedal (“Brake On”) were compared between groups.

Results:

Overall, mean RTs were statistically significantly slower in glaucoma patients (3.39±3.88 s) compared with controls (2.39±1.99 s; P=0.005) for the “Brake On” task but not for the “Gas Off” task (2.74±3.42 vs. 2.13±1.91 s, respectively; P=0.120). For subjects with glaucoma, multivariable models adjusted for age, gender, race, and visual acuity demonstrated significantly slower RTs for worse values of binocular mean sensitivity for both “Gas Off” and “Brake On” tasks (1.12 and 1.14 s slower per 10 dB worse; P=0.009 and P<0.001, respectively). Subjects with glaucoma took significantly longer times to brake for smaller (low saliency) hazards compared with larger (high saliency) hazards (P=0.027).

Conclusions:

RTs in response to hazardous driving situations were slower for glaucoma patients compared with controls. Individualized assessment of driving fitness using hazardous scenarios in driving simulators could be helpful in providing an assessment of driving risk in glaucoma patients.
Outcomes of Corneal Transplant in Childhood Glaucoma
Authors: Vidal-Villegas Beatriz , Burgos-Blasco Barbara , Ariño-Gutierrez Mayte , Cuiña Sardiña Ricardo , Mendez-Hernandez Carmen Dora , Torres-Gonzalez Juan Ignacio , Mendez-Fernandez Rosalía , Díaz-Valle David , García-Feijóo Julián
Published: May 2023

Précis:

Childhood glaucoma produces alterations in the postnatal development and function of various ocular structures, including the cornea. Childhood glaucoma patients present lower corneal transplant survival rates. Our series shows outcomes of corneal transplant in childhood glaucoma with survival rates of 29% at 2 years.

Objective:

To investigate the surgical outcome of different types of keratoplasty in eyes with childhood glaucoma.

Patients and Methods:

A retrospective review was made of the medical records from 17 eyes of 15 patients who were diagnosed with childhood glaucoma and received a corneal transplantation between January 2010 and July 2020. Patient demographics, intraocular pressure, previous ocular surgery, comorbidities, corneal transplant surgery, and follow-up outcome were collected. The primary efficacy endpoint was graft survival (in months) until failure, the latter being considered as irreversible loss of corneal transparency. Secondary efficacy points were the need for an increase in topical hypotensive therapy and the need for additional surgery.

Results:

Seventeen eyes of 15 patients were included, 11 eyes (10 patients) with primary congenital glaucoma and 6 with other types of childhood glaucoma. Corneal transplantation was performed at the mean age of 23.76 ± 14.86 years. At the time of the transplantation, the number of topical medications was 1.35 ± 1.27, intraocular pressure was 15.00 ± 8.34 mm Hg, and patients had received up to 7 glaucoma surgeries. Descemet stripping automated endothelial keratoplasty was performed in 13 eyes (76%) and penetrating keratoplasty in 4 (24%). After surgery, 7 (41%) eyes required increased topical treatment and 2 (12%) glaucoma surgery. Twelve eyes (71%) developed graft failure at 24 months, the mean time of survival being 13.88 ± 8.25 months.

Conclusions:

Management of corneal decompensation in childhood glaucoma poses a challenge. In this series of childhood glaucoma with corneal transplantations, the survival rate was 29% at 24 months.
Effect Modification of Racial Differences in Pediatric COVID-19 Inpatient Admissions in a Large Healthcare Database
Authors: Watson Dave , Spaulding Alicen , Norton Laura
Published: May 2023

Background:

Coronavirus disease 2019 (COVID-19) has been more severe in racial and ethnic minorities relative to non-Hispanic White populations. Here, we investigate how these disparities vary across effect modifiers in a pediatric population.

Methods:

Using the TriNetX Dataworks Network from April 2020 to September 2021, we compared inpatient rates between non-Hispanic Black and non-Hispanic White patients among pediatric COVID-19 cases. Following propensity score matching, comparisons were performed within subgroups of 4 potential effect modifiers: age group (0–2, 3–5, 6–11 and 12–18 years), presence of complex comorbidities, quarter of the year (from 2020 Q2 to 2021 Q3) and geographic regions of the United States.

Results:

The cohort included 47,487 COVID-19 cases, of which 13,130 were Black patients. Among most subgroups of effect modifiers, inpatient rates were higher among the Black patients. The largest variation in disparities was observed across age groups and the presence of complex comorbidities. Twelve to 18 years old Black children had a 1.7% point [confidence interval (CI): 0.8–2.4] higher inpatient rate than the matched White children, whereas 0–2 years old Black children had a 2.5% point (CI: 0.9–4.1) lower rate than the matched White children. Among children with complex comorbidities, inpatient rates for Black children was 6.2 (CI: 3.4–8.9) percentage points higher than the White children; however, among kids without complex comorbidities, inpatient rates were comparable.

Conclusions:

Among pediatric patients experiencing COVID-19, higher inpatient rates for Black compared with White patients were observed among older children and those with complex comorbidities. These findings can spur discussions of potential root causes of these disparities, including structural racism.
Prevalence of Common Respiratory Viruses in Children at a Tertiary Care Hospital in Saudi Arabia
Authors: Al-Shehri Amal , Saleh Ahmed , Khan Mohammad Aatif , Dandachi Iman , AlJabr Waleed
Published: May 2023

Acute lower respiratory viral infections are significant contributors to morbidity/mortality in children less than 2 years of age. In this retrospective study conducted at a major hospital, between 2017 and 2019, it was observed that rhinovirus, respiratory-syncytial-virus and influenza virus are the most frequently detected with the seasonal distribution. Mortality rate was significantly higher in children less than 12 months and significantly increased in males and in those requiring intubation.
Clinical Presentation and Outcome of Acute Respiratory Illnesses in South African Children During the COVID-19 Pandemic
Authors: Redfern Andrew , van der Zalm Marieke M. , Lishman Juanita , Goussard Pierre , Smit Liezl , Dagan Ron , Barday Mikhail , Mare Minette , Claassen Mathilda , Van Zyl Gert , Rabie Helena , Verhagen Lilly M.
Published: May 2023

Background:

Data from low- and middle-income countries (LMICs) show higher morbidity and mortality in children with acute respiratory illness (ARI) from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, whether SARS-CoV-2 infection is distinct from other causes of ARI in this regard is unclear. We describe clinical characteristics and outcomes of South African children with SARS-CoV-2 and non-SARS-CoV-2 ARIs.

Methods:

We performed a cross-sectional study including 0–13 years old children admitted to Tygerberg Hospital between May and December 2020 with an ARI. Routine clinical data were collected by the attending clinicians. All children underwent SARS-CoV-2 polymerase chain reaction testing. For severity of disease, the need for respiratory support and duration of support was considered. Multivariable logistic regression models were built to determine the factors associated with SARS-CoV-2 infection and severity.

Results:

Data for 176 children were available, 38 (22%) children were SARS-CoV-2 polymerase chain reaction positive and 138 (78%) were negative. SARS-CoV-2 positive children were more likely to be female (OR: 2.68, 95% CI: 1.18–6.07), had lower weight-for-age Z score (OR: 0.76, 95% CI: 0.63–0.93), presented more frequently with fever (OR: 3.56, 95% CI: 1.54–8.24) and less often with cough (OR: 0.27, 95% CI: 0.11–0.66). SARS-CoV-2 infection was associated with significantly longer duration of oxygen treatment (median 8 vs. 3 days; OR: 1.1, 95% CI: 1.01–1.20). Overall, 66% of children had viral coinfection, with no significant difference between the groups. In total, 18% of SARS-CoV-2 positive children were readmitted within 3 months for a respiratory reason, compared with 15% SARS-CoV-2 negative children (P = 0.64).

Conclusions:

Our data show that ARIs from SARS-CoV-2 cannot be easily differentiated, but were associated with a higher morbidity compared with ARIs from other causes. Overall outcomes were good. The long-term implications of severe SARS-CoV-2 pneumonia in young children in low- and middle-income countries require further study.
Association Between Disrupted Cerebral Autoregulation and Radiographic Neurologic Injury for Children on Extracorporeal Membrane Oxygenation: A Prospective Pilot Study
Authors: Sanford Ethan L. , Akorede Rufai , Miller Isabel , Morriss Michael Craig , Nandy Karabi , Raman Lakshmi , Busch David R.
Published: May 2023

Validation of a real-time monitoring device to evaluate the risk or occurrence of neurologic injury while on extracorporeal membrane oxygenation (ECMO) may aid clinicians in prevention and treatment. Therefore, we performed a pilot prospective cohort study of children under 18 years old on ECMO to analyze the association between cerebral blood pressure autoregulation as measured by diffuse correlation spectroscopy (DCS) and radiographic neurologic injury. DCS measurements of regional cerebral blood flow were collected on enrolled patients and correlated with mean arterial blood pressure to determine the cerebral autoregulation metric termed DCSx. The primary outcome of interest was radiographic neurologic injury on eligible computed tomography (CT) or magnetic resonance imaging (MRI) scored by a blinded pediatric neuroradiologist utilizing a previously validated scale. Higher DCSx scores, which indicate disruption of cerebral autoregulation, were associated with higher radiographic neurologic injury score (slope, 11.0; 95% confidence interval [CI], 0.29–22). Patients with clinically significant neurologic injury scores of 10 or more had higher median DCSx measures than patients with lower neurologic injury scores (0.48 vs. 0.13; p = 0.01). Our study indicates that obtaining noninvasive DCS measures for children on ECMO is feasible and disruption of cerebral autoregulation determined from DCS is associated with higher radiographic neurologic injury score.
Immunotherapy-related pneumonitis and the synergic impact of thoracic radiation and preexisting interstitial lung disease
Authors: Azhar Maria , Abrencillo Rodeo , Gandhi Saumil , Altan Mehmet , Sheshadri Ajay
Published: May 2023

Purpose of review

Immune checkpoint inhibitors (ICIs) are the frontline of therapy for most cancers. Although ICIs are sometimes considered to be less harmful than systemic chemotherapies, ICIs may cause immune-related adverse events, which are cases of off-target inflammation in healthy tissues. Pneumonitis, an immune-related adverse event, is the leading cause of therapy-related mortality with ICIs. The aim of this review is to discuss how preexisting interstitial lung disease (ILD) and thoracic radiation increase the risk for ICI-pneumonitis. We discuss potential mechanisms of lung injury and how pneumonitis may impact cancer treatments.

Recent findings

Preexisting ILD and thoracic radiation are major risk factors for ICI-pneumonitis. The mechanisms of injury are still not fully understood but may involve the same inflammatory and profibrotic cytokines as those seen in sporadic ILD. Thoracic radiation increases the risk for ICI-pneumonitis and may synergize with preexisting ILD to worsen toxicity.

Preexisting ILD and thoracic radiation may increase the risk for the future development of ICI-pneumonitis. However, while these should not preclude potentially life-saving immunotherapy, in some cases, an alternative treatment strategy may be advisable. A multidisciplinary approach is required involving oncologists, pulmonologists, and radiation oncologists to guide in the selection of cancer treatment and in the diagnosis and treatment of pneumonitis.
The effect of pain-education nursing based on a mind map on postoperative pain score and quality of life in patients with colorectal cancer
Authors: Li Shan , Zhu Xiaohong , Zhang Lihua , Huang Cui , Li Dan
Published: May 2023

Mind mapping is a combination of images and logical thinking in the form of pictures and texts. It presents a natural expression process that conforms to the divergent thinking of the brain, helping patients understand memory. This study aimed to investigate the impact of pain-education nursing with the aid of mind maps on postoperative pain scores and quality of life in patients with colorectal cancer. The medical records of 100 colorectal cancer patients treated from July 2020 to July 2022 were selected as retrospective research participants and divided into control and observation groups. The control group received routine pain care, and the observation group was given pain-education nursing based on a mind map. The effects on quality of life, pain, negative emotions, and comfort after nursing were compared between the 2 groups. There was no significant difference in quality of-life scores between the 2 groups before the nursing intervention (P > .05). After nursing, the physical, emotional, cognitive, and social functions of patients in the observation group were significantly higher than those in the control group. However, the overall quality of life and financial difficulties of patients in the observation group were significantly lower than those in the control group (P < .05). The observation group’s social, physical, and psychological comfort scores were significantly higher than those in the control group after nursing intervention (P < .05). After nursing, the observation group’s visual analog scale scores at different times after the operation were significantly lower than those of the control group. The scores on the self-rating anxiety scale and self-rating depression scale in the observation group were significantly lower than those in the control group (P < .05). Pain-education nursing based on mind maps can effectively improve the daily living ability, pain symptoms, and quality of life of patients after colorectal cancer, and there is a reference value for post-nursing care of patients after colorectal cancer.
Bioinformatics identification and validation of aging‑related molecular subtype and prognostic signature in breast cancer
Authors: Li Jingtai , Gao Fangfang , Su Jiezhi , Pan Tao
Published: May 2023

Patients with metastatic breast cancer have a poor clinical outcome, accounting for more than 90 percent of breast cancer-related deaths. Aging could regulate many biological processes in malignancies by regulating cell senescence. The role of aging has not been fully clarified. Consensus cluster analysis was performed to differentiate The Cancer Genome Atlas (TCGA) breast cancer cases. Least absolute shrinkage and selection operator (LASSO) cox regression analysis was performed to construct an aging-related prognostic signature. A total of 118 differentially expressed aging-related genes (ARGs) was obtained in breast cancer. Consensus clustering analysis identified 3 categories of TCGA-breast cancer with significant difference in prognosis and immune infiltration. We also constructed an aging-related prognostic signature for breast cancer, which had a good performance in predicting the 1-year, 3-year and 5-year OS and disease specific survival (DSS) of breast cancer patients. Further single gene analysis revealed that the expression of PIK3R1 was significantly different in different pT and pN stages of breast cancer. Moreover, low expression of PIK3R1 showed resistance to many drugs based on the data of Genomics of Drug Sensitivity in Cancer (GDSC) and Genomics of Therapeutics Response Portal (CTRP). PIK3R1 played a vital role in many well-known cancer-related pathways. The current study identified 3 clusters of TCGA-breast cancer cases with significant differences in prognosis and immune infiltration. We also constructed an aging-related prognostic signature for breast cancer. However, further in vivo and in vitro studies should be conducted to verify these results.
Role of a fluid-restrictive strategy in flap-surgery: A single center retrospective cohort study
Authors: Rhee Harin , Jeong Ho Yoon , Yi Changryul Claud , Kim Joo Hyoung
Published: May 2023

In this study, we evaluated the outcomes of flap surgery and the incidence of acute kidney injury (AKI) in patients who underwent flap surgery using a fluid-restrictive strategy. We retrospectively reviewed the consecutively collected medical records of patients who underwent flap surgery using the fluid-restrictive strategy of our hospital. The patients were divided into 2 groups based on the period of flap surgery: 2011 to 2014 (initiation period of the fluid-restrictive strategy) and 2015 to 2020 (implementation period). Outcomes of flap surgery and the incidence of AKI were evaluated based on percentage changes in cumulative fluid balance to initial body weight (%FO) on post-operative day 7. A total of 140 patients were enrolled in the study; 50 (35.7%) underwent flap surgery in 2011 to 2014 and 90 (64.3%) in 2015 to 2020. In 2015 to 2020, the median %FO significantly decreased from 2.7 (interquartile range [IQR]: 0.8–7.1) to 0.1 (IQR: −2.2 to 3.4%, P < .001), whereas the success rate significantly increased from 53.3% to 70.5% (P = .048) compared to 2011 to 2014. The incidence of AKI remained unchanged. In multivariate analysis, the odds ratio for success was 2.759 (95% confidence interval: 1.140–6.679) in 2015 to 2020 compared to 2011 to 2014. After successfully implementing the fluid-restrictive strategy, the success rate of flap surgery significantly increased without any further increase in the incidence of AKI. Our experience could serve as a model for implementing a fluid-restrictive strategy in flap surgery.
p53 and PTEN expression evaluation with molecular evident recent criteria in laryngeal carcinoma
Authors: Tan Ayca , Eskiizmir Gorkem , Kamiloglu Ugur , Sarioglu Sulen
Published: May 2023

The prognosis of laryngeal cancer is affected by clinicopathological factors. Because of that, an effective prognostic marker is very valuable in managing the clinical process. The p53 evaluation method, used in the literature recently, was used for the first time in laryngeal cancer. We evaluated PTEN with 2 methods with the highest significance in the literature on laryngeal cancer. All demographic and histopathological data from 140 laryngeal cancers were compared with p53 and PTEN expressions and survival. p53 staining patterns were classified as wild and mutant. PTEN expression was evaluated according to the staining intensity named PTEN1 and according to the proportion of stained cells named PTEN2. In the series, 93.6% were males, and the mean survival was 38 months. 69.3% of cases were p53 mutants. PTEN loss was found to be 85.7% and 57.9%, respectively. Tumor size and thyroid cartilage invasion for PTEN1 and age for p53 were identified as independent predictive factors (P < .01). Advanced age, total laryngectomy, and extranodal spread were independent poor prognostic factors for overall survival and the presence of subglottic involvement, perineural invasion, and extranodal spread were for disease-free survival (P < .01). This is the first study in which the new p53 classification was used in laryngeal cancer, and will contribute significantly to the literature with differences from the previous evaluation patterns. Evaluation of PTEN based on staining intensity is more appropriate compared to the percentage of stained cells.
High-throughput metagenomics analysis in early and precise diagnosis of eosinophilic meningoencephalitis complicated with respiratory failure: A case report
Authors: Qiu Guoqing , Zhu Liqun , Chen Sida , Li Na , Ye Chunxing , Zhuo Songming , Shen Yan
Published: May 2023

Rationale:

Human infection with Angiostrongylus cantonensis is uncommon and has only been sporadically reported in the literature. Patients infected with A cantonensis usually have a delayed diagnosis and sometimes a poor prognosis.

Patient concerns:

A 70-year-old woman presented to the respiratory department with complaints of headache, chest pain, myalgia, fatigue, and anorexia for 7 days.

Diagnoses:

Complete blood count showed eosinophilia. The serum was tested showing a positive finding of A cantonensis antibody. Cerebrospinal fluid was tested using high-throughput metagenomics analysis and 16 reads for A cantonensis were mapped. The patient was diagnosed with A cantonensis infection.

Interventions:

The patient received a 7-day course of albendazole and 4-day course of prednisone.

Outcomes:

When discharged from the hospital, the patient still suffered from fatigue and poor memory. Aminotransferase levels were high due to albendazole’s liver toxicity. In a post-discharge follow-up about 1 month later she had recovered completely both physically and mentally, and peripheral eosinophil count and aminotransferase levels were both normal.

Lessons:

Because the direct identification of parasites is difficult, high-throughput metagenomics analysis may provide a reliable alternative tool for the diagnoses of infection with A cantonensis. When albendazole is prescribed, caution must be taken with respect to its liver toxicity.
Shared decision-making intervention regarding dialysis modality in patients with CKD stage 5
Authors: Lee Young-Ki , Kim Yang-Hyeon , Kim Do-Hyoung , Kim Jin-Heog , Lee Jeong-Hwan , Park Ji Hyeon , Ko Gang-Jee , Hwang Won-Min , Gil Hyo-Wook , Kang Young-Sun , Jin Kyu-Bok , Do Jun-Young , Kim Se-Joong , Kim Beom-Seok , Shin Ho Sik
Published: May 2023

Background:

Patients with kidney failure must make complicated decisions about the dialysis modalities used either at home or in-hospital. Different options have varying levels of impact on patients’ physical and psychological conditions and their social life. The purpose of this study was to evaluate the implementation of an intervention designed to achieve shared decision making (SDM) in patients’ options for dialysis.

Methods:

SDM was performed after consent was written for stage 5 chronic kidney disease patients before dialysis, and 435 cases were performed in 408 patients from December 16, 2019 to June 30, 2021. Among these, 101 patients were compared by SDM measurement scale, patient satisfaction, disease recognition scale survey, and dialysis method.

Results:

The average age of participants was 56 years, with a gender composition of 55 males (54.5%) and 46 females (45.5%). Following SDM, the final dialysis methods decided upon by patients and clinicians were peritoneal dialysis (67 patients, 66.3%), hemodialysis (22 patients, 21.8%), and kidney transplantation (1 patient, 1.0%).

Conclusions:

Among participating patients, SDM was effective when used to decide on dialysis treatment, and patients were satisfied with the dialysis method decision process. On the disease awareness scale, those who participated in this project had relatively high positive and low negative perceptions, so it can be concluded that SDM was relatively effective. The implementation of SDM was helpful in selecting patients’ best dialysis methods, and SDM scale results were higher in the peritoneal dialysis group than in the hemodialysis group.
Autophagy in hepatic macrophages can be regulator and potential therapeutic target of liver diseases: A review
Authors: Ge Jun , Li Hao , Yang Jia-Qi , Yue Yuan , Lu Sheng-Yu , Nie Hong-Yun , Zhang Tao , Sun Pei-Ming , Yan Hong-Feng , Sun Hong-Wei , Yang Jian-Wu , Zhou Jin-Lian , Cui Yan
Published: May 2023

Hepatic macrophages are a complex population of cells that play an important role in the normal functioning of the liver and in liver diseases. Autophagy, as a maintainer of cellular homeostasis, is closely connected to many liver diseases. And its roles are not always beneficial, but manifesting as a double-edged sword. The polarization of macrophages and the activation of inflammasomes are mediated by intracellular and extracellular signals, respectively, and are important ways for macrophages to take part in a variety of liver diseases. More attention should be paid to autophagy of hepatic macrophages in liver diseases. In this review, we focus on the regulatory role of hepatic macrophages’ autophagy in a variety of liver diseases; especially on the upstream regulator of polarization and inflammasomes activation of the hepatic macrophages. We believe that the autophagy of hepatic macrophages can become a potential therapeutic target for management of liver diseases.
Benign pancreatic lesion on 18F-FDG PET-MRI: A case report
Authors: Xiao Yuqiang , Zha Yong , Li Jindan , Yang Conghui , Chen Long , Xie Ran
Published: May 2023

Rationale:

Differentiation of benign and malignant lesions in the head of pancreas is the key. When the mass is small, it is difficult to distinguish via conventional imaging modalities. Positron emission tomography and magnetic resonance imaging (PET/MRI) can distinguish benign and malignant lesions from the perspective of metabolism, which provides a new idea for the diagnosis of pancreatic head mass.

Patient concerns:

We report the case of a 44-year-old male patient who underwent an 18F-fluorodeoxyglucose PET/MRI for medical examination. The patient did not complain of special discomfort.

Diagnoses:

PET-MRI revealed in the head of the pancreas, there is a circular space-occupying lesion without obvious fluorodeoxyglucose accumulation, which tends to be benign based on its MRI and metabolic characteristics.

Interventions:

The patient refused further laboratory examination or ultrasound gastroscopy as there is no discomfort.

Outcomes:

No special discomfort was found in the patient after 6 months follow-up.

Lessons:

If routine examination fails to diagnose benign or malignant pancreatic head occupying, and the patient refuses invasive examination, PET-MRI can be performed for identification.
A case report and literature review on primary solitary fibrous tumor of the bladder
Authors: Li Tian Yu , Zhang Bo , Zhang Ji
Published: May 2023

Rationale:

Solitary fibrous tumors (SFT) is a rare mesenchymal tumor originating from a CD34-positive dendritic mesenchymal cell, most of which is benign, the most common sites is pleura and mediastinum, and rarely in the bladder. The clinical manifestations are mainly related to the tumor volume. When the tumor volume is large, it will compress the surrounding tissues or organs and cause corresponding symptoms. Laparoscopic Incision biopsy is effective means for diagnosing SFT.

Patient concerns:

A 70-year-old female patient was admitted to the hospital with a bladder neoplasm detected by computed tomography scan after experiencing intestinal obstruction 3 days following esophageal cancer surgery. She denied any history of tumor disease.

Diagnoses:

No abnormality was found in the physical examination and laboratory testing after admission. Ultrasound imaging showed a large solid mass with low echogenicity in the bladder. Urological computed tomography with 3D reconstruction revealed a large cystic-solid mass located on the right wall of the bladder, measuring approximately 6.8 cm × 7.1 cm × 6.5 cm, with uneven density and mild inhomogeneous enhancement after contrast administration. Cystoscopy revealed a large mucosal bulge on the right wall of the bladder and laparoscopic exploration revealed a smooth-surfaced round mass, approximately 7 cm in size.

Interventions:

Incision biopsy was performed to make a clear diagnosis, and appropriate tissue specimens were obtained for pathological testing.

Outcomes:

The patient was diagnosed as SFT according to pathology. The patient was followed up for 6 months after surgery, and no recurrence was observed.

Lessons:

SFT occurring in the bladder are extremely rare, and the site is scarcely reported in the relevant literature; thus, it is easy to misdiagnose and laparoscopic incision biopsy may be a good choice.
Treatment adherence and anxiety levels of bronchiectasis patients in the COVID-19 pandemic
Authors: Borekci Sermin , Vardaloglu Ilgim , Gungordu Nejdiye , Caliskaner Ozturk Buket , Culpan Hazal Cansu , Aksoy Poyraz Cana , Gemicioglu Bilun
Published: May 2023

It has been reported that during the coronavirus disease-2019 (COVID-19) pandemic, bronchiectasis patients were adversely affected due to their limited respiratory functions and acute exacerbations which were triggered by viral infections. The increased concern in the population during the pandemic has affected the attitudes of people toward avoiding disease and patients’ treatment compliance. It is unclear whether treatment adherence and anxiety levels of bronchiectasis patients have changed during the pandemic. We aimed to evaluate treatment adherence and anxiety levels in patients with bronchiectasis. A cross-sectional survey was conducted between May and November 2021. A total of 123 patients with bronchiectasis and 110 adults without chronic diseases were included in the control group. Patient demographic information, bronchiectasis follow-up data, and COVID-19 history were recorded. Then, patients filled out “MARS-5 Index” (Medical Adherence Report Scale-5), Beck Anxiety Scale and the Effect of Events Scale (IES-R). Responses of questionnaires were statistically analyzed. Our results showed that the majority of patients with bronchiectasis had high Medical Adherence Report Scale-5 index total scores during the COVID-19 pandemic (86.2%). The total scores on the Beck Anxiety Scale of bronchiectasis patients who did not have COVID-19 were significantly higher than those who had COVID-19 (P = .04). The total scores on the IES-R were found to be significantly higher in the control group (P < .001). No significant difference was found in the total scores on the Beck Anxiety Scale between the patients and the control group. The bronchiectasis patients had high adherence to their current treatment during the COVID-19 period and were less affected by the pandemic and its psychological effects compared to the healthy population. Furthermore, individuals diagnosed with bronchiectasis who were not infected with COVID-19 demonstrated increased levels of anxiety compared to those who were infected with COVID-19 which may be due to their concern about contracting the disease.
Intraoperative phenylephrine infusion to reduce perioperative shivering in lower segment caesarean section: A randomised controlled study
Authors: Tan Sook Kuan Jessica , Musthafa Qurratu Aini , Abdullah Farah Hanim , Sayed Masri Syarifah Noor Nazihah
Published: May 2023

Background:

Shivering is described as an involuntary, repetitive activity of the skeletal muscles that can have deleterious effects on anaesthetized patients. This study aimed to evaluate the effectiveness of phenylephrine infusion in preventing perioperative shivering in patients undergoing lower segment cesarean section under spinal anesthesia and to observe the change in the patient’s core temperature between the study and control groups.

Methods:

A total of 118 patients scheduled for elective lower segment cesarean section under spinal anesthesia were recruited for this prospective, double-blind, randomized controlled study. The patients were randomized into 2 groups with 59 patients per group. The phenylephrine Group received phenylephrine infusion at a rate of 0.5 mcg/kg/minutes, while the Control Group received normal saline at an equivalent rate. Systolic and diastolic blood pressure, heart rate, core temperature, and the presence and intensity of shivering were recorded before induction and every 15 minutes intraoperatively and postoperatively.

Results:

The incidence of intraoperative shivering was significantly lower in the Phenylephrine Group compared to control group (29.1% vs 47.5% respectively; P = .044). Postoperatively, the Phenylephrine Group also had a lower incidence of shivering (34.5% vs 42.4%), but the difference was not statistically significant (P value = 0.391). There were no significant differences in the intensity of shivering between the 2 groups perioperatively, as well as in the systolic and diastolic blood pressure and core temperature. The phenylephrine Group showed a significantly lower heart rate at 15, 30, and 45 minutes after spinal block (P value = .005, .000, and .008, respectively), and at 0 and 30 minutes (P value = .004 and .020 respectively) in the recovery room. There were no significant differences in perioperative adverse events such as hypotension, hypertension, and bradycardia.

Conclusion:

Phenylephrine infusion reduces the incidence of perioperative shivering in lower segment cesarean sections under spinal anesthesia.
Progressive unilateral leg weakness after lumbar decompression due to ischemic monomelic neuropathy misdiagnosed as epidural hematoma: A CARE-compliant case report
Authors: Lee Gun Woo , Park Wook-Tae , Chang Min Cheol
Published: May 2023

Rationale:

Ischemic monomelic neuropathy (IMN) is a disease that occurs after acute arterial occlusion or steal phenomenon in an extremity that results in single or multiple axonal mononeuropathies in the distal limb without the classical features of limb ischemia, including a skin color change, limb swelling, and ischemic claudication. IMN can easily be misdiagnosed as any other neuropathic disorder. Here we present a case of IMN that was misdiagnosed as spinal epidural hematoma.

Patient concerns:

A 77-year-old man presented with sudden motor weakness and pain in his left foot and calf 5 days after a bilateral L4 to 5 posterior decompression for lumbar spinal stenosis. His symptoms progressed over the next 5 days. The strengths of the left ankle dorsiflexors, first toe extensors, and ankle plantar flexors were Medical Research Council 0. On brain and whole-spine magnetic resonance imaging, no specific abnormalities correlated with his symptoms were observed. Computed tomography angiography of the lower extremities revealed segmental occlusion of the left common femoral artery and multifocal severe stenoses in the bilateral anterior and posterior tibial arteries of the left leg. No skin color change or swelling was observed in the left lower extremity.

Diagnosis:

Based on his clinical features and imaging findings, he was diagnosed with IMN.

Intervention:

The patient underwent thrombectomy of the left femoral artery.

Outcomes:

After the treatment, his pain almost completely disappeared.

Lessons:

When patients exhibit acute-onset pain in the unilateral limb with or without motor weakness but no correlated abnormality on spinal magnetic resonance imaging or computed tomography, clinicians should consider the possibility of IMN.
Acute mesenteric ischemia diagnosed using the aquarium sign: A case report
Authors: Higashijima Ushio , Sekino Motohiro , Iwasaki Naoya , Araki Hiroshi , Motokawa Tetsufumi , Inoue Yusuke , Taniguchi Yasuhiro , Sato Shinya , Miyazaki Yasushi , Hara Tetsuya
Published: May 2023

Rationale:

The diagnosis of mesenteric ischemia in critically ill patients remains challenging; however, the aquarium sign, comprising a large number of bubble images in the right cardiac chambers on echocardiography, may be used as a point-of-care ultrasound finding to diagnose acute mesenteric ischemia (AMI).

Patient concerns:

A 65-year-old woman diagnosed with lymphoma was urgently admitted to the intensive care unit with suspected tumor lysis syndrome. High-dose vasopressor and inotropic agents were required to manage the patient’s shock with marked lactic acidosis and peripheral hypoperfusion with mottled skin, and multidisciplinary treatment was initiated. By day 6, the lactate levels normalized and there were no abnormal abdominal findings. An echocardiogram was performed to examine the mass lesion associated with lymphoma in the right atrium and evaluate the hemodynamics; it revealed an “aquarium sign.” Similar findings were found in the inferior vena cava and portal vein.

Diagnoses:

Contrast-enhanced computed tomography of the abdomen revealed hepatic portal vein gas, poor contrast of the colon wall, and intramural emphysema, and a diagnosis of AMI was made. Lower gastrointestinal endoscopy showed necrosis of the colon.

Interventions:

The patient underwent urgent subtotal colorectal resection.

Outcomes:

Although a tracheostomy was required, the patient’s general condition improved after surgery, and she was discharged to the ward without mechanical ventilatory support in the intensive care unit on Day 19.

Lessons:

In patients with risk factors for AMI, repeated evaluation for the presence of aquarium signs by echocardiography may be warranted, even if there are no abdominal findings or abnormalities in biomarkers, such as lactate levels and trends. When the aquarium sign is found, AMI should be aggressively suspected, and a definitive diagnosis should be made to initiate early therapeutic intervention.
A case of West syndrome and global developmental delay in a child with a heterozygous mutation in the TBL1XR1 gene: A case report
Authors: Wu Xiao-Hui , Lin Shuang-Zhu , Liu Zhen-Xian , Qi Yang-Fan , Wang Wan-Qi , Li Jia-Yi , Chen Qian-Dui , Yang Lu-Lu
Published: May 2023

Background:

TBL1XR1, also known as IRA1 or TBLR1, encodes a protein that is localized in the nucleus and is expressed in most tissues. TBL1XR1 binds to histones H2B and H4 in vitro and functions in nuclear receptor-mediated transcription. TBL1XR1 is also involved in the regulation of the Wnt–β-catenin signaling pathway. Mutations in the TBL1XR1 gene impair the Wnt–β-catenin signaling pathway’s ability to recruit Wnt-responsive element chromatin, affecting brain development. Mutations in this gene cause various clinical phenotypes, including Pierpont syndrome, autism spectrum disorder, speech and motor delays, mental retardation, facial dysmorphism, hypotonia, microcephaly, and hearing impairment.

Case Summary:

A 5-month-old female child was admitted with “episodic limb tremors for more than 1 month.” At the time of admission, the child had recurrent episodes of limb tremors with motor retardation and a partially atypical and hypsarrhythmic video electroencephalogram. It was determined that a heterozygous mutation in the TBL1XR1 gene caused West syndrome and global developmental delay. Recurrent episodes persisted for 6 months following oral treatment with topiramate; the addition of oral treatment with vigabatrin did not show any significant improvement, and the disease continued to recur. The child continued to have recurrent episodes of limb tremors at follow-up until 1 year and 3 months of age. Additionally, she developed poor eye contact and a poor response to name-calling.

Conclusion:

We report the case of a child with West syndrome and a global developmental delay caused by a heterozygous mutation in the TBL1XR1 gene. This study adds to our understanding of the clinical phenotype of TBL1XR1 mutations and provides a realistic and reliable basis for clinicians.
Bilateral decompressive craniotomy complicated by postoperative mycoplasma hominis epidural empyema and meningitis: A case report
Authors: Chen Lizhen , Lu Yue , Liu Jia , Zhang Xiuzhong , Wang Ke
Published: May 2023

Rationale:

Postoperative intracranial mycoplasma hominis infection was a rare complication. Timely diagnosis was difficult due to its growth characteristics and nonspecific clinical symptoms.

Patient concerns:

A 52-year-old man underwent bilateral decompressive craniotomy for severe traumatic brain injury. On the seventeenth day after surgery, the patient developed an unexplained high fever. Empirical anti-infective therapy was ineffective, and the fever persisted. In addition, viscous pus oozed from the head incision. Empiric therapy was still ineffective, the fever persisted, and the culture result was negative. The lumbar puncture pressure was 150 mmH2O and the cerebrospinal fluid white blood cell count was 3600 × 106/L, suggesting an intracranial infection.

Diagnoses:

Culture growth morphologically consistent with mycoplasma species was obtained from multiple specimens (scalp incision fluid and cerebrospinal fluid) and the identification of mycoplasma hominis was confirmed by 16S rDNA sequencing.

Intervention:

Targeted anti-infective therapy (Minocycline), change of fresh wound dressing, and continued lumbar cerebrospinal fluid drainage.

Outcome:

At the 3-month follow-up, the patient was still in the rehabilitation department of the local hospital for treatment, but there were no symptoms of intracranial infection.

Lessons:

Neurosurgeons should carefully examine postoperative incisions and be aware of the possibility of mycoplasma infection during clinical management.