bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of Life in Palliative Post-mastectomy Reconstruction: Keystone versus Rotational Flap
Authors: Rini Irena Sakura , Gunardi Alberta Jesslyn , Yashinta  , Kevin Jonathan , Marsaulina Renate Parlene , Aryandono Teguh , Dachlan Ishandono , Dwiprahasto Iwan
Published: August 2023

Background:

Late stage breast cancer presents with malignant wound causing skin infiltration, pain, bleeding, and malodour, which affect quality of life (QoL). Palliative mastectomy aims to eliminate wound symptoms and requires prolonged wound care to improve QoL. This study aimed to prospectively investigate QoL differences in 2 alternative reconstructive methods: keystone flap and rotational flap.

Methods:

Twenty-four late stage breast cancer patients with symptoms of cancer wounds were included in this study. They were divided into 2 groups: keystone flap and rotational flap. Each patient’s QoL was evaluated using EORTC QLQ-C30 and QLQ-BR23 before and 3 weeks after surgery.

Results:

Global health post-surgery was significantly improved compared with pre-surgery in all patients (P < 0.001), across both the keystone (P = 0.018) and rotational groups (P = 0.007). Breast symptoms post-surgery were also improved compared with pre-surgery in all patients (P = 0.035). However, when analyzed per group, breast symptoms were only improved significantly in the keystone group (P = 0.013) but not in the rotational group (P = 0.575). When compared between 2 groups, future perspective post-surgery in the keystone group [100 (0–100)] was better than the rotational group [66.7 (0–100)], (P = 0.020).

Conclusions:

Reconstructive surgery after mastectomy improves QoL in late stage breast cancer patients. The keystone flap is superior to the rotational flap in improving global health and breast symptoms.
Shewanella algae, an Emerging Pathogen, Causing Skin and Soft Tissue Infections
Authors: Kalathuru Sowmya , Singla Aakriti , Kumar Ashok , Swami Aditi
Published: August 2023

Shewanella species, gram-negative saprophytic bacteria, are frequently found in warmer marine environments and soil. Among the Shewanella genus, Shewanella algae and Shewanella putrefaciens cause human infections, with S. algae being more common. Shewanella species are opportunistic bacteria and are being identified as potential pathogens causing wide range of illnesses in both immunocompromised and immunocompetent patients. Diagnosis can be difficult because of limited awareness and microbiologic data. However, high index of clinical suspicion and history of recent exposure to marine environments can help in facilitating early diagnosis. Delay may lead to sepsis and multiorgan failure. Infections can be identified in cases without exposure to aquatic environments, as seen in our case. A 39-year-old man with no marine exposure presented with progressively worsening lower extremity cellulitis with positive wound cultures for S. algae. We aim to increase awareness of this rare emerging pathogen so that treatment can be tailored rapidly and appropriately.
Incidence, risk factors, and outcomes of venous thromboembolism in patients undergoing surgery for retroperitoneal tumors: a propensity-matched retrospective cohort study
Authors: Guo Qiang , Zhao Jichun , Du Xiaojiong , Hu Hankui , Huang Bin
Published: August 2023

Background:

Venous thromboembolism (VTE) is a common postoperative complication; however, the incidence and risk stratification of postoperative VTE in patients with retroperitoneal tumor remains unclear. The authors aim to quantify the incidence, identify risk factors, and determine the outcomes of VTE in patients undergoing retroperitoneal tumor surgery.

Methods:

The authors retrospectively reviewed the characteristics, perioperative outcomes, and overall survival (OS) of patients (VTE and non-VTE) who underwent retroperitoneal tumor surgery between 2015 and 2020. Perioperative and oncologic outcomes were compared using propensity-matching and Cox analyses.

Results:

Of 1223 patients with retroperitoneal tumor surgery, 2.1% had VTE. Age [odds ratio (OR) 1.140, 95% CI: 1.053–1.239, P=0.004], recurrence (OR 1.851, 95% CI: 1.241–2.761, P=0.003), and vascular resection (OR 2.036, 95% CI: 1.054–3.934, P=0.034) were independent risk factors, with significant between-group differences regarding age, recurrence, sarcoma, organ resection, vascular resection, and operation time. No between-group differences in 30-day all-cause mortality (8 vs. 4%, OR 0.657, 95% CI: 0.375–1.151, P=0.427) and major complications (12 vs. 8%, OR 0.775, 95% CI: 0.483–1.244, P=0.572) were observed. Mean hospitalization duration (20.1 vs. 22.9 days, OR 1.153, 95% CI: 1.022–1.386, P=0.033) and ICU stay (3.2 vs. 5.5 days, OR 1.193, 95% CI: 1.034–1.347, P=0.012) were shorter in non-VTE versus VTE, respectively, with inferior OS (hazard ratio 2.090, 95% CI: 1.014–4.308, P=0.046) in VTE.

Conclusions:

Age, recurrence, and vascular resection are positively associated with VTE, which is associated with inferior OS.
Development and validation of a mutation-annotated prognostic score (MAPS) for intrahepatic cholangiocarcinoma after resection: a retrospective cohort study
Authors: Wang Xiang-Yu , Zhu Wen-Wei , Lu Lu , Li Yi-Tong , Zhu Ying , Yang Lu-Yu , Sun Hao-Ting , Wang Chao-Qun , Lin Jing , Huang Chong , Yang Xin , Fan Jie , Jia Hu-Liang , Zhang Ju-Bo , Yin Bao-Bing , Chen Jin-Hong , Qin Lun-Xiu
Published: August 2023

Background:

The value of existing prognostic models for intrahepatic cholangiocarcinoma (ICC) is limited. The inclusion of prognostic gene mutations would enhance the predictive efficacy.

Methods:

In the screening cohorts, univariable Cox regression analysis was applied to investigate the effect of individual mutant genes on overall survival (OS). In the training set, multivariable analysis was performed to evaluate the independent prognostic roles of the clinicopathological and mutational parameters, and a prognostic model was constructed. Internal and external validations were conducted to evaluate the performance of this model.

Results:

Among the recurrent mutations, only TP53 and KRAS

G12
were significantly associated with OS across all three screening cohorts. In the training cohort, TP53 and KRAS

G12
mutations in combination with seven other clinical parameters (tumor size, tumor number, vascular invasion, lymph node metastasis, adjacent invasion, CA19-9, and CEA), were independent prognostic factors for OS. A mutation-annotated prognostic score (MAPS) was established based on the nine prognosticators. The C-indices of MAPS (0.782 and 0.731 in the internal and external validation cohorts, respectively) were statistically higher than those of other existing models (P<0.05). Furthermore, the MAPS model also demonstrated significant value in predicting the possible benefits of upfront surgery and adjuvant therapy.

Conclusions:

The MAPS model demonstrated good performance in predicting OS of ICC patients. It may also help predict the possible benefits of upfront surgery and adjuvant therapy.
A novel staging system derived from natural language processing of pathology reports to predict prognostic outcomes of pancreatic cancer: a retrospective cohort study
Authors: Li Bo , Wang Beilei , Zhuang Pengjie , Cao Hongwei , Wu Shengyong , Tan Zhendong , Gao Suizhi , Li Penghao , Jin Wei , Shao Zhuo , Zheng Kailian , Wu Lele , Gao Bai , Wang Yang , Jiang Hui , Guo Shiwei , He Liang , Yang Yan , Jin Gang
Published: August 2023

Objective:

To construct a novel Tumor-Node-Morphology (TNMor) staging system derived from natural language processing (NLP) of pathology reports to predict outcomes of pancreatic ductal adenocarcinoma (PDAC).

Method:

This retrospective study with 1,657 participants was based on a large referral center and The Cancer Genome Atlas Program (TCGA) dataset. In the training cohort, NLP was used to extract and screen prognostic predictors from pathology reports to develop the TNMor system, which was further evaluated with the tumor-node-metastasis (TNM) system in the internal and external validation cohort, respectively. Main outcomes were evaluated by the log-rank test of Kaplan-Meier curves, concordance index (C-index) and area under receiver operating curve (AUC).

Results:

The precision, recall, and F1 scores of the NLP model were 88.83%, 89.89%, and 89.21%, respectively. In Kaplan-Meier analysis, survival differences between stages in the TNMor system were more significant than that in the TNM system. In addition, our system provided an improved C-index (Internal validation, 0.58 vs. 0.54, P< 0.001; External validation, 0.64 vs. 0.63, P< 0.001), and higher AUCs for 1, 2, and 3-year survival (Internal validation: 0.62 vs. 0.54, P< 0.001; 0.64 vs. 0.60, P=0.017; 0.69 vs. 0.62, P=0.001; External validation: 0.69 vs. 0.65, P=0.098; 0.68 vs. 0.64, P=0.154; 0.64 vs. 0.55, P=0.032, respectively). Finally, our system was particularly beneficial for precise stratification of patients receiving adjuvant therapy, with an improved C-index (0.61 vs. 0.57, P< 0.001), and higher AUCs for 1, 2, and 3-year survival (0.64 vs. 0.57, P< 0.001; 0.64 vs. 0.58, P< 0.001; 0.67 vs. 0.61, P< 0.001; respectively) compared with the TNM system.

Conclusion:

These findings suggest that the TNMor system performed better than the TNM system in predicting PDAC prognosis. It is a promising system to screen risk-adjusted strategies for precision medicine.
The predictive role of hematologic markers in resectable nsclc patients treated with neoadjuvant chemoimmunotherapy: a retrospective cohort study
Authors: Liu Wenliang , Ren Siying , Yang Lulu , Xiao Ying , Zeng Chao , Chen Chen , Wu Fang , Hu Yan
Published: August 2023

Background:

Neoadjuvant chemoimmunotherapy is an important therapeutic modality for resectable non-small cell lung cancer (NSCLC). The roles of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in predicting the efficacy and prognosis of patients with resectable NSCLC receiving neoadjuvant chemoimmunotherapy remain uncertain. This study aimed to explore the association of baseline and preoperative NLR, PLR, and LMR with the treatment response and survival of patients with resectable NSCLC treated with neoadjuvant chemoimmunotherapy.

Materials and Methods:

Data of patients with resectable NSCLC treated with neoadjuvant chemoimmunotherapy between May 2019 and July 2022 at our institute, were retrospectively analyzed. Peripheral blood cell counts were obtained at baseline and before surgery. Data that may affect treatment efficacy were also collected and analyzed, including age, sex, body mass index, cumulative smoking exposure, pathological type, clinical stage, PD-L1 tumor proportion score, immune checkpoint inhibitors, dosage of neoadjuvant therapy, duration from final therapy to surgery, and baseline and preoperative oncological markers. The present work has been reported in compliance with REMARK criteria and guidelines, Supplemental Digital Content 1, http://links.lww.com/JS9/A860.

Results:

A total of 116 patients were included in the study. Univariate logistic regression analysis showed that a higher baseline NLR (P=0.001) and preoperative NLR (P=0.001) were associated with a lower incidence of pathological complete response (pCR) following neoadjuvant therapy. Multivariate analysis indicated that a lower incidence of pCR was achieved in the high baseline NLR group (P=0.014). Higher baseline NLR (P=0.021), preoperative NLR (P=0.004) and higher preoperative CEA levels (P=0.059) were associated with shorter disease-free survival (DFS). Multivariate Cox proportional hazard regression analyses showed that shorter DFS was achieved in the high preoperative NLR group (P=0.033).

Conclusion:

In patients with resectable NSCLC treated with neoadjuvant chemoimmunotherapy, a higher baseline NLR was associated with a lower incidence of pCR, and a higher preoperative NLR was associated with shorter DFS. However, future prospective study with large sample size and long-term follow-up is needed to verify the predictive value of NLR in these patients.
Hepatic arterial infusion chemotherapy versus transarterial chemoembolization, potential conversion therapies for single huge hepatocellular carcinoma: a retrospective comparison study
Authors: Deng Min , Cai Hao , He Benyi , Guan Renguo , Lee Carol , Guo Rongping
Published: August 2023

Background:

The treatment efficacy of transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) for huge single hepatocellular carcinoma (HCC) has not been fully documented. The aim of this study was to compare TACE and HAIC for patients with solitary nodular HCCs ≥10 cm without vascular invasion and metastasis.

Methods:

From July 2015 to June 2020, a total of 147 patients with single nodular HCC ≥10 cm without vascular invasion and metastasis receiving TACE (n=77) or HAIC (n=70) were retrospectively enrolled. The tumor response, overall survival (OS), and progression-free survival (PFS) were investigated and compared. The treatment outcome of 2 transarterial interventional therapies was explored.

Results:

The objective response rate and PFS were higher in patients who received HAIC than in those who received TACE (44.3% vs. 10.4% and 8.9 vs. 4.2 mo, respectively; P=0.001 and P=0.030), whereas the disease control rate and OS were not significantly different (92.9% vs. 84.4% and 21.3 vs. 26.6 mo, respectively; P=0.798 and P=0.749). The decreased levels of alpha‐fetoprotein and protein induced by vitamin K absence or antagonist-II (PIVKA-II) in patients treated with HAIC were significantly higher than those treated with TACE (P=0.038 and P<0.001). Multivariable analysis showed that the aspartate aminotransferase/platelet ratio index was associated with OS, whereas albumin-bilirubin grade and PIVKA-II were associated with PFS.

Conclusions:

HAIC has better potential than TACE to control local tumors for huge single HCC without vascular invasion and metastasis and thus may be the preferred conversion therapy for these tumors.
Biodistribution of recombinant factor IX, extended half-life recombinant factor IX Fc fusion protein, and glycoPEGylated recombinant factor IX in hemophilia B mice
Authors: van der Flier Arjan , Hong Vu , Liu Zhan , Piepenhagen Peter , Ulinski Gregory , Dumont Jennifer A. , Orcutt Kelly D. , Goel Apollina , Peters Robert , Salas Joe
Published: August 2023

Extended half-life recombinant FIX (rFIX) molecules have been generated to reduce the dosing burden and increase the protection of patients with hemophilia B. Clinical pharmacology studies with recombinant factor IX Fc fusion protein (rFIXFc) report a similar initial peak plasma recovery to that of rFIX, but with a larger volume of distribution. Although the pegylation of N9-GP results in a larger plasma recovery, there is a smaller volume of distribution, suggesting less extravasation of the latter drug.

In this study, we set out to compare the biodistribution and tissue localization of rFIX, rFIXFc, and glycoPEGylated rFIX in a hemophilia B mouse model.

Radiolabeled rFIX, rFIXFc, and rFIX-GP were employed in in vivo single-photon emission computed tomography imaging (SPECT/CT), microautoradiography (MARG), and histology to assess the distribution of FIX reagents over time.

Immediately following injection, vascularized tissues demonstrated intense signal irrespective of FIX reagent. rFIX and rFIXFc were retained in joint and muscle areas through 5 half-lives, unlike rFIX-GP (assessed by SPECT). MARG and immunohistochemistry showed FIX agents localized at blood vessels among tissues, including liver, spleen, and kidney. Microautoradiographs, as well as fluorescent-labeled images of knee joint areas, demonstrated retention over time of FIX signal at the trabecular area of bone.

Data indicate that rFIXFc is similar to rFIX in that it distributes outside the plasma compartment and is retained in certain tissues over time, while also retained at higher plasma levels. Overall, data suggest that Fc fusion does not impede the extravascular distribution of FIX.
Effects of frozen storage conditions and freezing rate on the stability of coagulation proteins in human plasma
Authors: Fenclova Tereza , Marecek Frantisek , Hrachovinova Ingrid
Published: August 2023

Objectives

Degradation of coagulation proteins in frozen plasma may influence assay results. The aims of this study were to explore the changes in coagulation parameters in patient plasma and internal quality control (IQC) after different freezing and storage conditions during the short-term and long-term periods.

Methods

Platelet poor plasma was prepared from citrated peripheral blood collected from a group of healthy donors. The plasma was pooled, frozen and stored in a variety of freezing and storage conditions. The changes were monitored using routine coagulation assays, as well as factor VIII (FVIII) and protein S (PS) assays.

Results

Plasma stored in liquid nitrogen (LN2) or in −80°C showed long-term stable values for routine tests for a period of over 12 months, and 6 months for FVIII. Interestingly, the activated partial thromboplastin time (aPTT) showed a temporary significant prolongation over the first two weeks. Plasma frozen and stored in −40°C is not viable for aPTT and FVIII testing, otherwise it can be used for other parameters for up to 4 months. PS showed a significant increase in all frozen samples. Freezing rate has a significant impact on plasma quality and the final storage temperature influences the long-term stability.

Conclusion

The optimal storage conditions are ultra-low temperatures (LN2 or −80°C) and the highest freezing rate possible. However, frozen plasma is not viable for IQC of aPTT during a period of two weeks after freezing. This study is unique in its conception as a practical guide for the handling of frozen plasma samples in modern laboratory settings.
Left ventricular assist device thrombosis in the setting of supratherapeutic international normalized ratio (INR) and bleeding
Authors: Gupta Gaurav , Yan Crystal L. , Kalwar Tricia , Thakkar-Rivera Nina
Published: August 2023

A 71-year-old female with heart failure who underwent left ventricular assist device (LVAD) placement presented for evaluation of low hemoglobin and dark stools. She also had leg pain, numbness, and weakness for which she was taking ibuprofen. She was found to have a gastrointestinal bleed, INR of 4.3, and arterial thrombi in the left leg. She was stabilized, had her anticoagulation held, and underwent mechanical thrombectomy. On hospital day 6, LVAD interrogation revealed signs of thrombosis, while subsequent labs revealed a persistently supratherapeutic INR of 5.2.

The patient had the LVAD removed and underwent further hematologic workup. Her platelets remained normal throughout the admission, indicating this was not acute disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura (TTP), or heparin induced thrombocytopenia (HIT). Echocardiography identified it as a primary thrombus.

This case illustrates the importance of appropriate anticoagulation to balance the bleeding risk with the risk of thrombi, as well as the importance of maintaining high suspicion for LVAD thrombosis regardless of INR.
Nutrition and thyroid disease
Authors: Duntas Leonidas H.
Published: August 2023

Purpose of review

The aim of this review was to determine, based on the most recent findings, the involvement of trace elements and vitamins critical for thyroid function and combating thyroid disease.

Recent findings

Nutritional guidance is pivotal to reducing the risk of thyroid disease and to managing it when it arises, this meaning the prescription of diets rich in such micronutrients as iodine, selenium, iron, zinc, and vitamins B12, D3, and A. Most of the above micronutrients are good antioxidants, building up an anti-inflammatory profile, reducing thyroid autoantibodies and body fat, and improving thyroid function. Diets are increasingly being prescribed, especially for those suffering from Hashimoto's thyroiditis. Notable among prescribed diets is the Mediterranean diet. Rich in critical elements, it benefits patients at the immune endocrine and biomolecular levels.

Importantly, it is likely that widespread adherence to the Mediterranean diet, together with a reduction of meat consumption and potential elimination of gluten and lactose may improve inflammation and have an impact on public health while possibly diminishing thyroiditis symptoms. It is hoped that this review can direct policymakers towards undertaking cost-effective interventions to minimize deficiency of essential minerals and vitamins and thus protect both general and thyroid health.
Sex differences in clinical characteristics and outcomes associated with alcoholic hepatitis
Authors: Pemmasani Gayatri , Tremaine William J , Suresh Kumar Vishnu Charan , Aswath Ganesh , Sapkota Bishnu , Karagozian Raffi , John Savio
Published: August 2023

Background

Alcohol-associated liver disease is increasing among females with an earlier onset and more severe disease at lower levels of exposure. However, there is paucity of literature regarding sex differences related to alcoholic hepatitis.

Methods

Hospitalized patients with alcoholic hepatitis were selected from the US Nationwide readmissions database 2019. In this cohort, we evaluated sex differences in baseline comorbidities, alcoholic hepatitis related complications and mortality. A subset of patients with alcoholic hepatitis who were hospitalized between January and June 2019 were identified to study sex differences in 6 month readmission rate, mortality during readmission, and composite of mortality during index hospitalization or readmission.

Results

Among 112 790 patients with alcoholic hepatitis, 33.3% were female. Female patients were younger [48 (38–57) vs. 49 (39–58) years; both P < 0.001] but had higher rates of important medical and mental-health related comorbidities. Compared with males, females had higher rates of hepatic encephalopathy (11.5% vs. 10.1; P < 0.001), ascites (27.9% vs. 22.5%; P < 0.001), portal hypertension (18.5% vs. 16.4%; P < 0.001), cirrhosis (37.3% vs. 31.9%; P < 0.001), weight loss (19.0% vs. 14.5%; P < 0.001), hepatorenal syndrome (4.4% vs. 3.8%; P < 0.001), spontaneous bacterial peritonitis (1.9% vs. 1.7%; P = 0.026), sepsis (11.1% vs. 9.5%; P < 0.001), and blood transfusion (12.9% vs. 8.7%; P < 0.001). Females had a similar in-hospital mortality rate (4.3%) compared to males (4.1%; P = 0.202; adjusted odds ratio (OR) 1.02, 95% CI (cardiac index) 0.89–1.15; P = 0.994). In the subset of patients (N = 58 688), females had a higher 6-month readmission rate (48.9% vs. 44.9%; adjusted OR 1.12 (1.06–1.18); P < 0.001), mortality during readmission (4.4% vs. 3.2%; OR 1.23 (1.08–1.40); P < 0.01), and composite of mortality during index hospitalization or readmission (8.7% vs. 7.2%; OR 1.15 (1.04–1.27); P < 0.01).

Conclusion

Compared to their male counterparts, females with alcoholic hepatitis were generally younger but had higher rates of comorbidities, alcoholic hepatitis related complications, rehospitalizations and associated mortality. The greater risks of alcohol-associated liver dysfunction in females indicate the need for more aggressive management.
Application of preoperative fluorodeoxyglucose-PET/CT parameters for predicting prognosis of high-grade neuroendocrine cervical cancer
Authors: Song Changho , Lee Jong Jin , Lee Shin-Hwa , Park Jeong-Yeol , Kim Dae-Yeon , Suh Dae-Shik , Kim Jong-Hyeok , Kim Yong-Man , Kim Ju-Hyun
Published: August 2023

Objective

High-grade neuroendocrine cervical cancer (HGNECC) is a rare and aggressive cervical cancer subtype. In this study, we aimed to evaluate the prognostic value of fluorodeoxyglucose-PET/computed tomography (CT) parameters for HGNECC.

Materials and methods

This single-center retrospective study included 29 patients with HGNECC who underwent fluorodeoxyglucose-PET/CT scan followed by surgery between 2006 and 2016.

Results

The median follow-up period was 40 (range, 4–184) months. After surgery, the resection margins were tumor-negative in 28 patients (96.6%), 8 (27.6%) patients had parametrial tumor invasion, and 7 patients (24.1%) tested positive for lymph node metastasis. The tumor recurred in 20 patients (69%) and 18 patients (62.1%) died during the observation period. In the univariate analyses, age and total lesion glycolysis (TLG) were associated with worse disease-free survival (DFS) (age, hazard ratio 1.056, 95% CI 1.014–1.100, P = 0.009; TLG2.5, hazard ratio 1.003, 95% CI 1–1.006, P = 0.033; and TLG3.0, hazard ratio 1.003, 95% CI 1–1.006, P = 0.034). In the multivariate analyses, older age and higher TLG3.0 were identified as independent poor prognostic factors for DFS (age, hazard ratio 1.058, 95% CI 1.014–1.104, P = 0.009; TLG3.0, hazard ratio 1.004, 95% CI 1–1.007, P = 0.033), while resection margin involvement was identified as an independent factor to predict poor overall survival (hazard ratio 20.717, 95% CI 1.289–332.964, P = 0.032).

Conclusion

Among the preoperative fluorodeoxyglucose-PET/CT parameters, TLG3.0 may be useful for predicting DFS in patients with HGNECC.
Quantitative uptake in 99mTc-EDDA/HYNIC-TOC somatostatin receptor imaging – the effect of long-acting release somatostatin analogue therapy
Authors: Gemmell Alastair J. , Brown Colin M. , Ray Surajit , Small Alexander
Published: August 2023

Purpose

Withdrawal of long-acting release somatostatin analogue (LAR-SSA) treatment before somatostatin receptor imaging is based on empirical reasoning that it may block uptake at receptor sites. This study aims to quantify differences in uptake of 99mTc-EDDA/HYNIC-TOC between patients receiving LAR-SSA and those who were not.

Methods

Quantification of 177 patients (55 on LAR-SSA) imaged with 99mTc-EDDA/HYNIC-TOC was performed, with analysis of pathological tissue and organs with physiological uptake using thresholded volumes of interest. Standardised uptake values (SUVs) and tumour/background (T/B) ratios were calculated and compared between the two patient groups.

Results

SUVs were significantly lower for physiological organ uptake for patients on LAR-SSA (e.g. spleen: SUVmax 13.3 ± 5.9 versus 33.9 ± 9.0, P < 0.001); there was no significant difference for sites of pathological uptake (e.g. nodal metastases: SUVmax 19.2 ± 13.0 versus 17.4 ± 11.5, P = 0.552) apart from bone metastases (SUVmax 14.1 ± 13.5 versus 7.7 ± 8.0, P = 0.017) where it was significantly higher.

Conclusion

LAR-SSA has an effect only on physiological organ uptake of 99mTc-EDDA/HYNIC-TOC, reducing uptake. It has no significant effect on pathological uptake for most sites of primary and metastatic disease. This should be taken into account if making quantitative measurements, calculating T/B ratios or assigning Krenning Scores. There is the potential for improved dosimetric results in Peptide Receptor Radionuclide Therapy by maintaining patients on LAR-SSA.
Incidence and associated factors of post-dural puncture headache among orthopaedic patients after spinal anesthesia: a prospective cohort study
Authors: Oumer Keder Essa , Aychew Habtamu , Daniel Tenbite , Mekete Getachew , Belete Kumlachew Geta , Negash Tadese Tamire
Published: August 2023

Background:

Post-dural puncture headache (PDPH) is one of a complication of spinal anaesthesia, influenced mostly by various factors including the patient’s age, spinal needle size and design and sex. This headache can be severe and debilitating, preventing ambulation and limiting daily living activities.

Objective:

This study assessed the incidence and associated factors of PDPH among patients who received spinal anaesthesia for orthopaedic procedures at the Debre Tabor Comprehensive Specialized Hospital from June to August 2022

Methods:

Prospective cohort study design was employed using Consecutive sampling method among patients who received spinal anaesthesia for orthopaedics procedure at Debre Tabor Comprehensive Specialized Hospital from June to August 2022. Data were collected by face to face interview and direct observation based on questionnaire. The data were entered to epidata 4.6 and analyzed by SPSS version 20 software. A total 95 patients aged 16–75 was participated in study. Those independent variable that were significant on binary logistic regression at P less than 0.2, were analyzed on multivariate regression, and considered significant association with PDPH at P value less than 0.05.

Result:

Ninety-five study participants were included in our study of which 19 (20%) had developed PDPH. Among patients who develop PDPH; 9.5% of the patients reported moderate pain while 10.5% experience mild PDPH and 80% of patient has no pain. The BMI and age were found to have significant association with PDPH [(P value 0.018, adjusted odds ratio 8.738, 95% CI, 1.461–52.269) and (P value 0.011, adjusted odds ratio 12.146, 95% CI, 1.753–84.170)], respectively) to PDPH.

Conclusion and recommendation:

The incidence of PDPH was found to be higher in Debre Tabor Comprehensive Specialized Hospital. The hospital management and the anaesthetists should minimize the magnitude of by strictly following different preventive strategies.
Vascular multiple sclerosis: addressing the pathogenesis, genetics, pro-angiogenic factors, and vascular abnormalities, along with the role of vascular intervention
Authors: Prajjwal Priyadarshi , Shree Anagha , Das Soumyajit , Inban Pugazhendi , Ghosh Shankhaneel , Senthil Arihant , Gurav Jaiprakash , Kundu Mrinmoy , Marsool Marsool Mohammed Dheyaa , Gadam Srikanth , Marsool Marsoo Ali Dheyaa , Vora Neel , Amir Hussin Omniat
Published: August 2023

Dysfunction in the epithelium, breakdown of the blood–brain barrier, and consequent leukocyte and T-cell infiltration into the central nervous system define Vascular Multiple Sclerosis. Multiple sclerosis (MS) affects around 2.5 million individuals worldwide, is the leading cause of neurological impairment in young adults, and can have a variety of progressions and consequences. Despite significant discoveries in immunology and molecular biology, the root cause of MS is still not fully understood, as do the immunological triggers and causative pathways. Recent research into vascular anomalies associated with MS suggests that a vascular component may be pivotal to the etiology of MS, and there can be actually a completely new entity in the already available classification of MS, which can be called ‘vascular multiple sclerosis’. Unlike the usual other causes of MS, vascular MS is not dependent on autoimmune pathophysiologic mechanisms, instead, it is caused due to the blood vessels pathology. This review aims to thoroughly analyze existing information and updates about the scattered available findings of genetics, pro-angiogenetic factors, and vascular abnormalities in this important spectrum, the vascular facets of MS.
Navigating unique challenges and advancing equitable care for children with ADHD in Africa: a review
Authors: Olatunji Gbolahan , Faturoti Olamide , Jaiyeoba Babafemi , Toluwabori Ayodele V. , Adefusi Temiloluwa , Olaniyi Peter , Aderinto Nicholas , Abdulbasit Muili O.
Published: August 2023

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that presents distinct challenges for African children due to a complex interplay of social, economic and cultural factors. This review examines the various obstacles faced by children with ADHD in Africa, focusing on the lack of awareness and stigma surrounding the disorder, limited access to mental health services, educational system constraints, economic limitations and cultural beliefs and practices. The review underscores the significance of public awareness campaigns and educational initiatives to dispel myths and misconceptions surrounding ADHD. These efforts should target the general public, educators, healthcare professionals, religious leaders and traditional healers. Crucial to addressing this issue is strengthening mental health services, especially in rural and underserved areas, through increased funding and the availability of trained mental health professionals specialised in ADHD diagnosis and treatment. Integrating mental health services into primary healthcare systems is proposed to enhance accessibility for children with ADHD. By training primary care providers to recognise ADHD symptoms and provide initial support and referrals, early identification and intervention can be facilitated. Addressing the affordability and accessibility of ADHD treatment is a priority, with policy recommendations including subsidising medications and therapies and providing financial assistance to families in need. A call for collaborative efforts between governments, nongovernmental organisations and pharmaceutical companies is advocated to ensure that ADHD treatment is affordable and widely available.
Challenges in Accessing Mental Health Care during Pregnancy and Postpartum in Rural Montana
Authors: Hanson Marcy N. , Reese Sarah , Newcomer Sophia R.
Published: August 2023

Purpose:

Postpartum depression is a well-known maternal health care concern. For women using substances or experiencing underlying mental health conditions, incidence of postpartum depression is higher than that of the general population. The purpose of this study was to identify barriers and facilitators associated with seeking mental health care among women with substance use disorder or mental health concerns.

Study Design and Methods:

Qualitative methods using interviews were conducted via the narrative inquiry approach. Women receiving care at a clinic in rural Montana and reporting substance use or mental health concerns were referred to the research team by the care manager. Participants were at least 18 years of age, English speaking, and pregnant or within 12 months postpartum at time of referral.

Results:

Twenty-five women met inclusion criteria and were referred for potential study participation. Seven women were interviewed. Four themes on family history, stigmatization, lack of postpartum depression awareness, and isolation were identified.

Clinical Implications:

Our findings provide a better understanding of barriers and facilitators to seeking mental health care during pregnancy and postpartum among women living in rural areas with mental health concerns or perinatal substance use. An environment where opportunities for women to receive mental health care in a location that is free of stigma and judgment, while understanding the effects of familial trauma and limited or inconsistent social support, is essential to promote optimal outcomes.
Sociodemographic Characteristics and Clinical Profile of Suicide Attempters Attending the Emergency Department at a Tertiary Care Hospital in Oman: A Retrospective Study
Authors: Al Khatri Mahmood , Al Huseini Salim , Almaqbali Mandhar , Cucchi Angie , Al Saadi Al-khatib , Al Farsi Abdulmunim , Jose Sachin , Al-Sibani Nasser , Al-Adawi Samir
Published: August 2023

Objective:

This study examined the sociodemographic and clinical characteristics of individuals who attended the emergency department of a tertiary care center in Muscat, Oman following a suicide attempt.

Methods:

A retrospective study (N=154) was conducted between January 2015 and June 2018. Information that was collected included sociodemographic variables (age, nationality, sex, marital status, and occupation), risk (medical comorbidities, psychiatric history, substance misuse, alcohol misuse, and previous history of suicide attempts), and precipitating factors, as well as the chosen methods for the suicide attempts.

Results:

In all, 83.1% of the sample were Omanis, and women constituted 69.5%. The mean age of the sample was 27 years; 30% were students, 42% were unemployed, and 40.9% had a history of psychiatric disorders. Family conflict, suffering from chronic illness, and having social problems were the most common precipitating factors for the suicide attempt. The most common method used in the suicide attempt was drug overdose (48.1%), mainly involving paracetamol (acetaminophen) (40%). Significant gender differences emerged in precipitating factors, history of substance misuse, and methods of suicide.

Conclusions:

The data from this study are consistent with international trends that suggest that women and younger age groups are the most vulnerable to suicide attempts. Although in its infancy, the type of research presented here could lay the groundwork for preventive interventions and programs.
Pulmonary cystic echinococcosis
Authors: Weber Tim Frederik , Junghanss Thomas , Stojković Marija
Published: August 2023

Purpose of review

The aim of our review is to summarize specific clinical, diagnostic and treatment aspects of pulmonary cystic echinococcosis. The lung is the organ second most affected by cystic echinococcosis with approximately a quarter of cystic echinococcosis cysts. Most cysts are in the liver. Apart from the watch and wait approach for selected inactive cysts [cystic echinococcosis CE4, CE5], the well established WHO cystic echinococcosis cyst classification-based treatment of hepatic cystic echinococcosis cannot be applied to pulmonary cystic echinococcosis cysts. Some standard interventions can even be harmful when applied to pulmonary cystic echinococcosis cysts.

Recent findings

Cystic echinococcosis is one of the neglected tropical diseases (NTDs). Development of new diagnostics and treatment modalities is hampered by low investment into research and is accordingly slow.

Surgery is the mainstay of treatment for pulmonary cystic echinococcosis cysts. Parenchyma-sparing surgical techniques should be used whenever possible. Albendazole induces decay of the parasitic cyst membrane, opening of cystobronchial fistulas and cyst complications, which can be life threatening. It is strongly recommended to seek advice from expert centres, including differential diagnoses, treatment and a long-term management plan.
The Feasibility of Deep Learning–Based Reconstruction for Low-Tube-Voltage CT Angiography for Transcatheter Aortic Valve Implantation
Authors: Kojima Tsukasa , Yamasaki Yuzo , Matsuura Yuko , Mikayama Ryoji , Shirasaka Takashi , Kondo Masatoshi , Kamitani Takeshi , Kato Toyoyuki , Ishigami Kousei , Yabuuchi Hidetake
Published: August 2023

Objective

The purpose of this study is to evaluate the efficacy of deep learning reconstruction (DLR) on low-tube-voltage computed tomographic angiography (CTA) for transcatheter aortic valve implantation (TAVI).

Methods

We enrolled 30 patients who underwent TAVI-CT on a 320-row CT scanner. Electrocardiogram-gated coronary CTA (CCTA) was performed at 100 kV, followed by nongated aortoiliac CTA at 80 kV using a single bolus of contrast material. We used hybrid-iterative reconstruction (HIR), model-based IR (MBIR), and DLR to reconstruct these images. The contrast-to-noise ratios (CNRs) were calculated. Five-point scales were used for the overall image quality analysis. The diameter of the aortic annulus was measured in each reconstructed image, and we compared the interobserver and intraobserver agreements.

Results

In the CCTA, the CNR and image quality score for DLR were significantly higher than those for HIR and MBIR (P < 0.01). In the aortoiliac CTA, the CNR for DLR was significantly higher than that for HIR (P < 0.01) and significantly lower than that for MBIR (P ≤ 0.02). The image quality score for DLR was significantly higher than that for HIR (P < 0.01). No significant differences were observed between the image quality scores for DLR and MBIR. The measured aortic annulus diameter had high interobserver and intraobserver agreement regardless of the reconstruction method (all intraclass correlation coefficients, >0.89).

Conclusions

In low tube voltage TAVI-CT, DLR provides higher image quality than HIR, and DLR provides higher image quality than MBIR in CCTA and is visually comparable to MBIR in aortoiliac CTA.
Appendiceal Neuroendocrine Neoplasms: A Comprehensive Review
Authors: Padmanabhan Nair Sobha Renjith , Jensen Corey T. , Waters Rebecca , Calimano-Ramirez Luis Fernando , Virarkar Mayur K.
Published: August 2023

Appendiceal neuroendocrine neoplasm (NEN) is the most common adult appendiceal malignant tumor, constituting 16% of gastrointestinal NENs. They are versatile tumors with varying morphology, immunohistochemistry, secretory properties, and cancer genomics. They are slow growing and clinically silent, to begin with, or present with features of nonspecific vague abdominal pain. Most acute presentations are attributed clinically to appendicitis, with most cases detected incidentally on pathology after an appendectomy. Approximately 40% of them present clinically with features of hormonal excess, which is likened to the functional secretory nature of their parent cell of origin. The symptoms of carcinoid syndrome render their presence clinically evident. However, slow growing and symptomatically silent in its initial stages, high-grade neuroendocrine tumors and neuroendocrine carcinomas of the appendix are aggressive and usually have hepatic and lymph node metastasis at presentation. This review article focuses on imaging characteristics, World Health Organization histopathological classification and grading, American Joint Committee on Cancer/Union or International Cancer Control, European Neuroendocrine Tumor Society staging, European Neuroendocrine Tumor Society standardized guidelines for reporting, data interpretation, early-stage management protocols, and advanced-stage appendiceal NENs. Guidelines are also set for the follow-up and reassessment. The role of targeted radiotherapy, chemotherapy, and high-dose somatostatin analogs in treating advanced disease are discussed, along with types of ablative therapies and liver transplantation for tumor recurrence. The search for newer location-specific biomarkers in NEN is also summarized. Regarding the varying aggressiveness of the tumor, there is a scope for research in the field, with plenty of data yet to be discovered.
Understanding Tricuspid Regurgitation Post Cardiac Transplantation; Why “Anatomical” and “Functional” Just Won’t Cut It
Authors: Bart Nicole K. , Macdonald Peter S.
Published: August 2023

Tricuspid regurgitation (TR) is common after cardiac transplantation and results in poorer outcomes. Transplant recipients are at high prohibitive risk for redo surgical procedures because of risks associated with a subsequent sternotomy, immunosuppression, and renal failure. Percutaneous therapies have recently become available and may be an option for transplant recipients. However, transplant recipients have complex geometry, and there is a myriad of causes of TR posttransplant. There is a need for careful patient selection for all percutaneous valve interventions, and this is particularly true in transplant recipients who suffer from right ventricular failure and rejection and may undergo repeated endomyocardial biopsies. Cognizant of the rapid developments in this space, this review article focuses on the causes of TR, treatments, and future therapies in heart transplantation recipients to the transplant cardiologist navigate this complex area.
The characterisation of antimicrobial resistant Escherichia coli from dairy calves
Authors: Mwenifumbo Merning , Cookson Adrian L. , Zhao Shengguo , Fayaz Ahmed , Browne A. Springer , Benschop Jackie , Burgess Sara A.
Published: August 2023

Introduction. Dairy calves, particularly pre-weaned calves have been identified as a common source of multidrug resistant (MDR)

Escherichia coli

.

Gap statement.

E. coli

strains isolated from dairy calves and the location of their resistance genes (plasmid or chromosomal) have not been well characterised.

Aim. To characterise the phenotypic and genotypic features as well as the population structure of antimicrobial-resistant

E. coli

isolated from calves located on dairy farms that feed waste-milk to their replacement calves.

Methodology. Recto-anal swab enrichments from 40 dairy calves (≤ 14 days old) located on four dairy farms were examined for tetracycline, streptomycin, ciprofloxacin, and third-generation cephalosporin resistant

E. coli

. Whole genome sequencing was performed using both short- and long-read technologies on selected antimicrobial resistant

E. coli

.

Results. Fifty-eight percent (23/40) of calves harboured antimicrobial resistant

E. coli

: 43 % (17/40) harboured tetracycline resistant, and 23 % (9/40) harboured chromosomal mediated AmpC producing

E. coli

. Whole genome sequencing of 27 isolates revealed five sequence types, with ST88 being the dominant ST (17/27, 63 % of the sequenced isolates) followed by ST1308 (3/27, 11 %), along with the extraintestinal pathogenic

E. coli

lineages ST69 (3/27, 11 %), ST10 (2/27, 7 %), and ST58 (2/27, 7 %). Additionally, 16 isolates were MDR, harbouring additional resistance genes that were not tested phenotypically. Oxford Nanopore long-read sequencing technologies enabled the location of multiple resistant gene cassettes in IncF plasmids to be determined.

Conclusion. Our study identified a high incidence of tetracycline and streptomycin-resistant

E. coli

in dairy calves, and highlighted the presence of multidrug-resistant strains, emphasising the need for further investigation into potential associations with farm management practices.
Childhood intelligence and risk of depression in later-life: A longitudinal data-linkage study
Authors: Ball Emily L , Altschul Drew M , Cox Simon R , Deary Ian J , McIntosh Andrew M , Iveson Matthew H
Published: August 2023

Background

Lower childhood intelligence test scores are reported in some studies to be associated with higher risk of depression in adulthood. The reasons for the association are unclear. This longitudinal data-linkage study explored the relationship between childhood intelligence (at age ∼11) and risk of depression in later-life (up to age ∼85), and whether environmental factors in childhood and adulthood accounted for some of this association.

Methods

Intelligence test scores collected in the Scottish Mental Survey 1947 were linked to electronic health records (hospital admissions and prescribing data) between 1980-2020 (n=53,037), to identify diagnoses of depression. Mixed-effect Cox regression models were used to explore the relationship between childhood intelligence test scores and risk of depression in later-life. Analyses were also adjusted for environmental factors experienced in childhood (number of siblings) and adulthood (Carstairs index, urban/rural).

Results

Twenty-seven percent of participants were diagnosed with depression during follow-up (n=14,063/53,037). Greater childhood intelligence test scores were associated with a reduced risk of depression in an unadjusted analysis (HR=0.95, 95% CI=0.93 to 0.97, P<0.001), and after adjustment for environmental factors experienced in childhood and adulthood (HR=0.95, 95% CI=0.91 to 1.00, P=0.032).

Conclusions

This study provides additional evidence of an association between higher childhood intelligence and reduced risk of later depression. Of the environmental factors included in this study, childhood and adulthood environmental factors did not seem to be substantial confounders.

Key messages

Identifying modifiable environmental risk factors, may help to identify interventions for the primary prevention of depression.

Greater childhood intelligence test scores (at age 11) were associated with a reduced risk of depression in later-life (up to age 85) following unadjusted analysis.

The association between childhood intelligence and risk of depression in later-life remained even after adjusting for childhood environmental factors (number of siblings) and adulthood environmental factors (Carstairs and urban/rural).

How depression is defined in epidemiological research (e.g., diagnostic codes in hospital admissions or being prescribed antidepressants) could influence the association between childhood intelligence and depression in later-life.