bluuebunny/crossref_metadata_2025 huggingface dataset:
A Review of 75th Ranger Regiment Battle-Injured Fatalities Incurred During Combat Operations From 2001 to 2021
Authors: Moore Charles H , Kotwal Russ S , Howard Jeffrey T , Silverman Montane B , Gurney Jennifer M , Rohrer Andrew J , Knight Ryan M
Published: August 2023

Introduction

The 75th Ranger Regiment is an elite U.S. military special operations unit that conducted over 20 years of sustained combat operations. The Regiment has a history of providing novel and cutting-edge prehospital trauma care, advancing and translating medical initiatives, and documenting and reporting casualty care performance improvement efforts.

Materials and Methods

A retrospective case fatality rate (CFR) review, mortality review, and descriptive analysis of fatalities were conducted for battle-injured personnel assigned or attached to the 75th Ranger Regiment from 2001 to 2021 during combat operations primarily in Afghanistan and Iraq. Fatalities were evaluated for population characteristics, cause of death, mechanism of death, injury severity, injury survivability, and death preventability.

Results

A total of 813 battle injury casualties, including 62 fatalities, were incurred over 20 years and 1 month of continuous combat operations. The Regiment maintained a zero rate of prehospital preventable combat death. Additionally, no fatalities had a mechanism of death because of isolated extremity hemorrhage, tension pneumothorax, or airway obstruction. When comparing the CFR of the Regiment to the U.S. military population as a whole, the Regiment had a significantly greater reduction in the cumulative CFR as measured by the difference in average annual percentage change.

Conclusions

Documentation and analysis of casualties and care, mortality and casualty reviews, and other performance improvement efforts can guide combatant commanders, medical directors, and fighting forces to reduce preventable combat deaths and the CFR. Early hemorrhage control, blood product resuscitation, and other lifesaving interventions should be established and maintained as a standard prehospital practice to mitigate fatalities with potentially survivable injuries.
Close-Range Fire Inflicting Behind Armor Blunt Trauma: Case-Series and Implications for Battlefield Care
Authors: Talmy Tomer , Itah Amir , Ahimor Alon , Drukarov Dor , Shovali Amiram , Malkin Michael , Shina Avi , Gendler Sami , Tsur Avishai M , Almog Ofer
Published: August 2023

Behind armor blunt trauma (BABT) is a non-penetrating injury caused by energy transfer and rapid deformation of protective body armor. Although modern military body armor is designed to prevent penetrating trunk injuries, high-energy projectiles can produce a significant energy transfer to tissues behind the armor and inflict injuries such as fractures or organ contusions. However, knowledge of BABT is limited to biomechanical and cadaver modeling studies and rare case reports. We report two cases of BABT resulting from close-range fire and discuss the potential implications for triaging patients with BABT in battlefield scenarios. In the first case, a 19-year-old male soldier sustained a single close-range 5.56-mm assault rifle gunshot to his chest body armor. The soldier initially reported mild pain in the parasternal region and assessment revealed a 4 cm × 3 cm skin abrasion. Following emergency department evaluation, the soldier was diagnosed with a non-displaced transverse fracture of the sternal body. In the second case, a 20-year-old male sustained five machine gun bullets (7.62 mm) to his body armor. Computed tomography of the chest revealed pulmonary contusions in the right lower and middle lobes. Both soldiers achieved full recovery and returned to combat duty within several weeks. These cases highlight the potential risks of energy transfer from high-velocity projectiles impacting body armor and the need for frontline providers to be aware of the risk of underlying blunt injuries. Further reporting of clinical cases and modeling studies using high-velocity projectiles could inform recommendations for triaging, evacuating, and assessing individuals with BABT.
Clinician Testing and Treatment Thresholds for Management of Urinary Tract Infection
Authors: Harris Andrea , Pineles Lisa , Baghdadi Jonathan D , Magder Larry , Dhaliwal Gurpreet , Korenstein Deborah , Harris Anthony D , Morgan Daniel J
Published: August 2023

Greater understanding of clinical decision thresholds may improve inappropriate testing and treatment of urinary tract infection (UTI). We used a survey of clinicians to examine UTI decision thresholds. Although overestimates of UTI occurred, testing and treatment thresholds were generally rational, were lower than previously reported, and differed by type of clinician.
Development and Effects of a Virtual Reality Simulation Nursing Education Program Combined With Clinical Practice Based on an Information Processing Model
Authors: Lee Eunju , Baek Gyuli
Published: August 2023

The need to strengthen patient human rights and create a patient-centered healthcare environment is growing. Also as science and technology develop, new educational methods using virtual reality in nursing education are emerging. This study aimed to develop a virtual reality simulation nursing education program related to postoperative patient nursing based on an information processing model and to verify its effectiveness. Clinical practice–linked virtual reality simulation nursing education was conducted for a total of 4 weeks. Nursing students were divided into an experimental group (n = 22) experiencing virtual reality simulation combined with clinical practice and a control group (n = 22) having routine clinical practice. The analytical results of this study indicated that the information processing model–based virtual reality simulation nursing education program was effective in improving nursing students' performance confidence and clinical decision-making ability. Therefore, the virtual reality simulation program developed in this study can provide basic data for the development of a simulation curriculum in the future and can contribute to the development of clinical competency as a professional nurse by improving the performance confidence and clinical decision-making ability of nursing students.
Characteristics and Treatment of Exercise Intolerance in Patients With Long COVID
Authors: Edward Justin A. , Peruri Adithya , Rudofker Eric , Shamapant Nikhil , Parker Hugh , Cotter Ryan , Sabin Katherine , Lawley Justin , Cornwell William K.
Published: August 2023

The post-acute sequalae of SARS-CoV-2, also known as “Long COVID,” is characterized by profound fatigue, impaired functional capacity with post-exertional malaise, orthostatic intolerance, and tachycardia. At least 25-30% of individuals impacted by SARS-CoV-2 will go on to experience the Long COVID syndrome, underscoring the detrimental impact this condition has on society. Although efforts are underway to further understand risk factors for Long COVID and identify strategies to prevent disease development entirely, implementation of treatment strategies is warranted to alleviate symptom burden among those affected. This review provides a rationale for exercise prescriptions tailored to the Long COVID patient based on the pathophysiology underlying this syndrome, as well as the previously demonstrated benefits of exercise training in other similar populations whose clinical manifestations result from cardiac deconditioning. Herein, we discuss methods to tailor exercise protocols, accommodating exercise intolerance and post-exertional malaise that may otherwise limit the ability to participate in a training protocol, as well as data demonstrating that a focused exercise prescription may effectively alleviate symptom burden in these patients. Long COVID results, in large part, from deconditioning, which may result from as little as 20 hr of inactivity. Exercise prescriptions tailored to patients with Long COVID may effectively alleviate symptom burden associated with this condition and in the absence of overt contraindications should be considered in management.
The “How” and “Why” Behind Clinical Site Visits: A Qualitative Study Exploring Director of Clinical Education Perspectives
Authors: Greco Jamie L. , Hochman Lori , Silberman Nicki
Published: August 2023

Introduction.

Several studies have investigated stakeholder perspectives regarding clinical site visits (SVs). An SV is one of the many ways of building strong relationships through collaborative communication. This study explored perceptions of directors of clinical education (DCEs) about why SVs are important, why they prefer certain methods of communication over others, and how they prioritize their decision-making process regarding structure and communication methods used.

Literature Review.

Barriers to conducting SVs exist, including scheduling challenges, time, and cost. Some studies suggest preferences for using in-person communication.

Subjects.

Fifteen DCEs from across the United States.

Methods.

Subjects participated in one-on-one semi-structured interviews. Transcripts were analyzed using a grounded theory approach and thematic analysis.

Results.

Six themes emerged from the data: (1) communication is vital, (2) SVs are fact-finding missions that serve multiple purposes, (3) flexibility is essential, (4) showing up in person has a strong impact, (5) DCEs strategically schedule in-person SVs, and (6) faculty assistance can be valuable. Some of the purposes of an SV include learning about the clinic's expectations, gathering data to ensure that the student is having a good experience, keeping current with curricular trends and contemporary practice, and building and nurturing relationships. Faculty may be able to assist in conducting SVs when properly trained. In-person SVs show a powerful message of support to students and clinicians.

Discussion and conclusion.

Similar to other stakeholders, DCEs value SVs for building, maintaining, and strengthening clinical and academic relationships. Site visits also bridge curricular gaps, support stakeholders, and help DCEs do their job. Directors of clinical education are strategic when considering SV structure, communication methods, and prioritizing student and clinician needs. Results were used in conjunction with prior findings of our mixed-methods explanatory sequential study to create recommendations, which will empower DCEs to advocate for resources to continue conducting SVs, particularly in-person SVs, especially under certain circumstances. Future research should explore clinician perspectives, specifically related to preferred communication methods, structure of the SV, and meeting with faculty other than the DCE.
Endocarditis in critically ill patients: a review
Authors: Nedel Wagner , Boniatti Marcio Manozzo , Lisboa Thiago
Published: August 2023

Purpose of review

To summarize the advances in literature that support the best current practices regarding infective endocarditis (IE) in critically ill patients.

Recent findings

IE due to rheumatic diseases has decreased significantly, and in fact, the majority of cases are associated with degenerative valvopathies, prosthetic valves, and cardiovascular implantable electronic devices. The Duke criteria were recently updated, addressing the increasing incidence of new risk factors for IE, such as IE associated with the use of endovascular cardiac implantable electronic devices and transcatheter implant valves. The presence of organ dysfunction, renal replacement therapies, or extracorporeal membrane oxygenation should be considered in the choice of drug and dosage in critically ill patients with suspected or confirmed IE. As highlighted for other severe infections, monitoring of therapeutic antibiotic levels is a promising technique to improve outcomes in critically ill patients with organ dysfunction.

The diagnostic investigation of IE must consider the current epidemiological criteria and the diagnostic particularities that these circumstances require. A careful evaluation of these issues is necessary for the prompt clinical or surgical management of this infection.
EUS-guided Gastroenterostomy
Authors: Kahaleh Michel , Tyberg Amy , Sameera Sohini , Sarkar Avik , Shahid Haroon M. , Abdelqader Abdelhai , Gjeorgjievski Mihajlo , Gaidhane Monica , Muniraj Thiruvengadam , Jamidar Priya A. , Aslanian Harry R. , Abraham Mathew , Lajin Michael , Kedia Prashant , Nieto Jose , Parsa Nasim , Andalib Iman , Bashir Muhammad , Kowalski Thomas E. , Loren David E. , Kumar Anand , Schlachterman Alexander , Chiang Austin , Holmes Ian , Mendoza Ladd Antonio H. , Oleas Roberto , Zolotarevsky Eugene , Robles-Medranda Carlos , Barthet Marc
Published: August 2023

Background:

Endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) is a minimally invasive therapy for patients with gastric outlet obstruction without the risks of surgical bypass and the limited long-term efficacy of enteral self-expanding metal stent placement. However, due to its novelty, there is a lack of significant data comparing long-term outcomes of patients with EUS-GE, based on the underlying disease. In this study, we compare outcomes of EUS-GE on benign versus malignant indications.

Methods:

Consecutive patients from 12 international, tertiary care centers who underwent EUS-GE over 3 years were extracted in a retrospective registry. Demographic characteristics, procedure-related information and follow-up data was collected. Primary outcome was the rate of adverse events associated with EUS-GE and the comparison of the rate of adverse events in benign versus malignant diseases. Secondary outcomes included technical and clinical success as well as hospitalization admission.

Results:

A total of 103 patients were included: 72 malignant and 31 benign. The characteristics of the patients undergoing EUS-GE is shown in Table 1. The mean age of the cohort was 68 years and 58 years for malignant and benign etiology. Gender distribution was 57% and 39% being females in malignant and benign etiology group, respectively. Clinical success, technical success, average procedure time, and hospital length of stay were similar in both groups. Patients with benign underlying etiology had significantly higher number of surgically altered midgut anatomy (P=0.0379).

Conclusion:

EUS-GE is equally efficient regardless of the underlying etiology (malignant vs. benign), and the adverse events both groups were comparable.
Analysis of the sacroiliac joint vacuum phenomenon in adolescent thoracic idiopathic scoliosis (Lenke types 1 and 2)
Authors: Morimoto Tadatsugu , Yamamoto Yusuke , Suzuki Satoshi , Yagi Mitsuru , Kobayashi Takaomi , Mawatari Masaaki , Matsumoto Morio , Watanabe Kota
Published: August 2023

The sacroiliac joint (SIJ) is the largest axial joint in the human body, and the SIJ vacuum phenomenon (SIJ VP) is a common finding in computed tomography studies of the abdomen, pelvis, and lumbosacral spine in adults, with the incidence increasing with age. Adolescent idiopathic scoliosis (AIS) is an abnormal spinal curvature that appears during adolescence and places abnormal stress on the SIJs. This retrospective observational study aimed to investigate the incidence of the SIJ VP in thoracic AIS (Lenke types 1 and 2). Sixty-seven patients with AIS (age: 12–19 years) and 76 controls (age: 11–19 years) were retrospectively analyzed to investigate SIJ VP, subchondral bone cysts, and SIJ degeneration (Eno classification: type 0, no degenerative change; type 1, mild degenerative changes; type 2, substantial degenerative changes; and type 3, ankylosis). SIJ degeneration was defined as type ≥ 2. The association between SIJ VP, cysts, SIJ degeneration, and sagittal/coronal spinopelvic alignment was assessed. SIJ VP (59% vs. 35.5%, P < .01), cysts (32.8% vs. 1.3%, P < .01), and SIJ degeneration (3.2% vs. 2.6%, P = .823) differed significantly between the 2 groups. There were 0 cases of SIJ ankylosis (Eno classification type 3) in both groups. The VP was not correlated with lumbar lordosis, sacral slope, or Cobb angle. All lumbar modifier type C belonged to the VP present group, whereas none to VP absent group. Our results suggest an association between AIS and SIJ VP and SIJ cysts. SIJ VP and SIJ cysts in AIS may be caused and accelerated by abnormal mechanical stress on SIJ due to spinal deformity.
Renal arteriovenous malformation causing hematuria: Case report and review of the literature
Authors: Wang Xin , Zhao Zhankui
Published: August 2023

Rationale:

Renal arteriovenous malformations are rare vascular morphological anomalies that can be classified as congenital, idiopathic and acquired, of which congenital renal arteriovenous malformations are the most common. This disease is a rare cause of hematuria. In this case report, we report the diagnosis and treatment of a patient with renal arteriovenous malformation. We also review the symptoms, diagnosis and treatment of renal arteriovenous malformations in the published literature.

Patient concerns:

A 35-year-old female patient presented to a local hospital with right-sided lumbar abdominal pain with hematuria for 2 days. Physical examination showed percussion pain in the right renal area. Laboratory tests such as routine blood and blood biochemistry did not show any significant abnormalities when the patient entered the hospital. Considering the patient’s medical history, a urological computed tomography scan showed blood accumulation in the right renal pelvis, upper middle ureter and bladder. Subsequently, routine blood tests showed that the patient’s red blood cells and hemoglobin continued to decrease. An emergency renal arteriogram was performed, which showed a tortuous right upper renal pole branch artery and multiple thickened veins communicating with it.

Diagnosis:

This patient was diagnosed with cirsoid renal arteriovenous malformation.

Interventions:

Renal artery embolization was performed immediately after the renal arteriogram was performed on the patient.

Outcomes:

On review of the angiogram, the tortuous right upper renal pole branch artery was found to be obstructed, and the thickened vein disappeared, and the renal vein was normally visualized in due course. On the third postoperative day, the patient was free of hematuria. Physical examination showed no percussion pain in the renal area. The patient healed and was discharged. A 1-year follow-up was performed and the patient gave feedback that she no longer had symptoms such as back pain and hematuria in her daily life.

Lessons:

This case illustrates that early use of vascular interventions is an important method for the diagnosis and treatment of cirsoid renal arteriovenous malformations.
The effect of butylphthalide on improving the neurological function of patients with acute anterior circulation cerebral infarction after mechanical thrombectomy
Authors: Wang Xinghua , Luan Xinchi , Yang Zhigang
Published: August 2023

Butylphthalide can improve blood circulation in patients with acute cerebral infarction. Complement 3a receptor 1 (C3aR1) is involved in the regulation of innate immune response and pathogen monitoring, which is closely related to the pathophysiological processes of breast cancer, neurogenesis and lipid catabolism. Our study explored the therapeutic effect of butylphthalide on improving the neurological function of patients with acute anterior circulation cerebral infarction after mechanical thrombectomy, and evaluated the correlation between serum C3aR1 and butylphthalide on improving the neurological function after mechanical thrombectomy. 288 patients with acute anterior circulation cerebral infarction who were admitted to our hospital from January 2019 to November 2022 and were treated with mechanical thrombectomy for the first time were included in this retrospective study and divided into the butylphthalide group and control group that they received treatment methods. The National Institutes of Health Stroke Scale (NIHSS) scale was used to evaluate the patient neurological function treatment efficacy, and the modified Rankin Scale (mRS) scale was used to measure the patient neurological function status 3 months after surgery. Enzyme-linked immunosorbent assay method was used to determine the content of C3aR1 in serum. Two weeks after thrombus removal, the NIHSS efficacy of the butylphthalide group and the control group were 94.44% and 72.22%, respectively. The butylphthalide group was significantly higher than the control group (P < .001). Three months after the operation, the mRS score of the butylphthalide group was significantly lower than that of the control group (P = .001), and the excellent and good rate was significantly higher than that of the control group (P < .001). The serum C3aR1 level of the butylphthalide group was significantly lower than that of the control group 2 weeks after operation and 3 months after operation (P < .001). The serum C3aR1 was positively correlated with the efficacy of NIHSS (R = 0.815, P = .004), which was positively correlated with mRS score (R = 0.774, P = .007). Butylphthalide can improve the therapeutic effect of neurological function in patients with acute anterior circulation cerebral infarction after mechanical thrombus removal. The patient serum C3aR1 is related to the patient neurotherapy efficacy and neurological function status, and its level can reflect the patient neurological function recovery to a certain extent.
Comparison of oxybuprocaine and lidocaine topical anesthesia for pain control in radiofrequency ablation treatment of great saphenous vein insufficiency
Authors: Yan Chao , Liu Zhenjie , Chen Bing
Published: August 2023

Topical anesthetics have been used for radiofrequency ablation of great saphenous vein insufficiency. A total of 74 patients with great saphenous vein insufficiency treated at our center between February 2021 and August 2022 were enrolled. The patients were selected and divided into an oxybuprocaine group(n = 30) and a lidocaine group (n = 44). The visual analogue scale (VAS) was used to evaluate intraoperative and postoperative pain. Patient satisfaction with anesthesia, maintenance time of anesthesia, and disturbance of the surgeons were also recorded and assessed. The VAS scores and other indices of the 2 groups were compared to assess the effectiveness of anesthesia. Perioperative surgical complications and painkiller use were also recorded. The median VAS score of the patients during the process was 2 in both groups, and the difference between the groups was not statistically significant. In the 2 groups, 93.33% of the patients in the oxybuprocaine group and 93.18% of the patients in the lidocaine group were satisfed with the anesthesia. Nine patients in the lidocaine group and 14 in the oxybuprocaine group received additional anesthetic drugs. The average maintenance time of anesthesia was longer in the lidocaine group. No serious complications occurred in either of the groups. Both oxybuprocaine and lidocaine topical anesthesia combined with tumescent anesthesia could provide effective pain control in radiofrequency ablation treatment of great saphenous vein insufficiency. Although the average maintenance time of anesthesia was longer in the lidocaine group, there was no difference in the associated complications and pain control.
Comparison of efficacy between unilateral biportal endoscopic lumbar fusion versus minimally invasive transforaminal lumbar fusion in the treatment of lumbar degenerative diseases: A systematic review and meta-analysis
Authors: Li Yang , Gao Shang Jun , Hu Xu , Lin Shi Shui
Published: August 2023

Background:

To evaluate the clinical efficacy and prognosis of unilateral biportal endoscopic lumbar fusion (ULIF) and minimally invasive transforaminal lumbar fusion (MIS-TLIF) for lumbar degenerative diseases.

Methods:

Chinese and English databases were retrieved for the period from database creation to December 31, 2022. Case-control studies on unilateral biportal endoscopic lumbar fusion were collected. The observation indexes consisted of operation times, intraoperative blood loss, postoperative drainage volume, length of hospital stay, postoperative pain score, postoperative oswestry disability index score, postoperative MacNab excellent and good rate, imaging fusion rate at the last follow-up, and complications. The NO rating table was employed to assess the quality of the included literature, and a meta-analysis was conducted using Revman5.4.1 and Stata17.

Results:

Ten studies with 738 surgical patients were considered, including 347 patients in the ULIF group and 391 in the MIS-TLIF group. This Meta-analysis demonstrated statistically significant differences in mean operation duration, intraoperative blood loss, postoperative drainage volume, length of hospital stay, and early postoperative (1–2W) visual analogue scale/score (VAS) scores for back pain. No significant differences were observed in the final follow-up postoperative VAS scores for back pain, postoperative leg VAS score, postoperative oswestry disability index score, excellent and good rate of postoperative modified MacNab, imaging fusion rate, and complications.

Conclusion:

Compared with the MIS-TLIF group, the ULIF group had longer operation time, lower intraoperative blood loss and postoperative drainage volume, lower lumbar VAS score in the early postoperative period, and shorter hospital stay. ULIF is less invasive than traditional MIS-TLIF, making it a trustworthy surgical option for lumbar degenerative diseases with comparable fusion efficiency, superior MacNab rate, and complication rate.
Acupuncture is an effective therapy for macular damage: A case report
Authors: Lu Qi , Sun Mengmeng , Cao Jinfeng , Wang Weizheng , Wang Haili , Gao Yu , Wang Ying , Guo Xiaole , Yang Weiwan , Wang Hongfeng
Published: August 2023

Rationale:

Many factors can contribute to the development of macular injury, which results in vision loss as a result of a disease. Heredity, age, underlying eye illness, internal eye surgery, or eye trauma can all cause it. A safer alternative to current therapies for macular degeneration is urgently needed since they all induce ocular irritation and postoperative recurrence as well as a host of other adverse effects.

Patient concerns:

A 12-year-old girl was the patient. A laser pen burnt her right eye. There was a spot and a shadow in the middle of her right eye’s visual field.

Diagnoses:

Macular degeneration.

Interventions:

Given the patient’s age, we opted out of medicine and instead used acupuncture as a symptomatic treatment.

Outcomes:

Two months after therapy concluded, optical coherence tomography result report indicate that the macula region of the right eye is better than it was previously. The corrected visual acuity of the right eye recovered from 0.25 to 1.0, and the clinical accompanying symptoms of the right eye disappeared.

Lessons:

No additional medication or surgical procedure was employed in this instance. We treated the macular damage with acupuncture, which relieved the patient’s clinical symptoms and had no adverse effects. This demonstrates that acupuncture may be beneficial in treating ophthalmopathy in this direction.
Severe bradycardia induced by postoperative nausea and vomiting: A case report
Authors: Li Xiaoyu , Lu Bo
Published: August 2023

Introduction:

Postoperative nausea and vomiting is a common complication for patients after anesthesia and surgery, which may result in increased parasympathetic activity, such as diaphoresis, pallor, or bradycardia. However, few cases of fatal bradycardia induced by postoperative nausea and vomiting have been reported before. Clinicians generally attribute bradycardia to certain anesthetics, instead of postoperative nausea or vomiting.

Patient concerns:

A fifty-year-old female with a history of well-controlled hypertension underwent elective radical mastectomy. When recovering from anesthesia in the post-anesthesia care unit, the patient experienced severe bradycardia accompanied by hypotension and unconsciousness, shortly after nausea and vomiting.

Interventions:

The patient received cardiopulmonary resuscitation immediately.

Outcomes:

Five minutes later, She recovered sinus rhythm and her vital sings tended to be stable. Three hours later, blood tests showed the N-terminal pro-B-type natriuretic peptide 127 pg/mL and cardiac troponin I 0.44 ng/mL, which peaked to 2.65 ng/mL 10 hours after the emergency. Electrocardiography revealed sinus rhythm, ST-segment depression in the inferior and anterior lateral leads, QTc prolongation, and left ventricular high voltage. Her serum cTnI continued to decline to 0.27 ng/mL on the 3rd day after surgery. She was discharged from the hospital on the fifth day and had no sequelae.

Conclusion:

Although postoperative nausea and vomiting occurs frequently, it should be kept in mind as a potential cause to blame for severe bradycardia or even life-threatening situations.
Cuproptosis-related prognostic signatures predict the prognosis and immunotherapy in HCC patients
Authors: Peng Hong , Zou Zhaoxia , Xiang Ziye , Lu Xingjun , Zhang Yiya , Peng Xiaozhen
Published: August 2023

Cuproptosis, an unusual type of programmed cell death mechanism of cell death, involved the disruption of specific mitochondrial metabolic enzymes in the occurrence and development of tumors. However, it was still unclear how the relationship between cuproptosis-related genes (CRGs) may contribute to hepatocellular carcinoma (HCC) potential the prognosis of HCC remained limited. Here, the landscape of 14 CRGs in HCC was evaluated using the Cancer Genome Atlas and International Cancer Genome Consortium datasets. And then, 4 CRGs (ATP7A, MTF1, GLS, and CDKN2A) were screened for the construction of risk signatures for prognosis and drug therapy. The HCC patients with CRGs high-risk showed poor prognosis than those with low risk. Moreover, the CRGs risk signature was shown to be an independent prognostic factor and associated with the immune microenvironment in HCC. Meanwhile, we constructed and verified a prognostic model based on cuproptosis-related lncRNAs (Cr-lncRNAs). We obtained 291 Cr-lncRNAs and constructed Cr-lncRNA prognosis signature based on 3 key Cr-lncRNAs (AC026356.1, NRAV, AL031985.3). The Cr-lncRNA prognosis signature was also an independent prognostic factor and associated with the immune microenvironment in HCC. Finally, the drug sensitivity database showed that 8 candidate drugs related to CRGs signature and Cr-lncRNAs signature. In summary, we evaluated and validated the CRGs and Cr-lncRNAs as potential predictive markers for prognosis, immunotherapy, and drug candidate with the personalized diagnosis and treatment of HCC.
Study on the prevention and nursing intervention of infection after flap transfer for hand trauma
Authors: Guo Fang-Xiang , Wu Cai-Yun
Published: August 2023

To analyze the factors associated with infection after flap transfer for hand trauma and use them to develop nursing strategies and observe the effects of their application. Eighty-two patients admitted to our hospital for flap transfer for hand trauma from January 2020 to May 2020 were selected for the retrospective analysis. Logistic regression analysis was performed to analyze the factors associated with postoperative infections to develop care strategies. Another 88 patients admitted for flap transfer for hand trauma from September 2020 to June 2021 were retrospectively analyzed and divided into the observation (n = 44) and control groups (n = 44) according nursing strategies that they received. The operative time, intraoperative bleeding, incision healing time, first postoperative time to get out of bed on their own and hospital stay were compared between the 2 groups. The patients postoperative adverse effects and flap survival rates were also counted. visual analogue score, total active motion, manual muscle test, Barthel index, self-rating anxiety scale, self-rating depression scale scores were used to assess patients pain, hand function recovery and psychology before and after treatment. Logistic regression analysis manifested that postoperative bed rest time, affected limb immobilization, and pain were independent factors affecting postoperative infection after flap transfer (P < .05). After using targeted care strategies, the observation group had dramatically shorter operative time, intraoperative bleeding, incision healing time, time to first postoperative bed release on their own, and hospital stay, less postoperative pain and adverse effects, and higher flap survival rate than the control group (P < .05). Total active motion, manual muscle test, and Barthel index were higher in the observation group than in the control group after treatment, while self-rating anxiety scale and self-rating depression scale scores were lower than in the control group (P < .05). Finally, total satisfaction was higher in the observation group than in the control group (P < .05). Postoperative bedtime, fixation of the affected limb, and pain are independent factors affecting postoperative infection after flap transfer for hand trauma. Implementing infection prevention care strategies based on these factors can effectively improve the safety of flap transfer, reduce the possibility of infection, and shorten the recovery period of patients, which has high clinical application value.
Trimethylamine N-oxide and risk of inflammatory bowel disease: A Mendelian randomization study
Authors: Banno Yukika , Nomura Miho , Hara Risako , Asami Momoko , Tanaka Kotone , Mukai Yuuka , Tomata Yasutake
Published: August 2023

A previous study suggested that inflammatory bowel disease (IBD) patients have low plasma levels of trimethylamine N-oxide (TMAO). In the present study, we examined this hypothesis using Mendelian randomization analysis. We used summary statistics data for single-nucleotide polymorphisms associated with plasma levels of TMAO, and the corresponding data for IBD from a genome-wide association meta-analysis of 59,957 individuals (25,042 diagnosed IBD cases, 34,915 controls). The association between genetically predicted plasma TMAO levels and IBD showed odds ratios (95% confidence interval [CI]) per 1 interquartile range increment (per 2.4 μmol/L) in TMAO levels were 0.91 (0.81–1.01, P = .084) for IBD, 0.88 (0.76–1.02, P = .089) for ulcerative colitis, 0.91 (0.79–1.05, P = .210) for Crohn disease. There was no evidence for pleiotropy based on the Mendelian randomization-Egger regression analyses (P-intercept = 0.669 for IBD). Further investigations would be needed to understand the causal relationship between TMAO and IBD.
High prevalence of postoperative arytenoid dislocation in patients undergoing liver transplantation: A case-control study
Authors: Yan Wenqing , Chen Zhi , Dong Weihua , Qian Yihong
Published: August 2023

Arytenoid dislocation (AD) is a rare complication of surgery under general anesthesia. The potential factors for AD remain poorly defined, and the identification of risk factors is beneficial for reducing its incidence. We found that patients undergoing liver transplantation appeared to be more susceptible to postoperative AD at our hospital. The present study was designed to clarify this issue. A retrospective hospital-based case-control study was conducted in patients undergoing surgery under general anesthesia between 2017 and 2021. Recorded data for all patients were age, sex, body weight, height, body mass index, position of patients during surgery, duration of surgery, emergency status of surgery, and liver transplantation. Logistic regression analysis was performed to determine risk factors for AD. Thirty thousand one hundred fifty-four patients who underwent general anesthesia between 2017 and 2021 were included. Sixteen (0.05%) patients were diagnosed with AD, including 10 (3.9%) patients among 259 patients who underwent liver transplantation and 6 patients had complications among the 29,895 patients who underwent other operations (P < .0001). Postoperative AD incidence was significantly elevated in patients undergoing liver transplantation. This finding should be clinically relevant and alarming for anesthesiologists and clinicians to help avoid arytenoid dislocation and improve patient outcomes. Further studies that incorporate detailed data are needed to determine risk factors for AD.
Correlation between preoperative frailty and postoperative delirium in elderly patients undergoing hip arthroplasty
Authors: Ma Zihan , Wang Jianlin , He Tianyi , Zhu Shaoxiong , Sheng Chaoxu , Ge Yeying , Yuan Liyong
Published: August 2023

Background:

Postoperative delirium (POD) refers to acute brain dysfunction occurring within 7 days after operation or before discharge. Frailty refers to the state that the body’s physiological reserve is insufficient, so that the compensative capacity to endogenous and exogenous stress stimuli decreases. The purpose of this study is to explore the association of preoperative frailty (PF) with POD in elderly patients undergoing hip arthroplasty.

Methods:

Totally 228 elderly patients (age ≥ 65 years) who received elective hip arthroplasty in the Ningbo No. 6 Hospital between December 2021 and June 2022 were enrolled. One day before surgery, the frailty phenotype scale was adopted for evaluation of patients’ frailty. On the 1st–3rd day after operation, the confusion assessment method was adopted for evaluation of delirium, and the patients were grouped into a POD group and non-POD group. Logistic regression was conducted to analyze the correlation between PF and POD.

Results:

Among the patients, the incidence of PF was 30.70% (70/228), and the incidence of delirium within 3 days after operation was 25.88% (59/228). According to binary logistic regression analysis, PF, age, hypertension, diabetes mellitus, and preoperative sleep disorder were independent risk factors for POD in elderly patients undergoing hip arthroplasty (all P < .05).

Conclusion:

PF is a crucial risk factor for POD in elderly patients undergoing hip arthroplasty.
A network pharmacology and molecular docking investigation on the mechanisms of Shanyaotianhua decoction (STT) as a therapy for psoriasis
Authors: Yue Chen , Feng Jiahao , Gao Aili
Published: August 2023

Psoriasis is an immune-mediated inflammatory skin disease with a complex etiology involving environmental and genetic factors. Psoriasis patients often require long-term treatment.Shanyaotianuadecoction (STT), a typical traditional Chinese medicine prescription, positively affects psoriasis, although its molecular targets remain unknown. To elucidate its molecular mechanisms, a combination of network pharmacology, bioinformatics analysis, and drug similarity comparisons were employed. Participants were separated into 3 groups: non-lesional (NL), lesions after medication (LM), and psoriasis lesion groups (LS). Based on the Gene Ontology/kyoto encyclopedia of genes and genomes enrichment analyses, the key targets were mainly enriched for biological processes (immuno-inflammatory responses, leukocyte differentiation, lipid metabolic disorders, and viral infection) with the relevant pathways (Janus kinase/signal transducers and activators of transcription and adipocytokine signaling and T-helper 17 cell differentiation), thus identifying the possible action mechanism of STT against psoriasis. Target prediction for 18 STT compounds that matched the screening criteria was performed. Then, the STT compounds were intersected with the differentially expressed genes of the psoriatic process, and 5 proteins were potential targets for STT. Based on the open-source toolkit RDKit and DrugBank database, and through molecular docking and drug similarity comparisons, spinasterol, diosgenin, and 24-Methylcholest-5-enyl-3belta-O-glucopyranoside_qt may be potential drugs for psoriasis.
The deficiency of 5-methylcytosine (5mC) and its ramification in the occurrence and prognosis of colon cancer
Authors: Yan Xin-Xin , Guo Na , Ru Song-Wei , Wang Zhi-Yuan , Sui Hai-Juan , Xu Yin-Shi , Yao Zhen-Dan
Published: August 2023

The incidence and mortality of colon cancer are increasing, and effective biomarkers for its diagnosis are limited. 5-methylcytosine (5mC), a vital DNA methylation marker, plays important roles in gene expression, genomic imprinting, and transposon inhibition. This study aimed to identify the predictors of colon cancer prognosis and lay the foundation for research on therapeutic targets by detecting the levels of 5mC, 5-hydroxymethylcytosine (5hmC), 5-formyl cytosine (5fC), and 5-carboxylcytosine (5caC) in colon cancer and adjacent non-tumor tissues. A tissue microarray including 100 colon cancer tissue samples and 60 adjacent non-tumor tissue samples was used. The expression levels of 5mC and its ramifications were assessed by immunohistochemistry. According to the expression levels, patients were divided into moderately positive and strongly positive groups, and the correlation between clinicopathological characteristics and methylation marks was assessed using 2-sided chi-square tests. The prognostic values of 5mC, 5hmC, 5fC, and 5caC were tested using Kaplan–Meier analyses. Compared with adjacent non-tumor tissues, the overall levels of DNA methylation were lower in colon carcinoma lesions. However, the clinical parameters were not significantly associated with these methylation markers, except for 5hmC, which was associated with the age of cancer patients (P value = .043). Kaplan–Meier analysis disclosed that moderate positive group had a significantly shorter disease specific survival than strong positive group for patients with different levels of 5mC (65.2 vs 95.2 months, P = .014) and 5hmC (71.2 vs 97.5 months, P = .045). 5mC and its ramifications (5hmC, 5fC, and 5caC) can serve as biomarkers for colon cancer. 5mC and 5hmC are stable predictors and therapeutic targets in colon cancer. However, further understanding of its function will help to reveal the complex tumorigenic process and identify new therapeutic strategies.
Is laparoscopic surgery safe and feasible in acute adhesive ileus?
Authors: Gojayev Afig , Erkent Murathan , Aydin Hüseyin Onur , Karakaya Emre , Yildirim Sedat , Moray Gökhan
Published: August 2023

Although the classical surgical treatment of adhesive ileus is performed using the open method, laparoscopic surgery has recently been performed in some centers. This study aimed to discuss the feasibility and role of laparoscopic surgery in the treatment of adhesive small bowel obstruction. In this retrospective study, the data of 830 patients who were operated for ileus in Başkent University Faculty of Medicine, Ankara Hospital, Department of General Surgery between January 2011 and September 2022 were analyzed. Missing data and intraabdominal cancer-related ileus were accepted as exclusion criteria and 648 patients were excluded from the study. The development of adhesion-related ileus and completeness of the data were accepted as inclusion criteria. Data were compared between the 2 groups [open group (OG; 152 cases) and laparoscopic group (LG; 30 cases]). When the patient characteristics were evaluated, it was found that the history of previous abdominal surgery (P < .001) and the number of previous abdominal surgery (P < .001) were statistically significantly higher in OG. Operation time was significantly longer in the LG (P = .022). There were no statistically significant differences between the groups in terms of intraoperative bowel injury (P = .216), bowel resection (P = .284), and stoma creation (P = .331). OG had a significantly higher rate of Clavien-Dindo grade ≥ 3 serious complications (P < .001) and mortality rate (P = .045). The first gas out occurred significantly earlier in the LG (P = .014). Oral intake was initiated earlier in the LG (P = .004). The length of hospital stay was significantly shorter in the LG (P < .001). There was no significant difference between the groups in terms of postoperative ileus, readmission, and reoperation. Laparoscopic surgery can be safely performed for the treatment of selected patients with adhesive small bowel obstruction. In addition, it is advantageous in terms of postoperative recovery.
The efficacy and safety of duloxetine for the treatment of patients after TKA or THA: A systematic review and meta-analysis
Authors: Zhou Yongqiang , Chen Xiao , Chen Chang , Cao Yuan
Published: August 2023

Background:

Duloxetine, a serotonin–norepinephrine dual reuptake inhibitor, may improve analgesia after total joint arthroplasty (TJA). However, there is still no consensus on its effectiveness and safety. We conducted the meta-analysis to investigate the analgesic effect and safety of duloxetine for the treatment of patients received total knee or hip arthroplasty.

Methods:

Pubmed, Cochrane Central Registry for Clinical Trials, Embase, OVID, Web of Science, and Google Scholar were searched using a predetermined search strategy from inception to September 21, 2022. Only randomized controlled trials of duloxetine in treatment of patients after total knee or hip arthroplasty were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards.

Results:

A total of 8 randomized controlled trials with 739 patients were included in the literature review of postoperative pain and adverse effects. The result of meta-analysis showed statistically significant lower opioid requirement with duloxetine (P < .05) for the different postoperative period. Duloxetine group had significant reductions in visual analog score for the 24-hour (walking: WMD = −0.98; 95% confidence interval [CI] = −1.69 to −0.26, P = .007; resting: WMD = −1.06; 95%CI = −1.85 to −0.27, P = .008) and 1-week (walking: WMD = −0.96; 95%CI = −1.42 to −0.50, P < .001; resting: WMD = −0.69; 95%CI = −1.22 to −0.16, P = .01); knee injury and osteoarthritis outcome score over 3-month (WMD = 2.94; 95%CI = −0.30 to 6.18, P = .008) and complication (odds ratio = 4.74; 95%CI = 0.23 to 96.56, P = .01) postoperative period compared with the control group. However, no difference on numeric rating scale (P > .05) for the different postoperative period; visual analog score (P > .05) for the 6-week or 3-month and knee injury and osteoarthritis outcome score (P > .05) for the 6-week postoperative period. Furthermore, it did not increase the incidence of adverse effects (odds ratio = 0.87; 95%CI = 0.72 to 1.05, P = .15).

Conclusion:

Duloxetine could decrease the opioids consumption and relieve early postoperative pain without increasing the risk of adverse medication effects in patients undergoing total knee or hip arthroplasty. Considering the ongoing opioid epidemic, duloxetine could act as a good supplement in multimodal pain management protocol for patients undergoing total joint arthroplasty.
The effects of physical activity and exercise therapy on frail elderly depression: A narrative review
Authors: Zhang Yaqun , Jiang Xin
Published: August 2023

Due to aging, decreased immune function, and an increase in various diseases, frail elderly people are prone to symptoms of depression, which may seriously affect their quality of life. Physical activity and exercise therapy have been identified as a promising method for preventing and treating depression in the elderly. This narrative review assesses the relationship between physical activity and depressive symptoms in frail elderly people, the mechanisms by which physical activity affects depressive symptoms, and the effectiveness of exercise therapy on the health status of frail elderly people. Through searches on the web of science, scopus, PubMed, and CNKI databases, there are a large number of studies on the relationship between physical activity and depression; However, few of them give us a mechanism for how physical activity affects depression. Although all progress has been made in developing appropriate exercise therapy to treat depression, the mechanisms underlying the effects of different types of exercise therapy on depression in frail elderly people have not been satisfactorily addressed, and the optimal effect of exercise therapy on depression cannot be achieved. In this way, future research should more effectively clarify the mechanism of physical activity affecting depression in frail elderly people in China, in order to understand which exercise therapy or how to formulate exercise prescriptions can make exercise therapy play the greatest role in treating depression in vulnerable elderly people in China.