bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of THSD7B and PRMT9 mutations as risk factors for familial lung adenocarcinoma: A case report
Authors: Zhang Qianqian , Zhao Yanwei , Song Zhaona , Zhang Qiang , Tian Conghui , Li Rongrong , Zheng Juan , Yan Lili , Gu Mingliang , Jia Xiaodong , Li Mingjun
Published: February 2023

Rationale:

Lung tumors arise from the unrestrained malignant growth of pulmonary epithelial cells. Lung cancer cases include both small and non-small cell lung cancers, with lung adenocarcinoma (LUAD) accounting for roughly half of all non-small cell lung cancer cases. Research focused on familial cancers suggests that approximately 8% of lung cancer cases are linked to genetic susceptibility or heritability. The precise genetic factors that underlie the onset of lung cancer, however, remain to be firmly established.

Patient concerns:

A 43-year-old presented with nodules in the lower left lung lobe. Following initial antibiotic treatment in a local hospital, these nodules remained present and the patient subsequently underwent the resection of the left lower lobe of the lung. The patient also had 4 family members with a history of LUAD.

Diagnosis:

Immunohistochemical staining results including cytokeratin 7 (+), TTF-1 (+), new aspartic proteinase A (+), CK5/6 (−), P63 (−), and Ki-67 (5%+) were consistent with a diagnosis of LUAD.

Intervention:

Whole exome sequencing analyses of 5 patients and 6 healthy family members were performed to explore potential mutations associated with familial LUAD.

Outcomes:

Whole exome sequencing was conducted, confirming that the proband and their 4 other family members with LUAD harbored heterozygous THSD7B (c.A4000G:p.S1334G) mutations and homozygous PRMT9 (c.G40T:p.G14C) mutations, as further confirmed via Sanger sequencing. These mutations were predicted to be deleterious using the SIFT, PolyPhen2, and MutationTaster algorithms. Protein structure analyses indicated that the mutation of the serine at amino acid position 1334 in THSD7B to a glycine would reduce the minimum free energy from 8.08 kcal/mol to 68.57 kcal/mol. The identified mutation in the PRMT9 mutation was not present in the predicted protein structure. I-Mutant2.0 predictions indicated that both of these mutations (THSD7B:p.S1334G and PRMT9: p.G14C) were predicted to reduce protein stability.

Lessons:

Heterozygous THSD7B (c.A4000G:p.S1334G) and the homozygous PRMT9 (c.G40T:p.G14C) mutations were found to be linked to LUAD incidence in the analyzed family. Early analyses of these genetic loci and timely genetic counseling may provide benefits and aid in the early diagnosis of familial LUAD.
Efficacy and safety of pregabalin in eye pain: A systematic review
Authors: Shen Xiaohua , Chen Xingying , He Yanyan , Xu Hui , Zhu Jia
Published: February 2023

Background:

The pregabalin is approved for the management of persistent pain. The aim of this study is to assess the advantages and disadvantages of the use of pregabalin in eye pain management.

Methods:

The PubMed, Cochrane Library, Embase, and Web of Science databases were searched until January 2022 for randomized controlled trials. Randomized, double-blinded trials comparing pregabalin with placebo in eye pain management were included. The primary outcome was visual analog scale or numerical rating scale at acute (24 hours) and chronic (≥7 days after surgery) timepoints. The secondary outcomes were analgesic medication requirements and pregabalin-related complications (nausea, vomiting, dizziness, and headache). We also compared the effect of pregabalin on dry-eye syndrome.

Main results:

Six relevant articles were identified that studied the use of pregabalin as pain relief for photorefractive keratectomy (n = 2), laser epithelial keratomileusis (n = 1), laser-assisted in situ keratomileusis (n = 1), eyelid surgery (n = 1), and dacryocystorhinostomy (n = 1). Pregabalin was associated with a significant reduction in pain scores (95% confidence interval = −0.41 [−0.76–−0.06]) 24 hours after surgical procedures. The data were insufficient to draw conclusions regarding dry eye symptoms. Because of the high heterogeneity of outcomes regarding adverse effects, there is no conclusion regarding the safety of pregabalin in eye pain.

Conclusions:

Pregabalin reduced acute eye pain but had no significant effect on long-term analgesia after ophthalmological surgery in adults. It had no effect on dry-eye symptoms after ocular surgery. Further studies on the safety of pregabalin in eye pain management are required to draw solid conclusions.
The usefulness of image-enhanced endoscopy to distinguish gastric carcinoma in tumors initially diagnosed as adenomas by endoscopic biopsy: A retrospective study
Authors: Umeda Yuhei , Tanaka Kyosuke , Ikenoyama Yohei , Hamada Yasuhiko , Yukimoto Hiroki , Yamada Reiko , Tsuboi Junya , Nakamura Misaki , Katsurahara Masaki , Horiki Noriyuki , Ogura Toru , Tamaru Satoshi , Nakagawa Hayato , Tawara Isao
Published: February 2023

Superficial epithelial gastric neoplasms can be divided into adenomas and early carcinomas. Histological diagnosis by endoscopic forceps biopsy is crucial for the diagnosis and management of gastric neoplasms. It is difficult to distinguish features of gastric neoplasms in small biopsy specimens; hence, gastric carcinomas can be underdiagnosed as adenomas. Recent developments in image-enhanced endoscopy have improved the ability to differentiate between carcinomatous and non-carcinomatous lesions. To investigate the prevalence of gastric carcinoma in lesions initially diagnosed as adenomas by forceps biopsy and assess the usefulness of image-enhanced endoscopy in distinguishing carcinomas. A total of 142 lesions of gastric adenomas, diagnosed by biopsy and resected endoscopically between January 2010 and May 2020, were retrospectively evaluated. Images were captured by white-light endoscopy (WLE), magnifying endoscopy with narrow-band imaging (M-NBI), and magnifying endoscopy with acetic acid and narrow-band imaging (M-AANBI); they were analyzed and compared with histopathological results. The diagnostic performance of M-AANBI was compared with that of M-NBI. Of the 142 lesions, 58 (40.8%) were pathologically diagnosed as adenocarcinomas. On WLE images, a depressed macroscopic type and size ≥20 mm were significant predictors of carcinoma (P < .001); however, they displayed low sensitivities (32.8% and 41.4%, respectively). M-AANBI displayed significantly higher sensitivity, specificity, and accuracy for distinguishing carcinomas than M-NBI (94.8% vs 74.1%, 81.0% vs 72.6%, and 86.6% vs 73.2%, P < .05). In conclusion, carcinoma was prevalent in 40.8% of gastric lesions initially diagnosed as adenomas by forceps biopsy. M-AANBI may be more useful than M-NBI and WLE in distinguishing gastric carcinomas from adenomas.
The role of claudin 18.2 and HER-2 in pancreatic cancer outcomes
Authors: Kayikcioglu Erkan , Yüceer Ramazan Oğuz
Published: February 2023

To examine the prognostic value of claudin 18.2 (CLDN18.2) and human epidermal growth factor receptor-2 (HER-2) expression in patients with resected pancreatic ductal adenocarcinoma (PDAC). This study enrolled patients who underwent surgery and were diagnosed with PDAC at Suleyman Demirel University Hospital, Turkey between 2015 and 2019. Sixty-eight patients with resected PDAC treated at a medical oncology clinic were assessed. All patients were over the age of 18 years, underwent follow-up and treatment in our unit, and had pathology slides that we could access. Clinicopathological data were obtained from medical files, including the patients’ age, sex, pathological parameters, and clinical stage according to the Eighth International Union against Cancer/American Joint Committee on Cancer. Patient survival and the period from the date of diagnosis to death were assessed in the follow-up data. There was no statistically significant difference between CLDN18.2 and HER-2 expression scores for samples and patient clinicopathological characteristics. No HER-2 expression scores of ≥2 were found in the samples. Only 25% (n = 17) of the samples had HER-2 expression scores of +1. CLDN18.2 expression was detected in 54.4% (n = 37) of the patient samples. CLDN18.2 expression scores were +1 in 30.8% (n = 21) of the patient samples, +2 in 16.2% (n = 11), and +3 in 7.4% (n = 5). When CLDN18.2 and HER-2 expression were compared, a statistically significant difference and moderate positive correlation were observed. No significant relationship between HER-2 expression and survival was observed in the survival analysis of PDAC patients; however, high CLDN18.2 expression was related to longer overall survival. Our study is the third to research CLDN18.2 expression in PDAC. HER-2 expression is low and CLDN18.2 expression is high in patients with PDAC. HER-2 expression is not related to overall survival but CLDN18.2 is related and may be used as a prognostic marker in patients with PDAC.
Down syndrome patients with normal hearts: are they really normal?
Authors: Abdelrahman Eman G , Kamal Naglaa M , Alharthi Sultan , Albalawi Muflih , Assar Effat
Published: February 2023

Even though congenital heart disease is a common finding in down syndrome (DS) patients, some of them have anatomically normal hearts. However, the term “normal” might not be suitable, as these patients usually suffer from functional cardiac dysfunction. Several research highlighted that despite the absence of anatomical heart defects, subtle cardiac function derangements are present in DS patients. We aim to assess cardiac functions by Two-dimensional echocardiography and tissue Doppler imaging (TDI) in pediatric DS patients who have anatomically normal hearts. One hundred seventy-two patients with karyotyping confirmed DS with anatomically normal hearts and 165 healthy normal control children were enrolled in the current study. Their cardiac functions were assessed using both 2-dimensional echocardiography and TDI. Both patients and controls had structurally and anatomically normal hearts. In DS patients, the right side of the heart showed a significant reduction in both systolic and diastolic functions. Systolic dysfunction was evident by significantly decreased levels of Tricuspid annular plane systolic excursion and systolic wave by TDI. Diastolic dysfunction of the right ventricle was evident by prolonged deceleration time by conventional echocardiography and a significant decrease in annular tissue doppler velocity during early diastole/late diastole ratio by TDI. The E/De ratio was significantly increased. Even with anatomically normal hearts, DS patients should undergo cardiac function assessment by echocardiography & TDI. TDI is superior to conventional echocardiography in detecting subtle cardiac dysfunction especially left ventricular diastolic dysfunction in DS patients. TDI showed a significant decrease in the early/atrial ratio of mitral valve annulus and prolongation of left ventricle isometric relaxation time in DS children. Also, the left ventricle E/De ratio was prolonged denoting elevated filling pressures and diastolic dysfunction. This indicates that the TDI has higher sensitivity to detect diastolic dysfunction than conventional Echocardiography. Biventricular TDI-derived myocardial performance index was found to be significantly increased in DS children.
Comparison of ability of lesion detection of two MRI sequences of T2WI HASTE and T2WI BLADE for hepatocellular carcinoma
Authors: Jhan Song-Ru , Wu Yi-Ying , Chang Pi-Yi , Chai Jyh-Wen , Su Te-Cheng
Published: February 2023

We investigated the diagnostic accuracy of 2 magnetic resonance imaging (MRI) sequences of T2 weighted image (T2WI) half-Fourier acquired single turbo spin-echo (HASTE) and BLADE, for hepatocellular carcinoma (HCC) detection. From November 2010 to August 2018, patients diagnosed with HCC and regularly followed up, and who underwent MRI with 2 kinds of T2WI, were included in this study. The diagnosis of HCC was established based on histopathological findings or LI-RADS 4 and 5 by image. The sensitivities and positive predictive value for the detection of HCC by T2WI HASTE and BLADE were compared for each sequence. Quantitative assessment with lesion contrast-to-noise ratio and visual rating scoring of image quality, based on factors such as artifact, margin of organs, and vessel sharpness of the 2 sequences, were compared. No significant differences in lesion detection were observed based on paired comparison of all lesions and lesions larger than 1 cm across both sequences. The sensitivity was higher in larger than 1cm group in all sequences. The HASTE sequence had less motion artifact, but the BLADE images had advantage in edge sharpness of organs and vessels. The HASTE without fat-saturation seems to have better overall image quality. The lesions contrast-to-noise ratio of the 2 image modalities were not significantly different. Compared with T2 BLADE, T2 HASTE may be a more effective protocol for detecting HCC larger than 1 cm without loss of sensitivity. The accuracy of data from 2 T2WI protocols could be applied to streamline MRI protocols of HCC screening and surveillance.
Liraglutide on type 2 diabetes mellitus with nonalcoholic fatty liver disease: A systematic review and meta-analysis of 16 RCTs
Authors: Zhao Yan , Zhao Wenli , Bu Huaien , Toshiyoshi Maeda , Zhao Ye
Published: February 2023

Background:

Nonalcoholic fatty liver disease (NAFLD) is a common comorbidity of type 2 diabetes mellitus (T2DM). Our aim is to investigate the effects of liraglutide on T2DM with NAFLD.

Methods:

Relevant articles published from the earliest publication to March 2022 were selected from several databases. The Cochrane Collaboration’s RevMan software was used for the analysis.

Results:

Sixteen studies are selected for this meta-analysis, which includes totally 634 patients in the treatment group and 630 patients in the control group. As a result, 14 studies show that fasting plasma glucose levels of the experimental group are lower than that of the control group; 15 studies show that glycosylated hemoglobin A1c levels of the experimental group are lower than that of the control group; 13 studies show that triglyceride levels of the experimental group are lower than that of the control group; twelve studies show that total cholesterol levels of the experimental group are lower than that of the control group; 10 studies show that alanine aminotransferase levels of the experimental group is lower than that of the control group; 10 studies show that no significant difference in changes in aspartate transaminase between 2 groups; 13 studies show that low density lipoprotein cholesterol levels of the experimental group is lower than that of the control group; 9 studies show that no significant difference in changes in high density lipoprotein cholesterol between 2 groups; 7 studies mentioned adverse effects and the difference is significant.

Conclusion:

Liraglutide is potentially curative for T2DM with NAFLD.
Simple screening model based on electrocardiogram for patients with dilated cardiomyopathy
Authors: Wang Xiangyu , Zhang Qian , Yang Na , Wang Xishu , Zhang Zhiguo
Published: February 2023

Dilated cardiomyopathy (DCM) is one of the most common causes of heart failure. Therefore, screening and early diagnosis of potential DCM patients is beneficial. Electrocardiogram (ECG) can be an inexpensive and easily available screening tool. We aimed to construct a simple screening model for DCM based on electrocardiogram. In this retrospective observational study, we consecutively enrolled 117 DCM patients between July 1, 2016 and July 1, 2021 as the DCM group, while 117 patients hospitalized in the same period with normal echocardiography and ECG were selected as the non-DCM group. Patients were randomly assigned to the training and validation sets at 8:2. ECG parameters of left ventricular related leads were exacted. Logistic regression was performed to evaluate screening indicators of ECG parameters and a nomogram was conducted. The screening ability of the model was evaluated using receiver operating characteristic analysis. Furthermore, the nomogram was assessed using calibration curve and decision curve analysis. Screening indicators included in the nomogram were the amplitude of S wave in V1 and V3 leads, the amplitude of R wave in aVF and V6 leads, and PR interval. The nomogram performed satisfactory discrimination in the training (area under the receiver operating characteristic curve = 0.904) and validation (area under the receiver operating characteristic curve = 0.878) sets and good calibration (Hosmer–Lemeshow P = .066). Decision curve analysis demonstrated the model can generate a net benefit of 0.33 when the threshold probability was 0.543. The nomogram based on electrocardiogram is a simple and practical screening tool for potential DCM patients.
Outcomes of COVID-19 patients with acute kidney injury and longitudinal analysis of laboratory markers during the hospital stay: A multi-center retrospective cohort experience from Pakistan
Authors: Ahsan Muhammad Nadeem , Asghar Muhammad Sohaib , Iqbal Sadia , Alvi Haris , Akram Mohammed , Fayyaz Basmah , Irshad Syeda Ghazala , Ullah Irfan , Alvi Sarosh , Yousaf Zohaib
Published: February 2023

The frequency of acute kidney injury (AKI) in COVID-19 patients can be varied and related to worse outcomes in the disease population. AKI is common among hospitalized patients with COVID-19, particularly the ones needing critical care. This study was conducted in order to determine the outcomes of hospitalized patients with prolonged hospital stays who suffered from COVID-19 associated AKI. It was conducted as a multi-centered, retrospective, cohort study, and including all patients who were diagnosed on COVID-19 PCR. End-stage renal disease patients on hemodialysis were excluded. The cohort included 1069 patients, with 68% males, mean age of 56.21 years, and majority within 50 to 75 years age group (60%). Mean disease onset was 14.43 ± 7.44 days and hospital stay was 7.01 ± 5.78 days. About 62% of patients stayed in intensive care and 18% of them were on invasive ventilation. The mortality rate was 27%. Frequency of AKI was 42%, around 14% of them were resolving during hospital stay and other 28% worsened. The mortality rate was significantly higher with AKI (OR: 4.7, P < .001). Alongside AKI, concomitant liver dysfunction was also significantly contributing to mortality (OR: 2.5), apart from ICU stay (OR: 2.9), invasive ventilation (OR: 9.2), and renal replacement therapy (OR: 2.4). Certain laboratory markers were associated with AKI throughout in-hospital stay.
Top 100 most-cited articles on renal cell carcinoma: A bibliometric analysis
Authors: Zhou Huiyu , Cui Fan , Lv Dingyang , Gong Qian , Wen Jie , Shuang Weibing
Published: February 2023

Background:

To analyze the top 100 most-cited articles on renal cell carcinoma (RCC) using bibliometric methods based on the Web of Science core collection database and to explore the research status, hotspots, and emerging trends in RCC.

Methods:

The literature on RCC was searched in the Web of Science core collection database using a specific search strategy, and the types of literature were limited to articles and reviews, with no restrictions to language and publication date. The top 100 articles with the highest number of citations were extracted after the manual screening. The publication year, the number of citations, authors, country, institution, journal, and keywords of these articles were collected and analyzed. Descriptive statistics and visual analysis were performed using Microsoft Excel, VOSviewer, CiteSpace, R, and SPSS.

Results:

The number of citations of the top 100 articles varied from 541 to 4530, with a median citation count of 807.5, and the citation rates ranged from 13.8 to 448.4 citations per year. Motzer RJ (n = 22), Escudier B (n = 13), Rini BI (n = 13), and Hutson TE (n = 11) were major contributors to this research area, with Motzer RJ publishing 16 articles as the first author. The US (n = 73), France (n = 5), Canada (n = 4), and Sweden (n = 4) were the leading countries for RCC studies. MEMORIAL SLOAN KETTERING CANCER CENTER (n = 22) was the institution with the highest number of publications. These 100 articles were derived from 24 journals, and the New England Journal of Medicine had the largest number of articles published (n = 18, impact factor = 91.245). The keyword co-occurrence network analysis showed that research hotspots in this field included molecular mechanisms of RCC development and progression, surgical treatment, targeted drug-related clinical trials, and immunotherapy.

Conclusion:

We analyzed the top 100 articles with the highest number of citations in the field of RCC and identified the influential authors, countries, institutions, and journals in this field. This study also presented the current research status, hotspots, and future trends in RCC.
Privacy awareness among healthcare professionals in intensive care unit: A multicenter, cross-sectional study
Authors: Ozdinc Ahmet , Aydin Zuleyha , Calim Muhittin , Ozkan Ahmet Selim , Bakir Huseyin , Akbas Sedat
Published: February 2023

This multicenter, cross-sectional study aimed to determine and examine the privacy awareness and patient rights education of healthcare professionals working in intensive care units (ICUs). The primary purpose of this study was to determine the privacy awareness of healthcare professionals working in the ICU. In addition, the secondary aim was to examine the relationship between patient rights education and awareness scores, as well as to question the need for privacy awareness education. The study population consisted of ICU physicians, nurses, and allied health personnel working in university hospitals, training and research hospitals, state hospitals, and private hospitals in Turkey. The data were collected through a questionnaire prepared by the researchers, including a question set about sociodemographics, a question about patient rights education, and the privacy awareness scale (PAS) scores using online Google Forms. In the results of the study conducted among 569 participants, the mean total PAS score was 38.31 ± 2.54. The PAS score was significantly different according to the occupation. The PAS scores of the nurses were higher than physicians and allied health personnel. The PAS scores differed according to whether the participants had received patient rights education. This study found that nurses were the group with the highest PAS scores among healthcare professionals. In addition, the PAS scores of nurses working in private and training and research hospitals were higher than those of other hospital employees. On the other hand, the lowest scores belonged to university hospitals and receiving patient rights education increased the PAS score of the nurses. This study showed that all enrolled healthcare professionals required in-service training to gain privacy awareness.
CtDNA’s prognostic value in patients with early-stage colorectal cancer after surgery: A meta-analysis and systematic review
Authors: Fan Xiaoyuan , Zhang Jiakai , Lu Dewen
Published: February 2023

Background:

Circulating tumor DNA (ctDNA) positivity has been shown to suggest the presence of minimally residual tumor cells in numerous investigations. We aimed to assess the prognostic value of ctDNA positivity for recurrence-free survival in patients with early-stage colorectal cancer after radical surgery and following adjuvant chemotherapy.

Methods:

We systematically reviewed studies published in English until August 15, 2022, concerning ctDNA and tumor-node-metastasis I to III colorectal cancer after surgery, and quantified the correlation between ctDNA positivity and early-stage (tumor-node-metastasis stage I–III) colorectal cancer using meta-analysis methods.

Results:

In total, the meta-analysis comprised 1713 patients from 6 studies. Patients with ctDNA-positive colorectal cancer after surgery had a significantly higher risk of recurrence than patients with ctDNA-negative colorectal cancer (hazard ratio 4.64, 95% confidence interval 2.17–9.92, z = 3.96; P < .001). After adjuvant chemotherapy, patients who were ctDNA-positive had a significantly higher risk of recurrence than those who were ctDNA-negative (hazard ratio 7.27, 95% confidence interval 4.50–11.75, z = 8.1; P < .001).

Conclusions:

CtDNA positivity may potentially be a predictor for early-stage colorectal tumor recurrence following surgery and adjuvant chemotherapy.
Enhanced recovery after surgery (ERAS) protocol in geriatric patients underwent unicompartmental knee arthroplasty: A retrospective cohort study
Authors: Li Jia , Zhao Feng , Gao Jianbao , Dong Wei , Yu Xiaoguang , Zhu Chaohua , Liu Sen , Jiang Xiangming , Liu Guobin
Published: February 2023

The enhanced recovery after surgery (ERAS) pathway was formulated with the aim to reduce surgical stress response, alleviate pain and guarantee the best-fit experience of patients’ perioperative period. However, the application of ERAS in geriatric patients who underwent unicompartmental knee arthroplasty (UKA) was relatively lacking. We hypothesize that UKA patients can benefit from the ERAS protocol. A total of 238 patients were recruited in this retrospective study from August 2018 to December 2021, and Oxford phase III UKA was applied to all patients. ERAS pathway included nutrition support, anesthesia mode, interoperative temperature, and blood pressure control, application of tranexamic acid, early initiation of oral intake and mobilization, and pain management. Demographic data, operation-relative variables, and postoperative complications were analyzed. Forgotten Joint Scores, Oxford Knee Score, Lysholm score, numerical rating scale, and knee range of motion were introduced to estimate the activity function and pain of surgical knee, and these variables were compared between the 2 groups. There were 117 patients in the ERAS group and 121 patients in the traditional group, respectively. The ERAS group had a shorter length of surgical incision and less intraoperative blood loss. Postoperative hemoglobin and albumin of patients in the ERAS group were better than those in the traditional group (P < .05), after 17.0 ± 10.8 months follow-up, the numerical rating scale, Lysholm, Oxford Knee Score, Forgotten Joint Scores, and knee range of motion of patients in the ERAS group were significantly better than the traditional group. The length of hospital stay for patients who underwent ERAS was 11.7 ± 3.8 days and the postoperative complication rate was lower for the ERAS group patients (P = .000 and 0.031). ERAS can reduce the length of hospital stay, and patients can achieve excellent postoperative knee function. The formulation and implementation of the ERAS protocol require good collaboration across multiple disciplines, as well as a deep understanding of the existing clinical evidence and the concept of the ERAS program.
Catastrophic antiphospholipid syndrome in lupus-associated immune thrombocytopenia treated with eltrombopag A case series and literature review
Authors: Garra Wakar , Carmi Or , Kivity Shaye , Levy Yair
Published: February 2023

Background:

Eltrombopag, a thrombopoietin receptor (TPO-R) agonist, is considered a second-line treatment for patients with refractory immune thrombocytopenia (ITP). Systemic lupus erythematosus (SLE) is frequently associated with ITP. In some cases, thrombocytopenia in SLE patients is attributed to concurrent antiphospholipid antibodies (APLA). Currently, data regarding treatment with TPO-R agonists for ITP in SLE or APLA patients are limited. The incidence of SLE flare or antiphospholipid syndrome while on TPO-R agonists has not been well-studied.

Cases:

We report 2 cases of female patients with SLE and concurrent triple positive APLA, without thrombotic events in their medical history, in our rheumatology clinic, who were treated for refractory ITP with eltrombopag. Both developed catastrophic antiphospholipid syndrome a few weeks after beginning treatment with eltrombopag. They were admitted to the intensive care unit and treated with solumedrol, plasmapheresis, anticoagulation and rituximab.

Conclusions:

We describe a severe possible side-effect of eltrombopag as a trigger of catastrophic antiphospholipid syndrome, a rare initial manifestation of antiphospholipid syndrome, in SLE patients with APLA. We suggest that APLA should be tested before initiating eltrombopag in patients with SLE-associated ITP. The safety of this treatment should be considered in these cases.
Bibliometric analysis of research articles on post-herpetic neuralgia published from 1991 to 2020
Authors: Kim Jeongsoo , Cheun Hyeon , Jeong Jeong , Lee Ho-Jin
Published: February 2023

Post-herpetic neuralgia (PHN) is one of the most painful diseases, which has made it a major concern for pain physicians. We aimed to quantitatively analyze the research outputs of studies on PHN published over the past 30 years using bibliometric analysis. We also aimed to analyze the research outputs of studies on interventional treatments for PHN and evaluate the academic achievements of Korean pain physicians. Bibliometric analysis was performed by searching the Web of Science database for PHN-related articles published between 1991 and 2020. Publication number, year, source, country, institution, and citation-related information were retrieved from the database. We also quantitatively analyzed publications related to interventional treatments for PHN. A total of 3285 publications were extracted from the database; 101 (3.1%) of the articles were published by South Korean authors, making South Korea the 11th in the order of countries that published the most articles. There were 185 articles on the effects of interventional treatments for PHN. South Korean authors published 30 (16.2%) articles out of these, making South Korea the 3rd in the order of countries that published the most articles on the effects of interventional treatment for PHN. Our results showed an increasing trend in the number of PHN-related publications and the academic achievements of Korean pain physicians in this field over the past 3 decades. However, the proportion of studies on interventional treatments is relatively small. Korean pain physicians need to establish academic evidence on interventional treatment to expand their role in this field and improve the outcomes of PHN patients.
Cross-sectional study examining the epidemiology of chronic pain in Nepal
Authors: Higgins Cassie , Sharma Saurab , Bimali Inosha , Hales Tim G. , Cameron Paul A. , Smith Blair H. , Colvin Lesley A.
Published: February 2023

Introduction:

The World Health Organization recognizes chronic pain as a global public health concern; however, there is a bias towards research conducted in relatively affluent nations. There is a dearth of large-scale epidemiological studies in Nepal using rigorously validated, cross-culturally adapted instruments.

Objectives:

The aim of this study was to examine the prevalence of both chronic pain and chronic pain of predominantly neuropathic origin and their associations with a range of sociodemographic and psychosocial characteristics.

Methods:

We conducted a cross-sectional study of adults (≥18 years) in all households in Ranipani, Baluwa Village Development Committee, Nepal. All adults (n = 887) were approached, and those consenting, who met the inclusion criteria (n = 520, 58.6%), participated. Questionnaires validated in Nepali were used to examine several constructs: demographics; chronic pain; neuropathic pain; pain catastrophizing; resilience, pain intensity; pain interference; sleep disturbance; and depression.

Results:

The point prevalence of chronic pain was 53.3% (n = 277). The point prevalence of chronic pain of predominantly neuropathic origin was 12.7% (n = 66). Chronic pain was associated with female gender, older age, and manual labour occupations. Using standardized scoring techniques, compared with available population estimates from other countries, those with chronic pain were associated with lower pain intensity and resilience scores and higher pain catastrophizing, pain interference, and depression scores.

Conclusion:

These findings are broadly comparable to epidemiological studies from other countries, and these indicate areas for targeting interventions (eg, occupational and mental health). For comparison, more data are needed, from larger population samples in this region.
High Deductibles are Associated With Severe Disease, Catastrophic Out-of-Pocket Payments for Emergency Surgical Conditions
Authors: Scott John W. , Neiman Pooja U. , Scott Kirstin W. , Ibrahim Andrew M. , Fan Zhaohui , Fendrick A. Mark , Dimick Justin B.
Published: February 2023

Background:

Out-of-pocket spending has risen for individuals with private health insurance, yet little is known about the unintended consequences that high levels of cost-sharing may have on delayed clinical presentation and financial outcomes for common emergency surgical conditions.

Methods:

In this retrospective analysis of claims data from a large commercial insurer (2016–2019), we identified adult inpatient admissions following emergency department presentation for common emergency surgical conditions (eg, appendicitis, cholecystitis, diverticulitis, and intestinal obstruction). Primary exposure of interest was enrollment in a high-deductible health insurance plan (HDHP). Our primary outcome was disease severity at presentation—determined using ICD-10-CM diagnoses codes and based on validated measures of anatomic severity (eg, perforation, abscess, diffuse peritonitis). Our secondary outcome was catastrophic out-of-pocket spending, defined by the World Health Organization as out-of-pocket spending >10% of annual income.

Results:

Among 43,516 patients [mean age 48.4 (SD: 11.9) years; 51% female], 41% were enrolled HDHPs. Despite being younger, healthier, wealthier, and more educated, HDHP enrollees were more likely to present with more severe disease (28.5% vs 21.3%, P<0.001; odds ratio (OR): 1.34, 95% CI: 1.28–1.42]); even after adjusting for relevant demographics (adjusted OR: 1.23, 95% CI: 1.18–1.31). HDHP enrollees were also more likely to incur 30-day out-of-pocket spending that exceeded 10% of annual income (20.8% vs 6.4%, adjusted OR: 3.93, 95% CI: 3.65–4.24). Lower-income patients, Black patients, and Hispanic patients were at highest risk of financial strain.

Conclusions:

For privately insured patients presenting with common surgical emergencies, high-deductible health plans are associated with increased disease severity at admission and a greater financial burden after discharge—especially for vulnerable populations. Strategies are needed to improve financial risk protection for common surgical emergencies.
Barriers and Facilitators to Communication Accessibility as Perceived by People With Aphasia
Authors: Kim Esther S. , Mauriks Kira , Wilson Carlee , Auch Leah , Koo Herman , Swensrude Daralynn , Laccett Jessica , Ruelling Andrea
Published: February 2023

Purpose:

Communication access is a human right, but many individuals with communication impairments face challenges accessing their environments. As part of a larger study investigating barriers and facilitators to communication access in the retail/service industry, the purpose of the present study was to investigate the experiences of people with aphasia (PWA) accessing goods and services in their communities.

Methods:

Nine PWA were interviewed about their experiences accessing retail businesses and services. Interviews were coded and thematically analyzed to identify key themes related to barriers and facilitators to communication during business interactions. Stakeholders on the research team included two PWA, who provided input throughout the research process.

Results:

Three main themes were found: supporting communication, aphasia awareness and education, and respect for PWA. Codes within each theme comprised facilitators that led to positive experiences and barriers that led to negative business interactions.

Discussion/Conclusions:

People with aphasia identified tangible ways that retail businesses can be made more communicatively accessible. Stakeholders with aphasia made meaningful contributions to the research process. Future work will investigate how these findings, integrated with business perspectives, can be used to support businesses in applying strategies to become more communicatively accessible.
Long-term Outcomes Associated With Post–kidney Donation Pregnancy Complications
Authors: Palzer Elise F. , Helgeson Erika S. , Evans Michael D. , Vock David M. , Matas Arthur J.
Published: February 2023

Background.

Kidney donors have increased risk of postdonation gestational hypertension (gHTN) and preeclampsia. In the general population, pregnancy complications are associated with long-term maternal risk. However, little data exist on whether donors with postdonation pregnancy-related complications have similar increased long-term risks. We studied whether postdonation gHTN, preeclampsia/eclampsia, or gestational diabetes (gDM) was associated with increased risk of developing hypertension, DM, cardiovascular disease, or estimated glomerular filtration rate <45 mL/min/1.73 m2.

Methods.

Postdonation pregnancies with complications were matched to pregnancies without complications based on time from donation. Incidence of outcomes was compared using sequential Cox regression with robust standard errors. Donors with predonation pregnancy complications were excluded. Models were adjusted for age at pregnancy, gravidity, year of donation, and family history of hypertension, DM, and heart disease.

Results.

Of the 384 donors with postdonation pregnancies (median [quartiles] follow-up of 27.0 [14.2–36.2] y after donation), 39 experienced preeclampsia/eclampsia, 29 gHTN without preeclampsia, and 17 gDM. Median interval from donation to first pregnancy with preeclampsia was 5.1 (2.9–8.6) y; for gHTN, 3.7 (1.9–7.8) y; and for gDM, 7.3 (3.7–10.3) y. Preeclampsia/eclampsia (hazard ratio [HR] 2.70; 95% confidence interval [CI], 1.53-4.77) and gHTN (HR 2.39; 95% CI, 1.24-4.60) were associated with development of hypertension. Preeclampsia/eclampsia (HR 2.15; 95% CI, 1.11-4.16) and gDM (HR 5.60; 95% CI, 1.41-22.15) were associated with development of DM. Pregnancy-related complications were not associated with increased risk of cardiovascular disease or estimated glomerular filtration rate <45 mL/min/1.73 m2.

Conclusions.

In our single-center study, postdonation preeclampsia, gHTN, or gDM was associated with long-term risk of hypertension or DM.
Current advances in endovascular treatment
Authors: Molad Jeremy , Honig Asaf
Published: February 2023

Purpose of review

Endovascular thrombectomy (EVT) is the most beneficial reperfusion therapy for acute ischemic stroke. Currently, much effort is done to promote trials examining EVT efficacy and safety in various conditions not included in the main randomized controlled trials established the superiority of EVT. This review summarizes the current advances of EVT patients’ selection and periprocedural management.

Recent findings

Recent evidence points to beneficial effect of EVT among patients with relatively large ischemic core, premorbid independent nonagenarians and basilar artery occlusion, and suggest that intravenous thrombolysis bridging treatment is associated with better reperfusion rates. Ongoing trials currently examine EVT efficacy and safety in distal vessel occlusions and in large vessel occlusion with low NIHSS. Current evidence also support use of general anaesthesia and avoid postprocedural extremely low or high blood pressure as well as haemodynamic instability.

The field of EVT is rapidly evolving. The results of recent trials have dramatically increased the indications for EVT, with many ongoing trials examining further indications.
Pharmacological treatment for older adults with epilepsy and comorbid neurodegenerative disorders
Authors: O’Dwyer Rebecca , Foster Emma , Leppik Ilo , Kwan Patrick
Published: February 2023

Purpose of review

An increased interest in epilepsy in older adults has emerged as the global population ages. The purpose of this article is to review the literature regarding the pharmacological treatment of epilepsy in older adults, highlighting issues specifically pertinent to those living with comorbid neurodegenerative disorders.

Recent findings

Although new original research remains sparse, in the last 5 years, there has been a growing number of studies addressing the relationship between epilepsy and neurodegenerative disorders. Accurate diagnosis is incredibly challenging with electroencephalogram findings often requiring circumspect interpretation. Older individuals are often excluded from or under-represented in clinical trials, and there are sparse guidelines offered on the management of these patients, with even less available in reference to those with neurodegenerative comorbidities.

We propose that seizures occurring earlier in the neurodegenerative process should be treated aggressively, with the goal to inhibit neuro-excitotoxicity and the associated neuronal loss. By strategically choosing newer antiseizure medications with less adverse effects and a holistic approach to treatment, a patient's time living independently can be conserved. In addition, we advocate for original, multinational collaborative research efforts.
Lessons from the coronavirus disease 2019 pandemic in schizophrenia: a review
Authors: Fond Guillaume , Boyer Laurent
Published: February 2023

Purpose of review

Multiple countries have reported increased COVID-19 mortality in patients with schizophrenia. The purpose of this review was to synthetize the consequences of the pandemic on patients with schizophrenia including vaccination data.

Recent findings

We have synthetized data on the increased risk of infection and increased mortality, the impact of the pandemic and lockdowns on psychiatric care, vaccination policies, unwillingness to vaccine in patients and the rates of vaccination.

Schizophrenia has been confirmed at increased risk of both COVID-19 infection and developing a severe/lethal form of the infection. Patients with schizophrenia should, therefore, be prioritized for vaccination whenever possible and should be prioritized for psychiatric and somatic care access. Psychotic symptomatology may be a barrier to vaccination in some patients, and heterogenous vaccination rates were identified in national databases. The COVID-19 pandemic has been also a unique opportunity to develop telehealth. A mixed face-to-face and distance model should be encouraged, whenever possible, to improve the experience of patients, relatives and healthcare professionals. No major change of long-acting antipsychotics has been reported in most countries, and there was no consistent evidence for clozapine prescription to increase the risk of COVID-19 infection or severe outcomes.
Is climate change affecting mental health of urban populations?
Authors: Cianconi Paolo , Hanife Batul , Hirsch Daniele , Janiri Luigi
Published: February 2023

Purpose of review

In this article, we outline an up-to-date overview of the climate change impact on mental health of urban population, conducted by searching the PubMed database for relevant studies published in the past 12–18 months, in English.

Recent findings

Climate change is part of a larger systemic ecological problem in which human demands are exceeding the regenerative capacity of the biosphere. We are witnessing a ‘climate chaos’, a phase of instability and transformation, which is leading humans into a psychological condition of ‘systemic insecurity’ and a shared feeling of uncertainty. Currently, one of the places where our species is particularly exposed to climate change are cities, due to build-up in urban infrastructure, rapid and chaotic urbanization, high densities and recent rapid growth, social inequality, and ‘heat island effect’.

The impact of climate change on cities exposes vulnerable groups to the worse mental health consequences. These groups include the homelessness, slum dwellers for whom the ‘neighbourhood effects’ are being discussed, climate refugees and migrants, young people, and finally those who assist these people.

In order to realize broader mental health prevention in cities exposed to climate change phenomena, public health approaches are needed. Institutions must avoid reinforcing inequalities among the more vulnerable groups or create new inequalities.
Molecular tracking of carbapenem-resistant Acinetobacter baumannii clinical isolates: a multicentre study over a 4-year period across eastern China
Authors: Zhao Yayun , Zhu Yunzhu , Zhang Hui , Zhang Lingyan , Li Jiabin , Ye Ying
Published: February 2023

Introduction. Colonization by carbapenem-resistant

Acinetobacter baumannii

(CRAB) causes therapeutic and economic problems for critically ill patients.

Gap Statement. The analysis of CRAB in China was limited to certain regions.

Aims. To investigate the antibiotic susceptibility, molecular characterization and clonal relationship among CRAB isolates from multiple hospitals of eastern China.

Methodology. Isolates from 29 tertiary hospitals from September 2015 to September 2018 were recovered. All strains were analysed using antimicrobial susceptibility testing to detect their tolerance. PCR was also used to detect multiple β-lactamase genes. After multilocus sequence typing (MLST) of seven house-keeping genes. eBURST was used to assess clonal complexes and explore evolutionary relationships.

Results. All isolates showed resistance to carbapenems, while remaining susceptible to colistin and tigecycline. All isolates were detected with bla
OXA-51 gene by PCR, and 80.1 % harboured the bla
OXA-23 gene. The prevalence of blaOXA-23 gene was remarkably increased from 50.7 % in 2015 to 90.5 % in 2018. Other genes such as bla
OXA-24, bla
OXA-58, bla
IMP-2/4, bla
VIM-2, bla
SHV, bla
AmpC and bla
TEM were also obtained. While bla
KPC, bla
NDM-1, bla
IMP-4 and bla
SIM-1 were not found in these strains. MLST showed all isolates could be divided into 26 known sequence types (STs) and ten novel STs and 47.2 % isolates belong to ST195 and ST208. eBURST revealed clonal complex 92 as the major clonal complex (98.4 %), which includes 88.5 % (23/26) of known STs and 80 % (8/10) of unknown STs. Phylogenetic analysis also found that almost all CRAB isolates could cluster into one lineage, suggesting an epidemic of this CRAB lineage. This indicated severe nosocomial infections of CRAB in multiple hospitals of eastern China.

Conclusion. An outbreak of ST195 and ST208 CRAB-resistant clones with bla
OXA-23 gene might be happening in multiple hospitals in eastern China.