bluuebunny/crossref_metadata_2025 huggingface dataset:
Acupuncture and its role in the treatment of ischemic stroke: A review
Authors: Wang Zuoshan , Wang Manya , Zhao Haishen
Published: October 2024

Acupuncture is a traditional Chinese medicine therapy that is treatment by placing a needle or pressure in a specific position on the patient’s skin. Although used in the treatment of various diseases, acupuncture is effective in the treatment of ischemic stroke (IS), and has made some progress in the mechanism of action of the treatment of this disease. IS is difficult to treat, and there is a high rate of disability. Drug therapy is usually the first line of treatment, but adjuvant therapy has outstanding efficacy in promoting the rehabilitation of the disease and preventing sequelae. Among them, acupuncture is getting more and more attention as a more popular treatment method. Therefore, this study excavates the high-quality randomized controlled trials and meta-analysis of acupuncture for IS in recent years to further summarize the efficacy of acupuncture for IS. In this review, we provide an overview of the current understanding of acupuncture and IS, and the current studies investigating the effectiveness of acupuncture in the treatment of IS.
The relationship between fragility scores and intraoperative body temperature changes in geriatric patients: Prospective observational research
Authors: Arslan Fatma Nur , Dagli Recai , Ceran Güzin , Horoz Levent , Türker Yunus
Published: October 2024

Today, to evaluate morbidity and mortality in elderly surgical patients, fragility scores, which reflect the patient’s current condition rather than increasing age, are used as a basis. Our research examines the association between fragility groups, body temperature changes, and inadvertent perioperative hypothermia (IPH) in major orthopedic surgery patients. Patients over the age of 65 who underwent major orthopedic surgery were evaluated. Body temperature measurements were taken tympanically preoperatively and every 5 minutes during surgery. Temperature changes (Δn) were calculated. Patients whose body temperature was below 36 °C were recorded as IPH. The Canadian Study of Health and Aging-Clinical Frailty Scale scoring system, consisting of 9 categories, was used for fragility scores. As the category number increases, the level of fragility increases. These categories are classified into 3 subgroups: Group F1 (Level 1–3), Group F2 (Level 4–7), and Group F3 (Level 8–9). Age groups: it is defined as Group A1 (66–74 years), Group A2 (75–84 years), and Group A3 (85<). The median (min–max) of surgery time was determined as 75 (35–131). For Δ35 (ºC), the differences between both fragility groups (P = .054) and the age groups (P = .145) were not significant. IPH frequency is 44.0% (n = 149). No difference was detected between hypothermia frequencies in the fragility groups (P = .546) and the age groups (P = .065). Nearly half of major surgery patients developed IPH. We did not find a relationship between both fragility groups and age groups and the frequency of IPH.
Clinical and pathological characteristics of gastric large cell neuroendocrine carcinoma: A report of 2 cases series and literature review
Authors: Wang Bo , Si Yuan , Dou Yan , Li Yongcai , Liu Zhongxin , Huang Chaokang , Xu Xin
Published: October 2024

Rationale:

Gastric large cell neuroendocrine carcinoma (LCNEC) is a rare, aggressive neuroendocrine carcinoma that arises from the stomach and with high malignancy. Patients with gastric LCNEC usually have a poor prognosis. The standard treatment plan has not been established and its curative effect is poor. The present study described 2 cases diagnosed with gastric LCNEC and reviewed in depth the literature to improve our understanding more about this uncommon tumor and further to provide more experience to diagnose and treat this disease.

Patient concerns:

The present study reported 2 cases of gastric LCNEC in male patients aged 51 and 73 years old, respectively. Both patients had epigastric discomfort, pain, acid reflux and heartburn. The medical history was unremarkable.

Diagnoses:

The ulcerative lesion located at gastric was examined in the 2 patients by taking the esophagogastroduodenoscopy (EGO), computed tomography (CT) and digital gastrointestinal radiography (GI), that both were suspected gastric malignancy. Endoscopic biopsies of the tumor led to the initial diagnosis of gastric cancer. Postoperative pathological and immunohistochemical examinations of the surgical specimens confirmed that 1 case had mixed adeno-neuroendocrine carcinoma (MANEC) and the other had LCNEC.

Interventions:

Both patients underwent surgical resection and received etoposide-cisplatin combination chemotherapy following surgery.

Outcomes:

The operation was successful. Both patients had uneventful recoveries following surgery, and had been followed-up regularly. The general condition was satisfactory, and no tumor metastasis was observed at present.
Clinical application of myofascial therapy in the treatment of postpartum pain-related functional disorders: A review
Authors: Zhang Jiangchun , Pang Tingting , Yao Junjie , Li Ailin , Dong Li , Wang Yueting , Wang Yufeng
Published: October 2024

During pregnancy, fetal growth could lead to changes in human biomechanics. If postpartum recovery was not properly managed, it could be exacerbated, resulting in myofascial system disorders and various functional impairments. Among them, pain-related functional disorders were an important issue affecting quality of life in postpartum women. The pathogenesis of these disorders remained unclear but it was primarily associated with changes in biomechanics, the endocrine system, and nervous function. However, postpartum pain-related dysfunction had been considered a normal physiological response to childbirth, leading to a lack of attention. Therefore, many postpartum women failed to receive timely, effective, and standardized treatment, hindering their ability to reintegrate into family and society, and causing severe damage to their physical and mental health. In clinical practice, myofascial therapy could effectively alleviate postpartum pain and muscle spasms, improve excessive tension injuries in myofascial, and had a good therapeutic effect on postpartum pain-related functional disorders. The mechanism of myofascial therapy involved improving core muscle strength, restoring normal body alignment, and promoting the remodeling of myofascial mechanical structures. This article explored the positive effects of myofascial therapy on postpartum pain-related functional disorders from a biomechanical perspective, aiming to provide diverse treatment approaches for clinical practitioners.
Association between oxidative balance score and chronic obstructive pulmonary disease: A cross-sectional study
Authors: Chen Weiyan , Zhang Wei
Published: October 2024

Oxidative stress is an essential contributor to the progression of chronic obstructive pulmonary disease (COPD). A systematic assessment of diet patterns and lifestyle with the oxidative balance score (OBS) to reflect oxidative stress levels will help predict the risk of COPD. This study conducted a cross-sectional analysis to assess the link between OBS and COPD. 5162 participants were collected from 2013 to 2018 from the National Health and Nutrition Examination Survey (NHANES). Multivariate logistic regression models were applied to assess the relationship between OBS and COPD prevalence. The linearity of the association was explored using smoothed curve fitting. In addition, further subgroup analysis and interaction tests were conducted to ascertain the consistency of the relationship across diverse populations. Results of the multivariate logistic regression models indicated a negative association between OBS and the odds of COPD prevalence. Each incremental unit in OBS correlated with a 3% reduction in the odds of COPD in the fully adjusted model (OR 0.97, 95% CI 0.95–0.99). Further analysis by OBS tertiles indicated that individuals in the highest OBS tertile (T3) had a 17% lower probability of COPD compared to those in the lowest tertile (T1) in the fully adjusted model (OR 0.83, 95% CI 0.64–0.97). The smoothed curve fitting supported the negative association between OBS and COPD. Subgroup analyses revealed that the protective effect of OBS was notably pronounced among the non-hypertensive and non-diabetic populations. These findings suggest a negative link between OBS and COPD, underscoring the importance of antioxidant-rich diets and lifestyles in preventing COPD.
Current advances in the treatment of myofascial pain syndrome with trigger point injections: A review
Authors: Anwar Nadia , Wei Xiong , Jie Yuan , Hongbo Zhao , Jin Hao , Zhu Zhaoqiong
Published: October 2024

Myofascial pain syndrome (MPS) caused by trigger points in muscles is a common cause of local or generalized pain, which is clinically common, has a high incidence, and has no specific cure. The most popular and widely used clinical method mainly targets the trigger point for treatment, i.e. trigger point injection (TPI) therapy. The injectable drugs mainly include glucose, saline, local anesthetics, botulinum toxin type A, platelet-rich plasma, platelet-poor plasma, steroid preparations, etc. This method is low cost and less invasive, and early clinical applications have shown good efficacy. In this paper, we have reviewed clinical research progress in treating MPS with TPI therapy.
Intra-articular injection of chitosan combined with low-dose glucocorticoid for the treatment of knee osteoarthritis in early and middle stages
Authors: Liu Jiuxiang , Huang Xiaowen , Lv Tianrun , Cao Liang , Lu Lu
Published: October 2024

This study explores the clinical efficacy of intra-articular injection of chitosan combined with low-dose glucocorticoid for the treatment of knee osteoarthritis in early and middle stages. The visual analog scale (VAS) score, Lysholm score, Hospital for Special Surgery (HSS) score, and changes in the levels of inflammatory cytokines IL-1, IL-6, and TNF-α in the joint fluid before and after treatment in the 3 groups were compared, and the clinical efficacy was evaluated. All cases were followed up, with a follow-up time of 7 to 12 months, and no lost cases. The horizontal comparison showed that the VAS score, Lysholm score, HSS score, and levels of inflammatory cytokines IL-1, IL-6, and TNF-α in the joint fluid after treatment in each group were better than before treatment, and the difference was statistically significant (P < .05). The longitudinal comparison showed that there was no significant difference in VAS score, Lysholm score, HSS score and levels of inflammatory cytokines IL-1, IL-6, and TNF-α in synovial fluid among the 3 groups before treatment (P > .05); However, after treatment, there were significant differences among the 3 groups (P < .05), group C was better than group A and group B, group B was better than group A, and the differences were statistically significant (P < .05). The difference in clinical efficacy among the 3 groups was statistically significant (P < .05). The clinical efficacy of chitosan combined with low-dose glucocorticoid intra-articular injection in the treatment of knee osteoarthritis in early and middle stages is significant, with the characteristics of small trauma, rapid onset, and lasting efficacy, and it avoids the adverse reactions of topical or oral nonsteroidal anti-inflammatory drugs. As a first-line treatment option, it is recommended for promotion and use in clinical practice.
Association of hepatitis B virus and thyroid hormones during pregnancy
Authors: Wang Jing , Yang Xiaoqiong , Liang Xiuzhen , Zhang Yan
Published: October 2024

This study aims to evaluate the correlation between serum thyroid hormone levels and hepatitis B virus (HBV) DNA and HBV genotypes in pregnant women with chronic hepatitis B. A total of 96 pregnant women with chronic HBV-infected pregnant women between January 2020 and December 2022 were selected as the observational study subjects. About 50 HBV-uninfected pregnant women during the same period were selected as the control group. Serum thyroid hormone levels at different stages of pregnancy, including free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), thyroperoxidase antibody (TPOAb), and thyroglobulin antibody (TGAb), were compared between the 2 groups. Thyroid hormones levels were also compared between HBV-DNA-positive and HBV-DNA-negative women in the HBV-infected pregnancy group, and to determine the correlation between thyroid hormones levels and HBV-DNA load and HBV genotype in HBV-DNA-positive pregnant women. The TSH levels in mid and late pregnancy and TPOAb levels in early, mid, and late pregnancy of HBV-infected pregnant women were higher than those in the same period in HBV-uninfected pregnant women (P < .05). The TPOAb and TGAb levels in early, mid, and late pregnancy of HBV-DNA-positive pregnant women were higher than those in the same period in HBV-DNA-negative pregnant women (P < .05). The HBV-DNA load and FT3 or FT4 levels were negatively correlated (P < .05), and the HBV-DNA load and TGAb levels were positively correlated (P < .05). However, there was no statistical difference in thyroid hormone levels between different HBV genotypes (P > .05). The thyroid hormone levels will change in pregnant women infected with hepatitis B virus, and there is a certain correlation between HBV-DNA load and thyroid hormone levels. Therefore, timely monitoring of thyroid hormones and HBV-DNA load can provide early prevention and treatment for HBV infection in pregnant women, ensuring the health of pregnant women and fetuses.
Macrofollicular subtype of papillary thyroid carcinoma: Ultrasonographic findings and clinical implications
Authors: Oh Jiyun , Shin Jung Hee , Hahn Soo Yeon , Kim Haejung , Kim Myoung Kyoung , Oh Young Lyun
Published: October 2024

The macrofollicular subtype of papillary thyroid cancer (MFS-PTC) is a rare subtype often leading to a challenging diagnosis. To evaluate the ultrasonographic (US) features and clinical implication of MFS-PTC. Records of 14 patients histologically diagnosed with MFS-PTC at our institution over a period of 16 years were retrospectively reviewed. Preoperative US features, Bethesda categories determined by fine-needle aspiration (FNA) or core needle biopsy (CNB), and final pathology were assessed in all patients with MFS-PTC. Of the 14 MFS-PTC cases, most nodules were noted as smooth marginated, solid or predominantly solid isoechoic on US and were categorized as low suspicion in 12 cases and intermediate suspicion in 2 cases. The median tumor size was 1.2 cm (range, 0.6–5.6 cm). Of 11 cases that underwent FNA or CNB, 4 (36.4%) with Bethesda category II or III underwent the follow-up because of benign-looking appearance on US and benign results in subsequent CNBs. However, the patients underwent delayed surgery (31.3 months, range 12–41 months) because of serially increased tumor size. Seven patients diagnosed with Bethesda type IV, V, and VI subsequently underwent surgery. Gross extrathyroidal extension into subcutaneous fat tissue and lateral lymph node metastasis were noted in a patient who underwent follow-up. No distant metastases or recurrence was detected. MFS-PTC is representative of a benign sonographic appearance of PTC subtypes. Tumor growth on serial US images is the only suspicious finding for MFS-PTC because FNA or CNB is often false negative.
Pain and cognitive function in Korean older adults aged 60 years or more: A retrospective longitudinal study
Authors: Kim Yun-A , Cho Yoon Jeong , Kwak Sang Gyu , Ko Hae-Jin
Published: October 2024

To elucidate the relationship between pain and cognitive decline in adults aged ≥60 years using data from the Korean Longitudinal Study of Aging survey. We included 3,287 older adults aged ≥60 years with a Korean Mini-Mental State Examination score ≥24. We assessed the presence of pain and pain interference using self-administered questionnaires. Pain interference was determined based on whether the pain limited the participants’ activities of daily living. According to this assessment, participants were categorized as no pain, low-impact pain, and high-impact pain. Cognitive function was assessed using the Mini-Mental State Examination and classified into 3 groups: normal, cognitive impairment, and suspected dementia. Potential confounding factors, including pain × survey year, were adjusted in the analyses. We also performed subgroup analyses of participants experiencing pain to elucidate the association between pain interference, suspected dementia, and cognitive impairment. A significant difference in the Mini-Mental State Examination scores was observed between individuals with and without pain (P < .001). Pain remained negatively associated with the Mini-Mental State Examination score through the first to the eighth wave even after adjusting for confounding factors (β = ‐1.170, 95 % confidence interval (CI): −0.243, −0.097). Compared to the absence of pain, the presence of pain increased the odds of suspected dementia and cognitive impairment by approximately 1.6 and 1.4 times, respectively (odds ratio [OR] = 1.56, 95% CI: 1.26, 1.93; OR = 1.36, 95% CI: 1.20, 1.54). Compared to low-impact pain, high-impact pain increased the odds of suspected dementia and cognitive impairment by approximately 2.1and 1.5 times, respectively (OR = 2.12, 95% CI: 1.76, 2.56; OR = 1.47, 95% CI: 1.31, 1.65). Pain was negatively associated with Mini-Mental State Examination scores in Korean older adults aged ≥60 years and increased the odds of suspected dementia and cognitive impairment. Furthermore, individuals with high-impact pain exhibited higher risks of both suspected dementia and cognitive impairment than those with low-impact pain.
Invasive fungal infections in patients with acute leukemia: A retrospective cohort study at a tertiary-care hospital
Authors: Alkan Asli , Buyukasik Yahya , Uzun Omrum , Demir Ahmet Ugur , Coplu Lutfi
Published: October 2024

Invasive fungal infection (IFI) is an important cause of morbidity and mortality in acute leukemia patients. In the past few decades, the incidence of IFI has dramatically increased. Nevertheless, the management of IFI has become more complicated owing to changes in the epidemiology of fungal diseases and therapeutic regimens. Therefore, it is important to establish an appropriate strategy for centers that provide the diagnosis and treatment of acute leukemia patients based on scientific data and with available resources. In this study we investigated the incidence of IFI, pathogens, the use of diagnostic methods, and risk factors for IFI in acute leukemia patients over a 17-year period. A total of 502 acute leukemia patients (male/female: 57%/43%, mean age: 57.7 ± 15.5 years) hospitalized at adult and oncology hospitals between 2003 and 2020 were reviewed retrospectively. The incidence of proven and probable IFI was 13.2% (33.1%, when possible cases were included). The most common IFI was aspergillosis (49 patients, 9.7%), followed by candidemia, mucormycosis, and Pneumocystis jirovecii pneumonia. The galactomannan antigen test was positive in the serum of 39 (23.5%) patients and in bronchoalveolar lavage (BAL) fluid in 6 (3.6%) patients. Thirteen (7.8%) sputum cultures (11 Aspergillus spp. and 2 Candida spp.) and 4 (2.4%) BAL fluid (1 Aspergillus spp., 2 Candida spp., 1 P jirovecii) were positive for a fungal pathogen. Neutropenia, intensive care unit (ICU) follow-up and mechanical ventilation (MV) increased the risk of IFI by 3.5, 2.5, and 1.8 times, respectively. The median survival was 5 (range: 1.9–8) months. ICU follow-up shortened the survival by 12 months and increased the death risk by 2.49-fold. MV shortened survival by 57 months and increased the death risk by 3.82-fold. IFI remains a significant contributor to the morbidity and mortality in acute leukemia patients. Pulmonary involvement is the most common site. Neutropenia, ICU follow-up and MV are associated with an increased risk for IFI and mortality. We recommend in the IFI approach, to be aware of IFI in patients receiving intensive chemotherapy and/or recipients of hematopoietic stem cell transplantation, and to evaluate with microbiological, serological and radiological tests during the clinical follow-up.
The impact of femoral/internal jugular vein selection on postoperative infection in central vein cannulation of newborns undergoing cardiac surgery
Authors: Ozalp Serife , Ozalp Onur , Gumuş Ozcan Funda
Published: October 2024

In the low-weight newborn patient group, the development of catheter related bloodstream infections after cardiac surgery significantly impacts morbidity and mortality. In our study, the effects of choosing femoral or internal jugular vein localization in newborns on postoperative infection will be examined. Our hypothesis is that there may be a higher risk of catheter related bloodstream infections in the femoral region. This study was conducted retrospectively on newborn cases who underwent congenital heart surgery between September 1, 2020, and March 1, 2022. The cases were divided into 2 groups: those with central catheters inserted in the femoral and in internal jugular veins. Postoperative infection parameters were examined and the results were statistically evaluated. The study was conducted with a total of 201 newborn cases, of which 61.2% (n = 123) were male and 38.8% (n = 78) were female. The age of the cases ranged from 0 to 1 month, with a mean of 12 ± 9 days. Weight measurements ranged from 1.8 to 5.5 kg, with a mean of 3.20 ± 0.66 kg. Central catheters were placed in the femoral vein (FV) region in 71.6% of the babies (n = 144) and in the internal jugular vein region in 28.4% (n = 57). When culture results were examined between postoperative days 3 to 14, blood culture tests were positive in 12.4% (n = 25). The most common bacteria in positive cases were Klebsiella spp. (n = 13) and methicillin-resistant Staphylococcus aureus (n = 5). There was no statistically significant difference in blood culture results between the groups (P > .05). Changes in white blood cells, C-reactive protein, and procalcitonin measurements between preoperative and postoperative day 3 did not show statistically significant difference between the groups (P > .05). According to the results of our study, the placement of FV and internal jugular vein in neonates undergoing cardiac surgery did not differ in terms of postoperative infection risk. With appropriate sterilization, preventive measures and care considerations, FV or internal jugular vein region may be preferred based on the practitioner’s expertise and choice in this patient group.
A novel BCHE frameshift mutation in a Chinese woman with butyrylcholinesterase deficiency: A case report and literature review
Authors: Zeng Jiantao , Yang Dan , Dai Tao , Xia Jun , Zheng Zhaobin
Published: October 2024

Rationale:

Congenital butyrylcholinesterase deficiency (BCHED) is a rare autosomal recessive genetic disorder caused by a pathogenic mutation in the BCHE gene. Patients with BCHED may experience prolonged apnea or even death after the application of drugs such as succinylcholine. We aimed to identify the genetic basis of disease in a patient presenting with butyrylcholinesterase deficiency in order to confirm the diagnosis, expand BCHE gene mutation spectrum, and elucidate potential genotype-phenotype associations to inform management.

Patient concerns:

A 51-year-old woman presented with “vague pain in the upper and middle abdomen.” Her serum cholinesterase level was 211 U/L (reference value 4000–13,000 U/L). Other laboratory findings were normal. Genetic analysis revealed compound heterozygous mutations in BCHE gene, which was considered pathogenic in this case.

Diagnoses:

The patient presented with low serum cholinesterase levels, which excluded common causes such as liver disease, drug toxicity, and chronic illness. Whole exon examination revealed compound heterozygous mutations in the BCHE gene; thus, the patient was diagnosed with congenital BCHED.

Interventions:

Gastroscopy without succinylcholine or mivacurium chloride was recommended. The gastroscopy results were “gastric polyps,” and gastroscopic “polypectomy” was performed. The patient was advised to avoid succinylcholine use.

Outcomes:

The patient’s serum cholinesterase level was reviewed 3 months later, and the result was 215 U/L. Double heterozygous mutations are the cause of BChE deficiency of this woman in this study, including a novel mutation NM_000055.4: c.666_669del (p.Phe223Glufs*38). A review of the literature reveals considerable variation in the hotspot variants of the BCHE gene across different populations. The Chinese population displays a higher prevalence of the silent type, which is more sensitive to anesthetics such as succinylcholine.

Lessons:

Clinical manifestations of congenital BCHED were not significant. This study avoided a potential anesthetic accident, and the novel variant enriched the BCHE gene mutation spectrum.
Successful placement of a chest wall venous infusion port via persistent left superior vena cava: A case report
Authors: Wang Ziqiang , Li Rongguo , Du Qiwei , Zhang Weijun , Wang Zhenyu
Published: October 2024

Rationale:

Persistent left superior vena cava (PLSVC) is a rare congenital venous anomaly occurring in approximately 0.3% to 0.5% of the population. The presence of PLSVC complicates central venous catheter placement, increasing procedural risks. This case report describes the successful placement of a chest wall venous infusion port in a patient with PLSVC, offering valuable insights for managing similar cases and ensuring safer clinical outcomes.

Patient concerns:

A 51-year-old female, 3 weeks post-right breast cancer surgery, was admitted for her first adjuvant hemotherapy session. She requested the placement of a venous infusion port due to the prolonged duration of chemotherapy.

Diagnoses:

Imaging studies suggested the presence of PLSVC. Echocardiography revealed a dilated coronary sinus, and subsequent chest computed tomography and angiography confirmed the presence of PLSVC.

Interventions:

A chest wall venous infusion port was inserted via the left internal jugular vein. Due to the PLSVC, the catheter was adjusted to ensure proper placement.

Outcomes:

The patient successfully completed chemotherapy without any complications or discomfort associated with the venous port. Imaging studies, including chest X-ray and computed tomography, confirmed proper port function and catheter positioning, with no evidence of thrombosis, infection, or other related issues. The patient remained in good overall condition throughout the treatment.

Lessons:

Detailed preoperative evaluations, intraoperative imaging guidance, and postoperative follow-ups are crucial for the safe and effective management of PLSVC patients undergoing central venous catheter placement.
Predictive value of serological indices for guiding bundle of care to prevent the occurrence of poststroke fatigue for ischemic stroke survivors
Authors: Ma Qiuping , Yang Jinpan , Suen Lorna Kwai Ping , Zhang Jialin , Yang Chunxiao , Zhong Mingyang
Published: October 2024

Almost half of ischemic stroke (IS) survivors have poststroke fatigue (PSF) during rehabilitation, which can reduce their rehabilitation compliance and quality of life. The primary link of PSF management is early identification, which can guide bundle of care for prevention. This study aimed to explore the predictive value of serological indicators for guiding bundle of care to prevent the occurrence of PSF among IS survivors. This study was a prospective observational study. A total of 350 patients with IS who were hospitalized in 2 tertiary hospitals in Nanning from October 2022 to September 2023 were selected. The general data of patients and serological indicators within 24 hours of admission were collected. Based on the follow-up results, the patients were divided into the PSF group and the NPSF group. Multivariate logistic regression analysis was used to screen the risk factors affecting the occurrence of PSF, and the receiver operating characteristic curve (ROC curve) method was used to analyze the predictive value of this factor. The incidence of acute-phase PSF among elderly patients with IS was 49.26%. The elevated levels of fasting plasma glucose (FPG) (OR = 1.485, 95% CI: 1.145–1.925, P = .003), total cholesterol (TC) (OR = 1.394, 95% CI: 1.013–1.917, P = .041), C-reactive protein (CRP) (OR = 1.394, 95% CI: 1.013–1.917, P = .041), and homocysteine (Hcy) (OR = 1.370, 95% CI: 1.233–1.524, P < .001) were risk factors of PSF in elderly patients with acute IS (P < .05). FPG (area under the curve = 0.632), TC (area under the curve = 0.621), CRP (area under the curve = 0.889), and Hcy (area under the curve = 0.807) had a good predictive value for acute-phase PSF, and the combination of the 4 indicators could further improve the predictive efficacy (area under the curve = 0.938, sensitivity 86.2%, specificity 90.7%, P < .05). The elevated levels of FPG, TC, CRP, and Hcy could predict the risk of PSF, and the combination of the 4 indicators can effectively improve prediction efficiency and provide a reference for guiding the formulation of bundle nursing programs.
Is the acute compartment syndrome diagnosed in snake bites true?: A review
Authors: Cañas Carlos A.
Published: October 2024

Envenomation caused by venomous snakes can induce clinical symptoms and signs resembling those of traumatic acute compartment syndrome (ACS), but it is uncertain whether its treatment guidelines are applicable or beneficial for ACS that is associated to snakebites. Nonetheless, recommendations for the diagnosis and treatment of trauma-induced ACS, particularly following fractures of the tibial diaphysis, are extrapolated to the diagnosis and treatment of snakebites despite evidence that the ensuing injuries are frequently not true ACS. Most biologists agree that the venom of snakes, especially those of the Crotalinae family (vipers) evolved to immobilize, kill, and initiate the digestion of their prey. The human local effects of viper envenoming are the result of digestion like those described in biological processes as acute pancreatitis, including secondary inflammatory and induction of reparative effects. The first-line treatment should focus on mitigation of venom-induced tissue digestion rather than surgery solution for “ACS-like” symptoms and signs. This type of analysis leads to questioning that treatment of ACS associated with snakebite cannot be extrapolated from recommendations formulated for trauma-induced ACS. The cornerstone of snake envenoming treatment is antivenom, and some clinical and experimental experiences start to show that surgical procedures frequently employed for trauma-induced ACS, such as debridement and fasciotomy, may be exaggerated and even deleterious in most viper bite envenoming.
Lived Experience of Postpartum Women in Recovery for Opioid Use Disorder on Medication-Assisted Therapy
Authors: MacPherson Caron
Published: October 2024

Purpose:

The purpose of this study was to understand the lived experiences of postpartum women on medication-assisted therapy for opioid use disorder.

Study Design and Methods:

van Manen's interpretive hermeneutic phenomenological design was used. Recruitment and data collection from seven participants occurred at an outpatient office offering care for perinatal patients on medication-assisted therapy for opioid use disorder. Data collection occurred between September 2021 and March 2022 via in-person interviews using a demographic data sheet, interview guide, speech recognition software, and digital recordings. Demographic data were analyzed using descriptive statistics. Qualitative data were analyzed using precoding, coding, and thematic analysis via van Manen's interpretive hermeneutic phenomenological method.

Results:

Seven themes were identified: troubled origins, used opioids to deal with life issues, needed to be self-reliant, opioid use disorder overtook their life, the baby was a motivator to seek treatment, the need for combined medication-assisted therapy and collaborative care, and hope for a better life.

Clinical Nursing Implications:

Nurses can provide trauma-informed care, support the importance of medication-assisted therapy in recovery, incorporate a collaborative care team with expertise in postpartum opioid use disorder, continue the collaborative care team for a minimum of 1 year, and advocate for the patient's role as parent.
Holistic Nursing Care for Perinatal Loss Based on Swanson's Theory of Caring
Authors: Berry Shandeigh N. , Lazcano Shania
Published: October 2024

Purpose:

The purpose of this study was to inform perinatal loss care by expanding upon the five processes of Swanson's Theory of Caring through a holistic lens.

Study Design and Methods:

This study was a qualitative content analysis of 34 interview transcripts of parents' experiences with perinatal loss. A priori codes were identified using a holistic model which guided the integration of parents' holistic needs into Swanson's Theory.

Results:

Nurses can address parents' physical, psychological, social, spiritual, and cultural needs using Swanson's Theory to provide high-quality, holistic care that may foster healing. Parents were appreciative of nurses who were transparent, did not avoid talking about their baby, facilitated memorialization, and fostered bonding. Anticipating parents' needs, being emotionally present, and recognizing the meaning of the perinatal loss experienced helped parents to have a more positive loss experience.

Clinical Implications:

By incorporating holistic interventions into care guided by Swanson's Theory, nurses can empower parents within their loss experience. Interventions to create memories, foster bonding and connection, promote autonomy, and celebrate personhood may facilitate healing. It is necessary to ensure nurses have the support and resources to attend to parents' holistic needs, including education and sufficient time for care interactions. Providing education in perinatal loss and grief, particularly to new nurse graduates, is necessary to ensure nurses are equipped to provide holistic care to families experiencing perinatal loss.
Perceptions of Rural Access to Prenatal Care in the United States by Patients, Nurses, Midwives, and Physicians
Authors: Durfee Stephanie , Nazarenko Danielle N. , Agbemenu Kafuli
Published: October 2024

Background:

Despite substantial investments in maternity care, the United States continues to experience higher maternal mortality rates than most high-income countries. Rural regions lack adequate prenatal care services, a contributing factor to disparate maternal health outcomes.

Methods:

This integrative review on patient, nurse, midwife, physician, and community perspectives on accessing prenatal care in rural areas of the United States follows Whittemore and Knafl's integrative review framework, including a systematic literature search in various databases from January 1, 2010, to May 1, 2024. Eligible articles were published in English, peer-reviewed, and focused on subjective accounts of accessing prenatal care in rural areas of the United States. Seven articles met inclusion criteria and were assessed for quality using the Joanna Briggs Institute checklists.

Results:

Three major categories influencing access to prenatal care in rural areas were developed. Individual factors included transportation, family support, motivation, and work commitments. Socioeconomic factors encompass health insurance, rurality, income, and housing. System factors involved the qualities of nurses, midwives, physicians, the clinic environment, and collaboration within the health care system. The findings emphasized the complexity of rural prenatal care access.

Conclusions:

Understanding patient and care giver perspectives on accessing prenatal care in rural areas is crucial for addressing the factors influencing maternal outcomes. Rural pregnant women face unique challenges, contributing to an increased risk of maternal morbidity and mortality. Further research is needed to explore their experiences and develop interventions to improve access and outcomes in rural areas.
Beta-Lactam Antibiotic Exposure During Pediatric Extracorporeal Membrane Oxygenation: Retrospective Cohort Analysis of Drug Levels Using Standard Dosing, 2018–2020
Authors: Marsaux Alice , Léger Pierre-Louis , Rambaud Jérôme , Bille Emmanuelle , Renolleau Sylvain , Tréluyer Jean Marc , Gana Inès , Lorrot Matthie , Grimaud Marion , Toubiana Julie , Béranger Agathe , Benaboud Sihem , Oualha Mehdi
Published: October 2024

OBJECTIVES:

Children on extracorporeal membrane oxygenation (ECMO) are at high risk of infection that may worsen prognosis. Even though treatment with beta-lactam antibiotics is frequent, dosing is not adapted to altered pharmacokinetic and pharmacodynamic characteristics of children on ECMO. There is, therefore, a risk of inadequate drug levels when using standard dosing. In this study, we aimed to describe beta-lactam exposures of children on ECMO using current dosing and to identify factors associated with inadequate exposure. The optimal pharmacokinetic/pharmacodynamic target was considered as a plasma concentration four times above the minimum inhibitory concentration throughout the dosing interval target.

DESIGN:

Two-center retrospective cohort study.

SETTING:

Two PICUs in Paris, France.

PATIENTS:

Children (from birth to 18 yr) undergoing venovenous or venoarterial ECMO, from 2018 to 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

There were 57 patients who received 11 different beta-lactams, with 226 plasma concentrations analyzed. A total of 32 infections were documented. Overall, 133 of 226 concentrations (58.8%) were insufficient, primarily in samples from children younger than 28 days (p = 0.035), with low body weight (p = 0.013), or in instances of hypoalbuminemia (p = 0.011) and increased renal clearance (p = 0.032). Supratherapeutic concentrations were observed in 25 of 226 samples (11.1%), associated with being taken from patients with renal impairment (p < 0.01).

CONCLUSIONS:

In this retrospective cohort of pediatric ECMO cases, there is an associated risk of underexposure when prescribing conventional dosing of beta-lactams, which are likely associated with renal impairment and fluid overload. Prospective testing of therapeutic drug monitoring combined with pharmacokinetic/pharmacodynamic models should be tested as a risk-reduction strategy in this vulnerable population.
Effects of Papaverine on Experimentally Induced Myringosclerosis
Authors: Durna Yusuf Muhammed , Edizer Deniz Tuna , Yigit Ozgur , Yasak Ahmet Gorkem , Kelten Talu Esra Canan
Published: October 2024

Objective:

This study aims to investigate the effects of papaverine on experimentally induced myringosclerosis (MS). MS is characterized by hyaline degeneration and calcification of the lamina propria of the tympanic membrane and can adversely affect hearing function if left untreated. The study examined the potential effects of both systemic and topical applications of papaverine on this process.

Materials and Methods:

In the study, 20 Wistar albino rats were used. The rats were divided into 4 groups and different treatment methods were applied in each group. In group 1, myringotomy was performed, but no additional intervention was performed. In group 2, saline-impregnated gelfoam was applied after myringotomy. In groups 3 and 4, topical and systemic applications of papaverine hydrochloride were performed. Tympanic membranes were examined under a microscope after 21 days, and the severity of MS and histopathologic changes were evaluated.

Results:

The papaverine-treated groups observed a significant increase in otomicroscopic sclerosis, the degree of inflammation, and tympanic membrane thickness. The degree of fibrosis was higher in group 3 compared with the other groups. The results showed that papaverine administration increased the occurrence of MS.

Conclusion:

This study suggests that papaverine may increase MS through its vasodilating effect. Vasodilation is thought to cause an increase in oxygen-derived free radicals, which may contribute to the pathogenesis of MS. The results suggest that the effects of papaverine on MS should be carefully evaluated.
Biotin concentration affects anaplerotic reactions functioning in glutamic acid production in Corynebacterium glutamicum
Authors: Ochiai Takako , Wachi Masaaki , Hirasawa Takashi
Published: October 2024

The study investigates the effect of biotin concentration on the role of anaplerotic reactions catalysed by pyruvate carboxylase (PC) and phosphoenolpyruvate carboxylase (PEPC) in glutamic acid production by Corynebacterium glutamicum. C. glutamicum requires biotin for its growth, and its glutamic acid production can be induced by the addition of Tween 40 or penicillin or by biotin limitation. The biotin enzyme PC and the non-biotin enzyme PEPC catalyse two anaplerotic reactions to supply oxaloacetic acid to the TCA cycle in C. glutamicum. Therefore, they are crucial for glutamic acid production in this bacterium. In this study, we investigated the contribution of each anaplerotic reaction to Tween 40- and penicillin-induced glutamic acid production using disruptants of PEPC and PC. In the presence of 20 µg l–1 biotin, which is sufficient for growth, the PEPC-catalysed anaplerotic reaction mainly contributed to Tween 40- and penicillin-induced glutamic acid production. However, when increasing biotin concentration 10-fold (i.e. 200 µg l–1), both PC- and PEPC-catalysed reactions could function in glutamic acid production. Western blotting revealed that the amount of biotin-bound PC was reduced by the addition of Tween 40 and penicillin in the presence of 20 µg l–1. However, these induction treatments did not change the amount of biotin-bound PC in the presence of 200 µg l–1 biotin. These results indicate that both anaplerotic reactions are functional during glutamic acid production in C. glutamicum and that biotin concentration mainly affects which anaplerotic reactions function during glutamic acid production.
Diverse Participant Recruitment for Infant Sequencing in the BabySeq Project
Authors: del Rosario Maya C. , Walmsley Sheyenne A. , Harrison Barbara W. , Stephens Crystal T. , Zettler Bethany , Rivera-Cruz Greysha , Agrawal Priyal , Brower Amy , Chigbu Stephanie , Christensen Kurt D. , Genetti Casie A. , Givens Richetta , Gold Nina B. , Reeves Inez V. , Schichter Isabella , Shariat Habib , Simon Sandra , Smith Hadley Stevens , Uveges Melissa , Green Robert C. , Holm Ingrid A. , Pereira Stacey
Published: October 2024

Purpose

It is essential that studies of genomic sequencing (GS) in newborns and children include individuals from under-represented racial and ethnic groups (URG) to ensure future applications are equitably implemented. We conducted interviews with parents from URG to better understand their perspectives on GS research, develop strategies to reduce barriers to enrollment, and facilitate research participation.

Methods

Semi-structured interviews with 50 parents from URG.

Results

Nearly all parents (44) said they would be interested in participating in an infant GS study. Parents were interested in participating in GS research for reasons including clinical utility, personal utility, and/or family health benefits. Deterrents to enrollment cited by parents were discomfort with enrollment procedures (e.g., not wanting a heel stick), limited emotional bandwidth, unfavorable perceptions of the study, and concerns about potential results. Most parents (35 of 40) said they would want to receive all types of genetic results, including actionable and non-actionable, as well as childhood- and adult-onset.

Conclusion

Our findings demonstrate that parents from URG are interested in participating in GS research. Based upon these findings, we provide recommendations for designing GS studies that are responsive to their concerns.
Staff experiences and perspectives of delivering an integrated child health and social care service in community settings: A qualitative exploration using the SELFIE framework
Authors: Litchfield I , Harper L , Abbas S , Dutton F , Wolhuter C , Bird C
Published: October 2024

Introduction

It’s suggested that integrated care is well-placed to address the prevalence of chronic conditions, obesity, and mental ill health in children and young people living in minoritized and economically-marginalised communities in high-income countries. This work describes staff perspectives of delivering an integrated place-based service providing multidisciplinary clinical care and early intervention social support to children and young people in an ethnically diverse and economically disadvantaged community in the UK.

Materials and Methods

We conducted a qualitative exploration of the experiences of staff delivering the service and used a directed content analysis to populate and present the results within the Sustainable integrated chronic care model for multi-morbidity: delivery, financing, and performance (SELFIE) framework. The first part of the analysis presented here focusses on the domain of Service delivery, relating to the availability and access of care.

Results

A total of 14 staff were interviewed including clinicians from primary and secondary care, social care providers, local voluntary groups, and school-based family mentors. Staff described at a Micro-level how the service increased engagement of families and facilitated referral to social support and preventative care; at a Meso-level the benefits of collocation, collaborative working, and community outreach were described. Finally at the Macro level, improvements to the access and availability of appropriate care were observed despite limited engagement by the local care system.

Conclusions

The pilot appeared to deliver multiple benefits for both patients and staff and the broader health economy particularly through collocating health care and social support. However, to implement truly integrated care, greater institutional commitment and leadership are needed.
Analysis of R-loop forming regions identifiesRNU2-2PandRNU5B-1as neurodevelopmental disorder genes
Authors: Jackson Adam , Thaker Nishi , Blakes Alexander , Banka Siddharth
Published: October 2024

R-loops are critical for gene regulation but their contribution to human Mendelian disorders has not been explored. We show that in rare disease cohortsde novovariants are highly prevalent in genomic regions which form R-loops. Using this insight, we demonstrate that variants in two novel disorder genes,RNU2-2PandRNU5B-1, together with the recently describedRNU4-2provide a genetic explanation for an exceptionally large proportion of individuals with suspected rare Mendelian disorders.