bluuebunny/crossref_metadata_2025 huggingface dataset:
A Qualitative Exploration of Barriers to Treatment Among HPV-Positive Women in a Cervical Cancer Screening Study in Western Kenya
Authors: Isaacson Sinéad , Adewumi Konyin , Smith Jennifer S , Novak Carissa , Oketch Sandra , Huchko Megan J
Published: October 2022

Background

Cervical cancer screening through self-collected high-risk human papillomavirus (HPV) testing has increased screening uptake, particularly in low-resource settings. Improvement ultimately depends, however, on women with positive results accessing follow-up treatment. Identifying the barriers to timely treatment is needed to tailor service delivery for maximum impact.

Materials and Methods

This qualitative study was conducted within a self-collected HPV screening trial in Migori County, Kenya. HPV-positive women were referred for no-cost cryotherapy treatment at the county hospital. Women not attending within 60 days of receiving HPV-positive results were randomly selected for in-depth interviews (IDIs). IDIs were coded and analyzed to develop an analytical framework and identify treatment barriers.

Results

Eighty-one women were interviewed. IDIs showed a poor understanding of HPV and cervical cancer, impacting comprehension of screening results and treatment instructions. All 81 had not undergone treatment but reported intending to in the future. Eight reported seeking treatment unsuccessfully or not qualifying, primarily due to pregnancy. Transportation costs and long distances to the hospital were the most reported barriers to treatment. Other obstacles included work, household obligations, and fear of treatment. Impacts of social influences were mixed; some women reported their husbands prevented seeking treatment, others reported their husbands provided financial or emotional support. Few women experienced peer support.

Conclusions

Women faced many barriers to treatment following HPV screening in rural Kenya. Transportation barriers highlight a need for local treatment capacity or screen-and-treat approaches. Ensuring women understand their results and how to seek treatment is essential to improving cervical cancer screening in low-resource settings.
What governs attitudes toward artificial intelligence adoption and governance?
Authors: O’Shaughnessy Matthew R , Schiff Daniel S , Varshney Lav R , Rozell Christopher J , Davenport Mark A
Published: October 2022

Designing effective and inclusive governance and public communication strategies for artificial intelligence (AI) requires understanding how stakeholders reason about its use and governance. We examine underlying factors and mechanisms that drive attitudes toward the use and governance of AI across six policy-relevant applications using structural equation modeling and surveys of both US adults (N = 3,524) and technology workers enrolled in an online computer science master’s degree program (N = 425). We find that the cultural values of individualism, egalitarianism, general risk aversion, and techno-skepticism are important drivers of AI attitudes. Perceived benefit drives attitudes toward AI use but not its governance. Experts hold more nuanced views than the public and are more supportive of AI use but not its regulation. Drawing on these findings, we discuss challenges and opportunities for participatory AI governance, and we recommend that trustworthy AI governance be emphasized as strongly as trustworthy AI.
Priming Mesenchymal Stem/Stromal Cells with a Combination of a Low Dose of IFN-γ and Bortezomib Results in Potent Suppression of Pathogenic Th17 Immunity Through the IDO1-AHR Axis
Authors: Park Ha Young , Kim Chae Eun , Lee Soung-Min , Ahn Joo Mi , Yoon Eun Hye , Yoo Minjoo , Kim Jung-Mi , Back Jiyeon , Park Dae Hwi , Jang Won Hee , Kwon Byungsuk , Seo Su-Kil
Published: October 2022

Preconditioning of mesenchymal stem/stromal cells (MSCs) with the inflammatory cytokine IFN-γ enhances not only their immunosuppressive activity but also their expression of HLA and proinflammatory genes. We hypothesized that prevention of the upregulation of inflammatory cytokines and HLA molecules in IFN-γ-primed MSCs would render these cells more immunosuppressive and less immunogenic. In this study, we discovered the following findings supporting this hypothesis: (1) activated human T cells induced the expression of IDO1 in MSCs via IFN-γ secretion and those MSCs in turn inhibited T-cell proliferation in an AHR-dependent fashion; (2) there was no difference in the expression of IDO1 and HLA-DR in MSCs after priming with a low dose (25 IU/mL) versus a high dose (100 IU/mL) of IFN-γ; (3) the transient addition of bortezomib, a proteasome inhibitor, to culture MSCs after IFN-γ priming decreased the expression of HLA-DR, inflammatory cytokine genes and Vcam1 while increasing the expression of IDO1 and the production of L-kynurenine; finally, MSCs primed with a combination of a low dose of IFN-γ and bortezomib were more effective in inhibiting Th17-mediated idiopathic pneumonia syndrome (IPS) and chronic colitis than unprimed MSCs. Our results suggest that bortezomib significantly eliminates the unfavorable effects of IFN-γ priming of MSCs (increased expression of MHC molecules and inflammatory cytokines and cell aggregation genes) and simultaneously increases their immunosuppressive activity by upregulating IDO1. Taken together, our newly established MSC priming method may contribute to MSC-based cell therapy for inflammatory diseases.
Opuntia ficus indica (L.) fruit extract alleviates oxidative stress through activation of dual oxidases and Keap1/Nrf2 signaling cascades in high-fat-diet associated atherosclerosis rats
Authors: Aslam Noreen , Faisal Muhammad Naeem , Khan Junaid Ali , Majeed Wafa
Published: October 2022

Atherosclerosis is a metabolic disorder characterized by chronic inflammation associated with progressive thickening and hardening of the large to medium-sized arteries due to plaque formation. The study aims to evaluate the antioxidative, anti-inflammatory, and hypolipidemic efficacy of Opuntia ficus-indica (OFI) fruit extract against the high-fat-diet associated atherosclerotic rat model. In-vitro qualitative and quantitative phytochemical screening of OFI fruit extract revealed the significant presence of total phenolic content and total flavonoid contents. In-vitro antioxidant activity of fruit extract was determined through 2,2-diphenyl-1-picrylhydrazyl and FRAP assays that have shown their protective efficacy against the overproduction of reactive oxygen species. Results revealed that the level of total oxidant stress was significantly (P < 0.05) reduced and down expression levels of dual oxidases (Duox, Duoxa-1, and Duox-2) in all the treatment groups (I, II, III) as compared with positive control were observed. The total antioxidant capacity was significantly (P < 0.05) increased in all treatment groups in comparison with the positive control group and higher expression level of the Nrf-2 signaling pathway (Nfe-212, NFR-1, and Keap-1) was observed in all the treatment groups compared with the positive control group. Histopathological examination of the aorta showed that high-fat diet markedly increased endothelial lining and thickness of tunica media and adventitia, with irregular media segments having wavy laminae, and a significant increase in entropy of fibers disposition was observed. Conclusively, OFI fruit extract has shown promising protective, anti-oxidative, and anti-inflammatory efficacy through the restoration of normal parenchyma in high-fat dieting-associated oxidative stress and endothelial inflammation.
Formal recognition and classification of gene transfer agents as viriforms
Authors: Kogay Roman , Koppenhöfer Sonja , Beatty J Thomas , Kuhn Jens H , Lang Andrew S , Zhaxybayeva Olga
Published: October 2022

Morphological and genetic features strongly suggest that gene transfer agents (GTAs) are caudoviricete-derived entities that have evolved in concert with cellular genomes to such a degree that they should not be considered viruses. Indeed, GTA particles resemble caudoviricete virions, but, in contrast to caudoviricetes (or any viruses), GTAs can encapsidate at best only part of their own genomes, are induced solely in small subpopulations of prokaryotic host cells, and are transmitted vertically as part of cellular genomes during replication and division. Therefore, the lifecycles of GTAs are analogous to virus-derived entities found in the parasitoid wasps, which have recently been recognized as non-virus entities and therefore reclassified as viriforms. We evaluated three distinct, independently exapted GTA groups, for which the genetic basis for GTA particle production has been established. Based on the evidence, we outline a classification scheme for these viriforms.
Capnocytophaga sputigena Bacteremia in an Immunocompromised Child, When to Suspect? A Case Report and Review of the Literature
Authors: Larragoity González Erika Aidé , Pérez Cavazos Samantha , Tobías Ávila Griselda del Carmen , Rodríguez Saldívar María Mayela , Vaquera Aparicio Denisse Natalie , Castillo Bejarano José Iván , Mascareñas de los Santos Abiel
Published: October 2022

Background

Within febrile neutropenic episodes, bacteremia is the most frequent cause. Capnocytophaga species bacteremia represents less than 3% of all etiologies, being an uncommon agent. Only a few pediatric cases have been reported in the literature.

Case Presentation

A 6-year-old male patient was diagnosed with acute lymphoblastic leukemia and a bone marrow relapse. He was admitted to our institution with an episode of febrile neutropenia with grade II mucositis. A nonhemolytic gram-negative rod was isolated from a blood culture, with gray colonies in blood agar at 48 hours of incubation. Capnocytophaga sputigena was identified by matrix-assisted laser desorption/ionization and time of flight. The patient was successfully treated with imipenem-cilastatin for 10 days.

Conclusions

Although this pathogen is uncommon, Capnocytophaga species bacteremia should be suspected as a causal agent in immunocompromised patients, particularly in cases of febrile neutropenia with oral cavity involvement.
A Rapid Nucleic Acid Amplification Test–Based, Conditional Release-to-Work Policy for Health Care Personnel With Symptoms Consistent With COVID-19
Authors: Jacobson Mark A. , Hart Colin , Huen Will , Suarez Guardado Griselda , Villanueva Allyson , Whitman Jeffrey , Blanc Paul D.
Published: October 2022

Objective

Most health care personnel (HCP) reporting symptoms consistent with COVID-19 illness are assessed by high-accuracy SARS-CoV-2 assays performed in clinical laboratories, but the results of such assays typically are not available until the following day.

Methods

This is an observational study over 16 weeks of a rapid nucleic acid amplification test (NAAT) performed at point of contact. The benchmark for comparison was a simultaneously obtained specimen assayed by a routine NAAT assay performed in a clinical laboratory.

Results

There were 577 paired rapid and routine NAAT results. Rapid test positive predictive value was 90.0% (95% confidence interval = 88.8%–91.2%), and negative predictive value was 95.2% (95% confidence interval = 93.5%–96.9%). The rapid test avoided an estimated 160 to 184 lost work shifts over 4 months.

Conclusions

A rapid NAAT test–based strategy proved effective in safely clearing symptomatic employees without infection for earlier return to work.
Job Automation and Concerns During the COVID-19 Pandemic Among Middle and Low-Income US Adults
Authors: Tsai Jack , Umucu Emre , Fish Kaylee
Published: October 2022

Objective

This study examined job automation and concerns about job automation during the COVID-19 pandemic.

Methods

Data from a national sample of 6607 middle- and low-income US adults in May to June 2020 were analyzed.

Results

Among recently employed participants, 19.1% reported partial or complete job automation during the pandemic. Male sex, racial/ethnic minorities, students, higher education, full-time employment, and any history of psychiatric disorder were associated with job automation. In the total sample, 57.5% had concerns about job automation, which were associated with younger age, male, racial/ethnic minorities, students, veterans, more minors in the household, Northeast residence, any history of psychiatric diagnosis, COVID-19 infection, and any recent job changes.

Conclusions

Job automation is impacting the lives of middle- and low-income US adults, and particular groups are vulnerable to ongoing changes in the nature of work.
Segmentation of Vestibular Schwannomas on Postoperative Gadolinium-Enhanced T1-Weighted and Noncontrast T2-Weighted Magnetic Resonance Imaging Using Deep Learning
Authors: Yao Peter , Shavit Sagit Stern , Shin James , Selesnick Samuel , Phillips C. Douglas , Strauss Sara B.
Published: October 2022

Objective

Surveillance of postoperative vestibular schwannomas currently relies on manual segmentation and measurement of the tumor by content experts, which is both labor intensive and time consuming. We aimed to develop and validate deep learning models for automatic segmentation of postoperative vestibular schwannomas on gadolinium-enhanced T1-weighted magnetic resonance imaging (GdT1WI) and noncontrast high-resolution T2-weighted magnetic resonance imaging (HRT2WI).

Study Design

A supervised machine learning approach using a U-Net model was applied to segment magnetic resonance imaging images into pixels representing vestibular schwannoma and background pixels.

Setting

Tertiary care hospital.

Patients

Our retrospective data set consisted of 122 GdT1WI and 122 HRT2WI studies in 82 postoperative adult patients with a vestibular schwannoma treated with subtotal surgical resection between September 1, 2007, and April 17, 2018. Forty-nine percent of our cohort was female, the mean age at the time of surgery was 49.8 years, and the median time from surgery to follow-up scan was 2.26 years.

Intervention(s)

N/A.

Main Outcome Measure(s)

Tumor areas were manually segmented in axial images and used as ground truth for training and evaluation of the model. We measured the Dice score of the predicted segmentation results in comparison to manual segmentations from experts to assess the model's accuracy.

Results

The GdT1WI model achieved a Dice score of 0.89, and the HRT2WI model achieved a Dice score of 0.85.

Conclusion

We demonstrated that postoperative vestibular schwannomas can be accurately segmented on GdT1WI and HRT2WI without human intervention using deep learning. This artificial intelligence technology has the potential to improve the postoperative surveillance and management of patients with vestibular schwannomas.
Comparison of an Implantable Middle Ear Microphone and Conventional External Microphone for Cochlear Implants: A Clinical Feasibility Study
Authors: Craddock Louise C. , Hodson James , Gosling Amy , Cooper Stacey , Morse Robert P. , Begg Philip , Prokopiou Andreas , Irving Richard M.
Published: October 2022

Objectives

All commercially available cochlear implant (CI) systems use an external microphone and sound processor; however, external equipment carries lifestyle limitations. Although totally implantable devices using subcutaneous microphones have been developed, these are compromised by problems with soft tissue sound attenuation, feedback, and intrusive body noise. This in vivo pilot study evaluates a middle ear microphone (MEM) that aims to overcome these issues and compares hearing performance with that of an external CI microphone.

Design

Six adult participants with an existing CI were implanted with a temporary MEM in the contralateral ear. Signals from the MEM were routed via a percutaneous plug and cable to the CI sound processor. Testing was performed in the CI microphone and MEM conditions using a range of audiometric assessments, which were repeated across four visits.

Results

Performance of the MEM did not differ significantly from that of the CI on the assessments of Auditory Speech Sounds Evaluation loudness scaling at either 250 or 1000 Hz, or in the accuracy of repeating keywords presented at 70 dB. However, the MEM had significantly poorer aided sound-field thresholds, particularly at higher frequencies (≥4000 Hz), and significantly poorer performance on Arthur Boothroyd words presented at 55 dB, compared with the CI.

Conclusion

In this pilot study, the MEM showed comparable performance to that of an external CI microphone across some audiometric assessments. However, performance with the MEM was poorer than the CI in soft-level speech (55 dB) and at higher frequencies. As such, the benefits of MEM need to be considered against the compromises in hearing performance. However, with future development, MEM is a potentially promising technology.
Use of a Novel Clinical Decision-Making Tool in Vestibular Schwannoma Treatment
Authors: La Monte Olivia A. , Moshtaghi Omid , Tang Edison , Du Eric Y. , Swisher Austin R. , Dixon Peter R. , Nemati Shamim , Djalilian Hamid R. , Schwartz Marc S. , Friedman Rick A.
Published: October 2022

Objective

To determine the usefulness of a personalized tool and its effect on the decision-making process for those with vestibular schwannoma (VS).

Study Design

Prospective study.

Setting

Single institution, academic tertiary care lateral skull base surgery program.

Patients

Patients diagnosed with VS.

Interventions

A comprehensive clinical decision support (CDS) tool was constructed from a previously published retrospective patient-reported data obtained from members of the Acoustic Neuroma Association from January to March 2017. Demographic, tumor, and treatment modality data, including associated side effects, were collected for 775 patients and integrated in an interactive and personalized web-based tool.

Main Outcome Measures

Pre- and posttool questionnaires assessing the process of deciding treatment for VS using a decisional conflict scale (DCS) and satisfaction with decision (SWD) scale were compared.

Results

A pilot study of 33 patients evaluated at a single institution tertiary care center with mean ± SD age of 63.9 ± 13.5 years and with average tumor size of 7.11 ± 4.75 mm were surveyed. CDS implementation resulted in a mean ± SD total DCS score decrease from 43.6 ± 15.5 to 37.6 ± 16.4 (p < 0.01) and total SWD score increase from 82.8 ± 16.1 to 86.2 ± 14.4 (p = 0.04), indicating a significant decrease in decisional conflict and increase in satisfaction.

Conclusions

Implementing a decision-making tool after diagnosis of VS reduced decisional conflict and improved satisfaction with decision. Patients considered the tool to be an aid to their medical knowledge, further improving their comfort and understanding of their treatment options. These findings provide a basis for developing predictive tools that will assist patients in making informed medical decisions in the future.
Povidone-Iodine Fails to Eradicate Chronic Suppurative Otitis Media and Demonstrates Ototoxic Risk in Mice
Authors: Kaufman Adam C. , Bacacao Brian S. , Berkay Betul , Sharma Devesh , Mishra Anupam , O'Toole George A. , Saunders James E. , Xia Anping , Bekale Laurent A. , Santa Maria Peter L.
Published: October 2022

Hypothesis

Commercially available povidone-iodine solution can eliminate biofilms and persister cells rapidly in in vivo achievable concentrations without inducing ototoxicity.

Background

Chronic suppurative otitis media (CSOM) is a substantial global problem. Current treatment options often induce a temporary remission without leading to a permanent cessation of symptoms secondary to the treatments' inability to eliminate persister cells. Povidone-iodine has been shown to be able to clear biofilm and planktonic cells in in vitro assays, but there are reports of ototoxic effects limiting its clinical utility.

Methods

Bacterial and biofilm growth with quantification by spectrophotomer, murine auditory brainstem response (ABR), and distortion product otoacoustic emissions, immunohistochemistry, in vivo povidone-iodine treatment of murine CSOM, persister cell assay.

Results

Commercially available 10% povidone-iodine solution is able to completely eradicate multiple clinical strains of Pseudomonas aeruginosa and Staphylococcus aureus in vitro with 10 minutes of exposure. Mice that have received a transtympanic injection of 1% povidone-iodine solution did not have significantly different auditory brainstem response or distortion product otoacoustic emission results compared with the control. Mice that received a povidone-iodine scrub or 10% povidone-iodine solution had significantly worsened hearing (25- and 13-dB increase in threshold, respectively; p < 0.05). In vivo CSOM infection recurred in all mice after the completion of treatment with 10% povidone-iodine solution, and there was no improvement in the bacterial load after treatment, indicating in vivo failure of therapy.

Conclusion

Povidone-iodine solution is effective at eliminating biofilm and persister cells in vitro at in vivo achievable concentrations but fails in vivo most likely because of kinetics of distribution in vivo. Even if drug distribution could be improved, the therapeutic window is likely to be too small given that the diluted solution does not have ototoxic potential, whereas while the scrub variant, which contains detergents, and the undiluted solution are ototoxic after a single treatment.
Comparing Patient Satisfaction After Upfront Treatment Versus Wait-and-Scan for Small Sporadic Vestibular Schwannoma
Authors: Nassiri Ashley M. , Lohse Christine M. , Tombers Nicole M. , Link Michael J. , Carlson Matthew L.
Published: October 2022

Objective

Management of small vestibular schwannoma (VS) remains controversial, as patients are typically candidates for all three management options including microsurgery, stereotactic radiosurgery, or wait-and-scan. This study compares patient satisfaction across treatment modalities in patients with small VS.

Study Design

Cross-sectional study.

Setting

Survey distributed to members of the Acoustic Neuroma Association and Mayo Clinic patients.

Methods

Patients with small (<1 cm in any location) sporadic VS who completed at least one survey regarding treatment history and patient satisfaction were included.

Results

Among 346 patients with small VS, 106 (31%) underwent microsurgery, 78 (23%) radiosurgery, 152 (44%) wait-and-scan, and 10 (3%) multimodal treatment. Collectively, 307 (89%) patients indicated “Yes, I am happy with my treatment type and in hindsight I would not change anything,” and 39 (11%) indicated “No, in hindsight I would have chosen a different treatment type.” Satisfaction differed significantly by treatment group with 85, 86, 96, and 40% of patients in the microsurgery, radiosurgery, wait-and-scan, and multimodal groups reporting that they were satisfied with treatment, respectively (p < 0.001). Satisfaction also differed significantly among those undergoing upfront treatment with microsurgery or radiosurgery (81%), initial wait-and-scan followed by treatment (88%), and wait-and-scan only groups (96%; p = 0.001). Specifically, the wait-and-scan only group demonstrated greater satisfaction compared with the other two treatment strategies (p < 0.05 for both).

Conclusions

Patient satisfaction with the management of small VS is generally high. Management with wait-and-scan, even if treatment is eventually pursued, may offer higher patient satisfaction compared with upfront treatment.
Evaluation of Bivalirudin Dosing in Pediatric Extracorporeal Membrane Oxygenation with Renal Insufficiency or Renal Replacement Therapy
Authors: Hamzah Mohammed , Seelhammer Troy G. , Yabrodi Mouhammad , Beshish Asaad G. , Byrnes Jonathan W. , Hall James , Wang Lu , Niebler Robert A.
Published: October 2022

Bivalirudin offers several important advantages of relevance to the management of extracorporeal membrane oxygenation (ECMO) patients. This multicenter retrospective analysis evaluated the bivalirudin dosing in pediatric ECMO and correlated these doses with the severity of renal dysfunction. A total of 75 patients were included in this analyses: estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73 m2 (n = 29), eGFR 30–60 (n = 18), eGFR < 30 (n = 28), and of those 23 were on renal replacement therapy (RRT). The initial bivalirudin dose used to reach therapeutic anticoagulation in patients with eGFR > 60 was significantly higher than the dose required in those with renal impairment (0.25 mg/kg/hr in patients with eGFR > 60 and 0.19 mg/kg/hr in patients on RRT, 0.18 mg/kg/hr in patients with eGFR 30–60 and 0.13 mg/kg/hr in patients with eGFR < 30 with no RRT). Progressive dose escalations (two to threefold increase) were required to maintain therapeutic range over the initial 4 days of ECMO that coincided with improving renal creatinine clearance during that same time period. Establishing an initial starting dose of bivalirudin contingent upon eGFR is essential for the rapid achievement of target anticoagulation intensity. Further dose adjustments guided by laboratory monitoring is necessary given the dynamic changes in creatinine clearance following ECMO initiation.
Quantifying the breadth of antibiotic exposure in sepsis and suspected infection using spectrum scores
Authors: Smith Joshua T. , Manickam Raj N. , Barreda Fernando , Greene John D. , Bhimarao Meghana , Pogue Jason , Jones Makoto , Myers Laura , Prescott Hallie C. , Liu Vincent X.
Published: October 2022

A retrospective cohort study. Studies to quantify the breadth of antibiotic exposure across populations remain limited. Therefore, we applied a validated method to describe the breadth of antimicrobial coverage in a multicenter cohort of patients with suspected infection and sepsis. We conducted a retrospective cohort study across 21 hospitals within an integrated healthcare delivery system of patients admitted to the hospital through the ED with suspected infection or sepsis and receiving antibiotics during hospitalization from January 1, 2012, to December 31, 2017. We quantified the breadth of antimicrobial coverage using the Spectrum Score, a numerical score from 0 to 64, in patients with suspected infection and sepsis using electronic health record data. Of 364,506 hospital admissions through the emergency department, we identified 159,004 (43.6%) with suspected infection and 205,502 (56.4%) with sepsis. Inpatient mortality was higher among those with sepsis compared to those with suspected infection (8.4% vs 1.2%; P < .001). Patients with sepsis had higher median global Spectrum Scores (43.8 [interquartile range IQR 32.0–49.5] vs 43.5 [IQR 26.8–47.2]; P < .001) and additive Spectrum Scores (114.0 [IQR 57.0–204.5] vs 87.5 [IQR 45.0–144.8]; P < .001) compared to those with suspected infection. Increased Spectrum Scores were associated with inpatient mortality, even after covariate adjustments (adjusted odds ratio per 10-point increase in Spectrum Score 1.31; 95%CI 1.29–1.33). Spectrum Scores quantify the variability in antibiotic breadth among individual patients, between suspected infection and sepsis populations, over the course of hospitalization, and across infection sources. They may play a key role in quantifying the variation in antibiotic prescribing in patients with suspected infection and sepsis.
The efficacy of Yiqi Huoxue method in treating coronary artery disease after percutaneous coronary intervention: A meta-analysis in accordance with PRISMA guideline
Authors: Zhang Miao , Sun Ming-Yue , Chen Qi-Ting , Xu Feng-Qin , Chen Zong-Zheng , Wei Wen-Bo , Wang Rui-Ting , Xu Gui-Peng , Yin Hui-Jun
Published: October 2022

Background:

Percutaneous coronary intervention (PCI), the most common method in treating coronary artery disease (CAD), has a variety of side effects. Yiqi Huoxue therapy (YQHX) can effectively alleviate the symptoms of patients and reduce the side effects. However, a reliable and systematic assessment of the methodologies is not available.

Methods:

Seven electronic databases were searched to identify randomized controlled trials of YQHX method for CAD after PCI. The quality assessment of the trials included was performed by employing the Cochrane Risk of Bias tool.

Results:

One thousand eight hundred sixty-eight patients from 23 randomized controlled trials were included in this review. The aggregated results showed that the experimental group got better effect in increasing ORR, TCMSRR, ECG, HDL-C, and in lowering the level of CRP, TC, and MACE in comparison with the control group.

Conclusion:

YQHX method is a valid complementary and alternative therapy in the management of CAD after PCI, and is an effective and safe therapy for CAD.
Aging of the mesolimbic tract in the human brain: A diffusion tensor imaging study
Authors: Seo Jeong Pyo , Ryu Heun Jae
Published: October 2022

The mesolibic tract (MLT) is a dopaminergic tract that has been shown to play a role in regulating reward stimuli, including both incentive salience and social stimuli. In the current study, we examined the aging of MLT in normal human participants to explain human brain structures using diffusion tensor tractography (DTT). Fifty-seven healthy participants were recruited for this study and allocated to six groups based on their age. Diffusion tensor imaging (DTI) scanning was performed and MLTs were reconstructed using the probabilistic tractography method. MLTs were defined by selecting fibers passing through the seed and target regions of interest placed on the ventral segmental area and nucleus accumbens. A significant negative correlation was observed between age and the voxel number (VN) of MLT, while a positive correlation was observed between age and the apparent diffusion coefficient (ADC). The mean VN value of the MLT was significantly lower in the 60s and 70s age groups than in the 20s, 40s, and 50s (P < .05). The mean ADC value of the MLT was significantly higher in the 60s and 70s groups than in the 20s, 30s, and 40s, 50s groups (P < .05). We found that aging of the MLT began in the 20s or 30s and progressed steadily throughout life until the 60s, when it exhibited significant degeneration. We believe this affect may play a role in the decline of memory and social interaction with aging in normal participants.
Data-independent acquisition-based quantitative proteomic analysis of m.3243A>G MELAS reveals novel potential pathogenesis and therapeutic targets
Authors: Chang Xueli , Yin Zhaoxu , Zhang Wei , Shi Jiaying , Pu Chuanqiang , Shi Qiang , Wang Juan , Zhang Jing , Yan Li , Yang Wenqu , Guo Junhong
Published: October 2022

The pathogenesis of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke like episodes (MELAS) syndrome has not been fully elucidated. The m.3243A > G mutation which is responsible for 80% MELAS patients affects proteins with undetermined functions. Therefore, we performed quantitative proteomic analysis on skeletal muscle specimens from MELAS patients. We recruited 10 patients with definitive MELAS and 10 age- and gender- matched controls. Proteomic analysis based on nanospray liquid chromatography-mass spectrometry (LC-MS) was performed using data-independent acquisition (DIA) method and differentially expressed proteins were revealed by bioinformatics analysis. We identified 128 differential proteins between MELAS and controls, including 68 down-regulated proteins and 60 up-regulated proteins. The differential proteins involved in oxidative stress were identified, including heat shock protein beta-1 (HSPB1), alpha-crystallin B chain (CRYAB), heme oxygenase 1 (HMOX1), glucose-6-phosphate dehydrogenase (G6PD) and selenoprotein P. Gene ontology and kyoto encyclopedia of genes and genomes pathway analysis showed significant enrichment in phagosome, ribosome and peroxisome proliferator-activated receptors (PPAR) signaling pathway. The imbalance between oxidative stress and antioxidant defense, the activation of autophagosomes, and the abnormal metabolism of mitochondrial ribosome proteins (MRPs) might play an important role in m.3243A > G MELAS. The combination of proteomic and bioinformatics analysis could contribute potential molecular networks to the pathogenesis of MELAS in a comprehensive manner.
The Effect of comprehensive rehabilitation on Lithuanian adolescent’s nonspecific low back pain, depending on the duration: Nonrandomized single-arm trial
Authors: Aukštikalnis Tomas , Sinkevičius Romualdas , Rašimaitė Odeta , Šidlauskienė Aurelija , Aukštikalnytė Aurelija Emilija , Dulskas Audrius , Jasiūnas Eugenijus , Raistenskis Juozas
Published: October 2022

Objective:

To determine pain and functional changes during comprehensive rehabilitation (CR) in adolescents with nonspecific low back pain (NLBP), and to determine the optimal CR duration.

Methods:

The study included 106 adolescents (39 boys [36.8%], 67 girls [63.2%]), 14 to17 years old, with the following inclusion criteria: duration of NLBP for at least 12 weeks; conservative NLBP treatment was effectless; pain intensity using the visual analogue pain scale (VAS) ≤ 7 points; disrupted daily activities; ability to understand and answer the questions; written consent to participate voluntarily in the study. The pain was assessed using the VAS scale, functional changes were assessed using the Oswestry Disability Index (ODI), 12-Item Short Form Survey, Hospital Anxiety and Depression Scale (HAD), and physical functional capacity and proprioception (Proprio) were assessed using an isokinetic dynamometer. The participants performed a comprehensive pain rehabilitation program consisting of physiotherapy, TENS, magnetotherapy, lumbar massage, and relaxing vibroacoustic therapy. The active CR cycle lasted for 22 sessions (with intermediate measurements after 5 and 16 sessions), after which we performed passive observation for another half a year. Five measurements were performed.

Results:

Pain, functional assessment, and physical capacity were improved with CR. Statistically significant improvement became apparent after 5 CR sessions, but statistical and clinical significance became apparent after 16 CR sessions. In the distant period, after the completion of CR, neither statistical nor clinical changes occurred.

Conclusions:

CR is effective in reducing pain, and improving functional state and physical capacity quickly and reliably in 16 CR sessions, which is sufficient to obtain clinically satisfactory CR results. Good results were achieved during CR and neither improved nor deteriorated spontaneously in the distant period. This study shows a possible mismatch between NLBP intensity and impaired functional state in adolescents.
Recurrent pulmonary arteriovenous malformation in a patient with Sjögren syndrome: A case report
Authors: Shin Yoon Mi , Kim Yook , Yang Jiyoul , Yang Bumhee , Choi In Ah , Lee Ki Man
Published: October 2022

Rationale:

Pulmonary manifestations of Sjögren syndrome (SS) are variable and may involve the airway or lung parenchyma and increase the risk of vascular and malignant disease. However, to date, only one case of pulmonary arteriovenous malformation (AVM) has been reported in a patient with SS. Here, we report a rare case of recurrent pulmonary AVMs with aggravating multiple cysts in a patient with SS during a period of 14 years.

Patient concerns:

A 45-year-old woman was diagnosed with SS and pulmonary AVM in the right lung. Her AVMs were embolized successfully and she was followed up annually for 14 years. Eleven years after the initial treatment, her chest computed tomography showed new pulmonary AVMs in the left lung with aggravating multiple cysts.

Diagnosis:

We diagnosed her with SS according to the American–European consensus group criteria of 2010. Chest computed tomography and angiographic findings confirmed the recurrence of pulmonary AVMs.

Interventions:

The patient’s recurrent pulmonary AVMs were successfully treated by embolization.

Outcomes:

Although her multiple cystic lung lesions had been aggravating during 14 years, she received embolization for the pulmonary AVMs twice and developed no complication related to these procedures. Currently, the patient is 56 years old and still alive with good performance state.

Lessons:

To date, only one case of pulmonary AVM has been reported in a patient with SS. The patient died 2.5 years after the diagnosis without recurrence of AVM. Here, we present a rare case of recurrent pulmonary AVMs associated with aggravating multiple cysts in both lungs, which were observed during long-term follow-up, in a patient with SS.
Suspected adverse events following immunization against SARS-CoV2 in a university hospital in 2021: Observational study
Authors: Rodríguez Dolores , Ordoñez Pilar , Llop Roser , Videla Sebastián , Otero Aurema , Carnaval Thiago , Poltorak Violeta , Moya-Guerola Miguel , Masuet-Aumatell Cristina , Rodriguez Soledad , Hereu Pilar
Published: October 2022

Aim:

Vaccination against SARS-CoV2 has been proposed as a fundamental element for the control of the pandemic. This study aimed to describe the suspected adverse reactions (ADR) reported by vaccinated hospital workers.

Methods:

A descriptive study of suspected ADR was conducted between January and March 2021. The suspected ADR were identified using a specifically designed electronic form and spontaneous reporting. Data were also collected regarding the characteristics of the professionals, vaccine administered, severity, and outcome of ADR.

Results:

8169 professionals received 2 doses of SARS-CoV2 vaccine (6672 Comirnaty® and 1497 Spikevax®) and 894 reports of suspected ADR were reported (762 for Comirnaty® and 132 for Spikevax®), resulting in a cumulative ADR incidence of 10.94% (95%CI: 10.27-11.62). The majority of ADR were reported only after the second dose, 497 (56.2%), while 211 (23.6%) were reported only after the first dose and 186 (21%) after both doses. The symptoms were mostly mild, did not require medical assistance, and disappeared within approximately 3 days. One hundred and seventeen professionals had a history of COVID-19 infection. These studies reported, statistically significant, more suspected ADR after the first dose (42.7%) than those with no history of COVID-19 (20.7%). Among professionals, more ADR occurred after the first dose with the Spikevax® vaccine (41.6%) than with the Comirnaty® vaccine (20.5%).

Conclusion:

The majority of suspected ADR reported were described in the summary of product characteristics (SmPC). Professionals with a history of COVID-19 reported more suspected ADR after the first dose than did those without a history.
Acceptable deviation of labial tubercle and anterior tooth midlines relative to facial midline in smile aesthetics: A retrospective observational study
Authors: Wang Xiuhong , Long Jinlie , Mei Mei , Huang Jin , Chen Yuan , Zhou Yuanzhong , Zhang Jiangtao
Published: October 2022

Smile aesthetics are mainly influenced by the relative position of facial midline (FC-line), anterior tooth midline (AT-line) and labial tubercle midline (LT-line). However, the acceptable deviation of LT-line and AT-line relative to FC-line is unknown. This study aims to fill the critical gap. We adopted the method of cross-sectional study, the frontal full-face smile photographs of 1 subject set (1 male) were enrolled. Taking the FC-line as the center line, twelve images with 1-mm increment relative to FC-line (right or left deviation, the maximum deviation distance was 3-mm) in LT-line deviation model or LT + AT-line deviation model (LT-line coincided with AT-line basing on LT-line deviation model) were produced. Basing on Q-sort assessment, the images were evaluated by 160 dentists, 165 orthodontic patients and 163 freshmen. And the collected Q-sort scores were subjected to nonparametric comparative analysis using SPSS 18.0. There were significant differences in Q-sort scores among different groups (P < .01). When the deviation distance was 1 mm in dentist and orthodontic patient or 2 mm in freshman group, there was no significant difference in smile attractiveness scores between the LT line deviation model and the LT + AT line deviation model (P > .05). We also found that the score of male dentist significantly higher than female dentist (P < .05). However, the scores of right deviation in dentists and orthodontic patients were significantly lower than those in left deviation (P < .05). The acceptable deviation of LT-line and AT-line relative to FC-line should be kept within 2 mm. Besides, raters’ occupation and gender, and deviation direction of model may influence the smile aesthetics.
Clinicopathological characteristics, survival outcomes and prognostic factors in the cT1N0M0 pancreatic neuroendocrine tumors: A SEER-based study
Authors: Guo Nian , Liang Zhen , Xiong Li Jiao
Published: October 2022

Small nonfunctional pancreatic neuroendocrine tumors ≤2 cm have different biological features, and there is no gold standard treatment for them. This study aimed to assess the risk of malignancy of small non-functional pancreatic neuroendocrine tumors and their outcomes after radical resection. The optimal management of small, incidentally detected pancreatic neuroendocrine tumors is controversial, with the aim of identifying factors predicting survival in patients with clinical stage T1N0M0 (cT1N0M0) pancreatic neuroendocrine tumors and whether surgical treatment improves survival. Using the Surveillance, Epidemiology, and End Results database, we identified 637 patients with cT1N0M0 pancreatic neuroendocrine tumors from 2010 to 2015, including clinicopathological characteristics, treatment modalities, and outcome data. From the surveillance, epidemiology, and end results database of 637 patients with cT1N0M0 PNENs, 564 were treated surgically. Age (P = .000), sex (P < .001), and surgery (P < .001) were independent risk factors affecting survival. Patients who have undergone surgery, women and young adults have a higher overall survival rate. The following independent prognostic predictors for cT1N0M0 pNENs were identified: age, sex, and surgery. At last, we concluded that Surgery can increase the overall survival of pancreatic neuroendocrine tumors in T1N0M0.
Multiplex PCR: Aid to more-timely and directed therapeutic intervention for patients with infectious gastroenteritis
Authors: Montasser Karim , Osman Heba Ahmed , Abozaid Hanan , Khalil Haidy S. , Hatem Amer Wesam , Sabry Abeer M. M.
Published: October 2022

Background:

Multiplex PCR is a sensitive and rapid method compared with conventional methods. Therefore, we use multiplex PCR for the rapid detection of the four major intestinal pathogens causing gastroenteritis (Shigella spp., Campylobacter spp., Aeromonas spp. and Enterohemorrhagic Escherichia coli [EHEC]) in stool specimens.

Materials and methods:

A prospective randomized study using 200 stool samples obtained from patients presented with acute gastroenteritis during the study period (between February 2019 and December 2021). Bacteria in stool samples were identified using conventional culture methods and multiplex PCR for stool samples

Results:

The identified organisms using conventional cultures; were Shigella (27%), Aeromonas species (10%) and EHEC (O157) (8%). Using multiplex PCR. Shigella spp. was the most commonly identified pathogen (detected in 40.5% of positive samples), followed by Aeromonas spp. (30%), EHEC (20%) and Campylobacter species was only detected in (1%) of positive samples. The diagnostic evaluation of multiplex PCR in relation to conventional method in diagnosis of Shigella, EHEC and Aeromonas showed, sensitivity of 100% (for each), specificity of 88.5%, 92.4%, 77.8% respectively. However, the diagnostic evaluation of multiplex PCR in relation to conventional method in diagnosis of Campylobacter showed specificity of 99% and NPV of 100%.

Conclusions:

Multiplex PCR is an accurate and rapid method for detection of common intestinal pathogens causing severe gastroenteritis. a rapid method that could be used in outbreaks for diagnosis of the common enteric pathogens causing fatal gastroenteritis.
Graves’ hyperthyroidism induced pancytopenia, epilepsia and muscle weakness: A case report
Authors: Fu Bao , He Dinghong , Geng Zhengguang , Fu Xiaoyun
Published: October 2022

Rationale:

Pancytopenia and epilepsia are rare complications of Graves’ disease (GD). Muscle weakness is a physical sign of GD. It is extremely rare for GD patients to present 3 symptoms at the same time.

Patient concerns:

A 35-year-old female was admitted to hospital for dizziness for 1 day. The results of laboratory examination on admission showed pancytopenia and hypothyroidism. Her clinical manifestations include pancytopenia, epilepsy, and muscle weakness.

Diagnosis:

Graves’ hyperthyroidism.

Interventions:

She received endotracheal intubation, ventilator, antithyroid drugs, and hormone therapy.

Outcome:

The patient was discharged after treatment.

Lesson:

Severe complications caused by GD are rare and require antithyroid therapy. Although glucocorticoid is not recommended by the guidelines, it can effectively improve thrombocytopenia.
Resource utilization and variation among practitioners for evaluating voice hoarseness secondary to suspected reflux disease: A retrospective chart review
Authors: Korsunsky Sydney R.A. , Camejo Leonel , Nguyen Diep , Mhaskar Rahul , Chharath Khattiya , Gaziano Joy , Richter Joel , Velanovich Vic
Published: October 2022

The purpose of this study was to assess the variation in resource utilization for the diagnosis and treatment of dysphonia or hoarseness in patients with suspected laryngopharyngeal reflux (LPRD) and/or gastroesophageal reflux (GERD). Secondary data was collected from a single-institution database of charts from patients evaluated between October 1, 2011 and March 31, 2020. This study was conducted as a retrospective chart review. Key outcome variables included demographic data, initial specialty visit, date of first symptom evaluation to final follow-up visit, additional procedural evaluation, and final diagnosis as attributed by the diagnosing physician. Inclusion criteria included patients ≥18 older referred to providers for suspected LPRD/GERD with a primary complaint of voice changes or hoarseness and appeared for follow-up. A total of 134 subjects were included for analysis. Data analysis included descriptive and univariate analysis, chi-square test of independence, independent means t test, and 1-way analysis of variance. Most patients (88) received some form of procedural evaluation in addition to clinical evaluation. The most frequent was videostroboscopy (59). Patients who first visited a gastroenterologist were more likely to undergo esophageal pH-monitoring (n = 14, P < .001) and manometry (n = 10, P < .001). Patients referred to speech-language pathology were very likely to undergo videostroboscopic evaluation (n = 7, P < .001). The prevailing final diagnosis as attributed by the diagnosing physician was confirmed to be of non-reflux etiology (49) or due to GERD alone (34). LPRD only was the least frequent diagnosis (10). Our results demonstrate that there is significant variation in the number and type of diagnostic tests based on the type of practitioner initially seen by the patient. Additionally, of patients thought to have voice change or hoarseness because of LPRD and/or GERD, more than a third had a non-reflux cause of their symptoms. Further research should identify beneficial patterns in resource utilization and further diagnostic utility of diagnostic procedures for more accurate diagnosis.