bluuebunny/crossref_metadata_2025 huggingface dataset:
Mario Vargas Llosa between Literature and Politics
Authors: Köllmann Sabine
Published: June 2022

Mario Vargas Llosa’s contribution to the Latin American novel earned him the 2010 Nobel Prize in Literature “for his cartography of structures of power and his trenchant images of the individual’s resistance, revolt, and defeat.” The political dimension emphasized here is only one of many different facets that can be found in his narrative work, often side by side: history and social satire, dictatorship and fanaticism, eroticism and metafiction, crime and melodrama, art and self-parody. The unifying factor is his dual interest in the effects of politics on the individual and the role of fiction in society. An overview of the complete novelistic oeuvre in its biographical, political, and aesthetic context reveals continuities in narrative features, such as dual structures and multiple perspectives, and themes such as authoritarianism, fanaticism, and the search for truth: the truth of the “lies” of fiction, and the truth distorted by politics or the media.
Gabriel García Márquez as Local and Universalist, Traditional cum Modernist Storyteller
Authors: Bell-Villada Gene H.
Published: June 2022

García Márquez’s reach as a novelist is vast, in both its breadth of subject matter and its range of readership. He writes with equal mastery about love and sex; family life and loneliness; social conflict, dictatorship, and war; childhood, youth, and old age; and much more. His timeframe can cover entire centuries. With the fame achieved by One Hundred Years of Solitude, he became an iconic figure throughout the Hispanic world, his profile further enlarged by his excellent work as a journalist. Eventually his literary reach also became global, with millions of admirers and avowed artistic disciples in the United States, Japan, China, South Asia, Africa, and the Arab world. At the same time, his writing is very locally and vividly rooted in the Caribbean region of his native Colombia. In a similar combination, his narrative builds to a significant degree on traditional, folk elements as well as on the cosmopolitan, modernist workshop of Joyce, Faulkner, Hemingway, and Woolf. And, it goes without saying, he fuses magic with realism in a way so seamless and subtle that it has become part of the available repertory for fiction writers across the globe. This chapter briefly recounts García Márquez’s life and development as a writer, surveys his body of work in the light of the above traits, and describes his overall legacy and place in world literary culture.
Transnational, Intermedial Pressures in Roberto Bolaño’s Prose Poem Novels
Authors: Monroe Jonathan B.
Published: June 2022

Roberto Bolaño demonstrated an acute sense of the transnational, intermedial pressures facing the novel in the last two decades of the twentieth century and first few years of the twenty-first. These pressures are strikingly manifest in his two bookend novels El espíritu de la ciencia-ficción (The Spirit of Science Fiction, 2016, written 1980–1984) and Una novelita lumpen (A Little Lumpen Novelita, 2002). While the former stages Bolaño’s early attempts to negotiate the aspiring Latin American writer’s peripheral “Third World” status in the Cold War era, the latter explores in a European context, from a post-Cold War perspective, the thoroughgoing displacement of literary-historical frames of reference by media and popular culture. At the core of Bolaño’s novels, from his initial interest in science fiction to his much greater investment in detective fiction, are questions of value posed by an increasingly global, media-saturated culture to the novel and to literature generally.
A cross-sectional study examining the equitability of invitation, uptake and coverage for NHS Health Check
Authors: Ogunlayi Fatai , Chauhan-Lall Nina , Hughes David , Myers Paulette , Sitch Alice
Published: June 2022

Background

The evidence for access to NHS Health Check (NHSHC) varies considerably across the country. This study examined the equity in invitation, uptake and coverage of NHSHC and impact of different invitation methods.

Methods

This patient-level cross-sectional study from 52 general practices in Walsall used adjusted logistic regressions to examine the association between patient characteristics (age, sex, ethnicity and deprivation) and NHSHC access.

Results

Over the 5-year study period, 61 464 people were eligible for NHSHC, 66% were invited, uptake was 74% and coverage was 55%. Males had lower odds of: invitation (AOR: 0.78, 95% CI: 0.75–0.81), uptake (0.73, 95% CI: 0.70–0.77) and coverage (0.69, 95% CI: 0.66–0.71). Compared with White, the ‘Other’ ethnicity group (mixed backgrounds, other Asians that are not South Asians and other ethnic groups) had lower odds of: invitation (0.74, 95% CI: 0.67–0.81), uptake (0.86, 95% CI: 0.75–0.98) and coverage (0.74, 95% CI: 0.68–0.81). The most deprived areas had lower odds of invitation, uptake and coverage. Opportunistic invitation had a 25-fold increase in odds of uptake.

Conclusions

The study has highlighted areas of inequities in access to NHSHC. The group most negatively affected were men, people from particular minority ethnic groups and people from deprived communities. Further actions are needed to reduce these inequities.
Public deliberation and the regulation of gene drive in the USA
Authors: West William F , Buchman Leah W , Medina Raul F
Published: June 2022

Gene drive is a new form of biotechnology designed to bias the inheritance of selected traits in animal or plant species that reproduce sexually and have relatively short reproductive cycles. Unlike traditional breeding techniques and other forms of biotechnology, gene drive is designed to spread in wild populations. As such, the prospect of its application raises ecological and socioeconomic concerns that the current system of biotechnology regulation in the USA is ill-equipped to address. Foremost among the proposals for reform is the need for deliberative participation in decision-making by stakeholders representing a broader range of interests and analytical perspectives. As appealing as they are in the abstract, these recommendations overlook both practical and political challenges to democratic governance in administration that have received little attention.
Volatile versus Propofol General Anesthesia and Long-term Survival after Breast Cancer Surgery: A National Registry Retrospective Cohort Study
Authors: Enlund Mats , Berglund Anders , Enlund Anna , Bergkvist Leif
Published: June 2022

Background

Several retrospective studies using administrative or single-center data have failed to show any difference between general anesthesia using propofol versus inhaled volatiles on long-term survival after breast cancer surgery. Although randomized controlled trials are ongoing, validated data from national clinical registries may advance the reliability of existing knowledge.

Methods

Data on breast cancer surgery performed under general anesthesia between 2013 and 2019 from the Swedish PeriOperative Registry and the National Quality Registry for Breast Cancer were record-linked. Overall survival was compared between patients receiving propofol and patients receiving inhaled volatile for anesthesia maintenance.

Results

Of 18,674 subjects, 13,873 patients (74.3%) received propofol and 4,801 (25.7%) received an inhaled volatile for general anesthesia maintenance. The two cohorts differed in most respects. Patients receiving inhaled volatile were older (67 yr vs. 65 yr), sicker (888 [19.0%] American Society of Anesthesiologists status 3 to 5 vs. 1,742 [12.8%]), and the breast cancer to be more advanced. Median follow-up was 33 months (interquartile range, 19 to 48). In the full, unmatched cohort, there was a statistically significantly higher overall survival among patients receiving propofol (13,489 of 13,873 [97.2%]) versus inhaled volatile (4,039 of 4,801 [84.1%]; hazard ratio, 0.80; 95% CI, 0.70 to 0.90; P < 0.001). After 1:1 propensity score matching (4,658 matched pairs), there was no statistically significant difference in overall survival (propofol 4,284 of 4,658 [92.0%]) versus inhaled volatile (4,288 of 4,658 [92.1%]; hazard ratio, 0.98; 95% CI, 0.85 to 1.13; P = 0.756).

Conclusions

Among patients undergoing breast cancer surgery under general anesthesia, no association was observed between the choice of propofol or an inhaled volatile maintenance and overall survival.

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Significant Improvement in Digoxin Immunoassays Over Four Decades: Newer Assays are Less Affected by Interferences
Authors: Dasgupta Amitava
Published: June 2022

Background:

Digitalis glycosides derived from foxglove plants have been used for medicinal purposes since the 16th century. Currently, digoxin derived from foxgloves is used clinically. Owing to the narrow therapeutic range, therapeutic drug monitoring is essential; however, digoxin immunoassays suffer from interference.

Methods:

The issue of interference was reviewed for both older polyclonal antibody–based digoxin assays and newer monoclonal antibody–based digoxin assays. A literature search was conducted using PubMed, ScienceDirect, Scopus, Web of Science, and ResearchGate for studies on digoxin immunoassays published in the English language from 1969 to the present.

Results:

Radioimmunoassays for digoxin in the 1970s and, later, first-generation nonradioimmunoassay methods were liable to several interferences, including digoxin-like immunoreactive substances, spironolactone, potassium canrenoate, and various digoxin metabolites. However, for the last 10–15 years, next next-generation digoxin immunoassays have been virtually free from such interferences. Nevertheless, certain herbal supplements, as well as both Digibind and DigiFab, interfere with serum digoxin measurement, even with the more recently developed digoxin assays.

Conclusions:

More recently introduced monoclonal antibody–based digoxin assays are superior to the older polyclonal antibody–based digoxin assays.
Teaching a New Dog Old Tricks: Ultrafast Liquid Chromatography/Tandem-Mass Spectrometry Analysis of Nine ß-Lactam Antibiotics for Improved Therapeutic Drug Monitoring
Authors: Hodgkins Christopher , Cordwell Stuart J. , Kocic Danijela
Published: June 2022

Background:

Therapeutic drug monitoring (TDM) of β-lactam antibiotics provides critical knowledge in hospital intensive care unit environments to support dosing within the narrow window between therapeutic failure and toxicity. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is the most suitable analytical technique for these drugs; however, clinicians, patients, and laboratories would benefit from shortening the timeframe between the collection of samples and reporting of results.

Methods:

The authors developed a very rapid LC-MS/MS method for 9 β-lactam antimicrobial drugs on a commercial core–shell reverse-phase LC column by exploiting the performance of such stationary phase materials at a high mobile-phase linear velocity and using a simple flow split to optimize ionization conditions in the mass spectrometer ion source. The method's performance was assessed using a currently validated routine LC-MS/MS assay performed on the same instrument.

Results:

Routine ß-lactam assays were reduced from >6 minutes per sample to less than 2 minutes with improved chromatographic resolution, while still maintaining acceptable analytical performance (average correlation coefficient: 0.99670, interday imprecision: 2.0%–10.8%, and bias: –1.68%), hence generating results in agreement with an existing validated method for patient and quality assurance program samples.

Conclusions:

Time-critical results, such as those for β-lactam antimicrobials, may be reported by the TDM laboratory several hours earlier than current methods allow, providing improved patient care and generating capacity on LC-MS/MS instruments for larger batch sizes and/or additional assays. The simple-to-implement technique demonstrated in this study may be applicable to other TDM assays or any LC-MS/MS method where faster turnaround times are desirable.
Tacrolimus Population Pharmacokinetic Model in Adult Chinese Patients with Nephrotic Syndrome and Dosing Regimen Identification Using Monte Carlo Simulations
Authors: Liao Minghao , Wang Minglu , Zhu Xu , Zhao Limei , Zhao Mingming
Published: June 2022

Background:

The study aimed to establish a population pharmacokinetic (PPK) model of tacrolimus for Chinese patients with nephrotic syndrome using the patient's genotype and Wuzhi capsule dosage as the main test factors.

Methods:

Ninety-six adult patients with nephrotic syndrome, who were receiving tacrolimus treatment, were enrolled. A nonlinear mixed-effects model was used to determine the influencing factors of interindividual tacrolimus metabolism variation and establish a PPK model. To optimize the tacrolimus dosage, 10,000 Monte Carlo simulations were performed.

Results:

The 1-chamber model of first-order absorption and elimination was the most suitable model for the data in this study. The typical population tacrolimus clearance (CL/F) value was 16.9 L/h. The percent relative standard error (RSE%) of CL/F was 12%. Increased Wuzhi capsule and albumin doses both decreased the tacrolimus CL/F. In CYP3A5 homozygous mutation carriers, the CL/F was 39% lower than that of carriers of the wild-type and heterozygous mutation. The tacrolimus CL/F in patients who were coadministered glucocorticoids was 1.23-fold higher than that of the control. According to the patient genotype and combined use of glucocorticoids, 26 combinations of Wuzhi capsule and tacrolimus doses were matched. The Monte Carlo simulation identified the most suitable combination scheme.

Conclusions:

An improved tacrolimus PPK model for patients with nephrotic syndrome was established, and the most suitable combination of Wuzhi capsule and tacrolimus doses was identified, thus, facilitating the selection of a more economical and safe administration regimen.
Chest pain in a pediatric emergency department: clinical assessment and management reality in a third-level Portuguese hospital
Authors: Pissarra Rita , Pereira Marisa , Amorim Rita , Neto Bárbara Pereira , Lourenço Lara , Santos Luís Almeida
Published: June 2022

Background:

Chest pain in children and adolescents is a common complaint in the emergency department (ED), being mostly benign. A thorough patient history and physical examination should be enough in most cases for its proper management. Regarding non-cardiac chest pain, anxiety plays an important role.

Methods:

Retrospective analysis of all admissions in a pediatric ED of a Portuguese third-level hospital with a chief complaint of chest pain between January and December 2018. Chi-square test was used to compare different etiologies, considering a significance level of 5%.

Results:

A total of 798 visits were included: 53.6% girls, 80.8% adolescents (mean age: 13years old). According to the Pediatric Canadian Triage and Acuity Scale, 77.7% was prioritized as level IV: less urgent; 65.3% reported associated symptoms including dyspnea (31.8%), cough (18.2%), and palpitations (16.1%). In physical examination, 45.5% had alterations: 62.8% with chest wall tenderness. Further investigation was done in 84% of patients: 62.4% electrocardiograms (altered in 14.7%), 52.6% chest radiographies (altered in 17.1%) and 8.9% cardiac biomarkers (altered in 12.7%). The 3 main causes of chest pain were musculoskeletal (33%), idiopathic (24.4%) and psychogenic (21.6%), with 1.1% of cardiac etiology. Less than 3% needed hospital admission and 18.9% were oriented to an outpatient consultation. 7.1% readmissions reported. When compared to other causes as a group, psychogenic chest pain presented a statistically significant association with female sex, adolescence, psychiatric antecedents, previous stressful event, and normal physical examination. Of these, <30% were oriented to a pedopsychiatry/psychology consultation.

Conclusions:

Opposing to the low priority level in triage, benign diagnosis found, and low hospital admissions, there was a high percentage of complementary diagnostic tests performed with few altered results. In psychogenic chest pain there was a low postdischarge referral. The authors highlight the importance of clinical algorithms to reduce unnecessary tests performed and readmissions and improve orientation and follow-up, particularly in psychogenic etiology.
Functional improvement by body-powered 3D-printed prosthesis in patients with finger amputation
Authors: Lee Min-Yong , Lee Seung Hak , Leigh Ja-Ho , Nam Hyung Seok , Hwang Eun Young , Lee Jung Yeon , Han Sol , Lee Gangpyo
Published: June 2022

Rationale:

The most common upper limb amputations are finger amputations, resulting in functional limitations that lead to problems with activities of daily living or job loss. For many years, prosthetic options for finger amputations have been limited to passive prostheses. In many countries including South Korea, body-powered finger prostheses have rarely been prescribed due to high cost, lack of experience of physicians and prosthetists, low interest and no coverage by insurance benefits. We report 2 cases of work-related finger amputations in patients who received body-powered 3D-printed finger prostheses.

Patient concerns and diagnosis:

Patient 1 was a 25-year-old woman with second and third finger amputations at the proximal interphalangeal level. Patient 2 was a 26-year-old man who sustained a second finger amputation at proximal interphalangeal level.

Interventions:

We created body-powered 3D-printed finger prostheses that mimicked distal interphalangeal joint motion through patient-driven metacarpophalangeal joint motion using a string connected to a wrist strap and a linkage system. The source code “Knick Finger” was downloaded from e-NABLE.

Outcomes:

After 1 month of prosthesis training, both patients were satisfied with the prostheses and showed improved performance in patient-derived goals of cooking (patient 1) and typing on a computer (patient 2).

Lessons:

Over the past decade, significant advances have been made in 3D-printed prosthetics owing to their light weight, low cost, on-site fabrication, and easy customization. Although there are still several limitations in the general application of 3D-printed finger prostheses, our study suggests that for patients with finger amputations, body-powered 3D-printed finger prostheses have high potential as an additional prosthetic option to the existing passive cosmetic prostheses.
Prognostic significance of A-kinase interacting protein 1 expression in various cancers
Authors: Xue Shanshan , Zhang Chuanmeng , Xu Jie , Zhou Chenglin
Published: June 2022

Background:

Cumulative evidence suggests that A-kinase interacting protein 1 (AKIP1) plays an important role in tumor progression. However, the prognostic value of AKIP1 expression in various cancers remains unclear. Here, we conducted a meta-analysis to evaluate the prognostic value of AKIP1 expression in patients with cancer.

Methods:

The PubMed, Web of Science, EMBASE, CNKI, and Wanfang databases were systematically searched to identify studies in which the effect of AKIP1 expression on prognosis (overall survival or disease-free survival) was investigated. Hazard ratios (HRs) with 95% confidence intervals (CIs) were combined to assess the effect of AKIP1 expression on patient survival. Odds ratios (ORs) with 95% CIs were pooled to estimate the association between AKIP1 expression and clinicopathological characteristics of patients with cancer.

Results:

Nineteen eligible studies, encompassing 3979 patients, were included in the meta-analysis. AKIP1 expression was negatively associated with overall survival (HR = 1.86, 95% CI: 1.58–2.18, P < .001) and disease-free survival (HR = 1.69, 95% CI: 1.53–1.87, P < .001) in patients with cancer. Moreover, AKIP1 overexpression was positively correlated with adverse clinicopathological features, such as tumor size (OR = 2.22, 95% CI: 1.67–2.94, P < .001), clinical stage (OR = 2.05, 95% CI: 1.45–2.90, P < .001), depth of tumor invasion (OR = 2.98, 95% CI: 2.21–4.02, P < .001), and degree of lymph node metastasis (OR = 2.12, 95% CI: 1.75–2.57, P < .001).

Conclusions:

High AKIP1 expression is an unfavorable prognostic biomarker and may serve as a potential therapeutic target in patients with cancer.
Primary hypothyroidism with an episode of ventricular tachycardia in a patient with COVID-19
Authors: Liao Pin-Hsu , Cheng Yu-Cheng , Liu Po-Yu , Lee I-Te
Published: June 2022

Rationale:

Coronavirus disease 2019 (COVID-19) is a systemic disease with major clinical manifestations in the respiratory system. However, thyroid involvement has also been reported. We present a case of hypothyroidism with ventricular tachycardia following diagnosis with COVID-19.

Patient concerns:

A 77-year-old man was admitted to the isolation ward due to COVID-19. After respiratory support and medical treatment, the patient was successfully weaned off the ventilator. However, an episode of short-run ventricular tachycardia was detected, and primary hypothyroidism was also diagnosed.

Diagnosis:

Ventricular tachycardia was detected by electrocardiography.

Interventions:

Intravenous amiodarone administration and oral levothyroxine replacement.

Outcomes:

No arrhythmia detected following treatment.

Lessons:

Awareness of the association between hypothyroidism and COVID-19 is important in preventing possible complications.
Intraoperative malignant glaucoma during femtosecond laser-assisted cataract surgery
Authors: Xu Rong , Cao Danmin , Jiao Ya , Zeng Qingyan
Published: June 2022

Rationale:

Femtosecond laser-assisted cataract surgery (FLACS) has grown in popularity among ophthalmologists as a novel surgical technique. However, malignant glaucoma (MG) is a complication of FLACS. Herein, we report a case of MG following FLACS.

Patient concerns:

A 66-year-old woman presented with complaints of blurred vision in the right eye and a foreign body sensation in both eyes. Ophthalmological examinations showed that the corrected distance visual acuity was 20/50 and 20/25 in the right and left eyes, respectively. Without any topical anti-glaucoma medication, the intraocular pressure (IOP) was 20 mmHg in the right eye and 17 mmHg in the left eye. Slit-lamp examination of the right eye revealed a transparent cornea with a defect in the punctate overlying epithelium; the central anterior chamber depth was shallow the peripheral iris laser shot was visible, the pupil was normal, and the lens was mainly cortical opacified.

Diagnoses:

Based on the patient's symptoms, examination results, and preliminary diagnoses, age-related cataract in the right eye, binocular post-antiglaucoma surgery, pseudophakicin in the left eye, and Sjogren syndrome were included.

Interventions:

FLACS was performed to facilitate anterior capsulotomy and segmentation of the nucleus in the right eye. MG occurred after the femtosecond procedure, and with the treatment of medicines combined with phacoemulsification, IOP was eventually normal without further antiglaucoma therapy.

Outcomes:

IOP was 16 mmHg on postoperative day 1. Ocular ultrasonography revealed no choroid detachment or hemorrhage in the right eye. Two weeks postoperatively, uncorrected visual acuity was 20/25, and IOP remained normal with no further antiglaucoma treatment on 1 month postoperatively.

Conclusions:

We describe the occurrence of MG after FLACS and illustrate that miosis and bubble formation after FLACS may be risk factors for MG during FLACS.
Postaxial hypoplasia of the lower extremity associated with congenital dislocation of the patella
Authors: Charles-Lozoya Sergio , Ruíz-Zenteno Gibran , Cobos-Aguilar Héctor , Lizcano-Martínez María , Manilla-Muñoz Edgar , De La Parra-Márquez Miguel Leonardo , García-Hernández Adrián
Published: June 2022

Rationale:

Evaluation of clinical and radiologic abnormalities in patients with postaxial hypoplasia of the lower extremity (PHLE) for treatment decisions represents a major challenge, which is more complicated when PHLE is associated with congenital dislocation of the patella.

Patient concerns

: Herein, we present the case of an 8-year-old female patient with evident length inequality in her left lower extremity and inability to walk.

Diagnoses:

Radiological evaluation revealed PHLE with fibular hemimelia, proximal femoral focal deficiency, tarsal coalition, and congenital patellar dislocation of the patella. The right lower extremity was also affected by fibular hemimelia.

Interventions and outcomes:

Surgical management included the Roux-Goldthwait technique for patellofemoral joint realignment, a medial knee stapled with Blount technique, and femur enlargement using the Wagner technique. The results from surgical intervention included a left femoral elongation of 6.7 cm featuring callus with angulation, displacement, and a discrepancy of 5 cm between femurs with a flexor contraction in the knee of −15° and a centralized knee.

Lesson:

PHLE accompanied by congenital dislocation of the patella has not been extensively described in the literature; therefore, there is no established management. Starting reconstruction at an early age, together with an adequate classification of the deformity, are essential factors when opting for limb reconstruction.
Aberrantly methylated-differentially expressed genes and related pathways in cholangiocarcinoma
Authors: Lin Guan , Xinhe Zhang , Haoyu Tian , Yiling Li
Published: June 2022

This study aimed to explore aberrantly methylated-differentially expressed genes and related pathways in cholangiocarcinoma (CCA).

The mRNA expression data (GSE26566) and methylation profiling data (GSE44965) were collected from the Gene Expression Omnibus (GEO) Datasets. Differentially expressed genes and differentially methylated genes were identified using GEO2R. Gene ontology analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed using clusterprofiler in R. MCODE clustering tool was used to screen modules of the protein–protein interaction network in Cytoscape. Related pathways of hub gene by using gene set enrichment analysis.

Eighty-one hypermethylated, lowly expressed genes (Hyper-LGs) and 76 hypomethylated, highly expressed genes (Hypo-HGs) were identified in this study. Hyper-LGs were enriched in ion channel binding and transcription factor activity, which was associated with Mineral absorption and Cell adhesion molecules. Hypo-HGs were enriched in cysteine-type endopeptidase activity, which was associated with Sphingolipid signaling pathway and T cell receptor signaling pathway. Based on protein–protein interaction networks, MYC and VWF were identified as hub genes for Hyper-LGs, and no hub genes for Hypo-HGs.

This study found methylated-differentially expressed genes and signaling pathways that are connected with the CCA by using a series of bioinformatics databases and tools. MYC and VWF act as hub genes of CCA, which can be used as biomarkers based on aberrant methylation for the accurate diagnosis and treatment of CCA.
Analysis of risk factor for nail breakage in patients with mechanical failures after proximal femoral nail antirotation in intertrochanteric fractures
Authors: Lee Young-Kyun , Kim Jung-Taek , Park Chan Ho , Song Ji-Ung , Kim Tae-Young , Koo Kyung-Hoi
Published: June 2022

Breakage of the intramedullary nail is a rare complication after proximal femoral nail antirotation (PFNA) in intertrochanteric fracture treatment. The purpose of this study was (1) to investigate the frequency of nail breakage among the patients who were treated for mechanical failure after PFNA for intertrochanteric/pertrochanteric fracture, and (2) to determine the risk factors for nail breakage in PFNA treatment of intertrochanteric fracture.

To identify mechanical failure after internal fixation using PFNA, we retrospectively reviewed the data of 35 patients (35 hips) who required reoperation after PFNA with a helical blade for intertrochanteric/pertrochanteric fracture between June 2005 and June 2018.

We evaluated the frequency of breakage of PFNA and compared the demographic and radiologic parameters between the breakage and control (non-breakage) groups. We also compared the lever arm for the load of stress from the fulcrum according to the centrum-collum-diaphyseal (CCD) angle of blade by using reverse design technique.

Among the 25 patients with mechanical failure after PFNA except 10 patients with peri-implant infection and osteonecrosis, 7 (28.0%) showed breakage of PFNA at average of 8 months (range, 5–13 months) after index surgery. A larger horizontal offset (the horizontal distance from the lateral surface of the IM nail and the medial tip of helical blade) was associated with an increased risk of nail breakage. A CCD angle of 130° has a shorter lever arm for the load of stress from the fulcrum, meaning a higher stress for nail breakage, although there was no association between CCD angle and breakage of the nail.

Our study suggested that higher horizontal offset and a higher CCD angle can increase the risk of breakage of the PFNA nail at the aperture for the helical blade.
Lower gastrointestinal bleeding in a male with jejunal Dieulafoy's lesion after successful surgical resection
Authors: Chen Liang-Ying , Hong Yu-Han , Luo Shao-Ciao , Fu Jing-Tong , Shiu Sz-Iuan
Published: June 2022

Introduction:

Dieulafoy's lesion (DL) presented with small bowel bleeding constitutes a group of rare and potentially life-threatening prognosis. Several case series have described this condition, yet it remains unclear as to what is the optimal treatment and predicted outcome for patients who have been diagnosed.

Patient concerns:

We present a 21-year-old male experiencing bloody stool for 1 day.

Diagnosis:

Computed tomography of the abdomen exhibited active contrast extravasations and segmental wall thickening in the jejunum, and enteroscopy showed one 15-millimeter sized subepithelial tumor at the proximal jejunum.

Interventions:

Due to unstable vital signs he received an emergent transcatheter arterial embolization, and surgeon performed a laparoscopic surgical resection thereafter under the impression of potential malignancy. The pathologist confirmed jejunal DL with organizing thrombus.

Outcomes:

He was discharged on the 8th day of hospitalization without recurrent bleeding.

Conclusion:

A systematic literature review of 98 published cases taken from PubMed dating back to 1978 was undertaken, and the patients with DL and small bowel bleeding involved mainly the jejunum, followed by the duodenum and ileum. Meanwhile, DL-related duodenal bleeding was diagnosed mostly by an enteroscopy, as well as endoscopic interventions. Jejunal and ileal bleeding due to DL was surveyed through endoscopy and surgery, while surgical resection remained the choice for bleeding cessation. Only anticoagulant use (OR = 18.16; P = .08) was associated with a higher risk of overall mortality, although it was non-significant in univariate analysis. We emphasize that individualized treatment as well as prompt measurement should be implemented accordingly.
The analysis of prognostic factors of primary small intestinal gastrointestinal stromal tumors with R0 resection
Authors: Qu Hui , Xu ZhaoHui , Ren YanYing , Gong ZeZhong , Ju Ri Hyok , Zhang Fan , Shao Shuai , Chen XiaoLiang , Chen Xin
Published: June 2022

Objective:

We aim to assess factors that affect overall survival in patients with primary small intestinal gastrointestinal stromal tumors (GISTs) who had undergone R0 resection.

Method:

A retrospective analysis reviewed the data of 82 consecutive confirmed GIST patients at a single medical center in China from January 2012 to June 2020. The survival curve was estimated using the Kaplan–Meier method, and independent prognostic factors were confirmed using the Cox regression model.

Results:

A total of 82 patients were included in the study: 42 men and 40 women, the mean age was 59 years old (23–83 years old). Tumors were commonly found in the jejunum (46.3%), ileum (20.7%), and duodenum (32.9%). The median tumor size was 6.0 cm (range: 1.0–15.0 cm). The number of mitoses per one 50 high-power field was used to define the mitotic rates. In our present study, 56 patients presented a mitotic rate ≤5 (68.3%) and 26 patients showed a rate >5 (31.7%) at the time of diagnosis. All patients accepted tumor resection without lymph node resection. The positivity rate was 97.6% for CD117, 96.3% for delay of germination 1, 65.9% for CD34, 6.1% for S-100, and 59.8% for smooth muscle actin using immunohistochemistry. Tumor size, tumor rupture, Ki67 index, mitotic index, and postoperative imatinib were independent prognostic factors for small intestinal GISTs.

Conclusions:

In this study, larger tumor size, high Ki67 index, high mitotic index, the occurrence of tumor rupture, and use of imatinib were independent unfavorable prognostic indicators.
Echocardiographic evaluation of total anomalous pulmonary venous connection
Authors: Xiang Yonghua , Peng Yinghui , Qiu Jun , Gan Qing , Jin Ke
Published: June 2022

This study aims to compare the differences between obstructed and unobstructed total anomalous pulmonary venous connection (TAPVC) using echocardiography, and to evaluate the clinical and echocardiographic parameters associated with pulmonary venous obstruction (PVO).

We conducted a retrospective study of 70 patients with TAPVC between 2014 and 2019. The morphologic and hemodynamic echocardiographic parameters of patients were observed and measured, and the parameters between obstructed and unobstructed TAPVC were compared. The clinical and echocardiographic parameter differences between the two groups were used for ROC curve analysis.

Obstructed TAPVC was found in 30 (42.9%) of 70 patients. Between obstructed and unobstructed TAPVC, there were significant differences in atrial septal defect size, pulmonary artery maximum velocity (PA Vmax ), peak E velocity of mitral valve, left ventricular fractional shortening, left ventricular ejection fraction, stroke volume and the incidence of patent ductus arteriosus, but there was no significant difference in birth weight. The first diagnosis age of obstructed TAPVC was earlier than unobstructed type. The ROC curve analysis for the first diagnosis age showed the sensitivity and specificity were 76.7%, 80% respectively. The ROC curve analysis for the PA Vmax showed the sensitivity and specificity were 88.5%, 67.6% respectively.

Patients with TAPVC had a high incidence of PVO. The presence of PVO can affect the size of atrial septal defect and the closure of the ductus arteriosus, cause significant changes in PA Vmax, peak E velocity of mitral valve, left ventricular fractional shortening, left ventricular ejection fraction, stroke volume, lead to earlier symptoms and earlier first diagnosis age. The first diagnosis age and PA Vmax were excellent values since they associated with PVO.
Effect of diagnosis level of certainty on adherence to antibiotics’ guidelines in ED patients with pneumonia: a post-hoc analysis of an interventional trial
Authors: Tubiana Sarah , Epelboin Loïc , Casalino Enrique , De Saint Aurin Bérangère Gallet , Naccache Jean-Marc , Feydy Antoine , Khalil Antoine , Hausfater Pierre , Duval Xavier , Claessens Yann-Erick ,   on behalf of the ESCAPED study group
Published: June 2022

Background and importance

Clinical diagnosis of community-acquired pneumonia (CAP) is difficult to establish with certainty. Adherence to antibiotic guidelines independently affects the prognosis of CAP patients.

Objective

We aimed to determine whether guidelines’ adherence was related to CAP diagnosis level of certainty and could be reinforced accordingly to diagnosis improvement.

Design

Secondary analysis of a prospective, multicenter study, which evaluated the impact of early thoracic CT scan on diagnosis and therapeutic plan in patients with clinically suspected CAP visiting emergency departments.

Setting and participants

In total 319 patients with clinically suspected CAP were enrolled in four emergency departments, Paris, France, between Nov 2011 and Jan 2013.

Outcome measures and analysis

We evaluated guidelines’ adherence before and after CT scan and its relationship with CAP diagnosis level of certainty. Antibiotics were categorized as adherent according to 2010 French guidelines. CAP diagnosis level of certainty was prospectively classified by the emergency physicians based on a Likert scale as excluded, possible, probable or definite before and immediately after the CT scan. These classifications and therapeutic plans were also completed by an independent adjudication committee. Determinants of adherence were assessed using Poisson regression with robust variance.

Main results

Adherence to guidelines increased from 34.2% before CT scan to 51.3% after CT scan [difference 17.1% (95% CI, 9.5–24.7)], meanwhile CAP diagnosis with high level of certainty (definite and excluded CAP) increased from 46.1 to 79.6% [difference 33.5% (95% CI, 26.5–40.5)]. Diagnosis level of certainty before CT scan was the strongest determinant of adherence in multivariate analysis (RR, 2.63; 95% CI, 1.89–3.67).

Conclusion

Antibiotic guidelines’ adherence was poor and positively related to CAP diagnosis level of certainty. The results suggest that improvements in CAP diagnosis may increase adherence to antibiotic guidelines. Clinical trial registered with www.clinicaltrials.gov (NCT 01574066).
Long-Term Follow-up of Individual Therapist Delivered and Standardized Hypnotherapy Recordings in Pediatric Irritable Bowel Syndrome or Functional Abdominal Pain
Authors: Rexwinkel Robyn , Bovendeert Jeske F.M. , Rutten Juliette M.T.M. , Frankenhuis Carla , Benninga Marc A. , Vlieger Arine M.
Published: June 2022

Objectives:

We previously showed that standardized home-based gut-directed hypnosis exercises with compact disc (CD) is non-inferior to individual hypnotherapy (iHT) by a therapist in the treatment of children with irritable bowel syndrome (IBS) and functional abdominal pain (syndrome) (FAP(S)). Aim of this follow-up study was to investigate the long-term effects of standardized-hypnosis-recordings at home in comparison to iHT.

Methods:

All participants from our previous randomized controlled trial were invited to complete: 1) an online standardized abdominal pain dairy, on which pain frequency and intensity were scored, and 2) an online questionnaire including adequate relief (AR), anxiety/depression scores, somatization, quality of life (QOL), pain beliefs, school and/or work absenteeism and health care utilization.

Results:

227 out of 250 (91%) participants completed this study. After a median duration of 6 years follow-up (5.8-6.2), 80.0% in the CD group vs 86.6% in the iHT group reported AR of their abdominal complaints (P=.22). Compared to the 1-year follow-up, AR percentages were stable. Treatment success was seen in 67.6% in the CD group vs 71.3% in the iHT group (P=.66). Anxiety and depression scores, somatization, pain beliefs, health care utilization and school/work absenteeism also improved significantly in both study groups compared with baseline. No differences were found in QOL-scores.

Conclusions:

Both home-based treatment with standardized-hypnosis-recordings and iHT given by a therapist show persisting positive results in more than 80% of children with IBS and FAP(S) after 6 years of follow-up. These results support the rationale for implementation of this easy-to-use, widely available and cost-effective home-treatment in daily practice.
The Pyruvate Dehydrogenase Complex Mitigates LPS-Induced Endothelial Barrier Dysfunction by Metabolic Regulation
Authors: Mao Liangfeng , Sun Maomao , Chen Zhenfeng , Zeng Zhenhua , Wu Jie , Chen Zhongqing , Zhang Weijin , Huang Qiaobing
Published: June 2022

Sepsis is a fatal health issue induced by an aberrant host response to infection, and it correlates with organ damage and a high mortality rate. Endothelial barrier dysfunction and subsequent capillary leakage play major roles in sepsis-induced multiorgan dysfunction. Anaerobic glycolysis is the primary metabolic mode in sepsis and the pyruvate dehydrogenase complex (PDHC) serves as a critical hub in energy regulation. Therefore, it is important to understand the role of PDHC in metabolic regulation during the development of sepsis-induced endothelial barrier dysfunction.

In present study, human umbilical vein endothelial cells (HUVECs) and C57 BL/6 mice were treated with lipopolysaccharide (LPS) as models of endotoxemia. LPS increased basal glycolysis, compensatory glycolysis, and lactate secretion, indicating increased glycolysis level in endothelial cells (ECs). Activation of PDHC with dichloroacetate (DCA) reversed LPS-induced glycolysis, allowing PDHC to remain in the active dephosphorylated state, thereby preventing lactic acid production and HUVECs monolayers barrier dysfunction, as assessed by transendothelial electrical resistance and Fluorescein Isothiocyanate-labeled dextran. The in vivo study also showed that the lactate level and vascular permeability were increased in LPS-treated mice, but pretreatment with DCA attenuated these increases. The LPS-treated HUVEC model showed that DCA reversed LPS-induced phosphorylation of pyruvate dehydrogenase E1α Ser293 and Ser300 to restore PDHC activity. Immunoprecipitation results showed that LPS treatment increased the acetylation level of PDH E1α in HUVECs.

Our study suggested that activation of PDHC may represent a therapeutic target for treatment of LPS-induced endothelial barrier dysfunction.
Defining Sepsis Phenotypes—Two Murine Models of Sepsis and Machine Learning
Authors: Stolarski Allan E. , Kim Jiyoun , Nudel Jacob , Gunn Sophia , Remick Daniel G.
Published: June 2022

Introduction:

The immunobiology defining the clinically apparent differences in response to sepsis remains unclear. We hypothesize that in murine models of sepsis we can identify phenotypes of sepsis using non-invasive physiologic parameters (NIPP) early after infection to distinguish between different inflammatory states.

Methods:

Two murine models of sepsis were used: gram-negative pneumonia (PNA) and cecal ligation and puncture (CLP). All mice were treated with broad spectrum antibiotics and fluid resuscitation. High-risk sepsis responders (pDie) were defined as those predicted to die within 72 h following infection. Low-risk responders (pLive) were expected to survive the initial 72 h of sepsis. Statistical modeling in R was used for statistical analysis and machine learning.

Results:

NIPP obtained at 6 and 24 h after infection of 291 mice (85 PNA and 206 CLP) were used to define the sepsis phenotypes. Lasso regression for variable selection with 10-fold cross-validation was used to define the optimal shrinkage parameters. The variables selected to discriminate between phenotypes included 6-h temperature and 24-h pulse distention, heart rate (HR), and temperature. Applying the model to fit test data (n = 55), area under the curve (AUC) for the receiver operating characteristics (ROC) curve was 0.93. Subgroup analysis of 120 CLP mice revealed a HR of <620 bpm at 24 h as a univariate predictor of pDie. (AUC of ROC curve = 0.90). Subgroup analysis of PNA exposed mice (n = 121) did not reveal a single predictive variable highlighting the complex physiological alterations in response to sepsis.

Conclusion:

In murine models with various etiologies of sepsis, non-invasive vitals assessed just 6 and 24 h after infection can identify different sepsis phenotypes. Stratification by sepsis phenotypes can transform future studies investigating novel therapies for sepsis.
Defining Endotheliopathy in Murine Polytrauma Models
Authors: Wallen Taylor E. , Singer Kathleen E. , Elson Nora C. , Baucom Matthew R. , England Lisa G. , Schuster Rebecca M. , Pritts Timothy A. , Goodman Michael D.
Published: June 2022

Introduction:

“Endotheliopathy of trauma” is recognized as endothelial dysfunction following traumatic injury leading to poor patient outcomes. Acute post-traumatic disruptions in endothelial cell function have been associated with profound physiologic, hemodynamic, and coagulation derangements. The goal of this study was to define the generation and extent of endotheliopathy in murine polytrauma models by evaluating the post-traumatic release of serum biomarkers of ongoing cellular injury.

Methods:

Mice were randomized to undergo moderately severe concussive TBI by weight drop, 60-min hemorrhagic shock to MAP 25 mmHg with subsequent resuscitation with Lactated Ringer's, submandibular bleed (SMB), and/or midline laparotomy with rectus muscle crush. Mice were sacrificed at 1, 4, or 24 h for serum biomarker evaluation.

Results:

Serum biomarkers revealed differential timing of elevation and injury-dependent release.

At 24 h, soluble thrombomodulin was significantly elevated in combined TBI + shock + lap crush compared to untouched, and shock alone. Syndecan-1 levels were significantly elevated after shock 1 to 24 h compared to untouched cohorts with a significant elevation in TBI + shock + lap crush 24 h after injury compared to shock alone. UCHL-1 was significantly elevated in shock mice at 1 to 24 h post-injury compared to untouched mice. UCHL-1 was also significantly elevated in the TBI + shock cohort 24 h after injury compared to shock alone. Hyaluronic acid release at 4 h was significantly elevated in shock alone compared to the untouched cohort with further elevations in TBI + shock + lap crush and TBI + shock compared to shock alone at 24 h. Hyaluronic acid was also increased in lap crush and laparotomy only cohort compared to untouched mice 24 h after injury.

Conclusions:

A murine model of polytrauma including TBI, hemorrhagic shock, and laparotomy abdominal crush is a reliable method for evaluation of endotheliopathy secondary to trauma as indicated by differential changes in serum biomarkers.