bluuebunny/crossref_metadata_2025 huggingface dataset:
Supine versus prone percutaneous nephrolithotomy for renal calculi: Our experience
Authors: Mulay Abhirudra , Mane Deepak , Mhaske Sunil , Shah Avreen S. , Krishnappa Deepak , Sabale Vilas
Published: March 2022

Objectives:

To compare operative times, safety, and effectiveness of percutaneous nephrolithotomy in the supine versus the prone position.

Materials and methods:

An observational study of 100 patients was conducted in our institution for 2years from 2018 to 2020 divided into 2 groups: 50 patients underwent modified supine percutaneous nephrolithotomy (PCNL) and 50 patients underwent standard prone PCNL. The inclusion criteria included a renal calculus (calyx or pelvis) of any size for which PCNL was indicated and exclusion criteria were patients having contraindications for PCNL such as bleeding disorders, pregnancy, high risk, and co-morbid conditions. The measured data included operative time, number of punctures, stone-free rate, length of hospital stays, and rate of complications.

Results:

The 2 groups were comparable in mean age, male to female ratio, calculus size, number of punctures, residual calculi, and postoperative fever and pain. The mean difference of hemoglobin in the supine PCNL group was 0.37 g/dL whereas in the prone PCNL group it was 0.61 g/dL. The p value was significant at 0.043. The mean time to finish from initial postion was 72.24 minutes in supine PCNL and 88.12 minutes in prone PCNL. The p value was significant (p < 0.001). The mean time before puncture was 20.92 minutes in the supine position and 31.84 minutes in the prone position. The p value was significant (p < 0.001). The mean time from puncture to finish was 51.32 minutes in the supine position and 56.28 minutes in the prone position. The p value was significant (p < 0.001).

Conclusions:

As observed from this study, supine PCNL is associated with a significantly reduced operating time when compared to conventional prone position PCNL procedures. The postoperative complications such as pain and fever were not significantly different. Hence, the supine PCNL is an equally effective modality for treatment of a renal calculus with benefits of simultaneous retrograde access and less operative time compared to the prone PCNL.
The Importance of Accessible Language for Development in Deaf and Hard of Hearing Children
Authors: Spellun Arielle , Shearer Eliot , Fitzpatrick Kaitlyn , Salamy Nicole , Landsman Rachel , Wiley Susan , Augustyn Marilyn
Published: March 2022

CASE:

Brady is a 5-year-old boy who was seen in a multidisciplinary clinic for evaluation of deaf and hard of hearing children. Brady was born full-term after an uncomplicated pregnancy. He was referred for audiological evaluation after his newborn hearing screen and was diagnosed with a severe-to-profound bilateral sensorineural hearing difference at age 6 months. He has no other medical history.

Brady was referred for developmental evaluation after completing his medical workup and cochlear implantation at an outside institution. No etiologic cause of his hearing difference was identified, and his diagnosis was presumed to be genetic and nonsyndromic. He had previously undergone right cochlear implantation at age 14 months and left cochlear implantation at age 23 months. Brady received speech and language therapy, with an emphasis on spoken language through early intervention, and met all motor and social milestones at appropriate times. Despite therapy, he continued to show delays in meeting language and communication milestones. Given concerns over persistent language delays after cochlear implantation, he underwent an interdisciplinary speech, language, and psychological evaluation at 3 years 4 months old. At the time of his evaluation, he was noted to have robust social skills but significantly delayed expressive and receptive language skills with language use limited to single words.

After the initial evaluation, he was enrolled at a school for the deaf with instruction provided in both spoken English and American Sign Language. In follow-up evaluation at age 4 years 8 months, Brady was described as happy, cooperative, and eager to connect socially. It was noted that he had age-appropriate visual spatial cognitive and motor skills and had made some gains compared with prior assessments in both spoken and sign language. Notably, however, his language abilities and most areas of adaptive living skills remained below what would be expected by his developmental age and in some domains plateaued compared with prior assessments. He was able to produce some words and signs and responded to all prompts using only single words or signs and gestures. Brady's parents present today to your multidisciplinary clinic asking to understand why his language has not progressed further and to learn how they can help him reach his full potential.
Evaluation of a Highly Efficient Multidrug Biochip Array Technology for a Simultaneous and High-Throughput Urine Drug Screening in Clinical and Toxicological Settings
Authors: Castaneto Marisol S. , Huang Chihyon , Capps Duriza , Ke Pucheng , VanZile Michael , Calero Eva
Published: March 2022

Background:

A high-throughput and highly efficient analytical platform for urine drug screening is critical in both clinical and forensic settings. Mass spectrometry (MS) has better sensitivity and specificity than conventional immunoassays (IA); however, not all laboratories have the necessary resources and workforce to operate MS. The goal of this study was to evaluate a multidrug biochip with 20 discrete testing regions (DTRs) for high-throughput urine drug screening (UDS).

Methods:

The Randox DOA Ultra Urine (DOAULT URN) biochip employs chemiluminescent IA to detect various analytes, including stimulants, hallucinogens, sedatives, narcotics, and dextromethorphan. The verification included the evaluation of the limits of detection (LOD), stability of calibrators and controls, cross-reactivity, carryover, interference, and overall performance.

Results:

LODs < quality control low for each DTR. The reconstituted calibrators were stable for up to 2 weeks at −20°C. Controls were stable for 4–6 hours at 22–25°C, with <20% within-day and ≤23% between-day imprecision. The accuracy of the controls (%bias) was within ±20% of the target concentration, except for dextromethorphan at −23.8%. No interference was observed with common over-the-counter medications. No carryover was detected in the high-concentration samples. Satisfactory cross-reactivity (≥50%) with known analytes produced presumptive positive results, with readings higher than the proposed decision points. The overall biochip performance of 165 confirmed samples showed 98.0% sensitivity, 96.9% specificity, and 97.5% efficiency.

Conclusions:

The DOAULT URN biochip is a multidrug analyte IA capable of detecting dozens of parent drugs and their metabolites in urine. It offers clinical and forensic laboratories an alternative UDS tool with LODs comparable to those of MS.
Effects of Cardiac Rehabilitation on Physical Fitness, Physical Function, and Self-reported Outcomes in Patients ≥80 yr
Authors: Brosved Madeleine , Hirlekar Geir , Philip Wigh Julia , Sundberg Helen , Zidén Lena , Karlsson Thomas , Albertsson Per , Bäck Maria
Published: March 2022

Purpose:

The beneficial effects of exercise-based cardiac rehabilitation (CR) after an acute coronary syndrome (ACS) are well known, but patients ≥80 yr have been less studied. The aim was to evaluate the effects of CR on patients with ACS ≥80 yr on peak cardiorespiratory fitness (CRF), physical function, and patient-reported outcome measures (PROMs) compared with a control group.

Methods:

A total of 26 patients with ACS, median age 82 (81, 84) yr, were randomized to hospital-based CR combined with a home-based exercise program (CR group) or to a control group (C) for 4 mo. Outcomes were assessed at baseline and 4 mo and included the peak CRF (primary outcome), 6-min walk test (6MWT), muscle endurance, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), one-leg stand test, and PROMs.

Results:

There were no significant differences between the groups in peak CRF. The CR group improved significantly in terms of the 6MWT (P = .04), isotonic muscle endurance (P < .001), one-leg stand test (P = .001), SPPB total score (P =.03), Activities-specific Balance Confidence (P =.01), and anxiety (P =.03), as compared with C. There were no significant intergroup differences in the TUG, the self-reported health question or depression.

Conclusions:

Patients with ACS ≥80 yr improved in walking distance, muscle endurance, physical function, and PROMs, but not in peak CRF, by participating in a CR program. These results suggest an increased referral to CR for this growing group of patients to enable preserved mobility and independence in daily living, but this needs to be confirmed in larger studies.
Severity of Rotavirus-Vaccine-Associated Intussusception: Prospective Hospital-Based Surveillance, Australia, 2007–2018
Authors: Sheel Meru , Wood Nicholas , Macartney Kristine , Buttery Jim , Dinsmore Nicole , Marshall Helen , Elliott Elizabeth , Kynaston Anne , Richmond Peter , Chateau Dan , McIntyre Peter ,   on behalf of PAEDS Network
Published: April 2022

Background:

Multiple studies have shown an association between intussusception (IS) and receipt of monovalent or pentavalent rotavirus vaccine (RV) in the previous 21 days. Disease severity is an important consideration for risk-benefit evaluations of RV, but no studies have compared the severity of IS within 21 days of vaccination (vaccine-associated, VA) and later (not temporally-associated, VNA).

Methods:

We used active hospital-based surveillance in the Australian Paediatric Active Enhanced Disease Surveillance (PAEDS) network (July 2007 to February 2018) to identify infants ≤9 months of age meeting Brighton level 1 criteria for IS. We used five severity levels: (1) no surgery and length of stay (LOS) ≤1 day, (2) no surgery and LOS ≥2 days, (3) surgery, no bowel resection, (4) bowel resection, and (5) ICU admission.

Results:

Of 323 eligible cases, 87 (26.9%) were VA and 236 (73.1%) VNA. VA-IS cases (median 21 weeks; 24.1% ≤14 weeks) were significantly younger than VNA-IS cases (median 28 weeks, 7.2% ≤14 weeks). Cases 0–≤14 weeks of age were significantly more likely than cases ≥25 weeks to require bowel resection (relative risk ratio 4.6, 95% CI, 1.48–14.3). This effect was not associated with RV. After adjustment for age and sex, VA-IS was not significantly overrepresented in severity levels 2–5; adjusted RRR of 1.37 (95% CI: 0.61–3.11) for bowel resection in cases 0–≤14 weeks of age.

Conclusions:

IS was uncommon but significantly more severe under 14 weeks of age. After adjustment for age and sex, IS severity was not related to RV.
Injury Trends in Special Olympics Athletes From the 2018 USA Games
Authors: Newman Bram , Fudge Jessie , Haskins Amy , Holt Christina , Dexter William
Published: April 2022

Objective:

To categorize injury types and occurrence among athletes participating in the Special Olympics (SO).

Design:

Retrospective cross-sectional cohort study.

Setting:

2018 SO USA Games.

Participants:

Athletes participating in 14 sports at the 2018 SO USA Games (n = 2251).

Independent Variables:

Individual and team sports.

Main Outcome Measures:

Percentage of athletes injured per individual sport, percentage of injury type by sport, rate of injuries per 1000 exposures, and number of injuries per game in team sports.

Results:

In individual sports, the percentage of athletes injured ranged from 38.5% in gymnastics to 12.9% in golf. Musculoskeletal (MSK) injuries occurred in 53.3% of gymnastics injuries and 58.6% of tennis injuries. For stand-up paddleboard, most injuries were non-MSK (66.7%). The highest rate of MSK injuries occurred in gymnastics (25.6/1000 exposures), whereas the highest rates of non-MSK injuries (95.2/1000 exposures) and minor injuries (47.6/1000 exposures) were among stand-up paddleboard athletes. In team sports, the highest number of injuries per game occurred in softball (1.9 per game).

Conclusions:

A high percentage of injuries occurred at the 2018 SO USA Games. The high rate of non-MSK injuries is unique to the SO and should be considered when planning medical coverage for future events.
Efficacy and safety of acupuncture on oligomenorrhea due to polycystic ovary syndrome
Authors: Park Kyoung Sun , Gang Weijuan , Kim Pyung-Wha , Yang Changsop , Jun Purumea , Jung So-Young , Kwon Ojin , Lee Jin Moo , Lee Hye Jeong , Lee Su Jeong , Jing Xianghong , Zhang Ning , Hu Jing , Zhao Jiping , Pang Ran , Jin Chunlan , Lee Jun-Hwan
Published: April 2022

Background:

Polycystic ovary syndrome (PCOS) is one of the most common disorders of reproductive endocrinology affecting women of reproductive age. Our study aims to explore the feasibility of a full-scale trial to evaluate the efficacy and safety of acupuncture for PCOS.

Methods:

This study is a two-armed, parallel, multi-country, multi-center, pilot randomized controlled trial (RCT) for PCOS with oligomenorrhea. We will recruit 60 women aged 20 to 40 years with oligomenorrhea due to PCOS. The participants will be randomly assigned to acupuncture and control groups. The acupuncture group will undergo a total of 40 sessions for 16 weeks with usual care. The control group will be managed with usual care (regular meals, sufficient sleep, and appropriate exercise) only. The primary clinical outcome is mean change in menstrual frequency from baseline to 16 weeks and 32 weeks (follow-up) after the start of the trial. The secondary outcomes are menstrual period, levels of estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and total testosterone, LH/FSH ratio, antral follicle count and ovarian volume, body mass index, waist hip ratio, acne severity, and health-related quality of life questionnaire scores at 16 and 32 weeks after the start of the trial.

Discussion:

This is the first protocol for multi-country, multi-center RCTs for PCOS in Korea and China. The control group in this study will be subjected to usual care (regular meals, enough sleep, and appropriate exercise). The results of this study will provide evidence for future clinical decisions and guidelines.

This trial has been registered at ClinicalTrials.gov (Identifier: NCT04509817).
Diagnosis of sepsis with inflammatory biomarkers, cytokines, endothelial functional markers from SIRS patients
Authors: Xue Mingming , Xu Feixiang , Yang Yilin , Tao Zhengang , Chen Yumei , Wang Sheng , Yin Jun , Min Min , Shi Dongwei , Yao Chenling , Song Zhenju
Published: April 2022

Background

Sepsis is a life-threatening illness with a challenging diagnosis. Rapid detection is the key to successful treatment of sepsis. To investigate diagnostic value, the plasma protein profiles of inflammatory biomarkers, cytokines, and endothelial functional markers were compared between healthy controls, SIRS, and septic patients.

Methods

The plasma protein profiles were performed by Luminex Assay in a cohort of 50 SIRS patients, 82 septic patients and 25 healthy controls. Fourteen plasma proteins were analyzed in the same cohort: IL-1β, IL-6, IL-8, IL-10, CCL-2, VEGF, VEGF-C, VEGFR2, CD62E, CD62P, MFG-E8, ICAM-1, TFPI, Urokinase.

Result

IL-2R, IL-6, IL-8, IL-10, CCL-2, ICAM-1, and Urokinase were significantly higher in sepsis patients than SIRS patients. VEGF, IL-1β, CD62E, CD62P, MFG-E8, and TFPI have no statistical difference. VEGF-C, VEGFR2 were significantly different in SIRS patients than sepsis patients. Urokinase, ICAM-1, and VEGFR2 were significantly different between sepsis group and SIRS group. The AUCs of Urokinase, ICAM-1, and VEGFR2 and the combination for the diagnosis of sepsis were 0.650, 0.688, 0.643, and 0.741, respectively.

Conclusions

Most patients have the higher level of several cytokines and developed endothelial cell injury in the initial phase of sepsis, Urokinase, ICAM-1, and VEGFR2 may be useful to evaluate severity and prognosis of sepsis patients.
A case of crescentic glomerulonephritis in a patient with COVID-19 infection
Authors: Alawad Mouhammad J. , Subahi Eihab A. , Al-Ani Haneen A. , Taha Noheir M. , Kamal Ijaz
Published: April 2022

Rationale:

Kidney involvement with COVID-19 infection is a well-known complication, and the majority of kidney involvement is related to ischemic injury/acute tubular injury. However, there are some cases of glomerulonephritis, the etiology of which is not yet known, but an immune process is likely to be the trigger.

Patient concerns:

A 27-year-old man presented to our hospital with facial puffiness and lower-limb swelling.

Diagnosis:

Laboratory assessment revealed features of impaired kidney function with proteinuria and hematuria; COVID-19 polymerase chain reaction was positive, which was consistent with pauci-immune crescentic focal segmental glomerulonephritis.

Intervention:

After renal biopsy, the patient was started on methylprednisolone and rituximab. Due to worsening kidney parameters, he underwent intermittent hemodialysis as needed.

Outcome:

Kidney function tests partially improved; he was discharged on oral steroids with follow-up in the nephrology clinic to observe for the need for further hemodialysis.

Lessons:

We conducted a literature review of cases of glomerulonephritis associated with COVID-19 and described numerous types of glomerulonephritis. This report highlights the importance of recognizing emerging glomerulonephritis with COVID-19, the different pathological patterns of renal biopsies, and management interventions and responses.
Radiologic placement of Hickman catheters using intravenous sedation in pediatric patients under 20 kg
Authors: Kim Jin Hyeok , Jeon Ung Bae , Jang Joo Yeon , Kim Yong-Woo , Hwang Jae-Yeon , Lim Young Tak , Yang Eu Jeen
Published: April 2022

Surgeons generally perform Hickman catheter insertion in children under general anesthesia. At times, it is difficult to perform procedures with an anesthesiologist for an interventional radiologist. Several diagnostic and therapeutic procedures are efficiently and safely conducted using intravenous (IV) sedation in children with a pediatrician. This study aims to evaluate the efficacy and safety of radiologically placed Hickman catheters using IV sedation in children under 20 kg.

Fifty-nine catheters were inserted in 45 children under IV sedation. With continuous monitoring of vital signs, IV midazolam and ketamine were slowly infused by a pediatrician. Mean age and body weights were 3.2 years and 15.2 kg, respectively. Acute leukemia was the most common disease for the procedure (72.9%). The location of the catheter tip was evaluated by measuring the height of the thoracic vertebra.

Technical success rate was 100%, and IV sedation-related complications did not occur. The right internal jugular vein was accessed for 51 catheters (86.4%), and the mean procedure time was 21.5 minutes. The 2 vertebral body units below the carina were the cavoatrial junction on a fluoroscopy image. Mean catheter life was 285 days, and catheters were removed post-treatment (35.6%). During follow-up, complications occurred in 29 cases (1.72 per 1000 catheter-days). Catheter-related infections were suspected in 4 patients (6.8%), with 1 positive result.

Radiological Hickman catheter placement in children under 20 kg using IV sedation by pediatricians is effective and safe, with minimal complications. The carina is a landmark to estimate the cavoatrial junction in pediatric patients.
Anticipating VA/non-VA care coordination demand for Veterans at high risk for hospitalization
Authors: Vanneman Megan E. , Yoon Jean , Singer Sara J. , Wagner Todd H. , Goldstein Mary K. , Hu Jiaqi , Boothroyd Derek , Greene Liberty , Zulman Donna M.
Published: April 2022

U.S. Veterans Affairs (VA) patients’ multi-system use can create challenges for VA clinicians who are responsible for coordinating Veterans’ use of non-VA care, including VA-purchased care (“Community Care”) and Medicare.

To examine the relationship between drive distance and time—key eligibility criteria for Community Care—and VA reliance (proportion of care received in VA versus Medicare and Community Care) among Veterans at high risk for hospitalization. We used prepolicy data to anticipate the impact of the 2014 Choice Act and 2018 Maintaining Internal Systems and Strengthening Integrated Outside Networks Act (MISSION Act), which expanded access to Community Care.

Cross-sectional analysis using fractional logistic regressions to examine the relationship between a Veteran's reliance on VA for outpatient primary, mental health, and other specialty care and their drive distance/time to a VA facility.

Thirteen thousand seven hundred three Veterans over the age of 65 years enrolled in VA and fee-for-service Medicare in federal fiscal year 2014 who were in the top 10th percentile for hospitalization risk.

Key explanatory variables were patients’ drive distance to VA > 40 miles (Choice Act criteria) and drive time to VA ≥ 30 minutes for primary and mental health care and ≥60 minutes for specialty care (MISSION Act criteria).

Veterans at high risk for hospitalization with drive distance eligibility had increased odds of an outpatient specialty care visit taking place in VA when compared to Veterans who did not meet Choice Act eligibility criteria (odds ratio = 1.10, 95% confidence interval 1.05–1.15). However, drive time eligibility (MISSION Act criteria) was associated with significantly lower odds of an outpatient specialty care visit taking place in VA (odds ratio = 0.69, 95% confidence interval 0.67, 0.71). Neither drive distance nor drive time were associated with reliance for outpatient primary care or mental health care.

VA patients who are at high risk for hospitalization may continue to rely on VA for outpatient primary care and mental health care despite access to outside services, but may increase use of outpatient specialty care in the community in the MISSION era, increasing demand for multi-system care coordination.
Impact of 2 different posterior screw fixation techniques on primary stability in a cervical translational injury model
Authors: Oberkircher Ludwig , Riemenschneider Julia , Bäumlein Martin , Knauf Tom , Bliemel Christopher , Ruchholtz Steffen , Krüger Antonio
Published: April 2022

Background:

In case of injuries to the subaxial cervical spine, especially in osteoporotic bone, the question of the most stable operative technique arises. There are several techniques of screw fixation available regarding dorsal stabilization. This study investigates 2 techniques (lateral mass screws (LMS) vs cervical pedicle screws (CPS)) in the subaxial cervical spine regarding primary stability in a biomechanical testing using a translational injury model.

Methods:

A total of 10 human formalin fixed and 10 human fresh-frozen specimens (C 4 - T 1) were investigated. Specimens were randomized in 2 groups. Fracture generation of a luxation injury between C 5 and C 6 was created by a transection of all ligamentous structures as well as the intervertebral disc and a resection of the facet joints.

Dorsal stabilization of C 4/C 5 to C 6/C 7 was performed in group A by lateral mass screws, in group B by pedicle screws. In the biomechanical testing, the specimens were loaded at 2 N/s in translation direction until implant failure.

Results:

Formalin fixed specimen: Mean load failure was 513.8 (±86.74) Newton (N) for group A (LMS) and 570.4 (±156.5) N for group B (CPS). There was no significant difference (P = .6905).

Fresh frozen specimen: Mean load failure was 402.3 (±96.4) N for group A (LMS) and 500.7 (±190.3) N for group B (CPS). There was no significant difference (P = .4206).

Conclusion:

In our loading model respecting the translational injury pattern and a flexion movement we could not verify statistically significant differences between lateral mass screws and cervical pedicle screws. Mean loading failure was slightly higher in the CPS group though.
A novel NOTCH3 mutation and its clinical, neuroimaging and pathological presentation in a Chinese patient with CADASIL
Authors: Dang Jing , Lei Shengsuo , Xia Mingwan , Chen Jihua
Published: April 2022

Rationale:

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common form of familial cerebral small vessel disease in adults, and is caused by NOTCH3 mutations. However, individual symptom types, onset, and disease severity span a wide range.

Patient concerns:

Herein, we report a case of chronic neurological symptoms including slurring of speech, recurrent weakness in both limbs and legs, and progressive memory loss. Cranial magnetic resonance imaging revealed recurrent acute lacunar subcortical infarction and extensive white matter hyperintensities. Skin biopsy revealed granular osmiophilic materials close to the cell surface of smooth muscle cells in an arteriolar vessel. The patient's genomic DNA showed a mutation c.635G>C[p.(Cys212Ser)] in exon 4.

Diagnosis:

The patient was finally diagnosed with CADASIL.

Interventions:

The patient was treated with antiplatelet therapy and extremity rehabilitation.

Outcomes:

There was no improvement in speech, extremity function, or memory.

Lessons:

Accurate early diagnosis and appropriate treatment are crucial to improve the prognosis of patients with CADASIL.
Stenosing tenosynovitis with rice bodies formation diagnosed by ultrasound
Authors: Ge Lei , Zhang Lei , Lu Libin
Published: April 2022

Rationale:

Rice bodies are usually found in several nonspecific chronic inflammatory diseases that are symptomatically dominated by primary disease and local compression symptoms. Rice bodies are usually detected by magnetic resonance imaging; however, some remote areas and areas with poor economic conditions do not have access to magnetic resonance imaging examination, which leads to delayed diagnosis of the disease.

Patient concerns:

We report the case of a 62-year-old man with pain in the metacarpophalangeal joint of his right middle finger and limited flexion activity of his middle finger.

Diagnoses:

The mass was 1 cm, well-circumscribed, soft, and painless. Ultrasound showed stenosing tenosynovitis with rice body formation.

Interventions:

The patient underwent tenosynovectomy with synovectomy of the right middle finger tendon sheath under plexus block anesthesia.

Outcomes:

No postoperative complications were noted. A 6-month follow-up showed no recurrence. The activity of the patient's middle finger improved significantly.

Lessons:

Stenosing tenosynovitis with rice body formation is a very rare condition, and we use ultrasound for diagnosis. Ultrasound is convenient, rapid, inexpensive, and can obtain blood flow information, facilitate disease follow-up, and even allow ultrasound localization in advance for guided needle biopsy.
Japanese pediatric patient with moderately active ulcerative colitis successfully treated with ustekinumab
Authors: Kakiuchi Toshihiko , Yoshiura Masato
Published: April 2022

Rationale:

Ustekinumab is effective in the treatment of adult Crohn disease (CD) and ulcerative colitis (UC). However, data on its efficacy and safety in pediatric CD and UC are limited. To the best of our knowledge, there are no reports of Japanese children with UC treated with ustekinumab in the long-term.

Patient concerns:

A 14-year-old man with diarrhea and bloody stools was referred to our hospital. Colonoscopy revealed total colitis-type UC. His pediatric UC activity index score was 50, indicating moderately active UC.

Diagnoses:

Ulcerative colitis.

Interventions:

Infliximab was introduced because of steroid-resistant refractory UC; however, secondary ineffectiveness was observed 17 months later. Therefore, ustekinumab was administered along with prednisolone (16 years of age).

Outcomes:

The patient achieved UC remission after ustekinumab treatment, leading to maintained remission without side effects.

Lessons:

To the best of our knowledge, this is the first pediatric case of moderately active UC successfully treated with ustekinumab in Japan. Ustekinumab combined with steroids is an effective and safe induction therapy for UC.
Congenital aphallia associated with congenital urethrorectal fistula
Authors: Luo Si-Si , Yang Zhe , Ma Ning , Wang Wei-Xin , Chen Sen , Wu Qi , Qu Si-Wei , Li Yang-Qun
Published: April 2022

Rationale:

Aphallia is an extremely rare congenital malformation of unknown cause, with few reports in the literature. It is usually associated with other urogenital and gastrointestinal anomalies and is believed to be a result of either the absence of a genital tubercle or chromosome polymorphism. Herein, we describe an extremely rare case of congenital aphallia with congenital urethrorectal fistula and describe our treatment for this patient.

Patient concerns:

An 8-year-old boy was brought to our hospital by his parents because of congenital absence of the penis. The child was male per karyotype and had excess heterochromatin on chromosome 9 (46 XY with 9 qh+). No urethral orifice was identified, and urine passed rectally since birth; thus, urinary tract outlet obstruction led to urine reflux from the anus to the epididymis for a long time. The boy had to be placed on prophylactic antibiotics because he developed urinary tract infection and epididymitis almost every day.

Diagnosis:

Congenital aphallia (46 XY normal male karyotype) associated with congenital urethroretal fistula.

Interventions:

We performed urethral exteriorization via perineal urethroplasty and urethrorectal fistula repair. The parents approved for phallic reconstruction when the boy reached puberty.

Outcome:

A new external urethral orifice was created on the lower scrotum. The urinary reflux was corrected, and the epididymitis symptoms disappeared. The urethral fistula was then closed. At 8 months follow up, the patient was no longer on antibiotics and had no symptoms of urinary tract infection or epididymitis.

Conclusions:

Compatible treatment should be adopted to address urinary tract drainage and infection. Management requires a stepwise approach to address needs as they arise. Neophalloplasty should be performed by an experienced team in early adolescence.
Successful treatment of thrombotic thrombocytopenic purpura with plasmapheresis and anti-CD20 antibodies in a patient with immune thrombocytopenia and systemic lupus erythematosus
Authors: Jung Ju-Yang , Kim Ji-Won , Suh Chang-Hee , Kim Hyoun-Ah
Published: April 2022

Rationale:

Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology with diverse clinical and laboratory manifestations, including thrombocytopenia. About 25% of patients with SLE may be affected by thrombocytopenia, many of whom are asymptomatic. Some patients, however, experience platelet counts that drop quite low and predispose them to bleeding. Thrombotic thrombocytopenic purpura (TTP) is defined with a classic pentad of clinical features, such as thrombocytopenia, microangiopathic hemolytic anemia, neurological symptoms and signs, renal symptoms and signs, and fever. The association of TTP and SLE has been sporadically reported in the literature.

Patient concerns and diagnosis:

We describe a 16-year-old girl with SLE and immune thrombocytopenia, in whom TTP was diagnosed.

Interventions and outcomes:

She was treated with pulse methylprednisolone, whose platelet counts normalized after therapy with plasmapheresis and an anti-CD20 monoclonal antibody (rituximab).

Conclusion:

A pediatric patient with SLE and immune thrombocytopenia in whom TTP developed was treated with plasmapheresis and rituximab therapy successfully, though the patient experienced a disease relapsed after 18 months, which was controlled by the same management.
Effectiveness and safety of aromatherapy massage for knee osteoarthritis
Authors: Pang Tingting , Liu Chang , Li Jiahui , Yao Junjie , Li Zhongxu , Lei Siyuan , Zhang Jiangchun , Li Xuefei , Dong Li , Wang Yufeng
Published: March 2022

Background:

The purpose of this study was to evaluate the effectiveness and safety of aromatherapy massage in the treatment of knee osteoarthritis.

Methods:

To collect relevant literature, we will research following databases: PubMed, Web of Science, Scopus, Cochrane Library, Embase, China National Knowledge Infrastructure, China Science and Technology Journal Database and Wanfang Data the time is from inception to December 30, 2021, and the language is limited to Chinese and English. In addition, we will retrieve other literature resources, including the Chinese Clinical Trial Register, conference papers. Two reviewers will independently complete the literature screen and data extraction, and quality assessment of the included studies will be independently completed by 2 other researchers. The primary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index scale, the visual analog scale, symptom score, Lysholm knee scoring scale, adverse events, and adverse reactions as secondary outcomes would be assessed. RevMan V.5.4.1 software will be used for meta-analysis, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess the quality of evidence.

Results:

This systematic review will be showed a high-quality synthesis to evaluate the efficacy and safety of aromatherapy massage in the treatment of knee osteoarthritis, providing reference for the safe and effective treatment of knee osteoarthritis.

Conclusion:

This study provides evidence of whether aromatherapy massage is effective.

Systematic review registration: INPLASY202210010

URL: https://inplasy.com/inplasy-2022-1-0010/
A case report of low grade fetal lung adenocarcinoma with TP53 mutation
Authors: Wang Bo , Jin Huri
Published: March 2022

Rationale:

Fetal lung adenocarcinoma (FLAC) is a rare malignant tumor that occurs in the alveolar epithelium. FLAC, as a distinct entity, is a malignancy with a very low incidence, accounting for less than 0.5% of all lung tumors, with a high rate of misdiagnosis due to its rarity, lack of typical presentation and imaging signs. According to histopathological differences, FLAC is further divided into 2 types: low-grade FLAC and high-grade FLAC. In the article, we report a young woman who was diagnosed with low-grade fetal-type lung adenocarcinoma.

Patient concerns:

An 18-year-old female patient was admitted due to cough and chest distress.

Diagnosis:

The final pathological examination confirmed that the lesion was a low-grade fetal lung adenocarcinoma.

Interventions:

The patient underwent thoracoscopic left lower lobectomy and regional lymph node dissection.

Outcomes:

The postoperative course was stable, and no recurrence was observed 1 year after operation.

Lessons:

To the best of our knowledge, there are no previous case reports of low-grade fetal-type adenocarcinoma, TP53 gene mutation, and the significance of its mutation is not extensively studies. FLAC, although extremely rare, is considered in the differential diagnosis of lung cancer. In addition, biopsy, histopathology, and specific immunohistochemical staining of larger tissue specimens are helpful for accurate diagnosis of FLAC.
Does COVID-19 infection increase the risk of pressure injury in critically ill patients?
Authors: Baron Miriam Viviane , Santos Michele Paula dos , Werle Taís Michele , Scherer Gabriela D.L.G. , Santos Mariana Martins Dantas , Dominguez Luis Manuel Ley , Brandenburg Cristine , Feltez Gabriela , Sampaio Aline Ronis , de Mello Pinto Marcus Vinicius , Carvalho Sonia , Meyer Patrícia Froes , Picariello Felice , Pacheco Esteban Fortuny , Reinheimer Isabel Cristina , Sancho Alexandre Gomes , da Costa Bartira Ercília Pinheiro
Published: March 2022

Patients with severe COVID-19 may have endothelial dysfunction and a hypercoagulable state that can cause skin damage. In the presence of external pressure on the tissues, the local inflammatory process regulated by inflammatory cytokines can increase and prolong itself, contributing to the formation of pressure injury (PI). PI is defined as localized damage to the skin or underlying tissues. It usually occurs as a result of intense and/or prolonged pressure in combination with shear. The aim of the study is to perform a narrative review on the physiological evidence of increased risk in the development of PI in critically ill patients with COVID-19.

In patients with severe COVID-19 a pattern of tissue damage consistent with complement-mediated microvascular injury was found in the lungs and skin of critically ill COVID-19 patients, suggesting sustained systemic activation of complement pathways. Theoretically, the same thrombogenic vascular changes related to COVID-19 that occur in the skin also occur in the underlying tissues, making patients less tolerant to the harmful effects of pressure and shear. Unlike the syndromes typical of acute respiratory illnesses and other pathologies that commonly lead to intensive care unit admission, COVID-19 and systemic viral spread show that local and systemic factors overlap. This fact may be justified by current epidemiological data showing that the prevalence of PI among intensive care unit patients with COVID-19 was 3 times higher than in those without COVID-19. This narrative review presents physiological evidence to suggesting an increased risk of developing PI in critically ill patients with COVID-19.
Can adjuvant chemotherapy improve the prognosis of adult ovarian granulosa cell tumors?
Authors: Zhuang Yuan , Zhang Shushan , Liu Yao , Yang Hua
Published: March 2022

Adult granulosa cell tumors (aGCTs) are rare ovarian neoplasms with a relatively favorable prognosis. They follow an indolent course, characterized by a prolonged natural history and a tendency to late recurrences, Around a quarter of patients develop recurrence and More than 70% of women with recurrence die from their disease, The percentage of patients received chemotherapy increases over time, whether adjuvant chemotherapy improve the prognosis of aGCTs is equivocal? The purpose of this review is to summarize the previously published evidence to evaluate whether adjuvant chemotherapy improve the prognosis of aGCTs to provide guidance for clinical practice. EMBASE, PubMed, Web of Science, WanFang Data and Chinese National Knowledge Infrastructure are searched up to December 2020, used the search strategy of ovar* and granulosa cell* and (tumor* or tumour* or malignan* or cancer* or carcinom* or neoplasm*) and chemotherapy. The screening process was conducted strictly based on inclusion and exclusion criteria. Clinical studies based on human including randomized controlled trial, quasi-randomised controlled trials, nonrandomised trials cohort study and case control study were included without restriction of time. The percentage of patients received chemotherapy increases over time, but the benefit of adjuvant chemotherapy is lack of high-grade evidence of prospective study, based on the current retrospective studies, we still do not have the evidence to confirm the survival benefit of adjuvant chemotherapy in early stage, advanced stage or recurrent aGCT with no residual tumor, but for inoperable disseminated disease or disease with suboptimal cytoreduction, adjuvant chemotherapy maybe an Optable options. Multinational prospective randomised controlled trials are urgently needed to validate the role of adjuvant chemotherapy. Further research on molecular mechanisms and developing novel targeted medicines may improve the survival of aGCTs.
Clinical outcomes and etiology of acquired sixth cranial nerve palsy
Authors: Oh Shin Yeop
Published: March 2022

The objective of this study was to investigate the difference in clinical features according to age and factors affecting recovery of acquired sixth cranial nerve (CN6) palsy.

A total of 156 patients with acute CN6 palsy between March 2016 and August 2021 who were followed up for at least 3 months were included in this study. Etiology, rate of recovery, and factors associated with recovery were retrospectively investigated.

The average age of patients with CN6 palsy was about 60years and the mean duration of recovery was about 2.5 months. Of 156 patients, 72 (46.15%) had a microvascular etiology and 25 (16.03%) patients had a brain vascular lesions. Brain neoplasm, trauma, and “others” were found in 10 (6.41%), 11 (7.05%), and 15 (9.62%) patients, respectively. Among the total of 156 patients, 28 (17.95%) failed to completely recover. Non-isolated CN6 palsy with other cranial nerve palsies were recorded in 29 (18.59%) cases. Comparison of age (<50years vs ≥50years), between recovery and non-recovery groups showed that etiology was significantly different.

The recovery rate of acquired CN6 palsy was about 82% and about 27% of patients had brain lesions. Also, varying rates and duration of recovery were found according to etiology, so we should be pay attention to diagnosis of causative disease in CN6 palsy patients.
Evaluation of response to stereotactic body radiation therapy for nonsmall cell lung cancer: PET response criteria in solid tumors versus response evaluation criteria in solid tumors
Authors: Han Jixia , Song Qi , Guo Feng , Du Rui , Fang Henghu , Kang Jingbo , Lu Zejun
Published: March 2022

Objective

Recommendations for surveillance after stereotactic body radiation therapy (SBRT) for early-stage nonsmall cell lung cancer (NSCLC) are not well defined. Recently, PET response criteria in solid tumors (PERCIST) have been proposed as a new standardized method to assess radiotherapeutic response both quantitatively and metabolically. The aim of this study was to evaluate therapeutic response following SBRT in early-stage NSCLC patients by comparing PERCIST with the currently widely used RECIST.

Materials and methods

Forty-nine patients with early-stage NSCLC who had been prescribed SBRT were studied. Responses of lesion were evaluated using CT and 18F-FDG PET according to the RECIST and PERCIST methods. PET-CT scans were obtained before SBRT and 3–6 months after SBRT. Associations between overall survival (OS) and clinicopathologic results (histology, tumor location, tumor size, lymphatic invasion, clinical stage, and radiotherapeutic responses in RECIST and PERCIST) were statistically analyzed. The median patient follow-up was 30 months.

Results

Thirteen patients had stage IA, 9 stage IB, 10 stage IIA, and 17 stage IIB biopsy-proven NSCLC. Three-year OS was 79.6%. CT scans indicated three regional recurrences. PET-CT/chest indicated three regional recurrences and distant metastasis. Significant differences were observed in response classification between RECIST and PERCIST (Wilcoxon signed-rank test, P = 0.0041). Univariate analysis showed that clinical stage, RECIST, and PERCIST were significant factors associated with OS, whereas by multivariate analysis PERCIST was the only predictor of OS. SMD, PMD/PMR, and CMR in PERCIST criteria were indicative of a 9.900-fold increase in the risk of OS in early NSCLC patients [risk ratio, 9.900 (95% CI, 1.040–21.591); P = 0.001].

Conclusion

RECIST based on the anatomic size reduction rate did not demonstrate the correlation between radiotherapeutic response and prognosis in patients with early-stage NSCLC receiving SBRT. However, PERCIST was shown as the strongest independent predictor of outcomes. PERCIST might be considered more suitable for the evaluation of NSCLC tumor response to SBRT than RECIST.
Social Determinants of Health
Authors: Johnson Charla B. , Luther Brenda , Wallace Andrea S. , Kulesa Marjorie Gibson
Published: March 2022

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report recognizes nurses' impact on the medical and social factors that drive health outcomes (National Academies of Sciences, Engineering, and Medicine [NASEM], 2021). The report calls for nursing to take bold steps to address individual and structural level social determinants of health (SDoH)—or social and environmental factors contributing to poor health, poor health outcomes, and health disparities (NASEM, 2021, p. 5). Nurses must recognize the significance of SDoH on patient health outcomes in order to advance health equity and employ nursing interventions to affect positive change for our patients. SDoH are part of our patients' stories, and holistic nursing means we know the whole patient story.

Although it is now widely recognized that SDoH affect health outcomes, a key challenge for nurses is that they represent an enormous range of factors—from food and housing insecurity to personal safety and environmental exposures—that may be more or less able to change with interventions in clinical settings. Furthermore, concerns have been raised that screening for SDoH—especially when not done with sensitivity, cultural competence, or ready intervention—may compromise therapeutic relationships and marginalize patients (Wallace et al., 2020). However, despite these concerns, healthcare systems are widely adopting SDoH assessments, generally through electronic health record screening questions, and attempting to implement associated workflows and interventions. Given this landscape, the purpose of this article, within this special issue of Orthopaedic Nursing, is to provide an overview of SDoH factors, identify best practices related to screening and referral, and highlight nurse-directed interventions in clinical settings.
Racial Disparities and Inequalities in the Management of Patients With Osteoporosis
Authors: Lewiecki E. Michael , Erb Sarah F.
Published: March 2022

Osteoporosis is a skeletal disease characterized by low bone density and poor bone quality that weakens bones and increases the risk of fractures. Serious consequences of fractures include disability, loss of independence, and death. Despite the availability of clinical tools to evaluate fracture risk and medications to reduce fracture risk, many or most patients at risk, even those with a recent fracture, are not being treated. This represents a large osteoporosis treatment gap that has reached a crisis level. Importantly, the treatment gap is not evenly distributed among populations of different race/ethnicity. Black women are less likely to have bone density testing when indicated, are less likely to be treated, and have worse outcomes after a fracture than White women. This is a review and update of race-based disparities and inequalities, with suggestions for interventions to optimize patient care.
The Influence of Health Equity on Patient Outcomes in Orthopaedics
Authors: Smith Mary Atkinson , Smith W. Todd
Published: March 2022

Health equity has become both a national and international health priority when addressing health disparities that influence health outcomes across all patient populations. Orthopaedic nurses play a critical role in advancing health equity among orthopaedic patients when it comes to ensuring orthopaedic patients have fair and just opportunities to achieve their best state of musculoskeletal health. For health equity to be realized by the specialty of orthopaedics and the orthopaedic patient populations being served, it is important for the orthopaedic nurse to be involved in community-based partnerships, research opportunities, and health policy initiatives that focus on the advancement of health equity for all populations.