bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Drains Associated With Infection After Operative Fixation of High-Risk Tibial Plateau and Pilon Fractures?
Authors: Boissonneault Adam , O'Toole Robert V. , Hayda Roman , Reid J. Spence , Caroom Cyrus , Carlini Anthony , Dagal Arman , Castillo Renan , Karunakar Madhav , Matuszewski Paul E. , Hymes Robert , O'Hara Nathan N. ,   METRC
Published: November 2024

OBJECTIVES:

To determine the association between closed suction drainage and postoperative infection in patients with tibial plateau or pilon fractures. Secondarily, this study assessed whether intrawound vancomycin powder modified the association of closed surgical drains with infection.

METHODS:

Design:

Secondary analysis of the Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial (VANCO).

Setting:

Thirty-six academic trauma centers.

Patient Selection Criteria:

All patients with high-risk tibia fractures Orthopaedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen (OTA/AO classification 41B/C or 43B/C) from the VANCO trial were considered. Closed suction drains were placed based on the treating surgeon's discretion. Patients were randomly assigned to receive 1-gram intrawound vancomycin powder in the surgical wound at definitive fixation or the standard infection prevention protocol at each center.

Outcome Measures and Comparisons:

Deep surgical site infection (SSI) within 6 months. Comparisons were made between patients treated with and without drains. Subgroup analysis also examined the effect of drains in patients with and without intrawound vancomycin powder.

RESULTS:

Of the 978 study patients, 197 (20%) were treated with drains. Deep infection rates did not significantly differ between patients with or without surgical drains (8% vs. 8%, P = 0.88). However, intrawound vancomycin powder significantly modified the association of surgical drains on deep SSI (interaction P = 0.048). Specifically, patients with drains but no vancomycin powder had the highest deep infection rate (13%; 95% confidence interval, 6%–19%). When vancomycin powder was used in addition to a drain, deep SSI rates were reduced by 10% (95% confidence interval, 2%–17%, P = 0.01).

CONCLUSIONS:

This study suggests that closed suction drains after operative fixation of high-risk tibia fractures may not be associated with deep infection in general. However, a secondary analysis raises the possibility that drains are associated with reduced deep infection rates if topical vancomycin powder is used but associated with increased infection rates if vancomycin powder is not used.

LEVEL OF EVIDENCE:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Investigation of the Association Between Hyperlipidemia and Ossification of the Posterior Longitudinal Ligament Through Two-Sample Mendelian Randomization Analysis
Authors: Zhang Ranxi , Yang Qiujun , Wang Yang , Zhao Yongsheng
Published: November 2024

Study Design.

A 2-sample Mendelian randomization (MR) analysis.

Objective.

This study aimed to investigate the association between genetically predicted hyperlipidemia and ossification of the posterior longitudinal ligament (OPLL) using a 2-sample MR analysis.

Background.

Several observational studies suggested associations between hyperlipidemia and OPLL.

Materials and Methods.

Genome-wide association study summary statistics for hyperlipidemia and OPLL were retrieved from the public database. The MR analysis employed the inverse variance weighted method, which was supplemented by MR-Egger, weighted median, and weighted mode analyses. Sensitivity analyses, incorporating the Cochran Q test, MR-Egger regression, and the MR pleiotropy residual sum and outlier test, in addition, assessed the robustness of the findings.

Results.

The inverse variance weighted analysis revealed a significant association between total cholesterol levels and OPLL (odds ratio: 1.44, 95% CI: 1.06–1.96, P = 0.02). Similarly, a significant association was observed between low-density lipoprotein (LDL) cholesterol and OPLL (odds ratio: 1.31, 95% CI: 1.05–1.63, P = 0.02). Supplementary analyses further supported the significant association of total cholesterol levels and LDL cholesterol on OPLL (P < 0.05). In sensitivity analyses, LDL cholesterol exposure showed robust results, with no outliers detected by loo or mrpresso, despite MR-Egger hints at pleiotropy. For total cholesterol exposure, MR-Egger suggested no pleiotropy, though heterogeneity and outliers were present. Outlier removal confirmed the initial positive association, underlining study stability. However, no significant associations were found between hyperlipidemia, triglycerides, and high-density lipoprotein (HDL) cholesterol in OPLL.

Conclusion.

This study suggests an association between total cholesterol levels and LDL cholesterol levels in OPLL. Further research is warranted to validate these findings and explore potential therapeutic implications.
The Impact of Disc Height on Outcomes Following Cervical Disc Replacement
Authors: Kazarian Gregory S. , Cecere Robert , Zabat Michelle A. , Dekhne Mihir S. , Sheha Even , Dowdell James , Iyer Sravisht , Qureshi Sheeraz
Published: November 2024

Study Design.

Systematic review.

Objective.

To describe the impact of disc height (DH) on outcomes after cervical disc replacement (CDR).

Background.

Implant sizing and positioning may impact outcomes after CDR.

Materials and Methods.

A systematic review was performed in accordance with the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” guidelines using the EMBASE and PubMed databases. The goal of this review was to assess the impact of postoperative “DH” on clinical and radiologic outcomes after CDR.

Results.

A total of 12 studies were included in the systematic review. In the literature, “DH” was assessed using multiple different measures: postoperative DH (n = 4), DH change (DHC; n = 4), degree of disc distraction (n = 2), prosthesis height (n = 2), functional spinal unit height (n = 2), and facet distraction (n = 1). DH and DHC were the most common measures studied. DHC was associated with statistically and clinically significant differences in several patient-reported outcomes measures (PROMs). However, DH was not associated with any statistically or clinically significant differences in PROMs. With respect to cervical range of motion (ROM), DHC appeared to demonstrate statistically and clinically relevant differences in some of the studies included in this review, while DH was associated with statistically, but not clinically, significant differences. The majority of studies identified DHC <2 mm as an important cutoff to optimize outcomes.

Conclusions.

“DH,” especially as measured by DHC, may be an important intraoperative consideration when selecting implant size during CDR. Maintaining DHC <2 mm may optimize PROMs and ROM. Improving technique and implant sizing may aid in translating ex vivo advantages in implant mobility to in vivo improvements in ROM and PROMs.
Real-life effectiveness on overall survival of continued immune checkpoint inhibition following progression in advanced melanoma: estimation from the Melbase cohort
Authors: Macaire Camille , Lefevre Wendy , Dalac Sophie , Montaudié Henri , Legoupil Delphine , Dereure Olivier , Dutriaux Caroline , Leccia Marie Thérèse , Aubin François , Grob Jean Jacques , Saiag Philippe , De Quatrebarbes Julie , Maubec Eve , Lesimple Thierry , Granel-Brocard Florence , Mortier Laurent , Dalle Stéphane , Lebbé Céleste , Prod’homme Chloé
Published: November 2024

The link between palliative care and oncology must continue to develop, taking into account advances in treatment.Immune checkpoint inhibition (ICI) for metastatic melanoma is associated with different types of response, making it difficult to assess the benefits to the patient. Some clinical trials suggest a survival advantage of ICI even in the absence of an objective radiographic response. The aim of this study is to assess the impact of continuing ICI after progression of the disease on the overall survival (OS) in a cohort of final-line metastatic melanoma patients. Clinical data from 120 patients with metastatic melanoma were collected via Melbase, a French multicentric biobank, prospectively enrolling unresectable melanoma. Two groups were defined: patients continuing final-line ICI at progression (treated) and patients stopping ICI at progression (controls). The primary end-point is the OS from progression. Propensity score weighting was used to correct for indication bias. From the 120 patients, 72 (60%) continued ICI. Median OS from progression was 4.2 months [95% confidence interval (CI) 2.6–6.27] in the treated group and median OS was 1.3 months (95% CI 0.95–1.74) in the control group (P < 0.0001). The calculated hazard ratio was 0.20 (0.13–0.33). Continued ICI was discovered to have an association with a higher rate of hospitalization at the end of life; more treatments received in the last 15 days of life and less utilization of specialist palliative care. This study discovered that patients with metastatic melanoma show a significant decrease in the instantaneous probability of mortality when they continue with finale-line ICI after progression.
Predicting blood pressure response to renal denervation based on a new approach
Authors: Bytyqi Venera , Kannenkeril Dennis , Striepe Kristina , Bosch Agnes , Karg Marina V. , Schmid Axel , Schiffer Mario , Uder Michael , Schmieder Roland E.
Published: November 2024

Background:

Identifying predictors of blood pressure (BP) response to renal denervation (RDN) is crucial for patient selection. According to Wilder's principle, baseline BP predicts BP change after any antihypertensive intervention. Thus, any observed BP change after RDN is the sum of the BP change depending on the baseline BP and the specific BP reduction due to RDN. Based on this concept, we propose a new definition of BP responders.

Methods:

In our center, 148 patients with uncontrolled hypertension underwent RDN, and 24-h ambulatory BP (ABP) was measured at baseline, and 6 months after the procedure. The decrease in 24-h systolic BP (SBP) correlated with baseline SBP (P = <0.001, r = −0.374). We determined the RDN-specific effect by subtracting the predicted SBP decrease from the observed SBP decrease. The cohort was divided into RDN responders, neutral responders, and nonresponders.

Results:

Our study population had a mean age of 59 ± 10.4 years and was 74% male. The RDN-specific (residual) 24-h ABP decreased by −14.9 ± 6.3/−8.2 ± 3.8 mmHg (responder group), 1.0 ± 3.2/0.2 ± 1.9 mmHg (neutral group), and 14.2 ± 10.4/8.3 ± 3.9 mmHg (nonresponder group) 6 months after RDN. Responders had fewer antihypertensive medications (P = 0.018), higher baseline office heart rate (HR) (P = 0.019), higher 24-h ambulatory HR (P = 0.003), lower BMI (P < 0.038), and absence of type 2 diabetes (T2D) (P = 0.020).

Conclusion:

Our definition of BP responders to RDN separates baseline BP-related changes from RDN-specific changes. Positive predictors for BP response to RDN include low BMI, fewer antihypertensive medications, high baseline office HR, high 24-h ambulatory HR, and absence of T2D.
The Bloom Syndrome and Retinoblastoma patient exhibits two RB1 gene mutations in the germline
Authors: Rangel-Charqueño Martha , Flores Cynthia Soto , Sánchez Dra Mayra Martínez , Moctezuma-Dávila Mariana , Illana Dra Vanesa Olivares
Published: November 2024

Purpose:

To report the case of a patient with Bloom Syndrome and retinoblastoma from a genetic perspective. The patient exhibits two RB1 gene mutations in the germline.

Methods:

The patient underwent an ultrasound study, followed by enucleation of the left eye. Peripheral venous blood samples were collected to isolate mononuclear cells for total RNA and DNA extraction. Subsequently, cDNA synthesis and RT-qPCR were performed. The DNA was used for PCR amplification of the 27 exons. The sequence of the exons of RB1 was analysed.

Results:

The patient with Bloom Syndrome (BS) and retinoblastoma underwent treatment, and blood samples from the patient and a family member were analysed. The results revealed two germline mutations on exons 13 and 17. The levels of RB1 mRNA were found to be low compared to those of a healthy control and a family member.

Conclusion:

Without a family history of cancer, a patient with retinoblastoma and BS presents two mutations in the germline on the RB1 gene; this results in very low levels of RB1 mRNA systemically, thereby increasing the patient´s risk of developing another type of cancer throughout his life.
The Relationship Between Leadership Characteristics and Services Provided Among IHS Urban Indian Health Programs
Authors: Tribble G. Grant , Borkowski Nancy M. , Corso Phaedra S. , Hall Allyson G. , Hearld Kristine R.
Published: November 2024

The Urban Indian Health Program was created by the Indian Health Service to establish a culturally appropriate health care delivery model for Native Americans who relocate to urban areas. The 31 community-based Indian Health Programs under the Office of Urban Indian Health Program vary in culture, socioeconomic, and patient mix. Strategic decision-making by these community-based Indian Health Programs depends upon various factors, including leaders’ characteristics, organizational characteristics, and service area market factors.
A prediction model of echocardiographic variables to screen for potentially correctable shunts in adult atrial septal defect-pulmonary hypertension patients
Authors: Li He-Zhi , Wen Song , Huang Ze-Han , Fei Hong-Wen , Zhang Cao-Jin
Published: November 2024

Background:

Atrial septal defect (ASD) is a prevalent congenital heart condition in adults that leads to pulmonary hypertension (PAH) and right heart failure if left untreated. During a routine follow-up of adult ASD-PAH patients, the suitability of shunt closure depends on the invasive right heart catheterization (RHC). Nevertheless, performing RHC at every follow-up is impractical and may be harmful. The present retrospective cross-sectional study was designed to investigate which echocardiographic variables were associated with pulmonary vascular resistance (PVR) in adult ASD-PAH patients and propose a model using these variables to screen for patients with a correctable shunt.

Methods:

A total of 530 adult ASD-PAH patients with pulmonary arterial systolic pressure (PASP) of ≥60 mmHg measured using transthoracic echocardiogram (TTE) were included in the study. All RHCs were performed within 3 months after TTE. The correctable shunt was defined as PVR ≤3 Wood units (WU). Multivariable regressions were performed utilizing echocardiographic variables. A scoring system was constructed based on the predictors of PVR ≤3 WU using multivariable logistic regression analysis. The scoring system was then examined using a receiver operating characteristic (ROC) analysis. In addition, clinical utility of the model was determined based on decision curve analysis, and a calibration curve was used to evaluate model conformity.

Results:

Estimated PASP, velocity through the pulmonary valve, tricuspid annulus early diastolic velocity, and maximum defect dimension were identified as independent predictors. The area under the ROC curve of the predictive value in the model was 0.905 (95% CI, 0.878-0.931, sensitivity: 84.3%, specificity: 83.6%). The net benefit of the model was notable in terms of a wide-range probability threshold in decision curve analysis, indicating that the prediction model had good clinical applicability. The model’s calibration curve was close to an ideal diagonal line, showing good predictive accuracy between the actual and predictive probabilities.

Conclusion:

The study provided a valuable model in predicting adult ASD-PAH patients with a correctable shunt, which may help clinicians to make appropriate treatment decision for follow-up patients.
Effects of Resilience and Personal Accomplishment on the Relationship Between Quality of Work Life and Turnover Intention Among Newly Employed Nurses
Authors: LEE Huan-Fang , CHIANG Hui-Ying , CHANG Ying-Ju , CHANG Mei-Yu , LEE Chiu-Hsiang , WU Hsiu-Chuan , LIU Doressses , FETZER Susan
Published: November 2024

Background

Turnover among newly employed nurses is an indicator of workforce stability in healthcare organizations. The factors influencing turnover intention in this group are complex and differ by generation. The relationships among variables including work-life quality, personal accomplishment, resilience, and turnover intention have been explored separately. However, a knowledge gap exists in terms of scholarly understanding regarding the respective impacts of perceived personal accomplishment and resilience on the relationship between work-life quality and turnover intention.

Purpose

This study was designed to explore the respective effects of resilience and personal accomplishment on the relationship between work-life quality and turnover intention.

Methods

A cross-sectional approach was used, and 387 newly employed nurses who had worked for just 1 month at six medical centers in Taiwan were enrolled as participants. The following four instruments were used for data collection: Quality of Nurse Work-life Scale, Connor–Davidson Resilience Scale, the personal accomplishment subscale of the Maslach Burnout Inventory, and Turnover Intention Scale. Hayes PROCESS analysis method was used to analyze the influence of resilience and personal accomplishment on the relationship between work-life quality and turnover intention.

Results

There was a positive correlation among work-life quality, resilience, and personal accomplishment, and a negative correlation was found between all three variables and turnover intention. Resilience was found to negatively mediate the relationship between work-life quality and turnover intention (B = −.032, p < .001). The moderating effect of work-life quality on personal accomplishment was significant (B = .012, p < .05). Work-life quality and sense of personal accomplishment explained 61% of the variance in resilience. Work-life quality and resilience explained 50.5% of the variance in turnover intention. Furthermore, sense of personal accomplishment moderated the mediating effect of resilience on the relationship between work-life quality and turnover intention.

Conclusions/Implications for Practice

Resilience mediates the relationship between work-life quality and turnover intention, whereas personal accomplishment may moderate the mediating effect of resilience in the relationship. Administrators should provide strategies to improve professional competence and improve psychological capacity in new nurses to increase their sense of personal accomplishment and resilience to decrease turnover intention.
Pretransplant metabolic tumor volume predicts recurrence following liver transplantation for colorectal metastasis: A multicenter study
Authors: Wehrle Chase J. , Chávez-Villa Mariana , Byrne Matthew , Kusakabe Jiro , Gross Abby , Mahajan Paresh , Ruffolo Luis , Whitsett Linganna Maureen , Sobotka Annie , Naffouje Samer , Khalil Mazhar , Pita Alejandro , Fujiki Masato , Tomiyama Koji , Schlegel Andrea , Kwon David C.H. , Line Pal-Dag , Miller Charles , Hashimoto Koji , Hernandez-Alejandro Roberto , Aucejo Federico
Published: November 2024

Liver transplant (LT) for colorectal cancer liver metastases (CRLM) is increasingly popular, yet the ideal selection criteria remain unknown. Pretransplant positron emission tomography (PET) metabolic tumor volume (MTV) has been described as predicting recurrence, with a proposed cutoff of MTV ≥70 cm3. This approach has not been validated. Patients undergoing LT for CRLM at 2 academic transplant centers (January 1, 2017, to December 1, 2023) were included. PET-MTV was calculated by a staff radiologist from the most recent PET-scan before LT using the published protocol. Twenty-six patients were included. Median follow-up was 609 days (IQR 320–1069) and from PET to LT was 1.9 months (1.3–2.6). Nearly all (n=24, 92.3%) received living donor transplantation. Absolute recurrence rate was 30.8% (n=8). Actuarial unadjusted 1- and 2-year recurrence-free survival (RFS) were 83% (n=15/18) and 62% (n=8/13); 1- and 2-year overall survival were 100% (n=18/18) and 85% (n=11/13). The incidence of recurrence-per-year follow-up was 0.35 when MTV ≥70 cm3 versus 0.10 if MTV <70 cm3 (P<0.001). Median RFS using Kaplan-Meier product-estimate was 0.83 years (95% CI: 0.43–1.23) in MTV≥70 cm3 versus 4.1 years (95% CI: 2.90–5.22) when MTV<70 cm3 (p<0.001); this was also associated with improved overall survival (p=0.003). MTV>70 cm3 demonstrated HR=2.42 (95% CI: 2.2–62.2, p=0.006) for association with RFS on univariate Cox-proportional hazards analysis, and an AUC=0.771 (95% CI: 0.560–0.981) for predicting recurrence (p=0.030). Nineteen patients (69.2%) had histologically viable tumors, which were associated with recurrence (43% vs. 0%, p=0.039) and reduced RFS (log-rank p=0.019). PET-MTV was associated with the presence of histologically viable tumor (AUC=0.763, 95% CI: 0.583–0.944). PET-MTV ≥70 cm3 was associated with reduced RFS and overall survival after LT for CRLM, confirming findings from the Norway group. This is likely due to its ability to identify residual viable tumors, which are independently associated with recurrence. PET-MTV should be a key selection criterion prior to LT for CRLM.
Molecular mechanism analysis of a family with hereditary coagulation FXI deficiency caused by compound heterozygous mutations
Authors: Chen Yuan , Zeng Manlin , Zhang Ke , Ye Longying , Jiang Shuting , Jia Kaiqi , Yang Lihong , Wang MingShan
Published: November 2024

Objective

The purpose of this study was to determine the molecular basis of a Chinese family with factor XI (FXI) deficiency.

Methods

The qRT-PCR was used to detect the transcription of F11 mRNA in transfected cells. ELISAs and western blot were used to detect the expression of FXI protein in culture media and lysates.

Results

Genetic analysis revealed that the proband carried a heterozygous nonsense mutation c.1107C>A (p.Tyr351stop) in exon 10 and a heterozygous missense mutation c.1562A>G (p.Tyr503Cys) in exon 13. The expression study revealed that p.Tyr351stop mutation resulted in the degradation of F11 mRNA. The p.Tyr503Cys mutation, however, had no effects on biosynthesis and secretion of FXI protein, but it had affected the catalytic activity of FXI.

Conclusion

The inherited FXI deficiency of this family is related to nonsense mutation p.Tyr351stop and missense mutation p.Tyr503Cys.
Management of sedation during weaning from mechanical ventilation
Authors: Vollbrecht Hanna , Patel Bhakti K.
Published: November 2024

Purposes of review

Critically ill patients frequently require mechanical ventilation and often receive sedation to control pain, reduce anxiety, and facilitate patient-ventilator interactions. Weaning from mechanical ventilation is intertwined with sedation management. In this review, we analyze the current evidence for sedation management during ventilatory weaning, including level of sedation, timing of sedation weaning, analgesic and sedative choices, and sedation management in acute respiratory distress syndrome (ARDS).

Recent findings

Despite a large body of evidence from the past 20 years regarding the importance of light sedation and paired spontaneous awakening and spontaneous breathing trials (SATs/SBTs) to promote ventilator weaning, recent studies show that implementation of these strategies lag in practice. The recent WEAN SAFE trial highlights the delay between meeting weaning criteria and first weaning attempt, with level of sedation predicting both delays and weaning failure. Recent studies show that targeted interventions around evidence-based practices for sedation weaning improve outcomes, though long-term sustainability remains a challenge.

Light or no sedation strategies that prioritize analgesia prior to sedatives along with paired SATs/SBTs promote ventilator liberation. Dexmedetomidine may have a role in weaning for agitated patients. Further investigation is needed into optimal sedation management for patients with ARDS.
How to prevent postextubation respiratory failure
Authors: Hernández Gonzalo , Hill Nicholas S.
Published: November 2024

Purpose of review

Postextubation respiratory support treatment approaches, indications, and subgroups of patients with different responses to those therapies are rapidly changing. Planning optimal therapy in terms of choosing devices, timing of application and selecting settings with the goal of minimizing extubation failure is becoming a challenge. This review aims to analyze all the available evidence from a clinical point of view, trying to facilitate decision making at the bedside.

Recent findings

There is evidence for high flow nasal cannula support in patients at low risk of extubation failure. Noninvasive ventilation based strategies should be prioritized in patients at very high risk, who are obese or are hypercapnic at the end of a spontaneous breathing trial. Patients not included in the previous groups merit a tailored decision based on more variables.

Optimizing the timing of therapy can include facilitation of extubation by transitioning to noninvasive respiratory support or prolonging a planned preventive therapy according to clinical condition.

Planning postextubatin respiratory support must consider the risk for failing and the presence of some clinical conditions favoring noninvasive ventilation.

Extubation can be safely accelerated by modifying screening criteria and spontaneous breathing trial settings, but there is room to increase the role of postextubation noninvasive respiratory support for this indication, always keeping in mind the dangers of delaying a needed intubation.
Spontaneous breathing-induced lung injury in mechanically ventilated patients
Authors: Hoshino Taiki , Yoshida Takeshi
Published: November 2024

Purpose of review

Recent experimental and clinical studies have suggested that spontaneous effort can potentially injure the lungs. This review summarizes the harmful effects of spontaneous breathing on the lungs during mechanical ventilation in ARDS and suggests potential strategies to minimize spontaneous breathing-induced lung injury.

Recent findings

Recent clinical and experimental studies have shown that vigorous spontaneous breathing during mechanical ventilation can potentially injure the lungs due to high transpulmonary pressure, the Pendelluft phenomenon, increased pulmonary perfusion, and patient–ventilator asynchrony. A definitive approach to minimize spontaneous breathing-induced lung injury is the systemic use of neuromuscular blocking agents; however, there is a risk of muscle atrophy. Alternatively, partial paralysis, bilateral phrenic nerve blockade, and sedatives may be useful for decreasing force generation from the diaphragm while maintaining muscle function. A higher positive end-expiratory pressure (PEEP) and prone positioning may reduce force generation from the diaphragm by decreasing neuromechanical efficiency.

Several potential strategies, including neuromuscular blockade, partial paralysis, phrenic nerve blockade, sedatives, PEEP, and prone positioning, could be useful to minimize spontaneous breathing-induced lung injury.
V–V ECMO for severe Chlamydia psittaci pneumonia presenting with sudden cardiac arrest: A case report and literature review
Authors: Chen Juan , Sun Yong , Luo Jian , Wu Yang , Wang Kaiyu , Zhang Weiwen , Fang Honglong
Published: November 2024

Rationale:

Psittacosis, also known as parrot fever, is an infectious disease caused by Chlamydia psittaci, which can lead to C psittaci pneumonia. Clinical manifestations are highly nonspecific, which can vary from asymptomatic infection to severe pneumonia and even death.

Patient concerns:

In this case presentation, we reported one 65-year-old male case of C psittaci pneumonia who was admitted to our hospital on December 2, 2022 due to the chief complaints of poor appetite and fatigue for 3 days as the clinical manifestations. He denied contact with birds but admitted riding horses 1 week ago.

Diagnoses:

Chlamydia psittaci pneumonia of patient was confirmed through metagenomic sequencing of bronchoalveolar lavage fluid under bronchoscopy.

Intervention:

Patient was treated with V-V ECMO, invasive mechanical ventilation and CRRT.

Outcomes:

On December 12, the patient was successfully weaned off V–V ECMO and discharged on December 20, 2022. During postoperative follow-up, CT scan in a local hospital revealed the infiltrative lesions of the lung were absent.

Lessons:

This case prompts that metagenomic next-generation sequencing is a feasible diagnostic tool for psittacosis, which can rapidly worsen and even cause sudden cardiac arrest. V–V ECMO might be a viable emergency therapeutic option.
Knowledge, attitude, and perception of exercises among post-hematopoietic stem cell transplant patients: A cross-sectional study
Authors: Han Na , Wu Changqing , Liu Na , Deng Yu , Zhang Li , Zhu Yan
Published: November 2024

Exercise rehabilitation is crucial for the recovery after hematopoietic stem cell transplantation (HSCT). This study aimed to investigate knowledge, attitude, and perception (KAP) of exercise among post-HSCT patients. This cross-sectional study was conducted at Zhujiang Hospital, Southern Medical University between January 2020 and December 2022 among post-HSCT patients, using a self-designed questionnaire. A total of 192 patients were included, with the mean age of 37.90 ± 11.96 years; 116 (60.42%) reported to exercise before. The mean KAP scores were 9.22 ± 2.05 (possible range: 0–12), 43.51 ± 5.47 (possible range: 12–60) and 51.79 ± 7.45 (possible range: 15–75), respectively. Patients previously inactive in exercise exhibited significant differences in KAP scores from active patients: attitude total score, positive attitude, perception total score, willingness to exercise, aerobic exercise, breathing training (all P < .001), with a noteworthy distinction in resistance exercise (P = .018). According to structural equation modeling, perception was directly influenced by knowledge (β = 0.87, P < .001), attitude (β = 0.26, P = .007), and exercise habits (β = 3.36, P = .001), as well as indirectly by education (β = 0.44, P = .010) and knowledge (β = 0.18, P = .029). Post-HSCT patients had adequate knowledge, moderate attitude and perception of exercises, even 1 year after HSCT. Patients inactive in exercises exhibited significant differences in knowledge and exercise perception from active patients. Healthcare professionals should tailor education, target attitude, and personalize exercise plans to facilitate effective recovery post-HSCT.
Herbal medicine for the treatment of non-erosive reflux disease: A systematic review and meta-analysis
Authors: Kim Minjeong , Park Chaehyun , Park Jae-Woo , Kim Jinsung , Ko Seok-Jae
Published: November 2024

Background:

Non-erosive reflux disease (NERD) is the most prevalent gastroesophageal reflux disease. Currently, proton pump inhibitors are the most commonly used treatment for NERD. Recently, the demand for herbal medicines with relatively few side effects is increasing and trials confirming the effectiveness and safety of herbal medicines for the treatment of NERD have been conducted. This study aimed to investigate the effectiveness and safety of herbal medicine in the treatment of NERD through published randomized-controlled trials.

Methods:

Ten electronic databases were searched from inception until May 2023. Disease, intervention-related terms, and publication type keywords were combined as search terms. Studies designed as randomized controlled trials, including participants diagnosed with NERD with any type of herbal medicine as a treatment intervention were included. Data extraction and analysis were conducted by 2 independent reviewers. The total clinical efficacy rate was assessed as a primary outcome, while the secondary outcomes were recurrence rate, reflux diagnostic questionnaire score, short-form 36 health survey score, and serum motilin level. The risk of bias in each study and quality of evidence were assessed.

Results:

Thirty-four randomized controlled trials involving 3759 patients were analyzed. Herbal medicine was significantly more effective in improving total clinical efficacy, recurrence rate, reflux diagnostic questionnaire score, some domains of short-form 36 health survey, and serum motilin levels in patients with NERD than conventional medical therapy. No severe intervention-related adverse effects were observed. Regarding the quality of evidence, most outcomes were revealed to have moderate to low levels of evidence.

Conclusion:

This systematic review and meta-analysis suggests that herbal medicine can be an effective and safe therapy for NERD; however, there are several limitations regarding the methodological quality of the included studies. Further research with high methodological quality is necessary to improve the quality of evidence.
Current status and prospects of congenital adrenal hyperplasia: A bibliometric and visualization study
Authors: Chen Sheng , Wu Lingling , Ma Xiaohan , Guo Lin , Zhang Jianqiang , Gao Hongjun , Zhang Ting
Published: November 2024

Background:

Congenital adrenal hyperplasia (CAH) is increasingly prevalent, leading to a surge in related research. To pinpoint emerging trends and recommend future directions, a bibliometric analysis of relevant CAH literature was performed.

Methods:

From January 1, 2000, to October 1, 2023, we searched the Web of Science Core Collection for CAH literature. For the bibliometric analysis, tools such as VOSviewer, CiteSpace, and the R package “bibliometrix” were employed.

Results:

The United States and England are at the forefront among 113 countries, contributing 5034 papers to CAH research. However, there is a need for more extensive global collaboration across institutions in this field. The number of publications on CAH is increasing annually. Leading research institutions include the University of Michigan, University of California, San Francisco, Karolinska Institutet, and Karolinska University Hospital. The Journal of Clinical Endocrinology & Metabolism is the most cited in this area. The most prolific author is Falhammar H, with 88 publications, 2568 co-citations, and a significant overall contribution. Key research areas include diagnostic methods and therapeutic strategies for CAH. Emerging research hotspots are identified by keywords such as “disorders of sex development,” “21-hydroxylase deficiency,” “ambiguous genitalia,” “testosterone” and “adrenal insufficiency.”

Conclusions:

Research on CAH is expected to expand globally. Future studies will primarily focus on exploring CAH’s diagnostic aspects and developing new therapies. This paper will help scholars better understand the dynamic evolution of the CAH and point out the direction for future research.
Intranasal acupuncture for allergic rhinitis: A systematic review and meta-analysis
Authors: Li Yongjun , Wang Yijie , Liang Yuan , Si Xiuying , Li Zhixiang , Wang Youpeng
Published: November 2024

Background:

To evaluate the efficacy of intranasal acupuncture as a treatment for allergic rhinitis (AR) through a comprehensive review.

Methods:

Comprehensive searches were performed in both Chinese (CNKI, VIP, CBM, and Wanfang) and English databases (PubMed, Embase, Cochrane Library, and Web of Science) to gather randomized controlled trials available from the inception of the database until August 2024. The primary outcomes considered were the effectiveness rate, visual analog scale score, total nasal symptom scores, total nonnasal symptom scores, Rhinoconjunctivitis Quality-of-Life Questionnaire score, adverse effects, and follow-up observations. The quality of each study was assessed using the Cochrane Collaboration risk of bias tool, and data analysis was conducted using RevMan 5.4 software.

Results:

This study incorporated 14 articles involving a total of 1009 patients. The meta-analysis revealed that patients with AR who underwent intranasal acupuncture experienced more significant improvements compared to the control group. Notably, the treatment considerably improved both nasal and nonnasal symptoms, along with the patients’ quality of life. Moreover, during the follow-up, it was noted that intranasal acupuncture patients had a lower recurrence rate compared to the control group, indicating better long-term effects in alleviating symptoms like nasal congestion, runny nose, and sneezing. Nonetheless, there was no marked improvement of nasal itching. It’s noteworthy that some adverse effects were reported, but all were mild.

Conclusions:

The findings suggest that intranasal acupuncture serves as an effective intervention for AR, particularly in alleviating both nasal and nonnasal symptoms and enhancing quality of life. However, these positive outcomes should be approached with caution, and further high-quality and extensive studies to substantiate these results are warranted.
Causal relationship between leukocyte telomere length and two cardiomyopathies based on a bidirectional Mendelian randomization approach
Authors: Li Jun , Hu Lanshuo , Huang Xuanchun
Published: November 2024

This study aims to employ the Mendelian randomization (MR) approach to investigate the relationship between leukocyte telomere length (TL) and 2 prevalent forms of cardiomyopathies. Using R software (4.3.1) for MR study, independent genetic variants associated with leukocyte TL were extracted from the Integrative Epidemiology Unit database, while cardiomyopathies data were pooled from FinnGen and European Bioinformatics Institute databases. Analytical methodologies included inverse-variance weighting, MR-Egger regression, and weighted median methods. Further analyses involved MR-Egger intercept and MR-PRESSO for handling horizontal pleiotropy and Cochran Q test for study heterogeneity. Our forward Mendelian randomization study indicates a positive correlation between longer leukocyte TL and the risk of 2 forms of cardiomyopathies: the longer the leukocyte telomere, the higher is the risk of cardiomyopathies. Specifically, for hypertrophic obstructive cardiomyopathy the OR is 2.23 (95% CI: 1.19–4.14, P = .01), for hypertrophic cardiomyopathy the OR is 1.80 (95% CI: 1.14–2.85, P = .01), and for dilated cardiomyopathy the OR is 1.32 (95% CI: 1.01–1.71, P = .04). In contrast, our reverse Mendelian randomization showed that cardiomyopathies were not directly associated with TL, and the inverse-variance-weighted test was not statistically significant for any of the 3 (P > .05). The reliability tests for the forward Mendelian randomization, including both MR-Egger intercept and MR-PRESSO tests, show no evidence of horizontal pleiotropy, and Cochran Q test indicates no heterogeneity. The “leave-one-out” sensitivity analysis revealed no outlier genes. The reliability tests for the reverse Mendelian randomization, including both MR-Egger intercept and MR-PRESSO tests, also indicate no genetic pleiotropy. Despite the heterogeneity shown in our study between hypertrophic cardiomyopathy and leukocyte TL, the sensitivity analysis did not identify any anomalies. Our Mendelian randomization study suggests that longer leukocyte TL is associated with an increased risk of hypertrophic obstructive cardiomyopathy, hypertrophic cardiomyopathy, and dilated cardiomyopathy. However, the onset of these 2 kinds of disease does not directly lead to changes in leukocyte TL.
Rehabilitation for complicated dysphagia after synchronous head-and-neck and esophageal cancer surgery: A case report
Authors: Xue Xinyuan , Azman Amerull , Zhang Cuicui , Chen Yangjia , Ni Jun , Wang Zhi-Yong
Published: November 2024

Rationale:

Surgical intervention for synchronous head-and-neck and esophageal cancers often results in complex dysphagia, significantly affecting postoperative quality of life. Swallowing dysfunction may become permanent or worsen, with potential impacts on noncancer-related mortality.

Patient concerns:

We report a rare case of multiple synchronous squamous cell carcinomas of the head and neck (tonsillar and epiglottic cancer) along with esophageal cancer, presenting for dysphagia rehabilitation following surgery.

Diagnoses:

Comprehensive evaluations—including magnetic resonance imaging, laryngoscopy, gastroscopy, and histopathology—led to diagnoses of left tonsil cancer (squamous cell carcinoma, T2N2bM0), epiglottic cancer (squamous cell carcinoma, T1N2bM0), and lower esophageal cancer (squamous cell carcinoma, T2N0M0). Postoperative videofluoroscopic swallowing study identified an anastomotic stricture at the level of the fifth cervical vertebra.

Interventions:

The patient underwent an 8-week rehabilitation program incorporating stretching exercises, swallowing behavior therapy, super-supraglottic swallow techniques, catheter balloon dilation, electrical stimulation, and respiratory therapy.

Outcomes:

Following rehabilitation, the patient was able to resume partial oral intake without aspiration, with significant improvement in anastomotic stricture and swallowing function.

Lessons:

This case of dysphagia underscores the anastomotic stenosis resulting from oncological surgical intervention. Dysphagia is a frequent complication in patients with synchronous head-and-neck and esophageal cancers. Comprehensive rehabilitation and assessment of swallowing function enabled safe oral intake postoperatively in this patient.
Genetic determinants of cerebrospinal fluid metabolites and risk of Guillain-Barré syndrome: A bidirectional two-sample Mendelian randomization study
Authors: Qi Xiangjia , Gao Liqian , Qi Lifeng
Published: November 2024

This study aims to investigate the potential causal relationship between cerebrospinal fluid (CSF) metabolites and Guillain-Barré syndrome (GBS) using a bidirectional two-sample Mendelian randomization (MR) approach. Publicly available summary data from genome-wide association studies (GWAS) were utilized for comprehensive analysis. The CSF metabolite GWAS summary data were extracted from a GWAS conducted by Panyard et al encompassing 338 CSF metabolites in European participants (n = 291). GWAS summary statistics for GBS were obtained from the FinnGen consortium (n = 215,931) comprising European populations. The primary method for MR analysis was the inverse variance weighted method. Various sensitivity analyses were conducted to assess the heterogeneity and pleiotropy of the findings. In the forward MR analysis, we identified a causal relationship between 15 CSF metabolites, including ribitol levels (odds ratio = 3.833, 95% confidence interval: 1.949–7.540, P = 9.87E−05), and the risk of developing GBS. In the reverse MR analysis, we found a causal relationship between GBS and 21 CSF metabolites, including gamma-glutamylphenylalanine levels (odds ratio = 0.934, 95% confidence interval: 0.904–0.966, P = 7.10E−05). No evidence of heterogeneity or horizontal pleiotropy was found in the MR analysis. Our findings suggest that the identified CSF metabolites and metabolic pathways can serve as valuable biomarkers for clinical screening and prevention of GBS. They may also be considered as candidate molecules for future research into the underlying mechanisms and for selecting drug targets.
Deciphering the role of LncRNA in alcoholic liver disease: Mechanisms and therapeutic potential
Authors: Zhang Lin , Wang Rongqi , Nan Yuemin , Kong Lingbo
Published: November 2024

Alcoholic liver disease (ALD) is a spectrum of liver damage caused by chronic alcohol consumption. The disease progresses in stages, starting with simple fatty liver, progressing to alcoholic hepatitis and potentially leading to fibrosis and cirrhosis. The pathophysiology of ALD is complex and involves several cellular and molecular mechanisms. Recent research has highlighted the role of long non-coding RNAs (LncRNAs) as critical regulators in the development and progression of ALD. This article reviews the current understanding of LncRNAs in ALD, focusing on their functions in key pathological processes and their potential as diagnostic markers and therapeutic targets.
Clinical characteristics and bloodstream infection pathogens by gram-negative bacteria in different aged adults: A retrospective study
Authors: Su Li , Cao Yawen , Liu Yaomin , Zhang Jianhua , Zhang Guomin
Published: November 2024

This study aims to determine the characteristics and distribution of pathogenic bacteria in bloodstream infections (BSIs) by gram-negative bacteria in adults. One hundred seventy-one adult patients with BSIs who were treated at the Affiliated Hospital of Chengde Medical College between January 2018 and January 2020 were included in this study. The patients were assigned to the young- and middle-aged group and elderly group based on age. General patient data were analyzed. More elderly patients had BSIs and gram-negative bacteria than young- and middle-aged patients. The incidence of underlying diseases in elderly patients was significantly higher than the young- and middle-aged patients (P < .01). The composition of Brucella spp. was significantly different between the elderly group and young- and middle-aged group (P < .05). There were significantly more gallbladder infections in the elderly group than the young- and middle-aged group, and significantly fewer elderly patients had no definite infection sites than the young- and middle-aged group (P < .05). The incidence of complications and in-hospital mortality in the elderly group was higher than the young- and middle-aged group (P < .05). BSIs caused by gram-negative bacteria mainly involved elderly patients. BSIs were characterized by complications and a poor prognosis, as well as pathogenic bacteria and primary infection sites.
Surface ablation laser surgery: Bibliometric and visualized analysis from 2004 to 2023
Authors: Ning Jiliang , Zhang Lijun
Published: November 2024

Surface ablation laser surgery has resurged in popularity recently because of its safety in correcting myopia and favorable postoperative corneal biomechanical properties. This study aimed to investigate the current focal points and future trends in surface ablation laser surgery over the last 2 decades. The Web of Science Core Collection was used as the primary data source to retrieve literature related to surface ablation laser surgery. All records, including full records and reference details, were exported in plain text format. VOSvivewer, CiteSpace, and Pajek were used to perform the bibliometric and visual analyses of the countries/regions, institutions, authors, journals, and keywords of relevant publications. A total of 3415 articles on surface ablation laser surgery were published in 253 journals. These articles were authored by 9681 individuals from 2751 institutions across 79 countries. The United States leads in terms of productivity and influence in this field. The Tehran University of Medical Sciences and Kymion GD were the most productive institutions and authors, whereas the University of Crete and Randleman JB were the most influential. The Journal of Cataract and Refractive Surgery was the most productive and influential in this area, and citation analysis revealed that the top 10 most-cited references focused primarily on postoperative wound healing and wavefront aberration. The keywords were grouped into the following 5 clusters: clinical effects and complications, special indications, iatrogenic corneal ectasia, haze, and pain management. High-frequency keywords in recent years included transepithelial photorefractive keratectomy, retreatment, transepithelial phototherapeutic keratectomy, and biomechanical properties. This bibliometric analysis examined the development trends, global cooperation, research hotspots, and future directions of surface ablation over the past 20 years.