bluuebunny/crossref_metadata_2025 huggingface dataset:
Ocular features in Aicardi syndrome: A case report
Authors: Sirek Sebastian , Filipek Erita , Wójcik–Niklewska Bogumiła , Pojda-Wilczek Dorota , Mrukwa-Kominek Ewa
Published: January 2023

Rationale:

Aicardi syndrome is a genetic malformation syndrome with a triad of dysgenesis or agenesis of the corpus callosum, distinctive chorioretinal lacunae and infantile spasms. It is a rare developmental disorder first described in 1965. The disease affects 1 in 100,000 live births.

Patient concerns:

We describe a 34-month-old girl diagnosed with Aicardi Syndrome.

Diagnosis:

Based on the results of color images of the fundus, medical history as well as the analysis of karyotype and DNA microarrays, the patient was diagnosed with Aicardi’s syndrome.

Interventions:

Additionally an B-scan ultrasonography and an electrophysiological test was performed.

Outcome:

Fundoscopic examination revealed optic disc colobomas in both eyes, extensive chorioretinal lacunae at the posterior pole with retinal pigment epithelium regrouping and atrophy. Flash visual evoked potentials (FVEP) P2 amplitude was lower than normal range. B-scan ultrasonography revealed an optic disc lesion consistent with optic disk coloboma.

Lessons:

Children with congenital central nervous system malformations should undergo regular ophthalmic checkups to facilitate diagnosis and determine prognosis of visual function development.
Association of urinary caffeine and caffeine metabolites with bone mineral density in children and adolescents
Authors: Luo Juan , Liu Mingjiang , Zheng Zhong , Zhang Ya , Xie Ruijie
Published: January 2023

In epidemiological research, the link between coffee consumption and bone mineral density (BMD) is still debated. Moreover, there hasn’t been any research on the relationship between urine caffeine and caffeine metabolites and BMD. This study aimed to investigate if there was a connection between urine caffeine and its metabolites and BMD in people between the ages of 8 and 19. Using data from the National Health and Nutrition Examination Survey 2009 to 2014, multivariate logistic regression models were utilized to investigate the association between urinary caffeine and caffeine metabolites and total BMD. Fitted smoothing curves and generalized additive models were also used. A total of 1235 adolescents were included in this analysis, after controlling for various variables, we found that the association between urinary theophylline and total BMD was negative, whereas the association between urinary paraxanthine, theobromine and caffeine and total BMD was positive. In our study, an inverted U-shaped association between urinary paraxanthine and urinary caffeine was found with BMD in women. In this cross-sectional study, the correlation between urinary caffeine and its metabolites and total BMD differed by sex and race. More studies are needed to confirm the results of this study and to investigate the underlying causes.
Lymphoscintigraphy in patients with breast cancer-related lymphedema after sentinel lymph node dissection and axillary radiation therapy
Authors: Oh Se Hyun , Kim Ju Hyeon , Seong Seung Tae , Park Jun Young , Lee Jae Hyun , Kim Ghi Chan , Jeong Ho Joong , Sim Young Joo
Published: January 2023

The purpose of this study was to investigate lymphoscintigraphy pattern according to the presence or absence of axillary site radiation therapy (aRTx) in breast cancer-related lymphedema (BCRL) patients who underwent sentinel lymph node dissection (SLND). The participants were patients who visited our facility from July 2014 to June 2021 due to upper extremity edema. Among them, patients who underwent SLND after the diagnosis of breast cancer were included. The participants were divided into a group without aRTx (group A) and a group with aRTx (group B). In each patient’s lymphoscintigraphy, axillary lymph node uptake (ALNU), lymphatic flow delay, dermal back flow, and the presence of any collateral pathway were checked. Thirty-three patients were enrolled. In all, 27 patients were classified in Group A, and 6 patients were classified in Group B. Between the 2 groups, we found a significant difference (P value < .05) between groups at ALNU and lymphatic flow delay. However, there was no significant difference between groups at the dermal backflow and the presence of a collateral pathway (P value > .05). And 24.2% of patients who developed lymphedema after SLND showed normal lymphoscintigraphy. In this study we suggest that SLND and aRTx affects the activity of the axillary lymph node and ultimately adversely affects lymphatic flow, becoming a risk factor for lymphedema. In addition, regardless of SLND or aRTx, lymphedema may eventually occur in the patient with normal lymphoscintigraphy.
Extraosseous osteochondroma of superficial fascia layer of the heel: A case report and review of literature
Authors: Zhu Shaobo , Zeng Junhao , Zhang Zhi , Rong Cunmin
Published: January 2023

Rationale:

Osteochondroma is a common benign bone tumor consisting of cartilage-covered bone confluent with the medullary canal of the epiphysis. Extraosseous osteochondroma shares the same appearance and histologic features as a typical osteochondroma but does not have any attachment to surrounding bone structures. Because of its low incidence, extraosseous osteochondroma is uncommon in clinical workups and thus prone to misdiagnosis. The diagnosis of extraosseous osteochondroma should be considered when there is a well-defined bony mass in the soft tissue with no direct continuity with the adjacent bone or joint. Here, we present a case of an imaging diagnosis of “calcified bursitis in the subcutaneous superficial fascial layer” and a postoperative pathological diagnosis of “extraosseous osteochondroma.”

Patient concerns:

The patient was a 61-year-old man who had a right plantar heel mass for 2 years and recently visited the hospital because of discomfort in shoes.

Diagnoses:

The patient was diagnosed with pathological examination.

Interventions:

After completing the relevant preoperative examination and preoperative preparation and excluding contraindications to surgery, surgery was performed under nerve block anesthesia.

Outcomes:

We performed surgical resection, and the patient did not have obvious discomfort when discharged from the hospital. Auxiliary examination showed no abnormalities.

Lessons:

For foot tumors, we need to consider the possibility of extraosseous osteochondroma. After completing the auxiliary examination, we should determine the relationship between the tumor and its surrounding tissues and blood supply before surgery to avoid causing major trauma.
Thymoma with systemic lupus erythematosus and immune-related anemia: A case of thymoma with SLE and IRA
Authors: Zhang Huayang , Chen Ting , Zhang Xuesong , Zhang Peng , Chen Yuan
Published: January 2023

Introduction:

Thymic epithelial tumors (TETs), including thymomas and thymic carcinomas. Thymomas are rare tumors, but are one of the most common mediastinal neoplasms in adults. The pathology of thymoma with Systemic Lupus Erythematosus (SLE) and severe pancytopenia is rarely reported. Thus, the current study demonstrates a case of thymoma with SLE and immune-related anemia with unique clinical manifestation.

Patient concerns:

A 27-year-old woman suffered from abdominal pain, arthralgia, intermittent high fever for a long time.

Diagnosis:

Based on the clinical and histopathological manifestations, diagnosis of thymoma with SLE and immune-related anemia was established.

Interventions:

Patient was treated with methylprednisolone and a complete thymectomy and thymomectomy, the CAP regimen was given 4 times of adjuvant chemotherapy after the operation.

Outcomes:

After inter-disciplinary consultation as well as extensive discussion and steroid pulse therapy underwent surgery, the patient’s blood count and immune function gradually entry sent back to normal.

Conclusion:

we present the diagnosis and treatment of a case of thymoma with SLE and immune-related anemia, and provides references for the clinical diagnosis and treatment of thymoma combined with SLE, and attempts to explain that SLE patients with thymoma may contribute to the clinical remission of SLE after thymoma resection. It should arouse the attention of clinicians when diagnosing and treating related diseases.
Efficacy and safety of Qi and Blood Tonic Chinese Medicines in the treatment of COVID-19: A protocol for systematic review and meta-analysis
Authors: Yang Feifei , Zhang Xiaosi , Zhang Zhe , Lu Hao , Li Jiawei , Bai Ning , Geng Naizhi
Published: January 2023

Background:

Coronavirus disease in 2019 (COVID-19) is a sudden public event affecting all human beings, with the rapid transmission, extensive groups affected, many complications, and high mortality. Traditional Chinese Medicine has a long history of preventing and treating infectious diseases, and numerous studies have shown that Traditional Chinese Medicine, especially herbal medicine, has a positive effect on the prevention, treatment, and post-healing recovery of this COVID-19, and herbal medicines to supplement qi and blood often occupy a certain proportion of it. However, there is no relevant meta-analysis to date. Therefore, this study aims to evaluate the efficacy and safety of qi and blood tonic herbal medicines in the treatment of COVID-19 through Systematic Review and meta-analysis to provide a reference basis for widespread clinical application.

Methods:

We will search from the following databases for the period from the time of database construction to March 1st, 2023. The English databases include: PubMed, MEDLINE, EMBASE, Cochrane library, WOS, Google Scholar, and CENTRAL; The Chinese databases include: China National Knowledge Infrastructure, China Biomedical Literature Database, Technology Journal Database, and Wanfang. Randomized controlled trials in English or Chinese that include Chinese herbal medicines for tonifying Qi and Blood in the treatment of patients with COVID-19 will be included. Data were independently screened and collected by 2 investigators. The risk of bias for each trial was assessed using the Cochrane Risk of Bias Tool 2.0. RevMan 5.3 software was used for the meta-analysis of the data. Primary outcome indicators included cure, mortality, and exacerbation rates (change in disease severity category, patient admission to ICU, etc.). Secondary outcome indicators included recovery rate or duration of major symptoms (e.g., fever, cough, fatigue, and weakness, etc.), rate or duration of nucleic acid conversion for severe acute respiratory syndrome coronavirus-2, improvement or recovery of chest CT performance, length of hospital stay, and other adverse events.

Results:

This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-P guidelines to ensure clarity and completeness of reporting in all phases of the systematic review.

Conclusion:

This study will provide evidence regarding the efficacy and safety of Qi and Blood Tonic Chinese Medicines for the treatment of COVID-19.

PROSPERO registration number:

CRD42022361822 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022361822).
Uncovering the molecular mechanism of Gynostemma pentaphyllum (Thunb.) Makino against breast cancer using network pharmacology and molecular docking
Authors: Wang Wen-Xiang , He Xiao-Yan , Yi Dong-Yang , Tan Xiao-Yan , Wu Li-Juan , Li Ning , Feng Bin-Bin
Published: January 2023

Because of their strong anti-cancer efficacy with fewer side effects, traditional Chinese medicines (TCM) have attracted considerable attention for their potential application in treating breast cancer (BC). However, knowledge about the underlying systematic mechanisms is scarce.Gynostemma pentaphyllum(Thunb.) Makino (GP), a creeping herb, has been regularly used as a TCM to prevent and treat tumors including BC. Again, mechanisms underlying its anti-BC properties have remained elusive. We used network pharmacology and molecular docking to explore the mechanistic details of GP against BC. The TCM systems pharmacology database and analysis platform and PharmMapper Server database were used to retrieve the chemical constituents and potential targets in GP. In addition, targets related to BC were identified using DrugBank and Therapeutic Target Database. Protein–protein interaction network, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses of crucial targets were performed using the Search Tool for the Retrieval of Interacting Genes/Proteins and database for annotation, visualization, and integrated discovery databases, whereas the network visualization analysis was performed using Cytoscape 3.8.2. In addition, the molecular docking technique was used to validate network pharmacology-based predictions. A comparison of the predicted targets of GP with those of BC-related drugs revealed 26 potential key targets related to the treatment of BC, among which ALB, EGFR, ESR1, AR, PGR, and HSP90AA1 were considered the major potential targets. Finally, network pharmacology-based prediction results were preliminarily verified by molecular docking experiments. In addition, chemical constituents and potential target proteins were scored, followed by a comparison with the ligands of the protein. We provide a network of pharmacology-based molecular mechanistic insights on the therapeutic action of GP against BC. We believe that our data will serve as a basis to conduct future studies and promote the clinical applications of GP.
Fertility problems in men carrying a translocation involved in breakpoints on chromosome 17p13: A retrospective, observational study
Authors: Li Ranwei
Published: January 2023

Male infertility is a multifactorial reproductive disorder. The effect of genetic factors on male infertility has been the focus of research. Although a variety of genetic techniques are applied to male infertility in clinical practice, karyotype analysis remains a powerful and inexpensive technology. Reciprocal chromosomal translocation (RCT) is closely related to male infertility, but the clinical phenotypes of RCT carriers are varied, and the underlying pathological mechanism is unclear. Some studies suggest that RCT breakpoints disrupt the structure and function of important genes responsible for spermatogenesis. Several breakpoints of chromosome 17 are related to important genes, which can lead to spermatogenic failure. This study aimed to identify the clinical features of 3 men with translocation karyotypes involving breakpoints on chromosome 17p13. Semen analysis and cytogenetic analysis were performed with informed consent. Gene ontology analysis was performed for 60 pathogenic genes on chromosome band 17p13. Cytogenetic analysis showed that the karyotypes were 46, XY, t(6;17) (p21;p13), 46,XY,t(10;17)(q11.2;p13), and 46, XY, t(17;20) (p13;q13), respectively. Relevant studies and genes on breakpoints on chromosome 17p13 were searched for using PubMed. Fourteen reported cases of the same karyotype were reviewed. The results suggest that although chromosome 17 is closely related to spermatogenic failure, the clinical phenotypes of RCT carriers with involvement of 17p13 breakpoints are varied. The important genes involved in the breakpoint were analyzed. The results of molecular functions suggested that these targets genes on chromosome band 17p13 were mostly involved in microfilament motor activity, ATPase activity. These results suggested that the translocation chromosome and breakpoint analysis should be considered in the clinical assessment of the patients. Physicians should be aware of these in genetic counseling. These breakpoints and the function of related genes require further study.
Prognostic factors and survival prediction for patients with metastatic lung adenocarcinoma: A population-based study
Authors: Wu Bo , Chen Jianhui , Zhang Xiang , Feng Nan , Xiang Zhongtian , Wei Yiping , Xie Junping , Zhang Wenxiong
Published: January 2023

The prognosis of metastatic lung adenocarcinoma (MLUAD) varies greatly. At present, no studies have constructed a satisfactory prognostic model for MLUAD. We identified 44,878 patients with MLUAD. The patients were randomized into the training and validation cohorts. Cox regression models were performed to identify independent prognostic factors. Then, R software was employed to construct a new nomogram for predicting overall survival (OS) of patients with MLUAD. Accuracy was assessed by the concordance index (C-index), receiver operating characteristic curves and calibration plots. Finally, clinical practicability was examined via decision curve analysis. The OS time range for the included populations was 0 to 107 months, and the median OS was 7.00 months. Nineteen variables were significantly associated with the prognosis, and the top 5 prognostic factors were chemotherapy, grade, age, race and surgery. The nomogram has excellent predictive accuracy and clinical applicability compared to the TNM system (C-index: 0.723 vs 0.534). The C-index values were 0.723 (95% confidence interval: 0.719–0.726) and 0.723 (95% confidence interval: 0.718–0.729) in the training and validation cohorts, respectively. The area under the curve for 6-, 12-, and 18-month OS was 0.799, 0.764, and 0.750, respectively, in the training cohort and 0.799, 0.762, and 0.746, respectively, in the validation cohort. The calibration plots show good accuracy, and the decision curve analysis values indicate good clinical applicability and effectiveness. The nomogram model constructed with the above 19 prognostic factors is suitable for predicting the OS of MLUAD and has good predictive accuracy and clinical applicability.
Efficacy and safety of Xinmai’an tablet in treatment of premature ventricular contractions due to coronary heart disease: A protocol for systematic review and meta-analysis
Authors: Wang Meiling , Che Sihua , Pan Weiwei , Zhang Shumao , Shi Guijun
Published: January 2023

Background:

Coronary heart disease (CHD) is the leading cause of human death in the world and a public health problem of global concern. As a common arrhythmia in CHD, premature ventricular contractions are very likely to progress to fatal arrhythmias, resulting in serious adverse consequences. At present, the treatment of premature ventricular contractions due to CHD mainly focuses on catheter ablation, beta-blockers and antiarrhythmics. Both require ongoing monitoring because relapses may lead to redevelopment of cardiomyopathy, and there are varying degrees of indications and side effects. Several clinical studies have shown that Xinmai’an can effectively control the occurrence of premature ventricular contractions and reduce the risk of recurrence. However, there is currently no systematic review evaluating its effectiveness. Therefore, the purpose of this study is to provide strong evidence-based medical evidence for Xinmai’an tablet in the treatment of premature ventricular contractions due to CHD.

Methods:

We will search the main Chinese and English databases from inception to June 5, 2022. And identified as the randomized controlled trials. In addition, a reference list of studies meeting the inclusion criteria will be retrieved. Two researchers will conduct literature screening and quality evaluation. And we will conduct bias risk assessment and sensitivity analysis. The analysis software uses RevMan 5.3.

Results:

Mainly by observing the number of ventricular premature beat attacks (24-hour holter monitoring electrocardiogram), electrocardiogram efficacy (ST segment and T wave changes) and echocardiogram assesses the structure and function of the left and right ventricular, left ventricular ejection fraction, etc. To evaluate the clinical effect of Xinmai’an on premature ventricular contractions due to CHD.

Conclusion:

The results of this study will provide a basis for the selection of treatment options for premature ventricular contractions due to CHD.
Comparison of the incidence of adverse reactions between herbal decoction and Chinese patent medicine combined with western medicine in treatment of COVID-19: A protocol for systematic review and meta-analysis
Authors: Zhang Yunliang , Li Xuhao , Yu Wenyan
Published: January 2023

Introduction:

Coronavirus disease 2019 (COVID-19) is an acute respiratory infectious disease that has led to millions of confirmed cases and deaths worldwide. Traditional Chinese Medicine plays an irreplaceable role in the treatment and prevention of epidemics in China. Western medicine improves clinical symptoms as well as bringing many adverse reactions. The combination of Chinese and western medicine can significantly improve the clinical symptoms and efficacy of patients. Currently, there is a lack of systematic reviews on the comparison of the incidence of adverse reactions between the difference treatments. We conducted this study to evaluate the comparison of the incidence of adverse reactions between herbal decoction and Chinese patent medicine combined with western medicine in treatment of COVID-19.

Methods and analysis:

Randomized controlled trials in 9 databases from December 2019 to September 2022, will be included, without language restrictions. Two independent researchers will screen and select studies, extract data, and evaluate the study quality. The Cochrane risk-of-bias tool for randomized controlled trials will be used to assess the risk of bias in the included studies. Statistical analyses will be conducted using Review Manager.

Results:

Our findings will compare the incidence of adverse reactions between herbal decoction and Chinese patent medicine combined with western medicine in treatment of COVID-19, which will be disseminated in a relevant conference and published in a peer-reviewed publication.

Ethics and dissemination:

This study will not include personal information. Ethical approval is not required for this study.

PROSPERO registration number:

CRD42022371001.
Lung ultrasound in diagnosis of acute heart failure: A protocol for systematic review and meta-analysis
Authors: Chen Hao , Chen Yang , Liu Shidong , Liu Guangzu , Liu Hongxu , Song Bing
Published: January 2023

Background:

Lung ultrasound has been used more and more in clinical diagnosis of acute heart failure (AHF) in recent years. The purpose of this paper is to evaluate the diagnostic value of lung ultrasound in AHF by meta-analysis.

Methods:

PubMed, Cochrane Library, Web of Science, and Embase were searched. The time limit for retrieval is from the establishment to October 2022. According to the criteria, the literatures were screened and the relevant data was extracted. Efficacy of lung ultrasound in AHF was evaluated using Stata Version 16.0, (Stata Corp, College Station, TX).

Results:

This study will be submitted to a peer-reviewed journal for publication.

Conclusion:

This study conducted a systematic review of relevant studies, which aims to systematically evaluate the diagnostic value of lung ultrasound in AHF.
Effect of systolic blood pressure fluctuations during resuscitation on postoperative complications following meningioma surgery: A retrospective observation study
Authors: Luo Dong Xue , Yue Zi Chuan , Shi Min , Guo Xing Jie , Zhou Ya Qing , Shao Lu Yi , Xu Miao Miao , Zhou Jie Jie , Yu Li Xiang , Duan Manlin
Published: January 2023

It is unclear whether blood pressure variability in the post-anesthesia care unit is associated with postoperative complications. This study aims to characterize the impact of blood pressure fluctuations on postoperative complications and postoperative length of stay after meningioma surgery. Adult meningioma patients undergoing general anesthesia were retrospectively recruited. The principal exposure was blood pressure variability in the post-anesthesia care unit, calculated by noninvasive blood pressure measurements. The primary outcome was major postoperative complications, defined as II or higher in the Clavien-Dindo classification grades. Secondary outcomes included healthcare resource utilization parameters among patients. Multivariable logistic regression was used and adjusted for potential confounding variables. Data sensitivity analyses were performed via different variable transformations and propensity score matching analyses. A total of 578 patients qualified for the study, and 161 (27.9%) cases experienced postoperative complications. The multivariable analysis found that increased systolic blood pressure variability in the post-anesthesia care unit was associated with postoperative complications (adjusted odds ratio [aOR] = 1.15; 95% confidence interval [CI], 1.09–1.22, P < .001) and prolonged postoperative length of stay (adjusted regression coefficients [β] = 1.86; 95% CI, 0.58–3.13, P = .004). Patients with postoperative complications had a higher frequency of intensive care admission (44.1% vs 15.3%), major postoperative interventions (6.6% vs 0%), and 30-day readmission (5.0% vs 0.7%). Systolic blood pressure fluctuations during resuscitation have an independent impact on postoperative complications and postoperative length of stay following meningioma surgery.
Laparoscopy combined with transvaginal surgery for Herlyn–Werner–Wunderlich syndrome: A case report
Authors: Niu Gaoli , Zhai Yanhong , Meng Luhong , Zhao Lingli , Liu Nannan , Xing Xuejiao , Wen Xin , Chen Jingjing
Published: January 2023

Background:

Herlyn–Werner–Wunderlich (HWW) syndrome is a rare congenital Mullerian duct anomaly disease that is characterized by a triad of symptoms, didelphys uterus, blind hemivagina, and ipsilateral renal agenesis. Herein, we reported a case from China.

Case presentation:

An 11-year-old patient presented to our hospital with lower abdominal pain and frequent urination. Computed tomography and magnetic resonance imaging revealed hematocolpos, uterine hemorrhage, didelphys uterus, and renal agenesis on the right side. Thus, the patient was diagnosed with HWW syndrome. Laparoscopic combined with transvaginal surgery to remove the vaginal septum, the symptoms of the lesion disappeared after the blood was discharged.

Conclusion:

Abnormal urination and other symptoms should be carefully examined in adolescent girls with abdominal pain not menarche, since they may be related to reproductive organ development disorders and other diseases. We recommend laparoscopy combined with transvaginal surgery to remove the oblique septum in HWW syndrome, which is rarely reported.
A multicenter prospective study of the treatment and outcome of patients with gastroduodenal peptic ulcer bleeding in Japan
Authors: Kawaguchi Koichiro , Yoshida Akira , Yuki Takafumi , Shibagaki Kotaro , Tanaka Hisao , Fujishiro Hirofumi , Miyaoka Youichi , Yanagitani Atsushi , Koda Masaharu , Ikuta Yukihiro , Hamamoto Tetsuro , Mukoyama Tomoyuki , Sasaki Yuichiro , Kushiyama Yoshinori , Yuki Mika , Noguchi Naoya , Miura Masahiko , Ikebuchi Yuichiro , Yashima Kazuo , Kinoshita Yoshikazu , Ishihara Shunji , Isomoto Hajime
Published: January 2023

Gastroduodenal peptic ulcers are the main cause of nonvariceal upper gastrointestinal bleeding (UGIB). We believe that recent advances in endoscopic techniques and devices for diagnosing upper gastrointestinal tract tumors have advanced hemostasis for UGIB. However, few prospective multicenter studies have examined how these changes affect the prognosis. This prospective study included 246 patients with gastroduodenal peptic ulcers treated at 14 participating facilities. The primary endpoint was in-hospital mortality within 4 weeks, and the secondary endpoints required intervention and refractory bleeding. Subsequently, risk factors affecting these outcomes were examined using various clinical items. Furthermore, the usefulness of the risk stratification using the Glasgow-Blatchford score, rockall score and AIMS65 based on data from the day of the first urgent endoscopy were examined in 205 cases in which all items were complete there are two periods. Thirteen (5%) patients died within 4 weeks; and only 2 died from bleeding. Significant risk factors for poor outcomes were older age and severe comorbidities. Hemostasis was required in 177 (72%) cases, with 20 cases of refractory bleeding (2 due to unsuccessful endoscopic treatment and 18 due to rebleeding). Soft coagulation was the first choice for endoscopic hemostasis in 57% of the cases and was selected in more than 70% of the cases where combined use was required. Rockall score and AIMS65 predicted mortality equally, and Glasgow-Blatchford score was the most useful in predicting the requirement for intervention. All scores predicted refractory bleeding similarly. Although endoscopic hemostasis for UGIB due to peptic ulcer had a favorable outcome, old age and severe comorbidities were risk factors for poor prognosis. We recommend that patients with UGIB should undergo early risk stratification using a risk scoring system.
Association of Skilled Nursing Facility Participation in Voluntary Bundled Payments With Postacute Care Outcomes for Joint Replacement
Authors: Ying Meiling , Thirukumaran Caroline P. , Temkin-Greener Helena , Joynt Maddox Karen E. , Holloway Robert G. , Li Yue
Published: January 2023

Importance:

The Medicare Bundled Payments for Care Improvement (BPCI) model 3 of 2013 holds participating skilled nursing facilities (SNFs) responsible for all episode costs. There is limited evidence regarding SNF-specific outcomes associated with BPCI.

Objective:

To examine the association between SNF BPCI participation and patient outcomes and across-facility differences in these outcomes among Medicare beneficiaries undergoing lower extremity joint replacement (LEJR).

Design, Setting, and Participants:

Observational difference-in-differences (DID) study of 2013–2017 for 330 unique persistent-participating SNFs, 146 unique dropout SNFs, and 14,028 unique eligible nonparticipating SNFs.

Main Outcome Measures:

Rehospitalization within 30 and 90 days after SNF admission, and rate of successful discharge from the SNF to the community.

Results:

Total 636,355 SNF admissions after LEJR procedures were identified for 582,766 Medicare patients [mean (SD) age, 76.81 (9.26) y; 424,076 (72.77%) women]. The DID analysis showed that for persistent-enrollment SNFs, no BPCI-related changes were found in readmission and successful community discharge rates overall, but were found for their subgroups. Specifically, under BPCI, the 30-day readmission rate decreased by 2.19 percentage-points for White-serving SNFs in the persistent-participating group relative to those in the nonparticipating group, and by 1.75 percentage-points for non-Medicaid–dependent SNFs in the persistent-participating group relative to those in the nonparticipating group; and the rate of successful community discharge increased by 4.44 percentage-points for White-serving SNFs in the persistent-participating group relative to those in the nonparticipating group, whereas such relationship was not detected among non-White–serving SNFs, leading to increased between-facility differences (differential DID=−7.62). BPCI was not associated with readmission or successful community discharge rates for dropout SNFs, overall, or in subgroup analyses.

Conclusions:

Among Medicare patients receiving LEJR, BPCI was associated with improved outcomes for White-serving/non-Medicaid–dependent SNFs but not for other SNFs, which did not help reduce or could even worsen the between-facility differences.
Discontinuation of Buprenorphine Treatment for Opioid Use Disorder During the Coronavirus Disease-2019 Pandemic
Authors: Saloner Brendan , Chang Hsien-Yen , Alexander G. Caleb , Stein Bradley D.
Published: January 2023

Background:

The coronavirus disease-2019 pandemic has been associated with large increases in opioid-related mortality, yet it is unclear whether specific subpopulations were especially likely to discontinue buprenorphine treatment for opioid use disorder as the pandemic ensued.

Objective:

The aim was to assess predictors of buprenorphine discontinuation in the early months of the coronavirus disease-2019 pandemic (April–July 2020) compared with a prepandemic period (April–July 2019).

Design:

In each time period, we estimated a multilevel regression models to assess risk of discontinuation in April–July for people who started buprenorphine in January–February. Models included person-level, prescriber-level, and area-level covariates.

Subjects:

Individuals age 18 years or older in the all-payer IQVIA Longitudinal Prescription Claims.

Measures:

The primary outcome was buprenorphine discontinuation (ie, no filled prescriptions during the follow-up periods).

Results:

Overall, 13.98% of patients discontinued buprenorphine in April–July 2020, less than the 15.71% in 2019 (P<0.001). In 2020, patient-level factors associated with discontinuation included younger age, male sex, shorter baseline possession ratio, and payment by cash. Compared with patients with a primary care physician prescriber, specialties most associated with discontinuation were pain medicine and physician assistant/nurse practitioner. Compared with the South Atlantic region, discontinuation risk was lowest in New England and highest in the West South Central States. The association between patient, prescriber, and geographic variables to risk of discontinuation was very similar in 2019 and 2020.

Conclusions:

While clinical and policy interventions may have mitigated opioid use disorder treatment discontinuation following the pandemic, such discontinuation is nevertheless common and varies by identifiable patient, provider and geographic factors.
A novel urokinase plasminogen activator receptor-targeted peptide-based probe for in-vivo molecular imaging of glioblastoma
Authors: Han Yunfeng , Tu Le , Zhang Yongxue , Xu Liying , Sun Ziyan
Published: January 2023

Aim

The urokinase plasminogen activator receptor (uPAR) is a promising biomarker for cancer diagnosis and therapy. We herein fabricated a new type of uPAR-targeted imaging probe Al18F-NOTA-VC and preliminarily evaluated its potential application in PET imaging of the glioma model in vivo.

Methods

Peptide VC was synthesized and identified by MALDI-TOF-MS. The IC50 between VC/precursor NOTA-VC and uPAR was then determined before the synthesis and purification of Al18F-NOTA-VC, followed by further studies of in-vitro properties of Al18F-NOTA-VC. Meanwhile, the AE105-based probe followed a similar procedure in-vitro test. Finally, the PET imaging properties, including uPAR-targeting ability and the metabolism of Al18F-NOTA-VC, were investigated.

Results

The VC and NOTA-VC were obtained successfully and demonstrated a good affinity with uPAR. Followed by Al18F labeling successfully, excellent properties, including the serum stability, water solubility, and specificity of Al18F-NOTA-VC, were obtained in-vitro test compared with AE105 based probe. An excellent tumor uptake and renal excretion data of Al18F-NOTA-VC were acquired from in-vivo U87MG tumor model PET imaging, consistent with the subsequent biodistribution study.

Conclusion

In addition to the excellent specificity and high tumor/normal tissue contrast for uPAR-targeted PET imaging of U87MG tumor, Al18F-NOTA-VC possessed promising clearance ability by renal system route. These excellent properties facilitated Al18F-NOTA-VC to be a promising imaging agent for uPAR high-expressing tumors and, thus, provided a paradigm for developing peptide-based probes for uPAR-associated disease diagnosis.
Clinical value of fluorine-18–fluorodeoxyglucose PET/MRI for liver metastasis in colorectal cancer: a prospective study
Authors: Akkus Gunduz Pinar , Ozkan Elgin , Kuru Oz Digdem , Soydal Cigdem , Araz Mine , Erden Gul Ayse , Yavuz Yasemin , Kucuk Nuriye Ozlem , Kir Kemal Metin
Published: January 2023

Purpose

To evaluate the diagnostic performance of liver 18F-FDG PET/MRI in addition to whole-body PET/CT and to compare it with MRI in the detection and clinical management of liver metastasis in patients with colorectal cancer (CRC).

Material and methods

Seventy-eight patients with CRC who underwent whole-body 18F-FDG PET/CT followed by liver PET/MRI were prospectively included. Histopathological confirmation and/or at least 3 months of clinical follow-up after PET/MRI were accepted as gold standard. Lesion and patient-based analyses were performed to evaluate the diagnostics performances of PET/CT, PET/MRI and MRI. In addition, changes of clinical management were evaluated.

Results

On lesion-based analysis, for PET/CT, PET/MRI and MRI; sensitivity (Se): 55.6%, 97.2% and 100%; specificity (Sp): 98.5%, 100% and 80.5%; and accuracy (Acc): 70.7%, 98.2% and 93.1% were calculated, respectively. Se and Acc of PET/MRI and MRI were significantly superior than PET/CT (P < 0.001). Se and Acc of PET/MRI and MRI were comparable; however, Sp of PET/MRI was significantly better than MRI (P < 0.001). On patient-based analysis, Se: 75.6%, 100% and 100%; Sp: 97.3%, 100% and 86.5%; and Acc: 85.9%, 100% and 93.5% were calculated, respectively. Se and Acc of PET/MRI were significantly superior than PET/CT (P < 0.001). Also, Se of MRI was significantly superior than PET/CT (P < 0.001). Se of PET/MRI and MRI were comparable, but Sp and Acc of PET/MRI were significantly better than MRI. The additional information obtained from liver PET/MRI changed treatment strategy in 14/78 (18%) patients compared to PET/CT or alone liver MRI.

Conclusion

Diagnostic performances of PET/MRI and MRI for detection of CRC liver metastasis is superior to PET/CT. PET/MRI especially helps in the accurate detection of liver metastases that are suspicious on MRI and has the potential to change the clinical management of especially oligometastatic patients by identifying uncertain liver lesions.
High Cure Rate Among Pregnant Women in a Chlamydia trachomatis and Neisseria gonorrhoeae Testing and Treatment Intervention Study in Gaborone, Botswana
Authors: Mussa Aamirah , Wynn Adriane , Ryan Rebecca , Babalola Chibuzor , Simon Selebaleng , Ramontshonyana Kehumile , Tamuthiba Lefhela , Ndlovu Neo , Moshashane Neo , Klausner Jeffrey D. , Morroni Chelsea
Published: January 2023

A high cure rate was observed after testing and treatment of Chlamydia trachomatis and Neisseria gonorrhoeae infection among pregnant women in a nonrandomized cluster trial in Gaborone, Botswana.

Between March 2021 and March 2022, 251 pregnant women were tested for Chlamydia trachomatis and Neisseria gonorrhoeae infection in Botswana. Fifty-eight (23%) tested positive for at least 1 infection, and 57 (98%) were treated. No participants tested positive at test of cure. In some settings, cost of test of cure may outweigh the benefits.
How Old Is He Really? The Association Between “Gay Age” and Sexual Behaviors Among Men Who Have Sex With Men
Authors: Exten Cara , Vasilenko Sara A. , Rosenberger Joshua G.
Published: January 2023

Time since first engaging in oral or anal sex with another man may act as a marker of engagement in sexual behaviors associated with sexually transmitted infection/HIV transmission among men who have sex with men.

Background

Men who have sex with men (MSM) are disproportionately impacted by HIV and other sexually transmitted infections, with sexual behaviors acting as a primary predictor of disease acquisition. Predictors of engagement in specific sexual behaviors may act as key targets for preventive strategies. We hypothesized that time since first engaging in oral or anal sex with another man, or one's “gay age,” is associated with sexual behavior among MSM.

Methods

We examined 5280 MSM aged 18 to 40 years who were recruited from social and sexual connection Web sites. We used modified Poisson regression to examine associations between gay age and 4 sexual behaviors (enema use, group sex, receptive anal intercourse, insertive anal intercourse). We used time-varying effect models to examine how the prevalence of these behaviors varies across gay age.

Results

In total, 76% of participants reported receptive anal intercourse in the past year, and 76% reported insertive anal intercourse. Group sex and enema use in the past year were reported by 39% and 36%, respectively. Modified Poisson and time-varying effect model analyses indicated that the prevalence of enema use, group sex, and insertive anal intercourse significantly increased with increasing gay age.

Conclusions

Gay age may serve as an important marker of engagement in sexual behaviors associated with sexually transmitted infection/HIV acquisition among MSM.
Addressing the Operational Challenges for Outpatient Stroke Rehabilitation
Authors: Jenkins La’Tai , Gonzaga Spencer , Jedlanek Erin , Kim Gina , Raghavan Preeti
Published: January 2023

The traditional model of rehabilitation services includes clear requirements for provision of services in the acute inpatient rehabilitation setting. However, there are fewer guidelines on the frequency and duration of rehabilitation services beyond the acute setting. Recent research has suggested that neurorehabilitation interventions that are provided frequently enough upon discharge from acute inpatient rehabilitation to facilitate repeated practice and feedback improve long-term stroke outcomes. However, it is challenging to provide high-frequency outpatient rehabilitation, as the logistics of scheduling and insurance limitations often do not allow it. The Sheikh Khalifa Stroke Institute at Johns Hopkins Medicine innovated a new model to provide the appropriate frequency of therapy for stroke rehabilitation in the outpatient setting. This article describes the restructured operational infrastructure for outpatient stroke rehabilitation to facilitate high-frequency transdisciplinary stroke rehabilitation in the real world, including the development of the outpatient postacute therapy programs and the identification of appropriate patients for each program, the development of scheduling matrices and treating teams to deliver the postacute therapy programs, the implementation of transdisciplinary neurorehabilitation, and the steps taken to empower patients to engage in rehabilitation at home and address barriers to accessing the programs. We assessed the effect of the operational restructuring on schedule utilization, no-show rates, and cancellation rates in the 3 mos before and after implementation of the program and show that it increased schedule utilization and reduced no-show rates and cancellation rates, suggesting that it may increase compliance with rehabilitation. It is possible to create the infrastructure needed to bridge the continuum of care for poststroke recovery and rehabilitation.
Acute and subacute postsurgical pain in women with breast cancer: incidence and associations with biopsychosocial predictors—a secondary analysis of a randomized controlled trial
Authors: Munk Alice , Jacobsen Henrik Børsting , Schnur Julie , Montgomery Guy , Reme Silje Endresen
Published: January 2023

Introduction:

Women who undergo breast cancer surgery risk suffering from postsurgical pain long after their surgery. Still, research on postsurgical pain in the subacute phase has been neglected.

Objective:

This study aims to investigate the incidence, intensity, unpleasantness, and presurgical predictors of acute and subacute postsurgical pain after breast cancer surgery.

Methods:

The study used an observational design through secondary analyses of the control group in a randomized controlled trial. Data from 102 women undergoing breast cancer surgery were included. Levels of acute and subacute pain intensity and unpleasantness were measured using 100 mm Visual Analogue Scales on the day of surgery and 4 weeks postsurgery. Linear regression analyses were performed to identify presurgical biopsychosocial predictors of acute and subacute postsurgical pain.

Results:

Average levels of postsurgical pain intensity and unpleasantness were as follows: 22.7 mm for acute pain intensity, 19.0 mm for acute pain unpleasantness, 10.3 mm for subacute pain intensity, and 11.7 mm for subacute pain unpleasantness. Pain expectancy predicted acute pain intensity (R2 = 0.04, p = 0.047) and acute unpleasantness (R2 = 0.06, p = 0.02). Perceived social support inversely predicted acute pain unpleasantness (R2 = 0.04, p = 0.014).

Conclusion:

Mild and moderate acute pain intensity and unpleasantness are common after breast cancer surgery, whereas levels of subacute pain intensity and unpleasantness are low. Pain expectancy predicts acute postsurgical pain intensity and unpleasantness, whereas expected social support inversely predicts acute postsurgical pain unpleasantness.
Recommendations from the ISPO lower-limb COMPASS: Patient-reported and performance-based outcome measures
Authors: Tan Jade M. , Halford Gregory R. J. , Lukin Martina , Kohler Friedbert
Published: January 2023

Background:

Outcome measures (patient-reported and performance-based) are used widely but not uniformly within the clinical setting for individuals with lower-limb absence (LLA). The need for more detailed information by funding bodies, service planners and providers, and researchers requires the systematic and routine use of outcome measures. Currently, there is no consensus on which outcome measure(s) should be used for individuals with LLA. The aim of the International Society of Prosthetics and Orthotics (ISPO) lower-limb Consensus Outcome Measures for Prosthetic and Amputation Services (COMPASS) was to produce a recommended list of outcome measures to be actively promoted for routine use within clinical practice before and after an episode of care.

Methods:

Between May and June 2021, 46 users, clinicians, researchers, managers, and policymakers working in the field of LLA and prosthetic users met virtually. Consensus participants were first asked to complete an online survey with questions based on the results from a systematic review and the outcomes from an expert panel. A modified Delphi technique was used to determine outcome measures for use in routine clinical practice. This paper discusses the ISPO lower-limb COMPASS process from which recommendations were made.

Results:

The ISPO lower-limb COMPASS resulted in the following 6 recommendations: (1) Amputee Mobility Predictor, Timed Up and Go, Two-Minute Walk Test, Prosthetic Evaluation Questionnaire—Residual Limb Health, Prosthetic Evaluation Questionnaire—Utility, and Trinity Amputation and Prosthesis Experience Scales-Revised, which make up the ISPO lower-limb COMPASS; (2) Comprehensive High-Level Activity Mobility Predictor and Six-Minute Walk Test are 2 additional outcome measures recommended for higher-activity-level individuals with LLA, which make up the COMPASS+; (3) Patient-Specific Function Scale makes up the COMPASS Adjunct; (4) a generic health-related quality of life outcome measure such as the European Quality of Life-5D-5L or Patient-Reported Outcomes Measurement Information System—29 item can be used to supplement the COMPASS; (5) outcome measures suited to low- and middle-income countries need to be developed with a focus on activities such as sitting cross-legged, kneeling, squatting, and other culturally important mobility-related activities; and (6) translation, validation, and open sharing of translated outcome measures included in the COMPASS, COMPASS+, and COMPASS Adjunct occurs.

Conclusion:

The above recommendations represent the current status of knowledge on outcome measures for LLA based on research and international consensus and hence, will change over time. This work has been developed for clinicians and researchers to improve knowledge on outcome measures to guide clinical decision-making and future research initiatives.
Altered Biodistribution on 99mTc-Dimercaptosuccinic Acid Renal Scan
Authors: Mercer Megan K. , Parisi Marguerite T. , Revels Jonathan W. , Blacklock Lisa , Elojeimy Saeed
Published: January 2023

99mTc-dimercaptosuccinic acid (99mTc-DMSA) scans are used to evaluate renal cortical defects typically related to parenchymal scarring or pyelonephritis, and ectopic renal parenchyma. 99mTc-DMSA binds to metalloproteins in proximal tubular cells and typically localizes to the renal cortex, with minimal excretion. Planar and SPECT images are obtained 2 to 4 hours after IV administration of 99mTc-DMSA. Altered 99mTc-DMSA biodistribution has been reported in various conditions, including renal injury, technical issues, infiltrative processes, and hematologic disorders. Here, we present a case of altered biodistribution, with hepatic and splenic radiotracer uptake in the setting of hepatosplenomegaly and hematologic abnormalities concerning for a systemic hematologic disorder/lymphohistiocytosis.