bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Associated With Readmission for Postpartum Preeclampsia [ID: 1378401]
Authors: Nienow-Birch Mary , Class Quetzal A. , Harrison Rachel , Owens Thomas
Published: May 2023

INTRODUCTION:

Factors associated with preeclampsia with severe features (PSF) diagnosed on postpartum readmission are understudied, although important.

METHODS:

Patients were identified using ICD-9/10 codes of PSF diagnosed antenatally or postnatally between 2010 and 2019. We collected background and pregnancy characteristics via electronic medical records and used the Chicago Health Atlas to assign zip code-based socioeconomic hardship and education scores. Descriptive statistics and logistic regressions evaluated whether individual, pregnancy, and neighborhood factors predicted odds of readmission. Model 1 included age, body mass index (BMI), fetal growth restriction, urine protein, preterm delivery, and cesarean section. Model 2 added neighborhood factors, number of hypertensive medications at discharge, and length of delivery inpatient stay.

RESULTS:

Seven hundred forty-seven participants with PSF were identified, and 108 (14.8%) were diagnosed on postnatal readmission. Our sample was 68.8% Black, aged 29.0±6.8 years, with a mean BMI of 34.7±9.7 kg/m2. In model 1, older age was associated with an increased risk for readmission (adjusted odds ratio [aOR] 1.07, 95% CI 1.03–1.11) while the presence of proteinuria (aOR 0.38, 95% CI 0.24–0.61) and preterm birth (aOR 0.52, 95% CI 0.30–0.91) were associated with decreased risk for readmission. In model 2, older age (aOR 1.09, 95% CI 1.04–1.14) remained significantly associated with increased risk of readmission while the presence of proteinuria (aOR 0.24, 95% CI 0.12–0.45), more hypertensive medications given at discharge (aOR 0.44, 95% CI 0.24–0.82), and longer inpatient stay (aOR 0.60, 95% CI 0.40–0.92) showed decreased odds of readmission. No other studied factors were associated with readmission.

CONCLUSION:

Older mothers were consistently more at risk for readmission, while more intensive hypertensive treatment (higher number of medications, longer inpatient stay at delivery) protected against readmission.
High-Dose Steroids for Nonresolving Acute Respiratory Distress Syndrome in Critically Ill COVID-19 Patients Treated With Dexamethasone: A Multicenter Cohort Study*
Authors: Lopinto Julien , Arrestier Romain , Peiffer Bastien , Gaillet Antoine , Voiriot Guillaume , Urbina Tomas , Luyt Charles-Edouard , Bellaïche Raphaël , Pham Tái , Ait-Hamou Zakaria , Roux Damien , Clere-Jehl Raphaël , Azoulay Elie , Gaudry Stéphane , Mayaux Julien , Mekontso Dessap Armand , Canoui-Poitrine Florence , de Prost Nicolas
Published: May 2023

OBJECTIVES:

To determine the impact of high doses of corticosteroids (HDCT) in critically ill COVID-19 patients with nonresolving acute respiratory distress syndrome (ARDS) who had been previously treated with dexamethasone as a standard of care.

DESIGN:

Prospective observational cohort study. Eligible patients presented nonresolving ARDS related to severe acute respiratory syndrome coronavirus 2 infection and had received initial treatment with dexamethasone. We compared patients who had received or not HDCT during ICU stay, consisting of greater than or equal to 1 mg/kg of methylprednisolone or equivalent for treatment of nonresolving ARDS. The primary outcome was 90-day mortality. We assessed the impact of HDCT on 90-day mortality using univariable and multivariable Cox regression analysis. Further adjustment for confounding variables was performed using overlap weighting propensity score. The association between HDCT and the risk of ventilator-associated pneumonia was estimated using multivariable cause-specific Cox proportional hazard model adjusting for pre-specified confounders.

SETTING:

We included consecutive patients admitted in 11 ICUs of Great Paris area from September 2020 to February 2021.

PATIENTS:

Three hundred eighty-three patients were included (59 in the HDCT group, 324 in the no HDCT group).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

At day 90, 30 of 59 patients (51%) in the HDCT group and 116 of 324 patients (35.8%) in the no HDCT group had died. HDCT was significantly associated with 90-day mortality in unadjusted (hazard ratio [HR], 1.60; 95% CI, 1.04–2.47; p = 0.033) and adjusted analysis with overlap weighting (adjusted HR, 1.65; 95% CI, 1.03–2.63; p = 0.036). HDCT was not associated with an increased risk of ventilator-associated pneumonia (adjusted cause-specific HR, 0.42; 95% CI, 0.15–1.16; p = 0.09).

CONCLUSIONS:

In critically ill COVID-19 patients with nonresolving ARDS, HDCT result in a higher 90-day mortality.
Genetic risk factors for chronic postsurgical pain in children
Authors: He Billy Haitian , Diatchenko Luda , Ingelmo Pablo
Published: May 2023

Genetic risk factors for chronic postsurgical pain in adults have been established, but little is known whether the same associations exist in children. It is even less clear how much influence single nucleotide polymorphisms can exert on the phenotypic expression of chronic postsurgical pain in children in general. To this effect, a search was made for original articles which met the following criteria: evaluation of postsurgical pain in children with known genetic mutations or, conversely, evaluation of atypical pain trajectories of postsurgical children assessing for possible genetic mutations that may explain the phenotype. All titles and abstracts retrieved were reviewed for suitability for inclusion. The references of the selected articles were also checked for additional relevant papers. To assess the transparency and quality of the genetic studies both STrengthening the REporting of Genetic Association studies scores and Q-Genie scores were applied. Overall, there is a paucity of information regarding the link between genetic mutations and eventual chronic postsurgical pain development although there is some information on acute postoperative pain. Evidence has shown that the contribution of genetic risk factors to chronic postsurgical pain development appears to be minor, with its clinical relevance yet to be described. More advanced techniques in systems biology (proteomics, transcriptomics) suggest promising avenues for investigating the disease.
Determination of Orelabrutinib in Human Plasma Using LC-MS/MS
Authors: Zhao Yang , Guo Yu-Jiao , Chen Xiang-Long , Yang Yan-Ling , Ma Hong , Wang Yong-Qing , Sun Lu-Ning
Published: May 2023

Background:

Orelabrutinib is a second-generation Bruton tyrosine kinase inhibitor that improves the management of B-cell malignancies. The objective of this study was to develop and validate an LC-MS/MS method for quantifying orelabrutinib in human plasma.

Methods:

Plasma samples were processed using acetonitrile to precipitate proteins. Ibrutinib-d5 was used as the internal standard. The mobile phase comprised 10 mM ammonium formate containing 0.1% formic acid and acetonitrile (62:38, vol/vol). The multiple reaction monitoring transitions at m/z = 428.1 → 411.2 and 446.2 → 309.2 were selected for orelabrutinib and ibrutinib-d5, respectively, after ionization in the positive mode.

Results:

Total runtime was 4.5 minutes. The validated curve ranges were 1.00–500 ng/mL. This method exhibited acceptable selectivity, dilution integrity, matrix effects, and recovery. Interrun and intrarun accuracy ranged from −3.4% to 6.5%, and interrun and intrarun precision was between 2.8% and 12.8%. Stability was studied under different conditions. The incurred sample reanalysis demonstrated good reproducibility.

Conclusions:

The LC-MS/MS method provided a simple, specific, and rapid quantification of orelabrutinib in the plasma of patients with mantle cell lymphoma or chronic lymphocytic leukemia/small lymphocytic lymphoma. The results indicated that orelabrutinib exhibits large variability between individuals and should be prudently used in combination with CYP3A4 inhibitors.
Long non-coding RNA TLR8-AS1 induces preeclampsia through increasing TLR8/STAT1 axis
Authors: Peng Chuyu , Zhu Jianbin , Guo Hong , Zhao Ling , Wu Feifei , Liu Bo
Published: May 2023

Objective:

Our current study tried to assay the role of long noncoding RNAs (lncRNAs) TLR8-AS1 in regulating preeclampsia.

Methods:

TLR8-AS1 expression was examined in the clinical placental tissues of preeclampsia patients and the trophoblast cells induced by lipopolysaccharide (LPS). Then, different lentivirus was infected into trophoblast cells to study the role of TLR8-AS1 in cell functions. Furthermore, interactions among TLR8-AS1, signal transducer and activator of transcription 1 (STAT1) and toll-like receptor 8 (TLR8) were determined. A rat model of preeclampsia induced by N(omega)-nitro-L-arginine methyl ester was developed to validate the in-vitro findings.

Results:

High expression of TLR8-AS1 was detected in placental tissues of preeclampsia patients and LPS-induced trophoblast cells. In addition, overexpression of TLR8-AS1 arrested the proliferation, migration and invasion of trophoblast cells, which was related to the upregulation of TLR8 expression. Mechanistically, TLR8-AS1 recruited STAT1 to bind to the TLR8 promoter region, and thus promoted the transcription of TLR8. Meanwhile, overexpression of TLR8-AS1 was shown to aggravate preeclampsia by elevating TLR8 in vivo.

Conclusion:

Our study confirmed that TLR8-AS1 aggravated the progression of preeclampsia through increasing the expression of STAT1 and TLR8.
Blood pressure excursion on admission and intravenous thrombolysis in ischemic stroke
Authors: Du Linzhe , Zhang Yuqiao , Li Xiaohui , Liu Chengfang , Li Zhongyuan , Zhou Junshan , Liu Yukai
Published: May 2023

Background:

Blood pressure (BP) excursion on admission was common in patients with acute ischemic stroke, but its influence on thrombolysis effect was not fully evaluated.

Methods:

Patients with acute ischemic stroke who received thrombolysis without subsequent thrombectomy were included. Admission BP excursion was defined as higher than 185/110 mmHg. Multivariate logistic regression analysis was used to evaluate the relationship between admission BP excursion and poor outcome as well as hemorrhage rates and mortality. Poor outcome was defined as a 90-day modified Rankin Scale score 3–6. Subgroup analysis was performed according to stroke severity, which was assessed by the National Institutes of Health Stroke Scale (NIHSS) score, and hypertension status.

Results:

A total of 633 patients were enrolled and 240 participants (37.9%) had admission BP excursion. Admission BP excursion was associated with poor outcome [adjusted odds ratio (OR) 0.64, 95% confidence interval 0.42–0.99, P = 0.046]. No significant difference was found regarding hemorrhage rates or mortality between patients with and without admission BP excursion. In subgroup analysis, admission BP excursion was related to poor outcome in patients with NIHSS score at least 7 (adjusted OR 1.89, 95% confidence interval 1.03–3.45, P = 0.038), but not in patients with NIHSS score less than 7 (P for interaction <0.001).

Conclusion:

Admission BP excursion above the guideline thresholds did not increase postthrombolysis hemorrhage risk or mortality, but was associated with poor outcome, especially in patients with severe stroke.
Overview of Guidelines for the Medical Treatment of Acute Kawasaki Disease in Japan (2020 Revised Version) and Positioning of Plasma Exchange Therapy in the Acute Phase
Authors: Mori Masaaki , Matsubara Tomoyo
Published: May 2023

Background:

Kawasaki disease (KD) is a medium-sized vessel vasculitis of unknown origin that predominantly affects infants and young children. As KD causes cardiac complications such as coronary artery lesions, it is known as a disease that causes sudden death in children with acquired cardiac disease.

Methods:

The clinical trials of prednisolone, infliximab and cyclosporin A have led to the insurance coverage of these drugs in the treatment of KD, in addition to intravenous immunoglobulin therapy, which was already indicated for the treatment of KD. Despite not being a drug, plasma exchange therapy as a procedure was also approved for insurance coverage in Japan. Furthermore, new guidelines for KD treatment were published by the American Heart Association in 2017 and the Single Hub and Access Point for Paediatric Rheumatology in Europe in 2019. In light of these circumstances, the Japanese Society of Pediatric Cardiology and Cardiac Surgery guidelines were revised.

Conclusions:

Here, we provide an overview of the revised guidelines and mention the position and actual practice of plasma exchange therapy as one of the ultimate treatment modalities.
Study on the mechanism of Baihe Dihuang decoction in treating menopausal syndrome based on network pharmacology
Authors: Tian Mingmin , Yang Anming , Lu Qinwei , Zhang Xin , Liu Guangjie , Liu Gaofeng
Published: May 2023

Menopausal syndrome (MS) refers to a series of symptoms with autonomic nervous system dysfunction caused by decreased sex hormones before and after menopause. Baihe Dihuang (BHDH) decoction positively affects MS, but its mechanism remains unclear. This study aimed to reveal the underlying mechanism through network pharmacology. The components of the BHDH Decoction were found through HERB, while corresponding targets were obtained from the HERB, Drug Bank, NPASS, Targetnet, and Swisstarget databases. The MS targets were obtained from GeneCards and OMIM. STRING was used to construct the protein-protein interaction networks. OmicShare tools were used for Gene Ontology and Kyoto encyclopedia of genes and genomes analyses. Finally, Autodock Vina 1.1.2 software (https://vina.scripps.edu/downloads/) was used for molecular alignment to verify whether the main active ingredients and key targets had good binding activity. We screened out 27 active ingredients and 251 effective targets of BHDH Decoction, 3405 MS-related targets, and 133 intersection targets between BHDH Decoction and MS. Protein-protein interaction network identified tumor protein P53, Serine/threonine-protein kinase AKT, epidermal growth factor receptor, Estrogen Receptor 1, and jun proto-oncogene as critical targets. Gene ontology analysis showed that these targets were mainly involved in the cellular response to chemical stimulus, response to oxygen-containing compound, cellular response to endogenous stimulus, response to an organic substance, and response to chemical, etc. Kyoto encyclopedia of genes and genomes pathways were mainly enriched in endocrine resistance, pathways in cancer, and the ErbB signaling pathway, etc. Molecular docking results showed that emodin and stigmasterol are strongly associated with Serine/threonine-protein kinase AKT, Estrogen Receptor 1, epidermal growth factor receptor, sarcoma gene, and tumor protein P53. This study preliminarily revealed the multi-component, multi-target, and multi-channel mechanism of BHDH Decoction in treating MS. It provides a reference for in vitro and in vivo research and clinical application of BHDH Decoction in the treatment of MS.
The 95% control lines on both confirmed cases and days of infection with COVID-19 were applied to compare the impact on public health between 2020 and 2021 using the hT-index
Authors: Chuang Hua-Ying , Kan Wei-Chih , Chien Tsair-Wei , Tsai Chia-Liang
Published: May 2023

Background:

COVID-19, the disease caused by the novel coronavirus, is now a worldwide pandemic. The number of infected people has continually increased, and currently, this pandemic continues to present challenges to public health. Scatter plots are frequently used to interpret the impact in relation to confirmed cases. However, the 95% confidence intervals are rarely given to the scatter plot. The objective of this study was to; Develop 95% control lines on daily confirmed cases and infected days for countries/regions in COVID-19 (DCCIDC) and; Examine their impacts on public health (IPH) using the hT-index.

Methods:

All relevant COVID-19 data were downloaded from GitHub. The hT-index, taking all DCCIDCs into account, was applied to measure the IPHs for counties/regions. The 95% control lines were proposed to highlight the outliers of entities in COVID-19. The hT-based IPHs were compared among counties/regions between 2020 and 2021 using the choropleth map and the forest plot. The features of the hT-index were explained using the line chart and the box plot.

Results:

The top 2 countries measured by hT-based IPHs were India and Brazil in 2020 and 2021. The outliers beyond the 95% confidence intervals were Hubei (China), with a lower hT-index favoring 2021 ( = 6.4 in 2021 vs 15.55 in 2020) and higher hT indices favoring 2021 in Thailand (28.34 vs 14,77) and Vietnam (27.05 vs 10.88). Only 3 continents of Africa, Asia, and Europe had statistically and significantly fewer DCCIDCs (denoted by the hT-index) in 2021. The hT-index generalizes the h-index and overcomes the disadvantage without taking all elements (e.g., DCCIDCs) into account in features.

Conclusions:

The scatter plot combined with the 95% control lines was applied to compare the IPHs hit by COVID-19 and suggested for use with the hT-index in future studies, not limited to the field of public health as we did in this research.
Glomerular filtration rate is an independent prognostic factor in patients with B-large cell lymphoma
Authors: Premužić Vedran , Bašić-Kinda Sandra , Radman Ivo , Dujmović Dino , Ilić Ivana , Živković Neno , Maleta Lucija , Kralik Marko , Dobrenić Margareta , Galunić-Bilić Lea , Rončević Pavle , Vodanović Marijo , Aurer Igor
Published: May 2023

Chronic kidney dysfunction is associated with increased mortality in multiple cancer types. Preliminary evidence suggests the same to be true for B-large cell lymphomas (B-LCL). To analyze the relationship of glomerular filtration rate (GFR) and outcome of B-LCL in detail we collected data on outcomes of 285 consecutive patients with newly diagnosed B-LCL treated at our institution with standard rituximab-containing regimens who did not have preexisting kidney disease or urinary tract obstruction at presentation. Median age was 59, range 18 to 87, 145 were male and 140 females. Forty-four had GFR < 60 mL/min, 123 had 60 to 90 mL/min, and 118 > 90 mL/min. Median follow-up of surviving patients was 49 months and estimated 3-year survival 76%. In univariate analysis age (P < .001), GFR (P = .014), stage (P < .001), performance status (P = .044), chemotherapy regimen (P < .01), and international prognostic index (IPI) (P < .001) were statistically significant prognostic factors. In multivariate analysis, age and GFR remained the only independent prognostic factors. Subtracting 1 from the IPI score of patients who had GFR > 90 mL/min and IPI > 1 resulted in a prognostic index that divides patients into 3 prognostic groups (low risk = 0–1, intermediate risk = 2–3 and high risk = 4–5) with an acceptable patient distribution frequency (38%, 39%, and 23%, respectively) and improved statistical significance and separation in comparison to IPI (5-year survival rates of 92%, 74%, and 42%, respectively). GFR is an important independent prognostic factor for B-LCL that should be taken into account in clinical decision making and data analysis and probably be incorporated in prognostic indices.
Long-term results of huge deep-seated liposarcoma in the thigh: Two case reports
Authors: Wang Hyung Woo , Kim Youn Hwan , Park Seong Oh
Published: May 2023

Rationale:

Liposarcoma is an uncommon malignant tumor that develops in the fatty tissue; thus, the long-term follow-up results of extremely large liposarcomas in the submuscular layer of the thigh have rarely been reported. Here we share the course and outcome of 2 cases of a huge deep-seated liposarcoma in the thigh.

Patient concerns:

Two patients visited our clinic, each with a deep-seated mass in the thigh. First, a 44-year-old man presented to the outpatient clinic with a left thigh mass. Approximately 1 year later, an 80-year-old man presented to the outpatient clinic with a right posterior thigh mass.

Diagnosis:

Magnetic resonance imaging revealed an approximately 14 × 8 × 21 cm well-differentiated liposarcoma between the sartorius and iliopsoas muscle and an approximately 14 × 12 × 31.5 cm lipomatous mass in the posterior compartment of the right thigh involving the right adductor muscles. After complete marginal resection, an excisional biopsy was performed to confirm the diagnosis.

Interventions:

Both patients underwent complete marginal resection without chemotherapy or radiotherapy.

Outcomes:

A biopsy showed a 20 × 17 × 7 cm well-differentiated, well-encapsulated liposarcoma in the 44-year-old man and a 30 × 17 × 10 cm well-differentiated liposarcoma in the 80-year-old man. These patients have achieved approximately 61 and 44 months of recurrence-free survival to date, respectively.

Lessons:

Here we described the long-term outcomes of 2 patients with a huge deep-seated liposarcoma in the lower extremity. Complete marginal excision of well-differentiated liposarcoma can achieve excellent recurrence-free survival.
Guillain-Barre syndrome and pulmonary embolism in an adult female with COVID-19 infection in Ghana: A case report
Authors: Tetteh-Wayoe Eugene , Duodu Fiifi , Pekyi-Boateng Prince Kwabla , Agyeman Badu Nana Boakye , Akpalu Albert , Adjei Patrick
Published: May 2023

Introduction:

The coronavirus disease 2019 (COVID-19) pandemic began at the end of 2019 in Wuhan, the capital of Hubei Province, China. This novel coronavirus is classified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neurological manifestations are commonly associated with moderate to severe COVID-19 infection. Guillain-Barré syndrome (GBS) is a rare immune-mediated postinfectious neuropathy but there has been an increase in the number of cases of GBS associated with COVID-19, supporting the present body of global evidence of the notable association between the 2 conditions. We present the first proven case of GBS and pulmonary embolism associated with COVID-19 infection in Ghana, West Africa.

Case Presentation:

A 60-year-old apparently healthy female presented in August 2020 to the COVID-19 treatment center of the Korle-Bu Teaching Hospital in Accra, Ghana from a referral facility following a week’s history of low-grade fever, chills, rhinorrhoea, and generalized flaccid limb weakness. A positive SARS-CoV-2 test result was recorded 3 days after the onset of symptoms and the patient had no known chronic medical condition. Following cerebrospinal fluid analysis, neurophysiological studies and a chest computed tomography pulmonary angiogram, Guillain-Barre syndrome and pulmonary embolism were confirmed. The patient was however managed supportively and then discharged after 12 days on admission, as he made mild improvement in muscular power and function.

Conclusion:

This case report adds to the body of evidence of the association between GBS and SARS-CoV-2 infection, particularly from West Africa. It further highlights the need to anticipate potential neurological complications of SARS-CoV-2, particularly GBS even in mild respiratory symptoms for prompt diagnosis and initiation of appropriate therapy to improve outcomes and avert long-term deficits.
Contactin-associated protein-2 and anti-aquaporin-4 antibody positive autoimmune encephalitis secondary to herpes simplex encephalitis: A case report
Authors: Zhang Lin-Ming , Zhang Huan-Bo , Zou Yong-Fang , Liu Ming-Wei
Published: May 2023

Rationale:

Recurrent herpes simplex encephalitis (HSE) can easily induce autoimmune encephalitis (AE). However, there are few reports of anti-contactin-associated protein-2 (CASPR2)-related encephalitis, especially with positive anti-aquaporin 4 (AQP4) antibodies.

Patient concerns:

A 14-year-old boy was admitted to the Department of Neurology of the First Affiliated Hospital of Kunming Medical University for “headache, dizziness, and fever for four days” with positive anti-CASPR2 and anti-AQP4 antibodies in the cerebrospinal fluid.

Diagnoses:

Cranial MRI showed lesions in the right hippocampus, amygdala, and insular lobe, with local sulcus enhancement in the right insular, temporal, and frontal lobes. The fluid-attenuated inversion recovery was significantly enhanced. Human herpes virus type I was detected by cerebrospinal fluid metagenomic testing. The patient was diagnosed with AE secondary to HSE, with positive anti-CASPR2 and anti-AQP4 antibodies.

Interventions:

After 2 weeks of immunoglobulin and methylprednisolone immunomodulatory therapy, acyclovir antivirus, mannitol dehydration, reducing intracranial pressure, and other symptomatic support therapy.

Outcomes:

The patient’s symptoms significantly improved, with no complaints of discomfort, and he was discharged for observation. The patient was followed up a month after discharge and had no complaints of discomfort.

Lessons:

CASPR2 and anti-aquaporin-4 antibody-positive AE have not been reported to be positive. This case will raise awareness of CASPR2 and anti-aquaporin-4 antibody-positive AE secondary to HSE, strengthen diagnostic capacities, and provide advice to treat it.
Effectiveness of techniques for insertion of nasoenteral probe in critical patients: Randomized clinical trial
Authors: Queiroz Cintia Galvão , Dantas Joyce Karolayne dos Santos , de Araújo Sara Cristina Matias , Rocha Mayara Araújo , Mendes Francisco De Cassio de Olivira , Medeiros Kleyton Santos , Dantas Daniele Vieira , Dantas Rodrigo Assis Neves
Published: May 2023

Introduction:

despite being a common procedure, nasally placed small-bowel feeding tube insertion is not risk-free and can compromise patient safety. Due to the fact that nasally placed small-bowel feeding tube is commonly inserted ‘“blindly,” with the patient head in the neutral position, sometimes the process becomes difficult and traumatic, and may present higher level of complexity in physiological or induced coma and intubated patients. Therefore, adverse events (AEs) route errors can occur during this procedure. This study aimed to determine the effectiveness of different nasally placed small-bowel feeding tube insertion techniques in coma and intubated patients, in comparison with conventional method.

Methods:

A prospective, randomized and controlled clinical trial will be carried out with coma and intubated patients admitted to the Intensive Care Unit (ICU). Thirty-nine patients will be randomly divided into 3 groups: group who will have the tube inserted in a conventional manner with the head in the neutral position, group with the head positioned laterally to the right, and, finally, with the head in the neutral position, with assistance of a laryngoscope. The primary endpoint will be: first, second and total attempt success rate; and time required for the first successful attempt and the sum of all attempts. Complications during insertion included tube bending, twisting, knotting, mucosal bleeding, and insertion into the trachea. Patient vital signs will be measured.
Treatment of unstable C1 semi-ring fractures with direct C1 pedicle screw fixation using a navigational template: A case report and literature review
Authors: Dong Wei-Xin , Chu Zhen-Tao , Hu Yong
Published: May 2023

Rationale:

Because of the risk of C1 to C2 instability, which would reduce the mobility of the occipito-atlanto-axis articulation, unstable C1 semi-ring fractures are typically treated with C1 to C2 or C0 to C2 fusion. The vertebral artery and spinal cord are at risk of harm during the installation of C1 pedicle screws. There is a need for a method that can maintain the occipito-atlanto-axis articulation’s mobility and increase the safety of C1 pedicle screw fixation, particularly for surgeons who have less experience inserting C1 pedicle screws freehand.

Patient concerns:

A 45-year-old man who had suffered a severe fall from a height of 2.5 m presented with pain in his cervical spine. Magnetic resonance imaging and computed tomography were used to diagnose unstable atlas fractures.

Diagnosis:

According to radiographic studies, the patient had a unilateral anterior and posterior arch fracture (semi-ring fracture, Landells type II), as well as fractures and transverse ligament avulsion at the attachment site.

Interventions:

We fixed the C1 directly with a pedicle screw using a navigational template.

Outcomes:

Both during and after the operation, there were no connected complications. Imaging at 12 months after surgery demonstrated that the fracture had united. The average visual analog scale score decreased from 8 before surgery to 2.

Lessons:

In particular for surgeons with less experience placing freehand C1 pedicle screws, direct C1 pedicle screw fixation with the aid of a navigational template was a good option because it can preserve the mobility of the occipito-atlanto-axis articulation and improve the safety of C1 pedicle screw.
The prevalence of anemia among human immunodeficiency virus-infected individuals in East Africa: A systematic review and meta-analysis
Authors: Getu Fasil , Aynalem Melak , Walle Muluken , Enawgaw Bamlaku
Published: May 2023

Background:

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients face several hematological abnormalities. Of these abnormalities, anemia is the most common one. Africa has a high prevalence of HIV/AIDS, especially in the East and South African region, which is heavily affected by the virus. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of anemia among patients with HIV/AIDS in East Africa.

Methods:

This systematic review and meta-analysis was conducted based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. PubMed, Google Scholar, Science Direct, Dove Press, Cochrane Online, and African journals online were searched systematically. The quality of the included studies was assessed by 2 independent reviewers using the Joanna Briggs Institute critical appraisal tools. Data were extracted into an Excel sheet and then exported to STATA version 11 for analysis. A random-effect model was fitted to estimate the pooled prevalence and Higgins I
2 test statistics were done to test the heterogeneity of studies. Funnel plots analysis and Egger-weighted regression tests were done to detect publication bias.

Results:

The pooled prevalence of anemia among HIV/AIDS patients in East Africa was 25.35% (95% CI: 20.69–30.03%). A subgroup analysis by highly active antiretroviral therapy (HAART) status showed that the prevalence of anemia among HAART naive HIV/AIDS patients was 39.11% (95% CI: 29.28–48.93%) whereas the prevalence among HAART experienced was 36.72% (95% CI: 31.22–42.22%). A subgroup analysis by the study population showed that the prevalence of anemia among adult HIV/AIDS patients was 34.48% (95% CI: 29.52–39.44%) whereas the pooled prevalence among children was 36.17% (95% CI: 26.68–45.65%).

Conclusion:

This systematic review and meta-analysis revealed that anemia is among the most common hematological abnormalities in HIV/AIDS patients in East Africa. It also underscored the importance of taking diagnostic, preventive, and therapeutic measures for the management of this abnormality.
Association of neutrophil-to-lymphocyte ratio with clinical, pathological, radiological, laboratory features and disease outcomes of invasive breast cancer patients: A retrospective observational cohort study
Authors: Jadoon Sarosh Khan , Soomro Rufina , Ahsan Muhammad Nadeem , Ijaz Khan Raja Muhammad , Iqbal Sadia , Yasmin Farah , Najeeb Hala , Saleem Nida , Cho Namiya , Resham  , Shaikh Taha Gul , Saba Hasan Syeda Fatima , Khalid Muhammad Zain , Alvi Sarosh , Rizvi Ahsan Mujtaba , Asghar Muhammad Sohaib
Published: May 2023

Inflammatory conditions play part in the progression of malignancies, and markers signifying growth of these factors can indicate prognosis. Neutrophil-to-lymphocyte (NLR) is used as a marker of subclinical inflammation that may become an integral part of workup to indicate prognosis and associated pathology. This study aims to explore the association of NLR ratio with clinical characteristics, radiological assessment and staging, histopathology, and disease outcomes of breast cancer. A retrospective cohort study was conducted in a tertiary care center to include breast cancer patients that were diagnosed between January 2001 and December 2020. Data including tumor size, lymph nodes, metastasis, histological grading, ER/PR/HER2-neu status, molecular subtypes, clinical staging); nodal findings (sentinel and axillary); pathology from frozen section; and disease outcomes were assessed. Multivariable regression and Kaplan–Meier survival curves were employed to indicate the association of NLR with breast cancer features and disease-free survival. A total of 2050 patients had a median age of 50 years, median NLR levels of 2.14, most common pathology ductal followed by lobular, and most common site of metastasis being lungs followed by bones. Disease-free rate was 7.6%, and a recurrence rate of 1.8%, while 1.6% deaths were reported. NLR was found associated with age, treatment outcomes, tumor size, lymph nodes, metastasis and clinical staging. Other positive correlations were with Ki67 proliferation index, molecular subtypes, and tumor size on frozen section (at transverse and craniocaudal dimensions). Negative correlations were seen with estrogen and progesterone receptors. However, NLR was not found predictable of disease-free survival (P = .160). Significant predictors of disease-free survival were histological grading, ER, PR status, molecular subtype, and Ki67 proliferation index. NLR being a readily available marker has shown novel findings in its association with tumor staging, disease outcomes and characteristics of breast malignancy.
Analysis of the potential relationship between COVID-19 and Behcet’s disease using transcriptome data
Authors: Zhao Zhibai , Zhou Chenyu , Zhang Mengna , Qian Ling , Xia Wenhui , Fan Yuan
Published: May 2023

To investigate the potential role of COVID-19 in relation to Behcet’s disease (BD) and to search for relevant biomarkers. We used a bioinformatics approach to download transcriptomic data from peripheral blood mononuclear cells (PBMCs) of COVID-19 patients and PBMCs of BD patients, screened the common differential genes between COVID-19 and BD, performed gene ontology (GO) and pathway analysis, and constructed the protein-protein interaction (PPI) network, screened the hub genes and performed co-expression analysis. In addition, we constructed the genes-transcription factors (TFs)-miRNAs network, the genes-diseases network and the genes-drugs network to gain insight into the interactions between the 2 diseases. We used the RNA-seq dataset from the GEO database (GSE152418, GSE198533). We used cross-analysis to obtain 461 up-regulated common differential genes and 509 down-regulated common differential genes, mapped the PPI network, and used Cytohubba to identify the 15 most strongly associated genes as hub genes (ACTB, BRCA1, RHOA, CCNB1, ASPM, CCNA2, TOP2A, PCNA, AURKA, KIF20A, MAD2L1, MCM4, BUB1, RFC4, and CENPE). We screened for statistically significant hub genes and found that ACTB was in low expression of both BD and COVID-19, and ASPM, CCNA2, CCNB1, and CENPE were in low expression of BD and high expression of COVID-19. GO analysis and pathway analysis was then performed to obtain common pathways and biological response processes, which suggested a common association between BD and COVID-19. The genes-TFs-miRNAs network, genes-diseases network and genes-drugs network also play important roles in the interaction between the 2 diseases. Interaction between COVID-19 and BD exists. ACTB, ASPM, CCNA2, CCNB1, and CENPE as potential biomarkers for 2 diseases.
Characteristics and management of tumor treating fields-related dermatological complications in patients with glioblastoma
Authors: Yang Chao , Zhang Qing , Ma Chao , Huang Yong , Ding Hai-Xia , Lu Jun-Wei , Wang Jie , Li Xiang , Zhong Ya-Hua , Li Zhi-Qiang
Published: May 2023

Tumor treating fields (TTFields) is a novel approved modality for the treatment of glioblastoma (GBM) exhibiting a satisfactory effect. Although TTFields has shown considerable safety for the normal brain, dermatological adverse events (DAEs) often occur during therapy. However, studies focused on the identification and management of DAEs are rare. The clinical data and photos of skin lesions from 9 patients with GBM were retrospectively analyzed, and the types and grades of individual scalp dermatitis were evaluated based on the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v 5.0). Adherence and safety were also evaluated on the basis of the device monitoring data. Eight patients (88.9%) exhibited grade 1 or grade 2 CTCAE DAEs, all of whom were cured after interventions. The adherence was >90%, with no relevant safety events reported. Finally, a guideline for preventing DAEs in patients with GBM was proposed. The identification and management of TTFields-related DAEs is necessary and urgent in patients with GBM. Timely interventions of DAEs will help to improve the adherence and quality of life of patients, which ultimately improves prognosis. The proposed guideline for preventing DAEs in patients with GBM assists in the management of healthcare providers and may avoid dermatologic complications.
Case report of a patient with Erdheim-Chester disease presenting with neuro-endocrine symptoms and negative for BRAF mutation
Authors: Lu Liuze , Zhou Jing , Yan Xu , Jin Rihua , Deng Shuanglin , Lu Weiwen , Chen Dawei
Published: May 2023

Rationale:

Erdheim-Chester disease (ECD) is a rare progressive disease affecting multiple systems. It has recently been recognized as a neoplastic disease following the discovery of activating mutations in the MAPK pathway. There are several striking signs of ECD, such as the long bone involvement, as well as the hairy kidney appearance on computed tomography scan. It is rare for ECD to manifest neurological symptoms. Central nervous system involvement is a strong prognostic factor and independent predictor of death. ECD is characterized by the overproduction and accumulation of foamy histiocytes and Touton’s giant cells in various tissues and organs. ECD is a multisystem disorder in which any organ may be affected.

Patient concerns:

This case report describes a 57-year-old woman with headaches and ataxia as the first clinical manifestation, without characteristic bone pain, but with delayed enuresis. In addition to the renal involvement, this patient had rarer splenic involvement.

Diagnoses:

The imaging presentation of this patient was similar to that of a “multiple meningiomas”. A combination of clinical, imaging and pathology for the diagnosis of ECD.

Interventions:

Patients were given INF-α therapy.

Outcomes:

Fortunately, the patient responded well to INF-α treatment.

Lessons:

ECD patient with neuro-endocrine symptoms.
Case Report: Multiple Sclerosis Presenting as Unilateral Gaze-Evoked Nystagmus
Authors: Tsai Ping-Feng , Chen Ying-Jen
Published: May 2023

Significance

Unilateral gaze-evoked nystagmus is a rare neurologic finding that is largely diagnosed in connection with ischemic stroke. Gazed-evoked nystagmus is also a rare initial presentation of multiple sclerosis.

Purpose

This study aimed to report a rare presentation of gaze-evoked nystagmus, in a patient with multiple sclerosis and review the mechanism underlying the gaze-evoked nystagmus.

Case Report

A 32-year-old man who presented with one-week history of diplopia. Neurologic examination revealed right-sided gaze-evoked nystagmus and right-sided ataxia. Lab test revealed positive for oligoclonal bands. Contrast brain MRI revealed multiple hyperintense T2 lesions including a hyperintense patch at the right inferior cerebellar peduncle. A diagnosis of multiple sclerosis was made. The patient received methylprednisolone 500 mg intravenously for 14 days. The diplopia and gaze-evoked nystagmus resolved and remained stable 2 months later.

Conclusions

Our case demonstrates that damage to the inferior cerebellar peduncle may result in ipsilesional gaze-evoked nystagmus and ipsilesional ataxia, in contrast to ipsilesional gaze-evoked nystagmus and contralesional ataxia.
Through The Valley of the Shadow of Death. Journey Through Major Mental Illness as Experienced by a Mental Health PhD Candidate
Authors: MCALLISTER KIRSTY M.
Published: May 2023

The author describes her struggle with depression and borderline personality disorder, self-harm, and suicidality. She first reviews the long years during which she did not respond to any of the numerous antidepressant medications that were prescribed. She then describes how she finally achieved healing and good functioning as a result of long-term caring psychotherapy in the context of a strong therapeutic relationship in combination with medications that were found to be effective for her symptoms.
Afterword to “Through The Valley of the Shadow of Death. Journey Through Major Mental Illness as Experienced by a Mental Health PhD Candidate”
Authors: PLAKUN ERIC M.
Published: May 2023

The author describes her struggle with depression and borderline personality disorder, self-harm, and suicidality. She first reviews the long years during which she did not respond to any of the numerous antidepressant medications that were prescribed. She then describes how she finally achieved healing and good functioning as a result of long-term caring psychotherapy in the context of a strong therapeutic relationship in combination with medications that were found to be effective for her symptoms.
Causal Beliefs About and Perceptions of Illness in Persons Experiencing Schizophrenia and in Close Relatives of Such Individuals: An Exploratory Study
Authors: Villani Murielle V. , Kovess-Masféty Viviane
Published: May 2023

Background:

The cause to which persons experiencing schizophrenia attribute their illness influences emotional and adjustment variables. This is also true for close relatives (CRs), who are important players in the affected individual’s environment and whose mood can influence the person’s day-to-day life or treatment adherence. Recent literature has highlighted a need to further explore the impact of causal beliefs on different aspects of recovery as well as on stigma.

Aims:

The objective of this study was to explore causal beliefs about the illness and their relationship to other illness perceptions and stigma among persons experiencing schizophrenia and their CRs.

Methods:

Twenty French individuals experiencing schizophrenia and 27 CRs of individuals with schizophrenia answered the Brief Illness Perception Questionnaire, which investigates probable causes of an illness and other illness perceptions, and the Stigma Scale. A semi-structured interview was used to collect information about diagnosis, treatment, and access to psychoeducation.

Results:

The individuals with schizophrenia identified fewer causal attributions than the CRs. They were more likely to endorse psychosocial stress and family environment as probable causes, while CRs mostly favored genetic explanations. We found significant relationships between causal attributions and most negative perceptions of the illness, including components of stigma, in both samples. Among CRs, having received family psychoeducation was strongly correlated with viewing substance abuse as a probable cause.

Conclusions:

Relationships between causal beliefs about illness and perceptions of illness both in individuals experiencing schizophrenia and in CRs of such individuals should be explored further with harmonized and detailed tools. Assessing causal beliefs about schizophrenia as a framework for psychiatric clinical practice could prove useful for all those involved in the recovery process.
Two Year Comparison of Sagittal Synostosis Morphometric Outcomes Following Open Posterior Expansion Versus Endoscopic Strip Craniectomy with Helmet Molding Performed before Four Months of Age
Authors: Chen Leah , Mercan Ezgi , Massenburg Benjamin B. , Hopper Richard A. , Susarla Srinivas , Lee Amy , Ellenbogen Richard G. , Birgfeld Craig B.
Published: May 2023

BACKGROUND:

Open middle and posterior cranial vault expansion (OPVE) or endoscopic (ES) strip craniectomy are two surgical techniques for normalization of head shape in isolated sagittal synostosis. This study aims to compare two-year cranial morphometrics after these two approaches.

METHODS:

We performed morphometric analysis on preoperative (t0), immediately post-operative (t1) and 2-year (t2) postoperative CT scans of patients who underwent OPVE or ES prior to 4 months of age. Perioperative data and morphometrics were compared between the two groups and age-matched controls.

RESULTS:

Nineteen patients were included in the ES cohort, 19 age-matched patients in the OPVE cohort, and 57 as controls. Median surgery time and blood transfusion volume were less for the ES approach (118 min; 0cc) compared to OPVE (204 min; 250cc). Anthropometric measurements after OPVE were closer normal controls at t1 compared to ES, but the skull shapes were comparable at t2. In the mid-sagittal plane, anterior vault was higher after OPVE at t2 compared to both ES and controls, but the posterior length was shorter and closer to controls than the ES cohort. Cranial volumes were like controls for both cohorts at t2. There was no difference in complication rate.

CONCLUSIONS:

Both OPVE and ES techniques result in normalization of cranial shape in patients with isolated sagittal synostosis after two years with minimal morphometric differences. Family decision-making between the two approaches should be based on age at presentation, avoidance of blood transfusion, scar pattern, and availability of helmet molding and not on expected outcome.

LEVEL OF EVIDENCE:

III
COVID-19 in people with HIV in the Netherlands, the ATHENA cohort study
Authors: Wit Ferdinand WNM , Reiss Peter , Rijnders Bart , Rokx Casper , Roukens Anna , Brinkman Kees , van der Valk Marc
Published: May 2023

Objectives:

We investigated occurrence of and risk factors for severe COVID-19 outcomes in PWH in the Netherlands.

Design:

Ongoing prospective nationwide HIV cohort study.

Methods:

COVID-19 diagnoses and outcomes with other relevant medical information were prospectively collected from electronic medical records in all HIV treatment centers in the Netherlands, from the start of the COVID-19 epidemic until 31 December 2021. Risk factors for COVID-19 related hospitalization and death were investigated using multivariable logistic regression, including demographics, HIV-related factors, and comorbidities.

Results:

The cohort comprises 21,289 adult PWH, median age 51.2 years, 82% male, 70% were of Western origin, 12.0% were of sub-Saharan African and 12.6% Latin American / Caribbean origin, 96.8% had HIV-RNA <200 copies/mL, median CD4 count 690 (IQR 510–908) cells/mm3. Primary SARS-CoV-2 infections were registered in 2,301 individuals, of whom 157 (6.8%) required hospitalization and 27 (1.2%) ICU admission. Mortality rates were 13% and 0.4% amongst hospitalized and non-hospitalized individuals, respectively. Independent risk factors for severe outcomes (COVID-19-related hospitalization and death) were higher age, having multiple comorbidities, a CD4 count <200 cells/mm3, uncontrolled HIV replication and prior AIDS diagnosis. Migrants from sub-Saharan Africa, Latin America and the Caribbean were at increased risk of severe outcomes independently of other risk factors.

Conclusions:

In our national cohort of PWH, risk of severe COVID-19 outcomes was increased in individuals with uncontrolled HIV replication, low CD4 count and prior AIDS diagnosis, independently of general risk factors like higher age, comorbidity burden and migrants originating from non-Western countries.