bluuebunny/crossref_metadata_2025 huggingface dataset:
Perinatal Depression and Risk of Mortality: Nationwide, Register-Based Study in Sweden
Authors: Hagatulah N. , Bränn E. , Oberg A.S. , Validmarsdóttir U.A. , Shen Q. , Lu D.
Published: November 2024

(BMJ. 2024;384:e075462. doi: 10.1136/bmj-2023-075462)

Perinatal depression (PD), which occurs either during pregnancy or after delivery, is diagnosed with the Diagnostic and Statistical Manual of mental disorders (DSMMD). Although PD is associated with decreased maternal well-being and an increased risk of suicide, the impact on maternal mortality is not clearly understood. The risk of death following a diagnosis of PD is specifically explored in this matched cohort Swedish study. To understand whether there are familial risk factors, including genetics and shared childhood experiences, in PD, the study design includes sibling comparison. Data for the study was sourced from the Swedish health registers, including the medical birth register, the national patient register, the national drug register, the multigenerational register, and the causes of death register. Pregnancies from 2001 to 2017 were examined, with exclusions including: multiple pregnancies, pregnancies after PD, and missing age. After exclusions, 1,029,215 women were considered part of the study base, while 86,551 of these women had received their first diagnosis of PD and received treatment either with antidepressants or other care (before the first year postpartum). The women diagnosed with PD were followed based on whether they were diagnosed with antepartum or postpartum depression. Ten women from the study base without a PD diagnosis were included for each woman (index) diagnosed with PD. Specifically, these 865,510 women, which make up the reference group for the study, were chosen based on their similar age and similar delivery date with the index women. In total, the reference group and the index women make up the population cohort. In addition, the sibling cohort was selected, with all pregnant women who gave birth during the study years (2001 to 2017) and had at least 1 full sister included.
Time Trends in Preeclampsia and Gestational Diabetes in Denmark and Alberta, Canada, 2005 to 2018: A Population-Based Cohort Study
Authors: Lihme F. , Savu A. , Basit S. , Sia W. , Yeung R. , Barrett O. , Luoma L. , Ngwezi D.P. , Davidge S. , Norris C.M. , Ospina M.B. , Cooke C.L. , Greiner R. , Wohlfahrt J. , Melbye M. , Lykke J. , Kaul P. , Boyd H.A.
Published: November 2024

(Acta Obstet Gynecol Scand. 2024;103:266–275. doi: 10.1111/aogs.14703)

Preeclampsia (PEC) and gestational diabetes mellitus (GDM) have similar risk factors including increased maternal age and obesity. Both conditions are associated with adverse pregnancy outcomes and long-term health issues for mothers and children, and health care resources could be strained if the prevalence of PEC and GMA are increasing.
Safety of GLP-1 Receptor Agonists and Other Second-Line Antidiabetics in Early Pregnancy
Authors: Cesta C.E. , Rotem R. , Bateman B.T. , Gabriel C. , Cohen J.M. , Furu K. , Gissler M. , Huybrechts K.F. , Kjerpeseth L.J. , Leinonen M.K. , Pazzagli L. , Zoega H. , Seely E.W. , Patorno E. , Hernandez-Diaz S.
Published: November 2024

JAMA Intern Med. 2024;184(2):144–152. doi: 10.1001/jamainternmed.2023.6663

Metformin is the first-line treatment in T2D. However, more patients are taking second-line antidiabetic medications (ADMs) as well to achieve adequate glycemic control. In pregnancy, insulin has historically been used due to its safety profile and metformin administration is now also common. With the recent increased use of ADMs, unintended exposure in early pregnancy is occurring and the risk of major congenital malformations (MCMs) in the infant is unknown. This large multinational study looked at the use and safety of GLP-1 receptor agonists and other noninsulin ADMs early in pregnancy in comparison to insulin.
First Trimester Use of Buprenorphine or Methadone and the Risk of Congenital Malformations
Authors: Suarez E.A. , Bateman B.T. , Straub L. , Hernandez-Diaz S. , Jones H.E. , Gray K.J. , Connery H.S. , Davis J.M. , Lester B. , Terplan M. , Zhu Y. , Vine S.M. , Mogun H. , Huybrechts K.F.
Published: November 2024

(JAMA Intern Med. 2024;184(3):242–251. doi: 10.1001/jamainternmed.2023.6986)

For pregnant patients with opioid use disorder (OUD), buprenorphine and methadone are prescribed to lower the risk of overdose and prevent withdrawal symptoms. Studies have shown a lower risk of preterm birth, low birth weight, and neonatal abstinence syndrome using buprenorphine compared with methadone. There have not been large studies to understand the risk of congenital malformations. This retrospective cohort study looked at data from a national Medicaid database on first-trimester pregnancies from 2000 to 2018. The goal was to assess the comparative risk of congenital malformations among infants exposed to buprenorphine compared with methadone.
The Effect of Digital Health Interventions on Postpartum Depression or Anxiety: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Lewkowitz A.K. , Whelan A.R. , Ayala N.K. , Hardi A. , Stoll C. , Battle C.L. , Tuuli M.G. , Ranney M.L. , Miller E.S.
Published: November 2024

(Am J Obstet Gynecol. 2024;230(1):12–43. https://doi.org/10.1016/j.ajog.2023.06.028)

Around 15% of women experience postpartum depression (PPD) and 20% encounter postpartum anxiety (PPA) within the first year after childbirth. Research has shown that psychoeducation, psychotherapies, and mindfulness can effectively prevent and treat PPD and PPA. However, <20% of women with these conditions can access these interventions due to a shortage of trained mental health professionals during the perinatal period. Digital health interventions (DHIs) offer a potential solution by providing evidence-based psychoeducation and psychotherapy through the Internet, smartphone apps, or text messaging services. DHIs are highly accessible, as nearly all reproductive-age individuals in the US own smartphones, and a majority have broadband internet access. They also overcome barriers such as lack of childcare and unreliable transportation, which hinder adherence to in-person postpartum care. In addition, DHIs can be scaled effectively without compromising intervention fidelity.
Method of Anesthesia and Perioperative Risk Factors, Maternal Anesthesia Complications, and Neonatal Mortality Following Cesarean Delivery in Africa: A Substudy of a 7-Day Prospective Observational Cohort Study
Authors: Gerber C. , Bishop D.G. , Dyer R.A. , Maswime S. , Rodseth R.N. , van Dyk D. , Biccard B.M. ,   on behalf of the African Surgical Outcomes Study (ASOS) Investigators
Published: November 2024

(Anesth Analg. 2024;138(6):1275–1284.)

Maternal and neonatal mortality rates are significantly high in Africa. The African Surgical Outcomes Study (ASOS) revealed that maternal mortality (MM) following cesarean delivery is 50 times higher in Africa compared with high-income countries, primarily due to obstetric hemorrhage and anesthesia complications. General anesthesia (GA) was particularly risky, with 1 in 66 GAs resulting in maternal death and a higher MM rate compared with spinal anesthesia (SA) (1.5% vs. 0.3%). A substudy was conducted within ASOS to estimate the association between preoperative risk factors and anesthesia methods. Secondary aims included examining the relationship between anesthesia type and maternal intraoperative hypotension, severe anesthesia complications, and neonatal mortality. This secondary analysis of the ASOS obstetric cohort involved patients aged 18 and older across 183 hospitals in 22 African countries. Data collected included gravidity, parity, gestational age, and complications like preeclampsia and eclampsia. The study followed the STROBE guidelines and received ethical approvals from relevant committees.
Shock Index as a Predictor of Postpartum Hemorrhage After Vaginal Delivery: Secondary Analysis of a Multicenter Randomized Controlled Trial
Authors: Madar H , Deneux-Tharaux C , Sentilhes L ,   on behalf of the TRAAP Study Group
Published: November 2024

(BJOG. 2024;131:343–352. doi: 10.1111/1471-0528.17634)

A reliable predictive indicator of postpartum hemorrhage (PPH) could be a significant medical advance. Shock index (SI) is a measurement dividing heart rate (bpm) by systolic blood pressure (mmHg), with a healthy individual usually between 0.5 and 0.7 and the cutoff, where morbidity and mortality is expected, at 0.9. Elevated SI values have been associated with various cardiovascular conditions including hypovolemia and left heart dysfunction. Previous studies have shown values in the immediate postpartum period to range from 0.5 to 0.9, although these studies excluded women who experienced PPH. Additional research suggests the potential for SI to be used as an early sign of PPH, with a range of 0.9 and 1.0; however, the SI included for each patient was their highest in the postpartum period, which technically means the value is being used as a detection tool rather than a predictor. SI is currently recommended as a tool for PPH management.
Mid-Trimester Uterine Artery Doppler for Aspirin Discontinuation in Pregnancies at High Risk for Preterm Preeclampsia: Post Hoc Analysis of StopPRE Trial
Authors: Bonacina E. , Garcia-Manau P. , Lopez M. , Caamina S. , Vives A. , Lopez-Quesada E. , Ricart M. , Maroto A. , de Mingo L. , Pintado E. , Castillo-Ribelles L. , Martin L. , Rodriguez-Zurita A. , Garcia E. , Pallarols M. , Vidal-Sagnier L. , Teixidor M. , Orizales-Lago C. , Perez-Gomez A. , Ocana  , Puerto L. , Millan P. , Alsius M. , Diaz S. , Maiz N. , Carreras E. , Suy A. , Mendoza M.
Published: November 2024

(BJOG. 2024;131(3):334–342. doi: 10.1111/1471-0528.17631)

Preeclampsia (PEC) is characterized by hypertension and proteinuria or organ dysfunction after 20 weeks of gestation. The cause of the condition has not been fully elucidated; however, PEC is associated with a defect in the development of the placenta in early-onset patients. In unaffected individuals, uterine artery flow impedance (UtA) decreases during early gestation through week 24. However, if pulsatility index (PI) in UtA remains high, it is a sign of maladaptation and is commonly found in patients with preterm PEC. An additional consequence of impaired placentation is uteroplacental ischemia, during which the levels of placental growth factor (PIGF) are decreased and soluble fms-like tyrosine kinase-1 (sFlt-1) increases. In screening first trimester patients for risk of PEC, UtAPI and PIGF may be used. Clinicians prescribe aspirin daily as a preventative measure in patients who screen at risk for PEC. Although the incidence of PEC greatly decreases with this treatment, it is also noteworthy that screening for risk of PEC during the first trimester results in a high false positive rate. Thus, most women pre-emptively receiving aspirin for PEC are false positives. The authors previously performed a study where aspirin was discontinued in patients between 24 and 28 weeks of gestation with a normal sFlt-1/PlGF ratio of ≤38, identifying false positives cases. Although this study showed promising results, the ratio may not be available for use in every clinic. Thus, in this study, the authors examine whether UtAPI can be a correlate for these angiogenic factors and act as an alternative screening measure at 24 to 28 weeks of gestation with the same purpose to discontinue aspirin and assess incidence of preterm PEC.
Maternal Morbidity According to Mode of Delivery Among Pregnant Patients With Pulmonary Hypertension
Authors: Meng M.-L. , Fuller M. , Federspiel J.J. , Engelhard M. , McNeil A. , Ernst L. , Habib A.S. , Shah S.H. , Quist-Nelson J. , Raghunathan K. , Ohnuma T. , Krishnamoorthy
Published: November 2024

(Anesth Analg. 2024;138(5):1011–1019. doi: 10.1213/ANE.0000000000006523)

Pulmonary hypertension (PHTN) conveys significant risk for morbidity and mortality during pregnancy leading to many patients being counseled against pregnancy or for termination should pregnancy occur. Despite this risk, some women do proceed with pregnancy beyond 25 weeks; however, information on these cases remains elusive and limited to case series or reports with small samples. Current recommendations surrounding delivery for women with PHTN recommend cesarean delivery (CD), but new evidence is showing that trial of labor in these circumstances is safe and that vaginal delivery (VD) may reduce associated rates of morbidity and mortality. This study assessed the association between mode of delivery and maternal morbidity in individuals with PHTN and pregnancies past 25 weeks of gestation, with a hypothesis that an intended VD has lower morbidity rates than intended CD.
Association Between Intrapartum Nitrous Oxide for Labor Analgesia and Short-Term Neonatal Outcomes
Authors: Starosta A. , Lundsberg L. , Culhane J. , Partridge C. , Grechukhina O. , Son M.
Published: November 2024

(Obstet Gynecol. 2024;143:677–682. doi: 10.1097/AOG.0000000000005554)

Methods of management for pain during labor can include systemic opioids, inhaled gas, and neuraxial analgesia; one popular and effective method is inhaled nitrous oxide, with its use increasing recently in the United States. Though its use is increasing, it is known to cross the placenta and it is unknown if its use is associated with adverse neonatal outcomes. There are biologically plausible concerns about the short-term effects on neonates if nitrous oxide is used intrapartum, but little evidence to support one conclusion or another. This study was designed to assess an association between intrapartum nitrous oxide and adverse short-term neonatal outcomes, with a null hypothesis that there would be no significant differences.
Prevalence and Persistence of Prescription Opioid Use Following Hospital Discharge After Childbirth: An Australian Population-Based Cohort Study
Authors: Varney B. , Zoega H. , Bjørn Gillies M. , Gisev N. , Weston Shand A. , Pearson S.-A. , Havard A.
Published: November 2024

(Anesth Analg. 2024;138(5):970–979. doi: 10.1213/ANE.0000000000006582)

Childbirth accounts for nearly 300,000 hospitalizations a year in Australia and is associated with acute pain. Pain treatment has shown that nonopioid analgesics are effective for mild to moderate pain, and opioids are effective for severe pain; the prescription rate of opioids in Australia is considered high, ranked eighth internationally in 2016. Opioid use has many general risks, but in addition to these the risk of persistent use after being exposed to opioids postpartum are elevated. In the United States, this risk has been shown to be up to 2.5 times higher for those prescribed opioids within a week of a vaginal delivery, along with a 1.5-fold risk of developing opioid use disorder and a 2-fold risk of an opioid overdose. This study was designed to evaluate the prevalence of dispensing of opioid medications following childbirth in Australia, as well as the extent to which individuals experienced persistent opioid use.
Intraoperative Burst Suppression by Analysis of Raw Electroencephalogram Postoperative Delirium in Older Adults Undergoing Spine Surgery: A Retrospective Cohort Study
Authors: Pawar Niti , Zhou Sara , Duarte Karina , Wise Amy , García Paul S. , Kreuzer Matthias , Barreto Chang Odmara L.
Published: November 2024

Background:

Postoperative delirium is a common complication in older adults, associated with poor outcomes, morbidity, mortality, and higher health care costs. Older age is a strong predictor of delirium. Intraoperative burst suppression on the electroencephalogram (EEG) has also been linked to postoperative delirium and poor neurocognitive outcomes.

Methods:

In this a secondary analysis of data from the Perioperative Anesthesia Neurocognitive Disorder Assessment-Geriatric (PANDA-G) observational study, the raw EEGs of 239 spine surgery patients were evaluated. Associations between delirium and age, device-generated burst suppression ratio, and visual detection of the raw EEG were compared.

Results:

Demographics and anesthesia durations were similar in patients with and without delirium. There was a higher incidence of burst suppression identified by analysis of the raw EEG in the delirium group than in the no delirium group (73.45% vs. 50.9%; P=0.001) which appeared to be driven largely by a higher incidence of burst suppression during maintenance of anesthesia (67.2% vs. 46.3%; P=0.004). Burst suppression was more strongly associated with delirium than with age; estimated linear regression coefficient for burst suppression 0.182 (SE: 0.057; P=0.002) and for age 0.009 (SE: 0.005; P=0.082). There was no significant interaction between burst suppression and age (−0.512; SE: 0.390; P=0.190). Compared with visual detection of burst suppression, the burst suppression ratio overestimated burst suppression at low values, and underestimated burst suppression at high values.

Conclusion:

Intraoperative burst suppression identified by visual analysis of the EEG was more strongly associated with delirium than age in older adults undergoing spine surgery. Further research is needed to determine the clinical importance of these findings.
Cell therapy for end-stage liver disease: Current state and clinical challenge
Authors: Zhang Lin , Deng Yuntian , Bai Xue , Wei Xiao , Ren Yushuang , Chen Shuang , Deng Hongxin
Published: November 2024

Liver disease involves a complex interplay of pathological processes, including inflammation, hepatocyte necrosis, and fibrosis. End-stage liver disease (ESLD), such as liver failure and decompensated cirrhosis, has a high mortality rate, and liver transplantation is the only effective treatment. However, to overcome problems such as the shortage of donor livers and complications related to immunosuppression, there is an urgent need for new treatment strategies that need to be developed for patients with ESLD. For instance, hepatocytes derived from donor livers or stem cells can be engrafted and multiplied in the liver, substituting the host hepatocytes and rebuilding the liver parenchyma. Stem cell therapy, especially mesenchymal stem cell therapy, has been widely proved to restore liver function and alleviate liver injury in patients with severe liver disease, which has contributed to the clinical application of cell therapy. In this review, we discussed the types of cells used to treat ESLD and their therapeutic mechanisms. We also summarized the progress of clinical trials around the world and provided a perspective on cell therapy.
Retroperitoneal laparoscopy for hydronephrosis due to multiple fibroepithelial polyps: A case series
Authors: Nguyen Huy-Hoang , Do Ngoc-Son , Do Minh-Tung
Published: November 2024

We retrospectively reviewed the medical records of four men and one woman who underwent retroperitoneal laparoscopic pyeloplasty for multiple fibroepithelial polyps in a tertiary hospital. The median age of the patients was 30 years (13–39 years). Ispsilateral flank pain was observed in all patients while two patients had hematuria. Preoperative computed tomography urography showed a contrast-enhanced solid mass in the arterial phase and hydronephrosis with images of a filling defect or frond-like in the excretory phase. Length of ureteral segment containing fibroepithelial polyp ranges from 4.3 to 5.6 cm (median, 4.7 cm) The median operation time was 80 minutes (range, 70–90 min) without any complications. Postoperative urine leakage was not observed. Flank pain was resolved in all patients. In addition, hydronephrosis was resolved in two cases and downgraded in three cases. Histopathology revealed fibroepithelial polyp in all cases.
Serum total bilirubin is a risk factor of metabolic syndrome and its components in obese Egyptians
Authors: El-Eshmawy Mervat M. , Mahsoub Nancy , Elsehely Ibrahim
Published: November 2024

Background/Aim:

The link between serum total bilirubin and metabolic syndrome and its components has been previously proposed. However, it is unknown whether total bilirubin is a risk factor of metabolic syndrome and its components in obese Egyptians. Therefore, this study was conducted to clarify the association of total bilirubin levels with metabolic syndrome and its components in obese Egyptians.

Methods:

A total of 200 adults with obesity were enrolled in this study. Obese participants were evaluated for metabolic syndrome; there were 92 obese participants with metabolic syndrome and 108 obese participants without metabolic syndrome. Anthropometric measurements, fasting blood glucose (FBG), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), HOMA-β (%), lipid profile, uric acid, alanine aminotransferase, aspartate aminotransferase, and serum total bilirubin were assessed.

Results:

Total bilirubin was significantly lower in obese participants with metabolic syndrome than in those without metabolic syndrome. Compared with middle bilirubin tertile, high and low bilirubin tertiles were independently associated with metabolic syndrome. Regarding metabolic syndrome components, a significant positive association between low bilirubin tertile and hypertension was found independent of the all studied confounding factors, whereas the association of total bilirubin level with waist circumference (WC), FBG, high-density lipoprotein cholesterol, and triglycerides was dependent on body mass index (BMI), HOMA-IR, and high sensitive C-reactive protein (hs-CRP).

Conclusion:

Total bilirubin is an independent risk factor of metabolic syndrome in obese Egyptians. We have found an independent association between high bilirubin level and reduced risk of metabolic syndrome, whereas low bilirubin level was associated with increased risk of metabolic syndrome. Bilirubin is also independently associated with hypertension, but its association with other components of metabolic syndrome is mainly dependent on BMI, HOMA-IR, and hs-CRP.
Effect of a Hydration Game-Based Learning Program in Improving Fluid Intake and Hydration Status in Institutional Residents
Authors: LIN Li-Chan , CHEN Ting-Wei , CHEN Yi-Heng , WU Shiao-Chi
Published: November 2024

Background

Approximately 50% of residents living in institutions have insufficient fluid intake, and 20%–30% experience dehydration. Implementing strategies that effectively increase fluid intake is crucial to preventing dehydration-related complications and reducing complications and comorbidities in this population.

Purpose

This study was designed to explore the effects on fluid intake and hydration status of a hydration game-based learning program in institutional residents.

Methods

A single-blind, cluster, randomized controlled trial was conducted. Sixty-four subjects from five long-term care facilities in northern Taiwan were randomly assigned to either an experimental or control group. The experimental group received a 40-minute game-based hydration care program intervention twice weekly for 8 weeks. The control group received routine care. The data obtained were analyzed using generalized estimating equation analysis to verify changes in observed variables in the two groups at 4 and 8 weeks (during and immediately after the intervention).

Results

The results showed a significant improvement in fluid intake in the experimental group at 4 and 8 weeks (p = .002 and p < .001, respectively). In terms of dehydration-related indicators, although total body water was significantly improved at 8 weeks in the experimental group (p = .009), no significant improvement was found in urine-specific gravity. In terms of signs of possible urinary tract infection, the experimental group showed significant improvement in urine leukocytes (p = .029) and nitrites (p = .004) at 8 weeks.

Conclusions/Implications for Practice

The findings of this study support the positive effects of applying the concept of uncertain rewards and game-based learning in institutional group activities. Specifically, the interventions increased social interaction and enhanced enjoyment of drinking. The findings call for nursing professionals at institutions to offer similar hydration game-based learning programs as part of residents' daily activities to improve fluid intake.
Physician Assistant Student Perceptions of the Benefits of and Barriers to a Doctor of Medical Science Degree
Authors: Sasek Cody , Quincy Brenda
Published: November 2024

Introduction

This study explored physician assistant (PA) student perceptions of benefits of and barriers to the Doctor of Medical Science (DMS) degree.

Methods

Program leaders from 30 purposively selected PA programs were asked to forward an email invitation to their students to complete a cross-sectional survey of student perceptions of the benefits and barriers of a DMS degree, their thoughts on timing of enrollment, and personal characteristics. Sponsoring institution characteristics were obtained from program websites. Student perception of benefits and barriers and their interest in enrollment in a DMS programs were compared across subgroups of personal and institutional characteristics.

Results

Respondents to the study's electronic survey included 312 PA students from 15 PA programs. Mean PA student interest in pursuing a DMS degree centers around neutral, with 51.3% of respondents indicating an interest in pursuing a DMS degree, with varied desired timing for entering a doctoral program. Benefits of a DMS degree identified most strongly included skills regarding scholarly activity such as presentations and research and remaining competitive in an evolving professional landscape. Barriers identified included cost, competing priorities, and burnout from PA school. Several significant relationships were found between the number of a respondent's PA faculty with a doctoral degree and student interest in a DMS degree. Gender differences were also identified.

Discussion

The current study offers perspective on PA student views of the DMS degree. Noted barriers and benefits should continue to be explored to better understand PA student understanding and perceptions of the DMS degree.
The role of integrin-related genes in atherosclerosis complicated by abdominal aortic aneurysm
Authors: Hong Degao , Ma Likang , Jin Lei , Tang Lele , Chen Liangwan , Qiu Zhihuang
Published: November 2024

Increasingly, the shared risk factors and pathological processes of atherosclerosis and abdominal aortic aneurysm (AAA) are being recognized. The aim of our study was to identify the hub genes involved in the pathogenesis of atherosclerosis and AAA. The analysis was based on 2 gene expression profiles for atherosclerosis (GSE28829) and AAA (GSE7084), downloaded from the Gene Expression Omnibus database. Common differential genes were identified and an enrichment analysis of differential genes was conducted, with construction of protein–protein interaction networks, and identification of common hub genes, and predicted transcription factors. The analysis identified 133 differentially expressed genes (116 upregulated and 17 downregulated), with the enrichment analysis identifying a potential important role of integrins and chemokines in the common immune and inflammatory responses of atherosclerosis and AAA. Regulation of the complement and coagulation cascades and regulation of the actin cytoskeleton were associated with both diseases, with 10 important hub genes identified: TYROBP, PTPRC, integrin subunit beta 2, ITGAM, PLEK, cathepsin S, lymphocyte antigen 86, ITGAX, CCL4, and FCER1G. Findings identified a common pathogenetic pathway between atherosclerosis and AAA, with integrin-related genes playing a significant role. The common pathways and hub genes identified provide new insights into the shared mechanisms of these 2 diseases and can contribute to identifying new therapeutic targets and predicting the therapeutic effect of biological agents.
The neurologically intact patient with TLICS 4 or 5 burst fracture should be given a trial of nonoperative management
Authors: Best Shawn A. , Shorten Peter L. , Ziino Chason , Kagan Benjamin D. , Lunardini David J. , Krag Martin H. , Monsey Robert D.
Published: November 2024

Thoracolumbar burst fracture treatment in neurologically intact patients is controversial with many classification systems to help guide management. Thoracolumbar Injury Classification and Severity score (TLICS) provides a framework, but evidence is limited, and recommendations are primarily based on expert opinion. In this retrospective cohort study, data was reviewed for patients with thoracolumbar burst fractures at a Level-1 Trauma Center in New England from 2013 to 2018. Neurologically intact patients without subluxation/dislocation on supine computed tomography were included. Multimodal pain control and early mobilization were encouraged. Patients that failed to mobilize due to pain were treated with operative stabilization. Outcome measures include degree of kyphosis, visual analog scale pain scores, and neurological function. Thirty-one patients with thoracolumbar burst fractures with TLICS scores of 4 or 5 were identified, of which 21 were treated nonoperatively. Kyphosis at final follow-up was 26.4 degrees for the nonoperative cohort versus 13.5 degrees for the operative group (P < .001). Nonoperative patients tended towards shorter hospital lengths-of-stay (3.0 vs 7.1 days, P = .085) and lower final pain scores (2.0 vs 4.0, P = .147) compared to the operative group. Two patients (6%) developed radicular pain with mobilization, which resolved after surgical intervention. No patients experienced decline in neurologic function. A trial of mobilization for neurologically intact TLICS grade 4 and 5 thoracolumbar burst fractures is a safe and reasonable treatment option that resulted in successful nonoperative management of 21 out of 31 (68%) patients.
Identification and validation of oxidative stress-related genes in primary open-angle glaucoma by weighted gene co-expression network analysis and machine learning
Authors: Yang Lu-Qian , Song Yue , Huang Feng , Wu Wei , Ji Hong-Pei
Published: November 2024

Primary open-angle glaucoma (POAG) is a common ocular disease, and there is currently no effective treatment for POAG therapy. Thus, identifying some effective diagnostic markers is beneficial to the treatment of patients. The expression profile was obtained from Gene Expression Omnibus (GEO) database. The functional enrichment was analyzed using Gene Ontology, Kyoto Encyclopedia of Genes and Genomes and gene set enrichment analysis. Co-expressed genes were identified using weighted gene co-expression network analysis (WGCNA). Hub genes were screened through Lasso regression, support vector machine-recursive feature elimination (SVM-RFE) and Random Forest, and receiver operating characteristic curve was used to assess diagnostic value. Immune cell infiltration was calculated using IOBR package. The regulatory network was constructed through STRING, miRactDB and Cytoscape. The oncoPredict package was employed to predict the candidate chemotherapy agents. According to GSE27276 database, 541 differentially expressed genes were identified. Five oxidative stress-related genes with high area under the curve value, namely HBB, MAOA, ACOX2, ALDH7A1 and TYMP, were determined using WGCNA and machine learning. Infiltration level of NK cells, CD4 T cells and dendritic cells were significantly increased in POAG group compared with normal group, while CD8 T cells and Tregs cells were significantly decreased. HBB was closely related to most immune cells. Hub genes were all targeted by 16 miRNAs. Drug sensitivity analysis exhibited that some drugs were more sensitivity for POAG, such as Acetalax_1804, Ibrutinib_1799 and OSI_027_1594. We identified 5 oxidative stress-related genes with high diagnostic value for POAG.
The diagnostic value of endoscopic ultrasound for esophageal subepithelial lesions: A review
Authors: Li Wanwen , Shao Mengqi , Hu Shichen , Xie Shenglong , He Bin
Published: November 2024

Esophageal subepithelial lesions (ESELs) encompass a variety of diseases, including leiomyoma, granular cell tumors, hemangioma, lipoma, stromal tumors, leiomyosarcoma, schwannoma, neuroendocrine tumors and more. These lesions often present asymptomatically, leading to a generally low clinical diagnosis rate. Common imaging techniques for diagnosing ESELs include conventional endoscopy, spiral computed tomography, and endoscopic ultrasound (EUS). Among these, EUS is currently regarded as one of the most accurate methods for diagnosing ESELs. In recent years, EUS has increasingly been combined with advanced technologies such as artificial intelligence, submucosal saline injection, high-frequency impedance measurement, and enhanced imaging to improve diagnostic accuracy and reduce missed diagnoses. This article reviews the application and recent advancements of EUS in diagnosing esophageal submucosal lesions.
Mitochondrial related Mendelian randomization identifies causal associations between metabolic disorders and childhood neurodevelopmental disorders
Authors: Hu Chenyan , Li Junjun , Heng Pengfei , Luo Jianrong
Published: November 2024

Childhood neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD), attention-deficit hyperactivity disorder, and Tourette syndrome, are a predominant cause of health-related disabilities in children and adolescents. Nevertheless, disease biomarkers are still limited. The aim of this study was to evaluate the potential, causal relationship between mitochondrial DNA copy number (mtDNA-CN), metabolic disorders, and childhood NDDs using the two-sample Mendelian randomization (MR) method. Genetic associations with mtDNA-CN, disorders of lipoprotein metabolism, and disorders of iron metabolism were selected as exposures, and genome-wide association data from ASD, attention-deficit hyperactivity disorder, and Tourette syndrome were utilized as outcomes. Results of the study suggested that a high degree of disordered lipoprotein metabolism related increases in ASD risk result from a decrease in mtDNA-CN (disordered lipoprotein metabolism–mtDNA: inverse variance weighting β: −0.03, 95% confidence interval: −0.05 to −0.02, P = 2.08 × 10–5; mtDNA-CN–ASD: inverse variance weighting odds ratio: 0.83, 95% confidence interval: 0.69–0.99, P = .034). The research findings implied that mtDNA-CN can mediate disorders of lipoprotein metabolism, potentially influencing the development of ASD. The potential impact of the results of this study for the prevention and treatment of childhood NDDs warrants validation in robust randomized clinical trials.
Risk factors for left ventricular remodeling after myocardial infarction: A meta-analysis
Authors: Xu Baozhu , Li Wenhui , You Zhuozhi , Yang Nan , Lin Lanxiang , Li Yuefeng
Published: November 2024

Background:

This study aimed to assess potential risk factors for left ventricular remodeling (LVR) after acute myocardial infarction (MI).

Methods:

We systematically searched PubMed, the Cochrane Library, MEDLINE, Embase, Web of Science databases CNKI Scholar, VIP, and WanFang databases for all relevant epidemiological studies published up to August 1, 2023. Fixed-effects model or random-effects model was employed to pool the study-specific effect sizes and 95% confidence intervals (CIs).

Results:

Fifteen studies with a total of 3,093,792 participants were included according to inclusion criteria. Major modifiable risk factors associated with LVR after MI were diabetes (odds ratio [OR] = 2.053, 95% CI: 1.504–2.803), MI site (OR = 2.423, 95% CI: 1.584–3.708), cystatin C (OR = 6.204, 95% CI: 1.830–21.036), B-type natriuretic peptide (OR = 2.280, 95% CI: 1.466–3.546), as well as creatine kinase-myocardial band (OR = 1.013, 95% CI: 0.985–1.042).

Conclusion:

The current study provides evidence indicating that diabetes, the site of MI, cystatin C, B-type natriuretic peptide, and creatine kinase-myocardial band are the primary risk factors for LVR after MI. Recognizing and addressing these modifiable risk factors is crucial for the development of effective preventive and treatment strategies.
Causal relationship of salt intake with osteoarthritis: A Mendelian randomization analysis
Authors: Yang Chengrui , Wang Tieqiang , Zhao Chunzhi , Lu Jiawei , Shen Runbin , Li Guoliang , Zhao Jianyong
Published: November 2024

Recent studies have demonstrated a correlation between salt intake (SI) and various diseases. However, it remains uncertain whether the relationship between SI (including salt added to food and sodium levels in urine) and benign osteoarthritis is causal. To investigate this, we conducted a 2-sample Mendelian randomization (MR) analysis to estimate the causal impact of SI on osteoarthritis (OA). A genome-wide association study of salt added to food and sodium in urine was used as the exposure, while hip osteoarthritis, knee osteoarthritis, and rheumatoid arthritis were defined as the outcomes. Inverse variance weighting (IVW) was used to calculate causal estimates, and sensitivity analyses were performed using methods including weighted mode, weighted median, MR-Egger, and Bayesian weighted MR. All statistical analyses were conducted using R software. Our results, primarily based on the IVW method, support the existence of a causal relationship between salt added to food and knee osteoarthritis (KOA). Specifically, salt added to food was associated with a decreased risk of KOA (OR = 1.248, P = .024, 95% CI: 1.030–1.512). This study is the first MR investigation exploring the causal relationship between salt added to food and KOA, potentially providing new insights and a theoretical basis for the prevention and treatment of KOA in the future.
Algofunctional outcome after intra-articular bipolar pulsed radiofrequency ablation for pain in osteoarthritis of the knee: A retrospective study
Authors: Yalçin Çiğdem , Salman Mehmet Alper , Aşkin Turan Suna , Karabakan Güldane , Özmen Harun
Published: November 2024

There is a paucity of research and evidence, regarding the effectiveness of applying bipolar pulsed radiofrequency (bPRF) in osteoarthritis of the knee. This study aimed to search for the impact of intra-articular bPRF (IA-bPRF) on pain, functionality, and quality of life in individuals with advanced knee osteoarthritis. A total of 35 patients experiencing knee pain were included in the study. IA-bPRF was applied at 42 °C temperature, 45 V, with a pulse-width of 20 ms and a frequency of 2 Hz for 3 cycles of 120 seconds. Pain severity was evaluated using the numeric rating scale. Assessment tools included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne Algofunctional Index for knee. All measurements were made before the intervention, as well as 2 weeks and 6 months after application of IA-bPRF. Significant improvement was observed in numeric rating scale scores for walking pain from 8.57 ± 0.17 to 4.11 ± 0.35, total WOMAC scores decreased from 75.5 ± 2.71 to 36.7 ± 3.6 and Lequesne Algofunctional Index for knee scores decreased from 18.6 ± 0.70 to 10.4 ± 0.93 by the end of the sixth month (P < .01). WOMAC subgroups for pain, stiffness and functionality, were also significantly lower at the 2nd week and 6th month compared to pre-intervention scores (P < .01). No serious adverse events related to the procedure occurred. IA-bPRF use seems to be safe and effective in relieving pain among individuals with advanced knee osteoarthritis. As a result, with further research, we expect that IA-bPRF may be considered for inclusion in upcoming guidelines for the treatment of chronic pain related to osteoarthritis of the knee.
Factors associated with severity and anatomical distribution of diabetic foot ulcer in a tertiary care hospital in Bangladesh: A cross-sectional study
Authors: Salam Md. Abdus , Ziko Md. Raihan Kabir , Oishee Arefin Naher , Yadav Anuj , Monaem Md. Abdul , Salman Abdullah , Kadariya Suman , Chowdhury Faisal , Kafley Shashwat , Pulok Mushfiqur Rahman , Kc Unika , Subedi Rimsa , Shrestha Aman Babu
Published: November 2024

Diabetic foot ulcers are characterized by disturbances in the epidermis and/or a portion of the dermis in patients with the disease. With over a million amputations performed annually, it has also emerged as one of the primary causes of lower limb amputation globally. To better understand the severity and anatomical distribution of ulcerated areas in patients with type II diabetes mellitus, this study aimed to identify the factors associated with diabetic foot ulcers (DFUs). This descriptive cross-sectional study was conducted at M Abdur Rahim Medical College Hospital in Dinajpur, Bangladesh, from July to September 2023. The study population was selected using a purposive sampling technique based on the patients’ availability during their usual and regular treatment at MARMCH. Using a Bangla questionnaire data was obtained to evaluate the DFUs, in addition to measuring blood pressure and assessing the affected area’s neurological function. The severity of the ulcer is calculated by using the Wagner grading system. Data was analyzed by using STATS v15 and chi-square was applied. A total of 113 DFU patients took part in this study. The mean age in years was 56 ± 12 (SD + mean) and the male proportion was greater (61.9%). Most of them (93.91%) were negligent about foot care and suffered from severe DFU (86.37%). The majority of respondents (57.94%) had a right foot ulcer, of which 94.50% had severe ulcers. Almost all ulcers were severe (86.14%) and measured <5 cm in diameter (69.71%). The results highlight the tremendous burden of DFUs, which can have serious consequences and substantial mental and economic effects on patients’ healthcare systems.
Complex intestinal fistula treatment and care: A case report and literature review
Authors: Hu Yuee , Qin Yanyan , Dong Wei , Zhong Yuxu , Chu Haibo
Published: November 2024

Rationale:

Abdominal cocoon is an uncommon abdominal disease. Intestinal rupture complicated with intestinal fistula rarely occurs in patients with abdominal cocoon.

Patient concerns:

A 51-year-old man was referred to hospital, with a 4-hour history of abdominal injuries caused by traffic accident. Intraoperatively, the small intestine in the abdominal cavity was surrounded by dense, tough, grayish-white fibrous tissue. There were the rupture of 2 sites in the ileum. The ileum was anastomosed side-to-side using a cutting and closing device. The patient was postoperatively transferred to the intensive care unit and received ventilator-assisted breathing, along with anti-infection and supportive treatments. On the 10th day after surgery, grass green turbid fluid of approximately 150 mL was extracted from the abdominal drainage tube. The secondary laparotomy was performed on the 12th day post-surgery, revealing a 1.5 cm diameter fistula at the end of the ileum.

Intervention and outcomes:

Nursing strategies included ensuring optimal mechanical ventilation for oxygenation, utilizing Li’s double cannula for continuous abdominal irrigation and negative pressure drainage to prevent abdominal abscess formation, emphasizing the importance of enteral nutrition, implementing direct suture treatment to manage retrograde infection and expedite stoma healing, and employing Li’s double cannula and vacuum-assisted closure technique to promote incision healing. After 48 days secondary post-surgery, the incision was fully healed, and the patient was discharged home with the stoma bag. Five months later, he was readmitted to the hospital, and the stoma was reversed.

Lessons:

Intestinal fistula poses a remarkable challenge after abdominal cocoon surgery, typically manifesting 4 to 5 days postoperatively. However, in this case, it occurred on the 10th day, highlighting the critical role of vigilant monitoring of drainage fluid color and volume in postoperative care. Navigating the complex management of intestinal rupture in abdominal cocoon necessitates a more efficacious approach, highlighting the importance of accumulating comprehensive nursing expertise through such cases.
The effects of rapid rehabilitation nursing on improving postoperative rehabilitation effect and life quality of early breast cancer patients
Authors: Wu Meng , Zhao Lei , Chen Meijie , Li Shan , Liao Yanyan
Published: November 2024

This study was intended to determine whether rapid rehabilitation nursing can enhance postoperative rehabilitation and life quality for breast cancer (BC) patients. One hundred seventy-two patients with BC treated in our hospital from March 2020 to September 2022 were included in this retrospective study and divided into the observation group (n = 86) and control group (n = 86) based on the different nursing methods that they received. The control group accepted routine nursing care, and the observation group accepted rapid rehabilitation nursing intervention. The amount of intraoperative blood loss, anesthesia awake time, postoperative drainage tube removal time, postoperative time of getting out of bed, length of hospital stays, incidence of postoperative complications, and postoperative recovery rate of affected limb, Barthel index and quality of life instruments for cancer patients: breast cancer (QLICP-BR) of BC patients were analyzed. The amount of intraoperative bleeding in the observation group was less, and the difference was statistically significant (P < .05). The awake time of anesthesia, the time of pulling out the drainage tube after operation, the time of getting out of bed after operation and the time of hospitalization in the observation group were significant shorter (P < .05). The incidence of postoperative complications in the observation group was notably lower (P < .05). The excellent and good rate of postoperative rehabilitation of the affected limbs in the observation group was notably higher (P < .05). Before nursing, there exhibited no notable difference in the scores of Barthel index (P > .05). After 10 days of nursing, the score of Barthel index in the observation group was notably higher (P < .05). After 10 days of nursing, the QLICP-BR score of the observation group was significant higher (P < .05). Rapid rehabilitation nursing is beneficial to reduce the intraoperative blood loss of BC patients, shorten the recovery time of anesthesia, promote the excellent and good rate of rehabilitation of affected limbs, and improve the quality of life.
Impact of cytotoxic therapy on clonal hematopoiesis and myeloid neoplasms in breast cancer patients
Authors: Kim Heyjin , Jin Hyeon-Ok , Kim Ji-Young , Hong Young Jun , Lee Jin Kyung
Published: November 2024

Clonal hematopoiesis (CH), which is characterized by variants of hematopoietic stem cells, increases the risk of subsequent myeloid neoplasms (MNs). This study aimed to investigate the prevalence and characteristics of CH variants in breast cancer (BC) patients treated with cytotoxic therapy (CT), focusing on those who developed MNs after cytotoxic therapy (MN-pCT). We retrospectively analyzed 107 BC patients from a biobank and sequenced peripheral blood and bone marrow samples from 31 CH-associated genes at 2 time points. We analyzed changes in CH for paired samples: T0 to T1 (before and after CT) and T1 to T2 (after CT vs greater CT exposure). Additionally, we compared CH variants in patients with and without MN-pCT. 29% of patients harbored CH variants that were restricted to 8 genes and DNMT3A was the most frequent variant. Among 54 patients with paired samples (T1 to T2), the variant allele frequency (VAF) of CH variants significantly increased after greater CT exposure (P = .02). However, there were no significant changes in VAF before and after CT. Five of the 9 patients who developed MN-pCT harbored CH variants. TP53 was the most frequently mutated gene, but it did not significantly affect MN-pCT risk compared to patients without CH variants. Although the presence of CH did not directly predict MN-pCT development in patients with BC, CT induced changes in CH genes. Further studies are required to determine the role of specific CH variants in the risk of MN-pCT and their potential as predictive biomarkers.