bluuebunny/crossref_metadata_2025 huggingface dataset:
Naturally conceived heterotopic pregnancy: an atypical presentation rare case report and review of current literature
Authors: Lugata John , Shao Baraka , Batchu Nasra
Published: May 2024

Heterotopic pregnancy (HP) is the coexistence of living or dead intrauterine pregnancy, single or multiple, and extrauterine pregnancy located in the oviduct, ovary, uterine corner, cervix or peritoneal cavity. This condition is very rare (1:30 000 pregnancies). HP constitutes a rare obstetric condition. Its occurrence after natural conception is sparsely documented in the literature. Here in, we present a case of a 27-year-old primeparous women who presented at 18 weeks with features of ruptured ectopic pregnancy. Initial ultrasonographic imaging showed an intrauterine pregnancy corresponding to 18 weeks. It also revealed a floating fetus with significant collection of fluid in the pouch of Douglas, retroceacal recess and both hepatocellular recess. An emergency explorative laparotomy was done where right salpingectomy was performed. She was later followed up to term and delivered by elective cesarean section successfully. A brief narrative of the challenges in the management, clinical presentation and limitation in the management is highlighted in the present case report.

Key message: Heterotopic pregnancy can occur in natural conception irrespective of usage of ovulation induction. Routine early pregnancy ultrasound can promote early detection with prompt surgical intervention to mitigate its complications.
‘Life is peaceful here’: Nigerian refugees in Limassol between colonial afterlives and city-making
Authors: Fischer Leandros
Published: May 2024

Divided by ethnic conflict, plagued by an economic crisis, and enforcing restrictive bordering practices at the edge of Europe, the Republic of Cyprus hardly constitutes an obvious choice for Nigerians fleeing conditions of state breakdown, crisis, and social immobility. The perceived ‘unusualness’ of this migration has made Nigerian and other African refugees particularly vulnerable to human rights abuses, violent nativist discourse, and racialised hyper-exploitation in the labour market. Yet despite these difficulties, some Nigerians strive to build a life on the island, with modest success. Based on ethnographic fieldwork, this article attempts to unravel the prevailing methodological nationalism, upon which notions of the ‘unusualness’ of African migration to the island are premised, in two ways. In contrast to notions of being itself a former colony, ‘too small’ to accommodate refugees, I show that colonial-era emigration to Africa has engendered anti-black racism in Cyprus, which has only been strengthened by EU membership and economic crisis. By focusing, on the other hand, on the city of Limassol as an ambivalent landscape of crisis and opportunity, I demonstrate how the urban rather than the national dimension can put notions of ‘unusualness’ into perspective. Within a global condition of crisis and social immobility, Nigerian refugees emplace themselves within the opportunities that Limassol, as a nodal point of social relations along multiple scales—national, regional, European, and global—has to offer. While this fact in itself does not improve their position vis-à-vis a restrictive asylum policy framework, it nonetheless renders them a constituent part of the city.
The shaping of mRNA translation plasticity by RNA G-quadruplexes in cancer progression and therapy resistance
Authors: Cammas Anne , Desprairies Alice , Dassi Erik , Millevoi Stefania
Published: May 2024

Translational reprogramming in response to oncogenic signaling or microenvironmental stress factors shapes the proteome of cancer cells, enabling adaptation and phenotypic changes underlying cell plasticity, tumor progression and response to cancer therapy. Among the mechanisms regulating translation are RNA G-quadruplexes (RG4s), non-canonical four-stranded structures whose conformational modulation by small molecule ligands and RNA-binding proteins affects the expression of cancer proteins. Here, we discuss the role of RG4s in the regulation of mRNA translation by focusing on paradigmatic examples showing their contribution to adaptive mechanisms of mRNA translation in cancer.
An Opt-out Tobacco Treatment Group Intervention Within an Intensive Substance Use Disorders Treatment Program: Initial Outcomes in the Veterans Health Administration
Authors: Bertucci Stephanie , Schultz Erica , Stevenson Brittany , Fu Steven S
Published: May 2024

Introduction

Despite steadily declining rates of tobacco use in the United States, individuals suffering from substance use disorders (SUD) and other mental illnesses continue to use tobacco at alarmingly high rates, resulting in increased mortality. Given the synergistic consequences to those who suffer from both tobacco use disorders (TUD) and other SUD, embedding tobacco treatment into structured SUD programs using an opt-out approach may yield a greater impact. The current study compares clinical outcomes (ie, quit attempts and prescription of tobacco cessation medications) for an opt-out versus opt-in approach to tobacco treatment.

Aims and Methods

Tobacco use information was collected prior to and after implementation of an opt-out, eight-session, tobacco group treatment intervention. Patient self-report and medical chart review were utilized to identify individuals who began a tobacco cessation medication during treatment as well as those who reported quitting tobacco, defined as sustained tobacco abstinence for at least 7 days. The analysis includes a total of N = 332 Veterans who enrolled in the intensive outpatient program.

Results

Those enrolled in the opt-out tobacco treatment group reported a significantly higher rate of quitting tobacco (24.57%) than those in the opt-in group (2.55%; p < .001). Likewise, the opt-out group was prescribed tobacco cessation medications at a significantly higher rate than the opt-in group (55.00% compared to 14.65%; p < .001).

Conclusions

An opt-out treatment approach to TUD in SUD treatment settings produced improved outcomes, including significantly more patients engaged in TUD treatment and a higher overall rate of SUD treatment completion.

Implications

Given the disproportionately high rate of tobacco use among those seeking treatment for SUD, enhanced tobacco cessation interventions could result in both improved tobacco as well as other substance use outcomes. The implementation of an opt-out tobacco treatment intervention embedded into SUD programming is supported by our findings of reduced tobacco use among patients.
The impact of the COVID-19 pandemic on dietary behaviors among school-age children, adolescents, and young adults: a systematic review and meta-analysis
Authors: Na Xiaona , Zhang Junhan , Xie Chenyou , Zeng Huatang , Wu Liqun , Fan Dongying , Yang Haibing , Shi Xiaojin , Zhou Yiguo , Yu Haoran , Tan Yuefeng , Zhang Yulin , Zhao Ai
Published: May 2024

Context

The COVID-19 pandemic has had a global impact on food security and nutrition, both in the short and long term. The influence on school-age children, adolescents, and young adults may be particularly significant and long-lasting.

Objective

This systematic review and meta-analysis aimed to quantify the impact of the COVID-19 pandemic on dietary habits among school-age children, adolescents, and young adults worldwide.

Data Sources

PubMed, Web of Science, and Embase were searched from inception to October 5, 2023.

Data Extraction

We included observational studies published in English that reported dietary quality scores and dietary intake quantities during and before the COVID-19 pandemic among school-age children, adolescents, and young adults. We included a total of 22 cohort studies and 20 cross-sectional studies of high or moderate quality.

Data Analysis

We conducted a meta-analysis, expressing dietary quality scores and dietary intake quantities as standardized mean differences (SMD) with 95% confidence intervals (CIs). For studies with low heterogeneity, we used a fixed-effects model; otherwise, we applied a random-effects model. The Newcastle–Ottawa Scale was employed by 2 reviewers independently to evaluate methodological quality. The analysis indicated that, overall, juice intake increased (SMD = 0.12, 95% CI: 0.04 to 0.20), while alcohol consumption reduced during the COVID-19 pandemic (SMD = −0.28, 95% CI: −0.47 to −0.08). However, the age-stratified results varied. Among school-age children, intake of fruit, dairy products, sugar, and juice increased. Adolescents showed an increase in meal frequency and vegetable intake. Young adults showed reduced carbohydrate and alcohol intakes, while protein and dairy product intakes increased, based on limited included studies.

Conclusion

Dietary changes in school-age children from before to during the pandemic were mixed, while dietary behavior changes in adolescents and young adults tended to be more positive. Considering the lasting effects of negative dietary behaviors, attention should be given to addressing the increased sugar and juice intakes. It is also crucial that caregivers and researchers monitor whether positive dietary behaviors will rebound after returning to normal study and life.

Systematic Review Registration

PROSPERO registration no. CRD42023420923.
Savoir détecter l’exposition des enfants à la violence entre partenaires intimes, qu’elle soit présumée ou divulguée, et savoir intervenir
Authors: Kimber Melissa , McTavish Jill , Shouldice Michelle , Ward Michelle G K , MacMillan Harriet L
Published: May 2024

L’exposition des enfants à la violence entre partenaires intimes (EEVPI), qu’il s’agisse des parents ou d’autres proches, représente près de la moitié de tous les cas qui font l’objet d’une enquête et sont corroborés par les services de protection de l’enfance du Canada. Les atteintes affectives, physiques et comportementales associées à l’EEVPI sont semblables aux effets d’autres formes de maltraitance envers les enfants. Il peut être difficile d’établir quels enfants et adolescents sont exposés à la violence entre partenaires intimes (VPI) en raison des comportements non spécifiques parfois associés à une telle exposition, de même que de la stigmatisation et du secret entourant souvent ce type de violence. Par ailleurs, une intervention en toute sécurité auprès des enfants et des adolescents chez qui on présume une exposition à la VPI peut être compliquée par la nécessité d’également tenir compte de la sécurité et du bien-être d’un proche non contrevenant. Le présent document de principes propose une approche fondée sur des données probantes mise au point par le projet VEGA (Violence, Evidence, Guidance, Action ou violence, données probantes, conseils, action) pour détecter l’exposition des enfants et des adolescents à la VPI et intervenir en toute sécurité auprès d’eux.
Natural variation in LONELY GUY-Like 1 regulates rice grain weight under warmer night conditions
Authors: Sandhu Jaspreet , Irvin Larissa , Chandaran Anil Kumar , Oguro Shohei , Paul Puneet , Dhatt Balpreet , Hussain Waseem , Cunningham Shannon S , Quinones Cherryl O , Lorence Argelia , Adviento-Borbe Maria Arlene , Staswick Paul , Morota Gota , Walia Harkamal
Published: May 2024

Global nighttime temperatures are rising at twice the rate of daytime temperatures and pose a challenge for rice (Oryza sativa) production. High nighttime temperature (HNT) stress affects rice yield by reducing grain weight, size, and fertility. Although the genes associated with these yield parameters have been identified and characterized under normal temperatures, the genetic basis of grain weight regulation under HNT stress remains less explored. We examined the natural variation for rice single grain weight (SGW) under HNT stress imposed during grain development. A genome-wide association analysis identified several loci associated with grain weight under HNT stress. A locus, SGW1, specific to HNT conditions resolved to LONELY GUY-Like 1 (LOGL1), which encodes a putative cytokinin-activation enzyme. We demonstrated that LOGL1 contributes to allelic variation at SGW1. Accessions with lower LOGL1 transcript abundance had higher grain weight under HNT. This was supported by the higher grain weight of logl1-mutants relative to the wild type under HNT. Compared to logl1-mutants, LOGL1 over-expressers showed increased sensitivity to HNT. We showed that LOGL1 regulates the thiamin biosynthesis pathway, which is under circadian regulation, which in turn is likely perturbed by HNT stress. These findings provide a genetic source to enhance rice adaptation to warming night temperatures and improve our mechanistic understanding of HNT stress tolerance pathways.
Global Firms in Large Devaluations
Authors: Blaum Joaquin
Published: May 2024

I investigate the consequences of firms’ joint import and export decisions in the context of large devaluations. I provide empirical evidence that large devaluations are characterized by an increase in the aggregate share of imported inputs in total input spending and by reallocation of resources toward import-intensive firms, contrary to what standard quantitative trade models predict. These facts are explained by the expansion of exporters, which are intense importers. I develop a model where firms globally decide their import and export strategies and discipline it to match salient features of the Mexican micro data. After a devaluation, the model reproduces the pattern of low aggregate substitution and firm reallocation observed in the data. Compared with a benchmark without global firms, the model predicts higher growth of total exports and imports and a smaller reduction in the trade deficit.
Countermovements from the core: the assetization of pharmaceuticals, transparency activism and the access to medicines movement
Authors: Bourgeron Théo , Geiger Susi
Published: May 2024

The assetization of essential goods brings to high-income countries the logics of scarcity that have been dominant for long in low-to-middle income countries—fostering the rise of new forms of activism. Will this new activism strengthen already existing social movements or weaken them through more moderate politics? Building on interviews and the observation and mapping of activist events, we investigate this question through the case of pharmaceuticals. We detail how the assetization of pharmaceutical drugs has triggered the constitution of a new ‘flank’ in the access to medicines (A2M) movement—pharmaceutical transparency activism. We argue that transparency activism has expanded the contestation of the pharmaceutical state of affairs, by bringing into the broader A2M movement countries that were previously at the core of global pharmaceutical chains. Our article illuminates how the assetization of essential goods creates forms of activism that have significant impact on existing social movements.
Land Policies and Institutions for Equitable and Resilient Growth in Africa
Authors: Deininger Klaus , Goyal Aparajita
Published: May 2024

In coming decades, Africa's urban populations will expand, and the effects of climate change be more keenly felt. Land policies and institutions will be key for urban dwellers to be able access productive jobs, breathe clean air, and live in decent housing; for entrepreneurs, especially women, to leverage land for productive investment; and for farmers to diversify, insure against shocks, and accumulate capital. Yet, many African land registries perform poorly, command little trust, and have failed to capitalize on opportunities to improve quality, relevance, and outreach via digital interoperability, use of earth observation, and connectivity. Literature highlights scope for regulatory and institutional reforms to (a) expand property taxation and land value capture and to improve urban service delivery, planning, and land use regulations; (b) increase quality and affordability of land services and access to land price and ownership data; (c) guide issuance of rural land use rights to reduce barriers to rural factor markets, including by spatially enabling farmer registries to improve subsidy targeting and effectiveness; and (d) demarcation and transparent decentralized management of public land to attract investment, including in climate finance, without fueling corruption, and to manage disputes before they escalate into ethnic violence.
Nursing Students’ Resilience and Intent to Work at the Bedside
Authors: Gerdes Michele A. , Schuessler Jenny B.
Published: May 2024

AIM

The primary purpose of this study was to explore relationships between self-efficacy, peer support, coping style, intent to work at the bedside, and resilience in nursing students.

BACKGROUND

Resilience correlates with one-year retention at the bedside. Retention of bedside nurses improves patient outcomes.

METHOD

A quantitative, correlational design determined relationships between variables. Surveys were completed by 205 participants. Surveys included a program type list, intent to work at the bedside items, the Brief Cope Scale, the General Self-Efficacy Scale, the Peer Group Caring Interaction Scale.

RESULTS

Significant relationships were found between resilience and self-efficacy, resilience and coping style, and peer support and approach coping style. Half of the respondents intended to work at the bedside for two years after graduation. Self-efficacy and avoidance coping were resilience predictors.

CONCLUSION

To support resilience, educators should facilitate students’ development of self-efficacy and approach coping style.
The Effects of Nursing Students’ Locus of Control, Motivation, and Learning Strategies on Their Academic Performance
Authors: Abdrbo Amany Ahmed , Miligi Eman , Taha Nadia
Published: May 2024

The academic performance of nursing students significantly impacts their ability to deliver quality patient care. This descriptive correlational study investigated the effects of nursing students’ locus of control, motivation, and learning strategies on their academic performance in a sample of 515 students. External locus of control was associated with higher scores in extrinsic goal orientation, task value, elaboration, and academic performance. Locus of control, test anxiety, and organization were identified as predictors of academic performance. The study highlights the need for further research on factors affecting academic performance and effective educational interventions.
A Correlational Study Measuring Burnout and Resilience Among Nurse Educators
Authors: Ochs Jessica , Mitsakis Cynthia , Ochberg Richard
Published: May 2024

Burnout, one possible cause of the nurse faculty shortage, may be mitigated by resilience. This study found that faculty who scored unusually low in resilience were likely to feel emotionally exhausted and depersonalized; however, even those with average scores in resilience were likely to feel emotionally exhausted, if not depersonalized. These findings suggest that interventions that increase resilience may reduce the frequency of the most severe burnout profiles among nurse educators. Only a change in the structure of the job will reduce the more prevalent problem of emotional exhaustion.
Reasons for Revision Surgery After Cervical Disk Arthroplasty Based on Medical Device Reports Maintained by the US Food and Drug Administration
Authors: Altorfer Franziska C.S. , Kelly Michael J. , Avrumova Fedan , Zhu Jiaqi , Abjornson Celeste , Lebl Darren R.
Published: May 2024

Study design.

Retrospective database review.

Objective.

The aim of this study was to analyze revisions of CDAs reported to the MAUDE database.

Summary of Background Data.

Cervical disk arthroplasty (CDA) has emerged as a motion-preserving alternative to anterior cervical discectomy and fusion (ACDF) for degenerative cervical disease, demonstrating comparable outcomes. Despite the availability of variable CDA designs, there is limited data on the specific complications of individual CDAs. The Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) database has been used to systematically report complications associated with CDAs. However, data on specific reasons for CDA revision remains scarce. The purpose of this study is to compare common complications associated with revision for different CDAs.

Methods.

The MAUDE database was queried from January 2005 to September 2023, including all nine FDA-approved CDAs. The full-text reports of each complication were categorized based on whether revision surgery was performed, the complications and the type of CDA collected and compared.

Results.

A total of 678 revisions for nine CDAs were reported: Mobi-C (239), M6 (167), Prodisc-C (88), Prestige (60), PCM (44), Bryan (35), Secure (23), Simplify (21), and Discover (1). The top three complications associated with revision were migration (23.5%), neck pain (15.5%), and heterotopic ossification (6.6%). The most common complications per device were migration for Mobi-C (26.4%), Prodisc-C (21.3%), Prestige (24.6%), PCM (84.1%), Bryan (48.6%), Secure (30.4%), and Discover (100%). For M6, the most common complications associated with revision surgery were osteolysis (18.6%) and neck pain (18.6%), while neck pain (23.8%) was the most common for the Simplify.

Conclusions.

The MAUDE database highlights complications related to CDA revision in which the primary complications consistently include implant migration, neck pain, and heterotopic ossification, varying in their rerelvance depending on the CDA.

Level of Evidence.

Level II.
Motion Capture-based 3-Dimensional Measurement of Range of Motion in Patients Undergoing Cervical Laminoplasty
Authors: Kato So , Fujiwara Sayaka , Ohtomo Nozomu , Yamato Yukimasa , Sasaki Katsuyuki , Yu Jim , Doi Toru , Taniguchi Yuki , Matsubayashi Yoshitaka , Ushikubo Tomohiro , Ogata Toru , Tanaka Sakae , Oshima Yasushi
Published: May 2024

Study design:

A prospective study.

Objective:

To measure 3-dimensional cervical range of motion (ROM) by noninvasive optical tracking-based motion-capture technology in patients undergoing laminoplasty, and to elucidate the postoperative effects of laminoplasty on cervical mobility.

Summary of Background Data:

Cervical laminoplasty is a motion-sparing decompression surgery for degenerative cervical myelopathy. Unlike cervical laminectomy and fusion, the true postoperative impact of laminoplasty on neck motion has not been well studied.

Methods:

Participants comprised 25 patients undergoing double-door cervical laminoplasty for degenerative cervical myelopathy in a single center. Maximum flexion/extension, left/right rotation, and left/right side bending were recorded using the motion-capture device preoperatively and 3 months postoperatively. ROMs in 3 orthogonal axes were calculated. Preoperative differences in C2–7 Cobb angles on lateral flexion/extension x-rays were also measured as the radiologic ROM to assess reliability. Preoperative and 1-year postoperative Japanese Orthopaedic Association score, Neck Disability Index [NDI], and Euro-QOL were recorded, and correlations with ROMs were assessed.

Results:

Preoperative mean (±SD) ROMs for flexion/extension, rotation, and side bending were 90±17, 107±16, and 53±17 degrees, respectively. Although radiologic sagittal ROM measurement showed a smaller range than motion capture, averaging 36±13 degrees, a moderate to strong correlation between radiologic and motion capture values was observed (R=0.57, P=0.003). Preoperative NDI showed a negative correlation with coronal ROM (rho=−0.547, P=0.02). Postoperative ROM showed a significant reduction in rotation (95±16 degrees, P=0.002) but not in flexion/extension or side bending.

Conclusions:

Three-dimensional motion-capture analysis allowed reliable measurement of cervical ROM. Rotational ROM was significantly reduced after laminoplasty, showing that cervical kinematics are still significantly altered.
Stopping at C2 Versus C3/4 in Elective Posterior Cervical Decompression and Fusion
Authors: Long Connor C. , Dugan John E. , Chanbour Hani , Chen Jeffrey W. , Younus Iyan , Jonzzon Soren , Khan Inamullah , Terry Douglas P. , Pennings Jacqueline S. , Lugo-Pico Julian , Gardocki Raymond J. , Abtahi Amir M. , Stephens Byron F. , Zuckerman Scott L.
Published: May 2024

Study Design:

This is a retrospective cohort study.

Objective:

In patients undergoing elective posterior cervical laminectomy and fusion (PCLF) with a minimum of 5-year follow-up, we sought to compare reoperation rates between patients with an upper instrumented vertebra (UIV) of C2 versus C3/4.

Summary of Background Data:

The long-term outcomes of choosing between C2 versus C3/4 as the UIV in PCLF remain unclear.

Methods:

A single-institution, retrospective cohort study from a prospective registry was conducted of patients undergoing elective, degenerative PCLF from December 2010 to June 2018. The primary exposure was UIV of C2 versus C3/4. The primary outcome was reoperation. Multivariable logistic regression controlled for age, smoking, diabetes, and fusion to the thoracic spine.

Results:

Of the 68 patients who underwent PCLF with 5-year follow-up, 27(39.7%) had a UIV of C2, and 41(60.3%) had a UIV of either C3/4. Groups had similar duration of symptoms (P=0.743), comorbidities (P>0.999), and rates of instrumentation to the thoracic spine (70.4% vs. 53.7%, P=0.210). The C2 group had significantly longer operative time (231.8±65.9 vs. 181.6±44.1 mins, P<0.001) and more fused segments (5.9±1.8 vs. 4.2±0.9, P<0.001). Reoperation rate was lower in the C2 group compared with C3/4 (7.4% vs. 19.5%), though this did not reach statistical significance (P=0.294). Multivariable logistic regression showed increased odds of reoperation for the C3/4 group compared with the C2 group (OR=3.29, 95%CI=0.59-18.11, P=0.170), though statistical significance was not reached. Similarly, the C2 group had a lower rate of instrumentation failure (7.4% vs. 12.2%, P=0.694) and adjacent segment disease/disk herniation (0% vs. 7.3%, P=0.271), though neither trend attained statistical significance.

Conclusions:

Patients with a UIV of C2 had less than half the number of reoperations and less adjacent segment disease, though neither trend was statistically significant. Despite a lack of statistical significance, whether a clinically meaningful difference exists between UIV of C2 versus C3/4 should be validated in larger samples with long-term follow-up.

Level of Evidence:

Level—3
Barriers to longitudinal follow-up for hepatitis B treatment in rural Sierra Leone: A mixed methods study of retention in care
Authors: Lebbie Williams , Allan-Blitz Lao-Tzu , Nyama Emmanuel T. , Swaray Mohamed , Lavalie Daniel , Mhango Michael , Patiño Rodriguez Marta , Gupta Neil , Bitwayiki Remy
Published: May 2024

HBV disproportionately affects resource-limited settings, and retaining patients in longitudinal care remains challenging. We conducted a mixed methods investigation to understand the causes of losses to follow-up within an HBV clinic in rural Sierra Leone. We developed a multivariable logistic regression model of baseline clinical and sociodemographic factors predicting losses to follow-up, defined as failing to present for a follow-up visit within 14 months of enrollment. We included patients enrolled between April 30, 2019 and March 1, 2020, permitting 14 months of follow-up by April 30, 2021. We then developed a survey to solicit patient perspectives on the challenges surrounding retention. We interviewed randomly selected patients absent from HBV care for at least 6 months. Among 271 patients enrolled in the Kono HBV clinic, 176 (64.9%) did not have a follow-up visit within 14 months of the study end point. Incomplete baseline workup (aOR 2.9; 95% CI: 1.6–4.8), lack of treatment at baseline (aOR 5.0; 95% CI: 1.7–14.4), and having cirrhosis at baseline (aOR 3.3; 95% CI: 0.99–10.8) were independently associated with being lost to follow-up. For the patient survey, 21 patients completed the interview (median age 34 years [IQR: 25–38]). Travel-related factors were the most frequently reported barrier to retention (57%). Almost 30% suggested improved customer care might support retention in care; 24% requested to be given medication. In our setting, factors that might reduce losses to follow-up included expanded criteria for treatment initiation, overcoming transportation barriers, reducing wait times, ensuring against stockouts, and scaling up point-of-care testing services.
Single-cell RNA sequencing reveals the process of CA19-9 production and dynamics of the immune microenvironment between CA19-9 (+) and CA19-9 (−) PDAC
Authors: Zhang Deyu , Cui Fang , Zheng Kailian , Li Wanshun , Liu Yue , Wu Chang , Peng Lisi , Yang Zhenghui , Chen Qianqian , Xia Chuanchao , Li Shiyu , Jin Zhendong , Xu Xiaojiang , Jin Gang , Li Zhaoshen , Huang Haojie
Published: May 2024

Background:

Pancreatic ductal adenocarcinoma (PDAC) is one of the main types of malignant tumor of the digestive system, and patient prognosis is affected by difficulties in early diagnosis, poor treatment response, and a high postoperative recurrence rate. Carbohydrate antigen 19-9 (CA19-9) has been widely used as a biomarker for the diagnosis and postoperative follow-up of PDAC patients. Nevertheless, the production mechanism and potential role of CA19-9 in PDAC progression have not yet been elucidated.

Methods:

We performed single-cell RNA sequencing on six samples pathologically diagnosed as PDAC (three CA19-9-positive and three CA19-9-negative PDAC samples) and two paracarcinoma samples. We also downloaded and integrated PDAC samples (each from three CA19-9-positive and CA19-9-negative patients) from an online database. The dynamics of the proportion and potential function of each cell type were verified through immunofluorescence. Moreover, we built an in vitro coculture cellular model to confirm the potential function of CA19-9.

Results:

Three subtypes of cancer cells with a high ability to produce CA19-9 were identified by the markers TOP2A, AQP5, and MUC5AC. CA19-9 production bypass was discovered on antigen-presenting cancer-associated fibroblasts (apCAFs). Importantly, the proportion of immature ficolin-1 positive (FCN1+) macrophages was high in the CA19-9-negative group, and the proportion of mature M2-like macrophages was high in the CA19-9-positive group. High proportions of these two macrophage subtypes were associated with an unfavourable clinical prognosis. Further experiments indicated that CA19-9 could facilitate the transformation of M0 macrophages into M2 macrophages in the tumor microenvironment.

Conclusions:

Our study described CA19-9 production at single-cell resolution and the dynamics of the immune atlas in CA19-9-positive and CA19-9-negative PDAC. CA19-9 could promote M2 polarization of macrophage in the pancreatic tumor microenvironment.
Changes in blood lipid levels and influencing factors among treatment-naïve adult male HIV/AIDS patients following BIC/FTC/TAF vs. 3TC+EFV+TDF
Authors: Wang Xi , Liu An , Li Zaicun , Zhang Hongwei , Wu Ruojun Esther , Shao Ying , Li Jianwei , Ye Jiangzhu , Liu Wei , Sun Lijun
Published: May 2024

Background:

Antiretroviral therapy (ART) was often associated with dyslipidemia among human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients. This study aimed to assess treatment-naïve adult male patients with HIV/AIDS who initiated ART with either co-formulated bictegravir, emtricitabine, and tenofovir alafenamide (BIC/FTC/TAF) or lamivudine, efavirenz, and tenofovir disoproxil fumarate (3TC+EFV+TDF), monitoring at weeks 4, 12, 24, and 48.

Methods:

A case-control retrospective study was conducted. The newly diagnosed HIV-infected individuals attending the sexual transmission disease (STD)/AIDS clinic of Beijing Youan Hospital, Capital Medical University, from January to December 2021. The patients were divided into BIC/FTC/TAF group or 3TC+EFV+TDF group. High-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and total cholesterol (TC) at different time points over 48 weeks between two groups were compared. A multivariate Cox regression model was used to identify relevant influencing factors for the population at high risk of increased LDL-C.

Results:

A total of 870 participants, with 510 in BIC/FTC/TAF group and 360 in 3TC+EFV+TDF group. There were no statistically significant differences in median age, baseline CD4/CD8 ratio, median body mass index (BMI) between the two groups. In both two groups, levels of TG, TC, and LDL-C were higher at 4 weeks, 12 weeks, and 24 weeks of treatment (all P <0.05), and there were no statistically significant differences at 48 weeks compared to those at baseline (all P >0.05). In addition, the differences in average changes of the level of TG, TC, HDL-C, and LDL-C from weeks 4, 12, 24, and 48 to baseline between two groups were not statistically significant (all P >0.05). Multivariate Cox proportional risk model analysis showed that initiating ART with HIV RNA ≥105 copies/mL (compared with <105 copies/mL) was associated with an increased risk of elevated LDL-C (hazard ratio = 1.26, 95% confidence interval: 1.07–1.48, P = 0.005).

Conclusions:

Transient elevations in blood lipid levels (TC, TG, HDL-C, and LDL-C) were observed in treatment-naïve adult male HIV/AIDS patients with BIC/FTC/TAF at 4 weeks, 12 weeks, and 24 weeks of treatment. However, these levels did not differ significantly from baseline after 48 weeks of treatment, regardless of whether patients were in the BIC/FTC/TAF or 3TC+EFV+TDF group.
Understanding the factors associated with nurse employment in clinics: Experiences in Taiwan
Authors: Ma Hsin , Chiang Shu-Chiung , Lin Ming-Hwai , Chang Hsiao-Ting , Ming Jin-Lain , Chen Tzeng-Ji , Chen Yu-Chun
Published: May 2024

Background:

The shortage and distribution of nurses affect healthcare access in aging societies. Limited research has explored the nursing workforce in clinics, which is vital for healthcare delivery. This study aimed to investigate the shortage and distribution of nurses in clinics in Taiwan, considering geographical, institutional, and specialty variations.

Methods:

We conducted a cross-sectional analysis of the national nursing workforce in Western medicine clinics in Taiwan using open government data. The nursing practice rate (NPR) was calculated. The ratio of clinics employing nurses (RCN) was determined by calculating the percentage of clinics with nurses in each category. A logistic regression model was fitted to examine the factors associated with nurse employment, including urbanization level and different specialty clinics. Adjusted odds ratios (OR) and 95% CIs were calculated.

Results:

The study revealed an overall NPR as low as 59.1%, and a decreasing trend with age. Among the 11 706 clinics in the study, nearly a quarter did not employ nurses, with an overall RCN of 72.3%. Urbanization level and clinic specialty were associated with nurse employment (p < 0.05). After adjusting for urbanization level, the fitted regression model identified the top three specialties as plastic surgery (OR = 11.37, RCN = 96.8%), internal medicine (OR = 1.94, RCN = 84.1%), and orthopedics (OR = 1.89, RCN = 83.6%), while the bottom three were otolaryngology (OR = 0.59, RCN = 61.5%), psychiatry (OR = 0.49, RCN = 57.1%), and rehabilitation medicine (OR = 0.30, RCN = 45.2%). Nurses were more likely to be employed in areas at urbanization level 1 (OR = 1.17), 3 (OR = 1.37), and 6 (OR = 1.48), which represent highly urbanized areas within the urban, suburban, and rural categories, respectively, than in urbanization level 4.

Conclusion:

Clinics in Taiwan showed nursing shortages and maldistribution, with 72.3% RCN and variations based on urbanization and specialty. These factors may be considered in nursing research conducted in other countries to inform future workforce planning.
Preventive Effects of Ramelteon, Suvorexant, and Lemborexant on Delirium in Hospitalized Patients With Physical Disease
Authors: Henmi Ryuji , Nakamura Tomoyuki , Mashimoto Masaya , Takase Fumitake , Ozone Motohiro
Published: May 2024

Background

New sleep-inducing drugs (eg, ramelteon, suvorexant, and lemborexant) have been shown to prevent delirium in high-risk groups. However, no single study has simultaneously evaluated the delirium-preventing effects of all novel sleep-inducing drugs in hospitalized patients. Therefore, this study aimed to clarify the relationship between sleep-inducing drugs and delirium prevention in patients hospitalized in general medical-surgical settings for nonpsychiatric conditions who underwent liaison interventions for insomnia.

Methods

This retrospective cohort study included patients treated in general medical-surgical settings for nonpsychiatric conditions with consultation-liaison psychiatry consult for insomnia. Delirium was diagnosed by fully certified psychiatrists using the Diagnostic and Statistical Manual of Mental Disorders 5th edition. The following items were retrospectively examined from medical records as factors related to delirium development: type of sleep-inducing drugs, age, sex, and delirium risk factors. The risk factors of delirium development were calculated using adjusted odds ratios (aORs) via multivariate logistic regression analysis.

Results

Among the 710 patients analyzed, 257 (36.2%) developed delirium. Suvorexant (aOR, 0.61; 95% confidence interval [CI], 0.40–0.94; P = 0.02) and lemborexant (aOR, 0.23; 95% CI, 0.14–0.39; P < 0.0001) significantly reduced the risk of developing delirium. Benzodiazepines (aOR, 1.90; 95% CI, 1.15–3.13; P = 0.01) significantly increased this risk. Ramelteon (aOR, 1.30; 95% CI, 0.84–2.01; P = 0.24) and Z-drugs (aOR, 1.27; 95% CI, 0.81–1.98; P = 0.30) were not significantly associated with delirium development.

Conclusions

The use of suvorexant and lemborexant may prevent delirium in patients with a wide range of medical conditions.
Comparison of clinical outcomes and repair integrity after arthroscopic versus mini-open rotator cuff repair: An observational study
Authors: Tosyali Hakan Koray , Kaya Hüseyin , Hancioglu Sertan , Tamsel Ipek , Orguc Sebnem , Tekustun Ferit , Kayikci Kayahan , Kucuk Levent , Ozalp Tackin
Published: May 2024

This study aimed to evaluate the differences between mini-open (MO) and arthroscopic (ART) repair procedures for rotator cuff tendon tears in terms of clinical and radiological outcomes. This retrospective study included 59 patients, and data were collected prospectively. Patients with full-thickness rotator cuff tears were randomized to undergo MO or ART repair at 2 centers by 2 surgeons between January 2012 and December 2017. Data were collected 3 weeks before surgery and 6 and 12 months after surgery. Physical function was assessed using the American Shoulder and Elbow Surgeons index, VAS, and Constant scoring system. Radiological outcomes were assessed using the Sugaya classification, adapted for ultrasound. Changes between baseline and follow-up were compared between the 2 groups. Fifty-nine patients who underwent ART or MO rotator cuff repair were included in this study. The 2 groups had similar demographic characteristics and preoperative baseline parameters. Both the MO and ART groups showed statistically significant improvement in outcome parameters (P ≤ .0001); however, cuff repair integrity was significantly better in the ART group (P = .023). All other improvements in the patient-derived parameters were equivalent. None of the patients in either group required revision surgery. According to the results of our retrospective study, MO and ART rotator cuff repair are effective and viable options for surgeons to repair rotator cuff tears. There were no differences in objective and subjective outcomes between the full ART and MO techniques for rotator cuff tears. Surgeons should choose a technique with which they are more familiar.
Correlation between depression and adherence to respiratory function exercise in elderly frail patients with tuberculosis: A cross-sectional survey
Authors: Si Qin , Guo Jing , Feng Yin-Ping , Luo Shui-Rong , Liu Zhong-Da , Zhou Guang-Nao
Published: May 2024

Background:

We investigated the current state of frailty in elderly patients with tuberculosis and analyzed the factors that influence it.

Methods:

Using a convenience sampling method, 120 elderly patients with tuberculosis were selected from the Department of Infectious Diseases at Lishui Hospital of Traditional Chinese Medicine in Zhejiang Province. A cross-sectional survey was conducted using general demographic questionnaires, the FRAIL (fatigue, resistance, aerobic capacity, illnesses, and loss of weight) screening scale, the self-rating depression scale (SDS), and a questionnaire on respiratory function exercise adherence. The influencing factors for depression were analyzed using logistic regression.

Results:

The average depression score of the 120 elderly patients with frailty and tuberculosis was 54.88 ± 5.61, indicating a mild level of depression. The correlation between this score and respiratory function exercise adherence was negative. According to a logistic regression analysis, marital status and payment methods were influencing factors for depression in these elderly patients with frailty and tuberculosis.

Conclusion:

There is a need to increase respiratory function exercise adherence among elderly patients with frailty and tuberculosis who have a high incidence of depression. Medical staff should assess adverse emotions in patients and their adherence to respiratory function exercises on a periodic basis.
Prostate tuberculosis mimicking malignancy on 18F-FDG PET/CT in a patient with diffuse large B-cell lymphoma: A case report
Authors: Bai Min , Yu Qinchuan , Yuan Ling , Zhao Yuanyuan , Zheng Meijing , Su Liping , Wang Lieyang
Published: May 2024

Background:

Prostate tuberculosis (TB) is a rare and often underdiagnosed condition due to its nonspecific symptoms and imaging features, which can mimic malignancies on 18F-fluorodeoxyglucose positron emission tomography (PET) scans. This resemblance poses a challenge in differentiating TB from prostate cancer, especially in patients with preexisting tumors such as diffuse large B-cell lymphoma. The purpose of this study is to highlight the importance of considering TB in the differential diagnosis of patients with atypical imaging findings, even in the presence of known malignancies.

Case:

We present a case of a 60-year-old man with diffuse large B-cell lymphoma who was initially misdiagnosed with a prostate tumor based on 18F-fluorodeoxyglucose PET/computed tomography scans. The subsequent ultrasound-guided prostate biopsy confirmed the presence of prostate TB, not malignancy.

Conclusions:

This case report underscores the critical role of considering TB as a potential diagnosis in patients with hematological tumors and atypical imaging results. It serves as a reminder for clinicians to exercise caution when interpreting PET/computed tomography scans and to incorporate TB into their differential diagnoses, thereby avoiding misdiagnosis and inappropriate treatment.
Mucinous epidermoid carcinoma of the lung with ALK mutation: Case report and literature review
Authors: Yang Lijiao , Ren Yanyan , Yin Xing
Published: May 2024

Rationale:

Pulmonary mucoepidermoid carcinoma (PMEC) is a rare lung malignancy, especially in combination with ALK mutations, whose clinical presentation lacks specificity and for which there are no standardized treatment guidelines.

Patient concerns:

We report a case of a patient with PMEC-predominant primary lung cancer combined with an ALK mutation.

Diagnoses:

One patient was diagnosed with PMEC combined with ALK mutation.

Interventions:

After diagnosis by puncture pathology, the patient was treated with oral targeted drugs.

Outcomes:

The patient’s cough and fever were controlled, her diet improved significantly, and she gained 20 pounds in 6 months. During this period, the primary and metastatic foci in the lungs were significantly reduced on repeat chest CT.

Conclusion:

PMEC combined with ALK mutation is an extremely rare primary lung cancer, and the diagnosis is mainly based on pathology, histology and immunohistochemistry. The application of molecularly targeted drugs to patients with mutations can significantly improve the prognosis of patients with PMEC, which is expected to be a new breakthrough in the treatment of PMEC.
Comparison of percutaneous nephrolithotripsy combined with retrograde intrarenal surgery and multi-tract percutaneous nephrolithotripsy for octopus stone: A propensity score-matching study
Authors: Cui Deheng , Chen Guoqiang , Luo Jianbin , Ma Qinghong , Wang Guangzhi , Yang Zesong , Ye Liefu
Published: May 2024

To compared the effectiveness and safety of single standard mini percutaneous nephrolithotripsy (SM-PCNL) combined with retrograde intrarenal surgery (RIRS) and multiple standard mini percutaneous nephrolithotomy (MSM-PCNL) in the treatment of octopus stone of 2 to 4 cm. The clinical data of SM-PCNL combined with RIRS and MSM-PCNL for octopus stone with a 2 to 4 cm diameter from October 2019 to December 2022 were analyzed retrospectively, and propensity score matching was used to screen patients. The matched patients were paired, and the operation time, complications, postoperative pain, tubeless rate, stone-free rate (SFR), and postoperative hospital stay were further compared between the 2 groups. 88 patients underwent SM-PCNL combined with RIRS (combined group), and 143 patients underwent MSM-PCNL (multiple channel group). After matching analysis, there were 49 patients in each group, and there was no significant difference in the general preoperative data between the 2 groups. The perioperative complications and stone-free rate were no statistical difference. In postoperative pain (4.00 ± 0.74 vs 5.00 ± 0.74, P = .00), tubeless rate (44.90% vs 20.41%, P = .01), hemoglobin drop (9.38 ± 7.48 vs 14.22 ± 7.69, P = .01), postoperative hospital stay (3.37 ± 1.09 vs 5.08 ± 1.29, P = .00), the combined group was significantly better than the multiple channel group. Regarding operation time, the combined group was more than the multiple channel group (103.27 ± 27.61 vs 78.39 ± 19.31, P = .000). For octopus stone with a diameter of 2 to 4 cm, the effectiveness and safety of SM-PCNL combined with RIRS were similar to those of MSM-PCNL The surgeon should carefully evaluate the patient’s physical condition, stone characteristics, and expectations before the operation and assist the patient in choosing an appropriate plan.