bluuebunny/crossref_metadata_2025 huggingface dataset:
PCR-based versus conventional stool tests in children with diarrhea who underwent solid organ transplantation or hematopoietic stem cell transplantation
Authors: Sidafong Seewalee , Tanpowpong Pornthep , Boonsathorn Sophida , Anurathapan Usanarat , Chantarogh Songkiat , Treepongkaruna Suporn
Published: September 2023

Infectious diarrhea is a common problem among post-transplant recipients. Compared to conventional tests, polymerase chain reaction (PCR)-based stool tests have been shown to improve diagnostic yield but the aforementioned data in children remain limited. Our aims were to assess the detection rate of PCR-based tests in post-transplant children and compare with the conventional tests; and to investigate how these stool tests help in managing these children. We enrolled children aged 1 to 19 years who underwent solid organ transplantation or hematopoietic stem cell transplantation that remained on immunosuppressive agents and developed diarrhea ≥ 24 hours between January 2015 and February 2023. Besides stool tests, data on demographics, clinical characteristics and management were collected. We analyzed 68 patients and 92 episodes of diarrhea with PCR-based tests. PCR-based tests provided a detection rate of 41.8% versus 16.5% for the conventional tests. While conventional tests may detect a higher proportion of Clostridiodes difficile infection, PCR-based tests showed greater yields in detecting Salmonella spp. and viruses especially norovirus. PCR-based tests had an impact in management among 22/38 (58%) diarrheal episodes especially with Campylobacter jejuni and C difficile; and among 16 episodes that positive PCR-based tests had a minimal impact, the most common reason was due to the need for continuation of antimicrobial agents for concomitant site-specific infection (69%). Among transplanted children presenting with diarrhea, PCR-based tests provide a higher yield when compared with the conventional tests. The PCR-based stool tests may also further guide clinicians for providing proper antimicrobial agents.
The relationship between bi-spectral index and VOTE score in evaluation of drug-induced sleep endoscopy: A systematic meta-analysis
Authors: Öner Özlem , Ecevit Mustafa Cenk , Gökmen Ali Necati
Published: September 2023

Objective:

The aim of this study was to investigate both the presence and severity of collapse in anatomical regions defined by the VOTE score (velum, orofarinx, tongue, and epiglottis), during drug induced sleep endoscopy (DISE) in patients diagnosed with obstructive sleep apnea, based on the bi-spectral index (BIS) sedation level.

Methods:

In order to conduct a meta-analysis of articles examining the relationship between the VOTE score and BIS sedation level in determining the presence and severity of upper airway collapse during DISE, a literature review was performed.

Results:

As a result of the search made in the specified databases, a total of 1864 articles were reached. Five articles included in this review that had sufficient statistical data to be included in the meta-analysis were found. A statistically significant correlation was found between the BIS sedation level and the areas of obstruction in the VOTE score. The strongest association is at the epiglottis level, followed by the velum, oropharynx, and tongue, respectively (CC: 0.639, CC: 0.53, CC: 0.49, and CC: 0.346, P < .001). In the subgroup analysis of publications with BIS sedation levels in the range of 60 to 65, the distribution in the epiglottis region was heterogeneous, and it was found to be statistically significant according to the random effect model (P < .001). The distribution in the tongue was homogeneous, and it was found to be statistically significant according to the fixed effect model (P < .001). When the publications in which the BIS sedation level is in the range of 65 to 75 are examined according to the areas of obstruction; the distribution in 4 anatomical regions was homogeneous and statistically significant according to the fixed effect model (P < .001).

Conclusion:

It was found that BIS sedation levels during DISE application in obstructive sleep apnea patients were associated with obstruction of the anatomical regions of the upper airway. The strongest association was found at the epiglottis level, followed by the velum, oropharynx, and tongue, respectively. It is helpful to monitor the sedation level with BIS in order to better define the collapsed areas during DISE application. However, more studies are needed to better understand the relationship between BIS sedation values and sleep stages.
A case report of dangerous pelvic infundibulum ligament in the second trimester of pregnancy with massive hemorrhage
Authors: Dai Jiahui , Chen Jin , Xu Xiaohan , Gao Ni , Wang Yunfei
Published: September 2023

Rationale:

Abdominal pregnancy is a rare ectopic pregnancy and its diagnosis and treatment are more challenging than those of other ectopic pregnancies. Because of a variable pregnancy site, abdominal pregnancy is associated with an increased risk of fatal abdominal hemorrhage, and consequently, an increased risk of maternal death compared with intrauterine pregnancy.

Diagnoses:

Pelvic infundibulum ligament pregnancy complicated with massive hemorrhage.

Patient concerns:

42-year-old pregnant woman who did not undergo an obstetric examination during the first trimester presented with sudden abdominal pain during the second trimester. Abdominal pregnancy was confirmed after emergency treatment, causing difficulty in the comprehensive preoperative evaluation.

Interventions: In order to save the patient life, we actively carried out surgical treatment.

Outcomes:

The patient recovered well after the operation and was discharged on the 11th postoperative day. Blood β-human chorionic gonadotropin (β-hCG) levels and routine blood test results were normal 1 month after the surgery, and the patient had recovered.

Lessons:

Several challenges are encountered in the diagnosis of abdominal pregnancy with regard to insufficient economic, cultural, and medical resources. In case of ectopic pregnancies, surgery should be the first choice of treatment, and preparations of blood transfusion are essential to combat the risk of rapid hemorrhagic shock caused by placenta implantation in the infundibulum ligament of the pelvis. The operation must be performed by experienced obstetricians and gynecologists.
A bibliometric and visual analysis of research trends and hotspots of myocardial apoptosis: A review
Authors: Lian Kun , Li Xin , Wang Xiaoyi , Wang Fei , Yang Meng , Ye Jiahao , Li Lin , Hu Zhixi
Published: September 2023

Background:

Recent studies have found that cardiomyocyte apoptosis is closely associated with the pathophysiological development of various cardiovascular diseases, for example chronic heart failure and myocardial infarction. At present, there are many researches in this field, such as pharmacological research, traditional Chinese medicine intervention research and pathway research. However, the relevant research is fragmented, with few comprehensive analysis and systematic combing.

Methods:

The relevant literature on cardiomyocyte apoptosis was downloaded from the Web of Science Core Collection (WoSCC) and PubMed databases. Citespace 6.1.R2 software Microsoft Excel 2019 and VOSviewer1.6.18.0 were used for bibliometric and visual analysis of publication volume, countries, institutions, journals, authors, keywords.

Results:

Since 1996, there are 1881 research articles and reviews related to cardiomyocyte apoptosis published by 10,313 researchers from 1648 institutions in 58 countries or regions were included. The number of annual publications showed an upward trend, especially in recent years. Countries participating in this research area include China, the United States, and Japan. Capital Medical University, Harbin Medical University are the key research institution, and other institutions also have substantial contribution on the project as to cardiomyocyte apoptosis. The journal EUR REV MED PHARMACO has a large number of publications, whereas CIRCULATION has the highest number of co-citations. Keywords analysis showed that apoptosis, expression and oxidative stress had higher frequencies, leading to 8 clusters.

Conclusions:

Cardiomyocyte apoptosis is a hot research field in recent years. Through visualization and bibliometric analysis, it is found that this field focus on hotspots like clinical manifestations including heart failure or myocardial infarction, and microscopic mechanisms such as oxidative stress and inflammation.
Study on the active ingredients and mechanism of Jiaotai Pill in the treatment of primary insomnia based on network pharmacology and GEO statistics: A review
Authors: Pan Limin , Wang Yaolei , Guan Ruiqian , Shi Qingchun
Published: September 2023

Objective:

To explore the active components and mechanism of Jiaotai Pill (JTP) in the treatment of primary insomnia (PI) based on gene expression omnibus.

Methods:

The main active components of Jiaotai Pills were obtained by TCMSP and literature mining, and the targets of the active components of Jiaotai Pills were predicted. The targets were verified and standardized by Uniprot database. PI-related targets were obtained from GeneCards, OMIM, DrugBank, PharmGKB, and TTD databases. Obtaining an intersection action target point of the Jiaotai pill and the PI by using a Venny diagram; Gene chip data (GSE208668) was downloaded from gene expression omnibus database, and then gene probe enrichment analysis (GSEA) was used to screen the differentially expressed genes between PI patients and normal controls, and molecular docking was used to virtually verify the screened differentially expressed genes with potential active compounds.

Results:

21 active components and 263 potential targets of Jiaotai Pill were screened by database analysis and literature mining, 112 of which were intersected with PI. Molecular docking results showed that quercetin, EGCG, kaempferol, R-kanatin, stigmasterol, berberine and other core active components had good docking activity with related differential genes.

Conclusion:

Jiaotai Pill can regulate the release of inflammatory factors through multiple active ingredients, multiple disease targets, multiple biological pathways and multiple pathways to achieve the purpose of treating PI, which provides a theoretical basis for the clinical treatment of PI and broadens the clinical use of Jiaotai Pill.
Cap-assisted colonoscopy can increase the rate of sessile serrated lesion detection at the left lateral decubitus position: A retrospective case-control study
Authors: Nishimoto Satomi , Kudo Takahiro , Horiuchi Ichitaro , Yabe Kiyoaki , Kurasawa Shingo , Horiuchi Akira
Published: September 2023

We investigated the effectiveness of cap-assisted colonoscopy conducted with the patient in the left lateral decubitus position at both the colonoscope’s insertion and withdrawal timepoints compared to the effectiveness of colonoscopy without a cap conducted in the supine position at withdrawal.

This was a case-control study, based on historical comparisons of patients over 2 time periods. The first group of patients underwent colonoscopies with a transparent cap and the patient was in the left lateral decubitus position at both the insertion and withdrawal timepoints from April to June 2019. The subsequent group underwent colonoscopies without a cap and with the patient in the supine position at withdrawal from July to September 2019. The rates of successful intubation, cecal intubation time, and number, size, shape, and location of the detected adenomas and sessile serrated lesions were compared between the 2 groups. Data from 644 colonoscopies (cap-assisted colonoscopy + left lateral decubitus position, n=320; other colonoscopies, n=324) were analyzed. The demographic characteristics and technical performances were similar. The SSL detection rate was significantly higher with cap-assisted colonoscopy and the left lateral decubitus position than with other colonoscopies (3.4% vs 0.93%, P=.029). The adenoma detection rates in the 2 groups were similar (31% and 28%, respectively, P=.43).Cap-assisted colonoscopy in the left lateral decubitus position may increase the detection rate of sessile serrated lesions compared to colonoscopy without a cap and supine position at withdrawal.
Prognostic significance of TP53 and PIK3CA mutations analyzed by next-generation sequencing in breast cancer
Authors: Choi Jin Hyuk , Yu Jesang , Jung Minjung , Jekal Junyong , Kim Ku Sang , Jung Sung Ui
Published: September 2023

Breast cancer is one of the most prevalent malignant tumors affecting women globally. It is a heterogeneous disease characterized by mutations in several genes. Several gene panels have been applied to assess the risk of breast cancer and determine the appropriate treatment. As a powerful tool, Next-generation sequencing (NGS) has been widely utilized in cancer research due to its advantages, including high speed, high throughput, and high accuracy. In this study, we aim to analyze the correlation between somatic mutations in breast cancer, analyzed using NGS, and the prognosis of patients. Between May 2018 and May 2019, a total of 313 patients with breast cancer underwent surgical treatment, which included total mastectomy and breast-conserving surgery. Among these patients, 265 were diagnosed with invasive ductal carcinoma. In this study, we analyzed the NGS results, clinicopathological characteristics, and their correlation with prognosis. Using a gene panel, we examined 143 somatic mutations in solid cancers. Notably, the study population included patients who had received neoadjuvant chemotherapy. The mean age of the patients was 53.1 (±10.28) years, and the median follow-up time was 48 months (range, 8–54). Among the 265 patients, 68 had received prior systemic therapy. Of these, 203 underwent breast-conserving surgery, and 62 underwent a mastectomy. Various somatic mutations were observed in NGS, with the most frequent mutation being PIK3CA mutations, which accounted for 44% of all mutations. TP53 mutations were the second most frequent, and ERBB2 mutations were the third most frequent. TP53 mutations were associated with poor disease-free survival (P = .027), while PIK3CA mutations were associated with better disease-free survival (P = .035) than PIK3CA wild-type. In our study, we identified various somatic mutations in breast cancer. Particularly, we found that TP53 and PIK3CA mutations are potentially associated with the prognosis of breast cancer. These findings suggest that the presence of specific mutations may have implications for predicting the prognosis of breast cancer. Further research and validation are needed to gain a deeper understanding of the role of these mutations and their mechanisms in prognosis prediction.
The determinants of neonatal asphyxia in the tropical province of China: A case-control study
Authors: Li Xiaohua , Bu Weizhen , Hu Xiaojing , Han Tianhong , Xuan Yan
Published: September 2023

As the major public health problem among under-5 children in the world, neonatal asphyxia (NA) contributes to 24% of the main causes of neonatal death. The effects of NA is not only limited to death but also has a long-term brain injury with lifelong adverse effects. Therefore, the goal of this study was to identify determinants of NA among newborns in the tropical province of China to guide early interventions and improve the survival and quality of life of these infants. A case control study was conducted at Hainan Women and Children’s Medical Center from January 1 to December 31, 2021. A total of 255 newborns (85 cases and 170 controls, 1:2 case to control ratio) were enrolled in the study. A systematic random sampling approach was adopted based on hospital delivery registration. Structured questionnaires were used to collected data. The data was entered into statistical software SPSS version 20.0 for analysis. In the bivariable analysis, variables with P values less than .1 were entered into multivariable logistic regression analysis. At a P value of .05, a statistically significant level was reported. Amniotic fluid stained by meconium/blood (AOR = 3.19, 95% confidence interval [CI]: 1.47–6.95), primiparity, fetal presentation of malpresentation (AOR = 3.89, 95% CI: 1.25–12.09), and low birth weight (AOR = 10.51, 95% CI: 3.02–36.55) were to be significantly associated with NA. This study identified that amniotic fluid stained by meconium/blood, primiparity, low birth weight were determinants of NA. Thus, preventive solutions such as close monitoring of fetus presentation, meliorating the obstetric care setup during antenatal care consultations should be stressed in China.
A novel model predicted liver cirrhosis constructed by ultrasound and serological in autoimmune liver hepatitis
Authors: Feng Siyi , Tu Haibin , Chen Lihong
Published: September 2023

To establish a noninvasive model based on two-dimensional shear wave elasticity (2D-SWE) technology, ultrasound feature and serological indicators to predict cirrhosis in autoimmune hepatitis (AIH) and verified. Patients with AIH confirmed by liver biopsy with liver ultrasound and serological examination were collected from January 2019 to May 2022. Patients were divided into cirrhosis and non-cirrhosis groups. Basic indexes, ultrasound indexes and serological indexes were collected. Multivariable logistic regression used for screening independent risk factors predicting cirrhosis, construct the AIH cirrhosis prediction model, named autoimmune hepatitis cirrhosis (AIHC). Determine best cutoff score according to the Youden index, verified the model’s predictive efficacy. One hundred forty-six patients were collected. The following indicators were independent risk factors for predicting cirrhosis: LS (OR: 1.416, P = .015), splenomegaly (OR: 10.446, P = .006), complement C4 (OR: 0.020, P = .009). The best cutoff score was 65, with a sensitivity 88.9% and specificity 75.6%; the area under curve was 0.901, AIHC possessed a higher net reclassification index (NRI) and integrated discrimination improvement compared with other indexes, and AIHC had the best clinical decision curve. The AIHC constructed in this study has better predictive efficacy than other noninvasive indexes, and we visualized the model for easy application, which was worth further promotion in clinical practice.
Platelet count predicts mortality in patients with sepsis: A retrospective observational study
Authors: Hua Yusi , Wang Ruoran , Yang Jie , Ou Xiaofeng
Published: September 2023

Platelet count is a key component of sepsis severity score. However, the predictive value of the platelet count at admission for mortality in sepsis remains unclear. We designed a retrospective observational study of patients with sepsis admitted to our hospital from January 2017 to September 2021 to explore the predictive value of platelet count at admission for mortality. A total of 290 patients with sepsis were included in this study. Multivariate logistic regression analysis was used to evaluate the risk factors for mortality and construct a predictive model with statistically significant factors. Compared with survivors, nonsurvivors tended to be much older and had significantly higher acute physiology and chronic health evaluation II and sequential organ failure assessment scores (P < .001). The platelet count was significantly lower in the nonsurvivor group than in the survivor group (P < .001). Multivariate logistic regression analysis indicated that age (P = .003), platelet count (P < .001) and lactate level (P = .018) were independent risk factors for mortality in patients with sepsis. Finally, the area under the receiver operating characteristic curve of platelet count predicting mortality in sepsis was 0.763 (95% confidence interval, 0.709–0.817, P < .001), with a sensitivity of 55.6% and a specificity of 91.8%. In our study, platelet count at admission as a single biomarker showed good predictability for mortality in patients with sepsis.
E3 Ubiquitin Ligase MARCH8 Promotes Pancreatic Cancer Growth and Metastasis by Activating STAT3 via Degradation of PTPN4
Authors: Chen Chao , Wang Ying , Zhao Qing , Li Guo-dong , Wang Yao-hui , Xu Li-chao , Huang Hao-zhe , Song Ge , Li Wen-tao , He Xin-hong
Published: September 2023

Objective

The role E3 ubiquitin ligase membrane-associated RING-CH 8 (MARCH8) has not been studied in pancreatic cancer.

Method

Pancreatic cancer cell lines and the normal pancreatic cells were tested in vitro studies and male athymic nude mice were tested in vivo studies. Measuring cell viability by Cell Counting Kit-8 assay (CCK8), 5-ethynyl-2′- deoxyuridine (Edu) staining, and colony formation assay. Wound healing assay was implemented for cell migration and Transwell assay was performed for cell invasion to evaluate the histological status by hematoxylin and eosin staining and to detect the protein ubiquitination by ubiquitination assay. The protein expression was determined by immunohistochemistry staining and western blotting, and mRNA expression was measured by quantitative reverse transcription polymerase chain reaction.

Result

The expression of MARCH8 was increased whereas PTPN4 was decreased in pancreatic cancer cells. Overexpression of MARCH8 promoted the growth, migration, and invasion of cells, and knockdown of PTPN4 had the similar effects both in vitro and in vivo. MARCH8 promoted PTPN4 protein degradation through ubiquitination. Moreover, PTPN4 suppressed the transcription activities of STAT3 by impairing the level of pSTAT3 (705), while inhibition of PTPN4 activated phosphorylation of STAT3.

Conclusions

MARCH8 promoted pancreatic cancer growth and invasion through mediating the degradation of PTPN4 and activated the phosphorylation of STAT3.
Evidence-based management of adult traumatic brain injury with raised intracranial pressure in intensive critical care unit at resource-limited settings: a literature review
Authors: Gedeno Kanbiro , Neme Derartu , Jemal Bedru , Aweke Zemedu , Achule Astemamagn , Geremu Kuchulo , Bekele Uddo Tesfanew
Published: September 2023

Background:

In underdeveloped countries, there is a greater incidence of mortality and morbidity arising from trauma, with traumatic brain injury (TBI) accounting for 50% of all trauma-related deaths. The occurrence of elevated intracranial pressure (ICP), which is a common pathophysiological phenomenon in cases of TBI, acts as a contributing factor to unfavorable outcomes. The aim of this systematic review is to analyze the existing literature regarding the management of adult TBI with raised ICP in an intensive critical care unit, despite limited resources.

Methods:

This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Search engines such as PubMed, the Cochrane database, and Google Scholar were utilized to locate high-level evidence that would facilitate the formation of sound conclusions.

Result:

A total of 11 715 articles were identified and individually assessed to determine their eligibility for inclusion or exclusion based on predetermined criteria and outcome variables. The methodological quality of each study was evaluated using recommended criteria. Ultimately, the review consisted of 51 articles.

Conclusion:

Physical examination results and noninvasive assessments of the optic nerve sheath diameter (ONSD) via sonography are positively associated with elevated ICP, and are employed as diagnostic and monitoring tools for elevated ICP in resource-limited settings. Management of elevated ICP necessitates an algorithmic approach that utilizes prophylactic measures and acute intervention treatments to mitigate the risk of secondary brain injury.
HepPar1 and GATA-3 Expression in Neuroendocrine Neoplasms: A Potential Trap for Pathologic Diagnosis
Authors: Xu Lin , Yu Guohua , Jiang Lei , Song Xiao , Qu Guimei , Luo Jie , Cai Li
Published: September 2023

Objective:

To investigate the expression and clinical significance of HepPar1 and GATA-3 in neuroendocrine neoplasms (NENs).

Materials and methods:

The expression of HepPar1 and GATA-3 in 144 cases of NENs was detected using immunohistochemistry, and the relevant literature was reviewed.

Results:

HepPar1 was localized in the cytoplasm, and the positive rate of HepPar1 was 6.25% (9/144) in 144 NENs, 9 of which were derived from gastrointestinal and pancreatic NENs, including 4 cases of neuroendocrine tumor, grade 1 (NET G1), 4 cases of NET G2, and 1 case of NET G3. GATA-3 was localized in the nucleus; the positive rate of GATA-3 was 7.62% (11/144), which was derived from 5 cases of gastrointestinal and pancreatic NENs, 2 cases of the lung, 2 cases of the liver, 1 case of the testis, and 1 case of the mediastinum. HepPar1 and GATA-3 were coexpressed in 4 cases: 2 cases of gastric NET G1, 1 case of gastric NET G2, and 1 case of pancreatic NET G3 with liver metastasis.

Conclusions:

HepPar1 and GATA-3 can be expressed in NENs, which are potential traps for the pathologic and differential diagnosis of tumors.
Is it Time to Retire the Term of Low-Grade Ductal Carcinoma in Situ and Replace it With Ductal Neoplasia?
Authors: Masood Shahla , Silverstein Melvin J.
Published: September 2023

As the leading cause of cancer morbidity and the second leading cause of cancer mortality among women, breast cancer continues to remain a major global public health problem. Consequently, significant attention has been directed toward early breast cancer detection and prevention. As a result, the number of image-detected biopsies has increased, and minimally invasive diagnostic procedures have almost replaced open surgical biopsies. Therefore, pathologists are expected to provide more information with less tissue and diagnose increasing numbers of atypical proliferative breast lesions, in situ lesions, and small breast carcinomas. This is a difficult task, as reflected by continuous reports highlighting the challenges associated with morphologic distinction between atypical ductal hyperplasia and low-grade ductal carcinoma in situ. The current interobserver variability among pathologists to accurately define these two entities often leads to silent overdiagnosis and overtreatment. Up to now, there are no reproducible morphologic features and/or any reliable biomarkers that can accurately separate the above-mentioned entities. Despite these reports, patients diagnosed with low-grade ductal carcinoma in situ are subject to cancer therapy regardless of the fact that low-grade ductal carcinoma in situ is known to be an indolent lesion. Studies have shown that low and high-grade ductal carcinoma in situ are genetically different forms of breast cancer precursors; however, the term ductal carcinoma in situ is followed by cancer therapy regardless of the grade and biology of the tumor. In contrast, patients with the diagnoses of atypical ductal hyperplasia do not undergo cancer therapy. In the current article, attempts are made to highlight the continuous dilemma in distinction between atypical ductal hyperplasia and low-grade ductal carcinoma in situ. Going forward, we suggest that low-grade ductal carcinoma in situ be referred to as ductal neoplasia. This alternative terminology allows for different management and follow-up strategies by eliminating the word carcinoma.
What Do We Know About Patient Safety Culture in Saudi Arabia? A Descriptive Study
Authors: Alaska Yasser A. , Alkutbe Rabab B.
Published: September 2023

Background

Patient safety is described as the prevention and mitigation of medical errors that can result in harm while a patient is receiving care. One important way to improve safety is through improving the patient safety culture in healthcare. The purposes of this study are to evaluate the patient safety culture trend in Saudi Arabia and assess the improvement over time.

Methods

This study is a descriptive study that used a retrospective analysis of a national data set for 3 cycles from 2019 to 2022. To generate a baseline and allow comparison of the hospital’s survey results with the aggregated findings from the database, the 10th, 25th, 50th, 75th, and 90th percentiles were calculated to set the percentage of values.

Result

Our results found that one of the barriers to developing a strong patient safety culture in Saudi Arabia is management support of patient safety, which caused a blame culture. This could explain the absence of improvement in the average percentage of reporting patient safety events for all 3 cycles. On the other hand, a decrease was observed in organizational learning/continuous improvement as well as a reduction in the positive percentage of patient safety ratings in the last cycle. Moreover, areas of strength in all 3 cycles did not reach the 75th percentile, whereas staffing and response to error domains remained the lowest-scoring composites in all cycles.

Conclusion

Our results have determined the percentile of the positive rate that could guide hospitals to improve their culture survey results. More investigations can focus on change over the years in both patient safety culture and the effectiveness of implementing interventions to measure the impact on quality of care.
Malpractice Trends Involving Active Surveillance Across Cancers
Authors: Chang Samuel , Daskivich Timothy J. , Vasquez Missael , Sacks Wendy L. , Zumsteg Zachary S. , Ho Allen S.
Published: September 2023

Objective:

To characterize malpractice trends related to active surveillance (AS) as a treatment strategy across cancers.

Background:

Active surveillance is increasingly considered a viable management strategy for low-risk cancers. Since a subset of AS cases will progress, metastasize, or exhibit cancer-related mortality, a significant barrier to implementation is the perceived risk of litigation from missing the window for cure. Data on malpractice trends across cancers are lacking.

Methods:

Westlaw Edge and LexisNexis Advance databases were searched from 1990-2022 for malpractice cases involving active surveillance in conjunction with thyroid cancer, prostate cancer, kidney cancer, breast cancer, or lymphoma. Queries included unpublished cases, trial orders, jury verdicts, and administrative decisions. Data were compiled on legal allegation, procedure performed, and verdict or settlement rendered.

Results:

Five prostate cancer cases were identified that pertained to active surveillance. Two cases involved alleged deliberate indifference from AS as a management strategy but were ruled as following appropriate standard of care. In contrast, three cases involved alleged physician negligence for not having explicitly recommended AS as a treatment option, after complications from surgery occurred. All cases showed documented informed consent for AS, leading to defense verdicts for the physicians. No cases of AS-related malpractice were identified for other cancer types.

Conclusions:

To date, no evidence of successful malpractice litigation for active surveillance in cancer has been identified. Given the legal precedent detailed in the identified cases and increasing support across national guidelines, active surveillance represents a sound management option in appropriate low-risk cancers, with no increased risk of medicolegal exposure.
Clinical evidence and mechanisms of traditional Chinese medicine in major diseases
Authors: Luo Binyu , Li Yiwen , Wang Wenting , Liu Yanfei , Xian Yanfang , Liu Yue , Chen Keji
Published: September 2023

Major diseases cause a double blow to patients' physical and mental health and family life and pose a great challenge to the healthcare system. The high incidence of major diseases compels us to constantly improve the medical prevention and treatment system to reduce disability and death rates as much as possible. Traditional Chinese medicine (TCM) has been widely used in the treatment of malignancies and cardiovascular and cerebrovascular diseases such as myocardial infarction and stroke, in the rehabilitation of patients with these diseases, as well as in the prevention and treatment of new outbreaks of infectious diseases and other major illnesses. After the coronavirus disease 2019 outbreak, the clinical application of “three prescriptions and three drugs” has greatly increased the cure rate, reduced the mortality rate, and provided a “Chinese solution” for global epidemic prevention and control. This article reviewed the clinical evidence and mechanisms of action of TCM in the prevention and treatment of major diseases, summarized the advances, and proposed future research directions to provide scientific evidence to expand the clinical application of TCM and improve its efficacy for the benefit of all humankind.
Management of Established Small-for-size Syndrome in Post Living Donor Liver Transplantation: Medical, Radiological, and Surgical Interventions: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference
Authors: Kirchner Varvara A. , Shankar Sadhana , Victor David W. , Tanaka Tomohiro , Goldaracena Nicolas , Troisi Roberto I. , Olthoff Kim M. , Kim Jong Man , Pomfret Elizabeth A. , Heaton Nigel , Polak Wojtek G. , Shukla Akash , Mohanka Ravi , Balci Deniz , Ghobrial Mark , Gupta Subash , Maluf Daniel , Fung John J. , Eguchi Susumu , Roberts John , Eghtesad Bijan , Selzner Markus , Prasad Raj , Kasahara Mureo , Egawa Hiroto , Lerut Jan , Broering Dieter , Berenguer Marina , Cattral Mark S. , Clavien Pierre-Alain , Chen Chao-Long , Shah Samir R. , Zhu Zhi-Jun , Ascher Nancy , Ikegami Toru , Bhangui Prashant , Rammohan Ashwin , Emond Jean C. , Rela Mohamed
Published: September 2023

Small-for-size syndrome (SFSS) following living donor liver transplantation is a complication that can lead to devastating outcomes such as prolonged poor graft function and possibly graft loss. Because of the concern about the syndrome, some transplants of mismatched grafts may not be performed. Portal hyperperfusion of a small graft and hyperdynamic splanchnic circulation are recognized as main pathogenic factors for the syndrome. Management of established SFSS is guided by the severity of the presentation with the initial focus on pharmacological therapy to modulate portal flow and provide supportive care to the patient with the goal of facilitating graft regeneration and recovery. When medical management fails or condition progresses with impending dysfunction or even liver failure, interventional radiology (IR) and/or surgical interventions to reduce portal overperfusion should be considered. Although most patients have good outcomes with medical, IR, and/or surgical management that allow graft regeneration, the risk of graft loss increases dramatically in the setting of bilirubin >10 mg/dL and INR>1.6 on postoperative day 7 or isolated bilirubin >20 mg/dL on postoperative day 14. Retransplantation should be considered based on the overall clinical situation and the above postoperative laboratory parameters. The following recommendations focus on medical and IR/surgical management of SFSS as well as considerations and timing of retransplantation when other therapies fail.
Yersinia pseudotuberculosis bacteraemia with splenic abscesses: a case report
Authors: Zewude Rahel Tefera , Stefanovic Aleksandra , Alem Zersenay
Published: September 2023

Introduction.

Yersinia pseudotuberculosis

has been known to cause a variety of clinical manifestations ranging from mild enteric illness to bacteraemia with septic shock and extraintestinal abscesses. Patients with liver disease and iron overload are at risk of more severe disease manifestations.

Case Report. A middle-aged male with chronic alcohol use disorder presented with confusion and jaundice, with ascites and asterixis noted on examination. His blood work was remarkable for neutrophilic leukocytosis, elevated liver enzymes and lactate. An abdominal computed tomography scan revealed splenic microabscesses and a cirrhotic liver.

Yersinia pseudotuberculosis

was recovered from his blood cultures and he was treated with ceftriaxone following susceptibility results.

Conclusion.

Y. pseudotuberculosis

should be considered in the differential diagnosis of splenic or other extraintestinal microabscesses particularly in patients with chronic liver disease.
Association of Cognitive Deficits with Sociodemographic Characteristics among Adults with Post-COVID Conditions: Findings from the United States Household Pulse Survey
Authors: Wu Daniel J , Liu Nianjun
Published: September 2023

Background

People infected with COVID-19 may continue to experience symptoms for several weeks or even months after acute infection, a condition known as long COVID. Cognitive problems such as memory loss are among the most commonly reported symptoms of long COVID. However, a comprehensive evaluation on the risks of cognitive decline following COVID infection among different sociodemographic groups has not been undertaken at the national level in the United States.

Methods

We conducted a secondary analysis on the datasets from U.S. Census Bureau Household Pulse Survey, encompassing the data collected from June 1, 2022 to December 19, 2022. Based on a cohort of 385,370 individuals aged 18 or older, we employed logistic regression analyses to examine the association between self-reported cognitive deficits and different sociodemographic factors among individuals with long COVID conditions.

Results

Among individuals aged 18 or older, 44.7% percent of survey respondents report having been diagnosed with COVID in the past, and 29.0% of those with previous COVID infection experienced long COVID symptoms lasting for more than 3 months. We have demonstrated that individuals with long COVID had significantly higher risk of experiencing cognitive deficits compared to those with no history of COVID infection. Furthermore, females, young adults, people with multiple races, or low levels of education attainment are at high risk of cognitive deficits if they experience long COVID. At the state level, the prevalence of cognitive deficits among long COVID patients varied across different US states, with the highest prevalence in West Virginia and Kentucky, and the lowest prevalence in Connecticut and Maryland. The variation could be due to differences in racial composition and education level among long COVID patients in the four states.

Conclusions

The risks of cognitive deficits among adults with post-COVID conditions are substantial. Various sociodemographic groups can have different risks of developing cognitive deficits after experiencing long COVID. Findings of this large-scale study can help identify sociodemographic groups at higher risk of cognitive deficits, and facilitate medical interventions and guide resource allocation to target populations at risk and to prioritize areas with a high rate of cognitive decline.
Modeling the Transmission Mitigation Impact of Testing for Infectious Diseases
Authors: Middleton Casey , Larremore Daniel B.
Published: September 2023

A fundamental question of any program focused on the testing and timely diagnosis of a communicable disease is its effectiveness in reducing transmission. Here, we introduce testing effectiveness (TE)—the fraction by which testing and post-diagnosis isolation reduce transmission at the population scale—and a model that incorporates test specifications and usage, within-host pathogen dynamics, and human behaviors to estimate TE. Using TE to guide recommendations, we show that today’s rapid diagnostics should be used immediately upon symptom onset to control influenza A and respiratory syncytial virus (RSV), but delayed by up to 2d to control omicron-era SARS-CoV-2. Furthermore, while rapid tests are superior to RT-qPCR for control of founder-strain SARS-CoV-2, omicron-era changes in viral kinetics and rapid test sensitivity cause a reversal, with higher TE for RT-qPCR despite longer turnaround times. Finally, we illustrate the model’s flexibility by quantifying tradeoffs in the use of post-diagnosis testing to shorten isolation times.
Bi-directional communication between monocytes and trophoblasts under hypoxia and hypoxia-reperfusion conditions
Authors: Yankello Hannah , Lee Yerim , Megli Christina , Wayne Elizabeth
Published: September 2023

Introduction

Pregnancy-related disorders such as preeclampsia are associated with syncytiotrophoblast (STB) stress and monocyte dysregulation. It remains unclear whether this stress derives from prolonged placental hypoxia or a hypoxia-reperfusion-type injury. Thus, this study investigated how these two models of STB stress impact trophoblast-monocyte interactions.

Method

Cobalt chloride chemically induced hypoxia in BeWo b30 cells. A transwell coculture system was used to examine trophoblast-monocyte signaling. qPCR quantified gene expression changes following coculture. Monocyte phagocytosis ofE. Colior adhesion to placental cells was determined via flow cytometry. Monocyte migration to placental signals was quantified using a cell counter.

Results

Cobalt chloride induced a hypoxic state in BeWo b30s. Reperfusion restored the expression of indirect hypoxia genes and ER stress genes. Coculturing THP-1 monocytes with normoxic, hypoxic, and hypoxic-reperfused BeWo b30s promoted b30 survival but not wound-healing capacity. Compared to hypoxic-reperfused BeWos, hypoxic cells increased monocyte adhesion and inflammatory gene expression, decreased monocyte phagocytosis, and did not change monocyte migration. Finally, placental signaling in early-onset PE decreased monocyte chemotaxis, but monocyte precondition more strongly influenced migration compared to placental state.

Discussion

Overall, hypoxic placental signals most effectively recapitulate monocyte functional behavior observed in preeclampsia. Further research is needed to understand spatial and temporal changes in monocyte-trophoblast interactions and pregnancy outcomes. Monocyte chemotaxis to primary placental signals varied by gestational age, maternal diagnosis, and monocyte condition, implying monocytes could be used as functional biomarkers to predict their behavior at the maternal-fetal interface as well as the onset of disease.

Abstract Figure
Recurrent activity within microcircuits of macaque dorsolateral prefrontal cortex tracks cognitive flexibility
Authors: Nolan Suzanne O , Melugin Patrick R , Erickson Kirsty R , Adams Wilson R , Farahbakhsh Zahra Z , Mcgonigle Colleen E , Kwon Michelle H , Costa Vincent D , Lapish Christopher C , Hackett Troy A , Cuzon Carlson Verginia C , Constantinidis Christos , Grant Kathleen A , Siciliano Cody A
Published: September 2023

Human and non-human primate data clearly implicate the dorsolateral prefrontal cortex (dlPFC) as critical for advanced cognitive functions1,2. It is thought that intracortical synaptic architectures within dlPFC are the integral neurobiological substrate that gives rise to these processes, including working memory, inferential reasoning, and decision-making3–7. In the prevailing model, each cortical column makes up one fundamental processing unit composed of dense intrinsic connectivity, conceptualized as the ‘canonical’ cortical microcircuit3,8. Each cortical microcircuit receives sensory and cognitive information from a variety of sources which are represented by sustained activity within the microcircuit, referred to as persistent or recurrent activity4,9. Via recurrent connections within the microcircuit, activity can propagate for a variable length of time, thereby allowing temporary storage and computations to occur locally before ultimately passing a transformed representation to a downstream output4,5,10. Competing theories regarding how microcircuit activity is coordinated have proven difficult to reconcilein vivowhere intercortical and intracortical computations cannot be fully dissociated5,9,11,12. Here, we interrogated the intrinsic features of isolated microcircuit networks using high-density calcium imaging of macaque dlPFCex vivo. We found that spontaneous activity is intrinsically maintained by microcircuit architecture, persisting at a high rate in the absence of extrinsic connections. Further, using perisulcal stimulation to evoke persistent activity in deep layers, we found that activity propagates through stochastically assembled intracortical networks, creating predictable population-level events from largely non-overlapping ensembles. Microcircuit excitability covaried with individual cognitive performance, thus anchoring heuristic models of abstract cortical functions within quantifiable constraints imposed by the underlying synaptic architecture.
Neuroplasticity of speech-in-noise processing in older adults assessed by functional near-infrared spectroscopy (fNIRS)
Authors: Mai Guangting , Jiang Zhizhao , Wang Xinran , Tachtsidis Ilias , Howell Peter
Published: September 2023

Functional near-infrared spectroscopy (fNIRS), a non-invasive optical neuroimaging technique that is portable and acoustically silent, has become a promising tool for evaluating auditory brain functions in hearing- vulnerable individuals. This study, for the first time, used fNIRS to evaluate neuroplasticity of speech-in-noise processing in older adults. Ten older adults, most of whom had moderate-to-mild hearing loss, participated in a 4-week speech-in-noise training. Their speech-in-noise performances and fNIRS brain responses to speech (auditory sentences in noise), non-speech (spectrally-rotated speech in noise) and visual (flashing chequerboards) stimuli were evaluated pre- (T0) and post-training (immediately after training, T1; and after a 4-week retention, T2). Behaviourally, speech-in-noise performances were improved after retention (T2 vs. T0) but not immediately after training (T1 vs. T0). Neurally, we intriguingly found brain responses to speech vs. non-speech decreased significantly in the left auditory cortex after retention (T2 vs. T0 and T2 vs. T1) for which we interpret as suppressed processing of background noise during speech listening alongside the significant behavioural improvements. Meanwhile, functional connectivity within and between multiple regions of temporal, parietal and frontal lobes was significantly enhanced in the speech condition after retention (T2 vs. T0). We also found neural changes before the emergence significant behavioural improvements. Compared to pre-training, responses to speech vs. non-speech in the left frontal/prefrontal cortex were decreased significantly both immediately after training (T1 vs. T0) and retention (T2 vs. T0), reflecting possible alleviation of listening efforts. Finally, connectivity was significantly decreased between auditory and higher-level non-auditory (parietal and frontal) cortices in response to visual stimuli immediately after training (T1 vs. T0), indicating decreased cross-modal takeover of speech-related regions during visual processing. The results thus showed that neuroplasticity can be observed not only at the same time, but alsobeforebehavioural changes in speech-in- noise perception. To our knowledge, this is the first fNIRS study to evaluate speech-based auditory neuroplasticity in older adults. It thus provides important implications for current research by illustrating the promises of detecting neuroplasticity using fNIRS in hearing-vulnerable individuals.