bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Trauma Resuscitation Emergency Care Nurse Deployment in Trauma Activations in a Rural Trauma Center
Authors: Holder Michael W. , Leonard Matthew A. , Collins Hannah W. , Brogan Allison A. , Burns J. Bracken
Published: July 2023

BACKGROUND:

Although the role of a dedicated trauma nurse has been implemented in an urban setting, it has not been studied in the rural trauma setting. We instituted a trauma resuscitation emergency care (TREC) nurse role to respond to trauma activations at our rural trauma center.

OBJECTIVE:

This study aims to determine the impact of TREC nurse deployment on the timeliness of resuscitation interventions in trauma activations.

METHODS:

This pre- and postintervention study at a rural Level I trauma center compared the time to resuscitation interventions before (August 2018 to July 2019) and after (August 2019 to July 2020) deploying TREC nurses to trauma activations.

RESULTS:

A total of 2,593 participants were studied, of which 1,153 (44%) were in the pre-TREC group and 1,440 (56%) in the post-TREC group. After TREC deployment, the median (interquartile range [IQR]) emergency department times within the first hour decreased from 45 (31.23–53) to 35 (16–51) min (p = .013). The median (IQR) time to the operating room within the first hour decreased from 46 (37–52) to 29 (12–46) min (p = .001), and within the first 2 hr, decreased from 59 (43.8–86) to 48 (23–72) min (p = .014).

CONCLUSION:

Our study found that TREC nurse deployment improved resuscitation intervention timeliness during the first 2 hr (early phase) of trauma activations.
Patterns of progression in non-IPF fibrotic interstitial lung disease
Authors: Wells Athol U.
Published: July 2023

Purpose of review

To characterize patterns of disease progression in the designation of progressive pulmonary fibrosis (PPF), including their relative prevalence and subsequent prognostic significance, in patients with fibrotic interstitial lung disease (ILD), including key patient sub-groups.

Recent findings

In recent large clinical cohorts, PPF criteria suited to early PPF identification, based on their prevalence and short time to progression, include a relative forced vital capacity (FVC) decline exceeding 10% and various combinations of lower thresholds for FVC decline, symptomatic worsening and serial progression of fibrosis on imaging. Amongst numerous candidate PPF criteria, these progression patterns may have the greatest prognostic significance based on subsequent mortality, although there are conflicting data based on subsequent FVC progression. The prevalence of patterns of progression is similar across major diagnostic sub-groups with the striking exception of patients with underlying inflammatory myopathy.

Based on prevalence and the prognostic significance of PPF criteria, and the need for early identification of disease progression, recent published data in large clinical cohorts provide support for the use of the INBUILD PPF criteria. The patterns of disease progression used to designate PPF in a recent multinational guideline are mostly not based on data in previous and subsequent real-world cohorts.
Correlation between the parameters of quadrilateral vowel and dysphonia severity in patients with traumatic brain injury
Authors: Park Eo Jin , Yoo Seung Don
Published: July 2023

Dysarthria and dysphonia are common in patients with traumatic brain injury (TBI). Multiple factors may contribute to TBI-induced dysarthria, including poor vocalization, articulation, respiration, and/or resonance. Many patients suffer from dysarthria that persists after the onset of TBI, with negative effects on their quality of life. This study aimed to investigate the relationship between vowel quadrilateral parameters and Dysphoria Severity Index (DSI), which objectively reflects vocal function We retrospectively enrolled TBI patients diagnosed using computer tomography. Participants had dysarthria and dysphonia and underwent acoustic analysis. Praat software was used to measure vowel space area (VSA), formant centralization ratio (FCR), and the second formant (F2) ratio. For the 4 corner vowels (/a/,/u/,/i/, and/ae/), the resonance frequency of the vocal folds was measured and is shown as 2-dimensional coordinates for the formant parameters. Pear-son correlation and multiple linear regression analyses were performed between the variables. VSA showed a significant positive correlation with DSI/a/ (R = 0.221) and DSI/i/ (R = 0.026). FCR showed a significant negative correlation with DSI/u/ and DSI/i/. The F2 ratio showed a significant positive correlation with DSI/u/ and DSI/ae/. In the multiple linear regression analysis, VSA was found to be a significant predictor of DSI/a/ (β = 0.221, P = .030, R2 = 0.139). F2 ratio (β = 0.275, P = .0.015) and FCR (β = −0.218, P = .029) was a significant predictor of DSI/u/ (R2 = 0.203). FCR was a significant predictor of DSI/i/ (β = –0.260, P = .010, R2 = 0.158). F2 ratio was a significant predictor of DSI/ae/ (β = 0.254, P = .013, R2 = 0.154). Vowel quadrilateral parameters, such as VSA, FCR, and F2 ratio, may be associated with dysphonia severity in TBI patients.
Comparative efficacy and safety of glucagon-like peptide 1 receptor agonists for the treatment of type 2 diabetes: A network meta-analysis
Authors: Chen Han , Li Xin-Zhu , Chen Jia-Qing , Ren Tian-Shu , Zhang Ying-Shi , Wang Yi-Nuo , Zhao Qing-Chun
Published: July 2023

Introduction:

This study aimed to evaluate the clinical efficacy and safety of 4 weekly formulations of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on glycemic control, including glycemic control, by using a network meta-analysis (NMA).

Methods:

PubMed, EMBASE, and Cochrane Library Central Register of Controlled Trials were searched from inception until June 10, 2022. Randomized clinical trials (RCTs) enrolling participants with diabetes mellitus type 2 and a follow-up of at least 12 weeks were included, for which 4 eligible GLP-1RAs Exenatide, Dulaglutide, Semaglutide, Loxenatide were compared with either each other or placebo. The primary outcome is the change of hemoglobin A1c level. Secondary outcomes including additional glycemic control indicators and adverse events (AE). Frequentist random-effect NMA were conducted for effect comparison. This meta-analysis was registered on PROSPERO, CRD42022342241.

Results:

The NMA synthesized evidence from 12 studies covering 6213 patients and 10 GLP-1RA regimens. A pairwise comparison of glycosylated hemoglobin type A1C (HbA1c) lowering effects showed that once-weekly GLP-1 receptor agonists were significantly better than placebo, and their glucose-lowering intensity was Semaglutide 2.0mg, Semaglutide 1.0mg, Dulaglutide 4.5mg, and Semaglutide 0.5mg, Dulaglutide 3.0mg, PEX168 200ug, Dulaglutide 1.5mg, PEX168 100ug and Dulaglutide 0.75mg. The GLP-1RA regimen has a comparable safety profile for hypoglycemia. And with the exception of PEX168, all other long-acting GLP-1RA drugs had lower rates of diarrhea, nausea and vomiting than placebo.

Conclusion:

Regimens of GLP-1RAs had differential glycemic control. The efficacy and safety of Semaglutide 2.0mg in comprehensively lowering blood sugar showed the best performance.
A novel de-escalation antiplatelet therapy for patients with acute coronary syndrome undergoing percutaneous coronary intervention
Authors: Li Yachao , Lei Mengjie , Yang Yanli , An Lei , Zhou Haili , Wang Jingyao , Zhao Zhigang , Wang Xiangjin , Nie Shaoping , Wang Xiao , Hau William Kongto , Xue Zengming
Published: July 2023

To investigate the effect of different DAPTs in patients with ACS undergoing PCI, and to identify the most efficient DAPT to reduce the risk of ischemia and bleeding after PCI. Between March 2017 and December 2021, 1598 patients with ACS who underwent PCI were included in the study. The DAPT protocol included the clopidogrel group (aspirin 100 mg + clopidogrel 75 mg), ticagrelor group (aspirin 100 mg + ticagrelor 90 mg), de-escalation Group 1 (reduced dose of ticagrelor [from 90 mg to 60 mg]) after 3 months of oral DAPT [aspirin 100 mg + ticagrelor 90 mg]), and de-escalation Group 2 (switched from ticagrelor to clopidogrel after 3 months of oral DAPT [aspirin 100 mg + ticagrelor 90 mg]). All patients received a 12-month follow-up. The primary endpoint was net adverse clinical events (NACEs) that included the composite endpoints of cardiac death, myocardial infarction, ischemia-driven revascularization, stroke, and bleeding events. There were 2 secondary endpoints, major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding. No statistically significant difference was found in the incidence of NACEs between the 4 groups at the average 12-month follow-up (15.7% vs 19.2% vs 16.7% vs 20.4%). Cox regression analysis revealed that DAPT ticagrelor group regimen (hazard ratio [HR] 0.547; 95% confidence interval [CI]: 0.334–0.896; P = .017) were associated with a lower risk of MACCEs. Age (HR 1.024; 95% CI: 1.003–1.046; P = .022). DAPT de-escalation Group 2 regimen (HR 1.665; 95% CI: 1.001–2.767; P = .049) were marginally associated with a higher risk of MACCEs. Ticagrelor group regimen (HR 1.856; 95% CI: 1.376–2.504; P < .001) was associated with higher risk of bleeding events. Ticagrelor group regimen (HR 1.606; 95% CI: 1.179–2.187; P = .003) were associated with a higher risk of minor bleeding events. For patients with ACS underwent PCI, there were no significant difference in the incidence of NACEs between 3 and 12 months after PCI between de-escalation and non-de-escalation therapies. Compared with ticagrelor-based 12-month DAPT, there was no significant difference in MACCEs and bleeding events in patients receiving de-escalation treatment (ticagrelor reduction from 90 to 60 mg, 3 months after PCI).
Effect of a randomized group intervention for depression among Nigerian pre-service adult education teachers
Authors: Okeke Nkechi Mercy , Onah Beatrice N. , Ekwealor Nwakaego Ebele , Ekwueme Stella Chinweudo , Ezugwu Joy Onyinyechukwu , Edeh Esther Nwarube , Okeke Polycarp M. D. , Onwuadi Charles C. , Obeagu Emmanuel Ifeanyi
Published: July 2023

Objective:

Studies show that depression undermines the mental health of pre-service teachers. The objective of this research was to determine whether a rational emotive behavior intervention will be effective in treating depression among Nigerian pre-service adult education teachers.

Methods:

The study participants comprise 70 pre-service adult education teachers with moderate to severe depression. The treatment arm consist 35 pre-service adult education teachers, while the control arm consist 35 pre-service adult education teachers. With randomized control group design, an 8-week rational emotive behavior intervention was delivered to the treatment arm while the control arm participants were waitlisted. Hamilton Depression Rating Scale (HDRS) and Goldberg Depression Scale (GDS) were used for data collection. We utilized repeated ANOVA to analyze the study data collected at 3 time points (pretest, post-test, and follow-up).

Results:

The rational-emotive behavior intervention was significantly effective in reducing the mean depression scores of pre-service adult education teachers in the treatment arm when compared to those in the control arm (HDRS: P < .001, ηp
2 = 0.869; GDS: P < .001, ηp
2 = 0.827). The treatment intervention consistently reduced mean depression scores of the pre-service adult education teachers at follow-up compared to the control arm (HDRS: P < .000, 95% confidence interval: −24.049, −19.837, ηp
2 = 0.864; GDS: P < .001, 95% confidence interval: −37.587 to 31.213, ηp
2 = 0.872). The results also showed significant effects of Time as well as significant interaction effects of Time and Group on HDRS and GDS scores of pre-service adult education teachers.

Conclusion:

The study concludes that among pre-service adult education teachers, a rational emotive behavior therapy treatment model was significantly effective and consistent in depression treatment. It is crucial to apply this rational-emotive behavior treatment approach in depression treatment among Nigerian pre-service adult education teachers. Compliance to the REBT treatment plans and timing is very crucial in achieving desired results.
Secretory breast cancer in a boy: A case report with genetic analysis using next-generation sequencing and literature review
Authors: Deng Lili , Li Yang , Zhong Jincai
Published: July 2023

Rationale:

Male secretory breast cancer is a rare, low-grade carcinoma, especially in boys. Due to its rarity, not much is known about this disease.

Patient concerns:

A 5-year-old boy presented with a 1.4 cm painless mass in the right breast.

Diagnoses:

Ultrasonography could not distinguish whether the breast tumor was benign or malignant. After a biopsy of the lumpectomy specimen, it was diagnosed to be secretory breast carcinoma.

Interventions:

The patient underwent a modified radical mastectomy for his right breast. No postoperative chemotherapy or radiotherapy was performed. Next-generation sequencing of 211 cancer-related genes was detected, and the results revealed an ETV6-NTRK3 translocation and a PDGFRB c.2632A > G mutation. None of the most commonly altered molecules in male aggressive breast cancer (such as BRCA1-2, TP53, RAD51C, and RAD51D mutations) has been identified.

Outcomes:

The patient was still free from local recurrence or metastases at 6-month follow-up.

Lessons:

The genomic profile of male pediatric SCB is relatively simple, no other known driver genes have been found except for the ETV6-NTRK3 fusion. Our report will improve our understanding of secretory breast cancer.
Hematomyelia associated with coronavirus disease 2019: A rare case report
Authors: Zhang Lin-Ming , Zhang Huan-Bo , Fan Fu-Rong , Liu Ming-Wei
Published: July 2023

Rationale:

Coronavirus disease 2019 (COVID-19) can damage the central nervous system. Although there have been reports of cerebral hemorrhage and infarction caused by COVID-19, hematomyelia due to COVID-19 has never been reported.

Patient concerns:

A 40-year-old male was admitted to the hospital with positive nucleic acid detection for COVID-19 after experiencing fever for 2 weeks, urinary retention, fecal retention, and pain in both lower extremities for a week.

Diagnoses:

The patient diagnosis was established using thoracic and lumbar magnetic resonance imaging (MRI). Contrast-enhanced thoracic and lumbar MRI revealed subdural (dorsal predominant) short T1 and slightly long T2 bands in the T12-S2 infundibular canal in the scan field, and the subdural hematoma was yet to be distinguished from other diseases. Spinal cord edema was observed in the left vertebral plate and facet joint of the T11 vertebral body, indicative of inflammation. The cerebrospinal fluid (CSF) was positive for COVID-19 nucleic acid.

Interventions:

Antiinfection, immunomodulation, correction of acid-base balance and electrolyte disorders, improvement of circulation, nerve nutrition, and other symptomatic supportive treatments were administered to the patient.

Outcomes:

The patient symptoms significantly improved after 4 weeks of anti-infection and immunomodulatory therapy. Repeat thoracolumbar MRI revealed absorption of the spinal cord hematoma, and the patient was discharged from the hospital. To date, COVID-19-related hematomyelia has not been reported and anti-infective and immunomodulatory therapies may be effective.

Lessons:

COVID-19 not only easily leads to brain injury but can also cause spinal cord injury and even spinal cord hemorrhage. When patients with COVID-19 experience symptoms and signs of spinal cord injury, spinal cord injury and bleeding caused by COVID-19 should be considered, and MRI and lumbar puncture should be performed as soon as possible to make a clear diagnosis.
Unreliable diagnostic accuracy of laboratory risk indicator for necrotizing fasciitis (LRINEC) score but good outcome predictor in necrotizing fasciitis due to Vibrio vulnificus: A retrospective and matched-pair study
Authors: Chang Chia-Peng , Hsiao Cheng-Ting
Published: July 2023

The diagnostic accuracy of laboratory risk indicator for necrotizing fasciitis (LRINEC) score system in specific Vibrio vulnificus (V vulnificus) necrotizing fasciitis (NF) have not been fully investigated yet. This aim of our study is to validate the LRINEC score in patients with V vulnificus NF. A retrospective study of hospitalized patients was conducted in a hospital in southern Taiwan between January 2015 and December 2022. Clinical characteristics, variables and outcomes were compared among V vulnificus NF, non-Vibrio NF and cellulitis patients. A total of 260 patients were included, 40 in V vulnificus NF group, 80 in non-Vibrio NF group and 160 patients in cellulitis group. In V vulnificus NF group with an LRINEC cutoff score ≥ 6, the sensitivity was 35% (95% confidence interval [CI]: 29%–41%), specificity was 81% (95% CI: 76%–86%), PPV was 23% (95% CI: 17%–27%), and NPV was 90% (95% CI: 88%–92%). The AUROC for accuracy of the LRINEC score in V vulnificus NF was 0.614 (95% CI: 0.592–0.636). Multi-variable logistic regression analysis revealed that LRINEC > 8 was significantly associated with higher in-hospital mortality (adjusted odds ratio = 1.57; 95% CI: 1.43–2.08; P < .01). The LRINEC score may not be an accurate tool for V vulnificus NF. That should be used with caution as a routine diagnostic tool. However, LRINEC > 8 is significantly associated with higher mortality in V vulnificus NF patients.
Renal artery aneurysm induced by neurofibromatosis type 1: A case report and review of the endovascular interventions for this rare vasculopathy
Authors: AlSheikh Sultan
Published: July 2023

Rationale:

The autosomal dominant condition known as neurofibromatosis type 1 (NF-1) is characterized by café au lait macules and neurofibromatosis. Aneurysms in renal arteries are rare. Renal artery aneurysm (RAA) can be successfully treated with endovascular procedures; however, successful cases in NF-1 adults have not been reported.

Patient concerns:

Here, we report the case of a 30-year-old female suffering from NF-1. The patient presented to the emergency department with complaints of chronic, poorly controlled hypertension. A left RAA was found om the computed tomography angiography (CTA).

Diagnoses:

A left renal artery aneurysm was diagnosed using CTA during workup for secondary hypertension.

Interventions:

Selective angiographym of the left renal artery confirmed a fusiform aneurysm of the distal renal artery. A self-expandable covered stent was placed, and a completion angiogram demonstrated good aneurysm sealing and contrast flow to the left kidney.

Outcomes:

The patient’s blood pressure improved after the procedure. Her medications were lowered to almost half of their baseline doses, and hydralazine was discontinued. On the follow-up visit after 4 months, the patient reported his home-measured systolic blood pressure to be less than 120 mm Hg. A repeated CTA of the abdomen showed post-left RAA repair with a covered stent and interval improvement of the left kidney.

Lessons:

RAA caused by NF-1 are manageable and feasible with endovascular intervention.
A case report of Ovarian hyperstimulation syndrome and corpus luteum rupture in twin pregnancies with IVF-ET
Authors: Luo Yunliao , Shen Huajuan , Li Hongjing , Tan Zongjian , Chen Chaojun , Chen Weiming , He Jun
Published: July 2023

Introduction:

Ovarian hyperstimulation syndrome (OHSS) is a common complication during assisted conception treatment, mostly seen in patients with ovarian hyperresponsiveness such as polycystic ovary syndrome, especially in post-invitro fertilization and embryo transfer (IVF-ET) pregnancies. Its main symptoms are abdominal distension, abdominal pain, nausea and vomiting with ascites, pleural fluid, leukocytosis, hemoconcentration and hypercoagulation. This disease is a self-limiting disease and can be gradually cured by rehydration, albumin infusion and correction of electrolyte disorders in moderate to severe cases. Luteal rupture is a more common gynecological emergency abdomen. The combination of twin pregnancy, OHSS and ruptured corpus luteum is very rare. We successfully avoided the stimulation of the risk of pregnancy abortion by surgical exploration through dynamic ultrasound monitoring and vital signs observation in the absence of experience in primary care, and the patient hard-won twin pregnancy was successfully treated conservatively.

Patient concerns:

The patient is a 30-year-old post-IVF-ET woman with an established twin pregnancy, OHSS and sudden onset of lower abdominal pain.

Diagnosis:

Twin pregnancy, OHSS combined with ruptured corpus luteum.

Interventions:

Rehydration, albumin infusion, low molecular heparin for thromboprophylaxis, luteinizing support, ambulatory ultrasound monitoring.

Outcomes:

After more than 10 days of standardized treatment for OHSS, dynamic ultrasound monitoring and close observation of vital signs, the patient was discharged cured of her condition and is continuing her pregnancy.

Conclusion:

Our case shows that the possibility of acute abdominal rupture of the corpus luteum is still present in the case of combined OHSS in pregnancy, and that some patients with corpus luteum rupture can heal spontaneously during close testing to avoid the increased risk of miscarriage with surgical exploration.
Quantitative chest CT imaging characteristics and outcome of patients with COVID-19 associated pulmonary artery thrombosis: A single-center retrospective cohort study
Authors: Niculae Cristian-Mihail , Hristea Adriana , Albulescu Andreea Simona , Petre Vladimir Bogdan , Anghel Ana-Maria-Jennifer , Damalan Anca-Cristina , Bel Adela-Abigaela , Lazar Mihai
Published: July 2023

Coronavirus disease 2019 (COVID-19)-associated pulmonary thrombotic events occur frequently and are associated with disease severity and worse clinical outcomes. We aimed to describe the clinical and quantitative chest computed tomography (CT) imaging characteristics based on density ranges (Hounsfield units) and the outcomes of patients with COVID-19 associated pulmonary artery thrombosis. This retrospective cohort study included all patients with COVID-19 hospitalized in a tertiary care hospital between March 2020 and June 2022 who underwent a CT pulmonary angiography. We included 73 patients: 36 (49.3%) with and 37 (50.7%) without pulmonary artery thrombosis. The in-hospital all-cause mortality was 22.2 versus 18.9% (P = .7), and the intensive care unit admission rates were 30.5 versus 8.1% (P = .01) at the time of diagnosis of pulmonary artery thrombosis. Except for D-dimers (median of 3142 vs 533, P = .002), the other clinical, coagulopathy, and inflammatory markers were similar. Logistic regression analysis revealed that only D-dimers were associated with pulmonary artery thrombosis (P = .012). ROC curve analysis of D-dimers showed that a value greater than 1716 ng/mL predicted pulmonary artery thrombosis with an area under the curve of 0.779, 72.2% sensitivity, and 73% specificity (95% CI 0.672–0.885). Peripheral distribution of pulmonary artery thrombosis was recorded in 94.5% of cases. In the lower lobes of the lungs, the incidence of pulmonary artery thrombosis was 6 times higher than that in the upper lobes (58–64%), with a percentage of lung injury of 80% to 90%. Analysis of the distribution of arterial branches with filling defects revealed that 91.6% occurred in lung areas with inflammatory lesions. Quantitative chest CT imaging provides valuable information regarding the extent of COVID-19 associated lung damage and can be used to anticipate the co-location of pulmonary immunothrombotic events. In patients with severe COVID-19, in-hospital all-cause mortality was similar regardless of the presence of associated distal pulmonary thrombosis.
Female exposed to the Chinese famine increases the risk of dyslipidemia in later life
Authors: Xiong Huali , Liu Daiqiang , Tang Dayi , Ma Fengxun
Published: July 2023

The Developmental Origins of Health and Disease theory suggests that early-life malnutrition is associated with an increased risk of chronic disease in adulthood. In this study, we aimed to analyze the association between exposure to the Chinese famine during fetal, childhood, and adolescence, while also exploring potential gender disparities in this association.

From August 2018 to 2022 December, a 3-stage stratified random sampling method was employed to recruit 6916 eligible participants in Chongqing for this study. The participants were enrolled into 4 cohorts based on their birthdates: non-exposed, fetal-exposed, childhood-exposed, and adolescence-exposed. Participants were defined as having dyslipidemia according to the 2016 Chinese guideline for the management of dyslipidemia in adults, as well as self-reported dyslipidemia. In total, 6916 eligible participants were interviewed, including 1686 participants exposed when fetal, 1626 participants exposed during childhood, 1648 participants exposed during adolescence, and 1956 participants who had no exposure.

The prevalence of dyslipidemia in the non-exposed, fetal-exposed, childhood-exposed, and adolescence-exposed cohorts was 21.43%, 25.00%, 24.38%, 22.52% in males and 20.00%, 36.57%, 34.60%, 32.59% in females, respectively. There was an increased risk of dyslipidemia among females exposed to the Chinese famine during the fetal (odds ratio [OR] = 1.613, 95% confidence interval [CI]: 1.179–2.205), childhood (OR = 1.857, 95% CI: 1.384–2.491), adolescence (OR = 1.531, 95% CI: 1.137–2.060) stage, However, no significant association was observed in male adults.

Exposure to the Chinese famine during fetal, childhood, and adolescence stages increases the risk of dyslipidemia in adulthood in females, but not in males. The observed gender differences may be attributed to mortality advantage and son preference in China.
The effect on vital signs of concomitant administration of nicardipine and dexmedetomidine sedation after spinal anesthesia: A double-blind, randomized controlled trial
Authors: Lee Sangho , Ahn Ye Na , Lee Junbum , Kwon SoonOh , Kang Hee Yong
Published: July 2023

Background:

We evaluated heart rate (HR) and blood pressure (BP) trends when nicardipine (NCD) was co-administered during dexmedetomidine (DEX) sedation after spinal anesthesia.

Methods:

Sixty patients aged 19 to 65 were randomly assigned to the DEX or DEX-NCD groups. Five minutes after infusion of the loading dose of DEX, the NCD was administered intravenously at a rate of 5 μg/kg for 5 minutes in the DEX-NCD group. The study starting point was set at 0 minute when the DEX loading dose was initiated. The primary outcomes were the differences in HR and BP between the 2 groups during the study drug administration. Secondary outcomes included the number of patients whose HR was < 50 beats per minute (bpm) after the DEX loading dose infusion, and associated factors were evaluated. The incidence of hypotension in the postanesthesia care unit, postanesthesia care unit length of stay, postoperative nausea and vomiting, postoperative urinary retention, time to first urination after spinal anesthesia, acute kidney injury, and postoperative hospital length of stay were evaluated.

Results:

The HR was significantly higher at 14 minutes, and the mean BP was significantly lower at 10 minutes in the DEX-NCD group than in the DEX group. The number of patients with an HR < 50 bpm during surgery was significantly higher in the DEX group than in the DEX-NCD group at 12, 16, 24, 26, and 30 minutes. The DEX group and a low initial HR were independently associated with the occurrence of an HR < 50 bpm after DEX loading dose infusion. Postoperative outcomes were not significantly different between the 2 groups.

Conclusions:

Simultaneous administration of NCD during the administration of a loading dose of DEX prevented severe bradycardia. Co-administration of NCD may be considered in patients with a low initial HR when severe bradycardia is expected during the DEX loading dose infusion. NCD and DEX may be safely infused simultaneously without affecting postoperative complications (see Figure S1, Supplemental Digital Content, http://links.lww.com/MD/J241, Graphical abstract).
Fistula formation into other organs secondary to intraductal papillary mucinous neoplasm of the pancreas: A case report and literature review
Authors: Shishido Yutaka , Mitsuoka Eisei , Ito Rieko , Ishii Masayuki , Fujimoto Koji
Published: July 2023

Introduction:

Fistula formation from intraductal papillary mucinous neoplasm (IPMN) of the pancreas is uncommon; however, IPMN penetrating various organs has been increasingly reported. To date, there is a lack of literature reviewing recent reports and the clinicopathologic details of IPMN with fistula formation are still poorly understood.

Methods:

This study describes the case of a 60-year-old woman presenting with postprandial epigastric pain and diagnosed with main-duct (MD) IPMN penetrating to the duodenum, and presents comprehensive literature review of IPMN with fistulae. A literature review was performed using PubMed for all articles in English using predetermined search terms, including (fistula or fistulization), (pancreas or pancreatic or pancreato or pacreatico), (intraductal papillary mucinous), and (neoplasm or tumor or carcinoma or cancer).

Results:

A total of 83 cases and 119 organs were identified in 54 articles. Affected organs were as follows: the stomach (34%), duodenum (30%), bile duct (25%), colon (5%), small intestine (3%), spleen (2%), portal vein (1%), and chest wall (1%). Fistula formation into multiple organs was detected in 35% of cases. Approximately one-third of the cases had tumor invasion around the fistula. MD and mixed type IPMN accounted for 82% of cases. IPMN with high-grade dysplasia or invasive carcinoma were over three times more common than IPMN without these components.

Discussion and conclusion:

Based on the pathological examination of the surgical specimen, this case was diagnosed of MD-IPMN with invasive carcinoma and mechanical penetration or autodigestion was considered as the mechanism of fistula formation. Given the high risk of malignant transformation and intraductal dissemination of the tumor cells, aggressive surgical strategies, such as total pancreatectomy, should be recommended to achieve complete resection for MD-IPMN with fistula formation.
Association between chromosome 6p21 translocation and asthenozoospermia: A retrospective, observational study
Authors: Zhang Yi , Zhan Peng , Wang Yanli , Tian Wenjie , Yang Xiao , Wang Xu
Published: July 2023

Asthenozoospermia (AZS) is the commonest cause of male-related infertility. The patients with AZS easily exhibit infertility, with their wives having spontaneous miscarriages or seeking assisted reproductive treatment. Reciprocal chromosomal translocation (RCT) is an important chromosome structural abnormality and has been reported to affect sperm motility. Genetic counseling for male RCT patients with AZS is still a challenge. This study reported 4 RCT carriers, which were 46,XY,t(1;6) (p36.1;p21), 46,XY,t (6;10) (p21;q11.2), 46,XY,t (6;11) (p21;p15), and 46,XY,t (6;17) (p21;q21), respectively. The association between chromosome 6p21 translocation and AZS is discussed, considering 19 published cases as well. In 6 patients with available semen parameters and 4 patients in this study, all of them were diagnosed with AZS. The SLC26A8 gene and the DNAH8 gene located on chromosome 6p21 are closely related to AZS by gene search using OMIM. For the chromosome 6p21 breakpoint, 72 pathogenic genes were found through the DECIPHER search. Gene ontology analysis showed that these target genes have several molecular functions and are strongly involved in various biological processes. The proteins expressed by these genes are involved in multiple cellular components. These results suggest that the breakpoint of chromosome 6p21 in male RCT carriers is closely related to AZS. The breakpoint may disrupt the structure and function of related genes, resulting in reduced sperm motility. Karyotype analysis should be recommended for AZS patients. Chromosomes and breakpoints involved in RCT should be paid attention to in genetic counseling for patients.
Cross-cultural adaptation and validation of simplified Chinese version of the Waddell Disability Index for patients with nonspecific low back pain in Mainland China
Authors: Cheng Xingdong , Xue Rong
Published: July 2023

The current study aimed to translate the Waddell Disability Index (WDI) in a cross-cultural fashion, and evaluate the reliability and validity of the adapted simplified Chinese version (SC-WDI) for patients with nonspecific low back pain (LBP). The cross-cultural adaptation of the SC-WDI was conducted following international guidelines. The reliability and validity of the SC-WDI was assessed in a prospective observational study. The test–retest reliability was assessed by comparing the results of the first and final SC-WDI scales, 3 days interval. The discriminative, concurrent, and construct validity of the cross-cultural adapted questionnaire was evaluated. The relationship between the SC-WDI with SC-Oswestry Disability Index, SC-Roland-Morris Disability Questionnaire and visual analogue scale was assessed using the correlation coefficients. SPSS 18.0 (Chicago, IL) was used for statistical analysis. Two hundred eighty patients with LBP were included in current study. The mean age of participants was 48.4 years (range 25–82), and the mean disease duration was 1.3 years (range 0.5–24). The mean BMI was 24.6 ± 2.2. No floor or ceiling effects were noted for the SC-WDI. Cronbach’s α for the total scale of was excellent with the value of 0.821. The intraclass correlation coefficient values of total SC-WDI was 0.74, which reflected a satisfactory test–retest reliability. SC-WDI had a good discriminative validity. It also indicated that the SC-WDI had a good concurrent criterion validity (R = 0.681, 0.704, and 0.615, respectively) and construct validity with SC-Oswestry Disability Index, SC-Roland-Morris Disability Questionnaire, and visual analogue scale (all P values of < .0001). The SC-WDI demonstrated a good acceptability, score distribution, internal consistency, test–retest reliability and validity. It has high sensitivity in evaluating the HRQOL. Therefore, it is was considered as a satisfactory tool for evaluating HRQOL of Chinese patients with LBP.
An update: maternal iodine supplementation, thyroid function tests, and child neurodevelopmental outcomes
Authors: Nguyen Caroline T.
Published: July 2023

Purpose of review

The impact of maternal iodine supplementation (MIS) during pregnancy on thyroid function and child neurodevelopmental outcomes in areas of mild-to-moderate iodine deficiency (MMID) remains unclear.

Recent findings

Despite growing success of salt iodization programs, a 2022 meta-analysis found that 53% of pregnant patients worldwide continue to have insufficient iodine intake during pregnancy. A 2021 randomized controlled trial (RCT) found that MIS in women with mild iodine deficiency led to iodine sufficiency and positive effects on maternal thyroglobulin. A 2021 cohort study of MIS initiated prior to pregnancy was associated with lower thyroid-stimulating hormone (TSH), higher FT3, and FT4. Other cohort studies, however, found that neither salt iodization nor MIS were adequate to meet pregnancy iodine needs. Data have been mixed regarding maternal iodine status and pregnancy outcomes in patients of MMID. Meta-analyses have not shown any clear benefit on infant neurocognitive outcomes with MIS of MMID patients. A 2023 meta-analysis found that the prevalence of excess iodine intake in pregnancy was 52%.

MMID continues to exist during pregnancy. Salt iodization alone may be insufficient to ensure adequate iodine status during pregnancy. There is an absence of high-quality data to support routine MIS in areas of MMID. However, patients with specialized diets (vegan, nondairy, no seafood, noniodized salt, and so on) may be at risk for inadequate iodine status in pregnancy. Excess iodine intake can be detrimental to the fetus and should be avoided during pregnancy.
Association between depressive symptoms and heart rate variability in older patients admitted for rehabilitation: a cross-sectional study
Authors: Owari Go , Kono Kenichi , Kanouchi Daiki , Uchiyama Masayoshi , Nishida Yusuke
Published: July 2023

Heart rate variability (HRV) is associated with depressive symptoms, but this relationship in older inpatients undergoing rehabilitation remains unclear. This study investigated the relationship between HRV and depressive symptoms in older inpatients undergoing rehabilitation. Fifty patients aged ≥65 years were assessed for depressive symptoms using the Geriatric Depression Scale. HRV was assessed by frequency analysis. The relationship between depressive symptoms and HRV indices, age, sex, Short Physical Performance Battery (SPPB) score, Mini-Mental State Examination score was examined using simple linear regression. Next, the predictors from the simple linear regression analysis significant at the 0.15 level were inputted in a multiple regression model. Multiple regression analysis revealed that very low frequency HRV [β = −2.13, 95% confidence interval (CI) −3.15 to −1.11, P < 0.05] and SPPB score (β = −0.30, 95% CI −0.52 to −0.08, P < 0.05) were negatively associated with depressive symptoms: the lower the HRV and the more severe the mobility impairment, the higher the severity of the depressive symptoms. Very low frequency (VLF) HRV and physical performance, as measured by the SPPB score, were associated with depressive symptoms in older patients undergoing rehabilitation. VLF HRV may serve as a useful biomarker for detecting depressive symptoms in this population.
Respiratory Assessment
Authors: Wodwaski Nadine , Webber Elaine
Published: July 2023

Respiratory illnesses often require acute care admissions and are a leading cause of death globally, thus creating a financial burden for healthcare systems. Home healthcare clinicians can significantly reduce morbidity and hospital readmissions by becoming proficient at respiratory assessment. This article aims to assist homecare clinicians in performing a respiratory assessment in a logical and structured approach, including inspection, palpation, percussion, and auscultation. This article reviews the anatomy and physiology of the respiratory system and describes subjective and objective respiratory assessment. It is anticipated that becoming adept at these skills will enable home healthcare clinician to assess and identify those patients at risk for deterioration and readmission.
A Case of Rectal Dissemination of Gastric Cancer Diagnosed by Simultaneous 18F-FDG PET/MRI
Authors: Zeng Feiya , Zeng Feibi , Sugiyama Naoki , Nogami Munenobu , Murakami Takamichi
Published: July 2023

Metastatic rectal cancer is rare and difficult to differentiate from primary rectal cancer. A 79-year-old man with a rectal mass detected by CT during postoperative follow-up of gastric cancer underwent 18F-FDG PET/MRI. Fused PET/MRI images revealed a lower FDG uptake within the mass, which appeared to surround the outside of the rectum, than in the rectal wall, suggesting rectal dissemination of gastric cancer. PET/MRI was useful for differentiating between mass and rectal wall uptake, because of the high contrast resolution of MRI and precise image fusion made possible by simultaneous image acquisition.
Pedicled Forearm Fasciocutaneous Flap for Tracheal Reconstruction: Anomalous Radial Vasculature Preventing Free-Flap
Authors: Meyer Charles , McLean James , Higley Thomas , Holcomb Andrew J. , Militsakh Oleg , Osmolak Angela
Published: July 2023

A 61-year-old female presented with poorly differentiated thyroid carcinoma with anterior tracheal wall invasion. Following resection, the patient was to undergo anterior tracheal wall reconstruction with a radial forearm fasciocutaneous free flap and costal cartilage grafts. However, intraoperative identification of a “brachioradial artery” was identified with the deep radial and ulnar arteries completely separated from the radial artery. To maximize the chance for flap success, the fasciocutaneous flap was converted to a pedicled rotational flap with excellent results. This is the first pedicled radial forearm fasciocutaneous flap for composite reconstruction of the anterior trachea.
Decolonizing drug-resistant E. coli with phage and probiotics: breaking the frequency-dependent dominance of residents
Authors: Forsyth Jessica H. , Barron Natalie L. , Scott Lucy , Watson Bridget N. J. , Chisnall Matthew A. W. , Meaden Sean , van Houte Stineke , Raymond Ben
Published: July 2023

Widespread antibiotic resistance in commensal bacteria creates a persistent challenge for human health. Resident drug-resistant microbes can prevent clinical interventions, colonize wounds post-surgery, pass resistance traits to pathogens or move to more harmful niches following routine interventions such as catheterization. Accelerating the removal of resistant bacteria or actively decolonizing particular lineages from hosts could therefore have a number of long-term benefits. However, removing resident bacteria via competition with probiotics, for example, poses a number of ecological challenges. Resident microbes are likely to have physiological and numerical advantages and competition based on bacteriocins or other secreted antagonists is expected to give advantages to the dominant partner, via positive frequency dependence. Since a narrow range of

Escherichia coli

genotypes (primarily those belonging to the clonal group ST131) cause a significant proportion of multidrug-resistant infections, this group presents a promising target for decolonization with bacteriophage, as narrow-host-range viral predation could lead to selective removal of particular genotypes. In this study we tested how a combination of an ST131-specific phage and competition from the well-known probiotic

E. coli

Nissle strain could displace

E. coli

ST131 under aerobic and anaerobic growth conditions in vitro. We showed that the addition of phage was able to break the frequency-dependent advantage of a numerically dominant ST131 isolate. Moreover, the addition of competing

E. coli

Nissle could improve the ability of phage to suppress ST131 by two orders of magnitude. Low-cost phage resistance evolved readily in these experiments and was not inhibited by the presence of a probiotic competitor. Nevertheless, combinations of phage and probiotic produced stable long-term suppression of ST131 over multiple transfers and under both aerobic and anaerobic growth conditions. Combinations of phage and probiotic therefore have real potential for accelerating the removal of drug-resistant commensal targets.
Immunogenicity and safety of heterologous Omicron BA.1 and bivalent SARS-CoV-2 recombinant spike protein booster vaccines: a phase 3, randomized, clinical trial
Authors: Bennett Chijioke , Rivers E Joy , Woo Wayne , Bloch Mark , Cheung King , Griffin Paul , Mohan Rahul , Deshmukh Sachin , Arya Mark , Cumming Oscar , Neville A. Munro , Pardey Toni McCallum , Plested Joyce S , Cloney-Clark Shane , Zhu Mingzhu , Kalkeri Raj , Patel Nita , Buchanan Agi , Marcheschi Alex , Swan Jennifer , Smith Gale , Cho Iksung , Glenn Gregory M. , Walker Robert , Mallory Raburn M.
Published: July 2023

Background

Mutations present in emerging SARS-CoV-2 variants permit evasion of neutralization with prototype vaccines. A novel Omicron BA.1 subvariant-specific vaccine (NVX-CoV2515) was tested alone, or as a bivalent preparation in combination with the prototype vaccine (NVX-CoV2373), to assess antibody responses to SARS-CoV-2.

Methods

Participants aged 18 to 64 years immunized with 3 doses of prototype mRNA vaccines were randomized 1:1:1 to receive a single dose of NVX-CoV2515, NVX-CoV2373, or bivalent mixture in a phase 3 study investigating heterologous boosting with SARS-CoV-2 recombinant spike protein vaccines. Immunogenicity was measured 14 and 28 days after vaccination for the SARS-CoV-2 Omicron BA.1 sublineage and ancestral strain. Safety profiles of vaccines were assessed.

Results

Of participants who received trial vaccine (N=829), those administered NVX-CoV2515 (n=286) demonstrated superior neutralizing antibody response to BA.1 versus NVX-CoV2373 (n=274) at Day 14 (geometric mean titer ratio [95% CI]: 1.6 [1.33, 2.03]). Seroresponse rates [n/N; 95% CI] were 73.4% [91/124; 64.7, 80.9] for NVX-CoV2515 versus 50.9% [59/116; 41.4, 60.3] for NVX-CoV2373. All formulations were similarly well-tolerated.

Conclusions

NVX-CoV2515 elicited a superior neutralizing antibody response against the Omicron BA.1 subvariant compared with NVX-CoV2373 when administered as a fourth dose. Safety data were consistent with the established safety profile of NVX-CoV2373.
Validation of a HIV Whole Genome Sequencing Method for HIV Drug Resistance Testing in an Australian Clinical Microbiology Laboratory
Authors: Jenkins Frances , Le Thomas , Farhat Rima , Pinto Angie , Anzari M Azim , Bonsall David , Golubchik Tanya , Bowden Rory , Lee Frederick J , Van Hal Sebastiaan
Published: July 2023

Detection of HIV drug resistance is vital to successful anti-retroviral therapy (ART). HIV drug resistance (HIVDR) testing to determine drug resistance mutations (DRMs) is routinely performed in Australia to guide ART choice in either newly diagnosed people living with HIV or in cases of treatment failure. In 2022, our Australian clinical microbiology laboratory sought to validate a Next-generation sequencing (NGS)-based HIVDR assay to replace the previous Sanger sequencing (SS)-based ViroSeq assay. NGS solutions for HIVDR offer higher throughput, lower costs and higher sensitivity for variant detection. We sought to validate the previously described low-cost probe-based NGS method (veSEQ-HIV) for HIV-1 recovery and HIVDR testing in a diagnostic setting. The implemented veSEQ-HIV assay displayed 100% and 98% accuracy in major and minor mutation detection respectively and 100% accuracy of subtyping (provided >1000 mapped reads were obtained). Pairwise comparison exhibited low inter-and intra-run variability across the whole genome (Jaccard similarity coefficient [J] =0.993; J=0.972) and limited to the Pol gene only (J=0.999; J=0.999) respectively. The veSEQ-HIV assay met all our pre-set criteria based on the WHO “Recommended methods for validating an in-house genotyping assay for surveillance of HIV drug resistance” and has successfully replaced the ViroSeq assay in our laboratory.Scaling-down the veSEQ-HIV assay to a limited batch size and sequencing on the Illumina iSeq100, allowed easy implementation of the assay into the workflow of a small sequencing laboratory with minimal staff and equipment and the ability to meet clinically relevant test turn-around times.
Generalization Challenges in ECG Deep Learning: Insights from Dataset Characteristics and Attention Mechanism
Authors: Huang Zhaojing , MacLachlan Sarisha , Yu Leping , Herbozo Contreras Luis Fernando , Truong Nhan Duy , Ribeiro Antônio Horta , Kavehei Omid
Published: July 2023

This research investigates the influence of dataset characteristics on the performance and generalization capabilities of deep learning models, on ECG data. The study evaluates multiple subsets of the TNMG dataset with varying levels of curated characteristics to assess their impact on model performance. Additionally, an attention mechanism is introduced to enhance model accuracy and generalization. The experimental results reveal that models trained on balanced subsets and incorporating the attention mechanism consistently outperform those trained on unbalanced data or without attention, emphasizing the critical importance of dataset balance and attention mechanism for achieving improved model performance.

Surprisingly, the largest ECG dataset, TNMG, proved less effective in generalization than smaller, curated subsets. The study demonstrates that a well-balanced and thoughtfully curated dataset, combined with the attention mechanism, can lead to competitive model performance, even with a significantly smaller size.

This research on ECG data underscores the critical importance of dataset curation, balance, and attention mechanisms in biomedical machine learning. It highlights that well-balanced, thoughtfully curated datasets with attention mechanisms can outperform larger, unbalanced datasets, challenging conventional notions and offering potential advancements in medical data analysis and patient care.