bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Impairment of the Blood-Spinal Cord Barrier in Patients With Post-Traumatic Syringomyelia and its Effect on Prognosis
Authors: Yuan Chenghua , Xia Pingchuan , Duan Wanru , Wang Jiachen , Guan Jian , Du Yueqi , Zhang Can , Liu Zhenlei , Wang Kai , Wang Zuowei , Wang Xingwen , Wu Hao , Chen Zan , Jian Fengzeng
Published: November 2023

Study Design.

Cohort study.

Objective.

The aim of this study was to explore the association between blood-spinal cord barrier (BSCB) markers and other factors associated with an unfavorable outcome among patients with post-traumatic syringomyelia (PTS) who achieved successful intradural adhesion lysis (IAL).

Summary of Background Data.

Only approximately half of PTS patients receiving IAL have a favorable outcome.

Patients and Methods.

Forty-six consecutive patients with PTS and 19 controls (CTRL) were enrolled. All PTS patients underwent physical and neurological examinations and spinal magnetic resonance imaging before and 3 to 12 months after IAL. All patients underwent myelography before surgery. BSCB disruption was detected by increased intrathecal and serum concentrations of albumin, immunoglobulin (Ig)G, IgA, and IgM. A multivariable analysis was performed with a logistic regression model to identify factors associated with unfavorable outcomes. Receiver operating characteristic curves were calculated to investigate the diagnostic value of biomarkers.

Results.

The ages and general health of the PTS and CTRL groups did not differ significantly. QAlb, IGAQ, IGGQ, and IGMQ was significantly higher in PTS patients than in controls (P=<0.001). The degree of intradural adhesion was significantly higher in the unfavorable outcome group than in the favorable outcome group (P<0.0001). QAlb, immunoglobulin (Ig)AQ, IGGQ, and IGMQ was significantly correlated with clinical status (R=−0.38, P<0.01; R=−0.47, P=0.03; R=−0.56, P=0.01; R=−0.43, P=0.05, respectively). Higher QAlb before surgery (odds ratio=2.66; 95% CI: 1.134–6.248) was significantly associated with an unfavorable outcome. The receiver operating characteristic curve analysis demonstrated a cutoff for QAlb higher than 10.62 with a specificity of 100% and sensitivity of 96.3%.

Conclusion.

This study is the first to detect increased permeability and BSCB disruption in PTS patients. QAlb>10.62 was significantly associated with unfavorable clinical outcomes following intradural decompression.

Level of Evidence.

Level III—prognostic.
Physician–hospital alignment
Authors: Brinsfield Chad T. , Priore Richard J. , Wehbi Nizar K.
Published: November 2023

The alignment of physicians’ interests with those of their hospital has garnered considerable interest in recent years, in part because of their central role in health care expenditure and patient outcomes. However, the systematic study of physician–hospital alignment is currently impeded by a lack of construct clarity. This is evidenced by research that conflates the actions intended to create alignment with alignment itself. It is also evidenced by a variety of different definitions, conceptualizations, and measures in the literature, most of which are confounded with constructs that are something other than alignment (e.g., commitment, trust).

Critical Theoretical Analysis

We draw on agency theory and person–organization fit to define physician–hospital alignment as a physician’s perception that their financial incentives, goals, and values and those of their hospital are mutually supporting and reinforcing rather than in conflict with one another.

Advance

To better understand the nature of the construct and to help guide future research, we present an integrative framework grounded in physicians’ perceptions.

Practice Implication

Our definition and framework set the stage for improved construct validation and more systematic study and management of physician–hospital alignment.
System justification theory as a foundation for understanding relations among toxic health care workplaces, bullying, and psychological safety
Authors: Porter Tracy H. , Rathert Cheryl , Ishqaidef Ghadir , Simmons Derick R.
Published: November 2023

Background

Toxic work environments and bullying are rampant in health care organizations. The Joint Commission asserted that bullying is a threat to patient safety, and furthermore, it implied that bullying affects clinician psychological safety. However, after decades of trying to reduce bullying, it persists.

Purpose

The purpose of this study was to determine if system justification (SJ) theory can help explain the persistence of bullying in health care organizations. SJ theory posits that people are motivated to justify the systems with which they are embedded, even if those systems are dysfunctional or unfair.

Method

A cross-sectional survey of health care workers (n = 302) was used to test a moderated mediation model to examine relations between instrumental work climate perceptions and psychological safety, as mediated by SJ and moderated by experiences of workplace bullying.

Results

Analysis revealed that SJ fully mediated negative relations between instrumental climate and psychological safety; because of SJ the instrumental climate no longer had a direct negative association with psychological safety. Furthermore, bullying was found to play a moderating role in the instrumental climate–SJ relationship.

Conclusion

This study found some support for the role of SJ in perpetuating instrumental workplaces and workplace bullying in health care.

Practice Implications

Some scholars have proposed that a focus on disrupting workplace contexts that trigger SJ in workers could help break patterns of behavior that enable toxic work environments and bullying to persist.
Pay practices and safety organizing
Authors: Conroy Samantha A. , Vogus Timothy J.
Published: November 2023

Background

Our understanding of how highly reliable care delivery is brought about remains elusive, in part, because there is limited evidence regarding the organizational practices that enable safety organizing—the behaviors and processes underlying high reliability.

Purpose

Because safety organizing relies on discretionary effort and lowering barriers to sharing expertise and discussing threats to safety and errors, we investigate three pay practices and their effects on information sharing and, in turn, safety organizing. Specifically, we examine average pay level, minimum pay rates, and pay dispersion on nursing units and their relationship with information sharing and safety organizing.

Method

Cross-sectional analyses of survey data from 1,461 registered nurses in 45 nursing units in three Midwestern hospitals on safety organizing linked to administrative data on pay practices from the organization’s human resource systems. Pay data and survey responses were aggregated to the nursing unit level. PROCESS and structural equation modeling were used to simultaneously test for direct and indirect effects of pay variables on information sharing and safety organizing.

Results

PROCESS and Mplus path analysis indicated that paying a higher minimum rate in the unit and having lower pay dispersion have indirect, desirable associations with safety organizing through information sharing.

Conclusion

Pay practices can help organizations enhance safety organizing. In particular, higher pay rates for the lowest level nurses and lower pay dispersion among nurses are associated with unit-level information sharing and safety organizing.

Practice Implications

Having pay practices associated with lower within-unit variation and higher pay for the lowest paid members of a unit may be viable strategies for greater information sharing and safety organizing.
Impact of Symblepharon Management With Ocular Surface Reconstruction on Scleral Lens Fitting in Eyes With Chronic Cicatrizing Conjunctivitis and Keratopathy
Authors: Chaudhary Simmy , Kate Anahita , Basu Sayan , Shanbhag Swapna S.
Published: November 2023

Purpose:

The aim of this study was to describe the importance of symblepharon release with ocular surface reconstruction (OSR) for optimal fitting of scleral contact lenses (SCLs) in eyes with chronic cicatrizing conjunctivitis (CCC) and keratopathy.

Methods:

This retrospective study included 32 eyes with CCC and keratopathy with symblepharon which underwent symblepharon release with OSR and were fitted with SCLs. The primary outcome measure was the improvement in best-corrected visual acuity with SCL wear.

Results:

A total of 32 eyes of 29 patients (66% men) with a median age of 30.5 years were included. The common causes of CCC were Stevens–Johnson syndrome (66%) and ocular burns (16%). The most common location of symblepharon was superior (59%) with limbal involvement in most eyes (94%). Symblepharon release was combined with mucous membrane grafting (63%), amniotic membrane grafting (31%), or conjunctival autografting (6%). The median interval between symblepharon release with OSR and SCL trial was 15 weeks [interquartile range (IQR): 6–24]. The median best-corrected visual acuity improved from logMAR 1.5 (IQR: 1.2–1.8) to logMAR 1.2 (IQR: 0.6–1.4) with SCLs after symblepharon release with OSR (P < 0.001). The median diameter of the SCL used was 15 mm (IQR: 15–16), with a median base curve of 7.9 mm (IQR: 7.9–8). Symblepharon recurrence was noted in 70% of eyes that underwent amniotic membrane grafting; no recurrence was seen with mucous membrane grafting or conjunctival autografting.

Conclusions:

In eyes with CCC with keratopathy and symblepharon, visual rehabilitation is possible with SCLs after symblepharon release with OSR without having to resort to a penetrating corneal procedure.
A case report of huge pancreas mucinous cystic neoplasm during pregnancy: How doctors think
Authors: Wang Lidan , Zhu Ling
Published: November 2023

Rationale:

Pancreas mucinous cystic neoplasm (PMCN) is uncommon, and its occurrence during pregnancy is rare. The management of PMCN during pregnancy, including diagnosis and surgical timing, is a great challenge.

Patient Concerns:

A nontender epigastric mass of the upper abdomen was detected by palpation in a 35-year-old woman, gravida 2, para 1, during the 36th week of gestation. She was referred to our institution for further evaluation.

Diagnoses:

Magnetic resonance imaging (MRI) showed a multilocular cystic mass in the body and tail of the pancreas (16.7/12.1/17.6 cm), well-circumscribed with a hyper signal on T2-weighted MRI images. The diagnosis of a pancreatic cyst, probable mucinous, was established.

Interventions:

The patient was informed of the possibilities of malignancy, rapid growth, and rupture of the tumor. After a laparotomy and cesarean section, a large cystic tumor was discovered adherent to the pancreas, spleen, mesocolon, and retroperitoneum. The spleen was preserved since there was no evidence of invasion. According to macroscopic examinations, the tumor measured 18 cm was filled with a dark yellow-brownish mucinous fluid and did not appear to communicate with the pancreatic ducts.

Outcomes:

After six months of follow-up, there were no signs of recurrence in the patient.

Lessons:

PMCN may need to be surgically resected in cases characterized by malignancy risk during pregnancy. As female sex hormones may influence the behavior of PMCN during pregnancy, surgical timing should be determined based on the stage of pregnancy, malignancy status, and condition of the mother and fetus.
Twin pregnancy with incomplete hydatidiform mole and coexistent normal live fetus: A case report and review of the literature
Authors: Mora-Palazuelos Carlos Ernesto , Garay-Vizcarra Luis , Gonzalez-Quintero Paul , Miranda-Rosas Daniel , Peña-Martínez Eri , Lizarraga-Verdugo Erik Rene , Beltrán-Ontiveros Saul Armando , Romero-Quintana Jose Geovanni
Published: November 2023

Rationale:

A pregnancy with incomplete mole is very rare case. Hydatidiform mole (HM) with live fetus is associated with a risk of a wide variety to maternal and fetal complications. The incidence of a normal live fetus and an incomplete mole such as the case we describe is extremely rare.

Patient concern:

We report a case of multiparous 34-year-old at Culiacan Mexico woman with incomplete mole coexisting with normal fetus, pregnant 35.3 weeks who presented anemia grade II.

Diagnosis:

The initial diagnosis of the mole was by ultrasound.

Interventions:

KERR-type cesarean section and bilateral tubal occlusion. The newborn was morphologically normal, and she did not require intervention or treatment.

Outcomes:

The newborn was feminine, morphologically normal, weighing 2380 g and 47 cm, APGAR score 8 to 9, delivered prematurely, and there was a large placental plate. The blood loss on surgery was estimated at 1000 mL. Histopathology report of an incomplete hydatidiform mole, negative for malignancy. Histopathology diagnostic was confirmed by immunohistochemistry staining for p57KIP2.

Lessons:

Although the incidence of this pregnancy is very rare, early recognition, diagnosis and divulge of the cases of medical community is very important for patient care.
The mechanism of the Shuang Bai Su Qing recipe in treating periodontitis based on network pharmacology and molecular docking technology
Authors: Zhang Haomin , Ning Ruirui , Zhao Yongqin , Yan Zhao , Chen Yongzhi
Published: November 2023

Aim:

To explore the material basis of action of the Shuang Bai Su Qing recipe in the treatment of periodontitis using network pharmacology.

Methods:

Using TCMSP, we screened the chemical components of 5 drugs. The components were input into the UniProt and PubChem databases to obtain target proteins; Genecards, Online Mendelian Inheritance in Man (OMIM), and CEO databases were used to screen target proteins for periodontal disease. The targets were imported into the Cytoscape software to obtain intersecting targets, and conduct visual analysis to build the PPI network. The intersecting targets were then input into the Matescape database and subjected to biological process (BP) analysis, molecular function (MF) analysis, cell component (CC) analysis, and KEGG enrichment analysis.

Results:

Twenty-seven TCM chemical components were obtained, with 198 target proteins associated with drugs and 2587 target proteins for periodontitis. Ten core targets were identified. Gene Ontology (GO) functional enrichment analysis yielded results for 20 BP, 11 MF, and 10 CC. KEGG analysis revealed that the main mechanisms of action were related to MAPK signaling pathway. Molecular docking results showed that luteolin strongly bind to TNF, IL6, and IL1B target proteins.

Conclusion:

The mechanism underlying the treatment of periodontitis with the recipe formula may be closely related to multiple targets in the MAPK signaling pathway.
Identification of key genes and their correlation with immune infiltration in osteoarthritis using integrative bioinformatics approaches and machine-learning strategies
Authors: Xia Duo , Wang Jing , Yang Shu , Jiang Cancai , Yao Jun
Published: November 2023

Osteoarthritis (OA) is a common degenerative joint disease and is closely associated with chronic, low-grade inflammation. Regulating ferroptosis by targeting ferroptosis-related genes may be a fast and effective way to delay the degeneration of OA. However, the molecular mechanisms and gene targets related to ferroptosis in OA are still unclear. Data of OA samples from 3 gene expression omnibus (GEO) datasets were combined to identify differentially expressed genes (DEGs). Ferroptosis-related genes (FRGs) retrieved by the Ferroptosis database were intersected with DEGs, and the intersected hub genes were used for functional enrichment analysis. The feature genes were obtained from the least absolute shrinkage and selection operator (LASSO) algorithm, support vector machine recursive feature elimination (SVM-RFE) algorithm, and random forest (RF) algorithm. Single sample gene set enrichment analysis (ssGSEA) was used to compare immune infiltration between OA patients and normal controls, and the correlation between feature genes and immune cells was analyzed. The expression levels of feature genes were confirmed by RT-PCR. In addition, to explore the applicability of these genes, we extended the bioinformatics analysis of these feature genes to cancer. Finally, 4 feature genes, GABARAPL1, TNFAIP3, ARNTL, and JUN, were confirmed in OA. Theirs expression level were validated by RT-PCR. ROC curves of the 4 genes exhibit excellent diagnostic efficiency for OA, suggesting that the 4 genes were associated with the pathogenesis of OA. Another GEO dataset validated this result. Further analysis revealed that the 4 feature genes were all closely related to the immune infiltration cells in OA. Additionally, results of prognosis analysis indicated that JUN might be a promising therapeutic target for cancer. GABARAPL1, TNFAIP3, ARNTL, and JUN may be predicted biomarkers for OA. The feature genes and association between feature genes and immune infiltration may provide potential biomarkers for OA prediction along with the better assessment of the disease.
A randomized, controlled clinical trial of acupoint catgut embedding as an effective control of functional anorectal pain
Authors: Li Jingjing , Sun Yuqing , Zhang Cairong , Thomas Katherine , Lin Wanqi , Cheng Changcheng , Li Huijia , Zhu Qianyang , Ma Sufan , Hua Qixin , Shi Qian , Zheng Xueping
Published: November 2023

Background:

Patients with functional anorectal pain (FAP) usually feel pain in the anal region, foreign body sensation, and defecation disorders. The pain may radiate to the perineum, thighs, and waist. Conventional biofeedback, local nerve block and surgical treatment have certain limitations. Thread-embedding acupuncture (TEA) is a complementary and alternative therapy, which is widely used in the clinical practice of traditional Chinese medicine to treat functional anorectal pain. This study evaluated the efficacy and safety of the catgut-embedding acupuncture in patients with FAP.

Methods:

FAP patients were enrolled and randomly divided into a thread-embedding acupuncture group (n = 35) and a sham-embedding acupuncture control group (n = 36). Patients underwent treatment twice monthly for 2 months and were assessed before and after treatments for visual analogue scales (VAS) of anorectal pain, VAS of lumbar pain or soreness, VAS of abdominal distension or pain, anal incontinence index, and SF-36 quality of life. The SF-36 quality of life score included assessment of physical functioning, role-physical, bodily-pain, general health, role-emotional, social functioning, vitality, and mental health.

Result:

The total effective rate was 85.71% for the treatment group versus 8.33% of the controls after 2 months (P < .001). The patients’ anal rectum VAS score was significantly higher after treatment versus pretreatment (P < .01), while the physical functioning, role-physical, bodily-pain, role-emotional, and mental health in the experimental group and the role-emotional, and mental health in the control group were all significantly improved versus pretreatment (P < .05). The anorectal VAS score, anal incontinence index, and the SF-36 scores of the physical functioning, role-physical, bodily-pain, role-emotional, and mental health were better in the treatment group compared to the control group (P < .05). Most importantly, there were no adverse reactions observed in either group during the treatment.

Conclusion:

The thread-embedding acupuncture treatment effectively and safely improved the emotional anxiety and quality of life in FAP patients.
Fall risk management in interventional prenatal diagnosis perioperative pregnant women based on tracking methodology and failure mode and effect analysis application
Authors: Yang Hao , Luo Wanying , Guo Liping , Zhu Hui , Peng Wentao
Published: November 2023

The aim was to explore the effectiveness of a tracing methodology combined with failure mode and effect analysis (FMEA) for managing falls in pregnant women during the perioperative period of interventional prenatal diagnosis. Using the tracing methodology, the process was evaluated and analyzed using FMEA after reviewing data, on-site interview, case tracking and on-site inspection, and improvement measures were proposed for the existing risk factors, and the fall-related quality indicators, satisfaction with fall-related health education, and risk priority number were compared before and after implementation. Effectiveness analysis for interventional prenatal diagnosis of perioperative maternal falls risk management resulted in a significant decrease in risk priority number (P < .01), a significant increase in the rate of correct fall risk identification and assessment, correct handover rate of pregnant women at risk of falls, correct intervention rate of pregnant women at high risk of falls, and effective coverage of falls-related health education (P < .01), a significant increase in satisfaction with falls-related health education (P < .001), and the incidence of falls among pregnant women decreased from 0.12% to 0%. The use of tracking methodology combined with FMEA can reduce the risk of perioperative maternal falls in interventional prenatal diagnosis and improve the safety of maternal visits.
Risk factors for distant metastasis of Chondrosarcoma in the middle-aged and elderly people
Authors: Deng Guang-hua
Published: November 2023

Chondrosarcoma is the second most common primary bone malignancy with the highest incidence in middle-aged and elderly people, where distant metastasis (DM) still leads to poor prognosis. The purpose of this study was to construct a nomogram for studying the diagnosis of DM in middle-aged and elderly patients with chondrosarcoma. Data on chondrosarcoma patients aged ≥ 40 years diagnosed from 2004 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The data were divided into a training set and an internal validation set according to a 7:3 ratio, and the training set data were screened for independent risk factors for DM in chondrosarcoma patients using univariate and multivariate logistic regression analysis. The screened independent risk factors were then used to build a nomogram. In addition, data from 144 patients with chondrosarcoma aged ≥ 40 years diagnosed in a tertiary hospital in China from 2012 to 2021 were collected as the external validation set. The results were evaluated by receiver operating characteristic curves, calibration curves, and decision curve analysis in the training set, internal validation set, and external validation set. A total of 1462 middle-aged and elderly patients with chondrosarcoma were included, and 92 (6.29%) had DM at the time of diagnosis. Independent risk factors for DM in middle-aged and elderly patients with chondrosarcoma included being married (OR: 2.119, 95% CI: 1.094–4.105), histological type of dedifferentiated chondrosarcoma (OR: 1.290, 95% CI: 1.110–1.499), high-grade tumor (OR: 1.511, 95% CI: 1.079–2.115), T3 stage (OR: 4.184, 95% CI: 1.977– 8.858), and N1 staging (OR: 5.666, 95% CI: 1.964–16.342). The area under the receiver operating characteristic curve (AUC) was 0.857, 0.820, and 0.859 in the training set, internal validation set, and external validation set, respectively. The results of the calibration curve and decision curve analysis also confirmed that the established nomogram could accurately predict DM in middle-aged and elderly patients with chondrosarcoma. Married, histological type of dedifferentiated chondrosarcoma, high-grade tumor, T3 stage, and N1 stage are independent risk factors for DM in middle-aged and elderly chondrosarcoma patients, and clinicians should see more attention.
Identification of a new risk score model based on hypoxia and EMT-related genes for predicting lung squamous cell carcinoma prognosis
Authors: Zhuang Xiaojie , Yu Shuang , Yang Shuren , Chen Jinping , Feng Jihong
Published: November 2023

A complicated analysis of the prognostic characteristics of lung squamous cell carcinoma (LUSC) is needed. The aim of this study was to develop a risk score model to predict immunotherapeutic response and prognosis for patients with LUSC. A hypoxia and epithelial-mesenchymal transition-related risk score model was developed for prediction of LUSC. The correlation between risk score and clinical characteristics was determined. The single sample gene set enrichment analysis algorithm was utilized to determine the abundance of cell infiltration in tumor immune microenvironment in LUSC. The predictive value of risk score model in response to immunotherapy was evaluated. A hypoxia and epithelial-mesenchymal transition-related risk score model was constructed. This risk score model was correlated with the overall survival of LUSC. Patients with low-risk presented a high survival possibility. The high-risk group was involved in ECM receptor interaction, complement and coagulation cascades, intestinal immune network for IgA production. Finally, patients with low-risk score had significant clinical benefit. The risk score model was constructed to predict immunotherapeutic response and prognosis for patients with LUSC. In addition to identifying LUSC patients with poor survival, the results provide more information for the immune immunotherapy and microenvironment for LUSC.
Flushing effect of micro-bolus pulse injection and its potential impact on peripheral veins under hemostasis
Authors: Li Jin , Wang Yan , Ma Jian-xiong , Dong Ben-chao , Sun Lei , Zhou Wei
Published: November 2023

To explore the feasibility of using micro-bolus pulse injection method to reduce the dilution effect of pipeline on high concentration injection, and to understand low liquid volume bolus injection based on low injection speed. Using a programmable pulse injection pump, a 25-cm – long pipeline containing water-soluble fluorescent agent was flushed using different volumes of bolus, and the time spent for the complete disappearance of the fluorescent agent was recorded to evaluate the flushing efficiency. The finite element simulation of 2-phase flow was carried out using computational fluid dynamics (CFD) technology, and the difference of shear rate and pressure distribution in the vein of pulse injection and direct injection of bolus under hemostasis was compared and simulated. Micro-bolus pulse flushing has advantages in completing perfusion imaging applications, such as small volume imaging agent injection. Compared with non-pulse injection, the effective flushing volume decreases by 49.7%, the average injection speed decreases by 56%, and the maintenance time of high shear rate is shorter when using micro-bolus pulse injection. The impact of micro-bolus pulse injection on the vein can achieve the same or even lower negative effects as other injection methods after increasing the hemostatic distance to 100 mm. In the case of bolus injection requiring high concentration and small volume, such as for radiopharmaceutical dynamic imaging, the application of micro-bolus pulse injection is an effective way to overcome the dilution phenomenon of the imaging agent in the pipeline. During hemostasis, the micro-bolus pulse injection needs to control a longer hemostasis distance to reduce the potential impact on peripheral veins.
The Analgesic effect of adding ultrasound-guided pericapsular nerve group block to suprainguinal fascia iliaca compartment block for hip fracture surgery: A prospective randomized controlled trial
Authors: Nuthep Luckapa , Klanarong Suwattana , Tangwiwat Suwimon
Published: November 2023

Background:

Both suprainguinal ultrasound-guided fascia iliaca compartment block (FICB) and pericapsular nerve group (PENG) block have been used to treat pain after hip surgery. Motor-sparing PENG block may further expedite early postoperative rehabilitation. This study aimed to compare the analgesic efficacy and recovery outcome of suprainguinal ultrasound-guided FICB alone with FICB combined with PENG block for hip fracture surgery.

Methods:

In this study, 59 elderly patients undergoing hip fracture surgery were randomized to receive either FICB alone or combined FICB + PENG block. The primary outcome was pain score at rest 12 hours after surgery as measured by the numerical rating scale (NRS, 0–10) and secondary outcomes were pain scores at rest and with movement measured at other time points within 48 hours, time to first sit up without pain, rescue morphine requirements, opioid-related side effects, incidence of delirium, in-hospital morbidities and mortality, and length of hospital stay.

Results:

Both patient groups had similar demographic profile and postoperative pain scores at rest and with movement. Median NRS pain scores at rest between FICB alone or combined FICB + PENG block at 4, 8, 12, 24, 36 and 48 hours after surgery were 3 versus 3 (P = .31), 3 versus 3 (P = .21) and 3 versus 3 (P = .69), 2 versus 2 (P = .35), 2 versus 3 (P = .17), 3 versus 2 (P = .18) respectively and NRS during movement at 12, 24, 48 hours were 10 versus 8 (P = .30), 6 versus 5 (P = .54) and 3.5 versus 2.0 (P = .64), respectively. There was also no significant difference in the time for patients to first sit up without pain (17.50 vs 19.37 hours vs h; P = .058) or any other secondary outcome measures. The procedure time was, however, significantly longer for the FICB + PENG block (10 vs 5 minutes, P < .001).

Conclusion:

Addition of ultrasound-guided PENG block to FICB did not improve postoperative analgesic or recovery outcomes in elderly patients undergoing hip fracture surgery.
Safety and effectiveness of endotracheal intubation in critically ill emergency patients with videolaryngoscopy
Authors: Mo Chenghang , Zhang Liang , Song Yingjiang , Liu Weifeng
Published: November 2023

To investigate the safety and efficacy of video laryngoscopy for endotracheal intubation in critically ill patients. A total of 106 critically ill emergency patients treated at our hospital between January 2021 and June 2022 were randomly divided into 2 groups, the visual and direct groups, with 53 patients in each group. Both groups were treated with endotracheal intubation; the visual group was treated with video laryngoscopy, and the direct group was treated with conventional direct laryngoscopy. The Cormack–Lehane grade, percentage of glottic opening score, success rate of one intubation, intubation time, number of intubation attempts, hemodynamic values, and complications were compared between the 2 groups. The success rates of glottis exposure and one-time intubation were significantly higher while the intubation time and number of intubation attempts significantly lower in the visual group than in the direct group. The heart rate, mean arterial pressure (MAP), or blood oxygen saturation did not differ significantly between the 2 groups 10 minutes after entering the room (T0) or after anesthesia induction (T1). MAP was significantly lower in the visual group than in the direct group during immediate intubation (T2). The heart rate and MAP were significantly lower in the visual group than in the direct group 1 minute (T3) and 5 minutes (T4) after intubation. The incidences of intubation-related complications in the visual and direct groups were 7.55% and 22.60%, showing a significant difference. Endotracheal intubation under videolaryngoscopy is safer and more effective for critically ill emergency patients than conventional direct laryngoscopy. This can improve the success rate of intubation, reduce the intubation time, and reduce its effect on hemodynamics. Therefore, it is worthy of further clinical application.
The effects of knee ligament load using simulated hip abductor and hamstring muscle strengthening during cutting maneuver
Authors: Kim Sungmin , Han Sanghyuk , Kim Seongyong , Moon Jeheon
Published: November 2023

Background:

This study aimed to analyze knee ligament of load and joint moment to simulate the strengthening of the hip abductor and hamstring muscles using musculoskeletal modeling, thereby contributing to decrease of knee ligament load.

Methods:

Forty participants (age: 21.85 ± 1.90 years; height: 1.76 ± 0.06 m; body mass: 68.5 ± 7.06 kg) were instructed to run at 4.5 ± 0.2 m/s from a 5 m distance posterior to the force plate, land their feet on the force plate, and perform the cutting maneuver on the left. In the musculoskeletal modeling, the hip abductor and hamstring muscles were targeted to construct a model with a 30% increase in the contraction force of the hip abductor, hamstring, and both 2 muscles. The variables were the ligament force and knee joint moment. One-way repeated measure ANOVA and Bonferroni test were used to compare the abductor/hamstring, abductor, hamstring and control models.

Results:

There were significant differences in anterior bundle of the anterior cruciate ligament (ACL) (P = .001), inferior bundle of the superficial layer of the medial collateral ligament (MCL) (P = .016), and posterior bundle of the superficial layer of the MCL (P = .022) force. The post hoc showed that the hamstring model had lower anterior bundle of the ACL and inferior bundle of the superficial layer of the MCL than the abductor/hamstring and abductor models (P < .05) and lower posterior bundle of the superficial layer of the MCL than the abductor and control models (P < .05). There was a significant difference in the adduction (P = .028) and internal rotation moments (P = .014). The post hoc showed that both moments were lower in the hamstring model than in the other models (P < .05).

Conclusions:

The hamstring strengthening may contribute significantly to preventing ACL or MCL injury by reducing knee ligament load.
The effect of myofascial therapy on postpartum rectus abdominis separation, low back and leg pain, pelvic floor dysfunction: A systematic review and meta-analysis
Authors: Wang Yueting , Zhang Shuang , Peng Peiqiang , He Wenxi , Zhang Haitao , Xu Haiyan , Liu Hong
Published: November 2023

Background:

During pregnancy and postpartum, changes in biomechanics can cause dysfunctions in the myofascial system, such as rectus abdominis diastasis, various types of pain, and pelvic floor dysfunction. These common postpartum problems seriously threaten women’s health. Myofascial therapy, as an effective means of improving biomechanics, has no unified understanding of its therapeutic effects on postpartum functional disorders. This study aims to systematically evaluate the rehabilitative effects of myofascial therapy on postpartum rectus abdominis diastasis, low back and leg pain, and pelvic floor dysfunction through a meta-analysis of published randomized controlled trials.

Methods:

A systematic literature search of databases in Chinese and English was performed through May 2023. The treatment methods were randomized controlled studies using myofascial therapy in the treatment of rectus abdominis separation, lumbo-leg pain, and pelvic floor dysfunction. The main outcome indicators were abdominal circumference, rectus abdominis separation distance, visual analogue pain score, pelvic floor muscle potential, ability to live daily activities, number of events, and treatment effectiveness.

Results:

There were 22 studies, including 2235 patients. The result showed that compared with control group, myofascial therapy demonstrated to reduce abdominal circumference and rectus abdominis separation index, improve lumbar function significantly, and decrease urinary incontinence and pelvic organ prolapse. In the myofascial therapy group, pelvic floor muscle strength was significantly enhanced, anterior/posterior resting potential of pelvic floor muscle was significantly decreased, and pelvic floor muscle potential was enhanced. Compared with the control group, the number of patients with various types of pain and pain scores were significantly reduced after myofascial therapy. When myofascial therapy lasted <4 weeks, pain relief was greater. In the myofascial therapy group, the ability to perform daily activities was significantly improved. An analysis of the effectiveness of the treatment showed that after myofascial therapy, the patient’s symptoms improved significantly. There also saw low heterogeneity among all outcomes.

Conclusion:

The results suggested that myofascial therapy could effectively reduce rectus abdominis separation, relieve pelvic floor muscle dysfunction, enhance lumbar function, relieve pain, and improve the ability of daily living activities. All the data demonstrated that myofascial therapy had a good therapeutic effect on postpartum dysfunction.
Anthracyclines and the risk of arrhythmias: A systematic review and meta-analysis
Authors: Dean Yomna E. , Dahshan Hazem , Motawea Karam R. , Khalifa Ziad , Tanas Yousef , Rakha Ibrahim , Hasan Walaa , Kishk Mohamed , Mahmoud Alaa , Elsayed Ahmed , Abdelkader Omar , Tokunaga Akiko , Khalifa Ahmed , Helmy Ahmed , Elhalag Rowan H. , Farghaly Raghad Moheyeldin , Abdelkader Omar Khalid Samir , Shah Jaffer , Hakim Diaa , Aiash Hani
Published: November 2023

Background:

There have been controversial findings from recent studies regarding anthracyclines use and the subsequent risk of arrhythmias. This study aimed to evaluate the existing evidence of the risk of arrhythmias in patients treated with anthracyclines.

Methods:

PubMed, Scopus, and Web of Science databases were searched up to April 2022 using keywords such as “anthracycline” and “arrhythmia.” Dichotomous data were presented as relative risk (RR) and confidence interval (CI), while continuous data were presented as mean difference (MD) and CI. Revman software version 5.4 was used for the analysis.

Results:

Thirteen studies were included with a total of 26891 subjects. Pooled analysis showed that anthracyclines therapy was significantly associated with a higher risk of arrhythmia (RR: 1.58; 95% CI: 1.41–1.76; P < .00001), ST segment and T wave abnormalities (RR: 1.73, 95% CI: 1.18–2.55, P = .005), conduction abnormalities and AV block (RR = 1.86, 95% CI = 1.06–3.25, P = .03), and tachycardia (RR: 1.736, 95% CI: 1.11–2.69, P = .02). Further analyses of the associations between anthracyclines and atrial flutter (RR = 1.30, 95% CI = 0.29–5.89, P = .74), atrial ectopic beats (RR: 1.27, 95% CI: 0.78–2.05, P = .34), and ventricular ectopic beats (RR: 0.93, 95% CI: 0.53–1.65, P = .81) showed no statistically significant results. Higher doses of anthracycline were associated with a higher risk of arrhythmias (RR: 1.49; 95% CI: 1.08–2.05; P = .02) compared to the lower doses (RR: 1.36; 95% CI: 1.00–1.85; P = .05). Newer generations of Anthracycline maintained the arrhythmogenic properties of previous generations, such as Doxorubicin.

Conclusion:

Anthracyclines therapy was significantly associated with an increased risk of arrhythmias. Accordingly, Patients treated with anthracyclines should be screened for ECG abnormalities and these drugs should be avoided in patients susceptible to arrhythmia. The potential benefit of the administration of prophylactic anti-fibrotic and anti-arrhythmic drugs should also be explored.
Application of dural puncture epidural technique combined with programmed intermittent epidural bolus mode in labor analgesia: A randomized clinical trial
Authors: Yan Ming , Wang Qiao , Zhang Yufeng , Zhou Jing , Cui Enhui , Sun Jian
Published: November 2023

Background:

This study aims to evaluate the onset, maintenance, side effects s and the effect on newborns of dural puncture epidural (DPE) technique combined with programmed intermittent epidural bolus (PIEB) mode for labor analgesia as compared to conventional epidural (EP) technique combined with continuous epidural infusion (CEI) mode.

Methods:

All patients were randomly assigned to receive EP + CEI (Group EC), EP + PIEB (Group EP), DPE + CEI (Group DC) and DPE + PIEB (Group DP). Record the time to reach Numerical Rating Scale (NRS) ≤ 1, ropivacaine consumption, the NRS when the uterine neck whole opened (NRS2), the incidence of bilateral sensory block level to S2, asymmetric block, incomplete analgesia, replacement of catheter, intrapartum fever, as well as the occurrence of neonatal Apgar score ≤ 7 at 1 minute and 5 minutes.

Results:

A total of 455 women were included (111 in Group EC, 116 in Group EP, 114 in Group DC and 114 in Group DP). The time to reach NRS ≤ 1 in Group DP and Group DC was shorter than that in Group EP and Group EC (P < .05); the consumption of ropivacaine in Group DP was less than that in 3 other groups (P < .05); the incidence of incomplete analgesia and intrapartum fever in Group DP was lower than that in other 3 groups (P < .05).

Conclusions:

DPE technique can provide faster analgesia than conventional EP technique, combined with PIEB mode maybe superior to traditional methods as a labor analgesia regimen.
Can texture analysis of T2-weighted MRI be used to predict extrathyroidal extension in papillary thyroid carcinoma?
Authors: Qian Chengjia , Chen Shan , Liu Li , Dou Weiqiang , Hu Shudong , Zhang Heng
Published: November 2023

Determining the presence of extrathyroidal extension (ETE) is important for established of different surgical protocol and postoperative patient management in patients with papillary thyroid carcinoma (PTC). The correlation relationship between texture features from T2-weighted imaging (T2WI) and ETE has not been explored extensively. This study aimed to explore the value of T2-weighted magnetic resonance imaging – based whole tumor texture analysis in predict extrathyroidal extension with PTC. In this retrospectively study, 76 patients with pathologically proven PTC were recruited, who received surgical resection and underwent preoperative thyroid magnetic resonance imaging. Based on histo-pathologically findings, patients were classified into ETE and no ETE groups. ETE group was further divided into 2 subgroups (minimal ETE and extensive ETE). Whole-tumor texture analysis was independently performed by 2 radiologists on axial T2WI images. Nine histogram and gray-level co-occurrence matrix (GLCM) texture features were automatically extracted. Univariate and multivariate analysis were performed to determine risk factors associated with ETE. Predictive performance was evaluated by receiver operating characteristic (ROC) analysis. Interobserver agreement, confirmed by intraclass correlation coefficients (ICCs) ranging from 0.78 to 0.89, was excellent for texture analysis between 2 radiologists. T2WI image derived entropy, standard deviation, energy and correlation have significant difference between PTC with and without ETE (all P < .05). Among these, entropy showed the best diagnostic efficiency with the area under ROC curve of 0.837, diagnostic threshold of 5.86, diagnostic sensitivity and specificity of 81.5% and 75.6%, respectively. Additionally, the multivariate analysis revealed that high entropy was an independent risk factor of ETE (odds ratio, OR = 19.348; 95%CI, 4.578-81.760; P = .001). The findings indicate a significant association between texture features of the primary tumor based on T2WI and the presence of ETE in PTC. These results have the potential to help predict ETE preoperatively in patients with PTC, offering valuable insights for clinical decision-making.
Association of Tarlov cyst with cauda equina syndrome and spinal cord infarction following caudal epidural block: A case report
Authors: Joo Sunyoung , Kim Chung Reen , Kim Sunyoung
Published: November 2023

Rationale:

Caudal epidural block (CEB), which injects drugs into the epidural space through a sacral hiatus, is considered a safer alternative to other approaches. Serious complications, such as cauda equina syndrome or spinal cord infarction, have been reported very rarely, but their coexistence after CEB, which may be related to the ruptured perineural cyst, also known as a Tarlov cyst, was not reported.

Patient concerns:

A 40-year-old male patient presented with bilateral lower extremity radicular pain. CEB was performed without image guidance. The patient exhibited sensory deficits below L2, no motor function (0-grade), hypotonic deep tendon reflexes, and no pathological reflexes.

Diagnoses:

Spinal cord infarction, cauda equina syndrome, and sacral level perineural cyst with hemorrhage.

Intervention:

High doses of steroids and rehabilitation were performed.

Outcomes:

The patient was discharged after 28 days with persistent bilateral leg paralysis and sensory deficits below the L2 level. The patient demonstrated no neurological improvement.

Lessons:

Magnetic resonance imaging, including the sacral area, should be performed before performing CEB, to confirm the presence of a perineural cyst.
Laparoscopic-assisted anorectoplasty for anorectal malformation with rectobulbar fistula: A two-center comparative study with posterior sagittal anorectoplasty
Authors: Ye Shiru , Feng Wei , Zhou Yan , Ming Anxiao , Chen Minming , Yang Changzhen , Zheng Chen , Gao Ruyue , Diao Mei , Wang Yi , Li Long
Published: November 2023

Due to the controversy on the feasibility of laparoscopic-assisted anorectoplasty (LAARP) for the treatment of the anorectal malformation (ARM) with rectobulbar fistula (RBF), this study aimed to compare the outcomes of LAARP and posterior sagittal anorectoplasty (PSARP) for ARM with RBF. Demographic data, postoperative complications, and bowel function of RBF patients who underwent LAARP and PSARP at 2 medical centers from 2016–2018 were retrospectively reviewed. Eighty-eight children with RBF were enrolled, including 43 in the LAARP group and 45 in the PSARP group. There were no significant differences in the sacral ratio (P = .222) or sacral agenesis (P = .374). Thirty-seven and 38 patients in the LAARP and PSARP groups were followed up for a median of 4.14 years. The postoperative complications were comparable between the groups (P = .624), with no cases of urethral diverticulum. The urination of all cases was normal and no evidence of cyst formation was found on MCU or MRI during the follow-up period. The incidence of rectal prolapse was similar between the 2 groups (9.3% vs 17.8%, P = .247). The groups had equivalent Bowel Function Score (15.29 ± 2.36 vs 15.58 ± 2.88, P = .645), but the LAARP group had better voluntary bowel movement (94.6% vs 84.2%, P = .148) by Krickenbeck classification. The intermediate-term outcomes of LAARP show that the urethral diverticulum was rare by the intraluminal incision of the fistular and the bowel function was comparable to that of PSARP in ARM with rectobulbar fistula. However, LAARP was associated with smaller perineal wounds.
Reporting of biochemical blood values in COVID-19 patients: A retrospective study
Authors: Eriten Berna , Eriten Semih
Published: November 2023

Background:

This study aimed to investigate the impact of biochemical blood parameters on the progression of coronavirus disease (COVID-19). This retrospective study analyzed the clinical characteristics and biochemical test parameters of 352 COVID-19 patients treated at Malatya Training and Research Hospital in Turkey between March 3, 2021, and February 28, 2022.

Methods:

The methodological approach of our study included specific analyses and examinations to assess the effect of biochemical blood values on disease progression in COVID-19 patients. To achieve this aim, blood samples were collected from patients and various biochemical tests were performed. The data obtained were evaluated using statistical analyses to examine the relationship between these specific biochemical blood values and the severity of COVID-19.

Results:

High glucose, urea, alkaline phosphatase and lactate dehydrogenase levels and low albumin and potassium levels were associated with a more severe disease course. The results showed a significant link between certain biochemical blood values and the severity of COVID-19. These findings suggest that these markers may serve as valuable clinical indicators for predicting the disease progression and severity.

Conclusion:

This study demonstrates the importance of monitoring and analyzing biochemical blood values as essential tools for assessing the severity and progression of COVID-19. The identified markers provide valuable information regarding the prognosis of the disease and may help healthcare professionals make informed decisions regarding patient care.