bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation of noninvasive imaging of tumour-infiltrating lymphocytes with survival and BCG immunotherapy response in patients with bladder cancer: a multicentre cohort study
Authors: Chen Ke , Li Xiaoyang , Liu Libo , Wang Bo , Liang Weiming , Chen Junyu , Gao Mingchao , Huang Xiaodong , Liu Bohao , Sun Xi , Yang Tenghao , Zhao Xiao , He Wang , Luo Yun , Huang Jian , Lin Tianxin , Zhong Wenlong
Published: August 2024

Background:

Tumour-infiltrating lymphocytes (TILs) are strongly correlated with the prognosis and immunotherapy response in bladder cancer. The TIL status is typically assessed through microscopy as part of tissue pathology. Here, the authors developed Rad-TIL model, a novel radiomics model, to predict TIL status in patients with bladder cancer.

Material and methods:

The authors enrolled 1089 patients with bladder cancer and developed the Rad-TIL model by using a machine-learning method based on computed tomography (CT) images. The authors applied a radiogenomics cohort to reveal the key pathways underlying the Rad-TIL model. Finally, the authors used an independent treatment cohort to evaluate the predictive efficacy of the Rad-TIL model for Bacillus Calmette-Guérin (BCG) immunotherapy.

Results:

The authors developed the Rad-TIL model by integrating tumoral and peritumoral features on CT images and obtained areas under the receiver operating characteristic curves of 0.844 and 0.816 in the internal and external validation cohorts, respectively. Patients were stratified into two groups based on the predicted radiomics score of TILs (RSTIL). RSTIL exhibited prognostic significance for both overall and cancer-specific survival in each cohort (hazard ratios: 2.27–3.15, all P<0.05). Radiogenomics analysis revealed a significant association of RSTIL with immunoregulatory pathways and immune checkpoint molecules (all P<0.05). Notably, BCG immunotherapy response rates were significantly higher in high-RSTIL patients than in low-RSTIL patients (P=0.007).

Conclusion:

The Rad-TIL model, a noninvasive method for assessing TIL status, can predict clinical outcomes and BCG immunotherapy response in patients with bladder cancer.
Extracorporeal membrane oxygenation as life-saving bridge for patients with airway obstruction caused by neck and chest tumors to salvage procedure: an in-depth review
Authors: Su Shitong , Liang Lianjing , Liu Zijian , Wang Ling , Zhang Tong , Chen Nianyong
Published: August 2024

Narrowed or stenotic airways are frequently encountered in emergency practice. Neck and chest tumors-caused airway obstruction usually follow a severe clinical course, necessitating urgent ventilation as a bridge to perform emergency operations. In certain cases, traditional ventilation methods may not safely address complicated airway conditions. In such instances, special cardiopulmonary support becomes necessary to manage both hemodynamics and ventilation for patients. Extracorporeal membrane oxygenation (ECMO) is considered a last resort treatment for respiratory failure. When dealing with emergency difficult airway situations, ECMO offers certain advantages over conventional ventilation. However, its effectiveness in managing airway obstruction due to solid tumors located in the neck or chest is not well-established due to limited clinical practice. Published articles about this topic are still limited and primarily rely on case series and reports. As a result, they offer insufficient data and illustrations to fully elucidate emergency issues. In the present article, the authors summarize the existing literature concerning ECMO utility in managing patients with airway obstruction due to solid tumor located in the neck or chest based on PubMed, Web of Science, and other medical databases, to conduct an in-depth review. The authors conducted an analysis of 27 studies, including a total of 54 patients with airway obstruction caused by tumors. All patients underwent surgical relief of airway obstruction with ECMO as ventilatory support. Postoperatively, 87% of the patients (47/54) survived. 7.4% of the patients (4/54) died due to postoperative disease progression, unrelated to ECMO complications. The prognosis of 5.6% of the patients (3/54) could not be obtained. Additionally, the authors present an interesting case series (n=5) based on a real-world research to demonstrate the different outcomes among airway-obstructed patients due to neck and chest masses. In this series, four patients supported by ECMO were successfully discharged postoperatively, while one patient on conventional ventilation died due to respiratory collapse before surgery. Meanwhile, the authors share novel illustrations and clinical figures to supplement the understanding of this condition. The findings presented in this article provide a basis for further studies and can be used to improve management of the patients.
A pilot study of safety and efficacy comparison of low molecular heparin calcium sequential oral anticoagulants in the treatment of cirrhotic portal vein thrombosis
Authors: Zhang Jie , Dang Xiaohong , Zhang Lijuan , Li Wenhua
Published: August 2024

Background

The objective of this study is to compare and assess the efficacy and safety of low-molecular-weight heparin calcium (LMWH-Ca), followed by either warfarin or rivaroxaban, as treatment options for portal vein thrombosis (PVT) in patients with cirrhosis.

Methods

In this pilot study, cirrhotic (with liver function score of Child-Pugh A) patients diagnosed with PVT who were not on anticoagulant therapy received 2 weeks of subcutaneous injections of LMWH-Ca. They were then randomized to either warfarin (a full course of oral warfarin for 6 months) or rivaroxaban (a full course of oral rivaroxaban for 2 months), with 30 cases in each group. After a treatment period of up to 6 months, a comparative analysis was performed to assess the efficacy and safety of both groups. Volumetric changes in PVT were monitored dynamically using enhanced computed tomography scans before treatment at week 2 and month 6.

Results

There were no statistically significant differences in the clinical characteristics of the patients between the two groups. Rivaroxaban treatment reduced PVT median volume from 1.83 cm3 at week 2 to 0.0 cm3 at month 6 and prevented the worsening of PVT after 6 months of treatment with LMWH-Ca (P < 0.001). On the other hand, warfarin treatment increased PVT median volume from 1.95 cm3 at week 2 to 3.78 cm3 at month 6 (P = 0.002). None of the 30 patients in the rivaroxaban group had clinically significant gastrointestinal bleeding, while 2 of the 30 patients (7%) in the warfarin group had gastrointestinal bleeding (P = 0.317).

Conclusion

Rivaroxaban followed by LMWH-Ca is an effective anticoagulant treatment strategy for PVT in cirrhosis.
Preoperative Chemotherapy With Gemcitabine for Pancreatic Cancer Causes Zinc Deficiency
Authors: Iseki Masahiro , Mizuma Masamichi , Shimura Mitsuhiro , Kokumai Takashi , Sato Hideaki , Kusaka Akiko , Aoki Shuichi , Inoue Koetsu , Nakayama Shun , Douchi Daisuke , Miura Takayuki , Maeda Shimpei , Ishida Masaharu , Nakagawa Kei , Kamei Takashi , Unno Michiaki
Published: August 2024

Objectives

The aim of this study was to investigate how preoperative chemotherapy affected the serum zinc concentrations in patients with pancreatic cancer (PC).

Materials and Methods

Two hundreds thirty-one patients with PC who underwent pancreatectomy at our department from 2013 to 2019 were enrolled in this study and measured for the serum zinc concentrations before pancreatectomy. Patient characteristics, course of treatment, and laboratory data were analyzed.

Results

One hundred thirty-five patients underwent upfront pancreatectomy and 58 received preoperative gemcitabine + S1 (GEM + S1) and 29 received gemcitabine + nab-paclitaxel (GEM + nab-PTX). Comparing the serum zinc concentrations before and after preoperative treatment, it was found to decrease after treatment with statistical difference (79.3 μg/dL vs 68.7 μg/dL, P < 0.001). The result was consistent with the investigation for both the patients who received GEM + S1 and those who received GEM + nab-PTX (P = 0.019, P < 0.001, respectively).

Conclusions

The preoperative chemotherapy consistently reduced the serum zinc concentrations in the PC patients, regardless of their regimen such as GEM + S1 and GEM + nab-PTX. Monitoring the serum zinc concentration and appropriate zinc supplementation may be essential for PC patients undergoing preoperative chemotherapy and pancreatectomy.
Comparing the incidence of postoperative painful bladder spasm between malecot catheter and 3-way Foley catheter: a clinical trial
Authors: Farahani Mojtaba , Dehghani Keramat , Shojaei Parisa
Published: August 2024

Background:

In this study, the effect of Pezzer (as a Pezzer catheter) and three-way Foley catheters, used for suprapubic catheterization after open prostatectomy, was investigated in terms of early incidence of painful bladder spasms.

Materials and methods:

In this single-blind clinical trial study, 160 patients diagnosed with LUTS/BPH were placed in two groups of 80 Pezzer catheter (Pezzer(size 28)) and three-way Foley catheters (size 24) for suprapubic catheterization. The evaluated variables in this study are age, prostate weight, narcotics dose, Spasm frequency, International Prostate Symptom Score (IPSS), visual analogue scale (VAS), catheterization period.

Results:

The frequency of spasm in Foley group was significantly lower (4.4±7.26 vs. 6.28±4.4; P value=0.000). There was no significant difference between the two groups regarding the frequency of dysuria (P value=0.3).

Conclusion:

The findings of our study showed that despite slightly favourable results in using suprapubic Foley catheter compared to Pezzer catheters in patients with open prostatectomy in terms of pain and spasm frequency, there was no significant difference between the use of these two types of catheters.
The effect of modified team-based learning method on the knowledge and skills of medical emergency personnel: a clinical trial
Authors: Alilu Leyla , Mohsenzadeh Assadollah , Habibzadeh Hossein , Rasouli Javad
Published: August 2024

Background:

Trauma is one of the most important issues and problems considered in most countries in today’s modern and industrial society. Since pre-hospital care is the first component of a trauma care system, if done properly, it can reduce the problems associated with long-term disability and death due to trauma. Therefore, the present study was conducted to determine the impact of training based on a modified team-based learning (TBL) method on the skills of medical emergency personnel in managing trauma patients in 2022.

Materials and methods:

The present study was a two-group clinical before/after study in which 96 technicians were selected using a stratified random sampling method. The sample members were randomly divided into an intervention group and a control group. In the intervention group, skills for dealing with trauma patients were taught through a modified team-based learning method. The results were analyzed using SPSS software version 21.

Results:

The results of the repeated measures analysis of variance showed a significant difference between the intervention and control groups in learning skills for dealing with trauma patients (P<0.001), which were determined by examining the effect of test repetition and the effect of interaction. The changes in the studied variables in the TBL groups were significantly greater than those in the control group (P<0.001).

Conclusion:

The results indicate that training based on the modified team-based learning method is effective for the management of trauma patients by medical emergency personnel and improves the readiness of personnel in this field.
Baricitinib in the treatment of systemic lupus erythematosus: a systematic review of randomized controlled trials
Authors: Shah Hussain Haider , Ashfaque Faiza , Hadi Zeenat , Waseem Radeyah , Rauf Sameer Abdul , Hussain Tooba , Anas Zahra , Zehra Syeda Alishah , Hussain Muhammad Sheheryar , Wasay Zuberi Muhammad Abdul , Haque Md Ariful
Published: August 2024

Background:

Baricitinib, a Janus Kinase (JAK) inhibitor, has emerged as a potential therapeutic option for systemic lupus erythematosus (SLE). This systematic review aims to synthesize evidence from randomized controlled trials (RCTs) evaluating the potential of baricitinib in treating SLE.

Methods:

A systematic search was conducted across electronic databases to identify relevant RCTs assessing baricitinib in patients with SLE. Studies reporting outcomes such as the Systemic Lupus Erythematosus Responder Index-4 (SRI-4), adverse events, and safety profiles were included. Data extraction and quality assessment were performed following PRISMA guidelines.

Results:

A total of four studies were evaluated for efficacy and safety of baricitinib therapy. Three studies reported SRI-4, British Isles Lupus Assessment Group (BILAG), and Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K), except for Dorner and colleagues Only Dorner and colleagues and Wallace and colleagues discuss the anti-dsDNA titres following treatment with baricitinib. The findings consistently demonstrated improved efficacy of baricitinib compared to placebo, particularly in terms of SRI-4 scores. Higher dosages of baricitinib showed significant improvement in disease activity and severity indices. Adverse events, including infections and gastrointestinal disturbances, were reported.

Conclusion:

Baricitinib holds promise for treating SLE, but caution is needed due to potential adverse events. Careful patient selection and monitoring are crucial. Future research should prioritize long-term safety and comparative effectiveness studies to better understand baricitinib’s role in managing SLE.
Pembrolizumab in combination with trastuzumab for treatment of HER2-positive advanced gastric or gastro-esophageal junction cancer
Authors: Qureshi Zaheer , Jamil Abdur , Fatima Eeshal , Altaf Faryal , Siddique Rimsha , Shah Shivendra
Published: August 2024

Introduction:

Gastric cancer remains a challenging malignancy with a high global mortality rate. Recent advances in targeted therapy and immunotherapy have shown promise in improving patient outcomes. This paper reviews the impact of incorporating targeted agents such as trastuzumab and immunotherapeutic agents like pembrolizumab into standard chemotherapy regimens for gastric cancer treatment.

Methods:

A comprehensive analysis was conducted on pivotal clinical trials, including KEYNOTE-590, KEYNOTE-811, and ToGA, focusing on their methodologies, patient populations, treatment regimens, and outcome measures. The review also explored emerging research avenues in precision medicine, particularly genomic sequencing and biomarker identification.

Aim:

To assess the efficacy and survival benefits of adding trastuzumab and pembrolizumab to standard chemotherapy in the treatment of gastric cancer and to outline future directions in gastric cancer research.

Results:

Including trastuzumab and pembrolizumab in treatment regimens for human epidermal growth factor receptor 2 (HER2)-positive and PD-L1-expressing gastric cancers significantly improved progression-free and overall survival rates compared to chemotherapy alone. These findings highlight the potential of personalized therapy in enhancing treatment outcomes. Furthermore, ongoing research into the gastric cancer microenvironment and the role of the microbiome suggests novel targets for future therapeutic interventions.

Conclusion:

The integration of targeted and immunotherapeutic agents with traditional chemotherapy represents a pivotal shift in gastric cancer treatment, moving towards more personalized and effective regimens.
Metaizeau technique in stabilizing Monteggia equivalent 1b associated proximal radial physeal injury in a rural setting: a case report
Authors: Bhattarai Ashbin , Subedi Dipendra , Bhandari Jyotsna , Homagain Sushan , Ghimire Jeevan , Paudel Suruchi , Sapkota Bipin , Dangol Sunil
Published: August 2024

Introduction:

The Monteggia equivalent type 1b fracture, consisting of an ulnar shaft fracture and radial head dislocation, is a rare condition first described by Giovanni Battista Monteggia. The Metaizeau technique, emphasizing percutaneous intramedullary fixation to preserve bone healing and prevent growth plate damage, has gained prominence in managing these fractures.

Case report:

A 10-year-old boy presented with left forearm pain, swelling, and deformity following a fall while playing football. X-rays revealed a proximal fourth ulnar fracture with dorsal and lateral angulation, along with a proximal radial metaphyseal fracture showing anterior rotation and physeal extension. This fracture pattern resembled a Monteggia fracture type III but differed in the lateral proximal radial disruption via a Salter–Harris type II fracture rather than radial epiphysis dislocation. Satisfactory reduction achieved for ulna was managed with standard nailing system but could not be achieved for radial physeal injury, which was managed with Metaizeau technique.

Discussion:

Type 1b Monteggia equivalents involving a Salter–Harris type 2 fracture of the proximal radius with an associated proximal ulnar fracture, adherence to Monteggia fracture reduction principles is vital. Closed reduction and internal fixation are preferred treatments, with the Metaizeau technique offering advantages such as minimal invasiveness and avoidance of implant-related complications. The Metaizeau technique is particularly beneficial for displaced radial neck fractures in children, providing stable fixation while preserving the fracture environment necessary for optimal healing.

Conclusion:

In cases of Monteggia fracture equivalents, most proximal radial fractures typically reduce to an acceptable level following ulnar reduction. However, proximal radial physeal fractures may require specific attention to achieve satisfactory reduction. The Metaizeau technique, commonly employed in the management of isolated radial neck fractures, can be utilized to achieve this reduction to an acceptable level.
Effect of transcutaneous electrical nerve stimulation on neuro-sensory disturbance after orthognathic surgery: a randomized clinical trial
Authors: Pourdanesh Fereydoun , Tabrizi Reza , Alam Mostafa , Farzan Avishan , Moslemi Hamidreza , Farzan Ava , Khorsand Ardeshir , Mohammadikhah Meysam , Farzan Ramyar
Published: August 2024

Background:

The present study aims to determine the effect of Transcutaneous Electrical Nerve Stimulation (TENS) on neuro-sensory disturbance after orthognathic surgery.

Materials and methods:

In a randomized clinical trial, the participants via split-mouth sampling were randomly divided into two intervention (n=27) and control (n=27) groups. In the intervention group, participants received TENS physiotherapy. TENS physiotherapy was performed on the day after surgery, 1, 2, 3, and 4 weeks after surgery, along with prescriptions for the use of painkillers. On the control group, no physical therapy was performed and the patients only used painkillers (immediately after the operation). Paresthesia was evaluated using the 2-point discrimination (TPD) test and the semi-quantitative sensory-neural disorders test called brush stroke 6 months after the surgical procedures. Self-reported sensory-neural disorders were measured and reported for each patient before and 6 months after surgery using the visual analog scale (VAS).

Results:

A total of 54 patients participated in this study. The mean TPD score in the TENS group and the control group 6 months after the operation were 5.76 (SD=0.73) and 6.14 (SD=0.54), respectively (P=0.003). The mean VAS score in the TENS group and the control group 6 months after the operation was 6.48 (SD=0.50) and 5.80 (SD=0.63), respectively (P=0.005). Also, 66.7 and 38.9% in the TENS and control groups, respectively, performed the brush stroke test correctly (P=0.007).

Conclusion:

In sum, the benefits of TENS physiotherapy can be effective in reducing complications such as pain in dental surgery treatments or orthognathic surgeries.
Measles resurgence in Armenia: unmasking health system vulnerabilities and crafting comprehensive eradication strategies – a review
Authors: George Marlyn Susan , Khan Hamza Rafique , Khadka Sheetal , Dey Rohit Chandra , Khadka Sworup , Sánchez-Velazco Diana F. , Manandhar Sarbagya , Kumar Harendra , Ahmed Shahzaib
Published: August 2024

Measles is an acute febrile illness associated with rashes, fever and life-threatening complications. It is a vaccine-preventable disease with the Measles Mumps Rubella(MMR) vaccine but a recent global trend unveils a resurgence of measles in various parts of the world including Armenia. Measles was declared eliminated from Armenia in 2021 before reports of local outbreaks surfaced in 2023. The WHO identified discrepancies in the vaccination coverage during COVID-19. Measles also poses a great financial burden as a public health issue worldwide. Sociocultural factors impacting measles transmission are maternal education, healthcare access, migration, vaccine hesitancy, and socioeconomic status (Table 3). Efforts to control and eradicate measles from Armenia are run by a collaborative approach of national and international health bodies such as United Nations Children’s Fund (UNICEF), WHO, Global Vaccine Alliance (GAVI), and the Ministry of Health. Thus, the resurgence of measles can be managed through widespread patient education, innovative approaches, strengthening the healthcare system and addressing vaccine hesitancy, sociocultural barriers, and humanitarian emergencies. This review investigates the complicated dynamics of measles inside Armenia’s health system in depth. A thorough examination of measles incidence and immunization patterns highlights the shift from few cases and high vaccination rates to a comeback caused by imported viruses. The causes of its recurrence have been thoroughly investigated, including reduced immunization programs and vaccine hesitancy. The research delves further into the ‘One Health’ idea, assessing the possibility of interspecies transmission among nonhuman primates and examining the environmental factors that influence measles transmission. Among the challenges are weaknesses within Armenia’s health system as well as the possibility of interruptions from the COVID-19 outbreak. In measles vaccination status, the combination of maternal education, postnatal care, and socioeconomic variables exposes the larger drivers at work. The study concludes with a comprehensive set of public health policy recommendations covering vaccination promotion, surveillance, healthcare provider education, public awareness, international collaboration, data analysis, law enforcement, emergency preparedness, research, and coordination. The research sheds light on the tangled web of measles dynamics, health system resilience, and contextual subtleties via this multifaceted approach, inviting readers to investigate the multiple strategies required for eliminating measles in Armenia.
Bacillus cereus infection of the penis: an unusual infection
Authors: Nasrallah Oussama G. , Mahdi Jana H. , Araj George F. , El Sayegh Noura , El Zakhem Aline , Bachir Bassel G.
Published: August 2024

Background:

Bacillus cereus (B. cereus) is a Gram-positive, rod-shaped, motile organism, found in the environment and may exist in contaminated food sources such as reheated rice, vegetables and may lead to gastrointestinal symptoms after ingestion including diarrhea, nausea, and vomiting due to enterotoxigenic and emetic toxins. Non-gastrointestinal infections of Bacillus cereus have been reported in the literature, which include cutaneous and non-cutaneous infections in immunocompetent and immunocompromised individuals.

Case presentation:

A 38-year-old man presented with a one-week history of penile swelling and redness that started after an episode of severe diarrhea and vomiting, which soiled his genital region few hours after vigorous intercourse with his wife. This has led to infection of the penile skin by an unusual organism: Bacillus (B.) cereus. The patient was treated using fucidic acid ointment applications for 2 weeks achieving complete recovery.

Clinical discussion:

The recovery of B. cereus from the penile infection in our patient reveals the first case of such an unusual infection, though this pathogen has been reported to cause a wide range of non-GI tract infections, which include bacteremia, meningitis, endocarditis, endophthalmitis, pneumonia, and soft tissue diseases. Virulence factors allow this organism to induce diarrhea in addition to having dermonecrotic, cytotoxic, hemolytic properties resulting in a wide range of dermatologic presentations.

Conclusion:

The authors report a unique case of penile skin infection caused by B. cereus, an unusual culprit for an uncommon presentation successfully treated with fucidic acid ointment. This is the first case in literature describing such an entity.
Open versus laparoscopic completion cholecystectomy in patients with previous open partial cholecystectomy: a retrospective comparative study
Authors: Nafea Mohammed A. , Elshafey Mohammed H. , Hegab Ahmed , Seleem Abdelhafez , Rafat Walid , Khairy Mostafa , Elaskary Hany , Mohamed Yumna Mahmoud , Monazea Khaled , Salem Abdoh
Published: August 2024

Background:

Some patients report recurrence or persistence of their manifestations after cholecystectomy, and retained gallstones may be a relevant etiology for their complaint. Completion cholecystectomy is advised for these cases to alleviate their manifestations. No previous studies have compared the outcomes of open versus laparoscopic outcomes in these patients, especially in patients who had initial open partial procedures. That is why we performed this study to report the perioperative outcomes of the two approaches in such patients.

Methodology:

This is a retrospective analysis of 80 patients who had a completion cholecystectomy in the authors’ center (40 open and 40 laparoscopic cases) after initial open partial cholecystectomy.

Results:

The duration elapsed since the primary procedure had an average of 18 months in the open group and 21 months in the laparoscopic group. Abdominal pain and dyspepsia were the most common presentations. Some patients had stump cholecystitis or jaundice. The intraoperative assessment revealed either the residual gallbladder or a long cystic duct stump. Laparoscopy yielded shorter operative time, earlier oral intake, and shorter hospitalization periods compared to the open approach (P<0.05). The latter was associated with a 20% wound infection rate that was never encountered after laparoscopy (P
=0.003).

Conclusion:

Previous open partial cholecystectomy does not hinder subsequent laparoscopic completion cholecystectomy. Additionally, laparoscopy is associated with better perioperative outcomes than the open approach.
Challenges in diagnosis and management of Langerhans Cell Histiocytosis in a 13-month-old child: a rare case report
Authors: Sedain Gopal , Khanal Kunjan , Pandey Asim , Parajuli Samriddhi , Sherpa Pasang L. , Adhikari Sujan , Thakuri Aruna , Kattel Aashiya
Published: August 2024

Introduction:

Langerhans Cell Histiocytosis is a rare condition characterized by the proliferation of abnormal Langerhans cells in the skin and mucosa. It is mostly seen in children between 1 and 3 years old. Although the skeleton accounts for 80% of infiltration and the skin accounts for 33%, it can affect other organs as well.

Case presentation:

The authors report a case of a 13-month-old male with fever, rash, and nontender swelling in the frontal, temporal, and infraorbital regions. Imaging showed diffusion restriction in the frontal, left parietal, right sphenoid, right temporal bones, and right maxillary antrum. Biopsy and immunohistochemistry from the right maxilla confirmed the diagnosis. The patient was treated with vinblastine and prednisolone for 3 months, resulting in reduced swelling and no fever on follow-up.

Discussion:

Langerhans Cell Histiocytosis (LCH), formerly Histiocytosis X, has diverse clinical manifestations and is classified as localized or disseminated based on organ involvement. It is associated with viral infections, communication defects, and cytokine processes, with BRAF mutations and the MAPK/ERK pathway implicated. Diagnosis involves clinical, radiological, histological, and immunophenotypic methods, including identifying Birbeck granules in Langerin-positive cells. Treatment varies by disease extent, with vinblastine and prednisolone for children with multisystem disease and tailored approaches for adults.

Conclusion:

Despite atypical presentation, thorough evaluation confirmed Langerhans Cell Histiocytosis in a pediatric patient. This highlights the necessity of considering Langerhans Cell Histiocytosis in differential diagnoses for persistent cutaneous lesions and bony swellings. Prompt detection and timely action are essential for successful treatment and better results.
Coexistence of Cecal duplication cyst and Meckel’s diverticulum presenting as intestinal obstruction: A rare case report
Authors: Dev Santosh , Yadav Alisha , Chaudhary Bikash , dev Barsha , Janugade Harshwardhan Dilip , Khadka Laxman , Koirala Dinesh Prasad
Published: August 2024

Introduction and importance:

Enteric duplication cyst (EDC) is a rare congenital anomaly with incidence of 1 in 4500 live birth. Meckel’s Diverticulum (MD) is the most common congenital anomaly of gastrointestinal (GI) tract. The coexistence of EDC and MD in same patient is extremely rare. Presentation of EDC depends on it’s location, may present with dysphagia, respiratory distress, abdominal pain, abdominal distension and intestinal obstruction. However, MD remains asymptomatic in most of the cases.

Case presentation:

We present a case of 11month boy, presenting with fever, vomiting, and abdominal distension for four days and decreased frequency of defecation with fowl smelling stool, not mixed with blood. All the systemic examination findings were regular except soft and generalized distension of abdomen. CECT scan of abdomen showed features suggestive of EDC versus mesenteric cyst. The patient underwent exploratory laparotomy with ileocecal resection, ileocolic anastomosis and appendectomy. Meckel’s diverticulum was discovered incidentally at distal ileum, and was left intact. The patient was discharged in stable state.

Clinical discussion:

EDCs can occur anywhere in the GI tract, most frequently in small intestine and least often in cecum. MD is true diverticulum of small intestine. This case report discusses a rare occurrence of a pediatric patient having both an EDC and MD, emphasizing diagnostic and management challenges in such unique cases.

Conclusion:

Clinicians should be aware about simultaneous occurrence of EDC and MD in pediatric population who may present as intestinal obstruction.
Identification of features of fear of progression in people with advanced cancer and systemic treatment: an international modified Delphi study
Authors: Kolsteren Evie E.M. , Kwakkenbos Linda , Prins Judith B. , Davis Lucy , van der Lee Marije , Poort Hanneke , Servaes Petra , Sharpe Louise , Lebel Sophie , Custers José A.E. ,   on behalf of the Delphi Study Participants
Published: August 2024

Background:

The growing group of people with advanced cancer and systemic treatment faces psychosocial challenges, including fear of progression (FoP). This study aimed to identify features that characterize FoP in people with advanced cancer and systemic treatment.

Methods:

An exhaustive list of possible FoP characteristics was generated based on literature, patient-reported outcome measures on FCR and FoP, interview data, and clinical expertise. Members of the International Psycho-Oncology Society (IPOS) Special Interest Group FORwards with expertise in FoP in people with advanced cancer and systemic treatment were invited to score features in a 2-round modified Delphi study. Features were scored on a 5-point Likert scale indicating their importance as a feature of FoP and reached consensus to be included or excluded if more than two-thirds applied the same score. A list of agreed features of FoP was generated.

Results:

A total of 21 participants completed both Delphi rounds, including psychologists, researchers, nurses, and one psychiatrist. Of the 55 rated features, 31 features reached consensus to be features of FoP in advanced cancer, including items on fear, uncertainty, worry, loss, hopelessness, and interference with daily life.

Conclusions:

Reaching expert consensus is a critical first step in identifying features of FoP in people with advanced cancer and systemic treatment, highlighting uncertainty and fear of death as unique challenges. Identifying features of FoP in advanced cancer is essential to guide future psycho-oncological research and clinical practice to improve psychosocial guidance with FoP for the growing group of people with advanced cancer and systemic treatment.
Self-assessment and Modulation of Traction During Shoulder Dystocia Simulation Training
Authors: Allen Robert H. , Islam Rushnan , Sant’Anna Marhino Caio , Allen Edith Gurewitsch
Published: August 2024

Objective

The aim of the study is to determine diagnostic traction for shoulder dystocia and to assess whether applied traction is modifiable with force training.

Methods

We tethered a force-measuring fetal mannequin (PROMPT, Limbs & Things) within a simulated pelvis such that it would not deliver. We asked participants to apply traction to diagnose shoulder dystocia then stop. Blinded from participants’ view, we recorded the peak traction. We then asked them to apply what they perceived to be 20 lb (89 N) traction. Each participant estimated the traction s/he applied. The actual force applied was then revealed to the participants and another blinded sequence was performed. We then allowed participants to view actual force measurements in real time while they practiced getting to their diagnostic traction and to 20 lb (89 N); this was followed by another blinded sequence of traction applications and estimations. Median diagnostic traction and injury threshold values (20 lb [89 N]), and mean ratio of estimated to actual force applied were compared pretraining and posttraining, using Wilcoxon signed rank sum test and t test. Rates of clinical shoulder dystocia and associated brachial plexus injury before and after the study period were compared using chi-square. Significance was set at P < 0.05.

Results

One hundred participants demonstrated a range of diagnostic traction. For 23 participants, traction exceeded injury thresholds, but the average was lowered with training. Before training, participants underestimated their own applied traction by an average of 30%.

Conclusions

Subjective diagnosis of shoulder dystocia during simulation training varies widely and exceeds possible injury threshold for 22% of participants. Accuracy of self-assessment applied delivery traction improves significantly with force training as does clinical diagnosis of shoulder dystocia and decrease in brachial plexus injury incidence.
Acceptability of Long-Acting Cabotegravir + Rilpivirine in a Large, Urban, Ambulatory HIV Clinic
Authors: Luc Casey Morgan , Max Blake , Pérez Sarah , Herrera Kara , Huhn Gregory , Dworkin Mark S.
Published: August 2024

Background:

Outside of randomized controlled trials, there are limited data regarding the acceptability of injectable long-acting cabotegravir + rilpivirine (LA-CAB+RPV) among persons living with HIV. To evaluate acceptability, we described participant-reported outcomes of LA-CAB+RPV among a population underrepresented in randomized controlled trials.

Setting:

Ruth M. Rothstein Core Center (CORE), large urban HIV clinic in Chicago, IL, USA.

Methods:

We interviewed persons living with HIV prescribed LA-CAB+RPV who receive primary care at CORE. Participant-reported outcome endpoints included treatment satisfaction, reasons for switching to LA-CAB+RPV, tolerability of injections, and unexpected effects of LA-CAB+RPV. Mean and standard deviations (mean ± SD) and proportions (%) are reported.

Results:

Among respondents (N = 150), 67% identified as non-Hispanic Black, 24% Hispanic, 56% male; the average age was 43 years (SD: 13.2), and 37% were ≥50 years old. Most respondents (93%) completed ≥3 injection appointments at the time of interview. The most common reasons for switching to LA-CAB+RPV were no longer wanting to take pills (89%) and trouble taking their pills daily (58%). Treatment satisfaction was high (6.7 ± 0.5 out of 7). Two-thirds (61%) reported an unexpected aspect of their life improved. Pain from injections was common (89%), with a mean pain score of 4.3 out of 10. Among those reporting pain, half (47%) reported that pain decreased after initial injection. Among participants reporting pain score >6 (n = 36), most (78%) reported no improvement since initial injection.

Conclusions:

We found high treatment satisfaction with LA-CAB+RPV in a diverse population. Participants reported moderate injection pain, which improved with time. Results suggest injectable LA-CAB+RPV will be met with acceptability across diverse participant populations.
Plastic Surgery and the Management of Surgical Infections
Authors: Lineaweaver William C. , Saad Mariam , Chaker Sara
Published: August 2024

Plastic surgeons bring wide anatomic competence and reconstructive surgical capacities to the management of surgical infections. Their anatomical expertise allows them to definitively explore and treat acute infections. Reconstructive options allow for the eradication of chronic infections with salvage of the infected body part. Hand infections illustrate the plastic surgeon's anatomic approach to acute infections. The management of distal tibial osteomyelitis illustrates how plastic surgeons can introduce techniques developed for other body regions in the treatment of a chronic infection.
Neural and Inflammatory Interactions in Wound Healing
Authors: Zeng Junhao , Pan Yuyan , Chaker Sara C. , Torres-Guzman Ricardo , Lineaweaver William C. , Qi Fazhi
Published: August 2024

The skin is an intricate network of both neurons and immunocytes, where emerging evidence has indicated that the regulation of neural-inflammatory processes may play a crucial role in mediating wound healing. Disease associated abnormal immunological dysfunction and peripheral neuropathy are implicated in the pathogenesis of wound healing impairment. However, the mechanisms through which neural-inflammatory interactions modulate wound healing remain ambiguous. Understanding the underlying mechanisms may provide novel insights to develop therapeutic devices, which could manipulate neural-inflammatory crosstalk to aid wound healing. This review aims to comprehensively illustrate the neural-inflammatory interactions during different stages of the repair process. Numerous mediators including neuropeptides secreted by the sensory and autonomic nerve fibers and cytokines produced by immunocytes play an essential part during the distinct phases of wound healing.
The Efficacy of Curcumin Application to Melanoma in Mice
Authors: Teng Liqun , Li Wei , Shi Yuedong , Qi Fazhi
Published: August 2024

Objective

Melanoma is a skin tumor that poses a serious threat to human health. Our study explores the effectiveness and safety of curcumin in the treatment of melanoma based on animal models, and providing evidence-based medical evidence for curcumin in the treatment of malignant melanoma.

Methods

The study collected all randomized controlled trial data from the establishment of the database to October 2023 of curcumin for the treatment of melanoma in mice by searching PubMed, Embase, and the Cochrane Library. According to inclusion and exclusion criteria, data were extracted and quality assessment of included studies was performed by using the SYRCLE (Systematic Review Center for Laboratory animal Experimentation) animal experiment bias risk assessment tool. RevMan 5.4 and Stata 15.1 software were used for meta-analysis.

Results

Eighteen randomized controlled trials were included in this study with a total of 185 mouse models, including 93 mice in the experimental group and 92 in the control group. The results of meta-analysis showed that the IC50 (inhibitory concentrations of 50%) in the experimental group is lower than that of the control group [standardized mean difference (SMD) = −4.68, 95% confidence interval (CI) (−7.30, −2.06), P < 0.01]; the tumor volume is significantly smaller than the control group [SMD = −3.10, 95% CI (−4.45, −1.75), P < 0.01]; the tumor weight is smaller than the control group [SMD = −3.01, 95% CI (−4.81, −1.21), P < 0.01]. However, there was no significant statistical difference in the apoptosis rate between the experimental group and the control group [SMD = 2.27, 95% CI (−1.39, 5.92), P < 0.01].

Conclusion

Based on animal models for meta-analysis, curcumin can inhibit the growth and proliferation of melanoma in mice. Melanoma may be an effective method for treating melanoma. However, this result still requires further in-depth research.
PET/CT Recognition of Costal Cartilage Infection After Breast Implant Surgery
Authors: Zhang Ru-fan , Shi Yue-dong , Zhang Yong , Yang Yan-wen , Qi Fa-Zhi
Published: August 2024

Background

Postoperative infection of breast implants can lead to implant removal and other complications. This study aimed to investigate the presence of costal cartilage infection following breast implant surgery and the diagnostic role of PET/CT in identifying this rare complication.

Patients and Methods

A retrospective study included 16 patients with persistent infections after breast implant removal surgery. Patients underwent PET/CT scans before surgery, and surgical plans were made based on PET/CT findings. Surgical procedures were guided by PET/CT, and specimens were collected for pathological examination and microbiological culture. Follow-up assessments were performed at 1, 3, and 12 months postoperatively.

Results

Among the 16 patients, 11 were diagnosed with costal cartilage infection, whereas 5 had subcutaneous soft tissue infections. PET/CT accurately identified costal cartilage infection in all cases and localized the infected costal cartilage in the majority of cases. Microbiological culture results showed various pathogens. All patients were cured with one or staged surgery.

Conclusion

Costal cartilage infection following breast implant surgery is a significant concern. PET/CT plays a crucial role in the accurate diagnosis and localization of infected costal cartilage, aiding in appropriate surgical management. Patients should be closely monitored for the possibility of costal cartilage infection when experiencing persistent symptoms after breast implant surgery
The Impact of Postoperative Complications on Recovery of Health-Related Quality of Life and Functional Capacity After Pancreatectomy
Authors: Pecorelli Nicolò , Guarneri Giovanni , Di Salvo Francesca , Vallorani Alessia , Limongi Chiara , Corsi Gianluca , Gasparini Giulia , Abati Martina , Partelli Stefano , Crippa Stefano , Falconi Massimo
Published: August 2024

Objective:

To evaluate the extent to which postoperative complications impact patient health-related quality of life (HRQoL) and survival after pancreatic surgery.

Background:

Pancreatectomy is frequently associated with severe postoperative morbidity, which can affect patient recovery. Few and conflicting data are available regarding the effect of post-pancreatectomy complications on patient-reported HRQoL.

Methods:

This is an observational cohort study including consecutive patients enrolled in a prospective clinical trial (NCT04431076) who underwent elective pancreatectomy (2020–2022). Before surgery and on postoperative days 15, 30, 90, and 180, patients completed the PROMIS-29 profile and Duke Activity Status Index questionnaires to assess their HRQoL and functional capacity. Mean differences in HRQoL scores were obtained using multivariable linear regression adjusting for preoperative scores and confounders.

Results:

Of 528 patients, 370 (70%) experienced morbidity within 90 days, and 154 (29%) had severe complications (Clavien-Dindo grade >2). Delayed gastric emptying had the greatest impact on HRQoL, showing decreased mental health up to POD90 and physical health up to POD180 compared with uncomplicated patients. An inverse relationship between complication severity grade and HRQoL was evident for most domains, with Clavien-Dindo grade 3b to 4 patients showing worse HRQoL and functional capacity scores up to 6 months after surgery. In 235 pancreatic cancer patients, grade 3b and 4 complications were associated with reduced disease-specific survival (median 25 vs 41 mo, P<0.001).

Conclusions:

In patients undergoing pancreatic resection, postoperative complications significantly impact all domains of patient quality of life with a dose–effect relationship between complication severity and impairment of HRQoL and functional capacity.
Incidence of Alzheimer Disease and Related Dementias in Iran From 2010 to 2019
Authors: Taheri Soodejani Moslem , Rasoulian Kasrineh Marjan , Tabatabaei Seyyed Mohammad
Published: August 2024

This is the first comprehensive national and subnational epidemiological study reporting the incidence of Alzheimer disease and related dementias (ADRD) in Iran from 2010 to 2019 and predictions for 2024. We extracted age-standardized incidence stratified by sex and provinces from the Institute for Health Measurement and Evaluation (IHME). Arc Map GIS was used to report the geographical distribution, and the Cochran-Armitage test was used for prediction. Predictions showed that the incidence of ADRD would reach 118 (women) and 109 (men) cases per 100,000 population in Iran in 2024. The most increasing incidence from 2010 to 2019 was reported among women in Qom, while Yazd had the most incidences among men and women in 2019. The results showed an increase in the incidence of ADRD in Iran in recent years, and the increase in life expectancy and population aging can be considered as an influential factor.
Predictors of Improvement after Cognitive Training in Mild Cognitive Impairment: Insights from the Cognitive Training and Neuroplasticity in Mild Cognitive Impairment Trial
Authors: Qian Min , Motter Jeffrey , Deehan Emily , Graff Jamie , Adhikari Alisa , Doraiswamy P. Murali , Goldberg Terry E. , Devanand Devangere P.
Published: August 2024

Objective:

Cognitive training may benefit older adults with mild cognitive impairment (MCI), but the prognostic factors are not well-established.

Methods:

This study analyzed data from a 78-week trial with 107 participants with MCI, comparing computerized cognitive training (CCT) and computerized crossword puzzle training (CPT). Outcomes were changes in cognitive and functional measures from baseline. Linear mixed-effect models were used to identify prognostic factors for each intervention.

Results:

Baseline neuropsychological composite z-score was positively associated with cognitive and functional improvements for both interventions in univariable models, retaining significance in the final multivariable model for functional outcome in CPT (P < 0.001). Apolipoprotein E e4 carriers had worse cognitive (P = 0.023) and functional (P = 0.001) outcomes than noncarriers for CPT but not CCT. African Americans showed greater functional improvements than non-African Americans in both CPT (P = 0.001) and CCT (P = 0.010). Better baseline odor identification was correlated with cognitive improvements in CPT (P = 0.006) and functional improvements in CCT (P < 0.001).

Conclusion:

Baseline cognitive test performance, African American background, and odor identification ability are potential prognostic factors for improved outcomes with cognitive interventions in older adults with MCI. Apolipoprotein E e4 is associated with poor outcomes. Replication of these findings may improve the selection of cognitive interventions for individuals with MCI.