bluuebunny/crossref_metadata_2025 huggingface dataset:
Using the increasing vaccination model and the moderating roles of chronic medical conditions and education to understand COVID-19 vaccination uptake in Singapore
Authors: Chen Xingyu Ken , Ong Juanita , Neo Loo Seng , Tan Li Feng
Published: April 2023

COVID-19 vaccination programmes have helped reduce deaths and morbidity from the pandemic and allowed for the resumption of normal life. However, vaccine hesitancy remains an issue even with recurrent surges in COVID-19 cases due to new SARS-CoV-2 variants. Purpose: To elucidate psychosocial factors that contribute to our understanding of vaccine hesitancy. 676 Participants in Singapore took part in an online survey on vaccine hesitancy and uptake between May and June 2021. Data on demographics, perception of the COVID-19 pandemic, and vaccine willingness and hesitancy factors were collected. The responses were analyzed using structural equation modeling (SEM). The study found that confidence in the COVID-19 vaccines and risk perception of the COVID-19 situation are significantly associated with vaccination intention, while vaccination intention is also significantly associated with reported vaccination status. Additionally, certain chronic medical conditions moderate the relationship between vaccine confidence/risk perception and vaccine intention. This study contributes to our understanding of factors behind vaccination uptake which can help anticipate challenges to future vaccination campaigns for the next pandemic.
Anticipating adaptation: tracking the impact of planned and unplanned adaptations during the implementation of a complex population-based genomic screening program
Authors: Allen Caitlin G , Judge Daniel P , Nietert Paul J , Hunt Kelly J , Jackson Amy , Gallegos Sam , Sterba Katherine R , Ramos Paula S , Melvin Cathy L , Wager Karen , Catchpole Ken , Ford Marvella , McMahon Lori , Lenert Leslie
Published: April 2023

In 2021, the Medical University of South Carolina (MUSC) launched In Our DNA SC. This large-scale initiative will screen 100,000 individuals in South Carolina for three preventable hereditary conditions that impact approximately two million people in the USA but often go undetected. In anticipation of inevitable changes to the delivery of this complex initiative, we developed an approach to track and assess the impact of evaluate adaptations made during the pilot phase of program implementation. We used a modified version of the Framework for Reporting Adaptations and Modification-Enhanced (FRAME) and Adaptations to code adaptations made during the 3-month pilot phase of In Our DNA SC. Adaptations were documented in real-time using a REDCap database. We used segmented linear regression models to independently test three hypotheses about the impact of adaptations on program reach (rate of enrollment in the program, rate of messages viewed) and implementation (rate of samples collected) 7 days pre- and post-adaptation. Effectiveness was assessed using qualitative observations. Ten adaptations occurred during the pilot phase of program implementation. Most adaptations (60%) were designed to increase the number and type of patient contacted (reach). Adaptations were primarily made based on knowledge and experience (40%) or from quality improvement data (30%). Of the three adaptations designed to increase reach, shortening the recruitment message potential patients received significantly increased the average rate of invitations viewed by 7.3% (p = 0.0106). There was no effect of adaptations on implementation (number of DNA samples collected). Qualitative findings support improvement in effectiveness of the intervention after shortening the consent form and short-term positive impact on uptake of the intervention as measured by team member’s participation. Our approach to tracking adaptations of In Our DNA SC allowed our team to quantify the utility of modifications, make decisions about pursuing the adaptation, and understand consequences of the change. Streamlining tools for tracking and responding to adaptations can help monitor the incremental impact of interventions to support continued learning and problem solving for complex interventions being delivered in health systems based on real-time data.
Barriers and facilitators to address vaping in Massachusetts schools: a mixed-methods study of school-based stakeholders
Authors: Liu Jessica , Roberts Jane , Reynolds Matthew J , Hanby Elaine , Gundersen Daniel A , Winickoff Jonathan P , Rees Vaughan W , Emmons Karen M , Tan Andy S L
Published: April 2023

We assessed vaping behaviors, environments, COVID-19 influences, and barriers and facilitators of existing approaches that address adolescent vaping in Massachusetts middle and high schools. Findings from this study will provide considerations for individual schools or districts as they advance adolescent vaping prevention and treatment efforts. We analyzed 310 open-ended comments from Massachusetts school administrators who completed a survey between November 2020 and January 2021. Further, we analyzed nine semi-structured interviews with administrators (e.g., principals, vice principals, school nurses) from Massachusetts school systems (n = 6) and school-based anti-tobacco advocates (n = 3); interviews took place between May and December 2021. Informed by Green’s PRECEDE model, we conducted a framework analysis using deductive codes based on the model constructs (enabling, reinforcing, and predisposing factors) and inductive codes of key themes emerging from the interviews. Challenges to addressing adolescent vaping included staff capacity, funding, and lack of mental health and counseling supports. The COVID-19 pandemic was a major barrier to conducting usual in-person vaping programs, but also reduced student vaping at school due to new social distancing practices and bathroom use policies. Facilitators of vaping interventions included peer-led initiatives and parental involvement. Participants discussed the importance of educating adolescents on the harms of vaping and the move toward alternatives-to-suspension programs rather than disciplinary action. School-based anti-vaping program implementers—such as school districts, state departments of education, or local health departments—will need to leverage facilitators such as peer-led initiatives, alternatives-to-suspension approaches, and parental involvement, to increase the potential impact of these programs.
Celastrol inhibits gastric cancer cell proliferation, migration, and invasion via the FOXA1/CLDN4 axis
Authors: Peng Wei , Chen Lin , Liu Jie
Published: April 2023

Background

Celastrol is a biologically active compound with potent anti-tumor properties. However, the mechanism of action of celastrol in gastric cancer (GC) has not been fully elucidated.

Methods

To explore the specific mechanism of the effect of celastrol on GC cells. GC cells were transfected with forkhead box A1 (FOXA1) or claudin 4 (CLDN4), or short hairpin RNA targeting FOXA1. The expressions of FOXA1 and CLDN4 in GC cells were determined by quantitative reverse transcription PCR and Western blot. GC cell proliferation, migration, and invasion were measured by MTT assay and Transwell assay, respectively. The interaction between CLDN4 and FOXA1 was examined by luciferase reporter assay.

Resluts

CLDN4 and FOXA1 were upregulated in GC cells. Celastrol prevented the proliferation, migration, and invasion of GC cells by downregulating FOXA1 expression. Overexpression of FOXA1 or CLDN4 accelerated GC progression. CLDN4 overexpression also induced the activation of the expressions of phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway. FOXA1 enhanced the transcription of CLDN4.

Conclusion

Celastrol regulated GC progression via targeting the FOXA1/CLDN4 axis to impede the PI3K/AKT pathway. Our study proposed a new mechanism of how celastrol inhibited tumorigenesis in GC, which provided evidence for the potential use of celastrol for anti-GC treatment.
Assessment of the oxidative damage and apoptotic pathway related to furan cytotoxicity in cultured mouse Leydig cells
Authors: Aydin Yasemin , Yilmaz Buse , Dikbasan Yasemin U , Orta-Yilmaz Banu
Published: April 2023

Research on heat-induced food contamination is being given more attention as a result of the health risks that have been publicly revealed in recent years. Furan is known as a colorless, combustible, heterocyclic aromatic organic molecule and is formed when food products are processed and stored. It has been established that furan, which is inevitably ingested, has a deleterious impact on human health and causes toxicity. Furan is known to have adverse effects on the immune system, neurological system, skin, liver, kidney, and fat tissue. Infertility caused by furan is a result of its damaging effects on several tissues and organs as well as the reproductive system. Although studies on the adverse effects of furan on the male reproductive system have been performed, there is no study revealing apoptosis in Leydig cells at the gene level. In this study, TM3 mouse Leydig cells were exposed to 250- and 2,500-μM concentrations of furan for 24 h. The findings demonstrated that furan decreased cell viability and antioxidant enzyme activity while increasing lipid peroxidation, reactive oxygen species, and apoptotic cell rates. Furan also increased the expression of the important apoptotic genes Casp3 and Trp53 while decreasing the expression of another pro-apoptotic gene, Bcl2, and antioxidant genes Sod1, Gpx1, and Cat. In conclusion, these results imply that furan may cause loss of cell function in mouse Leydig cells responsible for testosterone biosynthesis by impairing the efficiency of the antioxidant system, possibly by inducing cytotoxicity, oxidative stress, and apoptosis.
CsRVE1 promotes seasonal greening of albino Camellia sinensis cv. Huangkui by activating chlorophyll biosynthesis
Authors: Liu Xuyang , Cao Jingjie , Cheng Xin , Zhu Wenfeng , Sun Ying , Wan Xiaochun , Liu Linlin
Published: April 2023

Seasonal greening is a crucial survival strategy for albino tea cultivars, during which dysfunctional chloroplasts recover and chlorophyll biosynthesis increases in albino leaves. However, the regulatory mechanisms of seasonal greening in albino tea plants remain unclear. Here, we report that CsRVE1, a nuclear-located Myb-like transcription factor, can positively modulate the seasonal greening of albino Camellia sinensis cv. Huangkui leaves by activating the expression of genes involved in light harvesting and chlorophyll biosynthesis. The transcriptional expression of CsRVE1 increased during seasonal greening and was tightly correlated with increases in the expression of genes involved in light harvesting (CsLhcb) and chlorophyll biosynthesis (CsCHLH, CsHEMA1 and CsCAO). In vivo and in vitro molecular analyses showed that CsRVE1 can directly bind to the promoters of CsLhcb, CsCHLH and CsPORA, eventually leading to chlorophyll accumulation in tea leaves. Furthermore, transient suppression of CsRVE1 in tea leaves led to a decrease in target gene expression. In contrast, the overexpression of CsRVE1 in Arabidopsis led to chlorophyll increases and the activation of AtLhcb, AtPORA, AtCHLH, etc. These results identify CsRVE1 as an important promoter of seasonal greening that functions by regulating genes involved in chlorophyll biosynthesis in albino tea plants and shed new light on the regulatory mechanisms of leaf phenotypes in plants.
Progression of Xylella fastidiosa Infection in Grapevines Under Field Conditions
Authors: Kahn Alexandra K. , Sicard Anne , Cooper Monica L. , Daugherty Matthew P. , Donegan Monica A. , Almeida Rodrigo P. P.
Published: April 2023

The pathogen Xylella fastidiosa subsp. fastidiosa has circulated through California's vineyards since its introduction from Central America in the 1800s. This pathogen is responsible for a bacterial disease called Pierce's disease (PD) of grapevine. With no known cure, PD has had devastating effects on some vineyards. Important factors that impact disease severity and persistence include: the presence of insect vectors, grapevine cultivar, management, ecology, and winter temperatures. Removal of infected vines is critical for reducing pathogen spread but relies on accurate and rapid pathogen detection. In this study, we foster a greater understanding of disease symptom emergence by way of a 3-year field inoculation project in Napa Valley. Although PD emergence and symptom progression have been studied in greenhouse and experimental plots, there is a large knowledge gap in quantifying disease progression under commercial conditions. After inoculating 80 mature Vitis vinifera vines in April 2017, we measured bacterial populations and six symptom types at four locations within each plant throughout the subsequent three growing seasons. The main foci of the project were understanding X. fastidiosa movement through the plants, infection, overwinter curing, and symptom development. We observed greater winter recovery than expected, and shriveled grape clusters proved to be a more reliable early indication of infection than other more commonly used symptoms. Although there were differences among wine grape cultivars, this work suggests that disease progression in the field may not fit the paradigm of predominant leaf scorch and low recovery rates as neatly as has been previously believed.
Drive Time to Addiction Treatment Facilities Providing Contingency Management across Rural and Urban Census Tracts in 6 US States
Authors: Joudrey Paul J. , Chen Kevin , Oldfield Benjamin J. , Biegacki Emma , Fiellin David A.
Published: April 2023

Objective

We examined drive times to outpatient substance use disorder treatment providers that provide contingency management (CM) and those that integrate CM with medication for opioid use disorder (MOUD) services in 6 US states

Methods

We completed cross-sectional geospatial analysis among census tracts in Delaware, Louisiana, Massachusetts, North Carolina, New York, and West Virginia. We excluded census tracts with a population of zero. Using data from the 2020 Shatterproof substance use treatment facility survey, our outcome was the minimum drive time in minutes from the census tract mean center of population to the nearest outpatient CM provider, outpatient CM provider with MOUD services, and federally qualified health centers (FQHC). We stratified census tracts by 2010 Rural-Urban Commuting Area codes and by state.

Results

The population was greater than zero in 11,719 of 11,899 census tracts. The median drive time to the nearest CM provider was 12.2 [interquartile range (IQR), 7.0–23.5) minutes and the median drive time to the nearest CM provider increased from 9.7 (IQR, 6.0–15.0) minutes in urban census tracts to 38.8 (IQR, 25.4–53.0) minutes in rural (H = 3683, P < 0.001). The median drive time increased to the nearest CM provider with MOUD services [14.2 (IQR, 7.9–29.5) minutes, W = 18,877, P < 0.001] and decreased to the nearest FQHC [7.9 (IQR, 4.3–13.6) minutes, W = 11,555,894, P < 0.001].

Conclusions

These results suggest limited availability of CM, particularly within rural communities and for patients needing concurrent CM and MOUD treatment. Our results suggest greater adoption of CM within FQHCs could reduce urban-rural disparities in CM availability.
Indian Tick Typhus Presenting as Gangrene: a Case Report
Authors: Dash Nabaneeta , Gonttumukkula Vijayasree , Samyanathan Prasanna , Rajangam Muthuvel , Biswal Manisha , Verma Sanjay
Published: April 2023

Rickettsial infections are an important cause of acute febrile illness in developing countries. They can rarely present with cutaneous manifestations such as gangrene. Here we report a 12-year-old boy who presented with acute undifferentiated fever, multiorgan dysfunction, and gangrene of bilateral toes and ear lobes. The diagnosis was made by serologic testing of paired sera and clinical recovery occurred with doxycycline.
Structural effects on custom, flexible iris prostheses passing through injector systems
Authors: Tuzun Serra E. , Snyder Michael E.
Published: April 2023

Purpose:

To determine the suitability of various commercially available intraocular lens injection systems for the implantation of custom, flexible artificial irides of various sizes, both with and without fiber meshwork.

Setting:

Cincinnati Eye Institute, Blue Ash, Ohio.

Design:

Laboratory study.

Methods:

Custom, flexible iris prostheses, both with and without fiber meshwork, were either maintained at a 12.8 mm diameter or trephinated to a 10 mm diameter and subsequently inserted through 7 different intraocular lens injector systems. The ease of load, difficulty of injection, control of injection, and level of prosthetic distortion, if any, were observed and recorded.

Results:

The fiber-free devices universally passed through the injectors unaffected. Each of the iris prostheses with embedded fiber meshwork appeared grossly distorted after injection. The injection systems had differing amounts of effort to load the device into the cartridge, to advance the prosthetic through the system, and varying levels of control when the prosthetic was released, although all the systems delivered the device effectively.

Conclusions:

Any of the 7 injection systems tested in this study can be used effectively for fiber-free artificial irides. Caution should be taken to ensure that control of insertion is maintained throughout the injection process. Screw-type injectors required less effort and yielded more control than plunger-type injector. Fiber meshwork–containing artificial irides should not be inserted through an injector.
Institute-based nurse-led care versus home-based resistance training for patients with acute pancreatitis: Clinical outcomes analysis
Authors: Lu Yin-Cui , Zheng Ying-Ying
Published: April 2023

Surgeries may have worse clinical outcomes in pancreatitis. In our institute surgical procedure is barely used surgery to treat pancreatitis nowadays. Chinese guidelines recommended regular exercise for severe pancreatitis. The objectives of the current study were to compare nurse-led resistance training at the institute against usual care provided to patients with acute pancreatitis for favorable clinical outcome measures. For acute pancreatitis, patients (≥18 years, of age) received 6 months of resistance training in the garden of the institute under the supervision of registered nurses (NR cohort, n = 102), or received 6 months of resistance training at their home by themselves according to a training manual (HR cohort, n = 120) or received 6 months of usual care only (UC cohort, n = 120). Fewer numbers patients died in the follow-up period in the NR cohort than those of the HR (8 vs 21, P = .0447) and the UC (8 vs 32, P = .0046) cohorts. The frequency of rehospitalization of patients due to any of the reasons in the follow-up period was fewer for patients of the NR cohort than those of the HR and the UC cohorts (P < .05 for both). Hospitalization of patients due to any of the reasons in the follow-up period was fewer for patients of the HR cohort than those of the UC cohort (P < .05). A 52 median score was the quality of life of patients before the start of the non-treatment intervention(s). After 6 months of non-treatment intervention(s), patients of the NR cohort improved their quality of life as compared to their initial quality of life (P < .001), those of HR cohort (P < .05), and those of UC cohort (P < .001). The quality of life of patients with severe pancreatitis after the surgical procedure was worse. Six months of nurse-assisted resistant training at the institute has significant improvement on the quality of life of patients in the follow-up periods of acute pancreatitis. Resistant training at the institute would improve the quality of life of patients with acute pancreatitis (Level of Evidence: IV; Technical Efficacy Stage: 5).
Effect of multi-strain probiotics as an anti-obesity among overweight and obese Saudi adults
Authors: Almalki Samira M. , Al-Daghri Nasser M. , Al-Juhani Mariam Eid , Alfawaz Hanan A.
Published: April 2023

Background:

Obesity is classified as a low-grade chronic and systemic inflammatory disease and results from complicated interactions between genes and environmental factors, which leads to many diseases and affects the quality of life. There are growing interests in the effectiveness of probiotics as a supplementation to reduce obesity through regulating microbiota host metabolism. Probiotics may influence the interplays among gut, brain, adipose, and liver in a way leading to weight. Since limited studies have been conducted on human subjects, more investigation is needed in this field. Therefore, this study sheds light on the investigation of the anti-obesity effect of probiotic supplementation.

Methods:

Ninety adult Saudi overweight or obese adult will be enrolled in this clinical trial and randomized to receive daily placebo or probiotics “MCP® BCMC® strains” for 12 weeks in a double-blind study. Biochemical markers will be measured through blood samples analyzed. Measurements and samples will be obtained at baseline and by the end of the study, at 12 weeks of treatment.

Discussion:

This study expects that the multi-strain probiotic product will induce beneficial changes in gut microbiota (GM) including reduction in weight, especially the visceral fat, which leads to reduction in systemic inflammatory state associated with fat accumulation.
Sustained effect of leukocytapheresis/granulocytapheresis versus anti-human TNF-α monoclonal antibody on ulcerative colitis: A 2-year retrospective study
Authors: Sakai Masahiro , Hayashi Koichi , Ito Tomoyuki , Otani Haruka , Mori Yuya , Ito Shinsuke , Endo Keita , Matsuda Hiroto , Yoshino Kaede , Kitamura Koichi , Kubota Eiji , Motomura Yasuaki , Suzuki Yasuhiro , Fujitani Shigeki , Suzuki Toshihiko
Published: April 2023

Although anti-tumor necrosis factor-α monoclonal antibody biological preparations (BP) agents are widely used as an established treatment tool for refractory ulcerative colitis (UC), whether leukocytapheresis/granulocytapheresis (L/G-CAP) has similar beneficial impact on the disease activity remains undetermined. Furthermore, the costs defrayed for the treatment with these 2 modalities have not been compared. We retrospectively evaluated whether L/G-CAP offered sustained beneficial effects over 2-year period. The patients who had moderately to severely active UC (Rachmilewitz clinical activity index (CAI) ≧ 5) and were treated with a series (10 sessions) of L/G-CAP (n = 19) or BP (n = 7) as an add-on therapy to conventional medications were followed. Furthermore, the cost-effectiveness pertaining to the treatment with L/G-CAP and BP was assessed over 12 months. At baseline, L/G-CAP and BP groups manifested similar disease activity (CAI, L/G-CAP; 7.0 [6.0–10.0], BP; 10.0 [6.0–10.0], P = .207). The L/G-CAP and BP treatment suppressed the activity, with CAI 1 or less attained on day 180. When the L/G-CAP group was dichotomized into L/G-CAP-high and L/G-CAP-low group based on CAI values (≥3 or < 3) on day 365, CAI was gradually elevated in L/G-CAP-high group but remained suppressed in L/G-CAP-low group without additional apheresis for 2 years. Anemia was corrected more rapidly and hemoglobin levels were higher in BP group. The cost of the treatment with L/G-CAP over 12 months was curtailed to 76% of that with BP (1.79 [1.73–1.92] vs 2.35 [2.29–3.19] million yen, P = .028). L/G-CAP is as effective as BP in a substantial number of patients over 2 years. The cost for the treatment of UC favors L/G-CAP although the correction of anemia may prefer BP. Thus, L/G-CAP can effectively manage the disease activity with no additional implementation for 2 years although further therapeutic modalities might be required in a certain population with high CAI observed on day 365.
Attach importance to the individualized treatment of adult portal hypertension based on etiology and pathogenesis: A review
Authors: Li Ming-ke , Ma Lan-qing
Published: April 2023

There are many factors that can cause portal hypertension and secondary symptoms such as ascites, splenomegaly, and variceal hemorrhage, can seriously affect patients’ quality of life and even threaten their lives. In this paper, we summarize various causes of portal hypertension based on etiology and pathogenesis and give individualized treatment strategies in order to remind clinicians to pay attention to the identification of different causes and select corresponding treatment, so that patients are provided with the optimal treatment strategies and benefit from them.
Cesarean delivery was associated with low morbidity in very low birth weight infants: A retrospective cohort study
Authors: Li Jianqiong , Zhu Tingting , Liu Gu , Chen Yuyang , Xing Linli , Tian Yichao , Liang Fengbing
Published: April 2023

To estimate the relationship among the cesarean delivery (CD), mortality and morbidity in very low birth weight (VLBW) infants weighing less than 1500 g. This retrospective cohort study enrolled 242 VLBW infants delivered between the 24 to 31week of gestation from 2015 to 2021. We compared CD with vaginal delivery (VD). The primary outcome was a composite neonatal morbidity including bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, late-onset sepsis and retinopathy of prematurity. The secondary outcome included mortality within 28 days. A multivariate logistic regression was used and adjusted for birthweight, twin pregnancy and antenatal steroids intake. The overall CD rate was 80.6%. Compared with VD, a significantly lower composite neonatal morbidity was associated with CD (adjusted odds ratio, 0.33, 95% confidence interval, 0.12–0.90, P = .031). The relationship between CD and neonatal morbidity disappeared when the VLBW infants were stratified according to the gestational age. No significant difference was observed between the VD and CD cohorts regarding mortality. Compared with VD, CD was associated with a lower morbidity in VLBW infants. Further studies are required to clarify how this association is influenced by gestational age.
Bilateral endogenous fungal endophthalmitis: A case report
Authors: Wang Hao , Chang Yongye , Zhang Yifan , Yang Rong , Shi Huijun , Zhang Minglian
Published: April 2023

Rationale:

Endogenous fungal endophthalmitis is a challenging condition. There are no universally accepted diagnostic or management protocols. We share a case of endogenous fungal endophthalmitis who was successfully treated, focusing on the diagnostic and treatment procedures.

Patient concerns:

A 31-year-old female with a history of fungal vaginitis and tinea corporis presented with progressive visual decrease in both eyes after having an induced abortion. Her best corrected visual acuity at presentation was 20/1000 in her right eye and 20/250 in her left eye. Upon slit lamp examination, mild inflammatory reaction in the anterior chamber was found. Dilated fundus examination revealed a hazy view of the optic disc and posterior retina, and there was a whitish mass with “string and pearls” just in front of the macular region in each eye.

Diagnoses:

Bilateral fungal endogenous endophthalmitis was diagnosed empirically, which was confirmed later by deoxyribonucleic acid sequencing and culture of intraocular fluid.

Interventions:

Oral itraconazole and intravitreal voriconazole were administered to the patient at first. The intraocular inflammation was partially responsive to the medication, yet the visual acuity persisted to deteriorate and the vitreous whitish masses became more prominent. Then vitrectomy procedures were carried out and oral itraconazle was switched to intravenous fluconazole. The antifungal treatment lasted for 8 weeks.

Outcomes:

The intraocular inflammation alleviated and visual acuity improved after vitrectomy. At the 9-month follow-up visit, the patient’s best corrected visual acuity was 20/40 in the right eye and 20/30 in the left eye. There was no intraocular inflammatary reaction, and retinal scar was noticed in each eye.

Lesson:

Early and correct diagnosis, coupled with prompt and aggressive treatment, is crucial for cases of fungal endogenous endophthalmitis. Deoxyribonucleic acid sequencing techniques can contribute to early diagnosis, while vitrectomy may be necessary when antifungal medication is insufficient in controlling the condition.
Perioperative management and drug selection for sedated/anesthetized patients undergoing MRI examination: A review
Authors: Wang Xiaoyu , Liu XueQuan , Mi Junqiao
Published: April 2023

In recent years, magnetic resonance imaging (MRI) technology has become an indispensable imaging tool owing to significant improvements in MRI that have opened up new diagnostic perspectives. Due to the closed environment, long imaging time, and need to remain still during the examination process, the examiner may cannot cooperate with the completion of the examination of the procedure, which increases the need for deep sedation or anesthesia. Achieving this can sometimes be challenging, especially in the special nontraditional environment of MRI equipment (unfamiliar and narrow spaces, away from patients, strong magnetic fields) and in special populations requiring sedation/anesthesia during examinations, which pose certain challenges for the perioperative anesthesia management of MRI. A simple “checklist” is necessary because it allows the anesthesiologist to become familiar with the particular environment and human and material resources as quickly as possible. For the choice of sedative/anesthetic, the traditional drugs, such as midazolam and ketamine, are still used due to the ease of administration despite their low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, propofol, with high effectiveness and rapid recovery, and sevoflurane, which is mild and nonirritating, are preferred for sedation/anesthesia in children and adults undergoing MRI. Therefore, familiarity with the perioperative management of patient sedation and general anesthesia and drug selection in the MRI environment is critical for successful surgical completion and for the safe and rapid discharge of MRI patients receiving sedation/anesthesia.
Combined transjugular/percutaneous intrahepatic portosystemic shunts (cTIPS) for cavernous transformation of the portal vein after conventional transjugular approach TIPS failure
Authors: Bi Yonghua , Ren Jianzhuang , Han Xinwei , Guo Kefeng , Tu Xueliang
Published: April 2023

This study aim was to compare the safety and efficacy of combined transjugular/percutaneous intrahepatic portosystemic shunts (cTIPS) and transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients with cavernous transformation of the portal vein (CTPV) after conventional transjugular approach TIPS failure. Cirrhotic patients who were diagnosed as CTPV and treated by cTIPS or TIPS between July 2012 and April 2022 were retrospectively analyzed. Patients’ characteristics and clinical data were recorded. The clinical outcomes, long-term survival rates and patency rates between the 2 groups were compared. A total of 68 patients with CTPV were enrolled, of whom 23 were treated with TIPS and 45 with cTIPS. The initial technical success was 30.9% in TIPS group and 91.1% in cTIPS group. The hospitalization days increased significantly in the cTIPS group compared with TIPS group (P = .0131). However, the complication rate, patency rates and survival rates were similar between the 2 groups. In conclusion, cTIPS appeared to be safe and effective in cirrhotic patients with CTPV after conventional transjugular approach TIPS failure.
Peripheral interstitial lung abnormalities on LDCT in an asymptomatic, nonsmoking Chinese urban cohort
Authors: Gao Zhimei , Li Xin , Li Yan , Zhang Chenguang , Li Yaguang , Sun Mengyue , Wu Yalan , Li Shujing , Zhang Yingqi
Published: April 2023

To retrospectively investigate the imaging features and the related influencing factors of peripheral interstitial lung abnormalities (PILA) that caused “normal aging” by low-dose computed tomography (LDCT) in an nonsmoking, asymptomatic Chinese urban cohort. The clinical data of 733 subjects who underwent chest LDCT were retrospectively collected. The computed tomography (CT) signs of PILA (interlobular septal thickening [ILST], intralobular interstitial thickening [ILIT], ground-glass opacity [GGO], reticular shadow [RS], subpleural line [SL]) were evaluated at 6 levels and statistically analyzed. The effects of age, sex, body mass index (BMI), blood pressure (BP), and blood biochemistry parameters on ILST, ILIT, and RS were analyzed by Binary Logistic regression analysis. Significant age differences in PILA were found. None of the 5 PILA CT signs (GGO, ILST, ILIT, RS, and SL) was observed in subjects under 40 years old, while in subjects over 40 years old, the incidence of PILA increased with age. All 5 CT signs of PILA were significantly different among the subjects aged 18 to 49, 50 to 69, and 70 to 79 (P < .05). There was no significant sex difference in PILA. Among age, sex, BMI, BP, and laboratory biochemistry parameters, only age had a significant effect on ILST, ILIT, and RS. LDCT can be used as a noninvasive method to evaluate the PILA. PILA were mainly affected by age, while sex, BMI, BP, and laboratory biochemistry parameters had little effect on PILA. PILA observed before the age of 40 years should be considered an abnormal finding, whereas it is common in individuals over 70.
Prevalence of Elevated ALT in Adolescents in the US 2011–2018
Authors: Mischel Anna K. , Liao Zhengxu , Cao Fangyi , Dunn Winston , Lo Joan C. , Newton Kimberly P. , Goyal Nidhi P. , Yu Elizabeth L. , Schwimmer Jeffrey B.
Published: April 2023

Objective:

The objective of this study is to characterize suspected nonalcoholic fatty liver disease (NAFLD) using elevated alanine aminotransferase (ALT) in a diverse and nationally representative cohort of adolescents and to characterize higher ALT elevation in adolescents with obesity.

Methods:

Data from the National Health and Nutrition Examination Survey 2011–2018 were analyzed for adolescents 12–19 years. Participants with causes for elevated ALT other than NAFLD were excluded. Race and ethnicity, sex, body mass index (BMI), and ALT were examined. Elevated ALT was defined as >22 U/L (females) and >26 U/L (males) using the biologic upper normal limit (ULN). Elevated ALT thresholds up to 2X-ULN were examined among adolescents with obesity. Multivariable logistic regression was used to determine the association of race/ethnicity and elevated ALT, adjusting for age, sex, and BMI.

Results:

Prevalence of elevated ALT in adolescents was 16.5% overall and 39.5% among those with obesity. For White, Hispanic, and Asian adolescents, prevalence was 15.8%, 21.8%, and 16.5% overall, 12.8%, 17.7%, and 27.0% in those with overweight, and 43.0%, 43.5%, and 43.1% in those with obesity, respectively. Prevalence was much lower in Black adolescents (10.7% overall, 8.4% for overweight, 20.7% for obesity). Prevalence of ALT at 2X-ULN was 6.6% in adolescents with obesity. Hispanic ethnicity, age, male sex, and higher BMI were independent predictors of elevated ALT.

Conclusions:

Prevalence of elevated ALT in U.S. adolescents is high, affecting 1 in 6 adolescents during 2011–2018. The risk is highest in Hispanic adolescents. Asian adolescents with elevated BMI may comprise an emerging risk group for elevated ALT.
Salmonella meningitis, an unusual complication of salmonella species: a case report from Nepal
Authors: Bhattarai Himal Bikram , Rayamajhi Sushil , Bhattarai Madhur , Bhandari Sujata , Acharya Suryakiran , Uprety Manish , Yonghang Sapana , Kadel Gareema , Bhusal Sandhya , Joshi Sajeev
Published: April 2023

Introduction:

Salmonella meningitis, caused by a Gram-negative bacillus of the Enterobacteriaceae family, is an uncommon but serious complication of Salmonella infection that can result in high mortality rates, significant neurological damage, and a high relapse rate, and has become a leading cause of Gram-negative bacterial meningitis in the developing world.

Case presentation:

A 16-year-old boy presented with high-grade fever and altered sensorium for 2 days associated with vomiting, headache, and photophobia.

Case discussion:

After invading the abdominal barrier, Salmonella can enter bloodstream and rarely present with meningitis. Cerebrospinal fluid analysis and culture supported with other investigations can diagnose bacterial meningitis and its causative agent. Adequate treatment is essential to completely cure and prevent relapse.

Conclusion:

Given its invasive nature and potential serious consequences, such as relapse and antibiotic resistance, prompt, and appropriate treatment of Salmonella meningitis is essential.
Microsurgery of large falcine meningiomas: postoperative results at 1 year: a cross-sectional study
Authors: Nguyen Phuong Xuan , Nguyen Nhan Pham-Sy , Doan Ha Thi-Ngoc , Nguyen Bac Thanh
Published: April 2023

Background:

Performing microsurgery with the support of navigation in falcine meningioma management shows significant impacts in short and middle-time follow-up, including unilaterally skull opening with smallest and nearest skin incision, lessen the surgical duration, limit blood transfusion and prevent tumours from recurrence.

Materials and methods:

Sixty-two falcine meningioma patients treated by microoperation applying neuronavigation were enroled from July 2015 to March 2017. Patients are evaluated before and 1 year after surgery according to The Karnofsky Performance Scale (KPS) for comparison.

Results:

Histopathology: the most common was fibrous meningioma with 32.26%; meningothelial meningioma was 19.35% and transitional meningioma was 16.13%. KPS I before surgery was 6.45% and after was 83.87%. KPS III who needed assistance in activities preoperation was 64.52% and postoperation was 1.61%. After surgery, there was no disabled patient. All patients were followed up a year after surgery and received MRI to evaluate the recurrence. After 12 months, there were three recurrent cases, accounted for 4.84%.

Conclusions:

Microsurgery under neuronavigation help brings significant improvement in patient’s functional abilities and low recurrence of falcine meningiomas within 1-year post-surgery. Further studies with large sample size and longer follow-up duration should be performed to reliably evaluate safety and effectiveness of microsurgical neuronavigation in the management of the disease.
A cardiac injury and pericardial tamponade following a stab wound to the chest: a case report
Authors: Naseer Osama R. , Rishi Mahjoub B. , Alsherbini Mohamed G. , Sahoub Haytham A. , Gelia Abdulhakim , Elside Essam , Taggaz Khaled S.
Published: April 2023

Introduction and importance:

A stab wound in the heart is associated with high mortality rates. Rapid patient transfer to the closest hospital, maximal speed in establishing a diagnosis, and highly trained prompt surgical intervention are all crucial to achieving a positive result in the treatment of these critical patients.

Case presentation:

This report presents a 28-year-old man with a stab wound to the chest, causing pericardial tamponade and a myocardial injury that presented with shock. The patient was diagnosed by chest ultrasonography and operated on successfully after 45 min of the stab without complications.

Clinical discussion and conclusion:

Cardiac repair should be attempted as soon as possible if the patient with the stab wound to the heart is not dead upon arrival. The time from the stabbing to the start of the operation is vital, and any delay in the operation may lose the patient. Glasgow Coma Scale could be considered as predicting variable for complications or mortality in patients with stab heart wounds.
Cerebral venous thrombosis and miliary tuberculosis: a case report from Syria
Authors: Labbad Ibrahim , Hamzeh Ghassan
Published: April 2023

Background:

Cerebral venous thrombosis (CVT) is a relatively common disease. Risk factors for CVT include pregnancy, cancer, autoimmune diseases, and hypercoagulation. Acute and chronic meningitis are also considered predisposing conditions for CVT. Cases of CVT associated with tuberculous meningitis and miliary tuberculosis (TB) are rare in the medical literature, and here the authors report the first case report from Middle East.

Case presentation:

The authors present a 33-year-old female patient diagnosed initially with CVT to discover the presence of tuberculous meningitis and miliary TB.

Clinical discussion:

CVT is an urgent condition and the outcome is usually good when treated quickly. The mechanisms of TB causing thrombosis are endothelial injury, slow venous flow, and increased platelet aggregation. The clinical presentation of CVT can be confused and falsely attributed to TB Meningitis.

Conclusion:

Infectious causes of CVT should always be remembered, especially TB should be in mind in developing countries.
Bronchial carcinoid misdiagnosed as COVID pneumonia: a case report
Authors: Mishra Sarmendra , Karki Saurab , Baral Surakshya , Regmi Aavishkar Raj , Gurung Adarsh , Gyawali Pramisa , Rokaya Pranjal , Pandey Sushmita
Published: April 2023

Introduction:

Bronchial carcinoid tumours are rare, slow-growing, malignant, Low-grade neuroendocrine tumours that arise from Enterochromaffin (Kulchitsky) cells and are usually detected typically as indolent and solitary tumours. Approximately 2% of all lung tumours are bronchial carcinoid tumours.

Case presentation:

The authors report a case of 55-years-old man who presented with a history of cough for 1 month and was initially diagnosed with a case of COVID-19. Then he was treated as a case of pneumonia as seen on high-resolution computed tomography. Later, contrast-enhanced computed tomography and bronchoscopy-guided biopsy were done which revealed a right lower lobe neuroendocrine tumour (carcinoid), which was successfully resected.

Clinical discussion:

The majority of typical carcinoids are located in the central airways leading to bronchial obstruction with recurrent pneumonia, chest pain, and wheezing. During the COVID-19 pandemic, lung cancer patients were at higher risk of being affected by COVID-19. This study emphasizes that early identification and differential diagnosis are extremely difficult in the absence of comprehensive study and workup as the clinical and imaging findings of COVID-19 may resemble lung cancer. Although hilar and mediastinal lymph nodes are the most common metastatic sites for typical carcinoids, most lymphadenopathies are caused by a reactive inflammatory reaction.

Conclusion:

Bronchial carcinoids are uncommon, malignant neuroendocrine tumours for which the only curative management is complete surgical resection. With full resection, the result of typical carcinoids with lymph node metastases is favourable.
Metastatic squamous cell carcinoma of the lung to the thyroid gland presented as nodular goiter: a rare case report
Authors: Al-janabi Moatasem Hussein , Zainab Haneen , Wannous Hiba , Dowaji Maria , Zainab Deema , Rasheed Omeed , Kannan Samir , Issa Rana
Published: April 2023

Introduction and importance:

Metastasis of squamous cell lung carcinoma to the thyroid gland is an extremely rare event. It frequently metastasizes to lymph nodes, liver, adrenal glands, bone, brain, and pleura. Among the lung carcinomas metastasizing to the thyroid, adenocarcinomas are the most common followed by squamous cell carcinomas (SCCs).

Case presentation:

A 58-year-old male patient presented with bilateral neck swelling. Fine needle aspiration is performed and was undetermined. Ultrasonography of the neck demonstrated multiple hypoechoic nodules with thyroid enlargement. The patient was diagnosed with nodular goitre and he underwent a total thyroidectomy. Microscopically, the Hematoxylin and eosin-stained sections revealed thyroid follicles with sheets composed of polygonal cells with pleomorphic nuclei, prominent nucleoli, and a moderate amount of eosinophilic cytoplasm. Keratin pearls were present. Based on histopathological and clinical findings, the final diagnosis was metastatic SCC to the thyroid gland.

Clinical discussion:

Clinically, patients with thyroid metastasis presented with nonspecific symptoms such as thyroid nodule or goitre, cervical discomfort, dyspnoea, dysphagia, or dysphonia. Chemotherapy is used in the case of a poly metastatic tumour and radiotherapy as a palliative treatment whereas radioiodine treatment is not indicated for thyroid metastases.

Conclusion:

Diagnosis of SCC in the thyroid gland as a primary or metastatic neoplasm is a significant challenge. In the absence of specific clinical or radiological signs, pathological studies remain the gold standard for diagnosis.
Why Babies die in the first 7 days after birth in Somalia Region of Ethiopia?
Authors: Mekebo Gizachew G. , Aga Gudeta , Gondol Ketema B. , Regesa Belema H. , Woldeyohannes Birhanu , Wolde Temesgen S. , Tadesse Getachew , Galdassa Agassa , Adebe Kebede L. , Ketema Hirko
Published: April 2023

Introduction:

Early neonatal death, which occurs during the prenatal period, is defined as the death of a newborn between 0 and 7 days after birth. It is one of the major public health problems in several developing countries. This study aimed to determine the early neonatal mortality rate and identify determinants of early neonatal mortality in Somalia region of Ethiopia.

Methods:

The data used for this study were drawn from the 2019 Ethiopia Mini Demographic and Health Survey (2019 EMDHS) data. A multivariable logistic regression model was used to identify the determinants of early neonatal mortality. Adjusted odds ratio (AOR) with 95% CI was used to examine the association of factors with early neonatal mortality.

Results:

A total of 637 live births were included in this study. The early neonatal mortality rate in the study was 44 (95% CI: 31, 65) deaths per 1000 live births. Male babies (AOR: 1.628; 95% CI: 1.152–4.895), babies delivered at home (AOR: 2.288; 95% CI: 1.194–6.593), and babies born from uneducated mothers (AOR: 2.130; 95% CI: 1.744–6.100) were at increased risk of death in the first 7 days of life after birth. Contrarily, decreased risk of death of babies in the first 7 days of life after birth was associated with urban residence (AOR: 0.669; 95% CI: 0.033–0.721) and singleton (AOR: 0.345; 95% CI: 0.070–0.609).

Conclusion:

The early neonatal mortality rate in the region was high. The study revealed that sex of child, place of residence, birth type, mother’s educational level, and place of delivery were the determinants of the death of babies in the first 7 days of life after birth. Hence, providing health education to uneducated mothers and enhancing institutional delivery is recommended to minimize the early neonatal mortality rate in the region.
Validation and Extension of the Association Between Potentially Excess Oxygen Exposure and Death in Mechanically Ventilated Children
Authors: Geva Alon , Akhondi-Asl Alireza , Mehta Nilesh M.
Published: April 2023

OBJECTIVES:

“Cumulative excess oxygen exposure” (CEOE)—previously defined as the mean hourly administered Fio
2 above 0.21 when the corresponding hourly Spo
2 was 95% or above—was previously shown to be associated with mortality. The objective of this study was to examine the relationship among Fio
2, Spo
2, and mortality in an independent cohort of mechanically ventilated children.

DESIGN:

Retrospective cross-sectional study.

SETTING:

Quaternary-care PICU.

PATIENTS:

All patients admitted to the PICU between 2012 and 2021 and mechanically ventilated via endotracheal tube for at least 24 hours.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Among 3,354 patients, 260 (8%) died. Higher CEOE quartile was associated with increased mortality (p = 0.001). The highest CEOE quartile had an 87% increased risk of mortality (95% CI, 7–236) compared with the first CEOE quartile. The hazard ratio for extended CEOE exposure, which included mechanical ventilation data from throughout the patients’ mechanical ventilation time rather than only from the first 24 hours of mechanical ventilation, was 1.03 (95% CI, 1.02–1.03).

CONCLUSIONS:

Potentially excess oxygen exposure in patients whose oxygen saturation was at least 95% was associated with increased mortality.