bluuebunny/crossref_metadata_2025 huggingface dataset:
Post‐ovulatory aging is associated with altered patterns for small ubiquitin‐like modifier (SUMO) proteins and SUMO‐specific proteases
Authors: Feitosa Weber Beringui , Morris Patricia L.
Published: February 2023

Mammalian oocytes are ovulated arrested at metaphase of the second meiotic division. If they are not fertilized within a short period, the oocyte undergoes several progressive morphological, structural, and molecular changes during a process called oocyte aging. Herein, we focused on those functional events associated with proper cytoskeleton organization and those that correlate with spindle displacement and chromosome misalignment or scatter. Post‐translational modifications by Small Ubiquitin‐like Modifier (SUMO) proteins are involved in spindle organization and here we demonstrate that the SUMO pathway is involved in spindle morphology changes and chromosome movements during oocyte aging. SUMO‐2/3 as well as the SUMO‐specific proteases SENP‐2 localization are affected by postovulatory aging in vitro. Consistent with these findings, UBC9 decreases during oocyte aging while differential ubiquitination patterns also correlate with in vitro oocyte aging. These results are consistent with postovulatory aging‐related alterations in the posttranslational modifications of the spindle apparatus by SUMO and its SENP proteases. These findings are suggestive that such age‐related changes in SUMOylation and the deSUMOylation of key target proteins in the spindle apparatus and kinetochore may be involved with spindle and chromosome alignment defects during mammalian oocyte postovulatory aging. Such findings may have implications for ART‐related human oocyte aging in vitro regarding the activities of the SUMO pathway and fertilization success.
Pain and Disability Following Exercise-Induced Injury in Prognostic and Intervention Studies: The Why May Be More Important Than the How
Authors: Bishop Mark D. , George Steven Z.
Published: February 2023

Objectives:

In preclinical prognostic studies, the description of expected outcomes during an informed consent process indicates that the extent of pain and disability experienced and recovery time is unknown. In intervention studies, the consent process suggests that pain and disability will definitely occur and a treatment provided. Our objective was to determine whether study design (prognosis or intervention) was associated with the severity of pain intensity and disability reports from a preclinical model.

Materials and Methods:

We pooled pain and disability outcomes from prognostic and intervention studies using an exercise-induced muscle injury model of pain. Pain intensity, disability, and fear of pain were collected by validated self-report measures. Pain and disability data were z-transformed for pooled analyses and compared across the study design.

Results:

Data from 310 people were included. The primary findings were that self-reported pain intensity and disability were: (1) higher in prognostic studies than in the intervention studies and (2) associated with fear of pain. A secondary finding was that fear of pain was lower in the intervention compared with the prognostic studies.

Discussion:

Although there are other possible explanations, we speculate that these results could be related to the uncertainty inherent to providing informed consent for a prognostic study. In light of these findings, we recommend that informed consent language be more carefully considered when pain is induced in a controlled manner. Incorporating informed consent language commonly used in prognostic studies could result in higher pain intensity and disability ratings in studies that use preclinical models to test the efficacy of pain interventions.
A Parent-Targeted Group Intervention for Pediatric Pain Delivered In-Person or Virtually
Authors: Lee Soeun , Dick Bruce D. , Jordan Abbie , McMurtry C. Meghan
Published: February 2023

Objectives:

Parents play integral roles in their youth’s chronic pain and can experience elevated distress related to caregiving. This study examined a cognitive-behavior therapy-based parent-targeted group intervention, including understudied/novel resilience/risk (eg, distress, parenting self-regulation), and compared the effect of in-person versus virtual delivery format.

Hypotheses:

(1) Adequate feasibility and acceptability (enrolment>33%, attendance >60%, attrition <25%, satisfaction ratings >90%), with higher indicators of feasibility in the virtual groups; (2) Significant improvements in parent psychological flexibility, protectiveness, distress, and parenting self-regulation at posttreatment that were maintained at follow-up, with no difference between delivery type.

Methods:

Parents were enroled from an outpatient pediatric chronic pain clinic and participated in the group intervention in-person or virtually; questionnaires were completed at baseline, posttreatment, and 3-month follow-up.

Results:

Enrolment (55% in-person, 65% virtual) and attendance (86% in-person, 93% virtual) were higher, and attrition was lower than expected (4% in-person, 7% virtual). Satisfaction was high (4.95/5 in-person, 4.85/5 virtual); on written feedback, parents enjoyed connecting with other parents (27/56, 48%) the most. The least preferred were the virtual format (5/36, 14%) and timing of the group (6/52, 12%). There were no differences between delivery formats in feasibility/acceptability. The intervention significantly improved parents’ psychological flexibility, protectiveness, distress, and parenting self-regulation over time. A small group difference favored the in-person format for psychological flexibility, and an interaction effect for parenting self-regulation was found.

Discussion:

This standalone parent-targeted group intervention had positive effects on parent outcomes delivered either in-person or virtually.
Which Radiographic Parameter Can Aid in Deciding Optimal Allograft Height for Anterior Cervical Discectomy and Fusion?
Authors: Yang Jae Jun , Park Sehan , Kim Dong-Min
Published: February 2023

Study Design:

Retrospective cohort study.

Objectives:

To identify preoperative radiographic parameters that can guide optimal allograft height selection for anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:

Allograft height selection for ACDF depends on intraoperative assessment supported by trials; however, there is currently no radiographic reference parameter that could aid in allograft height selection for improved outcomes.

Methods:

A total of 148 patients who underwent ACDF using allografts and were followed up for more than 1 year were retrospectively reviewed. Fusion rates, subsidence, segmental lordosis, and foraminal height were assessed. Segments were divided into 2 groups according to whether the inserted allograft height was within 1 mm from the following 3 reference radiographic parameters: (1) uncinate process height, (2) adjacent disc height, and (3) preoperative disc height +2 mm.

Results:

This study included 101 patients with 163 segments. Segments with an allograft-uncinate height difference of ≤1 mm had a significantly higher fusion rate at 1-year follow-up compared with segments with allograft-uncinate height difference of >1 mm [85/107 (79.4%) vs. 35/56 (62.5%); P=0.025]. Subsidence, segmental lordosis, and foraminal height did not significantly differ between the groups when segments were divided according to uncinate height. Multivariate logistic regression analysis demonstrated that allograft-uncinate height difference of ≤1 mm and allograft failure were factors associated with fusion.

Conclusions:

The uncinate process height can guide optimal allograft height selection for ACDF. Using an allograft with an allograft-uncinate height difference of ≤1 mm resulted in a higher fusion rate. Therefore, the uncinate process height should be checked preoperatively and used in conjunction with intraoperative assessment when selecting allograft height.
U.S. Adult Critical Care Beds Per Capita: A 2021 County-Level Cross-Sectional Study
Authors: Kempker Jordan A. , Stearns Erin , Peterson Emily N. , Waller Lance A.
Published: February 2023

IMPORTANCE:

Per capita geographic distribution of adult critical care beds can be utilized for healthcare resources assessments.

OBJECTIVES:

Describe the per capita distribution of staffed adult critical care beds across the United States.

DESIGN, SETTING AND PARTICIPANTS:

Cross-sectional epidemiologic assessment of November 2021 hospital data from the Department of Health and Human Services’ Protect Public Data Hub.

MAIN OUTCOMES AND MEASURES:

Staffed adult critical care beds per adult population.

RESULTS:

The percent of hospitals reporting was high and varied by state/territory (median, 98.6% of states’ hospitals reporting; interquartile range [IQR], 97.8–100%). There was a total of 4,846 adult hospitals accounting for 79,876 adult critical care beds in the United States and its territories. Crudely aggregated at the national-level, this calculated to 0.31 adult critical care beds per 1,000 adults. The median crude per capita density of adult critical care beds per 1,000 adults across U.S. counties was 0.00 per 1,000 adults (county, IQR 0.00–0.25; range, 0.00–8.65). Spatially smoothed county-level estimates were obtained using Empirical Bayes and Spatial Empirical Bayes approaches, resulting in an estimated 0.18 adult critical care beds per 1,000 adults (range from both methodological estimates, 0.00–8.20). When compared to counties in the lower quartile of adult critical care bed density, counties in the upper quartile had higher average adult population counts (mean 159,000 vs 32,000 adults per county) and a choropleth map demonstrated high densities of beds in urban centers with low density across rural areas.

CONCLUSIONS AND RELEVANCE:

Among U.S. counties, the density of critical care beds per capita was not uniformly distributed, with high densities concentrated in highly populated urban centers and relative scarcity in rural areas. As it is unknown what defines deficiency and surplus in terms of outcomes and costs, this descriptive report serves as an additional methodological benchmark for hypothesis-driven research in this area.
Early Versus Delayed Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation—A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Al Lawati Kumait , Forestell Ben , Binbraik Yasser , Sharif Sameer , Ainsworth Craig , Mathew Rebecca , Amin Faizan , Al Fawaz Mohammed , Pinilla-Echeverri Natalia , Belley-Côté Emilie , Welsford Michelle , Rochwerg Bram
Published: February 2023

OBJECTIVES:

The optimal timing of coronary angiography remains unclear following out-of-hospital cardiac arrest (OHCA) without ST elevation on electrocardiogram. The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of early angiography versus delayed angiography following OHCA without ST elevation.

DATA SOURCES:

The databases MEDLINE, PubMed EMBASE, and CINHAL, as well as unpublished sources from inception to March 9, 2022.

STUDY SELECTION:

A systematic search was performed for randomized controlled trials of adult patients after OHCA without ST elevation who were randomized to early as compared to delayed angiography.

DATA EXTRACTION:

Reviewers screened and abstracted data independently and in duplicate. The certainty of evidence was assessed for each outcome using the Grading Recommendations Assessment, Development and Evaluation approach. The protocol was preregistered (CRD 42021292228).

DATA SYNTHESIS:

Six trials were included (n = 1,590 patients). Early angiography probably has no effect on mortality (relative risk [RR] 1.04; 95% CI 0.94–1.15; moderate certainty) and may have no effect on survival with good neurologic outcome (RR 0.97; 95% CI 0.87–1.07; low certainty) or ICU length of stay (LOS) (mean difference 0.41 days fewer; 95% CI –1.3 to 0.5 d; low certainty). Early angiography has an uncertain effect on adverse events.

CONCLUSIONS:

In OHCA patients without ST elevation, early angiography probably has no effect on mortality and may have no effect on survival with good neurologic outcome and ICU LOS. Early angiography has an uncertain effect on adverse events.
Development and External Validation of a Prediction Model for Quality of Life of ICU Survivors: A Subanalysis of the MONITOR-IC Prospective Cohort Study*
Authors: Porter Lucy L. , Simons Koen S. , Ramjith Jordache , Corsten Stijn , Westerhof Brigitte , Rettig Thijs C. D. , Ewalds Esther , Janssen Inge , van der Hoeven Johannes G. , van den Boogaard Mark , Zegers Marieke
Published: February 2023

OBJECTIVES:

To develop and externally validate a prediction model for ICU survivors’ change in quality of life 1 year after ICU admission that can support ICU physicians in preparing patients for life after ICU and managing their expectations.

DESIGN:

Data from a prospective multicenter cohort study (MONITOR-IC) were used.

SETTING:

Seven hospitals in the Netherlands.

PATIENTS:

ICU survivors greater than or equal to 16 years old.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Outcome was defined as change in quality of life, measured using the EuroQol 5D questionnaire. The developed model was based on data from an academic hospital, using multivariable linear regression analysis. To assist usability, variables were selected using the least absolute shrinkage and selection operator method. External validation was executed using data of six nonacademic hospitals. Of 1,804 patients included in analysis, 1,057 patients (58.6%) were admitted to the academic hospital, and 747 patients (41.4%) were admitted to a nonacademic hospital. Forty-nine variables were entered into a linear regression model, resulting in an explained variance (R
2) of 56.6%. Only three variables, baseline quality of life, admission type, and Glasgow Coma Scale, were selected for the final model (R
2 = 52.5%). External validation showed good predictive power (R
2 = 53.2%).

CONCLUSIONS:

This study developed and externally validated a prediction model for change in quality of life 1 year after ICU admission. Due to the small number of predictors, the model is appealing for use in clinical practice, where it can be implemented to prepare patients for life after ICU. The next step is to evaluate the impact of this prediction model on outcomes and experiences of patients.
Familial clustering of intrahepatic cholestasis of pregnancy: A nationwide population-based study in Denmark
Authors: Li Jiong , Chen Jiawen , Lee Priscilla Ming Yi , Zhang Jun , Li Fei , Ren Tai
Published: February 2023

Background and Aims:

Genetics plays a role in the pathogenesis of intrahepatic cholestasis of pregnancy (ICP); however, empirical evidence on familial clustering of ICP is scarce. We aimed to assess the extent of familial recurrence of ICP.

Approach and Results:

This population-based cohort study included all 668,461 primiparous women who gave birth between 1995 and 2018 in Denmark. Women diagnosed with ICP were included to the index cohort. Kinship with index women was determined with the Danish Civil Registration System. Log-binomial regression was used to calculate the relative recurrence risk (RRR) of ICP in relatives of index women. A total of 6722 (1.0%) primiparous women were diagnosed with ICP. In co-twins (n=57), first-degree (n=2279), second-degree (n=1373), and third-degree (n=1758) relatives of the index women, the incidence of ICP reached 5.3%, 2.6%, 0.7%, and 1.4%, respectively, corresponding to adjusted RRRs of 4.82 (95% CI, 1.60–14.48), 2.54 (1.98–3.26), 0.81 (0.44–1.51), and 1.15 (0.77–1.71), respectively. The first-degree relatives of women who had recurrent ICP or first-trimester ICP seemed to be at higher risks [RRR, 4.30 (2.85–6.48), 3.04 (1.93–4.77), respectively]. A minor increased risk was observed in nonbiological relatives [RRR, 1.35 (1.05–1.73); n=4274, including women’s full-brothers’ partner and women’s husbands’ full sisters].

Conclusions:

Co-twins and first-degree relatives of ICP patients were at ~5- and ~2.5-fold increased risk of ICP, respectively. No increased risk was observed in second-degree and third-degree relatives. Recurrent ICP and first-trimester ICP might indicate a higher degree of family clustering. Further investigation is needed to investigate the increased risk of ICP in nonbiological relatives.
Lean individuals with NAFLD have more severe liver disease and poorer clinical outcomes (NASH-CO Study)
Authors: Nabi Oumarou , Lapidus Nathanaël , Boursier Jerome , de Ledinghen Victor , Petit Jean-Michel , Kab Sofiane , Renuy Adeline , Zins Marie , Lacombe Karine , Serfaty Lawrence
Published: February 2023

Background and Aims:

The severity of liver injury and clinical outcomes in lean individuals with NAFLD is a subject of debate and very few studies have been performed in the general population. The aim of this study was to compare subject characteristics and mortality between lean and nonlean NAFLD in a community setting.

Approach and Results:

The study population included 169,303 participants from the nationwide Constances cohort. Subjects with excessive alcohol consumption, viral hepatitis, or other liver diseases were excluded and 137,206 subjects were analyzed. The diagnosis of NAFLD and fibrosis was performed using the Fatty Liver Index and the Forns Index. The median follow-up was 3.58 years. The prevalence of NAFLD was 5.3% (95% CI: 5.2–5.4) in lean subjects, while 16.3% (95% CI: 15.7–16.8) of NAFLD subjects were lean. Despite their better metabolic profile, the prevalence of advanced fibrosis was significantly higher in lean than in nonlean NAFLD (3.7% vs. 1.7%, respectively, p < 0.01). Among NAFLD subjects and after adjustment for demographics, metabolic risk factors and lifestyle, lean status was associated with advanced fibrosis (OR=1.26, 95% CI: 1.20–1.65, p = 0.005), an increased risk of liver-related events (adjusted HR=5.84, 95% CI: 4.03–8.46), chronic kidney disease (adjusted HR=2.49, 95% CI: 1.49–4.16), and overall mortality (adjusted HR=3.01, 95% CI: 2.21–4.11). Liver-related events and overall mortality were related to the severity of fibrosis, both in lean and nonlean NAFLD subjects, whatever the usual risk factors.

Conclusion:

This study in a large community-based cohort confirms that NAFLD in lean subjects is more severe for fibrosis, the progression of liver disease, chronic kidney disease, and overall mortality.
Contingency Management for Stimulant Use Disorder
Authors: Rawson Richard A. , Erath Tyler G. , Chalk Mady , Clark H Westley , McDaid Carol , Wattenberg Sarah A. , Roll John M. , McDonell Michael G. , Parent Sara , Freese Thomas E.
Published: February 2023

The United States is currently in the fourth wave of the overdose crisis wherein stimulants together with fentanyl are the major drivers of overdose deaths. To date, there has been limited effort outside the US Veterans Administration Health System health system to disseminate evidence-based treatment for people with stimulant use disorder. Contingency management, a behavioral intervention in which positive reinforcement is provided for a target behavior indicating treatment progress, has decades of empirical support but limited implementation in real-world, non-US Veterans Administration Health System settings. The purpose of the report is to provide an overview of contingency management, the barriers to adoption, and recommendations for overcoming these barriers.
Feasibility and Effect of Increasing Clozapine Plasma Levels in Long-Stay Patients With Treatment-Resistant Schizophrenia
Authors: Bogers Jan P.A.M. , Schulte Peter F.J. , Broekman Theo G. , de Haan Lieuwe
Published: February 2023

Background

It is unknown whether increasing the clozapine plasma level to 400, 750, or even 1000 ng/mL is a feasible and effective strategy in patients with treatment-resistant schizophrenia (TRS). We investigated this in long-stay patients with TRS.

Methods

In long-stay TRS patients, doses of clozapine were increased gradually to reach target plasma levels of 400, 750, or 1000 ng/mL, depending on the clinical response and tolerability. After an effective or tolerated level was reached, positive and negative syndrome scale scores were evaluated after 3 months and 1 year.

Results

Twenty-eight patients were included. Overall, 54% of the patients, and especially patients 60 years and older, could not achieve one of the clozapine target levels because of adverse effects. Three physically vulnerable patients died, probably not directly related to clozapine use. Although only 21% of patients achieved a more than 20% reduction in total symptoms at the 1-year follow-up, the mean severity of positive symptoms decreased from 18.18 to 15.10 (P < 0.01). The largest decrease in positive symptoms was seen in TRS patients who achieved a plasma level of 750 ng/mL of clozapine.

Conclusions

Most TRS patients older than 60 years could not tolerate high clozapine levels and so this should not be attempted in older or otherwise physically vulnerable patients. Increasing clozapine levels to approximately 750 ng/mL in middle-aged patients with longstanding TRS may modestly reduce the severity of positive symptoms and improve the response rate.
Pulmonary Functions and Oxidative Stress Biomarkers Among Silica-Exposed Foundry Workers
Authors: Hussein Asmaa Mohamed , Attia Dalia Ismail , Zayed Bahaa El-Din Mostafa , Rashed Laila Ahmed , EL-Sherif Ghada Hossam El-Din
Published: February 2023

Objective

To investigate the changes of the ventilatory function tests and the oxidative stress biomarkers among silica-exposed foundry workers.

Methods

The exposed group included 70 workers in an iron foundry. The nonexposed group included 40 subjects from Kasralainy outpatient clinic. Both groups were subjected to history taking, clinical examination, chest radiograph, spirometry, urinary silica, serum malondialdehyde (MDA), glutathione peroxidase (GPx), and 8-hydroxydeoxyguanosine (8-HdG).

Results

Higher urinary silica, serum MDA and serum 8-HdG, whereas lower serum GPx and ventilatory functions were detected in the exposed group compared with the controls. All parameters correlated with urinary silica. The exposed silicotic subgroup had increased work duration, urinary silica, serum MDA, and serum 8-HdG, and decreased serum GPx and ventilatory functions compared with non-silicotic subgroup.

Conclusion

Oxidative stress biomarkers were abnormal with impairment of ventilatory functions among silica-exposed workers.
Cholera outbreak in Balochistan amidst flash floods: an impending public health crisis
Authors: Jawed Shizra , Islam Muhammad Bilal , Awan Hashir Ali , Ullah Irfan , Asghar Muhammad Sohaib
Published: February 2023

Despite being the largest province in Pakistan due to inadequate and underdeveloped infrastructure, Balochistan has been the worst-inflicted region with biblical floods. Following these disastrous flash floods, a sudden rise in cholera cases was seen in the affected province. To overcome this public health crisis, the authorities must put in place a system to ensure food safety, an adequate supply of clean drinking water, and the provision of proper sanitation facilities for the locals.
Diarrhea in the critically ill: definitions, epidemiology, risk factors and outcomes
Authors: Dionne Joanna C. , Mbuagbaw Lawrence
Published: February 2023

Purpose of review

In this paper, we review the current evidence with respect to definitions, risk factors, and outcomes of diarrhea in the critically ill and highlight research gaps in the literature.

Recent findings

Definitions of diarrhea in the intensive care unit (ICU) include the World Health Organization quantified as >3 liquid bowel movements per day and the Bristol Stool Chart score of 7. Diarrhea incidence is 37.7–73.8% and varies based on definition applied. Clostridioides difficile associated diarrhea (CDAD) is uncommon with an incidence of 2.2%. Risk factors for diarrhea include total number of antibiotics, enteral nutrition, and suppository use. The composition of enteral nutrition including high osmolarity and high fiber feeds contributed to diarrhea occurrence. Opiates decrease diarrhea incidence whereas probiotics have no effect on the incidence or duration of diarrhea. Outcomes of diarrhea include increased length of stay in the ICU and hospital, however its impact on mortality is unclear.

Diarrhea remains a common problem in clinical practice and attention must be paid to modifiable risk factors. Further research is needed on interventions to decrease its burden.
Case report: Extravascular catheter migration in a child: A rare complication of the totally implantable venous access device
Authors: Lu Xuning , Ren Yueyi , Wan Hao , Xu Qiteng , Duan Shuhua
Published: February 2023

Background:

Totally implantable venous access devices (TIVADs) are widely used to gain intermittent central venous access, such as in patients who need long-term chemotherapy, total parenteral nutrition, and long-term antibiotic treatment. At present, there are many complications associated with the use of these devices. Complete extravascular migration of TIVADs via the internal jugular vein is a very rare and potentially serious condition, especially in children.

Case presentation:

A 1-year-old girl needed palliative chemotherapy because of hepatoblastoma complicated by inferior vena cava thrombosis. A TIVAD was implanted through the right internal jugular vein with a routine heparin flushing tube. On the second day after the operation, a pale bloody liquid was drawn out from the device and the chest X-ray was checked to confirm that the position of the catheter was normal. On the third day after the operation, however, the patient’s right respiratory sound was weakened on physical examination and auscultation. Fluoroscopy showed that the tip of the catheter was located in the right thoracic cavity, and there was a large amount of effusion in the right thoracic cavity. The pleural effusion was removed, the TIVAD was replaced again, and the child was discharged 2 days later.

Conclusions:

Following TIVAD implantation, if abnormalities are found, in addition to chest X-ray, saline flush and echocardiography should be performed to determine the position of the catheter and rule out extravascular migration of the catheter to avoid irreparable consequences.
The impact of Teach-back method on preoperative anxiety and surgical cooperation in elderly patients undergoing outpatient ophthalmology surgery: A randomized clinical trial
Authors: Shen Dan , Huang Weiyi , Wei Shujin , Zhu Yanjun , Shi Baoxin
Published: February 2023

Background:

The literatures have demonstrated that Teach-back method is an effective communication tool to understand health education, especially in the elderly patients. However, there is limited research of Teach-back method in preoperative education for outpatient surgical patients. This study was conducted to investigate the effects of the Teach-back method on preoperative anxiety and surgical cooperation in elderly patients undergoing outpatient ophthalmology surgery.

Methods:

One hundred sixteen elderly patients who underwent outpatient ophthalmology surgery were selected as the research objects. They were divided into the observation group (58 cases) and the control group (58 cases). The Teach-back preoperative education was adopted in the observation group and the standard preoperative education method was adopted in the control group. The degree of anxiety, surgical cooperation, and awareness of health knowledge were compared between the 2 groups, and the variations of blood pressure and heart rate, as well as the highest values of intraoperative blood pressure and heart rate before and after method, were recorded and compared.

Results:

The preoperative systolic blood pressure in the observation group was significantly lower than that in the control group. The intraoperative (the highest value) heart rate, systolic blood pressure, and diastolic blood pressure in the observation group were lower than those in the control group, and the differences were statistically significant (P < .05). After intervention, the anxiety score and information demand score of the observation group were lower than those of the control group, and the differences were statistically significant (P < .05). The degree of surgery cooperation and awareness of perioperative health knowledge in the observation group were all higher than those in the control group; the differences were statistically significant (P < .05).

Conclusion:

The Teach-back method could relieve the preoperative anxiety of the patients, improve the quality of patients surgery cooperation, and facilitate the awareness of health knowledge. Moreover, it could effectively improve the intraoperative stress response of the elderly patients and reduce the large fluctuations of blood pressure and heart rate.
Analysis of citation trends to identify articles on delirium worth reading using DDPP model with temporal heatmaps (THM): A bibliometric analysis
Authors: Ho Sam Yu-Chieh , Chien Tsair-Wei , Tsai Kang-Ting , Chou Willy
Published: February 2023

Background:

Delirium is one of the most common geriatric syndromes in older patients, accounting for 25% of hospitalized older patients, 31 to 35% of patients in the intensive care unit, and 8% to 17% of older patients in the emergency department (ED). A number of articles have been published in the literature regarding delirium. However, it is unclear about article citations evolving in the field. This study proposed a temporal heatmap (THM) that can be applied to all bibliographical studies for a better understanding of cited articles worth reading.

Methods:

As of November 25, 2022, 11,668 abstracts published on delirium since 2013 were retrieved from the Web of Science core collection. Research achievements were measured using the CJAL score. Social network analysis was applied to examine clusters of keywords associated with core concepts of research. A THM was proposed to detect articles worth reading based on recent citations that are increasing. The 100 top-cited articles related to delirium were displayed on an impact beam plot (IBP).

Results:

The results indicate that the US (12474), Vanderbilt University (US) (634), Anesthesiology (2168), and Alessandro Morandi (Italy) (116) had the highest CJAL scores in countries, institutes, departments, and authors, respectively. Articles worthy of reading were highlighted on a THM and an IBP when an increasing trend of citations over the last 4 years was observed.

Conclusion:

The THM and IBP were proposed to highlight articles worth reading, and we recommend that more future bibliographical studies utilize the 2 visualizations and not restrict them solely to delirium-related articles in the future.
Delayed recognition of autism spectrum disorder and attention-deficit/hyperactivity disorder in a girl with ornithine transcarbamylase deficiency: A case report
Authors: Kadono Shin , Miyawaki Dai , Goto Ayako , Hirai Kaoru , Sakamoto Shoko , Hama Hiroki , Nishiura Sayaka , Hamazaki Takashi , Inoue Koki
Published: February 2023

Rationale:

Ornithine transcarbamylase (OTC) deficiency, a urea cycle disorder, is a rare congenital metabolic error that leads to hyperammonemia. Psychiatric symptoms of hyperammonemia are nonspecific and can cause autism spectrum disorder (ASD)-like symptoms and attention-deficit/hyperactivity disorder (ADHD)-like symptoms. Some studies report that OTC deficiency is often initially diagnosed as ASD or ADHD. However, there are no reports of OTC deficiency comorbid with ASD and ADHD.

Patient concerns:

The patient is 17-year-old girl diagnosed with OTC deficiency at 3 years of age. She had behavioral problems since childhood, including depressed mood, irritability, and impulsive behavior; however, they were considered OTC-mediated nonspecific psychiatric symptoms. Therefore, the patient had not been appropriately assessed for ASD and ADHD. She presented with depressed mood and self-harm at 17 years of age.

Diagnoses:

We diagnosed her with ASD and ADHD based on her medical history and semistructured interviews.

Interventions:

We focused her ASD and ADHD traits and discussed strategies with her for better adaptive living.

Outcomes:

Our interventions resulted in her better social adjustment.

Lessons:

Physicians should consider the possibility of comorbid ASD and ADHD in individuals with OTC, facilitating appropriate and intervention for better outcomes.
Using chord diagrams to explore article themes in 100 top-cited articles citing Hirsch’s h-index since 2005: A bibliometric analysis
Authors: Lee Yei-Soon , Chow Julie Chi , Chien Tsair-Wei , Chou Willy
Published: February 2023

Background:

The h-index is increasingly being used as a measure of individual research achievement (IRA). More than 4876 citing articles have been published and indexed in Web of Science. The articles citing the h-index that have made the greatest contribution to scientific academics are still unknown. It is also unclear which subject categories (SCs) can be classified based on their keywords.

Methods:

These 4976 citing articles have been collected from the Web of Science since 2005. SCs were classified using chord diagrams to visualize their associations of SCs and documents in 100 top-cited articles (T100hciting). In addition to chord diagrams, 6 visualizations were used to illustrate study results: choropleth maps were used to depict the geographical distribution of publications across countries, network diagrams were created by using coword analysis, box plots were created to complement the network diagrams, Sankey diagrams highlighted the 5 most important elements in each article entity, the dot plot was used for displaying T100hciting, and a radar plot was used to present the top 10 high-IRA elements of countries, institutes, departments, and authors based on category, journal impact factor, authorship, and L-index scores.

Results:

A coword cluster analysis indicates that the majority of articles come from the US (918, 18%) and China (603, 12%), the top 2 SCs are h-index and bibliometric analysis, and the top 5 countries account for 55% in T100hciting, such as the US (25%), Spain (10%), Netherlands (9%), China (6%), and Belgium (5%). In T100hciting, 4 SCs are included, namely, the h-index (72%), bibliometric analysis (24%), physics & multidisciplinary (3%), and infectious diseases (1%).

Conclusion:

A total of 7 visualizations were used to display the results in this study. Chord diagrams are suggested as a tool for future bibliographical studies to classify SCs Future bibliometrics with chord diagrams should not be limited to the topic of h-index-citing articles, as we did in this study.
A systematic review and meta-analysis of the diagnostic value of circulating microRNA-17-5p in patients with non-small cell lung cancer
Authors: Hao Juntao , Shen Zengqiang
Published: February 2023

Background:

nonSmall Cell Lung Cancer (NSCLC) is the most common type of lung cancer with high morbidity and mortality rates. Studies have shown that miR-17-5p levels are significantly increased in the circulating blood of NSCLC patients. This meta-analysis aimed to investigate the diagnostic value of miR-17-5p in NSCLC in China.

Methods:

A literature search was conducted for studies on the correlation between miR-25 and the diagnosis of NSCLC until October 2022 using English and Chinese databases. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was adopted to evaluate the quality of studies in the literature. Numerical values for sensitivity and specificity were obtained from false negative (FN), false positive (FP), true negative (TN), and true positive (TP) rates, presented alongside graphical representations with boxes marking the values and horizontal lines showing the confidence intervals. Summary Receiver Operating Characteristic (SROC) curves were applied to assess the performance of the diagnostic tests. The data were processed using RevMan 5.3.

Results:

Three studies (208 cases of NSCLC patients and 198 healthy controls) met our evaluation criteria. The sensitivity was 0.70 to 0.75, and the specificity value was 0.82 to 0.83. The Area Under the Curve (AUC) from the SROC curves was > 80%; therefore, it was classified as a good category.

Conclusion:

Our meta-analysis shows that miR-17-5p can be used for the diagnosis of NSCLC and may serve as a biomarker for the detection of early NSCLC in the Chinese population.
Effect of weight-bearing Liuzijue Qigong on cardiopulmonary function
Authors: Li Desheng , Shen Mei , Yang Xiaoyan , Chen Desheng , Zhou Chunxiu , Qian Qiuyang
Published: February 2023

Background:

Since the outbreak of coronavirus disease 2019, many people have had to reduce their outdoor activities. Therefore, a convenient, simple, at-home training method to improve or maintain cardiopulmonary function is required. This study aimed to explore the therapeutic effect of weight-bearing Liuzijue Qigong on cardiopulmonary function in healthy volunteers.

Methods:

This study was a longitudinal trial. The health participants completed a 4-week Liuzijue Qigong exercise with 0.25 kg sandbag wore on each wrist. Each training session took 30 minutes to complete 2 consecutive cycles, and 5 times a week. The cardiopulmonary function of participants was evaluated at baseline (T0) and the end of the intervention (T4). Outcomes measures were pulmonary function, diaphragm movement, and cardiac hemodynamic parameters. Paired t test was used to analyze differences within the group.

Results:

After 4 weeks of weight-bearing Liuzijue Qigong exercise intervention, the differences in the forced expiratory volume in the 1st second (P = .006), forced vital capacity rate of 1 second (P = .003), maximal mid-expiratory flow curve (P = .002), forced expiratory flow at 50% of forced vital capacity (P = .003), and maximum ventilatory volume (P < .001) of the participants were statistically significant. The diaphragmatic excursion (P = .009) under the calm breathing mode and the diaphragmatic contraction speed (P = .003) under the deep breathing mode improved significantly. The cardiac output (P = .04), cardiac index (P = .035), contractility index (P = .018), early diastolic filling ratio (P = .042), systemic vascular resistance index (P = .019), systemic vascular resistance (P = .017), and estimated ejection fraction (P = .016) of participants improved significantly in the resting stage. At the end stage of fast walking, that is, the sixth minute of six-minute walk test, the stroke volume index (P = .048), heart rate (P = .019), cardiac output (P = .008), cardiac index (P = .003), and left cardiac work index (P = .028) of participants were significantly increased compared with those before training, and the systemic vascular resistance index (P = .003) and systemic vascular resistance (P = .005) were decreased.

Conclusion:

Weight-bearing Liuzijue Qigong training significantly improved cardiopulmonary function in healthy volunteers, thus representing home-based cardiopulmonary rehabilitation training.
A novel inflammasome-related gene nomogram predicts survival in hepatocellular carcinoma
Authors: Lv Zhengqi , Li Heng , Yuan Yiwen , Wu Qinghua
Published: February 2023

Inflammasomes are closely associated with the progression of multiple cancers. We established an inflammasome-related gene (IRG)-based model to predict the survival of patients with hepatocellular carcinoma (HCC). The RNA-sequencing data and clinical information of HCC patients were downloaded from the cancer genome atlas-liver hepatocellular carcinoma database, and the differentially expressed inflammasome-related gene were screened. Seven prognostic differentially expressed inflammasome-related genes were identified by univariate Cox analysis and incorporated into the risk model using least absolute shrinkage and selection operator-Cox algorithm. The predictive accuracy of the risk model was evaluated through the Kaplan–Meier, receiver operating characteristic and Cox regression analyses. The performance of the model was verified in the International Cancer Genome Consortium-Liver Cancer - RIKEN, JP cohort. A nomogram was constructed to predict the 1-, 2-, 3- ,and 5-year survival of HCC patients, and its performance was evaluated using calibration curves. The significantly enriched gene ontology terms, Kyoto encyclopedia of genes and genomes pathways and infiltrating immune cell populations associated with the IRG model were also analyzed to explore of the potential molecular mechanisms and immunotherapeutic targets. An independent and highly accurate prognostic model consisting of 7 IRGs was established and verified in 2 independent HCC cohorts. The IRG model was significantly associated with cell division and cell cycle. In addition, the high-risk group was more likely to have greater infiltration of immune cells and higher expression of immune checkpoint-related genes compared to the low-risk group. An IRG-based model was established to predict 1-, 2-, 3-, and 5-year survival rate in individual HCC patients, which provides new insights into the role of inflammasomes in HCC.
The effects of smoking on genotoxic and histopathologic damage in exfoliated oral epithelial cells and the periodontium: A cross-sectional study
Authors: Alkan Begum , Koroglu-Aydin Pinar
Published: February 2023

Smoking negatively affects the prognosis of periodontal disease by impairing tissue healing. While micronucleus is the most popular parameter for demonstrating DNA damage, inflammatory cell and vascular densities are the most evaluated parameters for determining histopathologic changes in the periodontium. This study aimed to study the effects of periodontitis and cigarette smoking on genotoxic changes in exfoliated oral epithelial cells and histopathologic changes in periodontal tissue. A cross-sectional study was conducted between November 2018 and July 2019 at a dental university hospital in Turkey, and registered as NCT05484765. Eighty systemically healthy subjects were divided into four groups according to periodontal status and smoking habits: 20 smokers with generalized periodontitis (SGP), 20 nonsmokers with generalized periodontitis (NGP), 20 smokers with healthy periodontium (SHP), and 20 nonsmokers with healthy periodontium (NHP). For each study participant, full-mouth clinical periodontal parameters (CPPs) were measured, smear samples were taken from buccal and gingival mucosa, and periodontal tissue was biopsied from the maxillary molars. Cytogenetic and histopathologic assays (primary and secondary outcomes) were conducted using Feulgen reaction and hematoxylin-eosin staining, respectively. The mean CPPs of healthy periodontium groups were lower than generalized periodontitis groups. No significant differences were found between other groups regarding CPPs. Buccal micronuclei counts in groups decreased with the highest to lowest counts occurring in the order SGP > SHP > NGP > NHP. Gingival micronuclei counts in groups decreased from SGP > SHP > NGP = NHP. The most intense inflammatory cell and vascular densities occurred in SGP and NGP groups, respectively; and the mildest values were in healthy periodontium groups. Histopathological damage score decreased significantly by group in order SGP > NGP > SHP > NHP. The synergy arising from the combination of smoking and periodontitis exposures exacerbates genotoxic and histopathologic damage in oral cells and the periodontium.
Efficacy and safety of double- versus single-balloon retrograde enteroscopy
Authors: Garg Rajat , Singh Amandeep , Mohammed Abdul , Aggarwal Manik , Stevens Tyler , Vargo John , Jang Sunguk
Published: February 2023

Introduction

Data on the safety and efficacy of double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE) are conflicting. We aimed to compare the efficacy and safety of retrograde DBE to SBE.

Methods

We performed a retrospective analysis of all patients who underwent retrograde DBE or SBE at a large tertiary referral center from 2008 to December 2018. Outcomes assessed included technical success, diagnostic yield, therapeutics, depth of insertion, and procedural duration.

Results

A total of 523 (403 DBE, 120 SBE) patients underwent retrograde enteroscopy during the study period. The mean age was 59.4 ± 17.24 and 59.57 ± 16.94 years in DBE and SBE groups, respectively. There was no difference in technical success (91.0% vs. 92.5%, P = 0.85), diagnostic yield (40.9% vs. 40.8%, P = 0.95), and therapeutics (17.1% vs. 19.1%, P = 0.61) between DBE and SBE. Compared to SBE, DBE had significantly shorter mean procedure time (26.5 ± 34.5 min vs. 34.8 ± 29.4 min, P = 0.01) and higher maximal depth of insertion from ileocecal valve (108.1 ± 84.1 cm vs. 73.3 ± 63.4 cm, P = 0.001). Safety events were rare and similar in both groups.

Conclusion

Retrograde DBE is associated with a significantly higher depth of insertion and shorter procedural duration, but similar diagnostic yield and technical success compared to SBE.
Outcomes after hospitalisation with spontaneous bacterial peritonitis over a 13-year period: a retrospective cohort study
Authors: Ubhi Nicholas , Mourad Adele , Tausan Matija , Lewis Declan , Smethurst James , Wenlock Rhys , Gouda Mahmoud , Bremner Stephen , Verma Sumita
Published: February 2023

Goals

Assess outcomes in patients with an index presentation of spontaneous bacterial peritonitis (SBP) over a 13-year period.

Background

SBP, a bacterial infection of ascites, has a poor prognosis.

Study

Retrospective cohort study assessing mortality (standardised to 32 months) and prognostic factors in patients with SBP during two periods: period 1 (June 2006–November 2012) and period 2 (December 2012–May 2019).

Results

The study included 178 patients who were followed up for 11.6 (29.2) months. Mortality was high, with 12-, 24- and 32-month survival being 32%, 26% and 24%, respectively. Inpatient mortality was 36% with mortality in those surviving hospitalisation being 62%. Serum creatinine at the time of SBP diagnosis was an independent predictor of mortality at 32 months [hazard ratio (HR) 1.002, P = 0.023] and inpatient mortality (HR 1.003, P = 0.035). Positive ascitic fluid culture and ascitic fluid neutrophil count were independent predictors of 32-month (HR 1.679, P = 0.008) and inpatient mortality (HR 1.0001, P = 0.005), respectively. Patients in period 2 had lower ascitic fluid albumin (5.9 ± 3.3 g/L vs. 10.8 ± 5.4 g/L, P < 0.001), higher ascitic fluid neutrophil count (815.0 cells/mm3 vs. 345.0 cells/mm3, P < 0.001) and higher rates of hepatorenal syndrome-acute kidney injury (58 vs. 35%, P = 0.002). Mortality at 32 months and mortality in those surviving hospitalisation were similar at 78 vs. 73%, P = 0.392 and 66 vs. 58%, P = 0.355, for periods 1 and 2, respectively.

Conclusions

Despite more advanced initial presentations, mortality rates have remained similar over the last 13 years. Serum creatinine at the time of SBP diagnosis is an independent predictor of mortality.
Satisfaction of Older Patients With Emergency Department Care
Authors: Hoonakker Peter L. T. , Carayon Pascale , Brown Roger L. , Schwei Rebecca , Green Rebecca K. , Rabas Mackenzie , Hoang Ly , Wust Kathryn L. , Rutkowski Rachel , Salwei Megan E. , Barton Hanna J. , Shah Manish N. , Pulia Michael S. , Patterson Brian W. , Dail Paula v.W. , Krause Sheryl , Buckley Denise , Hankwitz Jennifer , Werner Nicole E.
Published: February 2023

Background:

Patient satisfaction is an important indicator of quality of care, but its measurement remains challenging. The Consumer Emergency Care Satisfaction Scale (CECSS) was developed to measure patient satisfaction in the emergency department (ED). Although this is a valid and reliable tool, several aspects of the CECSS need to be improved, including the definition, dimension, and scoring of scales.

Purpose:

The purpose of this study was to examine the construct validity of the CECSS and make suggestions on how to improve the tool to measure overall satisfaction with ED care.

Methods:

We administered 2 surveys to older adults who presented with a fall to the ED and used electronic health record data to examine construct validity of the CECSS and ceiling effects.

Results:

Using several criteria, we improved construct validity of the CECSS, reduced ceiling effects, and standardized scoring.

Conclusion:

We addressed several methodological issues with the CECSS and provided recommendations for improvement.