bluuebunny/crossref_metadata_2025_split huggingface dataset:
Circulating exosomal miRNA-451 as an effective diagnostic biomarker and prognostic indicator for multiple myeloma
Authors: Zhang Jun , Luo Cheng , Long Haiying , Zhang Bin , Shan Hongtao , Hou Benli 
Published: September 2024

Objective Multiple myeloma (MM) is a plasma cell malignancy characterized by abnormal plasma cell proliferation in the bone marrow. Circulating exosomal miRNA-451 is associated with the progression of many tumors, but the relationship between its expression and MM has not been reported. In this study, we aimed to investigate the clinical value of miRNA-451 as a biomarker for diagnosis and prognosis of multiple myeloma. Methods A total of 120 patients with multiple myeloma and 120 healthy control people were recruited in this study. The miRNA-451 expression in serum exosomes of participants was measured by quantitative real-time polymerase chain reaction, and the diagnostic value of miRNA-451 for multiple myeloma was assessed by receiver operating characteristic (ROC) curve. The correlation between miRNA-451 expression and plasma cells ratio and M protein content was analyzed by Pearson correlation coefficient. The prognosis of different miRNA-451 expression was evaluated by survival curves. Results Results suggested that serum exosomal miRNA-451 expression was significantly decreased in patients with multiple myeloma rather than in the healthy controls. The ROC curve showed that area under the curve value of miRNA-451 was 0.888, suggesting that miRNA-451 had diagnostic value to multiple myeloma. Moreover, there was a negative correlation between miRNA-451 expression and plasma cells ratio or M protein content. Survival curves showed that patients with high miRNA-451 expression had a longer survival time, suggesting the value of miRNA-451 as a prognostic indicator of multiple myeloma. Conclusion We demonstrated the relationship between miRNA-451 expression and multiple myeloma, indicating that miRNA-451 in circulating exosomes may be an effective diagnostic biomarker and prognostic indicator for multiple myeloma.
Emotion Regulation Self-Efficacy as a Mechanism of Alliance and Outcomes in a Brief, Transdiagnostic Digital Mental Health Intervention: L'auto-efficacité de la régulation des émotions en tant que mécanisme d'alliance et de résultats dans une brève intervention transdiagnostique numérique en santé mentale
Authors: Macrynikola Natalia , Chang Sarah , Torous John 
Published: September 2024

Objectives Digital mental health interventions have shown promise for alleviating various forms of psychopathology, including depression and anxiety. However, the mechanisms of such interventions remain largely unexplored. The purpose of this study was to investigate a potential mechanistic process through which one hybrid digital mental health intervention (i.e., the Digital Clinic) might operate. We hypothesized that emotion regulation (ER) self-efficacy at the treatment midpoint may mediate the relationship between alliance (i.e., therapeutic alliance and digital alliance) and outcome (i.e., co-morbid symptoms of depression and anxiety) at the treatment endpoint. Methods Data used in this study came from the Digital Clinic, a brief transdiagnostic telehealth treatment program augmented by a dual-purpose digital phenotyping and intervention smartphone app. Recruited primarily from primary care, participants were 82 adults (73% White, 64% cisgender women, mean age 41) receiving outpatient treatment in the northeastern United States. All constructs were measured with validated scales, including The Working Alliance Inventory—Short Revised (WAI-SR) for therapeutic alliance, the Digital Working Alliance Inventory (DWAI) for digital alliance, the PROMIS Self-Efficacy for Managing Emotions Short Form scale for ER self-efficacy, and the Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS) for co-morbid symptoms of depression and anxiety. Results Significant reductions in co-morbid symptoms of depression and anxiety and significant increases in ER self-efficacy were found from baseline to treatment endpoint. Therapeutic and digital alliance at the midpoint each predicted reductions in co-morbid symptoms of depression and anxiety at the endpoint through ER self-efficacy, controlling for baseline scores. Conclusions Findings suggest that ER self-efficacy may be a proximal predictor of clinical improvement that may be enhanced by therapeutic and digital alliance. Future controlled research is essential to improve knowledge of the mechanisms of digital mental health interventions and to enhance their effectiveness.
An Alternative Application of Sodium Nitroprusside to Overcome Perioperative Spasm of the Internal Thoracic Artery
Authors: Yorgancioǧlu Cem , Tokmakoǧlu Hilmi , Günaydin Serdar , Çatav Zeki , Süzer Kaya 
Published: September 2024

Objective: The internal thoracic artery (ITA) is currently the preferred conduit for myocardial revascularization; however, perioperative vasospasm of the internal thoracic artery may cause morbidity. Pedicle preparation and pharmacological vasodilatory treatment vary greatly. This clinical study was performed in order to define the effectiveness of two different applications of sodium nitroprusside as vasodilating agent. Methods: Eighty-six (86) consecutive patients whose left internal thoracic artery was mobilized only by one surgeon for elective coronary artery bypass graft operations were randomly divided into two groups. The internal thoracic artery was allowed to bleed freely, and the flow was determined (flow 1). In group I ( n = 42) 3mg sodium nitroprusside in 10 ml of 5% dextrose solution was sprayed with pressure on the pedicle with a thin 25 gauge needle. In group II ( n = 44) half of the solution was sprayed in the same manner, and the other half of the solution was injected into the pedicle in the periarterial tissue along the length of the pedicle. Free flows of the internal thoracic artery were registered before cardiopulmonary bypass (flow 2) and also just prior to performing internal thoracic artery anastomosis to the left anterior descending artery (flow 3). With each measurement hemodynamic parameters and the time between measurements were recorded. Results: No statistically significant differences were found between the groups in respect to sex ratio, age, body surface area, heart rate 1 and 2, mean arterial pressure 1 and 3. There was no significant difference in the initial flow among groups. Significant differences were noted in the second flow measurement ( P < 0.05) and in the third flow measurement ( P < 0.01) between two groups. For each group there was a significant increase in flow from flow 1 to flow 2 and from flow 2 to flow 3 ( P < 0.02). Conclusion: Sodium nitroprusside injection to the pedicle provides a better flow than simple spraying of the same agent.
The Loss of Circadian Heart Rate Variations in Patients Undergoing Mitral Valve Replacement and Corridor Procedure — Comparison to Heart Transplant Patients
Authors: Velimirovic D.B. , Pavlovic S.U. , Petrovic P. , Neskovic A. , Zivkovic M. , Bojic M. 
Published: September 2024

We have presently demonstrated that when added to mitral valve replacement (MVR) the corridor procedure is 75% efficient in restoring and maintaining sinus rhythm in patients with chronic atrial fibrillation (AF), caused by rheumatic mitral valve disease, (follow up 13.9 months). In the same patient population, we observed that the typical day-night cycle heart rate (HR) variations were lost and our present study concentrates on this subject. Heart rate variability analysis based on 24-h Holter ECG recording (StrataScan 563 DelMar Avionics) or hospital discharge (12th-14th postoperative days) was performed in 3 patient groups: Group I: Patients with a Corridor procedure added to MVR (12 pts, m/f 10/2, mean age 47.3 ± 7.5 yr); Group II (control): with patients MVR performed through the left atrial approach, without additional antiarrhythmic procedures (10 pts, m/f 3/7 mean age 51.5 ± 6.7 yr). and Group III: heart transplant recipients (5 pts, mean age 46.4 ± 11.22yr). We analyzed the hourly heart rate over 24-h period divided into three 8-h segments (07–14 h; 15–22 h and 23–06 h). Statistical comparison of mean hourly heart rate values was made between the three time periods of Holter monitoring. The Corridor procedure performed with mitral valve replacement resulted in conversion of sinus rhythm in 75% of patients (Group I), but postoperative heart rate variability analyses based on Holter monitoring disclosed that the mean heart rate was not statistically significantly difficult between the three 8-h segments of the day-night ( P > 0.05). The same results were found in the group of patients after heart transplant ( P > 0.05). The same results were found in the group of patients after heart transplant ( P > 0.05). In the second group (classical MVR), statistically significant differences in mean HR variation existed between the three 8-h intervals ( P < 0.05), and although atrial fibrillation occurred postoperatively physiologic circadian heart rate variations were preserved. With the Corridor procedure, both atria were surgically and electrically isolated and chronotropic function of the ventricles was restored by creating a small strip of atrial tissue with isolated sinus node and atrio-ventricular node, connected to the ventricles. This technique produced heart denervation nervous system influence, producing the loss of circadian HR variations, similar to the transplanted heart.
A Case of a Primary Giant Adrenal Gland Hydatid Cyst—An Exceptional Location: A Case Report
Authors: Agarwal Prachi , Aiyer Hema Malini , Singh Tej Pratap , Sharma Gaurav 
Published: September 2024

Background and clinical presentation: The adrenal hydatidosis is an exceptional site location for the occurrence of hydatid cyst with an incidence of being 0.073%. We hereby report this rare case of adrenal hydatid cyst in a 38-year-old male who presented with a history of right flank pain and no other associated complaints. On non-contrast computed tomography/high-resolution computed tomography, the whole abdomen revealed the finding of an adrenal hydatid cyst. He underwent laparoscopic right adrenalectomy, which was further confirmed with the pathological examination. In an adjunct to this, he was put on anti-helminthic drug Albendazole. On one year of follow-up, there was no recurrence. Conclusion: The hydatid cyst rarely occurs in the adrenal glands and is an uncommon pathology. It should always be suspected in the case of any cystic tumour of the adrenal gland, especially in endemic countries. The clinical features are variable and non-specific in the majority of the cases. Ultrasonography and CT abdomen hold a significant sensitivity in the diagnosis of the hydatid cyst. Surgical excision is the main choice of treatment. Adjunctive medical treatment improves the outcome and decreases the recurrence rate.
Nearly complete hair re-pigmentation in an older patient treated with hydroxyurea for essential thrombocytosis
Authors: Salmasi Shiva , Hassan Ruba Alchaikh , Gafarzadeh Zahra , Dasanu Constantin A. 
Published: September 2024

Introduction Employed in the treatment of malignancies and non-neoplastic conditions, hydroxyurea is associated with integumentary adverse effects, including skin discoloration, xerosis, pruritus, cutaneous atrophy, chronic leg ulcers, oral ulcerations, alopecia, and some nail abnormalities. Case Report A 77-year-old woman was diagnosed with essential thrombocytosis and started on low dose hydroxyurea. After 20 weeks of treatment, she experienced an unexpected change in hair color from gray to dark brown, without using hair dye or supplements. She later developed bilateral dorsal hand melanoderma, melanonychia, and onychodystrophy. Management and outcome It was decided to monitor the patient with no action taken as she was happy with this side effect of hydroxyurea. The platelet count has remained in excellent control. The dark brown hair color persisted over time. Discussion/Conclusion Hair hyperpigmentation likely occurred through melanocyte activation via hydroxyurea. Severe side effects may require dosage adjustments, while milder effects can be monitored closely. The newly observed hair color restoration in this case highlights potential dual (therapeutic and aesthetic) applications of this class of agents.
Change of erythrocyte sedimentation rate as prognostic biomarker for Mycobacterium avium complex pulmonary disease through anti-mycobacterial treatment
Authors: Hwang Hyeontaek , Kim Joong-Yub , Yim Jae-Joon , Kwak Nakwon 
Published: September 2024

Background: It remains unclear whether erythrocyte sedimentation rate (ESR) accurately predicts prognosis during treatment and how ESR changes. Objectives: We aimed to assess the predictive values of ESR as a prognostic factor of Mycobacterium avium complex pulmonary disease (MAC-PD) while on anti-mycobacterial treatment and its changes according to the treatment responses. Design: This study is a retrospective cohort study. Methods: This study included patients aged 18 years or older who initiated anti-mycobacterial treatment for MAC-PD at Seoul National University Hospital between January 1, 2009 and March 31, 2022. ESR should be measured at least twice, with a minimum interval of 3 months, during the initial 12 months from the commencement of antibiotic treatment. A mixed linear regression and Cox proportional-hazards models were used to analyze repeated ESR data and the association with patient survival. Results: Of a total of 825 patients who initiated antibiotic treatment for MAC-PD, 369 patients were included in the analysis. Increased levels of ESR during the treatment process were associated with a higher risk of mortality (adjusted hazard ratio 1.03; 95% confidence interval, 1.02–1.03) after adjusting age, sex, comorbidities, presence of cavity, acid-fast bacilli smear positivity, and culture conversion at 12 months. During the treatment, ESR at 12 months of treatment significantly decreased compared to baseline ESR in both the culture-converted and not-converted groups, which was categorized based on whether the culture conversion was achieved within the 12 months after treatment initiation. Conclusion: ESR predicted mortality during treatment and decreased over time, regardless of treatment outcomes. Our results underscore the importance of administering anti-mycobacterial treatment even in patients who did not achieve a microbiological cure.
Traumatic Periprosthetic Fractures Following Total Ankle Replacement A Systematic Review and Proposed Classification
Authors: Hill Zachary P. , Brown Joseph R. , DeGenova Daniel , Taylor Benjamin C. , Mendicino Robert , Korb Isaac 
Published: September 2024

Total ankle replacements (TAR) are increasingly utilized, but postoperative traumatic periprosthetic fractures remain a rare yet challenging complication. This systematic review aims to address the gap in literature by proposing a comprehensive classification system for these fractures, considering implant stability, fracture location, and surrounding bone quality. A systematic review identified 13 cases from 9 studies meeting inclusion criteria. Fractures were categorized using the proposed Hill-Brown classification: Type A (talus or fibula), Type B (distal tibial component), and Type C (diaphysis/proximal tibial metaphysis). Implant stability was a key factor, with Type B fractures further classified as B1 (stable), B2 (unstable with adequate bone stock), and B3 (unstable with poor bone stock). Most fractures occurred at or near the distal tibial component (Type B), with implant stability largely dependent on fracture location and bone quality. Surgical fixation, particularly minimally invasive plate osteosynthesis (MIPO) with locking plates, was the preferred treatment for stable implants, showing low complication rates. Unstable implants often required revision TAR or conversion to arthrodesis. Surgical intervention is recommended following all traumatic periprosthetic fractures in the setting of a TAR. Bone quality, particularly in patients with rheumatoid arthritis or osteoporosis, significantly impacted treatment decisions. Our findings emphasize the importance of fracture location, implant stability, and bone quality in managing these fractures. Future multicenter studies are necessary to validate this classification system and refine treatment protocols. Level of Evidence: Level III
Comparison of Time Needed to Meet Common Rehabilitation Milestones After Anterior Cruciate Ligament Reconstruction According to Graft Type
Authors: Steiner Quinn , Walczak Brian E. , Chumanov Elizabeth , Haraldsdottir Kristin , Watson Andrew M. 
Published: September 2024

Background: The use of bone–patellar tendon–bone (BPTB) and hamstring tendon (HT) autografts is common in anterior cruciate ligament reconstruction (ACLR). After ACLR, patients typically progress through specific rehabilitation milestones, and graft type may play a role in patient progression. Purpose: To compare the time to meet rehabilitation milestones between BPTB and HT autografts after ACLR. Design: Cohort study; Level of evidence, 3. Methods: This was a single-institution study on patients who underwent ACLR with either BPTB or HT autograft between June 2018 and July 2021. The primary outcomes were time to meet return-to-sport criteria, including >90% limb symmetry index (LSI) for isokinetic quadriceps and hamstring strength, horizontal hop, 4-crossover hop, and single-hop height. The time to satisfaction of each criterion was compared between graft groups using Wilcoxon tests and Cox proportional hazards models. Results: Included in the analysis were 410 participants who underwent ACLR with either BPTB (n = 232) or HT (n = 178). The BPTB group took longer to achieve >90% LSI for knee extension than HT (11.1 ± 4.1 vs 7.63 ± 2.8 months; P < .001). Similarly, the BPTB group took longer than the HT group to achieve >90% LSI for horizontal hop (11.4 ± 3.5 vs 9.82 ± 2.8 months; P < .001), 4-crossover hop (11.8 ± 3.6 vs 10.4 ± 2.8 months; P = .002), and single-hop height testing (11 ± 3.7 vs 8.81 ± 3.2 months; P < .001). The median time to achieve >90% LSI for hamstring strength was similar between groups (7.18 ± 3 vs 7.56 ± 3.1 months; P = .2). Conclusion: Patients that underwent ACLR with BPTB autograft took longer than patients with HT to meet commonly used postoperative rehabilitation milestones. Clinicians should consider these differences when guiding patients regarding graft choice, postoperative expectations, and rehabilitation.
Knowledge, Attitude, Practice, and Associated Factors Toward the Prevention of Catheter-Associated Urinary Tract Infection Among Nurses in Ethiopia: Cross-Sectional Study
Authors: Dessie Zemene , Gela Debela , Yusuf Nete Tewfik 
Published: September 2024

Introduction Catheter-associated urinary tract infection (CAUTI) is one of the major device-associated hospital-acquired infections of the urinary tract. The nurse's knowledge, attitude, and practice (KAP) are the primary inputs for preventing the patient from developing CAUTI. Nevertheless, poor knowledge, a negative attitude, and poor practice toward the prevention of CAUTI among nurses remain an extensive problem. Objective This study aimed to assess KAP and associated factors toward the prevention of CAUTI among nurses in public hospitals in Addis Ababa, Ethiopia, in 2021. Methods An institution-based cross-sectional study was conducted among nurses from March 1 to April 30, 2021, in five public hospitals in Addis Ababa, Ethiopia. A total of 344 nurses were chosen for the study using a systematic random sampling technique. Data were collected using knowledge, attitude, and practice toward the prevention of CAUTI questionnaires. Data were entered into Epi Data 4.2 and exported into SPSS 25 for analysis. Binary and multivariate logistic regression were performed, and the statistical significance of associations between the variables was determined using odds ratios with a 95% confidence interval and p < .05. Results The study included 344 nurses, with a 97.7% response rate. Of the total nurses, 42.7% had good knowledge, 48.0% had a positive attitude, and 54.9% had good practice toward the prevention of CAUTI. Being married, having guidelines, and having a positive attitude were associated with good knowledge, whereas being married, having good knowledge, and having good practice were associated with a positive attitude toward the prevention of CAUTI. Having a high monthly income, having guidelines, having good knowledge, and having a positive attitude were associated with good practices toward the prevention of CAUTI. Conclusion The findings of this study show that nurses have a low level of knowledge, a negative attitude, and poor practice toward the prevention of CAUTI. Factors such as marital status, monthly income, and having guidelines in the working unit were associated with KAP toward the prevention of CAUTI. Therefore, the Ministry of Health and Hospital Interventions focused on these findings are required to improve KAP toward the prevention of CAUTI among nurses.
The Impact and Feasibility of a Student-led Program to Connect Patients and Caregivers via Synchronous Audiovisual Technology During Restricted Visitation Policies
Authors: Levine Marc , Hoskins Meloria A. , Yedigarian Sevan , Ceasar Justin , Cannon Nathan , Feiertag Jacob , Mellen James , Lokey Nancy , Romanoski Natasha L. 
Published: September 2024

OBJECTIVE During the SARS-CoV-2 pandemic, hospital visitation restrictions hindered patients’ access to vital social support. This study explores the impact and feasibility of a student-led program facilitating audiovisual communication between inpatient rehabilitation patients and their caregivers. METHODS The study design employed a prospective observational approach, and convenience sampling enrolled 99 participants, including 33 patients, 33 caregivers, and 33 medical students. From September 2021 to March 2022, eligible patients admitted to an inpatient rehabilitation hospital identified a caregiver and participated in a 30-minute audiovisual call organized by a medical student. Post-visit surveys via RedCap were completed by all participants and covered limitations in video calls, program benefits, comfort levels in video conferencing, and overall program ratings. The study adopted a quantitative research paradigm for data analysis. Statistical analysis utilized pairwise McNemar's and Wilcoxon's test for inter-group comparison. RESULTS Patients, caregivers, and medical students all reported positive outcomes in program offerings including providing social support, decreasing feelings of isolation, and providing a feeling of connection. Patients rated the program 4.82 ± 0.47 on a Likert scale, with 97% recommending it to others, even beyond visitation restrictions. The most common diagnosis among patients was stroke (30%), highlighting the program's potential applicability across diverse patient populations. Caregivers rated the program 4.59 ± 0.87 and expressed a desire for its continuation post-restrictions (80%). Medical students (81%) recommended the program, citing benefits in reducing social isolation and gaining clinical experience. No statistical differences were observed between groups in emotional and humanistic domains. CONCLUSION This study highlights the potential for programs to utilize technology to address social isolation in the healthcare setting. When public health restrictions occur, medical educators should consider opportunities to support and foster innovation for student-led programs. Further research should explore broader impacts on healthcare outcomes and medical education.