bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre-operative ultrasound prediction of difficult airway management in adult patients
Authors: Giordano Giovanni , Alessandri Francesco , Zulian Aurora , Bilotta Federico , Pugliese Francesco 
Published: February 2023

BACKGROUND
Predicting a difficult airway, including difficult laryngoscopy, intubation or mask ventilation, is paramount in peri-operative management. As clinical predictors are only partially reliable, ultrasound-based measurements might be useful in evaluating anterior neck fat tissues depth.

OBJECTIVES
The aim of this systematic review is to report clinical evidence on pre-operative ultrasound as a predictor of difficult laryngoscopy, difficult intubation or difficult mask ventilation.

DESIGN
A systematic review of randomised controlled trials and observational studies.

DATA SOURCES
The MEDLINE, EMBASE and Google Scholar databases were queried from inception until 28 February 2022.

ELIGIBILITY CRITERIA
Studies involving adult patients who had undergone orotracheal intubation after evaluation with airways ultrasound were considered suitable. Exclusion criteria were a clinical history of difficult airways, cancer or trauma, pregnancy, supraglottic airway devices, video-laryngoscopy. Parameters were classified by reporting their accuracy in discriminating ‘difficult’ vs. ‘not difficult’ laryngoscopy, intubation or mask ventilation.

RESULTS
Thirty-one observational studies were included and a total of 41 single parameters and 12 different combinations of clinical and ultrasound parameters were reported. The distance from skin to epiglottis midway with neutral position of head and neck, the distance from hyoid bone to skin surface with a neutral position of head and neck and the hyomental distance extended/neutral ratio are the most associated with difficult laryngoscopy or difficult intubation. A combination of clinical and ultrasound parameters (a modified Mallampati score, the distance from the skin to the epiglottis midway with neutral position of the head and neck, and the USED-MSH score) showed high accuracy. Only two studies reported the role of ultrasound in predicting difficult mask ventilation: the distance from hyoid bone to skin surface with neutral position of head and neck, the thickness of the base of the tongue with hyperextension of the head, and the hyomental distance with hyperextension of the head and active subluxation of the mandible are the parameters with the highest correlation.

CONCLUSIONS
The use of ultrasound parameters might be useful in predicting difficult laryngoscopy or difficult intubation. Several ultrasound parameters and combinations have been associated with difficult laryngoscopy or difficult intubation prediction. The use of scores combining clinical predictors and ultrasound measures are very promising. Data on difficult mask ventilation are scarce and the role of ultrasound is still controversial. Future studies are needed.

CLINICAL TRIAL REGISTRATION
CRD42021250574.
Malnutrition in Patients With Moderate to Severe Acquired Brain Injury: Prevalence During 4 Weeks of Subacute Rehabilitation
Authors: Aadal Lena , Holst Mette , Rasmussen Henrik Højgaard , Nielsen Jørgen Feldbæk , Odgaard Lene 
Published: February 2023

ABSTRACT

BACKGROUND: Malnutrition is associated with high rates of complication, longer hospital stays, and increased morbidity and mortality. Malnutrition defined as undernutrition is common in patients with acquired brain injury (ABI); however, estimates vary remarkably. This study aimed to describe malnutrition at admission and after 4 weeks of subacute inpatient neurorehabilitation in patients with ABI using the new global consensus definition of malnutrition. METHODS: One hundred thirty-three patients with moderate to severe ABI consecutively admitted to a specialized neurorehabilitation hospital within a period of 4 months were screened for inclusion, of which 92 were included. Malnutrition was defined as at least 1 phenotypic criterion (weight loss, low body mass index, low muscle mass) and at least 1 etiologic criterion (reduced food intake, inflammation). Malnutrition on admission and after 4 weeks was compared using the McNemar test. RESULTS: The proportion of patients with malnutrition at admission was 42%, with more men (46%) than women (36%) fulfilling the criteria for malnutrition. The most frequent phenotypic and etiologic criteria were weight loss (56%) and inflammation (74%), respectively. During the 4 weeks of rehabilitation, the proportion of male patients fulfilling the individual criteria “weight loss” (difference, −21.4%) and “inflammation” (difference, −18.9%) decreased significantly; “low muscle mass” decreased borderline significant (difference, −8.9%), whereas “low body mass index” did not change. The proportion of female patients fulfilling individual criteria for malnutrition was stable or increased nonsignificantly. CONCLUSION: Malnutrition was common at admission to neurorehabilitation in patients with moderate to severe ABI, with more men than women fulfilling the criteria for malnutrition. The nutritional status improved after 4 weeks of rehabilitation in male patients, whereas it was largely unchanged in female patients. The results provide the basis for monitoring high-quality nutritional nursing care.
Characteristics and outcomes of patients with autoimmune pancreatitis after pancreatectomy: a retrospective study
Authors: Zhao Bangbo , Qin Cheng , Li Tianyu , Li Zeru , Wang Yuanyang , Wang Weibin 
Published: February 2023

Objective:
Autoimmune pancreatitis (AIP) is a rare and special type of pancreatitis, which is often difficult to distinguish from pancreatic cancer. We aimed to discuss the clinical characteristics, operation characteristics, and therapeutic effects of AIP patients who received surgical treatment based on retrospective analysis.

Methods:
The medical records of patients who underwent surgery at Peking Union Medical College Hospital from January 2012 to July 2021 and whose postoperative pathology was AIP were collected. Clinical symptoms, laboratory examinations, imaging features, surgical information, and prognostic data were analyzed.

Results:
Nineteen patients with AIP (median age 60 years old, 14 males) underwent surgery, whose main indication for surgery was suspected of a malignant lesion (n = 18, 94.7%). Ten patients underwent pancreaticoduodenectomy, 8 underwent distal pancreatectomy, and 1 underwent total pancreatectomy, the pathological result of whom were all AIP. The main postoperative complication was pancreatic fistula (n = 11, 57.9%), and one patient (5.3%) underwent a second operation due to gastrointestinal anastomotic bleeding. One patient (5.6%) had a recurrence of AIP, 3 patients (16.7%) were treated with glucocorticoid after surgery, and one patient (5.6%) was treated with immunosuppressors.

Conclusions:
Differential diagnosis of AIP from pancreatic cancer is complex. Operation difficulty and complication incidence for patients with AIP were similar to pancreatic cancer patients. Although glucocorticoid is the first-line treatment for AIP, surgery may still be necessary for patients who are strongly suspected of a malignant lesion.
Neoadjuvant programmed cell death 1 inhibitor before liver transplantation for HCC is not associated with increased graft loss
Authors: Wang Tielong , Chen Zhitao , Liu Yao , Jia Yu , Ju Weiqiang , Chen Maogen , Zhao Qiang , Wang Dongping , Guo Zhiyong , Tang Yunhua , He Xiaoshun 
Published: February 2023

Immune checkpoint inhibitors (ICIs) may lead to rejection and even graft loss of solid organ transplant recipients, making them not widely used in transplant patients. There is insufficient clinical experience in using ICIs as a bridging or downstaging therapy before transplantation. We performed a retrospective review of patients receiving programmed cell death 1 inhibitor (PD1) before liver transplantation for HCC in our center and analyzed the data of these patients with the purpose of investigating the safety and feasibility of preoperative PD1 inhibitor among liver transplant recipients and exploring the preoperative correlation ICIs and the postoperative risk of rejection and immune-related graft loss. A total of 16 patients enrolled in this study. Acute rejection occurred in 9 patients, with an incidence of 56.3%. The median time of rejection was 7 days after surgery. The median FK506 concentration at the time of rejection was 7.1 μg/L. All rejection reactions were reversed after adjusting the immunosuppression regimen. The interval between the last PD1 inhibitor and transplantation in the rejection group was shorter than that in the nonrejection group, and there was a statistical difference [21.0 (15.5–27.5) days vs. 60.0 (34.0–167.0) days, p=0.01]. In conclusion, PD1 inhibitor is a safe and feasible method for bridging or downstaging treatment before liver transplantation. Although preoperative PD1 inhibitor may increase the incidence of postoperative rejection, it is not associated with increased immune-related graft loss and patient death.
Combination of serum ACSL4 levels and low-dose 256-slice spiral CT exhibits the potential in the early screening of lung cancer
Authors: Yu Wenlong , Wang Li , Liu Shi , Liu Ying , Wang Shuying , Sun Xuejia 
Published: February 2023

Background:
The prognosis of lung cancer is related to the stage of the disease at the time of detection, and early diagnosis can prolong survival time. In this prospective observational cohort research, we aimed to analyze the diagnostic performance of the combined application of ACSL4 and low-dose 256-slice spiral computed tomography (CT) to lung cancer.

Methods:
This prospective observational cohort research enrolled a total of 512 patients with pulmonary nodules (PN) who were found with PN by CT. All patients were divided into 2 groups through biopsy operation, including 449 patients with benign PN and 63 patients with malignant PN. Both groups were scanned with a Philips Brilliance 256iCT machine. Imaging features of PN were recorded. All images of the nodules were used for data measurement and image analysis by the Lung Nodule Assessment analysis software. The serum ACSL4, carcinoembryonic antigen (CEA), cytokeratin 19 fragment 21-1 (CYFRA21-1), neuron-specific enolase, carbohydrate antigen 199 (CA199) and carbohydrate antigen 125 (CA125) levels were measured by enzyme-linked immunosorbent assay method. The demographic data and clinical data, including age, sex, body mass index, smoke condition, TNM stage, lymph node metastasis and distant metastasis were collected. All the patients were followed for 5 years. Statistical analysis was conducted using SPSS software with P < .05 as statistically different.

Results:
The diameter of nodules, the proportion of burr signs and smoking status, and the serum levels of CEA, CYFRA21-1, CA199, CA125 were significantly higher in malignant nodules group compared with the benign nodules group. Serum ACSL4 levels of malignant nodules group (19.33 ± 6.92 ng/mL) were remarkably lower than the benign nodules group (25.34 ± 3.78 ng/mL). ACSL4 was negatively correlated with CEA, CYFRA21-1, CA199, and CA125. ACSL4 was associated with the clinical outcomes in malignant PN patients and lower ACSL4 predicted poor clinic outcomes and prognosis. In addition, ACSL4 combined with low-dose 256-slice spiral CT had satisfactory diagnostic value for lung cancer.

Conclusion:
In summary, our results showed that combination application of ACSL4 and low-dose 256-slice spiral CT might be a potential method for the early screening of lung cancer.
Imaging and pathological diagnosis of primary intracranial malignant melanoma: A case report and literature review
Authors: Long Wei-Li , Chen Fu-Yong , Huang Xiao-Lin , Lu Jun-Xu , Xu Yan-Neng 
Published: February 2023

Rationale:
Primary intracranial malignant melanoma (PIMM) is a rare malignant tumor that lacks specific clinical manifestations. Preoperative diagnosis is difficult to differentiate from meningiomas on computed tomography (CT) scans. Magnetic resonance imaging (MRI) usually shows typical characteristics with high signal intensity on T1WI and low signal intensity on T2WI. PIMM is highly invasive, insensitive to chemoradiotherapy, and has a poor prognosis.

Patient concerns:
A 27-year-old woman was admitted to the hospital with a headache for 10 days. She did not experience nausea, vomiting, dizziness, or any other discomfort. A computerized tomography (CT) scan demonstrated a high-density mass in the left cerebellum with patchy calcification at the posterior edge, and heterogeneous enhancement was observed on a contrast-enhanced scan. MRI revealed typical characteristics of high signal intensity on T1WI and low signal intensity on T2WI. The signal characteristics of FLAIR were similar to those of T2WI, and diffusion-weighted imaging (DWI) sequence showed limited diffusion of the tumor. Magnetic resonance spectroscopy revealed increased choline (Cho) and decreased creatine (Cr) and N-acetyl aspartate (Naa) in the tumor.

Interventions:
The patient underwent tumor resection and postoperative chemoradiotherapy and immunotherapy.

Pathological diagnosis:
Histological and Immunohistochemistry (IHC) tests confirmed the diagnosis of PIMM. In addition, genetic testing revealed GNAQ gene variation.

Outcomes:
No recurrence or complications were observed during the follow-up for 6 months.

Lessons:
PIMM is rare, and its pathological diagnosis should be closely combined with clinical and medical history. GNAQ is a common variant of PIMM and is expected to be a therapeutic target.
Balancing new technology: Virtual reality for balance measurement case report
Authors: Weissberger Omer , Orr Eran , Levy Miki , Kimel-Naor Shani , Plotnik Meir , Arbel Tal 
Published: February 2023

Rationale:
Falling and the inability to maintain balance are the second leading cause of unintentional injury deaths globally. There are a number of chronic and acute conditions characterized by balance difficulties, including neurological diseases, and sport injuries. Therefore, methods to monitor and quantify balance are critical for clinical decision-making regarding risk management and balance rehabilitation. New advances in virtual reality (VR) technology has identified VR as a novel therapeutic platform. VRSway is a VR application that uses sensors attached to a virtual reality headset, and handheld remote controllers for measurement and analysis of postural stability by measuring changes in spatial location relative to the center of mass and calculates various postural stability indexes. This case report evaluates balance measures in 2 healthy participants with no previous history of balance disorders using the VRSway software application and compares to output generated by the current gold standard of balance measurement, force platform technology.

Case Presentation:
The primary objective of this case study was to validate the VRSway stability score for evaluation of balance. Here, we present posturography measures of the VRSway in comparison with force plate readouts in 2 healthy participants. Body Sway measurements were recorded simultaneously in both the force plate and VRSway systems. Data calculated by proprietary software is highly correlative to the data generated by force plates for each of the following measurements for participant-1 and participant-2, respectively: Sway index (r1 = 0.985, P < .001; r2 = 0.970, P < .001), total displacement (r1 = 0.982, P < .001; r2 = 0.935, P < .001), center of pressure mean velocity (r1 = 0.982, P < .001; r2 = 0.935, P < .001), ellipse radius 1 (r1 = 0.979, P < .001; r2 = 0.965, P < .001), ellipse radius 2 (r1 = 0.982, P < .001; r2 = 0.969, P < .001), and ellipse area (r1 = 0.983, P < .001; r2 = 0.969, P < .001).

Conclusions:
Data from this case study suggest that VRSway measurements are highly correlated with output from force plate technology posing that VRSway is a novel approach to evaluate balance measures with VR. More research is required to understand possible uses of VR-based use for balance measurement in a larger and more diverse cohort.
MicroRNA-375 in extracellular vesicles – novel marker for esophageal cancer diagnosis
Authors: Chen Jie , Cai Zhigang , Hu Jing , Zhou Lixia , Zhang Peili , Xu Xiaoping 
Published: February 2023

Background:
MicroRNAs have been confirmed to function as diagnostic biomarkers for esophageal cancer (EC). This study aimed to investigate the diagnostic potential of miR-375 in the plasma or extracellular vesicles (EVs) of esophageal cancers (ECs).

Methods:
miRNAs with diagnostic potential were identified through public database searches and validated through clinical sample testing. The diagnostic value of miR-375 in plasma and EVs was evaluated via receiver operating characteristic analysis and area under the curve. In addition, expression and survival analyses of the top ten target genes of miR-375 were conducted using the cancer genome atlas database.

Results:
MiR-375 was identified as a potential biomarker for ECs by searching the gene expression omnibus database. Results of clinical sample measurements showed that miR-375 in plasma or EVs was significantly different between ECs and controls (P < .01), but did not differ by gender or age. receiver operating characteristic analysis demonstrated that miR-375 in EVs could function as a diagnostic marker for ECs, with a higher area under the curve (0.852) than that in plasma. The expression and survival analysis of the top ten target genes for miR-375 showed that only EIF4G3 was significantly associated with survival (P < .05).

Conclusion:
This research shows that miR-375, particularly in EVs, could serve as a biomarker for the diagnosis of ECs.
Abdominal infection combined with pneumoperitoneum after renal transplantation: A case report
Authors: Deng Zhiming , Zhu Huachen , Du Wei , Zhang Hongwei 
Published: February 2023

Introduction:Abdominal infection combined with pneumoperitoneum after renal transplantation is rare, clinically confusing, and easily misdiagnosed by physicians as gastrointestinal perforation.Patient concerns:A 54-year-old man experienced abdominal pain and distension together with signs of peritoneal irritation after cadaveric renal transplantation. CT and standing abdominal plain film showed a large pneumoperitoneum in the abdominal cavity and the patient underwent an exploratory laparotomy but no gastrointestinal perforation was found.Diagnosis:No gastrointestinal perforation was found during the operation. In the search for the infectious agent, ascites culture was negative while next-generation sequencing was positive, suggesting the presence of intestinal flora ectopic to abdominal infection with anaerobic respiration fermentation leading to large amounts of gas.Interventions:The patient underwent exploratory laparotomy without gastrointestinal perforation, and then underwent abdominal lavage, placed abdominal drainage tube, and conducted culture and next-generation sequencing examination of ascites.Outcomes:Postoperative symptoms were relieved and intestinal function recovered. After 3 months of outpatient follow-up, the patient had stable transplanted kidney function and was in good spirits and sleeping well, with a good appetite, soft and regular stools, no abdominal pain and distension, and no fever.Conclusion:Patients after kidney transplantation should be wary of abdominal infection being misdiagnosed as gastrointestinal perforation.
Pedunculated subserosal leiomyoma with torsion, a rare cause of abdominal pain: A case report
Authors: Chang Ching-Tang , Lee Sieh-Yang , Chang Ching-Di 
Published: February 2023

Introduction:
Acute abdominal pain caused by torsion of the pedunculated subserosal leiomyoma is rare. Miss diagnosis can lead to ischemia, necrosis, and subsequent peritonitis which may cause significant morbidity. Torsion of the leiomyoma should be recognized as a surgical emergency and once suspected, early surgical intervention should be considered.

Patient concerns:
A 28-year-old woman with a medical history of uterine leiomyoma presented to our emergency department because of acute onset right lower abdominal pain.

Diagnoses:
The computed tomography was performed which demonstrated multiple leiomyomas of variable sizes and a subserosal leiomyoma located at right lower abdomen with poor contrast enhancement.

Interventions:
The gynecologist was consulted, and myomectomy was performed. The intraoperative finding showed a pedunculated subserosal leiomyoma with torsion.

Outcomes:
She underwent myomectomy for the twisted pedunculated subserosal leiomyoma as well as other leiomyomas and was discharged with a favorable outcome.

Conclusions:
Torsion of the leiomyoma is a surgical emergency as delayed in treatment may lead to marked morbidity. Once suspected, the gynecologist must be consulted, and surgical intervention should be considered.
Quality improvement for paediatric asthma care in acute settings
Authors: Kaplan Carl , Saint-Fleur Ashley L. , Kranidis Alexandra M. , Christophides Alexa H. , Kier Catherine 
Published: February 2023

Purpose of review
This is a summative review of recent trends and novel programming integrated into various clinical settings (i.e. emergency departments, urgent care centres and paediatric clinics) to enhance the quality of care received by paediatric asthma patients Asthma is the most common chronic disease in paediatric patients and despite recognized national management guidelines, implementation and aftercare, especially in the emergency room, remain challenging.

Recent findings
Outcome-based systematic quality improvement initiatives are described as well as evidence-based recommendations to enhance the education of providers, patients and caregivers.

Summary
Many of the care initiatives described in the literature have been integrated into the emergency room. The authors feel some of these process improvements, such as pathway-based care, reducing time to delivery of medications, and personalized asthma education, may also be applicable and add value to clinical practice in additional community-based acute care settings such as urgent care centers and paediatric clinics.
Procedural training in neonatology
Authors: Leone Tina A. 
Published: February 2023

Purpose of review
To discuss a structured training process that can be used to guide curricula development in procedural skills in neonatal perinatal medicine training programs.

Recent findings
Achieving proficiency in life savings skills such as neonatal endotracheal intubation does not occur for all graduates of neonatal perinatal medicine programs. Innovations in procedural skills training offer opportunities to enhance the current educational environment and improve competency at all levels of learning.

Summary
A deliberate process of planning for procedural skills training and assessment of training outcomes is essential to ensure competence among graduates and practicing clinicians.