bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-R07-3: BILATERAL ADRENAL TUMORS IN A PATIENT WITH PRIMARY ALDOSTERONISM CONCURRENT WITH CUSHING'S SYNDROME: A CASE REPORT.
Authors: Otomo Yusuke , Irie Junichiro , Miyashita Kazutoshi , Kobayashi Sakiko , Kinouchi Kenichiro , Nakamura Toshifumi , Kubota Yusuke , Nishimura Takeshi , Itoh Hiroshi 
Published: January 2023

Background:
Both primary aldosteronism (PA) and Cushing's syndrome (CS) cause hypertension. It is known that PA can be complicated with CS, but cases with both bilateral PA and unilateral CS are rare.

Case presentation:
A 65-year-old male patient was treated on 10 mg of amlodipine and 2 mg of doxazosin for hypertension from 6 years ago and his blood pressure was about 150/90 mm Hg on average. Because he gained 10 kg of weight over the last 6 months, he visited his primary physician. He had moon face and central obesity, and his blood examination showed the high concentrations of adrenal hormones, i.e., plasma aldosterone concentration (PAC) was 180 pg/mL and plasma renin activity (PRA) was 0.9 ng/mL/h (aldosterone-renin ratio (ARR) was 200.2), cortisol was 11.1 mcg/dL and adrenocorticotropic hormone was undetectable. The twenty-four-hour urine test showed that the greater secretion of adrenal hormones, i.e., aldosterone was 21.4 mcg/day, free cortisol was 148.5 mcg/day (sodium was 190 mEq/day). The computed tomography scan showed bilateral adrenal tumors (37 mm on the left and 8 mm on the right, respectively). The captopril challenge test, the furosemide stress test, and the 1 mg and 8 mg dexamethasone suppression tests were conducted, and he was diagnosed with both PA and CS. By adrenal scintigraphy using 131I-adosterol, high accumulation was detected in the left adrenal gland, whereas there was no accumulation in the right adrenal gland. Hence, the tumor of the left adrenal gland was likely a cortisol-secreting adrenocortical tumor. Furthermore, super-selective adrenal venous sampling indicated autonomous aldosterone secretion from bilateral adrenal glands. The patient underwent laparoscopic left adrenalectomy and the hypercortisolism was corrected. He lost 10 kg of weight 1 year after the surgery. PA remained as indicated by the blood test showing that PRA was 1.2 ng/mL/h, PAC was 347 pg/mL (ARR was 289.2). He is treated with 5 mg of esaxerenone, and his blood pressure is 130/70 mmHg on average.

Conclusion:
Adrenal venous sampling was able to determine laterality of PA with coexisting CS.
Additive or synergistic analgesic effect of metamizole on standard pain treatment at home after arthroscopic shoulder surgery
Authors: Stessel Björn , Lambrechts Mathieu , Evers Stefan , Vanderstappen Cedric , Callebaut Ina , Ory Jean-Paul , Herbots Jeroen , Dreesen Inge , Vaninbroukx Michaël , Van de Velde Marc 
Published: January 2023

BACKGROUND
There is growing evidence that the analgesic effect of metamizole is mediated at least partly by central mechanisms, including the endocannabinoid/endovanilloid system. Consequently, metamizole may have additive or even synergistic analgesic effects with paracetamol and nonsteroidal anti-inflammatory drugs (NSAID).

OBJECTIVE
This study aimed to assess if triple therapy with metamizole, ibuprofen and paracetamol (MIP) is superior to double therapy with ibuprofen and paracetamol (i.p.) in treating pain at home after ambulatory arthroscopic shoulder surgery.

DESIGN/SETTING/PATIENTS/INTERVENTION
In this double-blind, controlled, high-volume single centre, superiority trial, 110 patients undergoing elective ambulatory arthroscopic shoulder surgery were randomised to receive either MIP (n = 55) or i.p. (n = 55) orally for 4 days between December 2019 and November 2021. Pain intensity at movement and rest, using a numeric rating scale (NRS), perceived pain relief, use of rescue medication and adverse effects of study medication were recorded at the post-anaesthesia care unit (PACU) and on postoperative day (POD) 1 to 4 and 7. Quality of Recovery (QoR) and satisfaction with study medication were measured at POD 7 with telephone follow-up.

MAIN OUTCOME MEASURE
The primary outcome measure was postoperative pain intensity on movement measured by an 11-point NRS (where 0 = no pain and 10 = worst pain imaginable) on POD 1.

RESULTS
For the primary outcome, superiority of MIP in reducing postoperative pain at movement on POD 1 was not confirmed: mean difference NRS [95% confidence interval (CI), −0.08 (−1.00 to 0.84)]. For pain on movement and at rest, no significant differences were found between groups in the PACU nor on POD 1 to 4 or day 7. Nausea was reported significantly more frequently in the metamizole group (22.6 vs. 58.5; P < 0.001). Other adverse effects of study medication, rescue opioid consumption, perceived pain relief, QoR at POD 7, and overall patient satisfaction were similar in both groups.

CONCLUSION
Clinically, triple oral treatment with metamizole, paracetamol and ibuprofen is not superior to oral paracetamol and ibuprofen in multimodal pain treatment at home after ambulatory arthroscopic shoulder surgery.

TRIAL REGISTRATION
European Union Clinical Trials Register 2019-002801-23 and Clinicaltrials.gov NCT04082728.
Targeting VPS72 inhibits ACTL6A/MYC axis activity in HCC progression
Authors: Liu Furong , Liao Zhibin , Qin Lu , Zhang Ze , Zhang Qiaofeng , Han Shenqi , Zeng Weifeng , Zhang Hongwei , Liu Yachong , Song Jia , Chen Wei , Zhu He , Liang Huifang , Chen Xiaoping , Zhang Bixiang , Zhang Zhanguo 
Published: January 2023

Background and Aims:
HCC is a highly heterogeneous disease that is caused largely by genomic copy number variations. Herein, the mechanistic and therapeutically targeted role of vacuolar protein sorting 72 homologue (VPS72), a novel copy number variation cis-driven gained gene identified by genome-wide copy number variation and transcriptome analyses in HCC, is not well understood.

Approach and Results:
First, overexpression of VPS72 enhanced the initiation and progression of HCC in vitro and in vivo. Mechanistically, VPS72 interacted with the oncoproteins MYC and actin-like 6A (ACTL6A) and promoted the formation of the ACTL6A/MYC complex. Furthermore, ACTL6A regulated VPS72 protein stability by weakening the interaction between tripartite motif containing 21 (TRIM21) and VPS72. Thus, the interaction between VPS72 and ACTL6A enhanced the affinity of MYC for its target gene promoters and promoted their transcription, thereby contributing to HCC progression, which was inhibited by adeno-associated virus serotype 8 (AAV8)-mediated short hairpin RNA (shRNA) against VPS72.

Conclusions:
This study reveals the molecular mechanism of ACTL6A/VPS72/MYC in HCC, providing a theoretical basis and therapeutic target for this malignancy.
It Takes Two to Tango: High Rates of Injury and Concussion in Ball Carriers and Tacklers in High School Boys' Rugby
Authors: West Stephen W. , Shill Isla J. , Sick Stacy , Schneider Kathryn J. , WIley James Preston , Hagel Brent E. , Emery Carolyn A. , Black Amanda M. 
Published: January 2023

Objective:
To examine injury and concussion rates, mechanisms, locations, and types of injury in Canadian high school male rugby.

Design:
Prospective cohort study.

Setting:
High school male rugby.

Participants:
A total of 429 high school players (2018: n = 225, 2019: n = 256) were recruited from 12 teams in 7 schools in Calgary, Canada.

Interventions:
None.

Main Outcome Measures:
Injury surveillance included baseline questionnaires, weekly exposure, and injury reports. Injuries included those requiring medical attention, resulted in time loss and/or inability to complete a session. Concussion was defined as per the fifth Consensus on Concussion in Sport, and all players with a suspected concussion were referred to a study sport medicine physician.

Results:
A total of 134 injuries were captured, leading to an injury incidence rate (IR) of 57.9/1000 hours [95% confidence intervals (CIs): 45.4-73.8]. Median time loss was 6 days (range: 0-90). Injuries to the head were the most common (40%), followed by shoulder (12%) and ankle (10%). The concussion IR was 22.0/1000 hours (95% CIs: 15.9-30.4), which was the most common injury type (38%), followed by sprain (20%) and strain (15%). Sixty-five percent of injuries occurred in the tackle (ball carrier 35%, tackler 30%) and 76% of concussions (ball carrier 41%, tackler 35%).

Conclusions:
The rate of injury and concussion in Canadian youth high school male rugby is high, with tackle-related injuries and concussions the most common. Given this, there is a critical need for implementation of prevention strategies, in particular targeting concussion and the tackle event (eg, neuromuscular, tackle training, and law changes).
Frailty Screening in Geriatric Trauma: A Pilot Feasibility Study
Authors: Keiser Megan , Buterakos Roxanne , Gillespie Samantha , Musil Stephanie , Herek Jessica S. , Sachwani-Daswani Gul 
Published: January 2023

Background:
Frailty in older adult trauma patients is associated with increased complications and worsened outcomes. Frailty screening can help guide care. Yet, trauma center assessment of frailty is relatively new, can be challenging to implement, and is not yet standard practice.

Objectives:
The purpose of this pilot feasibility study is to assess the impact of implementing frailty screening for older adult trauma patients and to evaluate the effect of frailty screening on palliative care consultation, inhospital complications, hospital length of stay, and discharge disposition.

Methods:
We conducted a 3-month (July 2019 to September 2019) prospective observational pilot feasibility study of geriatric trauma patients 65 years and older presenting to a Level I trauma center. The Trauma-Specific Frailty Index score was completed within 24 hr of patient admission. Inferential statistics were used to assess the relationships.

Results:
Fifty subjects were included. Between frail and nonfrail patient groups, there was no significant correlation between mean Trauma-Specific Frailty Index score and palliative care consultation, χ2
(1,

N

=50) = 2.32, p = .149; inpatient complications, χ2
(1,

N

=50) = 0.000, p = 1.000; hospital length of stay, t
(48) = 0.95, p = .345; or discharge disposition (receiver operating characteristic curve, p = .337). There was a significant negative relationship between Trauma-Specific Frailty Index Scores and Injury Severity Scores, t
(15) = 2.33, p = .035.

Conclusion:
This pilot study demonstrates that frailty screening can be implemented to help guide older adult trauma care but is not without challenges. Barriers to frailty screening should be addressed to ensure trauma team engagement. Additional research with a larger sample size is warranted to explore the benefits of frailty screening in guiding care.
Developing a Trauma Intermediate Care Unit
Authors: Krause Morgan A. , Mantooth Jessica L. , Gibson Jesse E. 
Published: January 2023

Background:
Trauma-specific nursing units are integral to providing quality trauma care. Yet, little has been published on intermediate care units for the trauma population.

Objective:
This article aims to describe one trauma center's journey to develop and implement a trauma intermediate care unit.

Methods:
The need for a trauma intermediate care unit was identified during the review of patient care at a Level II trauma center. An interdisciplinary team was created and met weekly for 6 months to plan the implementation of a trauma intermediate care unit. Education plans, training, equipment procurement, and staffing were evaluated throughout the process.

Results:
Positive results were noted from the implementation of the intermediate care unit through the first year following implementation. The average length of stay for patients in the surgical trauma intensive care unit was reduced, resulting in cost savings for the organization. In addition, this collaborative work positively impacted patient safety, staff engagement, and finances.

Conclusion:
With leadership support, the proper key stakeholders, clear deliverables, and a well-defined development plan, the implementation of this intermediate care unit was successful.
Competency-based evaluation: Collaboration and consistency from academia to practice
Authors: Jenkins-Weintaub Edith , Goodwin Michal , Fingerhood Marianne 
Published: January 2023

ABSTRACT
Competency-based evaluation is not a new concept in nursing education. The Essentials: Core Competencies for Professional Nursing Education (AACN Essentials), published in 2021, and the NONPF Nurse practitioner Role Core Competencies (2022) have provided us with the most recent roadmap for curriculum development and student evaluation. Using these two national guidelines and the Standards for Quality Nurse practitioner Education (2022), we examined ways to unify curriculum and competency in clinical practice. Through a review of the available literature, the lack of standardization in evaluating competency in clinical practice was evident. A framework for evaluation was developed including concepts from other health care discipline competency models. This article presents the resulting evaluation of a tool across academia and practice. Clinical preceptors are an extension of the faculty and play a significant role in developing practice competencies in advanced practice nursing students. Providing preceptors with a comprehensive framework we derived from the already existing PRIME model, and which we use with simulated patients, allows for the evaluation of clinical competencies in a variety of clinical settings. Consistency of evaluation across settings assures the attainment of the competencies necessary to perform safely and effectively in the practice environment.
Short-term effects of transcatheter aortic valve replacement on blood pressure and cardiac function in elderly patients with severe aortic stenosis
Authors: Aoyama Rie , Takeda Kazuhiro , Ishikawa Joji , Harada Kazumasa 
Published: January 2023

Background
Transcatheter aortic valve replacement (TAVR) is a standard treatment for elderly and high-risk patients with aortic valve stenosis (AS); however, its short-term effects on blood pressure (BP) and cardiac function are not clear. Therefore, we aimed to determine the short-term effects of TAVR in elderly patients (>75 years), who reflect the clinical situation in Japan.

Method and results
Twenty-eight consecutive elderly patients with severe AS and hypertension who underwent TAVR under general anesthesia were retrospectively investigated. All patients had hypertension that was well controlled with antihypertensive drugs. Serum brain natriuretic peptide level and peak velocity in the aortic valve were significantly reduced. TAVR induces an increase in BP that requires additional antihypertensive agents. There was no correlation between the change rate of SBP and stroke volume index (SVI), but there was a positive correlation between the rate of change in pulse pressure (PP) and SVI. This tendency was particularly observed in patients with low brachial-ankle pulse wave velocity (baPWV).

Conclusion
We observed post-TAVR hypertension and required additional antihypertensive drugs. The increases in SVI and PP after TAVR resulted in post-TAVR hypertension. Moreover, post-TAVR hypertension is less likely to occur in elderly patients with a high baPWV, which indicates advanced arteriosclerosis.
The relationship between hyperhomocysteinemia and total coronary artery occlusion: a cross-sectional study from Southwest China
Authors: Xiao Kaiyong , Chen Yuxiong , Xiao Lian , Sun Hua , He Zhongwei , Huang Guan , Chen Lvhong , Xv Lei , Peng Ling , Li Juan , Xv Yuling , Wang Jianping 
Published: January 2023

Background
Increasing evidence points to hyperhomocysteinemia as an independent risk factor for coronary artery disease in addition to traditional cardiovascular risks, but few have studied the association between hyperhomocysteinemia and total coronary artery occlusion (TCAO). To understand the risk factors for TCAO, we investigated the potential relationship between hyperhomocysteinemia and TCAO, and the interactions between cardiovascular risk factors and hyperhomocysteinemia.

Methods
A total of 890 adult patients from Southwest China participated in this cross-sectional study between February 2018 and February 2021. TCAO was defined as complete occlusion of more than one of the 15 coronary segments. Hyperhomocysteinemia was defined as serum homocysteine levels ≥15 μmol/L. Multivariable logistic regression models were used to determine the relationship between hyperhomocysteinemia and TCAO. The relationship between homocysteine as a continuous variable and TCAO was also analyzed. Subgroup analyses by sex, age, weight, smoking, hypertension, diabetes, and dyslipidemia were done, and interactions between subgroup variables and hyperhomocysteinemia were performed.

Results
Individuals with hyperhomocysteinemia showed an increased risk for TCAO. The adjusted odds ratio for TCAO in individuals with hyperhomocysteinemia was 1.74 (95% confidence interval, 1.28–2.36). When analyzed as a continuous variable, homocysteine was associated with an increased risk for TCAO. Subgroup analysis showed that the association between hyperhomocysteinemia and TCAO was statistically significant in men, elderly, overweight, smokers, and non-diabetic people. Interaction analysis showed no significant interactions between hyperhomocysteinemia and group variables.

Conclusions
In Southwest China, hyperhomocysteinemia was significantly associated with TCAO. This association was particularly significant in men, elderly, overweight, smokers, and non-diabetic people.
Efficacy and Safety of Radiofrequency Ablation Plus Stent Versus Stent-alone Treatments for Malignant Biliary Strictures
Authors: Khizar Hayat , Hu Yufei , Wu Yanhua , Ali Kamran , Iqbal Junaid , Zulqarnain Muhammad , Yang Jianfeng 
Published: January 2023

Background/Aims:
Malignant biliary strictures (MBS) are very aggressive and cannot be diagnosed in the early stages due to their asymptomatic nature. Stenting the stricture area of the biliary tree is palliative treatment but has poor survival time. Radiofrequency ablation plus stent (RFA+S) have been recently used to improve the survival and stent patency time in patients with MBS. In this systematic review and meta-analysis, we tried to evaluate the efficacy and safety of radiofrequency ablation.

Materials and Methods:
Study search up to December 2021 was performed in different medical databases such as PubMed, Web of Science, and Cochrane library, etc. We selected eligible studies reporting survival time, stent patency time, and adverse events in patients with MBS. We compare the outcomes of RFA+S and stent-alone treatment groups.

Results:
A total of 15 studies (6 randomized controlled trials and 9 observational studies) with 1815 patients were included for meta-analysis of which 701 patients were in RFA+S group and 1114 patients in the stent-alone group. Pooled mean difference of survival time was 2.88 months (95% CI: 1.78-3.97) and pooled mean difference of stent patency time was 2.11 months (95% CI: 0.91-3.30) and clinical success risk ratio was 1.05 (95% CI: 1.01–1.09). Risk ratios for adverse events are given; Bleeding 0.84 (95% CI: 0.34-2.11), abdominal pain 1.06 (95% CI: 0.79-1.40), pancreatitis 0.93 (95% CI: 0.43-2.01), cholangitis 1.07 (95% CI: 0.72-1.59), and stent dysfunction 0.87 (95% CI: 0.70-1.07).

Conclusions:
Radiofrequency ablation is involved in increased survival and stent patency time for MBS patients. With the help of better techniques, adverse events can be limited.
Efficacy of acupuncture for generalized anxiety disorder: A PRISMA-compliant systematic review and meta-analysis
Authors: Li Meichen , Liu Xin , Ye Xinyi , Zhuang Lixing 
Published: January 2023

Background:
Generalized anxiety disorder (GAD) tightly traps modern people. Its incidence shows an increased peak during the 2019 novel coronavirus (COVID-19) epidemic. Acupuncture is regarded as an effective way to relieve anxiety symptoms. However, there are still controversies. This study aimed to systematically evaluate the clinical efficacy of acupuncture in patients with GAD.

Methods:
Four English and 3 Chinese databases were searched from their inception to January 2022. Only randomized controlled trials (RCTs) in which acupuncture was the main intervention were included. The literature was independently screened and extracted by two investigators. The Cochrane Bias Risk Assessment Tool was used for quality evaluation. Analyses were conducted by RevMan 5.3.0 and STATA 15.0 software. The primary outcome was the Hamilton Anxiety Scale (HAMA). The secondary indicators were the total effective rate, the Self-Rating Anxiety Scale (SAS), and the Treatment Emergent Symptom Scale (TESS).

Results:
Twenty-seven studies were included with a total of 1782 participants. The risk of performance bias or reporting bias for most of the included trials was unclear. Combined results showed the acupuncture group had better outcomes in the HAMA score [MD = −0.78, 95%CI (−1.09, −0.46)], the total effective rate [RR = 1.14, 95%CI (1.09, 1.19)], the SAS score [MD = −2.55, 95%CI (−3.31, −1.80)] compared with the control group. Regarding the number of adverse events, the acupuncture group was safer than the control group and scored less grade in the TESS score [MD = −1.54, 95%CI (−1.92, −1.17)].

Conclusions:
Acupuncture can effectively relieve the anxiety symptoms of generalized anxiety disorder patients with fewer side effects, but randomized controlled trials with large sample size and high quality are also required to support the result.
Prognostic value of metformin in cancers: An updated meta-analysis based on 80 cohort studies
Authors: Yang Jing , Yang Hang , Cao Ling , Yin Yuzhen , Shen Ying , Zhu Wei 
Published: January 2023

Background:
Experiments have shown that metformin can inhibit cancer cell growth, but clinical observations have been inconsistent, so we pooled the currently available data to evaluate the impact of metformin on cancer survival and progression.

Methods:
PubMed, web of science, Embase, and Cochrane databases were searched. Pooled hazard ratios (HRs) were identified using a random-effects model to estimate the strength of the association between metformin and survival and progression in cancer patients.

Results:
We incorporated 80 articles published from all databases which satisfied the inclusion criterion. It showed that metformin was associated with better overall survival (hazard ratio [HR] = 0. 81; 95% confidence interval [CI]: [0.77–0.85]) and cancer-specific survival (HR = 0.79; 95% CI: [0.73–0.86]), and metformin was associated with progression-free survival (HR = 0.76; 95% CI: [0.66–0.87]). In patients with diabetes mellitus, the HR of overall survival was 0.79(95% CI: [0.75–0.83]), progression-free survival was 0.72(95% CI: [0.60–0.85]), and the cancer-specific survival was 0.76(95% CI: [0.68–0.86]). It was proposed that metformin can improve the prognosis of cancer patients with diabetes mellitus.

Conclusion:
Based on cohort studies, metformin therapy has potential survival benefits for patients with malignancy, especially with the greatest benefits seen in breast cancer on overall survival, progression-free survival, and cancer-specific survival. And metformin also showed potential benefits in cancer-specific survival in colorectal and prostate cancer.