bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-R07-10: A MOTHER AND HER DAUGHTER CASES OF PRIMARY ALDOSTERONISM
Authors: Nemoto Yuhi , Honda Kazuya , Hasegawa Koji , Hashimoto Shigeatsu 
Published: January 2023

The majority of cases of primary aldosteronism (PA) occur sporadically. Familial forms of PA are rare with four subtypes defined. We reported a case of familial cluster of primary aldosteronism in two members, daughter and her mother.

Case presentation Case 1:
Daughter A 20-year-old woman with a history of hypertension and proteinuria for three years without treatment, was admitted for the treatment of accelerated hypertension of 182/121 mmHg and end stage kidney disease. Blood examination revealed low plasma renin activity (PRA) of 0.7 ng/ml/h, and high plasma aldosterone concentration (PAC) of 349 pg/mL, high aldosterone/renin ratio (ARR) of 498.6, and serum potassium (sK) of 4.9 mEq/L. (Plasma ACTH 12.9 pg /mL, plasma cortisol 7.4 mcg/dL) These findings suggested PA. Abdominal CT scan showed no adrenal mass. After control of accelerated hypertension with nifedipine GITS and alpha adrenoceptor blocker, confirmatory tests for PA, saline infusion test (SIT) were carried out and was positive test (PAC 240 min after infusion 264pg/mL). Adrenal venous sampling revealed bilateral hyper-aldosterone secretion. She was given diagnosis of bilateral adrenal hyperaldosteronism. Her blood pressure was decreased to 118/77 along with administration of spironolactone 25 mg/day. Her parents have hypertension. We investigate the cause of hypertension in her parents. Blood test of her father revealed PRA 3.4 ng/m/h, PAC 18.3 pg/ml, and sK 4.7 mEq/L.

Case 2:
Mother A 45-year-old women with hypertension treated with amlodipine 5 mg was referred to our hospital to examine the renal function after renal donation to her daughter. Blood test revealed mild renal dysfunction (eGFR 72,2), normal sK(4.0 mEq/L), low PRA (0.9 ng/ml/h), high PAC (118 pg/mL) for high salt intake (11.6 g/day as high as salt loading test). Abdominal CT scan showed no adrenal mass. SIT was positive (PAC 240 min after infusion 60.0 pg/mL). She was given diagnosis of PA.

Discussion:
Potential factors leading to BHA include rare disease-predisposing germline variants, circulating angiotensin II type 1 receptor autoantibodies, and paracrine activation of aldosterone production by adrenal mast cells have been reported. Primary hyperaldosteronism in 2 family members, a mother and daughter, suggests familial hyperaldosteronism which caused by germline mutation. We now investigate germline variants for BHA.
Environmental eustress promotes liver regeneration through the sympathetic regulation of type 1 innate lymphoid cells to increase IL-22 in mice
Authors: Liu Tingting , Li Jin , Li Qian , Liang Yiyi , Gao Jian , Meng Zihong , Li Peiying , Yao Ming , Gu Jinyang , Tu Hong , Gan Yu 
Published: January 2023

Background and Aims:
The liver has the unique ability of regeneration, which is extremely important for restoring homeostasis after liver injury. Although clinical observations have revealed an association between psychological stress and the liver, whether stress has a causal influence on the liver regeneration remains markedly less defined.

Approach and Results:
Rearing rodents in an enriched environment (EE) can induce eustress or positive psychological stress. Herein, EE-induced eustress was found to significantly enhance the ability of liver regeneration after partial hepatectomy or carbon tetrachloride-induced liver injury based on the more rapid restoration of liver/body weight ratio and the significantly increased number of proliferating hepatocytes in EE mice. Mechanistically, the cytokine array revealed that IL-22 was markedly increased in the regenerating liver in response to EE. Blockade of IL-22 signaling abrogated the enhanced liver regeneration induced by EE. Group 1 innate lymphoid cells (ILCs), including type 1 ILCs (ILC1s), have been identified as the major sources of IL-22 in the regenerating liver. EE housing led to a rapid accumulation of hepatic ILC1s after partial hepatectomy and the EE-induced enhancement of liver regeneration and elevation of IL-22 was nearly eliminated in ILC1-deficient Tbx21
-/- mice. Chemical sympathectomy or blockade of β-adrenergic signaling also abolished the effect of EE on ILC1s and attenuated the enhanced liver regeneration of EE-housed mice.

Conclusion:
The study findings support the brain-liver axis and suggest that environment-induced eustress promotes liver regeneration through the sympathetic nerve/ILC1/IL-22 axis.
Sutured Descemet Membrane Endothelial Keratoplasty in Patients With Complex Anatomy or Difficulty Positioning
Authors: Li Gavin , Shekhawat Nakul S. , Eghrari Allen O. 
Published: January 2023

Purpose:
In Descemet membrane endothelial keratoplasty (DMEK), some patients cannot adhere to postoperative positioning requirements or lack anatomic support for a gas bubble in the anterior chamber. We describe a suturing technique that stabilizes the graft postoperatively without tearing or tenting it.

Methods:
One to two 10-0 nylon sutures with a spatulated needle are used to secure DMEK grafts. Tied with minimal tension, the sutures traverse the corneal stroma at a steep, almost perpendicular angle and approach the graft from the limbus at an angle tangential to the circular graft to prevent vaulting the tissue off the central cornea. We report preoperative and postoperative best spectacle-corrected visual acuity, corneal pachymetry, and anterior segment optical coherence tomography confirming graft attachment in 3 patients.

Results:
In case 1 (aphakia, postvitrectomy, and positioning difficulty), pachymetry decreased from 637 μm preoperatively to 495 μm and best spectacle-corrected visual acuity improved from 20/70 to 20/50 at postoperative week 1. In case 2 (aphakia, limited follow-up, and medication adherence), pachymetry decreased from 1106 μm preoperatively to 783 μm at postoperative month 1. In case 3 (tube shunt and loss of gas bubble at 2 hours), slit-lamp examination at postoperative day 1 showed corneal clearing and graft attachment. Pachymetry decreased from over 795 μm preoperatively to 582 μm at postoperative month 1. Anterior segment optical coherence tomography confirmed graft attachment in all patients.

Conclusions:
Single or opposing tangentially oriented sutures can be safely applied to secure DMEK grafts postoperatively in challenging cases.
Patient Outcomes Based on the 2011 CDC Guidelines for Field Triage of Injured Patients
Authors: Fernandez Antonio R. , Bourn Scott S. , Hall Garrett D. , Crowe Remle P. , Myers J. Brent 
Published: January 2023

Background:
The Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients drive the destination decision for millions of emergency medical services (EMS)-transported trauma patients annually, yet limited information exists regarding performance and relationship with patient outcomes as a whole.

Objective:
To evaluate the association of positive findings on Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients with hospitalization and mortality.

Methods:
This retrospective study included all 911 responses from the 2019 ESO Data Collaborative research dataset with complete Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients and linked emergency department dispositions, excluding children and cardiac arrests prior to EMS arrival. Patients were categorized by Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients step(s) met. Outcomes were hospitalization and emergency department or inhospital mortality.

Results:
There were 86,462 records included: n = 65,967 (76.3%) met no criteria, n = 16,443 (19.0%) met one step (n = 1,571 [9.6%] vitals, n = 1,030 [6.3%] anatomy of injury, n = 993 [6.0%] mechanism of injury, and n = 12,849 [78.1%] special considerations), and n = 4,052 (4.7%) met multiple. Compared with meeting no criteria, hospitalization odds increased threefold for vitals (odds ratio [OR]: 3.07, 95% confidence interval [CI]: 2.77–3.40), fourfold for anatomy of injury (OR: 3.94, 95% CI: 3.48–4.46), twofold for mechanism of injury (OR: 2.00, 95% CI: 1.74–2.29), or special considerations (OR: 2.46, 95% CI: 2.36–2.56). Hospitalization odds increased ninefold when positive in multiple steps (OR: 8.97, 95% CI: 8.37–9.62). Overall, n = 84,473 (97.7%) had mortality data available, and n = 886 (1.0%) died. When compared with meeting no criteria, mortality odds increased 10-fold when positive in vitals (OR: 9.58, 95% CI: 7.30–12.56), twofold for anatomy of injury (OR: 2.34, 95% CI: 1.28–4.29), or special considerations (OR: 2.10, 95% CI: 1.71–2.60). There was no difference when only positive for mechanism of injury (OR: 0.22, 95% CI: 0.03–1.54). Mortality odds increased 23-fold when positive in multiple steps (OR: 22.7, 95% CI: 19.7–26.8).

Conclusions:
Patients meeting multiple Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients steps were at greater risk of hospitalization and death. When meeting only one step, anatomy of injury was associated with greater risk of hospitalization; vital sign criteria were associated with greater risk of mortality.
Feasibility of Risk Factor–Based Screening for Posttraumatic Stress Disorder in Trauma
Authors: Petersen-Pugmire Karen , Jimenez Brian , Carter Raquiah , Faroqui Naqeeb , Parks Madeline , Bliton John 
Published: January 2023

Background:
Posttraumatic stress disorder (PTSD) following traumatic injury can have severe psychiatric consequences. Current recommendations from the American College of Surgeons Committee on Trauma require implementing PTSD screening but specify neither who should be screened nor how. It is unknown whether narrowed screening selection criteria could identify an acceptable proportion of patients with PTSD.

Objective:
This study aimed to determine the feasibility of implementing risk factor–based PTSD screening in trauma patients by evaluating the sensitivity and clinical practicality.

Methods:
This is a prospective diagnostic study of a consecutive series of general ward patients at an urban Level I trauma center from December 2021 to March 2022. Screening indications included (a) interpersonal injury, (b) surgery, (c) intracranial hemorrhage, (d) less than 30 years of age, or (e) clinical suspicion. The protocol was assessed by measuring the proportion of positive screens captured by only clinical suspicion to estimate sensitivity and by qualitatively evaluating barriers to implementation.

Results:
Among the 200 patients screened, the number of patients who screened positive was 51 (25.5%). Eight patients were screened on clinical suspicion alone, seven (87.5%) of whom had positive screens, compared with 44 of the 192 (22.9%) patients who were screened for indications. Thus, 7 of 51 (13.7%; 95% confidence interval: 6.8%–26.7%) patients with PTSD-level symptoms would not have been screened on the basis of their risk factors. There were also practical difficulties in implementation.

Conclusion:
Limiting PTSD screening to only those injured patients with additional risk factors would have reduced overall sensitivity at our center. Consequently, we have implemented universal screening instead.
Navigating Trauma Patients and Families Through Unfamiliar Territory
Authors: Lee Donna B. 
Published: January 2023

Background:
Trauma teams work diligently to manage the complex medical needs of trauma patients. In addition to medical care, there is also a need to assist patients and their families as they navigate the emotional and physical journey of trauma. The role of trauma nurse navigator was developed to address these holistic needs.

Objective:
This article aims to describe the implementation of a trauma nurse navigator role.

Methods:
This article describes the development and implementation of a trauma nurse navigator role at a Level II trauma center in 2018. The trauma nurse navigator serves as a patient resource and utilizes creative problem solving to optimize care. The trauma nurse navigator also serves on the multidisciplinary team, working with providers, nursing staff, rehabilitation staff, and case management to provide seamless care to trauma patients.

Results:
Implementation of the trauma nurse navigator role was well received by patients, families, and the multidisciplinary trauma team. The trauma nurse navigator role expanded the psychosocial support of trauma patients and increased patient satisfaction.

Conclusion:
Although other specialties have seen the benefits of including a patient navigator on the team, this is a potential for trauma centers as they strive to provide high-quality patient care.
Double-bundle versus single-bundle anterior cruciate ligament reconstruction in preventing the progression of osteoarthritis: A protocol for systematic review and meta-analysis of randomized controlled trials
Authors: Zhou Yun , Li Linji , Chen Ran , Gong Min 
Published: January 2023

Background:
The knee has a high incidence of osteoarthritis (OA) following the anterior cruciate ligament (ACL) injury, which was reduced by ACL reconstruction including double-bundle (DB) techniques and single-bundle (SB) techniques. However, the effectiveness of preventing the progression of OA after the ACL reconstruction using DB and SB techniques is controversial.

Methods:
This meta-analysis was performed following the preferred reporting items for systematic reviews and meta-analyses guidelines. The databases, including PubMed, Embase, and Cochrane Library, were searched. Randomized controlled trials comparing DB with SB ACL reconstruction and reporting clinical outcomes of radiological OA were included. Quality of the included studies was assessed using the Cochrane Collaboration’s risk of bias tool. The outcome was analyzed using the risk ratio (RR) and its corresponding 95% confidence interval (CI).

Results:
Ten Randomized controlled trials studies were included in this meta-analysis (accounting 1062 knees: 475 SB and 587 DB). The rate of radiological OA after the ACL reconstruction was 39% in SB group and 34% in DB group. The results of meta-analysis showed no difference in the occurrence of radiological OA between DB group and in SB group (RR, 1.05; 95% CI, 0.85–1.30, P = .63), including subgroup of radiological scores of OA (subgroup of Minimal OA: RR, 0.95; 95% CI, 0.61–1.48; P = .82; subgroup of Notable OA: RR, 1.16; 95% CI, 0.75–1.78; P = .51), subgroup of follow-up time in 5 years and more than 5 years (RR, 0.98; 95% CI, 0.80–1.20; P = .85), and subgroup of autograft graft for ACL (RR, 0.97; 95% CI, 0.79–1.19; P = .77). However, the DB group had less incidences of knee OA than the SB group in subgroup of less than 5 years (RR, 1.48; 95% CI, 1.13–1.92; P = .004) and subgroup of allograft type (RR, 1.42; 95% CI, 1.06–1.91; P = .02).

Conclusion:
Overall, this meta-analysis showed that the DB technique was no more effective in preventing the progression of OA than the SB technique in ACL reconstruction at midterm follow-up.
Clinical efficacy and safety of astragalus injection combined with ACEI/ARB in the treatment of diabetic kidney disease: Protocol for a systematic review and meta-analysis
Authors: Zhu Zhiyue , Zhang Qi , Liu Le , Bao Pengjie , Liu Shilin , Song Chaoqun , Yang Wenbo , Nan Zheng 
Published: January 2023

Background:
Kidney disease is a common complication of diabetes and the main cause of end-stage renal disease. Astragalus (Huangqi) injection in combination with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) have been widely used for the treatment of diabetic kidney disease (DKD) in China. However, no supporting evidence yet exists with regard to the safety and effectiveness of this approach. Here a protocol is outlined for use in systematic evaluation of the safety and effectiveness of astragalus injection combined with ACEI/ARB for the treatment of DKD.

Methods:
Randomised controlled trials will be retrieved from 8 scientific databases, including PubMed, Web of Science, EMBASE database, Cochrane Library, China National Knowledge Infrastructure, Wanfang, China Biomedical Literature CD-ROM Database and China Science Journal Database. Ongoing clinical trial databases will also be searched for studies published from the time of establishment of each database to September 1, 2022. that will include the Chinese Clinical Trial Registration Centre (www.chictr.org.cn/), the World Health Organisation International Trial Registration Platform (https://www.who.int/clinical-trials-registry-platform), Google Scholar (https://scholar.google.com/), Baidu Scholar (https://xueshu.baidu.com), etc. The main outcome indicators included urinary albumin excretion rate or 24-hour urinary albumin excretion rate, and renal function (blood urea nitrogen, serum creatinine concentration). The secondary outcome indicators mainly include the following 4 aspects: blood sugar, blood pressure, blood lipid levels and adverse events. Two researchers will independently select and extract data from randomized controlled trials and determine risks of bias. Meta-analysis will be performed using Revman5.4 then the quality of evidence from randomized clinical trials will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) System tool.

Results:
This review will be the first to summarize meta-analysis results regarding the efficacy and safety of Huangqi injection combined with ACEI/ARB when administered during any stage of diabetic nephropathy rather than during only a single stage of the disease.

Discussion:
It will provide high-quality guidance for the treatment of diabetic kidney disease and provide patients with more treatment options.
Comparison of ultrasound-guided quadratus lumborum block-2 and quadratus lumborum block-3 for postoperative pain in cesarean section: A randomized clinical trial
Authors: Yetik Ferit , Yilmaz Canan , Karasu Derya , Haliloğlu Dastan Nesibe , Dayioğlu Mürüvvet , Baytar Çağdaş 
Published: January 2023

Introduction:
The aim of this study was to compare the postoperative analgesic effects of ultrasound-guided quadratus lumborum block-2 (QLB-2) and quadratus lumborum block-3 (QLB-3) after cesarean section (C/S) under general anesthesia.

Method:
This was a prospective, randomized, double-blind study. A total of 143 term pregnant women with American Society of Anesthesiologists II status, who were scheduled for elective C/S under general anesthesia were randomly separated into QLB-2 and QLB-3 groups. After surgery under standardized general anesthesia, QLBs were performed with 0.3 mL.Kg-1 0.25% bupivacaine in both groups. Patient-controlled analgesia (PCA) devices were used for additional analgesia. The primary outcomes were pain scores evaluated at 0, 2, 6, 12, and 24 hours. In addition, PCA demands, actual delivered tramadol doses, rescue analgesic requirements, anesthesia time, and patient satisfaction were recorded.

Results:
A total of 104 patients were analyzed statistically. Pain scores were statistically lower in the QLB-3 group at 2, 6, 12, and 24 hours postoperatively (P = .001). Anesthesia time was longer in the QLB-3 group. Patients who received QLB-3 block demonstrated significantly fewer PCA demands and lower consumption of tramadol (P = .003). Moreover, the first analgesic requirement time was longer along with higher patient satisfaction. In addition, all procedures were performed without any complications and side effects due to PCA were negligible.

Conclusions:
This study demonstrated that, although both QLBs were safe and reliable, QLB-3 provides more effective analgesia and patient satisfaction than QLB-2 in C/S.
An asymptomatic giant extra-renal retroperitoneal angiomyolipoma: Case report
Authors: Ayoub Kusay , Rakab Amine , Shibani Mosa , Bohsas Haidara , Alibrahim Hidar , Swed Sarya , Rais Mohammed Amir , Sawaf Bisher , Mahli Nihad 
Published: January 2023

Rationale:
Angiomyolipoma is a benign mesenchymal tumor that consists of adipose tissue, muscle cells and blood vessel. Renal angiomyolipomas represent almost one percent of all renal tumors.

Patient concerns:
We reported a case of a 42-year-old woman complaining of mild abdominal pain with no other symptoms and no remarkable medical history.

Diagnosis:
Clinical examination was inconclusive and revealed a large, smooth, non-tender, and immovable mass in the right abdomen. Ultrasound examination confirmed the existence of a large, homogeneous, hyperechoic tissue mass. Abdominal multi-slice computed tomography (CT) scans also confirmed the presence of a well-rounded mass in the right abdomen. The histopathology tests confirmed the diagnosis of a large retroperitoneal mass.

Interventions:
The patient underwent a traditional laparotomy without complications to remove the tumor.

Outcomes:
The open surgery was the best option, and the patient’s condition improved due to the following-up.

Lessons:
Retroperitoneal extra-renal angiomyolipomas are extremely rare, and in this case, we document a case of retroperitoneal angiomyolipoma manifested with only mild abdominal pain in Syrian women.
Durable response to osimertinib in an advanced lung adenocarcinoma patient with an uncommon EGFR T854A mutation: A case report
Authors: Zhao Nan , Xin Hua , Qin Changjuan , Li Zhiqi , Sun Hongbin 
Published: January 2023

Introduction:
Epidermal growth factor receptor (EGFR) T854A mutation in exon 21 is an uncommon EGFR mutation in patients with non-small cell lung cancer (NSCLC). It is a secondary EGFR mutation after first- and second-generation EGFR tyrosine kinase inhibitors (TKIs). All EGFR T854A mutations were co-occurred with EGFR L858R mutation in cis. There is still no clear evidence to guide the therapeutic options for patients with both EGFR T790M and T854A mutations.

Patient concerns:
A 60-year-old Chinese woman with no smoking history presented with a maximum diameter of 32.9 mm mass located in the right lower lung lobe.

Diagnosis:
The patient was diagnosed with stage IVA lung adenocarcinoma with an exceptionally uncommon EGFR T854A mutation in exon 21 was detected concomitantly with EGFR T790M in blood by next-generation sequencing (NGS).

Interventions:
The patient was initially treated with first-line afatinib. After disease progression, osimertinib was administered.

Outcomes:
Our patient exhibited a partial response (PR) to osimertinib with progression-free survival of nearly 8 months.

Conclusions:
Our study indicates that patients with NSCLC who are positive for uncommon EGFR T854A and T790M mutations might benefit from treatment with osimertinib.