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39057355_p14
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2.5. Statistical Analysis
| 4.140625 |
biomedical
|
Study
|
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To identify the bacterial genera exhibiting significant differences in relative abundance across various thinning intensities, an LEfSe analysis was employed, with a threshold LDA > 2 and p < 0.05, and the bacterial genera with relative abundance greater than 0.05% were screened. A correlation network analysis was performed using the igraph package, with species selected based on Spearman correlation |r| > 0.6, p < 0.05. The ggclust package was utilized to analyze core species within the network, categorizing node attributes into four types based on their topological characteristics. The fungal community function was predicted using the FUNGuild method , while the bacterial community function was predicted using the FAPROTAX method . The structural equation modeling (SEM) posits a causal pathway where thinning intensity affects the richness of endophytic bacteria and fungi in leaves through altering neighbor tree diversity, soil variables, and leaf traits, as conceptualized ; this pathway was constructed using the piecewiseSEM package . The path coefficient expresses the direction and intensities of the direct influence between the two variables. Graphs were generated using the ggplot2 package.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
39057355_p15
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3.1. Alpha Diversity of Leaf Endophytic Fungi and Bacteria
| 4.113281 |
biomedical
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Study
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The mixed-effect model analysis revealed that the alpha diversity (i.e., richness and Shannon index) of the leaf endophytic bacteria was significantly influenced by tree species, the degree of damage, and their interaction. However, thinning intensity and tree species identity had significant effects on the alpha diversity of endophytic fungi ( Table 1 ). Thinning intensity notably increased the alpha diversity of endophytic fungi. It decreased that of the endophytic bacterial community, compared to the CK plots . The richness and Shannon index of the leaf endophytic bacterial community were lowest in LT plots, whereas those of leaf endophytic fungi were highest in LT plots.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
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|
3.1. Alpha Diversity of Leaf Endophytic Fungi and Bacteria
| 4.132813 |
biomedical
|
Study
|
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In F. mandshurica , the endophytic bacterial richness and Shannon index were significantly lower in MT plots than in CK plots . In U. davidiana , the richness of endophytic bacteria was significantly lower in MT plots than in CK plots, while the richness of endophytic fungi showed the opposite trend . Except for T. amurensis species, the diversity of leaf endophytic bacteria, indicated by both richness and the Shannon index, was lower in thinning plots compared to CK plots, with diversity generally higher in damaged leaves than in healthy leaves . Conversely, the diversity of leaf endophytic fungal, except for in T. amurensis , increased due to forest thinning, with diversity generally lower in damaged leaves than in healthy leaves .
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
39057355_p17
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3.2. Composition of Leaf Endophytic Fungi and Bacteria
| 4.101563 |
biomedical
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Study
|
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We analyzed 120 leaf samples to identify fungal and bacterial endophytes, resulting in the identification of 4672 bacterial ASVs and 6390 fungal ASVs. The top 10 genera with the highest relative abundance of endophytic bacteria at the genus level included Achromobacter , Pseudomonas , Sphingomonas , Rhodococcus , Delftia , Methylobacterium , Agrobacterium , Friedmanniella , Variovorax , and Curtobacterium . The relative abundance of the remaining genera and unknown species accounted for more than 25% across all plots. Regarding fungal endophytes, the top 10 genera with the highest relative abundance were Tripospermum , Vishniacozyma , Sphaerulina , Dioszegia , Trichomerium , Pucciniastrum , Buckleyzyma , Cyphellophora , Papiliotrema , and Taphrina . More than 50% of the remaining genera and unknown species across all plots were also identified.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
39057355_p18
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3.2. Composition of Leaf Endophytic Fungi and Bacteria
| 4.105469 |
biomedical
|
Study
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We observed that thinning intensity influenced the relative abundance of endophyte taxa at genus levels . Among the endophytic bacteria, genera such as Sphingomonas , Variovorax , and Devosia exhibited the highest relative abundance in CK plots . Conversely, the relative abundance of Pseudomonas and Rhodococcus increased with the thinning intensity. For endophytic fungi, genera such as Tripospermum , Buckleyzyma , Cyphellophora , Apiotrichum , and Neoacrodontiella decreased in relative abundance with increasing thinning intensity . Notably, among endophytic fungi, Camptophora , Tricladiella , and Genolevuria had the highest relative abundance in LT plots.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
39057355_p19
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3.2. Composition of Leaf Endophytic Fungi and Bacteria
| 4.070313 |
biomedical
|
Study
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F. mandshurica , the relative abundance of endophytic bacteria, including Pseudomonas , Sphingomonas , Variovorax , and Devosia , significantly changed with thinning intensity . In U. davidiana , the relative abundance of Sphingomonas and Variovorax significantly decreased with thinning intensity . Regarding endophytic fungi, in T. amurensis , the relative abundance of endophytic fungi such as Buckleyzyma , Cyphellophora , and Neoacrodontiella decreased with thinning intensity, which was also true for Tripospermum , Cyphellophora in P. Koraiensis , and for Buckleyzyma in U. davidiana .
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
39057355_p20
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3.2. Composition of Leaf Endophytic Fungi and Bacteria
| 4.035156 |
biomedical
|
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In the damaged leaves, only three genera of endophytic bacteria, namely Sphingomonas , Rhodococcus , and Variovorax , were significantly impacted by thinning intensity . In U. davidiana , the relative abundance of the endophytic fungi, particularly Neoacrodontiella , significantly responded to thinning intensity in both healthy and damaged leaves, with the highest abundance observed in CK plots . Discrepancies in the abundance of certain fungi between healthy and damaged leaves in response to thinning intensity were also observed in A. pictum , P. Koraiensis , and T. amurensis .
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
39057355_p21
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3.3. Co-Occurrence Networks of Leaf Endophytic Fungi and Bacteria
| 4.125 |
biomedical
|
Study
|
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[
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A co-occurrence network was performed using the Spearman correlation coefficient. Node attributes were compared in Table 2 , including the number of nodes, edges, edge density, average degree, and relative modularity. For the endophytic bacterial community, the CK plot exhibited a higher number of nodes, edges, edge density, average degree, and relative modularity compared to LT and MT plots. The network structure of the bacterial community appeared more complex in the CK plot, which was reduced with the thinning intensity. For the endophytic fungal community, however, the MT plot showed a higher number of nodes, edges, edge density, average degree, and relative modularity compared to CK and LT plots. Increased thinning intensity resulted in greater complexity in the structure of the endophytic fungal community network.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
39057355_p22
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3.3. Co-Occurrence Networks of Leaf Endophytic Fungi and Bacteria
| 4.28125 |
biomedical
|
Study
|
[
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The network nodes were categorized by genus, with Sphingomonas showing the highest proportion among endophytic bacteria and Dioszegia among endophytic fungi . The key taxa were classified at the genus level via the core node discrimination method of the Zi-Pi network . The topological characteristics of nodes divide node attributes into four types: module hubs (nodes with high connectivity within modules), connectors (nodes with high connectivity between two modules), network hubs (nodes that have high connectivity throughout the network), and peripherals (nodes that do not have high connectivity within or between modules). The remaining three types of nodes, excluding peripherals, are generally classified as key species. After the modularization of the endophytic bacterial network, the intra-module connectivity (Zi) and inter-module connectivity (Pi) of the different nodes were calculated, showing 14 key species in the CK plots, 7 key species in the LT plots, and 12 key species in the MT plots . These key species act as modular hubs and connectors, for instance, ASV_3211 appeared in both CK and MT plots, but only the Cystobacterace family has been identified in ASV_3211. In addition, CK and MT samples shared the presence of the Methylbacterium genus. In endophytic fungi, the Zi-Pi values indicated 8 key species in CK plots, 5 key species in LT plots, and 13 key species in MT plots, with these key species functioning as modular hubs. Both CK and LT plots contained ASV_2271, identified as a Chaetothyriales order, and the CK and LT plots shared a common genus of Erythrobasidiomycetes . We also observed that the leaves of T. amurensis , A. pictum , U. davidiana , and P. Koraiensis harbored key species belonging to the genera Methylobacterium and Sphingomonas within their endophytic bacterial communities. Similarly, the endophytic fungi in the leaves of T. amurensis , A. pictum , and P. Koraiensis featured key species belonging to the Erythrobasidium genus ( Table S1 ).
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
39057355_p23
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3.4. Functional Prediction of Leaf Endophytic Fungi and Bacteria
| 4.121094 |
biomedical
|
Study
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Using the FAPROTAX functional annotation method, the ecological categories of endophytic bacteria were classified into three types, i.e., those involved in the carbon cycle, nitrogen cycle, and energy source. The dominant communities were Chemoheterotrophy, Aerobic Chemoheterotrophy, and Anaerobic Chemoheterotrophy, collectively accounting for over 50% . As thinning intensity increased, functional groups involved in nitrogen respiration and nitrate reduction significantly increased. Concurrently, the functional groups of Aerobic Chemoheterotrophy and Chemoheterotrophy significantly decreased .
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
39057355_p24
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3.4. Functional Prediction of Leaf Endophytic Fungi and Bacteria
| 3.90625 |
biomedical
|
Study
|
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The ecological classification of endophytic fungi is based on FUNGuild functional prediction, divided primarily into three types, i.e., saprotroph, pathotroph, and symbiotroph. The dominant communities include litter saprotrophs, plant pathogens, and soil saprotrophs, collectively accounting for more than 50% of the communities . Litter saprotrophs declined significantly with the increase in thinning intensity, whereas plant pathogens increased significantly under the same condition. However, there was no significant difference in soil saprotrophs .
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
39057355_p25
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3.4. Functional Prediction of Leaf Endophytic Fungi and Bacteria
| 3.533203 |
biomedical
|
Study
|
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Except for U. davidiana species, the endophytic bacteria involved in Aerobic Chemoheterotrophy and Chemoheterotrophy decreased with thinning intensity. In F. mandshurica , the endophytic bacteria involved in nitrogen respiration and nitrate reduction increased with thinning intensity . Similarly, the plant fungal pathogen also increased with thinning intensity . In P. Koraiensis , the litter saprotroph of endophytic fungi decreased with thinning intensity.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
39057355_p26
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3.4. Functional Prediction of Leaf Endophytic Fungi and Bacteria
| 3.089844 |
biomedical
|
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There were no significant differences in endophytic bacteria in both healthy and damaged leaves . In F. mandshurica , among the endophytic fungi of damaged leaves, the plant pathogen was the highest in the LT plot. In contrast, in healthy leaves, the endophytic fungi increased with the rise in thinning intensity, peaking in the MT plot . In P. Koraiensis , litter saprotrophs of endophytic fungi decreased with the increasing thinning intensity, observed in both healthy and damaged leaves.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
39057355_p27
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3.5. Drivers Triggering Variations in the Assemblages of Leaf Endophytic Fungi and Bacteria
| 4.074219 |
biomedical
|
Study
|
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Thinning intensity had significant effects on SLA, LDMC, Zn, and P ( Table 3 ). Using stepwise forward regression, we selected leaf traits that significantly explained the richness of leaf bacterial and fungal endophytes . A preliminary model was constructed based on previous studies . During the adjustment process of the structural equation model, SLA and LDMC were further identified as key leaf trait factors regulating the relationship between thinning intensity and leaf endophytic bacterial communities. Therefore, in the structural equation model, the composite variables of leaf traits comprised SLA and LDMC, and pH and soil moisture content were categorized as soil variables .
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
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3.5. Drivers Triggering Variations in the Assemblages of Leaf Endophytic Fungi and Bacteria
| 3.197266 |
biomedical
|
Study
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In healthy leaves, thinning intensity positively influenced the richness of endophytic fungi and bacteria, although the effect was not statistically significant . Moreover, thinning intensity indirectly affected the richness of the leaf endophytic fungi through modulating leaf traits . Additionally, the richness of endophytic bacteria was significantly affected by leaf traits, as well as soil variables . However, soil variables such as soil pH and water content did not affect endophytic fungal richness.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
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3.5. Drivers Triggering Variations in the Assemblages of Leaf Endophytic Fungi and Bacteria
| 3.777344 |
biomedical
|
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|
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In damaged leaves, thinning intensity significantly negatively affected the richness of endophytic bacteria, while it significantly positively influenced the richness of endophytic fungi . Furthermore, thinning intensity conferred indirect effects on the richness of both endophytic bacteria and fungi by modulating the neighbor tree diversity, which consequently changed the leaf traits of focal tree species and their associated bacterial and fungal richness . Additionally, in damaged leaves, soil variables were found to positively affect leaf traits .
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
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4.1. The Contrasting Responses of the Diversity of Leaf Endophytic Fungi and Bacteria to Thinning Intensity
| 4.199219 |
biomedical
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Study
|
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The susceptibility of soil bacteria to abiotic stresses is higher compared to fungi . However, there is limited literature regarding leaf endophytes in this context. Our findings indicate that under light thinning intensity, leaf endophytic fungal diversity significantly surpassed that of the control group, while leaf endophytic bacterial diversity was slightly lower in the thinning treatment compared to the control, although not significantly different . This suggests that leaf endophytic fungi exhibit greater sensitivity to thinning, whereas leaf endophytic bacteria demonstrate greater stability in response to thinning. Therefore, temperate forest thinning may intensify antagonistic interactions between leaf endophytic fungi and bacteria. In general, soil bacteria and fungi compete for resources, resulting in antagonism between these microbial groups , which may provide a plausible explanation for the contrasting trends observed in the diversity of fungal and bacterial communities. Furthermore, we observed that the most significant increase under the thinning gradient was in pathogenic fungi, while the dominant decrease in bacterial community diversity was observed in chemo-energy heterotrophs , supporting the notion that changes in bacterial diversity were driven by competition. Additionally, we found that host plant identity had a more significant impact on the structure of leaf endophytic bacterial communities compared to thinning intensity . This finding aligns with previous studies, indicating that the host plant primarily regulates leaf endophytes and is less influenced by inter-host dispersal , which helps explain the lack of significant changes in leaf endophytic bacterial diversity with thinned intensity.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
39057355_p31
|
39057355
|
sec[3]/sec[0]/p[1]
|
4.1. The Contrasting Responses of the Diversity of Leaf Endophytic Fungi and Bacteria to Thinning Intensity
| 4.1875 |
biomedical
|
Study
|
[
0.99755859375,
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[
0.99951171875,
0.0001990795135498047,
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0.00003898143768310547
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In terms of community composition, the temperate forest thinning significantly increased the relative abundance of Rhodococcus spp. in the endophytic bacterial community and concurrently reduced the relative abundance of Cyphellophora spp. in the endophytic fungal community. Conversely, thinning led to a significant increase in the relative abundance of Camptophora spp. in the endophytic fungal community . Thinning is generally predicted to alter the community structure of host trees, accelerating nutrient availability and modifying organic matter content . Moreover, thinning can cause significant changes in habitat conditions, such as increased exposure to direct sunlight and soil disturbance . The changes can greatly influence the makeup of microbial communities, resulting in the emergence of communities adapted to the new habitat conditions and resource utilization strategies. Consequently, leaf endophytes with adaptive advantages to the altered habitat conditions and resource utilization strategies, such as the fungal and bacterial species mentioned above, become more prevalent, while non-adapted communities may be outcompeted and eliminated through competition.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
39057355_p32
|
39057355
|
sec[3]/sec[1]/p[0]
|
4.2. The Contrasting Trends of the Complexity of Leaf Endophytic Fungal and Bacterial Co-Occurrence Networks
| 4.304688 |
biomedical
|
Study
|
[
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[
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0.00007838010787963867
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Thinning can exert significant effects on plant leaves by altering canopy density , water content , and the diversity of neighboring species . We observed a progressive reduction in the complexity of the co-occurrence network of leaf bacterial endophytes with increasing thinning intensity, resulting in a simpler network topology, which is consistent with changes in diversity . This indicates that thinning leads to a decrease in interactions among leaf endophytic bacteria. Conversely, the topological features of the network of leaf endophytic fungi became progressively more complex with increasing thinning intensity . These characteristics reflect the level of connectivity and interactions among microorganisms . One explanation for this topological variation is the differentiation of ecological niches within leaf tissues due to changes in the diversity of leaf endophyte communities triggered by thinning intensity . The increased diversity of leaf endophytic fungi associated with higher thinning intensity led to a more homogeneous distribution of ecotopes for leaf endophytic fungi. Weak ecotope differentiation may enhance interactions between microorganisms . Conversely, the decrease in the diversity of leaf endophytic bacteria may have resulted in significant ecotope differentiation, reducing competition, and allowing microorganisms to coexist within the community for extended periods. Additionally, this ecological niche differentiation may have inhibited interactions between different species of endophytic bacteria . Similarly, bacteria and fungi were predominantly positively correlated in microbial networks under thinning. Positive and negative correlations in microbial networks represent mutually beneficial symbiotic or competitive relationships among interrelated species . This pattern may arise from resource abundance and reduced competition among bacterial species, resulting in higher synergism between bacterial communities .
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
39057355_p33
|
39057355
|
sec[3]/sec[1]/p[1]
|
4.2. The Contrasting Trends of the Complexity of Leaf Endophytic Fungal and Bacterial Co-Occurrence Networks
| 4.140625 |
biomedical
|
Study
|
[
0.99951171875,
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[
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Node attributes in microbial networks can be categorized into four types based on the node’s topological characteristics: module hubs, connectors, network hubs, and peripherals. Typically, network hubs denote nodes that have a high degree of connectivity throughout the network (Zi > 2.5 and Pi > 0.62), i.e., nodes that play an important role both within modules and between different modules . From an ecological perspective, peripherals are considered specialists, while network hubs are super-generalists. Due to environmental determinism, specialists constitute a major part of most systems, whereas super-generalists are very few . In this study, network hubs were present neither in bacterial nor fungal networks. However, module hubs and connectors, which are closer to generalists, were found to varying degrees. These module hubs and connectors play an important role, highlighting their significance in bacterial and fungal endophytic network structures in temperate forests.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
39057355_p34
|
39057355
|
sec[3]/sec[1]/p[2]
|
4.2. The Contrasting Trends of the Complexity of Leaf Endophytic Fungal and Bacterial Co-Occurrence Networks
| 4.21875 |
biomedical
|
Study
|
[
0.9990234375,
0.0003895759582519531,
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[
0.99951171875,
0.00015497207641601562,
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0.00005733966827392578
] |
Given the intricate nature of leaf microbial communities, the concepts of microbial persistence (core taxa) and their significance in the microbial network (pivotal taxa) have been utilized to identify microbes playing key roles in leaf communities . Furthermore, as the thinning intensity changed, different ASVs were assigned to different modules, indicating that thinning intensity altered the key taxa within the network of the leaf endophyte community. Most of the key taxa showed strong specificity for leaf endophytes. Notably, the CK plots and MT plots shared a genus, Methylobacterium . It has been well documented that the enrichment of plant biomes with the genus Methylobacterium can promote plant growth and productivity, as well as plant drought tolerance . For leaf endophytic fungi, the CK and LT plots share a genus, Erythrobasidium , whose members have not been well studied, with only eight species found in nature so far , and whose functions are even less understood. It should be noted, however, that these key taxa are not the same across time and environments, that is, key species may play a critical role only under certain conditions . Our results support that this environmental deterministic influence applies equally well in leaf endophyte communities.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
39057355_p35
|
39057355
|
sec[3]/sec[1]/p[3]
|
4.2. The Contrasting Trends of the Complexity of Leaf Endophytic Fungal and Bacterial Co-Occurrence Networks
| 4.058594 |
biomedical
|
Study
|
[
0.9970703125,
0.0003306865692138672,
0.0023708343505859375
] |
[
0.99951171875,
0.0002720355987548828,
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0.000036716461181640625
] |
For different tree species, we found that there was a high variability of bacterial and fungal key taxa among the different tree species, suggesting that the key taxa of the endophytic bacteria in leaves are highly plant species-specific. Interestingly, when extending the bacterial key taxa to the genus level, we found the genus Sphingomonas existed in four of the tree species. Bacteria of the genus Sphingomonas are widespread in nature due to their low nutrient concentration requirements and have been shown to have resistance to bacterial pathogens. Additionally, they can spread vertically between plant generations through seeds . Overall, when investigating the network complexity of leaf endophytes, the key taxa should be well considered.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
39057355_p36
|
39057355
|
sec[3]/sec[2]/p[0]
|
4.3. Leaf Trait-Mediated Thinning Effects on Leaf Fungal and Bacterial Endophytes
| 4.214844 |
biomedical
|
Study
|
[
0.9990234375,
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[
0.99951171875,
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0.00006496906280517578
] |
Leaf surfaces present hostile environments where inhabiting microorganisms are exposed to various physicochemical stresses, including intense light and ultraviolet (UV) radiation, fluctuating temperature and humidity, and limited nutrient availability . Our findings indicate that both endophytic bacterial and fungal community richness were significantly positively influenced by leaf functional traits . Previous studies demonstrate that changes in endophytic microbial colonization and diversity are regulated by leaf economic profiles, which encompass trade-off strategies for leaf nutrient utilization . It is because most leaf endophytes are horizontally transmitted via airborne spores, that endophyte spores and mycelium inevitably interact with leaf traits. Upon reaching the leaf surface, endophytes typically colonize the tissue through wounding and stomatal infiltration . Consequently, traits related to leaf defense performance, such as specific leaf area and leaf dry matter mass, become particularly important for leaf endophytic bacterial communities. Furthermore, we found that leaf endophyte communities were less influenced by neighbors . This further corroborates our previous conclusion that endophytes may be primarily regulated by the host and less influenced by inter-host dispersal.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
39057355_p37
|
39057355
|
sec[3]/sec[2]/p[1]
|
4.3. Leaf Trait-Mediated Thinning Effects on Leaf Fungal and Bacterial Endophytes
| 4.3125 |
biomedical
|
Study
|
[
0.9990234375,
0.00043892860412597656,
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[
0.9990234375,
0.00017082691192626953,
0.0006194114685058594,
0.00007778406143188477
] |
Unlike inter-root and soil microbial communities, leaf microbes are inevitably influenced by pollinating insects and herbivorous visitors, which introduce and redistribute microbiota . Our findings reveal that in healthy leaves, soil properties can positively influence leaf endophytic bacterial abundance, whereas this relationship was not significant among damaged leaves. Previous studies indicate that the bacterial composition in leaves exhibits greater similarity to taxa present in soil than to bacteria in flowers and fruits . This suggests that bacterial members in the interleaf microflora in the healthy statues are primarily soil-derived, emphasizing the essential role of soil properties in shaping the bacterial community. Furthermore, we found that neighbor diversity, in the presence of leaf damage, indirectly affects leaf endophyte communities by influencing leaf functional traits . Functional traits, serving as the foundation of leaf economic profiles, effectively express the ecological strategies of plants in resource acquisition and the optimal allocation of limited available resources . The intensification of thinning is expected to decrease the neighborhood diversity of the target tree species and further increase ecological niches in the community, leading to an adjustment of the ecological strategy of the target tree species from a defensive to an aggressive development strategy. Finally, our results further elucidate that the effects of thinning on leaf endophytes may be primarily mediated by leaf damage, indicating that airborne microbial transmission and secretions from insect feeding possibly contribute to the reconstitution of the leaf microbial community.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
39057355_p38
|
39057355
|
sec[3]/sec[2]/p[2]
|
4.3. Leaf Trait-Mediated Thinning Effects on Leaf Fungal and Bacterial Endophytes
| 4.234375 |
biomedical
|
Study
|
[
0.99853515625,
0.000518798828125,
0.0011463165283203125
] |
[
0.9990234375,
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] |
Unlike those inhabiting healthy leaves, thinning had significant negative and positive effects on leaf endophytic bacteria and endophytic fungi in damaged leaves, respectively . Compared to the plant surface, the inner layers of leaves may provide a richer nutrient environment that protects microorganisms from external atmospheric fluctuations, including UV radiation and moisture . However, this proximity to the plant’s immune surveillance mechanisms and defense compounds may inhibit the colonization potential of endophytes, and leaf damage provides a pathway for changes in the microbial community. Damaged leaves expose the living environment for endophytes, triggering the growth of endophytic pathogenic fungi, consistent with previous observations that many pathogens causing forest leaf diseases require wounds or scrapes to penetrate host tissues, typically caused by mechanical damage from herbivores or other physical factors such as wind or water . In contrast, endophytic bacteria may be inhibited by fungal growth during competition, leading to a decrease under thinning gradients, representing a trade-off between different thinning intensities on leaf endophyte communities. The competition of both bacteria and fungi for resources among limited ecological niches inevitably results in a tendency for them to outcompete each other . This further explains that the changes in leaf endophyte communities’ diversity and co-occurrence network construction under different thinning intensities may be mediated by leaf damage.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
39057355_p39
|
39057355
|
sec[4]/p[0]
|
5. Conclusions
| 4.207031 |
biomedical
|
Study
|
[
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[
0.9990234375,
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Leaf endophytic fungi and bacteria exhibited contrasting responses to thinning intensity in temperate forest ecosystems. Specifically, endophytic fungal diversity increased significantly with thinning intensity, accompanied by an increase in the complexity of the co-occurrence network. Conversely, bacterial diversity did not show significant differences, but the complexity of the symbiotic network decreased as the thinning intensity increased. Moreover, the contrasting effects of thinning intensity on leaf fungal and bacterial endophytes were particularly noticeable in damaged leaves, compared to in healthy leaves, suggesting that the condition of the leaves—whether damaged or healthy—may be critical for constructing the trade-offs between leaf fungal and bacterial endophytes under forest thinning. Additionally, leaf endophytes were more strongly modulated by their host tree, with leaf functional traits having a significant positive effect on them, and the neighbor tree diversity also conferred an indirect effect on leaf endophytes via altering the leaf traits of host trees. Overall, our findings provide insight into the trade-offs between fungal and bacterial endophytes in response to forest thinning, particularly in damaged leaves.
|
[
"Beiping Liu",
"Chunhuan Li",
"Xiuhai Zhao",
"Chunyu Zhang",
"Xinyi He",
"Laiye Qu",
"Naili Zhang"
] |
https://doi.org/10.3390/jof10070470
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277625_p0
|
PMC11277625
|
sec[0]/p[0]
|
1. Introduction
| 4.242188 |
biomedical
|
Review
|
[
0.9921875,
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] |
[
0.01488494873046875,
0.0012331008911132812,
0.9833984375,
0.00046706199645996094
] |
Nutritional status is significantly important in cardiac surgery in view of patients with (or at risk of) malnutrition suffering worse post-operative outcomes . Malnutrition is related to a poor surgical outcome and to a higher prevalence of comorbidities and mortality, as a result of which the healing time is prolonged and the cost increases . Additionally, malnutrition is an important factor that negatively affects mental and physical functions . Coronary artery bypass grafting (CABG) surgical procedure is a major stress factor that can activate several inflammatory and catabolic pathways in patients. Consequently, post-operative cognitive decline (POCD), delirium, and dementia are commonly diagnosed among cardiac surgery patients. Nutritional status has been found to be one of the risk factors for the mentioned post-operative complications . It is believed that an appropriate nutritional status allows the body to react appropriately to this stressor and recover faster and more efficiently. Lopez-Delgado et al. highlight strategies in prehabilitation programs that align with Enhanced Recovery After Surgery (ERAS) principles to optimize patients pre-surgery. These programs focus on nutritional support, physical activity, and metabolic enhancement using dietary modifications and supplements rich in antioxidants and omega-3 polyunsaturated fatty acids. Evidence indicates that these interventions improve metabolic parameters and reduce post-operative complications, such as atrial fibrillation, leading to shorter hospital stays. Additionally, promoting healthy dietary habits and providing nutritional counseling before cardiac surgery can reduce cardio-metabolic risk factors, optimizing patient readiness and enhancing surgical outcomes .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11277625_p1
|
PMC11277625
|
sec[0]/p[1]
|
1. Introduction
| 4.007813 |
biomedical
|
Study
|
[
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[
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Moreover, sarcopenia and frailty, compounded by malnutrition, significantly impair cognitive outcomes in post-heart surgery patients. These conditions collectively diminish physical resilience and metabolic function critical for cognitive recovery. We focused on nutritional status due to its direct impact on post-operative recovery in cardiac surgery patients. Malnutrition affects vital processes like wound healing and immunity, crucial for recovery after surgery. Sarcopenia, marked by muscle loss and decreased strength, correlates with post-surgery cognitive decline . Frailty, reflecting reduced physiological reserves and heightened vulnerability to stressors, exacerbates cognitive impairment in these patients . The interrelated nature of these conditions highlights the necessity of cohesive nutritional interventions and comprehensive management strategies to enhance cognitive outcomes and overall recovery in this patient population.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277625_p2
|
PMC11277625
|
sec[0]/p[2]
|
1. Introduction
| 3.984375 |
biomedical
|
Review
|
[
0.97607421875,
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] |
[
0.0115966796875,
0.379638671875,
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Managing POCD involves a multifaceted approach that includes both preventive and therapeutic strategies. Pre-operative assessments should identify at-risk patients, with early interventions ensuring adequate caloric and protein intake. Specialized supplements like antioxidants and omega-3 fatty acids can help manage inflammation from cardiopulmonary bypass (CPB) . Intraoperatively, minimizing surgical stress through advanced techniques and careful anesthesia management can also reduce the likelihood of cognitive decline. Post-operatively, early mobilization, cognitive therapy, and continued nutritional support are essential in managing POCD . Additionally, close monitoring and early identification of cognitive impairments allow for timely interventions, improving overall recovery and reducing the long-term impact of POCD.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277625_p3
|
PMC11277625
|
sec[0]/p[3]
|
1. Introduction
| 3.953125 |
biomedical
|
Review
|
[
0.998046875,
0.0012903213500976562,
0.000888824462890625
] |
[
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However, explanations related to the effect of poor nutritional status pre-operatively on the incidence of POCD, specifically after cardiac surgery, are still lacking. Therefore, this paper aims to review the current incidence of malnutrition among cardiac surgery patients and explore in depth the relationship between nutritional status pre-operatively and the incidence of POCD among this population.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277625_p4
|
PMC11277625
|
sec[1]/p[0]
|
2. Methods
| 4.027344 |
biomedical
|
Review
|
[
0.99609375,
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[
0.0240020751953125,
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A literature search was conducted using six databases, namely PubMed, Elsevier, ScienceDirect, Google Scholar, SpringerLink, and ClinicalKey. Publications in the English language were used for this review. The terms used to search the related articles were “malnutrition”, “post-operative cognitive decline”, “cardiac surgery”, “nutritional status”, “hospitalized patient”, “nutritional assessment”, and “cognitive dysfunction”. The full articles were obtained if their abstracts explained malnutrition, referring to undernutrition, factors, and effects of malnutrition pre-and post-operatively, and the incidence of POCD after surgery, focusing on adult cardiac surgery patients.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277625_p5
|
PMC11277625
|
sec[2]/p[0]
|
3. Prevalence of Heart Disease
| 4.101563 |
biomedical
|
Study
|
[
0.99951171875,
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[
0.71875,
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The growing epidemic of cardiovascular disease (CVD) and the increasing number of aging populations globally have resulted in CVD remaining the number one cause of death for decades . According to studies, CVD caused 422.7 million cases and 17.9 million deaths in 2015, and it may result in over 23.6 million deaths yearly by 2030 . Recent data from the American Heart Association’s (AHA) Heart Disease and Stroke Statistics—2023 Update provide a comprehensive view of coronary heart disease (CHD) prevalence among US adults. According to the National Health and Nutrition Examination Survey (NHANES) 2017–2020, the overall CHD prevalence is 7.1%, with males at 8.7% and females at 5.8%. Ethnic variations from the National Health Interview Survey (NHIS) 2018 show rates of 5.7% among White adults, 5.4% among Black adults, 8.6% among American Indian/Alaska Native adults, and 4.4% among Asian adults .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277625_p6
|
PMC11277625
|
sec[2]/p[1]
|
3. Prevalence of Heart Disease
| 1.814453 |
biomedical
|
Other
|
[
0.9287109375,
0.006114959716796875,
0.06494140625
] |
[
0.0019702911376953125,
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Heart disease is the primary cause of mortality for men, women, and members of the majority of racial and ethnic groups in the United States. It is reported that a person dies due to CVD every 33 s in the United States . In the United States, heart disease caused approximately 695,000 deaths in 2021, which is one death out of every five . As a result, between 2018 and 2019, heart disease cost the United States $239.9 billion a year . This covers the expense of medical treatment, medications, and lost wages as a result of mortality .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277625_p7
|
PMC11277625
|
sec[2]/p[2]
|
3. Prevalence of Heart Disease
| 3.123047 |
biomedical
|
Other
|
[
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0.0007519721984863281,
0.004261016845703125
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[
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Over the past three decades, CVD mortality and morbidity in Malaysia have increased. According to the Malaysian Ministry of Health Report, CVD has remained the leading cause of death since 1980 . In 2020, 13.7% of 109,164 medically certified deaths were caused by ischemic heart disease (IHD), an increase of 2.0% from the previous year . However, the percentage of medically certified deaths due to IHD decreased to 13.7% in 2021 in view of the world experiencing the COVID-19 pandemic, including Malaysia. This has made COVID-19 infection the leading cause of death in Malaysia for 2021 (19.8%), followed by IHD .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277625_p8
|
PMC11277625
|
sec[3]/p[0]
|
4. Trends and Outcomes of Cardiac Surgery
| 3.941406 |
biomedical
|
Study
|
[
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0.0005812644958496094,
0.0005249977111816406
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[
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Generally, most large datasets were collected prior to the COVID-19 pandemic. The number of procedures performed in developed countries such as the United States (US) and the United Kingdom (UK) has been relatively constant over the past two decades. Despite the fact that there is an increase in the mean patient age, comorbidity burden, and logistic EuroSCORE, the outcomes have consistently improved . Data before the pandemic showed that cardiac operative mortality had fallen between 2.1% and 2.2% in developed countries such as the UK and the US . However, the global strike of the COVID-19 pandemic has unprecedentedly affected healthcare management, including decisions on performing surgical procedures for cardiac patients. The stark reduction in the inpatient provision of cardiovascular procedures was seen worldwide during the two years. Regardless of socioeconomic status, the pandemic is associated with greater risk-adjusted mortality (odds ratio 1.398) .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277625_p9
|
PMC11277625
|
sec[3]/p[1]
|
4. Trends and Outcomes of Cardiac Surgery
| 4.144531 |
biomedical
|
Study
|
[
0.99853515625,
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[
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0.0003821849822998047
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Nationwide data in Malaysia did not specifically address post cardiac surgery’s mortality and morbidity rate. The best referral is from the National Heart Institute (IJN) annual report. A similar trend of improvement was reported over the recent decade until the pandemic struck. The in-hospital mortality rate for patients undergoing isolated CABG in IJN was consistently low, ranging from 3.7% in 2016 to 3.0% in 2018 . Recently, IJN also reported a higher actual survival rate for all open-heart surgery (94.4%) and isolated CABG (96.1%) in 2022 as compared to the predicted survival rate estimated by the Parsonnet scoring system (predicted survival rate ranging from 91.7% to 92.2%) . Cardiac surgery is seen to be more difficult in patients with complicated medical histories. At the time of surgery, the majority of the patients had hypertension (74.7%) and hypercholesterolemia (74.8%), and nearly half of them had diabetes mellitus (47.4%) in 2022 . The improvement indicates that the nation’s main referral center for cardiac cases, including cardiac surgery, has advanced at par with the developed countries. Since the mid-1980s, operative mortality has been included as part of the indicator for the quality of healthcare in developed countries. Consequently, the US Society of Thoracic Surgeons (STS) formed the Adult Cardiac Surgery Database (ACSD) in 1989 as a formal report on the outcomes of cardiac procedures. The 30-day mortality has been an important metric guiding the evolution of the cardiac operative approach . Nevertheless, a direct comparison of the trend between countries may not be relevant as the contributing factors to the provision of surgical procedures for cardiac patients differ.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277625_p10
|
PMC11277625
|
sec[3]/sec[0]/p[0]
|
4.1. Malnutrition among Cardiac Surgery Patients
| 3.919922 |
biomedical
|
Review
|
[
0.9951171875,
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[
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The American Society for Parenteral and Enteral Nutrition (ASPEN) defined malnutrition as “An acute, subacute, or chronic state of nutrition in which varying degrees of overnutrition or undernutrition with or without inflammatory activity have led to a change in body composition and diminished function” . Malnourished patients undergoing cardiac surgery have been shown to have worse post-operative outcomes, including higher morbidity and mortality .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11277625_p11
|
PMC11277625
|
sec[3]/sec[0]/sec[0]/p[0]
|
4.1.1. Pre-Operative Malnutrition: The Possible Cause
| 4.394531 |
biomedical
|
Study
|
[
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[
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Pre-operative hospitalized patients had a high rate of malnutrition, reaching up to 46.4% among cardiac surgery patients . Acute and chronic diseases among cardiac surgery patients cause changes in body composition, resulting in poor nutritional status among this population . In addition to having poor nutrition uptake or intake, these patients frequently have impaired neurophysiological status or physical mobility . As a result of their illness, patients with heart failure are usually not physically active, which causes the disease to worsen. A longer stay in the hospital prior to surgery also results in less physical activity . Hospitalized patients tend to experience high levels of anxiety and depression, which may also negatively impact their nutritional intake before surgery . Sarcopenia and physical performance are impacted by malnutrition due to changes in the nervous and skeletal systems as well as loss of muscle mass and strength . All three have negative health effects, including increased morbidity and mortality; and decreased quality of life . Thus, all these factors might cause further nutritional state deterioration among pre-operatively hospitalized patients. Additionally, patients with malnutrition frequently have decreased cardiac muscle mass, which eventually lowers cardiac output and reduces renal perfusion. Furthermore, low levels of energy, micronutrients, and electrolytes alter cytokines, glucocorticoids, insulin, and insulin-like growth factors, all of which affect cardiac function . Congestive heart failure further decreases appetite and food intake, leading to the pathophysiological circulus vitiosus .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277625_p12
|
PMC11277625
|
sec[3]/sec[0]/sec[0]/p[1]
|
4.1.1. Pre-Operative Malnutrition: The Possible Cause
| 4.226563 |
biomedical
|
Review
|
[
0.99755859375,
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[
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Appetite changes among heart failure patients are common. A study conducted by Andrea et al. demonstrated that decreased appetite is a common issue for HF patients, both right before and 1.5 years after hospitalization . It is reported that almost 38% of heart failure patients had an appetite level at risk of future weight loss, based on the Council on Nutrition Appetite Questionnaire (CNAQ) assessment . The condition of the disease itself may impact the patients’ appetite. Heart failure may cause fluid retention and accumulation, bowel edema, and shortness of breath, making it difficult for patients to eat . Most patients with heart failure are elderly, and the process of aging itself may impact appetite hormones negatively. A study carried out by Andrea et al. found that almost half of the patients (49%) were discharged with decreased appetite . The condition worsened when further appetite decreases were seen among 141 patients (22%) after 18 months of follow-up. Another study conducted by Pilgrim et al. also found a consistent decrease in the patient’s appetite over time . Comorbidity, which includes signs of depression, sleep disorders, and impaired cognitive function, is a common issue in heart failure. It has been demonstrated to have a negative effect on appetite in general populations, but the evidence is limited in heart failure populations. Physical activity is a crucial part of managing heart failure, but it is unclear how it affects appetite. Additionally, medical management of heart failure is essential for symptom relief and lowering neurohormonal activation, but it may also have adverse effects on food intake. Many heart failure patients also experience loneliness, which could also affect their appetite . Furthermore, decreased appetite over time was independently predicted by fatigue, depressive symptoms, and poor quality of life. This problem occurs persistently and cannot be solved spontaneously. Hence, a patient’s appetite should be evaluated daily, similarly to other crucial nutritional evaluations such as weight. Thus, early nutritional counselling could be provided to avert or delay malnutrition .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277625_p13
|
PMC11277625
|
sec[3]/sec[0]/sec[0]/p[2]
|
4.1.1. Pre-Operative Malnutrition: The Possible Cause
| 4.5 |
biomedical
|
Study
|
[
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[
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Numerous studies have also demonstrated that immunological and neurohormonal disorders are key contributors to cardiac cachexia . The development of cardiac cachexia depends on comprehensive overexpression of catabolic mechanisms. This is due to the numerous immunologic, metabolic, and neurohormonal alterations . Patients with heart failure have increased energy expenditure and concurrently decreased calorie intake. As a result, compensatory proteolysis occurs, therefore causing muscle wasting. These two processes are frequently linked to the development of cachexia . Hypoalbuminemia is also one of the pathogenic stages that follow in the development of cardiac cachexia. A significant proteolysis causes nitrogen balance among heart failure patients. It appears that hypoalbuminemia causes changes in the activity of inflammatory cytokines, resulting in an increase in the secretion of TNF-alpha. TNF-alpha is a tumor necrosis factor which is one of the main inflammatory cytokines of the human body. TNF-alpha has an impact on the endothelium, negatively causing the tissue blood flow to be lower, and subsequently reducing the absorption of nutrients and physical fitness . Other than TNF-alpha, IL-1 and IL-6 are also secreted, and these can lead to the activation of catabolic processes . Additionally, hypoalbuminemia causes a reduction in the transforming growth factor activity (anti-inflammatory cytokines IL-10 and TGF-beta) . Thus, it can be concluded that hypoalbuminemia and muscle wasting are interrelated. However, the specific reason and order of the previously mentioned changes are still unclear.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277625_p14
|
PMC11277625
|
sec[3]/sec[0]/sec[0]/p[3]
|
4.1.1. Pre-Operative Malnutrition: The Possible Cause
| 4.367188 |
biomedical
|
Study
|
[
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[
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Additionally, hormonal changes are common among heart failure patients. Lower testosterone and an increase in cortisol blood concentration led to an increase in catabolic processes, adding to the proteolysis and muscle wasting . Elevated catabolic processes cause a decrease in testosterone levels and an increase in blood concentration of cortisol, adding to muscle wasting and proteolysis. Reduced body weight induces adiponectin secretion, promoting lipid oxidation and insulin sensitivity. As a result, concentrations of blood lipid and glucose become lower. Besides that, weight loss also can cause leptin concentration to increase. Leptin activity is similar to adiponectin, whereby it increases the sensitivity towards insulin and reduces lipogenesis . Nonetheless, heart failure patients commonly have insulin resistance . Additionally, leptin is mainly responsible for activating the satiety center, whereby it promotes the feeling of early satiety and lack of nutrient intake . This eventually will aggravate cardiac cachexia.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277625_p15
|
PMC11277625
|
sec[3]/sec[0]/sec[0]/p[4]
|
4.1.1. Pre-Operative Malnutrition: The Possible Cause
| 4.6875 |
biomedical
|
Study
|
[
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High energy expenditure in cardiac cachexia affects the balance between the sympathetic and parasympathetic systems. It increases the secretion of cortisol and renin–aldosterone–angiotensin system (RAAs) activation and natriuretic peptide system . Angiotensin II plays a major role in cachexia. It initiates proteolysis in the muscular tissue by elevating the secretion of IL-6 and glucocorticosteroids and reduces the IGF-1 secretion . Some researchers demonstrated that the muscle fibril proteins are mostly degraded in neoplastic cachexia via the ubiquitin-dependent mechanism of protein degradation . The processes are similar in cardiac cachexia. Their increased activity is brought on by angiotensin II-induced nicotinamide adenine dinucleotide phosphate (NADPH) activation, which results in increased oxidative stress in muscle tissue . The activation of muscular satellite cells is reduced by angiotensin II, which interferes with the repair of damaged muscle fibers. Additionally, it speeds up the breakdown of lysosome and proteasome proteins , triggers the corticoid-releasing hormone (CRH) secretion, and lowers the neuropeptide Y (NPY) and orexin secretion . As a result, it stimulates a feeling of satiety and lowers the appetite.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277625_p16
|
PMC11277625
|
sec[3]/sec[0]/sec[0]/p[5]
|
4.1.1. Pre-Operative Malnutrition: The Possible Cause
| 3.974609 |
biomedical
|
Review
|
[
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[
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Altered psychosocial and lifestyle further worsened the malnutritional status among this group. Ringaitienė et al. Ringaitienė, Gineitytė reported that psychological stress and neuropsychological issues, such as dementia and depression, contributed to the incidence of malnutrition. This shows that there is a strong relationship between these conditions, and it is important to practice a proper psychological screening for the patients before surgical procedure. In general, Lomivorotov et al. and Stoppe et al. stated that cardiac surgery patients with malnutrition can have poor outcomes. This includes deterioration of chronic heart failure, cardiac cachexia and sarcopenia, less metabolic and functional reserves, increased hemodilution (including coagulopathy, need for transfusion, and inflammation), and gastrointestinal endothelial dysfunction. Table 1 below summarizes the multifactorial aspects and consequences of malnutrition in cardiac surgery patients.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277625_p17
|
PMC11277625
|
sec[3]/sec[0]/sec[1]/p[0]
|
4.1.2. Effect of Malnutrition Post-Operatively
| 4.214844 |
biomedical
|
Study
|
[
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Nutritional deficits result in the reduction in defense mechanism and reduced metabolic reserves leading to the pathomechanism of inflammation in cardiac patients . Cardiac surgery patients commonly experience complex systemic inflammatory response syndrome. This can be seen through the manifestation of tachycardia, pyrexia, leukocytosis, edema, hypotension, and organ failure post-operatively . Additionally, the most common organ malfunction after heart surgery is pulmonary failure (up to 79%) , ventricular failure (up to 70%) , poor post-operative cognitive function (up to 65%) , and acute kidney injury in a third of the patients. Particularly, high-risk cardiac patients undergoing prolonged cardiac surgeries and cardiopulmonary bypass (CPB) are more susceptible to an elevated inflammatory response with adverse effects.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277625_p18
|
PMC11277625
|
sec[3]/sec[0]/sec[1]/p[1]
|
4.1.2. Effect of Malnutrition Post-Operatively
| 4.03125 |
biomedical
|
Study
|
[
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Organ malfunction leads to a longer stay in the intensive care unit (ICU) and a prolonged requirement for life-sustaining treatments. The patients’ health deteriorates even more when malnutrition led to the onset of endothelial gut mucosa malfunction, permitting the translocation of potential bacterial . Patients who are malnourished are therefore more prone to surgical stress, ischemia-and-reperfusion damage, complications from anesthesia, hemodilution, and inflammation. Despite this, pre-operative fasting and delayed post-operative nutritional supplementation are frequently reported, aggravating the already-existing malnutrition. Numerous observational studies have shown severe macro- and micronutrient depletion as well as the significance of energy and protein metabolism in the initial stages following heart surgery .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277625_p19
|
PMC11277625
|
sec[3]/sec[0]/sec[1]/p[2]
|
4.1.2. Effect of Malnutrition Post-Operatively
| 3.962891 |
biomedical
|
Review
|
[
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Longer hospital stays are common among malnourished patients. Higher percentage of hospitalization longer than 7 days among malnourished cardiac surgical patients was reported in a study by Ávila et al. . A study by Karst et al. which evaluated 83 cardiac patients in ICU showed that the mean hospital stay of malnourished patients was longer than well-nourished patients. While these cohort and observational studies suggest a potential link between nutritional status and cognitive outcomes, they may not be able to provide direct evidence for the efficacy of pre-operative nutritional interventions. A recent review by Dong et al. has shown associations between pre-operative nutritional markers and post-operative cognitive function in cardiac surgery patients, but interventional studies are lacking. A small pilot study by Jones et al. explored pre-operative nutritional supplementation in cardiac surgery patients, showing promising results for cognitive outcomes, but larger randomized controlled trials are needed to establish causality.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11277625_p20
|
PMC11277625
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sec[3]/sec[0]/sec[1]/p[3]
|
4.1.2. Effect of Malnutrition Post-Operatively
| 3.964844 |
biomedical
|
Study
|
[
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Another retrospective analysis study carried out by Drover et al. also demonstrated that post-surgical patients were more likely to become malnourished while in the post-operative ICU. Malnutrition can cause adverse effects on the post-operative outcome. This includes poor functional recovery, high risk of infection, increased incidence of pneumonia, and prolonged length of stay in ICU, which leads to a lower discharge-to-home rate and increased morbidity and mortality . In this case, nutritional support might be the best intervention to prevent further deterioration of nutritional status among this group.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11277625_p21
|
PMC11277625
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sec[3]/sec[0]/sec[1]/p[4]
|
4.1.2. Effect of Malnutrition Post-Operatively
| 3.992188 |
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|
Review
|
[
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According to ESPEN guidelines , nutritional support has been shown to help in improving the recovery process in many ways. This includes maintaining the metabolism, maintaining the gut function, reducing post-operative complications, promoting wound healing, and maintaining hydration and euglycemia adequacy. Good nutritional status with adequate dietary intake may also have a good impact on brain function. The processes that carry energy from foods to neurons are probably essential for regulating brain activity . Energy intakes regulate cerebral oxygenation, making it a crucial component for the preservation of brain function by providing energy to the brain tissue, and this includes cerebral microcirculation .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277625_p22
|
PMC11277625
|
sec[3]/sec[0]/sec[1]/p[5]
|
4.1.2. Effect of Malnutrition Post-Operatively
| 3.996094 |
biomedical
|
Study
|
[
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[
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Recent studies underscore the critical role of nutritional status in predicting outcomes following cardiac surgery. Almohammadi et al. highlighted that lower levels of the prognostic nutritional index (PNI) in heart surgery patients correlate with prolonged hospital stays and increased morbidity and mortality rates. Their study involving 264 individuals emphasized the significance of PNI and other nutritional markers in assessing risk in this patient population, despite mortality differences not reaching statistical significance across PNI levels. Similarly, Kawanishi et al. investigated the impact of pre-operative malnutrition on disability-free survival after elective cardiac and thoracic aortic surgery in older patients. Their findings indicated that poor pre-operative nutritional status significantly reduced the likelihood of disability-free survival at one year post-surgery, reinforcing the critical need for nutritional optimization strategies in pre-operative care protocols for improved surgical outcomes.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277625_p23
|
PMC11277625
|
sec[3]/sec[0]/sec[2]/p[0]
|
4.1.3. Association of Malnutrition with Cognitive Function Post-Operatively
| 4.054688 |
biomedical
|
Study
|
[
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[
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After cardiac surgery, including aortic valve replacement (AVR) and coronary artery bypass grafting (CABG), post-operative cognitive dysfunction (POCD) is a common complication. Between 15% and 50% of individuals undergoing cardiac surgery have POCD . According to a retrospective study, the most frequent cause of POCD following a cardiac operation is a CABG procedure, with incidence rates of 37.6% in the first week and 20.8% in the third month .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277625_p24
|
PMC11277625
|
sec[3]/sec[0]/sec[2]/p[1]
|
4.1.3. Association of Malnutrition with Cognitive Function Post-Operatively
| 4.003906 |
biomedical
|
Study
|
[
0.99951171875,
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[
0.98291015625,
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0.000171661376953125
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Predisposing factors include older age, female gender, higher bleeding episodes, and elevated post-operative creatinine levels . Laalou et al. reported that the incidence of POCD is influenced by age and the timing of assessment, with rates of 23–29% in patients aged 60–69 and over 70 years one week post-surgery, decreasing to 14% in those over 70 years by the third month post-surgery. Recent advances highlight the importance of considering nutritional status as a potential modifiable factor influencing cognitive outcomes in this population . This comprehensive approach enables the identification and targeted intervention of specific cognitive deficits.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11277625_p25
|
PMC11277625
|
sec[3]/sec[0]/sec[2]/p[2]
|
4.1.3. Association of Malnutrition with Cognitive Function Post-Operatively
| 4.054688 |
biomedical
|
Study
|
[
0.99951171875,
0.0002110004425048828,
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[
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Additionally, numerous studies revealed that the primary factor contributing to the development of POCD is the inflammatory reactions linked to surgery . It has been reported that inhibiting this inflammatory response can enhance cognitive recovery from surgery. Before surgery, enteral administration of enriched nutrition was thought to be able to trigger the vagal anti-inflammatory reflex, which would restrict the inflammatory response and subsequently decrease POCD . This mechanism also can be seen in a study by Hovens et al. , where enteral enriched nutrition before surgery in young rats was found able to reduce systemic inflammation and improve cognitive performance after surgery. However, old rats showed a mixed favorable/unfavorable cognitive response without effect on systemic inflammation.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277625_p26
|
PMC11277625
|
sec[4]/p[0]
|
5. Nutritional Screening and Assessment
| 4.019531 |
biomedical
|
Review
|
[
0.99755859375,
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] |
[
0.11602783203125,
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Nutritional screening and assessment among cardiac patients are crucial aspects of comprehensive care, as they help identify individuals who may be at risk for poor nutritional status and allow healthcare providers to implement appropriate interventions. Poor nutritional status among cardiac patients has been associated with worse outcomes in a pre-operative setting . In addition, malnutrition is prevalent among critical and high-risk cardiac patients, making it vital to identify those who may be malnourished or at increased risk of malnutrition . Varieties of parameters used in the nutritional assessment include anthropometric data, clinical history, biochemical parameters, physical examinations, and dietary records . Several nutritional screening tools have been proposed and evaluated for cardiac surgery patients. Lomivorotov et al. conducted a comparative study to evaluate the prognostic value of nutritional screening tools for patients scheduled for cardiac surgery and found that nutritional screening tools can effectively identify patients at high risk of malnutrition . Another study in agreement with the previous outcome also highlighted the importance of implementing nutritional screening in clinical routine practice to identify patients at nutritional risk and initiate optimization strategies .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277625_p27
|
PMC11277625
|
sec[4]/p[1]
|
5. Nutritional Screening and Assessment
| 3.880859 |
biomedical
|
Study
|
[
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[
0.6044921875,
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Subjective Global Assessment (SGA) has been widely used in assessing the nutritional status of the hospitalized patient. SGA is practical and sensitive in identifying patients with impaired nutritional status. The subjective assessment that combines both clinical and dietary information allows patients to be classified into three categories: well-nourished, moderately malnourished, or severely malnourished . Previous study proves that SGA is one of the tools that can effectively identify patients at high risk of malnutrition. In the evaluation, SGA includes weight loss, changes in subcutaneous fat, muscle wasting, and the presence of edema in its clinical factors. In addition to the clinical factors, the dietary factors included are changes in appetite, dietary intake, and gastrointestinal symptoms . Due to the fact that all these factors are subjective, its data are highly dependent on the operator. Therefore, multiple operators may result in different variants of results.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277625_p28
|
PMC11277625
|
sec[4]/p[2]
|
5. Nutritional Screening and Assessment
| 3.863281 |
biomedical
|
Review
|
[
0.99853515625,
0.0005612373352050781,
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] |
[
0.313232421875,
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0.6826171875,
0.00044655799865722656
] |
In addition to SGA, there are also many widely used nutritional screening and assessment tools including the Mini Nutritional Assessment Short-Form (MNA-SF), Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), and Nutrition Risk Screening 2002 . However, currently there is still no validated nutritional screening and assessment tool developed specifically for this population. Additionally, the nutritional screening and assessment tool was rarely used in cardiac surgery . Lomivorotov et al. found that most nutrition screening tools are insufficiently sensitive to the risk of developing post-operative complications . Identifying the nutritional status of hospitalized cardiac patients is essential to determine the most appropriate dietary treatment and to optimize health professionals’ and institutional managers’ planning .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277625_p29
|
PMC11277625
|
sec[4]/p[3]
|
5. Nutritional Screening and Assessment
| 3.960938 |
biomedical
|
Study
|
[
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[
0.76513671875,
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0.227783203125,
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] |
Another screening tool that has the potential for screening nutritional status among post-cardiac surgery patients is the Controlling Nutritional Status (CONUT). The tool combines several objective parameters, and it is simple to calculate in order to obtain the nutritional status score. The score was obtained from blood albumin level, serum total cholesterol, and total lymphocyte count. The score ranges from 0 to 12, whereby higher scores indicate greater nutritional risk . The multifaceted objective parameters taken into account allow a more nuanced evaluation among sensitive patients such as post-cardiac surgery patients as their nutritional status is susceptible to both acute and chronic aspects such as inflammation, lipid metabolism, and protein synthesis. Furthermore, this tool has the potential to detect subtle nutritional changes that can go unnoticed with the marker assessments. Thus, prompt interventions can be conducted to improve patients’ conditions. However, further validations are needed in order to include CONUT as the standard nutritional assessment tool for post-surgery patients . A list of nutritional assessment tools is presented in Table 2 .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277625_p30
|
PMC11277625
|
sec[4]/p[4]
|
5. Nutritional Screening and Assessment
| 3.998047 |
biomedical
|
Other
|
[
0.76220703125,
0.2344970703125,
0.0034770965576171875
] |
[
0.0120086669921875,
0.923828125,
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0.016754150390625
] |
As highlighted, it is clear that nutritional assessment is also part of important assessment upon admission. In the event that malnutrition is identified, interventions should include pre-operative nutrition optimization, potentially delaying elective surgery to implement intensive nutritional support, and providing oral nutritional supplements enriched with immunonutrients . Perioperative nutrition support should prioritize early enteral nutrition (EN) within 24–48 h post-surgery when feasible . In cases where EN is contraindicated or insufficient, parenteral nutrition (PN) should be initiated within 3–7 days post-surgery, depending on the severity of malnutrition and clinical status.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277625_p31
|
PMC11277625
|
sec[4]/p[5]
|
5. Nutritional Screening and Assessment
| 3.949219 |
biomedical
|
Other
|
[
0.9365234375,
0.061492919921875,
0.0018510818481445312
] |
[
0.0455322265625,
0.6005859375,
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The timing of perioperative PN requires careful consideration. For severely malnourished patients, PN may be initiated 7–10 days before surgery if adequate oral or enteral intake cannot be achieved . In the immediate post-operative period, PN should be reserved for patients unable to meet >60% of their energy and protein requirements through EN within 3–7 days after surgery . The decision to initiate PN should be made on a case-by-case basis, considering the patient’s nutritional status, expected duration of inadequate oral/enteral intake, and potential risks. By implementing these interventions and carefully timing nutritional support, we believe that the negative impact of malnutrition on cognitive outcomes and overall recovery in post-heart surgery patients can be mitigated, though further research is needed to establish optimal protocols specific to cardiac surgery patients and evaluate long-term effects on cognitive function.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277625_p32
|
PMC11277625
|
sec[5]/p[0]
|
6. Conclusions and Future Recommendations
| 4.007813 |
biomedical
|
Review
|
[
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[
0.0787353515625,
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Nutrition is one of the fundamental components listed in the ERAS protocols. Due to the fact that all open-heart surgeries are high-risk in nature, diligent consideration of adequate nutrition ensures optimum recovery and mitigates potential adverse complications . Despite significant advancements in cardiac surgery techniques and post-operative care, there remains a critical gap in our understanding of the long-term cognitive outcomes and their nutritional correlates in post-heart surgery patients. While ERAS protocols have shown promise in improving various aspects of patient recovery, their impact on cognitive function and the potential role of nutrition in this context are not yet fully elucidated. Recent studies have suggested a possible link between perioperative nutritional status and post-operative cognitive decline, but the specific mechanisms and optimal nutritional interventions remain unclear . Further research is needed to explore the complex interplay between nutritional factors, ERAS implementation, and cognitive outcomes in this patient population, with a particular focus on identifying modifiable risk factors and developing targeted interventions to enhance both short-term recovery and long-term cognitive health .
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277625_p33
|
PMC11277625
|
sec[5]/p[1]
|
6. Conclusions and Future Recommendations
| 4.058594 |
biomedical
|
Review
|
[
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[
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Managing malnutrition in cardiac surgery patients presents a complex challenge influenced by both chronic cardiovascular conditions and acute perioperative demands. While malnutrition often stems from physiological effects such as reduced appetite and metabolic dysregulation, addressing pre-operative nutritional deficits is crucial to enhance patient readiness for surgery. This approach complements the treatment of underlying diseases by bolstering physiological reserves and potentially reducing surgical complication. Thus, an accurate standardized assessment of nutritional status among this pool of patients pre- and post-operatively is crucial. To date, there is a paucity of universally recognized gold-standard nutrition assessment tools tailored for cardiac surgery patients. This patient cohort has a diverse spectrum of functional states . Therefore, it is imperative that any nutritional status assessment tool utilized be expeditious and objective and minimize the susceptibility to operator judgement. In a nutshell, the current endeavor is focused on identifying the most effective nutritional assessment tool. The integration of nutrition screening into clinical practice and the subsequent initiation of tailored nutritional support holds promising potential in optimizing cardiac patient outcomes.
|
[
"Norsham Juliana",
"Nur Adilah Shuhada Abd Aziz",
"Sofwatul Mokhtarah Maluin",
"Noor Anisah Abu Yazit",
"Sahar Azmani",
"Suhaini Kadiman",
"Kamilah Muhammad Hafidz",
"Nur Islami Mohd Fahmi Teng",
"Srijit Das"
] |
https://doi.org/10.3390/jcm13144015
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277637_p0
|
PMC11277637
|
sec[0]/p[0]
|
1. Introduction
| 4.179688 |
biomedical
|
Study
|
[
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[
0.72412109375,
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Although accounting for just <1% of female neoplasms , the global incidence of vulvar cancer (VC) is varying not only regionally but also temporally, with distinct regional clusters of continued high incidence rates in Germany and South Africa, as well as a globally increasing incidence trend within the last decade(s) due to human papillomavirus (HPV) infections . The small German state of Saarland stands out, with both the highest incidence nationwide as well as the most pronounced rise of the age-standardized incidence rate in general (reaching a maximum of 5.7 cases per 100,000 inhabitants), comparing the time periods 1988–2002 and 2008–2012 . This epidemiological trend contrasts with the still disillusioning survival data of 50–70% (five-year survival) , which have not improved sufficiently in recent decades and further underline the clinical need for a broader scientific approach to VC, focusing not only on treatment options but also on pathohistological risk factors, early diagnostics, and advanced strategies of prevention .
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277637_p1
|
PMC11277637
|
sec[0]/p[1]
|
1. Introduction
| 4.28125 |
biomedical
|
Review
|
[
0.99560546875,
0.002349853515625,
0.00201416015625
] |
[
0.1513671875,
0.004016876220703125,
0.84375,
0.0008549690246582031
] |
Between 2020 and 2021, nationwide lockdowns and severe restrictions in Germany resulted as a response to the declared pandemic situation of SARS-CoV-2—severe acute respiratory syndrome coronavirus type 2—by the World Health Organization (WHO) at the beginning of March 2020. Due to such distinct restraining orders (contact bans), several cancer screening programs were temporarily canceled in a broad range of countries in order to reduce further transmission of the respiratory disease within society as much as possible and to lessen the burden on clinics, which were, at that point, heavily occupied with the emergency care of critically ill COVID-19 patients . Although a final analysis of the resulting impact on oncological morbidity and mortality is still pending, it was postulated early on that strict preventive COVID measures resulted not only in a decrease in cervical cancer screenings but also overall cancer diagnoses . A systematic review and meta-analysis by Teglia et al. analyzed the number of performed cancer screening tests (cervical cancer, breast cancer, and colorectal cancer) before and during the pandemic and determined a striking decrease, especially in cervical cancer (−51.8%) and breast cancer screening (−46.7%) . An additional analysis emphasizing breast cancer screening was performed by Ng and Hamilton et al., who showed that not only breast cancer diagnosis and screening rates decreased within the pandemic but also that national, country-specific lockdown measures negatively influenced the rates of mammograms and cancer diagnosis even more . At that time, in response to the proposed negative impact of acute SARS-CoV-2 infection on the timing of treatment and on the clinical course and mortality of VC patients , the multidisciplinary team of Garganese et al. proposed a distinct concept of action in order to enable the most adequate and personalized diagnosis and treatment under the given circumstances, considering, among others, the patients’ individual vulnerability, the COVID-19 status, the clinical cancer stage, and the house interns’ multidisciplinary tumor board decisions . This seemed particularly important, given that there is currently no consensus-based prevention program to ensure that women with vulvar cancer can be treated at an early stage. In clinical practice, older women often feel ashamed to seek help, and younger women may not have vulvar cancer (VC) immediately recognized, leading to initial misdiagnosis and treatment as an infection or dermatosis.
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277637_p2
|
PMC11277637
|
sec[0]/p[2]
|
1. Introduction
| 4.070313 |
biomedical
|
Study
|
[
0.99951171875,
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[
0.99951171875,
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0.0000642538070678711
] |
Finally, the end of the global health emergency in 2023 will now enable a scientifically sound analysis (ex-post) of public healthcare issues and the clinical/scientific implications of the pandemic. Such retrospective evaluations should always be assessed in the specific context of the country/region of interest—a fact tragically highlighted by the reality that the COVID-19 pandemic has not only highlighted but also accelerated existing problems in several diverse national healthcare systems to a different extent . We retrospectively analyzed pathological data (before, during, and after main COVID restrictions) of patients with squamous cell VC in a region with one of the highest incidence rates worldwide. Our aim was to assess the association between the pandemic and the risk of advanced stages of VC, depicting a change in biological tumor characteristics (tumor staging and pathological risk factors).
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277637_p3
|
PMC11277637
|
sec[1]/sec[0]/p[0]
|
2.1. Patient Data and Data Collection
| 4.042969 |
biomedical
|
Study
|
[
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[
0.99951171875,
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Registered patients who were diagnosed at the Institute of Pathology (University Hospital Saarland) within the years 2018–2023 were identified using our internal clinic information program and the search terms “vulvar carcinoma” and “vulvectomy”. Additionally, querying of the corresponding ICD-O codes within the Saarland University Medical Center for Tumor Diseases (UTS) registry was performed. In this study, solely patients with squamous cell carcinoma of the vulva and accompanying surgery—allowing for sufficient TNM staging—were included. Exclusion criteria were defined as “high-grade dysplasia”, “bioptical diagnosis only”, “tissue-related/artifact-related insufficient pathological diagnostics”, “tumor entities of the vulva other than squamous cell carcinoma”, “recurrent tumor according to the originally assigned TNM classification within the pathological report”, and “palliative–reductive surgery”; see also Table S1 . The data collection was embedded in an ongoing research project focusing on risk factors and histological biomarkers in VC, approved by the Ethics Committee of Saarland . All data were handled in alignment with the Declaration of Helsinki .
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11277637_p4
|
PMC11277637
|
sec[1]/sec[0]/p[1]
|
2.1. Patient Data and Data Collection
| 4.136719 |
biomedical
|
Study
|
[
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After the inclusion of n = 90 (100%) patients, these were split into three distinct cohorts based on the year of diagnosis: a pre-COVID cohort , a COVID cohort , and a post-COVID cohort . The timeframe assignment of each cohort was set in accordance with the German national lockdown restrictions and the definition of the pandemic period defined by Resende et al. . In the next step, individual patient reports were screened and TNM staging data were collected, including tumor stage (T1-3, tumor size, invasion, and infiltration into regional tissue structures such as the vagina and urethra), groin lymph node involvement (N1-3, the involvement of regional lymph nodes), perineural infiltration (Pn, invasion of vital tumor cells within the perineurium of peripheral nerval structures), lymphovascular space invasion (L, infiltration of neoplastic cells within lymph vessels), blood vessel infiltration (V, infiltration of neoplastic cells within blood vessels), and resection status (R, presence/absence of vital tumor cells within the surgical margin), minimum resection margin distances (proximity of definite surgical margin to closest tumor area), and grading (rating of tumor cell morphology in relation to the histomorphology of the physiologic tissue of origin) . Additionally, patient age and depth of infiltration (defined by convention as the distance from the highest adjacent dermal papilla to the point of deepest infiltration) were noted. See Figure 1 for an overview of our study protocol.
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277637_p5
|
PMC11277637
|
sec[1]/sec[1]/p[0]
|
2.2. Statistical Analysis
| 4.0625 |
biomedical
|
Study
|
[
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[
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All data were stored in an Excel file and imported for visualization and calculation in Jamovi (Version 2.3.21.0) and GraphPad (Version 10.2.3, Boston, MA, USA). After initial data visualization, data were checked for normal distribution (Shapiro–Wilk test; p > 0.05 would allow for the assumption of the null hypothesis and therefore a normal data distribution). Subsequently, the Kruskal–Wallis test (including Dunn’s multiple comparisons test for a mean comparison of each group) and Fischer’s exact test were employed as non-parametric tests for hypothesis testing; α < 0.05 was considered statistically significant. Consecutively, the effect size of all available tests with subgroup analysis and α < 0.05 was estimated by calculating the value of Cohen’s d using means and standard deviations. Additionally, p -values were analyzed using the method of Benjamini and Hochberg to control for results incorrectly assigned as “significant” (so-called control of the false discovery rate) .
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277637_p6
|
PMC11277637
|
sec[2]/sec[0]/p[0]
|
3.1. Clinical Data Overview
| 4.046875 |
biomedical
|
Study
|
[
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[
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From 90 (100%) patients with histomorphologically diagnosed squamous cell carcinoma of the vulva in 2018–2023 at the Institute of Pathology (University Hospital Saarland), 30 (33.3%) patients received their diagnosis and treatment between 2018 and 2019, 23 (25.6%) patients between 2020 and 2021, and 37 (41.1%) patients between 2022 and 2023, reflecting a decrease of overall VC diagnoses during the lockdown phase and an increase afterward within the years 2022–2023. See Table 1 for a detailed overview of the data distribution of our parameters of interest according to our a priori-defined cohorts; Tables S2–S4 provide additional information about histomorphological tumor aspects of all three cohorts.
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11277637_p7
|
PMC11277637
|
sec[2]/sec[1]/p[0]
|
3.2. Pre-, Intra-, and Post-COVID Analysis
| 4.054688 |
biomedical
|
Study
|
[
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[
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We did not determine any statistically significant discrepancies in age (Kruskal–Wallis test; p = 0.483), T-stage (Kruskal–Wallis test; p = 0.184), or perineural infiltration (Fisher’s exact test; p = 0.825). Furthermore, we did not detect differences within blood vessel infiltration (Fisher’s exact test; p = 1.0) or tumor grading (Kruskal–Wallis test; p = 0.109) pre-, intra-, and post-COVID-19. A comparison of the surgical parameter resection status (Fisher’s exact test; p = 0.946) and resection margin distance (Kruskal–Wallis test; p = 0.878) did not show any differences within our three cohorts. See Table 2 for a detailed display of non-significant individual statistical assessments and their corresponding interpretations.
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277637_p8
|
PMC11277637
|
sec[2]/sec[1]/p[1]
|
3.2. Pre-, Intra-, and Post-COVID Analysis
| 4.105469 |
biomedical
|
Study
|
[
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[
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Interestingly, we did find divergences of our cohorts with respect to N-stage (Kruskal–Wallis test; p = 0.012), lymphovascular infiltration (Fisher’s exact test; p = 0.041), and infiltration depth (Kruskal–Wallis test; p < 0.001); see also Figure 2 . By comparing the individual group means of the parameters “N-stage” and “infiltration depth”, we were able to confirm that the pre-COVID cohort differs significantly from both alternate two cohorts (Dunn’s multiple comparisons test: N-stage: p = 0.022 for pre-COVID vs. COVID and p = 0.047 for pre-COVID vs. post-COVID; infiltration depth: p = 0.007 for pre-COVID vs. COVID and p = 0.001 for pre-COVID vs. post-COVID), while no significant differences could be observed between the COVID and the post-COVID group (Dunn’s multiple comparisons test: N-stage: p > 0.999 for COVID vs. post-COVID; infiltration depth: p > 0.999 for COVID vs. post-COVID), see also Table 3 .
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277637_p9
|
PMC11277637
|
sec[2]/sec[1]/p[2]
|
3.2. Pre-, Intra-, and Post-COVID Analysis
| 4.09375 |
biomedical
|
Study
|
[
0.99951171875,
0.0003192424774169922,
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[
0.99951171875,
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0.00025153160095214844,
0.000050902366638183594
] |
A consecutive and more detailed statistical analysis proves that the aforementioned results have at least a medium-to-large effect size (infiltration depth: Cohen’s d = 1.16 for pre-COVID vs. COVID and Cohen’s d = 0.85 for pre-COVID vs. post-COVID; N-stage: Cohen’s d = 0.88 for pre-COVID vs. COVID and Cohen’s d = 0.54 for pre-COVID vs. post-COVID). In addition, the conducted analysis following Benjamini and Hochberg confirmed the suggested differences between the cohorts of our study regarding groin lymph node involvement (N-stage) and infiltrating depth, even when setting significant thresholds as p -values < 0.013.
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277637_p10
|
PMC11277637
|
sec[3]/p[0]
|
4. Discussion
| 2.173828 |
biomedical
|
Other
|
[
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[
0.008758544921875,
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Evaluating the impact of the COVID-19 pandemic is of relevance not only in terms of health policy but also in clinical decision-making. The knowledge and interpretation of potentially deviating disease progressions post-pandemic would allow for the development and implementation of concrete measures, such as the adaptation of regular checkups due to more evolved malignancies if necessary.
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277637_p11
|
PMC11277637
|
sec[3]/p[1]
|
4. Discussion
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biomedical
|
Study
|
[
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It is not in doubt that necessary adjustments to the healthcare system resulting from the COVID-19 pandemic had an impact on the care of gyneco-oncological patients in 2020 and 2021, be it in terms of type and timing of oncological surgeries performed or in terms of radiation therapy—topics that have been consecutively addressed by various studies taking into account regional differences and which resulted in specific recommendations as well as alternative management statements from various expert panels and professional societies . Not surprisingly, a great amount of literature has already studied the impact of such statements and COVID-19-related variances in oncological diseases, albeit with sometimes contradictory findings up until now. Therefore, a focus was set on potential dynamics in tumor stages and tumor parameters during the pandemic. Despite a postulated marked decrease in cancer diagnoses with relation to sociodemographic aspects in the timeframe of the pandemic shown by the team of Han et al. in a cross-sectional study , significant increases in higher T-stages of head and neck cancers as well as a higher rate of progressed colorectal cancer during the pandemic were noted . The team of Resende et al. observed an increase in advanced-stage breast cancer due to the pandemic, whereas the team of Feron Agbo et al. did not find an increase in tumor stage but rather an incline in invasive neoplasms and precancerous lesions of breast cancer in France . Aiming to assess changes also within the post-COVID era, Hanuschak et al. determined a rather broad range of variations in clinical and pathological cancer stage dynamics of breast cancer, melanoma, and colorectal cancer pre- and post-COVID .
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277637_p12
|
PMC11277637
|
sec[3]/p[2]
|
4. Discussion
| 3.509766 |
biomedical
|
Study
|
[
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[
0.890625,
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] |
Even for vulvar cancer patients, the current literature remains inconclusive; while the team of Reid et al. reported an increase in incidence rates of vulvar neoplasms after the declared COVID-19 lockdown in a single center analysis, the group of Oymans et al. analyzed data from the Netherlands Cancer Registry and did not find a significant difference in incidence rates of VC before or during the pandemic .
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11277637_p13
|
PMC11277637
|
sec[3]/p[3]
|
4. Discussion
| 4.183594 |
biomedical
|
Study
|
[
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[
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Our results, which not only consider the timeframes before and during the pandemic but also take into account the post-COVID era, demonstrate that tumor stages in VC did not change due to the COVID pandemic, despite the constraint of a limited sample size. Furthermore, the analysis of the “resection margin positive/negative” and “resection margin distance” clinical parameters and surgical outcomes do not support any divergence in patient care or a loss in therapeutic-surgical treatment due to the pandemic, despite COVID-19 causing delays in elective surgeries and personnel limitations—proposing an exceptional adaptability of medical professionals even in the face of challenging circumstances . In line with data presented by Kumar et al., we did not report any differences in morbidity and mortality rates for VC surgeries before or during COVID-19 . Even though we did determine differences in lymph node involvement, lymphovascular invasion, and infiltration depth within the pre- and post-COVID cohorts, a greater extent of groin metastasis and deeper tumor infiltration was unexpectedly seen prior to the pandemic restrictions and not after the pandemic. One possible explanation for this phenomenon could be modified patient behavior due to the pandemic measures, e.g., contact restriction and lockdowns, which may have hindered low-threshold hospital visits and led to a quasi-selected patient population. In that sense, in a recent systematic review, Carbone et al. addressed rates of hospitalization and reasons for care seeking in gynecological patients and pregnant women during lockdown periods and selective control periods. Although they determined an overall increase in hospitalization rates during the pandemic (from 22.7 to 30.6%), fewer patients presented with vaginal bleeding due to gynecological reasons (7.4% vs. 9.2%) . In accordance, Turner et al. demonstrated how healthcare access was impaired for women during the pandemic, highlighting a disproportionate impact for women with a history of cancer and sexual minority women . To keep access to healthcare services as simple as possible, telehealth tools—which were partly implemented successfully during the pandemic—may provide future low-barrier contact with medical professionals in addition to the still-favored in-person visits .
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277637_p14
|
PMC11277637
|
sec[3]/p[4]
|
4. Discussion
| 4.042969 |
biomedical
|
Study
|
[
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[
0.99755859375,
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0.00007295608520507812
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Yet another possible rationale of our data presented—contrary to the aforementioned reasoning—could have been the psychological impact of the pandemic on patients causing exactly the opposite effect. Specifically, patients’ generally increased vigilance regarding health awareness may explain the superior compliance and earlier realization of medical (screening) examinations, leading to earlier disease detection at a less advanced stage of the disease during and after the pandemic. In favor of the latter argument, higher levels of anxiety and distress were reported during the pandemic for patients affected by gynecological cancers . Although such findings raise the necessary attention to increase psychological support and strengthen individual psychoeducational tools, their final effects and implications in cancer screening remain to be resolved; this can be remedied in future studies by analyzing a larger observation period.
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277637_p15
|
PMC11277637
|
sec[3]/p[5]
|
4. Discussion
| 4.140625 |
biomedical
|
Review
|
[
0.998046875,
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[
0.203857421875,
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Last but not least, the ongoing scientific discourse on the pathophysiological interplay between COVID-19 as a viral disease and oncological effects also has to be mentioned, in order to consider oncological diseases such as VC and their pathohistological diagnosis in their full clinical and scientific context. Patients with a systematic oncological treatment (such as chemotherapy or radiotherapy) are not only at a higher risk of more serious COVID-19 infections due to hampered cellular host immune responses due to a gain of pro-inflammatory IL-17-producing T cells and cytotoxic T cells as well as a decline of CD4 T cells and CD8 T cells , but also a link on a molecular level between cancer and COVID-19 has been proposed. In a review, Ghosh et al. highlight commonly shared features of both pathological conditions on an epigenetic, genetic, and proteomic level. Examples of this are protease CTSL/B, which is not only involved in biochemical processes of viral cell entry but is also amplified in different neoplasms, and ACE2 enzyme, which seems to be overexpressed in some carcinomas . Within the scope and according to the design of this study, pathophysiological and microbiological aspects of the relationship between COVID-19 and VC were not considered in detail; however, their potential context should be properly considered in order to put all epidemiological and clinical examinations into a meaningful perspective.
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277637_p16
|
PMC11277637
|
sec[3]/sec[0]/p[0]
|
Limitations
| 3.986328 |
biomedical
|
Study
|
[
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] |
[
0.99951171875,
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0.00005537271499633789
] |
In contrast to the existing literature on COVID-19 and VC , our study analyzes the impact of the pandemic on pathomorphological risk factors. Limitations of the study include its unicentric nature, which cannot take into account regional differences, as well as its lack of a deeper pathophysiological analysis. However, the aforementioned topic clearly remains beyond the scope of this study. Final assessments about the pandemic’s impact on VC need to be drawn in accordance with additional multicenter studies, which aim to elucidate the impact of the pandemic in a global approach, also considering the impact of sociodemographic factors and potential variabilities in healthcare access.
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277637_p17
|
PMC11277637
|
sec[4]/p[0]
|
5. Conclusions
| 4.078125 |
biomedical
|
Study
|
[
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] |
[
0.99755859375,
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The presented study compares the clinical and pathobiological characteristics of 90 patients with histomorphologically diagnosed VC pre- , during , and post-COVID . Our statistical results illustrate that these characteristics of VC were not impaired either during the pandemic or post-COVID. Following our analysis, a consecutive negative impact of the pandemic on prognosis may not be deduced—if anything, our data suggest that the quality of surgical cancer care remained consistent despite the unprecedented burden on the healthcare system caused by COVID-19, highlighting the ability of medical professionals to uphold the highest guideline-adhering standards of patient care despite challenging circumstances. Within clinical routines, a close monitoring of patients who have been diagnosed or treated during the pandemic according to current guidelines should maximize patients’ outcomes.
|
[
"Gilbert Georg Klamminger",
"Annick Bitterlich",
"Meletios P. Nigdelis",
"Laura Schnöder",
"Bashar Haj Hamoud",
"Erich-Franz Solomayer",
"Mathias Wagner"
] |
https://doi.org/10.3390/jcm13144058
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277649_p0
|
PMC11277649
|
sec[0]/p[0]
|
1. Introduction
| 3.951172 |
biomedical
|
Review
|
[
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[
0.267333984375,
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Hip fracture is an important medical issue, affecting at least 1.66 million people worldwide, and this is expected to increase to 4.5–6.3 million by 2050 according to the International Osteoporosis Foundation . Mortality rates associated with hip fractures are notably higher among elderly individuals . Numerous studies have identified the factors influencing clinical outcomes after hip fracture, including preoperative functional capacity, overall health status, and surgical technique . These fractures can be categorized as intracapsular (femoral neck fractures) or extracapsular (intertrochanteric and subtrochanteric fractures). ITFs account for 42% of all hip fractures and represent 44% of the associated costs .
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277649_p1
|
PMC11277649
|
sec[0]/p[1]
|
1. Introduction
| 3.886719 |
biomedical
|
Review
|
[
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[
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Surgery remains the primary treatment for hip fractures . The choice of surgical method depends on the fracture type. Stable fractures (AO/OTA 31-A1) benefit from sliding or dynamic hip screw (DHS) systems providing rigid fixation . In contrast, intramedullary nails have become the preferred implant for unstable fractures (AO/OTA 31-A2, A3), surpassing DHSs . Notably, the DHS is associated with a higher risk of postoperative mechanical failure compared to intramedullary nails .
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277649_p2
|
PMC11277649
|
sec[0]/p[2]
|
1. Introduction
| 3.794922 |
biomedical
|
Other
|
[
0.98291015625,
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0.0011844635009765625
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[
0.2587890625,
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The proximal femur nail anti-rotation II (PFNA II DePuy Synthes, Oberdorf, Switzerland) is the preferred choice for treating ITF at our hospital. Numerous meta-analyses have consistently shown that PFNA II offers advantages over the DHS in terms of reduced fixation failure, decreased blood loss, and shorter hospital stays . However, it is important to note that some studies have reported mechanical failures in ITFs treated with PFNA II .
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11277649_p3
|
PMC11277649
|
sec[0]/p[3]
|
1. Introduction
| 4.089844 |
biomedical
|
Study
|
[
0.998046875,
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[
0.99853515625,
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In addition to the well-known risk factors proposed by the article—such as a TAD greater than 25 mm , a varus neck-shaft angle , and blade position not being inferior on anteroposterior radiographs and not centrally placed on lateral radiographs —there may be other factors contributing to loss of reduction. While we recognize the critical importance of reduction quality, several additional factors influence the likelihood of mechanical failure post-surgery. These factors include implant seating position, complete occupancy of the medullary canal, and the use of a lateral wall side plate to ensure integral stability. Although many of these factors remain speculative, our study aims to validate a newly developed postoperative stability score for evaluating clinical outcomes in our patient series.
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277649_p4
|
PMC11277649
|
sec[1]/sec[0]/p[0]
|
2.1. Patients
| 3.902344 |
biomedical
|
Study
|
[
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[
0.99462890625,
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This retrospective study included 120 patients with ITF who underwent surgery at Kaohsiung Veterans General Hospital in Kaohsiung, Taiwan. The inclusion criteria comprised patients who underwent PFNAII (DePuy Synthes, Oberdorf, Switzerland) for hip fracture and had a follow-up period of more than 6 months. Exclusion criteria included patients under 65 years of age, those with multiple fractures, and patients with pathological fractures.
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277649_p5
|
PMC11277649
|
sec[1]/sec[1]/p[0]
|
2.2. Data Collection and Assessments
| 4.109375 |
biomedical
|
Study
|
[
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0.060211181640625,
0.0006723403930664062
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[
0.98779296875,
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0.0015964508056640625,
0.00322723388671875
] |
The data collected included patient age, gender, BMI, ASA classification, fracture side, and fracture classification according to AO/OTA classification. Additionally, we recorded nail length, blood transfusion during the operation, time of surgery, hospital stay after surgery, time to mobilization, time to bone union, lateral wall fracture gap length, TAD, Parker’s ratio in both anteroposterior (AP) and lateral views, the distance between posterior tip of blade to lateral cortex, and the newly developed postoperative stability score . TAD was a measurement of tip apex distance and is the sum of the distance from the apex of the femoral head to the top of the lag screw on anteroposterior and lateral radiographs. Parker’s ratio represents the percentage of the screw from the inferior border of the femoral neck. Immediate postoperative X-rays and X-rays taken one month later were evaluated by two orthopedic surgeons. Without knowledge of the patient’s outcome, we assessed the quality of reduction using the Chang reduction quality criteria (CRQC) . The CRQC considers positive and negative medial cortical support for fracture reduction and divides cases into three groups based on their scores. We defined a loss of reduction based on the decline in CRQC scores within one month. Our rationale for this definition is that displacement occurring within the first month may be related to the surgical procedure.
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277649_p6
|
PMC11277649
|
sec[1]/sec[2]/p[0]
|
2.3. Statistical Analysis
| 3.818359 |
biomedical
|
Study
|
[
0.99951171875,
0.00024819374084472656,
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[
0.9990234375,
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We conducted univariate analysis using a two-tailed independent-sample t -test for numerical factors and a chi-square test for categorical factors. For multivariate analysis, we employed a logistic regression model to estimate the odds ratio (OR) for loss of reduction in ITF fixation with PFNAII. All statistical analyses were carried out using IBM SPSS v.22.0 (SPSS IBM, New York, NY, USA).
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277649_p7
|
PMC11277649
|
sec[2]/p[0]
|
3. Results
| 3.626953 |
biomedical
|
Study
|
[
0.96875,
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[
0.99462890625,
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Of the 120 patients recruited, eight were younger than 65 years old, three had multiple fractures, and one had a pathological fracture. A total of twelve patients were excluded from the study. In total, 108 patients were eligible for analysis . The mean age of the patients was 82.1 years (range 66–97), with 76 (70.3%) being female. The median follow-up duration was 14.6 months (range 6–17). The AO/OTA fracture types included 31-A1 (21, 19.4%), A2 (61, 56.4%), and A3 (26, 24%).
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277649_p8
|
PMC11277649
|
sec[2]/p[1]
|
3. Results
| 4.078125 |
biomedical
|
Study
|
[
0.9951171875,
0.0043792724609375,
0.0002951622009277344
] |
[
0.99853515625,
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Patient demographics, medical comorbidities, and radiologic parameters are summarized in Table 1 . Among the patients, 23 (21.2%) presented with loss of reduction ( Table 2 ). Univariate analysis revealed that the newly developed postoperative stability score was significantly associated with loss of reduction, with mean scores of 6.68 and 4.83, respectively ( p = 0.045). This association remained significant in multivariate analysis, with odds ratios of 0.076 (95% confidence interval, 0.022–0.263; p < 0.05) ( Table 3 ).
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11277649_p9
|
PMC11277649
|
sec[3]/p[0]
|
4. Discussion
| 4.074219 |
biomedical
|
Study
|
[
0.9990234375,
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[
0.99951171875,
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The most important findings of the study revealed no statistically significant association between loss of reduction and general data based on univariate analysis. However, the newly developed postoperative stability scores exhibited a significant correlation with loss of reduction, with mean scores of 6.68 and 4.83, respectively ( p = 0.045). This significance persisted in multivariate analysis, with odds ratios of 0.076 (95% confidence interval, 0.022–0.263; p < 0.05).
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277649_p10
|
PMC11277649
|
sec[3]/p[1]
|
4. Discussion
| 4.171875 |
biomedical
|
Study
|
[
0.99853515625,
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] |
[
0.9951171875,
0.00119781494140625,
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Various evaluation methods exist for assessing postoperative reduction quality, including TAD, Parker’s ratio, and the Baumgaertner reduction quality criteria (BRQC). The BRQC, developed by Baumgaertner et al. , places emphasis on anatomical reduction, specifically valgus neck-shaft angle and less than 4 mm of displacement. In 2015, the CRQC introduced the concept of positive medial cortical support , which stands in contrast to the nonanatomic positive cortex buttress reduction proposed by Gotfried . According to Chang, positive medial cortical support indicates that the distal femoral shaft fragment is positioned laterally to the lower medial edge of the proximal fracture fragment. The CRQC primarily applies to assessing fracture reduction quality in pertrochanteric fractures treated with cephalomedullary nails such as the PFNA and Gamma nails. A retrospective study demonstrated that CRQC is reliable for predicting mechanical complications and outperforms BRQC in reliability . However, there is currently no new postoperative stability score that incorporates TAD, lateral wall integrity, and other evaluation methods. Therefore, we propose using the new postoperative stability score to assist in evaluating the likelihood of post-surgery reduction loss. Notably, the new score considers implant position, including TAD and Parker’s ratio, as well as nail thickness and the integrity of the lateral femoral wall .
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277649_p11
|
PMC11277649
|
sec[3]/p[2]
|
4. Discussion
| 4.117188 |
biomedical
|
Study
|
[
0.9990234375,
0.000637054443359375,
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[
0.98486328125,
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In patients with hip fractures, loss of reduction can lead to mechanical failure. To address this, Baumgaertner et al. developed a quantitative measure for outcome prediction. They introduced the concept of TAD, which represents the distance between the screw tip and the femoral head apex. In 1995, they proposed TAD as a predictor of cut-out failure. Recommendations include maintaining TAD values greater than 25 mm, with the lag screw positioned centrally or inferiorly on the AP view and centrally on the lateral view. Notably, this study was based on the DHS, which differs in design from the PFNA. A systematic review encompassing various hip fracture implants confirmed the significance of TAD in cut-out failure . The risk of cut-out failure was closely associated with TAD values exceeding 25 mm, consistent with Baumgaertner et al.’s findings. However, Amir Herman et al. offered a different perspective. They argued that the TAD scale solely considers length measurement and neglects direction. Their study identified the “safe zone” for lag screw placement—defined as the lower 25–50% of the head–neck interface line—as the critical factor in preventing mechanical failure. Our study also revealed that TAD alone cannot reliably predict loss of reduction.
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277649_p12
|
PMC11277649
|
sec[3]/p[3]
|
4. Discussion
| 4.050781 |
biomedical
|
Study
|
[
0.9990234375,
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] |
[
0.994140625,
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0.00030422210693359375
] |
Parker’s ratio, first described by M. J. Parker in 1992 , guides the optimal placement of screws in femoral neck fractures. According to Parker, the screw should be positioned centrally or inferiorly on the AP view and centrally on the lateral view. Consensus suggests that the lag screw should be centrally placed in the lateral plane and either centrally or inferiorly in the AP plane . Biomechanical studies have demonstrated that placing the lag screw slightly inferiorly on the AP radiograph, just above the calcar, and centrally in the femoral neck on the lateral radiograph can maximize biomechanical stiffness . Through the Parker’s ratio, the location of the screw could be well explained. Numerous studies found a higher Parker’s ratio in AP radiograph was significantly associated with increased rate of cut out . However, most studies have not found a significant association between Parker’s ratio in the lateral radiograph and cut-out rates . Our study aligns with this finding, emphasizing that Parker’s ratio alone is not the sole risk factor for predicting loss of function.
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277649_p13
|
PMC11277649
|
sec[3]/p[4]
|
4. Discussion
| 4.054688 |
biomedical
|
Study
|
[
0.9990234375,
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[
0.982421875,
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0.00016248226165771484
] |
Lateral wall thickness plays a crucial role in predicting postoperative loss of reduction. Previous studies have highlighted that lateral wall fractures are most common in AO/OTA 31-A2.2 and 31-A2.3 fractures . When a lateral wall fracture occurs, the screw and proximal part of the nail can slide laterally without any restraint. This lateral movement, combined with axial stress, can lead to screw cutout or loosening. CE Hsu et al. investigated the reliability of lateral wall thickness as a predictor of lateral wall fracture using the DHS system. They found that a lateral wall thickness greater than 20.5 mm reliably predicts postoperative lateral wall fractures and helps prevent secondary lateral wall fractures. Due to implant design differences between DHS and PFNA, it is notable that the optimal lateral wall thickness may vary depending on the implant design. For example, Liqin Zheng et al. valuated the influence of lateral wall thickness on implant failure using the PFNA system. They recommended a wall thickness of more than 21.4 mm to prevent secondary lateral wall fractures.
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277649_p14
|
PMC11277649
|
sec[3]/p[5]
|
4. Discussion
| 4.148438 |
biomedical
|
Study
|
[
0.99755859375,
0.002124786376953125,
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[
0.998046875,
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The treatment of ITF fractures involves several technical considerations. Fracture reduction is the crucial initial step and outweighs other factors . Subsequent fracture stability relies heavily on the attachment of the anterior and medial cortex. Studies have emphasized that achieving nonanatomic positive medial cortical support during reduction can prevent relative sliding and create a more favorable environment for bone union . Additionally, the position of the lag screw, as measured by the TAD and Parker’s ratio, plays a critical role. Furthermore, nail thickness is essential; ensuring that the canal is adequately filled can prevent sliding and provide buttress support. Lateral wall integrity is crucial, and a certain thickness is necessary to prevent secondary lateral wall fractures. Ultimately, predicting mechanical failure after surgery remains challenging due to the multifactorial nature of risk factors. All potential risks should be carefully considered. Thus, in our retrospective evaluation, we utilized a newly developed postoperative stability score to assess cases. We found a significant association between this score and loss of reduction, with mean scores of 6.68 and 4.83, respectively ( p = 0.045). Multivariate analysis further confirmed this significance, revealing odds ratios of 0.076 (95% confidence interval: 0.022–0.263; p < 0.05). The advantage of combining these factors lies in comprehensive evaluation. Notably, our results (as shown in Table 3 ) indicate that the tip–apex distance (TAD) and Parker’s ratio are not statistically significant predictors. Overall, the newly developed postoperative stability score provides valuable insights into the risk of loss of reduction.
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277649_p15
|
PMC11277649
|
sec[3]/p[6]
|
4. Discussion
| 3.560547 |
biomedical
|
Study
|
[
0.99755859375,
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[
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This study has several limitations. First, due to its retrospective design, some patients were lost to follow-up during the study. Second, we employed the CRQC to assess loss of reduction. It is important to note that CRQC sets a high standard; even in cases without screw cutout or cut-in, any displacement is considered as loss of reduction. Third, increasing the number of patients could enhance the statistical power of the study.
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277649_p16
|
PMC11277649
|
sec[4]/p[0]
|
5. Conclusions
| 2.960938 |
biomedical
|
Study
|
[
0.99072265625,
0.00536346435546875,
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[
0.7548828125,
0.2388916015625,
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0.00322723388671875
] |
The newly developed postoperative stability score, incorporating surgical technique assessment, improves prediction accuracy for loss of reduction in elderly ITF patients.
|
[
"Shih-Heng Sun",
"Chun-Yu Chen",
"Kai-Cheng Lin"
] |
https://doi.org/10.3390/life14070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277661_p0
|
PMC11277661
|
sec[0]/p[0]
|
1. Introduction
| 2.197266 |
biomedical
|
Other
|
[
0.990234375,
0.007366180419921875,
0.002208709716796875
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[
0.01258087158203125,
0.982421875,
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0.0024929046630859375
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As the population’s longevity increases, a growing number of cardiac surgical interventions are carried out on elderly people burdened with multiple comorbidities, including a history of ischemic stroke.
|
[
"Jerzy Pacholewicz",
"Paweł Walerowicz",
"Aleksandra Szylińska",
"Jakub Udzik",
"Paweł Wańkowicz",
"Ewelina Kuligowska",
"Ewelina Szuba",
"Mariusz Listewnik"
] |
https://doi.org/10.3390/jcm13144045
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277661_p1
|
PMC11277661
|
sec[0]/p[1]
|
1. Introduction
| 3.988281 |
biomedical
|
Review
|
[
0.99560546875,
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0.00093841552734375
] |
[
0.055999755859375,
0.01629638671875,
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] |
Postoperative ischemic stroke is a significant complication, substantially elevating mortality rates and undermining quality of life. The risk of ischemic stroke is estimated at 1–3% following isolated coronary artery bypass grafting (CABG) and at 5–10% in more complex surgical scenarios, including aortic interventions . Besides protracting hospitalization, ischemic stroke results in increased treatment expenditures, which are frequently exacerbated by the need for continuous post-discharge patient monitoring, thus underscoring its profound medical and socioeconomic significance.
|
[
"Jerzy Pacholewicz",
"Paweł Walerowicz",
"Aleksandra Szylińska",
"Jakub Udzik",
"Paweł Wańkowicz",
"Ewelina Kuligowska",
"Ewelina Szuba",
"Mariusz Listewnik"
] |
https://doi.org/10.3390/jcm13144045
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277661_p2
|
PMC11277661
|
sec[0]/p[2]
|
1. Introduction
| 4.042969 |
biomedical
|
Study
|
[
0.9990234375,
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[
0.55517578125,
0.058837890625,
0.384033203125,
0.0019197463989257812
] |
Ischemic stroke manifests predominantly in two temporal domains. Intraoperative strokes are predominantly associated with cerebral-perfusion disturbances attributable to carotid artery atherosclerosis, low-cardiac-output syndrome, and embolic events consequent to surgical manipulations involving the aortic and cardiac structures. The second period of stroke incidence pertains to the postoperative period, wherein it is primarily associated with atrial fibrillation and extant cerebrovascular pathologies .
|
[
"Jerzy Pacholewicz",
"Paweł Walerowicz",
"Aleksandra Szylińska",
"Jakub Udzik",
"Paweł Wańkowicz",
"Ewelina Kuligowska",
"Ewelina Szuba",
"Mariusz Listewnik"
] |
https://doi.org/10.3390/jcm13144045
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277661_p3
|
PMC11277661
|
sec[0]/p[3]
|
1. Introduction
| 3.607422 |
biomedical
|
Other
|
[
0.9833984375,
0.01499176025390625,
0.0016918182373046875
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[
0.0082855224609375,
0.6279296875,
0.35986328125,
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] |
Preoperative vascular interventions in asymptomatic patients used in order to mitigate the incidence of ischemic strokes remain a subject of debate. While the available guidelines offer clear directives concerning symptomatic carotid artery disease, recommendations concerning asymptomatic individuals with substantial carotid artery alterations necessitate meticulous scrutiny to determine optimal medical management strategies .
|
[
"Jerzy Pacholewicz",
"Paweł Walerowicz",
"Aleksandra Szylińska",
"Jakub Udzik",
"Paweł Wańkowicz",
"Ewelina Kuligowska",
"Ewelina Szuba",
"Mariusz Listewnik"
] |
https://doi.org/10.3390/jcm13144045
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277661_p4
|
PMC11277661
|
sec[0]/p[4]
|
1. Introduction
| 4 |
biomedical
|
Review
|
[
0.9970703125,
0.0021228790283203125,
0.0007672309875488281
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[
0.1180419921875,
0.004634857177734375,
0.87646484375,
0.0007066726684570312
] |
The established risk determinants for ischemic stroke include age, carotid artery atherosclerosis, hypertension, diabetes mellitus, atrial fibrillation, prolonged duration of extracorporeal circulation, and antecedent cerebrovascular incidents . The optimal timing for non-cardiac surgical interventions following an ischemic stroke has been defined as a 9-month interval post-incident . However, studies show discrepancies regarding the optimal interim between ischemic stroke occurrences and cardiac surgery with extracorporeal circulation. For patients with indications for surgery on an expedited/urgent basis, a 48-h period is deemed acceptable. Nonetheless, deferring non-urgent surgeries to a minimum of 4 weeks reduces the risk of neurological sequelae . In general, finding the optimal timing for surgical interventions and appraising the escalated risk profile for subsequent ischemic events in individuals with antecedent stroke is a crucial issue in cardiac surgery.
|
[
"Jerzy Pacholewicz",
"Paweł Walerowicz",
"Aleksandra Szylińska",
"Jakub Udzik",
"Paweł Wańkowicz",
"Ewelina Kuligowska",
"Ewelina Szuba",
"Mariusz Listewnik"
] |
https://doi.org/10.3390/jcm13144045
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
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