bluuebunny/crossref_metadata_2025 huggingface dataset:
Boundedness of Differential Transforms for Poisson Semigroups Generated by Bessel Operators
Authors: Zhang Chao
Published: March 2024

In this paper we analyze the convergence of the following type of series: $$ T_N \,\,f(x)=\sum_{j=N_1}^{N_2} v_j\Big({\mathcal P}_{a_{j+1}} \,\,f(x)-{\mathcal P}_{a_{j}} \,\,f(x)\Big),\quad x\in \mathbb R_+, $$ where $\{{\mathcal P}_{t} \}_{t\gt0}$ is the Poisson semigroup associated with the Bessel operator $\displaystyle \Delta_\lambda:=-{d^2\over dx^2}-{2\lambda\over x}{d\over dx}$, with λ being a positive constant, $N=(N_1, N_2)\in \mathbb Z^2$ with $N_1 \lt N_2,$  $\{v_j\}_{j\in \mathbb Z}$ is a bounded real sequence and $\{a_j\}_{j\in \mathbb Z}$ is an increasing real sequence. Our analysis will consist in the boundedness, in $L^p(\mathbb{R}_+)$ and in $BMO(\mathbb{R}_+)$, of the operators TN and its maximal operator $\displaystyle T^*\,\,f(x)= \sup_N \left\vert T_N \,\,f(x)\right\vert.$ It is also shown that the local size of the maximal differential transform operators is the same with the order of a singular integral for functions f having local support.
Poly(ADP‐ribose) mediates bioenergetic defects and redox imbalance in neurons following oxygen and glucose deprivation
Authors: Hossain M. Iqbal , Lee Jun Hee , Gagné Jean‐Philippe , Khan Junaid , Poirier Guy G. , King Peter H. , Dawson Valina L. , Dawson Ted M. , Andrabi Shaida A.
Published: March 2024

PARP‐1 over‐activation results in cell death via excessive PAR generation in different cell types, including neurons following brain ischemia. Glycolysis, mitochondrial function, and redox balance are key cellular processes altered in brain ischemia. Studies show that PAR generated after PARP‐1 over‐activation can bind hexokinase‐1 (HK‐1) and result in glycolytic defects and subsequent mitochondrial dysfunction. HK‐1 is the neuronal hexokinase and catalyzes the first reaction of glycolysis, converting glucose to glucose‐6‐phosphate (G6P), a common substrate for glycolysis, and the pentose phosphate pathway (PPP). PPP is critical in maintaining NADPH and GSH levels via G6P dehydrogenase activity. Therefore, defects in HK‐1 will not only decrease cellular bioenergetics but will also cause redox imbalance due to the depletion of GSH. In brain ischemia, whether PAR‐mediated inhibition of HK‐1 results in bioenergetics defects and redox imbalance is not known. We used oxygen–glucose deprivation (OGD) in mouse cortical neurons to mimic brain ischemia in neuronal cultures and observed that PARP‐1 activation via PAR formation alters glycolysis, mitochondrial function, and redox homeostasis in neurons. We used pharmacological inhibition of PARP‐1 and adenoviral‐mediated overexpression of wild‐type HK‐1 (wtHK‐1) and PAR‐binding mutant HK‐1 (pbmHK‐1). Our data show that PAR inhibition or overexpression of HK‐1 significantly improves glycolysis, mitochondrial function, redox homeostasis, and cell survival in mouse cortical neurons exposed to OGD. These results suggest that PAR binding and inhibition of HK‐1 during OGD drive bioenergetic defects in neurons due to inhibition of glycolysis and impairment of mitochondrial function.
Cervical Cancer Treatment Update: A Society of Gynecologic Oncology Clinical Practice Statement
Authors: Girda Eugenia , Randall Leslie M. , Chino Fumiko , Monk Bradley J. , Farley John H. , O’Cearbhaill Roisin E.
Published: March 2024

Despite increased screening and human papillomavirus (HPV) vaccination in high-income countries, cervical cancer represents the fourth most diagnosed cancer in women worldwide and the second highest cause of cancer mortality among women in low- and middle-income countries. This clinical practice statement describes therapies for cervical cancer by treatment setting, as well as quality of life, financial toxicity, and disparities associated with the disease.

Persistent HPV infection, particularly types 16 and 18, are the main factor in the development of cervical cancer. High-risk HPV variants integrate HPV DNA into the host genome to upregulate two viral oncoproteins, E6 and E7, which in turn inhibit the tumor suppressor proteins p53 and Rb. Certain driver mutations including PIK3CA, KRAS, and EGFR are frequently seen in cervical cancer, however further research is needed to identify an actionable biomarker based on targetable oncogenic alterations.

Locally advanced cervical cancer is defined as clinically visible tumor exceeding 4 cm or invading beyond the cervix, extending to the pelvic sidewalls, vagina, bladder, rectum, or involving pelvic and/or paraaortic lymph nodes. Standard treatment for locally advanced cervical cancer is external beam radiation therapy and concurrent weekly cisplatin. Standard treatment for advanced, recurrent, or metastatic cervical cancer is cisplatin, paclitaxel, and bevacizumab (possibly adding pembrolizumab). Several studies have shown that checkpoint inhibitors, when combined or sequenced with chemoradiation, may provide survival benefit in both locally advanced and recurrent/metastatic cervical cancer. Given these findings, immunotherapy should be incorporated in treatment of advanced or recurrent disease.

Negative effects on quality of life (QOL) in patients with cervical cancer often begin in people who receive negative Papanicolaou test results or positive HPV DNA tests. Negative body image, self-esteem, and relationships with partners contribute to an overall decrease in QoL. Surgical, radiation-induced, and chemotherapy-induced treatment effects further impact survivors’ physical health, body-image, and sexual function. Economic burdens of cancer diagnosis and treatment may disproportionally affect cervical cancer patients due to the intensity of curative treatment, decreases in QoL and functional status, and unique population including younger patients, those with poor access to health care at baseline, and those who identify as racial or ethnic minorities.
An Analysis of Workplace-Based Assessments for Core Entrustable Professional Activities for Entering Residency: Does Type of Clinical Assessor Influence Level of Supervision Ratings?
Authors: Shuford Alexandra , Carney Patricia A. , Ketterer Briana , Jones R. Logan , Phillipi Carrie A. , Kraakevik Jeff , Hasan Reem , Moulton Bart , Smeraglio Andrea
Published: March 2024

Purpose

The authors describe use of the workplace-based assessment (WBA) coactivity scale according to entrustable professional activities (EPAs) and assessor type to examine how diverse assessors rate medical students using WBAs.

Method

A WBA data collection system was launched at Oregon Health and Science University to visualize learner competency in various clinical settings to foster EPA assessment. WBA data from January 14 to June 18, 2021, for medical students (all years) were analyzed. The outcome variable was level of supervisor involvement in each EPA, and the independent variable was assessor type.

Results

A total of 7,809 WBAs were included. Most fourth-, third-, and second-year students were assessed by residents or fellows (755 [49.5%], 1,686 [48.5%], and 918 [49.9%], respectively) and first-year students by attending physicians (803 [83.0%]; P < .001). Attendings were least likely to use the highest rating of 4 (1 was available just in case; 2,148 [56.7%] vs 2,368 [67.7%] for residents; P < .001). Learners more commonly sought WBAs from attendings for EPA 2 (prioritize differential diagnosis), EPA 5 (document clinical encounter), EPA 6 (provide oral presentation), EPA 7 (form clinical questions and retrieve evidence-based medicine), and EPA 12 (perform general procedures of a physician). Residents and fellows were more likely to assess students on EPA 3 (recommend and interpret diagnostic and screening tests), EPA 4 (enter and discuss orders and prescriptions), EPA 8 (give and receive patient handover for transitions in care), EPA 9 (collaborate as member of interprofessional team), EPA 10 (recognize and manage patient in need of urgent care), and EPA 11 (obtain informed consent).

Conclusions

Learners preferentially sought resident versus attending supervisors for different EPA assessments. Future research should investigate why learners seek different assessors more frequently for various EPAs and if assessor type variability in WBA levels holds true across institutions.
Dexmedetomidine Inhibits Paraventricular Corticotropin-releasing Hormone Neurons that Attenuate Acute Stress-induced Anxiety-like Behavior in Mice
Authors: Qiu Gaolin , Wang Peng , Rao Jin , Qing Xin , Cao Chenchen , Wang Dijia , Mei Bin , Zhang Jiqian , Liu Hu , Yang Zhilai , Liu Xuesheng
Published: March 2024

Background

Dexmedetomidine has repeatedly shown to improve anxiety, but the precise neural mechanisms underlying this effect remain incompletely understood. This study aims to explore the role of corticotropin-releasing hormone–producing hypothalamic paraventricular nucleus (CRHPVN) neurons in mediating the anxiolytic effects of dexmedetomidine.

Methods

A social defeat stress mouse model was used to evaluate the anxiolytic effects induced by dexmedetomidine through the elevated plus maze, open-field test, and measurement of serum stress hormone levels. In vivo Ca2+ signal fiber photometry and ex vivo patch-clamp recordings were used to determine the excitability of CRHPVN neurons and investigate the specific mechanism involved. CRHPVN neuron modulation was achieved through chemogenetic activation or inhibition.

Results

Compared with saline, dexmedetomidine (40 µg/kg) alleviated anxiety-like behaviors. Additionally, dexmedetomidine reduced CRHPVN neuronal excitability. Chemogenetic activation of CRHPVN neurons decreased the time spent in the open arms of the elevated plus maze and in the central area of the open-field test. Conversely, chemogenetic inhibition of CRHPVN neurons had the opposite effect. Moreover, the suppressive impact of dexmedetomidine on CRHPVN neurons was attenuated by the α2-receptor antagonist yohimbine.

Conclusions

The results indicate that the anxiety-like effects of dexmedetomidine are mediated via α2-adrenergic receptor–triggered inhibition of CRHPVN neuronal excitability in the hypothalamus.

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Added Value of Liver MRI in Patients Eligible for Surgical Resection or Ablation of Colorectal Liver Metastases Based on CT: A Systematic Review and Meta-Analysis
Authors: Görgec Burak , Verpalen Inez M. , Sijberden Jasper P. , Abu Hilal Mohammad , Bipat Shandra , Verhoef Cornelis , Swijnenburg Rutger-Jan , Besselink Marc G. , Stoker Jaap
Published: March 2024

Background:

Abdominal computed tomography (CT) is the standard imaging modality for detection and staging in patients with colorectal liver metastases (CRLM). Although liver magnetic resonance imaging (MRI) is superior to CT in detecting small lesions, guidelines are ambiguous regarding the added value of an additional liver MRI in the surgical workup of patients with CRLM. Therefore, this systematic review and meta-analysis aimed to evaluate the clinical added value of liver MRI in patients eligible for resection or ablation of CRLM based on CT.

Methods:

A systematic search was performed in the PubMed, Embase, and Cochrane Library databases through June 23, 2023. Studies investigating the impact of additional MRI on local treatment plan following CT in patients with CRLM were included. Risk of bias was assessed using the QUADAS-2 tool. The pooled weighted proportions for the primary outcome were calculated using random effect meta-analysis.

Results:

Overall, 11 studies with 1440 patients were included, of whom 468 patients (32.5%) were assessed for change in local treatment plan. Contrast-enhanced liver MRI was used in 10 studies, including gadoxetic acid in 9 studies. Liver MRI with diffusion-weighted imaging was used in 8 studies. Pooling of data found a 24.12% (95% confidence interval, 15.58%–32.65%) change in the local treatment plan based on the added findings of liver MRI following CT. Sensitivity analysis including 5 studies (268 patients) focusing on monophasic portal venous CT followed by gadoxetic acid-enhanced liver MRI with diffusion-weighted imaging showed a change of local treatment plan of 17.88% (95% confidence interval, 5.14%–30.62%).

Conclusions:

This systematic review and meta-analysis found that liver MRI changed the preinterventional local treatment plan in approximately one-fifth of patients eligible for surgical resection or ablation of CRLM based on CT. These findings suggest a clinically relevant added value of routine liver MRI in the preinterventional workup of CRLM, which should be confirmed by large prospective studies.
Association between body mass index and in vitro fertilization/intra-cytoplasmic sperm injection outcomes: An analysis of 15,124 normal ovarian responders in China
Authors: Zheng Danlei , Wang Yuanyuan , Chen Lixue , Zeng Lin , Li Rong
Published: March 2024

Background:

High body mass index (BMI) results in decreased fecundity, and women with high BMI have reduced rates of clinical pregnancy and live birth in in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI). Meanwhile, ovarian responses show great heterogeneity in patients with a high BMI. This study aimed to analyze the effects of a high BMI on IVF/ICSI outcomes in the Chinese female with normal ovarian response.

Methods:

We performed a retrospective cohort study comprising 15,124 patients from the medical record system of the Reproductive Center of Peking University Third Hospital, with 3530 (23.3%) in the overweight group and 1380 (9.1%) in the obese group, who had a normal ovarian response (5–15 oocytes retrieved) and underwent fresh embryo transfer (ET) cycles from January 2017 to December 2018, followed by linked frozen-thawed embryo transfer (FET) cycles from January 2017 to December 2020. Cumulative live birth rate (CLBR) was used as the primary outcome. Furthermore, a generalized additive model was applied to visually illustrate the curvilinear relationship between BMI and the outcomes. We used a decision tree to identify the specific population where high BMI had the greatest effect on IVF/ICSI outcomes.

Results:

High BMI was associated with poor IVF/ICSI outcomes, both in cumulative cycles and in separate fresh ET or FET cycles. In cumulative cycles, compared with the normal weight group, obesity was correlated with a lower positive pregnancy test rate (adjusted odds ratio [aOR]: 0.809, 95% confidence interval [CI]: 0.682–0.960), lower clinical pregnancy rate (aOR: 0.766, 95% CI: 0.646–0.907), lower live birth rate (aOR: 0.706, 95% CI: 0.595–0.838), higher cesarean section rate (aOR: 2.066, 95% CI: 1.533–2.785), and higher rate of large for gestational age (aOR: 2.273, 95% CI: 1.547–3.341). In the generalized additive model, we found that CLBR declined with increasing BMI, with 24 kg/m2 as an inflection point. In the decision tree, BMI only made a difference in the population aged ≤34.5 years, with anti-Mullerian hormone >1.395 ng/mL, and the first time for IVF.

Conclusions:

High BMI was related to poor IVF/ICSI outcomes in women with a normal ovarian response, and CLBR declined with increasing BMI, partly due to suppressed endometrial receptivity. A high BMI had the most negative effect on young women with anticipated positive prognoses.
Emerging mechanisms of ferroptosis and its implications in lung cancer
Authors: Li Qian , Song Qibin , Pei Huadong , Chen Yali
Published: March 2024

Lung cancer is one of the most common malignancies and has the highest number of deaths among all cancers. Despite continuous advances in medical strategies, the overall survival of lung cancer patients is still low, probably due to disease progression or drug resistance. Ferroptosis is an iron-dependent form of regulated cell death triggered by the lethal accumulation of lipid peroxides, and its dysregulation is implicated in cancer development. Preclinical evidence has shown that targeting the ferroptosis pathway could be a potential strategy for improving lung cancer treatment outcomes. In this review, we summarize the underlying mechanisms and regulatory networks of ferroptosis in lung cancer and highlight ferroptosis-targeting preclinical attempts to provide new insights for lung cancer treatment.
Angiotensin-(1-7) Treatment Early in Life Prevents Cardiac Hypertrophy in Adult Hypertensive Rats
Authors: Pontes Carolina Nobre Ribeiro , Bessa Amanda de Sá Martins de , Macedo Larissa Matuda , Ferreira-Junior Marcos Divino , Cavalcante Keilah Valéria Naves , Campos Hericles Mesquita , Cruz-Leite Vanessa Rafaela Milhomem , Neves Ângela Ribeiro , Gomes Rodrigo Mello , Ghedini Paulo César , Biancardi Manoel Francisco , Mendes Elizabeth Pereira , Borges Clayton Luiz , Pedrino Gustavo Rodrigues , Castro Carlos Henrique
Published: March 2024

Angiotensin (Ang)-(1-7) is a cardioprotective peptide of the renin-angiotensin system. Prepuberty has been considered as a later susceptible window of development, and stressful factors in this life phase can induce chronic diseases in adulthood. We aimed to investigate whether the treatment with Ang-(1-7) during the prepuberty could attenuate the development of hypertension and cardiac injury in adult spontaneously hypertensive rats (SHRs). SHRs were treated with Ang-(1-7) (24 μg/kg/h) from age 4 to 7 weeks. Systolic blood pressure was measured by tail-cuff plethysmography up to 17th week. Thereafter, echocardiography was performed, and the rats were euthanized for the collection of tissues and blood. Ang-(1-7) did not change the systolic blood pressure but reduced the septal and posterior wall thickness, and cardiomyocyte hypertrophy and fibrosis in SHR. In addition, Ang-(1-7) reduced the gene expression of atrial natriuretic peptide and brain natriuretic peptide, increased the metalloproteinase 9 expression, and reduced the extracellular signal-regulated kinases 1/2 phosphorylation. Ang-(1-7) also prevented the reduction of Mas receptor but did not change the protein expression of angiotensin-converting enzyme, angiotensin-converting enzyme 2, AT1, and AT2. The treatment with Ang-(1-7) decreased the malondialdehyde (MDA) levels and increased superoxide dismutase-1 and catalase activities and protein expression of catalase. Our findings demonstrate that the treatment of SHR with Ang-(1-7) for 3 weeks early in life promotes beneficial effects in the heart later in life, even without altering blood pressure, through mechanisms involving the reduction of oxidative stress and ERK1/2 phosphorylation. In addition, this study supports the prepuberty as an important programming window.
Accurate location describe and management of lymph node recurrence after esophagectomy for thoracic esophageal squamous cell carcinoma: a retrospective cohort study
Authors: Zhao Qian , Sun Jinglong , Zheng Feng , Dan Han  , Fu Chengrui , Sun Hongfu , Liu Chengxin , Wang Zhongtang , Huang Wei , Wang Ruozheng , Li Baosheng
Published: March 2024

Background:

Describe the accurate locations of lymph node recurrence (LNR) of Chinese patients with postoperative thoracic esophageal squamous cell carcinoma (ESCC) is essential for determining the need for further surveillance protocols and treatments. The authors aimed to evaluate the patterns of postoperative ESCC and its current risk stratification with LNR.

Methods:

This population-based cohort study included a retrospective review of the medical records and image material of patients with ESCC who underwent LNR after radical surgery between January 2013 and September 2022, with a median follow-up time of 5.71 years. Clinical features were extracted from these records, and survival analysis was performed. The primary endpoint was the accurate location and range of LNR according to the nomenclature of the Japanese Society for Esophageal Diseases. The second endpoints was to explore the related factors of recurrence range and overall survival.

Results:

A total of 3268 lymph node regions were recurrence from 1129 patients, with a mean of 2.89 regions per patient. No.104, 106, and 107 was the most common recurrence of thoracic ESCC with an LNR rate higher than 15%. In upper thoracic ESCC, No.105 was a common recurrence site and abdominal LNR was rare. In lower thoracic ESCC, retroperitoneal lymph node was a unique regions (15.4%). Anastomotic recurrence is an important recurrence pattern in patients with postoperative esophageal cancer, with an incidence of 24.5%. Rates of LNR in range of lymph node dissection was low (13.9%). The median time of LRT was 20.0 (1.5–184.0) months. High range of recurrence was associated with significantly poorer OS in patients. Multiple linear regression analysis identified demonstrated N stage, tumor differentiation, adjuvant radiotherapy, and total lymph nodes removed were association with recurrence range for patients.

Conclusions:

Supraclavicular and upper mediastinums lymph nodes were common recurrence site for ESCC patients, and careful initial staging and surveillance are needed. Thorough lymph node dissection may reduce the range of regional recurrence.
The impact of using near-infrared autofluorescence on parathyroid gland parameters and clinical outcomes during total thyroidectomy: a meta-analytic study of randomized controlled trials
Authors: Safia Alaa , Abd Elhadi Uday , Massoud Saqr , Merchavy Shlomo
Published: March 2024

Background:

The added benefit of using near-infrared autofluorescence (NIRAF) during total thyroidectomy (TT) remains controversial. This study investigated whether or not NIRAF results in improved patient outcomes postoperatively.

Materials and methods:

We analyzed 1711 TT patients, reported in nine randomized controlled trials, following a systematic search of five databases. NIRAF was compared to the standard of care (naked eye with/without white light). Outcomes included parathyroid gland (PG) and calcium parameters and other clinical outcomes. For dichotomous outcomes, the log odds ratio (logOR) was calculated, and for continuous outcomes, the crude mean difference (MD) was measured. Sensitivity analysis was performed when heterogeneity was significant. The revised Cochrane risk of bias tool was used to assess the methodological quality.

Results:

Compared to the standard of care, the use of NIRAF was associated with a significant reduction in postoperative hypoparathyroidism [logOR=−0.31; 95% CI: −0.57: −0.05], inadvertent PG removal [logOR=−0.93; 95% CI: −1.60: −0.26], and postoperative hypocalcemia [logOR=−0.43 mmol/l; 95% CI: −0.77: −0.09]. It was also associated with significantly higher postoperative PTH levels [MD=4.78 pg/ml; 95% CI: 2.13: 7.43], PG identification rate [logOR=1.02; 95% CI: 0.31: 1.72], postoperative serum calcium [MD=0.05; 95% CI: 0.00: 0.09], and operative time [MD=9.38 min; 95% CI: 6.68: 12.09]. No difference was seen regarding PG autotransplantation, length of hospital stay, and hospitalization due to hypocalcemia. Seven trials had low risk and the remainder had some concerns.

Conclusion:

NIRAF is superior to the naked eye in identifying all four PGs during TT. The reduced risk of postoperative hypoparathyroidism and hypocalcemia reflected this preservation value. However, it was not associated with a change in the length of hospital stay. Although rare, the readmission rate due to hypocalcemia was similar across both methods.
Clinical efficacy of different surgical approaches in the treatment of thoracolumbar tuberculosis: a multicenter retrospective case–control study with a minimum 10-year follow-up
Authors: Liu Renfeng , He Jinpeng , Fan Qizhi , Zhou Hao , Wu Xin , Yan Zuyun , Tan Wei , Zang Xiaofang , Deng Youwen
Published: March 2024

Objective:

To evaluate the long-term clinical efficacy of three different surgical approaches in treating thoracolumbar tuberculosis.

Methods:

A total of 176 patients with thoracolumbar tuberculosis, treated with open surgery at two hospitals, were retrospectively analyzed. Patients were stratified into three groups based on the surgical approach: anterior-only (AO), posterior-only (PO), and anterior–posterior combined (AP) approaches. Collected data encompassed operative duration, intraoperative blood loss, hospital stay length, complications, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) classification, and radiographic measurements of segmental lordotic Cobb angles, correction angles, and correction rates.

Results:

The minimum duration of follow-up among all patients was 10 years. Postoperatively, all patients experienced a reduction in ESR and CRP, with normalization occurring within 3 months and sustained normal at the last follow-up. The AP group had a longer operative duration and higher intraoperative blood loss than the other two groups. The Cobb correction rates for AO, PO, and AP were (56.33±6.62)%, (72.82±5.66)%, and (74.45±5.78)%, respectively. The correction loss of Cobb angles for AO, PO, and AP were (2.85±1.01)°, (1.42±0.97)°, and (1.19±0.89)°, respectively. Patients in all groups showed significant improvement in VAS scores and ODI postoperatively, with no notable intergroup differences. The neurological recovery rates for the AO, PO, and AP groups were 84.62, 87.10, and 83.72%, respectively, while the complication rates were 12.73, 16.98, and 22.06%, respectively.

Conclusion:

An anterior-only approach is recommended for cases with localized lesions and smaller angular deformities. For patients with multisegmental lesions and larger angular deformities, a posterior-only or anterior–posterior combined approach is advised, with a preference for the posterior-only approach.
The obesity challenge in joint replacement: a multifaceted analysis of self-reported health status and exercise capacity using NHANES data: a population-based study
Authors: Zhang Xianzuo , Shen Xianyue , Bai Jiaxiang , Zang Wanli , Chen Mo , Maimaitiabula Abasi , Zhu Chen
Published: March 2024

Background:

Joint replacement is successful for end-stage oeteoarthritis, with obesity linked to elevated risk. But the impact of obesity on self-reported health and exercise capacity among joint replacement patients remains complex and requires investigation.

Methods:

This study utilizes data from the National Health and Nutrition Examination Survey (NHANES) to examine the relationship between obesity severity, demographic factors, medical comorbidities, and self-reported health status. The relationship between general health status and BMI was analyzed using multivariable regression, and further illustrated using a restricted cubic spline. Additionally, a bibliometric analysis and systematic review was done to frame the research within the broader context of existing knowledge and demographic specifics.

Results:

Analysis of NHANES data involving 327 joint replacement patients yielded intriguing insights. The difference in self-reported health between BMI groups did not achieve conventional statistical significance (P=0.06), and multivariable analysis showed that even severely obese patients did not exhibit significantly elevated risk of poor/fair self-reported health compared to normal weight subjects. Among severely obese individuals (BMI>40), 40.63% still rated their health positively. However, stratified analyses indicated that obesity correlated with negative health reports across sex, age, and education strata. Notably, physical functioning emerged as a robust predictor of self-reported health, with those reporting no walking difficulties having significantly lower odds of poor/fair health (Odds ratio=0.37, P=0.01).

Conclusion:

The study highlights the need for healthcare providers to consider individual physical abilities and comorbidities alongside obesity severity when discussing treatment options with joint replacement patients. It supports tailored interventions and informed shared decision-making. Future research could explore effective weight management strategies for obese individuals undergoing joint replacement.
The anterior neck scar outcomes of conventional thyroidectomy using a wound protector: a multicenter double-blinded randomized controlled trial
Authors: Kim Woochul , Yu Hyeong Won , Kim Su-jin , Chai Young Jun , Choi June Young , Lee Kyu Eun
Published: March 2024

Purpose:

This study aimed to investigate the effectiveness of a novel wound protector in enhancing the cosmetic outcomes of thyroidectomy.

Material and methods:

This multicenter, double-blinded randomized controlled trial enrolled 129 patients undergoing open thyroidectomy. The patients were divided into a wound protector group and a control group. Subjective patient assessments were conducted, measuring wound satisfaction, pain, and itchiness. Additionally, blinded observers evaluated scars using the Vancouver Scar Scale.

Results:

The Vancouver Scar Scale revealed significant advantages for the wound protector group, demonstrating improvements in pigmentation (P=0.002), vascularity (P=0.014), pliability (P=0.001), and height (P=0.001).

Conclusion:

The thyroid wound protector offers a potential to improve postoperative cosmetic outcomes. Further research is warranted to explore patient experiences and optimize the application of this innovative wound protector across diverse surgical contexts.
Combined simultaneous transsphenoidal and transcranial regimen improves surgical outcomes in complex giant pituitary adenomas: a longitudinal retrospective cohort study
Authors: Qiao Nidan , Gao Wei , Deng Xingli , Xin Tao , Zhang Gangli , Wu Nan , Wang Pan , Bi Yunke , Cong Zixiang , Zhou Zhiyi , Li Junjun , Sun Shengyu , Li Meng , Tang Wenlong , Yan Xiaorong , Wang Wenxiong , Qiu Wenjin , Yao Shun , Ye Zhao , Ma Zengyi , Zhou Xiang , Cao Xiaoyun , Shen Ming , Shou Xuefei , Zhang Zhaoyun , Wu Zhenyu , Chu Liangzhao , Qiu Yongming , Ma Hui , Wu Anhua , Ma Chiyuan , Lou Meiqing , Jiang Changzhen , Wang Yongfei , Zhao Yao
Published: March 2024

Background:

Surgical treatment of complex giant pituitary adenomas (GPAs) presents significant challenges. The efficacy and safety of combining transsphenoidal and transcranial approaches for these tumors remain controversial. In this largest cohort of patients with complex GPAs, we compared the surgical outcomes between those undergoing a combined regimen and a non-combined regimen. We also examined the differences in risks of complications, costs, and logistics between the two groups, which might offer valuable information for the appropriate management of these patients.

Patients and Methods:

This was a multicenter retrospective cohort study conducted at 13 neurosurgical centers. Consecutive patients who received a combined or non-combined regimen for complex GPAs were enrolled. The primary outcome was gross total resection, while secondary outcomes included complications, surgical duration, and relapse. A propensity score-based weighting method was used to account for differences between the groups.

Results:

Out of 647 patients [298 (46.1%) women, mean age: 48.5 ± 14.0 years] with complex GPAs, 91 were in the combined group and 556 were in the noncombined group. Compared with the noncombined regimen, the combined regimen was associated with a higher probability of gross total resection [50.5% vs. 40.6%, odds ratio (OR): 2.18, 95% confidence interval (CI): 1.30–3.63, P = 0.003]. The proportion of patients with life-threatening complications was lower in the combined group than in the non-combined group (4.4% vs. 11.2%, OR: 0.25, 95% CI: 0.08–0.78, P = 0.017). No marked differences were found between the groups in terms of other surgical or endocrine-related complications. However, the combined regimen exhibited a longer average surgery duration of 1.3 h (P < 0.001) and higher surgical costs of 22,000 CNY (~ 3,000 USD, P = 0.022) compared with the noncombined approach.

Conclusions:

The combined regimen offered increased rates of total resection and decreased incidence of life-threatening complications, which might be recommended as the first-line choice for these patients.
Step into the era of large multimodal models: a pilot study on ChatGPT-4V(ision)’s ability to interpret radiological images
Authors: Zhu Lingxuan , Mou Weiming , Lai Yancheng , Chen Jinghong , Lin Shujia , Xu Liling , Lin Junda , Guo Zeji , Yang Tao , Lin Anqi , Qi Chang , Gan Ling , Zhang Jian , Luo Peng
Published: March 2024

Background:

The introduction of ChatGPT-4V’s ‘Chat with images’ feature represents the beginning of the era of large multimodal models (LMMs), which allows ChatGPT to process and answer questions based on uploaded images. This advancement has the potential to transform how surgical teams utilize radiographic data, as radiological interpretation is crucial for surgical planning and postoperative care. However, a comprehensive evaluation of ChatGPT-4V’s capabilities in interpret radiological images and formulating treatment plans remains to be explored.

Patients and methods:

Three types of questions were collected: (1) 87 USMLE-style questions, submitting only the question stems and images without providing options to assess ChatGPT’s diagnostic capability. For questions involving treatment plan formulations, a five-point Likert scale was used to assess ChatGPT’s proposed treatment plan. The 87 questions were then adapted by removing detailed patient history to assess its contribution to diagnosis. The diagnostic performance of ChatGPT-4V was also tested when only medical history was provided. (2) We randomly selected 100 chest radiography from the ChestX-ray8 database to test the ability of ChatGPT-4V to identify abnormal chest radiography. (3) Cases from the ‘Diagnose Please’ section in the Radiology journal were collected to evaluate the performance of ChatGPT-4V in diagnosing complex cases. Three responses were collected for each question.

Results:

ChatGPT-4V achieved a diagnostic accuracy of 77.01% for USMLE-style questions. The average score of ChatGPT-4V’s treatment plans was 3.97 (Interquartile Range: 3.33–4.67). Removing detailed patient history dropped the diagnostic accuracy to 19.54% (P<0.0001). ChatGPT-4V achieved an AUC of 0.768 (95% CI: 0.684–0.851) in detecting abnormalities in chest radiography, but could not specify the exact disease due to the lack of detailed patient history. For cases from ‘Diagnose Please’ ChatGPT provided diagnoses consistent with or very similar to the reference answers.

Conclusion:

ChatGPT-4V demonstrated an impressive ability to combine patient history with radiological images to make diagnoses and directly design treatment plans based on images, suggesting its potential for future application in clinical practice.
Concurrent ascending colon adenocarcinoma and colonic tuberculosis: a case report from Syria
Authors: Ahmad Basel , Durra Suzana , Tayfour Sabine , Habka Sandra , Albatal Bassel , Ahmad Mohamad
Published: March 2024

Introduction and importance:

Tuberculosis (TB) has been one of the most devastating diseases to humanity in recent decades; although pulmonary infection is the most common, infection of any other organ is familiar as well. Colon cancer is another disease affecting the gastrointestinal (GI) system and mostly targets people over 50. Only a few studies mentioned the co-existence of cancer and TB occurring at the same place and time. Hence, the authors report a rare case of concurrent ascending colon adenocarcinoma and colonic TB.

Case presentation:

A 49 -year-old man presented to our clinic with constipation and abdominal pain. Two colonoscopies were performed, and two biopsies were taken; the first one showed granulomatous inflammation consistent with TB, and the second one showed low-grade adenocarcinoma. Computed tomography showed annular thickening of the ascending colon with infiltrates around the lesions. A right hemicolectomy was performed, and the final pathology confirmed adenocarcinoma grade II and extensive TB granulomas involving the colon into the serosa and the lymph nodes. Anti-TB medications were administered after surgery.

Clinical discussion:

Due to appropriate diagnostic methods, TB and cancer were detected at an early stage. In our treatment protocol, no adjuvant chemotherapy was applied after surgery due to the possibility of drug interaction with anti-TB medications.

Conclusion:

The two diseases may co-exist; thus, diagnosing them may not be the easiest, not to mention the lack of a clear treatment protocol in case of their accompany.
Bimaxillary fixed implant-supported zirconium oxide prosthesis therapy of an adolescent patient with non-syndromic oligodontia and two WNT10 variants: a case report
Authors: Grün Pascal , Pfaffeneder-Mantai Florian , Leunig Nikolai , Bytyqi Ditjon , Maier Cornelia , Gencik Martin , Bandura Patrick , Turhani Dritan
Published: March 2024

Introduction and importance:

Oligodontia is a rare genetic condition characterized by more than six congenitally missing teeth, either as an isolated non-syndromic condition or in association with other genetic syndromes. The impact of WNT10A variants on dental development increases with the presence of the c.321C>A variant and the number of missing teeth.

Case presentation:

A 21-year-old man with non-syndromic oligodontia was diagnosed at 15 years of age with misaligned teeth, speech problems, and the absence of 24 permanent teeth. Interdisciplinary collaboration between specialists was initiated to enable comprehensive treatment. DNA analysis confirmed that the patient was a carrier of the known pathogenic WNT10A variant c321C>A and WNT10A variant c.113G>T of unknown clinical significance.

Clinical discussion:

Dental implants are a common treatment; however, bone development challenges in adolescent patients with non-syndromic oligodontia necessitate careful planning to ensure implant success. Many WNT variants play crucial roles in tooth development and are directly involved in non-syndromic oligodontia, especially the WNT10 variant c.321C>A.

Conclusion:

A full-arch implant-supported monolithic zirconia screw-retained fixed prosthesis is a viable treatment option for young adults with non-syndromic oligodontia. Further studies are needed to clarify the possible amplifying effect of the WNT10A variants c321C>A and c.113G>T on the pathogenic phenotype of non-syndromic oligodontia.
Atypical twin-to-twin transfusion syndrome case managed in a single centre in Indonesia with fetoscopic laser photocoagulation and amniopatch: ‘Case Report’
Authors: Aldiansyah Dudy , Halim Binarwan , Lumbanraja Sarma N. , Asroel Edwin M. , Fahdy M. , Hartono Hanudse , Thomson Thomson
Published: March 2024

Introduction and importance:

The diagnostic criteria for Quintero staging in twin-to-twin transfusion syndrome (TTTS) are not applicable in all cases of TTTS, such as those in which the symptoms overlap with other monochorionic twin complications such as selective intrauterine growth restriction (sIUGR).

Case presentation:

A 25-year-old woman, G1P0A0, at 22–24 weeks’ gestational age was diagnosed with TTTS, with no outstanding history of medication use during pregnancy, and no family history of genetic disorder or twin pregnancy. In the donor twin, persistently absent end-diastolic flow in the umbilical artery was observed using Doppler velocimetry. Polyhydramnios was observed in the recipient twins. The fetal weight discordance between the twins was 39%. After 2 weeks of follow-up, the authors performed fetoscopic laser photocoagulation and successfully ablated five vascular anastomoses and amnioreduction by 2.5 l. Five days after the laser surgery, the patient developed amniotic fluid leakage, and an amniopatch was performed. The authors did the caesarean section at 34 weeks because of severe preeclampsia, the donor and recipient birth weights were 1,120 g and 1,837 g, respectively (weight discordance 39%). The APGAR scores were 3/4 and 6/8, respectively. The donor twin died 6 days after delivery due to respiratory failure, and the recipient twin survived. Neonatal echocardiography of the surviving twin showed no tricuspid regurgitation. No long-term follow-up was performed.

Clinical discussion:

The traditional diagnostic criteria for TTTS stage 3 were not met and overlapped with the diagnostic criteria for sIUGR type 2. This is the first procedure reported in Indonesia for atypical TTTS with the outcome, one twin survived.

Conclusion:

Some TTTS cases do not meet traditional diagnostic criteria and overlap with other monochorionic twin complications.
The utilization of three-dimensional imaging and three-dimensional-printed model in autologous microtia reconstruction
Authors: Koento Trimartani , Damara Fachreza Aryo , Reksodiputro Mirta Hediyati , Safitri Eka Dian , Anatriera Raden Ayu , Widodo Dini Widiarni , Dewi Dwi Juliana
Published: March 2024

Background:

The use of three-dimensional (3D) technology helps surgeons in performing autologous microtia reconstruction due to more accurate measurements and a better precision template model. However, the technical aspects of using a 3D imaging and 3D-printed model and the difference in outcomes postoperatively remain poorly reviewed.

Purpose:

This systematic review aimed to provide the current evidence of the benefit and technical aspects of using 3D technology in autologous microtia reconstruction.

Method:

A systematic literature search was conducted across multiple databases: Medline, Embase, Google Scholar, and Central until June 2022. Studies that evaluated the use of 3D imaging or 3D-printed models for autogenous microtia reconstruction were selected. The quality of the included studies was also assessed with respect to the study design.

Result:

A systematic literature search yielded 17 articles with a combination of observational and case report studies. Overall, 3D imaging showed a precise measurement for preoperative costal cartilage assessment. Compared to the 2D template, the utilization of a 3D-printed template provided a higher similarity rate relative to the unaffected ear, higher patient and surgeon satisfaction, and lower surgical time. Most 3D templates were fabricated using polylactic acid material on fused deposition modelling printers. The template costs were ranging from $1 to $4.5 depending on the material used.

Conclusion:

3D imaging and 3D-printed templates could improve the outcome of autologous microtia reconstruction. However, the quality of the existing evidence remains low due to the heterogeneity of the reported outcomes. Further studies with more adequate comparability and defined outcomes are still required.
Leiomyosarcoma of stomach extending to gastroesophageal junction and distal esophagus as a rare cause of dysphagia: a case report
Authors: Rajthala Lilamani , Gyawali Sagar , Banmala Sabin , Shah Surendra
Published: March 2024

Introduction and importance:

Gastric leiomyosarcoma is a rare malignant tumor among the primary gastric carcinomas. Among the different common presentations, dysphagia is an uncommon presentation of gastric leiomyosarcoma.

Case presentation:

A 29-year-old female presented with complaints of progressive dysphagia for 1 year associated with vomiting, significant weight loss, and anorexia for 6 months. On blood investigations, she had anemia, hypokalemia, prerenal acute kidney injury, and unconjugated hyperbilirubinemia. Upper gastrointestinal endoscopy and contrast-enhanced computed tomography (CECT) were initially suggestive of carcinoma of stomach. Immunohistochemistry was diagnostic of leiomyosarcoma of stomach extending to the gastroesophageal junction and distal esophagus. She underwent total gastrectomy with distal esophagectomy with lateral segmentectomy of liver (nonanatomical) with Roux-en-Y esophago-jejunal anastomosis (end-to-side and retro-colic) through thoracoabdominal approach. After 6 weeks, she received four cycles of doxorubicin therapy. Follow-up at 18 months after surgery revealed no recurrence of malignancy.

Clinical discussion:

Leiomyosarcoma, a rare malignant tumor arising from stomach involves commonly gastric body followed by antrum and fundus. Imaging including CECT and tissue diagnosis including immunohistochemistry (positive for α-SMA, desmin, calponin, h-caldesmon, or smoothelin) have been mainstay for definitive diagnosis. The standard treatment for leiomyosarcoma of stomach is complete surgical resection of tumor because it has malignant potential and does not respond to targeted treatment with a tyrosine kinase inhibitor. The type of surgery depends on the size and localization of the tumor.

Conclusions:

Early diagnosis with proper imaging, immunohistochemistry, and biopsy play important role in differentiating gastric leiomyosarcoma from gastrointestinal stromal tumor. Surgical resection is the mainstay of treatment.
The comparison of hot and cold executive functions in patients with bipolar II disorder, borderline personality disorder, and healthy individuals
Authors: Sabbah Ayyub , Mottaghi Shekoofeh , Ghaedi Parviz , Ghalandari Melika
Published: March 2024

Background:

Differential diagnosis of bipolar II disorder (BD-II) and borderline personality disorder (BPD) has always been challenging for clinicians due to symptoms’ overlap. This study aimed to compare hot and cold executive functions (EFs) in BD-II patients, as well as BPD and healthy controls (HCs), in order to differentiate these two disorders.

Methods:

In the present study, 30 BD-II and 30 BPD patients undergoing the drug therapy with mood stabilizers, and 30 HC were examined using EFs evaluated tests. The data were then analyzed using ANOVA and Tukey post hoc test.

Results:

The BD-II Patients performed significantly less in all cold EFs than the HC. Also, BPD patients had meaningfully lesser performance compared to HC in all cold EFs except sustained attention. No significant difference was perceived between the two patient groups in the cold EFs. In BD-II patients, the risky decision-making as a hot EFs’ component was not significantly different from HC; nevertheless, its amount was significantly higher in BPD than in the HC and BD-II patients.

Conclusion:

These findings underline the differences between the two mentioned disorders based on the hot EFs, which may indicate further disorder in the emotional information processing system among the BPD patients.
A comprehensive review of iPS cell line-based disease modelling of the polyglutamine spinocerebellar ataxias 2 and 3: a focus on the research outcomes
Authors: Raghunathan Narasimhan , Sankaran Sathyanarayanan , Miteu Goshen D.
Published: March 2024

Spinocerebellar ataxias (SCAs) are a rare autosomal dominant neurodegenerative disorder. To date, approximately 50 different subtypes of SCAs have been characterized. The prevalent types of SCAs are usually of PolyQ origin, wherein the disease pathology is a consequence of multiple glutamine residues being encoded onto the disease proteins, causing expansions. SCAs 2 and 3 are the most frequently diagnosed subtypes, wherein affected patients exhibit certain characteristic physiological manifestations, such as gait ataxia and dysarthria. Nevertheless, other clinical signs were exclusive to these subtypes. Recently, multiple molecular diagnostic methods have been developed to identify and characterize these subtypes. Despite these advancements, the molecular pathology of SCAs remains unknown. To further understand the mechanisms involved in neurodegenerative SCAs 2 and 3, patient-derived induced pluripotent stem cell (iPSC)-based modelling is a compelling avenue to pursue. We cover the present state of iPSC-based in-vitro illness modelling of SCA subtypes 2 and 3 below, along with a list of cell lines created, and the relevance of research outcomes to personalized autologous therapy.