bluuebunny/crossref_metadata_2025 huggingface dataset:
Gut microbiota and autoimmune diseases: Insights from Mendelian randomization
Authors: Mu Fangxiang , Rusip Gusbakti , Florenly Florenly
Published: September 2024

In recent years, the scientific community has shown interest in the role of gut microbiota in the development of autoimmune diseases (AID). Although observational studies have revealed significant associations between gut microbiota and AID like rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis, these connections do not necessarily imply causality. Mendelian randomization (MR) approach has been extensively employed to investigate the causal relationship. Relevant MR study findings indicate that a reduction in beneficial microbial populations, particularly Bifidobacterium and Lactobacillus, and an increase in potential pathogenic microbes, is correlated with an elevated AID risk. Given the innovative potential of MR in unraveling the etiopathogenesis of AIDs, this article offers an overview of this methodological approach and its recent applications in AID research.
The spinal muscular atrophy gene product regulates actin dynamics
Authors: Schüning Tobias , Zeug Andre , Strienke Katharina , Franz Peter , Tsiavaliaris Georgios , Hensel Niko , Viero Gabriella , Ponimaskin Evgeni , Claus Peter
Published: September 2024

Spinal Muscular Atrophy (SMA) is a neuromuscular disease caused by low levels of the Survival of Motoneuron (SMN) protein. SMN interacts with and regulates the actin‐binding protein profilin2a, thereby influencing actin dynamics. Dysfunctional actin dynamics caused by SMN loss disrupts neurite outgrowth, axonal pathfinding, and formation of functional synapses in neurons. Whether the SMN protein directly interacts with and regulates filamentous (F‐) and monomeric globular (G‐) actin is still elusive. In a quantitative single cell approach, we show that SMN loss leads to dysregulated F‐/G‐actin fractions. Furthermore, quantitative assessment of cell morphology suggests an F‐actin organizational defect. Interestingly, this is mediated by an interaction of SMN with G‐ and F‐actin. In co‐immunoprecipitation, in‐vitro pulldown and co‐localization assays, we elucidated that this interaction is independent of the SMN‐profilin2a interaction. Therefore, we suggest two populations being relevant for functional actin dynamics in healthy neurons: SMN‐profilin2a‐actin and SMN‐actin. Additionally, those two populations may influence each other and therefore regulate binding of SMN to actin. In SMA, we showed a dysregulated co‐localization pattern of SMN‐actin which could only partially rescued by SMN restoration. However, dysregulation of F‐/G‐actin fractions was reduced by SMN restoration. Taken together, our results suggest a novel molecular function of SMN in binding to actin independent from SMN‐profilin2a interaction.
The emerging role of ethanolamine phosphate phospholyase in regulating hepatic phosphatidylethanolamine and plasma lipoprotein metabolism in mice
Authors: A. Elmihi Kholoud , Leonard Kelly‐Ann , Nelson Randy , Thiesen Aducio , Clugston Robin D. , Jacobs René L.
Published: September 2024

Ethanolamine phosphate phospholyase (ETNPPL) is an enzyme that irreversibly degrades phospho‐ethanolamine (p‐ETN), an intermediate in the Kennedy pathway of phosphatidylethanolamine (PE) biosynthesis. PE is the second most abundant phospholipid in mammalian membranes. Disturbance of hepatic phospholipid homeostasis has been linked to the development of metabolic dysfunction‐associated steatotic liver disease (MASLD). We generated whole‐body Etnppl knockout mice to investigate the impact of genetic deletion of Etnppl on hepatic lipid metabolism. Primary hepatocytes isolated from Etnppl−/− mice showed increased conversion of [3H]ethanolamine to [3H]p‐ETN and [3H]PE compared to Etnppl+/+ mice. Male and female Etnppl+/+ and Etnppl−/− mice were fed either a chow or a western‐type diet (WTD). Irrespective of diet, Etnppl−/− mice had elevated fasting levels of total plasma cholesterol, triglyceride (TG) and apolipoprotein B100 (VLDL particles). Interestingly, hepatic TG secretion was unchanged between groups. Although hepatic lipids (phosphatidylcholine (PC), PE, TG, and cholesterol) were not different between mice, RNA sequencing analysis showed downregulation in genes related to cholesterol biosynthesis in Etnppl−/− mice. Furthermore, hepatic low‐density lipoprotein receptor‐related protein1 (LRP1) protein level was lower in female Etnppl−/− mice, which may indicate reduced uptake of remnant VLDL particles from circulation. Hepatic PE levels were only increased in WTD‐fed female Etnppl−/− mice, not chow diet‐fed mice. However, hepatic lipid accumulation and metabolic dysfunction‐associated steatohepatitis (MASH) development were unchanged between Etnppl+/+ and Etnppl−/− mice. To conclude, ETNPPL has a role in regulating plasma lipoprotein metabolism independent of hepatic TG levels.
Ultrasound-guided Superficial Cervical Plexus Blocks for Persistent Pain after Suboccipital Craniotomies: A Randomized Trial
Authors: Zeng Min , Zheng Maoyao , Ren Yue , Yin Xueke , Li Shu , Zhao Yan , Wang Dexiang , Zhang Liyong , Guan Xiudong , Li Deling , Sessler Daniel I. , Peng Yuming
Published: September 2024

Background:

The efficacy of superficial cervical plexus blocks for reducing persistent pain after craniotomies remains unclear. The authors tested the primary hypothesis that preoperative ultrasound-guided superficial cervical plexus blocks reduce persistent pain 3 months after suboccipital craniotomies.

Methods:

A single-center randomized and blinded parallel-group trial was conducted. Eligible patients having suboccipital craniotomies were randomly allocated to superficial cervical plexus blocks with 10 ml 0.5% ropivacaine or a comparable amount of normal saline. Injections were into the superficial layer of prevertebral fascia. The primary outcome was the incidence of persistent pain three months after surgery.

Results:

From November 2021 to August 2023, a total of 292 qualifying patients were randomly allocated to blocks with ropivacaine (n = 146) or saline (n = 146). The average ± SD age of participating patients was 45 ± 12 yr, and the duration of surgery was 4.2 ± 1.3 h. Persistent pain 3 months after surgery was reported by 48 (34%) of patients randomized to ropivacaine versus 73 (51%) in those assigned to saline (relative risk, 0.66; 95% CI, 0.50 to 0.88; P = 0.003) in the per-protocol population, and by 53 (36%) of patients randomized to ropivacaine versus 77 (53%) in those assigned to saline (relative risk, 0.69; 95% CI, 0.53 to 0.90; P = 0.005) in the intention-to-treat population.

Conclusions:

Superficial cervical plexus blocks reduce the incidence of persistent incisional pain by about a third in patients recovering from suboccipital craniotomies.
Computer Vision Identification of Trachomatous Inflammation-Follicular Using Deep Learning
Authors: Joye Ashlin S. , Firlie Marissa G. , Wittberg Dionna M. , Aragie Solomon , Nash Scott D. , Tadesse Zerihun , Dagnew Adane , Hailu Dagnachew , Admassu Fisseha , Wondimteka Bilen , Getachew Habib , Kabtu Endale , Beyecha Social , Shibiru Meskerem , Getnet Banchalem , Birhanu Tibebe , Abdu Seid , Tekew Solomon , Lietman Thomas M. , Keenan Jeremy D. , Redd Travis K.
Published: September 2024

Purpose:

Trachoma surveys are used to estimate the prevalence of trachomatous inflammation-follicular (TF) to guide mass antibiotic distribution. These surveys currently rely on human graders, introducing a significant resource burden and potential for human error. This study describes the development and evaluation of machine learning models intended to reduce cost and improve reliability of these surveys.

Methods:

Fifty-six thousand seven hundred twenty-five everted eyelid photographs were obtained from 11,358 children of age 0 to 9 years in a single trachoma-endemic region of Ethiopia over a 3-year period. Expert graders reviewed all images from each examination to determine the estimated number of tarsal conjunctival follicles and the degree of trachomatous inflammation-intense. The median estimate of the 3 grader groups was used as the ground truth to train a MobileNetV3 large deep convolutional neural network to detect cases with TF.

Results:

The classification model predicted a TF prevalence of 32%, which was not significantly different from the human consensus estimate (30%; 95% confidence interval of difference, −2 to +4%). The model had an area under the receiver operating characteristic curve of 0.943, F1 score of 0.923, 88% accuracy, 83% sensitivity, and 91% specificity. The area under the receiver operating characteristic curve increased to 0.995 when interpreting nonborderline cases of TF.

Conclusions:

Deep convolutional neural network models performed well at classifying TF and detecting the number of follicles evident in conjunctival photographs. Implementation of similar models may enable accurate, efficient, large-scale trachoma screening. Further validation in diverse populations with varying TF prevalence is needed before implementation at scale.
The pivotal role of head and neck surgeons in advancing thyroid ablation practices
Authors: Huang Tzu-Yen , Yang Tsung-Lin
Published: September 2024

Thyroid ablation techniques are becoming increasingly popular across various specialties, leading to significant advancements in the treatment of thyroid and head and neck diseases. Head and neck surgeons (HNS) play a pivotal role in advancing thyroid ablation practices due to several key advantages: their detailed understanding of the thyroid and head and neck anatomy, extensive experience with ultrasound and ultrasound-guided interventions, ability to manage post-ablation conditions, capability to perform surgeries if necessary, and expertise in voice assessment, rehabilitation, and management. In this narrative review, we combine a comprehensive literature review with our own decade-long experience in promoting thyroid ablation to demonstrate that HNS are essential in advancing these techniques, ensuring safety, and improving patient quality of life.
Incidence and risk factors for chronic rejection in pediatric liver transplantation
Authors: Dike Peace N. , Schady Deborah , Himes Ryan , Goss John A. , Guffey Danielle , Cerminara Dana , Mysore Krupa R.
Published: September 2024

Chronic rejection (CR) is a progressive immunological injury that frequently leads to long-term liver allograft dysfunction and loss. Although CR remains an important indication for retransplantation, as transplant immunosuppression has evolved, its prevalence in adults undergoing liver transplantation (LT) has declined. However, the incidence and factors that lead to CR in pediatric LT are poorly defined. Therefore, we sought to systematically measure CR’s incidence and assess both the risk factors for developing CR and outcomes in a large cohort of pediatric recipients of LT. In this single-center study, we retrospectively analyzed and compared relevant recipient characteristics, surgical details, immunosuppression, graft, and patient survival in the CR and control groups over a 17-year period. After a median time of 1.9 years after LT, 19/356 recipients of LT (5.3%) developed CR in our cohort. Posttransplant lymphoproliferative disorder (p = 0.01), infections (p = 0.02), autoimmune liver diseases (HR = 7.3, p = <0.01), Black race (HR = 11.5, p = 0.01), and 2 or more episodes of T cell mediated rejection (HR = 5.1, p = <0.01) were associated with CR development. The retransplantation rate among CR cases was 15.8% at a median follow-up time of 4.1 years. Overall, patient survival was lower in the CR group (78.9%) versus controls (91.1%). While CR incidence in our pediatric cohort was lower than previously reported rates of >12%, the CR group had a higher graft failure rate that required retransplantation and lower overall patient survival. Thus, identifying risk factors may warrant specialized immunosuppression protocols and closer posttransplantation monitoring to reduce the risk of morbidity and mortality from CR.
Core outcome sets and benchmarking complications: Defining best practices for standardized outcome reporting in liver transplantation
Authors: Wehrle Chase J. , de Goeij Femke H.C. , Zhang Mingyi , Abbassi Fariba , Satish Sangeeta , Jiao Chunbao , Sun Keyue , Pinna Antonio D. , Hashimoto Koji , Miller Charles , Polak Wojciech G. , Clavien Pierre-Alain , De Jonge Jeroen , Schlegel Andrea
Published: September 2024

The comparison of outcomes in liver transplantation (LT) is hampered by using clinically nonrelevant surrogate endpoints and considerable variability in reported relevant posttransplant outcomes. Such variability stems from nonstandard outcome measures across studies, variable definitions of the same complication, and different timing of reporting. The Clavien-Dindo classification was established to improve the rigor of outcome reporting but is nonspecific to an intervention, and there are unsolved dilemmas specifically related to LT. Core outcome sets (COSs) have been used in other specialties to standardize outcomes research, but have not been defined for LT. Thus, we use the 5 major benchmarking studies published to date to define a 10-measure COS for LT using previously validated metrics. We further provide standard definitions for each of the 10 measures that may be used in international research on the topic. These definitions also include standard time points for recording to facilitate between-study comparisons and future meta-analysis. These 10 outcomes are paired with 3 validated, procedure-independent metrics, including the Clavien-Dindo Classification and the Comprehensive Complications Index. The Clavien scale and Comprehensive Complications Index are specifically reviewed to enhance their utility in LT, and their use, along with the COS, is explored. We encourage future studies to employ this COS along with the Clavien-Dindo grading system and Comprehensive Complications Index to improve the reproducibility and generalizability of research concerning LT.
Esophageal Expert Development of a Preliminary Question Prompt List for Adults With Eosinophilic Esophagitis: A Modified Delphi Study
Authors: Achalu Sudharshan , Berry Rani , Joseph Abel , Bhargava Meera , Fernandez-Becker Nielsen Q. , Bredenoord Albert J. , Chang Joy , Dellon Evan , Falk Gary , Hirano Ikuo , Horsley-Silva Jennifer , Leiman David A. , Lynch Kristle L. , Peterson Kathryn , Kamal Afrin N.
Published: September 2024

Background:

Question prompt lists (QPLs) are structured sets of disease-specific questions intended to encourage question-asking by patients and enhance patient-physician communication. To date, an EoE-specific QPL has not been developed for EoE patients.

Aim:

To develop a preliminary QPL specific to adults with EoE by incorporating input from international esophageal experts.

Methods:

Sixteen experts were invited to generate QPL content through a modified Delphi (RAND/University of California, Los Angeles, CA) method consisting of 2 rounds of independent ratings. In round 1, experts provided 5 answers to the prompts “what general questions should patients ask when being seen for EoE?” and “what questions do I not hear patients asking but given my experience, I believe they should be asking?” In round 2, experts rated each question on a 5-point Likert scale, and responses rated as “essential” or “important” (determined by an a priori median threshold of ≥ 4.0) were accepted for the EoE QPL.

Results:

Ten esophageal experts participated in both rounds. Round 1 generated 100 questions. Questions were combined and modified to reduce redundancy, yielding 57 questions. After round 2, 51 questions (85%) were accepted for inclusion (median value ≥ 4.0) in the final QPL. Questions were then divided into 4 themes based on disease domains: (1) “What is EoE?,” (2) “Treatment Options,” (3) “Follow-up Surveillance and Long-term Risks,” and (4) “Allergy and Genetic Testing.” The largest number of questions covered was “What is EoE?” (16/51 or 31%). Questions with the highest agreement median (5.0) included examples such as “what should I do if I get a food impaction?” and “what are the treatment options?”

Conclusion:

This is the first preliminary EoE QPL developed in the field of medicine. We hope implementation enhances effective patient-physician communication by encouraging patients to ask relevant questions that experts prioritized. Future studies will aim to modify this communication tool by incorporating patient perspectives
Association of MORC2 expression with progression-free survival in cervical cancer patients treated with concurrent chemoradiotherapy
Authors: He Jing , Liao Xiao-Hong , Zhong Bing-Di , Liu An-Wen
Published: September 2024

MORC family CW-type zinc finger 2 (MORC2) is a newly identified chromatin remodeling protein, and has been proposed as a prognostic biomarker associated with survival in some types of human cancer, but the role of MORC2 in cervical cancer remains unknown. Here, we investigated the role of MORC2 expression in predicting the survival outcomes of locally advanced cervical cancer patients treated with cisplatin-based concurrent chemoradiotherapy (CCRT). In this retrospectively study, we detected MORC2 immunohistochemical expression on 55 biopsies from patients who underwent CCRT. The association between the MORC2 expression and various clinicopathological characteristics were analyzed, as were association between MORC2 expression and locoregional failure and progression-free survival (PFS) of cervical cancer patients. MORC2 expression was positively associated with pelvic node metastasis and locoregional failure. Higher MORC2 expression was a significant indicator of worse PFS. Our results suggest that MORC2 expression may be a prognostic indicator in patients with locally advanced cervical cancer undergoing CCRT.
A retrospective comparative case series of efficacy and safety of radiofrequency thermocoagulation versus drug therapy in patients with trigeminal neuralgia: A clinical case report
Authors: Fu Jing , Nie Zhiqiang , Zhang Yanfeng , Tang Min , Guo Jianguo
Published: September 2024

Background:

The trigeminal neuralgia (TN) is characterized by a unilateral, episodic, electric shock-like pain in the distribution of the trigeminal nerve. Both drug therapy and radiofrequency thermocoagulation (RT) are used to treat TN.

Objective:

To compare the efficacy and safety of RT and drug therapy in patients with TN.

Methods:

Between October 2020 and December 2022, 62 patients with TN were allocated to undergo TN treatment (group A) or drug therapy (group B). In group A, 30 patients received RT treatment, whereas 32 patients in group B receive drug treatment. Pain relief, clinical outcomes, and adverse events in both groups were evaluated.

Results:

And significantly greater reduction in Visual Analogue Scale scores was noted in group A than in group B in the initial 2-week period (P < .05). The excellent rate was 93.3% (28/30) in group A, whereas it was 68.8% (22/32) in group B during the initial 2-week period (P < .05). A total of 62 patients were followed up at least 12 months, with a mean follow-up time of 14.5 months. But there were no statistically significant differences between the 2 groups at the final follow-up. A total of 24 patients had facial numbness in group A. In contrast, ten patients in group B complained of discomfort including sedation, dizziness, nausea, vomiting. During the follow-up period, 4 patients in group A and 6 patients in group B experienced recurrent pain.

Conclusion:

RT is a safety and effective treatment for patients with classic TN, providing more benefits of quicker pain relief and higher patient’s satisfaction, compared with traditional drug therapy.
Construction and validation of a nomogram for predicting cancer-specific survival in middle-aged patients with advanced hepatocellular carcinoma: A SEER-based study
Authors: Li Ziqiang , Hong Qingyong , Guo Zhidong , Liu Xiaohong , Tan Chengpeng , Feng Zhe , Li Kun
Published: September 2024

Hepatocellular carcinoma is the predominant form of primary liver cancer and is the leading cause of cancer-related death. The aim of this study was to construct a nomogram to predict cancer-specific survival (CSS) in middle-aged patients with advanced hepatocellular carcinoma. Clinical data were downloaded from the Surveillance, Epidemiology and End Results (SEER) database for middle-aged patients diagnosed with advanced hepatocellular carcinoma (AJCC stage III and IV) from 2000 to 2019. The patients were randomized in a 7:3 ratio into training cohort and validation cohort. Univariate and multivariate Cox regression analyses were performed in the training cohort to screen for independent risk factors associated with cancer-specific survival for the construction of nomogram. The nomogram was examined and evaluated using the consistency index (C-index), area under the curve (AUC), and calibration plots. The clinical application value of the model was evaluated using decision curve analysis (DCA). A total of 3026 patients were selected, including 2244 in the training cohort and 962 in the validation cohort. Multivariate analysis revealed gender, marital status, American Joint Committee on Cancer (AJCC) stage, tumor size, bone metastasis, lung metastasis, alpha-fetoprotein (AFP) level, surgery, radiotherapy, chemotherapy as independent risk factors, which were all included in the construction of the nomogram. In the training cohort, the AUC values were 0.74 (95% CI: 0.76–0.72), 0.78 (95% CI: 0.82–0.75), and 0.82 (95% CI: 0.86–0.78) at 1-, 3-, and 5-year CSS, respectively. The calibration plots showed good consistency between the actual and predicted values. The DCA curves indicated that the nomogram model could more accurately predict CSS at 1-, 3-, and 5-year in middle-aged patients with advanced hepatocellular carcinoma compared with the AJCC staging system. Highly similar results to the training cohort were also observed in the validation cohort. In the risk stratification system, good differentiation was shown between the 2 groups, and Kaplan–Meier survival analysis indicated that surgery could prolong patient survival. In this study, we developed a nomogram and risk stratification system for predicting CSS in middle-aged patients with advanced hepatocellular carcinoma. The prediction model has good predictive performance and can help clinicians in judging prognosis and clinical decision making.
Comparative analysis of the immune repertoire between peripheral blood and bone marrow fluids in those infected by EBV and immunodeficiency: A retrospective case study
Authors: Yue Mei , Li Juanjuan , Li Junhui , Hu Tao , Feng Shunqiao , Cao Jing , Tang Ruihong , Wang Pengpeng , Zhu Fengjiao , Han Lu , Wu Jian , Cui Xiaodai , Liu Rong
Published: September 2024

High-throughput immune repertoire (IR) sequencing provides direct insight into the diversity of B cell receptor (BCR) and T cell receptor (TCR), with great potential to revolutionize the diagnosis, monitoring, and prevention of immune system–related disorders. In this study, multiplex PCR was applied to amplify the complementarity-determining regions of BCR and TCR, followed by comprehensive analysis by high-throughput sequencing. We compare the TCR (BCR) of bone marrow fluid (BMF) and peripheral blood (PB) samples from 17 patients in the Epstein-Barr and immunodeficiency groups, respectively. Our study shows that the diversity of the IR of blood samples is very similar to that of bone marrow samples statistically. However, the distributions of the monoclonal genes are significantly different in these 2 samples of most patients. This suggests that the BMFs can be replaced by the PB samples in diversity detection of IR to monitor the immune status of the body, while the detection of the BMFs is unreplaceable when the monoclonal change occurs. We used high-throughput sequencing to assess the TCR and BCR of the patients and provide a basis for the clinical analysis of PB and bone marrow samples and selection of disease diagnosis and monitoring methods.
An observational study on the modulation of anxiety, depression, and adverse event incidence in painless colonoscopy patients through venous access nursing
Authors: Zhu Linzhen , Zhu Linlin , Jin Chengfeng
Published: September 2024

To investigate the clinical significance of venous access nursing in modulating anxiety, depression, and adverse event incidence among patients undergoing painless colonoscopy. Sixty patients who underwent painless colonoscopy in our hospital from September 2021 to September 2022 were selected as the control group (CG, receiving routine perioperative nursing). Sixty patients who underwent painless colonoscopy in our hospital from October 2022 to August 2023 were taken as the study group (SG, receiving venous access nursing modulation). After nursing, patients in the SG exhibited lower scores of the Self-Rating Anxiety Scale and the Self-Rating Depression Scale than those in the CG (P < .05). The SG showed significantly lower mean Ottawa Bowel Preparation Score, but exhibited higher adequacy of bowel preparation compared with the CG (P < .05). The colonoscopy insertion time was (7.18 ± 1.02) minutes in the SG and (8.69 ± 1.00) minutes in the CG, and the colonoscopy withdrawal time was (4.66 ± 1.66) minutes in the SG and (5.64 ± 1.06) minutes in the CG, which showed statistically significant differences between the 2 groups (P < .05). The total incidence of adverse events did not have statistical significance between the 2 groups (P > .05). Application of venous access nursing in patients undergoing painless colonoscopy may help alleviate adverse emotions and shorten colonoscopy insertion time and colonoscopy withdrawal time, thus warranting recognition for its safety and efficacy.
Dose–response of epidural ropivacaine with 0.4 μg mL‐1 of dexmedetomidine for labor analgesia: A prospective double-blinded study
Authors: Yin Jun , Cao Shen , Lei Jie , Wang Xiao-Yan , You Jing-Ping , Xu Ding-Chao , Chen Xin-De , Xu Wen-Ping
Published: September 2024

Background:

Studies have shown that the ideal dose of epidural dexmedetomidine is 0.4 μg mL‐1 for epidural labor analgesia. However, the appropriate dose of ropivacaine when combined with 0.4 μg mL-1 of dexmedetomidine for epidural labor analgesia is still unknown. Therefore, we aimed to determine the dose–response of ropivacaine when using 0.4 μg mL-1 of dexmedetomidine as epidural adjuvant for labor analgesia.

Methods:

One hundred of nulliparous singleton pregnant patients were randomized allocated into 1 of 5 groups with epidural ropivacaine concentration of 0.05%, 0.0625%, 0.075%, 0.0875%, and 0.1%. Labor analgesia was initialed with 12 mL of the mixed study solution. Effective analgesia was defined as a visual analogue scale <10 mm 30 minutes after the initial epidural bolus. The EC50 and EC95 for epidural ropivacaine was calculated by probit regression.

Results:

Ninety-three of parturients were involved into the final analysis. Totals of 63.2% (12/19), 73.7% (14/19), 88.9% (16/18), 94.7% (18/19), and 100% (18/18) of parturients in group 0.05, 0.0625, 0.075, 0.0875, and 0.1 received effective epidural labor analgesia. The calculated EC50 and EC95 of epidural ropivacaine were 0.046% (95% CI 0.028–0.054%) and 0.086% (95% CI 0.074–0.137%), respectively.

Conclusions:

Under the condition of the study, a bolus of 12 mL ropivacaine 0.086% and dexmedetomidine 0.4 μg mL‐1 could afford 95% of nulliparous singleton pregnant patients without suffering labor pain after a test dose of lidocaine 45 mg.
The effect of percutaneous and transcutaneous BAHA on hearing and subjective auditory abilities: A comparative study
Authors: Mungan Durankaya Serpil , Olgun Yüksel , Kiremitçi Ilayda , Evin Eskicioğlu Hande , Güneri Enis Alpin , Kirazli Gülce , Gürkan Selhan , Erdağ Taner Kemal , Kirkim Gunay
Published: September 2024

Hearing loss significantly affects communication, social interactions, and the overall quality of life. The bone-anchored hearing aid (BAHA) is an implantable system that bypasses the outer and middle ear to directly stimulate the cochlea through bone conduction. This study aimed to compare hearing performance and subjective auditory ability improvements between transcutaneous and percutaneous BAHA devices using audiological assessments and Speech, Spatial and Qualities of Hearing Scale.

This cross-sectional prospective study included 29 participants aged 14 to 69 years who had used BAHA for at least 6 months. Both Cochlear Baha System’s percutaneous (connect) and transcutaneous (attract) implants were evaluated. Audiological assessments involved pure-tone audiometry, speech recognition threshold, and free-field (FF) audiometry, while subjective auditory ability was measured using the Turkish Speech, Spatial and Qualities of Hearing scale (Tr-SSQ).

Significant improvements in FF audiometry averages and speech recognition thresholds were observed with BAHA compared to without BAHA (P < .001). Both implant types provided similar FF averages, speech audiometry results, and Tr-SSQ outcomes, with no significant differences between them. Tr-SSQ scores showed substantial satisfaction, indicating significant improvements in speech perception, spatial perception, and hearing quality with BAHA (P < .001).

The findings align with previous research, demonstrating that BAHA is a reliable and effective solution for hearing rehabilitation. The study also emphasized the importance of using both audiological test results and daily hearing function scales to comprehensively evaluate the benefits of hearing rehabilitation in real-world environments. In conclusion, BAHA, regardless of the implant type, can provide predictable and lasting improvements in hearing thresholds and daily hearing abilities, making it a valuable option for patients with conductive hearing loss.
A cross-sectional study of the association between blood cadmium and mortality among adults with myocardial infarction
Authors: Li Ren-jie , Wen Ying-xu
Published: September 2024

Cadmium (Cd) plays a key role in the occurrence of myocardial infarction (MI). We aimed to explore the association between blood Cd levels and all-cause mortality of MI on the basis of the National Health and Nutrition Examination Survey databases. This study included 800 adults with MI to obtain blood Cd concentrations and their follow-up information. The association between Cd concentrations and mortality was analyzed using Cox regression, restricted cubic spline (RCS) models, mediation analysis, receiver operating characteristic curve, and Kaplan–Meier curves. All the patients were divided into 4 groups according to the quartiles of blood Cd levels (Q1, Q2, Q3, and Q4). Cox regression analysis with adjustment for covariates indicated that Cd was the promoting factor of mortality, and patients with higher Cd had a higher death risk. The RCS model indicated an “inverted checkmark” shaped correlation between Cd levels and mortality, and a turning point of 1.06 μg/L was found. A significant positive correlation was observed on the left of the turning point. Grouped patients by turning point into 2 groups, Kaplan–Meier analysis showed that the low-concentration group had a lower death risk than the high-concentration group. Subgroup analysis revealed that the prognostic effect of Cd was more pronounced in patients with former smoking history, and receiver operating characteristic curve showed that blood Cd had a better-predicting function in patients with MI. Blood Cd levels were significantly related to all-cause mortality in patients with MI, especially in patients with Cd < 1.06 μg/L.
A rare case report of endobronchial neurofibroma treated with transbronchial endoscopic resection and literature review
Authors: Chen Xing , Yu Shanlu , Sun Jian , Chen Yefeng , Zhang Chunyi , Wang Hua , Xiang Min , Liu Shuying
Published: September 2024

Rationale:

Endobronchial neurofibroma is an extremely rare neoplastic disease. The majority of endobronchial neurofibroma are symptomatic, but nonspecific. The treatment of endobronchial neurofibroma is controversial that surgery is previously considered to be the main option. With the development of bronchoscopic intervention, most endobronchial neurofibroma can be treated with transbronchial endoscopic resection with few complications. Here we reported a case of diagnosed endobronchial neurofibroma that was successfully resected with transbronchial electrical snaring and laser coagulation. Moreover, the relevant literature was reviewed to raise awareness of this disease.

Patient concerns:

A 57-year-old man presented to our hospital with cough, sputum, and shortness of breath for 2 days. Physical examination was normal. Laboratory tests revealed moderately increased C-reactive protein. Chest computed tomography showed a 10 × 8 mm round, polypoid-shaped nodule located in the left main bronchus, which was heterogeneous after contrast enhancement. It demonstrated a smooth, round, hypervascularized neoplasma obstructing most of the lumen of the upper left main bronchus under bronchoscopy.

Interventions and outcomes:

The tumor was removed with electrical snaring and laser coagulation completely instead of surgical resection, without any complications. Pathologically, it was confirmed of endobronchial neurofibroma. Repeated bronchoscopy showed no recurrence of the tumor, and the procedure site healed with a little of fibrotic scar formation.

Lessons:

Endobronchial neurofibroma is rare. Although the standard treatment for endobronchial neurofibroma is surgery, transbronchial endoscopic resection (electrical snaring and laser coagulation) is an applicable option, especially for those lesions strictly in the lumen.
Evaluating the prognostic performance of the novel ERAP score in Vietnamese acute pancreatitis patients
Authors: Phan Nhan Trung , Vo Dung My Thi , Huynh Tien Manh , Ho Phat Tan , Phuoc Ma Nguyen , Vo Thong Duy
Published: September 2024

Early recognition of severe acute pancreatitis (AP) is crucial for timely intervention. This study aims to evaluate the prognostic accuracy of the Emergency Room Assessment of AP (ERAP) score and compare it with the Bedside Index for Severity in AP (BISAP) score in predicting severe AP, mortality, and persistent multiple organ failure (MOF) in Vietnamese patients. This prospective cohort study included AP patients admitted to Cho Ray Hospital between August 2021 and May 2022. Patient data, including demographics, clinical presentations, and laboratory results, were collected upon admission. The ERAP and BISAP scores were calculated from these admission data. The prognostic accuracy for severe AP, mortality, and persistent MOF was assessed via the area under the receiver-operating characteristic curve (AUC). Among 167 AP patients (mean age 41.5 ± 12.0 years), hypertriglyceridemia (34.7%) and alcohol (22.2%) were the most prevalent etiologies. Severe AP accounted for 33.5% of the patients. Mortality rates were higher in persistent MOF patients (42.9%) than in persistent single-organ failure patients (3.6%), with a P value <.001. The ERAP score had AUCs for predicting severe AP, mortality, and persistent MOF of 0.899, 0.817, and 0.867, respectively, with an optimal cutoff of ≥2. The ERAP score had a better prognostic value than the BISAP score in predicting severe AP (AUC: 0.899 vs 0.820; P = .0072) and persistent MOF (AUC: 0.867 vs 0.785; P = .0193) but had a similar prognostic value for mortality (AUC: 0.817 vs 0.728; P = .0628). The ERAP score has strong predictive value for severe AP and persistent MOF, surpassing the BISAP score in these categories while maintaining similar accuracy for mortality prediction in the Vietnamese population. The ERAP score can be a valuable tool for the early identification of high-risk AP patients, enabling timely and appropriate clinical interventions.
Dissecting causal relationships between gut microbiome, immune cells, and brain injury: A Mendelian randomization study
Authors: Xian Lina , Xu Xiaochen , Mai Yongmeng , Guo Tongwu , Chen Zhen , Deng Xiaoyan
Published: September 2024

Increasing literature has affirmed that changes in the gut microbiome (GM) composition were linked to distinct brain injury (BI) through the gut–brain axis, but it is uncertain if such links reflect causality. Further, the immune cell changes mediating the impact of GM on BI are not completely understood. We made use of the summary statistics of 211 GM (MiBioGen consortium), 731 immune cells, and 2 different BIs (FinnGen consortium), namely traumatic BI (TBI) and focal BI (FBI), from the extensive genome-wide association studies to date. We executed bidirectional Mendelian randomization (MR) analyses to ascertain the causal relationships between the GM and BI, and 2-step MR to validate possible mediating immune cells. Additionally, thorough sensitivity analyses verified the heterogeneity, robustness, as well as horizontal pleiotropy of the results. Based on the results of inverse-variance weighted (IVW) and sensitivity analyses, in MR analyses, 5 specific GM taxa and 6 specific GM taxa were causally associated with FBI and TBI, respectively; 27 immunophenotypes and 39 immunophenotypes were causally associated with FBI and TBI, respectively. Remarkably, Anaerofilum, LachnospiraceaeNC2004group, RuminococcaceaeUCG004, CCR2 on myeloid dendritic cell (DC), CD123 on CD62L+ plasmacytoid DC, and CD123 on plasmacytoid DC were causally associated with TBI and FBI (all P < .040). However, our reverse MR did not indicate any influence of TBI and FBI on the specific GM. In mediation analysis, we found that the associations between Escherichia.Shigella and FBI were mediated by CD123 on CD62L + plasmacytoid DC in addition to CD123 on plasmacytoid DC, each accounting for 4.21% and 4.21%; the association between FamilyXIIIAD3011group and TBI was mediated by CCR2 on myeloid DC, with mediated proportions of 5.07%. No remarkable horizontal pleiotropy or heterogeneity of instrumental variables was detected. Our comprehensive MR analysis first provides insight into potential causal links between several specific GM taxa with FBI/TBI. Additionally, CD123 on plasmacytoid DC in conjunction with CCR2 on myeloid DC may function in gut microbiota-host crosstalk in FBI and TBI, correspondingly. Further studies are critical to unravel the underlying mechanisms of the links between GM and BI.
Noble element coatings on endotracheal tubes for ventilator-associated pneumonia prevention: A systematic review and meta-analysis of randomized controlled trials in emergency care settings
Authors: Ashiq Nabeel , Munir Fouzia , Khan Safeer , Yousaf Adil , Mahmood Malik Hassan
Published: September 2024

Background:

Ventilator-associated pneumonia (VAP) is the second most prevalent nosocomial infection in emergency care settings. An emerging strategy to reduce this risk involves coating endotracheal tubes (ETTs) with noble elements, leveraging the antimicrobial properties of elements such as silver, gold, and palladium. This systematic review and meta-analysis aimed to evaluate the effectiveness of noble element coatings on ETTs in reducing VAP incidence rates, mortality, duration of mechanical ventilation, and length of stay in the intensive care unit (ICU).

Methods:

Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search was conducted across 5 databases up to 2024. The quality of the randomized controlled trials was assessed using the updated Cochrane Risk of Bias (RoB) 2 tool. A random-effects meta-analysis was performed using RevMan 5.4 Comprehensive Meta-Analysis software. Statistical heterogeneity among the studies was evaluated using the Higgins I2 value, with P < .05 indicating statistical significance.

Results:

Seven randomized controlled trials from 5 countries were identified. Four studies had some concerns regarding bias, 2 had a high RoB, and 1 had a low RoB. Noble metal–coated ETTs resulted in a lower incidence of VAP compared to noncoated ETTs (relative risk, 0.76 [95% confidence interval [CI], 0.60–0.96]). However, there was no significant difference in mortality rates (relative risk, 1.06 [95% CI, 0.93–1.20]), duration of mechanical ventilation (mean difference, −0.10 [95% CI, −1.62 to 1.41]), and ICU stay (mean difference, 0.07 [95% CI, −1.98 to 2.12]).

Conclusion:

Noble metal–coated ETTs effectively reduce the incidence of VAP but do not significantly impact mortality rates, the duration of mechanical ventilation, or ICU stay. Therefore, these coated ETTs should be integrated into a holistic care plan addressing all aspects of patient management in emergency care settings.
A review on antitumor effect of pachymic acid
Authors: Xiao Yubo , Hu Zhaotun , Liu Hang , Jiang Xinglin , Zhou Taimei , Wang Haiying , Long Heng , Li Ming
Published: September 2024

Poria cocos, also known as Jade Ling and Songbai taro, is a dry fungus core for Wolfiporia cocos, which is parasitic on the roots of pine trees. The ancients called it “medicine of four seasons” because of its extensive effect and ability to be combined with many medicines. Pachymic acid (PA) is one of the main biological compounds of Poria cocos. Research has shown that PA has various pharmacological properties, including anti-inflammatory and antioxidant. PA has recently attracted much attention due to its anticancer properties. Researchers have found that PA showed anticancer activity by regulating apoptosis and the cell cycle in vitro and in vivo. Using PA with anticancer drugs, radiotherapy, and biomaterials could also improve the sensitivity of cancer cells and delay the progression of cancer. The purpose of this review was to summarize the anticancer mechanism of PA by referencing the published documents. A review of the collected data indicated that PA had the potential to be developed into an effective anticancer agent.
Prevalence of nephropathy among diabetic patients in North American region: A systematic review and meta-analysis
Authors: Zahra Sabahat , Saleem Muhammad Khurram , Ejaz Khawaja Faizan , Akbar Amna , Jadoon Sarosh Khan , Hussain Shoukat , Ali Amir Iqbal , Ifty Mehzabeen , Jannati Sadia Zafur , Armin Fariza , Sarker Deepannita , Islam Dewan Zubaer , Khandker Shahad Saif , Khan Mohammad Saleem , Alvi Sarosh
Published: September 2024

Background:

Nephropathy is one of the most common microvascular impediments of diabetes mellitus. In this study, we aimed to estimate the prevalence of nephropathy in diabetic patients across the North American region.

Methods:

Eligible studies were screened out from 3 electronic databases, for example, PubMed, Google Scholar, and ScienceDirect using specific search keywords based on the eligibility criteria. Extracting the data from the included studies publication bias, quality assessment, outlier investigation, and meta-analysis was done followed by the subgroup analysis. A total of 11 studies met the study inclusion criteria. Meta-analysis was performed with the extracted data.

Results:

Pooled prevalence of 28.2% (95% confidence interval [CI]: 19.7–36.7) with a high rate of heterogeneity (I
2 = 100%) was identified. The pooled prevalence of nephropathy among diabetic patients in the United States of America, Canada, and Mexico was 24.2% (95% CI: 13.8–34.5), 31.2% (95% CI: 25.8–36.5), and 31.1% (95% CI: 20.8–41.5), respectively.

Conclusion:

The prevalence of nephropathy among diabetic patients was found lower in the United States of America as compared to Canada and Mexico. Besides, the pooled prevalence of the North American region was found to be lower as compared to the African, European, and Asian regions. Minimizing the pathogenic factors, sufficient diagnostic, healthcare facilities, and awareness are recommended to improve the situation.
Primary osseous leiomyosarcoma of humerus misinterpreted as aneurysmal bone cyst: A case report and literature review
Authors: Cho Yong Jin , Koh Young Kwon , Lim Sung-Chul
Published: September 2024

Rationale:

Primary leiomyosarcoma of the bone (LMSB) is a rare aggressive sarcoma with limited treatment options. Histopathologic and immunohistochemical features are similar to their more common uterine and soft tissue counterparts. However, its broader spectrum of histopathologic features and rarity make diagnostic challenges.

Patient concerns:

We present a case of LMSB in a 20-year-old female who presented with left shoulder aching pain for 3 months. An osteolytic intramedullary lesion was found in the left proximal humeral epi-metaphysis.

Diagnoses:

Initial open biopsy showed a giant cell tumor of bone with aneurysmal bone cyst (ABC)-like changes. However, an open biopsy followed by extended curettage showed LMSB with ABC-like changes.

Interventions:

Wide excision of the lesion and bipolar hemiarthroplasty followed by concomitant chemoradiation therapy was conducted. The mass was completely removed without significant problems.

Outcomes:

Complete mass excision and symptomatic improvements were achieved, and no subsequent relapses were observed.

Lessons:

The authors encountered a rare case of LMSB. Most occurrences are in the lower extremity and trunk, respectively. ABC-like changes in bone tumors can lead to misdiagnosis. In this case, the ABC-like changes developed from the underlying LMSB as a secondary alteration. A careful examination of the underlying bone tumor is crucial to avoid misdiagnosing it as ABC or exhibiting ABC-like changes. Moreover, there has been no case report of LMSB with secondary ABC-like changes in bone.
Management of traumatic scalp arteriovenous fistula: Case report and literature review
Authors: Hsieh Yi-Ying , Chen Ching-Chang , Tu Po-Hsun , Yang Shun-Tai , Liu Zhuo-Hao
Published: September 2024

Rationale:

Blunt traumatic arteriovenous fistula (AVF) of scalp, are uncommon and most of them can be secured by simple embolization or surgical ligation of the feeders. Our goal in writing this paper is to show patients with traumatic scalp AVFs how to prevent complications and the likelihood of recurrence.

Patient concerns:

Complete treatment and reduce the recurrence rate of traumatic AVF on the scalp.

Diagnoses:

Traumatic scalp AVF.

Interventions:

Transarterial embolization and surgical resection.

Outcomes:

Complete resection of the AVF and subsequent angiography showed resolution of the contralateral lesion.

Lessons:

Combination of endovascular embolization with subsequent surgical removal may reduce intraoperative blood loss compared with surgery alone. In addition, a well-designed scalp flap can be performed based on the angiography findings after embolization.
Management strategy of primary ovarian mucinous carcinoid tumor: A rare case report
Authors: Kwon Byung Su , Kang Da Young , Na Kiyong , Kim Youngsun
Published: September 2024

Rationale:

Primary ovarian carcinoid tumors are rare neoplasms, first reported in 1939, with approximately 30 cases reported thus far. It is categorized into insular, trabecular, strumal, and mucinous types. Mucinous forms are extremely rare, comprising < 2% of all primary ovarian carcinoid tumors.

Patient concerns:

A 40-year-old gravida 3, para 0 woman visited our clinic with a 3-month history of lower abdominal pain. Ultrasound and abdominal pelvic computed tomography revealed a large, poorly enhancing soft tissue mass in the right adnexa (about 9.4 × 7.0 × 6.8 cm sized). Laparoscopic surgery was performed to a definitive diagnosis, including right salpingo-oophorectomy, left ovarian biopsy, and ascites washing cytology.

Diagnosis:

The patient was diagnosed with primary ovarian mucinous carcinoid tumor and received related treatment.

Outcomes:

After treatment, the patient symptoms improved, and he was discharged.

Lessons:

Approximately 40% of primary ovarian carcinoid tumors with insular morphology present in pure form, and mucinous forms are extremely rare. At present, the main diagnostic methods in cases of primary ovarian mucinous carcinoid tumor include macroscopic examination, histopathology and imaging examination. The main treatment modalities for primary ovarian mucinous carcinoid tumor are surgery. postoperative chemotherapy remains controversial.