bluuebunny/crossref_metadata_2025 huggingface dataset:
Anti-seizure gene therapy for focal cortical dysplasia
Authors: Almacellas Barbanoj Amanda , Graham Robert T , Maffei Benito , Carpenter Jenna C , Leite Marco , Hoke Justin , Hardjo Felisia , Scott-Solache James , Chimonides Christos , Schorge Stephanie , Kullmann Dimitri M , Magloire Vincent , Lignani Gabriele
Published: December 2023

Focal cortical dysplasias are a common subtype of malformation of cortical development, which frequently presents with a spectrum of cognitive and behavioural abnormalities as well as pharmacoresistant epilepsy. Focal cortical dysplasia type II is typically caused by somatic mutations resulting in mammalian target of rapamycin (mTOR) hyperactivity, and is the commonest pathology found in children undergoing epilepsy surgery. However, surgical resection does not always result in seizure freedom, and is often precluded by proximity to eloquent brain regions. Gene therapy is a promising potential alternative treatment and may be appropriate in cases that represent an unacceptable surgical risk. Here, we evaluated a gene therapy based on overexpression of the Kv1.1 potassium channel in a mouse model of frontal lobe focal cortical dysplasia. An engineered potassium channel (EKC) transgene was placed under control of a human promoter that biases expression towards principal neurons (CAMK2A) and packaged in an adeno-associated viral vector (AAV9). We used an established focal cortical dysplasia model generated by in utero electroporation of frontal lobe neural progenitors with a constitutively active human Ras homolog enriched in brain (RHEB) plasmid, an activator of mTOR complex 1. We characterized the model by quantifying electrocorticographic and behavioural abnormalities, both in mice developing spontaneous generalized seizures and in mice only exhibiting interictal discharges. Injection of AAV9-CAMK2A-EKC in the dysplastic region resulted in a robust decrease (∼64%) in the frequency of seizures. Despite the robust anti-epileptic effect of the treatment, there was neither an improvement nor a worsening of performance in behavioural tests sensitive to frontal lobe function. AAV9-CAMK2A-EKC had no effect on interictal discharges or behaviour in mice without generalized seizures. AAV9-CAMK2A-EKC gene therapy is a promising therapy with translational potential to treat the epileptic phenotype of mTOR-related malformations of cortical development. Cognitive and behavioural co-morbidities may, however, resist an intervention aimed at reducing circuit excitability.
Exploring the role of mutual prediction in inter-brain synchronization during competitive interactions: an fNIRS hyperscanning investigation
Authors: Zhang Yuxuan , Ye Weihao , Yin Junting , Wu Qin , Huang Yao , Hao Na , Cui Liying , Zhang Mingming , Cai Dan
Published: December 2023

Mutual prediction is crucial for understanding the mediation of bodily actions in social interactions. Despite this importance, limited studies have investigated neurobehavioral patterns under the mutual prediction hypothesis in natural competitive scenarios. To address this gap, our study employed functional near-infrared spectroscopy hyperscanning to examine the dynamics of real-time rock-paper-scissors games using a computerized paradigm with 54 participants. Firstly, our results revealed activations in the right inferior frontal gyrus, bilateral dorsolateral prefrontal cortex, and bilateral frontopolar cortex, each displaying distinct temporal profiles indicative of diverse cognitive processes during the task. Subsequently, a task-related increase in inter-brain synchrony was explicitly identified in the right dorsolateral prefrontal cortex, which supported the mutual prediction hypothesis across the two brains. Moreover, our investigation uncovered a close association between the coherence value in the right dorsolateral prefrontal cortex and the dynamic predictive performances of dyads using inter-subject representational similarity analysis. Finally, heightened inter-brain synchrony values were observed in the right dorsolateral prefrontal cortex before a draw compared to a no-draw scenario in the second block, suggesting that cross-brain signal patterns could be reflected in behavioral responses during competition. In summary, these findings provided initial support for expanding the understanding of cognitive processes underpinning natural competitive engagements.
Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives
Authors: Barwise Amelia K , Curtis Susan , Diedrich Daniel A , Pickering Brian W
Published: December 2023

Objectives

Inpatients with language barriers and complex medical needs suffer disparities in quality of care, safety, and health outcomes. Although in-person interpreters are particularly beneficial for these patients, they are underused. We plan to use machine learning predictive analytics to reliably identify patients with language barriers and complex medical needs to prioritize them for in-person interpreters.

Materials and methods

This qualitative study used stakeholder engagement through semi-structured interviews to understand the perceived risks and benefits of artificial intelligence (AI) in this domain. Stakeholders included clinicians, interpreters, and personnel involved in caring for these patients or for organizing interpreters. Data were coded and analyzed using NVIVO software.

Results

We completed 49 interviews. Key perceived risks included concerns about transparency, accuracy, redundancy, privacy, perceived stigmatization among patients, alert fatigue, and supply–demand issues. Key perceived benefits included increased awareness of in-person interpreters, improved standard of care and prioritization for interpreter utilization; a streamlined process for accessing interpreters, empowered clinicians, and potential to overcome clinician bias.

Discussion

This is the first study that elicits stakeholder perspectives on the use of AI with the goal of improved clinical care for patients with language barriers. Perceived benefits and risks related to the use of AI in this domain, overlapped with known hazards and values of AI but some benefits were unique for addressing challenges with providing interpreter services to patients with language barriers.

Conclusion

Artificial intelligence to identify and prioritize patients for interpreter services has the potential to improve standard of care and address healthcare disparities among patients with language barriers.
Lifestyle factors associated with presenteeism among city government office workers: a cross-sectional study
Authors: Otsubo Tsubasa , Kinjo Aya , Kuwabara Yuki , Hongja Kim , Osaki Yoneatsu
Published: December 2023

Objectives: Presenteeism is a critical issue in occupational health. This study aimed to examine the association between presenteeism and subjective sleep quality, smoking status, and alcohol consumption.

Methods: Anonymous data of 777 workers in a Japanese city were retrospectively obtained from City Government Office A. They included variables like absolute presenteeism scores (measured using the Japanese version of the World Health Organization Health and Work Performance Questionnaire short form), gender, age, family status, subjective sleep quality, smoking status, and alcohol consumption. A binary logistic regression analysis was performed with gender, age, family status, subjective sleep quality, smoking status, and alcohol consumption as the independent variables, and absolute presenteeism scores equal to or below 40 as the dependent variable. A gender-stratified binary logistic regression analysis was also performed.

Results: The logistic regression analysis results revealed that absolute presenteeism was positively associated with poor subjective sleep quality among all respondents (odds ratio [OR], 1.70; 95% CI, 1.18-2.44) and men (OR, 1.85; 95% CI, 1.12-3.05) and with current drinkers among women (OR, 3.49; 95% CI, 1.36-8.92); it was negatively associated with age among those who were ≥50 years old (OR, 0.50; 95% CI, 0.27-0.93) and with current drinkers among men (OR, 0.43; 95% CI, 0.20-0.92).

Conclusions: The factors associated with presenteeism differed between men and women office workers, suggesting that gender differences need to be considered when working toward improving workers’ productivity.
The discovery of a z = 0.7092 OH megamaser with the MIGHTEE survey
Authors: Jarvis Matt J , Heywood Ian , Jewell Sophie M , Deane Roger P , Klöckner H -R , Ponomareva Anastasia A , Maddox Natasha , Baker Andrew J , Bianchetti Alessandro , Hess Kelley M , Roberts Hayley , Rodighiero Giulia , Ruffa Ilaria , Sinigaglia Francesco , Varadaraj Rohan G , Whittam Imogen H , Adams Elizabeth A K , Baes Maarten , Murphy Eric J , Pan Hengxing , Vaccari Mattia
Published: December 2023

We present the discovery of the most distant OH megamaser (OHM) to be observed in the main lines, using data from the MeerKAT International Giga-Hertz Tiered Extragalactic Exploration (MIGHTEE) survey. At a newly measured redshift of z = 0.7092, the system has strong emission in both the 1665 MHz (L ≈ 2500 L⊙) and 1667 MHz (L ≈ 4.5 × 104 L⊙) transitions, with both narrow and broad components. We interpret the broad line as a high-velocity-dispersion component of the 1667 MHz transition, with velocity v ∼ 330 km s−1 with respect to the systemic velocity. The host galaxy has a stellar mass of M⋆ = 2.95 × 1010 M⊙ and a star formation rate of SFR = 371 M⊙ yr−1, placing it ∼1.5 dex above the main sequence for star-forming galaxies at this redshift, and can be classified as an ultraluminous infrared galaxy. Alongside the optical imaging data, which exhibit evidence for a tidal tail, this suggests that the OHM arises from a system that is currently undergoing a merger, which is stimulating star formation and providing the necessary conditions for pumping the OH molecule to saturation. The OHM is likely to be lensed, with a magnification factor of ∼2.5, and perhaps more if the maser emitting region is compact and suitably offset relative to the centroid of its host galaxy’s optical light. This discovery demonstrates that spectral line mapping with the new generation of radio interferometers may provide important information on the cosmic merger history of galaxies.
Linking UV spectral properties of MUSE Ly α emitters at z ≳ 3 to Lyman continuum escape
Authors: Kramarenko I G , Kerutt J , Verhamme A , Oesch P A , Barrufet L , Matthee J , Kusakabe H , Goovaerts I , Thai T T
Published: December 2023

The physical conditions giving rise to high escape fractions of ionizing radiation (LyC fesc) in star-forming galaxies – most likely protagonists of cosmic reionization – are not yet fully understood. Using the VLT/MUSE observations of ∼1400 Ly α emitters at 2.9 < z < 6.7, we compare stacked rest-frame UV spectra of candidates for LyC leakers and non-leakers selected based on their Ly α profiles. We find that the stacks of potential LyC leakers, i.e. galaxies with narrow, symmetric Ly α profiles with small peak separation, generally show (i) strong nebular O iii]λ1666, [Si iii]λ1883, and [C iii]λ1907 +C iii]λ1909 emission, indicating a high-ionization state of the interstellar medium (ISM); (ii) high equivalent widths of He iiλ1640 (∼1 − 3 Å), suggesting the presence of hard ionizing radiation fields; (iii) Si ii*λ1533 emission, revealing substantial amounts of neutral hydrogen off the line of sight; (iv) high C ivλλ1548,1550 to [C iii]λ1907 +C iii]λ1909 ratios (C iv/C iii] ≳0.75) , signalling the presence of low column density channels in the ISM. In contrast, the stacks with broad, asymmetric Ly α profiles with large peak separation show weak nebular emission lines, low He iiλ1640 equivalent widths (≲1 Å), and low C iv/C iii] (≲0.25), implying low-ionization states and high-neutral hydrogen column densities. Our results suggest that C iv/C iii] might be sensitive to the physical conditions that govern LyC photon escape, providing a promising tool for identification of ionizing sources among star-forming galaxies in the epoch of reionization.
Setting a Research Agenda on the Bioethics of Loneliness and Public Health
Authors: Lederman Zohar
Published: December 2023

This paper argue that loneliness is a public health ethics issue and maps a research agenda for bioethicists.
Vascular smooth muscle cell‐specific miRNA‐214 deficiency alleviates simulated microgravity‐induced vascular remodeling
Authors: Li Youyou , Zhao Yunzhang , Zhong Guohui , Xu Qing , Tan Yingjun , Xing Wenjuan , Cao Dengchao , Wang Yinbo , Liu Caizhi , Li Jianwei , Du Ruikai , Sun Weijia , Yuan Xinxin , Li Yeheng , Liu Zizhong , Jin Xiaoyan , Zhao Dingsheng , Song Jinping , Wang Yanqing , Kan Guanghan , Han Xuan , Liu Shujuan , Yuan Min , Gao Feng , Shu Jingdan , Li Yingxian , Ling Shukuan
Published: December 2023

The human cardiovascular system has evolved to accommodate the gravity of Earth. Microgravity during spaceflight has been shown to induce vascular remodeling, leading to a decline in vascular function. The underlying mechanisms are not yet fully understood. Our previous study demonstrated that miR‐214 plays a critical role in angiotensin II‐induced vascular remodeling by reducing the levels of Smad7 and increasing the phosphorylation of Smad3. However, its role in vascular remodeling evoked by microgravity is not yet known. This study aimed to determine the contribution of miR‐214 to the regulation of microgravity‐induced vascular remodeling. The results of our study revealed that miR‐214 expression was increased in the forebody arteries of both mice and monkeys after simulated microgravity treatment. In vitro, rotation‐simulated microgravity‐induced VSMC migration, hypertrophy, fibrosis, and inflammation were repressed by miR‐214 knockout (KO) in VSMCs. Additionally, miR‐214 KO increased the level of Smad7 and decreased the phosphorylation of Smad3, leading to a decrease in downstream gene expression. Furthermore, miR‐214 cKO protected against simulated microgravity induced the decline in aorta function and the increase in stiffness. Histological analysis showed that miR‐214 cKO inhibited the increases in vascular medial thickness that occurred after simulated microgravity treatment. Altogether, these results demonstrate that miR‐214 has potential as a therapeutic target for the treatment of vascular remodeling caused by simulated microgravity.
Serpin family E member 1 enhances myometrium contractility by increasing ATP production during labor
Authors: Wang Xiaodi , Chen Lina , Wen Bolun , Wang Lele , Yang Fan , Bao Junjie , Pan Xiuyu , Zhang Guozheng , Ji Kaiyuan , Liu Huishu
Published: December 2023

The uterine contraction during labor, a process with repetitive hypoxia and high energy consumption, is essential for successful delivery. However, the molecular mechanism of myometrial contraction regulation is unknown. Serpin family E member 1 (SERPINE1), one of the most upregulated genes in laboring myometrium in both transcriptome and proteome, was highlighted in our previous study. Here, we confirmed SERPINE1 is upregulated in myometrium during labor. Blockade of SERPINE1 using small interfering RNA (siRNA) or inhibitor (Tiplaxtinin) under hypoxic conditions in myocytes or myometrium in vitro showed a decrease contractility, which was achieved by regulating ATP production. Chromatin immunoprecipitation (ChIP‐seq), Co‐immunoprecipitation (Co‐IP), and glutathione‐S‐transferase (GST) pull down explored that the promoter of SERPINE1 is directly activated by hypoxia‐inducible factor‐1α (HIF‐1α) and SERPINE1 interacts with ATP Synthase Peripheral Stalk Subunit F6 (ATP5PF). Together they enhance hypoxia driven myometrial contraction by maintaining ATP production in the key oxidative phosphorylation pathway. The results provide new insight for uterine contraction regulation, and potential novel therapeutic targets for labor management.
Chimeric antigen receptor T-cell therapy in rheumatology: B-cell depletion 2.0
Authors: Appalaneni Rohith , Achanta Nikhila , Mohan Chandra
Published: December 2023

Purpose of review

Chimeric antigen receptor T-cell therapy (CAR-T) has revolutionized cancer treatment by harnessing the immune system's power to target malignancies. CD19, a B-cell surface antigen, a key target for CAR-T cell therapy in hematological malignancies, displayed remarkable clinical responses. Recently, there has been a growing interest in exploring the application of CD19 CAR-T cell therapy beyond oncology. The rationale for investigating CD19 CAR-T cells in Rheumatology stems from their ability to selectively target B cells, which play a central pathogenic role through autoantibody-dependent and independent mechanisms.

Recent findings

Preclinical and five completed clinical studies have shown remarkable efficacy and safety in diseases such as systemic lupus erythematosus, antisynthetase syndrome, and systemic sclerosis. It is thus not surprising that 17 active clinical trials exploring CAR-T cells in Rheumatology are in progress.

Although CAR-T therapy holds great promise in Rheumatology, many challenges loom. Whether this new way to deplete B-cells is superior to conventional antibody-based B-cell depletion in rheumatic diseases will be closely watched in the coming years.
Pediatric Floating Elbows … What Is All the Fuss About? A Multicenter Perspective
Authors: Zheng Jenny L. ,   CORTICES
Published: December 2023

Background:

Classic orthopaedic teaching states a high risk of pediatric acute compartment syndrome (PACS) and other adverse outcomes to be associated with pediatric floating elbow injuries. However, more recent data suggest otherwise. This study aims to evaluate treatment approaches and outcomes of pediatric floating elbow injuries and accurately determine the rate of associated PACS.

Methods:

A multicenter retrospective database was created to review patients below 18 years old who presented between 2014 and 2019 with floating elbow injuries. Patient demographics, injury characteristics, treatment course, and outcomes were evaluated. A severity classification (Children’s Orthopaedic Trauma and Infection Consortium for Evidence-Based Studies) was established: class 1 injuries included Gartland 1 supracondylar fracture, class 2 included Gartland 2 supracondylar fracture, and class 3 included Gartland 3 or 4 supracondylar or t-condylar fracture. Subclasses A and B were based on displacement of the distal fracture.

Results:

Four hundred fifty four patients were evaluated across 15 institutions. The cohort was 51% male and a median of 6.8 years old at injury. Thirteen patients (2.9%) presented without a palpable or dopplerable pulse, all having class 3 injuries. Ninety patients (20.0%) presented with nerve injuries, which were more common in class 3 injuries (P<0.001). Only 14 (3.1%) had persistent nerve injuries at the final follow-up. Displacement largely dictated whether the distal injury was treated with fixation (P<0.001) or immobilization only. Open reduction rate of the proximal fracture was 7.7% overall. There was 1 case (0.2%) of PACS involving displaced proximal and distal fractures. The median length of follow-up was 2.5 months. Modified Flynn outcomes at the last clinical visit were excellent/good in 315 patients (70%). More severe injuries had less good/excellent outcomes than less severe injuries (P=0.030).

Conclusions:

This multicenter study of a large cohort of pediatric floating elbow injuries identified a low rate of PACS (0.2%). Closed treatment of the distal fracture was more frequently performed for nondisplaced fractures. Nerve and vascular injury rates were consistent with those of isolated component fractures and were associated with fracture displacement. The Children’s Orthopaedic Trauma and Infection Consortium for Evidence-based Studies classification was an effective predictor of outcomes.

Level of Evidence:

Level IV.
Vaccine-preventable Pediatric Acute Bacterial Meningitis in France: A Time Series Analysis of a 19-Year Prospective National Surveillance Network
Authors: Rybak Alexis , Ouldali Naïm , Varon Emmanuelle , Taha Muhamed-Kheir , Bonacorsi Stéphane , Béchet Stéphane , Angoulvant François , Cohen Robert , Levy Corinne ,   on behalf of the French Pediatric Meningitis Network
Published: December 2023

Background:

In France, vaccination has been implemented against Hi serotype b (Hib), pneumococcus with pneumococcal conjugate vaccines (PCV), and Neisseria meningitidis serogroup C (MenC). These interventions with different coverage and uptake have disrupted the epidemiology of vaccine-preventable acute bacterial meningitis (ABM).

Methods:

We analyzed data from a French prospective surveillance network of ABM in children ≤15 years old enrolled by 259 pediatric wards (estimated national coverage: 61%). From 2001 to 2020, the effect of vaccine implementation was estimated with segmented linear regression.

Results:

We analyzed 7,186 cases, mainly due to meningococcus (35.0%), pneumococcus (29.8%), and Hi (3.7%). MenC ABM incidence decreased (−0.12%/month, 95% CI: −0.17 to −0.07, P < 0.001) with no change for the overall meningococcal ABM when comparing the pre-MenC vaccination and the post-MenC vaccination trends. Despite a decreasing MenB ABM incidence without a vaccination program (−0.43%/month, 95% CI: −0.53 to −0.34, P < 0.001), 68.3% of meningococcal ABM involved MenB. No change in pneumococcal ABM incidence was observed after the PCV7 recommendation. By contrast, this incidence significantly decreased after the switch to PCV13 (−0.9%/month, 95% CI: −1.6 to −0.2%, P = 0.01). After May 2014, a rebound occurred (0.5%/month, 95% CI: 0.3–0.8%, P < 0.001), with 89.5% of non-PCV13 vaccine serotypes. Hib ABM incidence increased after June 2017.

Conclusions:

PCV7 and MenC vaccine introduction in France, with slow vaccine uptake and low coverage, had no to little impact as compared to the switch from PCV7 to PCV13, which occurred when coverage was optimal. Our data suggest that MenB and next-generation PCVs could prevent a large part of the ABM incidence in France.
Implant-associated Infection After Pediatric Spine Deformity Surgery: Is Removal of Hardware Indicated?
Authors: Wei Jou , Brown Conrad , Moore Tomas , Graham Nicolette , Davis Mathew , Gatehouse Simon , Nourse Clare
Published: December 2023

Background:

Postoperative spinal implant infection following pediatric spinal surgery often presents a management dilemma. We aimed to characterize our experience in this cohort of patients, hoping to provide further insight when approaching these challenging cases.

Methods:

A retrospective, observational study was performed of all children who underwent spinal surgery from January 2015 to June 2021 in a tertiary pediatric spinal surgery referral center in Queensland, Australia. Records were reviewed to identify cases of postoperative surgical site infection, with particular focus on children with infection directly involving implants. Preoperative prophylaxis, microbiology, clinical course and outcomes were analyzed.

Results:

A total of 580 children underwent 933 procedures during the study period. The most common pathology requiring surgery was idiopathic scoliosis in 257 children (44.3%) followed by neuromuscular scoliosis in 192 children (33.1%). There were 35 cases of surgical site infection (6.03%), and 9 were implant-associated (1.55%). Infection rate among children with neuromuscular spinal deformity was almost 3-fold higher (11.5%) than idiopathic (3.89%). Methicillin-sensitive Staphylococcus aureus was the most commonly isolated organism (n = 15). Four implant-associated infections were successfully managed with retention of implant; all were diagnosed within 32 days (median = 20 days) and cultured either Staphylococcus aureus or Pseudomonas aeruginosa. Conversely, infections that necessitated implant removal had a more indolent onset (median = 175 days), and more often cultured Cutibacterium acnes and coagulase-negative Staphylococci.

Conclusions:

Postoperative spinal implant infection can be treated successfully with hardware retention in select cases. Earlier presentation and recognition appear to be associated with better rates of retention and are linked to certain organisms. Further exploration of specific preventative strategies may be key in preventing devastating late-onset infections.
Circle packing charts generated by ChatGPT to identify the characteristics of articles by anesthesiology authors in 2022: Bibliometric analysis
Authors: Ho Sam Yu-Chieh , Chien Tsair-Wei , Chou Willy
Published: December 2023

Background:

The ChatGPT (Open AI, San Francisco, CA), denoted by the Chat Generative Pretrained Transformer, has been a hot topic for discussion over the past few months. A verification of whether the code for drawing circle packing charts (CPCs) with R can be generated by ChatGPT and used to identify characteristics of articles by anesthesiology authors is needed. This study aimed to provide insights into article characteristics in the field of anesthesiology and to highlight the potential of ChatGPT for data visualization techniques (e.g., CPCs) in bibliometric analysis.

Methods:

A total of 23,012 articles were indexed in PubMed in 2022 by authors in the field of anesthesiology. The code for drawing CPCs with R was generated by ChatGPT and then modified by the authors to identify the characteristics of articles in 2 forms: 23,012 and 100 top-impact factors in journals (T100IF). Using CPCs and 3 other visualizations—network charts, impact beam plots, and Sankey diagrams—we were able to display article features commonly used in bibliometric analysis. The author-weighted scheme and absolute advantage coefficient were used to assess dominant entities, such as countries, institutes, authors, and themes (defined by PubMed and MeSH terms).

Results:

Our findings indicate that: further modifications should be made to the code generated by ChatGPT for drawing CPCs in R; publications in the field of anesthesiology are dominated by China, followed by the United States and Japan; Capital Medical University (China) and Showa University Hospital (Japan) dominate research institutes in terms of publications and IF, respectively; and COVID-19 is the most frequently reported theme in T100IF, accounting for 29%.

Conclusions:

No such articles with CPCs regarding bibliometrics have ever been found in PubMed. The code for drawing CPCs with R can be generated by ChatGPT, but further modification is required for implementation in bibliometrics. CPCs should be used in future studies to identify the characteristics of articles in other areas of research rather than limiting them to anesthesiology, as we did in this study.
Predicting risk of postpartum hemorrhage associated with vaginal delivery of twins: A retrospective study
Authors: Liu Zhaodong , Chen Rongxin , Huang Huihui , Yan Jianying , Jiang Caihong
Published: December 2023

Many studies have only focused on the risk factors for postpartum hemorrhage (PPH) in singleton vaginal deliveries and twin cesarean deliveries. We analyzed the factors of influencing PPH occurrence in twin vaginal deliveries and developed a nomogram for clinical application. This retrospective study included 274 pregnant women with twin pregnancies who were hospitalized for delivery from January 2014 to December 2018. The patients opted for vaginal delivery and experienced spontaneous labor. Univariate analysis of PPH risk factors was performed. Multivariate analysis was performed using the least absolute shrinkage and selection operator (LASSO) to obtain relevant factors and build a prediction model, which was presented as a nomogram. The model was internally validated by bootstrap self-sampling method. Model accuracy was evaluated with the concordance index (C-index). There were 36 (13.14%) and 238 (86.9%) patients in the PPH and no PPH groups, respectively. Univariate analysis identified twin chorionicity, hypertensive disorders complicating pregnancy (HDCP), anemia in pregnancy, delivery mode of the second twin, oxytocin use during labor, postpartum curettage, cervical laceration, intrapartum fever, fibrinogen degradation products (FDP), and platelet count (PLT) as significant PPH factors. On multivariate analysis, HDCP, anemia in pregnancy, intrapartum fever, oxytocin use during labor, fetal distress, PLT, direct bilirubin, and FDP were noted as significant PPH factors and were included in the prediction model. A C-index of 0.816 was noted after internal validation, and the calibration curve showed good consistency. We developed a model to predict PPH risk in the vaginal delivery of twin pregnancies and visualized it with a nomogram that can be applied clinically to assess PPH risk and aid PPH prevention.
Comparison of the efficacy of 5% versus 8% acetic acid concentrations for detecting premalignant and malignant lesions in colposcopy
Authors: Yilmaz Alpay , Gulbahar Aysegul , Sen Serhat
Published: December 2023

Although preventable; cervical cancer remains a significant cause of morbidity and mortality worldwide, especially in developing countries; thus, early diagnosis and treatment are essential to prevent its development into invasive cancer. Based on the screening results, diagnostic colposcopy was performed to evaluate women with abnormal Papinocalaou test results, high-risk human papillomavirus DNA positivity, or suspected cervical cancer. Therefore, this study aimed to determine the optimal acetic acid concentration (5% or 8%) for detecting cervical precancerous/cancerous lesions during colposcopy evaluation. This study included 607 patients admitted to our obstetrics and gynecology clinic. The medical records of the patients were obtained from the colposcopy registry in the hospital information system and retrospectively analyzed. The cases were divided into 2 groups according to the acetic acid concentrations (5% and 8%) used during colposcopy and examined. The duration of acetic acid application was 2 to 4 minutes. The probability of developing ≥ CIN2 was low in patients with negative for intraepithelial lesion or malignancy smear results in both groups, but increased in the high-grade squamous intraepithelial lesions/atypical squamous cells group with the 8% acetic acid concentration (P < .0001; P = .012). The probabilities of pathological detection of ≥ CIN2 in the 5% and 8% acetic acid groups were 17.3% and 46.6%, respectively (P < .0001). The enhancement of the efficiency of colposcopy should focus on improving the detectability of precancerous lesions. Given that this study compared the effectiveness of acetic acid concentration in colposcopy diagnostics, it can be considered a leading study in this field.
A nomogram for predicting the risk of postoperative fever in elderly patients undergoing endoscopic submucosal dissection of the upper gastrointestinal tract
Authors: Xu Zhixiang , Zhuang Jing , Zhu Xin , Yao Jun
Published: December 2023

To explore the risk factors of postoperative fever in elderly patients undergoing endoscopic submucosal dissection (ESD). A total of 439 patients who met the inclusion criteria were enrolled in this study and randomly divided into training (n = 311) and validation (n = 128) cohorts at a ratio of 7:3. Independent risk factors were screened by single-factor and multiple-factor logistic regression analyses, and a nomogram was established using them. The nomogram was evaluated using receiver operating characteristic curve analysis, decision curve analysis, and calibration plot using the “rms” package in R software (R4.2.1). The study included 439 patients. Female (OR = 2.55, 95% CI: 1.5–4.33), diabetes (OR = 2.38, 95% CI: 1.17–4.85), operation time (OR = 1.01, 95% CI: 1–1.02) were lesion located in the esophagus (OR = 2.37, 95% CI: 1.44–3.88), maximum tumor diameter (OR = 1.3, 95% CI: 1.07–1.57), and placement of a urinary catheter (OR = 7.09, 95%CI: 1.43–35.17) were independent risk factors for postoperative fever in elderly ESD patients (P < .05). Female sex, diabetes, lesions located in the esophagus, lesion size, operation time, and placement of a urinary catheter are risk factors for postoperative fever in ESD patients, and patients with these risk factors should be vigilant for postoperative fever and receive appropriate treatment.
Exploring the significance of tumor volume in endometrial cancer: Clinical pathological features, prognosis, and adjuvant therapies
Authors: Fan Zhixiang , Sun Xinxin , Han Xiting , Sun Caiping , Huang Dongmei
Published: December 2023

To assist clinicians in formulating treatment strategies for endometrial cancer (EC), this retrospective study explores the relationship between tumor volume and clinical pathological features, as well as prognosis, in patients undergoing staging surgery. Preoperative pelvic MRI examinations were conducted on 234 histologically confirmed EC patients. The ITK-SNAP software was employed to manually delineate the region of interest in the MRI images and calculate the tumor volume (MRI-TV). The analysis focused on investigating the relationship between MRI-TV and the clinical pathological features and prognosis of EC patients. Larger MRI-TV was found to be associated with various adverse prognostic factors (G3, deep myometrial invasion, cervical stromal invasion, lymphovascular space invasion, lymph node metastasis, advanced international federation of gynecology and obstetrics staging, and receipt of adjuvant therapy). The receiver operating characteristic curve indicated that MRI-TV ≥ 8 cm3 predicted deep myometrial invasion, and MRI-TV ≥ 12 cm3 predicted lymph node metastasis. Penalized spline (P-spline) regression analysis identified 14 cm3 of MRI-TV as the optimal prognostic cutoff value. MRI-TV ≥ 14 cm3 was an independent prognostic factor for overall survival and disease-free survival. For patients with MRI-TV ≥ 14 cm3, the disease-free survival rate with adjuvant therapy was superior to that of the sole staging surgery group. This study demonstrates a significant correlation between MRI-TV and clinical pathological features and prognosis in EC. For patients with MRI-TV ≥ 14 cm3, staging surgery followed by adjuvant therapy was superior to sole staging surgery.
Molecular and immunological characteristics of patients with CMTM6 low expression colorectal cancer
Authors: Lu Zheng-Min , Pan Shi-Ling , Yuan Wen-Li , Feng Jia-Li , Tian Dan , Shang Xue-Qin
Published: December 2023

CKLF-like MARVEL transmembrane domain-containing 6 (CMTM6), a regulator of programmed cell death ligand 1 (PD-L1), has attracted extensive attention due to its role in tumors. However, research on the expression of CMTM6 in colorectal cancer (CRC) and its relationship with PD-L1 expression and immune cell infiltration is limited. We used The Cancer Genome Atlas database to mine and analyze data from patients with CRC using bioinformatics methods. We investigated the expression of CMTM6 in CRC and its relationship with PD-L1 expression and immune cell infiltration. Immunohistochemistry and PCR were performed to detect CMTM6 and PD-L1 expression in CRC tissues. Differential gene expression analysis was performed using the edgeR package in R and immune cell infiltration analysis was performed using the ssGSEA algorithm. Additionally, GO and KEGG enrichment analyses were conducted to identify the biological processes and pathways associated with low CMTM6 expression. Our study found that CMTM6 expression was significantly upregulated in CRC tissues compared to that in adjacent normal tissues. Patients with high CMTM6 expression exhibited significantly increased levels of PD-L1 expression and higher levels of tumor-infiltrating immune cells compared to patients with low CMTM6 expression. GO and KEGG analyses suggested that CMTM6 may be involved in multiple immune regulatory pathways in CRC.
Correlation between body composition and white matter hyperintensity in patients with acute ischemic stroke
Authors: Wu Bin , Huang Dong , Yi Ziwei , Yu Fang , Liu Li , Tang Xianbi , Jing Kaiquan , Fan Jiangli , Pan Chuzheng
Published: December 2023

White matter hyperintensity (WMH) burden is associated with a higher risk of ischemic stroke. The relationship between WMH and obesity is somewhat controversial which might be interfered by different body composition such as skeletal muscle, fat and bone density. However, few researchers have evaluated the relationship between WMH burden and disaggregated body constituents in acute ischemic stroke (AIS) patients systematically. A total of 352 AIS patients were enrolled in this study. The subcutaneous adipose tissue, erector spinae muscle area and bone density were evaluated on the computed tomography scanning. The burden of WMH was evaluated using the Fazekas scale based on the fluid-attenuated inversion recovery sequence. The severity of overall WMH was defined as none-mild WMH (total Fazekas score 0–2) or moderate-severe WMH (total Fazekas score 3–6). Based on the severity of periventricular WMH (P-WMH) and deep WMH, patients were categorized into either a none-mild (Fazekas score 0–1) group or a moderate-severe (Fazekas score 2–3) group. We found that patients with moderate-severe WMH showed lower bone density and smaller erector spinae muscle area and subcutaneous adipose tissue than none-mild. The logistic regression analysis showed that the bone density was independently associated with moderate-severe overall WMH (odds radio = 0.98, 95% confidence interval, 0.972–0.992, P < .001) and similar results were found in the analyses according to P-WMH (odds radio = 0.98, 95% confidence interval, 0.972–0.992, P < .001). These findings suggest that among the AIS body composition, the bone density is independently associated with the severity of overall WMH and P-WMH.
WGCNA combined with machine learning to find potential biomarkers of liver cancer
Authors: Lv Jia-Hao , Hou A-Jiao , Zhang Shi-Hao , Dong Jiao-Jiao , Kuang Hai-Xue , Yang Liu , Jiang Hai
Published: December 2023

The incidence of hepatocellular carcinoma (HCC) has been increasing in recent years. With the development of various detection technologies, machine learning is an effective method to screen disease characteristic genes. In this study, weighted gene co-expression network analysis (WGCNA) and machine learning are combined to find potential biomarkers of liver cancer, which provides a new idea for future prediction, prevention, and personalized treatment. In this study, the “limma” software package was used. P < .05 and log2 |fold-change| > 1 is the standard screening differential genes, and then the module genes obtained by WGCNA analysis are crossed to obtain the key module genes. Gene Ontology and Kyoto Gene and Genome Encyclopedia analysis was performed on key module genes, and 3 machine learning methods including lasso, support vector machine-recursive feature elimination, and RandomForest were used to screen feature genes. Finally, the validation set was used to verify the feature genes, the GeneMANIA (http://www.genemania.org) database was used to perform protein–protein interaction networks analysis on the feature genes, and the SPIED3 database was used to find potential small molecule drugs. In this study, 187 genes associated with HCC were screened by using the “limma” software package and WGCNA. After that, 6 feature genes (AADAT, APOF, GPC3, LPA, MASP1, and NAT2) were selected by RandomForest, Absolute Shrinkage and Selection Operator, and support vector machine-recursive feature elimination machine learning algorithms. These genes are also significantly different on the external dataset and follow the same trend as the training set. Finally, our findings may provide new insights into targets for diagnosis, prevention, and treatment of HCC. AADAT, APOF, GPC3, LPA, MASP1, and NAT2 may be potential genes for the prediction, prevention, and treatment of liver cancer in the future.
Does the VHL polymorphisms rs779805 and rs1642742 affect renal cell carcinoma susceptibility, prognosis and survival in Central European population?
Authors: Chrabańska Magdalena , Szweda-Gandor Nikola , Drozdzowska Bogna
Published: December 2023

Renal cell carcinoma (RCC) is a common malignant tumor of the urinary system. The von Hippel–Lindau (VHL) tumor suppressor gene play an essential role in the tumorigenic pathway of clear cell RCC (ccRCC). This study was aimed to clarify the influence of VHL polymorphisms on ccRCC susceptibility and survival in Central European population. We genotyped 2 single-nucleotide polymorphisms (SNPs) rs779805 and rs1642742 in VHL gene and assessed their associations with ccRCC risk, clinicopathologic parameters, and prognosis in 171 cases. The selected SNPs were genotyped by ROCHE LifeCycler 96 using tumor tissue-derived DNA. Both SNPs do not directly influence ccRCC susceptibility and overall survival. A significant associations were found between allele G and genotypes AG and GG of rs779805 in the VHL tumor suppressor gene and increased tumor size, as well as high nuclear grade. Furthermore, a statistically significant association was observed between rs1642742 of VHL gene and low pathological tumor stage and between rs779805 of VHL gene and high pathological tumor stage. Both investigated SNPs can be important prognostic indicators of RCC in the Central European population, because statistically significant associations were observed between evaluated VHL polymorphisms and the best known factors with proven prognostic significance in kidney cancer.
Comparison of formulas in the implantable collamer lens vault prediction
Authors: Xiong Lu , Wu Jiawei , Du Huiyi , Wang Zheng
Published: December 2023

To compare the predictability of different formulas in the postoperative vault of an implantable collamer lens (ICL) surgery and assist physicians for formula selection in ICL implantation. This is a retrospective study. Patients who underwent ICL implantation between August 31, 2021 and October 29, 2021 at our clinic were reviewed. The clinical data, predicted ICL sizes and vaults, actual ICL size implanted and vaults at 1 month after surgery, and corresponding prediction formulas used were collected and analyzed. This study included 140 eyes from 72 patients (15 males and 57 females). Differences between ICL sizes recommended by the Visian ICL Online Calculation & Ordering System (OCOS) and NK formula (Version. 3) or KS formula (Version. 4) were statistically significant (P < .0001), except for the recommended ICL sizes between the NK and KS formulas (P > .05). Better consistency between predicted ICL vaults and achieved ICL vaults was observed when using the KS formula compared to the NK formula. The actual ICL vaults were 250 to 750 μm at 1 month after surgery in 66.4%, 76.5%, and 80.5% eyes of the OCOS, NK, and KS groups, respectively. There was significant difference between the OCOS and KS groups (P < .05), especially in the 12.6 mm ICL group. The KS formula is the most accurate formula for recommending an ICL size and vault prediction when compared to the NK formula and OCOS. Further studies for a more accurate formula are warranted.
Scalp nodules as the first presentation of prostate cancer: A CARE-compliant article
Authors: Oh Tae Hoon , Kim Hun Soo , Park Seung Chol
Published: December 2023

Rationale:

Bones are the most common site of prostate cancer metastasis. Other common sites of metastases include the distant lymph nodes, liver, thorax, brain, and digestive system. However, cutaneous metastases from prostate cancer are extremely rare.

Patient concerns:

We present a case of a 61-year-old man with scalp nodules without any cancer history.

Diagnosis:

The patient was diagnosed with metastatic prostate adenocarcinoma through an incisional biopsy for his scalp nodules. The patient presented with a serum prostate-specific antigen level of 10.2 ng/mL; imaging examinations revealed extraprostatic extension, lymph node involvement, and multiple bone metastases.

Intervention:

The patient was treated with androgen deprivation therapy with leuprolide acetate (7.5 mg every month) and abiraterone acetate (1000 mg daily).

Outcomes:

The scalp metastases resolved without adverse effects, and the serum prostate-specific antigen level decreased to 0.02 ng/mL.

Lessons:

Cutaneous metastasis, especially scalp metastasis from prostate cancer, is extremely rare. If there is a rash or nodule on the skin, it is necessary to evaluate it carefully and to confirm it through a biopsy.
Caroli disease with subcutaneous hemorrhage as the sole clinical manifestation: A case report
Authors: Yang Wentai , Jin Qing
Published: December 2023

Rational:

The disease of Caroli is a rare congenital disorder, characterized by the dilated intrahepatic bile ducts, resulting from mutations in the PKHD1 gene. Caroli syndrome, characterized by dilated intrahepatic bile ducts with congenital hepatic fibrosis, is linked to autosomal recessive polycystic kidney disease. The clinical manifestations of Caroli disease are not typical, and Caroli disease is easy to be missed and misdiagnosed. Therefore, we reported this case in the hope of raising awareness of the disease among clinicians.

Patient concerns:

The clinical manifestation of a 10-year-old girl was subcutaneous hemorrhage.

Diagnoses:

Magnetic resonance imaging (MRI ) indicates that the person may have Caroli disease, cirrhosis, splenomegaly, portal hypertension, esophagogastric fundal varices, or sponge kidneys.

Intervention:

The patient was advised for liver transplantation.

Outcomes:

The patient parents did not take our treatment advice, and they asked to go to a better hospital for further treatment, so we did not give the patient any treatment.

Lessons:

This case serves as a reminder that if we encounter a patient with hemophilia in our clinic, we should not only consider hematologic diseases and cirrhosis, but also perform an epigastric MRI and magnetic resonance cholangiopancreatography to rule out Caroli disease.