bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute respiratory distress syndrome as the initial symptom of hepatic angiosarcoma with Kasabach–Merritt syndrome: A case report
Authors: Cui Xiaoqian , Zhang Min , Song Debiao , Tian Jiakun
Published: September 2024

Rationale:

Hepatic angiosarcoma (HSA) has a poor prognosis. Our understanding of its clinical features, diagnosis, treatment, and prognosis remains limited. In certain cases, vascular tumors such as HSA can induce bleeding complications due to thrombocytopenia, known as Kasabach–Merritt syndrome (KMS). When KMS symptoms occur in the lungs, its clinical manifestations closely resemble those of ARDS, leading to misdiagnosis and poor outcomes. Unfortunately, this condition is extremely rare and there is a lack of relevant case reports, which further adds to the difficulty of its diagnosis and treatment.

Patient concerns:

This case report describes a patient who initially presented with symptoms of ARDS. Due to the unique nature of these symptoms, the patient underwent a complex diagnostic and treatment process before finally being diagnosed with HSA complicated by KMS through pathological examination.

Diagnoses:

The patient was eventually diagnosed with HSA by pathology and KMS with multiorgan hemorrhage.

Interventions:

Highly misleading clinical manifestations were recorded during the diagnosis and treatment, which, to our knowledge, have not been previously reported.

Outcomes:

The patient died from a massive pulmonary hemorrhage.

Lessons:

Dysfunction of a single organ or system may be the external manifestation of a multi-system clinical disease. Therefore, in the clinical diagnosis and treatment process, especially during early diagnosis, while it is important to focus on the primary or typical clinical symptoms, it is equally crucial not to underestimate or ignore accompanying symptoms that lack specificity. When diagnosis and treatment reach an impasse, these “atypical” symptoms often prove to be key in solving the puzzle.
Enhancing early-stage healing responses through the modified “Poncho” technique in customized titanium mesh–mediated bone regeneration: A soft tissue management approach—case series
Authors: Wang Siwei , De Santis Daniele
Published: September 2024

Rationale:

Soft tissue management is critical in bone augmentation surgery to prevent wound dehiscence. Several strategies for passive tissue primary closure have been explored. This article introduces a flap design known as the modified “Poncho” technique (MPT), integrated with customized titanium mesh–mediated bone regeneration, and investigates the healing quality during the initial stages of an incision.

Patient concerns:

The cohort consisted of 5 patients undergoing customized bone regeneration procedures, concerned primarily with the successful integration and healing of the augmented bone site without complications such as wound dehiscence or infection.

Diagnosis:

All patients were diagnosed with insufficient bone volume requiring augmentation to support future dental implants, necessitating the use of customized titanium mesh for guided bone regeneration.

Interventions:

The MPT was detailed and applied during the customized bone regeneration procedures. Postoperative evaluations included recording complications and using Landry’s healing index at intervals of 3, 7, 14, and 30 days post-surgery to assess the technique’s performance in early wound closure.

Outcomes:

The study found that 95.7% of surgery sites experienced uneventful soft tissue healing within the observation period. Only 1 of 23 sites exhibited partial wound dehiscence at postsurgical days 14 and 30, accompanied by mild inflammation. The Landry’s healing index increased from 3 ± 0.47 to a final value of 4.69 ± 1.06, indicating substantial improvement in healing over time.

Lessons:

The MPT shows promise as an innovative approach for promoting passive and predictable primary wound closure beneath a digitally customized titanium mesh for bone regeneration, demonstrating a high rate of successful healing and minimal complications during the early postoperative phase.
Dysbiosis of gut microbiota is associated with pathogenesis of peptic ulcer diseases through inflammatory proteins: A Mendelian randomization study
Authors: Li Jianing , Cai Hongbo , Zhang Yongsheng , Li Jingyi , Wang Dianxiang , Li Haolin , Cai Hongyu , Wang Qiuqiu , Fu Tong , Shao Zhonglin , Huang Huili , Wang Haiqiang , Tong Ying
Published: September 2024

The gut microbiota and inflammatory proteins may affect the development of peptic ulcer disease. However, this association remains unclear. We analyzed genome-wide association study data of gut microbiota, inflammatory proteins, and peptic ulcer disease using Mendelian randomization with instrumental variables to assess causal relationships. Various statistical methods, including inverse variance weighting, Mendelian randomization Egger regression, and sensitivity analysis were employed to evaluate the data and calculate mediation ratios. Our findings reveal that the genus Butyriciccus plays a role in mitigating the adverse effects of gastric ulcers by 7.9%, primarily through reducing beta-negative growth factor levels. Additionally, the genus Lachnospiraceae UCG004 can significantly alleviate the negative outcomes of gastric ulcers and reduces hepatocyte growth factor and beta-reserve growth factor levels by 6.39% and 7.45%, respectively. This study highlights the independent and mediating effects of the gut microbiota and inflammatory proteins on peptic ulcers, offering insights on potential pathways and targets for future preventive interventions.
Evaluation of biventricular function by cadmium–zinc–telluride SPECT gated tomographic radionuclide angiography: Comparison to conventional SPECT
Authors: Chen Yue , Pang Zekun , Wang Jiao , Yang Xuewen , Li Jianming
Published: September 2024

We compared and analyzed the consistency and repeatability of left and right ventricular ((LV/RV) functions obtained by gated-equilibrium radionuclide ventriculography (ERNV) with cadmium–zinc–telluride single-photon emission computed tomography (CZT-SPECT) and conventional SPECT (C-SPECT) with sodium iodide crystal detectors. Seventy-seven patients were included in the retrospective study. Both C-SPECT and CZT-SPECT imaging were performed on the same day. Correlations and differences in LV/RV ejection fraction (LVEF and RVEF), peak ejection rate (PER), and peak filling rate (PFR) were compared between the 2 models. Cardiac magnetic resonance (CMR) was partially used as the gold standard, and ultrasound results were included for comparative analysis. Interobserver reproducibility of each parameter obtained by the 2 cameras was compared. Between the 2 cameras, there were no significant difference in LVEF, LVPER, LVPFR, and RVPER (P > .05) and there were in RVEF and RVPFR (P < .05 or .001). The correlations (R value) were 0.831 (LVEF, excellent), 0.619 (RVEF, good), 0.672 (LVPER, good), 0.700 (LVPFR, good), 0.463 (RVPER, normal), and 0.253 (RVPFR, poor). There were no significant difference between CMR and CZT-SPECT in LVEF (P > .05) while there were between CMR and both C-SPECT and ultrasound (P < .05). The correlations were all good (R = 0.660, 0.658, and 0.695). There were no significant difference between CMR and both C-SPECT and CZT-SPET in RVEF (P > .05) and the correlations were good (R = 0.771 and 0.745). For repeatability, the intraclass correlation coefficient of RVPFR by C-SPECT was good (intraclass correlation coefficient = 0.698) and excellent for the rest of the groups (0.823–0.989). The repeatability of LVEF and RVEF was better for CZT-SPECT than for C-SPECT. The repeatability of PER was better for both cameras than PFR. CZT-SPECT tomographic ERNV correlated well with C-SPECT planar ERNV in evaluation of biventricular systolic function and LV diastolic function. Compared with the “gold standard” CMR, both models had good correlation in measuring LV/RVEF. CZT-SPECT had better inter-group reproducibility than C-SPECT. The accuracy of RV diastolic function need further study. CZT-SPECT tomographic ERNV will play an important and unique role in the clinical application of accurate evaluation of biventricular function in the future.
Type 2 diabetes mellitus has a positive role in osteomyelitis: A Mendelian randomization analysis
Authors: Fu Ma , Qi Han , Zhu Suyue , Zhu Dongsheng , Sun Chao
Published: September 2024

According to clinical evidence, type 2 diabetes mellitus (T2D) and osteomyelitis (OM) are currently the 2 major causes of mortality and morbidity in humans. Despite accounts of their coexistence, there is still no understanding of their fundamental connection. We attempted to assess the causal effect of T2D on OM using the two-sample Mendelian randomization method. The whole gene-wide association study’s aggregate data were examined. Single-nucleotide polymorphisms, which have a substantial correlation with T2D, were used as instrumental variables in a two-sample Mendelian randomization (MR) analysis to assess the causal relationship between T2D and OM risk using the inverse variance weighting, MR-egger regression, and weighted median approaches, respectively. A total of 114 single-nucleotide polymorphism were used as instrumental variables in this analysis. The inverse variance-weighted analysis showed a significant causal relationship between T2D and OM, indicating that T2D has a detrimental effect on OM risk. The odds ratio for the causal effect of T2D on OM was 1.317, with a 95% confidence interval of (1.140, 1.522) (P < .001). To assess heterogeneity, Cochran Q test statistics and MR-Egger regression were applied in the inverse variance-weighted technique. The P-value of .737 indicated a considerable level of heterogeneity was not absent in the data. This study used Mendelian randomization analysis to establish a causal relationship between T2D and OM. The findings suggest that T2D may increase the risk of OM.
Single nucleotide polymorphisms of CFAP43 and TEX14 associated with idiopathic male infertility in a Vietnamese population
Authors: Dinh Tran Huu , Phuong Anh Nguyen , Thao Dinh Huong , Duy La Duc , Bac Nguyen Duy , Quyet Pham Van , Son Trinh The , Lan Anh Luong Thi , Canh Nguyen Xuan , Hai Nong Van , Duong Nguyen Thuy
Published: September 2024

Male infertility is a multifactorial disease due to spermatogenesis impairment, with etiology remaining unknown for roughly one-third of infertile cases. Several studies have demonstrated that genetic variants are male infertility risk factors. CFAP43 and TEX14 are involved in the spermatogenesis process. The present study aimed to assess the association between single-nucleotide polymorphisms (SNPs) in CFAP43 (rs17116635 and rs10883979) and TEX14 (rs79813370 and rs34818467) and idiopathic male infertility in a Vietnamese population. A cohort of 206 infertile men and 195 controls were recruited for the study. CFAP43 and TEX14 SNPs were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Genotypes of randomly selected samples, accounting for 10% of the total, were confirmed using Sanger sequencing. The obtained data were analyzed using statistical methods. The results showed that 4 SNPs (rs17116635, rs10883979, rs79813370, and rs34818467) were in accordance with Hardy-Weinberg Equilibrium (HWE; P > .05). CFAP43 rs10883979 and TEX14 rs79813370 were associated with male infertility. For CFAP43 rs10883979, in the recessive model, the combination AA + AG was associated with male infertility when compared to the GG genotype (OR = 0.26; 95% CI: 0.06–0.85; P = .02). For TEX14 rs79813370, a protective effect against infertility risk was identified in the presence of the T allele of rs79813370 when compared to the G allele (OR = 0.48; 95% CI: 0.32–0.72; P < .001). Our results suggest that CFAP43 rs10883979 and TEX14 rs79813370 are likely associated with male infertility in the Vietnamese population, in which the G allele of rs79813370 may be a risk factor for male infertility.
Pilot study: Unveiling the impact of bisphenol A and phthalate exposure on women with asthma
Authors: Ahn Kyung-Min , Yang Min-Suk , Won Ha-Kyeong , Lim Jung Ah
Published: September 2024

Endocrine disruptors are considered estrogenic disruptors, and recent researches suggested that they may have a link to the severity of asthma. We aim to validate the correlation between endocrine disruptors and various clinical measurements of asthma, depending on the menopausal status. A pilot case–control study was performed in female asthmatic patients who visited allergy clinic in SMG-SNU Boramae Medical Center. Medical information and the urinary concentrations of 4 endocrine disruptors on their first visit were collected and analyzed: bisphenol A, mono (2-ethyl-5-hydroxyhexyl) phthalate, mono (2-ethyl-5-oxohexyl) phthalate, and mono-n-butyl phthalate. A total of 35 female participants enrolled in the study, including 20 asthmatic patients and 15 healthy controls. The average concentrations of urinary endocrine disruptors in patient and control group did not demonstrate significant differences. Twenty asthmatic patients were divided into 2 groups according to their menstrual state. Using the Spearman rank correlation test in premenopausal asthmatic patients (n = 7), we found negative correlations between urinary concentration of mono-n-butyl phthalate and asthma control test score, as well as postbronchodilator forced expiratory flow at 25% to 75% of forced vital capacity (P-value = .007 and .04, respectively). In contrast, it did not show any correlation with asthma control test or postbronchodilator forced expiratory flow at 25% to 75% of forced vital capacity (P-value = 1.00 and .74, respectively) in postmenopausal group (n = 13). Endocrine disruptors might have an impact on the decline of small airway function and asthma management among premenopausal, but not postmenopausal, female asthmatic patients.
Unveiling the influence of circulating immune cells count on type 1 diabetes: Insight from bidirectional Mendelian randomization
Authors: Luo Jia , Wang Jing , Xiang Yukun , Wang Ningning , Zhao Xin , Liu GengYan , Liu Lihui , Chang Haoxiao
Published: September 2024

Observational studies have demonstrated an association between circulating immune cell and type 1 diabetes (T1D) risk. However, it is unknown whether this relationship is causal. Herein, we adopted a 2-sample bidirectional Mendelian randomization study to figure out whether circulating immune cell profiles causally impact T1D liability. Summary statistical data were obtained from genome-wide association study (GWAS) to investigate the causal relationship between white cell (WBC) count, 5 specific WBC count, and lymphocyte subtypes cell count and T1D risk. After false discovery rate (FDR) correction, the results indicated that lower lymphocyte cell count (odds ratio [OR] per 1 standard deviation [SD] decrease = 0.746, 95% confidence interval (CI): 0.673–0.828, P
FDR = 0.036), and basophil cell count (OR per 1 SD decrease = 0.808, 95% CI: 0.700–0.932, P
FDR = 0.010) were causally associated with T1D susceptibility. However, the absolute count of WBC, monocyte, neutrophil, eosinophil, and lymphocyte subtypes cell had no statistically significant effect on T1D risk. Taken together, this study indicates suggestive association between circulating immune cell count and T1D. Moreover, lower numbers of circulating lymphocyte and basophil cell were associated with the increased risk of T1D, which confirmed the immunity predisposition for T1D.
Comparison of the value of ultrasound-guided fine needle aspiration biopsy and contrast-enhanced ultrasound in different sizes of thyroid nodules
Authors: Liu Qi , Ouyang Liquan , Zhang Shengchu , Yang Yuxia
Published: September 2024

The purpose of this study was to evaluate the diagnostic value of ultrasound-guided fine needle aspiration biopsy (US-FNAB) and contrast-enhanced ultrasound (CEUS) in the presence of thyroid nodules of different sizes. We retrospectively analyzed 110 patients with surgically operated unimodular thyroid nodules in Yichang City Central Hospital from July 1, 2021, to April 1, 2023, all of whom underwent conventional thyroid ultrasound, CEUS, and US-FNAB, and all of whom were classified according to the size of nodules into <0.5, 0.5 to 1, and ≥1 cm groups. The diagnostic accuracy, sensitivity, and specificity of the 2 methods for benign and malignant nodules were calculated. Among 110 thyroid nodules, 102 were malignant nodules and 8 were benign nodules. In patients with nodule diameters <1 cm the sensitivity of US-FNAB and CEUS was 87.02% and 93.89%, respectively, and the specificity was 100.00% and 66.67%, with an accuracy of 87.31% and 93.28%, respectively. In patients with nodule diameter <0.5 cm, the sensitivities of US-FNAB and CEUS were 74.29% and 100.00%, respectively, and the differences were statistically significant (P < 0.05); in patients with nodule diameter 0.5 to 1 cm, the sensitivities of US-FNAB and CEUS were 79.59% and 95.92%, respectively, and the differences were statistically significant (P < 0.05); among patients with nodule diameters ≥1 cm, the sensitivities of US-FNAB and CEUS were 88.89% and 77.78%, respectively, with no statistically significant difference (P > 0.05). For thyroid nodules ≤1 cm in diameter, the sensitivity of CEUS examination was higher than that of US-FNAB; and CEUS still has good diagnostic accuracy in the diagnosis of benign and malignant thyroid nodules <0.5 cm, CEUS is recommended for thyroid nodules diagnosed negatively by US-FNAB with a diameter of <1 cm; and CEUS should be preferred for thyroid nodules with a diameter of <0.5 cm. CEUS should be preferred for thyroid nodules <0.5 cm in diameter.
Effect of preoperative oral nutritional supplements on clinical outcomes in patients undergoing surgery for gastrointestinal cancer: A systematic review and meta-analysis
Authors: Zou QingHua , Yin ZhaoChuan , Ding LiLi , Ruan Jiang , Zhao GuoYun , Wang XiaoQiong , Li YiJun , Xu QingWen , Gong XueJing , Liu WenShuo , Shi KaiWen , Li WeiMing
Published: September 2024

Background:

The clinical benefit of preoperative oral nutritional supplements (ONS) in patients undergoing surgery for gastrointestinal cancer remains controversial.

Objective:

To evaluate the effect of preoperative ONS on postoperative clinical outcomes in patients with gastrointestinal cancer.

Methods:

We searched PubMed, EMBASE, Web of Science, Cochrane Library, Scopus, and the Chinese National Knowledge Infrastructure databases for randomized controlled trials evaluating preoperative ONS in patients undergoing surgery for gastrointestinal cancer from inception until April 2024. Two researchers independently assessed the quality of the included literature and performed statistical analyses using Review Manager 5.4 software.

Results:

A total of 12 eligible studies with 1201 patients (600 ONS group and 601 control group) were included in this meta-analysis. Compared with a normal diet, preoperative ONS effectively reduced infectious complications (odds ratio = 0.63; 95% confidence interval [CI], 0.40–0.98; P = .04), white blood cell count (mean difference [MD] = −0.66; 95% CI, −1.04 to −0.28; P = .0007), C-reactive protein (MD = −0.26; 95% CI, −0.33 to −0.19; P < .00001), and markedly improved albumin levels (MD = 1.71; 95% CI, 0.97–2.46; P < .00001), prealbumin (MD = 24.80; 95% CI, 1.72–47.88; P = .04), immunoglobulin G (MD = 0.86; 95% CI, 0.44–1.28; P < .00001), CD4 T lymphocyte cells (MD = 3.06; 95% CI, 2.21–3.92; P < .00001), and CD4 T lymphocyte cells/CD8 T lymphocyte cells (MD = 0.33; 95% CI, 0.10–0.56; P = .004). However, there were no significant differences between the 2 groups in terms of noninfectious complications (odds ratio = 0.77; 95% CI, 0.39–1.53; P = .46), immunoglobulin A (MD = −0.21; 95% CI, −0.44 to 0.02; P = .08) or length of hospital stay (MD = −0.04; 95% CI, −0.71 to 0.64; P = .92).

Conclusion:

Preoperative ONS may effectively reduce postoperative infectious complications, improve postoperative nutritional status and immune function, and relieve the inflammatory response in gastrointestinal cancer patients. Therefore, we recommend that preoperative nutrition could be optimized with ONS in patients undergoing gastrointestinal cancer surgery.
Triple-negative breast cancer treatment with core-shell Magnetic@Platinium-Metal organic framework/epirubicin nano-platforms for chemo-photodynamic based combinational therapy: A review
Authors: Xu Kangjie , Zhang Yanhua , Cheng Hui , Chen Weipeng , Chen Cheng , Zhang Minglei , Song He , Wang Feng
Published: September 2024

The combination of chemotherapy and photodynamic therapy (PDT), enabled by core-shell nano-platforms, is a promising method to improve cancer therapy by overcoming hypoxia and boosting drug penetration in breast tumor. Core-shell magnetic (iron oxide: Fe3O4)@platinum-metal organic framework/epirubicin (abbreviated as M@Pt-MOF/EPI) nano-platform is considered an effective cancer therapeutic agent. Relatively small particle size, round shape, and specific response to pH, are the key features of these nanomaterials to be used as promising therapeutic agents. Chemotherapy and photodynamic therapy, when applied in addition to the anticancer effects of nanomaterials, further enhance the therapeutic efficacy. The extensive use, utilization, and efficacy of Core-Shell Magnetic@Platinium-Metal Organic Framework/epirubicin Nano-Platforms for chemo-photodynamic combination therapy in the treatment of several cancers, including triple-negative breast cancer, are examined in this in-depth investigation.
Large-cell neuroendocrine carcinoma of the bile duct: Case report of surgical treatment and adjuvant chemotherapy of 2 cases
Authors: Seo Chang Ho , Choi Ho Joong
Published: September 2024

Rationale:

Neuroendocrine carcinoma originating from extrahepatic bile duct is very rare, and only a few cases have been reported. Because of its scarcity of incidence, not much is known about the disease but for its aggressiveness and poor prognosis.

Patient concerns:

In this report, we present 2 cases of large cell neuroendocrine carcinoma (LCNEC) originating from extrahepatic bile duct. Case 1: a 60-year-old woman presented with jaundice but no abdominal pain. Case 2: a 67-year-old man also presented with jaundice, along with abdominal discomfort and appetite loss.

Diagnoses:

Case 1: LCNEC with a focal adenocarcinoma component (pT2aN1M0, pStage IIIB). Case 2: LCNEC with a focal adenocarcinoma component (pT1N1M0, pStage IIB).

Interventions:

Case 1: the patient underwent left hepatectomy and caudatectomy with hepaticojejunostomy, followed by 6 cycles of adjuvant chemotherapy (etoposide and cisplatin). Case 2: the patient underwent laparoscopic pylorus–preserving pancreatoduodenectomy, followed by 6 cycles of adjuvant chemotherapy (etoposide and cisplatin).

Outcomes:

Case 1: liver metastasis was detected 6 months postoperatively, and despite multiple chemotherapy regimens, the patient died 24 months post-surgery. Case 2: liver metastasis was detected 23 months postoperatively. The patient is still alive 36 months post-surgery after receiving multiple chemotherapy regimens and radiotherapy.

Lessons:

Given the rarity of LCNEC, it is essential to continue collecting and reporting additional case studies to build a more comprehensive understanding of the disease. Although the prognosis for LCNEC is generally poor, the use of a multidisciplinary approach and further research will be critical in developing more effective treatment strategies in the future.
Left anomalous coronary artery originating from the opposite sinus causes acute myocardial infarction with syncope in a young woman: A case report
Authors: Zhang Cheng , Shi Dan
Published: September 2024

Rationale:

The left anomalous coronary artery originating from the opposite sinus represents a distinct subtype of anomalous coronary arteries originating from the opposite sinus. A comprehensive overview encompassing clinical characteristics, diagnostic approaches, and treatment modalities for this condition is presented herein.

Patient concerns:

The patient, a 17-year-old female, was admitted to the hospital due to chest pain and syncope following multiple exercises.

Diagnoses:

After conducting an electrocardiogram, myocardial injury markers, and echocardiography, she was diagnosed with acute myocardial infarction complicated by syncope. Further examinations including coronary angiography, coronary computed tomography angiography, and cardiac magnetic resonance imaging revealed an anomalous origin of the coronary artery with the left coronary artery (LCA) arising from the right sinus and exhibited intramural course.

Interventions:

The coronary “unroofing” technique was admitted according to her characteristics. The patient achieved successful recovery after surgery with no recurrence of chest pain or syncope during 1 year of follow-up.

Outcomes:

Anomalous origin of the LCA is a rare congenital anatomical anomaly. Surgical intervention represents the primary approach for subsequent management of symptomatic anomalous origin of the coronary artery. Importantly, individuals with anomalous origin of the LCA from the right coronary sinus are at potential risk of sudden cardiac death.

Lessons:

Therefore, enhancing diagnostic precision and actively pursuing surgical treatment in confirmed diagnoses can effectively mitigate myocardial ischemia and prevent instances of sudden cardiac death among adolescents and athletes.
Identification of potential core genes in lung cancer and therapeutic traditional Chinese medicine compounds using bioinformatics analysis
Authors: Zhang Yue , Wang Yaguang , Zhang Xuepu , Liu Jiansheng
Published: September 2024

Lung cancer (LC) remains the leading cause of cancer-related death. We identified potential therapeutic targets and traditional Chinese medicine (TCM) compounds for LC treatment. GSE43346 and GSE18842 were derived from the Gene Expression Omnibus (GEO) database and used to identify differentially expressed genes (DEGs). Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed using The Database for Annotation, Visualization and Integrated Discovery (DAVID). Protein–protein interactions were analyzed using STRING and Cytoscape software. Hub gene expression was validated using Gene Expression Profiling Interactive Analysis and the Human Protein Atlas. Kaplan–Meier survival analysis was conducted to evaluate the prognostic value of hub genes in patients with LC. Therapeutic TCM compounds were screened using the Comparative Toxicogenomics Database, and DEGs were largely enriched in biological processes, including cell division and mitotic nuclear division, such as the cell cycle and p53 signaling pathways. Elevated expression of hub genes was observed in LC samples. Overexpression ofCDC20,CCNB2, andTOP2Ais an unfavorable prognostic factor for postprogressive survival in patients with LC. Paclitaxel, quercetin, and rotenone have been identified as active substances in TCM.CDC20,CCNB2, andTOP2Aare novel hub genes associated with LC. Paclitaxel, quercetin, and rotenone can be used as therapeutic agents in TCM.
Investigating soluble CD40 ligand as a prognostic factor among acute coronary syndromes patients: A multi-center prospective case-control study
Authors: Nofal Reham , Martini Nafiza , Hanna Majd , Almasri Imad-Addin , Alsaadi Ahmad Rasheed , Ali Tahani
Published: September 2024

Soluble CD40 ligand (sCD40L) is a protein that plays a crucial role in the inflammatory response associated with the development and progression of acute coronary syndrome (ACS). Recent studies have suggested that sCD40L may be a useful prognostic factor for ACS, but the data are conflicting. This study aimed to investigate the potential of sCD40L as a prognostic marker among ACS patients and provide valuable insights for clinical practice. To our knowledge, this is the first study of its type in the Arabic World. A multi-center prospective case-control study was conducted in Damascus, Syria, involving 158 participants with different ACS subtypes (STEMI, NSTEMI, UA) and a control group of healthy individuals. Sociodemographic data, medical history, and sCD40L levels were collected. The predictive ability of sCD40L for ACS, STEMI, NSTEMI, and UA was assessed using receiver operating characteristic (ROC) curves. Statistical analysis was performed using IBM SPSS version 25. The study included 58 STEMI, 33 NSTEMI, 36 UA patients, and 30 healthy individuals. The mean age of participants was 55 years (SD 10.7 years). Analysis of sCD40L levels revealed significantly higher concentrations in ACS patients compared to the control group (P < .001). ROC curve analysis demonstrated that sCD40L had a significant predictive ability for ACS, STEMI, and NSTEMI (P < .05), while its predictive value for UA was not statistically significant. This study provides evidence supporting the potential of sCD40L as a prognostic factor in ACS. The elevated levels of sCD40L observed in these subtypes indicate its potential usefulness in risk stratification and predicting adverse cardiovascular events. Further investigations are warranted to establish standardized sCD40L cutoff values and evaluate its clinical implications in the management of ACS patients.
Longitudinal Fatigue Symptoms and Inflammatory Markers in African American Adults With Hypertension and Obstructive Sleep Apnea
Authors: Giordano Nicholas A. , Houser Madelyn C. , Pelkmans Jordan , Pasquel Francisco J. , Pak Victoria , Rogers Ann E. , Yeager Katherine A. , Mucha Susan , Schmitt Matthew , Miller Andrew H.
Published: September 2024

Background

There is a dearth of research inclusive of African American adults living with obstructive sleep apnea (OSA) despite differences in symptom presentations compared to non-Hispanic White patient populations. Less is known regarding the potential effect of comorbidities, including hypertension, on commonly reported symptoms, such as fatigue, and their association with inflammatory biomarkers.

Objective

This longitudinal pilot study aimed to characterize fatigue symptom presentations among African American adults newly diagnosed with OSA and discern peripheral blood analytes linked to symptoms while accounting for co-occurring hypertension.

Methods

African American adults newly diagnosed with OSA with and without co-occurring hypertension were approached by study staff and recruited following their diagnostic visit with sleep medicine clinicians at two health systems and followed over 6 months after commencing continuous positive airway pressure treatment. Patient-Reported Outcomes Measurement Information System Fatigue surveys and plasma were collected every 3 months from 29 participants. Mixed-effects models examined changes in fatigue symptom presentations over time while accounting for plasma-based analytes and hypertension status.

Results

Despite higher fatigue symptom severity upon diagnosis, participants with co-occurring hypertension reported greater improvements in fatigue scores after commencing continuous positive airway pressure treatment for up to 6 months than those without hypertension. Inverse correlations were observed between fatigue scores, C-reactive protein, matrix metalloproteinase-8, and osteoprotegerin analyte levels among participants with/without hypertension. Across all participants, changes in interleukin-6 were associated with changes in fatigue scores in the first 3 months after diagnosis.

Discussion

Findings indicate that hypertension is linked to increased fatigue upon diagnosis of OSA in this sample of African American adults. Fatigue in persons with hypertension improved after treatment in this sample. These hypothesis-generating findings can inform future interventional studies aimed at improving fatigue among persons with OSA while leveraging markers linked to fatigue symptom severity as potential objective markers of improvements. Further research on the role of inflammatory markers, such as IL-6, on fatigue symptom presentations is warranted in persons with OSA.
Isolated Primary Central Nervous System Lymphoma of the Optic Nerve
Authors: Jain Keertana , Volpe Nicholas J. , Dixit Karan
Published: September 2024

Introduction:

Optic nerve involvement in primary central nervous system lymphoma (PCNSL) has been reported only a few times in the literature, with generally dismal outcomes. We focused on an extremely rare presentation of PCNSL in an immunocompetent patient with isolated manifestations of the optic nerve.

Case Report:

A 72-year-old man presented with subacute vision loss in his left eye and optic disc swelling. Initial magnetic resonance imaging (MRI) of the orbits revealed a T2 hyperintense signal with enhancement of the left prechiasmatic optic nerve, suggestive of optic neuritis. He experienced visual improvement after 6 weeks of prednisone. However, 2 months after steroid tapering, he presented with worsening left-eye vision loss and new right-eye vision loss with imaging showing a peripherally enhancing chiasm lesion. A biopsy of the left optic nerve confirmed diffuse large B-cell lymphoma and negative systemic imaging was consistent with PCNSL. He was treated with high-dose methotrexate, rituximab, procarbazine vincristine (R-MVP), and cytarabine (AraC) with some visual improvement in the right eye and resolution of previously seen enhancement on MRI. The patient is in remission with no further deterioration of his vision.

Conclusion:

This is the first reported case of isolated optic nerve involvement with a durable response to chemotherapy. This case emphasizes the importance of considering malignancy and maintaining a low threshold for optic nerve biopsy in patients with atypical cases of severe steroid-refractory vision loss with enhancement or enlargement of the optic nerve on MRI. Standard chemotherapy regimens for PCNSL can potentially achieve a curative response in these patients.
Accessibility of Criteria to Exit Cervical Cancer Screening at Age 65 Years in the Electronic Health Record
Authors: Alimena Stephanie , Lykken Jacquelyn M. , Tiro Jasmin A. , Chubak Jessica , Haas Jennifer S. , Werner Claudia , Kobrin Sarah C. , Silver Michelle I. , Perkins Rebecca B. , Feldman Sarah
Published: September 2024

OBJECTIVE:

To describe the proportion of patients with documentation of meeting cervical cancer screening exit criteria in the medical record and to estimate the incidence of cancer and high-grade precancerous lesions after age 65 years detected by the end of the study period, by screening exit eligibility.

METHODS:

We conducted a retrospective analysis of patients who turned 66 years old between 2010 and 2019 at two large health care systems located in Dallas, Texas, and Boston, Massachusetts, from the METRICS (MultilEvel opTimization of the ceRvIcal Cancer Screening process in diverse Settings & populations) Research Center, part of the PROSPR II (Population-based Research to Optimize the Screening Process) consortium. The primary outcomes were 1) the percentage of patients who were eligible for screening exit at age 66 years after adequate documented negative screening history (at least three consecutive negative cytology test results or two consecutive negative human papillomavirus [HPV] test or co-test results [cytology+HPV testing] within the prior 10 years) and 2) the worst pathology or cytology outcome documented in the cohort after age 65 years.

RESULTS:

Among 42,393 people who turned 66 years old while in the METRICS cohort, approximately 75.7% (n=32,094) were not eligible to exit screening at age 66 years, primarily because too few screening tests were documented (n=29,354, 91.5% of those ineligible). Furthermore, only 4,037 patients at both sites had 10 years of prior observation within the health care system, meaning data from current and prior health care delivery sites would be needed to assess exit eligibility for more than 90% of the cohort. Patients remained in the cohort after their 66th birthday on average for 3.8 years (interquartile range 2.0–6.5 years), and most (79.3%) had no subsequent evaluation after their 66th birthday. Among those ineligible to exit due to insufficient screening history, 83.7% were not subsequently screened. Of the 16.3% who were screened, 90 (1.9%) were diagnosed with cancer or high-grade precancerous lesions, including 34 (0.7%) who were diagnosed with cervical cancer. By contrast, among patients eligible to exit with sufficient screening history, 34.3% had at least one subsequent cytology or pathology result or both, and high-grade precancerous lesions or cervical cancer were diagnosed in only 0.6% (n=16).

CONCLUSION:

Data documented in the medical record are often insufficient to meet guidelines for exiting cervical cancer screening.
Biomechanical effect between conventional and 3-dimensional printed customized foot orthoses on medial longitudinal arch support and rearfoot angle in adults with flexible flatfeet
Authors: Praewpipat Bongkoch , Ehara Yoshihiro , Kosorn Wasana , Nampichai Nutdanai
Published: September 2024

Background:

Customized foot orthoses are used to treat flexible flatfoot regarding medial longitudinal arch (MLA) support, alignment correction, and pain management. Recently, 3-dimensional (3D) printing orthosis has become the focus of discussion regarding function and manufacturing. We aimed to investigate differences in biomechanical effects between flat insole (Flat), conventional foot orthosis (Cinsole), and 3D printed foot orthosis (3Dinsole) use on MLA support and rearfoot alignment during walking in adult flexible flatfeet.

Methods:

Twelve men with flexible flatfoot were recruited. Data were collected and analyzed using a Vicon motion capture system under 3 trial conditions: Flat and >1 month after using Cinsole and 3Dinsole. Repeated-measures analysis of variance with Bonferroni post hoc tests was used to compare kinematics variables, foot pain, and satisfaction.

Result:

Dynamic navicular drop significantly reduced with the use of the Cinsole and 3Dinsole compared with Flat (P < 0.001; ηp2 = 0.65). The maximum rearfoot eversion angle with the use of the Cinsole and 3Dinsole significantly reduced from Flat (P < 0.001; ηp2 = 0.56). Foot pain score significantly decreased after using foot orthoses; satisfaction between Cinsole and 3Dinsole was not significantly different.

Conclusions:

Thus, Cinsole and 3Dinsole are effective alternative treatments of MLA support and rearfoot alignment in adults with flexible flatfoot. 3D printing is a future technology with potential to replace conventional production methods. However, material characteristics, design, and manufacturing process can affect treatment outcomes; hence, our results may not represent all variations of 3D printed foot orthoses.
Evaluation of Rehabilitation Techniques for Traumatic Ulnar Nerve Injuries After Surgical Repair
Authors: Sim Danielle , Kuo Keith T. , Rodriguez-Silva Waldemar , Seal Stella , Filippi Lourdes , Tuffaha Sami , Elhelali Ala
Published: September 2024

Background

Traumatic ulnar nerve injuries often result in significant loss of motor and sensory function, negatively impacting patients' quality of life. Physical rehabilitation is crucial for recovery, but standardized treatment protocols are lacking. This study aims to systematically review rehabilitation techniques to identify future research direction and improve existing protocols for ulnar nerve injury patients.

Methods

PubMed, Embase, CINAHL, Cochrane CENTRAL, Web of Science, and Scopus were queried from inception until July 31, 2023. Articles containing axonotmesis or neurotmesis injuries of the ulnar nerve were included. Reviews, opinions, editorials, technical reports without clinical outcomes, conference abstracts, non-English text, nonhuman studies, and studies without adult patients were excluded. Three independent reviewers performed screening and data extraction using Covidence, and risk of bias assessments utilizing Cochrane and JBI tools. Because of article heterogeneity, a narrative review was conducted. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database, registration number CRD42023442016.

Results

This systematic review included one randomized controlled trial and four observational studies (103 patients), which exhibited differences in study quality. Overall, motor and sensory outcomes improved after rehabilitation. Rehabilitation techniques varied widely, and early sensory reeducation appeared to improve sensory function. Only two studies included patient-reported outcomes.

Conclusions

Diverse rehabilitation techniques are used to address ulnar nerve injuries. The low number of included studies, differences in study quality, and small sample size underscore the need for larger and more inclusive studies to improve functional recovery after ulnar nerve injuries. Future research should consider the impact of patient and injury characteristics to develop comprehensive treatment guidelines for these patients.
Resuscitative endovascular balloon occlusion of the aorta in the patient with obesity
Authors: Loe Mallory , Broome Jacob M. , Mueller Lauren , Simpson John T. , Tatum Danielle , McGrew Patrick , Taghavi Sharven , Jackson-Weaver Olan , DuBose Joseph , Duchesne Juan
Published: September 2024

BACKGROUND

Palpation of anatomic landmarks is difficult in patients with obesity, which could increase difficulty of achieving femoral access and resuscitative endovascular balloon occlusion of the aorta (REBOA) placement. The primary aim of this study was to examine the association between obesity and successful REBOA placement. We hypothesized that higher body mass index (BMI) would decrease first-attempt success and increase time to successful aortic occlusion (AO).

METHODS

A review of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry was performed on patients who underwent REBOA placement with initiation systolic blood pressure >0 mm Hg from years 2013–2022. Patients were excluded if they received cardiopulmonary resuscitation on arrival, underwent open AO, or missing data entries for variables of interest. Body mass index categorization was as follows: non-obese (<30), class I (30–34.9), class II (35–39.9), and class III (40+) obesity. Patients were also stratified by access technique, including use of palpation or ultrasound guidance.

RESULTS

Inclusion criteria were met by 410 patients. On binary analysis, no primary outcomes of interest, including rate of success, time to placement, or mortality, were significantly impacted by BMI. Among BMI subgroups, there was no statistical difference in injury severity, admission systolic blood pressure (SBP), or augmented SBP. At initiation of aortic occlusion, patients with class II and class III obesity had higher median SBP compared with non- and class I obese patients (p = 0.03). Body mass index subgroup did not impact likelihood of first-attempt success or conversion to open procedure. When stratified by access technique, there was no difference in success rates, time to success or mortality between groups.

CONCLUSION

Body habitus did not impact success of REBOA placement, time to successful AO, or mortality. Further, ultrasound guidance was not superior to landmark palpation for arterial access. Following traumatic injury without hemodynamic collapse, obesity should not deter providers from considering REBOA placement.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
When more is more: Utilizing finite element analysis to assess chest wall injury stability after surgical stabilization of all rib fractures versus only a portion of the rib fractures
Authors: Bauman Zachary M. , Herrman Sven , Cantrell Emily , Khan Hason , Koval Gregory , Evans Charity H. , Kamien Andrew , Cemaj Samuel , Sheppard Olabisi , Lamb Gina , Veatch Jessica , Matos Mike , Nguyen Jonathan , White Thomas W.
Published: September 2024

BACKGROUND

Surgical stabilization of rib fractures (SSRF) continues to gain acceptance. Controversary exists around the number of rib fractures needing stabilization. We sought to analyze chest wall stability (CWS) after SSRF using finite element analysis (FEA) modeling in various rib fracture patterns, hypothesizing not stabilizing all fractures leaves the chest wall unstable.

METHODS

FEA thoracic model development was described previously. Two fracture patterns with three case scenarios each were defined for right ribs 4 to 9. Fracture Pattern 1; Case 1–all 6 ribs with lateral fractures and no stabilization; Case 2—all six fractures stabilized; Case 3–only fractures 5 to 7 were stabilized. Fracture Pattern 2; Case 4–all six ribs fractured in a flail pattern (anterior-lateral and posterior-lateral) and no stabilization; Case 5—all 12 fractures stabilized; Case 6—only six anterior-lateral fractures were stabilized. Three assessment criteria were used to quantify thoracic motion: normalized mean absolute error (NMAE), normalized root mean square error (NRMSE), and normalized interfragmentary motion (NIFM).

RESULTS

Fracture Pattern 1: Case 1—NMAE and NRMSE analysis demonstrated significant loss of CWS up to 50% with left axial rotation; Case 2—CWS almost completely returned to nonfractured state; Case 3—CWS loss up to 37%. Fracture Pattern 2: Case 4—up to 49% of CWS lost with right axial rotation; Case 5—less than 3% CWS lost; Case 6—over 40% CWS lost. For both fracture patterns, when stabilizing all fractures, NIFM decreased by 95%. In Case 3, NIFM decreased by 56% and in Case 6, NIFM increased by 1% at the non-stabilized fracture line.

CONCLUSION

Stabilizing all rib fractures significantly improves CWS. Not stabilizing both fractures of a flail segment worsens motion at the non-stabilized fractures.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
Whole-genome sequences of marine bacteria presenting the ability to promote the growth of the diatom Phaeodactylum tricornutum
Authors: Martins Rodrigo , Bertrand Constança D.F. , Quintas-Nunes Francisco , Reynolds-Brandão Pedro , Barreto Crespo Maria T. , Nascimento Francisco X.
Published: September 2024

We describe the whole-genome sequences of seven diverse marine bacteria isolated from Portuguese environments that presented the ability to promote the growth of the model diatom, Phaeodactylum tricornutum. The bacterial genome sequences will contribute to the study of genetic and molecular mechanisms involved in diatom–bacteria interactions.
Isolation and molecular detection of Newcastle Virus in an outbreak of poultry disease in a private farm in Rano, Rano Local Government, Kano, Nigeria
Authors: Modupe Saliu Hadiyat , Abraham-Oyiguh Joseph , Omatola Cornelius Arome , Yusuf Lamidi , Victoria Opaluwa Ede , Akpala Sumaila Ndah , Eneye Kizito Bello
Published: September 2024

Newcastle disease is a highly contagious disease among poultry birds and a major constraint in poultry production. Despite frequent vaccination, the virus keeps circulating among vaccinated and unvaccinated birds. Our study determined the prevalence of Newcastle Disease Virus in poultry Chicken and by molecular confirmation of the isolates obtained from poultry farms in Rano, Rano Local Government Area, Kano state. In this study, Cloacal samples were collected from 120 diseased poultry chickens for isolation of NDV in 9-13-day old specific pathogen free fertile hens’ eggs. Positive NDV was further detected in positive samples with molecular techniques using F-gene. The virus was isolated from some samples with the prevalence rate of 73.33%. This study revealed circulation of NDV in poultry birds in Kano. This highlights the need for stringent NDV control programs to reduce or eliminate the circulation of the virus in this province.