bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-effectiveness analysis of anticoagulation, percutaneous mechanical thrombectomy, and catheter-directed thrombolysis treatments for acute lower extremity deep venous thrombosis
Authors: Zou Jun , Ye Qianling , Zhao Bin , Hu Chenming , Li Xiang , Wu Huaping
Published: October 2024

Background:

There is a lack of health economics studies on the treatment of acute lower extremity deep venous thrombosis to measure the benefits to patients. The purpose of this study was to evaluate the cost-effectiveness of anticoagulation (AC), percutaneous mechanical thrombectomy (PMT), and catheter-directed thrombolysis (CDT).

Methods:

The above 3 methods were selected according to the patient’s treatment wishes. Related complications, clinical effective, occurrence of post-thrombotic syndrome (PTS) after 2 years, and total hospitalization costs of patients between the patients in these 3 treatment groups were analyzed. In the cost-effectiveness analysis, costs were expressed in monetary terms and the effect was expressed as the effective rate of clinical treatment. In addition, we used sensitivity analyses to validate the results.

Results:

The effective rate of clinical treatment for the AC, CDT, and PMT groups were 44.23%, 86.84%, and 92.59%, respectively. No serious complications occurred in any of the treated patients. There was no significant difference in the incidence of PTS among the 3 groups during the follow-up period. After 12 months, compared with the AC group, there were statistically significant differences in moderate-severe reduction in PMT group and CDT group separately. At 24 months, the incidence of moderate-severe disease in PMT group was significantly lower than that in CDT group.

Conclusion:

All 3 treatment methods have good safety. Compared with AC therapy alone, both PMT and CDT therapy resulted in a higher clinical efficacy rate, reduced the severity of PTS within 2 years, and reduced the cost of PTS. From the perspective of the cost-effectiveness ratio, within a certain range of treatment efficacy, AC therapy alone incurs the lowest cost per 1% improvement in therapeutic effect. The cost-effectiveness results show that if decision-makers consider the standard for improving the cure rate of lower limb deep vein thrombosis by 1% to be lower than the ratio of incremental cost to effect, then AC therapy alone is chosen. If decision-makers consider the standard for improving the cure rate of lower limb deep vein thrombosis by 1% to be higher than the ratio of incremental cost to effect, then the choice is AC plus CDT treatment.
RNF144A as a potential risk gene for endometrial carcinoma: Insights from Mendelian randomization, bulk RNA sequencing, single-cell RNA, and experimental analysis
Authors: Ruan Xiqin , Wang Ni , Xie Qingwen , Du Yi
Published: October 2024

Endometrial carcinoma (EC) is a prevalent gynecological malignancy that poses a significant threat to women’s health worldwide. However, its pathogenesis and underlying mechanisms remains unclear. In this study, expression quantitative trait loci data, Mendelian randomization analysis, and differential expression analysis were performed to identify potential targets. A prognostic risk signature was subsequently constructed for EC patients based on the expression of these genes. Four bioinformatics algorithms, including generalized linear model, extreme gradient boosting, support vector machine, and random forest, were used to identify hub genes in EC. The expression of ring finger protein 144A (RNF144A) was validated using quantitative real-time polymerase chain reaction. Cellular proliferation and migration ability were evaluated using CCK-8 and Transwell assays, respectively. The genes RNF144A, ketohexokinase, and Rab interacting lysosomal protein like 2 were identified as potential targets for EC. Their differential expression was observed in EC patients, and Mendelian randomization analysis revealed a negative correlation between these genes and the development of EC. Mechanistic analyses suggested a strong association between these genes and the tumor immune microenvironment. The constructed risk signature was significantly associated with the prognosis, age, cancer stage, and grade of EC patients. Furthermore, based on interacted model algorithms, RNF144A was identified as a hub gene in EC. It was found to be significantly downregulated in EC samples, and its expression was positively correlated with the stage and grade of EC patients. In vitro experiments showed that overexpression of RNF144A significantly promoted cell growth and migration in EC cells. In conclusion, this study provides insights into the molecular mechanisms underlying EC progression and identifies preliminary candidate biomarkers for the development of EC treatment strategies.
IGFL2 expression and surgical volume: Independent predictors of survival in gastric cancer
Authors: Yao Zengwu , Wu Jinhui , Li Miaomiao , Han Junping , Chen Ruyue , Jian Mi , Yang Zhensong , Wang Xixun , Zhang Yifei , Hu Jinchen , Jiang Lixin
Published: October 2024

This study aimed to assess the impact of surgeons’ annual volume and insulin-like growth factor-like family member 2 (IGFL2) expression on gastric cancer prognosis. Clinicopathological data from 475 patients who underwent D2 lymph node dissection were analyzed. IGFL2 expression was evaluated using immunohistochemistry. Patients were divided into training (70%) and validation (30%) groups. Univariate and multivariate Cox regression identified risk factors for overall survival (OS) and disease-free survival (DFS), leading to a clinical prediction model. Model performance was evaluated using C-index. High IGFL2 expression and low surgical volume independently predicted poorer OS and DFS (hazard ratio = 2.13, 2.17, all P < .01). Surgeons performing >26 cases annually had higher OS and DFS (hazard ratio = 1.65, 1.58, all P < .01). Nomograms integrating surgical volume, IGFL2 expression, grade, TNM staging, and carcinoembryonic antigen showed superior predictive accuracy for OS and DFS compared to TNM alone, with robust C-indices and area under the curve values. Surgeons’ annual volume and IGFL2 expression independently predict gastric cancer prognosis, emphasizing the need for specialized training and further research on IGFL2’s molecular mechanisms to enhance patient outcomes.
Barriers and facilitators to narrative nursing implementation for junior nurses: A qualitative study
Authors: Zhang Li , Han Qiang , Nan Lin , Yang Huiyun
Published: October 2024

This study aimed to explore the experiences of barriers and facilitators to the implementation of narrative nursing by junior nurses. Participants were recruited using purposive sampling. Semi-structured interviews were conducted from October 2023 to February 2024. Data were thematically analyzed using the Colaizzi seven-step method. Five barriers and 3 facilitators to the implementation of narrative nursing by junior nurses emerged in the study. Relevant barriers include lack of practical skills related to narrative nursing, neglect of the concept of humanistic care, negative events, high workload for junior nurses, restricted implementation environment. The facilitators contain patients’ and family members’ trust, training related to knowledge and skills, as well as harmonious and cooperative working atmosphere. There is still room for improvement in the implementation of narrative nursing for junior nurses, and the systematic training of narrative nursing knowledge and skills should be enhanced; the medical humanistic environment should be optimized; and the psychological resilience of junior nurses should be improved, so as to encourage them to actively implement narrative nursing at the early stage of their careers, and to deepen the high-quality development of nursing humanism.
Autoimmune complications of tyrosine kinase inhibitors in cancer therapy: Clinical insights, mechanisms, and future perspectives
Authors: Shi Juan , Fu Qingyuan , Ma Quancheng , Wei Zhenzhen , Su Xiaolian , Li Xiao
Published: October 2024

The tyrosine kinase inhibitors (TKIs) have emerged as a promising class of novel anticancer drugs, achieving significant success in clinical applications. However, the risk of autoimmune diseases associated with these drugs has raised widespread concerns. In this review, TKI-induced autoimmune diseases are reviewed in order to understand this complex phenomenon through clinical research and molecular mechanism exploration. Despite the relatively low incidence of autoimmune diseases, their potential severity demands heightened attention. The potential mechanisms underlying TKI-induced autoimmune diseases may involve immune system dysregulation, alterations in immune cell function, activation of inflammatory responses, and attacks on self-antigens. Various preventive strategies, including clinical monitoring, personalized treatment, optimization of therapeutic approaches, and patient education and communication, can be employed to effectively address these potential risks. Future research directions should delve into the molecular mechanisms of TKI-induced autoimmune diseases, integrate studies on genetics and immunogenetics, advance the development of novel TKIs, explore the possibilities of combining immunotherapy with TKI treatment, and propel large-scale clinical trials.
An open comparative randomized prospective study: Direct trocar insertion vs Veress needle technique in laparoscopic surgeries
Authors: Erdem Baki , Erciyestepe Sezgi Güllü , Aldanmaz Barişcan , Salman Süleyman
Published: October 2024

Laparoscopy is a minimally invasive technique utilized for both diagnostic and surgical approaches. Minimally invasive procedures compared to laparotomy offer the advantages of reduced hospital stay, lower morbidity, decreased pain, and faster recovery. Common methods for laparoscopic entry include Veress needle insertion (VNI), direct optical trocar entry, direct trocar insertion (DTI), and the Hasson technique. This study aims to compare the efficacy and safety of VNI and DTI in laparoscopic gynecological surgeries. An open comparative randomized prospective study was conducted involving 200 women aged 18 to 70 years, scheduled for laparoscopic surgery at 2 tertiary centers. Participants were randomized into 2 groups: 1 using VNI and other using DTI. The groups were homogeneous regarding age, parity, and body mass index. The mean age of the VNI group is 45.22 ± 11.65 and the DTI group is 44.89 ± 10.5 (P = .833). There were no statistical significance in terms of the presence of chronic diseases and history of previous abdominal surgery between the groups (P = .802 and P = .510, respectively). Entry time to the abdomen, the decrease in hemoglobin values, and hospitalization length were found to be statistically significant between the entry methods (P < .001, P = .002, and P < .001, respectively). Entry time, the decrease in hemoglobin value, and hospitalization length were higher in the VNI group. In conclusion, although there is no definitive consensus on the optimal laparoscopic entry technique, direct trocar entry is an effective alternative to the Veress needle insertion technique. Direct trocar entry is associated with shorter entry times, fewer perioperative complications, less reduction in hemoglobin levels, and shorter hospitalization duration compared to VNI.
Association between PaO2/(FiO2*PEEP) ratio and in-hospital mortality in COVID-19 patients: A reanalysis of published data from Peru using PaO2/(FiO2*PEEP) ratio in place of PaO2/FaO2 ratio
Authors: Chen Youli , Li Huangen , Lin Jinhuang , Su Zhiwei , Lin Tianlai
Published: October 2024

P/FP [PaO2/(FiO2*PEEP)] is associated with in-hospital mortality in patients with acute respiratory distress syndrome (ARDS). However, to the best of our knowledge, the association between P/FP after 24 hours of invasive mechanical ventilation (IMV) and in-hospital mortality in patients with ARDS due to Coronavirus Disease 2019 (COVID-19) remained unclear. This study aimed to evaluate the relationship between the P/FP after 24 hours of IMV and in-hospital mortality in patients with ARDS due to COVID-19. We reanalyzed previously published data from Peru. Hueda-Zavaleta et al conducted a retrospective cohort study between April 2020 and April 2021 in southern Peru. A total of 200 hospitalized COVID-19 patients requiring IMV were included in this analysis. We used Cox proportional hazard regression models and Kaplan–Meier survival analysis to investigate the effect of P/FP after 24 hours of IMV on in-hospital mortality. We used a restricted cubic spline regression and a two-piecewise Cox proportional hazards model to explore the relationship between P/FP after 24 hours of IMV and in-hospital mortality in patients with ARDS due to COVID-19. Of the 200 patients, 51 (25.50%) died in hospital. The median P/FP was 20.45 mm Hg/cmH2O [interquartile range 15.79–25.21 mm Hg/cmH2O], with a range of 5.67 mm Hg/cmH2O to 51.21 mm Hg/cmH2O. Based on the P/FP ratio, patients were equally divided into 2 groups (low group [P/FP < 20.50 mm Hg/cmH2O] and high group [P/FP ≥ 20.50 mm Hg/cmH2O]). In-hospital mortality was lower in the high P/FP group than in the low P/FP group (12 [12%] vs 39 [39%]; unadjusted hazard ratio [HR]: 0.33, 95% confidence interval [CI]: 0.17–0.63; adjusted HR: 0.10, 95% CI: 0.02–0.47). We also found a nonlinear relationship between P/FP and in-hospital mortality. After adjusting for potential confounders, the HR was 0.67 (95% CI: 0.56–0.79) for P/FP ≤ 22 mm Hg/cmH2O and 1.10 (95% CI: 0.83–1.47) for P/FP > 22 mm Hg/cmH2O. In addition, lymphocytes ≤ 1 × 109/L and acute kidney failure had a higher risk of death. After adjusting for potential confounders, the P/FP after 24 hours of IMV was nonlinearly associated with in-hospital mortality in patients with ARDS due to COVID-19.
Identification of a seven-gene prognostic model for renal cell carcinoma associated with CD8+T lymphocyte cell
Authors: Liu Jingbang , Jiang Tao
Published: October 2024

CD8+ T lymphocytes are important elements of the tumor microenvironment, hence their involvement in the development and progression of tumors is complex. Data on the precise tumor-infiltrating lymphocytes gene signature in renal cell carcinoma (RCC) remain limited. Therefore, this study created a tumor-infiltrating lymphocytes-related predictive model for patients with RCC using data from The Cancer Genome Atlas. The most important genes associated with CD8 + T lymphocytes were identified using weighted gene co-expression network analysis. Functional categories of important genes were revealed using gene ontology enrichment and Kyoto Encyclopedia of Genes and Genomes signaling pathway analyses. A CD8 + T lymphocyte-related prognostic model with 7 important genes was simultaneously created using the least absolute shrinkage and selection operator, univariate and multivariate Cox regressions, and the 7 genes were expressed particularly in CD8 + T lymphocytes according to single-cell sequencing data obtained from the Gene Expression Omnibus. This study identified a seven-gene prognostic model associated with CD8 + T lymphocytes that may significantly influence risk stratification in patients with RCC. The genes included in the model are apolipoprotein B mRNA editing catalytic polypeptide 3G, CD3 gamma, eomesodermin, protein tyrosine phosphatase, non-receptor type 7, signal regulatory protein gamma, Fas ligand, and T-cell immunoreceptor with Ig and ITIM domains.
Endoscopic ultrasound-guided gastroenterostomy versus duodenal stenting for gastric outlet obstruction: A systematic review, meta-analysis, and meta-regression
Authors: Jain Hritvik , Dey Debankur , Odat Ramez M. , Hussein Ayham Mohammad , Abbasi Haleema Qayyum , Madaan Hritik , Goyal Aman , Jain Jyoti , Ahmed Mushood , Marsool Mohammed Dheyaa Marsool , Yadav Rukesh
Published: October 2024

Background:

Gastric outlet obstruction (GOO) refers to mechanical obstruction at the level of the gastric outlet and is associated with significantly impacted quality of life and mortality. Duodenal stenting (DS) offers a minimally invasive approach to managing GOO but is associated with a high risk of stent obstruction. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel intervention that uses lumen-apposing metal stents to open the restricted lumen. The current evidence comparing EUS-GE to DS is limited and inconsistent.

Methods:

We conducted a systematic literature search on PubMed, Embase, Cochrane, Scopus, and clinicaltrials.gov to retrieve studies comparing EUS-GE to DS for GOO. Odds ratios (OR) and mean differences (MD) with their 95% confidence intervals (CI) were pooled using the DerSimonian-Laird inverse variance random-effects model. Statistical significance was set at P < .05.

Results:

Ten studies with a total of 1275 GOO patients (585: EUS-GE and 690: DS) were included. EUS-GE was associated with statistically significant higher clinical success [OR: 2.52; 95% CI: 1.64, 3.86; P < .001], lower re-intervention rate [OR: 0.12; 95% CI: 0.06, 0.22; P < .00001], longer procedural time [MD: 20.91; 95% CI: 15.48, 26.35; P < .00001], and lower risk of adverse events [OR: 0.49; 95% CI: 0.29, 0.82; P = .007] than DS. Technical success [OR: 0.62; 95% CI: 0.31, 1.25] and the length of hospital stay [MD: −2.12; 95% CI: −5.23, 0.98] were comparable between the 2 groups.

Conclusion:

EUS-GE is associated with higher clinical success, longer total procedural time, lower re-intervention rate, and lower risk of adverse events than DS. Technical success and the length of hospital stay were comparable between the 2 groups. EUS-GE appears to be a safe and effective procedure for managing GOO. Further large, multicentric randomized controlled trials are warranted to investigate the safety and outcomes of EUS-GE in patients with malignant GOO.
Association between serum globulins and diabetes mellitus in American latent tuberculosis infection patients: A cross-sectional study
Authors: Gao Yan , Wang Yiguo , Zhang Qiming , Gao Yu
Published: October 2024

Diabetes mellitus (DM) is predisposing to the development of latent tuberculosis infection (LTBI). An understanding of the underlying factors of LTBI–DM is important for tuberculosis prevention and control. This study aims to evaluate the association between LTBI and DM among the noninstitutionalized civilian population in the United States, focusing on the impact of serum globulins. We performed a cross-sectional study design using public data from 2011 to 2012 National Health and Nutrition Examination Survey, focusing on participants diagnosed with LTBI who were aged 20 and above. Weighted Wilcoxon rank-sum and weighted chi-square tests were used to compare group differences. A multivariable logistic regression model was constructed to assess the association between serum globulin and DM, with subgroup analyses and evaluations of nonlinear relationships. Receiver operating characteristic curves were used to assess the predictive power of the models. A total of 694 participants (512 DM and 182 nonDM) were included in our study and the incidence of DM was 22%. Higher serum globulin levels were significantly associated with an increased risk of DM, with a 21% increase in risk for each unit increase in serum globulin (odds ratio = 1.21, 95% confidence interval [1.03, 1.43], P < .001). The relationship between serum globulin and DM was linear, and higher serum globulin levels were associated with a higher risk of DM, particularly in males (P = .043) and obese individuals (P = .019). The area under the curve for serum globulin predicting DM was 0.795, with an optimal cutoff value of 2.9. Elevated serum globulin levels are significantly associated with an increased risk of DM among individuals with LTBI, highlighting the potential role of serum globulin as a predictive biomarker for DM in this population. However, the specific mechanism between globulin and LTBI–DM needs to be further investigated.
A cross-sectional study of the correlation of the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) with obstructive sleep apnea (OSA) in adult populations: NHANES (2005–2008 and 2015–2020)
Authors: Zhang Qi , Hu Zhiqiang , Zhang Han , Shi Xinning , Li Xinpeng , Zhu Xianchun
Published: October 2024

The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol, abbreviated as NHHR, represents a brand-new lipid biomarker for assessing cardiovascular disease risk. Research has suggested a link between lipid metabolism and obstructive sleep apnea (OSA). To delve deeper, this study was carried out using data derived from the NHANES to ascertain whether NHHR and OSA are associated. In this research, a cross-sectional analysis was executed based on data derived from NHANES across the years 2005 to 2008 and 2015 to 2020. After adjusting for confounders such as demographic characteristics, lifestyle, and health status, the link between NHHR and the likelihood of developing OSA was examined via weighted binary logistic regression as well as restricted cubic spline (RCS) models. In addition, subgroup analysis was completed to check if the obtained results were reliable. The study included 16,265 adult participants. Following comprehensive adjustment for confounders, results obtained suggested that, for each additional unit increment of NHHR, there is a 9% increased chance of developing OSA. Compared to the lowest quartile, the highest quartile of NHHR notably increased the risk of developing OSA in the overall population (OR: 1.65; 95% CI: 1.38–1.98; P < .001). The RCS curve indicated a linear positive correlation between NHHR and OSA, which remained significant in subsequent subgroup analyses (all P for interaction > .05). This suggested that the correlation between NHHR and OSA was stable across populations with different characteristics. Confounders such as demographics, lifestyle, and health status did not significantly affect this positive correlation. Findings from this study uncovered a strong connection between NHHR and an increased possibility of developing OSA in American adults. Further exploration of NHHR could offer insights into OSA prevention and treatment. However, owing to the constraints inherent in cross-sectional studies, more studies are required to establish a concrete link between NHHR and OSA.
Upregulation of ARHGAP9 is correlated with poor prognosis and immune infiltration in clear cell renal cell carcinoma
Authors: Xiong Yu-Ling , Peng Chao , Tian Yue
Published: October 2024

Rho GTPase activating protein (ARHGAP) family genes play critical roles in the onset and progression of human cancer. Rho GTPase activating protein 9 (ARHGAP9) is upregulated in various tumors. However, far too little attention has been paid to the prognostic value of ARHGAP9 and correlation with immune infiltration in clear cell renal cell carcinoma (ccRCC). Our aim is to evaluate the prognostic significance of ARHGAP9 expression and its correlation with immune infiltration in ccRCC. Transcriptional expression profiles of ARHGAP9 between ccRCC tissues and normal tissues were downloaded from The Cancer Genome Atlas. The ARHGAP9 protein expression was assessed by the Clinical Proteomic Tumor Analysis Consortium. Receiver operating characteristic curve was used to differentiate ccRCC from adjacent normal tissues. The Kaplan–Meier method was conducted to assess the effect of ARHGAP9 on survival. Protein–protein interaction networks were constructed by the STRING. Functional enrichment analyses were performed using the “ClusterProfiler” package. The immune infiltration patterns were evaluated via the tumor immune estimation resource 2.0 and Tumor-Immune System Interaction Database. ARHGAP9 expression was substantially higher in ccRCC tissues than in adjacent normal tissues. Increased ARHGAP9 mRNA expression was shown to be linked to high TNM stage and lymph node metastases. The diagnostic value of ARHGAP9 gene expression data was assessed using receiver operating characteristic curve analysis. The survival analysis module of GEPIA2 and the Kaplan–Meier plotter both showed ccRCC patients with high-ARHGAP9 had a worse prognosis than those with low-ARHGAP9. Correlation analysis indicated ARHGAP9 mRNA expression was significantly correlated with tumor purity and immune infiltrates. These findings demonstrate that upregulated ARHGAP9 indicates poor prognosis and immune infiltration in ccRCC. The current findings suggest that ARHGAP9 can be an effective biomarker and potential therapeutic strategy for ccRCC.
Vibrio vulnificus infection complicated by acute-on-chronic liver failure: A case report
Authors: Wang Tingting , Huang Qifeng
Published: October 2024

Rationale:

Vibrio vulnificus is a gram-negative bacterium that can cause 3 clinical syndromes: gastrointestinal symptoms, skin septicemia, and primary septicemia. V vulnificus infection can induce an exacerbation of liver disease, eventually requiring intensive care for multiorgan failure.

Patient concerns:

A 56-year-old Chinese male who was admitted for left lower limb swelling 5 days after sustaining an injury. His left lower leg was wounded with a machete used for cutting rubber. Notably, this machete had also been previously utilized for cutting seafood. Blood culture results indicated the presence of V vulnificus during the hospitalization. The patient’s condition deteriorated rapidly leading to acute liver failure. Over the ensuing days, the patient experienced separation of tendency of aminotransferase and bilirubin (bilirubin-aminotransferase dissociation), indicative of worsening liver function. Of note, the patient had a history of untreated hepatitis B virus infection and a long drinking history.

Diagnoses:

Acute-on-chronic liver failure following a V vulnificus infection.

Interventions:

We utilized double plasma molecular adsorption system (DPMAS) to address the deterioration of the patient’s liver function.

Outcomes:

After 2 DPMAS treatments, the patient’s liver function showed improvement.

Lessons:

This report underscores the importance of timely and repeated DPMAS treatment of patients with a drinking history or chronic liver disease when they present with V vulnificus septicemia.
A systematic review of case reports on mortality, modes of infection, diagnostic tests, and treatments for Nipah virus infection
Authors: Alla Deekshitha , Shah Dhruv Jayeshkumar , Adityaraj Navaneethan , Vagdevi Moparthi , Alla Sai Santhosha Mrudula , Sree Krithi , Aitha Praneeth , Bollampalli Ram Prasanjith Reddy , Pathinangil Antony Joseph , Patel Krupa , Issaka Yussif
Published: October 2024

Background:

First identified in Malaysia in 1998, the Nipah virus is a paramyxovirus related to the Hendra virus. The clinical manifestation can vary from a silent infection to a life-threatening encephalitis. The World Health Organization (WHO) has documented 25 outbreaks in South Asia, resulting in 429 cases and 307 deaths to date. Currently, there are no approved treatments for the deadly Nipah virus infection, which is a serious threat to public health worldwide. Consequently, a review was conducted to examine the geographic distribution of the Nipah virus, mortality, transmission pathways, and available methods for diagnosis and treatment.

Methods:

PubMed, Scopus, Web of Science, and Google Scholar servers were used to conduct a systematic search in compliance with the PRISMA guidelines. The results were tabulated and analyzed.

Results:

A total of 12 studies (7 case series and 5 case reports) were included in the final analysis, and 92 cases were analyzed. The most frequent symptoms were fever (80%), myalgia (47%), headache (47%), shortness of breath/acute respiratory distress syndrome (n = 44.1%), altered sensorium (44.1%), and vomiting (42.6%). The most commonly used diagnostic test was RT-PCR (45.5%). The most common route of transmission reported is direct human contact with the infected patients. Treatment modalities include interventional procedures, antiviral drugs, and symptomatic treatment. The most common complications were seizures (39.2%) and altered sensorium (35.7%). The mortality rate was 73.9%.

Conclusion:

It is crucial to emphasize the importance of early Nipah virus infection diagnosis and treatment to prevent life-threatening consequences.
Exploration in association between vitamin D, sleep quality, and osteoarthritis: A modeling study
Authors: Zhou Xuan , Gong Yaqi
Published: October 2024

Previous studies on the relationship between vitamin D, sleep quality, and osteoarthritis (OA) have been controversial and the aim of this study is to analyze the association. In this study, relevant data from 2 survey cycles (2009–2010 with 2011–2012) are downloaded from the CDC’s NHANES project to analyze the relationship between vitamin D, sleep quality, and osteoarthritis, as well as other related risk factors. The analysis of statistics in this study is performed using t-tests and chi-square tests, modeling is performed using logistic regression based on NHANES weights, and other risk factors are analyzed using forest plots. In association models between serum vitamin D, sleep quality, and OA is statistically significant during the stepwise inclusion of covariates. In model 1, Q3 (OR = 1.83; 95% CI: 1.05, 3.23) and Q4 (OR = 2.22; 95% CI: 1.27, 3.94) are significant. Neither model 2 nor model 3 is statistically significant and P for trend is more than .05 in all 3 models. After the inclusion of all covariates, forest plot showed that sleep deprivation (OR = 1.64; 95% CI: 1.05, 2.56), advanced age (OR = 1.03; 95% CI: 1.01, 1.04), female (OR = 1.79; 95% CI: 1.14, 2.85), overweight (25 ≤ BMI < 30) (OR = 1.92; 95% CI: 1.05, 3.61), and obesity (≥30) (OR = 2.06; 95% CI: 1.11, 3.93) are risk factors for OA. This study is based on a larger sample and a stepwise logistic regression of multiple covariates. We concluded that vitamin D may not influence OA. However other risk factors for OA are confirmed, including advanced age, female and high BMI, especially bad sleep quality.
Effect of continuous improvement of standardized construction of China Chest Pain Center on treatment time and mortality of acute ST-segment elevation myocardial infarction: A population-based study
Authors: Ma Honglan , Zhang Weihua , Li Juan
Published: October 2024

Standardized construction of China Chest Pain Center improves outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI). A total 778 patients with a definite diagnosis of STEMI who underwent percutaneous coronary intervention (PCI) in our hospital from March 2017 to November 2022 were selected. Among them, 194 patients admitted from March 2017 to December 2019 were included as the pre-continuous improvement period (control group), and 584 patients admitted from January 2020 to November 2022 were included as the continuous improvement period (study group). Major quality control indicators were compared between the 2 groups. In continuous improvement period, the time of electrocardiograph (ECG) diagnosis, time of dual antiplatelet drug administration, troponin I return time, catheter activation time, and door to wire (D2W) were all significantly shorter than those in the pre-continuous improvement period (P < .05). The reperfusion rate of patients in the continuous improvement period was 98.12%, which was significantly higher than that in the pre-continuous improvement period (92.78%; P < .001). The mortality rate of STEMI patients in continuous improvement period was 3.42%, lower than 4.64% in the pre-continuous improvement period with no statistical difference (P = .439). Age, previous history of coronary artery disease, and high Killip class (Killip III–IV) were derived as independent risk factors for death by logistic regression analysis (OR＞1, P < .05). Continuous improvement of the chest pain center can effectively shorten the treatment time of STEMI patients, improve the reperfusion rate, and improve myocardial blood supply by restoring TIMI blood flow as early as possible.
Staged angioplasty in 2 patients with severe carotid artery stenosis: A case report and literature review
Authors: Zhou Yong-Liang , Liu Shi-Min , Cao Wen-Feng , Cao Xian-Min , Wu Ling-Feng , Wen An
Published: October 2024

Rationale:

Cerebral infarction is a common ischemic cerebrovascular disease, associated with high rates of morbidity, disability, and recurrence, that can seriously affect patient physical and mental health, as well as quality of life. Carotid artery stenosis is an independent risk factor of cerebral infarction. Following rapid developments in interventional technology and materials science, carotid artery stenting has arisen an important treatment option for carotid artery stenosis. However, surgery is associated with complications, such as postoperative hyperperfusion syndrome, which poses a serious threat to the life and health of patients. Staged angioplasty (SAP), that is, one-time revascularization of the carotid artery stenting, is divided into 2 stages. This method reduces the occurrence of hyperperfusion syndrome after stenting by increasing the ipsilateral cerebral blood flow in stages and gradually increasing the cerebral perfusion pressure.

Patient concerns:

Herein, we present 2 cases of elderly patients with severe carotid artery stenosis who underwent SAP to prevent hyperperfusion syndrome.

Diagnoses:

The final diagnosis was based on cervical vascular color Doppler ultrasonography, cervical vascular magnetic resonance angiography, and cerebral vascular digital subtraction angiography.

Intervention:

Both patients with severe carotid artery stenosis underwent a staged intravascular intervention.

Outcomes:

Both patients were followed up for 1 year, with neither developing any new cerebral infarction or recurrent stent restenosis.

Lessons:

When treating SAP, it is crucial to consider that patients with unstable carotid plaques may not be suitable for staging. Additionally, during phase II carotid stenting, it is important to assess any changes in the arterial morphology and select the appropriate device accordingly.
Optic nerve sheath diameters predict mortality and severity in hepatic encephalopathy
Authors: Kus Cumali , Acehan Selen , Satar Salim , Gulen Muge , Sevdimbas Sarper , Akdoganlar Ali İlker , Gorur Mehmet
Published: October 2024

Objective:

The aim of this study was to compare the predictive power of optic nerve sheath diameter (ONSD) measured by brain computed tomography (CT) in patients diagnosed with hepatic encephalopathy (HE) in the emergency department, with other factors for mortality and disease severity.

Materials and methods:

A total of 217 patients aged 18 years and older with acute decompensation of cirrhosis diagnosed with HE in the emergency department were included in the study. To compare with patients diagnosed with HE, a total of 217 individuals were included in the study as the healthy control group. ONSD measurements were performed on both the HE patients and the healthy control group in the brain CT.

Results:

The mortality rate of HE patients was 32.7%. Regarding the severity of the disease, 53% of the patients had late-stage HE. The presence of acute-on-chronic liver failure was detected in 51.4% of patients. The mortality rate among acute-on-chronic liver failure patients was 56.6%. According to the study data, ONSD, creatinine, lactate, and procalcitonin were independent predictors of mortality. Meanwhile, Child-Pugh score, direct bilirubin, ONSD, ammonia, and total bilirubin were independent predictors of disease severity. In the receiver operating characteristic curve analysis, the ONSD had the highest predictive power for mortality and disease severity among the determined predictive values.

Conclusion:

The data from the study suggests that assessing the ONSD through brain CT scans in individuals diagnosed with HE in the emergency department may provide valuable insights for clinicians, aiding in the prediction of both mortality rates and the severity of the disease.
Interaction between trouble sleeping and diabetes on metabolic dysfunction-associated fatty liver disease and liver fibrosis in adults results from the National Health and Nutrition Examination Survey 2017–2018
Authors: Zhang Cui , Cao Lili , Xu Bo , Zhang Wei
Published: October 2024

Background

Metabolic dysfunction-associated fatty liver disease (MAFLD), trouble sleeping, and diabetes, as major public health problems, were closely related. The study examined the interaction between trouble sleeping and diabetes on MAFLD and liver fibrosis in adults with MAFLD.

Methods

The data were obtained from the National Health and Nutrition Examination Survey 2017–2018. Multivariate logistic regression model and subgroup analyses were conducted to assess the relationship between either trouble sleeping or diabetes on MAFLD and liver fibrosis. Relative excess risk due to interaction (RERI), attributable proportion of interaction (AP), and synergy index (S) were utilized to assess the additive interaction.

Results

Ultimately, 3747 participants were included, with 2229 known MAFLD subjects. Compared with participants without diabetes, those with diabetes had a higher risk of MAFLD [odds ratio (OR) = 5.55; 95% confidence interval (CI) = 4.07–7.56] and liver fibrosis risk (OR = 3.61; 95% CI = 2.67–4.89). We also found a significant association of trouble sleeping with an increased risk of MAFLD (OR = 1.54; 95% CI = 1.17–2.02) and liver fibrosis risk (OR = 1.51; 95% CI = 1.06–2.16), compared with those without trouble sleeping. Moreover, there was a significant interaction between diabetes and trouble sleeping on MAFLD [RERI = 1.76 (95% CI: −0.22 to 3.73), AP = 0.35 (95% CI: 0.08–0.63), S = 1.80 (95% CI: 1.02–3.16)] and liver fibrosis risk [RERI = 1.79 (95% CI: 0.37–3.21), AP = 0.44 (95% CI: 0.20–0.69), S = 2.44 (95% CI: 1.18–5.08)].

Conclusion

The findings highlight that trouble sleeping and diabetes had a synergistic effect on MAFLD and liver cirrhosis. The study highlights the importance of addressing both trouble sleeping and diabetes management in adults to mitigate the risk of MAFLD and liver fibrosis.
Investigating the Impact of Caregiver Adverse Childhood Experiences Screening and Pediatrician-Led Discussions on Posttraumatic Stress Disorder Symptoms in a Majority-Hispanic Pediatric Primary Care Clinic Setting
Authors: Bettale Chiara M. , Pomales Melyrene , Boy Angie , Moran Tim , Agarwal Maneesha , Powers Abigail
Published: October 2024

Background:

Evidence suggests that screening and provider-led discussions of parental adverse childhood experiences (ACEs) may help identify at-risk families and be linked to positive health outcomes in caregivers and their children. However, the direct effect of ACEs screening and discussions on posttraumatic stress disorder (PTSD) has yet to be studied.

Objectives:

To determine if screening or provider-led discussions of parental ACEs are associated with inadvertent worsening of PTSD symptoms 1 week after screening.

Research Design:

Data was obtained as part of a cluster randomized controlled trial to examine the effects of ACEs screening and provider-led discussions on child health care utilization outcomes. Baseline surveys were completed before scheduled infant well child checks (WCCs). Providers were randomized into the standard of care or intervention (discussion) conditions. Intervention providers were trained in delivering brief trauma-informed discussions about the impact of ACEs on parenting during WCCs.

Subjects:

Caregivers in a pediatric primary care clinic serving predominantly Hispanic and low socioeconomically resourced families (N=179, 93% female, 87% Hispanic).

Measures:

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief Resilience Scale (BRS), and ACEs screening were completed at baseline. PC-PTSD-5 was repeated 1-week after screening.

Results:

Mixed-effects ordinal logistic regression analysis of PTSD scores from baseline to 1-week postscreening with the full sample showed no significant effect of time [odds ratio (OR)=1.21, P=0.68], group (OR=1.68, P=0.33), or their interaction (OR=0.48, P=0.21).

Conclusions:

Screening or brief discussion of ACEs with providers trained in trauma-informed care were not associated with worsening PTSD symptoms.
Suicide Rates by Age and Time Among American Indian and Alaskan Native Veterans
Authors: Brenner Lisa A. , Miller Christin N. , Schneider Alexandra L. , Hoffmire Claire A. , McCloskey Charlotte , Forster Jeri E.
Published: October 2024

Objective:

Although recent work has highlighted high rates of suicide among American Indian and Alaska Native individuals who served in the US military, to date, a comprehensive evaluation of age-specific suicide rates, over time, has yet to be conducted.

Methods:

Population-based retrospective cohort study. Average annual suicide rates (2005–2020) were computed. The cohort included 207,955 Native Veterans who were alive as of January 1, 2005, and separated from military service on or before December 31, 2020. Suicide was identified via National Death Index codes.

Results:

Between 2005 and 2020, average annual, age-specific suicide rates among Native Veterans ranged from 16.32/100,000 (55+ y) to 64.49/100,000 (18–34 y). Compared with other age-related cohorts, the rate among those in the youngest age cohort (18–34y) was the highest between 2005 and 2018. The 2019–2020 average annual rate for 18- to 34-year-olds (41.86/100,000) dropped below that of the middle-aged cohort (35–45 y; 44.66/100,000). Across all age cohorts, firearms were the most used method of suicide [57.2% (18–34 and 35–54 y) to 66.17% (55+y)]; however, a notable percentage of Veterans died by suffocation, 16.54% (55 y and older), 26.71% (35–54 y), and 33.21% (18–34 y).

Conclusions:

Findings highlight differences in suicide rates by age groups overtime for Native Veterans irrespective of Veterans Health Administration use and across service eras, as well as means of suicide, which also differed across groups. Increased efforts are needed to identify culturally and age-relevant intervention strategies, as well as factors associated with risk, to reduce deaths among Native Veterans.
Health Care Workers’ Perspectives on Collecting Sexual Orientation and Gender Identity in the Adult Primary Care Setting
Authors: LeClair Amy M. , Rose Raviv , Barker Olivia , Carpenter Eilish , Concannon Thomas W. , Boehmer Ulrike , Blazey-Martin Deborah , Bird Chloe E. , Freund Karen M. , Lemon Stephenie C.
Published: October 2024

Background:

Despite numerous calls for standardized collection of sexual orientation and gender identity (SOGI) data in clinical settings, uptake of this practice still lags.

Objectives:

This study conducted a preimplementation assessment of staff attitudes toward SOGI data collection within an adult primary care practice in an urban academic medical center in the northeastern United States.

Research Design:

We created a process map of the flow of patient data from the point of registration to the clinical encounter to identify all staff roles associated with registration and patient demographic data collection. We purposively sampled staff members across these roles and conducted semistructured virtual interviews between November 2021 and February 2022. The research team used deductive and inductive coding and conducted a thematic analysis to identify barriers and facilitators to implementation.

Subjects:

Nine clinical staff and eleven nonclinical staff were interviewed.

Measures:

Participants were asked about their general experiences with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients, their perspectives on collecting this data, and potential barriers and facilitators to incorporating this into the workflow.

Results:

The main themes that emerged were the relevance of SOGI data to the clinical practice; concerns about patient acceptability; the prevalence of cis-gender, heteronormative assumptions; and concerns about linguistic, cultural, and generational differences. Differences were noted between clinical and nonclinical staff.

Conclusions:

Greater education is needed to help both clinical and nonclinical staff understand how patients’ SOGI demographics can be used to provide affirming, patient-centered care. Implementation strategies can be tailored to address specific barriers at the individual, organizational, and social levels.
Recent advances in peritoneal dialysis catheter placement: the association between method of insertion, operator, and prior abdominal surgery and outcomes
Authors: Quinn Robert R. , Oliver Matthew J.
Published: October 2024

Purpose of review

Peritoneal dialysis (PD) is associated with comparable outcomes to hemodialysis and is much less expensive to provide in most parts of the world. A well functioning PD catheter is required, but complications are frequent, and while there are guidelines for the placement and care of a PD access, they are based on low-quality evidence.

Recent findings

Data reporting the outcomes of percutaneous, as compared to surgical pathways for placement of catheters and the role of operator type in determining outcomes are examined. The impact of prior abdominal procedures on patient selection and the prognostic importance of the presence of adhesions at the time of catheter insertion are reviewed.

There are conflicting data about the relative merits of percutaneous as compared to surgical placement of catheters that may relate to differences in patient selection, operator experience, or operator volume. Prior abdominal procedures are not associated with worse PD catheter outcomes and likely should not influence patient selection, except in exceptional circumstances. Finally, the presence of adhesions is associated with a higher risk of complications. However, even in the presence of adhesions, the termination of PD therapy and need for re-intervention occurs in <20% of patients.
Acalvaria, rare congenital malformation in palestine: case report and literature review
Authors: Salah Yasmeen Z. , Maraqa Bara’ M.N. , Halahla Hadeel A. , Jobran Afnan W. M. , Abdulrazzak Mohammed , Qaisiya Dia’a. , Maraqa Beesan
Published: October 2024

Introduction and Importance:

Acalvaria is a rare congenital anomaly characterized by absent cranial vault bones, often misdiagnosed as anencephaly or encephalocele.

Case Presentation:

We present a case of a 10-day-old male neonate with Acalvaria, delivered normally at 37+5 weeks, with a birth weight of 2.7 kg and dysmorphic features including low-set ears and a sandal gap. Skull X-ray revealed absent parietal, temporal, and frontal bones. Initially admitted for potential sepsis, he has since shown normal development at three months, with ongoing conservative management.

Clinical Discussion:

Acalvaria is a rare congenital malformation marked by the absence of cranial vault bones, dura mater, and scalp muscles. Our case presents partial calvaria absence with normal skull base, classified as primary acalvaria. Associated anomalies necessitate thorough evaluation for prognosis. Diagnosis can occur as early as 12 weeks gestation via ultrasound, but management remains conservative, focusing on supportive care and monitoring for potential surgical interventions later.

Conclusion:

Acalvaria is a rare, fatal anomaly requiring conservative management; antenatal care and psychological preparation are essential for affected families.
What are the Tools in Your CM Toolbox for Pain?
Authors: Powell Suzanne K.
Published: October 2024

Some estimate that 1.5 billion people worldwide suffer from chronic pain. In the United States, chronic pain affects about 20% of the people with an annual cost of $600 billion. The most common type of chronic pain is chronic back pain. Since pain assessment and management is not always successful, this Editorial put some alternative pain modalities in the case managers’ toolbox.