bluuebunny/crossref_metadata_2025 huggingface dataset:
The quandary of sources and sinks of CO2 efflux in tree stems—new insights and future directions
Authors: Salomón Roberto L , Helm Juliane , Gessler Arthur , Grams Thorsten E E , Hilman Boaz , Muhr Jan , Steppe Kathy , Wittmann Christiane , Hartmann Henrik
Published: January 2024

Stem respiration (RS) substantially contributes to the return of photo assimilated carbon to the atmosphere and, thus, to the tree and ecosystem carbon balance. Stem CO2 efflux (ECO2) is often used as a proxy for RS. However, this metric has often been challenged because of the uncertain origin of CO2 emitted from the stem due to post-respiratory processes. In this Insight, we (i) describe processes affecting the quantification of RS, (ii) review common methodological approaches to quantify and model RS and (iii) develop a research agenda to fill the most relevant knowledge gaps that we identified. Dissolution, transport and accumulation of respired CO2 away from its production site, reassimilation of respired CO2 via stem photosynthesis and the enzyme phosphoenolpyruvate carboxylase, axial CO2 diffusion in the gas phase, shifts in the respiratory substrate and non-respiratory oxygen (O2) consumption are the most relevant processes causing divergence between RS and measured stem gas exchange (ECO2 or O2 influx, IO2). Two common methodological approaches to estimate RS, namely the CO2 mass balance approach and the O2 consumption technique, circumvent some of these processes but have yielded inconsistent results regarding the fate of respired CO2. Stem respiration modelling has recently progressed at the organ and tree levels. However, its implementation in large-scale models, commonly operated from a source-driven perspective, is unlikely to reflect adequate mechanisms. Finally, we propose hypotheses and approaches to advance the knowledge of the stem carbon balance, the role of sap pH on RS, the reassimilation of respired CO2, RS upscaling procedures, large-scale RS modelling and shifts in respiratory metabolism during environmental stress.
Enhancing Reniform Nematode Management in Sweetpotato by Complementing Host-Plant Resistance with Nonfumigant Nematicides
Authors: Alam Md Shah , Khanal Churamani , Roberts Joseph , Rutter William , Wadl Phillip A.
Published: January 2024

The reniform nematode (Rotylenchulus reniformis Linford and Oliveira) adversely impacts the quality and quantity of sweetpotato storage roots. Management of R. reniformis in sweetpotato remains a challenge because host plant resistance is not available, fumigants are detrimental to the environment and health, and crop rotation is not effective. We screened a core set of 24 sweetpotato plant introductions (PIs) against R. reniformis. Four PIs were resistant, and 10 were moderately resistant to R. reniformis, suggesting these PIs can serve as sources of resistance for sweetpotato resistance breeding programs. PI 595869, PI 153907, and PI 599386 suppressed 83 to 89% egg production relative to the susceptible control ‘Beauregard’, and these PIs were employed in subsequent experiments to determine if their efficacy against R. reniformis can be further increased by applying nonfumigant nematicides oxamyl, fluopyram, and fluensulfone. A 34 to 93% suppression of nematode reproduction was achieved by the application of nonfumigant nematicides, with oxamyl providing the best suppression followed by fluopyram and fluensulfone. Although sweetpotato cultivars resistant to R. reniformis are currently not available and there is a need for the development of safer yet highly effective nonfumigant nematicides, results from the current study suggest that complementing host plant resistance with nonfumigant nematicides can serve as an important tool for effective and sustainable nematode management.
A Randomized Controlled Trial Using Epidural Analgesia for Pain Relief After Lumbar Interlaminar Decompressive Spine Surgery
Authors: Hermans Sem M.M. , Lantinga-Zee Aniek A.G. , Droeghaag Ruud , van Santbrink Henk , van Hemert Wouter L.W. , Reinders Mattheus K. , Hoofwijk Daisy M.N. , van Kuijk Sander M.J. , Rijkers Kim , Curfs Inez
Published: January 2024

Study Design.

Prospective, double-blind randomized controlled trial.

Objective.

If an intraoperative single bolus of epidural bupivacaine can result in less postoperative pain following lumbar spinal decompression surgery.

Summary of Background Data.

Adequate postoperative pain management following lumbar spinal decompression surgery is important, as it will lead to early mobilization, less complications, and a shorter hospital stay. Opioid consumption should be limited due to their frequently accompanied side effects and their addictive nature. During the final phase of lumbar decompression surgery, the epidural space becomes easily accessible. This might be an ideal moment for surgeons to administer an epidural bolus of analgesia as a safe and effective method for postoperative pain relief.

Materials and Methods.

In this trial, we compared a single intraoperative bolus of epidural analgesia using bupivacaine 0.25% to placebo (NaCl 0.9%) and its effect on postoperative pain following lumbar spinal decompression surgery. The primary outcome was the difference in Numeric (Pain) Rating Scale between the intervention and placebo groups during the first 48 hours after surgery.

Results.

Both the intervention group and the placebo group consisted of 20 randomized patients (N=40). Statistically significant lower mean Numeric (Pain) Rating Scale pain scores were observed in the intervention group in comparison with the control group (main effect group: -2.35±0.77, P=0.004). The average pain score was lower in the intervention group at all postoperative time points. No study-related complications occurred.

Conclusion.

This randomized controlled trial shows that administrating a bolus of intraoperative epidural bupivacaine is a safe and effective method for reducing early postoperative pain following lumbar decompression surgery.
Flow-Limited and Reverse-Triggered Ventilator Dyssynchrony Are Associated With Increased Tidal and Dynamic Transpulmonary Pressure*
Authors: Sottile Peter D. , Smith Bradford , Stroh Jake N. , Albers David J. , Moss Marc
Published: January 2024

OBJECTIVES:

Ventilator dyssynchrony may be associated with increased delivered tidal volumes (Vts) and dynamic transpulmonary pressure (ΔPL,dyn), surrogate markers of lung stress and strain, despite low Vt ventilation. However, it is unknown which types of ventilator dyssynchrony are most likely to increase these metrics or if specific ventilation or sedation strategies can mitigate this potential.

DESIGN:

A prospective cohort analysis to delineate the association between ten types of breaths and delivered Vt, ΔPL,dyn, and transpulmonary mechanical energy.

SETTING:

Patients admitted to the medical ICU.

PATIENTS:

Over 580,000 breaths from 35 patients with acute respiratory distress syndrome (ARDS) or ARDS risk factors.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Patients received continuous esophageal manometry. Ventilator dyssynchrony was identified using a machine learning algorithm. Mixed-effect models predicted Vt, ΔPL,dyn, and transpulmonary mechanical energy for each type of ventilator dyssynchrony while controlling for repeated measures. Finally, we described how Vt, positive end-expiratory pressure (PEEP), and sedation (Richmond Agitation-Sedation Scale) strategies modify ventilator dyssynchrony’s association with these surrogate markers of lung stress and strain. Double-triggered breaths were associated with the most significant increase in Vt, ΔPL,dyn, and transpulmonary mechanical energy. However, flow-limited, early reverse-triggered, and early ventilator-terminated breaths were also associated with significant increases in Vt, ΔPL,dyn, and energy. The potential of a ventilator dyssynchrony type to increase Vt, ΔPL,dyn, or energy clustered similarly. Increasing set Vt may be associated with a disproportionate increase in high-volume and high-energy ventilation from double-triggered breaths, but PEEP and sedation do not clinically modify the interaction between ventilator dyssynchrony and surrogate markers of lung stress and strain.

CONCLUSIONS:

Double-triggered, flow-limited, early reverse-triggered, and early ventilator-terminated breaths are associated with increases in Vt, ΔPL,dyn, and energy. As flow-limited breaths are more than twice as common as double-triggered breaths, further work is needed to determine the interaction of ventilator dyssynchrony frequency to cause clinically meaningful changes in patient outcomes.
Common dihydropyrimidinase (DPYS) genetic variations do not predict fluoropyrimidine-related chemotherapy toxicity in a Canadian cohort
Authors: Medwid Samantha J. , Mailloux Jaymie L. , Wigle Theodore J. , Kim Richard B.
Published: January 2024

Known genetic variations in dihydropyrimidine dehydrogenase (gene name DPYD) do not fully predict patients at risk for severe fluoropyrimidine-associated chemotherapy toxicity. Dihydropyrimidinase (gene name DPYS), the second catabolic enzyme in fluoropyrimidine metabolism, has been noted as a potential determinant of variation in fluoropyrimidine metabolism and response. In this study, we genotyped for DPYS c.-1T>C (rs2959023), c.265-58T>C (rs2669429) and c.541C>T (rs36027551) in a Canadian cohort of 248 patients who were wild type for Clinical Pharmacogenetics Implementation Consortium recommended DPYD variants and had received a standard dose of fluoropyrimidine chemotherapy. None of our patients were found to carry the DPYS c.541C>T variant, while the minor allele frequencies were 63% and 54% for c.-1T>C and c.265-58T>C, respectively. There was no association between DPYS c.-1T>C wild type and heterozygote [odds ratio (OR) (95% confidence interval, CI) = 1.10 (0.51–2.40)] or homozygote variant carriers [OR (95% CI) = 1.22 (0.55–2.70)], or between DPYS c.265-58T>C wild-type patients and heterozygote [OR (95% CI) = 0.93 (0.48–1.80)] or homozygote variant carriers [OR (95% CI) = 0.76 (0.37–1.55)] in terms of fluoropyrimidine-associated toxicity. Therefore, in our cohort of mostly Caucasian Canadians, genetic variations in DPYS do not appear to be a significant contributor to severe fluoropyrimidine-associated toxicity.
Evolution of HIV Health Care Workforce Needs in the U.S. Mountain West During the COVID-19 Pandemic: A Mixed Method Study
Authors: Amura Claudia R. , Thorne Julia , Bean Meagan , Avery Lisa Krug , Sylla Laurie N. , Liss Hillary K. , Cook Paul F.
Published: January 2024

The COVID-19 pandemic drastically affected health care delivery for vulnerable populations. Many facilities shifted services to telemedicine, and people with HIV or at risk of acquiring HIV experienced interruptions in care. Simultaneously, traditional training approaches to help providers adapt were disrupted. Using a mixed method approach to examine changes over time, we integrated data on trainee needs collected by the Mountain West AIDS Education and Training Center (AETC): a 10-state needs assessment survey in 2020; feedback from a 2020 community of practice; aggregate training data from 2000 to 2022; and a second survey in 2022. HIV care providers' training needs evolved from wanting support on telemedicine and COVID-19 patient care issues, to a later focus on mental health and substance use, social determinants of health, and care coordination. This integrative analysis demonstrates the vital role that AETCs can play in addressing evolving and emergent public health challenges for the HIV workforce.
Study of Helicobacter pylori infection in patients with chronic atrophic gastritis and its relationship with lifestyle habits and dietary nutrient intake: A retrospective analysis
Authors: Li Peilin , Zhu Weiqin , Ding Jianhua , Lei Fenfang
Published: January 2024

To explore Helicobacter pylori (Hp) infection status and its relationship with lifestyle habits and dietary factors in patients with chronic atrophic gastritis. Six hundred thirty-eight patients with chronic atrophic gastritis, who were admitted to our hospital from March 2021 to April 2023, were selected for the study. All patients underwent the 13C urea breath test. The relationship between the detection rate of Hp infection and the clinical characteristics, lifestyle habits, and dietary factors of the patients was analyzed. Among the 638 patients with chronic atrophic gastritis, 531 patients were tested positive for Hp infection, the positive rate for Hp infection was approximately 83.23%. Analyzing the clinical characteristics of the patients, it was found that age, family history of gastric cancer, degree of chronic inflammation, degree of glandular atrophy, presence of low-grade dysplasia, and intestinal metaplasia all have an impact on the positive detection rate of patients (P < .05). Analyzing the patients’ lifestyle habits, it was found that BMI, smoking history, alcohol consumption, preference for spicy food, dining location, consumption of pickled foods, frequent consumption of grilled/barbecued foods, preference for strong tea, consumption of sweets, and work-related stress had an impact on the positive rate of Hp infection in patients (P < .05). The discovery showed that the levels of total protein, albumin, hemoglobin, cholesterol, and the intake of livestock and poultry meat, seafood, dairy products, vegetables, fruits, and fats have an impact on the positivity rate of Hp infection in patients (P < .05). A multiple logistic regression analysis was performed, and it was found that patients’ age, family history of gastric cancer, degree of chronic inflammation, degree of glandular atrophy, presence of low-grade dysplasia, presence of wasting or obesity, history of alcohol consumption, preference for spicy food, dining location, frequent consumption of strong tea, high work pressure, high intake of fish and seafood, low intake of dairy products, low intake of vegetables, low intake of fruits, and low intake of fats all had an impact on the occurrence of Hp infection in patients (P < .05). There is a certain correlation between patients’ lifestyle habits, dietary factors, and clinical characteristics with the occurrence of Hp infection. These factors can assist in the prevention of Hp infection.
Effects of electroacupuncture on obesity: A systematic review and meta-analysis
Authors: Kang Junhyuk , Shin Woo-Chul , Kim Koh-Woon , Kim Sungha , Kim Hyungsuk , Cho Jae-Heung , Song Mi-Yeon , Chung Won-Seok
Published: January 2024

Background:

This systematic review and meta-analysis evaluated the efficacy of electroacupuncture for the treatment of obesity.

Methods:

We searched 8 electronic databases for articles published between 2005 and 2021, including only randomized controlled trials (RCTs) in the review. The intervention groups received either electroacupuncture alone or electroacupuncture with standard care, whereas the control groups received sham electroacupuncture, standard care, or no treatment. The primary outcome was the body mass index (BMI), and the secondary outcomes were the body weight (BW), waist circumference (WC), hip circumference, waist-to-hip ratio (WHR), body fat mass, body fat percentage, and adverse effects. Continuous outcome data are presented as mean differences (MDs) with 95% confidence intervals (CIs).

Results:

This systematic review and meta-analysis included 13 RCTs involving 779 participants. Results revealed that the BMI (MD: −0.98; 95% CI: −1.35 to −0.61), BW (MD: −1.89; 95% CI: −2.97 to −0.80), WC (MD: −2.67; 95% CI: −4.52 to −0.82), and WHR (MD: −0.03; 95% CI: −0.06 to −0.01) were significantly improved in the intervention groups compared with those in the control groups. Adverse effects were reported in 5 studies. The most commonly used acupoint in the abdomen was ST25, whereas the most commonly used acupoints in other regions were ST36 and SP6 for the treatment of obesity. ST25 was the most commonly used acupoint connected by electroacupuncture.

Conclusion:

This systematic review and meta-analysis suggested that electroacupuncture is an effective and safe therapy for simple obesity. To increase the reliability of this study, further detailed, long-term studies should be conducted on the effects of electroacupuncture on obesity.
Stellate ganglion block with procaine in breast cancer survivors with hot flashes and sleep disturbances undergoing Endocrine Therapy
Authors: Soecknick Sven
Published: January 2024

Breast cancer survivors under endocrine therapy (ET) suffer from side effects such as hot flashes and sleep disturbance accompanied by poor quality of life. Many quit ET early and reduce their survival rate. Guidelines recommend gabapentin next to yoga or acupuncture. The role of side effects related to compliance with ET over years require new and effective therapies. Stellate ganglion block (SGB) has shown evidence of safety and efficacy and was found to be more effective than pregabalin without side effects. However, practical guidelines for the long-term use of SGB are still missing. We primarily used procaine instead of bupivacaine presuming effectiveness paired with lower toxic risks. Twenty-nine breast cancer survivors with severe hot flashes and sleep disturbance under ET received SGB with Procaine. Diaries recorded hot flashes and sleep quality scores up to week 24. All patients took part and none refused SGB. Each Patient received one SGB every 4 weeks without any side effects observed. Weekly scores were reduced from baseline by −33.6% (P < .01) (hot flashes) and −22.3% (P < .01) (sleep disturbances) after 4, and by −58.8% (P < .01) (hot flashes) and −50.8% (P < .01) (sleep disturbances) after twenty-for weeks. A wavelike reduction indicated a limited effect of a single SGB during continuous ET. We showed, that procaine in SGB is as effective as bupivacaine with lower risks and costs. High significant reductions in hot flashes and sleep disturbances after 1 and 6 months were found. We conclude that breast cancer survivors need individual treatment with SGB due to her personal impact. Hence, SGB should find its way to guidelines and daily routines as a valuable method for treating side effects in breast cancer survivors undergoing ET.
Biodegradable microneedle acupuncture has equivalent efficacy to traditional intradermal acupuncture for dry eye disease: A pilot single-blinded, randomized controlled trial
Authors: Song Ji-Hoon , Park Soo-Yeon
Published: January 2024

Background:

Dry eye disease (DED) is a common ocular disorder in which the tear film cannot maintain homeostasis. Acupuncture has been used to treat DED in Korean medicine. Particularly, intradermal acupuncture (IDA) is less painful and enables free movement after treatment. However, it can also provoke allergic reactions to metal. To overcome this, biodegradable microneedle acupuncture (BMA) has been developed. This study compared BMA with traditional IDA in terms of efficacy and safety in patients with DED.

Methods:

This study was designed as an investigator-initiated, assessor-blinded, single-center, parallel randomized controlled trial. Thirty patients with DED were enrolled and randomized to one of the treatments. One group was treated with BMA on the acupoints, including bilateral BL2, GB14, TE23, EX-HN5, and ST1. The other group was treated with traditional IDA at the same acupoints. Treatments were conducted 3 times a week for 4 weeks. The major endpoint was ocular surface disease index (OSDI). The minor endpoints were subjective symptoms visual analog scale (VAS), quality of life (QoL), and tear production measured by the Schirmer I test.

Results:

All enrolled participants successfully completed the trial, and all of their data was analyzed. Both treatments remarkably improved the OSDI score, VAS score, QoL score, and tear secretion after 4 weeks (P < .05). Except for tear production in the left eye (P < .05), there were no statistical differences between the 2 treatments on the final visit (P > .05). No adverse events were observed.

Conclusion:

BMA and IDA had the same therapeutic effect for improving DED and both were safe. BMA can be used in patients with DED as an alternative to traditional IDA.
Thrombocytopenia and associated factors among pregnant women attending antenatal care at Hiwot Fana Comprehensive Specialized Hospital, Eastern Ethiopia: A cross-sectional study
Authors: Arkew Mesay , Asmerom Haftu , Sileshi Beza , Walle Muluken , Adane Amlak , Ayele Firayad , Tebeje Fikru , Bete Tilahun , Ersino Tamirat , Gemechu Kabtamu
Published: January 2024

Thrombocytopenia (TCP) is the second most common hematological change during pregnancy and is considered as a major source of maternal and neonatal morbidity and mortality. Despite its effects to morbidity and mortality, it is frequently ignored or disregarded, particularly in resource-limited nations. Thus, the purpose of this study was to determine the prevalence of thrombocytopenia and associated factors among pregnant women attending antenatal care at Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia from June 20 to August 30, 2022. A hospital-based cross-sectional study was conducted among 199 pregnant women selected through a systematic sampling technique. Ethical approval was obtained from the Ethics Review Committee of Haramaya University. Data related to sociodemographic and reproductive variables were collected using structured questionnaires. Four milliliters of venous blood were collected from each study participant and a complete blood cell count was determined using UniCel DxH 800 hematology analyzer. Logistic regression analysis was done to assess the association between TCP and independent variables and P < .05 was considered statistically significant. In this study, the prevalence of TCP was 14.1% (95% CI: 9.6–19.7). Of them, 10 (35.7%), 12 (42.9%), and 4 (21.4%) had mild, moderate, and severe TCP, respectively. Having more than 3 children (adjusted odds ratio, AOR = 7.90, 95% CI: 2.60, 24.3), no antenatal care follow-up (AOR = 7.90, 95% CI: 2.40–26.2), being in the second and third trimester (AOR = 6.90, 95% CI: 1.70, 28.9 and AOR = 5.04, 95% CI: 1.12, 22.7, respectively), and history of heavy menstrual bleeding (AOR = 4.03, 95% CI: 1.25, 13.1) were significantly associated with TCP. TCP is a public health problem among pregnant women in the study area. Having more than 3 children, lack of antenatal care follow-up, being in the second and third trimesters, and having history of heavy menstrual bleeding was significantly associated with TCP. As a result, regular platelet count monitoring and appropriate intervention approaches based on identified predictors should be explored to mitigate adverse outcomes in pregnant women.
Enhancing quality healthcare in Nigeria through medical laboratory services: A review
Authors: Opeyemi Abdulrahman Abdulbasit , Obeagu Emmanuel Ifeanyi , Hassan Abdulwasiu Oladele
Published: January 2024

This article explores the pivotal role of medical laboratory services in enhancing the quality of healthcare in Nigeria. Medical laboratory science is a comprehensive field that involves a diverse array of diagnostic and analytical procedures. These procedures are of utmost importance in the provision of patient care, the early diagnosis of diseases, and the promotion of public health. The article elucidates the progression of medical laboratory services in Nigeria, tracing the transformation from the role of laboratory assistants to that of medical laboratory scientists. It underscores the significance of these services in informing healthcare decision-making. The essay also discusses the diverse obstacles encountered by the medical laboratory profession in Nigeria. The issues encompass insufficiencies in infrastructure, obsolescence of equipment, absence of a coherent policy framework, slow workforce expansion, persistent labor strikes, and a scarcity of trained specialists. The aforementioned issues not only impede the effectiveness of laboratory services, but also have extensive ramifications for healthcare provision throughout the nation. In order to address these difficulties and improve the standard of healthcare, the essay presents practical solutions and a thorough strategy. Furthermore, it underscores the significance of augmenting financial resources, mitigating corruption, and tackling wage inequalities in order to effectively retain medical laboratory specialists. The action plan is structured into distinct phases, each delineated by specified dates and delineating the duties of various stakeholders, such as government entities, healthcare establishments, professional associations, and diagnostic enterprises.
Different clinical diagnosis end up in the same pathological diagnosis of intravascular leiomyomatosis: Two case reports
Authors: Tan Yang , Han Jing , Wang Zhenglan , Yan Ju , Dong Lin , Liu Rui
Published: January 2024

Rationale:

Intravascular/intravenous leiomyomatosis (IVL) is a peculiar variant of uterine leiomyoma that is classified as a histologically benign smooth muscle tumor with a biological behavior similar to that of a malignant tumor. It is characterized by the proliferation of leiomyomas spreading along the uterine and extrauterine venous circulation.

Patient concerns:

Herein, we present 2 cases of IVL who had completely different clinical manifestations to stress the need for constant vigilance of IVL diagnosis and the understanding of uterine leiomyoma heterogenicity. Case 1 was registered for fever without specific triggering factors, irregular menstruation and clinically diagnosed uterine diverticula, while no information about fibroids was mentioned. Case 2 was characterized by an aggressively growing abdominal mass. With a large space-occupying lesion in the right abdominopelvic cavity and no imaging evidence of involvement of the iliac vein or above vein, the patient was initially diagnosed with multiple myomata.

Diagnoses:

Both patients’ diagnoses were confirmed as IVL by histopathology. To our knowledge, the mass of case 1 is the minimum IVL in the English literature.

Interventions:

Subtotal hysterectomy with bilateral salpingectomy was performed on the former, while total hysterectomy with bilateral salpingectomy was performed on the latter.

Outcomes:

Both patients were comfortable, and no relapse occurred.

Lessons:

Two cases in the study showed 2 different proceeding stages of the same disease and corroborated multiple pathogeneses, which have been mentioned in the available literature on IVL. Our work provides both supplement for clinical data to facilitate further research and better understanding of special types of fibroids to clinicians.
Understanding apoptosis in sickle cell anemia patients: Mechanisms and implications
Authors: Obeagu Emmanuel Ifeanyi , Ubosi Nwanganga Ihuoma , Obeagu Getrude Uzoma , Egba Simeon Ikechukwu , Bluth Martin H.
Published: January 2024

Sickle cell anemia (SCA) is a hereditary blood disorder characterized by the presence of abnormal hemoglobin, leading to the formation of sickle-shaped red blood cells. While much research has focused on the molecular and cellular mechanisms underlying the pathophysiology of SCA, recent attention has turned to the role of apoptosis, or programmed cell death, in the disease progression. This review aims to elucidate the intricate mechanisms of apoptosis in SCA patients and explore its implications in disease severity, complications, and potential therapeutic interventions. Different research search engines such as PubMed central, Scopus, Web of Science, Google Scholar, ResearchGate, Academia Edu, etc were utilized in writing this paper. Apoptosis, a highly regulated cellular process, plays a crucial role in maintaining homeostasis by eliminating damaged or dysfunctional cells. In SCA, the imbalance between pro-apoptotic and anti-apoptotic signals contributes to increased erythrocyte apoptosis, exacerbating anemia and vaso-occlusive crises. Various factors, including oxidative stress, inflammation, and altered cell signaling pathways, converge to modulate the apoptotic response in SCA. Furthermore, the interaction between apoptotic cells and the vascular endothelium contributes to endothelial dysfunction, promoting the pathogenesis of vasculopathy and organ damage seen in SCA patients. In conclusion, unraveling the complexities of apoptosis in SCA provides valuable insights into the disease pathophysiology and offers novel avenues for therapeutic interventions.
Risk factors and prognosis for the development of acute kidney injury in patients using colistin in the intensive care unit: A retrospective cohort study
Authors: Deniz Mustafa , Alişik Murat
Published: January 2024

Colistin, an antibiotic of polymyxin group, has recently been increasingly used in the treatment of multidrug resistant gram-negative bacteria. However, it has serious adverse effects such as acute kidney injury (AKI). We aimed to determine the factors affecting the development of AKI due to colistin, which has serious adverse effects, such as nephrotoxicity and neurotoxicity. We retrospectively analyzed the data of patients who received colistin for multidrug resistant gram-negative sepsis in adult intensive care units between January 2020 and December 2022. Demographic data, blood test results, concomitant drug use, need for renal replacement therapy, and mortality were recorded. Kidney damage was assessed according to the Kidney Disease Improving Global Outcomes criterion. We obtained data from 103 patients, 45 (43.7%) of whom were women. The most common comorbidity was a neurological disorder. Renal damage developed in 59.2% of patients. Renal replacement was required in 50.8% of the patients. Among patients who received colistin, 64.1% died. The use of vasopressors, diuretics, nephrotoxic agents with colistin, advanced age, and hypoalbuminemia were more common in patients with renal injury. Multivariate regression analysis showed that vasopressor use, prior creatinine elevation, and diuretic use were independent risk factors for colistin-induced AKI. Vasoactive agent use, previous kidney injury, and furosemide use were independent risk factors for colistin-induced nephrotoxicity. Considering these factors may be instructive for better monitoring of patients when colistin is required in intensive care units.
Primary hepatic mucosa-associated lymphoid tissue lymphoma complicated with atrial fibrillation: A case report and literature review
Authors: Liu Chenming , Liu Yuxing , Zhang Jiayao , Chai Yingjie , Lu Baochun , Tang Haijun
Published: January 2024

Rationale:

Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is a rare malignant primary hepatic lymphoma. The sensible choice of treatment for patients with primary lymphoma combined with atrial fibrillation (AF) is controversial and challenging.

Patient concerns:

The patient presented with both primary hepatic MALT lymphoma and AF, which was difficult to manage.

Diagnoses:

Pathological and immunohistochemical examination are helpful for definitive diagnosis.

Interventions:

Surgical resection and subsequent anticoagulant therapy are main treatment methods, and adjuvant therapy depends on the situation.

Outcomes:

Primary hepatic MALT lymphoma is easy to misdiagnosis due to a lack of typical symptoms and imaging signs.

Lessons:

This case highlights for patients with primary hepatic MALT lymphoma combined with AF, toxicity caused by adjuvant chemotherapy should be fully considered, and careful selection should be made based on the general conditions and complications of patients.
Anemia, iron, and HIV: decoding the interconnected pathways: A review
Authors: Obeagu Emmanuel Ifeanyi , Obeagu Getrude Uzoma , Ukibe Nkiruka Rose , Oyebadejo Samson Adewale
Published: January 2024

This review delves into the intricate relationship between anemia, iron metabolism, and human immunodeficiency virus (HIV), aiming to unravel the interconnected pathways that contribute to the complex interplay between these 3 entities. A systematic exploration of relevant literature was conducted, encompassing studies examining the association between anemia, iron status, and HIV infection. Both clinical and preclinical investigations were analyzed to elucidate the underlying mechanisms linking these components. Chronic inflammation, a hallmark of HIV infection, disrupts iron homeostasis, impacting erythropoiesis and contributing to anemia. Direct viral effects on bone marrow function further compound red blood cell deficiencies. Antiretroviral therapy, while essential for managing HIV, introduces potential complications, including medication-induced anemia. Dysregulation of iron levels in different tissues adds complexity to the intricate network of interactions. Effective management of anemia in HIV necessitates a multifaceted approach. Optimization of antiretroviral therapy, treatment of opportunistic infections, and targeted nutritional interventions, including iron supplementation, are integral components. However, challenges persist in understanding the specific molecular mechanisms governing these interconnected pathways. Decoding the interconnected pathways of anemia, iron metabolism, and HIV is imperative for enhancing the holistic care of individuals with HIV/AIDS. A nuanced understanding of these relationships will inform the development of more precise interventions, optimizing the management of anemia in this population. Future research endeavors should focus on elucidating the intricate molecular mechanisms, paving the way for innovative therapeutic strategies in the context of HIV-associated anemia.
Post-surgical thyroid bed myofibroma simulating a recurrent papillary thyroid carcinoma: A case report and review of the literature
Authors: Park Jun Hyeon , Yi Kyung Sik , Choi Chi-Hoon , Kim Yook , Lee Jisun , Park Yeongtae , Lee Ok-Jun
Published: January 2024

Rationale:

Myofibromas are rare benign spindle cell tumors of the soft tissue, bone, or internal organs that occur at any age. Here, we report a post-surgical thyroid bed myofibroma that mimicked a papillary thyroid carcinoma.

Patient concerns:

A 56-year-old male presented with a mass in the thyroid surgical bed, detected 3 years post thyroidectomy following papillary carcinoma.

Diagnosis:

Thyroid ultrasonography revealed a well-defined, lobulated, hypoechoic, solid nodule, with large rod-like echogenic foci in the thyroid surgical bed. The development of a postoperative suture granuloma was considered. However, ultrasonography performed 12 months later showed a marked increase in the lesion size. Two fine needle aspiration cytology yielded nondiagnostic results.

Intervention:

Considering the possibility of local tumor recurrence, surgical resection was performed.

Outcome:

The diagnosis of a myofibroma was confirmed, and no additional treatment was administered.

Lessons:

It is challenging to differentiate lesions occurring on the thyroid surgical bed after surgery, from recurrent thyroid cancer. A lesion measuring 6 mm, with a degree of punctate echogenicity, suggests tumor recurrence. Moreover, myofibromas are extremely rare. This case highlights that it is advisable to perform a core needle biopsy in cases of nondiagnostic fine needle aspiration results.
Anesthetic management of patients with difficult intubation due to temporomandibular joint osteoarthritis: A case report
Authors: Rao Changle , Huang Guihua , Mu Fangfang , Tan Zhengquan , Yuan Jie
Published: January 2024

Introduction:

Temporomandibular joint osteoarthritis (TMJOA) affects 8% to 16% of the global population, yet TMJOA remains relatively underappreciated clinically. To anesthesiologists, who is concerned about patient safety, adequate preoperative evaluation and preparation, as well as individualized anesthetic management of patients, are necessary. Therefore, the anesthesiologist should be alert for difficult airways due to TMJOA, have a full and comprehensive understanding of the disease, and possess the appropriate expertise for difficult airway intubation.

Case presentation:

A 52-year-old female patient was scheduled for laparoscopic operation of uterine adnexa under general anesthesia. The patient preoperative evaluation showed only 1 finger width of mouth opening, and the computed tomography scan showed bilateral temporomandibular arthritis, which was evident on the right side. Intraoperatively, the expected airway difficulties occurred, and the anesthesiologist opted to use lightwand intubation, which was ultimately successful in 1 pass without any complications.

Conclusion:

Intubation using a lightwand for patients with difficult intubation due to TMJOA is a very effective intubation modality.
Chinese expert consensus on prevention and treatment of delayed nausea and vomiting (2022 Edition)
Authors: Yuan Xiang-Lin ,   Committee of Neoplastic Supportive-Care (CONS)
Published: January 2024

Nausea and vomiting are common adverse reactions of antitumor therapy, among which chemotherapy-induced nausea and vomiting (CINV) has been studied most intensively. Because of insufficient prevention or insufficient attention, CINV brings a series of harms to cancer patients and even lead to the delay or termination of antitumor therapy. Delayed CINV is often underestimated because it mostly occurs outside the hospital, and patients cannot report it immediately. In recent years, the proportion of outpatient chemotherapy and day-time chemotherapy patients in China has increased year by year. Therefore, the prevention of delayed CINV is particularly important. Currently, the challenges faced by delayed CINV include the need to deeply explore its physiological and pathological mechanisms, improve its risk assessment standards, and optimize its prevention programs. However, there is still lack of practice guidelines or consensus on delayed CINV. Therefore, the Committee of Neoplastic Supportive-Care of China Anti-Cancer Association organized multidisciplinary experts in this field to formulate this consensus based on the analysis and discussion of current evidence-based medical research in combination with clinical problems that need to be solved urgently.
Contrast-enhanced ultrasonography of metanephric adenoma: a case report and literature review
Authors: Wang Han-Xiang , Wang Dan , Xi Ying-Tong , Zhou Lin-Yan , Shen Rui
Published: January 2024

Objective

To investigate the gray-scale ultrasound and contrast-enhanced ultrasound (CEUS) features of metanephric adenoma (MA) to improve our understanding and diagnostic accuracy.

Methods

Contrast-enhanced ultrasound findings and clinical data of a patient with MA are reported.

Results

The possibility of renal malignancy was considered after CEUS and computed tomography. A left renal nephron-sparing operation was performed using an endoscope, and MA was confirmed via surgical pathology.

Conclusion

Preoperative diagnosis of MA is difficult because of atypical imaging findings. The possibility of MA should be considered when a renal mass is found, and CEUS shows a “slow-in, fast-out” enhancement pattern.
Recent advances in conversion therapy schemes for stage IV gastric cancer
Authors: Liu Shuai , Zhang Kai , Luan Wei
Published: January 2024

“Conversion therapy” is a treatment modality that involves the use of radiotherapy, chemotherapy, targeted therapy, immunotherapy, and other therapeutic methods to transform initially late-stage tumors that cannot be cured into treatments that can achieve an R0 curative effect. However, selecting an appropriate conversion therapy scheme remains a challenge, and there are currently few relevant studies on this topic. This article reviews successful cases of conversion therapy and clinical studies on treatment schemes, at domestic and international levels, over the past few years to offer a broad range of treatment options for patients.
Do Not Turn a Blind Eye on Forensic Biochemistry
Authors: Auen Thomas , Linde Erin
Published: January 2024

In both medical and forensic autopsy, the kidneys may be overlooked grossly and histologically. As both acute and chronic kidney dysfunction have major implications on morbidity and mortality, it is essential to consider the kidneys as a pathologic source for both immediate and proximate cause of death. For decades, vitreous humor has been used as a measure of postmortem electrolyte analysis to help understand ionic disturbances carried over from the antemortem period. Renal insufficiency from both acute and chronic kidney dysfunction can be ascertained from vitreous investigations and should be a consideration for cause of death. Here, we present 4 cases in which vitreous analysis was used to determine the cause of death. In highlighting these cases, we support the use of biochemical testing in autopsy while demonstrating how it can help elucidate an often overlooked means of mortality. Importantly, it can help with the formulation of clinicopathologic correlations between antemortem and postmortem findings.
Association of chronotropic incompetence with reduced cardiorespiratory fitness in older adults with HIV
Authors: Oursler Krisann K. , Briggs Brandon C. , Lozano Alicia J. , Harris Nadine M. , Parashar Amitabh , Ryan Alice S. , Marconi Vincent C. ,   for the FIT VET Project Team∗
Published: January 2024

Objective:

Understanding the physiological drivers of reduced cardiorespiratory fitness in people with HIV (PWH) will inform strategies to optimize healthspan. Chronotropic incompetence is common in heart failure and associated with low cardiorespiratory fitness yet is understudied in PWH. The objective was to determine the prevalence of chronotropic incompetence and its relationship with cardiorespiratory fitness.

Design:

Participants were PWH at least 50 years of age with no prior history of heart failure or coronary heart disease who were enrolled in a randomized exercise trial. Baseline cardiopulmonary exercise testing (CPET) was used to measure cardiorespiratory fitness as peak oxygen consumption (VO2peak) and calculate the chronotropic index from heart rate values. Chronotropic incompetence was defined as an index less than 80%.

Results:

The 74 participants were on average 61 years old, 80% Black or African American, and 93% men. Chronotropic incompetence was present in 31.1%. VO2peak was significantly lower among participants with chronotropic incompetence compared with participants without chronotropic incompetence [mean (SD) ml/min/kg: 20.9 (5.1) vs. 25.0 (4.5), P = 0.001]. Linear regression showed that chronotropic incompetence and age were independent predictors of VO2peak, but smoking and comorbidity were not. The chronotropic index correlated with VO2peak (r = 0.48, P < 0.001).

Conclusion:

Among older PWH without heart failure or coronary heart disease, chronotropic incompetence was present in approximately one-third of individuals and was associated with clinically relevant impaired cardiorespiratory fitness. Investigation of chronotropic incompetence in large cohorts which includes PWH and heart failure may contribute to strategies that promote healthy aging with HIV infection and offer a preclinical window for intervention.
Three-dimensional Volumetric Visceral and Subcutaneous Fat Analysis on Opportunistic Computed Tomography Imaging of Patients With Greater Trochanteric Pain Syndrome Compared With Those With Predominant Osteoarthritis: A Case-Control Study
Authors: Garigipati Priyanka , Rehman Mahad , Xi Yin , Chhabra Avneesh
Published: January 2024

Objective

This study aimed to address the gap in knowledge assessing the impact of visceral and subcutaneous body fat on 3-dimensional computed tomography imaging in patients with greater trochanteric pain syndrome (GTPS) in comparison with those primarily diagnosed with osteoarthritis (OA).

Materials and Methods

We evaluated adult patients with a confirmed diagnosis of GTPS from our institutional hip-preservation clinic spanning 2011 to 2022. Selection criteria included their initial clinic visit for hip pain and a concurrent pelvis computed tomography scan. These patients were age- and sex-matched to mild-moderate OA patients selected randomly from the database. Visceral and subcutaneous fat areas were measured volumetrically from the sacroiliac joint to the lesser trochanter using an independent software. Interreader reliability was also calculated.

Results

A total of 93 patients met the study criteria, of which 37 belonged to the GTPS group and 56 belonged to the OA group. Both groups were sex and race matched. Average age in GTPS and OA groups was 59.3 years and 56 years, respectively. For GTPS group, average body mass index was 28.9 kg/m2, and for the OA group, average body mass index was 29.9 kg/m2, with no significant difference (P> 0.05). Two-samplettest showed no significant differences in the visceral fat, subcutaneous fat, or the visceral fat to total fat volume ratio between the GTPS and OA groups. There was excellent interreader reliability.

Conclusions

Our results indicate that there is no significant difference in fat distribution and volumes among GTPS and OA patients. This suggests that being overweight or obese may not be directly linked or contribute to the onset of GTPS. Other factors, such as gluteal tendinopathy, bursitis, or iliotibial band syndrome, might be responsible and need further investigation.
Trial Design for Mixed Urinary Incontinence: Midurethral Sling Versus Botulinum Toxin A
Authors: Harvie Heidi S. , Richter Holly E. , Sung Vivian W. , Chermansky Christopher J. , Menefee Shawn A. , Rahn David D. , Amundsen Cindy L. , Arya Lily A. , Huitema Carolyn , Mazloomdoost Donna , Thomas Sonia ,   for the NICHD Pelvic Floor Disorders Network
Published: January 2024

Importance

Mixed urinary incontinence (MUI) is common and can be challenging to manage.

Objectives

We present the protocol design and rationale of a trial comparing the efficacy of 2 procedures for the treatment of women with MUI refractory to oral treatment. The Midurethral sling versus Botulinum toxin A (MUSA) trial compares the efficacy of intradetrusor injection of 100 U of onabotulinimtoxinA (an office-based procedure directed at the urgency component) versus midurethral sling (MUS) placement (a surgical procedure directed at the stress component).

Study Design

The MUSA is a multicenter, randomized trial of women with MUI electing to undergo procedural treatment for MUI at 7 clinical centers in the NICHD Pelvic Floor Disorders Network. Participants are randomized to either onabotulinumtoxinA 100 U or MUS. OnabotulinimtoxinA recipients may receive an additional injection between 3 and 6 months. Participants may receive additional treatment (including crossover to the alternative study intervention) between 6 and 12 months. The primary outcome is change from baseline in Urogenital Distress Inventory (UDI) at 6 months. Secondary outcomes include change in UDI at 3 and 12 months, irritative and stress subscores of the UDI, urinary incontinence episodes, predictors of poor treatment response, quality of life and global impression outcomes, adverse events, use of additional treatments, and cost effectiveness.

Results

Recruitment and randomization of 150 participants is complete and participants are currently in the follow-up phase.

Conclusions

This trial will provide information to guide care for women with MUI refractory to oral treatment who seek surgical treatment with either onabotulinumtoxinA or MUS.