bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of different anesthetic modalities on postoperative delirium in elderly hip fractures: A meta-analysis
Authors: Fan Guangya , Zhong Musen , Su Wenshuo , An Zhongcheng , Zhu Yuchen , Chen Chen , Dong Liqiang , Wu Lianguo , Zhang Xiaoping
Published: June 2024

Background:

Previous findings on the effect of general versus spinal anesthesia on postoperative delirium in elderly people with hip fractures are somewhat controversial. This article included the latest randomized controlled study for meta-analysis to evaluate the effect of general anesthesia (GA) and spinal anesthesia (SA) on delirium after hip fracture surgery in the elderly, so as to guide the clinical.

Methods:

Cochrane Library, PubMed, Web Of Science, and Embase were searched from inception up to January 16, 2024. Randomized controlled trial (RCT) was included to evaluate the postoperative results of GA and SA in elderly patients (≥50 years old) undergoing hip fracture surgery. Two researchers independently screened for inclusion in the study and extracted data. Heterogeneity was assessed by the I²and Chi-square tests, and P < .1 or I² ≥ 50% indicated marked heterogeneity among studies. The Mantel–Haenszel method was used to estimate the combined relative risk ratio (RR) and the corresponding 95% confidence interval (CI) for the binary variables.

Results:

Nine randomized controlled trials were included. There was no significant difference (RR = 0.93, 95% CI = 0.774–1.111, P > .05) in the incidence of postoperative delirium between the GA group and the SA group. In intraoperative blood transfusion (RR = 1.0, 95% CI = 0.77–1.28, Z = 0.04, P = .971), pulmonary embolism (RR = 0.795, 95% CI = 0.332–1.904, Z = 0.59, P = .606), pneumonia (RR = 1.47, 95% CI = 0.75–2.87, P = .675), myocardial infarction (RR = 0.97, 95% CI = 0.24–3.86, Z = 0.05, P = .961), heart failure (RR = 0.80, 95% CI = 0.26–2.42, Z = 0.40, P = .961), urinary retention (RR = 1.42, 95% CI = 0.77–2.61, Z = 1.11, P = .267) were similar between the 2 anesthetic techniques.

Conclusion:

There is no significant difference in the effect of GA and SA on postoperative delirium in elderly patients with hip fracture, and their effects on postoperative complications are similar.
A bibliometric analysis of myocardial bridge combined with myocardial infarction
Authors: Zhang Haiyuan , Cao Yuejuan
Published: June 2024

Background:

The aim of this study is to analyze the process and frontiers of research in myocardial bridges (MB) to identify future research directions in the last 3 decades.

Methods:

Relevant literature on MB combined with myocardial infarction (MI) was searched from 1991 to 2023 in the Web of Science database, and was analyzed by bibliometric analysis using VOSviewer, CiteSpace, and the R package “bibliometrix.”

Results:

A total of 1233 English articles were included in this study. The number of published articles showed an increasing trend yearly. From 2017 to 2022, the annual publication volume rose rapidly, and in 2021 the publication volume even reached 95 articles, which was the highest in all years. These publications were from 68 countries and 1854 institutions, with the leading country being the U.S. and the leading institution being Columbia University. Myoho Clinical International has a close collaborative relationship with Columbia University, while in recent years, the Harvard Medical School has explored the study of MB combined with MI. Annals of Thoracic Surgery was the journal with the highest number of publications, and Takayama Hiroo and Naka Yoshifumi were the authors with the highest number of publications. The most common keywords were MI, cardiogenic shock, and MB.

Conclusions:

Our findings can help researchers explore the current status of MB combined with MI research and choose new survey routes for upcoming studies. Prevalence and prognosis, mechanism of MB combined with MI and molecular mechanism may become the focus of future research. In addition, more research and cooperation are needed worldwide.
Congenital hepatic fibrosis with negative endoscopic evaluation of esophageal and gastric varices: A case report
Authors: Pan Lin , Shao Huaguo
Published: June 2024

Rational:

Congenital hepatic fibrosis (CHF) is a rare autosomal recessive genetic disease, which is often diagnosed in children and young adults. The clinical manifestations of CHF were lack of specificity, mainly including portal hypertension related symptoms and signs, and normal or mildly abnormal liver function. When no obvious varices are indicated under endoscope, it can easily lead to misdiagnosis or missed diagnosis. We report this case in the hope of raising awareness of this disease.

Patient concerns:

A 31 years old male patient with major clinical manifestations of unexplained thrombocytopenia for 5 years.

Diagnoses:

Results of ultrasound, magnetic resonance imaging (MRI) and computed tomography portal venography (CTV) showed that patient had liver cirrhosis with portal hypertension and liver biopsy revealed CHF.

Intervention:

Patient received ursodeoxycholic acid tablets, fuzheng huayu capsule, ganshuang granule, etc for liver protection treatment.

Outcomes:

The condition of patient stabilized after symptomatic treatment. Spleen resection will be considered during follow-up.

Lessons:

This case reminds us that in case of patients with negative endoscopic evaluation, ultrasonic, computed tomography (CT) and MRI examination should be performed at the same time to determine whether patients have portal hypertension. When patients with normal or mildly abnormal liver function had unexplained liver cirrhosis complicated with portal hypertension, the possibility of CHF should be considered.
HyperArcTM volumetric modulated arc therapy for hypopharyngeal cancer with solitary recurrence in the cervical vertebra: A case report and literature review
Authors: Lin Chia-Hui , Que Jenny , Ho Sheng-Yow
Published: June 2024

Rationale:

It is difficult to reirradiate head and neck cancers because of the toxicity from previous radiation dose delivery. Conventional volumetric modulated arc therapy (VMAT) and intensity-modulated radiation therapy often have poor target coverage. The new HyperArcTM VMAT (HA-VMAT) planning approach reportedly has better target coverage, higher conformity, and can spare normal organs compared to conventional VMAT; however, research on recurrent head and neck cancers is limited. Here, we report the clinical outcomes of HA-VMAT for previously irradiated hypopharyngeal cancer with solitary recurrence in the first cervical vertebra (C1).

Patient concerns:

A 52-year-old Asian male was diagnosed with a hypopharyngeal cancer. The patient received concurrent chemoradiotherapy with a radiation dose of 70 Gy in 33 fractions and achieved complete clinical response. Two years later, solitary recurrence was observed in the C1 vertebra.

Diagnoses:

Solitary recurrence in the C1 vertebra.

Interventions:

Owing to concerns regarding the toxicity to adjacent organs, we decided to use HA-VMAT to achieve better tumor coverage and critical organ sparing.

Outcomes:

Tumor regression was observed on the imaging. At 9 months follow-up, the patient was disease-free and had no late toxicities.

Lessons:

This is the first report regarding the clinical outcomes of HA-VMAT for previously irradiated hypopharyngeal cancer with solitary recurrence over the C1 vertebra. HA-VMAT achieves highly conformal dose distribution and excellent sparing of critical organs. There was a favorable initial clinical response with no toxicity. Long-term follow-up is essential in such cases.
The potential mechanism of HIF-1α and CD147 in the development of triple-negative breast cancer
Authors: Chen Menghe , Liu Zitao , Zheng Kai , Hu Chaohua , Peng Pai
Published: June 2024

Background:

Triple-negative breast cancer (TNBC) is a subtype of breast cancer with a poor prognosis, and the outcomes of common therapy were not favorable.

Methods:

The samples of 84 patients with TNBC and 40 patients with breast fibroadenoma were collected in the pathology department specimen library of our hospital. The prognosis of patients was obtained through outpatient follow-up information, telephone and WeChat contacts, and medical records. The mRNA expression was analyzed using bioinformation and quantitative real-time polymerase chain reaction (qPCR). The protein expression was determined by hematoxylin-eosin staining and immunohistochemical staining. The results of survival analysis were visualized using Kaplan–Meier curves.

Results:

The immunohistochemical staining showed that hypoxia-inducible factor-1alpha (HIF-1α) was mainly distributed in the nucleus and cytoplasm, while CD147 is mainly distributed in cell membrane and cytoplasm. The qPCR results exhibited that the expression level of HIF-1α and CD147 in TNBC tissue was significantly higher than that in breast fibroadenoma tissue. The expression of HIF-1α was related to the histological grade and lymph node metastasis in TNBC, and the expression of CD147 was related to Ki-67, histological grade and lymph node metastasis. There was a positive relationship between the expression of CD147 and HIF-1α. The upregulated expression of CD147 was closely related to the poor prognosis of OS in TNBC.

Conclusion:

CD147 could be a biomarker for the prognosis of TNBC and closely related to the expression of HIF-1α.
Association between preoperative albumin and length of hospital stay in non-cardiac surgery patients with pulmonary hypertension: A secondary retrospective analysis
Authors: Wang Shu , Xue Zhouya , Su Dan , Ji Lin , Gao Yuanyuan
Published: June 2024

To explore the risk factors affecting the length of hospital stay (LOS) as well as to examine the relationship between preoperative serum albumin levels and LOS following non-cardiac, non-obstetric surgery in patients with pulmonary hypertension (PHTN). This study represents a secondary retrospective analysis based on 287 non-cardiac, non-obstetric procedures performed on 195 PTHN patients at a single institution in the USA between 2007 and 2013. The primary outcome was the LOS. We conducted a multiple logistic regression analysis to compare the LOS between the 2 groups, divided at a serum albumin level of 3.5 g/dL. After adjusting for multiple covariates, the ORs for the long length of stay (LOS > 7 days) for the high group(albumin > 3.5 g/dL) compared with the low group (albumin ≤ 3.5 g/dL) were 0.35 (95%CI: 0.21~0.6), 0.41 (95%CI: 0.22 ~0.76), 0.41 (95%CI: 0.18~0.94) from model 2 to model 4. The stratified analysis results indicate that these findings are stable (p for trend > 0.05). In this study, it was observed that low levels of preoperative albumin were associated with an increased risk of prolonged hospital stay after non-cardiac, non-obstetric surgery in patients with PHTN. This implies that optimizing preoperative nutrition could potentially reduce the LOS for non-cardiac, non-obstetric surgery in patients with PHTN.
The effects of various stair-climbing exercises on functional mobility and trunk muscle activation in community-dwelling older adults: A pilot randomized controlled trial
Authors: Kim Min-Kang , Kim Chang-Yong , Baek Chang-Yoon , Kim Suhng-Wook , Je Hyun Dong , Jeong Ji Hoon , Kim Hyeong-Dong
Published: June 2024

Background:

Stair-climbing (SC) is an essential daily life skill, and stair-climbing exercise (SCE) serves as a valuable method for promoting physical activity in older adults. This study aimed to compare the impact of SCEs with heel contact (HC) and heel off (HO) during SC on functional mobility and trunk muscle (TM) activation amplitudes in community-dwelling older adults.

Methods:

In the pilot randomized controlled trial, participants were randomly allocated to either the HC group (n = 17; mean age 75.9 ± 6.3 years) or the HO group (n = 17; mean age 76.5 ± 4.6 years). The HC participants performed SCE with the heel of the ankle in contact with the ground, while the HO participants performed SCE with the heel of the ankle off the ground during SC. Both groups participated in progressive SCE for one hour per day, three days per week, over four consecutive weeks (totaling 12 sessions) at the community center. We measured timed stair-climbing (TSC), timed up and go (TUG), and electromyography (EMG) amplitudes of the TMs including rectus abdominis (RA), external oblique (EO), transverse abdominus and internal oblique abdominals (TrA-IO), and erector spinae (ES) during SC before and after the intervention.

Results:

Both groups showed a significant improvement in TSC and TUG after the intervention (P < .01, respectively), with no significant difference between the groups. There was no significant difference in the EMG activity of the TMs between the groups after the intervention. The amplitude of TMs significantly decreased after the intervention in both groups (P < .01, respectively).

Conclusion:

Both SCE methods could improve balance and SC ability in older adults while reducing the recruitment of TMs during SC. Both SCE strategies are effective in improving functional mobility and promoting appropriate posture control during SC in older adults.
The long-term outcome and risk factors of histologic discrepancy between forceps biopsies and endoscopic resections in early gastric cancer: An observational study
Authors: Yeo Min-Kyung , Park Jae Ho , Kang Sun Hyung , Moon Hee Seok , Sung Jae Kyu , Jeong Hyun Yong , Kim Ju Seok
Published: June 2024

Although endoscopic forceps biopsy is the gold standard for early gastric cancer (EGC) diagnosis, the method can cause endoscopic resection of specimens and histological discrepancies. This study aims to examine the risk factors for histological discrepancies in EGC and long-term clinical outcomes.

This retrospective study included patients diagnosed with differentiated-type EGC using forceps biopsy. Patients without histological discrepancies and with undifferentiated types in endoscopic resection histology were categorized into the concordant and discordant groups, respectively. Clinical characteristics and long-term outcomes related to histological discrepancies were analyzed.

A total of 957 lesions from 936 patients were enrolled. An overall discrepancy rate of 8.7% was confirmed, with an undifferentiated-type discrepancy of 5.5%. The discordant group showed a higher tendency for lesions to be located in the upper third region, to have whitish discoloration, and to undergo a greater number of biopsies compared with the concordant group. Multivariate analysis confirmed that lesion location in the upper third region (odds ratio [OR]: 2.125; 95% confidence interval [CI]: 1.032–5.277; P = .041) and whitish surface discoloration (OR: 13.615; 95% CI: 6.028–28.728; P = .001) were significantly correlated with histologic discrepancy. Compared with the concordant group, the discordant group had a lower curative resection rate, but no differences were observed in complications, local recurrence, or survival rates.

Upper third location and whitish discoloration were risk factors for the histologic discrepancy between differentiated and undifferentiated types in patients with EGC. For curative resections performed in patients with EGC and histologic discrepancies and without additional treatment, careful follow-up is possible.
Effects of Mindfulness-Based Cancer Recovery training on anxiety, depression, post-traumatic stress disorder, and cancer-related fatigue in breast neoplasm patients undergoing chemotherapy
Authors: Xu Fan , Zhang Jiquan , Xie Shaoju , Li Qiao
Published: June 2024

Rationale:

Mindfulness-Based Cancer Recovery (MBCR) program is a group course training for cancer patients that combines cancer knowledge and psychological knowledge, emphasizing focusing on the psychosomatic symptoms of cancer patients. Currently, the application value of Mindfulness-Based Cancer Recovery in improving psychosomatic health of cancer patients has been confirmed, however, its intervention effect on breast neoplasm patients has not yet been widely studied in China.

Patient concerns and Diagnoses:

This study introduced the Mindfulness-Based Cancer Recovery protocol into the rehabilitation process of breast cancer patients, aiming to elucidate the effects of Mindfulness-Based Cancer Recovery on anxiety, depression, post-traumatic stress disorder, and cancer-related fatigue in breast neoplasm patients, to provide a practical basis for improving the physical and mental health of breast cancer patients.

Intervention:

In this study, 80 patients with chemotherapy-stage breast neoplasm attending the oncology department of a tertiary-level hospital from January 2022 to December 2022 were selected, 40 patients attending from January 2022 to June 2022 were included in the study group, and 40 patients attending from July 2022 to December 2022 were included in the control group. The control group was administered conventional care, and the study group was administered Mindfulness-Based Cancer Recovery based on conventional care in the control group for 8 weeks. After the intervention, hospital anxiety and depression scale, impact of event scale-revised, and cancer fatigue scale were used for evaluation.

Outcomes:

After the intervention, hospital anxiety and depression scale scores decreased in both groups compared with pre-intervention, with the study group scoring lower than the control group (P < .05). After the intervention, the impact of event scale-revised scores of the 2 groups decreased from the preintervention period, with the study group scoring lower than the control group (P < .05). After the intervention, cancer fatigue scale scores decreased in the 2 groups compared with the preintervention period, with the study group scoring lower than the control group (P < .05).

Lessons:

Mindfulness-Based Cancer Recovery can effectively reduce the levels of anxiety, depression and post-traumatic stress disorder in breast neoplasm patients undergoing chemotherapy, reduce the levels of cancer-related fatigue, and promote the physical and mental health of patients.
Prenatal detection of chromosome 7q deletion with duplication: A case report and literature review
Authors: Zhu Jinping , Hu Juan
Published: June 2024

Rationale:

With advances in prenatal diagnostic techniques, chromosomal microdeletions and microduplications have become the focus of prenatal diagnosis. 7q partial monosomy or trisomy due to a deletion or duplication of the 7q end is relatively rare and usually originates from parents carrying a balanced translocation.

Patient concerns:

Noninvasive prenatal screening (NIPT) showed a fetus with partial deletion and duplication of chromosome 7q. It was not possible to determine whether the fetus was normal.

Diagnoses:

Conventional chromosome G-banding and chromosome microarray analysis (CMA) were performed on fetal amniotic fluid samples and parental peripheral blood samples.

Interventions:

The pregnant women were given detailed genetic counseling by clinicians.

Outcomes:

The fetal karyotype was 46, XY on conventional G-banding analysis. The CMA test results showed a deletion of approximately 7.8 Mb in the 7q36.1q36.3 region and a duplication of 6.6Mb in the 7q35q36.1 region. The parents’ karyotype analysis and CMA results were normal, indicating a new mutation.

Lessons:

CMA molecular diagnostic analysis can effectively detect chromosomal microdeletions or microduplications, clarify the relationship between fetal genotype and clinical phenotype, and provide a reference for prenatal diagnosis of chromosomal microdeletion-duplication syndrome.
Sclerosing angiomatoid nodular transformation of the spleen: Case reports and literature review
Authors: Xia Leizhou , Li Zhitao , Jiang Pengcheng , Zhang Yongjun , Bu Xuefeng , Meng Nana
Published: June 2024

Rationale:

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is an uncommon benign vascular lesion with an obscure etiology. It predominantly affects middle-aged women and presents with nonspecific clinical signs, making preoperative diagnosis challenging. The definitive diagnosis of SANT relies on pathological examination following splenectomy. This study aims to contribute to the understanding of SANT by presenting a case series and reviewing the literature to highlight the clinical presentation, diagnostic challenges, and treatment outcomes.

Patient concerns:

In this retrospective study, we analyzed the clinical data of 3 patients with confirmed SANT admitted from November 2013 to October 2023. The cases include a 25-year-old male, a 15-year-old female, and a 39-year-old male, each with a splenic mass.

Diagnoses and Interventions:

All of the three cases were treated by laparoscopic splenectomy (LS). Pathological examination confirmed SANT in all cases.

Outcomes:

No recurrence or metastasis was observed during a 10-year follow-up for the first 2 cases, and the third case showed no abnormalities at 2 months postoperatively. Despite its rarity, SANT is a significant condition due to its potential for misdiagnosis and the importance of distinguishing it from malignant lesions. The study underscores the utility of LS as a safe and effective treatment option.

Lessons:

SANT is a rare benign tumor of the spleen, and the preoperative diagnosis of whom is challenging. LS is a safe and effective treatment for SANT, with satisfactory surgical outcomes and favorable long-term prognosis on follow-up. The study contributes to the limited body of research on this rare condition and calls for larger studies to validate these findings and improve clinical management.
Prognostic prediction of patients having classical papillary thyroid carcinoma with a 4 mRNA-based risk model
Authors: Xiang Lin , Zhao Jun-Hui , Tang Yao , Tan Jun-Wu , Li Liang-Bo , Gong Cheng
Published: June 2024

The dysregulation of protein-coding genes involved in various biological functions is closely associated with the progression of thyroid cancer. This study aimed to investigate the effects of dysregulated gene expressions on the prognosis of classical papillary thyroid carcinoma (cPTC). Using expression profiling datasets from the Cancer Genome Atlas (TCGA) database, we performed differential expression analysis to identify differentially expressed genes (DEGs). Cox regression and Kaplan–Meier analysis were used to identify DEGs, which were used to construct a risk model to predict the prognosis of cPTC patients. Functional enrichment analysis unveiled the potential significance of co-expressed protein-encoding genes in tumors. We identified 4 DEGs (SALL3, PPBP, MYH1, and SYNDIG1), which were used to construct a risk model to predict the prognosis of cPTC patients. These 4 genes were independent of clinical parameters and could be functional in cPTC carcinogenesis. Furthermore, PPBP exhibited a strong correlation with poorer overall survival (OS) in the advanced stage of the disease. This study suggests that the 4-gene signature could be an independent prognostic biomarker to improve prognosis prediction in cPTC patients older than 46.
Association of calcific rotator cuff tendinopathy with nephrolithiasis and/or cholelithiasis: A case–control study
Authors: Jomaa Yara , Aitisha-Tabesh Ouidade , Dgheim Dima , Faddoul Rafic , Haddad-Zebouni Soha , Fayad Fouad
Published: June 2024

This study aimed to examine the association between calcific rotator cuff tendinopathy (RCT) and nephrolithiasis and/or cholelithiasis. A case–control study was conducted on patients diagnosed with RCT between June 2016 and June 2022. RCT was confirmed by ultrasound, and patients were divided into 2 groups: calcific RCT (case) and non-calcific RCT (control). Data were collected retrospectively from electronic medical records and completed by phone calls, looking for a history of nephrolithiasis and/or cholelithiasis; based on clinical features or incidental findings on abdominal and pelvic imaging. A total of 210 patients with RCT were included. Among the 95 cases of calcific RCT, 43 had a history of lithiasis (45.3%) against 23 (20%) from the non-calcific RCT group (P < .001); 21 patients suffered from nephrolithiasis (22.1%) and 26 had cholelithiasis (27.4%) versus 10 (8.7%) (P = .006) and 16 (13.9%) (P = .015) in the non-calcific RCT group, respectively. Logistic regression showed that the independent predictors of calcific RCT included a history of nephrolithiasis (OR, 4.38; 95% CI: 1.61–11.92, P = .004) and a history of cholelithiasis (OR, 3.83; 95% CI: 1.64–8.94, P = .002). In patients with calcific RCT, the occurrence of lithiasis was significantly associated in the bivariate analysis with higher age, body mass index, fasting blood sugar, and HbA1c (all with P < .05), but only with the presence of another site of calcific tendinopathy than the shoulder (OR, 3.11; 95% CI: 1.12–8.65, P = .03) in the multivariate analysis. Nephrolithiasis and/or cholelithiasis are associated with calcific RCT, and their presence predicts calcific RCT at least 3 times. Further research is required to determine the common risk factors and preventive measures against lithogenesis in patients with calcific RCT, nephrolithiasis, and cholelithiasis.
Correlation between elevated HCLS1 levels and heart failure: A diagnostic biomarker
Authors: Li Chunguang , Zhang Li , Zhang Long , Zhang Guang
Published: June 2024

The correlation between hematopoietic cell-specific lyn substrate 1 (HCLS1) expression levels and heart failure (HF) remains unclear. HF datasets GSE192886 and GSE196656 profiles were generated from GPL24676 and GPL20301 platforms in gene expression omnibus (GEO) database and differentially expressed genes (DEGs) were obtained, which was followed by weighted gene co-expression network analysis, protein-protein interaction (PPI) networks, functional enrichment analysis and comparative toxicogenomics database (CTD) analysis. Heatmaps of gene expression levels were plotted. TargetScan was used to screen miRNAs regulating central DEGs. A total of 500 DEGs were found and mainly concentrated in leukocyte activation, protein phosphorylation, and protein complexes involved in cell adhesion, PI3K Akt signaling pathway, Notch signaling pathway, and right ventricular cardiomyopathy. PPI network identified 15 core genes (HCLS1, FERMT3, CD53, CD34, ITGAL, EP300, LYN, VAV1, ITGAX, LEP, ITGB1, IGF1, MMP9, SMAD2, RAC2). Heatmap shows that 4 genes (EP300, CD53, HCLS1, LYN) are highly expressed in HF tissue samples. We found that 4 genes (EP300, CD53, HCLS1, LYN) were associated with heart diseases, cardiovascular diseases, edema, rheumatoid arthritis, necrosis, and inflammation. HCLS1 is highly expressed in HF and maybe its target.
Effectiveness of integrase strand transfer inhibitors among treatment-naive people living with HIV/AIDS in Guangdong, China: A real-world, retrospective cohort study
Authors: Chen Mingyu , Liu Cong , Xie Jinzhao , Tang Xiaoping , Zhang Yao , Pan Deng , Zhong Haidan , Du Peishan , Li Quanmin , Li Linghua , Gu Jing , Cai Weiping
Published: June 2024

Integrase strand transfer inhibitors (INSTIs) in anti-retroviral therapy (ART) have been recommended by the World Health Organization for their higher efficacy, favorable safety and tolerability. However, the clinical evidence supporting switching to INSTI-containing regimens in low-and-middle-income countries (LMICs) is limited, as few patients have access to these regimens. We aimed to assess the effectiveness of INSTI-containing regimens in real-world settings in China compared to government-provided free ART. We compared the short-term (first 4 mo following ART initiation) and long-term (1 year after ART initiation) effectiveness between INSTI-containing regimens and free ART drugs provided by the Chinese government in 4 dimensions: viral suppression status, immune response, liver and kidney function, and AIDS-related diseases. We obtained data from electronic medical records in the National Infectious Disease Surveillance System. To control baseline confounders, we used propensity score matching (PSM), calculated using logistic regression including socio-demographic and baseline factors. Among 12,836 patients from 2012 to 2019, 673 (5.2%) used INSTI-containing regimens. Patients with INSTI-containing regimens were matched to those with free drugs (644 vs 644). For short-term effectiveness, patients initiating INSTI-containing regimens were more likely to achieve viral suppression (81.4% vs 52.0%; P < .001). The differences in immune response, liver and kidney function and AIDS-related diseases were not significant between the 2 groups. For long-term effectiveness, viral suppression rates were similar (87.96% vs 84.59%; P = .135), with no significant differences in immune response, liver and kidney function, or AIDS-related diseases. Our study suggests that patients initiating ART with INSTI-containing regimens have worse physical status at baseline than patients starting with free ART drugs. Furthermore, we found better virological performances of INSTI-containing regimens in the short-term but not in the long-term due to a high rate of drug changes. Our findings have clinical implications and provide new evidence regarding the effectiveness of INSTI-containing regimens in LMICs.
The effects of sensorial and mobility frailty on the overall and domain-specific cognition performance of Chinese community-dwelling older adults
Authors: Ruan Jian , Hu Xiuhua , Zhang Weibin , Zhang Min , Liu Yuehong , Han Zhao , Ruan Qingwei , Bao Zhijun , Yu Zhuowei
Published: June 2024

This study aimed to investigate the different impacts of sensorial and mobility frailty on overall and domain-specific cognitive function. Further, the independent associations between other intricate capacity (IC) dimensions, including vitality and psychological dimensions, and overall and domain-specific cognitive function were investigated. A total of 429 participants (mean age, 72.91 ± 7.014 years; 57.30% female) underwent IC capacity assessment. Other covariates, such as demographics, health-related variables were also assessed. Overall or domain-specific cognitive impairment was used as a dependent variable in logistic regression analyses adjusted for demographic, health-related, and psychosocial confounders. After adjustment for demographic, health-related, and psychosocial confounders, individuals with sensorial frailty (odds ratio [OR] = 0.435; 95% confidence interval [CI] = 0.236–0.801; P = .008) had a significantly lower risk of mild cognitive impairment (MCI), marginally low delayed memory impairment (OR = 0.601, 95% CI = 0.347–1.040; P = .069), and language impairment (OR = 0.534, 95% CI = 0.305–0.936; OR = 0.318, P = .029; OR = 0.318,95% CI = 0.173–0.586; P < .001) by Boston naming and animal fluency tests than did those with both sensorial and mobility frailty or mobility frailty only. Depressive symptoms had a significant negative influence on executive function. Cardiovascular disease and non-skin malignancy were independent determinants of MCI, and diabetes mellitus was independently associated with processing speed, attention, and executive function. Sensorial and mobility frailty were independent risk factors for cognitive impairment. Mobility frailty had a greater negative influence on the overall cognitive function and memory and language function than did sensorial frailty. The reserve decline in the psychological dimension of IC and chronic diseases also had a significant adverse influence on overall and domain-specific cognition function.
Comparing the efficacy of traditional Chinese exercises and general aerobic exercises in university students with sleep disorders: A systematic review and meta-analysis
Authors: Yang Zhihui , Zhai Haiting , Yang Zhiwei , Ning Boxuan
Published: June 2024

Background:

The objective of this study was to compare the impact of traditional Chinese exercise (TCEs) and general aerobic exercise (GAEs) on the sleep quality of university students and to determine which exercise is more effective in improving sleep quality in this specific population.

Methods:

We utilized Review Manager 5.3 to analyze data from 21 randomized controlled trials (RCTs), which included a total of 1252 participants. Effect sizes of TCEs and GAEs were compared using a random-effects model. Subgroup analyses were conducted on 3 modulating variables: times per session, frequency per week, and period.

Results:

A Meta-analysis of 14 RCTs showed that both TCEs (standard mean difference [SMD] = −0.89, 95% CI: −1.18 to −0.61; P < .00001) and GAEs (SMD = −1.53, 95% CI: −2.10 to −0.97; P < .00001) can significantly improve the sleep of university students, with a significant difference between TCEs and GAEs (P = .05). Both GAEs and TCEs had positive effects on various aspects of sleep quality, including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction. A subgroup analysis of aerobic exercise showed that the effect size was larger in the 40 to 60 minutes group compared to the 60 to 90 minutes group (SMD = −1.89; 95% CI: −2.19 to −1.59; P < .00001). Furthermore, the effect size was larger in the 3 to 5 times per week group compared to the 2 times per week group (SMD = −1.56; 95% CI: −2.33 to −0.80; P < .0001). The effect size was also found to be larger in a period of 2 to 4 weeks compared to 6 to 18 weeks (SMD = −1.85; 95% CI: −2.17 to −1.54; P < .00001).

Conclusion:

GAEs is more effective than TCEs in improving the sleep quality of university students. An optimal aerobic exercise regimen for enhancing sleep quality among university students involves engaging in sessions lasting 40~60 minutes, 3~5 times per week, over a duration of 4 weeks.
The learning curve of laparoscopic single-site salpingectomy with conventional laparoscopic instruments: A retrospective cohort study
Authors: Huang JinCheng , Zhang WenJian , Yang Mei , Li CuiFen , Jiang SuZhen , Zhou QiYin , Han WenDi
Published: June 2024

Tubal pregnancy is a common cause of maternal mortality in early pregnancy. Transumbilical laparoendoscopic single-site surgery (TU-LESS) has gained popularity due to its safety and aesthetic advantages. However, the lack of affordable disposable entry platforms hinders its widespread adoption. This study aimed to investigate the learning curve of tubal pregnancy removal using single-incision multiport (SIMP) laparoscopy and provide guidance for novice gynecologists. A retrospective analysis was conducted on cases of ectopic pregnancy (EP) diagnosed at Dongguan Songshan Lake Central Hospital from June 2020 to June 2022. The analysis included 50 cases, with 25 undergoing single-port laparoscopy and 25 undergoing conventional laparoscopy (CL). Various indicators, including body mass index (BMI), previous pregnancies, mass size, hemoglobin levels, surgical duration, and complications, were collected. Learning curve analysis using the cumulative sum (CUSUM) technique was performed to assess procedural proficiency. There were no significant differences in patient characteristics or complications between the 2 groups. However, the single-port laparoscopy group exhibited a statistically significant longer average surgical time (41.60 ± 13.38 minutes) compared to the conventional laparotomy group (32.96 ± 7.32 minutes). The CUSUM analysis demonstrated a decline in surgical time after the completion of approximately 11 cases, indicating an improvement in SIMP laparoscopy surgical proficiency. SIMP laparoscopy for tubal pregnancy removal achieved similar safety outcomes as CL. Notably, the CUSUM analysis revealed that proficiency in single-port laparoscopy could be achieved after approximately 11 cases, leading to stable surgical times. These findings serve as valuable guidance for novice gynecologists interested in adopting single-incision laparoscopy.
The migraine epidemic among medical students: a call for action
Authors: Saeed Muhammad , Farooq Muhammad Usman , Abbas Mohammad Najaf Ali , Khan Faheemullah , Tangmi Djabo Eric Adrien , Mittal Gaurav
Published: June 2024

Migraine is characterized by recurrent headaches of moderate-to-severe intensity and poses a significant challenge for medical students. This is a narrative literature review using PubMed and Scopus databases. This study examines how common migraine is in this group and suggests working together to address how it affects students’ well-being and chances of succeeding as a medical professional in the future. Early diagnosis by licensed medical specialists is essential for effective management of migraine. To address this, the authors propose a multifaceted strategy. By including direct education on migraines in medical school curricula, future doctors will be better prepared to treat patients with comparable problems and manage their own migraines. Students with migraines can also benefit greatly from creating a supportive learning environment through staff training, accommodating academic policies, and providing easily available healthcare resources. In addition, this technology may be helpful. Apps for relaxation and migraine tracking can help students better manage their condition. Long-term success requires cooperation among all parties. By promoting cooperation among medical schools, student associations, healthcare practitioners, and governmental organizations, the authors can raise public awareness of migraine, make pertinent resources easier to access, and create evidence-based solutions specially designed to meet the needs of medical students who experience migraine. In the end, putting student well-being first and working together to put these solutions into practice can enable aspiring doctors to succeed at both personal and professional levels.
A New Paradigm for Nurse Leader Decision-Making Within Complex Adaptive Systems
Authors: Watson Joni L.
Published: June 2024

Health care is a complex and ever-changing environment for nurse leaders and other health care industry decision-makers. The prevailing leadership and decision-making models, rooted in Industrial Age principles, often struggle to adapt to the complexities of modern health care. This article explores the foundations of complexity science and its application to health care decision-making, highlighting the importance of understanding systems dynamics and embracing complexity. Drawing from systems knowledge, the Cynefin Sensemaking Framework, and understanding how to develop enabling constraints, nurse leaders can navigate the complexities of health care by identifying the nature of the problem and applying appropriate decision-making strategies, fostering agility and innovation. By embracing complexity and adopting adaptive leadership approaches, nurse leaders can pragmatically navigate the complexities of modern health care and drive transformative change. This manuscript provides methods for nurse leaders to enhance decision-making within the dynamic landscape of health care as a complex adaptive system.
The biomechanics of splitting hairs
Authors: Taylor David , Barton Ellen , Duffy Isobel , Enea-Casse Ramona , Marty Guillaume , Teeling Robert , Santoprete Roberto
Published: June 2024

Splitting of hair, creating ‘split ends’, is a very common problem which has been extensively documented. However, the mechanics underlying the splitting phenomenon are poorly understood. This is partly owing to the lack of a test in which splitting can be generated and quantified under laboratory conditions. We developed three new tests, known as ‘loop tensile’, ‘moving loop’ and ‘moving loop fatigue’, aiming to simulate the mechanical environment of tangles of hair strands during combing. We tested straight strands of human hair, comparing low-quality hair (from a subject who experienced split ends) with hair from a control (non-splitting) subject. Significant differences were found, especially in the moving loop fatigue test where the low-quality hair failed in fewer cycles. Splitting occurred in both types of hair, but with the crucial difference that in the low-quality hair, splits originated inside the hair strand and propagated longitudinally over considerable distances, while in the control hair, splits originated at the strand surface and remained short. Bleaching of the control hair changed its behaviour, making it similar to that of the low-quality hair. Some simple calculations emphasized the role of longitudinal shear stress and shear stress intensity in generating microcracks which could then propagate within the moving loop, paving the way for a future theoretical model of the splitting mechanism.
Hierarchical nested honeycomb-based energy absorbers: design factors and tailorable mechanical properties
Authors: Ghimire Ashish , Hsu Ching-Han , Lin Chien-Chih , Chen Po-Yu
Published: June 2024

This study presents a novel hierarchical nested honeycomb drawing inspiration from the hierarchical structures found in energy-absorbing citrus peels. Our investigation reveals that integrating secondary hierarchical units into primary honeycomb cells results in energy absorption profiles featuring two distinct plateaus. Notably, we found that these profiles can be finely tuned by adjusting the thickness of primary and secondary cell walls. Additionally, our study demonstrates a strategic removal of cell walls at key positions, reducing material consumption without compromising specific energy absorption. By establishing comprehensive structure–property relationships, we offer valuable insights into the design and optimization of hierarchical cellular materials. Compared with traditional honeycomb structures, the nested honeycomb structure shows a twofold increase in compressive strength and a fivefold increase in specific energy absorption, positioning them as promising candidates for applications requiring two-step impact protection and tunable performance, ranging from packaging to high-speed automobiles.
Stiff morphing composite beams inspired from fish fins
Authors: Das Saurabh , Kunjam Prashant , Moling Baptiste , Gao Tian , Barthelat Francois
Published: June 2024

Morphing materials are typically either very compliant to achieve large shape changes or very stiff but with small shape changes that require large actuation forces. Interestingly, fish fins overcome these limitations: fish fins do not contain muscles, yet they can change the shape of their fins with high precision and speed while producing large hydrodynamic forces without collapsing. Here, we present a ‘stiff’ morphing beam inspired from the individual rays in natural fish fins. These synthetic rays are made of acrylic (PMMA) outer beams (‘hemitrichs’) connected with rubber ligaments which are 3–4 orders of magnitude more compliant. Combinations of experiments and models of these synthetic rays show strong nonlinear geometrical effects: the ligaments are ‘mechanically invisible’ at small deformations, but they delay buckling and improve the stability of the ray at large deformations. We use the models and experiments to explore designs with variable ligament densities, and we generate design guidelines for optimum morphing shape (captured using the first moment of curvature), that capture the trade-offs between morphing compliance (ease of morphing the structure) and flexural stiffness. The design guidelines proposed here can help the development of stiff morphing bioinspired structures for a variety of applications in aerospace, biomedicine or robotics.
Horizontally acquiredCSPgenes contribute to wheat adaptation and improvement
Authors: Wang Kai , Guo Guanghui , Bai Shenglong , Ma Jianchao , Zhang Zhen , Xing Zeyu , Wang Wei , Li Hao , Liang Huihui , Li Zheng , Si Xiaomin , Wang Jinjin , Liu Qian , Xu Wenyao , Yang Cuicui , Song Ru-Feng , Li Junrong , He Tiantian , Li Jingyao , Zeng Xiaoyu , Liang Jingge , Zhang Fang , Qiu Xiaolong , Li Yuanyuan , Bu Tiantian , Liu Wen-Cheng , Zhao Yusheng , Huang Jinling , Zhou Yun , Song Chun-Peng
Published: June 2024

Although horizontal gene transfer (HGT) often facilitates environmental adaptation of recipient organisms, whether and how they might affect crop evolution and domestication is unclear. Here we show that three genes encoding cold shock proteins (CSPs) were transferred from bacteria to the last common ancestor of Triticeae, a tribe of the grass family that includes several major staple crops such as wheat, barley, and rye. The acquiredCSPgenes in wheat (TaCSPs) are functionally conserved with their bacterial homologs by encoding a nucleic acid binding protein. Experimental evidence indicates thatTaCSPgenes positively regulate drought response and improve photosynthetic efficiency under water deficit conditions, by directly targeting a type 1 metallothionein gene to increase ROS scavenging, which in turn contributed to the geographic expansion of wheat. We identified an eliteCSPhaplotype inAegilops-tauschii, introduction of which to wheat significantly increased drought tolerance, photosynthetic efficiency and grain yields. These findings not only provide major insights into the role of HGT in crop adaptation and domestication, but also demonstrate that novel microbial genes introduced through HGT offer a stable and naturally optimized resource for transgenic crop breeding and improvement.
KLF4 in smooth muscle cell-derived progenitor cells is essential for angiotensin II-induced cardiac inflammation and fibrosis
Authors: Lu Sizhao , Jolly Austin J , Dubner Allison M , Strand Keith A , Mutryn Marie F , Hinthorn Tyler , Noble Tysen , Nemenoff Raphael A , Moulton Karen S , Majesky Mark W , Weiser-Evans Mary CM
Published: June 2024

Cardiac fibrosis is defined by the excessive accumulation of extracellular matrix (ECM) material resulting in cardiac tissue scarring and dysfunction. While it is commonly accepted that myofibroblasts are the major contributors to ECM deposition in cardiac fibrosis, their origin remains debated. By combining lineage tracing and RNA sequencing, our group made the paradigm-shifting discovery that a subpopulation of resident vascular stem cells residing within the aortic, carotid artery, and femoral aartery adventitia (termed AdvSca1-SM cells) originate from mature vascular smooth muscle cells (SMCs) through anin situreprogramming process. SMC-to-AdvSca1-SM reprogramming and AdvSca1-SM cell maintenance is dependent on induction and activity of the transcription factor, KLF4. However, the molecular mechanism whereby KLF4 regulates AdvSca1-SM phenotype remains unclear. In the current study, leveraging a highly specific AdvSca1-SM cell reporter system, single-cell RNA-sequencing (scRNA-seq), and spatial transcriptomic approaches, we demonstrate the profibrotic differentiation trajectory of coronary artery-associated AdvSca1-SM cells in the setting of Angiotensin II (AngII)-induced cardiac fibrosis. Differentiation was characterized by loss of stemness-related genes, includingKlf4, but gain of expression of a profibrotic phenotype. Importantly, these changes were recapitulated in human cardiac hypertrophic tissue, supporting the translational significance of profibrotic transition of AdvSca1-SM-like cells in human cardiomyopathy. Surprisingly and paradoxically, AdvSca1-SM-specific genetic knockout ofKlf4prior to AngII treatment protected against cardiac inflammation and fibrosis, indicating thatKlf4is essential for the profibrotic response of AdvSca1-SM cells. Overall, our data reveal the contribution of AdvSca1-SM cells to myofibroblasts in the setting of AngII-induced cardiac fibrosis. KLF4 not only maintains the stemness of AdvSca1-SM cells, but also orchestrates their response to profibrotic stimuli, and may serve as a therapeutic target in cardiac fibrosis.