bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of neurotoxicity and steroid therapy on cancer progression-free survival in lymphoma patients treated with anti-CD19 CAR T cells
Authors: Pensato Umberto , Muccioli Lorenzo , Taurino Daniela , Pondrelli Federica , Asioli Gian Maria , de Philippis Chiara , Mannina Daniele , Bagnato Gianmarco , Marcheselli Simona , Zinzani Pier Luigi , Bonifazi Francesca , Bramanti Stefania , Guarino Maria
Published: December 2024

Background

Immune effector cell–associated neurotoxicity syndrome (ICANS) is a frequent complication of chimeric antigen receptor (CAR) T-cell therapy. Most patients achieve complete symptom resolution without long-term neurological sequelae, yet the impact of ICANS and steroid therapy on oncological outcomes remains inadequately explored. We investigated the association between ICANS and steroid therapy with progression-free survival (PFS).

Methods

We included large B-cell lymphoma patients treated with anti-CD19 CAR T cells. The primary outcome was 90-day PFS. The secondary outcomes included PFS, complete response, and overall survival (OS) at 30, 90, 180, and 365 days. The association between outcomes and ICANS and steroid treatment was assessed using logistic regression analyses adjusted for baseline factors.

Results

Overall, 241 patients were included. The median age was 60 years (interquartile range [IQR] = 51–66), 81 (33.6%) were females, 67 (27.8%) developed ICANS, and 142 (58.9%) achieved 90-day PFS. There was no association between 90-day PFS and ICANS development (adjusted odds ratio [aOR] 1.39 [95% confidence interval {CI} = 0.75–2.61]), maximum grade (aOR 1.24 [0.97–1.59]), duration (aOR 1.00 [95% CI = 0.95–1.05] per 1-day increase), or day of onset (aOR 0.98 [95% CI = 0.86–1.11] per 1-day increase). There was no association between 90-day PFS and steroid therapy (aOR 1.25 [95% CI = 0.73–2.14]) or cumulative dose (aOR 1.00 [95% CI = 0.98–1.01] per 100-mg increase). Similar results were observed for secondary outcomes, except for an association between ICANS and OS at 30 days (aOR 0.05 [95% CI = 0.01–0.54]) and 90 days (aOR 0.35 [95% CI = 0.15–0.80]).

Conclusions

Our findings suggest that ICANS and steroid therapy do not adversely impact the PFS in lymphoma patients receiving anti-CD19 CAR T cells. Yet, ICANS might be associated with reduced early OS.
Artificial Doctors: Performance of Chatbots as a Tool for Patient Education on Keratoconus
Authors: Özer Özcan Zeynep , Doğan Levent , Yilmaz Ibrahim Edhem
Published: December 2024

Purpose:

We aimed to compare the answers given by ChatGPT, Bard, and Copilot and that obtained from the American Academy of Ophthalmology (AAO) website to patient-written questions related to keratoconus in terms of accuracy, understandability, actionability, and readability to find out whether chatbots can be used in patient education.

Methods:

Twenty patient-written questions obtained from the AAO website related to keratoconus were asked to ChatGPT, Bard, and Copilot. Two ophthalmologists independently assessed the answers obtained from chatbots and the AAO website in terms of accuracy, understandability, and actionability according to the Structure of Observed Learning Outcome taxonomy, Patient Education Materials Assessment Tool-Understandability, and Patient Education Materials Assessment Tool-Actionability tests, respectively. The answers were also compared for readability according to the Flesch Reading Ease scores obtained through the website.

Results:

Bard had significantly higher scores compared with ChatGPT-3.5, Copilot, and AAO website according to Structure of Observed Learning Outcome taxonomy and Patient Education Materials Assessment Tool-Understandability (P<0.001 for each), whereas there was no significant difference between the other groups. Bard and ChatGPT achieved significantly higher scores than the AAO website according to the Patient Education Materials Assessment Tool-Actionability scale (P=0.001). The AAO website achieved significantly higher scores than the Bard on the Flesch Reading Ease scale, whereas there was no significant difference between the other groups (P=0.017).

Conclusion:

Chatbots are promising to provide accurate, understandable, and actionable answers. Chatbots can be a valuable aid in the education of patients with keratoconus under clinician supervision. In this way, unnecessary hospital visits can be prevented, and the burden on the health care system can be alleviated, while patient awareness can be raised.
Comparative Analysis of Cosmetic and Functional Outcomes in Corneal Tattooing (Keratopigmentation) versus Ocular Prosthesis
Authors: Durmus Ebubekir , Yilmaz Omer Faruk , Sahin Zahide Büsra , Ersoy Ozkan Esma Ecem , Mangan Mehmet Serhat , Oguz Halit
Published: December 2024

Objectives:

This study compares the cosmetic and functional outcomes of corneal tattooing/keratopigmentation and ocular prostheses in rehabilitating disfigured eyes, focusing on esthetic appearance and emotional well-being.

Methods:

Ninety-two patients were included: 48 received corneal tattooing, and 44 were fitted with ocular prostheses. Anophthalmic surgery was indicated for trauma, painful blind eye, endophthalmitis, tumor, and corneal ulcer, while corneal tattooing was performed for trauma, corneal ulcer, and endophthalmitis. Comprehensive ophthalmic examinations, a seven-item satisfaction questionnaire, and assessments of ocular movement in four directions and postoperative complications (e.g., infection, enophthalmos, fornix loss, and eyelid disorders) were conducted.

Results:

Patients who underwent ocular cosmetic rehabilitation reported high satisfaction, with corneal tattooing yielding higher satisfaction rates across all measures (P<0.001). Patients with corneal tattooing exhibited significantly better ocular movement in all four cardinal directions (P<0.001 for temporal, nasal, superior, and inferior). The prosthesis group experienced more postoperative complications, including ocular surface disorders and structural anomalies.

Conclusion:

Corneal tattooing and ocular prostheses both provide viable options for rehabilitating disfigured eyes. Corneal tattooing offers advantages in ocular movement, fewer complications, and higher patient satisfaction, while ocular prostheses are more suitable for addressing phthisis bulbi, tumors, and ocular pain.
Assessing Long-Term Impacts of Occupational Welding Fume Exposure on Respiratory Health: A 5-Year Retrospective Cohort Analysis
Authors: Saadiani Elham , Sadeghi-Yarandi Mohsen , Nasiri Amirreza , Kalanatary Saba
Published: December 2024

Background

Welding in automobile manufacturing exposes workers to harmful fumes, impacting pulmonary function. This study examined changes in pulmonary function among welders.

Methods

A retrospective cohort study was conducted on 1200 welders and 1200 administrative staff in the automotive industry from 2018 to 2022. Pulmonary function tests were performed according to ATS guidelines, and metal fume sampling for copper, iron, and lead was conducted in welders' respiratory zones.

Results

The mean concentrations of Cu, Pb, and Fe were 0.124, 0.117, and 1.42 mg/m3, respectively. Pb exceeded TLV-TWA. Welders showed significantly lower pulmonary function compared to the control group (p < 0.05).

Conclusions

Prolonged exposure to welding fumes significantly reduces pulmonary function, necessitating preventive measures.
Health benefits, antimicrobial activities, and potential applications of probiotics: A review
Authors: Sepehr Amin , Miri Seyedeh Tina , Aghamohammad Shadi , Rahimirad Nazanin , Milani Mahnaz , Pourshafie Mohammad-Reza , Rohani Mahdi
Published: December 2024

Gut microbiota and its metabolic activities can influence the physiology and pathology of the human body. It is well established that alterations in the balance of living microbiota can contribute to various health problems, such as inflammatory bowel disease and autoimmune disorders. Probiotics administered in sufficient quantities as functional food ingredients provide health benefits to hosts. They help to maintain the stability and composition of the gut microbiota and provide resistance to infection by pathogens. The most important probiotic bacteria are Lactobacillus spp. and Bifidobacteria spp., which protect the intestine through various mechanisms such as the production of organic acids and bacteriocins. Scientific and clinical research has demonstrated that probiotics play a role in modulating immune response and preventing cancer and chronic inflammatory diseases, especially in the gastrointestinal tract. This article summarizes the potential health benefits, antimicrobial activities, and purposes for which probiotics can be used as functional foods to improve human health.
Shexiang Baoxin Pills alleviate doxorubicin-induced cardiotoxicity via the reactive oxygen species-mediated AKT/Bcl-2 pathway
Authors: Wang Shudan , Chen Mingcai , Qian Yi , Chen Xiaohan , Xu Weifeng
Published: December 2024

Background:

Shexiang Baoxin Pill (SBP) is a classical Chinese medicine that improves endothelial function and antioxidant and inflammatory responses. It may also alleviate doxorubicin (DOX)-induced cardiotoxicity. The aim of this study is to explore the potential influence and molecular mechanisms of SBP in DOX-induced cardiotoxicity using network pharmacology.

Methods:

We established control, SBP, DOX, and DOX + SBP groups to evaluate cell function using a Cell Counting Kit-8 assay, reactive oxygen species (ROS) measurement, cell cycle analysis, and apoptosis assessment. Network pharmacology was employed to predict potential targets and pathways of SBP in DOX-induced cardiotoxicity; the predictions were validated using protein blotting assays.

Results:

SBP (2.5 mg/L) significantly mitigated DOX-induced cardiotoxicity. DOX elevated ROS levels, induced phosphorylation of the AKT pathway, and altered the expression of apoptosis-related proteins Bcl-2 and Bax. SBP attenuated the impact of DOX on cardiomyocytes. Network pharmacology identified 10 candidate targets.

Conclusion:

SBP ameliorates DOX-induced cardiomyocyte apoptosis by activating the ROS-mediated AKT/Bcl-2 signaling pathway.
Bioinformatics-based discovery of biomarkers and immunoinflammatory infiltrates in hip fractures complicating deep vein thrombosis: A STROBE
Authors: Fu Zhijiang , Song Chao , Mei Yongliang , Zhou Daqian , Zhou Yang , Chen Jingwen , Liu Fei , Shang Qing , Liu Zongchao
Published: December 2024

Deep vein thrombosis due to hip fracture is a normally concomitant symptom when fracture arrival at middle-aged and olderly people, but its molecular mechanism is still not well explained. We hypothesized that there are several key biomarkers and associated signaling pathways that could predict deep vein thrombosis, our goal was to employ bioinformatics to find important biomarkers of deep vein thrombosis and the results of immune infiltration. From the GEO-NCBI database, venous thrombosis expression profiles were chosen, and hip fracture and venous thrombosis gene datasets were gathered from a comprehensive database that can be searched for human genes, which is called GeneCards. Building networks between proteins with the STRING web application, and Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO), 2 bioinformatic analytic tools, were used to conduct functional enrichment investigations. CIBERSORT was used to assess genetic data on the potential location of immune cells in venous thrombosis. Ultimately, 38 distinct genes from the first round and 10 crucial genes from the second round. GO and KEGG analyses showed that the intersecting distinct targets were enriched in routes of signaling mediated by chemokines, immune responses, and Inflammatory reactions were all involved, with the Jak-STAT and HIF-1 signaling pathways being the most significant. Immune cell infiltration analysis showed that immune inflammatory responses regulated by macrophages, and B cell, T cell all play a significant role in venous thrombosis. In conclusion, HIF-1, Jak-STAT signaling pathway, and mangy hub genes regulating inflammatory factors, and immune cells. They have a significant part in the venous thrombosis disease process.
Increased lactate dehydrogenase to albumin ratio is associated with short-term mortality in septic ICU patients: A retrospective cohort study
Authors: Xiao Xiaojia , Wu Jia-Jun , Liu Yao , Suo Zhijun , Zhang Haigang , Xu Hong-Bo
Published: December 2024

Sepsis is well known with high mortality, and there is a need for early recognition of septic patients with poor prognosis. The purpose of this study is to evaluate the association between lactate dehydrogenase to albumin ratio (LAR) and the short-term mortality in sepsis. Septic patients were selected from Medical Information Mart for Intensive Care IV database. The primary and secondary outcomes were 28-day and 90-day all-cause mortality. Cox regression analysis, Kaplan–Meier survival curves, restricted cubic spline and subgroup and sensitivity analyses were performed to explore the relationship between LAR and mortality. The study included 5784 patients with sepsis. Kaplan–Meier analysis showed that patients with higher LAR exhibited lower 28-day and 90-day survival rates. There existed a linear relationship between log2 transformed LAR and 28-day and 90-day mortality. Multivariable Cox regression analysis revealed a positive relationship between log2-LAR and 28-day mortality risk (HR, 1.36; 95% CI, 1.29–1.42; P < .001). Patients in the second and third tertile groups had higher risk for 28-day mortality (HR = 1.46, 95% CI = 1.26–1.70, and HR = 2.14, 95% CI = 1.85–2.49, respectively; P for trend < .001), compared to first tertile group. Similar results were found for 90-day mortality. Subgroup and sensitivity analyses revealed consistent results. High LAR was independently associated with an increased risk of 28-day and 90-day all-cause mortality in patients with sepsis. LAR was suggested to be a promising biomarker for early identification of septic patients at higher risk of short-term mortality.
Clinical effect analysis of timed strengthening moxibustion combined with continuing nursing on symptoms of qi deficiency and blood stasis type
Authors: Liu Fang , Wang Xuan , Zhao Man , Qin Qing
Published: December 2024

This study is based on the theory of meridian flow and aims to evaluate the clinical effect of timed strengthened moxibustion combined with continuous nursing on patients with shoulder-hand syndrome after stroke accompany with qi deficiency and blood stasis. This is a retrospective study. This study included 60 patients who visited the acupuncture and moxibustion Department of the local college of Chinese medicine from January 2022 to January 2023. They were separated into the experimental and controlling groups, 30 patients each. The clinical effect was evaluated through visual analogue scale, upper limb simplified Fugl-Meyer motor function score, Barthel index score, as well as other indicators. The treating period was 6 days per week, lasting for 2 courses. After treatment, the visual analogue scale score of the experimental group significantly decreased from 7.21 to 2.58 (t = 10.020, P < .01). Its upper limb simplified Fugl-Meyer motor function score significantly improved (P < .01). Its Barthel index score increased from 4.67 to 10.815 (P < .01), improving the daily living abilities. Its edema improved (Z = −2.898, P < .01), and its nursing satisfaction increased from 29.41% to 53.06% (P < .05). The combination of timed strengthening moxibustion and continuous nursing has a significant effect on treating the shoulder-hand syndrome in patients with qi deficiency and blood stasis type stroke. It can effectively reduce pain, improve motor function and daily living ability, and improve patient satisfaction with nursing, providing an effective treatment plan for post stroke rehabilitation.
Predictors of complications and extended length of stay following percutaneous transluminal renal artery angioplasty
Authors: Mustafa Ahmad , Wei Chapman , Khan Shahkar , Rizvi Taqi , Grovu Radu , Khan Danyal , Dilluvio Brandon , Bjorklund Jessica , El-Sayegh Suzanne , Weinberg Mitchell
Published: December 2024

Patients with renal artery stenosis (RAS) who fail medical management may be evaluated for Percutaneous transluminal renal artery angioplasty/stenting (PTRA/S). Comorbidities increasing the risk of complications following PTRA have not been explored well. Patients undergoing PTRA/S for RAS were sampled using National Inpatient Sample (NIS) Database. Demographics, length of stay (LOS), and comorbidities were gathered using ICD-10 codes. Complications included heart failure, myocardial infarction, cardiac arrest, major bleeding, stent thrombosis, renal artery dissection/embolism, aortic dissection/rupture and atheroembolism. Extended length of stay (ELOS) was defined as LOS >4 days. Univariate and multivariate logistic regression analyses were used to identify predictors for complications and ELOS. A sum of 517 patients underwent PTRA. Most prevalent comorbidities were peripheral vascular disease, coronary artery disease and dyslipidemia. On multivariate analysis, comorbidities significant for predicting major complications were end-stage renal disease, chronic liver disease, heart failure and coagulable disorders whereas comorbidities significant for predicting ELOS were age, chronic obstructive pulmonary disease, chronic kidney disease, anemia, chronic heart failure, and coagulable disorders. As we continue to identify the ideal candidates for PTRA, it is important to consider the comorbidities that predispose these patients to increased periprocedural complications and ELOS.
Research progress on Chaihu Shugan San in treating perimenopausal syndrome: A review
Authors: Zhang Xiaomeng , Luo Lele , Wang Chenchen , Lv Wenjing , Duan Yuanfei , Kong Lingyuan
Published: December 2024

Perimenopausal syndrome (PMS) refers to a series of physical and psychological symptoms caused by fluctuating or decreasing sexual hormone levels during the pre- and postmenopausal periods. With the rapid development of society, more and more women suffer from menstrual disorders and insomnia caused by PMS. Chaihu Shugan San (CSS) is a famous traditional Chinese medicine prescription known for soothing the liver, relieving depression, and regulating qi and blood. Numerous clinical experiments and pharmacological studies have confirmed that CSS has a significant effect on PMS treatment. However, the composition of CSS is complex, its pharmacological effects are diverse, and its therapeutic mechanism for PMS has not been clearly explained. Therefore, this article reviews the classical literature, mechanism, pharmacological effects and clinical research of CSS in the treatment of PMS, so as to provide a reference for clinical application and further research.
Evaluation of endoscopic retrograde cholangiopancreatography in Turkish children
Authors: Çirkin Gül , Akarsu Mesut , Öztürk Yesim , İyilikçi Leyla , Güler Yunus , Gülpinar Aydin Özlem
Published: December 2024

Background:

This study aimed to evaluate the indications, efficacy, and safety of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients at a single center in Turkey between 2017 and 2021.

Methods:

A retrospective review was conducted on 50 children (mean age, 12.7 years; range, 1–18 years) who underwent 65 ERCP procedures. Data collected included patient demographics, indications for ERCP, procedural details, success rates, and complications. All procedures were performed using therapeutic duodenoscopes under conscious sedation administered by an anesthesiologist.

Results:

The primary indications for ERCP were biliary tract issues, including choledocholithiasis (52.3%) and chronic pancreatitis (18.5%). The overall cannulation success rate was 92.3%. Multiple therapeutic interventions, such as sphincterotomies and stent placements, were often required. The most common complication was post-ERCP pancreatitis, observed in 6.1% of cases, all of which were moderate. No fatalities or serious anesthesia-related adverse events were reported.

Conclusion:

ERCP is an effective and safe therapeutic procedure in pediatric patients when performed in collaboration with adult gastroenterologists, despite technical challenges such as the lack of pediatric-specific duodenoscopes. The findings highlight the need for specialized pediatric ERCP equipment and suggest that centralized ERCP facilities could enhance patient outcomes in Turkey.
Exploring phenotypic and genotypic diversity among methicillin-resistant, vancomycin-resistant, and sensitive Staphylococcus aureus
Authors: Bakeer Walid , Gaafar Marwa , El-Gendy Ahmed O. , El Badry M. A. , Alblwi Noaf Abdullah N. , Selim Heba M. R. M. , Alharbi Nada K. , Bendary Mahmoud M.
Published: December 2024

Background:

Methicillin-Resistant Staphylococcus aureus (MRSA) is a global concern owing to the increasing prevalence of multidrug-resistant (MDR) strains. Vancomycin has been the primary treatment for MRSA; however, Vancomycin-resistant strains are being increasingly reported worldwide. Therefore, comparative studies are essential to support antimicrobial stewardship and improving clinical management. Ultimately, the findings from this study are expected to inform treatment strategies and guide public health interventions effectively.

Material and methods:

This study investigated the prevalence, antimicrobial resistance, and virulence characteristics of Vancomycin-sensitive S. aureus (VSSA) and Vancomycin-resistant S. aureus (VRSA) within MRSA strains. By employing a combination of phenotypic methods, such as antimicrobial susceptibility testing, and genotypic techniques, including molecular typing and identification of virulence genes, we obtained comprehensive insights into VRSA and VSSA profiles.

Results:

Of 250 clinical samples, 62 (24.8%) were S. aureus and 27 (43.5%) were identified as MRSA. All MRSA isolates exhibited MDR patterns. Most MRSA strains were VSSA (20/27, 74.1%), while 7 (25.9%) were VRSA. The VRSA isolates showed more antimicrobial resistance than VSSA isolates; however, the VRSA isolates had less virulence than VSSA isolates. Linezolid was the most effective treatment, with a 3.7% resistance rate. A higher percentage of biofilm-producing MRSA (96.3%) was confirmed by both phenotypic and genotypic methods. All isolates, except one VRSA, showed multi-virulence patterns (harbored more than 3 virulence genes). High diversity and low clonality (D-value = 0.99) were found in both VSSA and VRSA. Based on our correlation findings, the emergence of vancomycin resistance could modify the association between antimicrobial resistance and virulence, potentially affecting the pathogenic profile of these strains. The study also revealed complex interactions among host factors (including age and gender), sample origin, antimicrobial resistance, biofilm production, and virulence genes.

Conclusion:

This study highlights the alarming spread of MRSA and VRSA, which show significant resistance and virulence.
Association between C-reactive protein and sarcopenia: The National Health and Nutrition Examination Survey
Authors: Li Yang , Zhang Zhi-Wen
Published: December 2024

C-reactive protein (CRP), a clinical biomarker, is frequently used to evaluate the inflammatory status of the body. However, the association between CRP levels and sarcopenia among the general adult population in the USA is unknown. This study focused on assessing whether CRP levels were associated with sarcopenia. This cross-sectional study collected adult data of adults from the 2015 to 2018 National Health and Nutrition Examination Survey. Four-extremity total muscle mass was used to evaluate sarcopenia (appendicular lean mass). In addition, dual-energy X-ray absorptiometry was adopted to measure appendicular lean mass. The CRP levels were used to assess inflammation status. Odds ratios (OR) and 95% confidence intervals (95% CI) were determined using multivariable logistic regression to analyze the association between CRP levels and sarcopenia. A multivariable-adjusted restricted cubic spline model was built to plot OR curves at 4 knots. Among the 3710 participants involved in this study (average age, 39.4 [11.54] years; 1801 [48.5%] men), 352 (9.5%) displayed characteristics of sarcopenia, while 3358 (90.5%) did not. Compared with participates in the lowest quartile (Q1) of CRP level (Q1; ≤0.08 to ≤0.7), those in the highest quartile (Q4; ≤4.3 to ≤188.5) had an adjusted OR for sarcopenia of 2.74 (95% CI, 1.65–4.57; P < .001). Based on the multivariable restricted cubic spline model, CRP levels showed a nonlinear association with sarcopenia (P < .001). The adjusted OR of sarcopenia of 1.86 (95% CI, 1.37–2.51; P < .001) was determined by 2 piecewise regression models for those having the CRP level of 1.8. Based on subgroup analysis, CRP levels were related to sarcopenia in males (OR, 1.03; 95% CI, 1–1.05) and individuals aged <50 years (OR, 1.03; 95% CI, 1.01–1.05), drinking (OR, 1.02; 95% CI, 1–1.03), and body mass index ≥ 25 kg/m2 (OR, 1.02; 95% CI, 1–1.03). Our results indicated that CRP levels showed a nonlinear correlation with sarcopenia among adults in the US.
Construction of a risk prediction model to identify potential risk factors for the development of delirium after total hip arthroplasty
Authors: Cheng Yong-Chao
Published: December 2024

The aim was to investigate the factors associated with the development of delirium after total hip arthroplasty and to develop a predictive model. The clinical data of 320 patients who underwent total hip arthroplasty between January 2021 and December 2023 were retrospectively analyzed, and 72 cases were classified as the delirium group and 248 cases were classified as the no delirium group based on the occurrence of delirium after surgery. One-way ANOVA was used to compare the differences in basic information between the 2 groups; statistically significant indicators were included in the binary logistic regression model to analyze in depth the associated factors affecting postoperative delirium after total hip arthroplasty and to construct a prediction framework. Binary logistic regression analysis revealed that age, history of chronic obstructive pulmonary disease, femoral neck fracture, duration of surgery, intraoperative bleeding, C-reactive protein level at 4 hours postoperatively, postoperative hypoxemia, resuscitation time (≥1 hour), postoperative pain scores (≥4), nutritional deficits, sleep disorders, and cognitive deficits were all significant risk factors for the occurrence of delirium after total hip arthroplasty significant risk factors for delirium after total hip arthroplasty. The prediction model constructed based on these factors had an overall prediction accuracy of 99.7%, and the Hosmer–Lemeshow test confirmed that the model had a good fit. The area under the curve of the model was 0.992 as internally validated by Bootstrap method, which proved that the accuracy of the constructed model was strong. Age, history of chronic obstructive pulmonary disease, femoral neck fracture, duration of surgery, intraoperative bleeding, 4-hour postoperative C-reactive protein level, postoperative hypoxemia, resuscitation time (≥1 hour), postoperative pain score (≥4), nutritional disorders, sleep disorders, and cognitive dysfunctions were risk factors for delirium after total hip arthroplasty, and the risk prediction model constructed based on this demonstrated excellent stability and prediction ability.
Novel mutation in KCNJ2 gene causes long QT interval syndrome type 7 and learning disability: A case report
Authors: Zhang Hua-yong , Zhang Yong
Published: December 2024

Rationale:

Long QT interval syndrome type 7 (LQT7) is a rare hereditary multisystem disorder characterized by a classic triad of ventricular arrhythmias with QT interval prolongation, periodic paralysis, and distinctive skeletal and facial features. The Kir2.1 protein is encoded by the KCNJ2 gene, which has been associated with LQT7.

Patient concerns:

We report an 8-year-old boy who presented with frequent premature ventricular contraction with QRS electrical alternans, QT interval prolongation, bidirectional ventricular tachycardia, and learning disability with poor school performance. Gene sequencing revealed a novel missense mutation in the KCNJ2 gene (c.224 C>A, p.Thr75Lys).

Diagnoses:

The patient was diagnosed as LQT7 and a learning disability.

Interventions:

During the follow-up period, the ventricular arrhythmias were difficult to treat with β-blocker. Due to the frequent premature ventricular contraction and bidirectional ventricular tachycardia, radiofrequency catheter ablation was tried but failed.

Outcomes:

An implantable cardioverter-defibrillator was recommended due to the recurrent syncope, but the boy’s legal guardian rejected the recommendation, opting to continue his treatment in another hospital.

Lessons:

Clinical management is mostly focused on reducing adverse cardiac events. As a first option, β-blockers are often chosen as treatments for LQT7 patients, but there is no clear evidence for their effectiveness in preventing fatal arrhythmias. If the drug treatment is not effective, radiofrequency catheter ablation can be considered. However, it may be difficult to target accurately the right spot, and the attempt of the radiofrequency catheter ablation failed. Therefore, after ineffective medical treatment, implantable cardioverter-defibrillator implantation could be an option for patients with life-threatening cardiac events.
High-grade B-cell lymphoma manifested as peripheral nerve injury: A case report
Authors: Luo Han , Li Shanshan , Liu Bo
Published: December 2024

Rationale:

High-grade B-cell lymphoma is highly malignant and progresses rapidly, often being at the intermediate or advanced stage with poor prognosis when detected. This disease involves the central nervous system in 9% to 45% of cases, while peripheral nerve injury is relatively rare.

Patient concerns:

A 42-year-old male was admitted to the hospital due to recurrent peripheral facial paralysis lasting for 8 months and weakness in both lower extremities lasting for 1 month. No other symptoms and signs were apparent.

Diagnoses:

Fluorescence in situ hybridization showed the following results: IgH/Bcl2 t(14:18)(q32;q21) chromosomal translocation: negative; Bc16 gene translocation: positive; and Myc(8;q24) chromosomal translocation: positive. The clonal gene rearrangement test for B-cell lymphoma was positive, and the clonal gene rearrangement test for T-cell lymphoma was negative.The patient was diagnosed with high-grade B-cell lymphoma.

Interventions:

The treatment plan included chemotherapy, targeted drug therapy, biological therapy, immunotherapy, etc.

Outcomes:

The patient who was followed up for 1 and 3 years had stable conditions and was able to take care of himself, with an mRS score of 1. Five years after the initial diagnosis, the patient experienced recurrence and systemic metastasis of high-grade B-cell lymphoma, ultimately dying from multiple organ failure.

Lessons:

Lymphoma manifests mainly as progressive impairment of multiple cranial nerves or recurrent alternating peripheral nerve injury complicated with elevated protein concentrations in cerebrospinal fluid; it can be easily misdiagnosed as chronic inflammatory demyelinating polyradiculoneuropathy. Performing lymph node biopsy for high-grade B-cell lymphoma as early as possible helps detect lymphoma in the early stage.
A causal link between circulating immune cells and erectile dysfunction: Two-sample bidirectional Mendelian randomization study
Authors: Wu Guanwei , Wang Jiawei , Zhu Weiyu , Liu Heqian , Ding Wei , Liu Yingqing , Wang Zhonglang , Tao Lingsong
Published: December 2024

Emerging observational studies have highlighted a robust association between circulating immune cells and erectile dysfunction (ED); however, these associations may be confounded by underlying factors. To elucidate this relationship, we conducted a comprehensive two-sample Mendelian randomization (MR) analysis to evaluate the potential causal links between circulating immune cell and ED. Utilizing large-scale genetic datasets from publicly available sources, we systematically investigated causal associations across 731 distinct immunophenotypes and ED risk, supported by rigorous sensitivity analyses to ensure robustness, evaluate heterogeneity, and detect horizontal pleiotropy. In forward MR analyses, 28 immune phenotypes were identified as having a causal association with ED. Notably, 3 specific phenotypes: CD25 + resting Treg cells, CD33dim HLA-DR + CD11b + antigen-presenting cells, and CD3- lymphocyte antigen-presenting cells, exhibited consistent significance across multiple MR methods, including inverse-variance weighted, MR-Egger, and weighted median analyses. Additionally, reverse MR analyses revealed that ED could causally influence 41 immune phenotypes, with 11 phenotypes showing consistent significance across the same analytical approaches. These findings underscore the complex bidirectional relationship between circulating immune cells and ED, providing critical insights into ED pathogenesis and potential targets for novel therapeutic interventions.
Predictive effect of modified frailty index on postoperative nausea and vomiting in thyroid cancer patients
Authors: Zhang Chengzhen , Chi Wenying , Yu Xiaoqian , Wang Xia , Yang Yaning , Meng Fanjun
Published: December 2024

Postoperative nausea and vomiting (PONV) are common complications following thyroid cancer surgery, impacting patient well-being, prognosis, and potentially leading to severe complications. Frailty, a critical risk factor for postoperative complications, has not been thoroughly investigated concerning PONV in thyroid cancer patients. This study aimed to explore the correlation between frailty and PONV in thyroid cancer patients. A retrospective analysis was conducted on 908 patients who underwent radical thyroid cancer surgery at Jinan Central Hospital between January 2016 and September 2022. Patients were classified into the PONV group (626 patients) and the non-PONV group (282 patients). General and clinical data were collected for comparison. Independent risk factors for PONV were identified using univariate and multivariate logistic regression analyses. ROC curves evaluated the diagnostic efficiency of various indicators. A predictive model for PONV risk factors was developed, verified using ROC curves, and a scoring system was established. Age, Apfel score, modified frailty index (mFI) score, free fatty acids, uric acid, homocysteine (HCY), and fasting blood glucose were identified as independent risk factors for PONV through multivariable logistic regression analysis. The model achieved an area under the curve of 0.893 (0.871–0.915) in the ROC curve, with a sensitivity of 83.2%, specificity of 79.1%, and a maximum Youden index value of 0.623. mFI exhibited the strongest correlation with PONV post-radical thyroid cancer surgery, with a correlation coefficient of 0.523. The modified frailty index is a significant predictor of postoperative nausea and vomiting in patients undergoing thyroid cancer surgery.
Like Father, Like Daughter: A Family With a Constitutional Thrombocytopenia Variant Due to a Novel Heterozygous Missense Mutation in GP1BA
Authors: Light Jennifer , Quezada Gerardo
Published: December 2024

Constitutional platelet disorders have become better understood since Bernard and Soulier first described a case in 1948. Their diagnosis can also be challenging due to overlap in clinical presentation and lab findings with platelet type von Willebrand. Bernard-Soulier syndrome is a disorder caused by GPIb receptor mutations that decrease its affinity for von Willebrand factor resulting in reduced platelet function and macrothrombocytopenia. It is associated with multiple genetic mutations in either GPIBA, GPIBB, GP9, or GP5. We present a case report of a family with a Bernard Soullier-like thrombocytopenia variant due to a heterozygous missense mutation in GPIBA.
Validity and Reliability of the Videoconference-Based Berg Balance Scale in Stroke Survivors: The Tele-Berg Balance Scale
Authors: da Costa Aline Barbosa , Freire Bruno , da Silva Tayara Gaspar , Michaelsen Stella Maris
Published: December 2024

Background and Purpose:

Telerehabilitation represents an alternative for individuals who have difficulty accessing services to receive care. Therefore, telerehabilitation measures must be studied for their reliability and validity. This study evaluated the validity and reliability of the videoconference-based Berg Balance Scale assessment in stroke survivors.

Methods:

Thirty-one stroke survivors were assessed. Rater A conducted in-person and remote assessments via videoconferencing at 2 different times (test-retest), and rater B conducted an assessment using the second recording made remotely. The validity and agreement between the in-person and remote assessments were analyzed using the Pearson’s correlation coefficient and the Bland-Altman plots limits of agreement (LoA), respectively. Test-retest and inter-rater reliability were analyzed using the intraclass correlation coefficient (ICC) with a 95% confidence interval (95% CI), and individual item reliability was assessed by weighted Kappa. The standard error of measurement and minimal detectable change were computed. Cronbach’s alpha was used for the analysis of internal consistency, and the ceiling effect was investigated.

Results:

In-person and remote assessments showed a strong positive correlation (r = 0.96) and less than a 1-point difference between the 2 assessments. Both the test-retest (ICC = 0.96; 95% CI, 0.93-0.98) and inter-rater (ICC = 0.93; 95% CI, 0.87-0.97) reliability were excellent. The standard error of measurement and minimal detectable change were 1.8 and 5.1 points, respectively. Results showed adequate internal consistency and no ceiling effect.

Discussion and Conclusions:

The Tele-Berg demonstrated validity, excellent test-retest and inter-rater reliability, low measurement error, adequate internal consistency, and lack of ceiling effect. These findings suggest that the Tele-Berg is comparable to in-person Berg Balance Scale in stroke survivors.

Video abstract available for more insights from the authors (see Supplemental Digital Content, available at: http://links.lww.com/JNPT/A509).
Diagnostic Value of Surveillance 18F-FDG PET/CT in Head and Neck Squamous Cell Carcinoma After Curative Therapy
Authors: Whi Wonseok , Moon Seung Hwan , Oh Dongryul , Chung Man Ki , Jeong Han-Sin , Ahn Myung Ju , Choi Joon Young
Published: December 2024

Purpose

This study aimed to evaluate the diagnostic performance of surveillance FDG PET/CT for detection of clinically unexpected recurrent disease or second primary malignancy in head and neck squamous cell carcinoma (HNSCC) patients who underwent curative treatment.

Patients and Methods

We conducted a retrospective analysis of 739 consecutive patients with HNSCC who underwent 2396 surveillance FDG PET/CT scans. Surveillance FDG PET/CT scans were defined as routine follow-up scans after curative therapy without suspicion of recurrence. The diagnostic performance of FDG PET/CT was evaluated based on sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.

Results

Of the 2396 surveillance FDG PET/CT scans, 119 (5.0%) showed positive findings, with 93 (78.1%) confirmed as true-positives. True-positive detections included locoregional metastases, distant metastases, or second primary malignancies. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 97.9%, 98.9%, 78.2%, 99.9%, and 98.8%, respectively. The incidence of recurrence was significantly greater in patients initially diagnosed with stage IVA disease (P = 0.03) and for which 5 or more years had elapsed since treatment (P < 0.001) than in other subgroups. However, no significant differences in diagnostic performance were observed across subgroups divided by tumor location, disease stage, treatment modality, or time since treatment.

Conclusions

Surveillance FDG PET/CT showed excellent diagnostic performance for detection of clinically unexpected recurrent disease or second primary malignancies in patients with HNSCC after curative therapy. The frequency and duration of surveillance could be adjusted based on the initial disease stage to optimize early detection and intervention.
Fostering consumers’ intention to purchase energy-efficient appliances in an emerging market
Authors: Puspanathan Kalai Chelvam , Mohd Suki Norazah
Published: December 2024

Purpose

The purpose of this study is to investigate the influence of attitude, subjective norms, perceived behavioral control and perceived benefits on consumers’ intention to purchase energy-efficient appliances (EEAs) in an emerging market.

Design/methodology/approach

A total of 400 samples were collected via a self-administered questionnaire distributed in Kuala Lumpur, Malaysia. The data was analyzed using multiple regression analysis to assess the hypothesized relationships.

Findings

The results of this study reveal that attitude is the key predictor of consumers’ intention to purchase EEAs, followed by perceived benefits of EEAs. This positive attitude stems from the realization that reducing electricity consumption is not only crucial but also a commendable and valuable practice. They can contribute to the collective effort to mitigate climate change, reduce carbon emissions and conserve valuable natural resources. Their positive attitude toward EEAs reflects their sense of responsibility, mindfulness and desire to make an important contribution to promoting sustainability and creating a better future for generations to come.

Practical implications

Energy-efficient companies, retailers and marketers should implement a range of appealing cash rebate programs to stimulate immediate sales, foster future purchases of EEAs and reshape the perception that EEAs are costly. By implementing such rebate plans, the perceived financial burden on consumers is alleviated, resulting in improved attitudes toward EEAs and heightened recognition of their perceived benefits. Consequently, this encourages a surge in demand for EEAs, thereby further propelling the growth of the industry. These sustainable practices align with SDG 9 (Industry, Innovation and Infrastructure) and SDG 12 (Responsible Consumption and Production).

Originality/value

This study stands out for its exceptional contribution to theory, as it applies the theory of planned behavior as the underpinning theory and simultaneously integrates the perceived benefits of EEAs into the proposed model, aiming to foster consumers’ intention to purchase EEAs. What sets this study apart is its examination of an emerging market, which complements and expands upon previous research predominantly conducted in developed (Western) economies.
Promoting economic stability: the role of renewable energy transition in mitigating global volatility
Authors: Yadav Ashutosh
Published: December 2024

Purpose

This study aims to investigate how renewable energy consumption impacts economic risk in volatile economies, with a specific focus on the moderating effects of GDP per capita and trade openness. It further explores the nonlinear relationships between renewable energy consumption and economic risk, highlighting the role of gross domestic product per capita (GDP per capita) and trade openness in moderating these effects.

Design/methodology/approach

The dynamic panel threshold model (DPTM) is used to analyze data from the World Development Indicators (WDI) 2023 data set. Key variables include renewable energy share, gross domestic product per capita (GDP per capita), economic rent, trade openness and a composite economic volatility index. Quantile regression (QR) ensures robustness across different economic risk levels.

Findings

Trade openness significantly moderates the relationship between renewable energy consumption and economic risk. In high trade openness economies, renewable energy consumption markedly reduces economic risk. Higher GDP per capita also enhances the stabilizing effects of renewable energy. These findings highlight the importance of integrated economic policies that foster both renewable energy adoption and economic openness for sustainable development.

Practical implications

The findings offer policymakers insights into promoting economic stability through renewable energy investments. Policies enhancing trade openness and economic growth can significantly amplify the benefits of renewable energy, contributing to sustainable development goals.

Social implications

The study underscores renewable energy’s potential to foster long-term economic stability and environmental sustainability, ensuring current development does not compromise future needs.

Originality/value

This study advances the understanding of nonlinear relationships between renewable energy and economic risk, filling a gap in existing literature. It incorporates the moderating roles of GDP per capita and trade openness within a nonlinear framework.
Effect of an environmental education course on prospective teachers’ pro-environmental behavior: a study in education for sustainable development perspective
Authors: Bibi Saima , Nousheen Ayesha , Siddiquah Aishah
Published: December 2024

Purpose

This study aims to investigate the effect of environmental education (EE) on preservice teachers’ pro-environmental behavior.

Design/methodology/approach

A sequential mixed-method approach using both qualitative and quantitative research designs was adopted. The data were gathered from 42 preservice teachers enrolled in the MA Education program studying a subject, namely, EE. The pre- and post-experimental research design was used to carry out this study.

Findings

The findings of qualitative and quantitative data shows that EE has positive and significant effects on students–teachers’ pro-environmental behavior. A change in preservice teachers’ pro-environmental behavior was found after studying a course on EE. The study findings suggest the importance of standalone courses on EE and student-centered activities for developing students’ behavior toward the environment.

Research limitations/implications

By emphasizing the importance of EE and integrating it into their curriculum or programs, educational institutions can foster a more sustainable future while enhancing their reputation as socially responsible entities. Furthermore, they can develop sustainability-focused policies and practices that positively impact both the environment and the community.

Practical implications

Educators and learning practitioners can also use the findings of this research to design and implement effective EE programs that can develop students’ pro-environmental behavior. They can create learning environments that encourage critical thinking, problem-solving and collaboration among students, thereby developing their ability to address environmental issues. Overall, this research highlights the importance of EE in shaping the behavior of future teachers and leaders.

Originality/value

This study expends the discussion on the effectiveness of EE on preservice teachers’ pro-environmental behavior for a sustainable future.