bluuebunny/crossref_metadata_2025 huggingface dataset:
A predictive model for awakening in patients with prolonged disorders of consciousness after craniocerebral injury
Authors: Huang Lianghua , Kang Junwei , Zhong Yuan , Zhang Jieyuan , Qiang Mengxiang , Feng Zhen
Published: January 2024

This study aimed to develop and validate a nomogram to predict awakening at 1 year in patients with prolonged disorders of consciousness (pDOC). We retrospectively analyzed the data of 381 patients with pDOC at 2 centers. The data were randomly divided into training and validation sets using a ratio of 6:4. For the training set, univariate and multivariate logical regression analyses were used to identify the predictive variables. Receiver operating characteristic curves, calibration curves, and a decision curve analysis were utilized to assess the predictive accuracy, discriminative ability, and clinical utility of the model, respectively. The final model included age, Glasgow Coma Scale score, serum albumin level, and computed tomography midline shift, all of which had a significant effect on awakening after pDOC. For the 1-year awakening in the training set, the model had good discriminative power, with an area under the curve of 0.733 (95% confidence interval: 0.667–0.789). For the validation set, the area under the curve for 1-year awakening was 0.721 (95% confidence interval: 0.617–0.826). Model performance was good for both the training and validation sets according to calibration plots and decision curve analysis. We developed a precise, effective nomogram to assist clinicians in better assessing patients’ outcomes, guiding clinical judgment, and personalizing the therapeutic process.
Make your choice: Angiography or periodical health examination?
Authors: Yilmaz Tuğba , Çakmak Muhammed Ali , Öztürk Yusuf , Yilmaz Tarik Eren , Saatçi Yaşar Ayşe , Sari Oktay
Published: January 2024

Periodical health examination is one of the important factors influencing a healthy lifestyle. Patients undergoing routine physical examination in primary care are included in the scope of preventive medical services, which is the most basic principle of primary care. Identifying the risk factors enables individuals to adopt healthier lifestyle practices. In our study, we examined the correlation between patients undergoing coronary angiography for suspected coronary stenosis and the extent of primary care services they had received in their medical history, along with the severity of stenosis observed during the angiography. Patients were interviewed using a pre-structured questionnaire to gather information about their past utilization of primary healthcare services related to coronary matters and their cardiovascular (CV) risk profile as documented in their medical history. The necessary standard tests for angiography procedures were retrieved from patient records. The SYNTAX score, a tool that aids in the objective assessment of the severity of coronary artery disease (CAD), was computed and documented. This score was then compared with the history of primary care utilization. The patients’ utilization of services from the Primary Healthcare Center (PHC) was evaluated using a scoring system, with an average score of 29.27 ± 11.27 out of 100 points (minimum: 20; maximum: 60). The average SCORE Türkiye indicating the 10-year risk of CV events for all patients was calculated as 14.31% ± 8.65% (high—very high risk), while the average SYNTAX score was 15.20 ± 9.97. There was a positive and significant correlation found between fasting blood glucose and creatinine values with both SYNTAX score and SCORE Türkiye (respectively; R = 0.238, P = .013; R = 0.289, P = .002). Factors such as smoking and metabolic syndrome were associated with CAD severity. It important to highlight that individual recommended for angiography had a notably lower utilization of healthcare services from the PHC based on their medical histories. This circumstance has resulted in individuals who do not undergo CV event screenings at PHCs having higher SYNTAX scores, indicating more severe CAD that necessitates angiography. Conducting regular periodical health examinations at PHCs can help mitigate these statistics.
Identification of cuproptosis-related diagnostic biomarkers in idiopathic pulmonary fibrosis
Authors: Wang Qi , Shang Yu , Li Yupeng , Li Xincheng , Wang Xue , He Yaowu , Ma Jing , Ning Shangwei , Chen Hong
Published: January 2024

Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease with clinical and pathological heterogeneity. Recent studies have identified cuproptosis as a novel cell death mechanism. However, the role of cuproptosis-related genes in the pathogenesis of IPF is still unclear. Two IPF datasets of the Gene Expression Omnibus database were studied. Mann–Whitney U test, correlation analysis, functional enrichment analyses, single-sample gene set enrichment analysis, CIBERSORT, unsupervised clustering, weighted gene co-expression network analysis, and receiver operating characteristic curve analysis were used to conduct our research. The dysregulated cuproptosis-related genes and immune responses were identified between IPF patients and controls. Two cuproptosis-related molecular clusters were established in IPF, the high immune score group (C1) and the low immune score group (C2). Significant heterogeneity in immunity between clusters was revealed by functional analyses results. The module genes with the strongest correlation to the 2 clusters were identified by weighted gene co-expression network analysis results. Seven hub genes were found using the Cytoscape software. Ultimately, 2 validated diagnostic biomarkers of IPF, CDKN2A and NEDD4, were obtained. Subsequently, the results were validated in GSE47460. Our investigation illustrates that CDKN2A and NEDD4 may be valid biomarkers that were useful for IPF diagnosis and copper-related clustering.
Diabetes-related social stigma among university students in Saudi Arabia: A cross-sectional study
Authors: Khalafalla Husameldin Elsawi , Albasheer Osama , Alfaifi Bushra Ahmed Hussain , Abudayah Afraa Hassan Khalil , Almasary Manal Hassan , Alsulami Enas Saud , Alshuqayhi Deema Saleh , Kremers Stef P.J.
Published: January 2024

Diabetes-related stigma encompasses stereotypes, discrimination, and blame, significantly influencing diabetes management and overall well-being. Despite high diabetes-related stigma prevalence in various contexts, there is limited research in Saudi Arabia, especially that perceived/enacted by non-diabetics, the so-called social stigma. This cross-sectional study aimed to assess diabetes-related social stigma (DRSS) and to identify correlates among university students in Jazan, Saudi Arabia. A convenience sampling was employed to collect responses from 536 Jazan University students using an online questionnaire. After excluding participants with diabetes mellitus (n = 17), data from 519 individuals were analyzed. The DRSS questionnaire comprised 2 scales: social distancing and negative attitudes and stereotyping. The study found mixed results regarding the student population’s attitude toward diabetic patients. Most students displayed favorable answers on social distancing scale statements, with the majority of statements showing willingness to engage in different social aspects with diabetics getting a positive response from at least 96% of respondents. The study identified various types of negative attitudes and stereotyping, for example, 46% of the sample agreed that dealing with a diabetic is upsetting or tiring. Correlates of social distancing included academic year, rural residence, and nonmedical field of specialty, while predictors of negative attitude and stereotyping included female gender and higher family income. The findings indicate a need to improve attitudes related to diabetics among university students in Saudi Arabia, with a particular focus on negative attitude stereotyping. Raising awareness about DRSS, especially among future healthcare professionals, is essential. Further refinement of the DRSS measurement scales is recommended through broader testing among the general population to enhance our understanding of this important issue.
Construction and validation of a prognostic nomogram for ductal adenocarcinoma of the prostate: A population-based study
Authors: Li Cheng , Wan Zhengqiang , Wang Yinglei , Shan Guangming , Yang Baoquan
Published: January 2024

This study aimed to establish and validate a nomogram for ductal adenocarcinoma of the prostate (DAC) to accurately predict the prognosis of DAC patients. The data of 834 patients with confirmed DAC were obtained from the Surveillance, Epidemiology, and End Results database. The cases were randomly assigned to the training and internal validation cohorts. Data from patients attending our institution as an external validation cohort (n = 35). Nomogram and web-based dynamic nomogram were constructed based on Cox regression analysis, and their prediction accuracy was evaluated by concordance index (C-index), calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis. Multivariate analyses identified age, T-stage, N-stage, M-stage, surgery, lymph node dissection, Gleason score, and PSA as independent prognostic factors for overall survival. The C-index and calibration curves demonstrate the good discriminative performance of the prediction model. The area under the curve further confirmed the accuracy of the nomogram in predicting survival. In addition, the area under the curve and decision curve analysis were better than the 7th tumor-node-metastasis staging system. The Kaplan–Meier curves of the nomogram-based risk groups showed significant differences (P < .001). We constructed and validated the first nomogram to predict patients with DAC.
Logistic regression analysis of risk factors for hematoma after autologous arteriovenous fistula in hemodialysis patients
Authors: Tian Yuanru , Shi Kuanfan , Zhang Yan , Cao Yan , Zhou Yuping
Published: January 2024

To determine the risk factors and nursing countermeasures for post-operative hematoma in hemodialysis patients with autogenous arteriovenous fistula by logistic regression analysis. A retrospective analysis of 240 chronic hemodialysis patients admitted to our hospital from January 2019 to October 2022 was performed. Physical and vascular examinations of the patients were performed by surgeons. Continuous care measures were implemented for all patients. The patient serum creatinine (Scr) and blood urea nitrogen (BUN) were measured on the day of inclusion and after the implementation of care measures. Self-management scales were used to analyze patients’ self-management. Fatigue symptoms were assessed using the Fatigue Scale 14. The WHO Quality of Life Scale (WHOQOL-BREF score) was used to assess patients’ quality of life. Self-Rating Depression Scale and Self-Rating Anxiety Scale (SAS) were used to assess negative affect. Treatment compliance was assessed according to 3 levels: complete compliance, compliance, and noncompliance. In all, 240 patients underwent 240 initial and 48 repeat procedures; 18 of the 240 patients experienced fistula failure, with an overall success rate of 92.5% (222/240). There were no significant differences in renal function, self-management, General Self-Efficacy Scale, fatigue symptom scores, and WHOQOL-BREF scores between the postoperative hematoma group and no-hematoma group before the continuous care. After continuous care, renal function, self-management, General Self-Efficacy Scale, fatigue symptom scores, and WHOQOL-BREF scores were better in the postoperative no-hematoma group than in the hematoma group, and the difference was statistically significant (P < .05). Logistic regression analysis of risk factors for postoperative hematoma showed that elevated Scr and BUN levels, decreased self-management and SAS scores and poor treatment compliance were independent risk factors for postoperative hematoma in hemodialysis patients with autologous arteriovenous fistulas (P < .05). Elevated Scr levels, elevated BUN levels, decreased self-management scores, decreased SAS scores, and poor treatment compliance were independent risk factors for postoperative hematoma in hemodialysis patients with autogenous arteriovenous fistulas. By providing continuous care to hemodialysis patients based on timing theory, the negative emotions can be alleviated and the self-efficacy, quality of life, and treatment compliance of the patients can be improved.
Impact of occupational heat exposure on selected haematological parameters of bakery workers: A comprehensive study in Ilorin, Kwara State
Authors: Anyiam Arinze Favour , Arinze-Anyiam Onyinye Cecilia , Oyindamola Ajiboye Mariam , Obeagu Emmanuel Ifeanyi
Published: January 2024

The Occupational Health and Safety Administration has identified indoor industries at risk of experiencing heat-related illnesses due to the presence of heat-generating appliances; these include bakeries, kitchens, laundries, and furnaces. This study aimed to assess the effects of heat stress on haematological parameters and erythrocyte sedimentation rates (ESR) of bakery workers in Ilorin, Kwara State. It was a cross-sectional study, involving laboratory analysis, which lasted for 3 months. A total of 60 Male and female bakery workers aged between 18 and 65 years with 1 or more years of working experience were recruited for this study. Full blood count estimation was carried out using haematological analyzer (Sysmex-2000) and the ESR was carried out using the Westergren method in the Haematology unit, Kwara State University, Malete. Results were analyzed using SPSS version 20. This study found the bakery workers to have low ESR (2.13 ± 1.28) compared to (10.05 ± 4.95) of the control, the RBC was high (6.708 ± 2.08) compared to (5.46 ± 1.12) of the control group. TWBC was also found to be high (7.425 ± 1.74) compared to (6.95 ± 2.49) of the control population. Findings from this study concluded that working under high temperatures negatively affected the health of bakery workers with reports of heat stress-related symptoms and also affected ESR and haematological parameters. A comprehensive and effective national occupational health and safety program that includes relevant policies, decrees, and proper enforcement is needed to ensure the worker’s safety and health both in the formal and the fast-growing informal sectors.
Preliminary study on molecular mechanism of COVID-19 intervention by Polygonum cuspidatum through computer bioinformatics
Authors: Liu Tao , Han Rui , Yan Yiqi
Published: January 2024

To explore the mechanism of action of Polygonum cuspidatum in intervening in coronavirus disease 2019 using a network pharmacology approach and to preliminarily elucidate its mechanism. The active ingredients and action targets of P cuspidatum were classified and summarized using computer virtual technology and molecular informatics methods. The active ingredients and relevant target information of P cuspidatum were identified using the TCM Systematic Pharmacology Database and Analysis Platform, the TCM Integrated Pharmacology Research Platform v2.0, and the SwissTarget database. The GENECARDS database was used to search for COVID-19 targets. The STRING database was analyzed and combined with Cytoscape 3.7.1 software to construct a protein interaction network map to screen the core targets. Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis was then performed. The core compound, polydatin, was selected and the core targets were analyzed by computer virtual docking using software such as discovery studio autodock tool. In vitro cell models were constructed to experimentally validate the activity of the core compound, polydatin. By computer screening, we identified 9 active ingredients and their corresponding 286 targets from P cuspidatum. A search of the GENECARDS database for COVID-19 yielded 303 core targets. By mapping the active ingredient targets to the disease targets, 27 overlapping targets could be extracted as potential targets for the treatment of COVID-19 with P cuspidatum. In addition, the enrichment analysis of Kyoto Encyclopedia of Genes and Genomes pathway on core targets showed that the coronavirus disease, MAPK signaling pathway, NF kappa B signaling pathway, and other signaling pathways were highly enriched. Combined with the degree-high target analysis in the protein interaction network, it was found to be mainly concentrated in the NF-kappaB (NF-κB) signaling pathway, indicating that the NF-κB signaling pathway may be an important pathway for P cuspidatum intervention. In vitro assays showed no effect of 0.1 to 10 μM polydatin on cell viability, but an inhibitory effect on the transcriptional activity of NF-κB-RE. Molecular docking showed stable covalent bonding of polydatin molecules with Il-1β protein at residue leu-26, TNF protein ser-60, residue gly-121, and residue ile-258 of ICAM-1 protein, indicating a stable docking result. The treatment of COVID-19 with P cuspidatum is characterized by multi-component, multi-target, and multi-pathway, which can exert a complex network of regulatory effects through the interaction between different targets, providing a new idea and basis for further exploration of the mechanism of action of P cuspidatum in the treatment of COVID-19.
Whether specific genetic feature predicted immunotherapy efficacy: A case report
Authors: Chen Jun , Pang Linrong , He Lianxiang , Li Ting , Cheng Xiaochun
Published: January 2024

Rationale:

Blockade of programmed death protein 1 (PD-1), have been observed to have quite good efficacy in recurrent and metastatic cervical cancer. Generally, we believe that the biomarkers of PD-1 inhibitors are programmed cell death-ligand 1, tumor mutational burden, high microsatellite instability, or deficient mismatch repair. However, in the case reported below, we observed that the patient with negative existing predictive biomarkers have significant benefits after zimberelimab monotherapy, indicating that there were other biomarkers that may predict immunotherapy efficacy. However, currently, no one has explored and studied the other potential biomarkers of PD-1 inhibitors.

Patient concerns:

A 51-year-old patient, diagnosed with cervical adenocarcinoma nearly 11 years ago, requested treatment.

Diagnoses:

The next-generation sequencing has shown PIK3CA E545K, SMAD4 1309-1G, and ALK E717K gene mutations, receptor tyrosine kinase 2 (ErbB-2) amplification, microsatellite stability, and low tumor mutational burden of 6.3 mutations per megabase. And immunohistochemistry revealed that the tumor was programmed cell death-ligand 1 negative.

Intervention:

Zimberelimab monotherapy was accepted as third-line treatment.

Outcomes:

The patient had received zimberelimab for nearly 10 months, the best tumor response was PR (Response Evaluation Criteria in Solid Tumours) and no noticeable adverse reactions were observed.

Lessons:

PIK3CA-E542K, ErbB2 amplification, and SMAD4 mutations could be potential biomarkers for PD-1 inhibitors, but a single instance is insufficient to validate the hypotheses. A larger number of patients or more clinical data will be necessary to determine whether these gene mutations are appropriate biomarkers for patients when treatment with PD-1 inhibitors.
Adrenomyeloneuropathy manifesting as adrenal insufficiency and bilateral lower extremity spastic paraplegia: A case report and literature review
Authors: Chen Yan , Li Daojing , Xu Peng , Zhang Aimei , Chen Xu , Chen Yun
Published: January 2024

Rationale:

Adrenomyeloneuropathy (AMN) is a variant type of X-linked adrenoleukodystrophy, and it is a genetic metabolic disease with strong clinical heterogeneity so that it is easily misdiagnosed and underdiagnosed. Moreover, most patients with AMN have an insidious clinical onset and slow progression. Familiarity with the pathogenesis, clinical features, diagnosis, and treatment of AMN can help identify the disease at an early stage.

Patient concerns:

We present a case of 35-year-old male, who was admitted to our hospital due to “immobility of the lower limbs for 2 years and worsening for half a year,” accompanied by skin darkening and hyperpigmentation of lips, oral mucosa, and areola since puberty.

Diagnosis:

The level of very long-chain fatty acids was high and genetic testing depicted that exon 1 of the ABCD1 gene had a missense mutation of C.761c>T, which was diagnosed as AMN.

Interventions:

Baclofen was administered to improve muscle tension combined with glucocorticoid replacement therapy.

Outcomes:

The condition was relieved after half a year.

Lessons:

The clinical manifestations of AMN are diverse. When patients with adrenocortical dysfunction complicated with progressive spastic paraplegia of lower limbs are involved, AMN should be highly suspected, and the determination of very long-chain fatty acids and genetic testing should be performed as soon as possible to confirm the diagnosis because early treatment can help prevent or delay the progression of the disease.
Relationship between depression, anxiety, stress, and health-related quality of life in adults with and without chronic diseases: A cross-sectional study
Authors: Hwang Younghui , Oh Jihyun
Published: January 2024

Health-related quality of life (HRQoL) in patients with chronic diseases is an important tool to measure patient-reported health outcomes and evaluate the usefulness of treatment, management, and rehabilitation programs. Patients with chronic diseases are more likely than those without to experience psychological problems such as depression, anxiety, and stress, all of which can affect HRQoL. This study evaluated the impact of psychological problems such as depression, anxiety, and stress on HRQoL in people with and without chronic diseases in South Korea. The study’s descriptive survey included 501 participants (191 with and 310 without chronic diseases). Data were collected using structured questionnaires between April and May 2021. The general characteristics, DASS-21, and HRQOL of this study were analyzed using descriptive statistics. Differences in DASS-21 and HRQoL based on general characteristics were analyzed using t tests and ANOVA. The study analyzed the factors influencing the participants’ HRQoL using stepwise multiple regression analysis with SPSS Win 27.0. HRQoL was generally lower for patients with chronic diseases than for patients without. In patients with chronic diseases, the major variables affecting HRQoL were depression (β = −0.244, t = −3.582, P < .001), exercise (β = 0.201, t = 2.927, P = .004), and economic status (β = −0.150, t = −2.184, P = .030), of which depression was the most influential. These variables explained 12.5% of the variance in the regression model for total HRQoL. These results emphasize the need to explore intervention measures that can reduce depression in patients with chronic diseases and anxiety in patients without chronic diseases to improve their HRQoL. In addition, national efforts are needed to provide economic support, as economic status is an influential factor in HRQoL regardless of the presence of chronic disease. The study’s limitations include the fact that neither did it consider disease severity among chronically ill patients nor did it examine all the variables affecting HRQoL.
Granulomatosis with polyangiitis presenting headache: A case report and review of literature
Authors: Li Zhao , Zhang Qiushuang , Wang Xuebin , Shi Fang
Published: January 2024

Rationale:

Central nervous system involvement is a rare manifestation of active-phaselocalized Granulomatosis with polyangiitis (GPA). In hypertrophic dura meningitis, GPA with headache is typical. In this case, cerebral magnetic resonance (MR) enhancement revealed no meningeal thickening, to our knowledge, this manifestation had not been found previously.

Patient concerns:

The patient presented to the Rheumatology and Immunology Clinic with severe headache and hearing loss, and central nervous system granulomatosis with polyangiitis was confirmed after a series of examinations. The patient had no significant effect after treatment with cyclophosphamide (CTX), but after the use of rituximab, the headache and hearing loss were significantly improved, and laboratory indicators returned to normal levels.

Diagnosis:

We comprehensively screened for craniocerebral infection and malignant tumors, diagnosed central nervous system granulomatosis with polyangiitis.

Interventions:

We gave sequential treatment of rituximab.

Outcomes:

All indicators are mostly back to normal when the patient was monitored at the outpatient clinic.

Lessons:

GPA and severe headache are more prevalent in hypertrophic dura meningitis, but the patient early headache could not be explained by hypertrophic dura meningitis or localized granulomatous lesions that invaded the central nervous system. Patients with severe headaches likely have vascular inflammation and local bone destruction at the base of the skull.
Calling emergency medical services for terminally ill patients: a qualitative study exploring reasons why informal caregivers make the call
Authors: Poláková Kristýna , Brýdlová Helena , Uhlíř Marek , Peřan David , Vlčková Karolína , Loučka Martin
Published: January 2024

Background

Although emergency medical service is focused on providing acute prehospital treatment, it is often used by terminally ill patients and their informal caregivers during the last days of patient’s life. Little is known about why they decide to use the emergency medical services.

Study objective

The aim was to explore informal caregivers’ motivation and decision-making process for calling emergency medical services for their terminally ill loved ones.

Methods

This study used a qualitative design. Data were collected by semi-structured interviews with 31 relatives of 30 patients who used the emergency medical services. Data were analyzed with NVivo software by utilizing principles of thematic analysis.

Results

Through the analysis, four distinct themes emerged: (1) limited availability of support from health care services; (2) insufficient planning of care; (3) decline in the health of the patient and (4) being lost and desperate.

Conclusion

For informal caregivers, emergency medical services represented an important source of support while caring for their terminally ill loved ones due to the limited availability of other sources of help, including a lack of specialist palliative care providers. Additionally, informal caregivers had limited knowledge of the dying process and used emergency medical services for professional advice.
Bone scintigraphy with SPECT/CT in paediatric patients with neck and back pain in comparison with other imaging modalities: the experience of a tertiary paediatric referral centre
Authors: Eseonu Kelechi , Oduoza Uche , Robinson Phillip , Easty Marina , Nadarajah Ramesh , Biassoni Lorenzo
Published: January 2024

Objective

Retrospective review of the additional clinical value provided by single photon emission computed tomography-computed tomography (SPECT/CT) in children and adolescents with back pain.

Methods

A total of 207 consecutive paediatric patients (94 males, 113 females, age range 5–17 years, median age 14 years) were reviewed after referral to the spinal surgery clinic of a paediatric teaching hospital between November 2009 and February 2021. All patients had either only whole spine X-rays or whole spine x-rays and MRI, along with bone scan with planar whole-body images and SPECT/CT (with spot views of painful area).

Results

X-ray identified the pain generator in 23 of 177 (13.0%) cases. MRI identified the pain generator in 49 of 165 (29.7%) cases. SPECT/CT reported relevant positive findings which identified the pain generator in 107 of 185 (57.8%) cases. SPECT/CT changed patients’ management in 72 of 185 (38.9%) cases. SPECT/CT was most effective at identifying the pain generator in cases of facet arthropathy, previous vertebral fracture and patients with previous deformity correction, where the pain generator was identified in 76.5% (13 of 17), 71.4% (5 of 7) and 63.4% (26 of 41) of cases, respectively. CT settings were adjusted to minimise the radiation burden (50 mAs/80kVp under 8 years, 24 mAs/110 kVp over 8 years).

Conclusion

The role of SPECT/CT in diagnosing back pain is justified in selected paediatric patients, particularly with diagnostic uncertainty using conventional imaging. The CT component of the SPECT/CT study produced a lower radiation dose than conventional CT imaging, whilst producing bone images of diagnostic quality.
Evaluating therapeutic efficacy of extended shelf-life 90Y glass microspheres in transarterial radioembolization for colorectal cancer: a quantitative FDG PET/CT analysis
Authors: Kesim Selin , Balaban Genc Zeynep Ceren , Soydemir Efe , Baltacioglu Feyyaz , Kissa Tugba Nergiz , Ozdemir Berdan , Ozguven Salih , Filizoglu Nuh , Niftaliyeva Khanim , Engur Ceren Ozge , Kostek Osman , Akdeniz Esra , Turoglu Halil Turgut , Erdil Tanju Yusuf , Cimsit Cagatay , Ones Tunc
Published: January 2024

Objectives

There is a lack of sufficient evidence regarding the use of extended shelf-life (ExSL) Yttrium-90 (90Y) glass radiomicrospheres in metastatic colorectal cancer (mCRC) patients. We aimed to investigate the efficacy of ExSL 90Y glass radiomicrospheres with a personalized treatment approach by analyzing 18F-FDG PET/CT quantitative parameters [metabolic tumor volume (MTV) and total lesion glycolysis (TLG)] separately before and after the treatment.

Methods

A total of 93 radioembolization sessions involving 77 patients were included. Simplicit90Y software was utilized to perform multicompartmental voxel-based dosimetry. Adverse events were recorded using the CTCAE v5.0 criteria. The survival data were recorded in detail.

Results

The overall disease control rate was 84.9%, with a median overall survival (OS) of 12.7 months and median progression-free survival (PFS) of 8.3 months. A statistically significant increase in treatment response rate was observed when there was an increase in absorbed tumor dose for pre-treatment unit MTV (P = 0.005) and TLG (P = 0.004) values. We didn’t observe any additional side effects/vital risks that could be considered clinically significant.

Conclusion

Our study has provided evidence on the therapeutic effectiveness and safety in terms of dose-toxicity profile of ExSL 90Y glass microspheres in a large cohort of mCRC patients. With a personalized treatment approach, the increase in radiation dose absorbed by the tumor has shown a significant contribution to treatment response rate, as indicated by quantitative measurements obtained through 18F-FDG PET/CT.
Investigation of multi-infections and breast disease comorbidities in granulomatous mastitis
Authors: Esmaeil Nawzad Kh. , Salih Abdulwahid M.
Published: January 2024

Introduction:

Granulomatous mastitis (GM) is an inflammatory breast disease typically caused by infection, posing diagnostic challenges. It can coexist with other breast disorders or multiple infections, which have been vaguely discussed. This study investigates the incidence of multi-infection and breast disease comorbidities in GM.

Method:

The study enroled 63 females who had a confirmed diagnosis of GM. Laboratory investigations and bacterial cultures had been conducted for all the cases. The patients had undergone ultrasonography examination utilizing the LOGIQ E9 system. Core needle biopsy had been done to procure tissue samples for histopathological examination. Thorough scrutiny and assessment of patients’ records were performed. The variables encompassed age at presentation, breastfeeding data, parity, smoking status, seasonal affliction, hair-washing agents, exposure to radiation, comorbidities, and clinical, ultrasound and histopathological findings.

Results:

The patients’ ages ranged from 24 to 50. Breastfeeding history was positive in nearly all cases (97%). The majority of cases exhibited multiparity (81%). In total, 63.5% were passive smokers. Multi-infections were detected in six cases (9.5%). Among them,B. cepacia complexandToxoplasma gondiiwere identified in two cases (3.16%). Other multi-infections involvedStaphylococcus epidermidisandToxoplasma gondii,Burkholderia cepaciaandS. kloosiiandToxoplasma gondii,Staphylococcus epidermisandBrucellaspp.,Candidaspp. andBrucellaspp. Histopathological analysis revealed GM comorbidities with other breast diseases in 35% of the cases.

Conclusion:

Multi-infections and breast disease comorbidities may further complicate diagnosis and management of GM. The findings of this study may raise additional questions about the nature of the disease or potential complications associated with it.
Efficacy of metamizole to prevent kidney injury after renal-ischaemic reperfusion injury in Wistar rats
Authors: Kadar Dhirajaya Dharma , Warli Syah Mirsya , Ritarwan Kiking , Ichwan Muhammad , Ismi Jufriady , Fikri Erjan , Harahap Juliandi , Alferraly Ibnu
Published: January 2024

Background:

Renal ischaemia-reperfusion injury (RIRI) is a common kidney procedure complication due to temporary blood flow interruption, leading to kidney injuries. This study aimed to analyze the effect of metamizole on the levels of interleukin-18 (IL-18), neutrophil-gelatinase-associated lipocalin (NGAL), myeloperoxidase (MPO), and histopathological changes in rats with RIRI.

Materials and methods:

Animal pre-clinical design study was used. Thirty-two male Wistar rats (Rattus norvegicus) were divided into four groups: negative control, positive control, M100, and M200. Blood samples were collected by intracardiac puncture, followed by bilateral nephrectomy and analyzed histopathologically.

Results:

Significant difference in IL-18 levels between positive control vs negative control (114.1 + 12.07 vs. 94.0 + 11.4; P = 0.019) and positive control vs M100 (114.1 + 12.07 vs. 86.9 + 8.34; P = 0.007). There was no difference in NGAL. M100 group had the lowest serum MPO levels (14.78+2.01), there was a significant difference in MPO levels in all pairwise analyses. There was a difference in cumulative EGTI scores among the study groups [positive 10.5 (8–11) vs. negative 9 (7–10) vs. M100 9 (7–10) vs. M200 9 (7–11); P = 0.021].

Conclusion:

Metamizole 100 mg/kgBW can reduce IL-18 and MPO levels in RIRI, giving more optimal results without affecting NGAL levels. Metamizole administration can reduce cumulative EGTI scores in RIRI, both at doses of 100 mg/kgBW and 200 mg/kgBW. This study shows that Metamizole can be used to prevent kidney injury caused by RIRI. IL-18 and MPO can be biomarkers in predicting kidney injury in RIRI.
The administration of long in-vitro fertilization protocol in adenomyosis: case series
Authors: Tjahyadi Dian , Nulianti Rina , Nisa Aisyah Shofiatun , Djuwantono Tono
Published: January 2024

Background.

Adenomyosis is a gynaecological condition characterized by the infiltration of endometrial glands and stroma resulting in ectopic intramyometrial, leading to the generalized enlargement of the uterus. Various cyclical regimens are employed globally to assist infertile women with adenomyosis during in-vitro fertilization (IVF) treatment because there is no consensus regarding the best protocol for managing adenomyosis.

Case:

The authors reported two cases the administration of long IVF protocol in Adenomyosis with pregnancy outcome. In both cases examined were found that the levels of anti-Mullerian hormone (AMH) were below the 25th percentile. Nevertheless, in both of these cases, the number of oocytes successfully retrieved was more than 5, which may have been influenced by the use of GnRH agonists in previous cycles of long protocol. Both of them were diagnosed with intrauterine pregnancy after transfer embryo.

Conclusion.

Although there is currently no consensus on the most suitable protocol for adenomyosis cases, the application of a long protocol in both of the aforementioned cases has yielded positive IVF outcomes.
The risk of bone fractures in dementia patients receiving acetylcholinesterase inhibitors: a meta-analysis
Authors: Elhalag Rowan H. , Chèbl Pensée , Bayoumy Nervana M. , Hassan Noheir Ashraf Ibrahem Fathy , Hagar Hanan , Abowafia Marwan , Gaber Hamed , Belal Mohamed Mohamed , Shah Jaffer , Motawea Karam R.
Published: January 2024

Aim:

The authors aimed to conduct a meta-analysis to determine if acetylcholinesterase inhibitors may pose a direct threat, increasing the incidence of fractures in dementia patients.

Methods:

PubMed, Scopus, and Cochrane Library were searched. Inclusion criteria were any original studies that demonstrated the link between acetylcholinesterase inhibitors and the incidence of fracture in patients with dementia. RevMan(5.4) was used.

Results:

Seven observational studies were included. The total number of patients included in the acetylcholinesterase inhibitors group is 274 332 and 290 347 in the control group. The pooled analysis showed that the risk of bone fracture was not statistically different between dementia patients who received acetylcholinesterase inhibitors and those who did not receive them (odds ratio=1.44, CI 0.95, 2.19, P=0.09). Subgroup analysis showed no statistically significant difference between dementia patients who took acetylcholinesterase inhibitors, and those who didn’t take acetylcholinesterase inhibitors in those more than or equal to 80 years old and those less than 80 years old (P=0.44) and (P=0.34) respectively. However, our results showed a statistically significant association between dementia patients who received acetylcholinesterase inhibitors and decreased fracture risk in those receiving the treatment for more than or less than 2 years (risk ratio=0.48, CI= 0.45, 0.51, P<0.00001) and (risk ratio=0.84, CI 0.70, 0.99, P=0.04), respectively.

Conclusion:

Our study revealed no role for acetylcholinesterase inhibitors in increasing the risk of fracture compared with controls. Hence, based on our analysis, they might have a protective role against fracture when used for long periods considering their positive action on bone growth and development. Therefore, Acetylcholinesterase inhibitors could be considered a safe option for improving cognitive functions in elderly demented patients without carrying any additional risks.
Acute psychosis and behavioural changes with seizure-like hyperactive psychomotor activity secondary to isotretinoin initiation in a healthy young male: case report
Authors: Albalawi Rawan , Alsahli Hamoud , Almutairi Naif , Alhashemi Moustafa
Published: January 2024

Introduction and importance:

Acute psychosis is a common brief psychiatric emergency period of delusions, hallucinations, disorganized thoughts and/or speech with or without psychomotor elements, which is not commonly induced by isotretinoin therapy. Dermatologists should counsel the patient before starting the treatment with all new, uncommon side effects, especially neuropsychiatric manifestations before starting this medication.

Case presentation:

A 23-year-old male smoker with a known case of acne vulgaris recently started on isotretinoin for 2 weeks after which he developed abnormal hyperactive psychomotor activity. He was diagnosed with isoteritoin-induced acute psychosis based on clinical findings and exclusion, and valproic acid and olanzapine were initiated. The patient showed significant improvement.

Clinical discussion:

Acute psychosis is a new, unfamiliar side effect presenting after initiation of isotretinoin therapy in young adults who were previously healthy. The mechanism is not well known but is thought to result from a decrease in the adult’s neurogenesis or alterations in exposure of the serotonergic neurotransmitter system.

Conclusion:

Isotretinoin is commonly used nowadays for treating young adults. Patients and their families should be counselled about all the psychiatric side effects. Antipsychotics and antiepileptics with mood stabilizers may improve the acute status for patients with isotertoin-induced psychosis.
Meleney’s gangrene managed with a single extensive debridement and resultant defect closure with abdominoplasty technique – a case report
Authors: Ahmed Somi , Maharjan Niran , Hirachan Niroj
Published: January 2024

Introduction:

Meleney’s gangrene, or progressive bacterial synergistic gangrene, is a life-threatening subcutaneous tissue infection and skin necrosis of the abdomen that is persistent and quickly progressing and has documented cultural characteristics of a symbiotic organism. The nobility of this case lies in the use of the modern technique, abdominoplasty, used to close the wound post-radical debridement for Meleney’s gangrene. This uncommon illness has a high fatality rate and requires immediate diagnosis, aggressive antibiotic treatment, and extensive debridement.

Case presentation:

We report the case of a 55-year-old female with no known comorbidities, who presented to our center with features of Meleney’s gangrene and pleural effusion. Radical debridement was performed and empirical intravenous antibiotics were administered. The wound was closed using the abdominoplasty approach.

Clinical discussion:

Meleney’s gangrene should be identified quickly and treated with wide-spectrum antibiotics and rigorous surgical debridement. It is difficult to diagnose the illness early, and skepticism is strong during this process. An increased risk of death may follow a postponed diagnosis of Meleney’s gangrene. A long-term hospital stay can result from extensive debridement. Furthermore, skin transplants may be required to close wounds in certain instances.

Conclusion:

This case is presented to show how early intervention and radical debridement can improve the outcome in cases of Meleney’s gangrene, which is rare and clinically significant. Additionally, this suggests that a cosmetic procedure known as abdominoplasty could be a viable option for wound closure.
Biosimilars
Authors: Sheridan Maria , Massich Matthew , Ashourian Nazanin
Published: January 2024

Biologic drugs are large, complex molecules produced through biotechnology. A biosimilar is a biologic product that is highly similar to an already approved biologic (reference product), with no clinically meaningful differences in purity, safety, or efficacy; as such, a biosimilar does not need to undergo the same level of study in a clinical trial program as the original reference product. Due to the potential impact of biosimilars on patient access and health care systems, the US Food and Drug Administration introduced an abbreviated pathway for approving biosimilars (351[k]) in 2009. There is strong evidence that switching from a reference product to a biosimilar does not reduce treatment effectiveness or increase the risk of adverse events. Biosimilars may reduce costs and increase patient access to biologic therapies. Biosimilar use in the United States has increased, as have the associated biosimilar cost savings, which are expected to reach $104 billion between 2020 and 2024. Yet, a need remains for increased knowledge among health care professionals and patients. Prescriber confidence is key to patient acceptance of biosimilars and minimizing the incidence of the nocebo effect. Infusion nurses are well positioned to help educate patients and to improve clinical outcomes across a range of diseases.
Review of surgical strategies in gastric cancer
Authors: Vyas Soumil , Supe Avinash
Published: January 2024

Successful and effective management of gastric cancer involves a multidisciplinary approach.

Accurate and appropriate staging of gastric cancer is mandatory to define the optimum treatment strategy. Safe surgery achieving R0 resection is considered potentially curative. Surgery remains the cornerstone of multimodal therapy. There is a well-defined role for neoadjuvant and adjuvant chemotherapy regimens. Newer medications and chemotherapy combinations have improved tumor response rates, which have translated into more effective surgery and reduced local recurrences and improved long-term survivals.
Characterization of Demographical Histologic Diversity in Small Renal Masses With the Clear Cell Likelihood Score
Authors: Vazquez Louis C. , Xi Yin , Rasmussen Robert G. , Venzor Jose E. Rodriguez , Kapur Payal , Zhong Hua , Dai Jessica C. , Morgan Tara N. , Cadeddu Jeffrey A. , Pedrosa Ivan
Published: January 2024

Objective

This study aimed to develop a diagnostic model to estimate the distribution of small renal mass (SRM; ≤4 cm) histologic subtypes for patients with different demographic backgrounds and clear cell likelihood score (ccLS) designations.

Materials and Methods

A bi-institution retrospective cohort study was conducted where 347 patients (366 SRMs) underwent magnetic resonance imaging and received a ccLS before pathologic confirmation between June 2016 and November 2021. Age, sex, race, ethnicity, socioeconomic status, body mass index (BMI), and the ccLS were tabulated. The socioeconomic status for each patient was determined using the Area Deprivation Index associated with their residential address. The magnetic resonance imaging–derived ccLS assists in the characterization of SRMs by providing a likelihood of clear cell renal cell carcinoma (ccRCC). Pathological subtypes were grouped into four categories (ccRCC, papillary renal cell carcinoma, other renal cell carcinomas, or benign). Generalized estimating equations were used to estimate probabilities of the pathological subtypes across different patient subgroups.

Results

Race and ethnicity, BMI, and ccLS were significant predictors of histology (all P < 0.001). Obese (BMI, ≥30 kg/m2) Hispanic patients with ccLS of ≥4 had the highest estimated rate of ccRCC (97.1%), and normal-weight (BMI, <25 kg/m2) non-Hispanic Black patients with ccLS ≤2 had the lowest (0.2%). The highest estimated rates of papillary renal cell carcinoma were found in overweight (BMI, 25–30 kg/m2) non-Hispanic Black patients with ccLS ≤2 (92.3%), and the lowest, in obese Hispanic patients with ccLS ≥4 (<0.1%).

Conclusions

Patient race, ethnicity, BMI, and ccLS offer synergistic information to estimate the probabilities of SRM histologic subtypes.