bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple recurrent aneurysms with angiitis of the central nervous system in a girl: A case report
Authors: Wen Jiayu , Ye Shengda , Yang Bin , Liu Xi , Chen JinCao
Published: December 2022

Introduction:

Primary central nervous system (CNS) vasculitis is a rare immune inflammatory disease confined to the blood vessels of the brain and spinal cord. The total number reported in the world is about 500[1]. Most are negative in cerebral angiography or vascular stenosis and only 1 case of aortic aneurysms reported.

Patient concerns:

A 12-year-old female experienced sudden headache and vomiting. Previous findings of vascular stenosis. Diagnosed as a ruptured aneurysm bleeding. The aneurysm recurred a short time after treatment.

Diagnosis:

Multiple recurrent aneurysms with angiitis of the central nervous system

Interventions:

The patient underwent 2 aneurysm clipping operations, both of which completely clipped the aneurysm.

Outcomes:

The patient recovered well after surgery. Three months after discharge, DSA reexamination in our hospital showed that the aneurysm was completely clipped without recurrence.

Conclusion:

Subarachnoid hemorrhage after acute cerebral infarction is rare. In addition, the patient had recurrent aneurysms after the first aneurysm clipping, which emphasized the importance of postoperative drug therapy and blood pressure control.
Effectiveness of Jian-Pi-An-Tai formula for the pregnancy outcome of in vitro fertilization and embryo transfer in infertile women: Protocol of a randomized controlled trial
Authors: Cheng Ran , Liu Qing , Zhu Ying , Zhao Ying , Yang Liuqing , Zhang Qin
Published: December 2022

Introduction:

Infertility has become a global public health issue. In vitro fertilization and embryo transfer (IVF-ET) is widely performed as an infertility treatment. However, a significant number of infertile women continue to experience serial implantation failure, despite the high quality of the transferred embryos. Jian-Pi-An-Tai formula is an experience formula in treating threatened abortion in our team. It has also been used to treat infertile women after embryo transfer and shows superiority compared to single use of conventional western medicine. However, the of evidence on its effective in treating infertile women undergo IVF-ET is lacking.

Methods:

This randomized controlled trial (RCT) will be carried out in Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University planning to recruit 180 infertile patients undergoing IVF-ET with the type of deficiency of both the spleen and kidney. The control group will be treated by conventional western medicine and the treatment group will use conventional western medicine plus Jian-Pi-An-Tai formula. The primary outcomes will include Embryo implantation rate, Clinical pregnancy rate, Persistent pregnancy rate; and the secondary outcomes will include TCM symptom score and reproductive hormones. Safety evaluation will be recorded during the whole study. All data in this RCT will be analyzed by SPSS 23.0 software. This study has been approved by the Research Ethics Committee of the Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University (2022KY130).

Discussion:

The results of this RCT will contribute to provide scientific and rigorous evidence for the efficacy and safety of Jian-Pi-An-Tai formula in treating infertile women undergo IVF-ET. And the results from this RCT will be published in a relevant journal after finished.
Factors associated with improved outcome of inhaled corticosteroid use in COVID-19: A single institutional study
Authors: Manfra Andrew , Chen Claire , Batra Kavita , Min Tun Kyaw , Kioka Mutsumi John
Published: December 2022

Asthmatics seem less prone to adverse outcomes in coronavirus disease 2019 (COVID-19) and some data shows that inhaled corticosteroids (ICS) are protective. We gathered data on anecdotal ICS and outcomes of patients hospitalized with COVID-19, given there is literature supporting ICS may reduce risk of severe infection. In addition, we fill gaps in current literature evaluating Charlson Comorbidity Index (CCI) as a risk assessment tool for COVID-19. This was a single-center, retrospective study designed and conducted to identify factors associated intubation and inpatient mortality. A multivariate logistic regression model was fit to generate adjusted odds ratios (OR). Intubation was associated with male gender (OR, 2.815; 95% confidence interval [CI], 1.348–5.881; P = .006) and increasing body mass index (BMI) (OR, 1.053; 95% CI, 1.009–1.099; P = .019). Asthma was associated with lower odds for intubation (OR, 0.283; 95% CI, 0.108–0.74; P = .01). 80% of patients taking pre-hospital ICS were not intubated (n = 8). In-patient mortality was associated with male gender (OR, 2.44; 95% CI, 1.167–5.1; P = .018), older age (OR, 1.096; 95% CI, 1.052–1.142; P = <.001), and increasing BMI (OR, 1.079; 95% CI, 1.033–1.127; P = .001). Asthma was associated with lower in-patient mortality (OR, 0.221; 95% CI, 0.057–0.854; P = .029). CCI did not correlate with intubation (OR, 1.262; 95% CI, 0.923–1.724; P = .145) or inpatient mortality (OR, 0.896; 95% CI, 0.665–1.206; P = .468). Asthmatics hospitalized for COVID-19 had less adverse outcomes, and most patients taking pre-hospital ICS were not intubated. CCI score was not associated with intubation or inpatient mortality.
The association between lifestyles and health conditions and the choice of traditional Chinese medical treatment in China: A latent class analysis
Authors: Ma Xueping , Wang Mohan , Ma Juan , Zhang Zhengjun , Hao Yu , Yan Ning
Published: December 2022

Traditional Chinese medicine (TCM) plays a major role in preventing and treating the disease, however, it is also facing a slice of challenges as fewer choices of TCM treatment. Although lifestyles and health conditions might be paramount influencing factors for the choice of TCM treatment, the relative evidence is scarce. The current observational study was designed to evaluate this association.

A total of 24,173 Chinese individuals with a mean age of 47.3 years from the Chinese Family Panel Studies 2014 were selected. The choice of TCM treatment was acquired by the self-report questionnaire. Latent class analysis was employed to identify clusters of lifestyles and health conditions. The binary logistic regression model was employed to examine the association between lifestyles, health conditions and the choice of TCM treatment.

Lifestyles and health conditions were classified into 3 classes with latent class analysis, healthy group, unhealthy behavior group, and physical inactivity group. After controlling for potential confounding factors, the results showed individuals in unhealthy behavior group (odds ratio = 1.51, 95% confidence interval: 1.35–1.68, P < .001) or physical inactivity group (odds ratio = 1.11, 95% confidence interval: 1.02–1.22, P = .019) were more likely to visit TCM doctors than healthy group. Sex-specific difference was observed, the relationship still existed among the males.

The current study revealed the relationship between lifestyles, health conditions and the choice of TCM treatment. This will provide evidence for the TCM development and provide support for further research.
Connective tissue disease with macrophage activation syndrome: A case report
Authors: Chen Qu , Zhang Qiushuang , Wang Xuebin
Published: December 2022

Rationale:

Macrophage activation syndrome (MAS), or secondary hemophagocytic lymphocytosis (sHLH), is a rare systemic inflammatory response syndrome that is fatal. Adult patients lack clear criteria for diagnosis and treatment, primarily derived from guidelines and protocols for treating family hemophagocytic lymphocytosis and systemic juvenile idiopathic arthritis (sJIA)-related MAS in children or from retrospective case reports. As a subtype of sHLH, MAS has a clinical presentation like sHLH, but treatment varies. Herein, we report the case of a 40-year-old female with MAS caused by a connective tissue disease.

Patient concerns:

The patient presented to the Rheumatology and Immunology Clinic with recurrent fever and rash, and MAS was confirmed after a series of examinations. The patient had no significant effect after treatment with JAK inhibitors, but after the use of the IL-6 inhibitor tocilizumab, the fever and rash were significantly reduced, and laboratory indicators returned to normal levels.

Diagnosis:

Considering the patient’s condition and laboratory test results, we judged that the patient had connective tissue disease with MAS.

Interventions:

We gave sequential treatment of tocilizumab.

Outcomes:

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

Lessons:

MAS/HLH lacks clear criteria for diagnosis or treatment in adult patients and is extremely difficult to distinguish from bacterial sepsis or other systemic inflammatory response syndromes. Consequently, early diagnosis and treatment are indispensable for enhancing patient survival.
Metagenomic next-generation sequencing as an unconventional approach to warn of tumor cells in a patients with non-mucinous pneumonic-type lung adenocarcinoma: Case report
Authors: Shui Yuexiang , Wang Huabin
Published: December 2022

Rationale:

Pneumonic-type lung cancer (PTLC) is a special type of lung cancer with cough and expectoration as the main clinical symptoms and inflammatory signals as the main imaging manifestations. PTLC can be easily misdiagnosed as pneumonia, and the diagnosis and treatment are always delayed. Metagenomic next-generation sequencing (mNGS), as an emerging and effective method to identify occult pathogens, has been gradually adopted by clinicians.

Patient concerns:

A 58-year-old woman with recurrent cough and expectoration was admitted to hospital on January 12th, 2022. She reported that she was diagnosed with pneumonia half a month ago, after treatment with expectorant and antibiotics for 5 days, the symptoms were relieved. However, the symptoms worsened again 10 days after stopping the drugs. On the current presentation, she denied exposure to patients with infection of COVID-19, smoking history, night sweats, weight loss, rash, joint pain, fever, and shortness of breath.

Diagnoses:

The patient was diagnosed with non-mucinous pneumonic-type lung adenocarcinoma according to the clinical symptoms, changes of CT scans after treatment and cytopathology examinations.

Interventions and outcomes:

The patient was initially diagnosed with pulmonary infection according to computerized tomography (CT) scan. Expectorant and antibiotics used. However, the symptoms worsened again 10 days after stopping the drugs. On her return visit, the CT scan did not showed obvious consolidation absorption and was similar to the previous imaging findings. mNGS was performed to detect the occult pathogens. None pathogen was detected, however, 39 copy number variations were found in Human Chromosomal Instability Analysis of mNGS indicating the presence of tumor cells. The cytopathology findings confirmed the presence of lung adenocarcinoma (non-mucinous adenocarcinoma). She was treated with targeted antitumor drugs, and the CT scan after 20 days of targeted antitumor therapy showed obvious absorption of the lesions.

Lessons:

mNGS may have potential value to screen tumor cells in bronchoalveolar lavage fluid of patients with PTLC, especially in the patients whose samples in bronchioli cannot be collected using existing sampling tools.
The first case of bipolar transurethral resection of the prostate for giant prostatic hyperplasia: A case report
Authors: Cui Deheng , Chen Guoqiang , Luo Jianbin , Zhang Minjie
Published: December 2022

Rationale: We admitted an 89-year-old male patient diagnosed with benign prostatic hyperplasia and a prostate volume of approximately 522 ml measured by magnetic resonance imaging.

Patient concerns: He had previous hypertension, diabetes, and coronary artery disease.

Diagnoses: Giant prostatic hyperplasia.

Interventions: We opted for bipolar transurethral resection of the prostate (BTURP).

Outcomes: The urinary flow rate was detected 1 week after surgery, with a peak flow rate of 17 mL/s and a voided volume of 156 mL. The follow-up was 11 months, with an international prostate symptom score of 7 and a quality of life (QOL) of 1.

Conclusion: Complete removal of the prostate is not our goal; reducing the risk of surgery and improving the quality of life of the patient is the theme.
Synchronous isolated gastric metastases from ascending colon carcinoma: A case report
Authors: Yang Bin , Gan Zhonghua , Liu Shulan , Si Guangyan
Published: December 2022

Background:

Gastric metastases (GMs) are rare and often accompanied with synchronous metastases of other organs. Synchronous isolated GMs from ascending colon carcinoma are uncommon and rarely studied. GMs may be confused with primary gastric tumors.

Methods:

A 45-year-old man presented to our hospital with abdominal distension

and anal pendant expansion. The abdominal physical examination was negative. The positive fecal occult blood test and the negative tumor marker were obtained. Colonoscopy and gastroduodenoscopy revealed a polypoidal lesion in the ascending colon and a polypoid mass in the gastric body, respectively. CT showed the thickened wall of ascending colon and polypoid mass in the gastric body with homogenous enhancement. Additionally, synchronous gastric metastases from the ascending colon carcinoma were confirmed by pathology after laparoscopic right hemicolectomy and partial gastrectomy. After 13 individual doses of fluorouracil (2.8 g/time), calcium leucovorin (0.8 g/time), and oxaliplatin (85 mg/time), the patient was discharged without any discomfort, without any additional metastases detected during the following 18 months.1.

Results:

A rare case of synchronous isolated gastric metastasis from ascending colon carcinoma was confirmed by computed tomography (CT) and pathological diagnosis.

Conclusion:

GM may appear as a polypoid lesion. Surgery combined with chemotherapy may improve the prognosis in patients with synchronous isolated GM.
Anxiety and depression among pregnant women undergoing IVF-ET and WeChat group peer support during the COVID-19 pandemic: Study protocol for a randomized controlled trial
Authors: Cao Jing-Xian , Jiang Wen-Jing , Yan Meng-Han , Wang Dan-Dan , Hou Jin-Wei , Song Jing-Yan , Sun Zhen-Gao
Published: December 2022

Introduction:

The psychological well-being of pregnant women following assisted reproductive has increasingly gained attention in recent years. Anxiety and depression may be associated to pregnancy outcomes. This study aims to determine whether peer support and the WeChat group platform will reduce anxiety and depression among in vitro fertilization and embryo transfer (IVF-ET) women.

Methods and Analysis:

In the present randomized controlled study, 296 patients with confirmed clinical pregnancy following IVF-ET will be randomly assigned to receive standard intervention support or WeChat peer support on a 1:1 basis. The levels of anxiety and depression are the primary endpoints. Assessments will be performed at baseline measurements, first trimester, second trimester, and third trimester, and data will be collected.

Ethics and Dissemination:

This study has been approved as ethical by the affiliated hospital of Shandong University of Traditional Chinese Medicine’s Reproductive Ethics Committee. Each patient will sign a written statement of informed permission. All information and biological samples will be legally protected. A peer-reviewed academic journal will publish the findings of this investigation.

Discussion:

Given the inconvenience of visits due to the current pandemic of COVID-19, this study addresses the patient’s visit needs by combining WeChat, the most widely used social software in China, with peer support, while helping improve maternal anxiety, depression, and pregnancy outcomes following IVF-ET.
Perineal burn injury with hidradenitis suppurativa: A case report
Authors: Wang Linyue , Qi Wenyue , Gao Jihua , Tian Maosheng , Sun Hongyuan , Xu Wencong
Published: December 2022

Rationale:

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease which usually presents with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas. Severe HS has interconnecting sinus tracts and when it occurs in the perianal region, perianal fistulas can form. Obesity and smoking are 2 risk factors for the development of HS.

Patient concerns:

We report a case of a 33-year-old male diagnosed with perianal HS and perianal fistula following a burn injury to the area that occurred during childhood.

Diagnosis:

Through integration of the clinical signs and imaging results, the patient was diagnosed with HS, Hurley stage III with perianal fistulas.

Interventions:

The patient accepted surgical therapy. Performed under the general anesthesia, the procedure comprised sinus tracts excision and drainage.

Outcomes:

The patient was discharged from the hospital 6 weeks after surgery.

Lessons:

The pathogenesis of the HS in this case was the burn injury interfering with sweat gland formation around the anus. Moreover, the scar from the burn made surgical treatment difficult.
Awareness of stroke signs, symptoms, and risk factors among Jazan University students: An analytic cross-sectional study from Jazan, Saudi Arabia
Authors: Khalafalla Husameldin Elsawi , Alfaifi Bushra Ahmed , Alharbi Ruwaym Jaber , Almarei Shahd Othman , Kobal Taif Ahmed , Alsomaili Halimah Najea , Drbshi Shatha Ahmed , Sumayli Shareefa Ahmed , Kamili Amal Ahmed , Masmali Alanoud Mohammed
Published: December 2022

In the Kingdom of Saudi Arabia, the lifetime risk of stroke is estimated to be between 23% and 28.9%, whereas in Jazan region of the Kingdom there is a high prevalence of sickle cell anemia, which is known to increase the risk of stroke. This study aimed to assess awareness of stroke signs, symptoms, and risk factors among university students in the southern region of Saudi Arabia. In this analytical cross-sectional study, data obtained through an online questionnaire were collected from 897 university students. Data were entered, cleaned, and analyzed using SPSS (IBM, Chicago IL) software version 28. Knowledge was assessed using both open- and closed-ended questions (CEQ). The participants were predominantly female (72%), single (86.8%), a fifth had relatives with cerebrovascular accident (CVA), and a third knew a person with CVA. The open-ended questions showed that 11.8% did not know any symptoms or signs and 25% knew only 1, while in the CEQs, hypertension was selected by 83.0%. Regarding knowledge about symptoms and signs, 33.7% and 21.9% recognized weakness and speech disturbance, respectively, whereas in the CEQs, around 60% selected others. Regarding actions that should be taken if CVA is suspected, >80% preferred going directly to the hospital. The best time to seek professional care was considered to be within 4 hours by 47.5%, 10.3% suggested a later timing, and 42.3% had no knowledge of what to do. Multivariate logistic regression revealed that pursuing a health-related specialty and previous stroke experience in close relatives were significantly associated with good stroke knowledge. The level of knowledge and correct timing and action among participants were better than those reported nationally and internationally. However, there is still room for improvement in awareness, which is recommended to improve the outcomes.
Risk factors for inadequate bowel preparation in patients using high- and low-volume cleansing products
Authors: Occhipinti Vincenzo , Soriani Paola , Vavassori Sara , Annunziata Maria Laura , Bagolini Francesco , Cavallaro Flaminia , Lagoussis Pavlos , Milani Valentina , Rondonotti Emanuele , Spina Luisa , Vecchi Maurizio , Pastorelli Luca , Tontini Gian Eugenio
Published: December 2022

Introduction

Bowel preparation is crucial for colonoscopy completeness and lesions detection. Today, several cleansing products are equally recommended by guidelines, irrespective of patients’ characteristics. Identification of preparation-specific risk factors for inadequate bowel preparation may lead to a personalized prescription of cleansing products to refine patients’ tolerance and improve endoscopic outcomes.

Methods

We prospectively enrolled consecutive outpatients referred for colonoscopy using either a high-volume [HV: 4 l polyethylene glycol (PEG)] or a low-volume (LV: 2 l PEG + bisacodyl) preparation. Day-before regimen or split-dose regimen was used for morning or afternoon colonoscopies, respectively. Univariate and multivariate analyses were conducted to identify risk factors related to inadequate bowel preparation, according to the Boston bowel preparation scale for HV and LV preparations.

Results

We enrolled 2040 patients, of which 1815 were included in the final analysis (average age 60.6 years, 50.2% men). Half of them (52%) used LV preparation. Adequate preparation was achieved by 87.6% without differences between the HV and LV groups (89.2% vs. 86.6%; P = 0.098). The use of day-before regimen and incomplete assumption of PEG were independent predictors of poor visibility for either HV or LV preparation. However, different specific risk factors for HV [diabetes: odds ratio (OR), 3.81; 95% confidence interval (CI), 1.91–7.58; low level of instruction: OR, 1.95; 95% CI, 1.11–3.44; and previous abdominal surgery: OR, 2.27; 95% CI, 1.20–4.30] and for LV (heart disease: OR, 2.06; 95% CI, 1.09–3.88; age > 65 years: OR, 1.51; 95% CI, 1.01–2.27) preparations were identified.

Conclusion

Day-before preparation and incomplete assumption of the purgative agents affect bowel visibility irrespective of the preparation volume. LV should be preferred to HV preparations in patients with diabetes, low level of instruction, and previous abdominal surgery, whereas an HV preparation should be preferred in patients with heart disease and in older patients.
Celiac Disease Frequency Is Increased in IgE‐Mediated Food Allergy and Could Affect Allergy Severity and Resolution
Authors: Lega Sara , Badina Laura , De Leo Luigina , Andrade Stefanny , Ziberna Fabiana , Gaita Bartolomea , Di Leo Grazia , Bramuzzo Matteo , Barbi Egidio , Not Tarcisio , Berti Irene
Published: December 2022

Objectives:

An increased frequency of celiac disease (CeD) has been reported in severe Immunoglobulin E (IgE) ‐mediated food allergy (FA). This observation requires confirmation, and whether CeD affects FA severity and resolution is unknown. The study aims to estimate the prevalence of CeD in patients with FA and to investigate whether CeD affects FA severity and oral tolerance.

Methods:

Consecutive patients with FA referred for allergen reintroduction, either to evaluate allergy resolution or to start oral immunotherapy (OIT), were evaluated for CeD and for FA severity. The primary outcome was the prevalence of CeD. Secondary outcomes were the frequency of severe FA and the level of clinical tolerance at study entry and at last follow‐up in patients with isolated FA versus patients with FA + CeD.

Results:

Two hundred twenty‐eight patients were included. CeD was confirmed in 15 patients (6.6%) of whom, 8 patients had a previously established diagnosis of CeD and were on a gluten‐free diet. Severe FA was observed in 12 patients with FA + CeD (80%) versus 88 patients with FA (42%) (P = 0.006). At baseline, patients with FA + CeD had significantly higher median allergen‐specific IgE levels [61.8 kU/L; interquartile range (IQR) 11.6–279.0] compared to patients with FA (20.3 kU/L; IQR 2.9–72.7) (P < 0.001). Complete clinical tolerance was observed in 1 of 15 patients (7%) with FA + CeD versus 98 of 205 patients (48%) with FA (P = 0.002).

Conclusions:

CeD is highly prevalent in patients with FA and could affect FA severity and response to OIT. CeD screening should be considered in patients with severe or persistent FA.
What Makes A “Successful” Kasai Portoenterostomy “Unsuccessful”?
Authors: Matcovici Melania , Stoica Ionica , Smith Kristy , Davenport Mark
Published: December 2022

Objectives:

Clearance of jaundice (CoJ) is the first key objective of Kasai portoenterostomy (KPE) for biliary atresia (BA) and its achievement is by far the best index of long‐term prognosis. We sought to identify the reasons for failure [subsequent liver transplant (LT)] in this cohort

Methods:

Review of single‐center prospective BA database. Successful KPE was defined by achieving a postoperative bilirubin of ≤20 µmol/L. Pre‐KPE and post‐KPE variables were identified together with a multivariate logistic regression model to identify those observable at 3 months post‐KPE. Data are quoted as median (range). A P value of ≤0.05 was significant.

Results:

One hundred thirty‐five infants underwent KPE between January 2012 and December 2018, of which 90 (67%) achieved CoJ. From these 20 (22%) (Cohort A) underwent LT with the remainder continuing with native liver (Cohort B) (median follow‐up of 4.15 years). There was no difference in age at KPE (P = 0.41), APRi (aspartate aminotransferase‐to‐platelet ratio) (P = 0.07), associated anomalies (P = 0.7), and cytomegalovirus status (P = 0.7) between the 2 groups. Postoperatively, both cholangitis [any episode, 18/20 (90%) vs 15/70 (21%); P < 0.0001] and portal hypertension (PHT) [gastrointestinal (GI) bleed, 10/20 (50%) vs 2/70 (2.8%); P < 0.0001] were significantly more common in cohort A. Univariate analysis showed that the most significant predictive values at 3 months for LT by 2 years were high APRi, bilirubin, international normalized ratio, and ultrasound (US)‐detected ascites with multivariate logistic modeling confirming these variables with predictive values of r2 = 0.79, AUROC = 0.98.

Conclusions:

Failure is not preordained at KPE but due to recurrent cholangitis and/or symptoms of PHT.
Examining the Psychosocial Well‐Being of Children and Adolescents With Coeliac Disease
Authors: Ho Wing Huen Jamie , Atkinson Emily L. , David Annabel L.
Published: December 2022

This review aimed to synthesize the available literature regarding the psychosocial well‐being of children and adolescents with coeliac disease (CD). Research on psychosocial well‐being outcomes in children and adolescents with CD under the age of 18 were identified through a systematic search in the PsychInfo, Medline, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases in July 2021. Outcomes, including health‐related quality of life (HRQOL), psychological adjustment, mental health, and social functioning were examined. Changes in outcomes over time and the geographic representation of the included studies were also analyzed. A total of 43 studies were included. Mixed results were found in the domain of HRQOL and mental health. Both challenges with psychological adjustment and adaptive coping strategies were identified. Social functioning was found to be an area of difficulty for children and adolescents with CD. However, there was high heterogeneity in methodology and participant characteristics between studies. This review concluded there were mixed findings regarding the HRQOL and mental health of young people with CD. However, CD and the gluten‐free diet initiates a need for psychological adjustment and impacts on social functioning. The review highlights the need for the integration of physical and psychosocial care, and further research to determine the most appropriate screening measures, and the most efficacious psychological interventions for this group. Future research should continue examining changes in psychosocial outcomes over time given the increase in the availability of gluten‐free foods and changes in food labeling policies.
Novel Use of Time-Resolved Magnetic Resonance Angiography to Evaluate Retrograde Lumbar Vein Flow and Epidural Venous Plexus Enhancement in Chronic Headache Patients With and Without Nutcracker Physiology
Authors: Devcic Zlatko , Rozen Todd , Arora Manasi , Caserta Melanie P. , Montazeri S. Ali , Erben Young M. , Sandhu Sukhwinder S. , Huynh Thien , Lewis Andrew R. , Malik Komal , Toskich Beau
Published: December 2022

Objective

Compression of the left renal vein by the superior mesenteric artery, known as nutcracker phenomenon (NCP), can cause retrograde flow and congestion in communicating venous systems. It has recently been speculated that NCP can result in retrograde flow and congestion of the lumbar veins and epidural venous plexus (EVP), thereby affecting the central nervous system. This study describes the novel use of time-resolved magnetic resonance angiography (trMRA) to evaluate for retrograde left second lumbar vein (L2LV) flow and early EVP enhancement in patients with chronic daily headache (CDH) with and without NCP.

Methods

A retrospective analysis was performed of 31 patients with CDH (27 females and 4 males; median age, 38 years [range, 18–63 years]) who underwent trMRA centered over the L2LV to evaluate the direction of blood flow and presence of early EVP enhancement from May 2020 to March 2022. Descriptive statistics were performed, and anatomic associations were analyzed in patients with and without retrograde L2LV flow and early EVP enhancement. The accuracy of magnetic resonance imaging findings in detecting these flow patterns was also assessed.

Results

Patients with NCP who demonstrated narrowing of the left renal vein, a positive beak sign (P = 0.052), decreased aortomesenteric distance (P = 0.038), and decreased SMA angle demonstrated increased rates of retrograde L2LV flow and early EVP enhancement. A positive beak sign was 83% specific, and an aortomesenteric distance of ≤6.5 mm was 61% sensitive and 83% specific for identifying retrograde L2LV flow with early regional EVP enhancement in patients with CDH.

Conclusions

Retrograde L2LV flow with early EVP enhancement in CDH patients can be effectively evaluated using trMRA and was seen with greater propensity in those patients with NCP.
Lung Cancer Screening Using Clinical Photon-Counting Detector Computed Tomography and Energy-Integrating-Detector Computed Tomography: A Prospective Patient Study
Authors: Inoue Akitoshi , Johnson Tucker F. , Walkoff Lara A. , Levin David L. , Hartman Thomas E. , Burke Kristin A. , Rajendran Kishore , Yu Lifeng , McCollough Cynthia H. , Fletcher Joel G.
Published: December 2022

Objective

To evaluate the diagnostic quality of photon-counting detector (PCD) computed tomography (CT) in patients undergoing lung cancer screening compared with conventional energy-integrating detector (EID) CT in a prospective multireader study.

Materials

Patients undergoing lung cancer screening with conventional EID-CT were prospectively enrolled and scanned on a PCD-CT system using similar automatic exposure control settings and reconstruction kernels. Three thoracic radiologists blinded to CT system compared PCD-CT and EID-CT images and scored examinations using a 5-point Likert comparison score (−2 [left image is worse] to +2 [left image is better]) for artifacts, sharpness, image noise, diagnostic image quality, emphysema visualization, and lung nodule evaluation focusing on the border. Post hoc correction of Likert scores was performed such that they reflected PCD-CT performance in comparison to EID-CT. A nonreader radiologist measured objective image noise.

Results

Thirty-three patients (mean, 66.9 ± 5.6 years; 11 female; body mass index; 30.1 ± 5.1 kg/m2) were enrolled. Mean volume CT dose index for PCD-CT was lower (0.61 ± 0.21 vs 0.73 ± 0.22; P < 0.001). Pooled reader results showed significant differences between imaging modalities for all comparative rankings (P < 0.001), with PCD-CT favored for sharpness, image noise, image quality, and emphysema visualization and lung nodule border, but not artifacts. Photon-counting detector CT had significantly lower image noise (74.4 ± 10.5 HU vs 80.1 ± 8.6 HU; P = 0.048).

Conclusions

Photon-counting detector CT with similar acquisition and reconstruction settings demonstrated improved image quality and less noise despite lower radiation dose, with improved ability to depict pulmonary emphysema and lung nodule borders compared with EID-CT at low-dose lung cancer CT screening.
Comparative genomics and integrated system biology approach unveiled undirected phylogeny patterns, mutational hot spots, functional patterns and molecule repurposing for monkey pox virus
Authors: Singhvi Nirjara , Talwar Chandni , Mahanta Utkarsha , Kaur Jasvinder , Mondal Krishnendu , Ahmad Nabeel , Singh Inderjeet , Sharma Gaurav , Gupta Vipin
Published: December 2022

Monkeypox is a viral zoonosis with symptoms that are reminiscent to those experienced in previous smallpox cases. GSAID databases (Global Initiative on Sharing Avian Influenza Data) was used to assess 630 genomes of MPXV. Six primary clades were inferred from the phylogenetic study, coupled with a lesser percentage in radiating clades. Individual clades that make up various nationalities may have formed as a result of a particular SNP hotspot type, which may have mutated in a particular population type.

The most significant mutation, based on a mutational hotspot analysis, was found at G3729A and G5143A. The gene ORF138, which encodes the Ankyrin repeat (ANK) protein, was found to have the most mutations. This protein is known to mediate molecular recognition via protein-protein interactions. It was shown that 243 host proteins interacted with 10 monkeypox proteins identified as the hub proteins E3, SPI2, C5, K7, E8, G6, N2, B14, CRMB, and A41 through 262 direct connections. The interaction with chemokine system-related proteins provides further evidence that the human protein is being suppressed by the monkey pox virus in order to facilitate its survival against innate immunity.

A few FDA-approved molecules were likely used as possible inhibitors after being researched for blocking F13, a significant envelope protein on the membrane of extracellular versions of virus. A total of 2500 putative ligands were docked individually with the F13 protein. The F13 protein and these molecules’ interaction may help prevent the monkey pox virus from spreading. As a result, after being confirmed by experiments, these putative inhibitors might have an impact on the activity of these proteins and be utilised in monkeypox treatments.
Serum Thyroid-Stimulating Hormone and 25-Hydroxycholecalciferol Levels in Children with Autism Spectrum Disorder and Intellectual Disability in Northern India: A Case-Control Study
Authors: Singh Shivam , Basera Pragati , Agarwal Preeti , Arya Amit , Ali Wahid , Rohatgi Kopal , Ozair Ahmad
Published: December 2022

Background

Autism spectrum disorder (ASD) and intellectual disability (ID) affect 2-3% of the global population with both conditions having unclear pathophysiology. Little data exists from South Asia examining the association between these conditions and the disturbances in thyroid profile and vitamin-D status.

Objective

This study sought to characterize the association between these conditions and serum thyroid-stimulating hormone (TSH) and 25-hydroxycholecalciferol (25(OH)D3) levels, from a resource-limited setting in India.

Methods

The present work was a prospective, multi-arm, case-control study conducted and reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Children with ASD, children with ID, and age-and-sex matched healthy controls, attending the outpatient clinics of pediatrics and psychiatry in Northern India were included. Primary outcomes were serum TSH and 25(OH)D3 levels, which were measured by chemiluminescent immunoassay and compared using ANOVA.

Results

A total of 45 children were included of which 15 had ASD, 30 with ID, and 30 were controls. There were 44 males and 31 females, with a mean age of 7.01±2.77 years. Mean±SD levels of 25(OH)D3 were significantly lower in ASD (9.53±4.93 IU/mL) and ID (14.39±5.99 IU/mL) compared to healthy controls (16.37±10.68 IU/mL) [p=0.032]. Mean±SD levels of TSH were similar in ASD (2.65±1.96), ID (2.47±2.03), and controls (2.19±1.42), with no significant difference [F-value=0.37; P=0.69]. 8% (N=6/75) of the participants had a raised TSH level.

Conclusion

In conclusion, children with ASD and ID have significantly lower vitamin D3 levels compared to healthy controls. High-quality randomized controlled trials are warranted to further investigate the therapeutic impact of early-life vitamin D supplementation in these indications.

Lay Summary

Autism spectrum disorder (ASD) and intellectual disability (ID) affect 2-3% of the global population with both conditions having multiple etiologies. Little data exists from South Asia examining the association between these conditions and the disturbances in thyroid profile and vitamin-D status. This study aimed to explore the association between these conditions and serum thyroid-stimulating hormone (TSH) and 25-hydroxycholecalciferol (25(OH)D3) levels, from a resource-limited setting in India. For this, 15 children with ASD, 30 with ID and 30 healthy controls were recruited. Their serum TSH and 25-hydroxycholecalciferol levels were measured and compared. It was found that children with ASD and ID have significantly lower vitamin D3 levels compared to healthy controls, while levels of serum TSH were similar. High-quality randomized controlled trials are needed to explore the therapeutic impact of early-life vitamin D supplementation in ASD and ID.
How Does ChatGPT Perform on the Medical Licensing Exams? The Implications of Large Language Models for Medical Education and Knowledge Assessment
Authors: Gilson Aidan , Safranek Conrad , Huang Thomas , Socrates Vimig , Chi Ling , Taylor R. Andrew , Chartash David
Published: December 2022

Background

ChatGPT is a 175 billion parameter natural language processing model which can generate conversation style responses to user input.

Objective

To evaluate the performance of ChatGPT on questions within the scope of United States Medical Licensing Examination (USMLE) Step 1 and Step 2 exams, as well as analyze responses for user interpretability.

Methods

We used two novel sets of multiple choice questions to evaluate ChatGPT’s performance, each with questions pertaining to Step 1 and Step 2. The first was derived from AMBOSS, a commonly used question bank for medical students, which also provides statistics on question difficulty and the performance on an exam relative to the userbase. The second, was the National Board of Medical Examiners (NBME) Free 120-question exams. After prompting ChatGPT with each question, ChatGPT’s selected answer was recorded, and the text output evaluated across three qualitative metrics: logical justification of the answer selected, presence of information internal to the question, and presence of information external to the question.

Results

On the four datasets, AMBOSS-Step1, AMBOSS-Step2, NBME-Free-Step1, and NBMEFree-Step2, ChatGPT achieved accuracies of 44%, 42%, 64.4%, and 57.8%. The model demonstrated a significant decrease in performance as question difficulty increased (P=.012) within the AMBOSSStep1 dataset. We found logical justification for ChatGPT’s answer selection was present in 100% of outputs. Internal information to the question was present in>90% of all questions. The presence of information external to the question was respectively 54.5% and 27% lower for incorrect relative to correct answers on the NBME-Free-Step1 and NBME-Free-Step2 datasets (P<=.001).

Conclusion

ChatGPT marks a significant improvement in natural language processing models on the tasks of medical question answering. By performing at greater than 60% threshold on the NBME-FreeStep-1 dataset we show that the model is comparable to a third year medical student. Additionally, due to the dialogic nature of the response to questions, we demonstrate ChatGPT’s ability to provide reasoning and informational context across the majority of answers. These facts taken together make a compelling case for the potential applications of ChatGPT as a medical education tool.
Derivation, validation, and clinical relevance of a pediatric sepsis phenotype with persistent hypoxemia and shock
Authors: Sanchez-Pinto L. Nelson , Bennett Tellen D. , Stroup Emily , Luo Yuan , Atreya Mihir , Wardenburg Juliane Bubeck , Chong Grace , Geva Alon , Faustino E. Vincent S. , Farris Reid W. , Hall Mark , Rogerson Colin , Shah Sareen , Weiss Scott L. , Khemani Robinder G.
Published: December 2022

Background

Untangling the heterogeneity of sepsis in children and identifying clinically relevant phenotypes could lead to the development of enrichment strategies and targeted therapies. In this study, our aim was to analyze the organ dysfunction-based trajectories of children with sepsis-associated multiple organ dysfunction syndrome (MODS) to identify and characterize reproducible and clinically relevant sepsis phenotypes using a data-driven approach.

Methods

We collected data from patients admitted with suspected infections to 13 pediatric intensive care units (PICUs) in the U.S. between 2012-2018. We used subgraph-augmented nonnegative matrix factorization to identify candidate trajectory-driven phenotypes based on the type, severity, and progression of organ dysfunction in the first 72 hours of PICU admission. We analyzed the candidate phenotypes to determine reproducibility as well as prognostic, therapeutic, and biological relevance.

Results

Overall, 38,732 children had suspected infection, of which 15,246 (39.4%) had sepsis-associated MODS. Amongst patients with sepsis-associated MODS, 1,537 (10.1%) died in the hospital. We identified an organ dysfunction trajectory-based phenotype (which we termedpersistent hypoxemia and shock) that was highly reproducible, had features of systemic inflammation and coagulopathy, and was independently associated with higher mortality. In a propensity score matched analysis, patients with thepersistent hypoxemia and shockphenotype appeared to have a higher likelihood to benefit from adjuvant therapy with hydrocortisone and albumin than other patients. When compared to other high-risk clinical syndromes, thepersistent hypoxemia and shockphenotype only overlapped with 50 to 60% of patients with septic shock, those with moderate-to-severe pediatric acute respiratory distress syndrome, or those in the top tertile of organ dysfunction burden, suggesting that it represents a distinct clinical phenotype of sepsis-associated MODS with a disproportionately high risk of mortality.

Conclusions

We derived and validated thepersistent hypoxemia and shockphenotype, a trajectory-based organ dysfunction phenotype which is highly reproducible, clinically relevant, and associated with heterogeneity of treatment effect to common adjuvant therapies. Further validation is warranted. Future studies are needed to validate this phenotype, assess whether it can be predicted earlier in the course, study possible biological mechanisms underlying it, and investigate candidate therapeutic targets.
FCGRT, a cancer-derived immunoglobulin G binding protein, mediates the malignant phenotype of glioma
Authors: Wang Guohui , Wang Zheng , Zhang Tingting , Ge Hongyao , Pan Jie , Yu Wangyang , Yan Tianfang , Jiang Wei , Yang Gaoshan
Published: December 2022

CIgG has received increasing attention, and was first discovered by our group to indicate poor prognosis in glioma. Furthermore, by protein mass spectrometry, we found that FCGRT can combine with CIgG. However, the study of FCGRT in glioma has not been reported. We used the CGGA325, TCGA dataset and immunohistochemistry to verify the importance of FCGRT on the prognosis of glioma patients. Single cell sequencing data analysis evaluated that the role of FCGRT in the microenvironment of glioma. Estimate, ssGSEA, EPIC and xCell were used for immune infiltration analysis. FCGRT was knocked down in U251 cells to detect the effect of FCGRT on the malignant development of glioma. These results showed that patients with higher FCGRT expression had a shorter overall survival. FCGRT was closely related to the tumor microenvironment, especially to macrophages in the tumor microenvironment (r=0.743, p<0.001). Interestingly we also found that FCGRT was positively correlated with IGHG1. Finally, we found that knock-down of FCGRT resulted in a decrease in proliferation, migration and invasion of U251 cells. Taken together, we believe that FCGRT is an independent prognostic factor for glioma patients, and its possible mechanism is to promote proliferation and invasion of tumor cells by interacting with CIgG.
Innovative, rapid, high-throughput method for drug repurposing in a pandemic –a case study of SARS-CoV-2 and COVID-19
Authors: Bello Shaibu Oricha , Yunusa Abdulmajeed , Adamu Adamu Ahmed , Imam Mustapha Umar , Bello Muhammad Bashir , Shuaibu Abdulmalik , Igumbor Ehimario Uche , Habib Zaiyad Garba , Popoola Mustapha Ayodele , Ochu Chinwe Lucia , Bello Aishatu Yahaya , Deeni Yusuf Yahaya , Okoye Ifeoma
Published: December 2022

Several efforts to repurpose drugs for COVID-19 treatment have largely either failed to identify a suitable agent or agents identified did not translate to clinical use; either because of demonstrated lack of clinical efficacy in trials, inappropriate dose requirements and probably use of inappropriate pre-clinical laboratory surrogates of effectiveness. In this study, we used an innovative algorithm, that incorporates dissemination and implementation considerations, to identify potential drugs for COVID-19 using iterative computational and wet laboratory methods that highlight inhibition of viral induced cytopathic effect (CPE) as a laboratory surrogate of effectiveness. Erythromycin, pyridoxine, folic acid and retapamulin were found to inhibit SARS-CoV-2 induced CPE in Vero cells at concentrations that are clinically achievable. Additional studies may be required to further characterize the inhibitions of CPE and the possible mechanisms.

Funding

TETFund Covid-19 Special Intervention Research grant(grant number TETFund/DR&D/CE/ SI/COVID-19/UDUS/VOL 1)
Pre-mRNA splicing inhibits m6A deposition, allowing longer mRNA half-life and flexible protein coding
Authors: Luo Zhiyuan , Ma Qilian , Sun Shan , Li Ningning , Wang Hongfeng , Ying Zheng , Ke Shengdong
Published: December 2022

Both pre-mRNA splicing andN6-methyladenosine (m6A) mRNA modification occur during transcription, enabling the potential crosstalk regulation between these two fundamental processes. The regional m6A location bias of avoiding splice site region, calls for an open hypothesis whether pre-mRNA splicing could affect m6A deposition. By deep learning modeling, we find that pre-mRNA splicing represses a proportion (4% to 32%) of m6A deposition at nearby exons. Experimental validation confirms such an inhibition as the m6A signal increases in mRNA once the host gene does not undergo pre-mRNA splicing to produce the same mRNA. Pre-mRNA splicing inhibited m6A sites tend to have higher m6A enhancers and lower m6A silencers locally than the m6A sites that are not inhibited. Moreover, this m6A deposition inhibition by pre-mRNA splicing shows high heterogeneity at different exons of mRNAs at genome-widely, with only a small proportion (12% to 15%) of exons showing strong inhibition, enabling stable mRNAs and flexible protein coding for important biological functions.