bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term Clinical and Radiographic Results of Posteromedial Lateral Release for Neuromuscular Clubfoot Deformity
Authors: May Jared M. , DeMaio Emily L. , Larson Jill E.
Published: November 2024

Background:

Clubfoot occurs in up to 50% of patients with spina bifida (SB) and 90% with arthrogryposis (AR). Many of these patients with neuromuscular clubfoot deformity fail conservative casting and require surgery with posteromedial lateral release (PMLR). Limited data exist for the outcomes of PMLR in patients with SB and AR.

Methods:

Retrospective chart review was performed on PMLR in patients with SB and AR from January 2007 to June 2022, excluding those with follow-up <3 years or incomplete charts. Radiographic measurements were obtained pre-PMLR and post-PMLR when available.

Results:

In total, 51 patients with 79 cases of clubfeet treated with PMLR at a tertiary children’s hospital were identified. Of those, 35 patients with 54 cases of clubfeet treated with PMLR were analyzed, including 22 patients (29 feet) with SB and 13 patients (25 feet) with AR. In the SB cohort, 41% of feet required reoperation at an average of 4.6 years, and 76% of AR feet required reoperation at an average of 4.7 years post-PMLR. In addition, 21% of SB feet and 8% of AR feet required 2 or more reoperations. Talectomy was required post-PMLR in 24% of SB feet and 40% of AR feet at an average of 4.9 and 5.9 years, respectively. Younger age at time of PMLR was associated with significantly increased reoperation rates in AR (P=0.01). Greater change in calcaneus-fifth metatarsal angle after PMLR was associated with a future need for reoperation (P=0.047). Greater talo-first metatarsal angle after PMLR was associated with a future need for reoperations of any kind (P=0.040) in SB.

Conclusions:

Although PMLR remains a safe and successful treatment in the short term, many neuromuscular clubfeet will require additional procedures. Younger age and greater preoperative versus postoperative changes in calcaneus-fifth metatarsal and postoperative talo-first metatarsal angles were associated with increased reoperation rate. These results help orthopaedic surgeons counsel families about the long-term prognosis of clubfoot treatment in SB and AR.

Level of evidence:

Level IV.
EFFICACY OF EPIDERMAL GROWTH FACTOR RECEPTOR TYROSINE KINASE INHIBITOR IN TREATING CHOROIDAL METASTASIS FROM NON–SMALL-CELL LUNG CANCER
Authors: Chee Arnold S.H. , Mak Andrew C.Y. , Kam Ka Wai , Li Molly S.C. , Ho Mary , Brelen Marten E. , Chen Li Jia , Yip Wilson W.K. , Young Alvin L.
Published: November 2024

Background/Purpose:

To describe the clinical characteristics of choroidal metastasis in patients with non–small-cell lung carcinoma and report treatment outcomes following targeted therapy versus conventional radiotherapy and/or chemotherapy.

Methods:

A retrospective review was conducted in 2 hospitals in Hong Kong between 2013 and 2023. Outcomes included tumor response and visual function following treatment.

Results:

A total of 25 eyes of 21 Chinese patients with choroidal metastasis secondary to metastatic non–small-cell lung carcinoma were identified. The majority of patients were nonsmokers. At the time of diagnosis, 88% of eyes were visually symptomatic with a mean visual acuity of 20/100. There were 52% of tumors locating within the macula. Tyrosine kinase inhibitor monotherapy, tyrosine kinase inhibitor with radiotherapy, and radiotherapy and/or chemotherapy groups were observed to demonstrate similar tumor response from 1 month and comparable ocular progression-free indices. Untreated patients had deteriorated vision without any tumor response. The tyrosine kinase inhibitor monotherapy group achieved the most rapid and differential vision gain than other groups.

Conclusion:

Tyrosine kinase inhibitor achieved durable disease control in epidermal growth factor receptor mutation-positive non–small-cell lung carcinoma patients with choroidal metastasis, while improving visual function. Tyrosine kinase inhibitor can be considered as an alternative to conventional orbital radiotherapy or chemotherapy for these patients in view of the rapid visual recovery.
OUTCOMES IN EYES WITH RETAINED LENS FRAGMENTS UNDERGOING PARS PLANA LENSECTOMY AND SCLERAL-FIXATED INTRAOCULAR LENS INSERTION
Authors: Durrani Asad F. , Momenaei Bita , Martin Jonathan L. , Wakabayashi Taku , Hamdan Saif A. , Gupta Omesh P. , Garg Sunir J. , Khan Mohammed A. , Mehta Sonia , Vander James , Ho Allen C. , Kuriyan Ajay E. ,   for the Secondary IOL Outcomes Study Group
Published: November 2024

Purpose:

To report the visual outcomes and complications in eyes with retained lens fragments following cataract surgery undergoing pars plana lensectomy and scleral-fixated intraocular lens (SFIOL) insertion.

Methods:

Patients with retained lens fragments who underwent pars plana vitrectomy, pars plana lensectomy, and SFIOL insertion from January 2015 to December 2022 were included. The visual acuity outcomes and complication rates were compared between those receiving sutured versus sutureless SFIOL insertion as well as those undergoing SFIOL insertion at the time of pars plana vitrectomy and pars plana lensectomy versus those undergoing SFIOL insertion during subsequent surgery.

Results:

Sixty-five eyes of 65 patients were included. The median (interquartile range) preoperative logarithm of the minimum angle of resolution visual acuity was 2.3 (2–2.3; Snellen: HM). The median logarithm of the minimum angle of resolution visual acuity improved to 0.14 (Snellen: 20/100), at the most recent follow-up (P < 0.001, Hodges–Lehmann estimator: 1.56, 95% confidence interval −1.30 to −1.71). There was no statistically significant difference in visual acuity outcomes and complication rates, including cystoid macular edema, corneal edema, and retinal detachment, regardless of technique or timing of SFIOL insertion.

Conclusion:

In this retrospective study with a small sample size, similar visual acuity outcomes and complication rates were observed regardless of the timing or technique of SFIOL insertion.
Using Four-Component Instructional Design to Create an Interactive Point-of-Care Ultrasound Curriculum for Physician Associate Students
Authors: Dawkins Stacy , Cooper Shannon , Wilcox James , Morrow Eryn , Mayall Hayley , Rebman Rebecca
Published: November 2024

Introduction

Many physician assistant/associate (PA) programs lack point-of-care ultrasound (POCUS) education in the PA curricula and a standardized approach to ultrasound training. The four-component instructional design (4C/ID) model merges 4 concepts for developing effective instructional design content for complex content delivery, such as ultrasound. This research study created an interactive, 2-part ultrasound curriculum with an instructional designer for PA students using the 4C/ID model.

Methods

Two interactive ultrasound curriculum models were created from the 4C/ID model using a knowledge-based precurriculum quiz, learning tasks with online modules and recordings, part-task practice with ultrasound experts, skills checkoffs, and a postcurriculum quiz including questions on students' perspectives of ultrasound. Two-tailed paired t-test analysis assessed the effectiveness of training.

Results

Evaluation of prelearning and postlearning quizzes demonstrated multiple statistically significant assessments supporting the use of instructional design technology for a PA program's ultrasound curriculum.

Discussion

This small study demonstrated that the 4C/ID model may be beneficial for PA POCUS training. The 2-part interactive curriculum improved PA student competency of ultrasound principles and applications and increased confidence for future clinical use of ultrasound.
Classical Medical Cases of Doubt Narrative Foreclosure and Mediation in Traditional Chinese Medicine
Authors: JING Jiangang , JIANG Jiacheng , WANG Yilin
Published: November 2024

Narrative foreclosure is a phenomenon highlighted within the Chinese narrative medicine system, characterized by a state in which individuals become overly suspicious due to certain events in their development, leading to profound concerns about their health and safety. This article employs the logical discourse framework of Chinese narrative medicine to illustrate the experiences of various patients exhibiting typical instances of narrative foreclosure in traditional Chinese medicine (TCM) cases, such as Bei Gong She Ying (杯弓蛇影 to see a bow reflected in a cup as a snake), Wu Qiu Zhi Chong (吴球治虫 Wu Qiu treats worms), and Fa Jing Qu She (法靖驱蛇 Fajing drives away snakes). It explores how TCM practitioners leverage narrative wisdom to facilitate patients in dispelling their internal doubts through the concept of Bu Yao Wei Yao (不药为药 healing diseases without medicine). Through these medical cases, the article advocates for the significance of narrative competencies among medical practitioners in diagnosing and treating patients, alongside the use of pharmaceuticals and surgical interventions. Additionally, it outlines the prospects for the future development of narrative approaches in TCM.
Experience sharing of a case of dual atrioventricular nodal non-reentrant tachycardia: Case report
Authors: Gao Yixuan , Wang Yan , Zhao Ranzun , Yang Du , Chen Lei , Shi Bei
Published: November 2024

Rationale:

Tachycardia is a common arrhythmia in clinical practice, and its pathogenesis is mostly related to reentry. However, there are also a few tachycardia that are not related to reentry. Actively clarifying the pathogenesis of these non-reentry related tachycardia is of great significance for its treatment.

Patient concerns:

A 55-year-old female patient presented with recurrent palpitations with a fastest heart rate of 180 beats/minute 10 years ago.

Diagnosis:

Dual atrioventricular nodal non-reentrant tachycardia (DAVNNT).

Interventions:

DAVNNT can be cured by radiofrequency ablation of atrioventricular nodal slow path modification.

Outcomes:

The tachycardia has stopped.

Conclusion:

DAVNNT is a rare disease in clinical practice. Its characteristic is not reentration-related arrhythmias, but the phenomenon of increased heart rate caused by electrical conduction down the double pathway of atrioventricular nodal tract and subsequent pathway. Electrophysiological examination helps to clarify the diagnosis and pathogenesis, and catheter ablation can cure the disease.
Shwachman–Diamond syndrome: A case report
Authors: Liu Zumiao , Tang Qing , Chen Xiuqi , Huang Li , Lan Liancheng , Lv Zili , Yang Xia , Shan Qingwen
Published: November 2024

Rationale:

Shwachman–Diamond syndrome (SDS) is a rare autosomal recessive genetic disease, the diagnosis is a big challenge for clinician, as the clinical manifestations of the disease are diverse. Here, we report a girl who diagnosed with SDS with the symptoms of recurrent fever, elevated transaminase levels, and granulocytosis. The aspects of diagnosis and treatment were discussed and a literature review was conducted.

Patient concerns:

A 15-month-old girl admitted to our hospital because of recurrent fever, granulocytopenia, and elevated transaminase levels.

Diagnosis and interventions:

The compound heterozygous variant of Shwachman–Bodian–Diamond syndrome c.258 + 2T > C:p.84Cfs3 and c.96C > G:p.Y32* were detected after sequencing the blood samples from the patient and her parents. Finally, she was diagnosed with SDS and she was treated with compound glycyrrhizin, granulocyte-colony stimulating factor, and antibiotic in the case of co-infection.

Outcomes:

During the follow-up, her liver function showed the level of transaminases decreased and she rarely had infection after the age of 15 months although neutropenia is still present.

Lessons:

Patients with SDS lacks typical clinical symptoms, which presents a huge challenge for clinicians. Genetic testing techniques is playing an important role in the diagnosis of diseases. This patient without typical clinical manifestations such as exocrine pancreatic insufficiency and skeletal abnormality, we report this case aimed to strengthen the understanding of the disease.
When anaphylactic shock meets epinephrine and blood lactate increases: A case report
Authors: Zhang Zhi-Rong , Shen Ying-Ying , Yi Ru-Qin , Feng Wen , Chen Wei , Li Cheng-En , Fan Zhao-Kun
Published: November 2024

Rationale:

Anaphylactic shock, a severe and rapid systemic allergic reaction, poses significant treatment challenges. Epinephrine, the first-line treatment, effectively reverses symptoms but can complicate the clinical picture by elevating lactate levels, blurring the distinction between shock-induced hypoperfusion and drug-induced metabolic effects.

Patient concerns:

A 26-year-old female presented with anaphylactic shock following an antibiotic infusion, experiencing chest tightness, hypotension, and pulmonary edema, without significant past medical history apart from a noted allergy to fish and shrimp.

Diagnoses:

Anaphylaxis was diagnosed based on clinical presentation and supported by imaging that revealed pulmonary edema, despite normal troponin levels and electrocardiogram.

Interventions:

Treatment included 0.5 mg of intramuscular epinephrine and 5 mg of intravenous dexamethasone, with subsequent intubation and mechanical ventilation in the intensive care unit. An intravenous epinephrine infusion was also administered for hemodynamic support.

Outcomes:

While epinephrine resolved the pulmonary edema and stabilized circulation, it led to a significant, albeit transient, increase in lactate levels, which normalized following discontinuation of epinephrine, indicating the metabolic effect of the drug rather than ongoing tissue hypoperfusion.

Lessons:

This case illustrates the importance of recognizing epinephrine-induced lactate elevation in anaphylactic shock, necessitating a nuanced interpretation of lactate dynamics. Clinicians must differentiate between lactate elevations due to tissue hypoperfusion and those arising from epinephrine’s pharmacologic effects to optimize patient care.
Intersecting evidence: Bibliometric analysis and clinical trials illuminate immunotherapy in KRAS-mutation cancer: A review
Authors: Liu Hongyang , Qiang Min , Zhang Ying , Wang Hong , Xing Yang , Guo Rui
Published: November 2024

KRAS mutations play a critical role in the development and progression of several cancers, including non-small cell lung cancer and pancreatic cancer. Despite advancements in targeted therapies, the management of KRAS-mutant tumors remains challenging. This study leverages bibliometric analysis and a comprehensive review of clinical trials to identify emerging immunotherapies and potential treatments for KRAS-related cancers. Using the Web of Science Core Collection and Citespace, we analyzed publications from January 2008 to March 2023 alongside 52 clinical trials from ClinicalTrials.gov and WHO’s registry, concentrating on immune checkpoint blockades (ICBs) and novel therapies. Our study highlights an increased focus on the tumor immune microenvironment and precision therapy. Clinical trials reveal the effectiveness of ICBs and the promising potential of T-cell receptor T-cell therapy and vaccines in treating KRAS-mutant cancers. ICBs, particularly in combination therapies, stand out in managing KRAS-mutant tumors. Identifying the tumor microenvironment and gene co-mutation profiles as key research areas, our findings advocate for multidisciplinary approaches to advance personalized cancer treatment. Future research should integrate genetic, immunological, and computational studies to unveil new therapeutic targets and refine treatment strategies for KRAS-mutant cancers.
Association between self-reported sleep apnea and biomarkers of liver injury: Evidence from National Health and Nutrition Examination Survey
Authors: Jiang Yi-Bin , Huang Zhi-Wei , Lin Xue-Jun , Luo Jia-Min , Chen Li-Da
Published: November 2024

The community population based studies on the relationship between obstructive sleep apnea and liver injury are limited. The study aimed to clarify the association between sleep apnea (SA) and liver injury by using the data in The National Health and Nutrition Examination Survey. SA was assessed by the sleep questionnaire and liver injury was evaluated by liver function test, hepatic steatosis index, and fibrosis-4. Weighted multivariable linear regression was performed to examine the association between SA and liver injury. Subgroup analyses and sensitivity analysis were also conducted. A total of 19,362 eligible participants were included in the study. After adjusting for confounders, the presence of SA was significantly associated with increased levels of lnALT, lnAST/alanine aminotransferase, lnGGT, and lnHSI (all P values < .05), but not with lnFIB-4 (P > .05). There is a dose–response relationship between the severity of SA and increased levels of lnALT, lnGGT, and decreased levels of lnAST/alanine aminotransferase (test for trend, all P values < .05). Subgroup analyses revealed that the positive association between SA and liver function, liver steatosis showed a tendency to exist in nonobese, younger, non-Hispanic Black, and male populations. Sensitive analysis showed the relationship between SA and liver injury was stable. Self-reported SA was independently associated with elevated liver enzymes and liver steatosis among US population. The association was more pronounced among nonobese, younger, non-Hispanic Black, and male populations.
Impact of CDKN2A gene expression on colon adenocarcinoma via biosignature analysis
Authors: Xu Chen
Published: November 2024

Colorectal adenocarcinoma (COAD) has a poor prognosis. Cyclin-dependent kinase inhibitor 2A (CDKN2A) significantly affects the development and progression of various human tumors. However, the significance and pathological mechanisms of CDKN2A in COAD remain to be elucidated. We assessed expression levels, clinical significance, biological function, co-expressed genes, and enrichment of related pathways of CDKN2A in COAD using various databases, including The University of Alabama at Birmingham Cancer Data Analysis Portal, Gene Expression Profiling Interactive Analysis, Tumor Immune Estimation Resource, Human Protein Atlas, STRING, GeneMANIA, cBioPortal, and Linked Omics. Our investigation showed that CDKN2A was highly expressed in colon adenocarcinomas (P < .001). It is weakly expressed or not expressed in normal tissues. The survival time of patients with colon adenocarcinoma with high CDKN2A expression is significantly shorter than that of patients with low expression levels (P = .011). There was a significant positive correlation between the expression level of CDKN2A in colon adenocarcinoma tissues and the infiltration of CD4+ T cells, macrophages, and neutrophils. Moreover, there was a significant negative association between the expression level of CDKN2A in colon adenocarcinoma tissues and B cell infiltration. The ten hub genes included tumor protein 53, V-myc Avian Myelocytomatosis Viral Oncogene Homolog, AKT serine/threonine kinase 1, cyclin-dependent kinase 2, phosphatase and tensin homolog deleted on chromosome ten, cyclin D1, cyclin dependent kinase 4, cyclin dependent kinase inhibitor 1A, catenin beta 1, and B-Raf proto-oncogene, serine/threonine kinase. Mutations in the CDKN2A genome in colon adenocarcinoma reduce survival. Gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses showed that the differentially expressed genes were enriched in apoptotic signaling pathways and multiple pathways related to metabolic progression. Our results indicate that CDKN2A can be used as a marker of poor prognosis in patients with colon adenocarcinoma. CDKN2A may regulate the occurrence and development of colon adenocarcinomas by influencing immune cell infiltration and metabolic pathways.
Association between prostate cancer and susceptibility, hospitalization, and severity of COVID-19: Based on a Mendelian randomization study
Authors: Liu Jingwen , Wan Lijun , Zhu Jianyong , Pan Renbing
Published: November 2024

Several observational studies indicated a close association between prostate cancer and COVID-19. Nevertheless, whether there was a causal effect between them remained obscure. In this study, we aimed to detect the potential association between genetically determined prostate cancer and the risk of COVID-19. A bidirectional Mendelian randomization (MR) study was conducted to investigate the causal links between prostate cancer and COVID-19. Inverse variance weighted (IVW), MR-Egger, weighted median, weighted mode, and simple mode were used to estimate the causality. PIVW < 0.05 was considered statistically significant. The top single nucleotide polymorphisms associated with prostate cancer cases (n = 79,148) and COVID-19 cases (n = 54,071) were extracted from the summary genome-wide association study data obtained from a publicly available database. Cochran Q test was utilized to calculate the degree of heterogeneity. Additionally, we validated our findings in another replication cohort. In the forward MR study, the IVW method suggested no evidence for the causal effect of prostate cancer on COVID-19 susceptibility (OR = 1.00, 95%CI: 0.98–1.02, P = .978), COVID-19 hospitalization (OR = 1.05, 95%CI: 0.99–1.09, P = .054), and COVID-19 severity (OR = 1.03, 95%CI: 0.95–1.11, P = .453). Reverse MR analysis also showed no causal effect of COVID-19 diverse phenotypes on prostate cancer. Furthermore, the result of the East Asian cohort study was consistent with the European cohort. Sensitivity analysis showed no evidence of pleiotropy and heterogeneity. We did not discover genetic evidence to substantiate causal links between prostate cancer and COVID-19. Large-scale randomized controlled trials were required to enhance a more profound comprehension of this relationship in the future.
Robot-assisted resection of ganglion cell neuroma with a diameter of 78 mm: A case report
Authors: Zhang Qipeng , Liang Hengrui , Li Jiayang , Li Shouzhuo , Xu Enwu
Published: November 2024

Rationale:

Intrathoracic paragangliomas are typically found within the intricate posterior mediastinal region adjacent to the vertebrae, often presenting with substantial volume. Surgical excision of such tumors presents formidable challenges and is conventionally performed via open surgical procedures.

Patient concerns:

In this report, we present the case of a 53-year-old female patient who presented with the discovery of a left intrathoracic mass during a routine physical examination approximately 1 month prior. She complained of chest tightness and chest pain.

Diagnoses:

She complained of chest tightness and chest pain. Magnetic resonance imaging of the chest and brachial plexus revealed a mass adjacent to the left upper lung hilum, measuring approximately 78 × 63 × 72 mm. The initial suspicion leaned towards a benign lesion. Notably, there was slight compression of the left first thoracic nerve root and mild compression of the middle and lower trunks of the left brachial plexus. Based on the morphological features of the tumor and imaging findings, we suspected its benign nature.

Interventions:

We opted for robot-assisted thoracic surgery to resect the mediastinal tumor.

Outcomes:

Subsequent postoperative pathology confirmed the diagnosis as a paraganglioma. The patient did not experience any notable complications post-surgery, and a 6-month follow-up revealed no signs of recurrence.

Lessons:

The successful application of the robot-assisted thoracic surgery surgical technique underscores its efficacy in minimally invasive resection of sizable intrathoracic tumors situated in the posterior mediastinum.
Pain’s impact on eating patterns and inflammation: A case-control study
Authors: Şahin Kübra , Sürücüoğlu Metin Saip , Arslan Müge
Published: November 2024

Pain is a widespread and troubling clinical and social problem with important effects on society and individuals. The purpose is to assess the relationship between pain and eating behavior, macro-micronutrient intake, and dietary inflammation index. The study was carried with a total of 80 patients, consisting of 40 patients diagnosed with pain and 40 patients not diagnosed with pain, who applied to a private hospital in Istanbul as outpatients with a questionnaire face-to-face consisting of questions about sociodemographic characteristics, anthropometric measurements, pain-related information, Eating Attitude Test (EAT-19), and 24-hour food consumption record. The statistical analysis of the data was conducted with SPSS v27 package program. People who had pain had higher levels of disrupted eating attitudes than those who did not have pain. The “Bulimia” subfactor mean score of the EAT-19 was higher in those with pain (P < .05). No difference was found between the case-control groups regarding the mean dietary inflammation index (DII) score and energy, macro- and micronutrient consumption values (P > .05). No difference was detected between the case-control groups with disrupted eating attitudes regarding the median DII score (P > .05). The median DII score was significantly higher in individuals with pain and normal eating attitudes than in those without pain and with disrupted eating attitudes (P < .05). There is a relationship between pain, eating attitudes, and DII, the median DII score of those who had pain and had normal eating attitudes was higher.
Global awareness of antigenic peptides – Unraveling the impact on sickle cell anemia patients in the presence of pathogens: A narrative review
Authors: Obeagu Emmanuel Ifeanyi
Published: November 2024

Sickle cell anemia (SCA) is a genetic blood disorder characterized by the production of abnormal hemoglobin S (HbS), leading to sickle-shaped red blood cells and various complications, including increased susceptibility to infections. The presence of antigenic peptides, short amino acid sequences derived from pathogens or altered self-proteins, plays a crucial role in immune responses. This review explores the global awareness of antigenic peptides, their role in immune responses in SCA patients, and the challenges and opportunities in managing infections within this vulnerable population. Antigenic peptides are central to the adaptive immune response, facilitating the recognition and elimination of pathogens by T-cells. In SCA, altered antigen presentation and impaired T-cell responses due to chronic inflammation, functional asplenia, and ongoing hemolysis contribute to increased susceptibility to infections. Pathogens such as Streptococcus pneumoniae and Haemophilus influenzae pose significant risks to SCA patients, highlighting the importance of robust immune responses mediated by antigenic peptides. Strategies such as vaccination and immunotherapy aim to enhance immune function by targeting specific antigenic peptides, thereby reducing infection rates and improving patient outcomes. Advances in genomics and proteomics offer insights into individual variations in antigen presentation and immune responses, guiding the development of tailored therapeutic interventions. Global collaborations are essential to address disparities in healthcare access and implement effective preventive measures, ensuring equitable outcomes for SCA patients worldwide.
The relationship between the technical performance score (TPS) and outcomes and its discriminative ability in congenital heart surgery
Authors: TAN-RECEP Berra Zümrüt , Ozturk Erkut
Published: November 2024

Various scoring systems have been used to predict mortality and morbidity after congenital heart surgery. While the ideal system is still controversial, the technical performance score (TPS) has recently gained popularity. In this study, was investigated the effect of the TPS in predicting mortality and morbidity in pediatric patients who underwent congenital heart surgery in our clinic. Patients aged < 18 years who underwent congenital heart surgery between 2020 and 2023, were retrospectively analyzed. The patients’ TPS categorizations were assigned according to their echocardiographic results at discharge and whether they required reintervention. The primary endpoints of the study were mortality (death within 30 days postoperatively) and morbidity. The secondary endpoint was a comparison of the effectiveness of TPS with that of the widely used Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score. Included in this study were 1075 patients. The median patient age was 3 months (interquartile range, 1–5 months). The mortality and morbidity rates were 11% and 24%, respectively. Of the patients, 60% were categorized as TPS I (optimal), 25% as TPS 2 (adequate, minimal residual defect), and 15% as TPS 3 (inadequate, hemodynamically significant residual defect). Being categorized as TPS 3 was associated with mortality, prolonged ICU stay, and major adverse events. The predictive power of TPS for mortality and morbidity was an area under the receiver operating characteristic curve (AUC) of 0.810 (95% CI: 0.79–0.839, P < .001) and 0.78 (95% CI: 0.76–0.80, P < .001), respectively. These values were similar to those of the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score (0.81 vs 0.83 and 0.78 vs 0.80 for mortality and morbidity, respectively). In patients with highly heterogeneous congenital heart disease, the use of intraoperative TPS may be helpful in predicting mortality and morbidity.
Pleomorphic adenoma of hard palate: Review of updated literature and “case report”
Authors: AlSahman Lujain , Alghamdi Osama , Albagieh Hamad , AlRefai Ali , AlSahman Roba , Alnafea Shatha
Published: November 2024

Rational:

Pleomorphic adenoma (PA) is a rare benign tumor mainly affecting the major salivary glands, known for its diverse histological appearances that can mimic malignancies. When it occurs in the hard palate it present diagnostic and management challenges compared to other sites due to the anatomical location and potential proximity to critical structures. This case reports a rare presentation PA starting as an ulcer, alongside a review of rare cases of PA reported in last 5 years. We aim to highlight clinical challenges and emphasize the need for awareness in diagnosis of this diverse entity amongst the clinicians before reaching a definitive conclusion.

Patient concerns:

A 41-year-old female reported an asymptomatic large swelling on the right side of the posterior palatal region. Clinical diagnosis revealed a firm, rubbery, and non-tender swelling of approximately 4 cm × 4 cm diameter. A triangular incisional biopsy was performed to confirm the diagnosis.

Diagnosis:

The histopathological evaluation confirmed the presence of a PA with a well-encapsulated and compressed salivary gland. A wide surgical dissection was made to remove the entire encapsulated tumor mass, including the mucoperiosteum and eroded bone of the palate. The borderline of the tumor was carefully identified in the surrounding healthy tissue. The hemostasis was obtained using a simple interrupted suture.

Lesson:

The diagnosis of PA is difficult as it usually involves extensive squamous and mucous metaplasia, confusing it with malignant disorders. Histopathological and clinical examinations are important for differentiating this lesion from other tumors. Complete surgical excision is reported as the first line of treatment.
Prevention of cancer—Melanoma development and its diagnosis among Silesian Voivodeship residents: Preliminary results
Authors: Dąbek Józefa , Żerdka Julia , Brasse Patryk
Published: November 2024

Melanoma is a malignant tumor with the highest growth rate in the incidence and is the leading cause of death due to skin cancers. In Poland, approximately 1500 cases of melanoma are detected annually in advanced or metastatic stages. Intensive preventive measures can contribute to its early-stage diagnosis, consequently reducing the number of fatalities. The aim of the study was to assess the occurrence of melanoma risk factors among the residents of Silesia region and their knowledge about the diagnosis and prevention of this cancer. An original questionnaire was used in the study, and its completion was anonymous. The study was conducted among the residents of the Silesian Voivodeship. A total of 400 (100%) individuals were examined. Among them were 243 women and 157 men. The participants’ ages ranged from 16 to 84 years (mean age = 34.38 ± 18.39). The participants were burdened with melanoma development risk factors such as fair skin complexion (235; 58.75%), having more than 50 pigmented lesions (158; 39.50%) and sunburns (105; 26.25%). Over 40% (166; 41.50%) of the participants had never examined their pigmented lesions. A staggering 78% (311; 77.75%) of the respondents had never undergone dermatoscopic examination, and over 50% (215; 53.75%) did not know what this examination entailed. Just under 16% (63; 15.75%) of the participants stated that their family doctor had examined their pigmented lesions, and almost % (154; 97.47%) of those with numerous pigmented lesions had never been referred to a dermatologist for dermatoscopy. The surveyed residents of the Silesian Voivodeship were burdened with numerous risk factors for melanoma development, with the most common being fair skin complexion, having more than 50 pigmented lesions, and sunburns. The knowledge of the participants regarding the diagnosis and prevention of melanoma development was insufficient, thus highlighting the necessity for conducting systematic educational initiatives in the mentioned field. These initiatives should ultimately lead to the preservation of health and life, as well as the maintenance of its high quality.
Malnutrition and other associated factors among the hospitalized elderly in Vietnam: A cross-sectional study
Authors: Pham Thi Lan Anh , Le Ngoc Thao Vy , Doan Duy Tan , Pham Nhat Tuan
Published: November 2024

Malnutrition is common among older inpatients and can lead to severe consequences such as disability, assisted living, increased mortality, and prolonged hospital stays. Given the rapidly aging population in Vietnam, limited data is available regarding the nutritional status of the geriatric. This research aimed to determine the prevalence of malnutrition and associated factors among the hospitalized elderly. A prospective observational study with a cross-sectional design was conducted on 108 older inpatients at University Medical Center in Ho Chi Minh City, Vietnam. Patients aged 60 years or older admitted to the hospital were recruited. Malnutrition was assessed using a validated Mini Nutritional Assessment Short Form. Sociodemographic characteristics were measured using interview-administered questionnaires. Data about patients’ biochemical parameters were retrieved from records with the newest results. Among 108 hospitalized patients (mean age 74.6 ± 9.8 years; 50% female), 72.2% of patients had malnutrition (n = 78) while 27.8% had normal nutritional status (n = 30). Age group, education level, cohabitation, serum albumin, hand-drip strength, physical inactivity, and frailty were associated with malnutrition. The prevalence of malnutrition in the elderly accounts for a very high proportion. Nutritional status assessment is essential for the elderly; therefore, more attention should be paid to those risk factors in old age health care in order to improve medical outcomes.
Analysis of influencing factors of risk perception among emergency nurses in China: An observational study
Authors: Liu Fu-Yan , Sun Jia-Xi , Hao Wen-Nv
Published: November 2024

To understand the current saturation of emergency nurses’ risk perception and its influencing factors, and to explore the correlation between emergency nurses’ risk perception and nurse’s safety behavior. This study is a cross-sectional study. From January 2024 to February 2024 using the questionnaire star online survey method. The convenience sampling method was used to survey nurses in the emergency departments of 5 hospitals in China. Male and female emergency nurses (n = 189) from China were included in the final sample. Nursing risk perception questionnaire and nurses safety behavior scale were used for evaluation. The collected data were comprehensively analyzed using various statistical methods, including descriptive analysis, 2 independent samples t-test mean comparison, 1-way analysis of variance for differences, multiple linear regression analysis to identify influencing factors, and Pearson correlation analyze correlations. All analyses were performed using SPSS version 26.0, and P < .05 was considered statistically significant (2-sided). The emergency nurses score was (87.08 ± 20.18) on the risk perception scale, scoring rate 62.2%. The results of multiple regression showed that age, marital status, education level, professional title, monthly income level, and safety behaviors were the main factors influencing the risk perception of emergency nurses (P < .05). The results of correlation analysis showed a positive correlation between the dimensions of nurses’ risk perception and safety behaviors (R = 0.636, P < .01). Age, marriage, education level, years of work experience, professional title, duties. engagement type, monthly income level, participation in teaching work, safety training, and no adverse events were the influencing factors of risk perception. The research results emphasize that risk perception of emergency nurses has a positive prediction effect on safe behavior. It is suggested that nursing managers should optimize nursing workflow and human resource allocation, strategically add occupational risk training to vocational training, and strengthen nurses’ safety behaviors.
Diffusion-weighted MR image analysis based on gamma distribution model for differentiating benign and malignant brain tumors
Authors: Soleimani Zeinab , Saboori Masih , Abedi Iraj , Irannejad Maziar , Khanbabapour Saeid
Published: November 2024

Background:

Considering the invasiveness of the biopsy method, we attempted to evaluate the ability of the gamma distribution model using magnetic resonance imaging images to stage and grade benign and malignant brain tumors.

Methods:

A total of 42 patients with malignant brain tumors (including glioma, lymphoma, and choroid plexus papilloma) and 24 patients with benign brain tumors (meningioma) underwent diffusion-weighted imaging using five b-values ranging from 0 to 2000 s/mm2 with a 1.5 T scanner. The gamma distribution model is expected to demonstrate the probability of water molecule distribution based on the apparent diffusion coefficient. For all tumors, the apparent diffusion coefficient, shape parameter (κ), and scale parameter (θ) were calculated for each b-value. In the staging step, the fractions (ƒ1, ƒ2, ƒ3) expected to reflect the intracellular, and extracellular diffusion and perfusion were investigated. Diffusion <1 × 10‐4 mm2/s (ƒ1), 1 × 10‐4 mm2/s < Diffusion > 3 × 10‐4 mm2/s (ƒ2), and Diffusion >3 × 10‐4 mm2/s (ƒ3); in the grading step, fractions were determined to check heavily restricted diffusion. Diffusion lower than 0.3 × 10‐4 mm2/s (ƒ11). Diffusion lower than 0.5 × 10‐4 mm2/s (ƒ12). Diffusion lower than 0.8 × 10‐4 mm2/s (ƒ13).

Results:

The findings were analyzed using nonparametric statistics and receiver operating characteristic curve diagnostic performance. Gamma model parameters (κ, ƒ1, ƒ2, ƒ3) showed a satisfactory difference in differentiating meningioma from glioma. For b value = 2000 s/mm2, ƒ1 had a better diagnostic performance than κ and apparent diffusion coefficient (sensitivity, 88%; specificity, 68%; P < .001). The best diagnostic performance was related to ƒ3 in b = 2000 s/mm2 (area under the curve = 0.891, sensitivity = 83%, specificity = 80%, P < .001). In the grading step, ƒ12 (area under the curve = 0.870, sensitivity = 92%, specificity = 72%, P < .001) had the best diagnostic performance in differentiating high-grade from low-grade gliomas with b = 2000 s/mm2.

Conclusion:

The findings of our study highlight the potential of using a gamma distribution model with diffusion-weighted imaging based on multiple b-values for grading and staging brain tumors. Its potential integration into routine clinical practice could advance neurooncology and improve patient outcomes through more accurate diagnosis and treatment planning.
Study of obesity research using machine learning methods: A bibliometric and visualization analysis from 2004 to 2023
Authors: Gong Xiao-wei , Bai Si-yu , Lei En-ze , Lin Lian-mei , Chen Yao , Liu Jian-zhong
Published: November 2024

Background:

Obesity, a multifactorial and complex health condition, has emerged as a significant global public health concern. Integrating machine learning techniques into obesity research offers great promise as an interdisciplinary field, particularly in the screening, diagnosis, and analysis of obesity. Nevertheless, the publications on using machine learning methods in obesity research have not been systematically evaluated. Hence, this study aimed to quantitatively examine, visualize, and analyze the publications concerning the use of machine learning methods in obesity research by means of bibliometrics.

Methods:

The Web of Science core collection was the primary database source for this study, which collected publications on obesity research using machine learning methods over the last 20 years from January 1, 2004, to December 31, 2023. Only articles and reviews that fit the criteria were selected for bibliometric analysis, and in terms of language, only English was accepted. VOSviewer, CiteSpace, and Excel were the primary software utilized.

Results:

Between 2004 and 2023, the number of publications on obesity research using machine learning methods increased exponentially. Eventually, 3286 publications that met the eligibility criteria were searched. According to the collaborative network analysis, the United States has the greatest volume of publications, indicating a significant influence on this research. coauthor’s analysis showed the authoritative one in this field is Leo Breiman. Scientific Reports is the most widely published journal. The most referenced publication is “R: a language and environment for statistical computing.” An analysis of keywords shows that deep learning, support vector machines, predictive models, gut microbiota, energy expenditure, and genome are hot topics in this field. Future research directions may include the relationship between obesity and its consequences, such as diabetic retinopathy, as well as the interaction between obesity and epidemiology, such as COVID-19.

Conclusion:

Utilizing bibliometrics as a research tool and methodology, this study, for the first time, reveals the intrinsic relationship and developmental pattern among obesity research using machine learning methods, which provides academic references for clinicians and researchers in understanding the hotspots and cutting-edge issues as well as the developmental trend in this field to detect patients’ obesity problems early and develop personalized treatment plans.
Enhancing rural healthcare through internet-based remote collaborative outpatient services: A comprehensive evaluation in Changzhi, Shanxi Province
Authors: Zhao Hu , Zhang Zhichao , Tang Jie
Published: November 2024

Background:

The advancement of digital technology, particularly telemedicine, has become crucial in improving healthcare access in rural areas. By integrating cloud computing and mHealth technologies, Internet-based Collaborative Outpatient Clinics offer a promising solution to overcome the limitations of traditional healthcare delivery in underserved communities.

Methods:

A trial was conducted in 4 counties of Changzhi City in Shanxi Province, China. The system extended to 495 rural communities and served over 5000 rural residents. Deep learning algorithms were employed to analyze medical data patterns to increase the accuracy of diagnoses and the quality of personalized treatment recommendations.

Results:

After the implementation of the system, there was a significant improvement in the satisfaction levels of rural residents regarding medical services; the accuracy of medical consultations increased by 30%, and the convenience of medical access improved by 50%. There was also a notable enhancement in overall health management. Satisfaction rates among healthcare professionals and rural inhabitants were over 90% and 85%, respectively, indicating that the system has had a significant positive impact on the quality of health-care services.

Conclusion:

The study confirms the feasibility of implementing telemedicine services in rural areas and offers evidence and an operational framework for promoting innovative healthcare models on a large scale.
Application of the pancreatic body suspension technique in laparoscopic splenectomy combined with selective pericardial varicosity dissection: An observational study
Authors: Qian Daohai , Liu Bin , Jiang Bin , Xi Shihang , Wang Xu , Wang Xiaoming
Published: November 2024

To investigate the safety of pancreatic body suspension (PBS) technique in laparoscopic splenectomy combined with pericardial devascularization for patients. A retrospective study inclusive of 16 patients who underwent laparoscopic splenectomy combined with pericardial devascularization from 2017 to 2022 was performed. A total of 5 patients underwent PBS technique and 11 underwent the traditional technique. There was no significant difference in age, sex, body mass index (BMI), preoperative serum white cell count (WBC), platelets (PLT), hemoglobin (HB), albumin (ALB), prothrombin time (PT), total bilirubin (TBIL), or spleen size between the 2 groups (P > .05). In the PBS group, the operation time was 280 minutes. The estimated intraoperative blood loss (EBL) was 250 mL. The mean postoperative hospitalization length was 11.2 days. There was no conversion to an open procedure or postoperative bleeding. In the traditional method group, the mean operation time was 240.91 minutes. The EBL was 290.91 mL. There were 2 cases of conversion to open, 3 cases of postoperative bleeding, and 1 reoperation. The incidence of postoperative short-term complications (postoperative bleeding, reoperation) was significantly higher in the traditional method group than in the PBS group (36.36% vs 0%, P = .034). PBS technique improved the safety of laparoscopic splenectomy combined with pericardial dissection and is worthy of clinical promotion.
Advances in the use of chlorhexidine for periodontitis treatment in diabetic patients: A review
Authors: Sun Honglan , Chen Shizhao , Yang Chao , Kuang Huifang , Huang Yuqi , He Xiaoning , Luo Wen
Published: November 2024

Periodontitis and diabetes mellitus exhibit a bidirectional relationship. This narrative review descriptively outlines the role of chlorhexidine in the periodontal treatment of diabetic patients, focusing on its antimicrobial mechanisms against microbial communities and its antiplaque effects. Although chlorhexidine is proven to be effective in combating microbial presence and improving gingivitis with substantial supporting evidence, its impact on glycemic control and insulin resistance in diabetic patients remains contentious. Additionally, the effectiveness of chlorhexidine as an adjunctive chemotherapeutic in the periodontal treatment of gestational diabetes has not yet been studied, highlighting a gap in research that necessitates further prospective studies and randomized controlled trials. Considering the interconnection between periodontal inflammation and glycemic levels, this article finally advocates for collaborative care between dental and medical professionals to manage periodontitis in diabetic patients effectively.