bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic modulation of the liver immune microenvironment
Authors: Tilg Herbert , Adolph Timon E. , Tacke Frank
Published: April 2023

Inflammation is a hallmark of progressive liver diseases such as chronic viral or immune-mediated hepatitis, alcohol-associated liver disease, and NAFLD. Preclinical and clinical studies have provided robust evidence that cytokines and related cellular stress sensors in innate and adaptive immunity orchestrate hepatic disease processes. Unresolved inflammation and liver injury result in hepatic scarring, fibrosis, and cirrhosis, which may culminate in HCC. Liver diseases are accompanied by gut dysbiosis and a bloom of pathobionts, fueling hepatic inflammation. Anti-inflammatory strategies are extensively used to treat human immune-mediated conditions beyond the liver, while evidence for immunomodulatory therapies and cell therapy–based strategies in liver diseases is only emerging. The development and establishment of novel immunomodulatory therapies for chronic liver diseases has been dampened by several clinical challenges, such as invasive monitoring of therapeutic efficacy with liver biopsy in clinical trials and risk of DILI in several studies. Such aspects prevented advancements of novel medical therapies for chronic inflammatory liver diseases. New concepts modulating the liver immune environment are studied and eagerly awaited to improve the management of chronic liver diseases in the future.
SGLT2i reduces risk of developing HCC in patients with co-existing type 2 diabetes and hepatitis B infection: A territory-wide cohort study in Hong Kong
Authors: Lee Chi-Ho , Mak Lung-Yi , Tang Eric Ho-Man , Lui David Tak-Wai , Mak Jimmy Ho-Cheung , Li Lanlan , Wu Tingting , Chan Wing Lok , Yuen Man-Fung , Lam Karen Siu-Ling , Wong Carlos King Ho
Published: April 2023

Background and Aims:

Type 2 diabetes (T2D) and chronic hepatitis B infection (CHB) are risk factors of HCC. Sodium glucose co-transporter 2 inhibitors (SGLT2i) inhibit HCC oncogenesis in preclinical studies. However, clinical studies are lacking. This study aimed to evaluate the impact of SGLT2i use on incident HCC using a territory-wide cohort of exclusively patients with co-existing T2D and CHB.

Approach and Results:

Patients with co-existing T2D and CHB between 2015 and 2020 were identified from the representative electronic database of the Hong Kong Hospital Authority. Patients with and without SGLT2i use were 1:1 matched by propensity score for their demographics, biochemistry results, liver-related characteristics, and background medications. Cox proportional hazards regression model was used to assess the association between SGLT2i use and incident HCC. A total of 2,000 patients with co-existing T2D and CHB (1,000 in each SGLT2i and non-SGLT2i group; 79.7% on anti-HBV therapy at baseline) were included after propensity-score matching. Over a follow-up of 3,704 person-years, the incidence rates of HCC were 1.39 and 2.52 cases per 100 person-year in SGLT2i and non-SGLT2i groups, respectively. SGLT2i use was associated with a significantly lower risk of incident HCC (HR 0.54, 95%CI: 0.33-0.88, p=0.013). The association remained similar regardless of sex, age, glycemic control, diabetes duration, presence of cirrhosis and hepatic steatosis, timing of anti-HBV therapy, and background antidiabetic agents including dipeptidyl peptidase-4 inhibitors, insulin, or glitazones (all p interaction>0.05).

Conclusions:

Among patients with co-existing T2D and CHB, SGLT2i use was associated with a lower risk of incident HCC.
No effect of social interaction on experimental pain sensitivity: a randomized experimental study
Authors: Nim Casper Glissmann , Ravn Sophie Lykkegaard , Andersen Tonny E. , Engelsholm Emma , Hestbech Fie , Hvidkær Inge S. , Traidl Amanda N. , O'Neill Søren
Published: April 2023

Quantitative sensory testing (QST) is a commonly applied paradigm to investigate pain, which is a subjective experience influenced by a myriad of social and contextual factors. Therefore, it is important to consider the potential sensitivity of QST to the test setting and the social interaction that naturally is a part of it. This may particularly be the case in clinical settings where patients have something at stake. Therefore, we investigated differences in pain responses using QST in different test setups with varying degrees of human interaction. In a parallel three-armed randomized experimental study, we included 92 participants with low back pain and 87 healthy volunteers allocated to 1 of the 3 QST setups: 1 setup with manual tests performed by a human tester, 1 setup with automated tests performed by a robot and orally guided by a human tester, and 1 setup with automated tests performed solely by a robot without social interaction with a human tester. All 3 setups consisted of the same pain tests in the same order, including pressure pain threshold and cold pressor tests. We found no statistically significant differences between setups on the primary outcome of conditioned pain modulation nor any secondary QST outcomes. While this study is not without limitations, the results indicate that QST procedures are robust enough not to be influenced by social interaction to an appreciable degree.
Risk of Two Sport-Related Concussions in the Same Year: Is the Second Concussion Worse?
Authors: Williams Kristen , Zeoli Tyler , Allen Jackson H. , Jo Jacob , Yengo-Kahn Aaron M. , Terry Douglas P. , Zuckerman Scott L.
Published: April 2023

Objectives:(

1) Evaluate the frequency of same-year, repeat concussions; (2) assess predictors of sustaining a repeat concussion; and (3) compare outcomes of athletes with repeat concussions with athletes with single concussion.

Design:

A retrospective, case–control study.

Setting:

Regional sports concussion center.

Patients:

Adolescents sustaining a sport-related concussions (SRC) from November 2017 to October 2020.

Independent Variables:

Participants were dichotomized into 2 groups: (1) athletes with a single concussion; and (2) athletes with repeat concussions.

Main Outcome Measures:

Between group and within group analyses were completed to look for differences in demographics, personal and family history, concussion history, and recovery metrics between the 2 groups.

Results:

Of 834 athletes with an SRC, 56 (6.7%) sustained a repeat concussion and 778 (93.3%) had a single concussion. Between group: Personal history of migraines (19.6% vs 9.5%, χ2 = 5.795, P = 0.02), family history of migraines (37.5% vs 24.5%, χ2 = 4.621, P = 0.03), and family history of psychiatric disorders (25% vs 13.1%, χ2 = 6.224, P = 0.01) were significant predictors of sustaining a repeat concussion. Within group: Among those with a repeat concussion, initial symptom severity was greater (Z = −2.422; P = 0.02) during the repeat concussion and amnesia was more common (χ2 = 4.775, P = 0.03) after the initial concussion.

Conclusions:

In a single-center study of 834 athletes, 6.7% suffered a same-year, repeat concussion. Risk factors included personal/family migraine history and family psychiatric history. For athletes with repeat concussions, initial symptom score was higher after the second concussion, yet amnesia was more common after the initial concussion.
Enlightenment of chronic disease prevention from “Jiu Zuo Shang Rou (Long-time Sitting Damages Muscles)”: integrated traditional with modern perspectives
Authors: Lihong Lou , Xiaqiu Wu
Published: April 2023

Thousands of years ago, the conception of “Jiu Zuo (久坐)” which can be translated as long-time sitting, has been generated by traditional Chinese medicine (TCM) physicians. It was clearly recorded that “Jiu Zuo Shang Rou (久坐伤肉)” in the ancient book Huang Di Nei Jing (Yellow Emperor’s Inner Canon). TCM physicians believe that long-time sitting can affect the normal circulation of the body’s qi and blood, injures the muscles and dysfunctions the spleen, then cause diseases. Recent years, biomedicine evidences that sedentary behavior, which includes sitting, will affect the endocrine, metabolism, and other physiological functions of human body, leading to chronic diseases possibly. This paper attempts to systematically recapitulate both the ancient records of Jiu Zuo Damages and the latest research of sedentary sitting diseases, enabling better understandings of the relationships between sedentary behavior and health status from both traditional and modern medicinal perspectives. Going beyond this, this work may extend the applications of TCM “Zhi Wei Bing (治未病)” theory in the field of chronic disease prevention and treatment, bringing great benefits to national and local population’s health.
A new interpretation of the fragments of Tangut script medical prescriptions G21.004[20487] as a collection in Gansu Provincial Museum
Authors: Sun Lingzhi
Published: April 2023

There are 147 words and 3 repetition symbols in the document G21.004[20487] in Gansu, and was separated by two circles. The document G21.004[20487] is a fragment of Tangut script medical prescriptions in Gansu Provincial Museum. At present, the academic world believes that there are three kinds of medical prescriptions in the fragment. Take the controversial line 3 for example, it is not the "husked sorghum porridge" translated by the academic circles, but the meaning of "when the rice cooked as congee, the medicinal concoctions was succeed "; For the "hou-lao-xin-ma"(厚罗辛麻) in line 4, it is considered that it should be translated into "hou-lao-xi-ma"(厚蓉膝麻). For line 5, it should follow the writing paradigm of ancient medical books, which is translated as "cure and eliminate 100 kinds of cold diseases, macrobiotic sesame (prescription)". It is believed that there are 7 herbs in the fragment of Tangut script medical prescriptions, which are related to the treatment of "cold coagulation "(冷疾), not febrile disease(伤寒).
Dietary supplementation with resistant starch contributes to intestinal health
Authors: Wen Jia-jia , Li Ming-zhi , Nie Shao-Ping
Published: April 2023

Purpose of review

Resistant starch has received much attention recently as a healthy carbohydrate component of the diet. Resistant starch is not digested in the small intestine and can thus affect the gut microbiota of the host because of its fermentability. This review summarizes the interactions along the resistant starch–gut microbiota–host axis to help understand the health effects of resistant starch.

Recent findings

Recent studies indicate that resistant starch can be a helpful dietary component for special disease states like diabetes, metabolic syndrome, chronic kidney disease, constipation, and colitis. Its health effects are associated with modulation of the gut microbiota, and with gut microbes converting resistant starch into active and bioavailable metabolites that promote intestinal health.

The results from human clinical trials and studies in animal models indicate that supplementation of the diet with resistant starch in different metabolic diseases help remodel gut microbiota, especially increasing short-chain fatty acid (SCFA)-producing bacteria, and produce bioactive metabolites like SCFA, bile acids, and amino acids responsible for a variety of health effects. The gut microbiota and microbial metabolites probably mediate the effects of resistant starch on intestinal health.
A systematic review and meta-analysis of retrograde type A aortic dissection after thoracic endovascular aortic repair in patients with type B aortic dissection
Authors: Ali-Hasan-Al-Saegh Sadeq , Halloum Nancy , Scali Salvatore , Kriege Marc , Abualia Mohannad , Stamenovic Davor , Bashar Izzat Mohammad , Bohan Patrick , Kloeckner Roman , Oezkur Mehmet , Dorweiler Bernhard , Treede Hendrik , El Beyrouti Hazem
Published: April 2023

Background:

Retrograde type A dissection (RTAD) is a devastating complication of thoracic endovascular repair (TEVAR) with low incidence but high mortality. The objective of this study is to report the incidence, mortality, potential risk factors, clinical manifestation and diagnostic modalities, and medical and surgical treatments.

Methods:

A systematic review and single-arm and two-arm meta-analyses evaluated all published reports of RTAD post-TEVAR through January 2021. All study types were included, except study protocols and animal studies, without time restrictions. Outcomes of interest were procedural data (implanted stent-grafts type, and proximal stent-graft oversizing), the incidence of RTAD, associated mortality rate, clinical manifestations, diagnostic workouts and therapeutic management.

Results:

RTAD occurred in 285 out of 10,600 patients: an estimated RTAD incidence of 2.3% (95% CI: 1.9–2.8); incidence of early RTAD was approximately 1.8 times higher than late. Wilcoxon signed-rank testing showed that the proportion of RTAD patients with acute type B aortic dissection (TBAD) was significantly higher than those with chronic TBAD (P = .008). Pooled meta-analysis showed that the incidence of RTAD with proximal bare stent TEVAR was 2.1-fold higher than with non-bare stents: risk ratio was 1.55 (95% CI: 0.87–2.75; P = .13). Single arm meta-analysis estimated a mortality rate of 42.2% (95% CI: 32.5–51.8), with an I
2 heterogeneity of 70.11% (P < .001).

Conclusion:

RTAD is rare after TEVAR but with high mortality, especially in the first month post-TEVAR with acute TBAD patients at greater risk as well as those treated with proximal bare stent endografts.
Comparison the efficacy of amiodarone and lidocaine for cardiac arrest: A network meta-analysis
Authors: Wang Qi , Lin Zhen , Chen Hairong , Pan Biyun
Published: April 2023

Background:

There is no evidence that antiarrhythmic drugs can improve long-term survival or survival with favorable neurological outcomes in cardiac arrest patients. We did this network meta-analysis to comprehensively compare the efficacy of various antiarrhythmic drugs for cardiac arrest patients.

Methods:

We searched studies from inception until Nov 11, 2022 through PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Database, and Wanfang database. All studies comparing different antiarrhythmic drugs for cardiac arrest were included in this meta-analysis. Outcomes were survival to hospital discharge in cardiac arrest, survival to hospital admission/24 h and favorable neurological outcome. This network meta-analysis was performed by R software.

Results:

Finally, a total of 9 studies (10,980 patients) were finally included in this network meta-analysis. Amiodarone (odd ratio [OR] 2.28, 95% credibility interval [CrI] 1.61–3.27) and lidocaine (OR 1.53, 95% CrI 1.05–2.25) was superior than placebo in terms of the survival to hospital admission/24 h with statistically significant. Amiodarone (OR 2.19, 95% CrI 1.54–3.14) and lidocaine (OR 1.58, 95% CrI 1.09–2.32) was superior than placebo in terms of the survival to hospital discharge with statistically significant. Amiodarone (OR 2.43, 95% CrI 1.61–3.68) and lidocaine (OR 1.62, 95% CrI 1.04–2.53) was superior than placebo in terms of the favorable neurological outcome with statistically significant. The surface under the cumulative ranking (SUCRA) shows that amiodarone ranked first (SUCRA, 99.6%), lidocaine ranked second (SUCRA, 49.6%), placebo ranked the last (SUCRA, 0.86%). Inverted funnel plot is essentially symmetrical, it is possible that this study has a small sample effect or a small publication bias.

Conclusions:

Amiodarone had the best effect on both survival to hospital admission, discharge and more favorable neurological outcome. Thus, amiodarone should be listed as first line drug for cardiac arrest. However, the quality of available evidence limits the formation of powerful conclusions regarding the comparative efficacy or safety of amiodarone or lidocaine used to treat cardiac arrest. Higher-quality randomized controlled trials are required for further research in future.
Intrawound low-dose vancomycin is superior to high-dose in controlling the risk of wound dehiscence in spine surgeries
Authors: Sonbol Ahmed M. , Baabdullah Ayman M. , Mohamed Mohamed Awad A. , Kassab Farid N.
Published: April 2023

Wound complications in spine surgeries are common and serious. This study aimed to determine the risk of wound dehiscence with a low-dose of intrawound vancomycin compared to that with a high-dose and no-vancomycin and its effectiveness in the prevention of surgical site infection. Patients were categorized into 3 groups. The first group did not receive any intrawound vancomycin. In the second, patients received a high-dose of vancomycin (1 g). The third group included patients who received a low-dose of intrawound vancomycin (250 mg). Patient demographics, clinical data, and surgical data were also collected. Multivariate linear regression analysis was used to examine factors associated with dehiscence or infection. Of the 391 patients included in our study, 56 (14.3%) received a high-dose of intrawound vancomycin, 126 (32.2%) received a low-dose, and 209 (53.5%) did not receive any treatment. The overall incidence of wound dehiscence was 6.14% (24 out of 391 patients). Wound dehiscence was significantly higher (P = .039) in the high-dose vancomycin group than in the low-dose vancomycin group. The overall incidence of postoperative infection was 2.05% (8 patients) and no statistically significant differences were observed between the low-dose and high-dose vancomycin groups. Patients with higher body mass index were more likely to experience wound dehiscence and postoperative infection, irrespective of the dose of vancomycin used. The use of low-dose intrawound vancomycin (250 mg) resulted in less wound dehiscence compared with high-dose vancomycin. Further trials are required to evaluate the effectiveness of the low-dose in preventing postoperative infections.
Analysis of adverse events and quality of life in high-grade serous ovarian cancer patients with Olaparib maintenance therapy: A single-center study in China
Authors: Jiang Yi , Xu Ting , Yuan Lin , Zhang Lin , Ruan Xinjia , Wu Shan , Meng Huangyang , Cheng Wenjun
Published: April 2023

Olaparib showed good efficacy and tolerability in the maintenance treatment of patients with initial therapy or high-grade serous recurrent ovarian cancer patients. This study aimed to analyze adverse events (AEs) of patients taking Olaparib and the quality of life (QoL) with Olaparib in 1 center of China. The study included 98 patients who received Olaparib and 210 patients without Olaparib from July 2018 to October 2021 for high-grade serous ovarian cancer in the Gynecology Oncology Department of Jiangsu Provincial Hospital. Information of clinicopathologic characteristics was collected from medical records. Then, we used the QLQ-C30 and Quality of Life Ovarian Cancer 28 Questionnaire (QLQ-OV28) to determine the QoL of 98 patients with and 210 patients without Olaparib. Among all 98 patients with Olaparib, 66 patients in first-line and 32 patients in more than second-line treatment. Regarding the best objective response with Olaparib maintenance in 78 patients with partial remission from most recent chemotherapy, 3 (3.84%) patients showed complete response (CR) and 6 (7.69%) showed as partial response (PR), whereas stable disease was observed in 42 patients (53.84%) and 27 patients (34.6%) showed as progression disease. AEs of Grade 3 and more were: anemia in 16 patients (16.32%), neutropenia in 20 patients (20.40%), thrombocytopenia in 4 patients (4.08%), and headache in 4 patients (4.08%). Dose reduction and drug discontinuation accounted for 73.40% and 20.40%, respectively. Olaparib as maintenance therapy increased QoL on all functioning domains and several symptom domains. Consistent with previous clinical trials, Olaparib maintenance therapy was proved safe and effective. Most patients may experience Grade 1 and 2 AEs. Olaparib maintenance therapy can increase QoL in several domains.
Pseudophakic pupillary block after reverse sulcus intraocular lens implantation: A case report
Authors: Funarunart Panrapee , Treesit Isaraporn
Published: April 2023

Introduction:

Reverse sulcus intraocular lens (IOL) implantation can cause serious ophthalmic complications. Even routine ocular examinations can provoke significant consequences. Herein, we present a case of recurrent pupillary capture and pseudophakic pupillary block related to reverse sulcus IOL implantation.

Case report:

A 44-year-old man developed a pseudophakic pupillary block after pupil dilation aimed at relieving pupillary capture in an undetected reverse position of the sulcus IOL. The pupillary block was successfully treated with 2% pilocarpine and laser peripheral iridotomywas performed to prevent recurrence. The patient experienced recurrent pupillary capture with decreased vision in the affected eye. IOL exchange was the definite treatment resulting in improved vision and proper positioning of the IOL.

Conclusions and importance:

When the reverse position of sulcus IOL is detected postoperatively, prophylactic laser peripheral iridotomy should be considered to prevent pupillary block particularly when pupillary capture is present. Pharmacologic pupillary dilation should be performed cautiously. Recurrent pupillary capture is possible and IOL repositioning should be considered to prevent further complications.
Comparative study between photodynamic therapy and the use of probiotics in the reduction of halitosis in mouth breathing children: Study protocol for a randomized controlled clinical trial
Authors: Bruno Laura Hermida , Sobral Ana Paula Taboada , Gonçalves Marcela Leticia Leal , Fossati Ana Laura , Santos Elaine Marcilio , Gallo Juliana Maria Altavista Sagretti , Ferri Elza Padilha , Motta Pamella de Barros , Prates Renato Araujo , Deana Alessandro Melo , Horliana Anna Carolina Ratto Tempestini , Motta Lara Jansiski , Bussadori Sandra Kalil
Published: April 2023

Introduction:

Halitosis is a term that defines any odor or foul smell the emanates from the oral cavity, the origin of which may be local or systemic. One of the causes of local or oral halitosis is low salivary flow and dry mouth, which is also one of the complaints of individuals with the mouth-breathing habit. The aim of this study is to determine the effectiveness of antimicrobial photodynamic therapy (aPDT) and the use of probiotics for the treatment of halitosis in mouth-breathing children.

Methods:

Fifty-two children between 7 and 12 years of age with a diagnosis of mouth breathing and halitosis determined through an interview and clinical examination will be selected. The participants will be divided into 4 groups: Group 1—treatment with brushing, dental floss and tongue scraper; Group 2—brushing, dental floss and aPDT applied to the dorsum and middle third of the tongue; Group 3—brushing, dental floss and probiotics; Group 4—brushing, dental floss, aPDT and probiotics. The use of a breath meter and microbiological analysis of the tongue coating will be performed before, immediately after treatment and 7 days after treatment. The quantitative analysis will involve counts of colony-forming bacteria per milliliter and real-time polymerase chain reaction. The normality of the data will be determined using the Shapiro–Wilk test. Parametric data will be submitted to analysis of variance and nonparametric data will be compared using the Kruskal–Wallis test. The results of each treatment in the different periods of the study will be compared using the Wilcoxon test.

Discussion:

Due to the low level of evidence, studies are needed to determine whether treatment with aPDT using annatto as the photosensitizer and blue led as the light source is effective at diminishing halitosis in mouth-breathing children.
In silico structure-based design of peptides or proteins as therapeutic tools for obesity or diabetes mellitus: A protocol for systematic review and meta analysis
Authors: Medeiros Isaiane , Aguiar Ana Júlia Felipe Camelo , Fortunato Wendjilla Medeiros , Teixeira Ana Francisca Gomes , Oliveira e Silva Emilly Guedes , Bezerra Ingrid Wilza Leal , Maia Juliana Kelly da Silva , Piuvezam Grasiela , Morais Ana Heloneida de Araújo
Published: April 2023

Background:

In silico studies using dynamic simulation or molecular docking have boosted the screening and identification of molecules and/or targets in studies aimed at treating diseases such as obesity and diabetes mellitus, optimizing the development of new drugs. This study aims to describe a systematic review protocol on peptides and proteins evaluated in silico as potential therapeutic agents for obesity or diabetes mellitus.

Methods:

This protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols and was registered in the International Prospective Register of Systematic Reviews database (number: CRD42022355540). The databases to be searched will be PubMed, ScienceDirect, Scopus, Web of Science, virtual health library, and EMBASE. It will be included in silico studies that evaluate the simulation by dynamics or molecular docking of proteins or peptides involved in treating obesity or diabetes mellitus. Two independent reviewers will select studies, extract data, and assess methodological quality using the adapted Strengthening the reporting of empirical simulation studies. A narrative synthesis of the included studies will be performed for the systematic reviews.

Results:

This protocol contemplates the production of 2 systematic reviews to be developed focusing on obesity or diabetes mellitus.

Conclusion:

The reviews will enable knowledge of peptides and proteins involved in research treating these diseases and will emphasize the importance of in silico studies in this context and for the development of future studies.
Construction of an m6A-related lncRNA model for predicting prognosis and immunotherapy in patients with lung adenocarcinoma
Authors: Shen Hong-Yu , Zhang Jin , Xu Di , Xu Zheng , Liang Ming-Xing , Chen Wen-Quan , Tang Jin-Hai , Xia Wen-Jia
Published: April 2023

N6-methyladenosine (m6A)-related lncRNAs could be involved in the development of multiple tumors with an unknown role in lung adenocarcinoma (LUAD). Hence, gene expression data and clinical data of LUAD patients were acquired from The Cancer Genome Atlas Database. The prognostic m6A-related lncRNAs were identified through differential lncRNA expression analysis and Spearman’s correlation analysis. The least absolute shrinkage and selection operator regression was used to establish the prognostic risk model, so as to evaluate and validate the predictive performance with survival analysis and receiver operating characteristic curve analysis. The expression of immune checkpoints, immune cell infiltration and drug sensitivity of patients in different risk groups were analyzed separately. A total of 19 prognostic m6A-related lncRNAs were identified to set up the prognostic risk model. The patients were divided into high- and low-risk groups based on the median value of the risk scores. Compared with the patients in the low-risk group, the prognosis of the patients in the high-risk group was relatively worse. The receiver operating characteristic curves indicated that this model had excellent sensitivity and specificity. Multivariate Cox regression analysis demonstrated that the risk score could be supposed as an independent prognostic risk factor. We highlighted that the risk scores were correlated with immune cell infiltration and drug sensitivity for constructing a prognostic risk model in LUAD patients based on m6A-related lncRNAs.
Systemic lupus erythematosus complicated with cryptococcal meningitis: A case report
Authors: Ma Honglei , Wang Yuqun , Liu Junhong , Du Linping , Wang Xiaodong , Wang Yingliang
Published: April 2023

Rationale:

Patients with systemic lupus erythematosus (SLE) complicated with cryptococcal meningitis (CM) are easy to be misdiagnosed as neuropsychiatric lupus or tuberculous meningitis due to the lack of specificity of clinical symptoms, which may delay treatment. Through this case, we considered early improvement of India ink stain of cerebrospinal fluid (CSF) and metagenomic next generation sequences to determine whether there is microbial infection, and gave the idea of empirical anti-infection therapy, so as to make early diagnosis and slow down the progression of the disease.

Patient concerns:

We report the case of a 40-year-old female with SLE for 10 years. Five days ago she came down with a fever and a headache.

Diagnosis, interventions, and outcomes:

India ink stain of CSF in patients with SLE shows Cryptococcus neoformans growth. Combined with imaging findings, the patient was diagnosed with CM. The patient improved after 3 weeks of antifungal therapy with amphotericin B 42 mg/d and flucytosine 6000 mg/d.

Lessons:

The possibility of CM should be considered when SLE patients have sudden headache and fever. India ink stain of CSF and metagenomic next generation sequences should be actively improved in the early stage of the disease to identify whether there is microbial infection, and early empirical anti-infection treatment should be given to reduce mortality.
Efficacy of short-term splint immobilization in the treatment of pediatric discoid lateral meniscus after saucerization management
Authors: Liu Yao , Liu Ya , Zhu Lun-Qing , Zhen Yun-Fang , Zhang Fu-Yong , Wang Xiao-Dong
Published: April 2023

There are no universal guidelines for rehabilitation after saucerization for children with discoid lateral meniscus. This study determined if short-term knee splint immobilization and delayed rehabilitation produces the same benefit as early rehabilitation after saucerization in children, in terms of knee function and pain intensity. A retrospective review was performed by categorizing patients into 2 groups depending on whether a splint immobilization was adopted postoperatively: for group A, rehabilitation began early without splint immobilization after surgery, and for group B, a knee splint was immobilized for 2 weeks. Numerical rating scale scores were collected in patients 1, 3, and 7 days, Lysholm scores were measured at 4 and 8 weeks postoperatively, and the gradual return to normal activities was documented. Forty-eight patients and 53 knees were included: group A had 30 patients with 31 knees, and group B had 18 patients with 22 knees. There was no improvement in numerical rating scale scores on the 1st (P=.519), 3rd (P=.421), and 7th (P=.295) postoperative days in group B. The Lysholm scores of group A (62.94 ± 8.68) was higher than that of group B (46.68 ± 9.82) measured 4 weeks following surgery, but there was no difference at 8 weeks (P=.237), and both groups had similar time to return to normal activities (P=.363). For discoid lateral meniscus patients who underwent isolated saucerization, short-term splint immobilization did not significantly help relieve postoperative pain. There was a comparable time-course for return to normal activities in both study groups.
Prevalence of fast-food intake among a multi-ethnic population of middle-aged men and connection with sociodemographic factors and obesity
Authors: AlTamimi Jozaa Z. , AlFaris Nora A. , Alshwaiyat Naseem M. , Alkhalidy Hana , AlKehayez Nora M. , Alsemari Malak A. , Alagal Reham I.
Published: April 2023

Adults are increasingly eating fast-food, which is connected to adverse health outcomes such as obesity and chronic diseases. This work was carried out to study the prevalence of fast-food intake among a multi-ethnic population of middle-aged men and its connection with sociodemographic factors and obesity. This cross-sectional study enrolled 1800 middle-aged men from Riyadh, Kingdom of Saudi Arabia. A valid and reliable questionnaire was used to assess participants fast-food intake frequency. Fast-food was consumed weekly by 87.8% of participants and daily by 45.6% of participants. The nationality of participants was determined as a predictor of fast-food intake. The highest and lowest prevalence of weekly fast-food intake was reported among Turkish (99.6%) and Sudanese (48.3%) participants. The highest and lowest daily intake rates were reported among participants from the Philippines (85.9%) and Bangladesh (10.0%). Another factor predicting fast-food intake was obesity. Obese participants had a significantly higher odds ratio (OR) of weekly (OR = 5.83, P <.001) and daily (OR = 1.93, P <.001) fast-food intake than non-overweight/nonobese participants. Fast-food intake was prevalent among middle-aged men who reside in Kingdom of Saudi Arabia. Results connect fast-food intake with nationality and obesity.
Frailty is associated with an increased risk of postoperative pneumonia in elderly patients following surgical treatment for lower-extremity fractures: A cross-sectional study
Authors: Ou Yili , Wang Hong , Yang Ling , Jiang Wei
Published: April 2023

Elderly patients with lower-extremity fractures are at high risk of postoperative pneumonia (POP) after surgery due to longtime bed rest. This study aimed to explore whether preoperative frailty is an independent risk factor for POP in elderly patients undergoing surgical treatment for lower-extremity fractures. The study adopted a cross sectional design with 568 patients (≥60 years) admitted to a tertiary hospital in China from January 1, 2021 to June 30, 2022, for surgical intervention of a significant lower-extremity fracture. Preoperative frailty was assessed using the CFS (Clinical Frailty Scale). POP was assessed based on the classic diagnostic criteria reported in previous studies. Univariate and multiple logistic regression analyses were conducted to determine the impacts of preoperative frailty on POP. Of the 568 elderly patients, 65 (11.4%) developed pneumonia during postoperative hospitalization. There were significant differences among gender, hypoproteinemia, type of anesthesia, history of chronic obstructive pulmonary disease (COPD), and CFS scores. Multiple regression analysis revealed that the risk of POP in vulnerable, mildly frail, and severely frail patients increased by 2.38 times (P = .01, 95% CI [1.22–1.91]), 3.32 (P = .00, 95% CI [2.39–5.61]), and 5.36 (P = .00, 95% CI [3.95–6.52]), significantly. 12.8% of patients with hip fractures and 8.9% of patients with other main types of lower-extremity fractures developed POP. However, the difference between hip and non-hip fractures was not statistically significant (P > .05). Preoperative frailty increases the risk of POP in elderly patients after surgical treatment of main lower-extremity fractures. The severer the preoperative frailty is, the higher the risk of preoperative pneumonia is in elderly patients with lower-extremity fractures. CFS is simple and feasible for the assessment of frailty in elderly patients with lower-extremity fractures. Preoperative frailty assessment and appropriate management strategies should be considered in the perioperative management of elderly patients with lower-extremity fractures.
NLRP3 inhibitor dopamine receptors agonist as a potential therapeutic strategy for treatment of overactive immune responses in COVID-19
Authors: Zhu Jia-Lei , Jin Jing , Tang Jing
Published: April 2023

Patients infected with coronavirus disease 2019 (COVID-19) have high serum levels of proinflammatory cytokines. The “cytokine storm” has become one of the major causes of death for critically ill patients infected by COVID-19. Glucocorticoids, plasma from convalescent patients, blood purification, and tocilizumab are currently recommended for use when the body’s inflammatory response is overactivated. However, there are limitations in terms of medicinal effects, equipment reserves, and treatment expense. These challenges prompted us to assess classical agents with good safety and mature production technology. A recent study showed that nucleotide-binding oligomerization domain (NOD)-, leucine-rich repeat (LRR)-, and pyrin domain-containing protein 3 (NLRP3) inflammasomes drive COVID-19 pathology. We speculate that suppression of NLRP3 inflammasome-derived cytokine production may be beneficial in COVID-19–infected patients. Dopamine receptors are present in almost all immune cells and can modulate their activation, proliferation, and cytokine production of immune cells. Previous studies have shown that dopamine receptor agonists can control systemic inflammation through inhibition of the NLRP3 inflammasome. This suggests that dopamine receptor agonists may be a new strategy for the treatment of overactive immune responses in COVID-19 patients. This is worthy of further investigation in clinical practice.
Bulky Recurrent Juvenile Nasopharyngeal Angiofibroma
Authors: Dimitrijevic Milovan , Pavlovic Bojan , Jakovljevic Sasa
Published: April 2023

Juvenile nasopharyngeal angiofibroma is a rare and highly vascularized tumor that accounts for 0.05 to 0.5% of all head and neck neoplasms. The aim of this work was to present a case of a large recurrent juvenile nasopharyngeal angiofibroma coexisting with a facial lipoma in a 16-year-old boy. The patient was referred to our institution because of frequent unilateral epistaxis. Computed tomography revealed a hypervascular tumor with ethmoidal cell destruction and spread to the nasopharynx. Operative treatment of nasal cavity tumors was carried out using a transpalatal approach. After 6 months, the recurrence of the angiofibroma was verified radiologically. Primary as well as secondary surgical procedures were assisted with an endoscopic procedure. Accurate preoperative assessment and staging are essential for choosing a surgical procedure. The primary treatment is surgical excision. Early diagnosis, accurate staging, adequate treatment, and regular postoperative follow-up are essential in the treatment of these lesions.
Customized Augmentation Rhinoplasty With Morpheus 3-Dimensional Scanner
Authors: Hwang Jin , Lee Yong Seok , Park Tae Hwan
Published: April 2023

Purpose:

Three-dimensional (3D) scanning-based morphologic analyses of facial structures are becoming more popular in several clinical settings. However, the application has not yet been reported in augmentation rhinoplasty. The purpose of the study is to show the efficacy of the Morpheus 3D scanner for preoperative planning in rhinoplasty.

Methods:

In this retrospective review, 241 patients who underwent primary and secondary rhinoplasty from September 2018 to August 2020 were reviewed. The authors determined the degree of augmentation preoperatively using the Morpheus 3D scanner based on patients’ esthetic needs. According to the simulated 3D embodiment result, the Silicone implant was carved and implanted with closed or open rhinoplasty approach.

Results:

The operation was performed based on the simulated 3D shape, and the patients were satisfied with the esthetic outcomes.

Conclusions:

Morpheus 3D scanner can be a valuable tool for esthetic rhinoplasty planning. This tool also provides preoperative customized patient counseling based on their current anatomic characteristics and esthetic needs.
Unequal Treatment? Confronting Racial, Ethnic, and Socioeconomic Disparity in Management of Survivors of Violent Suicide Attempt
Authors: El-Qawaqzeh Khaled , Colosimo Christina , Bhogadi Sai Krishna , Magnotti Louis J. , Hosseinpour Hamidreza , Castanon Lourdes , Nelson Adam , Ditillo Michael , Anand Tanya , Joseph Bellal
Published: April 2023

Background:

Psychiatric inpatient hospitalization is nearly always indicated for patients with recent suicidal behavior. We aimed to assess the factors associated with receiving mental health services during hospitalization or on discharge among survivors of suicide attempts in trauma centers.

Study Design:

A 3-year analysis of the 2017-2019 ACS-TQIP. Adults (≥18 years) presenting following suicide attempts were included. Patients who died, those with ED discharge disposition, those with superficial lacerations, and who were transferred to non-psychiatric care facilities were excluded. Backward stepwise regression analyses were performed to identify predictors of receiving mental health services (inpatient psychiatric consultation/psychotherapy, discharge/transfer to a psychiatric hospital, or admission to a psychiatric distinct unit of a hospital).

Results:

18,701 patients were identified, 56% received mental health services. Mean age was 40 ± 15 years, 72% were males, 73% were White, 57% had a preinjury psychiatric comorbidity, and 18% were uninsured. 43% had moderate to severe injuries (ISS>8), and most common injury was cut/stab (62%), followed by blunt mechanisms (falls, lying in front of a moving object, and intentional MVCs) (18%) and firearm injuries (16%). On regression analyses, Black race, Hispanic ethnicity, male gender, younger age, and positive admission alcohol screen were associated with lower odds of receiving mental health services (p<0.05). Increasing injury severity, being insured, having preinjury psychiatric diagnosis, and positive admission illicit drug screen were associated with higher odds of receiving mental health services (p<0.05).

Conclusion:

Significant disparities exist in the management of survivors of suicide attempts. There is a desperate need for improved access to mental health services. Further studies should focus on delineating the cause of these disparities, identifying the barriers, and finding solutions.
On Bayesian mechanics: a physics of and by beliefs
Authors: Ramstead Maxwell J. D. , Sakthivadivel Dalton A. R. , Heins Conor , Koudahl Magnus , Millidge Beren , Da Costa Lancelot , Klein Brennan , Friston Karl J.
Published: April 2023

The aim of this paper is to introduce a field of study that has emerged over the last decade, called Bayesian mechanics. Bayesian mechanics is a probabilistic mechanics, comprising tools that enable us to model systems endowed with a particular partition (i.e. into particles), where the internal states (or the trajectories of internal states) of a particular system encode the parameters of beliefs about external states (or their trajectories). These tools allow us to write down mechanical theories for systems that look as if they are estimating posterior probability distributions over the causes of their sensory states. This provides a formal language for modelling the constraints, forces, potentials and other quantities determining the dynamics of such systems, especially as they entail dynamics on a space of beliefs (i.e. on a statistical manifold). Here, we will review the state of the art in the literature on the free energy principle, distinguishing between three ways in which Bayesian mechanics has been applied to particular systems (i.e. path-tracking, mode-tracking and mode-matching). We go on to examine a duality between the free energy principle and the constrained maximum entropy principle, both of which lie at the heart of Bayesian mechanics, and discuss its implications.
Free energy and inference in living systems
Authors: Kim Chang Sub
Published: April 2023

Organisms are non-equilibrium, stationary systems self-organized via spontaneous symmetry breaking and undergoing metabolic cycles with broken detailed balance in the environment. The thermodynamic free-energy (FE) principle describes an organism’s homeostasis as the regulation of biochemical work constrained by the physical FE cost. By contrast, recent research in neuroscience and theoretical biology explains a higher organism’s homeostasis and allostasis as Bayesian inference facilitated by the informational FE. As an integrated approach to living systems, this study presents an FE minimization theory overarching the essential features of both the thermodynamic and neuroscientific FE principles. Our results reveal that the perception and action of animals result from active inference entailed by FE minimization in the brain, and the brain operates as a Schrödinger’s machine conducting the neural mechanics of minimizing sensory uncertainty. A parsimonious model suggests that the Bayesian brain develops the optimal trajectories in neural manifolds and induces a dynamic bifurcation between neural attractors in the process of active inference.
A third transition in science?
Authors: Kauffman Stuart A. , Roli Andrea
Published: April 2023

Since Newton, classical and quantum physics depend upon the ‘Newtonian paradigm’. The relevant variables of the system are identified. For example, we identify the position and momentum of classical particles. Laws of motion in differential form connecting the variables are formulated. An example is Newton’s three laws of motion. The boundary conditions creating the phase space of all possible values of the variables are defined. Then, given any initial condition, the differential equations of motion are integrated to yield an entailed trajectory in the prestated phase space. It is fundamental to the Newtonian paradigm that the set of possibilities that constitute the phase space is always definable and fixed ahead of time. This fails for the diachronic evolution of ever-new adaptations in any biosphere. Living cells achieve constraint closure and construct themselves. Thus, living cells, evolving via heritable variation and natural selection, adaptively construct new-in-the-universe possibilities. We can neither define nor deduce the evolving phase space: we can use no mathematics based on set theory to do so. We cannot write or solve differential equations for the diachronic evolution of ever-new adaptations in a biosphere. Evolving biospheres are outside the Newtonian paradigm. There can be no theory of everything that entails all that comes to exist. We face a third major transition in science beyond the Pythagorean dream that ‘all is number’ echoed by Newtonian physics. However, we begin to understand the emergent creativity of an evolving biosphere: emergence is not engineering.
Embodied cognitive morphogenesis as a route to intelligent systems
Authors: Alicea Bradly , Gordon Richard , Parent Jesse
Published: April 2023

The embryological view of development is that coordinated gene expression, cellular physics and migration provides the basis for phenotypic complexity. This stands in contrast with the prevailing view of embodied cognition, which claims that informational feedback between organisms and their environment is key to the emergence of intelligent behaviours. We aim to unite these two perspectives as
embodied cognitive morphogenesis
, in which morphogenetic symmetry breaking produces specialized organismal subsystems which serve as a substrate for the emergence of autonomous behaviours. As embodied cognitive morphogenesis produces fluctuating phenotypic asymmetry and the emergence of information processing subsystems, we observe three distinct properties: acquisition, generativity and transformation. Using a generic organismal agent, such properties are captured through models such as tensegrity networks, differentiation trees and embodied hypernetworks, providing a means to identify the context of various symmetry-breaking events in developmental time. Related concepts that help us define this phenotype further include concepts such as modularity, homeostasis and 4E (embodied, enactive, embedded and extended) cognition. We conclude by considering these autonomous developmental systems as a process called connectogenesis, connecting various parts of the emerged phenotype into an approach useful for the analysis of organisms and the design of bioinspired computational agents.