bluuebunny/crossref_metadata_2025 huggingface dataset:
A295 A CHALLENGING DIAGNOSTIC CASE - SEVERE ACUTE HEPATITIS POTENTIALLY ASSOCIATED WITH COVID-19 IN AN IMMUNOCOMPETENT YOUNG ADULT
Authors: Lawendy B , Hudson D , Abdul-Karim R
Published: February 2024

Background

Severe hepatitis with liver enzymes in the thousands is usually associated with viral etiologies, toxins, vascular aetiologies, acute gall stones, autoimmune hepatitis, and Wilson disease. Acute hepatitis in the moderate range has been associated with COVID19 infection.

Aims

A potential case of severe hepatitis with initial ALT of 6863, who tested positive for COVID19. Acetaminophen ingestion confounded the presentation.

Methods

Case Report

Results

A 48-year-old woman, with history of Insomnia on Zopiclone, presented to Hospital with a 6-day history of fatigue, malaise, muscle aches and subjective fevers. She had a ten pack-years smoking history, consumed 8 alcoholic beverages weekly, used marijuana infrequently, and denied any herbal or naturopathic supplement usage. She was double vaccinated against COVID19 over a year ago.

On the 2nd day of symptoms, she ingested 5 grams of Acetaminophen over a 24-hour period. Subsequently, she continued to use Acetaminophen, but did not exceed a daily dosage of 4 grams. On the 5th day, she presented to clinic and was found to have elevated liver enzymes: ALT 6863, AST 5785, ALP 62, GGT 60, and INR 1.1 with Bilirubin 8. She had nausea and emesis, prompting her to present to the hospital on the 6th day. The patient was alert and oriented, with mild tenderness in the right upper quadrant with no jaundice, ascites, peripheral edema, or encephalopathy.

She had reactive lymphocytosis consistent with a potential viral infection. Testing for acute hepatitis A, B, and C, HIV, EBV, CMV, herpes simplex virus, and varicella-zoster was negative. COVID19 was detected by rapid antigen testing and confirmed via PCR. Blood and urine toxicology screens were unremarkable. Acetaminophen was detected at a low level of 67 μg/mL at presentation and given the diagnostic dilemma & concern for concomitant acetaminophen-associated liver injury she was started on N-acetylcysteine (NAC) infusion. Acetaminophen level was trended until undetectable. Ceruloplasmin and alpha-1 antitrypsin were unremarkable. Iron studies showed an elevated Ferritin 1032. Autoimmune workup was negative except for anti-dense fine speckled autoantibodies with 1:80 (low) titre. Abdominal ultrasound with doppler was normal.

Her liver enzymes improved (Figure1) without signs of acute fulminant liver failure. She was discharged after 48 hours (day 7). In follow-up, her labs were: ALT 11, AST 16, INR 1.1, Bilirubin 6, and Ferritin 61.

Conclusions

To our knowledge, this is one of the first case reports of severe hepatitis, possibly due to COVID-19 in an immunocompetent adult, however, concerns for concomitant unintentional acetaminophen toxicity complicate the diagnosis. NAC was given to mitigate diagnostic error given the risk of anchoring bias. If patient condition had deteriorated liver biopsy would have been considered.

Funding Agencies

None
A299 ACUTE TUMOUR RUPTURE POST-TRANSARTERIAL CHEMOEMBOLIZATION IN A PATIENT WITH HEPATOCELLULAR CARCINOMA
Authors: Parthasarathy P , Khan M
Published: February 2024

Background

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy, with increasing worldwide incidence. Transarterial chemoembolization (TACE) is an interventional radiological (IR) therapy used largely in intermediate stage HCC, which can provide successful bridge or downstaging to liver transplantation and increased survival rates. Tumour rupture is a very rare complication of TACE, with an estimated incidence of 0.68%. Potential risk factors include tumour size ampersand:003E 10 cm, and location of lesions in the right lobe or near the liver capsule. However, the pathophysiology of post-TACE tumour rupture is still not fully understood.

Aims

We aim to describe a case of HCC tumour rupture that occurred in the first 30 hours post-TACE. We also aim to highlight the extent of multiorgan ischemia associated with this tumour-related arterial bleed.

Methods

A PubMed literature review was done to ensure that post-TACE tumour rupture was a rare and sparsely reported event. Subsequently, inpatient notes, laboratory and imaging data were obtained from the patient's medical record in an anonymized manner.

Results

A 66-year-old male with alcohol-related liver cirrhosis (MELDNa 7; Child-Pugh Class A) was diagnosed with a 3.3 cm HCC, spanning segments 5 and 8. Six months later, after multidisciplinary discussion, he underwent successful elective TACE of a segment 8 artery that was supplying the HCC, as a bridge to liver transplantation. The next day, he developed diffuse abdominal pain, emesis, tachycardia, and abdominal firmness and tenderness. Labs showed a 45 g/L drop in hemoglobin (121 g/L to 76 g/L), leukocytosis (27.0 x109/L), and an elevated lactate (4.4 mmol/L). Computed tomography (CT) scan confirmed tumour rupture, with moderate-to-large hemoperitoneum with active bleeding from the embolized region of the HCC, and associated gas. Emergent IR-guided embolization was performed to the bleeding segment 8 artery.

CT scan two days later revealed interval ischemic infarction of the spleen, pancreatic tail, and stomach. This widespread ischemia was suspected to be due to hypovolemic hypoperfusion vs. post-TACE embolic phenomena. Aggressive supportive measures, antibiotics, and anticoagulation were implemented.

Due to tumour rupture, the patient was deemed no longer a suitable candidate for liver transplantation. Futility of definitive management was discussed, and the patient opted for medical care without resuscitation. After optimization of nutritional and physical functioning parameters, he was discharged home with medical management for pain and ascites.

Conclusions

Post-TACE tumour rupture is a rare occurrence for which the pathophysiology is not fully understood. This case provides an important reminder of this potential adverse event. Early detection and management are imperative to facilitating a favourable outcome in this life-threatening condition.

Funding Agencies

None
Non-gravid uterine torsion associated with small bowel obstruction
Authors: Barnabas Goh , Mathew Samuel , Shamassi Maryam , Rafique Mohammad
Published: February 2024

Uterine torsion is a rare condition. Even more so in cases of non-gravid torsion. We present the case of a post-menopausal woman in her 70s who arrived to our emergency department acutely unwell with abdominal pain and vomiting on a background of a large leiomyomatous uterus, complicated by aspiration pneumonia, acute anaemia, and acute kidney injury. Computed tomography demonstrated a small bowel obstruction secondary to a large heterogeneous calcified pelvic mass. Laparotomy performed demonstrated a large leimyomatous uterus that had torted on the cervical pedicle associated with perforation of the lower anterior segment. A short segment of healthy jejunum was adhered to the uterine fundus, which was easily mobilized. Total hysterectomy and bilateral oophorectomy was performed. The patient made a full recovery. Histopathology demonstrated a calcified leiomyomatous uterus with adjacent haemorrhagic infarction of the uterine wall.
Endosperm cell death: roles and regulation in angiosperms
Authors: Doll Nicolas M , Nowack Moritz K
Published: February 2024

Double fertilization in angiosperms results in the formation of a second zygote, the fertilized endosperm. Unlike its embryo sibling, the endosperm is a transient structure that eventually undergoes developmentally controlled programmed cell death (PCD) at specific time points of seed development or germination. The nature of endosperm PCD exhibits a considerable diversity, both across different angiosperm taxa and within distinct endosperm tissues. In endosperm-less species, PCD might cause central cell degeneration as a mechanism preventing the formation of a fertilized endosperm. In most other angiosperms, embryo growth necessitates the elimination of surrounding endosperm cells. Nevertheless, complete elimination of the endosperm is rare and, in most cases, specific endosperm tissues persist. In mature seeds, these persisting cells may be dead, such as the starchy endosperm in cereals, or remain alive to die only during germination, like the cereal aleurone or the endosperm of castor beans. In this review, we explore current knowledge surrounding the cellular, molecular, and genetic aspects of endosperm PCD, and the influence environmental stresses have on PCD processes. Overall, this review provides an exhaustive overview of endosperm PCD processes in angiosperms, shedding light on its diverse mechanisms and its significance in seed development and seedling establishment.
Confined chaos and the chaotic angular motion of Atlas, a Saturn’s inner satellite
Authors: Pereira Lucas S , Mourão Daniela C , Winter Othon C
Published: February 2024

The dynamics of the Solar system exhibit inherent chaos and instability. Mathematical tools, such as the maximum Lyapunov characteristic exponent (LCE) and Lyapunov time (TL), play a crucial role in providing a qualitative understanding of chaos within celestial objects, such as asteroids and moonlets. Celestial bodies with relatively small Lyapunov times have garnered significant research interest due to their stable orbits, a phenomenon referred to as stable or confined chaos. Notable examples include Saturn’s satellites: Atlas, with a Lyapunov time on the order of 10 yr, Prometheus, and Pandora. This work aims to study the chaotic behaviour of the Atlas satellite and its relatively small TL. We present a three-dimensional model approach designed to isolate the radial contribution from the LCE and assess its influence within the LCE. Our investigation focuses on the Saturn system, comprising Saturn itself, along with its satellites Atlas, Prometheus, Pandora, and Mimas. To estimate the radial contribution of the LCE, we find the projection of the radial vector of a ghost Atlas (a slightly displaced Atlas) onto the Atlas radial vector, which allows us to calculate the difference between the radial vectors. This methodology enables us to estimate the radial contribution of the LCE and calculate the Lyapunov time. Remarkably, our results demonstrate that orbits remain confined even for integration times exceeding TL. Furthermore, we investigate the temporal behaviour of Atlas’ angular position in its orbit, potentially shedding light on chaotic angular dynamics.
Single‐cell RNA‐Seq reveals the earliest lineage specification and X chromosome dosage compensation in bovine preimplantation embryos
Authors: Hu Bingjie , Jin Hao , Shi Yan , Yu Haotian , Wu Xiaotong , Wang Shaohua , Zhang Kun
Published: February 2024

Lineage specification and X chromosome dosage compensation are two crucial biological processes that occur during preimplantation embryonic development. Although extensively studied in mice, the timing and regulation of these processes remain elusive in other species, including humans. Previous studies have suggested conserved principles of human and bovine early development. This study aims to provide fundamental insights into these programs and the regulation using a bovine embryo model by employing single‐cell transcriptomics and genome editing approaches. The study analyzes the transcriptomes of 286 individual cells and reveals that bovine trophectoderm/inner cell mass transcriptomes diverge at the early blastocyst stage, after cavitation but before blastocyst expansion. The study also identifies transcriptomic markers and provides the timing of lineage specification events in the bovine embryo. Importantly, we find that SOX2 is required for the first cell decision program in bovine embryos. Moreover, the study shows the occurrence of X chromosome dosage compensation from morula to late blastocyst and reveals that this compensation results from downregulation of X‐linked genes in female embryonic cells. The transcriptional atlas generated by this study is expected to be widely useful in improving our understanding of mammalian early embryo development.
Immunohistochemistry assessment of tissue neutrophil-to-lymphocyte ratio (tNLR) predicts outcomes in melanoma patients treated with anti-programmed cell death 1 therapy
Authors: Teixeira Renan J. , de Souza Vinícius G. , Sorroche Bruna P. , Paes Victor G. , Zambuzi-Roberto Fabiana A. , Pereira Caio A.D. , Vazquez Vinicius L. , Arantes Lidia M.R.B.
Published: February 2024

Elevated neutrophil-to-lymphocyte ratio (NLR) is associated with diminished immunotherapy response in metastatic melanoma. Although NLR assessment in peripheral blood is established, tissue dynamics remain insufficiently explored. This study aimed to evaluate tissue NLR (tNLR)’s predictive potential through immunohistochemistry in immunotherapy-treated melanoma. Fifty melanoma patients who underwent anti-programmed cell death 1 (PD-1) therapy were assessed. Hematological, clinical and tumor features were collected from medical records. Responses were categorized using the Response Evaluation Criteria in Solid Tumors for immunotherapy (iRECIST) guidelines. Immunohistochemistry for tumor-infiltrating T cells (cluster differentiation 3) and neutrophils (myeloperoxidase) was performed on formalin-fixed paraffin-embedded tumor samples. NLR, derived NLR (dNLR) and tNLR were calculated. Overall survival (OS) and survival following immunotherapy (SFI) were calculated from diagnosis or immunotherapy start to loss of follow-up or death. Patients with high tNLR presented improved OS (P = 0.038) and SFI with anti-PD-1 therapy (P = 0.006). Both NLR and dNLR were associated with OS (P = 0.038 and P = 0.046, respectively) and SFI (P = 0.001 and P = 0.019, respectively). NLR was also associated with immunotherapy response (P = 0.007). In conclusion, tNLR emerged as a novel potential biomarker of enhanced survival post anti-PD-1 therapy, in contrast to classical NLR and dNLR markers.
Successfully Increasing the Diversity of the Nursing Workforce in Rural South Carolina
Authors: Wittmann-Price Ruth A. , Gittings Karen , Orrico Suzan
Published: February 2024

This innovative project was funded by the Health Resources and Services Administration (HRSA) Nursing Workforce Diversity (NWD) grant (2017), with a resultant increase in the diversity of the nursing workforce in the rural Pee Dee Region of South Carolina. The project provided resources to at-risk students (n = 100) and compared participants with a control group (n = 92). The project provided participants mentors, financial assistance, experiential learning, advising, and professional development. The project descriptively compared program outcome benchmarks between groups. The project's multifaceted approach was key to success, providing implications for other programs to increase diversity of the nursing workforce.
Re-do transoral robotic thyroidectomy is feasible: preliminary results of the surgical feasibility and efficacy of completion transoral robotic thyroidectomy - cohort study
Authors: Oh Moon Young , Park Dawon , Chai Young Jun , Kim Kwangsoon , Kim Hoon Yub
Published: February 2024

Background:

Transoral robotic thyroidectomy (TORT) has proven to be a safe and effective procedure with favorable surgical and cosmetic outcomes, but its application in completion thyroidectomy procedures remains to be established. In this study, we present our experience with completion TORT, assessing its surgical feasibility and efficacy. between February 2017 and August 2023.

Methods:

We conducted a retrospective analysis of consecutive patients who underwent completion TORT after an initial TORT procedure between February 2017 and August 2023.

Results:

A total of 10 patients (three males and seven females) were included in the study, with a mean age of 42.2±13.5 years. The indications for completion thyroidectomy included five cases of aggressive initial lesions and five cases of metachronous papillary thyroid carcinoma detected in the remnant lobe. The median interval between the initial and completion TORT procedures was 6.5 months. Flap dissection time showed no significant difference between the initial TORT and completion TORT operations (43.3±7.5 vs. 36.2±11.2, P=0.125). However, the mean console time (127.9±42.6 vs. 86.4±26.3 min, P=0.019) and mean total operation time (206.7±65.9 vs. 146.0±34.9 min, P=0.021) were significantly longer during the initial TORT procedure than during the completion TORT procedure. Two patients experienced transient hypoparathyroidism, which resolved within four weeks postoperatively. No other complications, such as vocal cord palsy, mental nerve injury, or bleeding, were observed. The median follow-up period was 21.5 months, and no recurrences were detected in any of the patients.

Conclusions:

Our study demonstrates that re-do TORT is feasible, showing excellent cosmetic results and minimal adverse effects. Completion TORT may be considered a viable option for selected patients who require completion thyroidectomy after an initial TORT procedure.
The research progress and research trends in acute coronary syndrome nursing: A review of visual analysis based on the Web of Science database
Authors: Liu Jialong , Li Chaojun , Mei Wanping , Qin Hanzhi
Published: February 2024

Acute coronary syndrome (ACS) is one of the most common and severe forms of cardiovascular disease and has attracted worldwide attention with increased morbidity and mortality in recent years. There are few review studies in the field of its care in the form of bibliometric studies. We searched the Web of Science Core Collection database for articles and reviews in the area of ACS nursing for visual mapping analysis. Our objectives are to explore the hot topics and frontiers of research in the field of ACS nursing and to identify collaborative relationships between countries, institutions, and authors. This study will provide researchers with intuitive reference data for future in-depth studies of ACSs.
Establishment of skin cutaneous melanoma prognosis model based on vascular mimicry risk score
Authors: Wang Yubo , Zou Linxuan , Song Mingzhi , Zong Junwei , Wang Shouyu , Meng Lei , Jia Zhuqiang , Zhao Lin , Han Xin , Lu Ming
Published: February 2024

Studies have indicated that Vascular mimicry (VM) could contribute to the unfavorable prognosis of skin cutaneous melanoma (SKCM). Thus, the objective of this study was to identify therapeutic targets associated with VM in SKCM and develop a novel prognostic model. Gene expression data from The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) were utilized to identify differentially expressed genes (DEGs). By intersecting these DEGs with VM genes, we acquired VM-related DEGs specific to SKCM, and then identified prognostic-related VM genes. A VM risk score system was established based on these prognosis-associated VM genes, and patients were then categorized into high- and low-score groups using the median score. Subsequently, differences in clinical characteristics, gene set enrichment analysis (GSEA), and other analyses were further presented between the 2 groups of patients. Finally, a novel prognostic model for SKCM was established using the VM score and clinical characteristics. 26 VM-related DEGs were identified in SKCM, among the identified DEGs associated with VM in SKCM, 5 genes were found to be prognostic-related. The VM risk score system, comprised of these genes, is an independent prognostic risk factor. There were significant differences between the 2 patient groups in terms of age, pathological stage, and T stage. VM risk scores are associated with epithelial biological processes, angiogenesis, regulation of the SKCM immune microenvironment, and sensitivity to targeted drugs. The novel prognostic model demonstrates excellent predictive ability. Our study identified VM-related prognostic markers and therapeutic targets for SKCM, providing novel insights for clinical diagnosis and treatment.
Identify novel inflammation-related prognostic signature in pancreatic cancer patients
Authors: Sun Yuan , Zhang Xiaoying , Zhu Haiyan
Published: February 2024

Pancreatic cancer (PC) is a malignant tumor of the digestive system with a poor prognosis. PC patients with pancreatitis have a worse prognosis. But nobody reported the relationship between inflammation and prognosis in PC. Based on this, we are going to explore inflammation-related prognostic signature to predict patients’ survival and potential therapeutic target. We screened gene expression profile and corresponding clinical information of patients from The Cancer Genome Atlas (TCGA) database. Gene set enrichment analysis (GSEA) was performed to identify differentially expressed genes (DEGs) between tumor and normal tissues with P value < .05. Univariate and multivariate Cox regression analysis was applied to identify possible prognostic inflammation genes and establish an inflammation-related risk score system, which was validated by Kaplan–Meier and Receiver operating characteristic (ROC) curves. Finally, we used the TISIDB database to predict targeted drugs for up-regulated gene hepatocyte growth factor receptor (MET) and used AUTODOCK software for molecular docking. We built a prognostic model consisted of 3 inflammation-related genes (tumor necrosis factor receptor associated factor 1/TFAR1, tyrosine kinase 2/TYK2, MET). According to the median value of those genes’ risk score, PC patients were ranked into high- (88) and low-risk (89) groups. Then, the results of the Kaplan–Meier curves and the area under the curve (AUC) of the ROC curves showed this model had a good predictive power (P < .001, AUC = 0.806). The result of human protein atlas (HPA) database showed the expression of TRAF1 and TYK2 were low in pancreatic cancer, the expression of MET was high. TISIDB database founded brigatinib could target to MET. And AUTODOCK showed brigatinib had a nice docking with MET. Taken together, our study suggested that inflammation-associated prognostic signature might be used as novel biomarkers for predicting prognosis in PC patients and potential therapeutic target of the disease.
Lemierre-like syndrome after soft tissue infection due to methicillin-resistant Staphylococcus aureus: A case report and literature review
Authors: Carreras Xosse , Salcedo Andrea S. , Ponce-Rosas Linda , Gonzales-Zamora Jose A. , Diaz Nelson , Alave Jorge
Published: February 2024

Rationale:

Lemierre-like syndrome (LLS) is characterized by bacteremia, septic thrombophlebitis of the internal jugular vein, and metastatic abscesses. In contrast to classic Lemierre syndrome, sources of infection are not related to oropharyngeal infections, as are frequent soft tissue infections. In recent years, Staphylococcus aureus has been identified as an emergent pathogen that causes this syndrome. The mortality rate of LLS caused by this pathogen is approximately 16%. Timely diagnosis, antibiotic treatment, and infection control are the cornerstones to treat LLS. Anticoagulant therapy as adjuvant treatment remains controversial.

Patient concerns:

A 31-year-old woman from California, United States (US), was admitted to the emergency room with a history of 2 days of fever and severe throbbing pain in the left cervical region. Thorax and neck CT tomography revealed confluent cavities suggestive of septic embolism in the lungs and a filiform thrombus in the lumen of the left internal jugular vein, with moderate swelling of the soft and muscular tissues. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture.

Diagnosis:

The thrombus in the internal jugular vein associated with cellulitis in the neck and multiple cavitary lesions in the lungs support the diagnosis of LLS caused by MRSA with septic embolization.

Interventions:

During treatment, the patient received vancomycin IV for 25 days and returned to the US with linezolid orally. In addition, assisted video-thoracoscopy and bilateral mini-thoracotomy with pleural decortication were performed for infectious source control, where 1700cc of purulent pleural fluid was drained.

Outcomes:

The patient was discharged with optimal evolution.

Lessons:

LLS should be suspected in patients with skin and soft tissue infections who develop thrombosis or metastatic infections. MRSA infections should be considered in patients from areas where this pathogen is prevalent.
Effects of early enteral nutrition in patients with severe burns: A systematic review
Authors: Yang Xiaojuan , Li Rong , Zhai Jiao , Fan Yu , Gong Shuangying , Li Linzhang , Nie Xinyue , Li Wei
Published: February 2024

Background:

Nutritional problems in the early stages of severe burns are prominent and seriously affect the clinical outcomes of patients. Our aim is to analyze the effects of early enteral nutrition (EEN) in patients with severe burns.

Methods:

In this study, relevant articles were searched in 8 English and Chinese data, with a time limit from the creation of the database to June 2023. Two researchers independently completed the search, screening and quality assessment of the articles. We conducted a systematic review and meta-analysis of randomized controlled trials that examined EEN therapy in people with severe burns. We compared the effects of EEN and non-EEN therapy in severely burned patients. The outcomes were mortality, gastrointestinal complications, nutritional indicators, gastrointestinal hormones, sepsis, length of hospital stay and wound healing time. Categorical variables were expressed as OR and 95% CI was calculated, and continuous variables were expressed as MD and 95% CI was calculated. The protocol for this systematic review was registered in PROSPERO on May 12, 2023 (identifier CRD42023422895).

Results:

Nineteen studies with a total of 1066 participants met the inclusion criteria. When comparing EEN therapy with non-EEN therapy, the experiment group had significantly lower mortality [OR = 0.39, 95% CI (0.20, 0.74), P = .004], lower wound healing time [MD = −10.77, 95% CI (−13.66,−7.88), P < .00001], fewer gastrointestinal complications [OR = 0.18, 95% CI (0.09, 0.36), P < .00001], lower rates of gastrointestinal hemorrhage [OR = 0.12, 95% CI (0.04, 0.36), P = .0001], lower rates of sepsis [OR = 0.40, 95% CI (0.24, 0.66), P = .0005], shorter length of hospital stay [MD = −12.08, 95% CI (−13.61, 9.19–10.56), P < .00001], and higher prealbumin levels [MD = 29.04, 95% CI (21.98, 36.10), P < .00001], higher total albumin levels [MD = 6.74, 95% CI (4.29, 9.19), P < .00001], and gastrin levels [MD = 15.93, 95% CI (10.12, 21.73), P < .00001]. However, there was no significant difference in albumin between the 2 groups [MD = 2.62, 95% CI (−0.30, 5.55), P = .08] or motilin levels [MD = 12.48, 95% CI (−43.59, 68.56), P = .66].

Conclusions:

EEN plays an important role in the rehabilitation of patients with severe burns. EEN is beneficial to reduce complications and the length of hospital stay, maintain organ function, optimize the nutritional status of patients, promote wound healing, and improve the survival rate of patients.
Identifying causal relationships between gastroesophageal reflux and extraesophageal diseases: A Mendelian randomization study
Authors: Yao Peishan , Liao Xiaomin , Huang Junming , Dang Yi , Jiang Haixing
Published: February 2024

Traditional observational and in vivo studies have suggested an etiological link between gastroesophageal reflux disease (GERD) and the development of extraesophageal diseases (EEDs), such as noncardiac chest pain. However, evidence demonstrating potential causal relationships is lacking. This study evaluated the potential causal relationship between GERD and EEDs, including throat and chest pain, asthma, bronchitis, chronic rhinitis, nasopharyngitis and pharyngitis, gingivitis and periodontal disease, cough, using multiple Mendelian randomization (MR) methods, and sensitivity analysis was performed. The Mendelian randomization Pleiotropy RESidual Sum and Outlier and PhenoScanner tools were used to further check for heterogeneous results and remove outliers. MR with inverse-variance weighted (IVW) showed a significant causal relationship between GERD and EEDs after Bonferroni correction. IVW results indicated that GERD increased the risk of chronic rhinitis, nasopharyngitis and pharyngitis (odds ratio [OR] = 1.482, 95% confidence interval [CI] = 1.267–1.734, P < .001], gingivitis and periodontal disease (OR = 1.166, 95% CI = 1.046–1.190, P = .001), throat and chest pain (OR = 1.585, 95% CI = 1.455–1.726, P < .001), asthma (OR = 1.539, 95% CI = 1.379–1.717, P < .001), and bronchitis (OR = 1.249, 95% CI = 1.168–1.335, P < .001). Sensitivity analysis did not detect pleiotropy. Leave-one-out analysis shows that MR results were not affected by individual single nucleotide polymorphisms. The funnel plot considers the genetic instrumental variables to be almost symmetrically distributed. This MR supports a causal relationship among GERD and EEDs. Precise moderation based on causality and active promotion of collaboration among multidisciplinary physicians ensure high-quality diagnostic and treatment recommendations and maximize patient benefit.
Exploring patient delay in people with chronic kidney disease: A cross-sectional study
Authors: Zheng Jie , Guo Ao-Han , Xue Bo-Wen , Wu Shu-Yan , Wang Xi-Xiang , Jing Yue-Juan , Zhai Lin-Jun , Liu Rong
Published: February 2024

To examine the factors that contribute to patient delays among individuals with chronic kidney disease (CKD) and offer insights to help develop specific risk management strategies. Conducted as a cross-sectional study between September 2021 and April 2022, this study used a convenient sampling technique to select 245 individuals diagnosed with CKD from a Grade 3 Class A hospital located in Shanxi Province. These individuals were chosen as the subjects of the study. The research participants underwent an investigation using several assessment tools, including socio-demographic information questionnaire, medical behavior, the social support rating scale, the simplified coping style questionnaire, and the General Self-efficacy Scale. The study revealed that 35.4% of individuals with CKD experienced patient delay (the interval between the initial onset and the time of seeking medical attention being longer than or equal to 3 months). Through a multifactorial logistic regression analysis, it was determined that various factors independently influenced patient delay in patients with CKD. These factors included the level of knowledge about CKD, educational level, frequency of attending physical examinations, severity of initial symptoms, social support, self-efficacy, positive coping, and negative coping. Numerous factors contribute to the Patient Delay. To effectively enhance awareness and coping abilities regarding CKD in high-risk groups, it is essential to implement focused and continuous interventions throughout the medical seeking process.
Single-nucleus RNA sequencing reveals that macrophages and smooth muscle cells promote carotid atherosclerosis progression through mitochondrial autophagy
Authors: Song Yamin , Zhang Qiang , Ban Ru , Zhao Xin , Sun Hao , Lin Jie , Guo Tingting , Wang Tao , Xia Kai , Xin Zhenxue , Zhang Guifeng , Jia Xiaodong , Xia Zhangyong
Published: February 2024

Carotid atherosclerotic plaques are the manifestation of atherosclerosis in the carotid arteries and can significantly increase the incidence of cerebrovascular disease. Macrophages and smooth muscle cells are crucial for their development. To reveal the mechanism of carotid atherosclerotic plaque formation, we performed single-nucleus RNA sequencing of the carotid plaque tissue and identified 11 cell types, and the macrophages were divided into 5 different macrophage subpopulations. The macrophages and smooth muscle cells in the patients with symptomatic carotid atherosclerotic plaques caused intraplaque cell death via the mitochondrial autophagic pathway, resulting in plaque instability and rupture, which in turn led to clinical cardiovascular and cerebrovascular events. The findings provide new insights into carotid atherosclerosis formation, and this may provide new directions for the prevention and treatment of carotid atherosclerosis.
Prediction of future research trends in bladder urothelial carcinoma: Bibliometric analysis
Authors: Shao Bo , Wu Kaixiu , Wan Shui , Sun Pingping , Zuo Yanggen , Xiao Li , Fan Zhengkai , Pi Jinbo , Han Zhongxiong , Wang Jin
Published: February 2024

Background:

Bladder urothelial carcinoma (BLCA) is a prevalent malignant tumor of the urinary system and, ranks 13th worldwide. Its incidence and mortality rates are consistently increasing, posing a significant threat to the physical and mental well-being of patients.

Methods:

We conducted a literature search in the field of BLCA from 2010 to 2023 using the Web of Science Core Collection (WoSCC) database. CiteSpace 6.2.R4 and VOSviewer 1.6.19 were utilized to visually represent the annual publications, countries, institutions, authors, journals, keywords, and references in the literature.

Results:

A total of 10,378 articles were included in this study. Since 2010, the number of published articles has been increasing. The countries and institutions that contributed the most were the USA and Medical University Vienna. The most frequently cited author was Bellmunt J, with 2551 citations. Shariat Shahrokh F holds the record for most published articles with 445. The journal “Urologic Oncology-Seminars and Original Investigations” had the largest number of publications, while “Eur Urol” was the most frequently cited journal. “survival” and “radical cystectomy” were identified as the most frequent keywords in recent years. Burst detection analysis revealed that the keyword with the highest intensity value was “Transitional-Cell Carcinoma,” and the reference with the highest intensity value was Babjuk M, 2013.

Conclusion:

This study aimed to analyze and predict the research hotspots and trends in BLCA to provide reference value for further research in this field. The findings of this study can contribute to the research progress in BLCA.
Identification of oxeiptosis-associated lncRNAs and prognosis-related signature to predict the immune status in gastric cancer
Authors: Wen Li , Xu Kaili , Huang Min , Pan Qin
Published: February 2024

As a novel form of cell death, oxeiptosis is mainly caused by oxidative stress and has been defined to contribute to the cellular death program in cancer. However, the precise involvement of oxeiptosis-related long non-coding RNAs (lncRNAs) within gastric cancer (GC) remains elusive. Thus, our study was aimed to elucidate the pivotal effect of hub oxeiptosis-related lncRNAs on GC by comprehensively analyzing lncRNA and gene expression data obtained from The Cancer Genome Atlas (TCGA) database. Subsequently, we constructed a risk signature (risk-sig) using lncRNAs and further evaluated its prognostic significance. We successfully identified thirteen lncRNAs closely related with oxeiptosis that exhibited significant relevance to the prognosis of GC, forming the foundation of our meticulously constructed risk-sig. Notably, our clinical analyses unveiled a strong correlation between the risk-sig and crucial clinical parameters including overall survival (OS), gender, TNM stage, grade, M stage, and N stage among GC patients. Intriguingly, the diagnostic accuracy of this risk-sig surpassed that of conventional clinicopathological characteristics, underscoring its potential as a highly informative prognostic tool. In-depth mechanistic investigations further illuminated a robust association between this risk-sig and fundamental biological processes such as tumor stemness, immune cell infiltration, and immune subtypes. These findings provide valuable insights into the complex interplay between oxeiptosis-related lncRNAs and the intricate molecular landscape of GC. Ultimately, leveraging the risk scores derived from our comprehensive analysis, we successfully developed a nomogram that enables accurate prediction of GC prognosis. Collectively, our study established a solid foundation for the integration of thirteen hub oxeiptosis-related lncRNAs into a clinically applicable risk-sig, potentially revolutionizing prognostic assessment in GC and facilitating the development of innovative therapeutic strategies.
Causality between alcohol usually taken with meals and Meniere disease: A 2-sample Mendelian randomization study
Authors: Liu Shihan , Zhang Lingli , Luo Wenlong
Published: February 2024

The recurrence of Meniere disease (MD) strongly affects patient quality of life. Identifying the risk factors for MD is highly important for its prevention and treatment. Previous studies have suggested that alcohol intake may play a role in the development of MD. However, recent studies have shown that the causal relationship between alcohol consumption and MD remains controversial. In this paper, the Mendelian randomization (MR) method was used to determine the causal relationship between alcohol consumption usually consumed with meals and MD, with the aim of providing suggestions for alcohol intake management in individuals with MD and helping in the prevention and treatment of MD. Two-sample MR was used to investigate the causal relationship between alcohol usually taken with meals and MD. We used a dataset from a publicly available large-scale genome-wide association study (GWAS). Inverse variance weighting (IVW), MR–Egger, simple weighting, weighted weighting and the weighted median method were used for analysis. The final results showed that IVW (OR = 0.991, 95% CI: 0.983–0.998, P = .016) results suggested that there was statistical significance, but MR–Egger (OR = 0.978, 95% CI: 0.886–1.080, P = .679), weighted median methods (OR = 0.994, 95% CI: 0.985–1.004, P = .307) and Simple mode (OR = 0.995, 95% CI: 0.980–1.010, P = .566), Weighted mode (OR = 0.995, 95% CI: 0.981–1.010, P = .557) found no significant causal relationship. The results suggest that alcohol usually taken with meals may be negatively correlated with MD.
Predicting coal workers’ pneumoconiosis trends: Leveraging historical data with the GARCH model in a Chinese Miner Cohort
Authors: Sun Peng , Wang Bosheng , Zhang Hengdong , Xu Ming , Han Lei , Zhu Baoli
Published: February 2024

Coal workers’ pneumoconiosis (CWP) is one of the most common and severe occupational diseases worldwide. The main risk factor of CWP is exposure to respirable mine dust. Prediction theory was widely applied in the prediction of the epidemic. Here, it was used to identify the characteristics of CWP today and the incidence trends of CWP in the future. Eight thousand nine hundred twenty-eight coal workers from a state-owned coal mine were included during the observation period from 1963 to 2014. In observations, the dust concentration gradually decreased over time, and the incidence of tunnels and mine, transportation, and assistance workers showed an overall downward trend. We choose a better prediction model by comparing the prediction effect of the Auto Regression Integrate Moving Average model and Generalized Autoregressive Conditional Heteroskedasticity model. Compared with the Auto Regression Integrate Moving Average model, the Generalized Autoregressive Conditional Heteroskedasticity model has a better prediction effect. Furthermore, the status quo and future trend of coal miners’ CWP are still at a high level.
Removal of schwannoma from the psoas muscle with intraoperative neurophysiological monitoring: A case report
Authors: Yoo Na Yoon , Kim Hyoung Seop , Yang Joong Won , Park Dougho
Published: February 2024

Rationale:

The incidence of a schwannoma within the psoas muscle is rare, and only a few cases have been reported. The surgical approach to removing schwannomas present in the psoas muscle is challenging because of its anatomical proximity to the lumbar plexus.

Patient concerns:

A 31-year-old man experienced right lower back pain and anterolateral thigh numbness for 2 months.

Diagnosis:

Magnetic resonance imaging of the patient’s lumbar spine revealed a mass lesion, which was radiologically diagnosed as a well-demarcated schwannoma.

Interventions:

The patient underwent surgery for excision of the schwannoma in the right psoas muscle at the second to fourth lumbar vertebrae levels. During surgery, intraoperative neurophysiological monitoring modalities, free-running and triggered electromyography and evoked potentials, from the target muscles were recorded.

Outcomes:

There was no neurotonic discharge corresponding to neuronal injury. Compound motor nerve action potential was detected in the triggered electromyography of muscles around the medial margin of the tumor. However, direct integration of the motor nerve was not observed in the intra-tumor region.

Lessons:

We report that schwannoma removal in the psoas muscle, which is adjacent to the lumbar plexus, can be safely performed using intraoperative neurophysiological monitoring.
Acute pancreatitis presented with diffuse ST-segment elevation: A case report and literature review
Authors: Hsieh Yi-Lin , Wu Shu-Hao , Liu Chia-Yuan , Lin Wei-Chen , Chen Ming-Jen , Chang Chen-Wang
Published: February 2024

Introduction:

Although electrocardiographic changes have been previously reported in patients with acute pancreatitis, diffuse ST-segment elevation without occluded coronary arteries is rarely documented.

Patient concerns:

A 45-year-old man presented to our emergency department due to persistent epigastric pain for 2 hours. However, ECG in the emergency department revealed regular sinus rhythm at 67 beats per minute, peaked T waves in lead V3-5, and upsloping ST-segment elevation in leads II, III, aVF, and V2-6.

Diagnosis:

He was diagnosed with acute pancreatitis and presented with diffuse ST-segment elevation.

Interventions:

Laboratory workup and computed tomography supported the diagnosis of acute gallstone pancreatitis and endoscopic retrograde cholangiopancreatography was performed. Coronary angiography showed patent coronary arteries finally.

Outcomes:

Endoscopic retrograde cholangiopancreatography and endoscopic papillo-sphincterotomy were performed, and the stone in the common bile duct was removed smoothly without immediate complication. Due to his relatively stable condition, he was discharged on day 7 of admission.

Conclusion:

We presented an uncommon case of acute pancreatitis demonstrating similar features of AMI. This reminds cardiologists and emergency physicians to make the judgment with more caution to avoid jumping to conclusions and providing inappropriate treatment.
Gastrointestinal bleeding among 151 patients undergoing maintenance hemodialysis for end-stage renal failure: A 5-year follow-up study
Authors: Nakayama Shiki , Yamanouchi Kohei , Takamori Ayako , Goto Taku , Shimada Furitsu , Imamura Tomohiro , Hirooka Yoshitaka , Kitajima Akira , Onozawa Koji , Kakiuchi Toshihiko , Takagi Kuniyasu , Kishi Takuya , Fujimoto Kazuma , Sakamoto Yuichiro
Published: February 2024

Gastrointestinal bleeding is one serious complication of patients undergoing hemodialysis with end-stage renal failure. The present study aimed to evaluate risks and clinical features of real-world clinical data on upper and lower gastrointestinal bleeding in patients undergoing hemodialysis during a 5-year longitudinal observation period. This study included 151 patients undergoing maintenance hemodialysis at Takagi Hospital between December 2017 and December 2022. Clinical data from December 2017 were recorded, and upper and lower gastrointestinal bleeding, mortality, prescribed medications, and bone fractures were examined during the five-year observation period. Of 151 patients, 32 (21.2%:4.2% per year) experienced bleeding, 24 had upper gastrointestinal bleeding, 7 had lower gastrointestinal bleeding, and one had an unknown origin of bleeding. Ulcers or erosions primarily cause upper gastrointestinal bleeding without Helicobacter pylori infection, whereas patients with H pylori eradication are more likely to experience bleeding caused by vascular lesions, often accompanied by underlying comorbidities. The prophylactic effects of proton pump inhibitors and histamine-2 receptor blockers were limited in hemodialysis patients, as 15 out of 24 patients with upper gastrointestinal bleeding (62.5%) were prescribed these medications. The mortality rate in patients with lower gastrointestinal bleeding (71.4%) was higher than that in those without bleeding (33.6%) (P < .05). All patients with lower gastrointestinal bleeding were prescribed nonsteroidal anti-inflammatory drugs and/or aspirin. In this study, endoscopic hemostasis was successfully achieved. The present study indicated that the incidence of gastrointestinal bleeding during hemodialysis was relatively high. Upper gastrointestinal bleeding may develop even with the prescription of proton pump inhibitors. Lower gastrointestinal bleeding was a complication in hemodialysis patients under serious pathological condition with nonsteroidal anti-inflammatory drugs and or aspirin.
Prognostic significance of RKIP, TGM2, and CMTM4 expression in oral squamous cell carcinoma
Authors: Luo Tianyu , Xu Tao , Ou Yurong , Ci Hongfei , Sun Junhui
Published: February 2024

Background:

The expression of RKIP, TGM2, and CMTM4 in oral squamous cell carcinoma (OSCC) and normal oral tissues was detected and their correlations were analyzed. The relationships between RKIP, TGM2, and CMTM4 and the clinicopathological parameters and prognosis of patients were analyzed.

Methods:

Seventy cancerous and adjacent normal tissue samples were selected, recorded in the pathology department, and embedded in paraffin. Protein expression was detected by immunohistochemistry. Statistical software (SPSS 25.0, IBM Corporation) was used for the statistical analysis. The chi-squared (χ2) test was used to analyze the expression of RKIP, TGM2, and CMTM4 proteins and their clinicopathological features. Differences in RKIP, TGM2, and CMTM4 protein levels between OSCC and normal tissues were compared using a χ2 test. Survival analysis was performed using the Kaplan–Meier method, and differences between survival curves were determined using the log-rank test. The effects of RKIP, TGM2, and CMTM4 expression on patient prognosis were analyzed using a multivariate Cox proportional hazards regression model. P < .05 was considered statistically significant.

Results:

The expression level of RKIP correlated with age and clinical stage (P < .05). TGM2 was associated with clinical stage and lymph node metastasis (P < .05). The expression of CMTM4 increased with a decrease in cancer differentiation. Kaplan–Meier survival analysis suggested that the positive expression of TGM2 and CMTM4 may predict poor prognosis in patients with OSCC. The multivariate Cox proportional hazards regression model suggested that TGM2 could be an independent prognostic factor for patients with OSCC.

Conclusion:

Combined expression of TGM2 and CMTM4 can be used as an indicator to evaluate the risk of metastasis and prognosis of OSCC.
Advances in the evaluation and treatment of autoimmune hepatitis
Authors: Pedersen M.R. , Mayo Marlyn J.
Published: February 2024

Purpose of review

The primary therapy of autoimmune hepatitis (AIH) has been established for over three decades. This review focuses on updates in the evaluation and management of patients with AIH.

Recent findings

The evaluation of patients has recently been updated to include more definitive screening for other autoimmune diseases, including thyroid disease and celiac disease. Antibody detection by ELISA, an easier and more commonly available method, has been incorporated into the latest iteration of the AIH scoring system. Corticosteroids and AZA remain the backbone of AIH treatment, but there is growing evidence for mycophenolate mofetil as both first-line and second-line therapy, and growing inquiry into calcineurin inhibitors. Noninvasive markers of liver disease have now been validated in AIH, with the strongest evidence for VCTE in patients with minimal hepatic inflammation.

Recent research of alternative immunosuppressant therapies, noninvasive markers of fibrosis, and updated society guidelines, have improved our ability to evaluate, treat, and follow patients with AIH.