bluuebunny/crossref_metadata_2025 huggingface dataset:
A nomogram for predicting overall survival in patients with gastric cancer based on tumor suppressor RCAN1.4 expression and clinical risk factors
Authors: Zhao Qiang , Miao Congxiu , Lu Qingpu , Wu Weipeng , He Yuan , Wang Mengzhu , Liu Huimin , Zhao Jiangman , Lian Changhong
Published: November 2024

Gastric cancer (GC) is one of the most prevalent malignant tumors in the world and has an extremely poor prognosis. Regulator of calcineurin 1 (RCAN1), a known tumor suppressor in various cancers, has an undefined role in the proliferation and metastasis of GC. Primary tumor and paired normal gastric tissues were collected from 77 patients with GC for evaluating the mRNA levels of 3 RCAN1 transcripts. Kaplan–Meier survival curves and Cox regression analysis were used to assess the prognostic value of 3 RCAN1 transcripts, and to select variables for nomogram. The mRNA levels of RCAN1 isoform 1 (RCAN1.1, P = .0312) and isoform 2 (RCAN1.2, P = .007) were significantly diminished in GC tissues compared with normal tissues, whereas isoform 4 (RCAN1.4) expression level showed no significant differences. GC patients with lower RCAN1.4 mRNA levels had shorter overall survival time than patients whose tumors had high RCAN1.4 levels (P = .04). Downregulated expression of RCAN1.4 was found to be an independent prognostic factor of overall survival in GC patients, with a hazard ratio of 2.485 and a significant P-value of .023 in multivariate Cox analysis. The concordance index of nomogram to predict overall survival was 0.788, based on RCAN1.4 level, tumor stage and lymph node metastasis status. In conclusion, our findings suggest that RCAN1.4 is a novel prognostic marker for gastric cancer, targeting RCAN1.4 may provide a promising therapeutic strategy in GC management.
Global trends and current research in post-traumatic osteoarthritis: A bibliometric and visualization analysis from 2010 to 2024
Authors: Gao Songnian , Zhang Yanwu , Ge Yongliang , Lu Hui , Li Min
Published: November 2024

Background:

To investigate global trends and current research on post-traumatic osteoarthritis (PTOA) from 2010 to 2024 using bibliometric and visualization techniques.

Methods:

A bibliometric analysis was conducted using data from the Web of Science Core Collection. The study examined publication trends, author contributions, institutional collaborations, keyword co-occurrence, and citation patterns, employing CiteSpace software to analyze key metrics such as publication frequency, centrality, and clustering.

Results:

A total of 3100 articles were published between 2010 and 2024, with a steady increase over the years, peaking at 320 articles in 2023. Most publications were from the USA (1141 articles), China (502), and Germany (268), with key fields being Orthopedics, Surgery, and Rheumatology. Early research focused on different types of osteoarthritis, while recent studies highlight therapeutic advances such as cartilage repair and oxidative stress. Co-citation analysis identified influential authors like Lohmander LS, and key research clusters include total hip arthroplasty and regenerative medicine.

Conclusion:

Over the past decade, PTOA research has expanded substantially, driven by contributions from Orthopedics and Surgery, and supported by growing international collaboration, particularly between the United States, China, and European countries. Future research directions should prioritize elucidating the molecular mechanisms underlying PTOA, advancing diagnostic methodologies, and developing innovative therapeutic approaches to improve patient outcomes. The interdisciplinary nature and international cooperation observed are essential to addressing the complex challenges posed by PTOA.
Identification and validation of a novel defined stress granule-related gene signature for predicting the prognosis of ovarian cancer via bioinformatics analysis
Authors: Chen Xiaoqi , Han Qianqian , Song Jing , Pu Yongqiang
Published: November 2024

Ovarian cancer (OC) is a malignant gynecological cancer with an extremely poor prognosis. Stress granules (SGs) are non-membrane organelles that respond to stressors; however, the correlation between SG-related genes and the prognosis of OC remains unclear. This systematic analysis aimed to determine the expression levels of SG-related genes between high- and low-risk groups of patients with OC and to explore the prognostic value of these genes. RNA-sequencing data and clinical information from GSE18520 and GSE14407 in the Gene Expression Omnibus (GEO) and ovarian plasmacytoma adenocarcinoma in The Cancer Genome Atlas (TCGA) were downloaded. SG-related genes were obtained from GeneCards, the Molecular Signatures Database, and the literature. First, 13 SG-related genes were identified in the prognostic model using least absolute shrinkage and selection operator (LASSO) Cox regression. The prognostic value of each SG-related gene for survival and its relationship with clinical characteristics were evaluated. Next, we performed a functional enrichment analysis of SG-related genes. The protein-protein interactions (PPI) of SG-related genes were visualized using Cytoscape with STRING. According to the median risk score from the LASSO Cox regression, a 13-gene signature was created. All patients with OC in TCGA cohort and GEO datasets were classified into high- and low-risk groups. Five SG-related genes were differentially expressed between the high- and low-risk OC groups in the GEO datasets. The 13 SG-related genes were related to several important oncogenic pathways (TNF-α signaling, PI3K–AKT–mTOR signaling, and WNT–β-catenin signaling) and several cellular components (cytoplasmic stress granule, cytoplasmic ribonucleoprotein granule, and ribonucleoprotein granule). The PPI network identified 11 hub genes with the strongest interactions with ELAVL1. These findings indicate that SG-related genes (DNAJA1, ELAVL1, FBL, GRB7, MOV10, PABPC3, PCBP2, PFN1, RFC4, SYNCRIP, USP10, ZFP36, and ZFP36L1) can be used to predict OC prognosis.
Virtual reality headset versus traditional training in orthopedic surgery: A comparative study on real surgical performance in total knee arthroplasty
Authors: Unal Yunus Can , Adanas Cihan , Kaya Sehmuz , Ozkan Sezai , Ismailov Ulan
Published: November 2024

Is it possible for a low-volume surgeon to enhance their surgical skills without performing actual surgeries by utilizing virtual reality headsets and emerging technologies? It has been observed that the time spent by surgical assistants in the operating room decreased after the post-shift leave regulation. In the literature, the use of virtual reality simulations as a support tool in surgical training is recommended. Although the efficacy of virtual reality surgical simulations in surgeries such as arthroscopy and laparoscopy has been proven, there are limited studies on their effect in open surgeries. In this study, 20 orthopedic and traumatology residents with no experience in primary total knee arthroplasty were divided into 2 groups. One group was prepared for surgery using surgical simulation with virtual reality headsets, while the other group was prepared for surgery with traditional methods. The actual surgical performance of the participants was evaluated with the Objective Structured Scale of Technical Skills (OSATS) surgical skills scale. It was observed that the virtual reality group was more successful in the “Time and Motion” and “Surgical Functioning and Fluency” criteria. Virtual reality surgical simulations are useful tool in surgical training and can contribute to the development of surgeons’ skills. However, more research is needed on how to integrate these simulations into training programs and in which areas they are most effective.
Factors associated with defensive medicine practice in United Arab Emirates: A cross-sectional study with multivariate analysis
Authors: Al Awar Shamsa , Sallam Gehan , Elbiss Hassan
Published: November 2024

Health services institutes worldwide are trying to reduce defensive medical practice to limit its negative impact on patient care. We evaluated the factors associated with this defensive medical practice among medical professionals in the United Arab Emirates. This study deployed multivariate logistic regression analysis. Defensive medical practice was defined according to the responses given to questions about potentially unnecessary referral, testing, and additional care in a cross-sectional 23-item questionnaire administered to medical professionals after obtaining ethical committee approval. The factors evaluated were: age, gender, medical specialty, job grade, years of practice, country of medical graduation, country of specialty board, current practice in hospital or private sector, feeling supported by workplace staff, being involved in litigation, and indemnity cover. Multivariate models determined the adjusted odds ratios (aOR) and 95% confidence intervals (CI) after taking account of confounding; aOR > 1 indicated a positive association of factors with defensive practice while aOR < 1 indicated a negative association. There were 562 respondents. The most common defensive medical practice related to referring on a case after sensing the possibility of a complaint (365, 64.9%); the factors associated were senior grades (aOR 0.74, 95% CI 0.56–0.98, P = .04), private sector (aOR 1.27, 95% CI 1.008–1.61, P = .04), and indemnity cover (aOR 0.49, 95% CI 0.26–0.93, P = .03). The second most common defensive practice was calling inpatient admission, delaying discharge, additional testing, etc without medical indication and solely on patient or family request (265, 47.1%); the factors associated were age (aOR 0.46, 95% CI 0.33–0.64, P = .001), private sector (aOR 0.66, 95% CI 0.53–0.83, P = .001), and support by workplace staff (aOR 0.50, 95% CI 0.34–0.73, P = .001). Other defensive practices included refraining from difficult procedures or referring cases to another colleague due to the fear of complications (166, 29.5%) and unwillingness to accept patients in case of previous litigation history (157, 28.1%). This multivariable analysis in the United Arab Emirates found that higher age, higher job grades, indemnity cover and support by workplace staff reduced the odds of defensive medicine practice while working in the private sector had a mixed effect.
Comparison of clinical outcomes between Castor single-branched stent graft and in situ fenestration in treating Stanford type B aortic dissection involving the left subclavian artery: A retrospective case-control study
Authors: Weng Xiang , Zhang Teng , Hu YiLiang , Li XianGui , Zhou Weimin
Published: November 2024

Stanford type B aortic dissection involving the left subclavian artery (LSA) poses significant clinical challenges. The Castor single-branch stent graft and in situ fenestration are commonly used techniques, but the better endovascular treatment remains debated. This study evaluates the clinical effects of the Castor single-branched stent graft versus in situ fenestration in treating Stanford type B aortic dissection involving the LSA. We selected 75 patients with Stanford type B aortic dissection involving the LSA, admitted to the Second Affiliated Hospital of Nanchang University from January 2018 to May 2022. All patients underwent thoracic endovascular aortic repair; 34 received the Castor single-branched stent graft, while 41 underwent in situ fenestration. Clinical efficacy and perioperative complications were compared. The technical success rate of the Castor single-branch stent graft was significantly higher than that of in situ fenestration (97.06% vs 80.49%, P = .04). The Castor group exhibited significantly better outcomes in operative time (136.45 ± 25.53 min vs 157.08 ± 18.14 min), LSA blood flow recovery time (6.8 ± 2.3 min vs 20.1 ± 9.8 min), blood loss (29.03 ± 9.78 mL vs 35.69 ± 10.77 mL), contrast medium usage (288.71 ± 72.70 mL vs 352.78 ± 81.02 mL), and immediate postoperative endoleaks (1/34 vs 7/41) (P < .05). Stroke incidence (1/34 vs 2/41) and perioperative mortality (0/34 vs 1/41) were similar (P > .05). Hospital stays were comparable (15.71 ± 6.04 days vs 14.22 ± 5.01 days, P = .28). However, the cost of medical supplies (154,168.62 ± 28,288.44 CNY vs 119,589.72 ± 34,199.67 CNY) and total hospital expenses (192,665.88 ± 40,027.99 CNY vs 153,920.47 ± 42,670.87 CNY) were significantly higher in the Castor group (P < .05). The median follow-up time was 9 months (1–60 months). Follow-up showed similar 30-day postoperative mortality (1/41 vs 0/34, P = 1.00), stent patency (33/34 vs 39/41, P = .67), and stent migration rates (0/34 vs 1/41, P = 1.00). However, the endoleak rate was significantly higher in the in situ fenestration group (11/41 vs 1/34, P = .01). Both the Castor single-branch stent graft and the in situ fenestration technique effectively protect and reconstruct the LSA in Stanford type B aortic dissection, with the Castor single-branch stent graft showing higher technical success and fewer complications, indicating better clinical potential.
Unveiling the truth: Pathogen infections linked to miscarriage: A STROBE-Compliant Mendelian randomization study
Authors: Zhou Jie , Yin Jiekai , Xu Yixin , Wang Haitao
Published: November 2024

Miscarriage represents a prevalent yet insufficiently studied adverse pregnancy outcome. The definitive causal links between various pathogens and miscarriage remain to be established. To investigate the causal connections between pathogen infections and miscarriage, we utilized a two-sample bidirectional Mendelian randomization (MR) analysis. We sourced genome-wide association studies data on pathogen infections from the UK Biobank, which included serological markers for infectious diseases and comprehensive whole-genome genetic information from approximately 10,000 individuals. Additionally, genome-wide association studies data on miscarriages were collected from 3 distinct European populations for our analysis. The MR analysis was primarily conducted using the inverse variance weighted method, complemented by Bayesian weighted MR and the weighted median method for robustness. To ensure the reliability of our findings, we performed heterogeneity and pleiotropy tests, leave-one-out sensitivity analyses, and a meta-analysis. Our extensive research has identified a causal association between miscarriage and infections by several human herpesviruses (HHV-1, HHV-3, HHV-4, HHV-6, and HHV-7), polyomaviruses (BK, JC, and Merkel cell polyomaviruses), and Chlamydia trachomatis (inverse variance weighted, P < .05). Notably, a meta-analysis of the integrated data highlighted the particularly high accuracy and consistency of the association with Merkel cell polyomavirus. Our MR analysis has clarified the causal relationships between specific pathogen infections and miscarriage, providing a critical foundation for the prevention and treatment of this adverse pregnancy outcome.
Subjective and objective health according to the characteristics of older adults: Using data from a national survey of older Koreans
Authors: Jung Nam-Hae , Lee Chun-Yeop
Published: November 2024

As society rapidly ages, older adults are becoming an important national issue. Health is a multidimensional concept and both objective and subjective health must be managed. This study investigated factors that influence the subjective and objective health of older adults. This study analyzed the data of 9391 people aged ≥65 years using raw data from a 2020 survey of senior citizens. The relationships among the characteristics of older adults, such as demographic variables, lifestyle, external activities, environment, physical function, depression, cognition, activities of daily living, satisfaction with life and health, perceived health level, and number of diseases, were investigated. Older adults who drink and do not exercise generally have good objective health but poor subjective health. Older adults who mainly engage in external activities tend to have poor subjective health despite good objective health. The factors affecting subjective health in older adults were depression, cognition, physical factors, activities of daily living, and satisfaction. This study identified the differences between subjective and objective health based on the characteristics of older adults. As many variables affecting the health of older adults have been identified, these basic data will help prepare various programs to promote a healthy life for older adults.
Oral vancomycin induced flushing syndrome in a multiple myeloma patient: A case report and review of the literature
Authors: Zeng Min , Wang HeMei , Qiu Huiying , Gao JunWei
Published: November 2024

Background:

Patients with hematological malignancies are at high-risk of Clostridium difficile infection (CDI). Oral vancomycin is a first-line treatment for CDI. Vancomycin has been widely reported to induce flushing syndrome (also known as Red man syndrome), a well-known hypersensitivity reaction mostly occurs after intravenous administration. However, a few cases of flushing syndrome due to oral vancomycin have been reported.

Methods:

We reported a case of the 68-year-old male with Multiple Myeloma contracted suspected CDI during chemotherapy, oral vancomycin (125 mg po q6h) was initiated for CDI. Approximately 24 hours after receiving oral vancomycin, the patient developed vancomycin flushing syndrome with facial flushing and an erythematous rash on the abdomen and back, despite normal vancomycin duration and renal function (no obvious risk factors).

Results:

The patient was diagnosed with Oral vancomycin induced flushing syndrome. The symptoms resolved after withdrawal of vancomycin and 4 days of treatment with loratadine.

Conclusion:

Oral vancomycin-induced flushing syndrome is a rare complication that can occur in patients with CDI despite the absence of obvious risk factors. The underlying mechanism of oral vacomycin-induced flushing syndrome may be direct activation of mast cells following mast cell degranulation and histamine release via the MRGPRX2 receptor. However, this is just speculation and there are insufficient data, particularly in vivo data, to draw any conclusions. For patients with risk factors such as gastrointestinal pathology and renal insufficiency, monitoring of vancomycin serum concentration, mast cell degranulation, histamine release, and MRGPRX2 levels is recommended to avoid vancomycin flushing Syndrome, and vancomycin can still be used under supervision.
When acute myocardial infarction meets renal abscess: Case report and literature review
Authors: Zhu Xiyan , Shu Hongyun , Han Sisi , Li Jianhong , Su Haicui , Li Qiaowen
Published: November 2024

Rationale:

Acute myocardial infarction (AMI) is the leading global cause of death from cardiovascular disease, and the mortality rate increases in the presence of comorbidities such as renal abscess. The treatment of AMI combined with renal abscess is challenging, especially in combination with urinary tract obstruction, as percutaneous coronary intervention (PCI) can lead to progression of the renal abscess and deterioration of renal function. Currently, there is no consensus on the treatment of renal abscess in AMI.

Patient concerns:

We reported a case of a 74-year-old male patient with acute non-ST-segment elevation myocardial infarction combined with urinary tract obstruction. During his hospitalization, the hydronephrosis progressed to a renal abscess, which we punctured and drained. He ultimately underwent twice PCI and surgical relief of the ureteral obstruction shortly thereafter.

Diagnoses:

He was diagnosed with acute non-ST elevation myocardial infarction on admission, unfortunately, his hydronephrosis progressed into a renal abscess after the first PCI, which made further treatment difficult.

Interventions:

We performed 2 coronary angiography examinations and implanted a stent in the stenotic coronary artery during the second procedure, which was preceded by an aggressive regimen of antibiotics and puncture and drainage of the renal abscess, which set the stage for the second PCI.

Outcomes:

We successfully performed coronary revascularisation to treat his coronary artery disease. One month later, his renal abscess drain was removed and the ureteral obstruction was finally resolved after undergoing percutaneous nephrolithotripsy for ureteral stone extraction.

Lessons:

The occurrence of renal abscesses is rare and may be unavoidable in those patients with preexisting structural lesions in the urinary tract where coronary angiography will increase the incidence of renal abscesses. Aggressive anti-infective therapy and drainage of pus by puncture will help the renal abscess to heal, and repeat coronary angiography has been shown to be safe in the meantime.
Warfarin-induced gastrointestinal bleeding with acute liver failure: A case report
Authors: Chen Jiahao , Li Le , Wang Shiyu
Published: November 2024

Rationale:

Warfarin is the most commonly used drug in patients with mechanical valve replacement. Acute liver damage after warfarin is rare but potentially harmful. We present a case of warfarin-induced gastrointestinal bleeding with liver injury, pharmacy monitoring, and its therapy.

Patient concerns:

A 64-year-old woman with warfarin 4.5 mg medical history 10 years after mechanical mitral valve replacement. Who presented with gastrointestinal bleeding and extensive ecchymosis, due to rising international normalized ratio (INR), and then progressed to acute liver injury.

Diagnoses:

Warfarin poisoning.

Interventions:

Discontinuing warfarin, and artificial liver support system with anti-inflammatory liver therapy, which used reduced glutathione, polyene phosphatidylcholine, and ademetionine 1,4-butanedisulfonate for injection, ursodeoxycholic acid for orally.

Outcomes:

The liver enzymes and hyperbilirubinemia were improved, she was placed on warfarin again, and the INR increased to 2.03. There was no significant increase in liver enzymes and hyperbilirubinemia, she was discharged on day 24.

Lessons:

Close monitoring and immediate dose adjustment of warfarin and to avoid drug–drug interaction. Timely stopped warfarin, adjusted INR and anti-inflammatory liver therapy may reduce the occurrence of warfarin-induced liver failure.
Effects of shared decision-making on the prognosis of peritoneal dialysis patients
Authors: Park Byung Hwa , Shin Ho Sik , Kim Jinseog , Lee Jeonghwan , Park Ji Hyeon , Ko Gang Jee , Hwang Won Min , Kim Do Hyoung , Lee Young Ki
Published: November 2024

Background:

Chronic kidney disease (CKD) patients face critical decisions in choosing kidney replacement therapy such as hemodialysis (HD) or peritoneal dialysis (PD), which significantly affect their quality of life and health outcomes. Recent studies highlight the importance of shared decision-making (SDM) in helping patients understand their treatment options and make informed choices. SDM not only improves patient satisfaction and autonomy but also emphasizes the need for comprehensive pre-dialysis education to support optimal treatment selection.

Methods:

Among patients with chronic kidney failure from 8 hospitals in Korea who started dialysis, 256 who participated in a pilot project for home management of PD were included in the present study. A mixed-methods study was conducted using questionnaires and semi-structured interviews. Our study focused on the effects of SDM on patient death, survival rate, HD conversion, emergency room visits, hospitalization days, and outpatient visits.

Results:

A significant difference was observed in hospitalization days (P = .0044) between the SDM and non-SDM groups. However, no significant differences were observed in survival rate, rate of conversion to HD, survival rate after conversion to HD, emergency room visit rate, number of hospitalizations per patient, outpatient visit rate, medical cost, hospitalization cost, outpatient cost, and phosphate-binding agent prescription rate.

Conclusions:

This study emphasizes the benefits of SDM in reducing hospitalization days for PD patients, suggesting its potential role as a guide in future decisions regarding PD. PD provides a particularly beneficial home-based treatment alternative for patients facing challenges with hospital visits, supported by advanced technologies. Overseas, various countries are implementing policies and incentives to promote home dialysis, demonstrating the potential for SDM to enhance patient satisfaction and outcomes in dialysis care globally.
Clinical characteristics and autonomic balance in patients with burning mouth syndrome: A retrospective chart review
Authors: Jeong Haein , Choi Su-Hyun , Ha Na-Yeon , Ko Seok-Jae , Park Jae-Woo , Kim Jinsung
Published: November 2024

This study aimed to identify the clinical characteristics of patients with burning mouth syndrome (BMS) according to the low frequency/high frequency (LF/HF) ratio in the heart rate variability test and to evaluate the potential of the LF/HF ratio as an indicator for the diagnostic or predictive assessment of patients with BMS. A total of 469 patients with BMS who visited the Oral Diseases Clinic of Kyung Hee University Korean Medicine Hospital between January 1, 2018, and December 31, 2022, were included in the study. The patients were asked to rate their tongue pain on a visual analog scale before and after treatment. Heart rate variability testing and measurement of the unstimulated and stimulated salivary flow rates were conducted. The patients were divided into 3 groups according to their LF/HF ratios. Clinical characteristics, including tongue pain, salivary secretion, and concomitant symptoms, were compared between the groups. Spearman correlation analysis was performed to determine any significant correlation between the LF/HF ratio and the clinical symptoms. The patients were also classified into 2 groups according to psychological factors to analyze their effects on the clinical characteristics of BMS. The pretreatment pain score (PRPS), posttreatment pain score (POPS), and incidence rate of dry mouth symptoms were higher in the parasympathetically activated group than in the other groups. Spearman correlation analysis revealed a negative correlation between the LF/HF ratio and the PRPS. The PRPS and POPS were higher and the unstimulated salivary flow rate, stimulated salivary flow rate, and LF/HF ratio were lower in the group with psychological factors than in the group without psychological factors. The parasympathetic group reported higher PRPS and POPS and a higher incidence of dry mouth symptoms. This may be attributable to the role of psychological factors in BMS, which is a functional pain disorder. The different clinical characteristics based on the LF/HF ratio indicate that the LF/HF ratio may serve as a significant indicator for diagnosing or predicting the prognosis of patients with BMS.
Association between gastroesophageal reflux disease and venous thromboembolism: A Mendelian randomization study
Authors: Ao Ting , Huang Yingxiu , Zhen Peng , Hu Ming
Published: November 2024

The link between gastroesophageal reflux disease (GERD) and venous thromboembolism (VTE) is not well understood. We performed a 2-sample Mendelian randomization (MR) study to explore the potential causal effect of GERD on VTE. To explore the causal relationship between genetically predicted GERD and the risk of VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT). Three MR statistical techniques (inverse variance weighting (IVW), weighted median, and MR-Egger) were used to evaluate the potential causal relationship in genome-wide association studies. As part of the sensitivity analysis, we assessed heterogeneity and pleiotropy, and used the leave-one-SNP-out method to enhance the robustness of our findings. MR analysis results indicated that genetically predicted GERD was associated with an increased risk of venous thromboembolism (odds ratio [OR] = 1.239, 95% confidence interval [CI] = 1.146–1.339), PE (OR = 1.307, 95% CI = 1.156–1.477) and DVT (OR = 1.160, 95% CI = 1.012–1.330). Moreover, this study did not detect any heterogeneity or pleiotropy. GERD has a causal effect on venous thromboembolism, PE, and DVT.
Causal effects of genetically determined circulating metabolites on endometriosis: A Mendelian randomization study
Authors: Liu Lusha , Yin Junping , Liu Yakun , Li Bin , Kang Shan , Du Naiyi
Published: November 2024

Endometriosis (EMs) is a common gynecological disease accompanied by metabolic disturbances. However, the causality between metabolites and the risk of EMs remains unclear. We conducted a 2-sample Mendelian randomization (MR) analysis using the publicly available genome-wide association study (GWAS) of 486 circulating metabolites and EMs. The inverse variance weighted (IVW) was mainly used for assessing causality. MR–Egger intercept, MR-PRESSO Global, leave-one-out, and Cochran Q test analyses were used for sensitivity analyses. A total of 25 causal metabolites related to EMs have been identified, including 13 known and 12 unknown ones. Among the known metabolites, caffeine (OR = 0.86, 95% CI: 0.76–0.98, P = .026), cortisol (OR = 0.64, 95% CI: 0.41–0.99, P = .047), glycocholate (OR = 0.67, 95% CI: 0.51–0.87, P = .003), adrenate 22:4n6 (OR = 0.52, 95% CI: 0.35–0.77, P = .001), and ergothioneine (OR = 0.62, 95% CI: 0.47–0.81, P = .000) were protective factors for EMs, while mannose (OR = 1.43, 95% CI: 1.01–2.03, P = .044), 4-acetamidobutanoate (OR = 1.92, 95% CI: 1.27–2.89, P = .002), 1-linoleoylglycerol (OR = 1.36, 95% CI: 1.10–1.68, P = .005), bilirubin (Z, Z) (OR = 1.15, 95% CI: 1.01–1.31, P = .032), threonate (OR = 1.42, 95% CI: 1.14–1.77, P = .002), bilirubin (E, E) (OR = 1.18, 95% CI: 1.01–1.38, P = .039), erythronate (OR = 1.59, 95% CI: 1.01–2.52, P = .047), and dimethylarginine (SDMA + ADMA) (OR = 2.07, 95% CI: 1.19–3.62, P = .010) were risk factors for EMs. Additionally, there was no evidence of heterogeneity or pleiotropy of the known metabolites. Leave-one-out analysis indicated that the MR findings were robust. Our findings provide valuable circulating biomarkers as well as therapeutic targets for the screening, prevention, and treatment of EMs.
Gong’s acupuncture treatment for mid pregnancy insomnia and anxiety: A case report
Authors: Wu Kuilin , Yu Ailan , Liu Zhong , Gao Xiujuan , Ding Yonghong , Shi Yufang , Zhang Zongwang
Published: November 2024

Rationale:

Gong’s brain acupuncture (GBA) is a acupuncture technique that restores the balance of the central nervous system by stimulating specific acupoints on the skull to transmit stimulation to the nerves. Insomnia during pregnancy is an increasingly concerning issue, and GBA provides new solutions.

Patient’s concerns:

The patient, a 26-year old woman at 26 + 1 weeks of pregnancy, presented with unexplained insomnia for 3 weeks. Her symptoms included difficulty initiating sleep, light sleep, and intermittent wakefulness throughout the night.

Diagnoses:

The patient was diagnosed with primary insomnia, scoring 16 on the Pittsburgh sleep quality index, which indicates poor sleep quality. Her self-rating anxiety scale (SAS) score was 49 points, suggesting that she had not yet reached a state of mild anxiety.

Interventions:

The patient received 15 sessions of GBA treatment.

Outcomes:

One month after treatment completion, the patient’s Pittsburgh sleep quality index score improved to 3 points, indicating good sleep quality. Her self-rating anxiety scale score decreased to 39 points.

Lessons:

This case report demonstrated the successful treatment of mid pregnancy insomnia with GBA, providing preliminary evidence for further research on the therapeutic potential of GBA. However, further research is still needed to enhance persuasiveness.
Characteristics, symptoms, and outcomes of patients with Vibrio vulnificus infection in Hainan, China: A retrospective study
Authors: Xu Heping , Liu Yiqiao , Niu Huan , Cai Xiongwei , Zhan Feng
Published: November 2024

With global temperatures on the rise and an expanding seafood trade, infections by Vibrio vulnificus, particularly in warm coastal areas like Hainan, China, are increasingly prevalent. These bacteria are notorious for causing grave infections with a high fatality rate. This study aims to dissect the clinical features, laboratory findings, treatment modalities, and patient outcomes associated with V vulnificus infections in Hainan Province. The medical records and clinical data of intensive care unit patients from Hainan General Hospital were retrospectively analyzed. Conventional sequencing and metagenomic sequencing were used to identify V vulnificus. The study involved 10 patients (9 males and 1 female) with a median age of 60.5 years, predominantly fishermen, with infections mainly occurring between May and October. Of note, 2 cases were linked to plant-related injuries. The typical manifestations included fever, pain, swelling, hemorrhagic vesicles, septic shock, and multi-organ dysfunction. It was found that delayed hospital admissions were associated with elevated Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores and increased mortality. Laboratory results indicated a robust inflammatory response, and interventions comprised antibiotic therapy and surgical procedures. A mortality rate of 50% was recorded. Vigilance for V vulnificus infections is crucial in coastal locales. The study endorses immediate and assertive treatment strategies, including the use of targeted antibiotics and surgical interventions, to enhance patient survival rates. A call for heightened awareness, intensified surveillance, and expanded research is essential to combat this life-threatening condition.
Association of patient comorbidities with colorectal cancer site as detected by computed tomography scan and colonoscopy: A retrospective study
Authors: Fataftah Jehad , El-Hammuri Naser , Gharaibeh Maha , Badran Mohammad , Ibrahim Aqleh , Alramahi Basil , Alfawadleh Abdel Rahman , Alqubelat Ayman
Published: November 2024

Colorectal cancer (CRC) ranks as the third most common cancer worldwide. The most prevalent site is sigmoid. Comorbidities are common in patients with CRC and may be an important prognostic factor. This study investigated the prevalence of comorbidities among patients with CRC and assessed the association between the number of comorbidities and various factors including age, tumor site, smoking status, cancer stage, and mortality. This retrospective study included patients diagnosed with cancer at our hospital between January 2018 and November 2021. The association between comorbid illnesses (diabetes mellitus and hypertension) and patient characteristics such as sex, marital status, and smoking status was evaluated. The impacts of comorbid illnesses on CRC diagnosis and outcomes (cancer stage, primary site, and patient status) were analyzed. A chi-square test was performed to assess the relationship between sex, marital status, smoking status, and the presence of comorbid conditions (diabetes mellitus and/or hypertension). The majority of patients had at least 1 comorbid illness. A higher proportion of males had comorbid conditions compared to females. The proportion of patients with an early-stage cancer was higher among those without comorbidities. The proportion of surviving patients was higher among those without comorbidities, suggesting that patients with comorbid conditions may have an increased risk of death. The sigmoid colon was the most common site for colon cancer. Hypertension was the most common comorbidity followed by diabetes mellitus. Almost 50% of patients with CRC were smokers.
Unraveling lipid metabolism for acute myeloid leukemia therapy
Authors: O’Brien Cristiana , Jones Courtney L.
Published: November 2024

Purpose of review

The aim of this review is to highlight the importance of lipids’ intricate and interwoven role in mediating diverse acute myeloid leukemia (AML) processes, as well as potentially novel lipid targeting strategies. This review will focus on new studies of lipid metabolism in human leukemia, particularly highlighting work in leukemic stem cells (LSCs), where lipids were assessed directly as a metabolite.

Recent findings

Lipid metabolism is essential to support LSC function and AML survival through diverse mechanisms including supporting energy production, membrane composition, signaling pathways, and ferroptosis. Recent work has highlighted the role of lipid rewiring in metabolic plasticity which can underlie therapy response, the impact of cellular and genetic heterogeneity in AML on lipid metabolism, and the discovery of noncanonical roles of lipid related proteins in AML.

Recent findings around lipid metabolism clearly demonstrates their importance to our understanding and therapeutic targeting of AML. We have only begun to unravel the regulation and utilization of lipids in this disease. Further, understanding the layered dynamics of lipid homeostasis could provide novel opportunities to target lipid metabolism in AML and LSCs with the potential of improving outcomes for patients with AML.
Family Sense of Coherence, Dyadic Coping, and Quality of Life in Young and Middle-Aged Patients With Advanced Lung Cancer and Spousal Caregivers
Authors: Qu Yitong , Zhang Yinan , Jin Shimei , Shen Yuehao , Li Mei , Yu Lijuan , Song Yuelin , Li Lehan , Zhuang Shumei
Published: November 2024

Background

Cancer is now recognized as a dyadic stress that seriously impacts the mental and physical well-being of both patients and their spousal caregivers (SCs). Analyzing from a dyadic perspective whether and how dyadic coping and family sense of coherence (FSOC) affect the quality of life (QOL) of couples is crucial.

Objective

To investigate the dyadic association between FSOC, dyadic coping, and QOL in young and middle-aged couples facing advanced lung cancer and to evaluate the mediating role of dyadic coping from a dyadic perspective.

Methods

From October 2023 to April 2024, 202 dyads were recruited from 2 tertiary care hospitals in Tianjin, China. The participants’ measurement indicators were evaluated using corresponding questionnaires. The procedure for dyadic analysis was based on the Actor-Partner Interdependence Mediation Model.

Results

The actor effect of FSOC on the QOL was mediated by the dyadic coping of patients (β = .100; 95% confidence interval [CI], 0.053-0.155; P = .001) and SCs (β = .124; 95% CI, 0.059-0.193; P = .002). The partner effect suggested that patients’ QOL may be indirectly impacted by SCs’ FSOC through patients’ dyadic coping (β = .078; 95% CI, 0.038-0.127; P = .004).

Conclusions

The QOL, dyadic coping, and FSOC of young and middle-aged couples facing advanced lung cancer were dyadically interdependent. To enhance couples’ QOL, strategies for intervention must be developed.

Implications for Practice

This study offered a novel viewpoint on the relationship between QOL, dyadic coping, and FSOC and provided a theoretical foundation for the creation of dyadic intervention strategies meant to enhance cancer couples’ QOL.
Correlates of Impaired Timing Abilities in Schizophrenia
Authors: Croce Enrico , Simonelli Gabriele , Ferrara Maria , Escelsior Andrea , Folesani Federica , Bovio Anna , Muscettola Angela , Toffanin Tommaso , De Bellis Giovanni Antonio , Nanni Maria Giulia , Caruso Rosangela , Belvederi Murri Martino , Grassi Luigi
Published: November 2024

This review aimed at summarizing the literature evidence on clinical, cognitive, and neurobiological correlates of impaired timing abilities in schizophrenia (SCZ). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature search was conducted in PubMed, EMBASE, and PsycInfo by looking at correlates between timing abilities and either symptom severity, cognition, and neurobiological data (imaging and electroencephalography) in individuals with SCZ, without restrictions on study design. A total of 45 articles were selected: associations were identified between impaired timing performance and positive, negative, and disorganization symptoms, as well as with executive functioning, working memory, and attention. Timing impairments were associated with altered motor coordination neural circuits. Despite high methodological and clinical heterogeneity, timing dysfunction may be associated with the symptom severity and cognitive impairments in SCZ. Further studies are needed to clarify the pathophysiology of this association and offer new therapeutic targets.
A Survey of Forensic Pathologists Regarding Medicolegal Investigation of Perinatal and Stillborn Deaths
Authors: Krywanczyk Alison , Jackson Nicole R. , Maloney Katherine , Gill James R.
Published: November 2024

Stillborn and perinatal deaths may be referred to medical examiners and coroners for investigation and determination of cause and/or manner of death. One of the key questions is determining a live birth from a stillbirth. We surveyed 147 forensic pathologists to assess their investigative practices for these deaths and for their ability to diagnose a live birth and a stillbirth. The results of this survey demonstrate the wide variability of investigative practices and policies between offices within the United States. Clinical history, maceration of the fetus, and food in the stomach were the only 3 factors considered by a majority of forensic pathologists to reliably distinguish liveborn from stillborn infants. High-quality research and expert guidance from national organizations are needed to ensure standardized adoption of evidence-based practices. The investigation and certification of these deaths is complex, yet the determination of stillborn or liveborn and cause and manner of death can have significant legal implications for the mother.
Targeted Temperature Management After Pediatric Cardiac Arrest: A Quality Improvement Program With Multidisciplinary Implementation in the PICU
Authors: McMullin Mason P. , Cadotte Noelle B. , Fuchs Erin M. , Kartchner Cory A. , Vincent Brian , Parker Gretchen , Sweney Jill S. , Flaherty Brian F.
Published: November 2024

OBJECTIVES:

We aimed to implement a post-cardiac arrest targeted temperature management (TTM) bundle to reduce the percent of time with a fever from 7% to 3.5%.

DESIGN:

A prospective, quality improvement (QI) initiative utilizing the Method for Improvement. The pre-intervention historical control period was February 2019 to March 2021, and the intervention test period was April 2021 to June 2022.

SETTING:

The PICU of a freestanding, tertiary children’s hospital, in the United States.

PATIENTS:

Pediatric patients 2 days old or older to 18 young or younger than years old who experienced cardiac arrest, received greater than or equal to 2 minutes of chest compressions, required invasive mechanical ventilation post-resuscitation, and had no documented limitations of care.

INTERVENTIONS:

We developed and implemented a TTM bundle that included standard temperature goals, instructions and training on cooling blanket use, scheduled prescription of antipyretics, an algorithm for managing shivering, and standardized orders in our electronic health record.

MEASUREMENTS AND RESULTS:

We reviewed data from 29 patients in the pre-intervention period and studied 46 in the intervention period. In comparison with historical controls, the reduction in median (interquartile range [IQR]) percentage of febrile (> 38°C) time per patient associated with the TTM bundle was 0% (IQR, 0–3%) vs. 7% (IQR, 0–13%; p < 0.001). The intervention period, vs. pre-intervention, was associated with fewer patients with fever at any time (16/46 vs. 21/29; mean reduction, 37%; 95% CI, 13.8–54.8%; p = 0.002). We failed to identify an association between the intervention period, vs. pre-intervention, and the development of hypothermia (< 35°C; 8/46 vs. 3/29; mean change, 7%; 95% CI, –10.9% to 21.8%; p = 0.40).

CONCLUSIONS:

In this QI project, we have demonstrated that implementation of a TTM bundle is associated with reduced duration and frequency of fever in patients who survive cardiac arrest.
Prospective Randomized Pilot Study Comparing Bivalirudin Versus Heparin in Neonatal and Pediatric Extracorporeal Membrane Oxygenation
Authors: McMichael Ali , Weller Jamie , Li Xilong , Hatton Laura , Zia Ayesha , Raman Lakshmi
Published: November 2024

OBJECTIVES:

To test feasibility of a randomized controlled trial (RCT) with an endpoint of time at goal anticoagulation in children on extracorporeal membrane oxygenation (ECMO) randomized to receive bivalirudin vs. unfractionated heparin.

DESIGN:

Open-label pilot RCT (NCT03318393) carried out 2018–2021.

SETTING:

Single-center quaternary U.S. pediatric hospital.

PATIENTS:

Children 0 days to younger than 18 years old supported with ECMO in the PICU or cardiovascular ICU.

INTERVENTIONS:

Randomization to bivalirudin vs. unfractionated heparin while on ECMO.

MEASUREMENTS AND MAIN RESULTS:

Sixteen patients were randomized to bivalirudin, and 14 patients were randomized to heparin. There was no difference in the primary outcome, time spent at goal anticoagulation, for patients randomized to bivalirudin compared with those randomized to heparin. While hemorrhagic complications were similar between study groups, thrombotic complications were higher with six of 16 patients in the bivalirudin group having one or more circuit changes compared with 0 of 14 patients in heparin group (mean difference, 37.5% [95% CI, 8.7–61.4%]; p = 0.02). Patients in the bivalirudin group received less packed RBC transfusions vs. those receiving heparin (median [interquartile range], 6.3 mL/kg/d [2.5–8.4 mL/kg/d] vs. 12.2 mL/kg/d [5.5–14.5 mL/kg/d]; p = 0.02).

CONCLUSIONS:

In this single-center pilot RCT carried out 2018–2021, we found that the test of anticoagulation therapy of bivalirudin vs. heparin during ECMO was feasible. Larger multicenter studies are required to further assess the safety and efficacy of bivalirudin for pediatric ECMO.
Effective Personalization of Stereotactic Radiosurgery for Brain Metastases in the Modern Era
Authors: Edwards Donna M. , Kim Michelle M.
Published: November 2024

As survival rates improve for patients with metastatic disease, more patients are requiring complex treatment for brain metastases. Stereotactic radiosurgery (SRS) is a conformal radiotherapy technique that allows high ablative dose to be delivered to a specific target and is a standard effective local therapy for the treatment of patients with limited brain metastases. This review highlights the current landscape of SRS treatment in the context of modern therapeutic advances and identifies new research frontiers to personalize SRS and maximize the therapeutic ratio.
The steady-state pharmacokinetics of fixed-dose combination dolutegravir+rilpivirine in hemodialysis
Authors: Gupta Samir K. , Friedman Allon N. , Desta Zeruesenay
Published: November 2024

Objective:

Fixed dose combination (FDC) dolutegravir (DTG) plus rilpivirine (RPV) is an approved antiretroviral treatment regimen for people with HIV. The steady-state pharmacokinetics of FDC DTG+RPV in hemodialysis has not been previously studied.

Design:

We performed a single-center, prospective evaluation of the steady-state pharmacokinetics of FDC DTG +RPV in four adults without HIV either requiring hemodialysis and in four matched participants with normal renal function.

Methods:

All participants received FDC DTG (50 mg)+RPV (25 mg) daily for 10–14 days with food before undergoing an intensive 24 h pharmacokinetic evaluation (performed between dialysis days for those requiring HD). Plasma drug and metabolite concentrations were measured using a validated UHPLC/MS/MS. Descriptive pharmacokinetic parameters were calculated.

Results:

The hemodialysis and normal renal function participants (each group with two men and two women) were of similar ages (range, 50-60 years) and BMI (range, 18.5–34.5 kg/m2). No participant experienced serious or grade 3–4 adverse events; there were no study discontinuations. The AUC0–τ mean (SD) ratios of hemodialysis to normal renal function for DTG and RPV were 1.1 (0.4) and 1.1 (0.9), respectively. The mean (SD) C
min for DTG and RPV in the hemodialysis group were 1033 (252) and 49 (18) ng/ml, respectively.

Conclusion:

Hemodialysis did not lead to clinically appreciable differential exposures to DTG and RPV. Exposures throughout the dosing interval were greater than the reported protein-binding-adjusted IC90 efficacy values for DTG (64 ng/ml) and RPV (12 ng/ml) in all participants. These data suggest no dosing modifications are needed for the FDC DTG+RPV regimen in hemodialysis.