bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid identification and management of stress-induced cardiomyopathy using POCUS after strangulation: A case report
Authors: An Juho , Lee Sung-Eun
Published: September 2024

Rationale:

Stress-induced cardiomyopathy (SCMP), also known as Takotsubo syndrome, is a transient cardiac condition often precipitated by severe emotional or physical stress. It is commonly mistaken for acute coronary syndrome due to similar clinical presentations. The use of point-of-care ultrasound (POCUS) provides a noninvasive, rapid diagnostic alternative that can potentially reduce the need for invasive coronary angiography, especially in emergency settings.

Patient concerns:

A 26-year-old woman with type 1 diabetes presented to the emergency department following a suicidal hanging attempt. Upon arrival, she was conscious but confused, with stable vital signs. There were visible signs of strangulation, but no other immediate physical abnormalities. Laboratory tests revealed elevated cardiac enzymes and hyperglycemia.

Diagnoses:

Initial bedside POCUS revealed a reduced ejection fraction and regional wall motion abnormalities in the midportion of the left ventricle, suggesting SCMP. These findings, combined with the patient’s history and absence of other contributory factors, led to a provisional diagnosis of SCMP.

Interventions:

The patient was admitted to the intensive care unit for close monitoring. Serial POCUS examinations were performed to track cardiac function. Due to the rapid improvement in regional wall motion abnormalities observed through POCUS, the planned coronary angiography was deferred.

Outcomes:

The patient exhibited significant clinical improvement within 24 hours, with normalization of cardiac function as demonstrated by follow-up POCUS. Cardiac enzyme levels also returned to normal. The patient was discharged directly from the intensive care unit without the need for further invasive procedures.

Lessons:

This case underscores the diagnostic value of POCUS in rapidly identifying SCMP in emergency settings, which can guide timely and appropriate management. The noninvasive nature of POCUS may reduce the need for invasive diagnostics, minimize hospital stay duration, and enhance cost-effectiveness in managing SCMP.
Global trends and hotspots of exercise interventions for mild cognitive impairment: A global bibliometric analysis
Authors: Yi Qing , Wang Shuo , Feng XiaoWei , Liu Xutao , Selvanayagam Victor Selvarajah , Cheong Jadeera Phaik Geok
Published: September 2024

Background:

Exercise interventions for mild cognitive impairment (MCI) have been extensively studied. However, there is no bibliometric study on exercise interventions for MCI. This study aimed to identify the collaborative networks, research hotspots, evolution trends, and future directions.

Methods:

Relevant documents were retrieved from the Web of Science Core Collection database. VOSviewer was used to analyze the co-authorship of the author, countries and institutions, and the keywords co-occurrence. CiteSpace was used to detect burst keywords’ research trends.

Results:

A total of 569 articles were included and showed an overall increasing trend in annual publications. The most influential subject categories, authors, journals, country, and institutions were “geriatrics gerontology,” “Doi, Takehiko and Shimada, Hiroyuki,” “Journal of Alzheimer’s Disease,” USA, and “Veterans Health Administration,” respectively. The research hotspots are “effectiveness,” “neural mechanism” and “correlation” of exercise interventions, and the emerging trend is “intervention quality.”

Conclusion:

This area is in a rapid development phase, whereby research hotpots are focused and the research trend is clear. The highly productive authors and institutions have made outstanding contributions and the subject categories present an interdisciplinary trend. However, there is weak cooperation between countries and institutions, and a substantial research gap exists between developed and developing countries. Future research may highlight the intervention quality, emphasizing the combination with virtual reality technology.
Prevalence of and factors associated with cognitive frailty in elderly patients with chronic obstructive pulmonary disease: A cross-sectional study
Authors: Ren Jie , Zhang Weihong , Liu Yanfei , Fan Xin , Li Xinxin , Song Xinying
Published: September 2024

The status of cognitive frailty in elderly patients with chronic obstructive pulmonary disease (COPD) and its influencing factors in China remains unclear. This study aimed to investigate the prevalence of and factors associated with cognitive frailty in elderly patients with COPD. This cross-sectional study enrolled elderly patients with stable COPD between May and November 2022 from the Respiratory Department of the First Affiliated Hospital of Zhengzhou University and the Fifth Affiliated Hospital of Zhengzhou University. Convenience sampling method was adopted. Frailty Phenotype scale, Montreal Cognitive Assessment scale, Geriatric Depression Scale, and Clinical Dementia Rating scale were used to assess the prevalence of cognitive frailty in elderly patients with COPD. Multivariable logistic regression analysis was used to explore the associated factors. A total of 406 valid questionnaires were collected, and 173 patients (35.6%) had cognitive frailty. Binary logistic regression analysis showed that sex (odds ratio [OR] = 0.009; 95%CI: 0.001–0.770; P = .038), depression (OR = 17.780; 95%CI: 1.092–289.478; P = .043), modified Medical Research Council grade 1–3 (OR = 28.394–4095.683; 95%CI: 1.086–4,592,652.211; P < .05), global initiative for chronic obstructive lung disease grade 2 and 3 (OR = 32.508–282.072; 95%CI: 1.101–12,516.874; P < .05), and frequencies of acute exacerbations of COPD and hospitalizations within 1 year of 2 times (OR = 21.907; 95%CI: 4.587–104.622; P < .001) were independently associated with cognitive frailty. The prevalence of cognitive frailty in elderly patients with stable COPD was high. Female, depression, modified Medical Research Council grade, global initiative for chronic obstructive lung disease grade, and frequencies of acute exacerbations of COPD and hospitalizations within 1 year might be the factors independently associated with cognitive frailty, educational level might be a protective associated factor for cognitive frailty.
Correlation between triglyceride glucose index and coronary plaque: An observational study
Authors: Jia Haiyan , Zhang Weifeng , Jia Shengqi , Zhang Jun , Xu Zesheng , Xu Zhanwen , Li Yaqin
Published: September 2024

The association between the triglyceride-glucose (Tyg) index and coronary plaque in patients with coronary heart disease remains unclear. This study aimed to investigate the relationship between Tyg index and coronary plaque under different levels of blood glucose metabolism. This retrospective study included patients with coronary artery disease who underwent coronary angiography and OCT between January 1, 2023 and January 1, 2024, and ultimately collected 232 coronary plaques. All patients were grouped according to the median Tyg index (T1 group 7.71 ≤ TyG index ≤ 9.13; T2 group 9.14 ≤ TyG index ≤ 10.99). The thickness of plaque fiber cap was measured under OCT, and the plaques were divided into vulnerable plaque and non-vulnerable plaque. The status of glucose metabolism is divided into non-diabetic and diabetic. Baseline data analysis showed that there were significant differences in clinical and biological characteristics between the T1 and T2 groups (P < .05). Logistic regression analysis showed that T2 group was significantly associated with vulnerable plaques compared with T1 group (odds ratio [OR]: 2.638; 95% confidence interval [CI] 1.548–4.494; P < .001). The OR of Tyg index was 2.175 (95% CI 1.409–3.357; P < .001). Receiver operating characteristic showed that the area under ROC curve (AUC) was 0.727 (95% CI 0.663–0.792; P < .001), the best cutoff value was 9.23, the sensitivity was 60%, and the specificity was 81%. In diabetic patients, there was a statistically significant correlation between Tyg index and coronary vulnerable plaque (OR: 3.273; 95% CI 1.240–8.636, P < .05). Triglyceride glucose index is a good predictor of coronary vulnerable plaque.
Evaluation of the associations of pulmonary vein vertical diameter, cardiothoracic ratio, and atrial fibrillation combined hiatal hernia
Authors: Xu Bowen , Zhang Xueshan , Qian Wei , Zhou Ran , Chen Tao , Ma Yanfeng , Chen Hongping
Published: September 2024

Recent studies have suggested that there may be a relationship between hiatal hernia (HH) and atrial fibrillation (AF), but the specific mechanism is unclear. The aim of this study was to explore the clinical characteristics associated with HH and AF and to identify the potential relationship between the 2 diseases. The study comprised 180 patients with HH, of which 54 had AF. Every patient had chest computed tomography to quantify the cardiothoracic ratio, HH volume, thoracic cavity volume, and diameters of the pulmonary veins. The clinical data of all patients was acquired through an electronic medical record system. Patients who experienced AF had a noticeably smaller total pulmonary vein vertical diameter (TPVVD) and a higher cardiothoracic ratio compared to those who only had HH. Logistic multivariate regression study demonstrated a significant association between TPVVD, cardiothoracic ratio, and AF in individuals with HH. This study established a correlation between TPVVD, cardiothoracic ratio, and HH in conjunction with AF. Patient with HH who had a thinner TPVVD and a bigger cardiothoracic ratio were found to have a greater likelihood of suffering from AF.
Identification of the shared gene MXD3 signatures and biological mechanism in patients with hip pain and prostate cancer
Authors: Huang Liang , Xie Yu , Jiang Shusuan , Gong Binbin , Feng Yao , Shan Hong
Published: September 2024

Prostate cancer (PRAD) is recognized as having a significant effect on systemic illnesses. This study examined possible immune cells, metabolic pathways, and genes that may explain the interaction between PRAD and hip pain. We used information retrieved from the Cancer Genome Atlas and the Gene Expression Omnibus databases. To find common genes, we utilized differential expression analysis and weighted gene co-expression network analysis. The genes that were shared were subjected to pathway enrichment studies using Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes. Additionally, hub genes were analyzed using LASSO regression, and a receiver operating characteristic curve was generated based on the screening outcomes. The genes for the nodes were chosen in a protein–protein interaction network that was built. Single-sample gene-set enrichment analysis was performed to identify the differentially expressed genes. Immunohistochemistry staining confirmed hub gene expression, and single-sample gene-set enrichment analysis assessed immune cell infiltration. We concluded by comparing MAX dimerization protein 3 (MXD3) and MAX interactor 1 (MXI1) expression in tumor tissues using Uniform Manifold Approximation and Projection and violin plots in the Tumor lmmune Single-cell Hub database. After analyzing the intersection of the differentially expressed genes and weighted gene co-expression network analysis-significant module genes, we determined that MXD3 was the best shared diagnostic biomarker for PRAD and hip pain. One potential predictor of PRAD development was the MXI1 node gene, which was found in the protein–protein interaction network. The analyses revealed that MXD3 had a relatively positive correlation with neutrophil and T-helper cell infiltration levels, whereas MXI1 had a negative correlation with mast and Tgd cell levels. Tumors had lower levels of MXI1 expression and higher levels of MXD3 expression compared to normal tissues. Endothelial cells, induced pluripotent stem cells, and smooth muscle cells were all found to express MXI1. This is the first study to investigate the close genetic link between hip pain and PRAD using bioinformatics technologies. The 2 most significant genes involved in crosstalk between PRAD and hip pain were MXD3 and MXI1. The immunological responses triggered by T cells, mast cells, and neutrophils may be crucial in the relationship between PRAD and hip pain.
Incidence, survival, and prognostic nomogram of patients with small intestinal neuroendocrine tumors: A SEER population-based study
Authors: Peng Yao , Xu Boqi , Zhang Fan , Wu Runda , Tong Shan , Mao Zhongqi
Published: September 2024

Small intestinal neuroendocrine tumors (SI-NETs) are a group of rare and significantly heterogeneous tumors with limited research currently available. This study aimed to investigate the incidence, survival, and prognostic factors of SI-NETs. We selected data from the surveillance, epidemiology, and end results (SEER) database between 2000 and 2019 and evaluated the incidence trend of SI-NETs during this period. We utilized the Kaplan–Meier method to examine the association between clinical variables and survival rates. Based on the multivariable Cox regression analysis results, we developed a nomogram to predict the 1-, 2-, and 3-year cancer-specific survival (CSS) of SI-NETs patients. We evaluated the consistency, accuracy, and clinical utility of the nomogram by drawing calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) curves. The incidence of SI-NETs showed an upward trend in recent years. Age, grade, T stage, M stage, and primary tumor surgery were independent risk factors for CSS in SI-NETs patients. The nomogram model based on these risk factors showed high accuracy and clinical benefit. SI-NETs are rare tumors with an increasing incidence rate. The nomogram model is expected to be an effective tool for personalized prognosis prediction in SI-NETs patients, which may benefit clinical decision-making.
Missing a Lipiodol-laden hepatocellular carcinoma?: Silent iatrogenic hepatoduodenal fistula after transarterial chemoembolization: a case report
Authors: Lee Byung Chan , Kim Hyoung Ook , Park Chan , Choi Inwoo , Kang Seung Wan
Published: September 2024

Rationale:

Owing to the abundant collateral blood supply to the duodenum, the development of a hepatoduodenal fistula after transarterial chemoembolization (TACE) is an extremely rare complication that usually requires hospitalization and intensive medical intervention. Here, we report a case of a silent hepatoduodenal fistula following TACE.

Patient concerns:

A 74-year-old man with a history of alcoholic liver cirrhosis and type 2 diabetes. He had undergone a partial hepatectomy due to hepatocellular carcinoma (HCC) 7 years ago. In addition, he had undergone 4 TACEs for the treatment of recurrent HCCs but still had a viable tumor in S4b of the liver, which abuts the duodenal 1st portion.

Diagnoses:

HCC.

Interventions:

The patient underwent a 5th TACE and was discharged from the hospital without major adverse events.

Outcomes:

Follow-up computed tomography scans showed a 2 cm–sized air cavity instead of a compact Lipiodol-laden tumor in S4b, which had shrunk over time. The patient had experienced a fluctuating nonspecific mild fever for 3 months, with improvements in symptoms and laboratory findings following conservative treatment alone.

Lessons:

Hepatic fistulas may arise following TACE for HCCs near the gastrointestinal tract and may be present with nonspecific symptoms. This case suggests that increased efforts should be directed toward achieving selective embolization when treating HCC adjacent to the gastrointestinal tract, with close monitoring required after treatment.
A case report of retroperitoneal liposarcoma
Authors: Bao Zicheng , Zhang Zhidong , Ding Pingan , Zhao Qun , Li Yong
Published: September 2024

Background:

Retroperitoneal liposarcoma is a rare and complex tumor originating from the mesenchymal tissues, with no specific manifestations in the early stage, and a large tumor size in the late stage. Patients often consult a physician because of large abdominal mass, increased abdominal circumference, and abdominal pain, and rarely because of leukocytosis.

Patient concerns:

A 54-year-old female presented to our hospital with complaints of “abdominal distension for over 3 months, left lumbar pain for over 2 months.” Considering the comprehensive symptoms, examinations, computed tomography scans, and pathological results, the possibility of retroperitoneal liposarcoma is high.

Diagnoses:

Retroperitoneal liposarcoma with leukocytosis.

Interventions:

Open retroperitoneal mass excision along with transcystoscopic left ureteral Double-J Ureterl Stent Insertion tube placement and left nephrectomy.

Outcomes:

The postoperative pathological findings of the abdominal mass, combined with morphological and immunohistochemical results, are consistent with retroperitoneal liposarcoma. The patient had no recurrence in 7 months of postoperative follow-up conducted on the telephone and is now in continued follow-up.

Conclusion:

Retroperitoneal liposarcoma is highly malignant and prone to recurrence. Radical surgery is currently the primary treatment modality for patients with this condition. Analogous to cancer patients, those with elevated white blood cell counts and retroperitoneal liposarcoma may have poor prognoses, with a high likelihood of local recurrence and distant metastasis. Close postoperative follow-up is necessary. Therefore, regular postoperative review of blood routine may be a relatively economical and convenient method for the early detection of recurrence and metastasis of retroperitoneal liposarcoma.
Effect of denosumab, an anti-osteoporosis drug, on vascular calcification: A meta-analysis
Authors: Wang Di , Liu Tongqiang , Lu Jingkui , Xu Wei
Published: September 2024

Background:

Denosumab is an effective drug for the treatment of osteoporosis. This meta-analysis was conducted to evaluate efficacy of denosumab on the treatment of vascular calcification (VC).

Methods:

Databases including PubMed, EMbase, the Cochrane Library, CNKI, Wanfang database were searched from the inception to January 10th, 2024. Eligible studies comparing denosumab versus no denosumab treatment on VC were included. Data were analyzed using Review Manager Version 5.3.

Results:

Five studies were included in this meta-analysis. Three were RCTs and 2 were non-randomized studies. As a whole, 961 patients were included in denosumab group and 890 patients were included in no denosumab group. The follow-up period was from 6 to 36 months. Compared with the no denosumab group, the denosumab group demonstrated a decrease on VC score or area in all enrolled patients (SMD −0.85, 95% CI −1.72–0.02, P = .05). In the subgroup of patients with non-CKD, there was no statistical difference between the denosumab and no denosumab group concerning the change of VC score (SMD −0.00, 95% CI −0.12–0.12, P = .98). In the subgroup of patients with CKD 3b-4, there was no significant difference between the denosumab and no denosumab group concerning the change of VC score (SMD 0.14, 95% CI −0.72–1.00, P = .75). In the subgroup of CKD patients undergoing dialysis, the denosumab group demonstrated a significant decrease on VC score or area compared with the no denosumab group (SMD −2.30, 95% CI −3.78–0.82, P = .002).

Conclusion:

Our meta-analysis revealed that denosumab did not show a very definite inhibitory effect on VC. However, denosumab showed the effective effect on inhibiting VC in CKD patients undergoing dialysis. More large RCTs are needed to verify these results.
Fibrodysplasia ossificans progressiva complicated with post traumatic and infectious myositis ossificans in masseter: A case report
Authors: Guan Yian , Ma Dongyang
Published: September 2024

Rationale:

Myositis ossificans (MO) is characterized by benign heterotopic ossificans in soft tissues like muscles, which can be classified into nonhereditary MO and fibrodysplasia ossificans progressiva (FOP). Nonhereditary MO is characterized by ossification of the soft tissues after acute or repetitive trauma, burns, or surgical intervention. FOP is a rare and crippling disease characterized by congenital malformation of the big toe and heterotopic ossification in muscle. The majority of FOP’s musculoskeletal traits are associated with dysregulated chondrogenesis. The diagnosis is mainly based on clinical manifestation, imaging examination, and genetic analysis. There is still no effective treatment to cure or slow its progression. The best approach remains early diagnosis, conservative drug treatment, and injury prevention to avoid local ossification.

Patient concerns:

A 34-year-old male presented at our hospital because of trismus caused by ossification of the masseter muscle. In addition, he had serious stiffness and multiple bony masses throughout the body, which led to limited movement.

Diagnoses:

Based on the clinical manifestation of movement restriction, characteristic radiographic images of ossification of soft tissues, the genetic test showing a heterozygous molecule (c.974G > C, p.G325A) of the activin A receptor type I, the patient was diagnosed as FOP complicated with localized MO in masseter after trauma and infection.

Interventions:

The patient underwent the surgical resection of ossification in the masseter muscle, he was instructed to insist on mouth-opening exercises and take glucocorticoids and nonsteroidal anti-inflammatory medications after surgery.

Outcomes:

The symptoms of trismus are relieved, and eating can be basically achieved after surgery, while the symptoms of trismus recurred 2 years later.

Lessons:

Although FOP has unique clinical manifestations, its diagnosis may be difficult because of its rarity. Gene analysis is the main standard for diagnosis, while patients with different genotypic variations may show different clinical symptoms. Therapeutic interventions are still supportive and preventive, and surgery is not recommended except under certain circumstances.
Advanced upper urinary tract urothelial carcinoma is indistinguishable from renal infection by imaging: A case report
Authors: Chai Jiagui , Feng Runlin , Li Yuhang , Ke Changxing
Published: September 2024

Rationale:

The current diagnostic approach for urinary tract urothelial carcinoma (UTUC) relies on symptoms and imaging. Nevertheless, the diagnosis can be challenging in advanced cases presenting with atypical imaging and symptoms. This article presents an unreported case with atypical imaging and symptoms to provide some experience in diagnosing advanced UTUC.

Patient concerns:

A 55-year-old male patient was admitted to the hospital with a 2-month history of persistent left scrotal pain and intermittent left lower back pain.

Diagnoses:

Computed tomography and magnetic resonance imaging revealed a left kidney infection. Paradoxically, the patient did not present with a fever, and the white blood cell count was within normal limits. To further clarify the diagnosis, urine cytology was performed. Surprisingly, malignant tumor cells were discovered. The diagnosis of UTUC was considered.

Interventions:

The patient underwent radical tumor resection.

Outcomes:

The surgery was successfully performed. The patient received regular chemotherapy after surgery. No recurrence was found during the follow-up.

Lessons:

This case is a rare and enlightening clinical scenario. When imaging reveals renal infection accompanied by varicocele or renal vein embolism, it is crucial to consider the possibility of advanced UTUC.
Clinical efficacy and safety of acupuncture combined with statin in dyslipidemia: A meta-analysis and system review
Authors: Liu Xinyu , Chen Kun , Chen Fujian
Published: September 2024

Background:

This study aims to systematically evaluate the clinical efficacy and safety of acupuncture in combination with statin therapy compared to statin monotherapy for the treatment of dyslipidemia.

Methods:

A comprehensive search for relevant randomized controlled trials assessing the clinical efficacy of acupuncture and statin combination in the treatment of dyslipidemia was conducted. Databases including PubMed, EMbase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc, Wanfang database, and China Science and Technology Journal Database were searched up to October 27, 2023.

Results:

Sixteen Chinese-language studies involving a total of 1333 subjects were included for analysis. The meta-analysis revealed that the total effective rate of acupuncture combined with statin was significantly higher than that of statin alone (odds ratios = 3.32, 95% confidence intervals [CI] = 2.33 to 4.72). Furthermore, the combination of acupuncture with statin treatment resulted in a significant reduction in triglyceride levels (mean differences [MD] = −0.72 mmol/L, 95% CI = −1.05 to −0.4), total cholesterol levels (MD = −0.79 mmol/L, 95% CI = −1.07 to −0.51), low-density lipoprotein cholesterol levels (MD = −0.61 mmol/L, 95% CI = −0.95 to −0.27) and traditional Chinese medicine syndrome integral (MD = −1.32, 95% CI = −1.75 to −0.89), compared to statin treatment alone. Additionally, the high-density lipoprotein cholesterol level was higher in the combined acupuncture and statin treatment group than in the statin treatment alone group (MD = 0.44 mmol/L, 95% CI = 0.09 to 0.79). Notably, the rate of adverse reactions reported with combined acupuncture and statin treatment was lower than that with statin therapy alone.

Conclusion:

Our findings support the potential of acupuncture combined with statin as a viable clinical treatment option for dyslipidemia. However, it is important to note that current research on the mechanism of acupuncture for lipid-lowering has not yielded definitive results, and there are inherent biases in the conducted clinical studies.
The effect of different potency glucocorticosteroids treatments on tear inflammatory factors and corneal optical density after femtosecond-assisted laser in situ keratomileusis
Authors: Zheng Jun , Hong Xiangbo , Li Shuangle
Published: September 2024

To assess the impact of glucocorticosteroids with varying potencies on inflammatory mediators in tears and corneal optical density after femtosecond-assisted laser in situ keratomileusis (FS-LASIK). In a prospective study, 110 patients (220 eyes) who underwent FS-LASIK were divided into 2 groups: 55 patients (110 eyes) received dexamethasone, and another 55 patients (110 eyes) received fluorometholone. Visual acuity, intraocular pressure, and corneal optical density were measured before, 1 week, and 1 month after surgery. Tear fluid samples were also collected to assess expression levels of TNF-α, IL-1α, IL-6, and TGF-β1. One week after the procedure, the dexamethasone group exhibited elevated intraocular pressure (IOP) levels (P > .05) and a decreased expression of TNF-α in tears (P < .001) compared to the fluorometholone group. Within the 0 to 2 mm range from the corneal apex, the anterior corneal layer’s optical density in the fluorometholone group surpassed that of the dexamethasone group (P < .05). At 1 month post-surgery, the IOP in the fluorometholone group was higher than that in the dexamethasone group (P < .05). In both the 0 to 2 mm and 2 to 6 mm intervals from the corneal apex, the optical density of the anterior corneal layer was significantly higher in the fluorometholone group compared to the dexamethasone group (P < .05). There was no statistically significant difference in visual acuity between the 2 groups at any postoperative time point. Short-term use of potent corticosteroids after FS-LASIK can swiftly address ocular surface inflammation, enhance corneal wound healing, reduce corneal edema, and accelerate the restoration of corneal transparency, in contrast to prolonged use of milder corticosteroids post-surgery.
Lack of association of ABO and RhD blood groups with COVID-19 mortality: A 2-center cross-sectional study in Saudi Arabia
Authors: Halawani Amr J. , Alhamoud Abdullah H. , Kabrah Saeed M. , Al Eissa Mariam M. , Daowd Rateb A. , Algarni Ateeg M. , Alqarni Abdulaziz H. , Alshahrani Musaed M. , Khan Anmar A. , Jalal Naif A. , Mujalli Abdulrahman , Malak Hesham A. , Bantun Farkad
Published: September 2024

Several diseases, including both noninfectious diseases and bacterial and viral diseases, are associated with the ABO and RH blood group systems. Previous studies have shown a link between blood type and the probability of coronavirus disease 2019 (COVID-19) infection. In this study, we aimed to explore the correlation between deaths caused by COVID-19 and ABO and RhD blood types in Saudi Arabia. In this cross-sectional observational study, data from COVID-19 patients were collected from 2 major hospitals treating COVID-19 in Riyadh City, Saudi Arabia, between March 2020 and November 2021. The association between ABO and RhD blood types and COVID-19 outcomes was investigated. A total of 2302 real-time polymerase chain reaction-confirmed COVID-19 patients were enrolled in this study; a chi-square test was used to determine the statistical significance of the data. Of the 2302 enrolled patients, 1008 (43.8%) had blood type O, 677 (29.41%) had blood type A, 502 (21.8%) had blood type B, and 115 (5%) had blood type AB. Of the patients, 2143 (93.1%) were RhD-positive. The O-positive blood type had the highest mortality rate among COVID-19-infected patients, whereas the AB-negative type had the lowest. However, statistical analysis revealed no significant correlation between blood type (ABO or RhD) and COVID-19-based susceptibility or mortality. In conclusion, we found no association between ABO and RhD blood types and either susceptibility to or mortality due to COVID-19 in Saudi Arabia.
Analysis of the nursing value of continuity care in the recovery of ureteral stone patients after Pneumatic ballistic lithotripsy: An observational study
Authors: Wang Lingying , Wang Hong , Fang Jianghong , Yao Minye
Published: September 2024

This study aims to assess nursing methods’ effects on ureteral stone patients post-Pneumatic ballistic lithotripsy with double J-tube placement. Through comparing interventions’ impact on recovery, complications, and overall quality of life, the study aims to establish a more effective nursing protocol for this patient group. This study investigates ureteral stone patients who underwent PL and subsequent double J-tube placement between January 2020 and October 2023. A total of 100 eligible subjects (n = 100), meeting the inclusion and exclusion criteria, were divided into an intervention group (n1 = 50) and a control group (n2 = 50) according to different treatments. The control group received routine in-hospital care combined with outpatient follow-up, while the intervention group underwent continuous care using the Omaha system. Nursing effects pre- and post-intervention were assessed using questionnaires, clinical indicators, and the Omaha evaluation system, evaluating aspects such as cognition, behavior, and status in terms of environment, psychosocial aspects, physiology, and health behavior. Additionally, complications during double J-tube placement and pain scores were compared among the patients. Prior to the intervention, no statistically significant differences were observed between the scores of both groups across environmental, psychosocial, physiological, and health behavioral domains. Subsequent to the nursing intervention on the first postoperative day, at discharge, and post-discharge, a statistically significant variance was evident between the groups across these domains (P < .05). Furthermore, the intervention group exhibited notably lower rates of infection, hematuria, and residual or fragmented stones, all significantly lower with a P-value of <.05, compared to the control group. While a reduction in tissue damage and acute kidney injury was observed in the intervention group compared to the control group, this difference did not reach statistical significance. Notably, 92% of patients in the intervention group reported no pain during the nursing intervention, in contrast to only 52% in the control group. Continuity care utilizing the Omaha system demonstrates favorable outcomes in managing double J stent placement post-PL among ureteral stone patients, notably leading to a significant reduction in both pain levels and the incidence of associated complications.
Hemifacial spasms triggered by compression of tortuous anterior inferior cerebellar artery loop on the facial nerve in the internal auditory canal: A case report
Authors: Chen Shuide , Pan Siyuan , Richard Seidu A. , Lan Zhigang
Published: September 2024

Rationale:

Hemifacial spasm (HFS) is triggered by neurovascular compression mostly at the root entry/exit zone of the facial nerve. HFS with the responsible blood vessel located in the internal auditory canal (IAC) is a very rare occurrence. In our case, the HFS was triggered by compression of the anterior inferior cerebellar artery (AICA) loop on the facial nerve in the IAC.

Patient concerns:

A 27-year-old female presented with a 5-year history of right-sided facial twitching with no obvious course. The frequency and severity of the attacks increases when the patient was anxious or agitated which severely affected her quality of life.

Diagnosis:

Preoperative 3D-TOF magnetic resonance imaging (MRI) evaluation of cranial nerves showed that the right AICA loop had a tortuous course within the IAC and compressed the facial nerve.

Intervention:

Microvascular decompression (MVD) surgery was carried out to separate the tortuous AICA loop and facial nerve in the IAC using a Teflon pad.

Outcomes:

The abnormal muscle response disappeared intraoperatively and 2-years follow-up revealed no recurrence of her symptomatology. She is current well and go about her daily activities with no neurological deficits.

Lesson:

The attachment of the facial nerve to the tortuous AICA loop coupled with the pulsatile impulse of tortuous AICA loop may have resulted in the entrapment and compression of the CN VII in the IAC.
Sleep duration and heart failure risk: Insights from a Mendelian Randomization Study
Authors: Zeng Lianlin , Fu Shasha , Xu Hailan , Zhu Lutao , Li Xiaomei , Cheng Kang , Li Yangan , Hu Kehui
Published: September 2024

To investigate the causal relationship between sleep duration and heart failure (HF) in a European population. We focused on the continuous sleep duration of 460,099 European individuals as our primary exposure. Genome-wide significant single nucleotide polymorphisms (SNPs, n = 9851,867) linked to continuous sleep duration were adopted as instrumental variables. The outcome of interest was based on HF events in a European cohort (n = 977,323; with 930,014 controls and 47,309 cases). We employed a two-sample Mendelian randomization (MR) approach to infer causality between sleep duration and the incidence of HF. For validation purposes, an additional cohort of 336,965 European individuals diagnosed with insomnia was selected as a secondary exposure group. Using its SNPs, a subsequent two-sample MR analysis was conducted with the HF cohort to further corroborate our initial findings. Employing the MR methodology, we selected 57 SNPs that are associated with sleep duration, and 24 SNPs that are associated with insomnia as instrumental variables. We discerned a substantial association between genetically inferred sleep duration and HF risk (odds ratio: 0.61; 95% confidence interval: 0.47–0.78, P < .0001). Our subsequent analysis highlighted a pronounced increased HF risk associated with insomnia (odds ratio: 1.54; 95% confidence interval: 1.08–2.17, P < .02). These conclusions were further bolstered by consistent results from sensitivity analyses. Our study suggests a causal linkage between sleep duration and the onset risk of HF in the European population. Notably, shorter sleep durations were associated with a heightened risk of HF.
Testosterone and the prevention of type 2 diabetes mellitus: therapeutic implications from recent trials
Authors: Wittert Gary , Umapathysivam Mahesh M.
Published: September 2024

Purpose of review

Type 2 diabetes (T2D) is increasing to epidemic proportions and frequently associated with obesity and a low serum testosterone concentration in men. This review valuates recent randomized controlled trials (RCTs) investigating the effect of testosterone treatment on glycemic control and T2D prevention.

Recent findings

The 2-year Testosterone for the Prevention of Type 2 diabetes Trial (T4DM) study showed that in men aged 50 years and over with visceral obesity and impaired glucose tolerance, testosterone treatment on the background of a lifestyle intervention reduced T2D risk by 40%. The Testosterone Effects on Atherosclerosis Progression in Aging Men and Testosterone Trials demonstrated modest improvements in insulin sensitivity and body composition. However, the Testosterone Replacement Therapy for Assessment of Long-Term Vascular Events and Efficacy Response in Hypogonadal Men trial found no significant glycemic benefits over 2 years. Recent data from the Diabetes Prevention Program Outcome Study support the cost efficacy and durability of metformin.

In men at high risk of T2D, treatment with testosterone prevents the disease; however, there are caveats to its use and other approaches may be more applicable. Differences in trial designs, age groups, and outcome measures contribute to varying results. HbA1C is a suboptimal outcome measure. Future research should explore potential synergies between testosterone and GLP-1 receptor agonists in T2D management, while considering cost-effectiveness.
Hypoparathyroidism and assisted reproductive technology: considerations while undergoing ovarian hyperstimulation
Authors: Arkfeld Christopher K. , Mannstadt Michael , Mahalingaiah Shruthi
Published: September 2024

Purpose of review

Hypoparathyroidism (hypoPTH) is a rare disease that requires diligent adherence to treatment regimens to prevent hypocalcemia but also treatment-induced hypercalcemia and hypercalciuria. The menstrual cycle, pregnancy, and lactation can all impact calcium homeostasis but there is little known regarding the impact of ovarian stimulation. Furthermore, the limited reports suggest no clear association between menstrual phase and calcium balance among those with hypoPTH. With increasing patient utilization of assisted reproductive technology (ART), there is a need for better understanding the care required for patients with hypoparathyroidism pursuing fertility technology.

Recent findings

There is currently no literature available on patients with hypoparathyroidism and the impact of controlled ovarian stimulation on calcium homeostasis. We present information regarding physiologic changes in pregnancy that impact calcium homeostasis and the first case presentation of a patient with hypoparathyroidism pursuing ART.

This article provides the first insights and guidance when providing fertility care for patients with hypoparathyroidism.
Comparison of anterior vs. posterior surgery for cervical myelopathy due to OPLL: a systematic review and meta-analysis
Authors: He Qicong , Lv Zhengpin , Hu Yaoquan , Chen Chao , Zhan Enyu , Wang Xuenan , Zhang Fan
Published: September 2024

Study design:

Systematic review and meta-analysis.

Objective:

To compare the effectiveness and safety between the anterior and posterior approach, and identify the more effective surgical approach for treating ossification of the posterior longitudinal ligament (OPLL) in the cervical spine.

Method:

This meta-analysis searched three electronic databases (PubMed, Embase, Cochrane library), including 17 randomized and non-randomized controlled studies published since 2000–2023 that compared the effectiveness and safety of anterior and posterior surgical approaches for the treatment of ossification of the posterior longitudinal ligament. Japanese Orthopaedic Association (JOA) scores, functional recovery rates, excellent and good outcomes of the surgical approaches, Visual Analogue Scale (VAS), C2–C7 angle cobb and complication were analyzed. RevMan 5.3 was utilized for data analysis.

Results:

This study suggested that there were no statistically differences between the anterior group and posterior group in terms of preoperative JOA score [WMD=0.23, 95% CI, (−0.22, 0.67), P=0.32], preoperative VAS [WMD=0.03, 95% CI, (−0.24, 0.30)], postoperative VAS [WMD=−0.16, 95% CI, (−0.47, 0.15) P=0.97] function recovery rate of patients with canal narrowing ratio less than 50–60% [WMD=−1.54, 95% CI, (−4.46, 1.38), P=0.30]. The anterior group showed higher postoperative JOA score [WMD=0.99, 95% CI, (036,1.63) P<0.05], post C2–C7 angle cobb [WMD=2.62, 95% CI, (0.36, 4.87), P=0.02] as well as function recovery rate (regardless of canal narrowing ratio) [WMD=16.05, 95% CI, (14.08, 18.03), P<0.05], especially a significant higher function recovery rate of patients with canal narrowing ratio greater than 50–60% [WMD=19.32, 95% CI, (17.25, 21.40), P<0.05]. There was a significant difference between anterior group and posterior group in complication. [OR=0.12, 95% CI, (0.01, 0.24), P<0.05].

Conclusion:

Based on the study’s finding, The study suggested that when the conservative treatment for OPLL is unsatisfied, the surgical approach of entering through the anterior approach is a better choice. Nevertheless, it is still necessary to consider the specific situation of the patient. One of the next research directions is how to reduce the complications of anterior surgery.
Brown Adipose Tissue Improves Angiogenesis and M2 Macrophage Polarization in Burn Wounds by Activating IL-17 Signaling
Authors: Zhou Shaolong , He Yufei , Lin Jiayan , Yang Fei , Zhou Wenqing , Cai Junrong , Liao Yunjun , Lu Feng
Published: September 2024

Background:

Burn wound healing is a complex physiological process that requires complicated regulation by different cells and tissues. Brown adipose tissue (BAT) plays a key role in the hypermetabolic response to severe burns. However, it is unclear whether BAT contributes to burn wound healing.

Methods:

Mice were divided into two groups: brown adipose tissue removal group (BR group) and control group. Burn wounds were created on the backs of mice (weighing 20–25g), who were exposed to 100°C hot water for 12 seconds using a homemade burn tube, resulting in a burned area measuring 10 mm in diameter. The treatments were applied once a day for 10 days. Full-thickness wound tissue was collected on days 1, 4, 7, 10, and analyzed by immunostaining of CD31，α-SMA+, F4/80 and CD206 (n = 3).

Results:

On days 4, 7, and 10, the wound healing rate of the control group was significantly higher than that of the BR group. In the histological analysis, evident inflammatory infiltration, severe collagen denaturation in the BR group. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis revealed that the IL-17 pathway was enriched and related genes were up-regulated in the heat map. Immunostaining and transcriptional analyses revealed that angiogenesis and fibroblast were enhanced in the control group, fewer CD206-positive M2 macrophages and higher levels of inflammatory infiltration in the BR group.

Conclusions:

Brown adipose tissue may reduce inflammatory signaling in burn wounds by increasing the IL-17A-HIF1α axis and driving M2 macrophage polarization.
Predictive modelling of Immunogenicity to Botulinumtoxin A Treatments for Glabellar Lines
Authors: Rahman Eqram , Carruthers Jean D A , Rao Parinitha , Yu Nanze , Philipp-Dormston Wolfgang G , Webb William Richard
Published: September 2024

Introduction:

Botulinum toxin A (BoNT-A), derived from Clostridium botulinum, is widely used in medical and aesthetic treatments. Its clinical application extends from managing chronic conditions like cervical dystonia and migraine to reducing facial wrinkles. Despite its efficacy, a significant challenge associated with BoNT-A therapy is immunogenicity, where the immune system produces neutralising antibodies (NAbs) against BoNT-A, reducing its effectiveness over time. This issue is critical for patients requiring repeated treatments. The study aims to compare FDA-approved BoNT-A products, examining the factors influencing NAbs development using advanced machine learning techniques.

Method:

This research analysed data from randomised controlled trials (RCTs) involving five main BoNT-A products. The study selected trials based on detailed immunogenic responses to these treatments, particularly for glabellar lines. Machine learning models, including logistic regression, random forest classifiers, and Bayesian logistic regression, were employed to assess how treatment specifics and BoNT-A product types affect the development of NAbs.

Results:

Analysis of 14 studies with 8,190 participants revealed that dosage and treatment frequency are key factors influencing the risk of NAbs development. Among BoNT-A products, IncobotulinumtoxinA shows the lowest, and AbobotulinumtoxinA the highest likelihood of inducing NAbs. The study's machine learning and logistic regression findings indicated that treatment planning must consider these variables to minimise immunogenicity.

Conclusion:

The study underscores the importance of understanding BoNT-A immunogenicity in clinical practice. By identifying the main predictors of NAbs development and differentiating the immunogenic potential of BoNT-A products, the research provides insights for clinicians in optimising treatment strategies. It highlights the need for careful treatment customisation to reduce immunogenic risks, advocating for further research into the mechanisms of BoNT-A immunogenicity.
A 12-Year Analysis of Demand and Supply for Hand Surgery Training in the United States
Authors: Silvestre Jason , Chang Benjamin , Levin L Scott , Daly Charles A , Daley Dane N
Published: September 2024

Introduction:

The consistent recruitment of quality applicants is critical to the integrity of the US surgical workforce. This study assesses the demand and supply for hand surgery training in the US.

Methods:

This was a cross-sectional analysis of US hand surgery fellowship applicants from 2012 to 2023. Data were obtained from the National Resident Matching Program. Primary outcomes were annual number of hand surgery fellowship applicants, training positions, training programs, and unfilled training positions. Temporal trends were assessed with linear regression.

Results:

The annual number of hand surgery programs (73 to 93, 27.4% increase, P<0.001) and training positions (150 to 193, 28.7% increase, P<0.001) increased over the study period while the annual number of applicants remained unchanged (199 to 198, P=0.431). The applicant-to-training position ratio decreased over the study period (1.3 to 1.0, P=0.001). The overall match rate increased (73.4% to 95.5%, P<0.001) along with the mean number of submitted ranks per applicant (8.2 to 14.9, P<0.001). The distribution of US allopathic graduates, (91.9%), US osteopathic graduates (4.6%) and international medical graduates (3.5%) was similar over the study period. The rate of applicants matching at their first-choice fellowship increased over the study period (28.1% to 38.4%, P=0.003) while the rate of unmatched applicants decreased (26.6% to 4.5%, P<0.001).

Conclusion:

There was consistent growth in the number of hand surgery programs and training positions without a commensurate increase in the number of interested applicants. Increased recruitment efforts are necessary to ensure adequate demand for available training positions in hand surgery.