bluuebunny/crossref_metadata_2025 huggingface dataset:
Prehabilitation to mitigate postintensive care syndrome in surgical patients
Authors: Rousseau Anne-Françoise , Thierry Gabriel , Lambermont Bernard , Bonhomme Vincent , Berger-Estilita Joana
Published: February 2025

The post-intensive care syndrome (PICS) refers to the long-term physical, psychological and cognitive impairments experienced by intensive care unit (ICU) survivors, while PICS-Family (PICS-F) affects their family members. Despite preventive strategies during the ICU stay, PICS remains a significant concern impacting survivors’ quality of life, increasing the healthcare costs, and complicating recovery. Prehabilitation offers a promising approach to mitigating PICS and PICS-F, especially when the ICU stay can be anticipated, such as in the case of major surgery. Recent literature indicates that prehabilitation – interventions designed to enhance patients’ functional capacity before critical illness – may mitigate the risk and severity of PICS. Studies have demonstrated that prehabilitation programs can improve muscle strength, reduce anxiety levels and enhance overall quality of life in ICU survivors. Family prehabilitation (prehabilitation-F) is also introduced as a potential intervention to help families to cope with the stress of critical illness. This article aims to explore the role of multimodal prehabilitation and post-ICU follow-up in preventing and managing PICS and PICS-F, focusing on improving patient outcomes, supporting families and optimising healthcare resources. Combining prehabilitation with post-ICU follow-up in peri-critical care clinics could streamline resources and improve outcomes, creating a holistic care pathway. These clinics, focused on both pre-ICU and post-ICU care, would thus address PICS from multiple angles. However, the heterogeneity of patient populations and prehabilitation protocols present challenges in standardising the interventions. Further research is necessary to establish optimal prehabilitation strategies tailored to individual patient needs and to demonstrate their utility in terms of patient outcome.
Pleural infection: controversies on the therapeutic strategies
Authors: Chan Ken K.P. , Lau Estee P.M. , Lee Y.C. Gary
Published: February 2025

Purpose of review

Management of pleural infection remains heterogeneous worldwide. This review highlights current controversies in therapeutic strategies for pleural infection, focusing particularly on recent studies and their implications.

Recent findings

The introduction of intrapleural therapy combining alteplase [a tissue plasminogen activator (tPA)] and deoxyribonuclease (DNase) has revolutionized treatment practices, though the optimal delivery and dosing regimen is an area of active investigation. Variations to simplify administration protocols and/or to lower the required drug doses have been published. Most were exploratory studies, but the variations showed maintained therapeutic efficacy.

Whether intrapleural alteplase/DNase or video-assisted thoracoscopic surgery (VATS) is superior is a topic of debate. Retrospective comparative analyses between the two revealed no clear benefits on all-cause mortality from either approach. Pilot randomized trials have been published and further full-scale, head-to-head trials are underway.

Effective management of pleural infection involves adequate pleural drainage and appropriate antibiotic use. This review outlines the current evidence (and its limitations) and highlights knowledge gaps in optimizing the therapeutic strategies.
The effects of self-management education on self-efficacy, self-esteem, and health behaviors among patients with stroke
Authors: Li Runping , Zhu Dan , Tan Zhiwen
Published: February 2025

The concept of self-management has become one of the most critical concepts in stroke rehabilitation. This study examined the impact of a 2-week stroke self-management program on the self-efficacy, self-esteem, and health behaviors of stroke patients. This retrospective study was conducted from January 2022 to October 2022 with 116 patients who had been admitted to the hospital with a stroke diagnosis after admission to the hospital. This study had 4 primary outcomes: self-efficacy, self-esteem, and health behaviors. Each of those outcomes was assessed at baseline, postintervention, and 1 month postintervention. Fifty-one participants were enrolled in the intervention group and 49 participants were enrolled in the control group. According to the baseline data, there was no significant difference between the 2 groups regarding demographics, clinical characteristics, self-efficacy, self-esteem, and health behaviors of participants (P > .05). Moreover, the difference between the mean scores of self-efficacy, self-esteem, and health behaviors between the 3 measurement time points was not significant (P > .05) in the control group, but there were considerable differences between the mean scores of all 3 factors in the intervention group (P < .05). A significant difference was observed between the groups in terms of self-efficacy, self-esteem, and health behaviors after the educational program (P < .05). Patients with stroke can significantly improve their self-efficacy, self-esteem, and health behaviors as a result of self-management education.
Comparison of different osteotomy schemes in the repair and treatment of moderate to severe hallux valgus deformities
Authors: Xie Zhe , Wang Zhaona , Zhai Shan , Wu Jianzhong , Zhang Lixing , Gao Yanbing , Wu Hailong
Published: February 2025

To explore the application efficacy and safety of different osteotomy schemes in the repair and treatment of moderate to severe hallux valgus deformities. A sum of 117 patients with moderate to severe acute hallux valgus who underwent treatment at our hospital from April 2020 to April 2022 were selected. The envelope method was used to group the patients. The control group (n = 58) underwent double-plane osteotomy of the first metatarsal bone, while the observation group (n = 59) underwent Scarf osteotomy. The clinical efficacy of the 2 groups was compared, the differences in imaging results between the 2 groups at 6 months after surgery were analyzed, and the occurrence of complications during the follow-up period was observed. The excellent rate of the study group patients was 83.05% (49/59), which was compared to that of the control group (81.03%, 47/58) (P > .05). In comparison to the control group patients, the pain, force line, and joint function scores of the study group were compared before surgery and at 3 months after surgery (P > .05). Compared to before surgery, the pain, force line, joint function scores, The American Orthopaedic Foot & Ankle Society (AOFAS) total score, and Berg Balance Scale (BBS) score of the patients in both groups increased at 3 months after surgery. Additionally, the AOFAS total score and BBS score of the study group patients were higher than those of the control group patients (P < .05). The visual analog scale (VAS) scores of the patients in the 2 groups were compared before surgery (P > .05). The VAS scores of the study group patients were higher than those of the control group patients at 1, 2, and 3 months after surgery (P < .05). The study group patients were compared with the control group patients in terms of the hallux valgus angle, the lengths of the first and second metatarsals, the angle between the first and second metatarsals, the angle of the metatarsophalangeal joint surface, the position of the sesamoids, and the shortening length of the first metatarsal (P > .05). The Scarf osteotomy has shown advantages in postoperative gait balance and functional scoring. Therefore, when choosing an osteotomy plan, the Scarf osteotomy can be given priority to enhance the patient’s balance ability and enhance their postoperative quality of life.
Invasive inflammatory fibroid polyp of the stomach: A case report and literature review
Authors: Yang Xingrong , Guo Sitong , Meng Ke , Tao Juan
Published: February 2025

Rationale:

Inflammatory fibrous polyp (IFP) is a distinct fibroblastic neoplasm with a predilection for the stomach and ileum. It usually presents prominent inflammatory infiltration, particularly eosinophils, and has been widely considered benign tumors without malignant biological behaviors. However, rare invasive cases have been reported.

Patient concerns:

A 75-year-old woman presented with unexplained hematemesis, dizziness, and weakness for 3 hours. Physical examination revealed upper abdominal tenderness on palpation.

Diagnoses:

Contrast-enhanced computed tomography revealed a 6 cm nodule with a high-density shadow and ring enhancement with well-defined borders in the gastric body. Gastroscopy showed multiple gastric polyps as well as a gastric submucosal mass with surface ulceration and mucosal disruption. Emergency laboratory results revealed anemia symptoms with an erythrocyte count of 2.63 × 1012/L and a hemoglobin level of 58.00 g/L. A laparoscopic distal gastrectomy was performed. The pathological results support the diagnosis of invasive IFP, and the tumor cells were infiltrated into gastric’s serosa layer.

Interventions:

The patient underwent laparoscopic distal gastrectomy resection. In addition, the patient received blood transfusion therapy for severe anemia, including Leukocyte privative red blood cell and Fresh frozen plasma.

Outcomes:

The patient was discharged home 2 weeks after surgery. There was no evidence of recurrence within the 4 years of surgery.

Lessons:

Except the common gastrointestinal stromal tumor and leiomyoma, IFP should also be considered by pathologists in the diagnosis of primary gastric non-epithelial tumor. Our case also emphasizes the invasive nature of IFP, a rare non benign biological feature (only 5 cases have been reported previously). Although it is very rare, it represents the potential development of the tumor, and should be paid attention to by pathologists and physicians. Otherwise, we report this case because of the first case of an IFP presenting with both gastritis cystica polyposa and inverted hyperplastic poly.
The role of pharmacological interventions in managing urological complications during pregnancy and childbirth: A review
Authors: Edyedu Isaac , Ugwu Okechukwu Paul-Chima , Ugwu Chinyere N. , Alum Esther Ugo , Eze Val Hyginus Udoka , Basajja Mariam , Ugwu Jovita Nnenna , Ogenyi Fabian Chukwudi , Ejemot-Nwadiaro Regina Idu , Okon Michael Ben , Egba Simeon Ikechukwu , Uti Daniel Ejim , Aja Patrick Maduabuchi
Published: February 2025

Pregnancy leads to a number of structural and functional changes in the urinary system, which makes females susceptible to urological complications. This review aims to discuss the epidemiology, complications and prevention and management of urinary tract infections (UTIs), kidney stones and bladder dysfunction in pregnancy. UTIs are the most common urological problem presenting in 10% of pregnant women; Escherichia coli is the most common causative organism. If left untreated, UTIs lead to acute pyelonephritis which occurs in about 2% of pregnant women and which has serious consequences for both the mother and the baby. Kidney stones, although rare, are hazardous, occurring in 1 in 200 to 1 in 1500 pregnancies, and may cause obstructive uropathy, and aggravation of “labor-like” pain. Urological complications are frequent in pregnancy; bladder dysfunction alone has been documented to affect 50% of the pregnant women. Urological complications can have severe consequences when not properly managed including preterm labor and renal dysfunction. In order to have the best pharmacological care, safe use of antibiotics for UTIs is needed along with other measures for kidney stones. This review highlights the importance of a team approach to patient management to optimize outcome and touches briefly on some of the ethical dilemmas that may be encountered when drug therapy in pregnancy is being considered. Therefore, it is feasible to enhance the health of women and the fetus during this period through patient focused care and innovative interventions.
The effect of ultrasound-guided drug injection at Neiguan point on the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy
Authors: Pan Ren , He Lilan , Xu Wenqiang , Luo Xuejing , Qin Xiarong
Published: February 2025

Background:

This study explores the feasibility and effectiveness of ultrasound-guided acupoint injection at Neiguan acupoint to prevent postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy.

Methods:

A total of 60 patients undergoing laparoscopic cholecystectomy in the General Surgery Department of Zhejiang Hospital from February 2021 to August 2021 were enrolled in this study. The patients were randomly divided into the injection group (n = 30) and the control group (n = 30). The patients in the injection group received ultrasound-guided injections of tropisetron at bilateral Neiguan acupoints, while those in the control group received intravenous injections of tropisetron. The incidence of PONV within 24 hours after surgery, the need for “rescue” treatment, the incidence of puncture complications, and patients’ satisfaction with PONV management were evaluated.

Result:

Neiguan point can be accurately located by ultrasound guidance. Compared with the control group, the incidence of PONV was significantly decreased in the Injection group within 0 to 6 hours after surgery, and the vomiting rate was decreased within 6 to 12 hours after surgery (P < .05).

Conclusion:

Ultrasound-guided drug injection at Neiguan to prevent PONV has the characteristics of visualization and accuracy, which is easy to promote and use, and the effect is satisfactory.
Exploring the mechanism of action of Phyllanthus emblica in the treatment of epilepsy based on network pharmacology and molecular docking
Authors: Xiao Longfei , Chen Wenjun , Guo Wenlong , Li Hailin , Chen Rong , Chen Qinghua
Published: February 2025

This study explores the mechanism of Phyllanthus emblica in treating epilepsy (EP) through network pharmacology and molecular docking. The Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform identified the chemical composition of P emblica, Swiss ADME screened active components, and Swiss Target Prediction predicted targets. EP-related targets were identified using Gene Cards, OMIM, Drug Bank, TTD, and DisGeNET, and Venny 2.1.0 was used to find intersecting targets. Protein–protein interaction network analysis was conducted with STRING and Cytoscape. Chem 3D and Pymol were used for structural optimization and molecular docking was performed with AutoDock Tools 1.5.7 and Vina. Fifty-three active components and 126 intersecting targets were identified. Gene Ontology analysis revealed 3416 biological processes, 287 cellular components, and 457 molecular functions. Kyoto Encyclopedia of Genes and Genomes pathways showed neuroactive ligand–receptor interactions, nitrogen metabolism, and serotonergic synapses as key pathways. Molecular docking indicated strong binding energies between P emblica core components and targets, especially 2-ethylhexyl ester with MAPK3, luteolin with SRC, and kaempferol with MAPK1. This study explores the therapeutic potential of P emblica in treating EP through network pharmacology and molecular docking. A total of 53 active components were identified, with key compounds like 2-ethylhexyl ester, phyllanthin, luteolin, and kaempferol targeting critical proteins such as SRC, AKT1, APP, MAPK3, and MAPK1. These targets are involved in pathways related to synaptic transmission, oxidative stress, and inflammation, indicating potential neuroprotective and anti-inflammatory effects. Gene Ontology analysis highlighted the regulation of synaptic activity, while Kyoto Encyclopedia of Genes and Genomes pathway analysis emphasized pathways like neuroactive ligand–receptor interactions and serotonergic synapses. Molecular docking demonstrated strong binding affinities between active components and core targets, supporting the effectiveness of P emblica in modulating neuronal excitability and reducing neuroinflammation. These findings provide a theoretical basis for its clinical application in EP management.
Evaluation of risk factors for thromboembolic events in multiple myeloma patients using multiple machine learning models
Authors: Huang Yi , Liang Haimei , Huang Shaoxin , Xie Xueli , Deng Bin , Liang Wenjie
Published: February 2025

Venous thromboembolic events (VTE) is a frequent complication in multiple myeloma (MM) patients, raising mortality. This study aims to use machine learning to identify VTE risk factors in MM, helping to pinpoint high-risk individuals for better clinical management and prognosis. A retrospective analysis was conducted on the basic information, laboratory test results, treatment plans, and thrombosis prevention measures of 428 newly diagnosed MM patients at our hospital from December 2018 to December 2022. We used logistic regression (LR), random forest, and gradient boosting machine (GBM) models to identify and assess the risk factors for VTE in patients with MM. Among 428 patients with MM, 48 cases (11.21%) had concomitant VTE, including 10 cases of deep vein thrombosis with pulmonary embolism, while the remaining 38 cases were solely deep vein thrombosis. The results of the multifactorial LR analysis indicate that C-reactive protein (CRP), fibrinogen, von Willebrand factor (vWF), factor VIII (FVIII), and treatment regimen immunomodulator in the patient’s treatment regimen are independent factors influencing the risk of VTE in patients with MM. In the analysis of the random forest model, we found that CRP and fibrinogen are the most important factors for predicting the risk of VTE in patients with MM, with the highest Gini indices of 12.76 and 12.31, respectively. In addition, vWF, FVIII, age, platelet count, D-dimer, β2 microglobulin, serum creatinine, and albumin were also considered key variables affecting the risk of VTE in MM patients. In the GBM model, the importance ranking of variables showed that FIB and CRP are the most important predictive factors, with influences of 36.84 and 28.56, respectively. In addition, other important variables include vWF, FVIII, age, albumin, neutrophils, β2 microglobulin, and D-dimer. We found that CRP and fibrinogen were the most important risk factors in all 3 models, while vWF and FVIII were also confirmed as significant risk factors. The identification of these common risk factors provides a clear focus for clinical practice to more accurately identify high-risk groups for VTE among MM patients.
Identification of key autophagy-related genes in arrhythmogenic right ventricular cardiomyopathy through gene expression profiling
Authors: Yin Jianrong , Zhu Qiqiang , Yu Chunqiang , Wang Lianhuan , Ge Rongling , Wang Lei , Wang Jin
Published: February 2025

The purpose of our study is to utilize bioinformatics methods to pinpoint genes linked to autophagy that may influence the progression of arrhythmogenic right ventricular cardiomyopathy (ARVC). By doing so, we hope to enhance the clinical intervention and handling of this cardiac condition by offering more informed guidance. The transcriptomic data corresponding to GSE29819 were accessed via the GEO repository. Utilizing R programming, we analyzed and searched genes associated with autophagy that might be relevant to ARVC. Subsequently, the identified genes underwent protein–protein interaction network and co-expression analysis, while GO and KEGG pathway enrichment analysis was employed to investigate the signaling cascades they may implicate. We intersected the down-regulated genes in GSE29819 with 222 autophagy-related genes, and finally got 12 differentially expressed autophagy-related genes. Examination of the Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) indicates that diverse genetic activity plays a role across numerous biological functions and systems. These include cytokine-related genes, lipid metabolism and atherogenesis, nucleotide oligomerization domain-like receptor signaling, chemokine-induced pathway, autophagic genes, apoptosis, natural killer cells-induced cell death, signal transduction involving tumor necrosis factor, and the activation of C-type lectin receptors which may influence the diverse clinical presentations of ARVC. Cytoscape software constructed a protein mutual aid network of common differentially expressed genes, and obtained a Cluster with a high score and 7 key genes, including CCR2, FAS, PRKCD, CASP1, CCL2, NAMPT and TNFSF10. Utilizing bioinformatics methods to identify genes involved in autophagy that exhibit fluctuating expression levels augments our understanding of the intricate aspects of ARVC. At the same time, combined with previous research reports in cardiomyopathy, we can speculate that Fas may affect the occurrence and development of ARVC through tumor necrosis factor signaling pathway mediating apoptosis. These results further illuminate our understanding of the origins and potential treatment focal points for ARVC.
Effect of Xiao’s double C nursing model on motor function, daily living activities, and quality of life in stroke patients
Authors: Hou Guanhua , Chen Ziwen , Zhu Kangli , Chen Yanfei , Fan Ruirui
Published: February 2025

This study evaluates Xiao double C nursing model’s impact on limb function, daily living abilities, and quality of life in stroke patients. This retrospective study involved 160 stroke patients from our hospital, June 2021 to June 2023, divided into control and observation groups after accounting for 10 dropouts. The control group received standard nursing, while the observation group used Xiao double C model. Effects on limb function, daily living abilities, and quality of life were compared. Initially, no significant differences in limb function scores (P > .05) existed between groups. Post-care, the observation group showed significantly higher Fugl-Meyer and Brunnstrom scores than the control group (P < .05). Similarly, while pre-care quality of life scores showed no significant difference, post-care scores for mental vitality, social interaction, and emotional restrictions in the observation group were significantly superior (P < .05). ADL scores and other quality of life aspects also showed significant improvements in the observation group post-care (P < .05). Xiao double C nursing model significantly enhances limb function, quality of life, and daily living abilities in stroke patients, suggesting its efficacy for stroke patient care.
Association between rs4673 and blood pressure response to acute saline infusion in Chinese population
Authors: Wang Hongyi , Wang Xue , Tian Yan , Yang Li , Han Xiaoxia , Wang Zhuo , Nie Xiaoyan , Sun Ningling
Published: February 2025

This study investigated the relationship between rs4673 of the nicotinamide adenine dinucleotide phosphate oxidase p22PHOX gene and blood pressure (BP) response to acute salt loading in a Chinese population diagnosed with essential hypertension. An acute salt loading test was performed using 2 L of normal saline (NS) infused over 4 hours. BP and heart rate were recorded immediately after NS infusion and hourly for the next 3 hours. Data analysis was performed using the chi-squared test, Student t test, and multivariable regression. A total of 159 patients were analyzed, including 129 with the CC genotype, 29 with the CT genotype, and 1 with the TT genotype. Individuals carrying the T allele exhibited greater tolerance to BP increases caused by 2 L NS infusion. Specifically, the systolic blood pressure change for T carriers was 0.26 ± 9.72 mm Hg, compared to 6.82 ± 11.65 mm Hg for those with the CC genotype (P = .005). Diastolic blood pressure changes were −3.35 ± 7.52 mm Hg in T carriers versus 1.38 ± 7.62 mm Hg in CC genotype carriers (P = .003), and mean arterial pressure changes were −2.13 ± 7.85 mm Hg in T carriers compared to 3.19 ± 7.81 mm Hg in CC genotype carriers (P = .001). These significant differences persisted after adjusting for gender, age, smoking, drinking, and baseline BP. Interestingly, not all subjects experienced increased BP following NS loading; 86.82% in the CC group did, versus 66.67% of T allele carriers (P = .014). The findings suggest that individuals carrying the T allele are less likely to be salt-sensitive, as indicated by a diminished BP response to acute saline infusion. This contributes to the understanding of the genetic factors that influence salt sensitivity in essential hypertension.
Causal association between varicose veins and atrial fibrillation: A 2-sample bidirectional Mendelian randomization study
Authors: Chen Weiyue , Jing Na , Liu Qingzhi , Mao Hong , Wang Xiangyu , Chen Boxun , Wang Yannan
Published: February 2025

This study selected genome-wide association study data from the FinnGen database and utilized a bidirectional 2-sample Mendelian randomization (MR) method to explore the causal association between varicose veins (VV) and atrial fibrillation (AF). Inverse variance weighted (IVW) was used as the primary analytical method to assess the causal relationship between VV and AF, supplemented by Weighted median, MR-Egger and Simple 1mode. Cochran’s Q test, MR-Egger regression intercept and Mendelian randomization pleiotropy residual sum and outlier were used as sensitivity analyses to detect heterogeneity and multilevel pleiotropy. Additionally, reverse MR was conducted to analyze the causal association between AF and VV. The IVW method indicated a positive causal relationship between VV and AF (odds ratio = 1.1571, 95% confidence interval = 1.0810–1.2384, P = 2.59 × 10−5). Reverse MR analysis shows no potential reverse causal relationships. The results showed a significant causal effect of VV on AF, suggesting that VV may increase the risk of developing AF. It also elaborates on the common risk factors and pathophysiological conditions between VV and AF.
Duodenal fluid analysis is an excellent differential diagnosis method of diseases with enterohepatic circulation disturbance
Authors: Dong Chen , Liu Sheng-Xuan , Zou Biao , Shu Sai-Nan , Huang Zhi-Hua , Zhang Ben-Ping
Published: February 2025

Enterohepatic circulation is essential for maintaining a constant bile acid concentration. Diseases with enterohepatic circulation disturbances are usually difficult to diagnose definitively without the time-consuming and expensive genetic tests. This study analyzed and compared duodenal fluid in patients with biliary atresia (BA), familial intrahepatic cholestasis 2 (FIC2), and sodium taurocholate cotransporting polypeptide (NTCP) deficiency. This study aimed to assess the diagnostic value of duodenal fluid analysis in patients with enterohepatic circulation disturbance. This study retrospectively analyzed data from 18 patients with BA, 13 patients with FIC2, and 15 patients with NTCP deficiency. All patients completed the duodenal tube tests before receiving treatment for cholestasis. The patients were intubated through the right nasal cavity to the middle or lower duodenum, as confirmed by radiography. 3–5 mL of duodenal fluid was collected at last. Clinical presentations, laboratory data, genetic data, and so forth were collected for the analysis. Among the 3 types of diseases, levels of total bile acid (TBA), total bilirubin (TB), direct bilirubin (DB), and gamma-glutamyl transpeptidase (GGT) in duodenal fluid showed significant differences (P < .01). Compared with the same indications in duodenal fluid, levels of TBA and GGT in serum did not show significant differences between patients with FIC2 and NTCP deficiency (P > .05). Duodenal TBA/serum TBA ratio, duodenal TB/serum TB ratio, duodenal DB/serum DB ratio, and duodenal GGT/serum GGT ratio also showed significant differences between patients with BA and NTCP deficiency, between patients with FIC2 and NTCP deficiency (P < .01). For diagnosis of BA, increased GGT and absent TB, DB, and TBAs had a sensitivity of 100%, 100%, 100%, and 100%, a specificity of 86.1%, 100%, 97.2%, and 97.2%. Duodenal tube tests have been used for the diagnosis of BA for over 10 years. Our findings support the duodenal fluid analysis as a tool for prompt timely diagnosis of BA. This study also indicates that the test is a useful diagnostic method with high accuracy for other diseases with enterohepatic circulation disturbance.
Diagnosis of early neurobrucellosis using metagenomic next-generation sequencing of the cerebrospinal fluid in nonepidemic zone: Case report and lecture review
Authors: Liu Haijun , Li Qianhua , Ouyang Xia , Li Qingfeng , Min Yu , Dai Lie
Published: February 2025

Rationale:

Brucella neuropathy is a rare clinical condition, particularly in nonendemic areas, where it often presents with nonspecific symptoms such as fever and headaches, leading to frequent misdiagnoses. In these regions, Brucella antibodies are not routinely tested, and the positive rate of blood cultures is relatively low during the early stage of the disease. In addition, the low culture-positive rate of cerebrospinal fluid (CSF) means that many neurobrucellosis diagnoses rely on peripheral blood cultures or Brucella antibodies, which is not rigorous. This is problematic because the treatment of central nervous system brucellosis differs significantly from that of other types of brucellosis. The purpose of this study is to provide a method for the early diagnosis of Brucella neuropathy in nonendemic areas. We present a case of early-stage neurobrucellosis diagnosed using metagenomic next-generation sequencing (mNGS) of CSF. This approach helps avoid delaying diagnosis in the early stage in nonepidemic areas, potentially reducing the duration before diagnosis, which is of great significance for timely and appropriate treatment.

Patient concerns:

The patient had fever, mild headache, and a slight increase in CSF leukocytes.

Diagnoses:

CSF mNGS detected Brucella, which was later confirmed by serum Brucella antibody testing.

Interventions:

The patient was treated with rifampicin, doxycycline, and ceftriaxone.

Outcomes:

The patient experienced significant relief from the headache, and the fever did not recur. Subsequent examinations revealed no abnormalities in the CSF leukocytes or mNGS results.

Lessons:

We reviewed 10 articles on brucellosis diagnosed using mNGS, including 7 articles on neurobrucellosis (10 cases). Our review highlights the sensitivity of mNGS as a powerful tool for early detection of neurobrucellosis in the CSF. The common symptoms include fever and headache, with brain magnetic resonance imaging detecting lesions in most cases. CSF mNGS results varied, with only a few positive Brucella cultures or antibody tests.
Auricular acupressure for insomnia in women with breast cancer: A systematic review and meta-analysis of randomized controlled trials
Authors: Huang Xin-Rui , Xu Min , Xu Yan , Wang Shu-Jie , Ni Fei-Lin
Published: February 2025

Background:

Breast cancer as the malignant tumor with the highest incidence and mortality rate among the global female population. Insomnia is a common complaint in breast cancer patients, more than one-third (38–47%) of breast cancer patients suffer it. Auricular acupressure (AA), a non-pharmacological therapy, has been used in the studies to intervene in insomnia in breast cancer patients. The objective of this systematic review and meta-analysis is to investigate the efficacy and safety of AA therapy in intervening with insomnia in breast cancer.

Methods:

A systematic literature search was performed for 10 databases up to January of 2024 to identify randomized control trials (RCTs). The methodological quality of RCTs was assessed independently using the Cochrane Handbook for Systematic Reviews of Interventions. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach. Data were screened and extracted independently using predesigned forms. The meta-analysis was conducted using RevMan 5.3 software, P-value < .05 means statistically significant.

Results:

This review included 15 studies from 3 different countries with a total of 1125 adult participants. The pooled results showed that AA significantly in improving sleep quality (mean difference [MD] = ‐3.36, 95% confidence interval [CI]: [‐4.65, −2.07], P < .001) and life quality (MD = ‐7.82, 95% CI: [‐14.76, ‐0.88], P = .03). Based on data from sleep monitoring devices, AA was valuable for improving sleep efficiency (MD = ‐3.63, 95% CI: [‐4.19,-3.07], P = .03) in breast cancer patients. Adverse events were reported in 5 RCTs. Common adverse reactions include auricular skin allergic reaction (10/259, 3.9%), bruising (7/259, 2.7%), pain (3/259, 1.2%), and local pressure ulcers on the auricular points (2/259, 0.8%). The evidence grade was moderate because of the substantial heterogeneity among studies. Heart, Shenmen, and Subcortex were the 3 most numerous auricular points, with a total share of up to 71.70%.

Conclusion:

This systematic review and meta-analysis demonstrates the efficacy and safety of AA in intervening insomnia in breast cancer patients, providing a basis for the selection of clinical auricular points. However, the high-quality RCTs in existence are not enough, and more rigorous trials are needed to identify the efficacy of AA and insomnia.
Bibliometric and visual analysis of breast cancer-related lymphedema: Knowledge structure, research status, and future trends
Authors: Shang Rui , Zhou Jie , Pan Ting , Wang Fengyang , Jin Hui , Nan Xi , Chen Xinhua , Song Chenyu
Published: February 2025

Background:

As the survival rate of breast cancer patients increases, breast cancer-related lymphedema (BCRL) has gradually received attention from researchers. This study aims to sort out and summarize the relevant studies on BCRL using bibliometric analysis and to explore future research trends.

Methods:

In this study, we searched the Web of Science Core Collection for publications related to BCRL, analyzed the publication trends by applying Microsoft Excel 2019, and analyzed authors, cited journals, journal mapping overlays, cited references, and keywords by applying CiteSpace (v.6.1.R3 Advanced). SCImago Graphica (v.1.0.39) was applied to analyze countries/regions, institutions, and published journals.

Results:

We finally included 1000 publications published between 2003 and July 4, 2024. Publications showed an upward trend, with the largest number of publications in 2023. USA is the most published country, Harvard University is the most published institution, Taghian AG is the most published author, and DiSipio T is the most cited author. Lymphatic Research and Biology is the most published journal, and Cancer-American Cancer Society is the most cited journal. “Breast cancer,” “arm lymphedema,” and “quality of life” were the most frequent keywords. Current research focuses on risk factors, treatment strategies, and patients’ quality of life with BCRL. Future research will mainly focus on establishing BCRL evaluation protocols, improving treatment techniques, and early prevention and detection of BCRL.

Conclusion:

Our study sorts out the current knowledge structure in the field and highlights the current state of research and future research directions. These findings inform researchers and clinicians.
Cervical arteries tortuosity and its association with dissection: A systematic review and meta-analysis
Authors: Bitar Anas , Almahder Dana , A. Jouini Jaafer , Alsaid Bayan
Published: February 2025

Background:

This study investigated the link between arterial tortuosity and cervical artery dissection, focusing on carotid and vertebral tortuosity indices, as well as carotid tortuosity classifications (kinking, looping, and coiling).

Methods:

We searched PubMed, SCOPUS, Web of Science, and Google Scholar from database inception to January 2024. The inclusion criteria encompassed human studies on tortuosity and cervical, carotid, or vertebral artery dissection. Exclusion criteria included case reports, non-English studies, and studies solely on connective tissue disorders and diseases. Quality and risk of bias were assessed using the Newcastle-Ottawa Scale. Random-effects model was employed for mean differences and odds ratios. When meta-analysis was not feasible, we summarized and integrated the results narratively.

Results:

Seven studies, involving 507 dissected patients and 582 non-dissected patients, were included. In a meta-analysis of 3 studies, vertebral tortuosity favored the dissection cases [MD = 3.58, 95% CI: 2.21–4.95]. The mean carotid tortuosity difference was not statistically significant in a meta-analysis of 2 studies [MD = 2.27, 95% CI: −0.16–4.70]. In the classification analysis, 2 studies indicated no conclusive association between kinking, coiling, and cervical arteries dissection. Regarding carotid classification and internal carotid artery dissection, meta-analyses only showed a significant association with kinking, but the result was inconclusive.

Conclusion:

Tortuosity index screenings may help prevent cervical artery dissection among at-risk individuals. However, the association with specific tortuosity classifications remains inconclusive, and further research is needed to validate these findings. Standardized measurement criteria are crucial for future studies.
CO2 and aerosol concentration during manual and mechanical chest compression while cardiopulmonary resuscitation
Authors: Heymer Johannes , Dengler Florian , Hein Anna , Krohn Alexander , Jaki Christina , Echterdiek Fabian , Schmid Stephan , Müller-Schilling Martina , Schilling Tobias , Ott Matthias
Published: February 2025

Background:

This study investigates the staff-to-staff transmission risk of Coronavirus disease 2019 during cardiopulmonary resuscitation in an ambulance vehicle.

Methods:

Comparing manual and mechanical chest compressions, CO2 concentrations were monitored as a proxy for infection risk.

Results:

Results suggest that mechanical chest compressions generate lower CO2 levels, indicating a reduced risk of infection among healthcare workers compared to manual compressions.

Conclusions:

These findings highlight the potential benefits of employing mechanical chest compressions to mitigate staff-to-staff infections in small, confined spaces during aerosol-transmitted diseases.
Correlation of cumulative fasting blood glucose exposure with gastrointestinal cancers: A prospective cohort study
Authors: Liu Kuan , Wang Wanchao , Liu Ye , Li Jiaxing , Ma Chao , Tian Yuan , Dong Zhigang , Zhu Lichao , Wei Wenqiang , Ren Minqiang , Wu Shouling , Liu Siqing
Published: February 2025

At present, there is a lack of research on the correlation between cumFPG and digestive malignancies, and previous cohort studies have not considered the competitive risk between death and digestive malignancies, which may overestimate the impact of related risk factors. To explore the correlation between cumFPG and malignant tumors of the digestive system. In this study, 53,747 participants who had undergone 3 consecutive physical examinations since 2006 were collected. Finally, a total of 53,747 participants were included in this study. According to the grouping method of previous studies, cumFPG was divided into 4 groups according to the quartile. Cox regression model and competitive risk model were used to assess the risk of new digestive system malignancy. In sensitivity analyses, participants with cancer within 5 years of follow-up were excluded to eliminate the possibility of reverse causation. Subjects taking hypoglycemic drugs were excluded to eliminate the effect of the drug on blood glucose. Restricted cubic splineregresion (RCS) was then used to calculate the relationship between cumFPG and GI cancers. The mean age of participants was 49.02 ± 11.78 years. During a mean follow-up of 10.58 years, 817 new Gastrointestinal cases were identified, and the Cox proportional hazards model suggested that the risk of incidence in the Q2 to Q4 group increased sequentially compared with the lowest Q1 group, even after excluding the diagnosis of digestive malignancy within 5 years, the participants taking hypoglycemic drugs, and the death competition risk model analysis. In site-specific analysis, we observed that this risk was more pronounced in colorectal cancer, liver cancer, and pancreatic cancer, while gastric cancer, small bowel cancer, and bile duct cancer all had a similar trend to the main model but were not statistically significant, while esophageal cancer was U-shaped but not statistically significant. RCS results showed that cumFPG was associated with a similar risk of digestive system tumors, showing an inverted “√” type relationship. High levels of cumFPG are an independent factor in malignancy of the digestive system. cumFPG can provide a new idea for the prevention of Gastrointestinal cancers.
Sustainable development goals (SDGs) and resilient healthcare systems: Addressing medicine and public health challenges in conflict zones
Authors: Ugwu Chinyere N. , Ugwu Okechukwu Paul-Chima , Alum Esther Ugo , Eze Val Hyginus Udoka , Basajja Mariam , Ugwu Jovita Nnenna , Ogenyi Fabian C. , Ejemot-Nwadiaro Regina Idu , Okon Michael Ben , Egba Simeon Ikechukwu , Uti Daniel Ejim
Published: February 2025

This review explores the integration of sustainable development goals (SDGs) into healthcare organizations in conflict zones, with a specific focus on emergent models aimed at improving population health. The primary objective is to examine how innovative approaches such as telemedicine, mobile health clinics, and community health worker initiatives can be aligned with SDG targets, thereby enhancing healthcare outcomes in conflict-affected regions. The review focuses on the important areas of concern which encompasses technology, infrastructure, community engagement, and social/psychological factors. Particularly, strategies of improving existing technologies such as electronic health records and mobile health applications, enhancing health systems and community-based interventions, and integrating of mental health services are highlighted. Other focal points include advancing better water, sanitation and hygienic practices, sustainable water resource management, and other alternative financing mechanisms, such as public–private partnerships. Integrating these strategies are closely linked with the active participation of international, local governments, and affected communities in their effective implementation. This review highlights the need for monitoring and evaluation to assess intervention effectiveness and advocacy efforts to ensure that interventions supported and advocated by the international community are creating successful outcomes towards the SDG goals and improving population health in post conflict settings.
Progress and prospects of Parkinson’s disease with depression research: A global bibliometric analysis based on CiteSpace
Authors: Li Jianlin , You Jianhang , Li Zaipu , Zang Jing , Wu Lin , Zhao Tao
Published: February 2025

Background:

Parkinson’s disease (PD) is a common neurodegenerative disorder marked by motor impairments such as stiffness, involuntary shaking, and slowed movement. In addition, PD patients frequently experience nonmotor symptoms, especially depression. This study uses a mixed-methods scientometric analysis to review global research trends and advancements in PD and depression. This analysis is vital for clinicians, researchers, and policymakers, identifying knowledge gaps and directing future research efforts.

Methods:

We conducted a comprehensive literature review on PD and depression using the Web of Science database from 2004 to 2023, facilitated by CiteSpace 6.1.R6. Our analysis examined collaborations among authors, institutions, countries, and keywords, incorporating insights from RCTs and qualitative studies. We calculated effect sizes and confidence intervals with precision. Ethical approval was not required as the study used publicly available data without personal information.

Results:

Our analysis included 3048 research papers and 915 reviews, involving 17,927 authors and 12,466 institutions. The United States and the University of Toronto led in publications. Studies revealed significant effect sizes with narrow confidence intervals, particularly on the prevalence and impact of depression in PD patients. High-frequency keywords included “Parkinson’s disease,” “depression,” “quality of life,” “non-motor symptom,” and “dementia.” Visual mapping identified critical research nodes and future directions.

Conclusion:

Over the past 2 decades, research on the PD-depression link has accelerated. Our analysis highlights prevailing trends and critical areas, providing evidence-based recommendations for therapeutic strategies. This study offers valuable insights for clinicians and researchers, emphasizing future research priorities to improve patient outcomes.
Safety and efficacy of carbon dioxide laser therapy for vocal cord leukoplakia: A systematic review and meta-analysis
Authors: Liang Jiao , Zhou Yanan , Xu Zhoujie , Cao Xingwei
Published: February 2025

Background:

Vocal cord leukoplakia is a precancerous lesion for which early surgical intervention following ineffective conservative treatment is the predominant approach. Carbon dioxide (CO2) laser treatment is a novel, minimally invasive therapy. However, there is insufficient evidence to suggest that CO2 laser treatment is superior to conventional surgical methods in terms of efficacy and safety. Therefore, this meta-analysis aimed to evaluate the efficacy and safety of CO2 laser treatment vs conventional surgical treatment for vocal cord leukoplakia.

Methods:

A literature search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across 8 databases. Studies on the use of carbon dioxide laser therapy for vocal cord leukoplakia were included in the review. Two researchers conducted a systematic search for randomized controlled trials in PubMed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure, Wanfang, Chinese Science and Technology Periodical Database, and Chinese Biomedical Literature databases. Meta-analysis was performed using Stata 18.0, and RevMan 5.2 software.

Results:

The findings indicated that Compared with conventional surgery, CO2 laser surgery significantly reduced the recurrence rate of vocal cord leukoplakia (odds ratio [OR] = 0.25, 95% confidence interval, CI [0.12, 0.51]). CO2 laser surgery significantly improved the cure rate of vocal cord leukoplakia (OR = 3.07, 95% CI [1.17, 8.09]). Voice quality following CO2 laser surgery was significantly superior to that following conventional surgery, particularly in terms of fundamental frequency disturbance (standardized mean difference [SMD] = −0.8, 95% CI [−1.25, −0.34]) and amplitude disturbance (SMD = −0.52, 95% CI [−0.95, −0.09]). The CO2 laser group exhibited a lower incidence of postoperative adverse reactions (OR = 0.32, 95% CI [0.03, 3.19]); however, this difference was not statistically significant.

Conclusion:

The results of this meta-analysis suggest that CO2 laser surgery can reduce the recurrence rate of vocal cord leukoplakia, improve the cure rate, and enhance voice quality. Therefore, CO2 laser surgery is recommended as a minimally invasive surgical approach for vocal cord leukoplakia.