bluuebunny/crossref_metadata_2025 huggingface dataset:
Metabolic reprogramming in the immunosuppression of tumor-associated macrophages
Authors: Wang Ying , Wang Dan , Yang Li , Zhang Yi
Published: November 2022

Tumor-associated macrophages (TAMs) are an essential proportion of tumor-infiltrating immune cells in the tumor microenvironment (TME) and have immunosuppressive functions. The high plasticity and corresponding phenotypic transformation of TAMs facilitate oncogenesis and progression, and suppress antineoplastic responses. Due to the uncontrolled proliferation of tumor cells, metabolism homeostasis is regulated, leading to a series of alterations in the metabolite profiles in the TME, which have a commensurate influence on immune cells. Metabolic reprogramming of the TME has a profound impact on the polarization and function of TAMs, and can alter their metabolic profiles. TAMs undergo a series of metabolic reprogramming processes, involving glucose, lipid, and amino acid metabolism, and other metabolic pathways, which terminally promote the development of the immunosuppressive phenotype. TAMs express a pro-tumor phenotype by increasing glycolysis, fatty acid oxidation, cholesterol efflux, and arginine, tryptophan, glutamate, and glutamine metabolism. Previous studies on the metabolism of TAMs demonstrated that metabolic reprogramming has intimate crosstalk with anti-tumor or pro-tumor phenotypes and is crucial for the function of TAMs themselves. Targeting metabolism-related pathways is emerging as a promising therapeutic modality because of the massive metabolic remodeling that occurs in malignant cells and TAMs. Evidence reveals that the efficacy of immune checkpoint inhibitors is improved when combined with therapeutic strategies targeting metabolism-related pathways. In-depth research on metabolic reprogramming and potential therapeutic targets provides more options for anti-tumor treatment and creates new directions for the development of new immunotherapy methods. In this review, we elucidate the metabolic reprogramming of TAMs and explore how they sustain immunosuppressive phenotypes to provide a perspective for potential metabolic therapies.
Extragonadal Germ Cell Tumors of the Mediastinum and Retroperitoneum
Authors: Aguiar Bujanda David , Pérez Cabrera Daniel , Croissier Sánchez Laura
Published: November 2022

Objectives:

Extragonadal germ cell tumors (EGCT) are a rare entity, most of them being located in the mediastinum and retroperitoneum. Information on these tumors is scarce, requiring carrying out large population-based studies to better understand these diseases. We aimed to determine the clinical features and prognosis of patients with EGCT of the mediastinum and retroperitoneum.

Materials and Methods:

Demographic and clinicopathological features of patients diagnosed with EGCT of the mediastinum and retroperitoneum from 1975 to 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database.

Results:

A total of 1674 patients were included, 1297 (77.5%) of mediastinal origin and 377 (22.5%) of retroperitoneum. Nonseminomatous tumors (56.3%) were slightly more frequent than seminomas (43.7%) with similar distribution between mediastinum and retroperitoneum. After a median follow-up of 137 months, the median overall survival was 263 months (95% CI, 220-296) whereas the median cause-specific survival (CSS) has still not been reached. The 10-year overall survival and CSS were 57.4% (95% CI, 55-59.7) and 63% (95% CI, 60.6-65.2) respectively. Multivariate analysis showed that older age, mediastinal location, nonseminomatous histology, and distant disease at diagnosis were independent prognostic factors correlated with a worse prognosis. Patients with mediastinal choriocarcinoma and embryonal carcinoma have the worst prognosis, both with a median CSS of only 12 months.

Conclusions:

Despite a decreasing incidence observed in recent decades, EGCT continues to represent a challenge for oncologists. The prognosis of choriocarcinoma and embryonal carcinoma of the mediastinum remains poor and treatment strategies need to be improved urgently.
Reflectance Confocal Microscopy for Identification of Vulvar Lichen Sclerosus et Atrophicus and Vitiligo
Authors: Gu Jing , Xia Rushan , Zou Yunmin
Published: November 2022

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory disease. The clinical presentation is clustered distribution of porcelain white spots that can be fused together. Early diagnosis of LSA is difficult, especially in the vulva, where it is difficult to distinguish from vitiligo. Traditional diagnostic methods mainly rely on histopathology. In this study, we used reflectance confocal microscopy (RCM) to study the characteristics of LSA and vitiligo. We investigated the clinical and confocal features of 40 cases of histopathologically proven genital LSA or vitiligo, and correlated the features with histopathologic findings. Through the analysis of the results, by RCM, we can easily distinguish genital LSA from vitiligo, which are clinically indistinguishable. This can reduce the number of unnecessary biopsies, and help with early diagnosis and timely treatment.
NASAL CROWDING AND NASAL TILTING OF THE MACULA AFTER EPIRETINAL MEMBRANE SURGERY
Authors: Jin Ki Won , Bae Seok Hyun , Park Young Joo , Park Kyu Hyung
Published: November 2022

Purpose:

To identify postoperative macula deviation after epiretinal membrane surgery and to investigate its clinical effects.

Methods:

Patients who underwent idiopathic epiretinal membrane removal and followed up for >12 months were enrolled. Macular deviation was evaluated using disk margin-to-fovea distance, foveal angle, and horizontal and vertical asymmetry of retinal thickness and volume. Horizontal or vertical asymmetry was defined as percentile asymmetry between nasal and temporal quadrants or between superior and inferior quadrants, respectively. The association between macular deviation parameters and best-corrected visual acuity and metamorphopsia were evaluated. Baseline and postoperative parameters were compared depending on epiretinal membrane severity.

Results:

Data from 102 eyes with a mean follow-up of 21.14 months were analyzed. Disk margin-to-fovea distance and foveal angle decreased with time and horizontal asymmetry of thickness and volume increased with time, showing nasal crowding and nasal tilting. Postoperative changes of disk margin-to-fovea distance and horizontal asymmetry were associated with best-corrected visual acuity. Severe epiretinal membrane eyes showed greater postoperative nasal deviation than mild epiretinal membrane eyes.

Conclusion:

Postoperative nasal crowding and tilting was quantitatively identified. The causative layers for nasal deviation might be the inner retinal layers, as the foveal angle decreased with time. Postoperative disk margin-to-fovea distance shortening and nasal-deviated horizontal asymmetry were correlated with best-corrected visual acuity improvement.
DRAINAGE RETINOTOMY IS A RISK FACTOR FOR SURGICAL FAILURE AFTER PARS PLANA VITRECTOMY IN PATIENTS WITH PRIMARY UNCOMPLICATED RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Ohara Hiromi , Yuasa Yuki , Harada Yosuke , Hiyama Tomona , Sadahide Ayako , Minamoto Akira , Hirooka Kazuyuki , Kiuchi Yoshiaki
Published: November 2022

Purpose:

To identify risk factors for recurrent retinal detachment after uncomplicated pars plana vitrectomy in patients with primary rhegmatogenous retinal detachment (RRD).

Methods:

This single-center retrospective study included patients with primary RRD who underwent 23-gauge and 25-gauge pars plana vitrectomy at Hiroshima University Hospital between January 2016 and May 2021. All patients had ≥3 months of follow-up. Patients were excluded if they had preoperative proliferative vitreoretinopathy worse than Grade C1; giant retinal tears; tractional, exudative, or traumatic retinal detachment; or the use of perfluorocarbon liquid. Factors that influenced RRD treatment outcome and postoperative complications were evaluated.

Results:

We analyzed 519 eyes of 509 patients who underwent pars plana vitrectomy for primary RRD. The primary and final success rates were 93.8% and 99.8%, respectively. Drainage retinotomy was a risk factor for surgical failure in both multivariate analysis (odds ratio 2.36, 95% confidence interval 1.08–5.15,P= 0.0314) and a propensity score-matching analysis (odds ratio 3.20, 95% confidence interval 1.14–9.04,P= 0.0277). Postoperative epiretinal membrane was associated with drainage retinotomy in multivariate analysis (odds ratio 1.93, 95% confidence interval 1.04–3.57,P= 0.0358).

Conclusion:

The avoidance of drainage retinotomy during small-gauge pars plana vitrectomy in patients with RRD may lead to better surgical success and less frequent epiretinal membrane formation.
FLUORESCENCE LIFETIME IMAGING OPHTHALMOSCOPY AS PREDICTOR OF LONG-TERM FUNCTIONAL OUTCOME IN MACULA-OFF RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Jaggi Damian , Solberg Yasmin , Dysli Chantal , Lincke Joel , Habra Oussama , Wolf Sebastian , Zinkernagel Martin
Published: November 2022

Purpose:

To assess whether macular fluorescence lifetimes may serve as a predictor for long-term outcomes in macula-off rhegmatogenous retinal detachment.

Methods:

A single-center observational study was conducted. Patients with pseudophakic macula-off rhegmatogenous retinal detachment were included and evaluated 1 and 6 months after successful reattachment surgery. Fluorescence lifetime imaging ophthalmoscopy lifetimes in the central Early Treatment Diabetic Retinopathy Study grid subfield, in two distinct channels (short spectral channel and long spectral channel) were analyzed. Best-corrected visual acuity optical coherence tomography of the macula and fluorescence lifetimes were measured at month 1 and month 6.

Results:

Nineteen patients were analyzed. Lifetimes of the previously detached retinas were prolonged compared with the healthy fellow eyes. Short lifetimes at month 1 were associated with better best-corrected visual acuity improvement (short spectral channel: r2 = 0.27, P < 0.05, long spectral channel: r2 = 0.23, P < 0.05) and with good final best-corrected visual acuity (short spectral channel: r2 = 0.43, P < 0.01, long spectral channel: r2 = 0.25, P < 0.05). Lifetimes were prolonged in some cases of outer retinal damage in optical coherence tomography scans.

Conclusion:

Fluorescence lifetime imaging ophthalmoscopy might serve as a prediction tool for functional recovery in pseudophakic macula-off rhegmatogenous retinal detachment. Retinal fluorescence lifetimes could give insight in molecular processes after rhegmatogenous retinal detachment.
Treatment for Intracorneal Hematoma by Anterior Chamber Gas Tamponade Combined With Keratocentesis
Authors: Toshida Hiroshi , Hayashi Yusuke , Ichikawa Kohei
Published: November 2022

Purpose:

To report a new surgical method for intracorneal hematoma removal using combination of keratocentesis and gas tamponade in the anterior chamber.

Methods:

We reviewed the clinical course and outcomes of surgical intervention.

Results:

An 82-year-old woman visited our department because of a sudden decline in visual acuity (20/800 on the Snellen chart) in her left eye. We observed neovascularization from the superior corneal limbus and a hematoma near the Descemet membrane, deep in the stroma of the corneal center. Filtered air was injected into the anterior chamber, keratocentesis was performed at four locations from the corneal epithelium through the stroma, and the hematoma was removed from the puncture sites. The corneal hematoma disappeared, and the best-corrected visual acuity reached 20/20 at postoperative month 4.

Discussion:

Combination of keratocentesis and gas tamponade in the anterior chamber is a simple and effective method for removing intracorneal hematomas.
Impact of prior pars plana vitrectomy on development of cystoid macular edema after uneventful cataract surgery
Authors: Du Jeanette , Landa Gennady
Published: November 2022

Purpose:

To investigate whether a history of prior pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) predisposes to the development of pseudophakic cystoid macular edema (CME).

Setting:

New York Eye and Ear Infirmary of Mount Sinai, New York, New York.

Design:

Retrospective cohort study.

Methods:

Records of 365 subjects who underwent PPV for RRD and subsequent cataract surgery between 2017 and 2020 were reviewed. Patients with a history of diabetic retinopathy, inflammatory retinal vascular disease, uveitis, advanced age-related macular degeneration, intraocular infection, myopic maculopathy, or significant intraoperative complications precluding posterior chamber intraocular lens placement were excluded. Age-matched subjects who underwent routine cataract surgery served as controls. Clinical data and macular optical coherence tomography (OCT) findings up to 4 years postoperatively were obtained.

Results:

54 eyes underwent uneventful cataract surgery by phacoemulsification and had a history of PPV with gas tamponade. 55 eyes underwent uneventful cataract surgery only. The average follow-up time after cataract surgery was 39.1 months. In eyes with a history of PPV, the incidence of OCT-detected CME was 27.8% (15/54) compared with 3.8% (2/55) in the control group (P < .001) and the incidence of clinically significant CME was 18.5% (10/54) compared with 1.8% (1/55) in the control group (P = .004). 80% (12/15) of CME cases were treated with topical therapy, and none required intravitreal injection.

Conclusions:

Prior PPV for RRD is associated with an increased incidence of pseudophakic CME after uneventful cataract surgery. Prophylactic or prolonged postoperative anti-inflammatory topical therapy may be prudent to consider in these patients.
The impact of body mass index on prostate cancer: An updated systematic review and meta-analysis
Authors: Tzenios Nikolaos , Tazanios Mary E. , Chahine Mohamed
Published: November 2022

Background:

Increasing evidence suggested obesity was associated with the risk of prostate cancer. Also, the association between prostate cancer risk and obesity has received much attention in recent years, but the results are still unclear. Therefore, the current systematic review and meta-analysis aimed to evaluate the impact of body mass index (BMI) on prostate cancer.

Methods:

We systematically searched PubMed, Google Scholar, Scopus and Cochrane databases with the appropriate key terms to identify the eligible articles related to the impact of BMI on prostate cancer. The Newcastle-Ottawa checklist was used for the quality assessment of studies, and the meta-analysis was carried out using Review Manager 5.3.

Results:

The present review includes 23 studies that fulfilled the criteria for inclusion. In the meta-analysis, a significant difference was observed between the obese and normal weight (P < .001) and 54% of obese has a risk compared to normal weight. Heterogeneity between the fifteen studies was high (I
2 = 100%). Test for overall effect: Z = 8.77 (P < .001) (odds ratio [OR] = 0.32 confidence interval [CI]: 0.25–0.42). However, there was no significant difference observed between the overweight and normal weight (P = .75). Heterogeneity between the fifteen studies is high (I
2 = 100%).

Conclusion:

Prostate cancer is a common malignancy that poses a threat to the health of men. Obesity is associated with a higher risk of death from prostate cancer based on the findings of the included studies. Furthermore, wherever possible, the impact of weight change on prostate cancer patient mortality should be investigated.
The use of radar plots with the Yk-index to identify which authors contributed the most to the journal of Medicine in 2020 and 2021: A bibliometric analysis
Authors: Shao Yang , Chien Tsair-Wei , Jang Fong-Lin
Published: November 2022

Background:

A consensus exists that the first author and corresponding author make the most contribution to the publication of an article. The Y-index has been proposed to assess the scientific achievements of authors, institutions, and countries/regions (AIC/R for short) based on the number of first-author publications (FPs) and corresponding-author publications (RPs). Nonetheless, the Y-index is defined in terms of count and radian (represented by j and h) instead of using the relative radius and angle degree to simplify understanding. In the literature, a method for drawing radar diagrams online with the Y-index is also lacking. This study was conducted to enhance the Y-index with an additional relative radius denoted by k and the angle degree represented by h* (named Yk-index), include easy-to-use features (e.g., copying and pasting) for the delivery of the online Radar-Yk, and identify which one of AIC/R contributed the most to a scientific journal.

Methods:

From the Web of Science (WoS) database, we downloaded 9498 abstracts of articles published in the journal of Medicine (Baltimore) in 2020 and 2021. Three visual representations were used, including a Sankey diagram, a choropleth map, and a radar diagram, to identify the characteristics of contributions by AIC/R to Medicine (Baltimore) using the Yk-index (j, k, h*). A demonstration of Rada-Yk with easy-to-use features was given using the copy-and-paste technique.

Results:

We found that Qiu Chen (China), Sichuan University (China), China, and South Korea (based on regions, e.g., provinces/metropolitan areas in China) were the most productive AIC/R, with their Yk equal to 27,715, 12415.1, and 2045, respectively; a total of 85.6% of the published articles in Medicine (Baltimore) came from the 3 countries (China, South Korea, and Japan); and this method of drawing the Radar-Yk online was provided and successfully demonstrated.

Conclusion:

A breakthrough was achieved by developing the online Radar-Yk to show the most contributions to Medicine (Baltimore). Visualization of Radar-Yk could be replicated for future academic research and applications on other topics in future bibliographical studies.
Differentiation of breast lesions on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) using deep transfer learning based on DenseNet201
Authors: Meng Mingzhu , Zhang Ming , Shen Dong , He Guangyuan
Published: November 2022

In order to achieve better performance, artificial intelligence is used in breast cancer diagnosis. In this study, we evaluated the efficacy of different fine-tuning strategies of deep transfer learning (DTL) based on the DenseNet201 model to differentiate malignant from benign lesions on breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). We collected 4260 images of benign lesions and 4140 images of malignant lesions of the breast pertaining to pathologically confirmed cases. The benign and malignant groups was randomly divided into a training set and a testing set at a ratio of 9:1. A DTL model based on the DenseNet201 model was established, and the effectiveness of 4 fine-tuning strategies (S0: strategy 0, S1: strategy; S2: strategy; and S3: strategy) was compared. Additionally, DCE-MRI images of 48 breast lesions were selected to verify the robustness of the model. Ten images were obtained for each lesion. The classification was considered correct if more than 5 images were correctly classified. The metrics for model performance evaluation included accuracy (Ac) in the training and testing sets, precision (Pr), recall rate (Rc), f1 score (f1), and area under the receiver operating characteristic curve (AUROC) in the validation set. The Ac of the 4 fine-tuning strategies reached 100.00% in the training set. The S2 strategy exhibited good convergence in the testing set. The Ac of S2 was 98.01% in the testing set, which was higher than those of S0 (93.10%), S1 (90.45%), and S3 (93.90%). The average classification Pr, Rc, f1, and AUROC of S2 in the validation set were (89.00%, 80.00%, 0.81, and 0.79, respectively) higher than those of S0 (76.00%, 67.00%, 0.69, and 0.65, respectively), S1 (60.00%, 60.00%, 0.60, 0.66, and respectively), and S3 (77.00%, 73.00%, 0.74, 0.72, respectively). The degree of coincidence between S2 and the histopathological method for differentiating between benign and malignant breast lesions was high (κ = 0.749). The S2 strategy can improve the robustness of the DenseNet201 model in relatively small breast DCE-MRI datasets, and this is a reliable method to increase the Ac of discriminating benign from malignant breast lesions on DCE-MRI.
Efficacy of combination colonoscopy using modified cap-assisted and water-exchange colonoscopy with prone position for detection of colorectal adenomas
Authors: Ko Jihwan , Kim Hyung Wook , Kang Dae Hwan , Choi Cheol Woong , Han Seong Ho , Ko Byung Gu
Published: November 2022

The efficacy of cap-assisted and water-exchange colonoscopy, individually or in combination for adenoma detection is well documented. Moreover, prone positioning colonoscopy may also improve adenoma detection by decreasing loop formation. However, the efficacy of triple-combination colonoscopy using the above methods for adenoma detection is unclear. This study aimed to compare the effectiveness of combining modified cap-assisted and water-exchange colonoscopy with prone position (CWP) and conventional colonoscopy (CC) for adenoma detection.

A total of 746 patients who underwent either CWP or CC, performed by 2 board-certified gastroenterologists between December 2019 and March 2020, were investigated retrospectively. Cap-assisted colonoscopy was modified using hooking and dragging maneuver. We evaluated the polyp detection rate (PDR), adenoma detection rate (ADR), and the mean number of adenomas detected per procedure (MAP).

There was no significant difference in sex, age, the indication of colonoscopy and quality of bowel preparation between the 2 groups. PDR, ADR, and proximal colon MAP were significantly higher in the CWP group than in the CC group (PDR: 84.9% vs 59.8%, P < .01; ADR: 70.1%, vs 49.2%, P < .01; proximal colon MAP: 1.24 vs 0.55, P < .01).

CWP is more effective than CC for PDR, ADR, and proximal colon MAP. Although it may facilitate adenoma detection, further studies assessing the synergistic or complementary effects of combining these methods are needed.
The mean kurtosis (MK) is more sensitive diagnostic biomarker than fractional anisotropy (FA) for Parkinson’s disease: A diagnostic performance study and meta-analysis
Authors: Huang Songtao , Dong Yanchao , Zhao Jiaying
Published: November 2022

Background:

The mean kurtosis (MK) and fractional anisotropy (FA) in patients of Parkinson’s disease (PD) are usually measured by diffusion kurtosis imaging (DKI) and diffusion tensor imaging (DTI), separately.

Methods:

In this study we perform a meta-analysis to discuss which noninvasive biomarker is more advantageous for PD, MK, or FA. Databases including Medline via PubMed, the Cochrane Central Register of Controlled Trials, Embase via OVID and China National Knowledge Infrastructure. Databases are searched up to December 31st, 2019. Four brain regions are identified for analysis based on data extracted from articles.

Results:

The articles contain 5 trials with 274 total PD patients and 189 healthy controls (HCs). The results show not only significantly higher MK values of putamen, caudate, globus pallidus in PD compared to that of HCs (weighted mean difference [WMD] = 0.06, 95% CI = 0.02–0.09, P = .002, WMD = 0.03, 95% CI = 0.01–0.067, P = .01, WMD = 0.18, 95% CI = 0.11–0.24, P < .00001), but also a significantly higher FA in caudate of PD compared to HCs (WMD = 0.02, 95% CI = 0.00–0.03, P = .006).

Conclusion:

This indicates that the sharp difference detected between PD patients and HCs can be detected by DKI and DTI. By further discussing results, we found that MK could be more sensitive diagnostic biomarker than FA toward PD diagnosis.
Effects of midazolam co-induction to general anesthesia: A randomized clinical trial
Authors: Mihalj Mirko , Karlović Zoran , Vladić-Spaić Dajana , Matić Boris , Mikulić Iva , Mikulić Vinka , Golubović Vesna
Published: November 2022

Background:

This study aimed to determine the potential advantages of midazolam co-induction with general anesthesia (GA) over the use of propofol alone.

Methods:

We conducted a randomized, placebo-controlled, single-blinded clinical trial of 102 patients, aged 18 to 65, American Society of Anesthesiologists II and III, who underwent elective laparoscopic gallbladder surgery. Patients were randomly divided into 3 groups: the placebo group (C) received 1 mL of 0.9% saline intravenously and the test groups received intravenous midazolam at doses of 0.03 mg/kg (M1) or 0.06 mg/kg (M2) before induction of GA. We assessed effects of midazolam co-induction on arterial pressure and heart rate (HR) in the early stage of GA prior to surgical incision and effects on perioperative and postoperative glycemia and cortisol levels. Systolic/mean/diastolic (SAP/MAP/DAP) arterial pressure and HR were measured 4 times (preoperative, on the third, sixth and ninth minute after atracurium administration). Cortisol was measured on 3 occasions (preoperatively, 60 minutes after surgical incision, and the following morning) and glucose on 4 occasions (preoperatively, 15 and 60 minutes after incision, and the following morning). We also assessed the incidence of postoperative anxiety, postoperative nausea and vomiting (PONV), and propofol requirement for induction.

Results:

SAP/MAP/DAP were significantly higher in M2 immediately after induction compared to the other study groups (P = .002/.004/.013). Midazolam co-induction led to a significant reduction in postoperative anxiety (P = .03), reduced cortisol concentration 60 minutes after surgical incision (P < .001) and propofol requirements (P < .001).

Conclusion subsections:

Midazolam co-induction prevented a marked decline in SAP/MAP/DAP immediately after induction of GA, led to reduced postoperative anxiety and cortisol response to surgery, and reduced propofol requirements for induction.
Effectiveness and tolerability of adjunctive perampanel in pediatric patients (aged 4–12 years) with refractory epilepsy: An observational study
Authors: Chu Si-Jia , Li Yan , Tang Ji-Hong
Published: November 2022

Information on the effects of perampanel in Chinese children ≤12 years of age with refractory epilepsy is limited; thus, we conducted an observational study to assess the effectiveness, safety, and tolerability of adjunctive perampanel in this pediatric population. In this study, we reviewed the medical records of pediatric patients aged 4 to 12 years with refractory epilepsy who were admitted to Children’s Hospital of Soochow University and prescribed perampanel between January 2020 and January 2021. Effectiveness of perampanel was measured by 50% responder rates, seizure-freedom rates, and retention rates for up to 48 weeks. Adverse events were monitored and recorded throughout the study. A total of 34 patients (male, n = 15) who exhibited refractory epilepsy were included in this study, and 64.71% of patients had focal-onset seizures combined with generalized epilepsy. The mean (± standard deviation) age of patients was 7.21 (± 2.12) years, with a mean (± standard deviation) age at seizure onset of 4.57 (± 2.59) years. After the addition of perampanel, the 50% responder rates at 4, 8, 12, 24, 36, and 48 weeks were 37.50% (12/32), 43.75% (14/32), 53.13% (17/32), 59.38% (19/32), 59.38% (19/32), and 62.07% (18/29). Two patients withdrew from perampanel treatment due to adverse events in the first 2 weeks. Adverse events were reported by 44.12% (15/34) of patients, and the retention rates at 36 and 48 weeks were 94.12% (32/34) and 85.29% (29/34), respectively. Overall, perampanel exhibited good effectiveness, safety, and tolerability in the treatment of pediatric patients (aged 4–12 years) with refractory epilepsy. These findings suggest that personalized treatment and better baseline seizure control may increase the responder rate and retention rate of perampanel.
A case report on the role of endoscopic retrograde cholangiopancreatography in the diagnosis of hemosuccus pancreaticus
Authors: Moon Sung Mi , Paik Kyu-Hyun , Kim Ji Chang , Park Won Suk
Published: November 2022

Rationale:

Hemosuccus pancreaticus (HP) is a rare cause of gastrointestinal bleeding that sometimes leads to life-threatening conditions. However, the diagnosis of HP is often delayed due to its rarity and intermittent signs of bleeding, making it challenging to determine the source of bleeding in some patients.

Patient concerns:

An 83-years-old man was transferred to our hospital for evaluation of the source of intermittent upper gastrointestinal bleeding involving melena and worsening anemia.

Diagnosis:

HP was diagnosed via endoscopic retrograde cholangiopancreatography (ERCP) and sequential angiography using a multidisciplinary approach.

Interventions:

Initial upper and lower gastrointestinal endoscopies did not reveal any source of bleeding. Emergency upper endoscopy performed when the patient had hematochezia and hypotension confirmed a spurt of bleeding from the major duodenal papilla. However, contrast-enhanced computed tomography and angiography could not identify the source of the bleeding from the major duodenal papilla. ERCP for inducing bleeding from the source and indicating the bleeding point was performed according to the decision of the multidisciplinary team. Immediately thereafter, sequential angiography was performed and HP, due to the rupture of a pseudoaneurysm of the splenic artery, was diagnosed. As a result, surgical resection of the pancreas could be avoided by accurately embolizing the bleeding focus of HP using a multidisciplinary team approach.

Outcomes:

The patient was discharged in a hemodynamically stable condition. There was no further gastrointestinal bleeding or procedure-related complication until 6 months after discharge.

Lessons:

HP should be considered by endoscopists during the differential diagnosis of intermittent upper gastrointestinal bleeding in patients with a history of pancreatitis. A multidisciplinary team approach is an effective method to determine the source or location of bleeding, which may reduce mortality and morbidity by avoiding additional pancreatectomies.
Nerve root compression due to lumbar spinal canal tophi: A case report and review of the literature
Authors: Wang Kai , Yang Quan-Zeng , Wen Hao-Nan , Hai Yun-Xaing , Gao Guo-Dong , Song Min
Published: November 2022

Rationale:

Gout in the spine and adnexa is rare in clinical practice and can also be easily misdiagnosed, we reported a patient with nerve root compression due to lumbar gout stones in the lumbar spinal canal.

Patient concerns:

A 51-year-old male was admitted to the hospital with lumbar pain with numbness in the left lower limb for more than 6 months. The physical examination showed that tenderness and percussion pain were present at L4-S1 spinous process. Straight leg raise test: 50° on the left side were positive. Laboratory tests showed that the sUA was 669 μmol/L, MRI of the lumbar spine showed that cystic T1WI low signal and T2WI mixed high signal shadows were seen in the spinal canal at the level of L4-L5.

Diagnoses:

Combining with lab examinations, imaging examinations, and histopathological results, the patient was diagnosed with lumbar spinal canal tophi.

Interventions:

After active improvement of all examinations, the patient underwent surgical treatment with decompression and internal fixation of the L4-L5 segment.

Outcomes:

After surgery, the patient’s symptoms improved and muscle strength returned to normal. Among the 95 previously reported patients with lumbar gout, the ratio of men to women was 2.96:1, and the peak age group of incidence was 56 to 65 years. The onset of the disease was mainly in a single segment of the lumbar spine, with 34.41% of all cases occurring at the L4-L5 level. 61.05% of the patients had a history of gout attacks or hyperuricemia, and the most frequently involved site was the foot and ankle, followed by the wrist. Sixty-seven patients underwent surgical treatment, and 22 chose conservative treatment, with overall satisfactory results.

Lessons subsections:

The incidence of lumbar gout is low and relatively rare in the clinic and pathological biopsy is still the gold standard. Vertebral plate incision and decompression are often selected for surgical treatment, and whether to perform fusion should be comprehensively considered for the destruction of vertebral bone by gout and the reasonable selection of the extent of surgical resection. Whether choosing surgical treatment or conservative therapy, the control of uric acid levels should be emphasized.
Metformin and bladder cancer: Drug repurposing as a potential tool for novel therapy: A review
Authors: Feng Yunzhu , Jia Benzhong , Shen Zhiyong
Published: November 2022

Bladder cancer (BC) is a common type of cancer worldwide. Currently, the gold standard treatment is transurethral resection of bladder tumor (TUR-Bt) accompanied by intravesical Bacillus Calmette–Guérin (BCG) instillation for patients with middle-to-high-risk non-muscle-invasive bladder cancer (NMIBC). However, intravesical BCG therapy fails in almost 50% of high risk cases, leading to NMIBC persistence or early recurrence. In these patients, the gold standard remains radical cystectomy; however, it can seriously affect the patients’ quality of life. Moreover, for patients with muscle-invasive bladder cancer (MIBC), the 5-year survival rate after radical cystectomy with neoadjuvant chemotherapy remains low. Recent discoveries have paved the way for a new era in BC treatment. Metformin is the most widely used oral hypoglycemic drug in clinical practice, being mostly used in the treatment of type 2 diabetes. Epidemiological studies have demonstrated that metformin exerts a potentially positive effect on reducing the incidence and mortality of cancer; therefore, a increasing number of studies have investigated the potential anticancer effects of metformin and its mechanisms of action. This review aims to summarize the evidence for the role of metformin in bladder cancer therapy, including how metformin mediates bladder cancer cell apoptosis.
BRCA2 gene mutation in cancer
Authors: Xie Chunbao , Luo Jiangrong , He Yangjun , Jiang Lingxi , Zhong Ling , Shi Yi
Published: November 2022

Breast cancer susceptibility gene 2 (BRCA2) is the main gene associated with hereditary breast cancers. However, a mutation in BRCA2 has also been found in other tumors, such as ovarian, pancreatic, thyroid, gastric, laryngeal, and prostate cancers. In this review, we discuss the biological functions of BRCA2 and the role of BRCA2 mutations in tumor progression and therapy.
Surgical treatment of recurrent postoperative discal pseudocyst: A case report and literature review
Authors: Wang Hong , Wang Shuang , Yu Hailong , Chen Yu , Zheng Liang , Ma Junxiong
Published: November 2022

Introduction:

Postoperative discal pseudocyst (PDP) is rare. Few studies have reported on the recurrence of PDPs, and there is a lack of understanding of their clinical features and treatment methods. This study discusses the clinical characteristics and treatment of recurrent PDPs.

Patient concerns:

A 25-year-old man presented with radiating pain and numbness in the lateral left calf and dorsum of the foot.

Diagnosis:

Postoperative discal pseudocyst.

Interventions:

He underwent lumbar discectomy, which provided immediate postoperative relief. However, the symptoms recurred 45 days later. Magnetic resonance imaging (MRI) showed a lesion compressing the dura and nerve roots at the site of the previous surgery. The lesion appeared hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging. The patient was treated conservatively for 1 month without significant relief. He then underwent lumbar discectomy and cyst removal, which immediately relieved his symptoms. However, 27 days later, the patient again developed the same symptoms. MRI examination showed recurrence of PDP. As 1 month of conservative treatment failed to relieve the patient’s symptoms, we performed posterior instrumented lumbar fusion and cyst removal.

Outcomes:

The patient’s symptoms disappeared, and have not recurred for 1 year at the time of writing.

Conclusions:

PDP is a rare complication of lumbar discectomy. Repeat lumbar discectomy can effectively treat PDP, but the cyst can recur. We, for the first time, used posterior instrumented lumbar fusion to successfully treat recurrent PDP.
Well-Differentiated Grade 3 Neuroendocrine Tumors
Authors: Boutin Mélina , Mathews Angela , Badesha Jasleen , Paul Ashley , Safro Maria , Gill Sharlene , Stuart Heather C. , Schaeffer David , Farnell David , Loree Jonathan M.
Published: November 2022

Objectives

We evaluated a population-based cohort of metastatic well-differentiated grade 3 gastroenteropancreatic neuroendocrine tumors (G3 NETs) to describe their characteristics, prognosis, and treatment outcomes.

Methods

The British Columbia provincial database was queried for G3 NETs diagnosed 2004 to 2021, and charts were reviewed to describe clinical features and outcomes.

Results

Forty-one patients were identified, most were diagnosed with pancreatic (58.5%) or midgut (26.8%) primary tumor and Ki-67 was less than 55% in 68.3%. The primary was resected in 19 (46.3%) with median disease-free survival of 25.2 months. Once metastatic, patients received a median of one line of systemic therapy. Median overall survival with metastatic disease was 33.8 months. Median progression-free survival was longest in patients treated with capecitabine-temozolomide (20.6 months) or somatostatin analogs (7.9 months), while etoposide-platinum provided little benefit (2.4 months). Limited data of efficacy for targeted therapies and radionuclide therapy was available. Seven patients (17.1%) were also treated with local therapies, which were associated with improved overall survival (median not reached, hazard ratio, 0.23; P = 0.012).

Conclusions

Capecitabine-temozolomide and somatostatin analogs were associated with clinically meaningful benefit, and use of local therapies provided benefits in selected patients. Multidisciplinary discussion is essential to optimize individual outcomes in this heterogeneous population.
The Use of Vasopressors During Deceased Donor Pancreas Procurement Decreases the Risk of Pancreas Transplant Graft Failure
Authors: Froehlich Mary , Koizumi Naoru , James Rosy M. , Christian Ana Gayle Weatherly , Choubey Ankur , Patel Sunil , Ortiz Jorge , Siskind Eric J.
Published: November 2022

Objectives

The objective of this study was to identify the effect of various vasopressors on pancreas graft failure and patient survival.

Methods

A retrospective analysis of the United Network for Organ Sharing database was performed between 2000 and 2019. Patient and graft survival rates were analyzed up to 5 years posttransplant.

Results

The data included 17,348 pancreas transplant recipients: 12,857 simultaneous pancreas-kidney, 1440 pancreas transplant alone, and 3051 pancreas-after-kidney transplant recipients. Use of dopamine during deceased donor procurement increased graft failure by 18% (hazard ratio [HR], 1.18; P < 0.001). Absence of vasopressor caused graft failure to rise by 8% (HR, 1.08; P = 0.09). Dopamine increased the mortality rate by 37% (HR, 1.37; P < 0.001) and the absence of vasopressor increased the mortality rate by 14% (HR, 1.14; P = 0.02). Phenylephrine and norepinephrine reduced the mortality rate by 10% (HR, 0.90; P = 0.05) and 11% (HR, 0.89; P = 0.10), respectively.

Conclusions

The absence of vasopressor use or the use of dopamine is associated with a higher risk of both pancreas transplant graft failure and recipient mortality. The use of phenylephrine and norepinephrine reduces the risk of mortality. This information should guide deceased donor hemodynamic support management in anticipation of pancreas procurement for future transplantation.
Association Between Family History and Risk of Pancreatic Cancer in Patients With BRCA1 and BRCA2 Pathogenic Variants
Authors: Shah Ishani , Silva-Santisteban Andy , Germansky Katharine A. , Kandasamy Cinthana , Mlabasati Jack , Huang Dora C. , Wadhwa Vaibhav , Bilal Mohammad , Sawhney Mandeep S.
Published: November 2022

Objectives

Current guidelines limit pancreatic cancer screening to those BRCA1/2 patients who have a family history of pancreatic cancer. We aimed to assess the association between family history and risk of pancreatic neoplasms in BRCA1/2 patients.

Methods

We reviewed medical records of BRCA1/2 patients followed at our institution between 1995 and 2020. Family history was defined as those with a first-degree relative with pancreatic cancer. We compared the incidence and prevalence of pancreatic neoplasms between patients with and without family history of pancreatic cancer.

Results

We identified 56 BRCA1/2 patients with family history and 238 without family history of pancreatic cancer. No difference between these groups was noted in age, race, or sex. Mean follow-up interval for BRCA1/2 patients was 4.6 years (range, 0–19.7 years). There was no significant difference in prevalence (19.6% vs 12.6; P = 0.3) or incidence (29% vs 14.1%; P = 0.08) of branch-duct intraductal papillary mucinous neoplasm between the 2 groups. No association between family history and pancreatic cancer risk was noted. Only 1 of 10 BRCA1/2 patients with pancreatic cancer had a family history.

Conclusions

Our results do not support using family history to determine eligibility for pancreatic cancer screening.
Concurrent Overexpression of Two Hyaluronidases, KIAA1199 and TMEM2, Strongly Predicts Shorter Survival After Resection in Pancreatic Ductal Adenocarcinoma
Authors: Kudo Yuzan , Sato Norihiro , Oba Takuya , Adachi Yasuhiro , Amaike Takao , Koga Atsuhiro , Kohi Shiro , Noguchi Hirotsugu , Nakayama Toshiyuki , Hirata Keiji
Published: November 2022

Objectives

Pancreatic ductal adenocarcinoma (PDAC) is characterized by accelerated hyaluronan metabolism. Our previous studies have shown increased expression of 2 newly identified hyaluronidases, KIAA1199 and transmembrane protein 2 (TMEM2), in PDAC. However, the relationship between these 2 hyaluronidases is unknown. In the present study, we investigated the correlation between KIAA1199 and TMEM2 expression in PDAC.

Methods

Using quantitative real-time reverse transcription polymerase chain reaction, we analyzed KIAA1199 and TMEM2 mRNA expression in 11 PDAC cell lines and frozen tissues from 12 patients with PDAC. We used immunohistochemistry to investigate expression patterns of KIAA1199 and TMEM2 in archival tissues obtained from 92 patients with PDAC who underwent surgical resection. We compared survival between 4 groups according to expression patterns of KIAA1199 and TMEM2.

Results

We found a significantly positive correlation between KIAA1199 and TMEM2 mRNA in PDAC cell lines and tissues. Immunohistochemical analysis found that median overall survival was 30.2 months in patients with low expression of KIAA1199 and TMEM2 and 12.5 months in those with high expression of both. Patients with high expression of KIAA1199 and TMEM2 had significantly shorter survival than other patient groups.

Conclusions

Concurrent overexpression of these 2 hyaluronidases could be a strong prognostic marker in PDAC.
Bioinformatics Analysis of Differentially Expressed Genes and Related Pathways in Acute Pancreatitis
Authors: Zhong Rui , Luo Xujuan , Xu Jin , Jiang Xin , Yan Yongfeng , Shi Xiaomin , Peng Yan , Tang Xiaowei , Fu Xiangsheng
Published: November 2022

Objectives

The aim of this study was to investigate differentially expressed genes (DEGs) in the acute pancreatitis (AP).

Methods

Microarray datasets GSE3644, GSE65146, and GSE109227 were downloaded from Gene Expression Omnibus database. Then, a comprehensive analysis of these genes was performed using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis, protein-protein interaction network analysis, core gene correlation analysis, and transcription factor prediction. Finally, the differences in the expression of hub genes in human organs and survival analysis in pancreatic carcinoma were evaluated.

Results

A total of 137 DEGs were screened, 128 genes were upregulated, and 9 genes were downregulated. Functional enrichment analysis demonstrated that these genes were mostly enriched in biological processes such as positive regulation of macroautophagy, cellular component such as focal adhesion, molecular function such as cadherin binding involved in cell-cell adhesion, and multiple pathways including tight junction. CDH1 and VCL were identified as hub DEGs, close interactions with MAZ, were expressed in human pancreas organs in various degrees. The high expression of CDH1 and VCL was significantly associated with poor prognosis in pancreatic carcinoma.

Conclusions

The core genes CDH1 and VCL may play a key role in AP through regulation by MAZ.
Stigma in the Context of COVID-19 Crisis
Authors: Khatooni Marzieh
Published: November 2022

Background:

Stigmatizing anyone during a pandemic poses a threat to everyone and can be an obstacle to disease treatment. The stigma around COVID-19 stems from the fact that it is a life-threatening disease and a lot is unknown about it.

Aim:

This study was conducted with the aim of analyzing and clarifying the concept of stigma in the context of COVID-19; determining its psychological and socio-psychological outcomes; enhancing understanding and recognition of features, antecedents, and consequences of the concept; and proposing an adequate definition for use in clinical practice or research.

Methods:

Rodgers' evolutionary concept analysis was used.

Results/Conclusion:

Stigma in the context of COVID-19 has antecedents, which include informational and psychological issues, media performance, and some governments' policies and actions to control COVID-19 pandemic. The attributes of COVID-19 stigma are subjective and variable, perceived, and/or experienced with interrelated intrapersonal, interpersonal, and structural or institutional dimensions that can be summarized as social stigma and self-stigma. The consequences of COVID-19 stigma are social isolation and psychological burden, physical and mental violence and harassment, hiding disease, and reduced care-seeking behavior. These results will extend the body of knowledge on theory and practice and also assists future researchers in many folds.

Implications for Case Management Practice:

These findings will be a major tool for the case manager/health care team, policy makers, and other human resource planning professionals to develop plans for preventing, combating, and stopping the COVID-19–related stigma.
End-of-Life Doulas
Authors: Powell Suzanne K.
Published: November 2022

Death doulas are people who help people at the end of life with dying, just like birth doulas help at the beginning of life. Views of traditions surrounding death, such as funerals and other ways to memorialize loved ones, are shifting. Death doula associations are seeing an increased interest from people who are seeking death doulas and those who wish to become death doulas.