bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular biology of carcinoid heart disease: Seeking therapeutic targets in the era of targeted therapy
Authors: Khan Sajjad Ahmed , Devkota Dikshya , Chaudhary Rahul Kumar , Luitel Anish , Parajuli Surya Bahadur , Bista Madhab , Rayamajhi Asmita
Published: December 2023

Carcinoid tumors (CT) are among the least studied tumors. It is a relatively rare and slow-growing tumor with good survival in its primary form. However, metastatic carcinoid tumor comes up with many different complications contributing to increased morbidity and mortality. Metastatic form of the disease has a wide spectrum of clinical manifestations and multisystem involvement including cardiovascular manifestations, neurological manifestations, and psychiatric manifestations and so on. In this review, we are centered towards the cardiovascular manifestations of the disease, which, by far, is one of the commonest causes of death in these patients. Being a neuroendocrine tumor, cardiovascular manifestations are mainly because of biologically active substances, produced by the tumor cells, remodeling the heart. Development of targeted therapies against carcinoid heart diseases is currently limited by lack of understanding of pathophysiology of the disease processes. In this review, we aim to figure out the spectrum of carcinoid heart diseases, along with the molecular biology of the changes going on, which, in turn, will not only pave a way to the development of targeted therapies but will also extend opportunities for molecular screening of the tumor and diagnosis at an early stage, thereby, reducing the morbidity and mortality.
Effect of TCM rehabilitation program on activities of daily living in patients with post-stroke limb spasticity: An observational study
Authors: Zhu Chuanxi , Qiu Long , Sun Weichen , Yang Chong , Cong Deyu , Wang Yufeng , Ji Guangcheng
Published: December 2023

Background:

Stroke is a neurological disease with many common complications that reduce the activities of daily living and the quality of life of patients. Traditional Chinese medicine (TCM) rehabilitation techniques, scalp acupuncture, and TCM can relieve spasticity symptoms and recovery from physical obstacles is significant.

Methods:

Three hundred twenty-one patients with post-stroke limb spasticity were randomly divided into trial and control groups, with 159 and 162 patients in the trial and control groups, respectively. The control group received basic treatment combined with modern rehabilitation techniques, whereas the trial group received basic treatment combined with TCM, Tuina, and scalp acupuncture with kinesiotherapy. The treatment course in both groups was 4 weeks. The Modified Ashworth Scale, magnetic resonance imaging, and Stroke Specific Quality of Life Scale were used to evaluate limb spasticity, activities of daily living, and quality of life, respectively. PASW 18.0 was used for statistical analysis.

Results:

With a longer treatment period, the improvement in limb spasticity was greater in the trial group than in the control group (P < .05). Similarly, improvements in activities of daily living and quality of life were better in the trial group than in the control group (P < .05).

Conclusion:

The TCM rehabilitation program using Tongjing Tiaoxing combined with scalp acupuncture and kinesiotherapy can effectively treat spasticity symptoms in stroke patients and improve their activities of daily living and quality of life.
Effective cochlear implantation for idiopathic hypertrophic pachymeningitis with bilateral profound hearing loss: A case report
Authors: Idei Katsuyoshi , Kitamura Mitsuru , Shimanuki Marie N. , Hosoya Makoto , Tsuzuki Nobuyoshi , Hasebe Natsuki , Nishiyama Takanori , Ozawa Hiroyuki , Oishi Naoki
Published: December 2023

Rationale:

Hypertrophic pachymeningitis (HP) is a local or diffuse fibrous thickness of the dura mater of the brain or spinal cord, caused by infection or connective tissue disease. Headache is the most common clinical symptom, followed by various cranial nerve disorders such as visual impairment, diplopia, and hearing loss. HP can be classified into secondary and idiopathic. Here, we report a case of bilateral progressive profound sensorineural hearing loss diagnosed in a patient with idiopathic HP, where a cochlear implant was effectively used.

Patient concerns:

The patient was a 77-year-old woman. Hearing loss gradually progressed bilaterally, and magnetic resonance imaging showed a space-occupying lesion with a continuous contrast enhancement in the bilateral internal auditory canals, and diffused dural thickening from the middle to the posterior cranial fossa.

Diagnoses:

A trans-labyrinthine biopsy was conducted, and a definite diagnosis of idiopathic HP was made. Thickening of the dura mater in the bilateral internal auditory canals was thought to cause profound hearing loss.

Interventions and outcomes:

A cochlear implant was implemented 4 months after biopsy, and a favorable hearing response was obtained postoperatively.

Lessons:

This is the first report of a cochlear implant in a patient with idiopathic HP. Cochlear implantation was considered a good treatment for profound hearing loss due to idiopathic HP, which provides a reference for patients to receive timely and correct treatment.
Atrial myxoma embolization of the basilar artery presenting with a convulsive seizure: Case report
Authors: Xu Yaning , Jiang Jiaojin , Zhang Meng
Published: December 2023

Background:

Basilar artery occlusion (BAO) is a rare cause of convulsive seizure. Such patients who are treated for epilepsy will miss the optimal time for treatment. Atrial myxoma is a rare cause of stroke and should be surgically removed as soon as possible after diagnosis.

Case summary:

We report a patient who presented with convulsions as the initial symptom and was diagnosed with BAO by computed tomographic angiography. After transthoracic echocardiogram, the cause of the disease was diagnosed as atrial myxoma. The patient recovered well after endovascular treatment and resection of the atrial myxoma.

Conclusion:

A small number of patients with BAO present with convulsive seizures. It is very important to make a timely diagnosis. Direct thrombaspiration may be the best choice for basilar artery cardioembolization, and thrombectomy for distal moderate vascular occlusion in posterior circulation is feasible. Atrial myxoma is a rare cause of cardioembolic stroke and should be resected as soon as possible to prevent further embolic complications.
Development of multidisciplinary, evidenced-based protocol recommendations and implementation strategies for anterior lumbar interbody fusion surgery following a literature review
Authors: Meyrat Richard , Vivian Elaina , Sridhar Archana , Gulden R. Heath , Bruce Sue , Martinez Amber , Montgomery Lisa , Reed Donald N. , Rappa Peter J. , Makanbhai Hetendra , Raney Kenneth , Belisle Jennifer , Castellanos Stacey , Cwikla Judy , Elzey Kristin , Wilck Kristen , Nicolosi Fallon , Sabat Michael E. , Shoup Chris , Graham Randall B. , Katzen Stephen , Mitchell Bartley , Oh Michael C. , Patel Nimesh
Published: December 2023

The anterior lumbar interbody fusion (ALIF) procedure involves several surgical specialties, including general, vascular, and spinal surgery due to its unique approach and anatomy involved. It also carries its own set of complications that differentiate it from posterior lumbar fusion surgeries. The demonstrated benefits of treatment guidelines, such as Enhanced Recovery after Surgery in other surgical procedures, and the lack of current recommendations regarding the anterior approach, underscores the need to develop protocols that specifically address the complexities of ALIF. We aimed to create an evidence-based protocol for pre-, intra-, and postoperative care of ALIF patients and implementation strategies for our health system. A 12-member multidisciplinary workgroup convened to develop an evidence-based treatment protocol for ALIF using a Delphi consensus methodology and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for rating the quality of evidence and strength of protocol recommendations. The quality of evidence, strength of the recommendation and specific implementation strategies for Methodist Health System for each recommendation were described. The literature search resulted in 295 articles that were included in the development of protocol recommendations. No disagreements remained once the authors reviewed the final GRADE assessment of the quality of evidence and strength of the recommendations. Ultimately, there were 39 protocol recommendations, with 16 appropriate preoperative protocol recommendations (out of 17 proposed), 9 appropriate intraoperative recommendations, and 14 appropriate postoperative recommendations. This novel set of evidence-based recommendations is designed to optimize the patient’s ALIF experience from the preoperative to the postoperative period.
The effect of atopic dermatitis in pediatric patients on height: Reflections triggered by a real-life case report
Authors: Zhang Mei , He Ming , Tang Ting
Published: December 2023

Rationale:

Atopic dermatitis (AD) is a burdensome skin disorder, especially in children. The prevalence of children with AD is increasing year by year in China. Typical symptoms like eczema-like lesions and severe pruritus can seriously affect the sleep quality and the growth and development of pediatric patients.

Patient concerns:

We observed a pair of fraternal twins, in which the younger sister had AD, while the elder one had no relevant medical history. At present, the height of the 2 individuals is significantly inconsistent, with a difference of about 10 cm.

Diagnoses:

Based on the little patient’s medical history and clinical manifestations, the diagnosis of AD was made.

Interventions:

This little patient was treated with oral routine antihistamines, topical glucocorticoids and Dupilumab.

Outcomes:

At present, her rash and xerosis have significant improvement. She also have relief of generalized itching and improved sleep quality.

Lessons:

Previous studies have indeed shown that AD has a negative impact on children’s height. This case leads us to consider the association between AD and height. It also gave us the opportunity to observe subsequent height changes after the intervention was carried out.
Clinical characteristics, early blood biochemical indicators, and prognostic status of children with bronchopneumonia
Authors: Ling Yuanyuan , Yang Dean , Yang Sha
Published: December 2023

To investigate the clinical characteristics, early blood biochemical indicators, and prognostic status of children with bronchopneumonia. We conducted a retrospective analysis of data from 500 children diagnosed with bronchopneumonia at our hospital from June 2019 to December 2022. Based on the severity of the disease, patients were assigned to the severe group (n = 180) or mild group (n = 320), and an additional 150 healthy children were chosen as the control group. Blood indicators [aspartate aminotransferase (AST), plasma carbon dioxide combining power (CO2CP), serum potassium (K+), serum sodium (Na+)], inflammatory markers [interleukin-17 (IL-17), interleukin-10 (IL-10), C-reactive protein (CRP), procalcitonin (PCT)], and cardiac enzyme profiles [lactate dehydrogenase (LDH), creatine kinase (CK), alpha-hydroxybutyrate dehydrogenase (α-HBDH), creatine kinase isoenzyme (CK-MB)] were compared among the 3 groups. The severe group showed more signs such as diarrhea, pleural effusion, and respiratory distress than the mild group. AST levels in the severe group were significantly higher than those in the mild group and control group, while CO2CP, K+, and Na+ were lower than those in the mild group and control group. AST levels in the mild group were significantly higher than those in the control group, while CO2CP and Na + were significantly higher than those in the control group (P < .05). IL-10, IL-17, PCT, and CRP levels in the severe group were higher than those in the mild group and control group, while those in the mild group were higher than those in the control group (P < .05). CK, CK-MB, LDH, and α-HBDH levels in the severe group were significantly higher than those in the mild group and control group. CK, CK-MB, LDH, and α-HBDH levels in the mild group were higher than those in the control group (P < .05). The severe group had a longer duration of fever, disappearance of symptoms, and cough relief time than the mild group (P < .05). Children with bronchopneumonia exhibit increased cardiac enzyme (CK, CK-MB, LDH, and α-HBDH) activity, and PCT and CRP expression levels increase with disease severity. Timely detection of relevant blood biochemical indicators and early implementation of prevention and treatment measures can improve the cure rate and reduce mortality in children with bronchopneumonia.
Treatment outcomes of tubal pregnancy with tubal preservation: A meta-analysis
Authors: Long Yan , Lin Yong , He Jin , Zhu Rong
Published: December 2023

Background:

Ectopic pregnancy is a common gynecological emergency that poses a significant risk of maternal mortality during the first trimester. It also increases the incidence of infertility and repeated ectopic pregnancy. The aim of this study was to evaluate whether there is a difference in the degree of tubal patency between salpingostomy and systemic treatment with methotrexate (MTX), as well as the odds of intrauterine pregnancy and repeat ectopic pregnancy, and the degree of tubal patency in salpingectomy with or without tubal suturing.

Methods:

We searched PubMed, EMBASE, and the Cochrane Library up to April 2023. Four randomized controlled trials were included in the review. We analyzed the combined data using Review Manager 5.3 software and Stata 12.0 software, utilizing a random effects model.

Results:

When comparing salpingostomy and systemic treatment with MTX, there was no significant difference in the degree of tubal patency (OR = 1.09, 95% CI (0.54–2.38), P = .83). For salpingostomy with or without tubal suturing, there were no significant differences in the rates of intrauterine pregnancy, repeat ectopic pregnancy, and tubal patency degree [(OR = 1.05, 95% CI (0.41–2.68), P = .92), (OR = 0.68, 95% CI (0.19–2.42), P = .92), (OR = 1.68, 95% CI (0.14–20.33), P = .68)].

Conclusion:

This meta-analysis demonstrates that systemic treatment with MTX is an effective treatment for patients who wish to preserve their fallopian tubes without undergoing surgery. This form of treatment can help avoid surgical procedures that may damage the fallopian tubes and improve fertility prospects. If choosing surgery, we believe that opting for salpingostomy without tubal suturing could reduce the operation time and minimize damage.
Acute generalized exanthematous pustulosis caused by hydroxychloroquine in a patient with rheumatoid arthritis and CARD14 mutation: Case report
Authors: Luo Feng , Yuan Xue-Mei , Xiong Hong , Chen Chang-Ming , Ma Wu-Kai , Yao Xue-Ming
Published: December 2023

Rationale:

Acute generalized exanthematous pustulosis (AGEP) is a serious adverse skin reaction characterized by the rapid appearance of densely distributed, small, sterile pustules with erythema. However, its pathogenesis is not fully understood. Hydroxychloroquine is widely used for the treatment of autoimmune diseases. Some patients presenting with AGEP have IL36RN and CARD14 gene mutations. Our report describes a patient with rheumatoid arthritis and AGEP associated with hydroxychloroquine and a newly discovered CARD14 gene mutation.

Patient concerns:

A 28-year-old woman with rheumatoid arthritis, treated with leflunomide therapy without marked relief of joint pain, developed multiple rashes with pruritis covering the body 5 days after switching to hydroxychloroquine treatment.

Diagnoses:

Based on the patient’s history, symptoms, and histopathological findings, AGEP was diagnosed.

Interventions:

Whole-exome sequencing and Sanger validation revealed no mutations in the IL36RN gene; however, a CARD14 gene mutation was present. The patient was treated using ketotifen fumarate tablets, dexamethasone sodium phosphate, calcium gluconate injection, methylprednisolone injection, vitamins C and B12, hydrocortisone butyrate cream, Reed acne cream, potassium chloride tablets, and pantoprazole enteric-coated capsules.

Outcomes:

The rash improved after 15 days.

Lessons subsections:

There has been little basic research on AGEP-related genetics, and the CARD14 mutation may underlie several pustular rashes, including AGEP and generalized pustular psoriasis. Follow-up studies and further accumulation of patient data are required.
Clinical efficacy of ultrasound doppler-guided hemorrhoidal artery ligation combined with procedure for prolapse and hemorrhoids in treatment of severe hemorrhoids
Authors: He Feng , Zhang Xiao , Lu Dan , Wang Ziming
Published: December 2023

Hemorrhoids are a prevalent anorectal condition that affects a wide range of adult populations. The severity of this condition was graded using a validated hemorrhoidal grading system, specifically focusing on grade III and IV cases. This retrospective study aimed to compare the clinical efficacy of a standard Procedure for Prolapse and Hemorrhoids (PPH) with a combined Doppler-guided Hemorrhoidal Artery Ligation (DG-HAL) and a PPH approach in patients with severe hemorrhoids. Conducted from May 2021 to January 2023, the study included patients aged 18–65 with confirmed diagnosis of Grade III or Grade IV hemorrhoids. Patients with a history of anorectal surgery and significant comorbidities were excluded. The control group underwent standard PPH, whereas the observation group received DG-HAL followed by PPH. Clinical outcomes were measured using variables such as the operative duration, intraoperative blood loss, postoperative wound healing time, and length of hospital stay. Efficacy was evaluated using a hierarchical scale and a visual analog scale (VAS) for postoperative pain. The complication rates were also assessed. baseline characteristics were homogeneous between the 2 groups. The observation group demonstrated significantly faster postoperative wound healing and shorter hospital stay (P < .01). The overall therapeutic efficacy in the observation group was 90.0%, which was higher than that of the control group (75.0%; P = .025). The VAS pain scores were also significantly lower in the observation group (P = .002). A marked decrease in complication rates was observed in the observation group (3.3%) compared with that in the control group (17.9%) (P < .05). The combined DG-HAL and PPH surgical approach exhibited superior clinical efficacy in treating severe hemorrhoids. This technique offers high effectiveness, reduced postoperative VAS pain scores, and lower complication rates. The long-term efficacy requires further observation.
Emergency contraceptive provision in the emergency department and risk analysis for delayed utilization in South Korea
Authors: Choi Yoon Jung , Lee Soo Hyung , Yi Jeongsik , Nho Woo Young
Published: December 2023

In certain nations, the emergency department (ED) has been designated as the primary center to provide emergency contraception (EC). However, analyses of ED visits for EC are limited. Moreover, ED-based research that focuses on time is limited to only a few surveys. The aims of this study were to examine the characteristics of ED visitors for EC and the interval between the coitus and arrival at the ED, and to analyze the factors associated with delays in visiting the ED. This retrospective cohort study involved patients at 2 urban tertiary academic hospitals in South Korea. All patients who presented to the ED for EC between January 2019 and December 2021 were analyzed. The median age of the participants was 26 years. The most common variables were age of 20 to 29 years (42.0%), evening visits (34.9%), weekends or public holidays (62.6%), single status (89.2%), and visits after contraceptive failure (79.1%). The mean time interval was 7.49 hours, and 77.4% of all patients visited the ED within 12 hours. Patients who received public sex education presented earlier (P < .001). ED visits after nonconsensual sexual incidents represented significantly delayed presentations (P < .001). Regression analysis revealed that both the lack of public education and the occurrence of nonconsensual coitus were associated with incident-to-ED visit intervals of >12 hours. Most patients received emergency contraceptive pill (ECP) within the recommended timeframe. In particular, nationwide school-based public sex education positively affected early ECP access. In contrast, ECP provision was delayed for patients who experienced nonconsensual coitus. Strategies for timely ECP access should account for possible concerns about stigmatization and privacy.
Efficacy of DAIR in managing Candida parapsilosis-infected total knee arthroplasty with five-year follow-up: A case report and review of literature
Authors: Li Menglong , Fan Mingrui , Zhang Yuchen , Xiao Jianlin , Liu Tong , Yu Qingwei
Published: December 2023

Rationale:

Fungal periprosthetic joint infections (fPJIs) are relatively uncommon, accounting for approximately 1% of all PJIs. Revision surgery is typically recommended for fungal infections; however, the physical and financial impact on patients is significant. In this report, we present a case of fPJI successfully treated with debridement, antibiotics, and implant retention (DAIR) with a favorable outcome over a 5-year period.

Patient Concern:

A 56-year-old male patient presented with a non-healing surgical incision 1 week after undergoing primary total knee arthroplasty on the right side.

Diagnosis:

Microbiological culture of the wound effusion identified Candida parapsilosis. Postoperatively, the patient exhibited a significant decrease in serum albumin levels and poor glycemic control. Both C-reactive protein and erythrocyte sedimentation rate were elevated.

Interventions:

A comprehensive DAIR procedure was performed, along with continuous closed irrigation using fluconazole for 1 week. The patient received intravenous voriconazole for 4 weeks, followed by oral fluconazole for an additional 3 months.

Outcomes:

At 1- and 5-year follow-up appointments, the patient C-reactive protein and erythrocyte sedimentation rate levels were within normal limits, and there was no evidence of swelling, erythema, or tenderness in the right knee joint, indicating no signs of infection.

Lessons:

DAIR is an effective treatment for early fPJIs, and continuous closed irrigation may provide specific advantages. The patient nutritional status plays a crucial role in the management of periprosthetic infections.
Comparison of survival between diffuse type and intestinal type early-onset gastric cancer patients: A large population-based study
Authors: Wang Qiang , Wang Tian
Published: December 2023

Currently, little knowledge about the survival of early-onset gastric cancer and little evidence about the difference of survival based on Lauren type has been reported. In order to investigate the difference, we conducted a retrospective study using the Surveillance, Epidemiology, and End Results (SEER) database and compared it comprehensively. SEER database was used to extracted patients and multiple imputation was utilized to fill blank data. Multivariate cox regression analysis and competing risk model were used to identify the risk factors of survival. K-M survival curve and propensity score matching (PSM) was applied to compare the difference of survival of patients based on Lauren type. Totally, we extracted 3932 EOGC patients including 2086 diffused type and 1846 intestinal type. K-M survival curve showed patients aged 20 to 29 had worse survival compared to patients aged at 30 to 45 years. The survival of EOGC patients would be greatly improved after surgery. Multivariate cox regression analysis revealed diffused type was an independent risk factor, as well as T stage, lymph node metastasis, tumor size (>5 cm) and metastasis, while surgery treatment and examined lymph nodes were protective factors. Multivariate competing risk regression model also showed diffused type was risk factor. We performed PSM by matching 1433 diffused EOGC with 1433 intestinal EOGC patients, finding patients with diffused type had a poorer survival. our results revealed that compared to diffused type EOGC, intestinal type was characterized by a better survival. EOGC should be attached more attention by clinicians.
Laparoscopic resection for appendiceal mucocele secondary to endometriosis: A case report
Authors: Hara Hitoshi , Shimizu Seito , Muto Yasuhide , Kido Tomoki , Miyata Ryohei
Published: December 2023

Introduction:

This case report describes a patient who underwent laparoscopic resection of the mucocele of the appendix secondary to endometriosis, a rarity in clinical practice.

Patient concerns:

The patient was a 38-year-old woman with a history of endometriosis and an ovarian cyst who sought medical advice with a chief complaint of mild right lower abdominal pain.

Diagnoses:

Computed tomography and ultrasonography of the abdomen revealed a cystic lesion at the distal end of the appendix without definitive findings of malignancy. Colonoscopy revealed a submucosal tumor-like elevation at the appendiceal orifice. Appendiceal mucocele was suspected preoperatively.

Interventions:

The lesion was resected laparoscopically. Secondary ileocecal resection with lymphadenectomy was possible if the resected specimen was pathologically diagnosed as a malignant tumor with the risk of lymph node metastasis.

Outcomes:

The resected specimen was pathologically diagnosed as an appendiceal mucocele secondary to endometriosis; therefore, additional surgery was avoided.

Conclusion:

Although appendiceal mucoceles secondary to endometriosis are rare, laparoscopic surgery in which only the lesion was resected is a useful strategy for the treatment and pathological diagnosis of appendiceal mucoceles without findings of malignancy.
Mechanisms of action underlying Shentong Zhuyu decoction based treatment of rheumatoid arthritis using systems biology and computer-aided drug design
Authors: Bai Shujun , Han Xue , Lan Yanchen , Wang Haodong , Wang Rui , Li Liyuan , Song Qiuhang , Li Aiying
Published: December 2023

Rheumatoid arthritis is an autoimmune disease characterized by chronic polyarticular pain, for which no cure currently exists. In Chinese medicine, rheumatoid arthritis (RA) is believed to be caused by phlegm and blood stagnation. Shentong Zhuyu decoction can be used to treat RA, as it promotes blood circulation, resolves blood stasis, and relieves pain. In our study, we used network pharmacology and computer-aided drug design to evaluate the components, active compounds, and targets of Shentong Zhuyu decoction (STZY). Our results suggest that STZY contains active compounds such as quercetin, luteolin, and formononetin that regulate immune network targets. RA associated genes are enriched in pathways including those associated with nuclear factor kappa B, phosphatidylinositol-3-kinase/AKT, and hypoxia inducible factor 1 signaling. The main active compounds in STZY (quercetin and luteolin) were derived from Achyranthis Bidentatae Radix, Carthami Flos, licorice, Cyperi Rhizoma, and Myrrha and targeted the pro-inflammatory cytokines interleukin 2, interleukin 1 alpha, interleukin 1 beta, and interleukin 6. In addition, the compounds quercetin, luteolin, and formononetin in these herbs can target the anti-inflammatory cytokines interleukin 4 and interleukin 10. Our results suggest that STZY can balance the immune network, promote an anti-inflammatory environment, and reduce the clinical symptoms of RA. Based on the close relationship between inflammatory response and osteoclast formation, we hypothesized that STZY may inhibit inflammation and alleviate bone destruction in RA. Our findings indicate that STZY can treat RA through multiple components, targets, and pathways. This study may provide a reference for the clinical application of STZY in RA treatment.
The essential role of glutamine metabolism in diabetic cardiomyopathy: A review
Authors: Zhang Yiying
Published: December 2023

Diabetic cardiomyopathy (DCM) is a pathophysiological condition caused by diabetes mellitus and is the leading cause of diabetes mellitus-related mortality. The pathophysiology of DCM involves various processes, such as oxidative stress, inflammation, ferroptosis, and abnormal protein modification. New evidence indicates that dysfunction of glutamine (Gln) metabolism contributes to the pathogenesis of DCM by regulating these pathophysiological mechanisms. Gln is a conditionally essential amino acid in the human body, playing a vital role in maintaining cell function. Although the precise molecular mechanisms of Gln in DCM have yet to be fully elucidated, recent studies have shown that supplementing with Gln improves cardiac function in diabetic hearts. However, excessive Gln may worsen myocardial injury in DCM by generating a large amount of glutamates or increasing O-GlcNacylation. To highlight the potential therapeutic method targeting Gln metabolism and its downstream pathophysiological mechanisms, this article aims to review the regulatory function of Gln in the pathophysiological mechanisms of DCM.
Assessing internal mammary lymph node metastasis by breast magnetic resonance imaging in breast cancer
Authors: Cho Su Min , Cha Joo Hee , Kim Hak Hee , Shin Hee Jung , Chae Eun Young , Choi Woo Jung , Eom Hye Joung , Kim Hee Jeong
Published: December 2023

The internal mammary lymph nodes (IMLNs) are a main pathway of metastasis in breast cancer, and breast magnetic resonance imaging (MRI) plays an important role in staging that disease. We investigated the MRI parameters that can predict metastatic IMLNs and evaluated their diagnostic performance by comparing the breast MRI findings for metastatic and benign IMLNs. From January 2016 to December 2020, 474 cases of enlarged IMLNs on breast MRI were identified. By cytopathology or integrated positron emission tomography/computed tomography (PET/CT), 168 IMLNs were confirmed as metastatic, and 81 were confirmed as benign. Breast MRIs were reviewed by 2 radiologists, and various parameters (node axes, fatty hilum, necrosis, margin characteristics, restricted diffusion, and involved levels; primary tumor location and skin involvement) were assessed. Independent t-tests, receiver operating characteristic (ROC) curve analyses, chi-square tests, and Fisher exact tests were performed to compare and evaluate the diagnostic accuracy of the imaging findings. Significant differences in the breast MRI findings for the short and long axes, fatty hilum, necrosis, margin characteristics, diffusion restriction, and tumor location were observed between benign and metastatic IMLNs. Compared with the long axis and the ratio of the axes, the short axis had the best diagnostic value (higher area under the ROC curve) for predicting metastatic IMLNs. In conclusion, breast MRI parameters such as short axis, presence of fatty hilum, necrosis, margin characteristics, and diffusion restriction can be used to evaluate and differentiate benign from metastatic IMLNs, offering valuable insights to improve diagnosis and treatment planning in breast cancer.
Biomechanical evaluation of a novel atlas polyaxial transverse connecting screw system, an in vitro human cadaveric study
Authors: Chen Yun-Lin , Lu Wen-Jie , Ma Yu-Li , Ma Wei-Hu , Jiang Wei-Yu
Published: December 2023

Purpose:

To introduce a novel transverse connecting screw system, and to evaluate the biomechanical stability of the novel screw system using human cadaveric specimens.

Methods:

Six fresh-frozen cadaveric upper cervical spines were used in our study. Every specimen was tested under 5 conditions: intact group; unstable group; C1 to C2 screw rod system group; C1 to C2 + crosslink system group; atlas polyaxial transverse connecting screw (APTCS) system.

Results:

Compared with the intact state, C1 to C2 screw rod system, C1 to C2 + CL system and APTCS showed statistically decrease range of motion in all directions except for the unstable group under posterior extension direction (P < .05). APTCS group has the least range of motion in all directions (P < .001).

Conclusion:

The APTCS system was able to restore stability to the atlantoaxial joint. APTCS system has the advantages of easy installation, convenient bone grafting, and strong biomechanical strength.
Healing of a bone-exposed soft tissue defect after surgical correction of traumatic patellar dislocation: A case report
Authors: Lee Kuan-I , Lin Yun-Nan , Lin Yu-Chuan , Kuo Yur-Ren
Published: December 2023

Rationale:

Reconstructive surgery is widely considered the primary treatment for soft tissue defects around the knee owing to its high flexibility. However, in our recent case study, we explored an alternative approach using decellularized collagen dressings, which proved highly effective in healing a soft tissue defect involving bone exposure following surgical correction of a traumatic patellar dislocation.

Patient concerns:

A 65-year-old male with a traumatic patellar dislocation in the lower extremity failed to approximate the wound after surgical correction. The patient refused additional surgical reconstruction because of the potential risks of multiple operative complications.

Diagnoses:

Traumatic patellar dislocation complicated by exposed bone following surgical treatment was made.

Interventions:

The procedure was performed using ABCcolla® Collagen Matrix (ACRO Biomedical, Taiwan), an acellular dermal matrix made from a decellularized native porcine collagen scaffold dressing. Collagen dressings were applied to the soft tissue defect, and biointegration was observed in the wound area of bone exposure.

Outcomes:

Through the application of ABCcolla® Collagen Matrix (ACRO Biomedical, Taiwan) and diligent wound care for a total of 105 days, the patient healed successfully and achieved partial functional recovery after undergoing rehabilitation. During recent outpatient clinic visits, the patient is now able to ambulate independently with the aid of crutches.

Lessons:

Collagen dressings circumvent the potential risks and complications associated with multiple surgical procedures. We believe that the utilization of collagen dressings, combined with careful wound management, could serve as a promising alternative treatment option for patients with soft tissue defects around the knee in the future.
Endovascular treatment of multiple intracranial aneurysms
Authors: Wang Ji-Wei , Li Cong-Hui , Liu Jian-Feng , Li Hui , Guo Hao , Gao Bu-Lang
Published: December 2023

Multiple intracranial aneurysms are difficult to treat. In order to investigate the effect and safety of endovascular treatment for multiple intracranial aneurysms, 54 consecutive patients with 116 multiple intracranial aneurysms treated with endovascular embolization were retrospectively enrolled. Angiography was performed immediately after embolization and at each follow-up. All clinical data were analyzed. Of the 116 aneurysms, 56 (48.3%) were embolized with coiling alone, 19 (16.4%) with stent-assisted coiling, 31 (26.7%) with stenting alone, and 10 (8.6%) with flow diverters plus coiling. After embolization, 31 (27.6%) aneurysms with stenting alone had no apparent change in size, and in the remaining 84 aneurysms, complete occlusion was achieved in 50 aneurysms (59.5%), near-complete occlusion in 26 (31.0%), and incomplete occlusion in 8 (9.5%). Thrombus formation at the aneurysm neck occurred in 3 patients (5.6%), coil protrusion in 2 (3.7%), and intraprocedural rupture in 1 (1.9%), resulting in a total complication rate of 11.1%. Follow-up angiography was performed in 44 (81.5%) patients 6 to 90 months (mean 49) later. Among 50 completely occluded aneurysms, 38 (76%) aneurysms remained completely occluded, and 4 (8%) aneurysms recurred. Among 26 aneurysms with initial near-complete occlusion, 12 (46.2%) aneurysms with neck remnant had progressive thrombosis to complete occlusion, 2 (7.7%) had no change compared with immediate occlusion, and 5 (19.2%) regrew. In conclusion, endovascular embolization with intracranial stenting and coiling is safe and effective and may play an increasingly important role in the management of multiple intracranial aneurysms.
Distribution of ABO and rhesus blood grouping with HIV infection among blood donors in Ekiti State Nigeria
Authors: Anyiam Arinze Favour , Arinze-Anyiam Onyinye Cecilia , Irondi Emmanuel Anyachukwu , Obeagu Emmanuel Ifeanyi
Published: December 2023

Erythrocyte antigens, particularly those which give rise to different blood group systems, are potentially known to perform as receptor sites for different types of disease-causing agents. It is for this reason that this study was carried out to determine the distribution of different blood groups and how susceptible they are to human immunodeficiency virus (HIV) infection. For this study, data were retrieved from different blood bank registers at 4 major blood banks in Ekiti State (National Blood Transfusion Services, Ado, State Specialist Hospital, Ikole, State Specialist Hospital, Ijero, State Specialist Hospital, Ikere. All in Ekiti State). Demographic data such as age and gender were collected on 2388 individuals who were recruited at the above stated facilities over a 2-year period. Their blood groups (Rhesus and ABO) and HIV status were equally recorded. Results of the ABO blood group analysis of the subjects showed that Blood Group O had the highest population (78.2%) while blood Group AB had the lowest (0.9%). The percentages of Rhesus positive and negative persons observed in this population were 94.7% and 5.3%, respectively. The total sero-prevalence of HIV infection was 0.81%. However, there was no significant difference in the prevalence of HIV among the different ABO and Rhesus blood types. This study revealed no association between ABO and Rhesus blood groups and HIV infection.
The efficacy of temperature intervention combined with tranexamic acid in reducing blood loss and accelerating recovery during spinal fusion
Authors: Li Fulin , Huang Xiao , Huang Yu , Liang Bin , Yin Dong
Published: December 2023

Objective:

This study aimed to evaluate the effect of temperature intervention combined with tranexamic acid (TXA) on perioperative blood loss during spinal fusion and accelerated rehabilitation.

Method:

Between August 2014 and July 2019, 310 lumbar fusion at our hospital were randomly divided into 4 groups as follows. Group A (placebo): no TXA and no temperature intervention. Group B: TXA (15 mg/kg) before skin incision. Group C: TXA (15 mg/kg) before skin incision and temperature intervention. Group D: temperature intervention without TXA. The primary outcomes were intraoperative blood loss, postoperative blood loss, total blood loss, and core temperature at different stages. We also recorded the hemoglobin level, blood transfusion rate, prothrombin time on postoperative day 1 (POD1), length of hospital stay, and the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Results:

The 4 groups showed statistically significant differences in intraoperative blood loss, postoperative blood loss, total blood loss, core temperature after anesthesia, average temperature during the operation, hemoglobin on POD1, and length of stay (P < .05). In contrast, prothrombin time on POD1 and the incidence of DVT or PE did not differ between the groups (P > .05). Comparing the transfusion rate in Group C (6/77, 7.79%) and Group A (17/78, 21.79%), the difference was statistically significant.

Conclusion:

Temperature intervention combined with TXA can significantly reduce blood loss and the transfusion rate of spinal fusion in the perioperative period, reduce the length of stay and accelerate rehabilitation after surgery without increasing the incidence of DVT or PE.
Endoscopic full-thickness resection vs. endoscopic submucosal dissection of residual/recurrent colonic lesions on scars: a retrospective Italian and Japanese comparative study
Authors: Barbaro Federico , Papparella Luigi Giovanni , Chiappetta Michele Francesco , Ciuffini Cristina , Fukuchi Takehide , Hamanaka Jun , Quero Giuseppe , Pecere Silvia , Gibiino Giulia , Petruzziello Lucio , Maeda Shin , Hirasawa Kingo , Costamagna Guido
Published: December 2023

Background and aims

Endoscopic treatment of recurrent/residual colonic lesions on scars is a challenging procedure. In this setting, endoscopic submucosal dissection (ESD) is considered the first choice, despite a significant rate of complications. Endoscopic full-thickness resection (eFTR) has been shown to be well-tolerated and effective for these lesions. The aim of this study is to conduct a comparison of outcomes for resection of such lesions between ESD and eFTR in an Italian and a Japanese referral center.

Methods

From January 2018 to July 2020, we retrospectively enrolled patients with residual/recurrent colonic lesions, 20 treated by eFTR in Italy and 43 treated by ESD in Japan. The primary outcome was to compare the two techniques in terms of en-bloc and R0-resection rates, whereas complications, time of procedure, and outcomes at 3-month follow-up were evaluated as secondary outcomes.

Results

R0 resection rate was not significantly different between the two groups [18/20 (90%) and 41/43 (95%); P= 0.66]. En-bloc resection was 100% in both groups. No significant difference was found in the procedure time (54 min vs. 61 min; P= 0.9). There was a higher perforation rate in the ESD group [11/43 (26%) vs. 0/20 (0%); P= 0.01]. At the 3-month follow-up, two lesions relapsed in the eFTR cohort and none in the ESD cohort (P= 0.1).

Conclusion

eFTR is a safer, as effective and equally time-consuming technique compared with ESD for the treatment of residual/recurrent colonic lesions on scars and could become an alternative therapeutic option for such lesions.
Association between novel inflammatory markers and non-alcoholic fatty liver disease: a cross-sectional study
Authors: Wang Gang , Zhao Yu , Li Zeya , Li Dan , Zhao Feng , Hao Jing , Yang Chunlei , Song Jiashu , Gu Xianzhong , Huang Rongchong
Published: December 2023

Objective

This study aimed to investigate the association between novel inflammatory markers (NIMs) and non-alcoholic fatty liver disease (NAFLD).

Methods

A total of 6306 subjects were enrolled in this cross-sectional study. NIMs, including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), C-reactive protein to albumin ratio (CAR), lymphocyte to monocyte ratio (LMR), systemic immune-inflammation index (SII) and prognostic nutritional index (PNI), were calculated. The prevalence of NAFLD and its association with NIMs were assessed by multivariable logistic regression analysis. Subgroup analysis were performed based on age, sex and BMI.

Results

The prevalence of NAFLD was 52.5% in the study population. Compared with non-NAFLD subjects, NAFLD patients were older and more frequent in females. The prevalence of NAFLD progressively increased among the higher quartile groups of CAR, LMR, SII and PNI (P-trend < 0.05), whereas it progressively decreased among the higher quartile group of NLR and PLR (P-trend < 0.05). According to multivariable logistic regression analysis, the highest quartile (Q4) had a significantly higher risk of NAFLD compared with Q1 in LMR [odds ratio (OR): 1.43; 95% confidence interval (CI): 1.17–1.75; P-trend < 0.001] and PNI (OR: 1.92; 95% CI: 1.57–2.35; P-trend < 0.001). The subgroup analysis showed a stronger association of PNI with NAFLD.

Conclusion

The study highlights the association between NIMs and NAFLD, with LMR and PNI identified as potential non-invasive markers of inflammation in NAFLD. Specifically, PNI exhibited the strongest association and may serve as a valuable marker for assessing inflammation in NAFLD.
Circulating immune signatures across clinical stages of chronic pancreatitis: a pilot study
Authors: Hagn-Meincke Rasmus , Hart Phil A. , Andersen Dana K. , Vege Santhi S. , Fogel Evan L. , Serrano Jose , Bellin Melena D. , Topazian Mark D. , Conwell Darwin L. , Li Liang , Van Den Eeden Stephen K. , Drewes Asbjørn M. , Pandol Stephen J. , Forsmark Chris E. , Fisher William E. , Yadav Dhiraj , Olesen Søren S. , Park Walter G. ,   on behalf of the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC)
Published: December 2023

Objective

This pilot study seeks to identify serum immune signatures across clinical stages of patients with chronic pancreatitis (CP).

Methods

We performed a cross-sectional analysis of prospectively collected serum samples from the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translation StuDies-study. CP subjects were categorised into three clinical stages based on the presence/absence of metabolic complications: (1) CP with no diabetes and exocrine pancreatic dysfunction (EPD), (2) CP with either diabetes or EPD, and (3) CP with diabetes and EPD. Blinded samples were analysed using an 80-plex Luminex assay of cytokines/chemokines/adhesion molecules. Group and pairwise comparisons were performed to characterise immune signatures across CP subgroups.

Results

A total of 135 CP subjects (evenly distributed between clinical stages) and 50 controls were studied. Interleukin-6 (IL-6), interleukin-8 (IL-8), and soluble intercellular adhesion molecule 1 (sICAM-1) were significantly elevated in CP subjects compared to controls. The levels of IL-6 and IL-8 increased with advancing disease stages, with the highest levels observed in CP with diabetes and EPD (clinical stage 3). Furthermore, hepatocyte growth factor and macrophage-derived chemokine were significantly increased in clinical stage 3 compared to controls.

Conclusion

Our study reveals a progressive elevation in pro-inflammatory cytokines and chemokines with advancing clinical stages of CP. These findings indicate potential targets for the development of disease-modifying interventions.
Risk Adjustment in Health Insurance Markets
Authors: van Kleef Richard C. , van Vliet René C.J.A. , Oskam Michel
Published: December 2023

Objectives:

The goals of this paper are: (1) to identify groups of healthy people; and (2) to quantify the extent to which the Dutch risk adjustment (RA) model overpays insurers for these groups.

Background:

There have been strong signals that insurers in the Dutch regulated health insurance market engage in actions to attract healthy people. A potential explanation for this behavior is that the Dutch RA model overpays insurers for healthy people.

Methods:

We identify healthy groups using 3 types of ex-ante information (ie, information available before the start of the health insurance contract): administrative data on prior spending for specific health care services (N = 17 m), diagnoses from electronic patient records (N = 1.3 m), and health survey data (N = 457 k). In a second step, we calculate the under/overpayment for these groups under the Dutch RA model (version: 2021).

Results:

We distinguish eight groups of healthy people using various “identifiers.” Although the Dutch RA model substantially reduces the predictable profits that insurers face for these groups, significant profits remain. The mean per person overpayment ranges from 38 euros (people with hospital spending below the third quartile in each of 3 prior years) to 167 euros (those without any medical condition according to their electronic patient record).

Conclusions:

The Dutch RA model does not eliminate the profitability of healthy groups. The identifiers used for flagging these groups, however, seem inappropriate for serving as risk adjuster variables. An alternative way of exploiting these identifiers and eliminating the profitability of healthy groups is to estimate RA models with “constrained regression.”