bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comprehensive Analysis Between Disk Geometry and Posterior Muscle Characteristics Among Degenerative Spine Patients
Authors: Jung Bongseok , Mathew Joshua , Sheikh Alshabab Basel , Elysee Jonathan , Duvvuri Priya , Fallon John , Abbas Anas , Katz Austen , Song Junho , Strigenz Adam , Zappia Luke , Lafage Renaud , Essig David , Lafage Virginie , Virk Sohrab
Published: February 2025

Study Design:

A retrospective Cohort Study.

Objective:

The aim of this study is to investigate the associations between posterior muscle health characteristics and disk geometry parameters between L1 and S1.

Summary of Background Data:

Paralumbar muscle changes have been associated with clinical outcomes. However, the relationship between disk geometry and paralumbar muscle changes has not been defined.

Methods:

Axial T2 MRI was analyzed for paralumbar muscle measurements, and lateral radiographs were analyzed for disk geometry parameters in patients with disk degeneration. Associations between disk shape and muscle health at each individual lumbar level were evaluated using a partial correlation controlling for age and sex. Demographic data were compared between the listhesis groups, and an ANCOVA analysis controlling for significant demographic parameters was conducted to evaluate differences in muscle characteristics.

Results:

In all, 435 patients were included (age: 55.6±15, BMI: 29.5±6, 60.9% female, 41.3% White). Muscle health median characteristics were CSA/BMI=140, LIV=13, and Goutallier Classification of 1. Partial correlations between focal disk parameters and muscle health controlling for age and sex showed moderate significant positive associations between focal lordosis and lumbar indentation value (LIV) at every level L1-S1 (mean r=0.264 between L1 and L5, P<0.001), weak positive association between focal lordosis and CSA/BMI (mean r=0.113 at L2-L5, P <0.03), and weak negative associations between disk height and Goutallier Classification (mean r=0.158 at L1–L5, P<0.03). Listhesis at L4–S1 was stratified, and ANCOVA controlling for sex and age demonstrated no significant association between S and R groups and CSA/BMI, LIV, or Goutallier classification (P>0.1).

Conclusions:

Posterior muscle health was significantly associated with disk shape, especially disk height and disk lordosis, with larger and more lordotic disks being associated with better muscle health. Disk listhesis was not significantly associated with muscle quality when controlling for demographic characteristics, and no differences in muscle health parameters were observed in patients with spondylolisthesis versus retrolisthesis. Overall, the results highlight important associations between lumbar compensation, disk geometry, and posterior muscle health.
Cystatin C-Guided Dosing Nomogram Improves Target Attainment for Cefepime in the Critically Ill
Authors: Barreto Erin F. , Scheetz Marc H. , Chang Jack , Cole Kristin C. , Fogelson Lindsay A. , Paul Johar , Jannetto Paul J. , Gajic Ognjen , Rule Andrew D. ,   for the Beta Lactam Optimization and Outcomes Management (BLOOM) Study Group
Published: February 2025

Objectives:

Estimated glomerular filtration rate is more accurate with combined creatinine and cystatin C equations (eGFRcr-cys) than creatinine alone. This study created and evaluated a cefepime dosing nomogram based on eGFRcr-cys for initial dosing in the critically ill.

Design:

Pharmacokinetic modeling and simulation study.

Setting:

Academic medical center.

Patients:

Critically ill adults treated with cefepime.

Interventions:

None.

Measurements and Main Results:

Data from 120 patients with baseline cystatin C and follow-up cefepime levels were used to develop a nomogram based on eGFRcr-cys and weight for initial cefepime dosing. The predicted proportion of patients who achieved a free cefepime concentration above the minimum inhibitory concentration of the organism for 100% of the dosing interval in the first 24 hours (100% ƒT > MIC at 24 hr) was compared between administered doses and those predicted by the nomogram doses. Overall drug exposure was estimated with the free area under the concentration time curve from 0 to 24 hours (ƒAUC0–24) and compared between administered and nomogram doses. Achievement of 100% ƒT > MIC at 24 hours was predicted to be significantly better with the nomogram compared with the administered dose (76% vs. 38%; p < 0.001). The median ƒAUC0–24 as predicted by the nomogram (666 mg·hr/L) was slightly higher than the actual ƒAUC0–24 with administered doses (612 mg·hr/L; p = 0.01), but the nomogram led to fewer ƒAUC0–24 values which were either too high (> 900) or too low (< 300) (7% vs. 20%; p = 0.004).

Conclusions:

Use of a cystatin C-inclusive dosing nomogram for cefepime could improve target attainment without increasing the risk of potentially toxic levels in the critically ill.
Multiple primary melanomas in Udine, northeastern Italy: a focus on epidemiology and new risk factors
Authors: Guglielmo Alba , De Benedittis Alba , Buligan Cinzia , Zelin Enrico , Stinco Giuseppe
Published: February 2025

Patients diagnosed with melanoma are at an elevated risk of developing subsequent primary melanomas. The aim of this study was to assess the prevalence and identify the risk factors associated with multiple primary melanomas (MPMs) in patients referred to the melanoma outpatient service of the Dermatology Unit at the University Hospital of Udine, Italy. We conducted a retrospective analysis on patients with MPMs. For each patient demographic, clinical, and histological data were collected. For each excised melanoma, we recorded Breslow thickness, histological subtype, and anatomical site. A total of 233 patients with melanoma were included in the study, comprising a subgroup of 51 (22%) patients diagnosed with MPM. The mean Breslow thickness for patients with a single melanoma was significantly higher than the Breslow thickness for the first melanoma in the MPM subgroup. Furthermore, a statistically significant decrease in Breslow thickness between the first and second melanomas was observed. In our cohort, patients with MPM had a significantly higher prevalence of nonmelanoma skin cancers (NMSCs) compared with those with a single melanoma. Our study indicates that the prevalence of MPM in the province of Udine is among the highest reported globally. Our finding aligns with the broader literature, which consistently reports lower thickness in second melanoma compared with first melanoma. Finally, the higher prevalence of NMSC in these patients suggests a potential link to chronic ultraviolet exposure.
Comparative Efficacy of Mechanical Versus Manual Compression Techniques on Radial Artery Hemostasis Following Transradial Coronary Angiography: A Meta-Analysis
Authors: Jain Hritvik , Shahzad Maryam , Patel Nandan , Jain Jyoti , Odat Ramez M. , Ahmed Raheel , Deora Surender
Published: February 2025

Mechanical compression for hemostasis posttransradial coronary angiography (CAG) or intervention is hypothesized to be more effective than manual compression owing to a more stable and continuous pressure. However, the current evidence comparing these 2 compression techniques is limited. A comprehensive search of the 3 major electronic databases—PubMed, Google Scholar, and Cochrane Library—was performed from inception to October 24, 2024, to identify relevant studies. Standardized mean difference and risk ratios (RR) with 95% confidence intervals (CIs) were pooled using the Mantel-Haenszel random effects model to calculate effect estimates. Statistical significance was set at P < 0.05. Four studies with 1235 patients undergoing transradial CAG were included [mechanical (n = 450) and manual (n = 785)]. On pooled analysis, the mechanical compression method demonstrated a significantly longer mean time to achieve hemostasis (standardized mean difference: 3.21; 95% CI: 1.71, 4.71; P < 0.0001) than the manual compression method. The risks of radial artery occlusion (RR: 1.05; 95% CI: 0.50, 2.22; P = 0.89), hematoma formation (RR: 1.86; 95% CI: 0.28, 12.40; P = 0.52), and bleeding during compression (RR: 0.23; 95% CI: 0.00, 24.81; P = 0.54) were comparable. Both types of hemostatic compression, manual and mechanical, are equally effective though mechanical compression takes significantly longer to achieve hemostasis. Further prospective randomized studies are needed to corroborate these findings.
Elevated C-reactive protein and cardiovascular risk
Authors: Chia Jia Ee , Ang Song Peng
Published: February 2025

Purpose of review

This review critically examines the evolving role of C-reactive protein (CRP) in cardiovascular disease (CVD), addressing its pathogenesis and relationship with various CVDs including coronary artery disease (CAD), heart failure, and atrial fibrillation.

Recent findings

CRP is mechanistically implicated in endothelial dysfunction, oxidative stress, and plaque destabilization. Recent studies demonstrate that lipid-lowering agents (statins, bempedoic acid) and anti-inflammatory therapies (canakinumab, colchicine) reduce CRP levels and improve outcomes in CAD. In heart failure, elevated CRP predicts adverse events, though evidence on phenotypes varies, and novel therapies (glucagon-like peptide-1 agonists, sodium-glucose cotransporter-2 inhibitors) lower CRP independently of weight loss. For atrial fibrillation, CRP correlates with postoperative incidence and recurrence postablation, though data remain inconsistent. Guidelines offer differing opinion with the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines cautiously endorsing CRP for risk stratification in intermediate-risk individuals, while European guidelines advise against its routine use for primary prevention, reflecting unresolved questions about CRP's additive value.

CRP remains a pivotal inflammation biomarker in CVD, yet its causal role and clinical applicability require clarification. While CRP-guided therapies show promise, discrepancies in guidelines highlight the need for robust trials to determine whether targeting CRP directly improves outcomes. Future research should focus on CRP's pathophysiological mechanisms and validate its utility in personalized CVD management.
The 2024 ILTS-ILCA consensus recommendations for liver transplantation for hepatocellular carcinoma and intrahepatic cholangiocarcinoma
Authors: Kodali Sudha , Kulik Laura , D’Allessio Antonio , De Martin Eleonora , Hakeem Abdul Rahman , Lewinska Monica , Lindsey Stacie , Liu Ken , Maravic Zorana , Patel Madhukar S. , Pinato David , Rammohan Ashwin , Rich Nicole , Sanduzzi Zamparelli Marco , Victor David W. , Vinaxia Carmen , Brombosz Elizabeth W. , Villanueva Augusto , Meyer Tim , Selzner Nazia , Ghobrial R. Mark , Rela Mohamed , Sapisochin Gonzalo
Published: February 2025

Background:

Liver transplantation (LT) provides the best long-term survival outcomes for patients with liver cancer. As a result, the field of transplant oncology has grown greatly over the past few decades, and many centers have expanded their criteria to allow increased access to LT for liver malignancies. Center-level guidelines and practices in transplant oncology significantly vary across the world, leading to debate regarding the best course of treatment for this patient population.

Methods:

An international consensus conference was convened by the International Liver Transplantation Society and the International Liver Cancer Association on February 1-2, 2024, in Valencia, Spain to establish a more universal consensus regarding LT for oncologic indications. The conference followed the Delphi process, followed by external expert review.

Results:

Consensus statements were accepted regarding patient assessment and waitlisting criteria, pre-transplant treatment (including immunotherapy) and downstaging, living donor liver transplantation, post-LT patient management, and patient- and caregiver-related outcomes.

Conclusion:

The multidisciplinary participants in the consensus conference provided up-to-date recommendations regarding the selection and management of patients with liver cancer being considered for LT. Although participants deferred to center protocols in many cases, there was great interest in safely expanding access to LT for patients with larger tumor burden and biologically amenable lesions.
Noninvasive Targeted Temperature Management of the Inner Ear: Numerical Simulations and Experimental Measurements in a Human Cadaver Model
Authors: Yepes Maria Fernanda , Hoffer Michael E. , Chiossone Juan Armando , Soejima Nathaniel , King Curtis S. , Rajguru Suhrud M.
Published: February 2025

Hypothesis

Mild therapeutic hypothermia (MTH) could be delivered to the human inner ear using a localized, noninvasive approach to achieve protective temperature reductions without systemic side effects.

Background

MTH has demonstrated protective effects in the cochlea following injuries such as device implantation, ototoxicity, and noise overexposure. It targets key cellular mechanisms, including proinflammatory pathways, oxidative stress, pyroptosis, and apoptosis. However, systemic and invasive methods for MTH carry risks and are less practical for broader clinical applications. Developing a localized, noninvasive approach could offer a safer, more accessible solution for hearing preservation after cochlear injury.

Methods

Cadaveric middle and inner ear structures, maintained near physiological conditions, were used to test a custom-designed cooling gel pack (ReBound) placed externally on the temporal bone. Temperature changes were recorded over 60 or 30 minutes. To complement experimental findings, three-dimensional geometrical models were created from imaging data, and finite element heat transfer analysis simulated temperature changes across inner ear structures.

Results

With external gel pack application, inner ear temperatures dropped by 2.9°C within 30 minutes and 4.6°C within 60 minutes. Cooling persisted for 10 minutes post-device removal. Numerical modeling corroborated these findings, indicating average temperature reductions of 2°C to 4°C. Biological sex differences were observed in cooling efficiency and overall temperature drop.

Conclusion

This study demonstrates that localized, noninvasive MTH can effectively reduce inner ear temperatures to therapeutically relevant levels. These findings support a promising, clinically translatable approach for protecting cochlear structure and function after injury, with minimal systemic risks.
Usefulness of a Digital Tool to Improve Methodology and Reporting of Breath Tests for Small Intestinal Bacterial Overgrowth
Authors: Pereyra Lisandro , Steinberg Leandro , Navar Sofia , Stefanolo Juan P. , Schlottmann Francisco
Published: February 2025

Goals:

We aimed to determine if the use of a web-based digital tool could improve methodology and reporting of breath tests (BT).

Background:

Although BT represent a noninvasive and low-cost tool for the diagnosis of small intestinal bacterial overgrowth (SIBO), lack of standardization and poor test performance have been described.

Methods:

We performed a retrospective analysis of a consecutive series of BT reports from 8 different gastroenterology units during the period April 2024 to July 2024. Data from the BT reports was extracted, masked, and uploaded in a digital tool that supports the entire breath test process and creates a report. Three experts in SIBO who were blinded for the test interpretation determined a diagnosis for each patient and delineated a total of 12 quality items that considered relevant to be included in a BT report. The main outcomes of the study were accuracy (ie, proportion of correct diagnoses) and quality of BT reports.

Results:

A total of 210 BT were analyzed; the type of substrate was informed in 187 (89.0%) BT and lactulose was used in most of the studies (162/187, 86.6%). Most tests measured only hydrogen (89.5%) and 38 (18.1%) extended the BT for <90 minutes. SIBO was diagnosed in 92 (43.8%) and 79 (37.6%) patients in the original BT report and the digital tool report, respectively. As compared with the diagnosis by the expert gastroenterologists and current guidelines, the original report was accurate in 182 (86.6%) patients and the digital tool report in 210 (100%) patients (P<0.0001). Regarding quality of reporting, the original BT report had a median of 5 (3 to 8) items included and the digital tool report described a median of 9 (7 to 11) items (P<0.0001).

Conclusions:

Breath tests methodology and interpretation for the diagnosis of SIBO are heterogenous and do not comply with current guidelines. The use of a web-based digital tool specifically developed to assist the entire BT process appears to improve accuracy and quality of reports.
Effects of Acupoints-Based TENS at Different Frequencies + tDCS on Poststroke Spastic Hemiplegia: A Randomized Controlled Trial
Authors: Wang Xiu-Yan , Qian Xu , Ma Liang-Xiao , Xiu Jing-Yun , Ma Ling-Hui , Chen Meng-Yu , He Jia-Ling
Published: February 2025

Background:

Acupoints-based transcutaneous electrical nerve stimulation (Acu-TENS) and transcranial direct current stimulation (tDCS) may contribute to the rehabilitation of poststroke spastic hemiplegia, but the evidence remains inadequate, particularly regarding the frequency selection of Acu-TENS.

Study Question:

Whether Acu-TENS + tDCS is effective for poststroke spastic hemiplegia and what is the optimal frequency of Acu-TENS?

Study Design:

Ninety patients were randomly allocated in a 1:1:1 ratio to 2 observation groups and a standard care control group. All participants received regular rehabilitation and standard care. In addition, 1 mA tDCS + Acu-TENS at 20 Hz or 100 Hz was applied in observation groups for 12 sessions for 4 weeks.

Measures and Outcomes:

The primary outcome was the Modified Ashworth Scale change from baseline to week 4. Secondary outcomes included the Fugl-Meyer Assessment, Modified Barthel Index, co-contraction ratio, and integrated electromyography. Outcomes were assessed at baseline, after 4-week treatment, with 4-week follow-up.

Results:

Both observation groups showed reductions in the change of Modified Ashworth Scale compared with the control group after 4-week treatment [Acu-TENS-20 Hz + tDCS vs. control, −0.48 (95% confidence interval, −0.64 to −0.33); P < 0.001; Acu-TENS-100 Hz + tDCS vs. control, −1.44 (95% confidence interval, −1.63 to −1.26); P < 0.001]. Acu-TENS-100 Hz + tDCS group provided a greater decrease in Modified Ashworth Scale than 20 Hz [−0.96 (95% confidence interval, −1.15 to −0.77); P < 0.001]. The observation groups increased Fugl-Meyer Assessment, Modified Barthel Index, and co-contraction ratio of limbs and declined integrated electromyography of spasmodic muscles of flexor carpi radialis and gastrocnemius (P < 0.05). No differences were observed among groups in integrated electromyography of antagonistic muscles.

Conclusions:

For poststroke spastic hemiplegia, Acu-TENS + tDCS might be an effective adjunctive modality, and 100 Hz Acu-TENS is recommended, which should be verified in larger trials.

Trial Registration:

www.chictr.org ChiCTR2200067186.
Gene therapy for sickle cell disease and thalassemia
Authors: Scaramellini Natalia , Panzieri Daniele Lello , Cappellini Maria Domenica
Published: February 2025

Purpose of review

Thalassemia and sickle cell disease are among the most frequent monogenic hereditary diseases. Access to transfusions, iron chelation therapies and drugs such as hydroxyurea have improved life expectancy and quality of life. However, these diseases still cause significant disability. The first available curative therapy, bone marrow transplantation, is unfortunately not feasible for all patients. Over the past decade, numerous studies have focused on finding new curative therapies, and many clinical trials have evaluated different gene therapy approaches.

Recent findings

The therapeutic targets focus on adding functional copies of the gene encoding β-globin in defective CD34+ cells, mainly using lentiviral vectors directed towards HSCs. More recently, the focus has shifted to inducing fetal hemoglobin production at therapeutic levels or repairing the underlying molecular defect, using novel gene editing techniques involving CRISPR-Cas9, transcription activation-like effector protein nucleases, zinc finger nucleases and base editing. Preclinical and clinical studies now focus on optimizing how gene therapy is performed and delivered to reduce or eliminate myeloablative treatment and its potential adverse events.

In this review, we explore the potential to induce fetal hemoglobin production at therapeutic levels or to repair the underlying molecular defect that causes the disease genetically. Here, we review recent gene editing studies that are opening a new era in curative treatment for hemoglobinopathies.
The promise of cerebral organoids for neonatology
Authors: Howard Clare E. , Cheenath Manju , Crouch Elizabeth E.
Published: February 2025

Purpose of the review

Applying discoveries from basic research to patients in the neonatal intensive care unit (NICU) is challenging given the difficulty of modeling this population in animal models, lack of translational relevance from animal models to humans, and lack of primary human tissue. Human cell derived cerebral organoid models are an appealing way to address some of these gaps. In this review, we will touch on previous work to model neonatal conditions in cerebral organoids, some limitations of this approach, and recent strategies that have attempted to address these limitations.

Recent findings

While modeling of neurodevelopmental disorders has been an application of cerebral organoids since their initial description, recent studies have dramatically expanded the types of brain regions and disease models available. Additionally, work to increase the complexity of organoid models by including immune and vascular cells, as well as modeling human heterogeneity with mixed donor organoids will provide new opportunities to model complex neonatal pathologies.

Organoids are an attractive model to study human neurodevelopmental pathologies relevant to patients in the neonatal ICU. New technologies will broaden the applicability of these models to neonatal research and their usefulness as a drug screening platform.
Ethosuximide-associated Aplastic Anemia Likely Due to Drug-induced Lupus Erythematosus: A Case Report With Immunologic Insights
Authors: Dcunha Nicholas J. , Kwan Olivia A. , Sen Sonali , Diaz-Medina Gloria E. , Elghetany M. Tarek , Bertuch Alison A. , Curry Choladda V.
Published: February 2025

Ethosuximide-associated aplastic anemia (AA) is a rare idiosyncratic disorder with unclear etiology. We report a 17-year-old female with absence seizures on ethosuximide, who was incidentally found to have pancytopenia and a markedly hypocellular marrow (<5% cellularity) with lupus erythematosus (LE) cells. The presence of antinuclear and anti-histone antibodies supported a diagnosis of AA secondary to drug-induced lupus erythematosus. Ethosuximide was discontinued, and prednisone started with marked blood count recovery. Our case is the first to elucidate the particular lupus erythematosus association, as evidenced by the combination of immunologic serology, marrow aplasia, and the presence of marrow LE cells.
Chemotherapy with a molecular rational basis, pentoxifylline as a promising antitumor drug
Authors: Cerda-Cruz Cesar R. , Vazquez-Urrutia Jorge R. , Ortiz-Lazareno Pablo , Villaseñor-García María M. , Cruz-Lozano Roberto , Hernandez-Flores Georgina , Bravo-Cuellar Alejandro
Published: February 2025

Cancer is one of the leading causes of death worldwide. In cancer therapy, anti-cancer drugs are the current treatment-of-choice for patients with metastatic cancers, but these drugs present a major drawback: they destroy healthy cells along with cancerous cells. Unfortunately, the drug discovery process for de novo drugs is costly and time-consuming. To address this global problem, our research team has established the concept of “Chemotherapy with a molecular rational basis”, which focuses on the identification of molecular targets in tumor cells, whose activation or inhibition induces apoptosis or sensitizes the tumor cells to apoptosis. Here we review the experimental and clinical evidence of pentoxifylline (PTX) in the setting of chemotherapy with a molecular rational basis. A search of the literature was conducted for articles published during the period from 2 January 2003 to 21 October 2024. Articles published in English or Spanish were included. The keywords “Pentoxifylline” OR “BL 191” OR “trental” AND “cancer” were used for in vitro, in vivo, and clinical studies. PTX is an approved, accessible, and relatively safe drug. Furthermore there is a large body of experimental and clinical evidence of the beneficial effects of PTX in cancer therapy, either alone or in combination with antitumor drugs, sometimes even more effective than traditional chemotherapy regimens. However, it is necessary to carry out larger clinical trials in cancer patients to identify the benefits, adverse effects and even pharmacological interactions of PTX with current chemotherapy regimens and thus achieve a new drug repositioning that benefits our patients.
Assessing basic life support awareness, and knowledge among university undergraduates: a cross-sectional study
Authors: Baklola Mohamed , Elnemr Mohammed , Ghazy Mohamed , Omar Yusof , Darwish Nour Edin , Ahmed Baher , Alkalla Eman , Reda Reem , Elmimy Hanaa , Mohamed Teeb , Sherif Aya , Al-Bawah Naji , Shaheena Dina Gamal
Published: February 2025

Background:

Basic life support (BLS) is a critical skill for saving lives during emergencies. This study aims to assess BLS awareness and knowledge among undergraduates at University, examining the impact of gender, faculty, and prior correct cardiopulmonary resuscitation (CPR) training on students’ confidence and competence.

Methods:

A descriptive, cross-sectional study was conducted from August to December 2023 across six faculties: medicine, nursing, engineering, sciences, commerce, and law. Using convenience sampling, a total of 1165 students participated by completing a self-administered, bilingual questionnaire. Descriptive statistics, Pearson correlation tests, t-tests, ANOVA, and multivariate logistic regression analyses were performed using SPSS software version 26, with visual representations created using R software.

Results:

The majority of participants were female (64.8%), with a significant portion (70%) believing that CPR training should be mandatory. Only 29.6% had received CPR training. Females scored higher on BLS knowledge than males (4.9 vs. 4.5, P < 0.05). Students from medical faculties had greater BLS knowledge compared to their non-medical peers (6.3 vs. 3.5, P < 0.05). Trained students were more confident in performing CPR (35.1% vs. 10.2% among untrained, P < 0.05). Multivariate logistic regression identified prior CPR training and medical faculty enrollment as significant predictors of higher BLS knowledge and confidence.

Conclusion:

Significant gaps in BLS knowledge and training exist among University undergraduates, with disparities based on gender, faculty, and prior training. The findings underscore the need for mandatory CPR training across all faculties to enhance student preparedness and competence.
Burden of mesothelioma in the Middle East and North Africa: a 32-year analysis of the Global Burden of Diseases Study 2021
Authors: Ghiasvand Mohammad , Fooladi Sarabi Shahnaz , Salehi Asal , Seyedi Asl Fatemeh Sadat , AlJasem Mohamad , Yaghoubi Mohammad , Ehsani Zunuz Babak , Sanatian Zahra , Alaghi Parisa , Khadembashiri Mohammad Amin
Published: February 2025

Background:

Mesothelioma, a cancer primarily caused by asbestos exposure, has been increasing in the Middle East and North Africa (MENA), raising concerns about the region’s occupational and environmental health landscape. With varying Sociodemographic Index (SDI) and differing asbestos regulations across MENA, understanding mesothelioma trends over time is crucial.

Methods:

Using data from the Global Burden of Disease (GBD) Study 2021, we analyzed mesothelioma incidence, mortality, and disability-adjusted life years (DALYs) in MENA from 1990 to 2021. Age-standardized incidence rate (ASIR), mortality rate (ASMR), and disability rate (ASDR) were assessed by age, sex, and country. Trend analyses were conducted using joinpoint regression to identify significant shifts in disease burden over the study period.

Results:

Between 1990 and 2021, mesothelioma cases rose from 597 to 1365, with ASIR declining at an average annual percent change (AAPC) of −0.49% (P < 0.001). Countries like Oman and Saudi Arabia exhibited rising burdens, while the United Arab Emirates and Turkey saw declines. Males and older age groups had higher ASIR, ASMR, and ASDR rates, indicating gender- and age-based disparities.

Conclusion:

While the mesothelioma burden in MENA has declined overall, significant increases in certain countries highlight the need for uniform asbestos regulations and targeted health interventions, especially among high-risk demographics. Further research on occupational exposure and Sociodemographic Index (SDI) improvements could help reduce mesothelioma rates across the region.
Bibliometric analysis of artificial intelligence applications in cardiovascular imaging: trends, impact, and emerging research areas
Authors: Alotaibi Hadi , Contreas Rafael , Thakker Nisarg , Mahapatro Abinash , Adla Jala Saisree Reddy , Mohanty Elan , Devulapally Pavan , Mirchandani Mohit , Marsool Marsool Mohammed Dheyaa , Jain Shika M , Joukar Farahnaz , Alizadeh Asl Azin , Hosseini Jebelli Seyedeh Fatemeh , Amini-Salehi Ehsan , Ameen Daniyal
Published: February 2025

Background:

The application of artificial intelligence (AI) in cardiac imaging has rapidly evolved, offering enhanced accuracy and efficiency in the diagnosis and management of cardiovascular diseases. This bibliometric study aimed to evaluate research trends, impact, and scholarly output in this expanding field.

Methods:

A systematic search was conducted on 14 August 2024, using the Web of Science Core Collection database. VOSviewer, CiteSpace, and Biblioshiny were utilized for data analysis.

Results:

The findings revealed a significant increase in publications on AI in cardiovascular imaging, particularly from 2018 to 2023, with the United States leading in research output. England and the United States have emerged as central hubs in the global research network, highlighting their role in generating high-quality and impactful publications. The University of London was identified as the top contributing institution, while Frontiers in Cardiovascular Medicine was the most prolific journal. Keyword analysis highlighted machine learning, echocardiography, and diagnosis as the most frequently occurring terms. A time trend analysis showed a shift in research focus towards AI applications in cardiac computed tomography (CT) and magnetic resonance imaging (MRI), with recent keywords like ejection fraction, risk, and heart failure reflecting emerging areas of interest.

Conclusion:

Healthcare providers should consider integrating AI tools into cardiovascular imaging practice, as AI has demonstrated the potential to enhance diagnostic accuracy and improve patient outcomes. This study highlights the rising importance of AI in personalized and predictive cardiovascular care, urging healthcare providers to stay informed about these advancements to enhance clinical decision-making and patient management.
Directly acting antivirals improve insulin resistance in nondiabetic patients with hepatitis C: a systematic review and meta-analysis
Authors: Lamichhane Pratik , Makhlouf Saed S.K. , Saleem Kanza , Jitendrabhai Senjaliya Darshakkumar , Wajid Afreen , Khanal Kapil , Agrawal Anushka
Published: February 2025

Aims:

Insulin resistance, beta-cell dysfunction, and diabetes mellitus (DM) are the extrahepatic complications of chronic hepatitis C virus (HCV) infection. The aim of the study was to determine the effects of novel directly acting antivirals (DAAs) on insulin resistance and insulin sensitivity parameters in nondiabetic patients with chronic HCV infection.

Methods:

A systematic search of medical databases (Pubmed, Scopus, and Google Scholar) was conducted for studies published until July 2024. Studies investigating the effect of any DAA on insulin resistance and insulin sensitivity parameters in non-diabetic patients with chronic HCV and sustained virologic response were included. Our study assessed the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) as the primary outcome. The pooled outcomes were compared pretreatment and posttreatment with DAAs using Hedges’ g (HG) with a 95% confidence interval (CI).

Results:

A total of 10 studies (1309 participants) were included in the meta-analysis. Insulin resistance measured by the HOMA-IR was significantly reduced with DAA therapy (HG = 0.86, 95% CI: 0.48–1.25, P < 0.001). A similar significant reduction in fasting insulin levels was observed following DAA therapy (HG = 0.88, 95% CI: 0.51–1.25, P < 0.001). However, no significant differences were seen in Homeostasis model assessment for beta-cell function (HOMA-B) (HG = 0.12, 95% CI: −0.0 to 0.24, P = 0.06) before and after DAAs use.

Conclusions:

The use of DAAs in nondiabetic chronic HCV patients with a sustained virologic response also significantly reduces insulin resistance and fasting insulin levels.
Platelet activation in breast cancer: mechanisms and therapeutic opportunities – a narrative review
Authors: Obeagu Emmanuel Ifeanyi
Published: February 2025

Platelet activation is increasingly recognized as a key factor in breast cancer progression, contributing to tumor growth, metastasis, and immune modulation. Platelets interact with tumor cells to promote their survival, facilitate metastasis, and enhance the formation of a pro-inflammatory microenvironment. These interactions are mediated by adhesion molecules such as P-selectin and glycoprotein receptors on both platelets and tumor cells. Additionally, activated platelets release growth factors like vascular endothelial growth factor and platelet-derived growth factor, which promote angiogenesis and tumor vascularization, crucial steps in cancer progression. The coagulation cascade, triggered by platelet activation, further enhances tumor cell dissemination and metastasis. Elevated levels of procoagulant activity in platelets, particularly through the expression of tissue factor, lead to increased thrombin generation, facilitating the formation of fibrin-rich clots that protect circulating tumor cells from immune surveillance. Platelet-derived factors also exert immunomodulatory effects, helping cancer cells evade detection by the immune system, thereby supporting tumor growth and spread.
Deep brain stimulation (DBS) in movement disorders management: exploring therapeutic efficacy, neurobiological mechanisms, and clinical implications
Authors: Hussein Abbas F. Abdul , Imran Wafa Mohammad , Serag Ibrahim , Abbas Abdallah , Mohamed Hammad Elsayed , Al-Aish Sandra Thair , Mahmoud Dina , Zazo Hassan Ahmed Mostafa , Ghattas Amr S. , Megali Mohamed H. , Muthana Ahmed , Hashim Almusawi Ali Abbas , Chaurasia Bipin
Published: February 2025

Introduction:

Deep brain stimulation (DBS) has emerged as a promising therapeutic approach, offering targeted neuromodulation for movement disorders refractory to medical management or stereotactic surgery. However, assessing its benefits against potential risks is essential. This meta-analysis aims to evaluate the efficacy and safety of DBS in movement disorders, shedding light on its role as an alternative therapeutic option.

Methods:

A comprehensive search of databases after systemic review yielded studies published in English from 2000 to the present. Data selection, screening, extraction, and risk of bias assessment were performed meticulously. Statistical analysis was conducted using RevMan 2.0, with significant heterogeneity addressed through appropriate methods.

Results:

Our meta-analysis included 40 studies assessing the Unified Parkinson’s Disease Rating Scale Part III, revealing a significant improvement in motor symptoms (mean difference [MD]: −18.05, 95% confidence interval [CI] [−20.17, −15.93], P < 0.00001). Hoehn and Yahr Stage analysis demonstrated a reduction in disease severity (MD: −0.58, 95% CI [−1.05, −0.12], P = 0.01). Tremor severity (MD: −8.22, 95% CI [−12.30, −4.15], P < 0.0001), overall tremor (MD: −2.68, 95% CI [−4.59, −0.77], P = 0.006), gait velocity (MD: 0.13, 95% CI [0.08, 0.18], P < 0.00001), and Yale Global Tic Severity Scale score (MD: −9.75, 95% CI [−14.55, −4.96], P < 0.0001) also showed significant improvements with DBS.

Conclusion:

DBS demonstrates efficacy in improving motor symptoms, disease severity, tremor, gait, and tic severity in movement disorders. However, further research is needed to elucidate long-term efficacy and safety outcomes.
Unveiling the hidden danger: a rachnoid cyst in the fourth ventricle: a rare case report and review of the literature
Authors: Bukhari Syed Mohsin Raza , Yadav Dipesh Kumar , Mehdi Hassan , Baig Mirza Subhan Ali , Raza Mohsin , Abbas Jalil , Mehdi Ali , Anjum Abdul Sattar
Published: February 2025

Introduction and importance:

Arachnoid cysts are benign CSF-filled sacs that commonly develop in the regions of the Sylvian fissure and cerebellopontine angle. Their occurrence in ventricles especially in the fourth ventricle is rare. These cysts can have a gamut of neurological symptoms. Surgical intervention is usually required to manage symptomatic cysts.

Case presentation:

A 55-year-old man presented with occipital headaches for 6 months, followed by increasing lower limb weakness, gait abnormalities, and cognitive impairments. Investigations revealed a cyst in the fourth ventricle extending into the foramina of Luschka, causing obstructive hydrocephalus, 8 mm tonsillar herniation, and brainstem compression. The surgical procedure involving a midline suboccipital craniotomy, cyst decompression, removal of adhering walls, and restoration of cerebrospinal fluid flow was performed, leading to the restoration of neurological functions.

Clinical discussion:

Arachnoid cysts can cause neurological symptoms as a result of pressure exertion on adjacent brain structures. Symptoms such as cognitive impairment, limb weakness, and obstructive hydrocephalus can occur due to the presence of fourth ventricular cysts, which are a rarity. The standard approach for managing a symptomatic cyst is surgical removal, which aims to relieve pressure and restore cerebrospinal fluid flow. Postoperative monitoring is essential to reduce the risk of recurrence and development of complications.

Conclusion:

The presence of an arachnoid cyst should be considered in atypical locations like the fourth ventricle in adults presenting with progressive neurological deficits. Timely surgical intervention is critical for symptom relief and avoiding complications. Long-term monitoring remains critical for detecting recurrence or treatment failure.
Primary hydatid cyst in rectus abdominis muscle: a rare presentation on an unusual location
Authors: Acharya Rabin , Saud Gaurav Singh , Bista Bindu , Mishra Bhola , Yadav Shashi Deo , Mahato Santosh Kumar
Published: February 2025

Introduction:

Hydatid disease, caused by Echinococcus granulosus, commonly affects the liver (80%) and lungs (15%). Muscular involvement is rare, with primary hydatid cysts in skeletal muscles comprising only 2–3% of cases. This report presents the first documented case of a primary hydatid cyst in the rectus abdominis muscle in Nepal, and the 11th case globally.

Case presentation:

A 38-year-old female presented with a progressively enlarging epigastric swelling and localized pain over 1 year. On examination, a firm, non-tender 5 × 5 cm mass was palpated in the left rectus abdominis muscle. Imaging, including ultrasonography and contrast-enhanced CT, showed a well-defined cystic lesion without involvement of other organs. Serology for hydatid disease was negative. The cyst was excised surgically under general anesthesia, ensuring no spillage, and the surgical site was irrigated with hypertonic saline. Histopathology revealed acellular laminated keratin, protoscolices, and inflammatory infiltrates. Postoperatively, the patient received albendazole for 4 weeks and recovered uneventfully, with no recurrence on follow-up.

Discussion:

Primary muscular hydatid cysts are rare, as muscle contraction and lactic acid provide an unfavorable environment for the parasite. Imaging plays a vital role, as serology often yields false negatives. Surgical excision is the gold standard treatment, supported by anthelmintic therapy to prevent recurrence.

Conclusion:

This case highlights a rare presentation of hydatid disease in the rectus abdominis muscle, underscoring the importance of considering atypical locations in diagnosis. Early surgical intervention and postoperative medical therapy ensure positive outcomes.
Artificial intelligence in surgical medicine: a brief review
Authors: Guo Chen , He Yutao , Shi Zhitian , Wang Lin
Published: February 2025

The application of Artificial Intelligence (AI) technology in the medical field, particularly in surgical operations, has evolved from science fiction to a crucial tool. With continuous advancements in computational power and algorithmic technology, AI is reshaping the surgical medicine landscape. From preoperative diagnosis and planning to intraoperative real-time navigation and assistance and postoperative rehabilitation and follow-up management, AI technology has significantly enhanced the precision and safety of surgical procedures. This paper systematically reviews the development and current applications of AI in surgery, focusing on specific case studies of AI in surgical procedures, diagnostic assistance, intraoperative navigation, and postoperative management, highlighting its significant contributions to improving surgical precision and safety. Despite the obvious advantages of AI in improving surgical success, reducing post-operative complications and accelerating patient recovery, its use in surgery still faces numerous challenges, including its cost-effectiveness, dependency, data privacy and security, clinical integration and physician training. This review summarizes the current applications of AI in surgical medicine, highlights its benefits and limitations, and discusses the challenges and future directions of integrating AI into surgical practice.
Assessing Advance Care Planning Readiness in Older Adults
Authors: Oliveira Sarah , Karlowicz Karen A.
Published: February 2025

The purpose of this pilot posttest-only, randomized, controlled group study was to evaluate if a combination of educational methods (written, video, and/or group discussion) would improve the readiness of older adults to participate in advance care planning (ACP). Participants were 65 years and older, English-speaking, receiving outpatient care, having at least one life-limiting illness, and without an advance directive. An independent t test and 1-way analysis of variance compared responses to 9 survey questions of readiness between the control group and the intervention groups. This pilot study found that educational materials are useful resources to acquaint patients with ACP, but they may be more effective if complemented with other approaches to increase patient awareness and readiness to create an ACP.
Cell Free DNA-Based Prediction of Prognosis for Patients on Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Li Jin , Li ChengLong , Wang Liangshan , Wang Xiaomeng , Xu Bo , Jiang Chunjing , Xin Meng , Guo Dong , Chen Jing , Du Zhongtao , Wang Hong , Hao Xing , Hou Xiaotong
Published: February 2025

Introduction

Elevated cell-free DNA (cfDNA) was observed in patients receiving venoarterial (VA) extracorporeal membrane oxygenation (ECMO), but the clinical relevance of cfDNA is still not clear. We aimed to establish an predictive model based on the cfDNA to predict the prognosis for patients on ECMO, and reveal the values of cfDNA for complications of limb ischemia and bleeding/thromboembolic events.

Methods

Single-center, retrospective evaluation of patients with ECMO support from 2018 through 2023. The derivation cohort included 133 adults diagnosed with cardiogenic shock who received VA-ECMO for circulatory support. We developed three independent features and combined them with a logistic model to predict mortality. Predictive performance was assessed through Bootstrap analysis and validated by another cohort of 27 patients. The values of cfDNA for complications were analysised by restricted cubic spline (RCS) analysis, receiver-operating characteristic curves (ROC) and multivariate regression analyses.

Results

A total of 133 adults who underwent VA-ECMO for refractory cardiogenic shock were entered into the derivation cohort. The logistic model, consisted of cfDNA, the worst mean arterial pressure (MAP) before ECMO and the worst lactate within 24 h of VA-ECMO implantation was predictive and performed similarly for validation cohorts (AUROC:0.768 vs 0.747). RCS analysis revealed a positive linear relationship for the risk of limb ischemia (linear, P = 0.006; AUROC of 0.75 [95% CI, 0.656-0.848]), a U-shaped trend for bleeding events (nonlinear, P = 0.214), and a negative trend for thrombotic events (linear, P = 0.552).

Conclusions

In addition to MAP and lactate levels, elevated cfDNA levels within 48 h of ECMO support were highly associated with mortality for patients. Additionally, cfDNA is predictive of limb ischemia.
Polymerase chain reaction for early identification of bacteria causing pneumonia in ventilated surgical and trauma patients
Authors: Pollock Aaron , Bailey Justin , Parmer Hunter , Stowe Alicia , Thelen Mitch , Carter Breanna , Sizemore Jay , Maxwell Robert
Published: February 2025

INTRODUCTION

Ventilator-associated pneumonia occurs in 20% to 25% of intubated trauma patients, and early effective antibiotic treatment decreases morbidity and mortality. We sought to determine the sensitivity and specificity of multiplex polymerase chain reaction amplification of bacterial DNA (Biofire FilmArray Pneumonia Panel [BFPP]) obtained during fiberoptic bronchoscopy in predicting the causative bacteria the day of bronchoalveolar lavage (BAL).

METHODS

This diagnostic accuracy study compared results of BAL with quantitative culture and BFPP testing on all intubated trauma and surgery patients suspected of developing pneumonia. Demographics, clinical data, BAL culture results, and BFPP results were recorded. McNemar analysis was performed.

RESULTS

Over a 3-year study period, 151 intubated surgical critical care patients suspected of developing pneumonia underwent 238 BALs with quantitative culture and BFPP testing. Bronchoalveolar lavages that had ≥105 colony-forming units/mL growth were considered consistent with the diagnosis of pneumonia. Of the 238 BALs, 82 (34.5%) were considered positive and then correlated to the genomic copy number per milliliter (GCN/mL) reported by BFPP testing.

CONCLUSION

In ventilated patients with high clinical suspicion for pneumonia, a BFPP cutoff value of 106 GCN/mL is a sensitive and specific test for initiating antibiotics targeted to the identified organism(s). In addition, a negative BFPP result may limit unnecessary and potentially harmful empiric antibiotic coverage, as its negative predictive value is 99.8%.

LEVEL OF EVIDENCE

Guide Clinical Decision-making, Health Policies, and Preventive Strategies; Level III.