bluuebunny/crossref_metadata_2025 huggingface dataset:
10010- NI-1 QUANTITATIVE ANALYSIS OF RECURRENCE PATTERNS AND DIRECTIONALITY IN PRIMARY GLIOBLASTOMA USING LESION MAPS & TRACTOGRAPHY
Authors: Shimizu Takeshi , Satoh Hirotaka , Sanada Takahiro , Saitou Masato , Mitsui Nobuyuki , Hiroshima Satoru , Kinoshita Manabu
Published: November 2024

INTRODUCTION

Identifying the sites of recurrence in primary glioblastoma is crucial for developing aggressive initial treatments. This study focuses on glioblastoma originating in the frontal lobe, hypothesizing that “recurrence progression is related to nerve fiber trajectories.” We quantitatively examined recurrence patterns.

METHODS

We analyzed 30 cases of primary glioblastoma in the frontal lobe treated at our institution with confirmed recurrences. For each patient, primary and recurrent lesion localizations were delineated using contrast-enhanced MRI and transformed to standard brain coordinates. This visualized the localization of lesions and allowed quantitative analysis of distribution changes. Additionally, virtual fiber tracking using DTI data from healthy subjects was performed with the primary lesion as a seed, and the correlation between the direction of recurrence and nerve fibers was analyzed using Pearson’s correlation coefficient.

RESULTS

Primary lesions were distributed in the MNI space across the frontal lobe, white matter, insula, putamen, thalamus, parietal lobe, temporal lobe, occipital lobe, and cerebellum at frequencies of 65.8%, 12.5%, 5.7%, 4.8%, 3.6%, 4.9%, 2.7%, 0.0%, and 0.0%, respectively. Recurrent lesions were distributed at 59.9%, 9.7%, 5.7%, 5.8%, 1.0%, 12.1%, 4.0%, 1.4%, and 0.3%, respectively. The changes in lesion distribution were statistically significant (p<0.001, Chi-square test), and post hoc Fisher’s test showed a tendency for increased occurrence in the parietal lobe (P=0.065). Recurrent lesion vectors significantly correlated with nerve fiber vectors (mean absolute correlation: 0.60, p<0.00001).

CONCLUSION

Primary glioblastomas in the frontal lobe tend to progress towards the parietal lobe, influenced by nerve fiber trajectories. These findings suggest that considering the direction of lesion progression could be essential in developing initial treatment strategies for glioblastoma.
10181- NI-14 RELATIONSHIP BETWEEN METHIONINE PET FINDINGS AND CLINICAL AND MOLECULAR PATHOLOGICAL FEATURES IN BRAIN TUMORS
Authors: Shiba Yoshiki , Ohka Fumiharu , Deguchi Shoichi , Yamaguchi Junya , Maeda Sachi , Saito Ryuta
Published: November 2024

INTRODUCTION

The usefulness of methionine PET scan in the diagnosis of brain tumors is widely recognized, and it is frequently used to distinguish nonneoplastic lesions in primary tumors and radiation necrosis in recurrent lesions. It is also useful in surgery to identify the extent of resection due to its ability to be taken up by actively dividing tumor cells.

METHODS

We retrospectively analyzed electronic medical records and genetic analysis data of 744 consecutive patients who underwent methionine PET examination at our department from February 2019 to April 2023. During this period, tumor cases and suspected tumor cases were basically included in the study.

RESULTS

There were 34 cases in which the pathological diagnosis of the excised specimen was “tumor” despite the absence of significant methionine accumulation. These included astrocytoma WHO Grade 2, cavernous hemangioma, and spinal ependymoma. On the other hand, 44 patients with a final diagnosis of “non-neoplastic disease” showed methionine accumulation. All patients with Glioblastoma and Oligodendroglioma were MET-PET positive, while 18 of 46 patients with Diffuse astrocytoma did not show methionine accumulation. Diffuse astrocytoma without methionine uptake tended to have better O S and P F S than those with methionine uptake.

CONCLUSION

Methionine PET is useful for the diagnosis of neoplastic disease, but it should be used with caution, especially in astrocytomas, because some cases were found to have no uptake, and a certain number of non-tumor cases were found to have uptake. In the treatment of patients with astrocytoma, data integration with intraoperative MRI and intraoperative molecular analysis techniques may improve the accuracy of surgery, and we report an actual case.
10293- ML-18 FLOW CYTOMETRY IS EFFECTIVE FOR THE RAPID DIAGNOSIS OF PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA
Authors: Nakamura Hikaru , Hiu Takeshi , Yoshida Michiharu , Kato Takeharu , Baba Shiro , Ujifuku Kenta , Morofuji Yoichi , Yoshida Koichi , Hayashi Yukishige , Miyazaki Yasushi , Matsuo Takayuki
Published: November 2024

INTRODUCTION

Primary central nervous system lymphoma (PCNSL) is characterized by an extremely high proliferation rate, making early diagnosis and therapeutic intervention crucial. To facilitate rapid diagnosis, our hospital has implemented flow cytometry (FCM) in addition to conventional histopathological methods. We evaluated the effectiveness of FCM for the rapid diagnosis of PCNSL.

METHODS

From 2010 to 2023, we retrospectively analyzed 67 consecutive patients with suspected PCNSL based on preoperative imaging findings, in whom FCM was performed using intraoperative specimens. B cell clonality was determined when CD19 or CD20 was expressed in 20% or more and the κ/λratio was either >3.0 or <0.5.

RESULTS

Pathological diagnosis confirmed PCNSL in 42 cases, all of which were diagnosed as diffuse large B-cell lymphoma (DLBCL). Six cases (14.3%) of PCNSL patients were discordant with FCM (FCM-D). In contrast, all cases of other tumor types were FCM-D. The sensitivity and specificity of FCM were 85.7% and 100%, respectively. Additionally, T cell surface markers such as CD3, CD4, CD5, and CD8 were significantly elevated in the FCM-D group of PCNSL patients (p<0.01).

DISCUSSION

FCM results can be obtained within a few hours after tissue collection. With a specificity of 100%, FCM provides a reliable basis for early therapeutic intervention and is anticipated to improve postoperative Karnofsky Performance Status (KPS) and overall survival (OS) in the future. The FCM-D cases among PCNSL patients may have indicated the infiltration of T lymphocytes. Sensitivity could potentially be improved by analyzing multiple samples with FCM.

CONCLUSION

FCM can serve as a reliable basis for the rapid diagnosis and therapeutic intervention of PCNSL patients.
10031- MET-5 CHANGES IN PROGNOSTIC FACTORS IN PATIENTS WITH BRAIN METASTASES FROM LUNG CANCER
Authors: Yamamoto Yohei , Tanaka Toshihide , Teshigawara Akihiko , Ishii Takuya , Akasaki Yasuharu , Murayama Yuichi
Published: November 2024

INTRODUCTION

In recent years, lung cancer treatment has undergone a turning point. A retrospective analysis was conducted to examine the changes in prognostic factors over time in cases of brain metastasis.

METHODS AND SUBJECTS

The study included 186 patients with metastatic brain tumors from lung cancer treated at the Third Hospital of the Jikei University School of Medicine from 2014 to 2023. The study was divided into two 5-year periods, and a statistical analysis of background factors and factors related to survival time was performed retrospectively. Factors were extracted from pretreatment factors such as age, number of metastases, and metastasis to other organs, and treatment factors such as surgical treatment and chemotherapy.

RESULTS

The average survival time was significantly extended from 4.7 months in the first group(F) to 10.9 months in the second group(S). In S, the use of immune checkpoint inhibitors (ICI), cases of neuronal death, and cases of stereotactic radiation therapy increased, and whole-brain irradiation decreased. Factors related to prolonged survival in F were surgery, high Karnofsky Performance Status (KPS), stereotactic radiation therapy, and molecular targeted drugs (MTD), while in S, high KPS, stereotactic radiation therapy, use of MTD, and use of ICI. When limited to cases where ICI was used, prolonged prognosis was observed in adenocarcinomas not suitable for molecular targeted drugs, and squamous cell carcinoma and small cell carcinomas in all cases in which they were used.

DISCUSSION AND CONCLUSION

In the treatment of lung cancer brain metastases, opportunities for stereotactic radiation therapy and ICI have increased, and it has been shown that these drugs prolong prognosis. In particular, the number of treatment targets for ICI is likely to expand in the future, and their therapeutic effect on brain metastases alone has also been reported.
10194- MET-15 USEFULNESS OF DWIBS IN SYSTEMIC EXAMINATION FOR METASTATIC BRAIN TUMOR
Authors: Koyahara Yuki , Hirai Nozomi , Saito Norihiko , Yagihashi Akinori , Takahagi Syusaku , Hiramoto Yu , Fujita Satoshi , Nakayama Haruo , Hayashi Morito , Ito Keisuke , Iwabuchi Satoshi
Published: November 2024

INTRODUCTION

DWIBS is an abbreviation for Diffusion Weighted Whole Imaging with Background body signal Suppression. It is an imaging method that uses MRI diffusion-weighted imaging (DWI) to image the entire body in multiple locations and then integrates them to form a wide-area image. In recent years, MRI has been used to search for heat sources of unidentified fever and distant metastasis of cancer. In this report, we describe two cases in which DWIBS was useful in the search for the primary tumor in patients with brain metastases.

CASE PRESENTATION

Case 1: Male in his 60s. The patient presented with headache and diplopia, and MRI showed a neoplastic lesion in the clivus bone. A transnasal endoscopic surgery was performed, and he was diagnosed with bone metastasis of squamous cell carcinoma. Contrast-enhanced whole body CT showed similar findings, and the patient was found to have brain metastasis of esophageal cancer. Case 2: Male, 50s. He presented with a complaint of left facial paralysis and left incomplete paralysis, and a head MRI showed a brain tumor in the right middle frontal gyrus. A craniotomy was performed, and the pathological diagnosis was adenocarcinoma. A systemic search did not reveal a primary tumor, and the patient was diagnosed with cancer of unknown primary, but later lung lesions became apparent. The DWIBS performed at that time also showed a high signal at the site where lung cancer was diagnosed.

DISCUSSION

In Japan, MRI is widely used, and DWIBS is gradually becoming popular as a whole-body search method because it can be performed with current MRI equipment. DWIBS may be an option for primary tumor detection in facilities or regions where 18F-FDG PET is not readily available.

CONCLUSION

DWIBS may be useful for close examination of primary metastatic brain tumors, and more cases should be accumulated in the future.
10058- COT-7 EFFICACY AND CHALLENGES REVEALED BY A SURVEY ON CANCER GENOME PROFILING IN BRAIN TUMORS
Authors: Koizumi Shinichiro , Oishi Tomoya , Yamasaki Tomohiro , Kida Satoshi , Kurozumi Kazuhiko
Published: November 2024

INTRODUCTION

Cancer genomic profiling (CGP) testing has become increasingly important in the WHO2021 classification, supporting molecular diagnosis and providing new approaches to personalized treatment and prevention. However, challenges remain regarding the specific impact on personalized treatment and hereditary tumor diagnosis, as well as the current medical service provision system. In this study, we investigated the actual state of personalized treatment and hereditary tumor diagnosis, and the subsequent intervention process and the establishment of medical service provision system for brain tumor cases in which CGP testing was performed at our hospital.

METHODS

The study included 28 brain tumor cases in which CGP testing was performed using Foundation One CDx, GenMineTOP, or NCC Oncopanel between May 2020 and July 2024. Based on the results, including genetic risk assessment, the presence or absence of drug suggestions and the diagnosis of hereditary tumors were analyzed to evaluate the effectiveness of personalized treatment.

RESULTS

Efficacy of Molecular Diagnosis: CGP testing enabled molecular diagnoses such as IDH mutations and TERTp mutations, demonstrating its efficacy as an adjunct to diagnosis based on the WHO2021 classification. Personalized Medicine and Drug Recommendations: Mutations such as BRAF V600E, IDH1 R132H and TMB-high were detected. It was confirmed that 21% of cases could be treated with molecular targeted drugs or checkpoint inhibitors. Diagnosis of Hereditary Tumors: CGP testing identified presumed pathogenic germline variant, making it possible to intervene with in cases diagnosed with Lynch syndrome.

CONCLUSION

CGP testing plays a crucial role in individualized treatment and in the diagnosis and prevention of hereditary tumors. Collaboration with genetic medical departments is essential, and a robust system construction is required. Challenges include quality assurance of the testing technology, costs, and widespread adoption within the healthcare system, and collaboration for early detection of hereditary tumors and provision of information to families is particularly important.
10128- COT-15 CURRENT STATUS AND CHALLENGES OF COMPREHENSIVE GENOME PROFILING FOR CNS TUMORS
Authors: Takahashi Yoshinobu , Ogawa Takahiro , Taniyama Ichita , Yamanaka Takumi , Hashimoto Naoya
Published: November 2024

BACKGROUND AND OBJECTIVES

Comprehensive Genome Profiling (CGP) has been covered by insurance since June 2019. This advancement has enabled the identification of therapeutic target gene mutations, improving access to drugs through clinical trials and patient-requested therapy programs. However, it has been noted that the number of cases that actually lead to treatment remains low. This study aims to examine the current status of CGP for brain and spinal cord tumor patients, assessing its utility and challenges.

METHODS

We investigated 46 cases of central nervous system tumors that underwent CGP by April 2024. The focus was on the detection of MSI-H, TMB-H, NTRK fusion genes, and BRAF gene mutations, as well as the genetic mutations associated with recommended drugs, and examined the cases that led to actual treatment.

RESULTS

The median age of the patients was 50 years. The breakdown included 26 cases of adult-type diffuse glioma, 5 cases of diffuse midline glioma with H3 K27M alteration, 1 case of pilomyxoid astrocytoma, 2 cases of ependymal tumors, 3 cases of atypical teratoid/rhabdoid tumor (AT/RT), 3 cases of anaplastic meningioma, and 6 other cases. MSI-H and TMB-H were found in 1 case of glioblastoma, TMB-H alone in 3 cases, NTRK fusion gene in 1 case of spinal glioma, and BRAF V600E mutation in 1 case of glioblastoma. Thirty cases (65%) received some form of recommendation, with 6 cases (13%) receiving drug treatment. Only the spinal glioma with the NTRK fusion gene showed significant improvement with entrectinib.

CONCLUSION

While CGP is useful for identifying genetic abnormalities, its connection to actual treatment is limited. Future efforts should focus on developing new therapies and enhancing clinical trials, as well as exploring high-precision biomarkers and detailed analyses of the relationship between treatment history, clinical information, and genetic abnormalities.
IL-2 OPTIMIZED SYSTEMS FOR THE STUDY OF GLIOMA DEVELOPMENT AND THERAPY.
Authors: Pieper Russell O
Published: November 2024

Our understanding of gliomagenesis, and in turn our ability to develop therapeutics targeting glioma, are highly dependent on the systems we use to study these issues. Historically our knowledge was based on the establishment of glioma cells in culture, on the genetic manipulation of these cells, and on their short-term in vitro response to therapeutics. The limitations of these studies however are obvious and include in vitro pressures that select for cells that grow in culture regardless of their importance in vivo, the focus on cultures that grow rapidly enough for quick analysis, and the lack of micro environmental context. Initial efforts to move away from such systems took two forms: first the generation of genetically defined glioma cells derived from normal precursors by serial genetic manipulation, and second the development of patient-derived xenografts (PDX). The former approach has been successful in defining pathways critical for glioma formation and in defining the roles of proteins commonly altered in glioma such as IDH1, while the latter PDX approach has also proven useful in therapeutic testing. Against this background, attempts are now being made to directly study glioma cells under non-selective conditions and in their natural environment. The use of so-called tumor organoids involves placing small biopsy pieces of glioma ranging from low-grade glioma to GBM directly into culture using serum-free medias and hypoxic conditions which more closely mimic those of the tumor in vivo. Under these conditions organoids survive, proliferate in a manner more closely associated with the actual tumor, and retain a variety of microenvironmental cues and genetic identity. Furthermore, the development of -omics approaches to measure drug response may allow these systems to more accurately test new therapies.
Portable EEG in groups shows increased brain coupling to strong health messages
Authors: Imhof Martin A , Flösch Karl-Philipp , Schmälzle Ralf , Renner Britta , Schupp Harald T
Published: November 2024

Health messages are core building blocks of public health efforts. Neuroscientific measures offer insights into how target audiences receive health messages. To move towards real-world applications, however, challenges regarding costs, lab restraints, and slow data acquisition need to be addressed. Using portable electroencephalography (EEG) and inter-subject correlation (ISC) analysis as measure of message strength, we ask whether these challenges can be met. Portable EEG was recorded while participants viewed strong and weak video health messages against risky alcohol use. Participants viewed the messages either individually or in a focus group-like setting with six participants simultaneously. For both viewing conditions, three correlated components were extracted. The topographies of these components showed a high spatial correlation with previous high-density EEG results. Moreover, ISC was strongly enhanced when viewing strong as compared to weak health messages in both the group and individual viewing conditions. The findings suggest that ISC analysis shows sensitivity to message strength, even in a group setting using low-density portable EEG. Measuring brain responses to messages in group settings is more efficient and scalable beyond the laboratory. Overall, these results support a translational perspective for the use of neuroscientific measures in health message development.
The impact of circulating nucleosomes on inflammation in acute lung injury
Authors: Dutta Saugata , Zhu Yin , Almuntashiri Sultan , Somanath Payaningal R. , Islam Shaheen , Zhi Wenbo , Ramírez Gustavo , Regino Nora , Leyva‐Zilli María Jose , Muñoz‐Guido Victoria , Jiménez‐Alvarez Luis , Cruz‐Lagunas Alfredo , Rodriguez‐Reyna Tatiana S. , Zuñiga Joaquin , Wang Xiaoyun , Zhang Duo
Published: November 2024

Extracellular histones are released in two major forms: free histones and nucleosomes (DNA‐bound histones). However, little distinction has been made between these two forms of circulating extracellular histones. Our study detected increased circulating nucleosomes in acute lung injury patients. Further, our group identified nucleosomes as the leading form of extracellular histones compared to free histones in the plasma of COVID‐19 patients, underscoring the necessity to reassess the forms of circulating histones and nucleosome contributions to immunopathology. Functionally, nucleosomes activated macrophages and induced inflammation in different organs. Mechanistically, we observed nucleosomes activating the NF‐κB signaling, while inhibition of NF‐κB by sulfasalazine attenuated nucleosome‐induced macrophage activation. Taken together, our study indicates that extracellular histones are predominantly released as nucleosomes, playing a critical role in the inflammation of the lungs and other organs.
CD11b deficiency attenuates the ischemia/reperfusion‐induced AKI‐to‐CKD process by regulating macrophage polarization
Authors: Zhou Huili , Zhao Shuan , Zhou Min , Fang Yi , Tsuboi Naotake , Ding Xiaoqiang , Shi Yiqin
Published: November 2024

Severe acute kidney injury (AKI) is a risk factor for the future development of chronic kidney disease (CKD), and macrophages are an essential cell group implicated in injury, repair, and fibrosis during this progress. However, the underlying mechanism of how macrophages participate in the development of the disease is largely unclear. CD11b (Integrin αM) is highly expressed in monocytes/macrophages and has been verified to mediate broad functions. We found that CD11b‐knockout mice were protected from the ischemia/reperfusion‐induced AKI‐to‐CKD process. Additionally, renal macrophages from the kidneys of CD11b‐deficient mice presented an M2‐like, anti‐inflammatory phenotype. We demonstrated both in vitro and in vivo that enhanced alternative activation in CD11b‐knockout macrophages is regulated by the interleukin (IL)‐4/signal transducer and activator of transcription (STAT) 6 axis, which is mediated by the inactivation of the Src‐family kinase (SFK) member Lyn. Importantly, the therapeutical administration of CD11b‐neutralizing antibody can effectively prevent AKI‐to‐CKD progress. Thus, our study verifies that CD11b plays a critical role in limiting the alternative activation of macrophages and may be a potential therapeutic target during the AKI‐to‐CKD process.
Does tranexamic acid reduce blood loss for children undergoing reconstruction for neuromuscular hip dysplasia? A matched comparative study
Authors: Hyer Lauren C. , Shull Emily R. , Westberry David E. , Southerland Brittney A. , Lew Daphne
Published: November 2024

Treatment for neuromuscular hip dysplasia (NMHD) typically involves osteotomies of the proximal femur and/or pelvis, and the potential for significant volume blood loss is high. Tranexamic acid (TXA) functions as an antifibinolytic and has been shown to reduce bleeding in many operative settings. Retrospective evidence for the use of TXA in children undergoing NMHD reconstruction is inconclusive, and to our knowledge, prospective evaluation has never been performed. The purpose of this study was to examine the effectiveness of TXA use on intra- and postoperative outcomes during bony reconstruction for NMHD. In this matched comparative study, a prospective cohort of patients undergoing bony reconstruction for NMHD who were given TXA was enrolled and then matched to a retrospective cohort who previously underwent the same surgery without administration of TXA. The primary outcome variable was a change in perioperative hemoglobin values from preoperative to 1 day postoperatively. Secondary objectives were percent loss of estimated blood volume, postoperative transfusion requirements, and length of hospital stay. Forty-eight patients, 24 in each cohort, were included in the analyses. Mean age at surgery was 7.09 years (±2.5). Fifty percent of each cohort underwent bilateral varus derotational osteotomy with pelvic acetabuloplasty. No statistical differences were found in postoperative hemoglobin differences (P = 0.18), length of hospital stay (P = 0.45), or blood transfusion requirements (P = 0.56) between cohorts. Intraoperative administration of TXA to patients undergoing bony reconstruction for NMHD was not found to reduce postoperative blood loss or requirement for blood transfusion. Future studies should employ a larger, prospective randomized controlled trial to verify these findings.
Readmission rates within the first 30 and 90 days after severe COPD exacerbations (RACE study)
Authors: Baydar Toprak Oya , Polatli Mehmet , Baha Ayşe , Kokturk Nurdan , Yapar Dilek , Ozkan Secil , Sen Elif , Ciftci Fatma , Ozturk Burcu , Kodalak Sumeyye , Ulubay Gaye , Serifoglu Irem , Varol Yelda , Mertoglu Aydan , Cirak Ali Kadri , Turan Onur , Dursunoglu Nese , Savurmus Nilufer , Gurgun Alev , Elmas Funda , Çoplu Lutfi , Sertcelik Umran , Yildiz Reyhan , Ozmen Ipek , Alpaydin Aylin , Karacay Ebru , Celik Deniz , Mete Burak
Published: November 2024

Chronic obstructive pulmonary disease (COPD) frequently results in hospital readmission and contributes to increased morbidity and mortality. This multicenter prospective study aimed to identify factors that increase the risk of readmission within 30 to 90 days of severe COPD exacerbation. A total of 415 patients admitted to the emergency department (ED) or general pulmonology ward after discharge due to severe exacerbations from 13 tertiary centers in Turkey were included. Of the participants, 346 (83.4%) were male and 69 (16.6%) were female, with an average age of 69.0 ± 9.1 years. Readmissions within 30 and 90 days after the initial hospitalization occurred in 176 (42.4%) and 191 (46%) patients, respectively. Prospective data collection focused on exacerbation severity, disease severity, and the utility of initial admissions. Factors for 30 to 90 day readmission were analyzed using univariate and multivariate regression models. A 30-day readmission correlated significantly with Hospital Anxiety Depression Scale scores above 16 [odds ratio [OR] 95% confidence intervals [CI]: 1.9 (1.1–3.6); P = .042], severe exacerbation history in the previous year [OR 95% CI: 1.7 (1.1–2.9); P = .038], hospital-acquired pneumonia [OR 95% CI: 1.9 (1–4.1); P = .049)], and frequent antibiotic use in the previous year [OR 95% CI: 1.8 (1.2–2.7); P = .007]. Risk factors for 90-day readmissions included: Grades 3 to 4 tricuspid regurgitation [OR 95% CI: 2.2 (1.1–4.4); P = .024], 2 or more moderate COPD exacerbations [OR 95% CI: 1.9 (1.2–3.1); P = .010], severe exacerbation history in the previous year [OR 95% CI: 2.5 (1.5–4.2); P = .001], immunosuppression [OR 95% CI: 2.7 (1.2–5.7); P = .013], frequent antibiotic use the previous year [OR 95% CI: 1.5 (1–2.4); P = .048], hospitalization via the ED [OR 95% CI: 1.6 (1.1–2.6); P = .028]. To mitigate complications and readmissions, patients with a history of frequent severe COPD exacerbations, high anxiety and depression scores, frequent antibiotic requirements, immunosuppression, tricuspid regurgitation, hospital-acquired pneumonia, and those admitted to the ED should be prioritized for remote monitoring after initial discharge.
Correlation between CT spectral quantitative parameters and expression levels of HIF-1α and ALX1 in non-small cell lung cancer
Authors: Jia Yulin , Sun Qiulian , Wang Yiqiao , Jiang Hao , Xiao Xigang
Published: November 2024

To detect the expression levels of hypoxia inducible factor-1alpha (HIF-1α) and aristaless-like homeobox 1 (ALX1) in non-small cell lung cancer and analyze the relationship between CT spectral quantitative parameters and immunohistochemical markers, in order to evaluate the biological characteristics of lung cancer by spectral CT. Spectral CT data and paraffin masses of 50 adult patients with lung cancer were collected. CT quantitative parameters including the slope of spectral curve, effective atomic number and iodine concentration in enhanced phases were acquired. Expression levels of HIF-1α and ALX1 were detected by immunohistochemical tests, and compared between different pathological types and differentiation grades of tumor cells. CT quantitative parameters at different expression levels of HIF-1α and ALX1 were compared, respectively. The relationship between CT quantitative parameters and expression levels of HIF-1α and ALX1 were analyzed. There was no significant difference of expression levels of HIF-1α and ALX1 between adenocarcinoma and squamous cell carcinoma. Expression levels of HIF-1α among different differentiation grades of tumor cells had significant difference (χ2
 = 27.100, P < .001), while without significant difference in ALX1 expression. CT spectral parameters had significant difference among expression levels of HIF-1α and ALX1 (P < .01). There was a positive correlation between each CT spectral parameter and the expression level of immunohistochemical markers. CT spectral quantitative parameters are significantly different among expression levels of immunohistochemical markers. The positive correlation between CT quantitative parameter and expression level of immunohistochemical markers suggests CT spectral imaging could predict biological characteristics of tumors.
Association between serum uric acid and prediabetes in a normal Chinese population: A cross-sectional study
Authors: Shen Keqing , Huang Yilin , Zhang Junlu , Chen Liangli , Cai Xixuan , Pan Jianjiang , Li Jingyi , Li Lusha , Chen Liying
Published: November 2024

Cardiovascular events are frequent among individuals with prediabetes. And the relationship between cardiovascular diseases and elevated serum uric acid (SUA) levels has been supported by extensive scientific evidence. However, there remains controversy regarding the correlation between elevated SUA and prediabetes. The aim of this study was to investigate the association between elevated SUA levels and the prevalence of prediabetes and gender differences in the association. A total of 190,891 individuals who participated in health checkups at the Health Promotion Center of Sir Run Run Shaw Hospital of Zhejiang University from January 2017 to December 2021 were included in this cross-sectional study. The health checkups were carried out by trained general practitioners and nurses. The diagnostic criteria for diabetes and prediabetes are defined in the Standards of Medical Care in Diabetes-2022. The association between SUA levels and diabetes and prediabetes was examined based on logistic regression analysis. The dose-response effect between SUA levels and diabetes and prediabetes in both sexes was assessed using a restricted cubic spline (RCS) regression model. Among 190,891 participants, this study included 106,482 males (55.8%) and 84,409 females (44.2%). There were 46,240 (24.2%) patients with prediabetes and 20,792 (10.9%) patients with diabetes. SUA was divided into quartiles (Q). Compared to the SUA Q1 group, the prevalence of prediabetes was elevated in the SUA Q4 group (OR = 1.378, 95% CI = 1.321–1.437), but diabetes risk was decreased in the SUA Q4 group (OR = 0.690, 95% CI = 0.651–0.730). We found that SUA levels were correlated with prediabetes more significantly in male subjects (OR = 1.328, 95% CI = 1.272–1.386) than in female subjects (OR = 1.184, 95% CI = 1.122–1.249) (P for interaction < .001). Higher SUA levels were strongly related to an elevated prevalence of prediabetes but a decreased prevalence of diabetes. The association of SUA in prediabetes was more significant in men.
Hemoglobin levels in red blood cells and risk of colorectal cancer: A causal investigation based on Mendelian randomization
Authors: Shen Jin , Qin Xiuyuan , Zeng Xiang , Xiao Hanyu , Lai Suhe
Published: November 2024

Mean corpuscular hemoglobin (MCH) is a critical parameter in red blood cells, associated with various diseases. While studies suggest a potential link between MCH levels and colorectal cancer (CRC), observational studies are insufficient to establish causality directly. This study utilized a 2-sample Mendelian randomization (MR) approach to investigate the genetic causal relationship between MCH and colorectal cancer (CRC). Genome-wide association study (GWAS) summary data for both MCH and CRC were sourced from relevant databases. MR analyses were performed using methods including inverse variance weighted (IVW), MR Egger, weighted median, simple mode, and weighted mode. Cochrane’s Q test was applied to assess heterogeneity in the MR findings. Horizontal pleiotropy was evaluated using the MR-Egger intercept test and the MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) test. Additionally, a leave-one-out analysis was conducted to assess the robustness of this association. The IVW method demonstrated that MCH is an independent risk factor for colorectal cancer (P = .013). Horizontal pleiotropy is unlikely to influence the causal relationship (P > .05), and there was no evidence of heterogeneity among the genetic variants (P > .05). Lastly, the leave-one-out test confirmed the stability and robustness of the association. All participants in the GWAS were derived from a specific population. Due to limitations inherent to the database, the Mendelian Randomization (MR) analysis was unable to incorporate stratified analyses by country, ethnicity, or age group.
Effectiveness of the clinical nursing pathway model in nursing mild acute pancreatitis: A retrospective study
Authors: Fan Yuan , Zhou Rui , Wu Hailong , Zhan Shuiping , Zou Wenjia , Li Wentao
Published: November 2024

This study aimed to evaluate the effectiveness of the clinical nursing pathway model in the care of patients with mild acute pancreatitis (MAP). We conducted a retrospective analysis of medical records for 80 patients diagnosed with MAP at our hospital between September 2021 and March 2023. The patients were randomly assigned to 2 groups: the control group, which received routine nursing care, and the observation group, which followed the clinical nursing pathway. The primary outcomes assessed were the time to symptom relief, recovery time from gastrointestinal bloating, emotional status, blood biochemical indicators, self-efficacy, self-care ability, and quality of life. The observation group experienced significantly shorter times for the resolution of abdominal pain and bloating, normalization of serum/urine amylase levels, and anal exhaust compared to the control group (P < .05). Additionally, the observation group reported lower scores on the self-rating anxiety scale and self-rating depression scale, and higher scores on the General Self-Efficacy Scale (P < .05). Biochemical analysis revealed that the levels of serum amylase, lipase, and C-reactive protein were significantly lower in the observation group (P < .05). Moreover, the observation group showed significantly higher scores for self-care ability and overall quality of life compared to the control group (P < .05). The clinical nursing pathway model significantly enhances the quality of care for patients with MAP by accelerating symptom relief, improving emotional status, reducing biochemical markers, and enhancing quality of life. This model effectively promotes both physical and mental health, increases self-care ability, and offers substantial potential for broader application in clinical practice.
Electroacupuncture versus 5-HT4 receptor agonist for functional constipation: A systematic review and meta-analysis of randomized controlled trials
Authors: Xu Shanchun , Li Jiacheng , Wang Aimei
Published: November 2024

Background:

Functional constipation (FC) has been found as a chronic gastrointestinal disease that is commonly diagnosed in patients. However, patients have a low satisfaction level with the treatment of constipation drugs (e.g., 5-HT4 agonists). A meta-analysis was performed to compare the efficacy and safety between electroacupuncture and 5-HT4 agonists.

Methods:

The included study were randomized controlled trials (RCTs), in which EA was used in the experimental group and 5-HT4 receptor agonist was used in the control group. Four English databases (PubMed, Cochrane Library, Web of Science, Embase) and 4 Chinese databases (China National Knowledge Infrastructure, CBM, WanFang, VIP) were searched. Relevant studies retrieved were published before September 30, 2024. The risk of bias was assessed by tool of Cochrane and GRADEpro. The Review Manager 5.4 was used for analyzing Data analysis, and Endnote X9 for screening studies.

Results:

In this paper, we included 12 studies, involving 1473 participants. We found that EA significantly improved patient assessment of cab quality of life questionnaire (PAC-QOL) (MD = −0.52, P = .03), self-rating anxiety scale (SAS) (MD = −3.00, P < .00001) and self-rating depression scale (SDS) (MD = −4.13, P < .00001) compared with 5-HT4 receptor agonists. In addition, we failed to identify any significant difference in Stool consistency, the number of weekly complete spontaneous bowel movements and weekly spontaneous bowel movements (SBMs) between the 2 groups.

Conclusion:

EA has been indicated to be better than 5-HT4 receptor agonists since it can more effectively improve FC patients’ life quality and mental state without an increased risk of adverse even. However, the previous evidence is characterized by low quality and small sample size, which should be further confirmed by high-quality and large-sample multicenter RCTs.
Chronic pyloric obstruction caused by Flammulina mushroom: A rare case report
Authors: Liu Zhaohui , Wu Ruinuan , Wang Zepeng , Sun Dayong , Wang Xiangyu
Published: November 2024

Rationale:

We report a rare case of chronic pyloric obstruction lasting 4 years. During the endoscopy examination, the cause was found to be foreign matter blocking the pylorus. We assessed the patient’s medical history and ultimately considered chronic pyloric obstruction caused by blockage of the Flammulina mushroom.

Patient concerns:

A man in his early 30 presented to the emergency department of the hospital due to recurrent vomiting for 4 years that had aggravated for 2 days.

Diagnoses:

Emergency CT indicated enlargement of the gastric cavity, numerous gastric contents in the gastric cavity, and suspicion of pylorus or duodenal bulb stenosis on imaging. Laboratory findings showed metabolic alkalosis and hypokalemia. When the gastroscope reached the antrum, the endoscopic doctor found a disc-shaped brown object (Flammulina mushroom) in the posterior wall of the posterior antrum.

Interventions:

A snare was used to remove the Flammulina mushroom through the endoscopy.

Outcomes:

The patient’s gastric emptying completely resolved, and no vomiting symptoms recurred after 1 month of follow-up.

Lessons:

For young men with a history of digestive disease, when gastric retention occurs, doctors are more inclined to diagnose the obstruction caused by the ulcer based on their subjective consciousness. This is a case that did not follow this expectation. Some food without sufficient chewing couldn’t be easily digested by gastric acid.
Comparative analysis of triplanar Chevron osteotomy (TCO) and Chevron osteotomy (CO) for treating mild to moderate hallux valgus via computer simulation and 3D printing: An observational study
Authors: Cao Jianming , Zhang Yu , Wang Xin , Ni Yulong , Niu Chao , Yin Zhigai , Xu Hongyu , Zhou Ying , Liu Dengxiang , Zhang Fengqi
Published: November 2024

Hallux valgus (HV) deformity, which is characterized by lateral deviation and pronation of the metatarsophalangeal joint, demonstrates complex 3-dimensional challenges, thus prompting the development of various surgical approaches, including traditional Chevron osteotomy (CO) and novel triplanar Chevron osteotomy (TCO). The objective of this study is to determine TCO at various tilt angles by employing 3D printing for ex vivo osteotomy angle simulations and computer modeling to correct deformities across 3 planes, thus aiming to enhance surgical outcomes by preserving or even increasing the length of the first metatarsal and thereby overcoming the limitations of CO. In this study, we collected and analyzed non-weight-bearing CT data from 55 patients (61 feet) with mild-to-moderate hallux valgus, plantar callosities and metatarsalgia from June 2019 to June 2020. The study utilized Mimics software for 3D digital reconstructions and simulation osteotomy of both TCO and CO. For both procedures, the apex was centered at the first metatarsal head, with CO specifically oriented towards the fourth metatarsal head at a 60° angle. The plantar-oblique Chevron osteotomy (POCO) was defined by a 15° plantar tilt, whereas TCO involved a further 9° tilt towards the metatarsal head. The key metrics that were measured included the hallux valgus angle (HVA), 1–2 intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and first metatarsal length (FML). Our study aged between 30 and 71 years, with an average age of 47.37 years. Postoperative assessments using Mimics software showed significant improvements in reducing the HVA, IMA, and DMAA after CO and TCO. However, when comparing both techniques, their corrective capacities were roughly equivalent, with no significant differences observed in these metrics. Notably, compared with CO, TCO significantly increased the FML (P < .001), thus suggesting that TCO has greater potential to effectively prevent transfer metatarsalgia. This study underscores the ability of TCO to significantly extend the first metatarsal, with precise adjustments to its distal tilt to tailor deformity corrections. In computational simulation experiments, TCO offers a superior alternative to CO for treating hallux valgus by addressing 3-dimensional deformities and preserving or even increasing FML, thereby preventing transfer metatarsalgia.
Implementation of a crash cesarean section policy and its impact on maternal and neonatal outcomes at King Abdulaziz University Hospital: A retrospective study
Authors: Alhawsawi Ebtihal , Bahkali Nedaa , Aljadani Sarah , Jambi Abdulaziz , Almwled Alhanouf , Al Basri Samera
Published: November 2024

A typical surgical technique for pregnant women with potentially fatal problems affecting the mother or fetus is an emergency cesarean section (ECS). The decision-to-delivery interval (DDI) for ECS should be within 30 minutes. The objective of this study was to investigate crash ECS indications and effects on maternal and neonatal outcomes. In this retrospective study, all women undergoing crash cesarean section (CS) at Obstetrics and Gynecology department at King Abdulaziz University hospital, Jeddah, Saudi Arabia during 2022 and 2023 were evaluated. Data about demographic and obstetric characteristics of mother, ECS indications, DDI, and outcomes for mothers and newborns was gathered from the patient’s sheet. One hundred 3 crash CS were performed during study period. Crash CS indications were fetal bradycardia (64.1%), prolapsed cord (24.3%), uterine rupture (6.8%), and severe antepartum hemorrhage (4.9%). D-D time range from 2 to 30 minutes. DDI was ≤15 minutes in 90 patients (87.4%) and >15 minutes in 13 patients (12.6%). Gestational age was <32 weeks (16.7%), between 32 and <37 weeks (15.5%), and ≥37 weeks (68.0%). Good maternal outcome was reported in 89 (86.4%), while 24 (13.6%) had complications. Intensive care unit maternal admission was significantly higher in gestational age 32 to <37 weeks versus <32 weeks and ≥37 weeks of gestation (18.8% vs 5.9% and 2.9%, P = .050). Fetal outcome was good in 69 (67.0%), while 34 (33.0%) had complications. Neonatal body weights, Apgar score at 1, 5, 10 minutes, and umbilical cord arterial pH were significantly decreased in preterm versus termed neonates (P < .0001, P < .0001, P < .0001, P = .014, and P = .003). Moreover, respiratory distress syndrome, jaundice, intubation, neonatal deaths, and sepsis were significantly higher in preterm versus term deliveries (P < .0001, P = .029, P < .0001, P = .010, and P = .031). Good neonatal outcome was significantly higher (P < .0001); while respiratory distress syndrome was significantly lower (P = .007) in deliveries with DDI ≤ 15 minutes versus > 15 minutes. The 30-minute standard for DDI time interval may be a feasible guideline at least for level-3 hospitals. Crash CS indication was mostly due to fetal bradycardia. The maternal and neonatal outcomes were better in term than preterm deliveries. The positive effect of very short intervals on neonatal outcome still needs to be proven.
Development of a nomogram for predicting cancer pain in lung cancer patients: An observational study
Authors: Li Yuewen , Wang Zhiyong , Gong Chuxiong , Zhang Yingsong , Fu Ling , Wu Bencheng , Wang Weifang , Chen Yilin , Zhou Kunzhong , Zhuang Li
Published: November 2024

During the progression of lung cancer, cancer pain is a common complication. Currently, there are no accurate tools or methods to predict the occurrence of cancer pain in lung cancer. Our study aims to construct a predictive model for lung cancer pain to assist in the early diagnosis of cancer pain and improve prognosis. We retrospectively collected clinical data from 300 lung cancer patients between March 2013 and March 2023. First, we compared the clinical data of the groups with and without cancer pain. Significant factors were further screened using random forest analysis (IncMSE% > 2) to identify those with significant differences. Finally, these factors were incorporated into a multifactorial logistic regression model to develop a predictive model for lung cancer pain. The predictive accuracy and performance of the model were assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) analysis. Our study collected data from 300 lung cancer patients, including 100 in the pain-free group and 200 in the pain group. Subsequently, we conducted univariate analysis on 22 factors and selected statistically significant factors using random forest methods. Ultimately, lymphocytes(LYM) percentage, bone metastasis, tumor necrosis factor alpha (TNFα), and interleukin-6 (IL6) were identified as key factors. These 4 factors were included in a multivariate logistic regression analysis to construct a predictive model for lung cancer pain. The model demonstrated good predictive ability, with an area under the curve (AUC) of 0.852 (95% CI: 0.806–0.899). The calibration curve indicated that the model has good accuracy in predicting the risk of lung cancer pain. DCA further emphasized the model’s high accuracy. The model was finally validated using 5-fold cross-validation. We developed a reliable predictive model for cancer pain in lung cancer. This can provide a theoretical basis for future large-sample, multi-center studies and may also assist in the early prevention and intervention of cancer pain in lung cancer.
Cost-effectiveness analysis of immune checkpoint inhibitors combined with targeted therapy and chemotherapy for HPV/HIV-related cervical cancer
Authors: Liang Yuqing , Ma Aixia
Published: November 2024

Background:

To systematically assess the cost-effectiveness of immune checkpoint inhibitors compared to the current standard therapy for human papillomavirus (HPV) and human immunodeficiency virus (HIV)-related cervical cancer.

Methods:

A partitioned survival model spanning a 20-year period was created to evaluate the cost and effectiveness of atezolizumab combined with bevacizumab and chemotherapy (ABC), and pembrolizumab combined with bevacizumab and chemotherapy (PBC) vs bevacizumab combined with chemotherapy (BC), based on clinical data from the BEATcc and KEYNOTE-826 trials. Royston-Parmar models were used for survival estimation. Costs and health state utilities were sourced from existing literature and publicly accessible databases. Cumulative costs (in US dollars), life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured and compared. The evaluation was from the US healthcare payer perspective, with the willingness-to-pay threshold set at $100,000 to $150,000. Deterministic sensitivity analysis (DSA), probabilistic sensitivity analysis (PSA), and scenario analyses were conducted.

Results:

The base-case analysis showed QALYs of 2.05 for BC, 3.18 for PBC, and 2.85 for ABC. PBC increased life-years by 1.76 and ABC by 1.18, with PBC showing the highest effectiveness. Total costs were $272,377 for BC, $715,472 for ABC, and $694,239 for PBC; severe adverse event (SAE) costs were $6189 for BC, $7603.31 for ABC, and $13,640 for PBC, indicating BC had the lowest SAE costs. The ICERs compared to BC were $372,151/QALY for PBC and $553,995/QALY for ABC. Given that the willingness-to-pay threshold was $100,000 to $150,000/QALY, both PBC and ABC exceed this threshold and were not considered cost-effective. BC had the lowest QALYs and the lowest costs, making it the least expensive option and the most cost-effective choice. DSA results indicated that drug prices and utility values were the main factors affecting cost-effectiveness. PSA confirmed BC as the most cost-effective option within a willingness-to-pay threshold of $0 to $300,000, primarily because it was the least costly.

Conclusions:

Immune checkpoint inhibitors significantly improve survival benefits for patients. However, their addition is costly and unlikely to be cost-effective for HPV/HIV-related metastatic cervical cancer.