bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of a self-management program for anticoagulated patients to improve their knowledge about treatment and time in therapeutic range
Authors: Romero-Arana Adolfo , González-Rodríguez María José , Sánchez-Vega Patricia , Gómez-Salgado Juan , Romero Adolfo
Published: November 2024

Oral anticoagulation self-control programs have demonstrated efficiency and cost-effectiveness over recent years. This study aimed to evaluate the effectiveness of a training intervention focused on patients with antivitamin K anticoagulants included in a self-care program. For this, we made a quasi-experimental study, pretest and post-test, using a validated questionnaire with 2 measures, before and after an educational intervention about oral anticoagulation focused on patients that will initiate the self-control program in consultation. To check the patient’s adherence and coagulation level, we evaluated the Rosendaal time in therapeutic rank, both before and after the intervention. One hundred fifty patients were included since the start of the self-monitoring program in our center in 2016. The mean age was 49 years (standard deviation [SD] = 17.24). The distribution by gender was 76 women and 69 men (52.4%–47.6%). The mean score for the first test was 14.61 (SD = 3.26) and the mean score for the second test was 17.01 (SD = 2.14) (P <.001). We also measured Rosendaal time in therapeutic rank, a parameter that indicates stabilization in international normalized ratio determinations and quality of the anticoagulation management. Values before and after interventions were also statistically significant (67.46 vs 70.53, P <.001). Patients’ knowledge improved after the training session, with statistical significance. Despite intentional sampling, the population was homogeneous. Scoring data dispersion in the second test was significantly lower than in the first one. Time on therapeutic rank values was better after the training. We intend to adapt its content to the rest of anticoagulated patients to enhance and improve their follow-up.
Central role of hypoxia-inducible factor-1α in metabolic reprogramming of cancer cells: A review
Authors: Zhu Bing , Cheng Lichao , Huang Baosu , Liu Runzhi , Ren Bin
Published: November 2024

Metabolic reprogramming is one of the characteristics of tumor cell metabolism. In tumor cells, there are multiple metabolic enzymes and membrane proteins to regulate metabolic reprogramming, and hypoxia inducible factor-1α (HIF-1α) can be regulated in transcription, translation, posttranslational modification and other aspects through multiple pathways, and HIF-1α affects multiple metabolic enzymes and membrane proteins during metabolic reprogramming, thus playing a central role in the metabolic reprogramming process, and thus has some implications for tumor therapy and understanding chemotherapy drug resistance. HIF-1α affects a number of metabolic enzymes and membrane proteins in the metabolic reprogramming process, thus playing a central role in the metabolic reprogramming process, which has certain significance for the treatment of tumors and the understanding of chemotherapeutic drug resistance. In this paper, we review the central role of HIF-1α in metabolic reprogramming, chemotherapeutic agents targeting HIF-1α, and chemotherapeutic drug resistance.
The effect of a subclinical dose of esketamine on depression and pain after cesarean section: A prospective, randomized, double-blinded controlled trial
Authors: Wan Xiangqian , Li Ming , Li Xiantao , Dai Huan , Peng Mingqing
Published: November 2024

Background:

The aim of this randomized, double-blind placebo-controlled clinical trial was to study the effects of subclinical doses of esketamine on postpartum depression and pain following elective cesarean sections.

Methods:

This randomized, double-blind placebo-controlled trial included 150 pregnant women undergoing elective cesarean sections. After umbilical cord clamping, participants received either subclinical doses of esketamine (0.25 mg/kg, diluted in 10 mL of 0.9% saline) or a placebo (10 mL of 0.9% saline). The primary outcome measures were the incidence of postpartum depression (PPD) and postoperative pain. The Edinburgh Postnatal Depression Scale was used to evaluate PPD on days 3, 7, and 14 postpartum, with an Edinburgh Postnatal Depression Scale score ≥ 10 indicating PPD. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 4, 24, and 48 hours post-surgery. Secondary outcomes included adverse reactions and Ramsay sedation scores at 5 and 15 minutes post-administration.

Results:

There were no significant differences in the incidence of PPD between the 2 groups on days 3, 7, and 14 postpartum (P > .05). The VAS scores showed significant differences between the 2 groups at 4 and 24 hours postoperatively (P < .05), but not at 48 hours (P > .05). The experimental group had significantly higher adverse reactions and Ramsay sedation scores 5 minutes post-administration compared to the control group (P < .05), but no significant differences were observed upon leaving the operating room (P > .05).

Conclusion:

Subclinical doses of esketamine did not reduce the incidence of PPD at 14 days postpartum but did significantly lower VAS scores at 24 hours post-surgery. The experimental group experienced temporary increases in adverse reactions and Ramsay sedation scores shortly after administration.
Generalized additive mixed model to evaluate the association between ventilatory ratio and mortality in patients: A retrospective cohort study
Authors: Yu Hongjie , Gu Jie , Lin Dang
Published: November 2024

Previous studies have indicated that a higher ventilatory ratio (VR) is associated with mortality. However, it is unknown whether dynamic changes in VR over time affect the prognosis of critically ill patients. This study aims to investigate the significance of VR during the progression of the disease in critically ill patients. The Medical Information Mart for Intensive Care III database was searched to identify critically ill patients. The primary outcome was 30-day mortality. Multivariable Cox regression was used to elucidate the relationship between the VR and mortality. Finally, we employed a generalized additive mixed model to compare trends in VR over time between survivors and non-survivors. A total of 8024 patients were enrolled. Multivariable Cox regression analysis identified a baseline VR ≥1.89 as an independent risk factor predicting 30-day mortality (hazard ratio: 2.10, 95% confidence interval: 1.89–2.33, P < .001) and 90-day mortality (hazard ratio: 2.18, 95% confidence interval: 1.97–2.41, P < .001) after adjusting for potential confounders. In the subgroup analyses, the observed association between VR and 30-day mortality showed consistent direction across most subgroups. The generalized additive mixed model results highlighted that the difference in VR between survivors and non-survivors increased by an average of 0.01 per day after adjusting for several covariates. In conclusion, VR dynamically mirrors pathophysiological changes in critically ill patients and its escalation is linked to higher mortality rates. Monitoring VR’s dynamic shifts might offer more immediate prognostic information, thus aiding in timely interventions and risk stratification.
Treatment and long term follow-up results in patients with pulmonary vascular thrombosis related to COVID-19
Authors: Aliyeva Nigar , Çalişkaner Öztürk Buket , Kiliçkiran Avci Burçak , Atahan Ersan
Published: November 2024

Pulmonary embolism is a complication of COVID-19 infection. The aim of this study is to assess prognosis and treatment response, including incidences of chronicity, relapse, and mortality among outpatients diagnosed with COVID-19-related pulmonary embolism between 2020 and 2022. A total of 101 patients with pulmonary embolism, started on anticoagulation during or within a month of COVID-19 infection, were included after testing positive by PCR. Data about comorbidities, Pulmonary Embolism Severity Index scores, PE diagnostic modalities, biochemical parameters, and transthoracic echocardiographic findings at diagnosis and at 24-month follow-up were collected. Cardiac catheterization parameters were recorded and compared between groups at diagnosis and at the 24-month follow-up. Groups were comparable with respect to gender, age, body mass index, and comorbidity score. Use of Q-SPECT for diagnosis was found significantly higher in patients with COVID-19-related pulmonary embolism (P < .001). The incidence of deep vein thrombosis was similar. In the study group, 43.6% of patients received anticoagulants for 3 months, with 49.1% using low molecular weight heparin and 50.9% using direct oral anticoagulants. At 24 months, rate of patients continuing treatment was comparable between groups. Specific pulmonary artery blockage value was found to be higher in patients with chronic thromboembolic pulmonary hypertension compared to those who demonstrated a response to pulmonary embolism treatment (P = .009). No adverse effects of anticoagulant therapy were observed during course of treatment. Over 24-month follow-up period, mortality, relapse, chronic thromboembolic hypertension and thromboembolic disease was observed in 2%, 2.2%, 4.9%, and 9.9% of patients, respectively.
Comparison of clinical characteristics, microvascular complications and inflammatory markers in type 2 diabetic patients under insulin versus metformin treatment: A cross-sectional study at Karbala Diabetic Center, Iraq
Authors: Mohammed Haithem Rauf , Ben Othman Rym , Alghurabi Hamid , Hussein Radhwan M. , Al-Obaidi Zaid , Abdesselem Haifa
Published: November 2024

Type 2 diabetes mellitus (T2DM) is a major global health issue associated with chronic inflammation, which contributes to both disease progression and its complications, including cardiovascular and microvascular disorders. Key inflammatory markers such as tumor necrosis factor-alpha, interleukin-6 (IL-6), E-selectin, and P-selectin are elevated in T2DM patients and are implicated in the development of these complications. Understanding how treatments such as insulin and metformin affect these markers is crucial for improving therapeutic strategies in T2DM. This study investigated the effects of insulin and metformin on these inflammatory markers in T2DM patients. This was a cross-sectional study involving patients with diabetes on insulin (group A), metformin only (group B), and healthy controls (group C). Participants were enrolled from the Diabetic Center in Karbala, Iraq and underwent clinical assessments including ophthalmologic examinations. Fasting blood glucose, HbA1c and lipids levels were assessed. The levels of inflammatory markers (IL-6 and TNF-α), and adhesion molecules (sE-selectin and sP-selectin) were measured using Enzyme-Linked Immunosorbent Assay (ELISA). The study included 522 patients with diabetes: 356 receiving insulin (group A), 70 receiving metformin (group B) and 96 healthy controls (group C). T2DM patients treated with insulin exhibited significantly more microvascular complications than those treated with metformin. Higher rates of retinopathy (64.3% vs 11.4%) and neuropathy (69.9% vs 11.4%) were observed in the insulin group, whereas the incidence of nephropathy did not differ significantly (14.6% vs 11.4%). Inflammatory markers were lower in the insulin group: TNF-α levels were 3-fold lower and IL-6 levels were 8-fold lower. Conversely, sE-selectin levels were 1.5-fold higher in the insulin group, and sP-selectin levels were 1.4-fold higher in the metformin group. This study highlights distinct differences in inflammatory markers and systemic complications between T2DM patients treated with insulin and those treated with metformin alone. Further research is needed to explore the mechanisms underlying these observations and optimize treatment strategies for T2DM patients.
Leiomyoma of the prostate: A case report and literature review
Authors: Liu Zejun , Lu Ji , Yu Kai , Jian Tengteng , Hu Rui , Liu Min
Published: November 2024

Rationale:

Prostate leiomyoma is a rare condition globally, often challenging to diagnose preoperatively, with most cases being definitively identified through postoperative pathology. This benign tumor generally has a good prognosis and is primarily treated with transurethral resection of the prostate in clinical settings. However, there are no established guidelines or therapeutic protocols for managing this disease.

Patient concerns:

The patient was admitted to our hospital’s Department of Urology with complaints of hematuria, urinary frequency, and urgency for 1 month. Pelvic computed tomography revealed an irregular, mass-like high-density shadow posterior to the bladder, indistinctly separated from the prostate. The patient had been diagnosed with renal insufficiency during a physical examination 4 years prior but had not received standardized treatment. Six years ago, the patient underwent electrocision of the prostate at our hospital, and postoperative pathology indicated prostate leiomyoma.

Diagnoses:

Postoperative pathology confirmed a diagnosis of prostate leiomyoma.

Interventions:

The patient presented with an enlarged prostate and preoperative hematuria. Holmium laser enucleation of the prostate (HoLEP) was performed. The Foley catheter was removed on the second postoperative day, and the patient was discharged 3 days after surgery.

Outcomes:

Following discharge, the patient was instructed to undergo reexaminations every 6 months. Current follow-up indicates the patient is in good health, with no recurrence of the mass observed.

Lessons:

Prostate leiomyoma is an extremely rare condition, and the current primary approach for managing prostate smooth muscle tumors involves active patient monitoring, regular evaluations, and timely surgical intervention if clinical symptoms emerge. In this study, we present a new case report of prostatic smooth muscle tumor and review the existing literature to explore treatment options for prostate leiomyoma within this field.
Immunologic and inflammatory pathogenesis of chronic coronary syndromes: A review
Authors: Chen Tingting , Yang Ying
Published: November 2024

Chronic coronary syndrome (CCS) is a major cause of progression to acute coronary syndrome. Due to its insidious onset and complex etiology, this condition is often underestimated and insufficiently recognized, and traditional interventions for risk factors do not effectively control the disease progression. Current research suggests that immune and inflammatory pathways contribute to atherosclerosis and its clinical complications, thereby triggering the progression of CCS to acute coronary syndrome. This article primarily reviews the possible mechanisms of immune and inflammatory responses in CCS, with the aim of providing references for the diagnosis, treatment, and prevention of CCS.
Effective treatment with intravenous immunoglobulin for Henoch–Schönlein purpura with refractory gastrointestinal symptoms in an adolescent: A CARE-compliant case report
Authors: Chen Liji , Zhong Cailing , Fan Longxiu , Luo Ming , Cai Linkun , Zhang Beiping , Zhang Haiyan
Published: November 2024

Rationale:

This article presents a complex case of refractory Henoch–Schönlein purpura (HSP), initially manifesting with complex gastrointestinal (GI) symptoms, and discusses diagnostic and therapeutic challenges encountered. It aims to enhance understanding of the disease and provide evidence for the potential efficacy of intravenous immunoglobulin (IVIG) treatment in this condition.

Patient concerns:

A 16-year-old male patient presented with persistent abdominal pain, nausea, vomiting, and constipation for 8 days, leading to hospital admission.

Diagnoses:

Establishing a definitive diagnosis was challenging initially due to the absence of typical petechiae. However, the appearance of characteristic petechiae subsequently confirmed the diagnosis of HSP.

Interventions:

Initial treatment with methylprednisolone sodium succinate for 3 days failed to elicit improvement. Subsequently, IVIG was introduced as a combination therapy.

Outcomes:

Following the combined administration of IVIG, the patient experienced complete resolution of abdominal pain, petechiae, and arthralgia within 4 days.

Lessons:

This case highlights the importance of considering HSP in the differential diagnosis of patients with complex GI symptoms. Furthermore, it suggests that IVIG may be a valuable therapeutic option for HSP patients with refractory GI symptoms. High-quality comparative trials are needed to establish more definitive evidence for the effectiveness of IVIG and to develop specific treatment guidelines.
Mediating role of circulating inflammatory proteins in the effect of immune cells on esophageal cancer risk: A Mendelian randomization study
Authors: Guo Jinzhou , Si Gao , Song Xuejie , Si Fuchun
Published: November 2024

The immune system and inflammatory processes play crucial roles in the development of esophageal cancer (EC). This study aimed to investigate the causal relationships between 731 immune cell phenotypes, 91 circulating inflammatory proteins, and EC, with a particular focus on the mediating role of circulating inflammatory proteins. Utilizing public genetic data, we applied a 2-sample Mendelian Randomization (MR) method to examine the causal relationships between 731 immune cell phenotypes, 91 circulating inflammatory proteins, and EC. Comprehensive sensitivity analyses were conducted to assess the robustness, heterogeneity, and horizontal pleiotropy of the MR results. Additionally, a 2-step MR method was employed to quantify the impact and proportion of immune cell phenotypes mediated by circulating inflammatory proteins on EC. Eleven immune cell phenotypes and 1 inflammatory cytokine were found to have causal relationships with EC, with results stable across all sensitivity analyses. Mediation analyses revealed that only 2 cell phenotypes had causal relationships with EC through interleukin-10: CD3 on human leukocyte antigen-DR (HLA-DR)+ T cells (mediation effect = −0.009; mediation proportion = 12.01%) and monocytic myeloid-derived suppressor cell absolute count (mediation effect = 0.018; mediation proportion = 18.97%). This study enhances the understanding of the causal relationships between immune cells, circulating inflammatory proteins, and EC. The findings highlight the potential mediating role of interleukin-10, providing new insights into the mechanisms by which immune cells may influence esophageal tumorigenesis.
Lnc NEAT1 facilitates the progression of melanoma by targeting the miR-152-3p/CDK6 axis: An observational study
Authors: Ning Ning , Tian Zeyu , Feng Hao , Feng Xing
Published: November 2024

Long noncoding (Lnc) RNAs are novel regulators in melanoma. Lnc nuclear enriched autosomal transcript 1 (NEAT1) was reportedly upregulated in melanoma; however, the functional roles and mechanisms of Lnc NEAT1 need further investigation. Therefore, we used quantitative real-time PCR to determine the mRNA levels of Lnc NEAT1, miR-152-3p, and cyclin-dependent protein kinase 6 (CDK6). The protein level of CDK6 was determined by Western blot. Cell counting kit 8 and colony formation assays were used to assess cell proliferation. Cell migration was measured by wound healing and Transwell assays. Direct binding of the indicated molecules was verified by an RNA-binding protein immunoprecipitation assay and a dual luciferase reporter assay. The results revealed that Lnc NEAT1 and CDK6 were elevated, while miR-152-3p was downregulated in melanoma. Furthermore, Lnc NEAT1 was positively correlated with CDK6 expression and negatively correlated with miR-152-3p level. Furthermore, Lnc NEAT1 facilitated proliferation, migration, and invasion of melanoma cells. The underlying mechanism is that Lnc NEAT1 serves as a sponge for miR-152-3p to suppress the inhibitory effect of miR-152-3p on CDK6. Furthermore, the miR-152-3p/ CDK6 axis was implicated in the progression of melanoma accelerated by Lnc NEAT1. Taken together, Lnc NEAT1 may promote melanoma development by serving as an endogenous sponge of miR-152-3p, increasing CDK6 expression, and identifying a new target for the treatment of melanoma.
The effect of Baduanjin on body mass and body composition of college students: A randomized controlled trial
Authors: Wen Nana , Zhao Fang , Sun Shanshan , Xiong Jian , Zheng Guohua
Published: November 2024

Background:

Previous studies have also found that Baduanjin training can improve health-related physical fitness in young adults. However, it is unclear whether Baduanjin training can improve body mass and body composition in young adults. The aim of this study was to investigate the effects of the Baduanjin training on body mass and body composition in college students.

Methods:

This was a single-center, randomized controlled trial comparing 12 weeks of Baduanjin exercise training group (BEG) at a frequency of 60 minutes per day, 4 days per week with no special exercise control group (CG) on the health-related physical fitness in college students. Body mass and body composition were assessed using the body mass index, waist-to-hip ratio, and Inbody 720 devices. A total of 93 college students (56 in the BEG and 37 in the CG) completed 2 body composition assessments and were included in the analysis. A mixed linear model was used to analyze the effect of the Baduanjin exercise intervention.

Results:

After 12 weeks of intervention, the body mass index and waist-to-hip ratio in the BEG were significantly lower than that in the CG (P =.007 and P =.028) with a moderate effect size (Cohen d = 0.584 and 0.474) and a significant interaction effect of group by time (P =.007 and.028). The fat mass indicators of body composition including percent body fat, body fat mass, and body fat mass of both arms, both legs and trunk in the BEG were significantly lower than those in the CG (all P <.05), with a moderate effect size (Cohen d from 0.452 to 0.624) and a significant interaction effect of group by time (all P <.05); no significant differences were found in the total body composition indicators and the fat-free mass indicators of body composition between the 2 groups.

Conclusion:

Regular Baduanjin exercise training may be beneficial for improving body composition in young adults.
Extremely rare mucinous adenocarcinoma of the small bowel causing bilateral metastatic Kukenberg tumors of the ovaries: A case report
Authors: Zhu Lichao , Liu Ye , Chen Shuai , Yang Guanghua , Wang Changyou
Published: November 2024

Rationale:

Small bowel adenocarcinoma (SBA) is an extremely rare tumor that is not fully understood, SBA accounts for less than 5% of gastrointestinal cancers, Krukenberg tumors account for a lower proportion of all ovarian tumors, close to 2%. Stomach is the most common primary site of Krukenberg tumor. The phenomenon of bilateral ovarian Kukenberg tumor caused by implantation and metastasis of small bowel cancer is extremely rare, with few literature reports and limited clinical diagnosis and treatment data. We present a case of a 55-year-old woman with bilateral Kukenberg’s tumor caused by small bowel cancer implantation and share our views on the diagnosis and treatment of this case.

Patient concerns:

A 55-year-old woman presented with vaginal bleeding and persistent lower abdominal pain after fatigue 10 days ago. Pelvic ultrasound at a local hospital revealed 2 solid masses in her pelvis, and she came to our hospital for further diagnosis and treatment. The results of colonofiberscope examination and histopathological examination confirmed intramucosal adenocarcinoma in the small intestine.

Diagnoses:

The results of colonofiberscope examination and histopathological examination confirmed intramucosal adenocarcinoma in the small intestine. Contrast-enhanced computed tomography showed multiple cystic space-occupying lesions in the pelvic cavity, and the possibility of ovarian tumor was considered.

Interventions:

Radical treatment of right half colon cancer and pelvic mass resection were performed under general anesthesia. Combined with intraoperative and postoperative pathological examination, the diagnosis was mucinous adenocarcinoma of the small intestine stage IV (pT4N1M1). Bilateral ovarian metastasis, metastatic cancer (3/19): lymph nodes around the small intestine (3/12), lymph nodes around the colon (0/7).

Outcomes:

He is currently receiving chemotherapy, the chemotherapy regimen is XELOX regimen. The specific drugs were oxaliplatin and capecitabine.

Lessons:

SBA is often difficult to diagnose due to few specific symptoms and is usually detected at stage IV. Bilateral ovarian Kukenberg tumor caused by small bowel cancer implantation metastases is extremely rare, and clinicians must be vigilant for women with fewer specific symptoms of gastrointestinal discomfort and conduct further diagnostic studies to avoid delayed diagnosis and treatment.
A deep dive into neonatal well-being and anesthesia in cesarean sections: From procedure to outcome
Authors: Chaudhary Rahul Kumar , Khan Sajjad Ahmed , Khanal Kanak , Yadav Siddhartha Kumar , Parajuli Surya Bahadur , Rajbanshi Laleet Kumar , Jha Chandra Bhushan
Published: November 2024

This observational study analyzed data from 502 participants undergoing cesarean section (CS) procedures at an obstetrics and gynecology department, aiming to explore anesthesia practices, neonatal outcomes, and demographic characteristics within the cohort. Participants, aged 17 to 59 years with a mean age of 32.23 years, were enrolled based on the clinical necessity for cesarean delivery during the study period. Informed consent was obtained from each participant or their guardians before data collection, which included detailed demographic information, medical histories, specifics of the cesarean section procedure, and APGAR scores of neonates immediately postbirth (at 0 and 5 minutes). Primary outcomes focused on APGAR scores, critical indicators of neonatal health, while secondary outcomes included the distribution of patient ages, reasons for cesarean sections, and the administration of Bupivacaine during anesthesia. Data were rigorously analyzed using descriptive and inferential statistics to summarize participant demographics, anesthesia practices, and neonatal outcomes. Statistical methods included measures of central tendency and dispersion, correlation analyzes to explore associations between variables, and regression models to identify predictors of neonatal APGAR scores. The study identified a range of indications for cesarean sections, with common reasons including fetal distress and maternal health complications. Findings indicated an average APGAR score of 7.02 at 0 minutes and 7.84 at 5 minutes, reflecting generally favorable immediate neonatal outcomes. Anesthesia protocols predominantly involved Bupivacaine, with doses ranging from 1.8 to 2.2 mL, administered based on clinical requirements. In conclusion, this study underscores the importance of comprehensive data collection and rigorous statistical analysis in evaluating cesarean section procedures. Future research could further explore long-term neonatal outcomes and refine anesthesia protocols to optimize maternal and neonatal health during cesarean deliveries.
Recovery of gastrointestinal functional after surgery for abdominal tumors: A narrative review
Authors: Xie Gui-Sheng , Ma Liang , Zhong Jian-Hong
Published: November 2024

Postoperative gastrointestinal dysfunction, including temporary nonmechanical suppression of gastrointestinal motility (known as postoperative ileus), occurs in about 10% surgeries of abdominal tumors. Since these complications can prolong hospitalization and affect eating, it is important to understand their risk factors and identify effective interventions to manage or prevent them. The present review comprehensively examined the relevant literature to describe risk factors for postoperative ileus and effective interventions. Risk factors include old age, open surgery, difficulty of surgery, surgery lasting longer than 3 hours, preoperative bowel treatment, infection, and blood transfusion. Factors that protect against postoperative ileus include early enteral nutrition, minimally invasive surgery, and multimodal pain treatment. Interventions that can shorten or prevent such ileus include minimally invasive surgery, early enteral nutrition as well as use of chewing gum, laxatives, and alvimopan. Most of these interventions have been integrated into current guidelines for enhanced recovery of gastrointestinal function after surgery. Future high-quality research is needed in order to clarify our understanding of efficacy and safety.
Application of Sini Decoction at acupoint on gastrointestinal dysfunction in patients with sepsis: A clinical study
Authors: Du Yuteng , Hu Jingjing , Zhang Pingping , Ge Ting’ai , Zhou Yidan
Published: November 2024

The occurrence of gastrointestinal dysfunction is widely recognized as a prevalent complication in patients with sepsis. To investigate clinical effect of Sini Decoction at acupoint on gastrointestinal dysfunction in sepsis patients. Seventy-five patients with gastrointestinal dysfunction caused by sepsis were randomly divided into 2 groups. Treatment group received routine Western medicine treatment combined with Sini Decoction at acupoint, while control group treated with talcum powder at acupoint. Treatments in both groups lasted 7 days. Changes in the acute physiology and chronic health evaluation II score, sequential organ failure assessment score, mechanical ventilation duration, the length of Intensive Care Unit (ICU) stay, enteral nutrition tolerance scores, abdominal circumference, gastric residual volume, bowel sounds, and serum index were observed. After treatment, the enteral nutrition tolerance score, abdominal circumference, gastric residual volume, and levels of lactate and interleukin-6 were significantly lower in the treatment group compared to the control group. Bowel sounds were more active and motilin levels were higher in the treatment group. Additionally, the length of ICU stay was significantly shorter in the treatment group than in the control group. Our findings demonstrated that the application of Sini Decoction at acupoints in sepsis patients with gastrointestinal dysfunction can effectively enhance gastrointestinal function, leading to a reduction in ICU stay duration and an improvement in patients’ prognosis.
Identifying Typologies of Symptoms and Functional Impairments in Chinese Children With Leukemia and Their Population Characteristics
Authors: Wang Jingting , Wu Xiaochen , Zhang Wen , Bi Xuanyi , Wang Yingwen , Yu Ling , Wu Huifang , Yang Qi , Huang Haiying , Wang Yanqing , Yuan Changrong
Published: November 2024

Background

Symptom distress and functional impairments in children with leukemia directly affect their quality of life.

Objectives

To identify subgroups of symptom distress and functional impairments in Chinese children with leukemia and to examine the associations of the latent classes with individual characteristics.

Methods

This multicenter cross-sectional survey study recruited children with leukemia who received chemotherapy in 4 hospitals in Shanghai, Jiangsu, Zhejiang, and Guangdong Province. The participants were surveyed via PROMIS-25 (Patient-Reported Outcomes Measurement Information System Pediatric-25 Profile). Latent profile analysis and multinomial logistic regression model were performed to identify subgroups of symptom distress and function impairments among children with leukemia.

Results

Latent profile analysis results suggested the classification of 3 subgroups: profile 1: “moderate symptom distress, moderate mobility impairment with fair peer relationship function” group (69, 28.3%), profile 2: “mild symptom distress, no mobility impairment with good peer relationship function” group (97, 39.8%), and profile 3: “no symptom distress, no mobility impairment with good peer relationship function” group (78, 32.0%). Sociodemographic characteristics, including gender of the children, gender and marital status of the parents, average monthly income of the family, and reimbursement ratio of treatment expenses, had significant associations with the latent profile membership (P < .05).

Conclusion

This study identified 3 distinct profiles of symptom distress and functional impairments in children with leukemia and found significant associations between these profiles and sociodemographic characteristics.

Implications for Practice

The classification of the 3 latent profiles in children with leukemia helps to provide targeted supportive intervention to those children and their families.
Pictorial Essay
Authors: Palaniswamy Shanmuga Sundaram , Subramanyam Padma , Puthenveettil Vinayan K.
Published: November 2024

Brain development is a very complex process that starts within first 20 days of gestation. By the third week, prosencephalon (forebrain), mesencephalon (midbrain), and rhombencephalon (hindbrain) appear. Failure of brain development can occur at any level. Defects in neural tube closure, folding, induction of neuroepithelial migration, and differentiation can result in congenital brain malformation. Similarly, disruption at neuronal cell proliferation, differentiation, migration, and organization also result in structural anomalies. This pictorial collection highlights the 18F-FDG brain PET-MR findings in children who presented with recurrent seizures. Further to imaging, many required additional investigations such as genetic testing, ophthalmic, cardiorespiratory, and screening laboratory metabolic studies.
When the Jugular Bulb Contacts the Facial Nerve
Authors: Rusu Mugurel Constantin , Toader Corneliu , Tudose Răzvan Costin , Grigoriţă Laura Octavia
Published: November 2024

Dehiscences of the intrapetrous canal of the facial nerve (FN) and those of a high jugular bulb (HJB) have various incidences. However, the HJB-FN common dehiscent osseous wall is a scarce finding and rarely reported. Thus, this work aimed to study this peculiar intrapetrous morphology on computed tomograms (CTs). A batch of 60 archived CTs was used. In 28.33% of cases, no HJBs were found; in 51.67% of cases, there were unilateral HJBs, and in 20% of cases, bilateral HJBs were found. 83.87% of the unilateral HJBs were on the right side, and the rest on the left side. In 3 cases with right-sided HJBs, 1 male and 2 females, FNs were found directly contacting the HJB. Therefore, the contact HJB-FN occurred in 5% of cases and 2.5% of the petrous bones/sides. HJBs’ dehiscences to the retrotympanum or the posterior cranial fossa were also found in those cases. A dehiscent posterior semicircular canal to the HJB was found in one of these. Incidences for the HJB and the HJB-FN contacts seem higher than in previous studies. However, as only a 60-case batch of study was used, an overestimation may have resulted. Although scarce, the HJB-FN contact could determine specific symptoms and must be documented before specific surgical procedures involving the mastoid, retrotympanum, and posterior cranial fossa.
Utility of Generative Artificial Intelligence for Patient Care Counseling for Mandibular Fractures
Authors: Shaari Ariana L. , Patil Disha P. , Mohammed Saad , Salehi Parsa P.
Published: November 2024

Objective:

To determine the readability and accuracy of information regarding mandible fractures generated by Chat Generative Pre-trained Transformer (ChatGPT) versions 3.5 and 4o.

Background:

Patients are increasingly turning to generative artificial intelligence to answer medical queries. To date, the accuracy and readability of responses regarding mandible fractures have not been assessed.

Methods:

Twenty patient questions regarding mandible fractures were developed by querying AlsoAsked (https://alsoasked.com), SearchResponse (https://searchresponse.io), and Answer the Public (https://answerthepublic.com/). Questions were posed to ChatGPT 3.5 and 4o. Readability was assessed by calculating the Flesch Kincaid Reading Ease, Flesch Kincaid Grade Level, number of sentences, and percentage of complex words. Accuracy was assessed by a board-certified facial plastic and reconstructive otolaryngologist using a 5-point Likert Scale.

Results:

No significant differences were observed between the two versions for readability or accuracy. Readability was above recommended levels for patient education materials. Accuracy was low, and a majority of responses were deemed inappropriate for patient use with multiple inaccuracies and/or missing information.

Conclusion:

ChatGPT produced responses written at a high level inappropriate for the average patient, in addition to containing several inaccurate statements. Patients and clinicians should be aware of the limitations of generative artificial intelligence when seeking medical information regarding mandible fractures.
Genetic Association Between Blood Metabolites and Craniosynostosis: A Mendelian Randomization Study
Authors: Zhang Zeya , Wang Binqing , Zhao Yanyong
Published: November 2024

Craniosynostosis is a congenital disorder characterized by the premature fusion of cranial sutures, leading to abnormal skull development and potential neurodevelopmental complications. The role of metabolic influences in craniosynostosis remains underexplored. This study investigates the causal relationship between specific blood metabolites and the risk of craniosynostosis using a 2-sample Mendelian randomization (MR) approach. Genetic instruments were selected from a genome-wide association study on blood metabolites and craniosynostosis data from the FinnGen database. The MR analysis was conducted using inverse variance weighted regression as the primary method, with MR-Egger and weighted median methods as sensitivity analyses. Additional tests for pleiotropy and heterogeneity were performed to validate the robustness of the findings. The analysis identified significant associations between elevated levels of gamma-glutamylglycine [odds ratio (OR) = 2.379, 95% CI = 1.261–4.488, P = 0.007], N6-acetyllysine (OR = 2.731, 95% CI = 1.081–6.901, P = 0.034), phosphocholine (OR = 2.205, 95% CI = 1.226–3.658, P = 0.038) and glycine (OR = 2.118, 95% CI = 1.226–3.658, P = 0.007) with an increased risk of craniosynostosis. Conversely, higher levels of 3-hydroxy-2-methylpyridine sulfate (OR = 0.411, 95% CI = 0.1717–0.988, P = 0.047) and 5,6-dihydrothymine (OR = 0.293, 95% CI = 0.098–0.876, P = 0.028) were associated with reduced risk. Sensitivity analyses confirmed the robustness of these findings, with no significant evidence of pleiotropy or heterogeneity detected. This study provides evidence that specific blood metabolites may causally influence the risk of craniosynostosis, suggesting potential metabolic pathways that could be targeted for therapeutic intervention. These findings help to develop metabolite-based strategies for the prevention and treatment of craniosynostosis.
Using the Nasopalatine Canal for Enhanced Distribution in Severely Atrophic Maxilla With Immediate Loading of Zygomatic Implants: An 8-Year Retrospective Cohort Study
Authors: Leighton Yerko , de Souza Raphael Freitas , Borie Eduardo
Published: November 2024

This study presents retrospective 8-year clinical performance data from a patient cohort treated with immediately loaded maxillary full prostheses supported by zygomatic implants combined with implants placed in the nasopalatine canal, as a treatment for severely resorbed edentulous ridges. A retrospective analysis was conducted on data of maxillary edentulous patients with severe bone atrophy. All of them received zygomatic implants in combination with an implant placed in the nasopalatine foramen and an immediately loaded fixed temporary prosthesis in the first 24 hours. The frequency of major and minor adverse events was presented according to the time of occurrence. Fifteen patients were included in the study, without cases of implant loss or sensitivity in the nasopalatine region were observed up to 8 years. Only 1 major complication was observed, whereas minor complications were more frequent. In conclusion, this 8-year follow-up study demonstrated that the nasopalatine canal can be considered a viable implant site, with no major risks, to improve biomechanics by enabling a polygonal distribution in severely atrophic maxillae treated with zygomatic implants and immediate loading
Longitudinal genomic surveillance of a UK intensive care unit shows a lack of patient colonisation by multi-drug-resistant Gram-negative bacterial pathogens
Authors: Snaith Ann E. , Moran Robert A. , Hall Rebecca J. , Casey Anna , Ratcliffe Liz , van Schaik Willem , Whitehouse Tony , McNally Alan
Published: November 2024

Vulnerable patients in an intensive care unit (ICU) setting are at high risk of infection from bacteria including gut-colonising Escherichia coli and Klebsiella species. Complex ICU procedures often depend on successful antimicrobial treatment, underscoring the importance of understanding the extent of patient colonisation by multi-drug-resistant organisms (MDROs) in large UK ICUs. Previous work on ICUs globally uncovered high rates of colonisation by transmission of MDROs, but the situation in UK ICUs is less understood. Here, we investigated the diversity and antibiotic resistance gene (ARG) carriage of bacteria present in one of the largest UK ICUs at the Queen Elizabeth Hospital Birmingham (QEHB), focusing primarily on E. coli as both a widespread commensal and a globally disseminated multi-drug-resistant pathogen. Samples were taken during highly restrictive coronavirus disease 2019 (COVID-19) control measures from May to December 2021. Whole-genome and metagenomic sequencing were used to detect and report strain-level colonisation of patients, focusing on E. coli sequence types (STs), their colonisation dynamics and antimicrobial resistance gene carriage. We found a lack of multi-drug resistance (MDR) in the QEHB. Only one carbapenemase-producing organism was isolated, a Citrobacter carrying bla
KPC-2. There was no evidence supporting the spread of this strain, and there was little evidence overall of nosocomial acquisition or circulation of colonising E. coli. Whilst 22 different E. coli STs were identified, only 1 strain of the pandemic ST131 lineage was isolated. This ST131 strain was non-MDR and was found to be a clade A strain, associated with low levels of antibiotic resistance. Overall, the QEHB ICU had very low levels of pandemic or MDR strains, a result that may be influenced in part by the strict COVID-19 control measures in place at the time. Employing some of these infection prevention and control measures where reasonable in all ICUs might therefore assist in maintaining low levels of nosocomial MDR.
Immunogenicity and safety of a monovalent Omicron XBB.1.5 SARS-CoV-2 recombinant spike protein vaccine in previously unvaccinated, SARS-CoV-2 seropositive participants: primary day-28 analysis of a phase 2/3 open-label study
Authors: Alves Katia , Kouassi Alex , Plested Joyce S. , Kalkeri Raj , Smith Katherine , Kaba Muneer , Nelson Joy , Zhu Mingzhu , Cloney-Clark Shane , Cai Zhaohui , Mallory Raburn M. , Noriega Fernando
Published: November 2024

Background

Most of the population has been infected with SARS-CoV-2 and, thus, is primed by natural exposure. As such, it was assessed whether a single dose of the monovalent XBB.1.5 vaccine, NVX-CoV2601, elicited a comparable immune response to XBB.1.5 in seropositive unvaccinated participants to that in previously vaccinated participants, thereby allowing the former to forego a two-dose primary series.

Methods

In this phase 2/3, open-label, single-arm study (2019nCoV-313/NCT05975060[part 2]), vaccine-naive participants ≥18 years with previous SARS-CoV-2 infection received one dose of NVX-CoV2601. This analysis compared the 28-day immunogenicity and safety of NVX-CoV2601 in vaccine-naive and previously vaccinated (≥3 prior mRNA-based vaccines, from 2019nCoV-313 part 1) participants.

Noninferiority of neutralizing antibody (nAb) response in vaccine-naive versus vaccinated participants was the primary objective. The day-28 geometric mean titer (GMT) ratio (GMTR) and seroresponse rate (SRR; percentage of participants with a ≥4-fold rise in antibody response from baseline) were measured, and safety was assessed.

Results

Of the participants enrolled from September 11–November 15, 2023, per-protocol sets included 306/338 (90.5%) vaccine-naive and 309/332 (93.1%) vaccinated participants. At day 28, adjusted GMTs (95% CI) against XBB.1.5 in the vaccine-naive and vaccinated groups were 1491.5 (1277.5–1741.4) and 841.4 (723.9–978.0), respectively. The vaccine-naïve—vaccinated nAb GMTR was 1.8 (95% CI 1.43–2.20) and SRRs were 74.3% and 64.3% for vaccine-naive and vaccinated participants, respectively (SRR difference: 10.0 [95% CI 2.6–17.4]). No new safety signals or events of special interest were reported.

Conclusions

A single dose of NVX-CoV2601 in vaccine-naive participants with a history of SARS-CoV-2 infection elicited a robust neutralizing antibody response that was noninferior to that observed in vaccinated participants. The vaccine was well-tolerated. These data support the use of NVX-CoV2601 as a single dose, regardless of prior vaccination history.

Trial registration:NCT05975060
Trend Analysis on the Application of Social Work Professionalism: The Case of Refugee Child-Focused Humanitarian Organizations in Ethiopia
Authors: Afework Fisehatsion , Mengsteab Mesele
Published: November 2024

This study investigated the trend in the application of social work professionalism in delivering child-focused social work services for refugee children within Ethiopian refugee camps. The study seeks to understand the how the various constituents of social work professionalism has been applied by child-focused humanitarian organizations between the years of 2017 to 2023. A time series trend analysis model employed along with a mixed-methods approach across three refugee camps selected through multi-stage cluster sampling. The research investigates how social work services align with professional standards and the challenges faced by practitioners. Findings reveal significant caseloads, resource constraints, and ethical dilemmas in service prioritization. However, positive trends emerge, including the implementation of the Child Protection Minimum Standards framework, a client-centered approach, and growing collaboration with the families of refugee children. The study translates these findings into actionable recommendations for strengthening social work practice, including increased funding, caseload management strategies, prioritizing child participation, and fostering inter-agency collaboration. A proposed model generated through the study visually depicts key challenges, positive trends, and recommendations to improve child-focused social work services through the lens of professional ethics in refugee settings. This research underscores the importance of a multi-pronged approach to ensure high-quality, ethical services for all refugee children.