bluuebunny/crossref_metadata_2025 huggingface dataset:
Venoarterial extracorporeal membrane oxygenation for group B streptococcal toxic shock syndrome: A case report and literature review
Authors: Iwasaki Naoya , Sekino Motohiro , Tominaga Tetsuro , Tanaka Takeshi , Araki Hiroshi , Yano Rintaro , Matsumoto Sojiro , Ichinomiya Taiga , Higashijima Ushio , Nonaka Takashi , Izumikawa Koichi , Hara Tetsuya
Published: September 2023

Rationale:

Streptococcal toxic shock syndrome (STSS) rapidly leads to refractory shock and multiple organ failure. The mortality rate among patients with STSS is 40%; however, most deaths occur within a few days of onset. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) may help avoid acute death in adult patients with STSS. However, the effectiveness of VA-ECMO is unclear. In this study, we report a case of group B STSS, which was successfully treated with VA-ECMO despite cardiopulmonary arrest (CPA) owing to rapidly progressive refractory shock.

Patient concerns:

A 60-year-old woman was hospitalized because of diarrhea and electrolyte abnormalities owing to chemoradiation therapy for rectal cancer. A sudden deterioration of her condition led to CPA. Conventional cardiopulmonary resuscitation was immediately performed but was ineffective. Therefore, VA-ECMO was initiated. Contrast-enhanced computed tomography revealed duodenal perforation. Hence, septic shock owing to peritonitis was diagnosed, and emergency surgery was performed under VA-ECMO. However, the patient had progressive multiple organ failure and required organ support therapy in the intensive care unit (ICU).

Diagnoses:

On day 2 in the ICU, blood and ascites fluid culture tests revealed beta-hemolytic streptococci, and the patient was finally diagnosed as having STSS caused by Streptococcus agalactiae.

Interventions:

Clindamycin was added to meropenem, vancomycin, and micafungin, which had been administered since the sudden deterioration. In addition, VA-ECMO, mechanical ventilation, blood purification therapy, and treatment for disseminated intravascular coagulation were continued.

Outcomes:

Thereafter, hemodynamics improved rapidly, and the patient was weaned off VA-ECMO on day 5 of ICU admission. She was transferred to a general ward on day 22 in the ICU.

Lessons:

In patients with fatal STSS and rapid progressive refractory shock or CPA, VA-ECMO may help to avoid acute death and improve prognosis by ameliorating tissue oxygenation and providing extra time to treat invasive streptococcal infection.
Distribution and 24-hour transition of SCAI shock stages and their association with 30-day mortality in acute myocardial infarction
Authors: Pham Hung Manh , Van Hanh Duc , Hoang Long Bao , Phan Phong Dinh , Tran Vu Hoang
Published: September 2023

The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification has been shown to predict mortality in acute myocardial infarction (AMI). However, data on the transition of SCAI stages and their association with mortality after AMI are limited. All patients with AMI admitted to Vietnam National Heart Institute between August 2022 and February 2023 were classified into SCAI stages A, B, and C/D/E at admission and were reevaluated in 24 hours. We used Kaplan–Meier estimate and multivariable Cox regression analysis to assess the association between SCAI stages transition and 30-day mortality. We included 139 patients (median age 69 years, 29.5% female). On admission, 50.4%, 20.1%, and 29.5% of patients were classified as SCAI stage A, B, and C/D/E, respectively. The proportion of patients whose SCAI stage improved, remained stable, or worsened after 24 hours was 14.4%, 66.2%, and 19.4%, respectively. The 30-day mortality in patients with initial SCAI stages A, B, and C/D/E on admission was 2.9%, 21.4%, and 61.0%, respectively (P < .001). The 30-day mortality was 2.4% for patients with baseline SCAI stage A/B who remained unchanged or improved, 30.0% for patients with baseline SCAI stage C/D/E who remained unchanged or improved, and 92.6% for patients with SCAI stage B/C/D/E who worsened at 24 hours after admission (log-rank P < .001). In patients with AMI, evaluating the SCAI stage shock stage on admission and reevaluating after 24 hours added more information about 30-day mortality.
Clinical effect analysis of using medical glue versus conventional suturing to treat dog bite in children’s maxillofacial region after negative pressure sealing drainage: A randomized trial
Authors: Lisong Huang , Lianfu Wang , Jinhong Yang , Haibin Zhang
Published: September 2023

Background:

To compare the clinical effectiveness of applying medical glue versus conventional suturing after primary suturing and continuous vacuum sealing drainage (VSD) technology in the treatment of facial wounds caused by dog bites in children’s maxillofacial region, with respect to operation time, wound infection rate, treatment effect, and patient satisfaction.

Methods:

From May 2020 to July 2022, 68 children with a dog bite in the maxillofacial region were randomly divided into medical glue and conventional suturing groups. The patients in both groups were treated with conventional debridement, tetanus and/or rabies immunization, and antibiotic therapy. The medical glue group was treated with VSD after the first-stage of the loose suture of the wound. After 5 days, the suture was removed, and the wound was tightly bonded with medical glue again. The conventional suturing group was treated with VSD after the first-stage of loose suture of the wound. The primary outcomes were the operation time and satisfaction of the 2 groups, and the secondary outcomes was the wound infection rate.

Results:

The operation time of the medical glue group was significantly lower than that of the conventional suturing group. However, there was no significant difference between the 2 groups in the wound infection rate. Still, the patient satisfaction was significantly better in the medical glue group than the conventional suturing group with statistically significant difference (P < .05).

Conclusion:

In conclusion, applying medical glue after using negative pressure sealing drainage in treating maxillofacial dog bites can reduce surgeons work intensity, lessen children’s pain, and improve the clinical treatment effect.
Observation of hemostatic effectiveness and safety of ultrasound-CT guided 3D intracavitary and interstitial brachytherapy in the treatment of larger cervical cancer with bleeding: A retrospective study
Authors: Hu Yuefeng , Jin Ying , Wang Dongdong , Luo Yunxiu
Published: September 2023

Cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women. This study explored the effectiveness and safety of ultrasound-CT guided 3D intracavitary and interstitial brachytherapy (US-CT-3D-IGBT) in the treatment of larger cervical cancer with bleeding. A retrospective study was conducted on 31 patients with larger cervical squamous cell carcinoma (tumor short diameter >4 cm) with vaginal bleeding. US-CT-3D-IGBT was used to deliver a single high-dose prescription of high-risk clinical target volume (HR-CTV) 1000 to 1200 centigray (cGy) to the cervical tumor, followed by conventional intensity-modulated radiation therapy (IMRT) synchronous chemoradiotherapy (45–50 gray (Gy)/25–28 fraction(f)) with weekly cisplatin 25 mg/m2. After external radiotherapy, simple intracavitary brachytherapy (BT) combined with manual interstitial BT was administered at 30 Gy/5F or 28 Gy/4F. Within 24 hours after high-dose 3D-IGBT, bleeding stopped in 2 patients (6.4%), and bleeding was reduced in a total of 11 patients (35.4%) within 48 hours. A total of 29 patients achieved hemostasis within 72 hours, with an effective rate of 93.5%. The remaining 2 patients reached the clinical hemostasis requirement on the 4th and 5th day. All patients experienced a significant reduction in vaginal bleeding after the initial BT, with an average reduction of 66 mL (160–20 mL). US-CT-3D-IGBT is effective in rapidly controlling bleeding in patients with larger cervical cancer (tumor short diameter >4 cm), and the treatment is relatively safe and feasible.
Herbal medicine for external use in acute gouty arthritis: A PRISMA-compliant systematic review and meta-analysis
Authors: Choi Su Hyeon , Song Ho-Sueb , Hwang Jihye
Published: September 2023

Background:

Acute gouty arthritis is accompanied by severe pain during an acute attack. This systematic review aimed to evaluate the efficacy and safety of herbal medicines acting directly on the affected area of acute gouty arthritis for external use.

Methods:

An envelope search was performed using 4 electronic databases (CNKI, PubMed, EMBASE, Cochrane), resulting in 27 clinical studies from inception to February 2023. Randomized controlled trials on external use herbal medicines for acute gouty arthritis were considered. The assessed outcomes were total effective rate, uric acid level, pain score, and inflammatory factor levels such as erythrocyte sedimentation rate and C-reactive protein. Quality assessment and meta-analysis of the included randomized controlled trials were also performed.

Results:

Twenty-seven randomized controlled trials with a total of 1951 participants were included in the meta-analysis. All assessed outcomes including pain, inflammation, and uric acid levels, indicated that the treatment effects in the external use herbal medicine group were significantly better than those of the western medicine control group. Of the 10 studies mentioning side effects, no side effects were reported in 4, and in the remaining 6, the incidence of complications in the intervention group was much lower than that in the control group.

Conclusions:

This systematic review and meta-analysis suggests that external use herbal medicines may be a safe and effective alternative for treatment of pain and symptoms of acute gouty arthritis. However, owing to the heterogeneity of interventions, outcomes, and regional bias, further high-quality clinical trials on this topic are needed to confirm the level of evidence.
Clinical manifestations and risk factors of coronary artery lesions in children with Kawasaki disease
Authors: Wang Ling , Zeng Xiaoyan , Chen Biquan
Published: September 2023

To analyze the clinical manifestations of children with Kawasaki disease (KD), and risk factors of coronary artery lesion (CAL). A total of 223 patients admitted to Anhui Children Hospital from January 2017 to December 2019 were enrolled. According to the clinical data, the children with KD were divided into complete Kawasaki disease (CKD) and incomplete Kawasaki disease (IKD) groups. According to the results of the cardiac color ultrasound, the children were divided into the CAL and nCAL groups. The clinical symptoms of children with KD were compared between the CKD and IKD groups. The risk factors of CAL were analyzed by univariate and binary logistic regression analyses. The incidence constituent ratio of KD increased annually from 2017 to 2019 (P < .05). The proportion of fever duration no longer than 10 days, chapped lips, fingertip decrustation, perianal desquamation, and fever combined with rash in the CKD group was significantly higher compared to the IKD group (P < .05), while intravenous immunoglobulin non-response and CAL were significantly lower than those in the IKD group (P < .05). The proportion of males, age <1 year, fever duration longer than 10 days, and IKD in the CAL group were significantly higher compared to the nCAL group, while hemoglobin levels were significantly lower than that in the nCAL group (P < .05). Sex, age, fever duration, atypical KD, and hemoglobin levels were risk factors for CAL in children with KD. Persistent fever, conjunctival hyperemia, chapped lips, and rash were common clinical symptoms in children with KD. The risk of CAL was relatively higher in children with low hemoglobin levels and IKD, whose ages were <1 year old and whose fever time was more than 10 days, which requires high clinical vigilance.
Comparing efficacy and factors of postoperative bleeding in endoscopic mucosal resection vs coagulation for intestinal polyps
Authors: Li Zhiang , Yu Fei , Wang Chaoqian , Du Zhang
Published: September 2023

This study aimed to assess the effectiveness of Endoscopic Mucosal Resection (EMR) and Argon Plasma Coagulation (APC) as therapeutic approaches for intestinal polyps in patients, and to examine the factors associated with postoperative bleeding. This study included 132 patients diagnosed with colorectal polyps (188 polyps) who underwent endoscopic surgery at our hospital between January 2022 and December 2022. Based on the surgical method employed, the patients were divided into 2 groups: EMR (68 cases, 97 polyps) and APC (64 cases, 91 polyps). Comparative analyses were conducted to assess the clinical efficacy, surgery-related indicators, and quality of life the 2 groups. Furthermore, an investigation was carried out to identify the factors associated with postoperative bleeding. The analysis revealed no statistically significant difference in the cure rate of flat and superficial raised polyps between the EMR group and the APC (P > .05). However, it was found that the EMR group exhibited a significantly higher cure rate for subpedunculated and raised-pedunculated polyps compared to the APC group (P < .05). The results of logistics analysis showed that patients with hypertension (OR = 2.876, 95% CI: 1.119–7.393), patients with diabetes (OR = 5.278, 95% CI: 1.388–20.064), patients with hyperlipidemia (OR = 2.594, 95% CI: 1.054–6.380), the polyps of right hemicolon (OR = 2.743, 95% CI: 1.003–7.504), rectal polyps (OR = 5.143, 95% CI: 1.728–7.504), pedunculated polyps (OR = 4.758, 95% CI: 1.322–17.129), adenomatous polyps (OR = 3.152, 95% CI: 1.018–9.757) were independent risk factors for postoperative bleeding in patients with colorectal polyps (P < .05). The findings suggest that for subpedunculated and pedunculated-raised polyps, EMR can be a suitable treatment approach. On the other hand, flat and superficial-raised polyps can be effectively managed with either EMR or APC. The presence of hypertension, diabetes, hyperlipidemia, polyps of the right hemicolon, rectal polyps, pedunculated polyps, and adenomatous polyps has been established as independent risk factors for postoperative bleeding in patients with colorectal polyps.
The correlation of lipid profile with subclinical and overt hypothyroidism: A cross-sectional study from Syria
Authors: Tarboush Fatima , Alsultan Mohammad , Alourfi Zaynab
Published: September 2023

We proceeded with this study to investigate the relationship between hypothyroidism and lipid profile disturbance. A cross-sectional study at Al- Mowasat University Hospital in Damascus was conducted from March 2021 to March 2022, and included 324 adults. For each participant with abnormal thyroid stimulating hormone (TSH), free thyroxine (FT4) was requested. The participants were categorized into 3 groups: euthyroid (226 participants), subclinical hypothyroidism (SCH) (75 participants), and overt hypothyroidism (23 participants). Fasting lipid profile was tested as: cholesterol (Chol), triglycerides (TG), low density lipoprotein (LDL), and high density lipoprotein (HDL). A significant relationship between hypothyroidism and dyslipidemia was noticed. LDL, TG, and Chol but not HDL showed a significant difference between study groups (euthyroidism, subclinical, and overt hypothyroidism). The lowest levels of these parameters were in euthyroidism and increased in subclinical and overt hypothyroidism subsequently. Overt hypothyroidism showed a significant difference in LDL, TG, and Chol compared to euthyroidism, however, we did not find a difference in lipid parameters in SCH compared to euthyroidism. LDL and Chol showed significant differences between subclinical and overt hypothyroidism. TSH had a positive weak correlation with LDL, TG, and Chol, however, there was no correlation with HDL. Also, FT4 had a negative weak correlation with LDL, TG, and Chol, however, there was a positive correlation with HDL. Our findings suggest a higher level of lipids (LDL, TG, and Chol) among SCH and overt hypothyroidism compared to general population. A weak correlations of lipid parameters with TSH and FT4 were detected. It is not well evident whether a restoration of euthyroidism might influence the morbidity and mortality, especially cardiovascular comorbidities, in this population, which mandates future studies.
Effect of ticagrelor and clopidogrel dual antiplatelet therapy on MPVLR, MAADP, and AA inhibition rate in acute coronary syndrome patients after percutaneous coronary intervention
Authors: Gao Song-Tao , Wang Yu , Ma Lei
Published: September 2023

Objective:

To explore the effects of ticagrelor and clopidogrel dual antiplatelet therapy on the mean platelet volume-to-lymphocyte ratio (MPVLR), maximum amplitude of adenosine diphosphate-induced platelet-fibrin clots (MAADP), and arachidonic acid (AA) inhibition rates in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).

Methods:

A total of 120 patients with ACS undergoing elective PCI in our hospital between March 2020 and November 2021 were recruited. Patients were divided into 2 groups using the random number table method, with 60 patients in each group. The control group received clopidogrel + aspirin dual antiplatelet therapy, while the study group received ticagrelor + aspirin dual antiplatelet therapy. MPVLR, MAADP, and AA inhibition rates were compared between the 2 groups. Platelet activation indices, platelet micro PNA-223, and platelet gelsolin levels were measured before and 4 weeks after PCI. Changes in cardiac function indices, bleeding rates, and major adverse cardiovascular events (MACE) were compared between groups.

Results:

The MAADP score of the study group was lower than that of the control group 3 days after surgery (P < .05). Compared with before surgery, CD62p, CD63, miR-223, PAC-1, platelet membrane glycoprotein IIb/IIIa complex, and gelsolin levels markedly decreased in both groups 4 weeks after surgery (P < .05). The platelet activation index and platelet miR-223 and gelsolin levels were significantly lower in the study group than in the control group 4 weeks after surgery (P < .05). The overall platelet inhibition effect was significantly better in the study group than in the control group (P < .05). Compared with before surgery, the left ventricular ejection fraction and stroke volume were significantly increased, and the left ventricular end-diastolic volume and left ventricular end-diastolic diameter significantly decreased in both groups 4 weeks after surgery (P < .05). No significant differences were found between the 2 groups in terms of the incidence of bleeding events or MACE (P > .05).

Conclusion:

Ticagrelor is more effective than clopidogrel for platelet inhibition after PCI in patients with ACS and is worthy of clinical recommendation.
Effect of esketamine on inflammatory factors in opioid-free anesthesia based on quadratus lumborum block: A randomized trial
Authors: Dai Jingwei , Li Shanliang , Zheng Riyue , Li Juan
Published: September 2023

Background:

As strong analgesics, opioids provide the analgesic component of general anesthesia, but they have bidirectional effects on the immune system, promoting the production of pro-inflammatory factors. The idea of opioid-free anesthesia is to replace the analgesic effect of opioids in the treatment of acute pain with comparably effective drugs that do not affect the immune system and thereby decrease the production of inflammatory factors. Therefore, this study aims to observe the effect of opioid-free esketamine anesthesia based on quadratus lumborum block on inflammatory factors in patients undergoing lower abdominal or pelvic surgery.

Methods:

A total of 122 patients who underwent lower abdominal or pelvic surgery in our hospital from March 2021 to June 2022 were selected and divided into the esketamine (E) group (n = 62) and control (C) group (n = 60) according to the random number table method. According to the surgical field, the 2 groups underwent unilateral/bilateral quadratus lumborum block in the supine position under ultrasound guidance. In addition, both groups received a target controlled infusion of propofol 3 to 3.5 μg/mL and intravenous rocuronium 0.8 mg/kg. Group E was given opioid-free anesthesia, group C was given opioid-based anesthesia. A 3 to 5 laryngeal mask was inserted according to body weight, and rocuronium 0.5 mg/kg was added intermittently. The levels of interleukin-6 (IL-6), interleukin-8 (IL-8), C-reactive protein (CRP), procalcitonin, tumor necrosis factor-α (TNF-α), numeric rating scales, dosage of propofol, dexmedetomidine and rocuronium, as well as the numeric rating scales score and analgesic complications were monitored in the 2 groups.

Results:

There was no significant differences in general outcomes between the 2 groups (P > .05). The blood pressure in group E was higher than in group C at T1 (P < .05). The levels of IL-6, TNF-α, CRP and IL-8 in group E were significantly lower than in group C at T1, T2, T3, and T4 (P < .05). The levels of IL-6, TNF-α, procalcitonin, CRP and IL-8 in the 2 groups at T1, T2, T3, and T4 were significantly higher than at T0 (P < .05).

Conclusion:

Opioid-free esketamine anesthesia based on quadratus lumborum block achieved perfect postoperative analgesia with little effect on inflammatory factors in patients undergoing lower abdominal or pelvic surgery.
A model study for the classification of high-risk groups for cardiac arrest in general ward patients using simulation techniques
Authors: Song Seok Young , Choi Won-Kee , Kwak Sanggyu
Published: September 2023

Currently, many hospitals use vital signs-based criteria such as modified early warning score (MEWS) and national early warning score (NEWS) to classify high-risk patients for cardiac arrest, but there are limitations in selecting high-risk patients with a possibility of cardiac arrest. The purpose of this study is to develop a cardiac arrest classification model to identify patients at high risk of cardiac arrest based on the patient family and past history, and blood test results after hospitalization, rather than vital signs. This study used electronic medical record (EMR) data from A university hospital, and patients in the high-risk group for cardiac arrest were defined as those who underwent cardio-pulmonary resuscitation (CPR) after cardiac arrest. Considering the use of the rapid response team of A university hospital, patients hospitalized in intensive care units (ICU), emergency medicine departments, psychiatric departments, pediatric departments, cardiology departments, and palliative care wards were excluded. This study included 325,534 patients, of which 3291 low-risk and 382 high-risk patients were selected for study. Data were split into training and validation data sets and univariate analysis was performed for 13 candidate risk factors. Then, multivariate analysis was performed using a bivariate logistic regression model, and an optimal model was selected using simulation analysis. In the training data set, it was calculated as sensitivity 75.25%, precision 21.59%, specificity 66.89%, accuracy 67.79%, F1 score 33.56, area under curve (AUC) 71.1 (95% confidence interval [CI] = 68.9–73.1Pvalue=<.001). In the validation data set, sensitivity 73.37%, precision 25.81%, specificity 75.03%, accuracy 74.86%, F1 score 38.19, AUC 74.2 (95% CI = 72.1–76.2,Pvalue=<.001) were calculated. A model for classifying the high-risk group of cardiac arrest should be developed from various perspectives. In the future, in order to classify patients with high risk of cardiac arrest, a prospective study on the combined use of the model developed by this study and NEWS or MEWS should be conducted.
Index of cardio-electrophysiological balance and Parkinson disease
Authors: Ozturk Unal , Ozturk Onder
Published: September 2023

Neurodegeneration of the autonomic nervous systems due to Parkinson disease (PD) may lead to increase in the QT duration. In recent years, a new parameter index of cardio-electrophysiological balance (ICEB) was found. ICEB is a significant parameter of medicine related dysrhythmia. The purpose of this research is to assess ICEB in PD. Twenty-eight PD cases and 26 controls participated in our investigation. First diagnosed PD patients were registered in the research. The symptom progression of PD was assessed Modified Hoehn and Yahr Scale. Analyzed ECG variables are QRS, PR, QT, corrected QT (QTc) interval, ICEB and corrected index of cardio-electrophysiological balance (ICEBc). All cases had sinus rhythm. ICEB was analyzed by the ratio of QT/QRS. ICEBc was analyzed by the ratio of QTc/QRS. Twenty-eight PD cases participated in this research. Among PD cases, 15 patients were female (53.5%). The mean age of PD patients are 59.03 ± 9.94 years. There was no important difference between groups with respect to the clinical variables. The Modified Hoehn and Yahr Scale was appreciably higher in the PD group than the Control group. The heart rate of the PD group was significantly lower than that of the control group. PR intervals and QRS duration were similar in both groups. QT and QTc duration were significantly longer in PD patients. Also, the ICEB and ICEBc variables were appreciably higher in PD cases. The findings of our investigation suggest that ICEB is related to PD. ICEB can help to evaluate arrhythmia risk in patients with PD.
Application of real time shear wave elastography to the differential diagnosis of secondary parathyroid hyperplasia and adenoma
Authors: Li Xiang-Yi , Li Hao-Wen , Liu Yong-Kang
Published: September 2023

We aimed to explore the value of ultrasonic elastic imaging in the diagnosis of parathyroid hyperplasia and adenoma in patients with secondary hyperparathyroidism and provide more evidence for clinical treatment. Forty patients who were on dialysis and underwent parathyroid surgery were selected All patients underwent routine ultrasound, ultrasound elasticity examination and blood biochemical examination before surgery, including calcium, phosphorus, parathyroid hormone (PTH), etc. According to postoperative results, adenoma group and hyperplasia group were divided into 2 groups. Receiver operating characteristic curve was drawn to evaluate the diagnostic efficacy and combined diagnostic efficacy of each index. The PTH levels significantly differed between the adenoma and hyperplasia groups (P < .001). The volume and blood flow grades significantly differed between the adenoma and hyperplasia groups (P < .001) The minimum of the adenoma group was 14.62 ± 6.79 kPa, mean was 19.42 ± 6.29 kPa, and maximum was 24.25 ± 6.35 kPa which were significantly different from those in the hyperplasia group (P < .05). The combinations of more than 6 indicators in the diagnosis of parathyroid adenoma resulted in an area under the curve of 0.892 (P < .001), and the sensitivity and specificity were 78.9% and 97.4%, respectively. Shear wave elastography can be used as an effective tool to distinguish secondary parathyroid hyperplasia from adenoma. When combined with PTH, conventional ultrasound blood flow grading and volume measurement, it has higher diagnostic efficacy.
To identify biomarkers associated with the transfer of diabetes combined with cancer in human genes using bioinformatics analysis
Authors: Li Yiting , Gu Shinong , Li Xuanwen , Huang Qing
Published: September 2023

Currently, the incidence of diabetes mellitus is increasing rapidly, particularly in China, and its pathogenesis is still unclear. The goal of this study was to find meaningful biomarkers of metastasis in patients with diabetes and cancer using bioinformatic analysis in order to predict gene expression and prognostic importance for survival. We used the Differentially Expressed Gene, Database for Annotation Visualization and Integrated Discovery, and Gene Set Enrichment Analyses databases, as well as several bioinformatics tools, to explore the key genes in diabetes. Based on the above database, we ended up with 10 hub genes (FOS, ATF3, JUN, EGR1, FOSB, JUNB, BTG2, EGR2, ZFP36, and NR4A2). A discussion of the 10 critical genes, with extensive literature mentioned to validate the association between the 10 key genes and patients with diabetes and cancer, to demonstrate the importance of gene expression and survival prognosis. This study identifies several biomarkers associated with diabetes and cancer development and metastasis that may provide novel therapeutic targets for diabetes combined with cancer patients.
Risk factors for difficult endoscopic hemostasis for colonic diverticular bleeding and efficacy and safety of transcatheter arterial embolization
Authors: Sano Tomoe , Ishikawa Toru , Azumi Motoi , Sato Ryo , Jimbo Ryo , Kobayashi Yuji , Sato Toshifumi , Iwanaga Akito , Yokoyama Junji , Honma Terasu
Published: September 2023

This study aimed to investigate the risk factors for difficult endoscopic hemostasis in patients with colonic diverticular bleeding and to evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for colonic diverticular bleeding. This study included 208 patients with colorectal diverticular hemorrhage. The non-interventional radiotherapy group consisted of patients who underwent successful spontaneous hemostasis (n = 131) or endoscopic hemostasis (n = 56), whereas the interventional radiotherapy group consisted of patients who underwent TAE (n = 21). Patient clinical characteristics were compared to identify independent risk factors for the interventional radiotherapy group. Furthermore, the hemostasis success rate, rebleeding rate, complications, and recurrence-free survival were compared between patients who underwent endoscopic hemostasis and those who underwent TAE. Bleeding from the right colon (odds ratio [OR]: 7.86; 95% confidence interval [CI]: 1.6–38.8; P = .0113) and systolic blood pressure <80 mm Hg (OR: 0.108; 95% CI: 0.0189–0.62; P = .0126) were identified as independent risk factors for the interventional radiology group. The hemostasis success rate (P = 1.00), early rebleeding rate (within 30 days) (P = .736), late rebleeding rate (P = 1.00), and recurrence-free survival rate (P = .717) were not significantly different between the patients who underwent TAE and those who underwent endoscopic hemostasis. Patients in the TAE group experienced more complications than those in the endoscopic hemostasis group (P < .001). Complications included mild intestinal ischemia (19.0%) and perforation requiring surgery (4.8%). Patients who required interventional radiotherapy were more likely to bleed from the right colon and presented with a systolic blood pressure of <80 mm Hg. TAE is an effective treatment for patients with colonic diverticular hemorrhage that is refractory to endoscopic hemostasis. However, complications must be monitored carefully.
Viewpoint: Patient safety in primary care – patients are not just a beneficiary but a critical component in its achievement
Authors: Kavanagh Kevin T. , Cormier Lindsay E.
Published: September 2023

Promoting and maintaining patient safety in primary care requires different strategies and monitoring than utilized in large healthcare delivery systems. Maintenance of a culture of safety is key to providing patient safety but has been difficult to measure in primary care. This is particularly true in rural settings where practice size is a major barrier to measurement reliability.

Primary care evaluates a wide range of patients, including those who are immunocompromised and others who have infectious diseases. Providing a safe environment with proper wearing of N95 masks, clean examination rooms, and adequate ventilation is important. Patients with infectious diseases should be separated from other patient populations.

Primary care is often less bureaucratic than hospitals, but also has fewer resources to implement patient safety initiatives, along with detecting safety lapses and adverse events. However, monitoring the practice’s safety practices and the culture of safety is of utmost importance and should be performed using both outcome and process measures. Because of the small size of many rural practices, effective monitoring of adverse events and maintenance of safety protocols should include patients. Patients are an important resource for reporting of adverse events and medical treatment outcomes.

The aim of this manuscript is to underscore the importance of patient safety in primary care and to stimulate future research in developing a metric for the culture of safety in primary care, which also incorporates the patient perspective. Patients should be viewed not only as beneficiaries of patient safety but also as a critical component of its maintenance.
Effect of comfort nursing in the perioperative period of free flap transplantation to repair the defects after surgery for malignant head and neck tumors
Authors: Yu Haidi , Yang Xishuang , Xie Fei , Cao Guihua , Tang Lina
Published: September 2023

To explore the effect of comfort nursing in the perioperative period of free flap transplantation to repair defects of malignant head and neck tumors. This retrospective study included 242 patients with postoperative defects of malignant head and neck tumors repaired using free flap transplantation from December 2017 to December 2022. Among them, 113 patients received routine nursing and were included in the control group, and 129 patients received comfort nursing and were included in the observation group. The perioperative indexes of skin flap transplantation, skin flap necrosis, hospital stay, and cortisol levels were compared. Albumin and pre-albumin levels were compared 1 hour before and 24 hours after surgery. The nursing quality, Self-Rating Depression Scale and Self-Rating Anxiety Scale scores, and nursing satisfaction were compared between the 2 groups. The success rate of skin flap transplantation in the observation group was significantly higher than that in the control group, whereas the rates of skin flap necrosis, length of stay, and cortisol levels were significantly lower in the observation group than in the control group. The Albumin and pre-albumin levels in the observation group were significantly higher than those in the control group 24 hours after surgery. The complication rate was significantly lower in the observation group than in the control group. The Self-Rating Depression Scale and Self-Rating Anxiety Scale scores in the observation group were significantly lower than those in the control group 24 hours after surgery. The satisfaction with nursing was significantly higher in the observation group than in the control group. Comfort nursing improved the success rate of free flap transplantation, reduced complications, reduced stress, improved nutritional, and psychological status of patients during the perioperative period, and improved nursing quality and patient satisfaction with nursing.
Correlation analysis of bone metabolism indices and glycosylated hemoglobin in middle-aged and older adult patients with type 2 diabetes mellitus
Authors: Hou Bo , Qiu Jiang
Published: September 2023

This study aimed to evaluate the association between bone metabolism indices and glycated hemoglobin (HbA1c) levels in middle-aged and older adult patients with type 2 diabetes mellitus (T2DM). We retrospectively analyzed 372 T2DM patients aged > 45 years who had attended the Endocrinology Department at our hospital (males, n = 192; postmenopausal females, n = 180). We collected data concerning patient characteristics, HbA1c levels, and bone metabolism indices (25-hydroxyvitamin D [25(OH)D], β-isomerized C-terminal telopeptides, N-terminal osteocalcin [N-MID], procollagen type 1 N-terminal propeptide [P1NP], bone-specific alkaline phosphatase [BAP], calcium [Ca], and phosphorus [P]). Study patients were divided into 3 groups according to their HbA1c levels: Group A, HbA1c < 7.5%; Group B, HbA1c 7.5 to 8.9%; and Group C, HbA1c ≥ 9.0%. Pearson correlation was used to determine the correlation between HbA1c levels and the bone metabolism indices. Multiple linear regression analysis was performed to identify factors influencing HbA1c in T2DM patients. Among the 3 groups, no differences were observed in 25(OH)D, β-CTx, Ca, or P indices among the 3 groups, whereas a statistically significant difference in N-MID was observed. Pearson correlation analysis showed an inverse correlation between HbA1c levels and N-MID and no correlation with other bone metabolism indices. Multiple linear regression analysis showed that N-MID was a factor influencing HbA1c levels after adjusting for age and body mass index (BMI). Serum N-MID levels negatively correlated with HbA1c levels in middle-aged and older adult men with T2DM. Therefore, high serum N-MID levels may contribute to blood glucose control in T2DM patients.
Analysis of the mechanism of action of Euphorbia fischeriana Steud on cirrhosis based on network pharmacology
Authors: Liu Lu , Xu Yinliang , Yang Liu , Jiang Zhenzhong , Li Xiaoyan
Published: September 2023

This study aimed to employ network pharmacology to elucidate the mechanism by whichEuphorbia fischerianaSteud (EFS) exhibits the efficacy on cirrhosis. The compounds and targets of EFS were retrieved from Traditional Chinese Medicine Integrated Database and Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP). Next, these compounds and targets were analyzed based on protein-protein interaction (PPI) network. Furthermore, Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling network was established based on KEGG database. We constructed a compound-compound target-intersection target-pathway PPI network, including 20 compounds, 19 intersection targets between compound targets and EFS targets. Among the 20 compounds, 8-Isopentenyl-kaempferol has the most targets, with 27 targets, followed by 3,4′,5-Trihydroxy-7-methoxy-8-isopentenylflavone, Formononetin, Isoxanthohumol, and Isokurarinone with potential targets of 26, 22, 18, and 14, respectively. Top 5 targets are HSP90AA1, PTGS2, NOS2, MAPK14, and PPARG. KEGG pathway enrichment analysis showed that pathways such as Hepatitis B, Hepatitis C, Lipid and atherosclerosis, and AGE-RAGE signaling pathway in diabetic complications were closely related to the infection and abnormal metabolism of the liver. The application of network pharmacology could identify potential targets of EFS with a low false-positive rate and provide novel insight into the mechanism of action of EFS on cirrhosis.
Comprehensive analysis of the oncogenic and immunological role of SPON2 in human tumors
Authors: Tang Jiali , Huang Qing , Li Xuanwen , Gu Shinong
Published: September 2023

Background:

Sapiens spondin-2 (SPON2) is a protein found in the extracellular matrix that plays a role in a number of processes, including immune reactions and cell adhesion, and is closely linked to the emergence of a number of tumor types. However, we know very little about Sapiens spondin-2. Therefore, we performed a systematic pan-carcinogenic analysis to explore the relationship between Sapiens spondin-2 and cancers.

Materials and methods:

By comprehensive use of datasets from TCGA, GEO, GTEx, HPA, CPTAC, GEPIA2, TIMER2, cBioPortal, STRING, we adopted bioinformatics methods to dig up the potential carcinogenesis of SPON2, including dissecting the correlation between SPON2 and gene expression, prognosis, gene mutation, Immunohistochemistry staining, immune cell infiltration, and constructed the interaction network of a total of 54 SPON2-binding proteins as well as explored the enrichment analysis of SPON2-related partners.

Results:

The expression of Sapiens spondin-2 in most tumor tissues was higher than that of normal tissues. In addition, SPON2 showed the early diagnostic value in 33 kinds of tumors and was positively or negatively associated with the prognosis of different tumors. It also validates that SPON2 is the gene associated with the majority of immune-infiltrating cells in pan-cancer. High SPON2 expression is associated with tumor progression related pathways.

Conclusion:

We found and validated the potential use of SPON2 in cancer detection for the first time through pan-cancer analysis. The expression levels of SPON2 in various tumors were quite different from those in normal tissues. Furthermore, the performance of SPON2 in tumorigenesis and tumor immunity verified our hypothesis. At the same time, it has high specificity and sensitivity in cancer detection. Therefore, SPON2 can be employed as an auxiliary index for the initial diagnosis of tumors and a prognostic marker for various types of tumors.
Moderating effects of psychological factors and frequency of experiences in the emergency department: The role of perceived quality of healthcare
Authors: Abidova Alina , Alcântara da Silva Pedro , Moreira Sérgio
Published: September 2023

The aim of this study is to identify the main moderators in the relationship between antecedents/predictors (doctors, privacy, accessibility, and availability, perceived waiting time to be called back by the doctor after the examinations and/or tests) and the perceived quality of healthcare (PQHC) in the emergency department (ED). Patients admitted to the ED of a public hospital in Lisbon, Portugal, between January and December 2016 were included in this study, with a representative sample size of 382 patients. A 5% margin of error and a 95% confidence interval were used, and all data were collected between May and November 2017. We used a stepwise multiple linear regression analysis to test the moderation models. We identified 3 main moderators with different moderating roles between the antecedents (predictors) and PQHC: level of life satisfaction, level of happiness, and frequency of ED experiences. Overall satisfaction with doctors is more likely to influence the PQHC among patients with lower levels of life satisfaction. Moreover, privacy and perceived waiting time to be called back by the doctor after an examination and/or test are more likely to influence the PQHC among patients with lower levels of life satisfaction and happiness. Finally, accessibility and availability are more likely to influence the PQHC among patients with more frequent ED experiences. Thus, knowing the moderating effects of psychological factors and the frequency of ED experiences may help to better understand the relationship between PQHC and certain predictors.
Preliminary research of the clinical pathways of glaucomatous optic nerve damage in cases with glaucomatocyclitic crisis: A retrospective study
Authors: Cao Danmin , Hu Jun , Sun Zhong , Lei Qiong , Zhang Wanping , Zhang Ying , Zhou Hezheng
Published: September 2023

To investigate the clinical pathways via which the glaucomatous optic nerve damage (GOND) occurred in cases with glaucomatocyclitic crisis (also called Posner-Schlossman syndrome, PSS). A retrospective study was conducted, 59 PSS patients with confirmed GOND were screened out from 190 PSS cases and followed up for a period of 5 ± 3.3 years. Clinical data were retrospectively analyzed systematically and dynamically, including intraocular pressure and its dynamic change, appearance of fundus, visual field and the state of anterior chamber angle in initial and later period during the episodes and intermission of PSS. Based on the clinical data, a classification and standard for the clinical pathways of GOND were established, and the clinical pathway of GOND in each patient was classified accordingly. There are at least 4 clinical pathways of GOND in PSS patients, namely: Type A: GOND was simply caused by the accumulation effect of high IOP during many attacks of PSS itself. Type B: GOND was resulted from the combined action of PSS itself and another type of secondary open-angle glaucoma. The recurrent inflammation during the episodes of PSS damaged the trabecular meshwork, which can cause elevation of IOP during the intermission of PSS. Type C: PSS combined with primary open angle glaucoma (POAG). Type D: PSS combined with primary angle-closure glaucoma (PACG). Base on the clinical gateways of GOND classification above, the cases of type A, B, C, and D were 27, 6, 19, and 7 respectively. The staging of visual field damage in cases with GOND from different clinical pathways showed a significant difference (Person chi-square χ2 test, χ2 = 7.211, P = .007). There are at least 4 clinical pathways of GOND in PSS patients, and each clinical pathway corresponds to different clinical features and different treatment principles. It is extremely important to correctly discriminate the pathways of GOND in PSS patients.
The effect of Caudal Epidural Injection on healing in the treatment of chronic anal fissure
Authors: Gökçek Erhan , Gökçe Recep , Kaçar Cem Kivilcim
Published: September 2023

Background:

Chronic anal fissure is called the reaching the muscle layer under the skin by deepening of the fissure in the breech skin. Our purpose is to enable the tissue to heal by relaxing the anal sphincter with caudal epidural injection.

Methods:

One hundred twenty cases were included in this randomized, controlled study. The cases were categorized into 2 groups; Under ultrasound guidance, the first group, caudal epidural injection group (Group CE, n = 60) was treated with 5 cc bupivakain + 5 cc isotonic from a caudal epidural for a total of 3 sessions at the beginning, 1 week and 2 weeks later; the second group, control group (Group C, n = 60) were provided medical treatment (cream, pill etc.) every day for 2 weeks. Wexner’s constipation score was used to assess constipation severity and visual analog scale was used to assess pain severity. Short Form-36 was used to determine the patient’s quality of life.

Results:

This study was conducted with 2 groups of 60 people and a total of 120 patients. There was no statistically significant difference between the groups in terms of demographic characteristics (age, body mass index, gender, American Society of Anesthesiologist, mean blood pressure, heart rate) (P > .05). Out of the detected fissures, 32 (26.7%) were located anteriorly and 88 (73.3%) were located posteriorly. The groups were statistically same in terms of fissure location (P = .423). When groups were compared with pain, Wexner constipation and visual analog scale scores decreased significantly in Group CE compared to Group C after 2.and 3.sessions (P = .001 and P = .002, respectively). In Group CE, the Short Form-36 subscales increased significantly (P = .003).

Conclusion:

Caudal epidural injection has a potential to be an alternative treatment option for chronic anal fissure.
Liver retransplantation: Timing is equally important
Authors: Li Le , Zhang Yuhong , Xiao Fei , Qu Wei , Zhang Haiming , Zhu Zhijun
Published: September 2023

Background and aim:

To evaluate the effect of transplantation interval on patient and graft survival in liver retransplantation (reLT) using meta-analytical techniques.

Methods:

Literature search was undertaken until January 2022 to identify comparative studies evaluating patient survival rates, graft survival rates, and the interval time. Pooled hazard ratio (HR) or risk ratio (RR) and 95% confidence intervals (95% CI) were calculated with either the fixed or random effect model.

Results:

The 12 articles were included in this meta-analysis. The late reLT survival rate is better than the early reLT in the 30 days group, and there is no statistical significance in other time groups. The patient survival was significantly higher in late reLT than early reLT at 1 and 5 years (respectively: RR, 0.81 [95% CI, 0.73–0.89]; RR, 0.64 [95% CI, 0.46–0.88]). The graft survival was significantly higher in late reLT than early reLT at 1 year (RR, 0.75 [95% CI, 0.63–0.89]). The risk of death after reLT in early group was 1.43 times higher than that in late group (HR, 1.43 [95% CI, 1.21–1.71]).

Conclusions:

Late reLT had significantly better survival rates than early reLT, and the transplantation interval was more reasonable to divide the early or late groups by 30 days.