bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Determinants of Health in Age-Related Macular Degeneration: A Nationally Representative Survey Study
Authors: Huang Ryan S. , Patil Nikhil S. , Mihalache Andrew , Xie Jim , Popovic Marko M. , Kertes Peter J. , Muni Rajeev H. , Kohly Radha P.
Published: December 2024

Purpose:

To investigate the relationship between social determinants of health (SDoH) and the prevalence of age-related macular degeneration (AMD).

Methods:

This analysis included adult respondents (>50 years old) from the 2017 National Health Interview Survey (NHIS). The primary outcomes were self-reported diagnosis of AMD and self-reported vision loss due to AMD. Univariable and multivariable logistic regression models were employed for analysis.

Results:

A total of 14,267 NHIS participants were included, of whom 668 (4.7%) reported an AMD diagnosis. In the multivariable analysis, respondents aged over 81 years had higher odds of AMD (OR=7.54, 95%CI=[4.76, 11.96], p<0.001) compared to those aged 51-60. Divorced, separated, or widowed participants (OR=1.27, 95%CI=[1.01, 1.61], p=0.042) were also associated with higher odds of AMD compared to married participants. Conversely, Black/African-American (OR=0.23, 95%CI=[0.14, 0.39], p<0.001), Asian (OR=0.38, 95%CI=[0.16, 0.88], p=0.023), and gay, lesbian, or bisexual respondents (OR=0.45, 95%CI=[0.22, 0.93], p=0.032) had lower odds of AMD compared to White and heterosexual respondents, respectively. Employment was also associated with lower odds of AMD (OR=0.71, 95%CI=[0.53, 0.96], p=0.026) compared to unemployment.

Conclusion:

Several SDoH were associated with self-reported AMD diagnosis. These factors should be considered by policymakers and clinicians to effectively orchestrate public health initiatives aimed at promoting equitable care.
Prevalence and associated factors of choroidal caverns in patients with type 2 diabetes mellitus.
Authors: Vidal-Oliver Lourdes , Spissinger Sabrina , Almeida Elisa Herzig-de , Garzone Davide , Chronopoulos Argyrios , Finger Robert P.
Published: December 2024

Purpose:

To study the prevalence of choroidal caverns (CCs) in patients with type 2 diabetes (T2DM) and their association with demographic and clinical data.

Methods:

We included patients with T2DM and nondiabetic controls in a cross-sectional, monocenter study. The main outcome measure was the presence of CCs. Exploratory variables included age, sex, diabetic retinopathy (DR) status, duration of T2DM, visual acuity, arterial hypertension (aHT), hyperlipidemia, HbA1c, choroidal thickness (CT) and choroidal vascularity index (CVI). Group differences between eyes with and without CCs and associations with demographic and clinical variables were assessed.

Results:

After including a total of 205 eyes of 116 patients, the prevalence of CCs was 25% in the control, 28% in the T2DM without DR and 9.5% in the DR groups. The locations of the caverns were: choriocapillaris (N=2, 4.2%), Sattler's (N=29, 60.4%) and Haller's layer (N=17, 35.4%). 34.3% of patients had caverns in both eyes. We found no significant differences in systemic conditions (including aHT, hyperlipidemia, HbA1c or T2DM disease duration). CVI was the only parameter independently associated with the presence of choroidal caverns (OR 1.37).

Conclusions:

We found choroidal caverns in almost a quarter of patients with and without T2DM. CCs were mainly located in the Sattler’s layer. CVI was independently associated with the presence of CCs. These findings suggest that the presence of CCs may be a sign of a higher metabolic activity within the choroidal microenvironment, irrespective of T2DM status.
Prolonged time from cross-clamp until normothermic machine perfusion start is associated with an increased risk of early allograft dysfunction following DCD liver transplant
Authors: Lee Charles , Mathur Amit K. , Mao Shennen , Heimbach Julie K. , Taner C. Burcin , Aqel Bashar , Croome Kristopher P.
Published: December 2024

There is a paucity of data on the impact of cold ischemia time before the initiation of normothermic machine perfusion (NMP), particularly in more susceptible organs such as livers from donation after circulatory death (DCD) donors. The present analysis aimed to investigate the impact of prolonged time from cross-clamp until NMP start on early allograft dysfunction and other peri–liver transplant (LT) outcomes. All DCD LT performed and placed on NMP at Mayo Clinic Arizona, Florida, and Rochester from January 2022 to March 2024 were included. The decision was made a priori to divide the population into 2 groups based on terciles: typical cross-clamp to on-pump time (lower 2 terciles) versus prolonged cross-clamp to on-pump time (upper tercile; >2 h 45.6 min). Three hundred eighty-four DCD LT undergoing NMP met the inclusion criteria. The rate of early allograft dysfunction was significantly higher in the prolonged cross-clamp to on-pump group (51.2%) compared to the typical cross-clamp to on-pump group (37.6%) (p = 0.01). The prolonged cross-clamp to on-pump group also had higher rates of acute kidney injury and the number of packed red blood cells transfused during LT. No significant difference in ischemic cholangiopathy (2.4% vs. 3.1%; p = 0.68) or graft survival at 12 months was seen between the prolonged cross-clamp to on-pump and typical cross-clamp to on-pump group, respectively. Following cross-clamp, DCD liver grafts should be placed on the NMP pump as quickly as is safely and logistically possible. In cases where delays are unavoidable, such as waiting for biopsy results or liver reallocation with another center, acceptable results can still be achieved, and therefore, livers with prolonged times should still be used.
A case of disseminated nocardia infection with initial symptoms manifesting as cognitive impairment: Case report and literature review
Authors: Li Xiayahu , Zhou Weiguo , Zhao Kai , Li Yaolin
Published: December 2024

Rationale:

Nocardia infections, although rare, pose significant challenges in diagnosis and treatment, especially when involving the central nervous system (CNS). Mortality rates in such cases can be high, highlighting the need for early recognition and tailored antimicrobial therapy.

Patient concerns:

A 58-year-old male with a history of chronic obstructive pulmonary disease, antineutrophil cytoplasmic antibody–associated glomerulonephritis, and steroid-induced diabetes mellitus presented with disorganized speech, fever, cough, dyspnea, and psychiatric symptoms.

Diagnoses:

The patient was diagnosed with severe pneumonia, left pneumothorax, bilateral pulmonary bullae, and CNS involvement. Next-generation sequencing (NGS) identified Nocardia farcinica as the causative agent.

Interventions:

Initial treatment with ceftriaxone was ineffective. Upon identification of N. farcinica via NGS, the patient was started on a tailored antimicrobial regimen consisting of sulfamethoxazole, linezolid, and meropenem.

Outcomes:

Despite initial clinical improvement, the patient was discharged early due to financial constraints. Unfortunately, he later succumbed to the infection.

Lessons:

This case underscores the difficulty of diagnosing Nocardia infections, particularly when they involve the CNS. The use of advanced diagnostic tools such as NGS, along with early and appropriate antimicrobial therapy, is crucial for improving patient outcomes. Financial and healthcare access challenges may impact the success of treatment, emphasizing the importance of comprehensive follow-up and patient support.
fMRI used to observe the acute craniocerebral response of esophageal cancer related depressive patients treated by rTMS: Initial experience
Authors: Yang Jianquan , Guo Wen , Pang Xuezhou , You Chuanyu , Zhou Chunyang , Gui Yan , Ma Daiyuan
Published: December 2024

To observe the immediate craniocerebral response, changes of spontaneous nerve activity and functional connection after repeated transcranial magnetic stimulation (rTMS) in esophageal cancer patients with depression (ECPD) by functional magnetic resonance imaging (fMRI), and to explore the therapeutic effect, neuroactivity response and mechanism. Eleven patients with ECPD were enrolled to treated with single rTMS. The patients were examined by fMRI before and after the treatment. The changes of low frequency amplitude (ALFF) and the functional connection network between different brain regions of ALFF in patients were compared before and after rTMS treatment. Compared with those before rTMS treatment, the Hamilton Depression Rating Scale (HAMD) score decreased significantly after rTMS treatment (t = −7.63, P = .0001). The ALFF of bilateral putamen, left thalamus, left posterior cingulate gyrus and right middle temporal gyrus decreased significantly (P = .02). In addition, the functional connection between the cortex-limbic system-striatum-thalamus nerve loop increased in patients after rTMS treatment. rTMS may achieve the effect of rehabilitation treatment by improving the spontaneous neural activity and regulating the neural connection network of cortical-limbic systems-triatum-thalamus loop in ECPD.
Acceptance status and influencing factors of advance care planning among elderly patients with chronic disease
Authors: Zheng Xiu , Gao Yunlei , Yan Xin-Xin , Zhu Xiaoxu , Wang Chunqi
Published: December 2024

The aging population has become a severe public health issue both in China and globally. Over 180 million elderly people in China have chronic diseases, with 75% of them suffering from 2 or more chronic diseases, posing significant threats to their independence and quality of life, and imposing immense mental and disease burdens on patients and their families. So our research analyzes the influencing factors based on the current acceptance status of advance care planning (ACP) among elderly patients with chronic diseases. Using convenience sampling, 120 elderly inpatients from the geriatrics department of a tertiary hospital in Beijing, from June 2023 to March 2024, were selected. Surveys included a general information questionnaire, an ACP acceptance questionnaire, and the revised version of the Terminal Care Experience and Death Attitude Profile. The total ACP acceptance score among elderly patients with chronic diseases was 73.98 ± 9.84 points. Factors influencing ACP acceptance included fear of death, whether the patient had cared for a dying relative, duration of chronic illness, presence of complications, natural acceptance, and religious beliefs (P < .05). The acceptance level of ACP among elderly patients with chronic diseases is moderately high. Medical staff should provide more choices to enhance the life value of elderly patients with chronic diseases based on fully respecting their wishes.
Comparison of traditional face-to-face teaching with synchronous distance education in medical theory courses teaching to medical undergraduates: A case-controlled study in China
Authors: Lyu Xiaohong , Zhao Jun , Tang Rui , Pan Hui , Chen Shi
Published: December 2024

Synchronous distance education (SDE) has recently been widely used for medical students. The purpose of this study was to compare the effects of SDE with traditional face-to-face education (TE) on the learning outcomes of undergraduate medical students. Participants were class enrolled in 2015 and class enrolled in 2016. The entire 2 classes (n = 148), when they were a 6th-year grade at a medical college, were invited to participate in the case-controlled study. The 6th-grade curriculum includes 5 courses in ophthalmology, otorhinolaryngology, dentistry, traditional Chinese medicine, and dermatology. Outcomes included postintervention exams evaluating the knowledge gained from the 5 courses, a self-assessment of learning based on examinable learning objectives, student satisfaction, learning behavior, and teacher–student communication. Sixty-nine students (SDE n = 39, TE n = 30) participated in the outcome assessments. The mean score of the otolaryngology course and the dermatology course in the SDE group was higher than the TE group (P < .05). Other courses and combined grades for the 5 courses were without statistical differences between the 2 groups. Of the 12 self-assessment learning objectives, 10 were significantly more positive in the SDE group than in the TE group. There was no statistical difference between the 2 groups regarding student satisfaction. The SDE group was more engaged than the TE group in the corresponding department apprenticeship after the theory class. The attendance rate and concentration in the class of the SDE group were comparable to the TE group. Students in the SDE group spoke more often in class and had a higher level of student–teacher communication than the TE group. The SDE is a teaching tool that can replace TE in the theoretical teaching of medical courses.
Identifying the molecular mechanism of blood stasis syndrome through the symptom phenotype–genotype association approach:
Authors: Tran Minh Nhat , Jun Hyeong Joon , Lee Sanghun
Published: December 2024

In traditional medicine (TM), blood stasis syndrome (BSS) is characterized by insufficient blood flow, resulting in a group of symptoms such as fixed pain, a dark complexion, bleeding, and an astringent pulse. While BSS pathology has been previously explored, its molecular mechanisms remain elusive owing to challenges in linking TM symptoms to genes. Our study aimed to elucidate the mechanisms underlying BSS using a phenotype–genotype association approach. We extracted BSS symptoms from various studies, linked them to medical terms using a Unified Medical Language System, and connected these terms to genes in the DisGeNET database. The molecular network patterns of BSS symptoms were revealed through analyzing protein–protein interactions and symptom–gene associations. Our findings revealed 1325 associations between 16 BSS symptoms comprising 32 concept-unified identifier terms and 937 genes. Network analysis highlighted the centrality of JAK2, ITGB3, and F2, associated with multiple BSS symptoms (≥5 concept-unified identifier terms) and numerous protein interactions (≥20 interactions). Enrichment analysis indicated the involvement of BSS genes in the immune system (P-value = 4.49e‐14) and hemostasis (P-value = 1.28e‐07) pathways. BSS symptoms were linked to genes regulating blood coagulation, immune responses, blood flow, and inflammatory reactions. This approach may be extended to establish genotype networks for understanding TM pattern identifications, which are composed of diverse groups of symptoms, for personalized diagnosis and treatment.
Persistent and severe hypotension during radical transabdominal ovarian cancer surgery: A case report
Authors: He Xinyan , Liu Hui
Published: December 2024

Rationale:

In radical surgery for ovarian cancer (OC), hypotension that is difficult to correct is usually rare unless there is significant blood loss. We recently encountered a patient who developed persistent and severe hypotension during radical transabdominal OC surgery.

Patient concerns:

A patient was 52 years old with a history of hypertension and well-controlled preoperative blood pressure (BP). A total of 2000 mL of ascites was drained and blood loss was 300 mL when the operation proceeded to 5.5 hours. The patient’s cardiopulmonary function and blood gas analysis showed no significant abnormalities.

Diagnoses:

persistent and uncorrectable hypotension.

Interventions:

There was no significant edema in the patient’s head or face, nor did the surgeon observe noticeable edema in her intestinal walls or other organs. No oozing was seen at the surgical site. Fluid resuscitation and vasopressor administration were continued. As BP control further deteriorated, blood counts, coagulation, and biochemical electrolyte analyses revealed severe hypoalbuminemia (13.5 g/L) and coagulation dysfunction.

Outcomes:

After intravenous human serum albumin (HSA) and fresh frozen plasma therapy, her hypoalbuminemia and coagulation were gradually corrected.

Lessons:

Based on this case, we suggest that in OC patients experiencing mild intraoperative bleeding and minimal heart rate variation but persistent refractory hypotension, hypoalbuminemia should be considered even if preoperative biochemical tests (including serum albumin levels) are normal. Confirming hypoalbuminemia warrants HSA administration to alleviate hypovolemic shock symptoms. Additionally, it is important to be cautious of potential coagulation issues with albumin use, possibly requiring plasma infusion to address coagulopathy.
Active social participation extends the healthy life expectancy of older men without spouses in Japan: The Yamanashi healthy active life expectancy cohort study
Authors: Oka Takeru , Yokomichi Hiroshi , Yamagata Zentaro
Published: December 2024

This study aimed to evaluate the association between family structure and healthy life expectancy among older Japanese adults, hypothesizing that social participation increases healthy life expectancy more in older men without a spouse than in older women. This study collected data on Healthy Life Expectancy from 541 older adults between 2003 and 2021 from the Healthy Life Expectancy Study, a cohort study of older adults in Yamanashi Prefecture, Japan. The Japanese long-term care insurance system serves as an indicator of a healthy life expectancy. The family structures of participants were categorized as living alone, with a spouse, and with non-spouse cohabitants, whereas social activity frequency was classified as low or high (Community participation was assessed using a 4-point scale: “often,” “sometimes,” “rarely,” and “never.”). Cox proportional-hazards regression was used to analyze the relationship between participant characteristics and the loss of healthy life expectancy. Each additional year of age for older men and women increases the risk of loss of healthy life expectancy by 13% and 16%, respectively. The risk of loss of healthy life expectancy was higher among older men who lived alone or lived with non-spouse cohabitants than older living with a spouse (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.01–3.75; hazard ratio: 1.66, 95% confidence interval: 1.05–2.64, respectively). However, older men living without a spouse and engaging in high social activity participation had a lower risk of loss of healthy life expectancy than did those with low social activity participation (hazard ratio: 0.35, 95% confidence interval: 0.17–0.71). In conclusion, older men living without a spouse with high social activity participation had longer healthy life expectancies than those living alone with low social activity participation did.
A bibliometric analysis of hepatolenticular degeneration research in traditional Chinese medicine using CiteSpace and VOSviewer: A study protocol for systematic review
Authors: Tao Zhuang , Wang Fei , Jiang Zhenzhen , Wang Chi , Jiang Chao , Ye Sheng , Yang Wenming , Wang Meixia
Published: December 2024

Background:

The purpose of this review was to analyze treatments for hepatolenticular degeneration (HLD) in traditional Chinese medicine (TCM), exploring the potential mechanisms and latest advances, as well as potential future directions.

Methods:

We searched articles from the China National Knowledge Infrastructure, the Wanfang database, the Chinese Medical Journal Database, PubMed, the Cochrane Library, and Embase. We used CiteSpace (version 5.8. R3) and VOSviewer (version 1.6.17) software for visual analysis of bibliometrics.

Results:

We selected a final total of 532 studies for visual analysis. In terms of authors, Yang Wenming was the most prolific author in this field, and there were 5 coauthor teams, namely Yang Renmin’s team, Bao Yuancheng’s team, Yang Wenming’s team, Chen Huaizhen’s team, and Han Hui’s team. The top 5 research topics focused on TCM syndrome (13.45%), clinical efficacy (9.45%), integrative medicine (6.91%), liver fibrosis (6.36%), and cognitive dysfunction (4.18%). The top 5 clusters were “#1 Gandouling tablet,” “#2 Gandou Fumu decoction,” “#4 Gandou decoction,” “#5 Clinical Efficacy,” and “#8 Theoretical research.” Research hotspots changed over the past decades, and current studies looked at damp-heat syndrome, phlegm stasis syndrome, and the efficacy of prescriptions.

Conclusion:

Currently, studies in TCM syndromes are relatively limited, and although the field of TCM in HLD is rapidly developing with established networks of teams and collaborations, large-scale collaboration is still in its infancy. Looking toward the future, despite the deficiencies in this field, it is crucial to further explore the advantages of integrative medicine for treating HLD.
Global trends and future directions on carbapenem-resistant Enterobacteriaceae (CRE) research: A comprehensive bibliometric analysis (2020–2024)
Authors: Gürbüz Melahat , Gencer Gülcan
Published: December 2024

The increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) poses a significant threat to public health. CRE, particularly Klebsiella pneumoniae, is associated with high morbidity and mortality owing to limited treatment options. This study identifies current research trends, major topics, and future directions in the scientific field of CRE. We systematically retrieved publications from the Web of Science database starting from 2020 to January 07, 2024. Using bibliometric tools such as VOSviewer, CiteSpace, and InCites, we analyzed publication counts, citation analysis, co-authorship, keyword co-occurrence, and thematic development to map the landscape and collaborative networks in the field. The search included keywords such as “carbapenem-resistant Enterobacteriaceae,” “carbapenemase-producing Enterobacteriaceae,” “carbapenemase-producing Klebsiella pneumoniae,” and “Klebsiella pneumoniae carbapenemase.” We reviewed 1946 articles. The largest contributors to the field were China, the United States, and Italy. This study highlights the significant increase in CRE-related publications, particularly in the context of hospital-acquired infections, antimicrobial resistance mechanisms, and novel therapeutic approaches. Keyword trend analysis revealed epidemiology, molecular biology, infection control, and public health implications, signaling a shift towards the broader impact of CRE in healthcare settings. This bibliometric analysis maps the current research landscape and identifies key areas for further research. Continued progress is essential to develop strategies to combat antimicrobial resistance and to improve patient outcomes.
Causal association between depression and constipation: A bidirectional two-sample Mendelian randomization study
Authors: Guan Xiaoyan , Ni Qianyang , Zhai Ziqi , Sun Yupei , Zhang Yan
Published: December 2024

There is currently insufficient research on the causal relationship between depression and constipation. This study aims to provide clear evidence for the positive and negative causal relationship between depression and constipation through bidirectional two-sample Mendelian randomization (MR) analysis. MR is a statistical method used to evaluate the credible causal relationship between exposure and outcomes. In this study, we extracted corresponding genetic data from independent cohorts of patients with depression and constipation. Depression data was obtained from the Finngen database, while constipation data was obtained from the IEU OPEN genome-wide association study database. MR analysis was conducted using 5 methods: inverse variance weighted (IVW), MR-Egger, weighted median, simple mode, and weighted mode. In addition, we also used Cochran Q test, MR-Egger intercept test, and leave-one-out analysis to test for the existence of horizontal pleiotropy and evaluate the robustness of MR analysis results. In the analysis of the impact of depression on constipation, we identified 15 significant and statistically strong single nucleotide polymorphisms, and the IVW random effects analysis showed a causal relationship (OR = 1.005 [1.003, 1.007], P = 1.26 × 10‐5). When analyzing the impact of constipation on depression, 10 significant and statistically strong single nucleotide polymorphisms were identified, but IVW analysis did not find a causal relationship (OR = 73.768 [0.004, 1.306 × 10‐6], P = .389). There is no heterogeneity in the impact of depression on constipation in the bidirectional analysis results, and there is heterogeneity in the impact of constipation on depression, but there is no horizontal pleiotropy. Our bidirectional two-sample MR analysis identified a causal relationship between depression and constipation. This discovery may help clinical doctors to intervene in depression patients in a timely and effective manner when treating constipation patients, avoiding further deterioration of the condition.
Global trends in machine learning applied to clinical research in liver cancer: Bibliometric and visualization analysis (2001–2024)
Authors: Zhuo Enba , Yang Wenzhi , Wang Yafen , Tang Yanchao , Wang Wanrong , Zhou Lingyan , Chen Yanjun , Li Pengman , Chen Bangjie , Gao Weimin , Liu Wang
Published: December 2024

This study explores the intersection of liver cancer and machine learning through bibliometric analysis. The aim is to identify highly cited papers in the field and examine the current research landscape, highlighting emerging trends and key areas of focus in liver cancer and machine learning. By analyzing citation patterns, this study sheds light on the evolving role of machine learning in liver cancer research and its potential for future advancements.
Resilience: A panacea for burnout in medical students during clinical training?: A narrative review
Authors: Sanjaya Ardo , Mianto Nathanael Andry , Wijayanto Karen Regina , Edwin Christian
Published: December 2024

Clinical rotations or clerkships are a necessary part of medical education but are associated with significant psychiatric morbidity, including burnout and psychological distress. This review aims to explore the role of resilience as a protective factor and assess the effectiveness of resilience-building interventions. We conducted a narrative review using the Medline database via PubMed. The search strategy included the terms “resilience,” “burnout,” and “medical students.” A total of 52 articles were included and synthesized narratively. Burnout affects 40% to 80% of medical students, with higher rates during their clinical years. Resilience was consistently found to be a stable, protective factor that buffers against stress and burnout. Most research focused on medical students, regardless of whether they are in clinical training. However, the effectiveness of resilience interventions varied. Interventions such as psychological workshops and curriculum changes showed mixed results, with competence-based approaches showing the most promise for long-term benefits. Resilience is a critical target for improving medical students’ psychological health and reducing burnout during clinical training. Future interventions should focus on combining psychological support with competence-based training to equip students for the challenges ahead.
Causal association between cholecystectomy and fracture: A Mendelian randomization study
Authors: Zheng Shijie , Xie Xinhui
Published: December 2024

Previous observational studies have reported that cholecystectomy is associated with an increased risk of fracture. However, the causality of this association remains unclear. This study aimed to explore the causal relationship between cholecystectomy and fracture using a Mendelian randomization (MR) approach. Our primary analytical method was the comprehensive two-sample MR analysis, with inverse variable weighting (IVW) serving as the main analysis technique. In addition, we use Bayesian weighted MR analysis to further confirm the results of IVW method. To enhance the robustness of our findings, we employed multiple analytical approaches including MR-Egger, weighted mode, simple mode, and weighted median. We further conducted sensitivity analyses to validate the stability and feasibility of our dataset. The results of IVW methods showed that there had no significant causal effect of cholecystectomy on fracture (forward P value: .82, .63, .96, .60, .19, .40, .58, .38, .37, .97, and .50 for fracture of wrist and hand, fracture of femur, fracture of foot, fracture of forearm, fracture of lower leg, fracture of lumbar spine and pelvis, fracture of neck, fracture of ribs, fracture of shoulder and upper arm, fracture of skull and facial bones, and fracture of spine), the results of Bayesian weighted MR showed similar results (P > .05). In the reverse, fracture of femur (P = .01) and fracture of shoulder and upper arm (P = .01) showed increased risks of cholecystectomy. The sensitivity analysis showed that none of our analyses were horizontally pleiotropic (P > .05 for MR-Egger’s intercept method). Our results do not support the causal effect of cholecystectomy on fracture, which was opposite to most previous observational studies.
Determinants of developing cardiovascular disease risk with emphasis on type-2 diabetes and predictive modeling utilizing machine learning algorithms
Authors: Das Shatabdi , Rahman Riaz , Talukder Ashis
Published: December 2024

This research aims to enhance our comprehensive understanding of the influence of type-2 diabetes on the development of cardiovascular diseases (CVD) risk, its underlying determinants, and to construct precise predictive models capable of accurately assessing CVD risk within the context of Bangladesh. This study combined data from the 2011 and 2017 to 2018 Bangladesh Demographic and Health Surveys, focusing on individuals with hypertension. CVD development followed World Health Organization (WHO) guidelines. Eight machine learning algorithms (Support Vector Machine, Logistic Regression, Decision Tree, Random Forest, Naïve Bayes, K-Nearest Neighbor, Light GBM, and XGBoost) were analyzed and compared using 6 evaluation metrics to assess model performance. The study reveals that individuals aged 35 to 54 years, 55 to 69 years, and ≥ 70 years face higher CVD risk with adjusted odds ratios (AOR) of 2.140, 3.015, and 3.963, respectively, compared to those aged 18 to 34 years. “Rich” respondents show increased CVD risk (AOR = 1.370, P < .01) compared to “poor” individuals. Also, “normal weight” (AOR = 1.489, P < .01) and “overweight/obese” (AOR = 1.871, P < .01) individuals exhibit higher CVD risk than “underweight” individuals. The predictive models achieve impressive performance, with 75.21% accuracy and an 80.79% AUC, with Random Forest (RF) excelling in specificity at 76.96%. This research holds practical implications for targeted interventions based on identified significant factors, utilizing ML models for early detection and risk assessment, enhancing awareness and education, addressing urbanization-related lifestyle changes, improving healthcare infrastructure in rural areas, and implementing workplace interventions to mitigate stress and promote physical activity.
Construction and validation: A nomogram model to predict recurrence after percutaneous endoscopic discectomy
Authors: Zhou Yong , Huang Ren-Lin , Liu Yi , Feng Chen
Published: December 2024

A systematic retrospective analysis of patients with lumbar disc herniation treated with percutaneous endoscopic discectomy was performed to identify key risk factors for postoperative recurrence, and a Nomogram prediction model was constructed based on them. The data of patients with lumbar disc herniation who were treated in our hospital between January 2021 and December 2023 were included in this study. Statistical tools, including univariate and multivariate logistic regression analyses, were used to accurately screen independent risk factors significantly associated with postoperative recurrence. Based on this, a nomogram prediction model was constructed to enable personalized prediction of postoperative recurrence risk. The model performance was evaluated by plotting the receiver operating characteristic curve and calculating the area under the curve, supplemented by calibration curve and decision curve analysis, to ensure the predictive accuracy and clinical practicability of the model. 286 patients with lumbar disc herniation were included in the study, and 29 patients had a postoperative recurrence, with a recurrence rate of 10.14%. After univariate and multivariate logistic regression analyses, a total of 5 variables were identified as independent risk factors for postoperative recurrence of lumbar disc herniation: age > 60 years (OR = 2.831; 95% CI = 1.089–5.430), body mass index (BMI) > 24 kg/m2 (OR = 4.632; 95% CI = 1.183–14.337), The type of lumbar disc herniation was herniation (OR = 5.064; 95% CI = 1.198–15.364), degeneration grade III-IV (OR = 5.916; 95% CI = 1.357–16.776), and postoperative high-intensity activity (OR = 4.731; 95% CI = 1.341–14.024). The nomogram constructed in this study for postoperative recurrence of lumbar disc herniation by percutaneous endoscopic discectomy has good predictive accuracy, and this tool can effectively assist orthopedic surgeons in identifying high-risk patients with recurrence after percutaneous endoscopic discectomy, providing a scientific basis for early intervention and individualized management strategies, thus optimizing patient prognosis.
Current Trends in Deep Plane Neck Lifting
Authors: Chinta Sachin R. , Brydges Hilliard T. , Laspro Matteo , Shah Alay R. , Cohen Joshua , Ceradini Daniel J.
Published: December 2024

Introduction

The aging neck is a prevalent aesthetic concern, with over 160,000 neck procedures performed in 2020. It is characterized by increased soft tissue laxity and displacement of cervical structures. While nonsurgical interventions like cryoablation and laser resurfacing show promise, their variable responses highlight the necessity for surgical solutions. Traditional neck lifts address superficial structures but often neglect the subplatysmal plane. Recently, deep plane neck lifts have gained attention for addressing deeper anatomical structures. This paper systematically reviews the literature on subplatysmal modifications in cervicoplasty, aiming to clarify the risks and benefits of these evolving surgical techniques.

Methods

On February 20, 2024, a systematic review adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 guidelines was performed. MEDLINE, PubMed, Cochrane, and Scopus databases were searched for terms related to neck rejuvenation. Independent reviewers screened titles, abstracts, and full texts, including all relevant studies. Data extracted included patient numbers, procedures, outcomes, and complications.

Results

From an initial 771 articles, 57 studies encompassing 8648 patients met inclusion criteria. The most commonly altered anatomical structures during “deep plane” neck lift (DPNL) were the submandibular gland (69.9%), digastric muscles (58.6%), and subplatysmal fat (48.6%). Postoperative complications were reported in 59.6% of studies, with nerve palsy (0.2%–12%) and hematoma (0.2%–4%) being most common. Aesthetic outcomes were less frequently reported (56% of studies); patient satisfaction ranged from 81.6% to 98.6%, while objective measures were reported in only 12% of studies.

Conclusions

Recent surveys indicate a growing concern over excess laxity under the chin, with patients increasingly seeking neck rejuvenation. Our review found that DPNL techniques vary widely, with the submandibular gland and digastric muscles being the most frequently altered structures. Despite a general lack of standardized outcome measures, patient satisfaction was high. However, DPNL showed a higher rate of postoperative nerve palsy compared to traditional neck lift. Overall, while DPNL demonstrates potential aesthetic benefits, the increased risk necessitates thorough patient counseling and further studies for standardization and comparison.
An “Expanded Zone” Concept for Soft Tissue Coverage of the Upper Extremity
Authors: Hallock Geoffrey G.
Published: December 2024

Vascularized soft tissue coverage of open wounds of the lower extremity has long been predicated on the zone of injury and the available local flap donor site options found therein. A hypothesis was presented decades ago in this journal that attempted to extend a similar approach to simplify upper extremity coverage as well, but appears to have long been forgotten. However, with the emergence of the fasciocutaneous flap and its offspring the perforator flap, now a plethora of additional local flap options within the upper extremity may justify this idea being further considered. Indeed, the upper extremity can arbitrarily be divided into distinct anatomical regions that each has unique characteristics. However, soft tissue requirements that must be restored cannot so simply be restricted by anatomical boundaries, so instead an “expanded zone” concept is more appropriate where comparable regions can be treated in a similar as long as functional fashion. All this must be with the realization that if a suitable local flap option does not exist, the selection of a free tissue transfer with the same preferable composition should instead be chosen, just as would be done in the lower extremity.
Paclitaxel-induced cognitive decline was attenuated by necroptosis inhibition
Authors: Liu Lan-Lan , Zhao Shuang , Li Zhao , Li Hui-Zhou , Ma Dong-Yang , Liu Xin , Wang Gui-Ying , Wang Xiu-Li
Published: December 2024

Anti-cancer agent paclitaxel induces cognitive impairment. Paclitaxel can induce limited neuron apoptosis and wide scope of neuroinflammation, but its precise mechanisms remain unclear. In this study, we determined paclitaxel causes necroptosis, a programmed cell death, via activation of the RIPK1-RIPK3-MLKL signaling pathway in hippocampal neurons (HT22 cells). Flow cytometric analysis, propidium iodide staining, and western blotting techniques were used to evaluate paclitaxel-induced necroptosis. Cell viability was determined using the Cell Counting Kit-8 assay, and the Ca2+ levels were measured using a Fluo-4 AM fluorescent probe. The number of cells positive for both annexin V and propidium iodide staining was significantly higher in paclitaxel-treated than vehicle-treated HT22 cells. Additionally, the nuclei of paclitaxel-treated cells exhibited more diffused necrotic propidium iodide staining than the vehicle-treated cells. The expression of necroptosis-associated proteins, including receptor-interacting protein kinase (RIPK)1, RIPK3, mixed lineage kinase domain-like protein (MLKL), and phosphorylated (p)-MLKL, were increased following paclitaxel treatment. Treating HT22 cells with necrostatin-1, a specific inhibitor for RIPK1, effectively decreased paclitaxel-induced necroptosis through lowering intracellular Ca2+ overload. In addition, administration of necrostatin-1 to paclitaxel-treated mice rescued cognitive impairments, as assessed by novel object recognition and Morris water maze tests. Necrostatin-1 also reduced the increases in necroptosis-associated protein levels of RIPK1, RIPK3, MLKL, and p-MLKL in hippocampal tissue of paclitaxel-treated mice. Paclitaxel induces cognitive deficits through RIPK1-mediated necroptosis. The inhibition of necroptosis may be a potential therapeutic approach to reduce paclitaxel-induced cognitive deficits.
Relatives' Knowledge, Attitudes, and Experiences Toward Electroconvulsive Therapy
Authors: Boone Klaus , Geerts Pieter-Jan , Van de Velde Nele , Verhaeghe Sofie , Lemmens Gilbert M.D.
Published: December 2024

Electroconvulsive therapy (ECT) is an effective treatment for patients with severe psychiatric disorders. Stigma and lack of knowledge surrounding ECT are major obstacles for both patients and their caregivers, who play an important role as shared decision-makers. Insight in caregivers' perspectives on ECT can support the consent process and patient compliance with ECT. We aimed to review perspectives on knowledge, attitudes, and experiences of caregivers of adult and adolescent patients who received ECT. We performed a computerized search (EMBASE, MEDLINE) for articles meeting the following inclusion criteria: (1) qualitative studies, quantitative studies, or quasi-experimental studies that (2) report on caregiver perspectives of patients who received ECT. We conducted our systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. In total, 29 articles were included. Variation in knowledge about ECT was high among caregivers. Their attitudes were generally positive and most would advise for future ECT if necessary. Psychoeducational tools and ECT experience increased knowledge and attitudes in caregivers. In general, caregivers were satisfied with ECT but wanted more information on risks and side effects before ECT. Caregivers reported more positive attitudes toward and had better experiences with ECT compared with patients. Our systematic review demonstrated moderate knowledge, but overall positive attitudes and experiences on ECT in caregivers. Overall low methodological quality of included studies limits our conclusions. Future research should focus more on qualitative methods and cohort studies.
Age- and Sex-Related Volumetric Density Differences in Trabecular and Cortical Bone of the Proximal Femur in Healthy Population
Authors: Brance María Lorena , Saraví Fernando Daniel , Henríquez Muriel M. , Larroudé María Silvia , Jacobo Jorge E. , Araujo Sebastian Abalo , Longobardi Vanesa , Zanchetta María Bélen , Ulla María Rosa , Martos Florencia , Salerni Helena , Oliveri Beatriz , Bonanno Marina Soledad , Meneses Naraline Luna , Baclini Pilar Diaz , Ramírez Stieben Luis A. , Gregorio Silvana Di , Brun Lucas R.
Published: December 2024

Background: There are age- and sex-related increases in the prevalence of osteoporosis. Bone densitometry based on dual energy X-ray absorptiometry (DXA) is the gold standard for the assessment of bone mineral density (BMD). Three-dimensional (3D) analysis of the proximal femur (3D-DXA) allows discrimination between cortical and trabecular compartments, and it has shown a good correlation with computed tomography. We aimed to assess age- and sex-related volumetric density differences in trabecular and cortical bone using 3D-DXA and determine the reference intervals for integral volumetric (v)BMD within the Argentine population.Methods: Healthy female and male adult subjects (N=1,354) from Argentina were included. Hip BMD was measured using DXA, and 3D analysis was performed using 3D-Shaper software. The integral vBMD, cortical surface BMD, and trabecular vBMD (trab vBMD) were measured.Results: The study population included 73.9% women (N=1,001) and 26.13% men (N=353). We found a significant decrease in integral vBMD between 20 and 90 years in both sexes (women, -23.1%; men, -16.6%). Bone loss indicated in the integral vBMD results was mainly due to a decrease in trabecular bone in both sexes (women, -33.4%; men, -27.7%). The age-related loss of cortical bone density was less and was limited to the female population, without no age-related differences in men. Moreover, 3D-DXA allowed us to propose reference intervals for integral vBMD.Conclusions: We found age- and sex-related bone loss between 20 and 90 years in an Argentine cohort via integral vBMD measurements using 3D-DXA, mainly due to decreases in trabecular bone in both sexes. The age-related loss of cortical bone density was less and was limited to the female population.
Discriminatory Accuracy of Fracture Risk Assessment Tool in Asian Populations: A Systematic Review and Meta-Analysis
Authors: Jha Dheeraj , Chandran Manju , Hong Namki , Rhee Yumie , Baek Seungjin , Ferguson Stephen J. , Helgason Benedikt , Praveen Anitha D.
Published: December 2024

Background: This review explores the discriminative ability of fracture risk assessment tool (FRAX) in major osteoporotic fracture (MOF) and hip fracture (HF) risk prediction and the densitometric diagnosis of osteoporosis in Asian populations.Methods: We systematically searched the EMBASE, Cochrane, and PubMed databases from the earliest indexing date to January 2024. Studies were included if FRAX was used to identify future osteoporotic fractures or a densitometric diagnosis of osteoporosis in an Asian population and reported the area under the curve (AUC) values. Meta-analyses were conducted after quality assessment for AUC with 95% confidence intervals across the following categories: standard FRAX without/with bone mineral density (BMD), adjusted FRAX, and BMD alone for fracture prediction, as well as standard FRAX for densitometric diagnosis of osteoporosis.Results: A total of 42 studies were included. The AUC values for predicting fracture risk using FRAX-MOF with BMD (0.73 [0.70–0.77]) was highest compared to FRAX-MOF without BMD (0.72 [0.66–0.77]), and adjusted FRAX-MOF (0.71 [0.65–0.77]). The AUC values for predicting fracture risk using FRAX-HF with BMD (0.77 [0.71–0.83]) was highest compared to FRAX-HF without BMD (0.72 [0.65–0.80]), and adjusted FRAX-HF (0.75 [0.63–0.86]). The AUC values for BMD alone (0.68 [0.62–0.73]) was lowest for fracture prediction. The AUC values for identifying a densitometric diagnosis of osteoporosis was 0.77 [0.70–0.84] and 0.76 [0.67-0.86] using FRAX-MOF and FRAX-HF, respectively.Conclusions: FRAX with BMD tends to perform more reliably in predicting HF compared to MOF in Asia. However, its accuracy in predicting fracture risk in Asian populations can be improved through region-specific, long-term epidemiological data.
Physical Performance Level and Patient-Reported Outcomes in Female Patients with Distal Radius Fracture
Authors: Oh Byung Hun , Kalantan Rawdhah Kamil , Kim Jae Kwang , Shin Young Ho
Published: December 2024

Background: This study aimed to evaluate the influence of physical performance level on patient-reported outcomes after surgery for distal radius fractures (DRF).Methods: We retrospectively reviewed 157 women with DRF who underwent surgery and completed the short physical performance battery (SPPB) within one month of trauma between January 2019 and August 2022. Patient-reported outcomes were assessed one year postoperatively using the disabilities of the arm, shoulder, and hand (DASH) and patient-rated wrist evaluation (PRWE) questionnaires. Multivariate linear regression analysis was conducted using patient characteristics, fracture type, treatment-related factors, and SPPB results to evaluate the factors associated with patient-reported outcomes.Results: Multivariate linear regression model revealed that dominant hand involvement (B=7.329; 95% confidence interval [CI], 2.901–11.757; P=0.001) and lower SPPB scores (B=-2.145; 95% CI, -3.194 to -1.096; P<0.001) were significantly associated with higher DASH and PRWE scores.Conclusions: Physical performance level evaluated using the SPPB was significantly associated with poor clinical outcomes of DRF after surgery. Physicians should implement a systematic approach to enhance physical performance along with appropriate fracture treatment to improve clinical outcomes following surgery for DRF.