bluuebunny/crossref_metadata_2025 huggingface dataset:
Patterns and outcomes of paracetamol poisoning management in Hamad Medical Corporation, Qatar: A retrospective cohort study
Authors: Abushanab Dina , Gasim Mahmoud , Devi Dyomgy , Elbdairy Mutwkil , Elqasass Hebatoallah , Ahmed Noon , Vincent Manna , Abdul Rouf Palli Valappila , Mohammed Haseebur Rahman , Hail Moza Al , Thomas Binny , Elkassem Wessam , Hanssens Yolande , Elgassim Mohammed , Elmoheen Amr , Azad Aftab , Mohammed Shaban , Salem Waleed
Published: September 2023

We aimed to investigate the characteristics and clinical outcomes of paracetamol poisoning and paracetamol overdose in Qatar. This retrospective cohort study included patients admitted to the emergency department (ED). We included patients who presented with excessive paracetamol ingestion, between December 2018 and September 2019. The primary outcomes were describing the characteristics and outcomes of paracetamol overdose (from a suicidal overdose or accidental overdose, dose ≤ 150 mg/kg, when serum levels of <60 mmol/L) or dose ingested (≤75 mg/kg) with staggered ingestion poisoning due to suicidal attempt or accidental attempt, defined as the dose ingested (>150 mg/kg), acute ingestion, nomogram level more than the treatment line, or dose ingested (>75 mg/kg) with staggered ingestion, and assessing the management of excessive paracetamol ingestion. Secondary outcomes included evaluation of the time difference between ingestion and time of administration, hospitalization, and adverse drug events. Significant differences were detected between patients who presented with paracetamol overdose and those who presented with paracetamol toxicity. A total of 69 patients were analyzed, of whom 43 received paracetamol overdose (mean age 27.5 ± 11.1 years) and 26 had paracetamol poisoning (mean age 25 ± 6.22 years). Paracetamol poisoning was identified in 26% of the patients with a 24.3% history of psychiatric illness, compared to 18.6% with paracetamol overdose. More patients presented with paracetamol toxicity in the time between ingestion and obtaining serum levels compared to the overdose group. A significantly longer length of hospitalization was observed in the toxicity group. A significantly higher number of patients in the toxicity group received N-acetylcysteine (NAC). More hypotension and rashes were observed among those who received NAC in the toxicity group. Patients presenting to the ED due to paracetamol toxicity are not uncommon, and most cases occur in young adults, and few in patients with a history of psychiatric illness, suggesting that preventive approaches are highly required.
Effect of ondansetron compared to lidocaine and placebo for reducing propofol injection pain: A systematic review and meta-analysis of randomized controlled trials
Authors: Zaazouee Mohamed Sayed , Mahmoud Abdelrahman Mohamed , Elfar Waleed Hosny , Hana Kerolous , Shamshoon Kerollos F. , Adly Michael H. , Hussein Tarek A. , Hamza Mohammad M. , Aly Abrar Abdelhamid , Eguzo Mohammed Ahmed , Farhat Abdullah Mohamed , Elsnhory Ahmed Bostamy , Morsy Mohammed Hassan , Ammar Manar Farag , Alnaji Abdalrhman Abdalmajid , Elshanbary Alaa Ahmed , Shah Jaffer , AbdelQadir Yossef Hassan
Published: September 2023

Objective:

Propofol is the most commonly used intravenous anesthetic medication and is most commonly associated with post-operative pain. Several drugs are investigated to reduce post-operative pain caused by propofol injection. Ondansetron is a potent anti-emetic drug showing promising results as an analgesic. This meta-analysis aims to compare the efficacy of ondansetron to placebo and lidocaine in reducing post-operative pain caused by propofol injection.

Methods:

PubMed, Embase, Cochrane Library, Web of Science, and Scopus were searched for relevant randomized controlled trials (RCTs) till May 2022. We conducted a meta-analysis using RevMan software version 5.4, and we assessed the quality of included RCTs using the Cochrane risk of bias tool.

Results:

In our study, we included 23 RCTs with 2957 participants. Compared to placebo, ondansetron significantly increased the rate of no pain [risk ratio (RR) = 2.36, 95% confidence interval (CI) (1.39–4.01)], and reduced moderate [RR = 0.39, 95% CI (0.30–0.52)] and severe pain [RR = 0.34, 95% CI (0.24–0.50)]. Furthermore, ondansetron significantly reduced PONV [RR = 0.73, 95% CI (0.58, 0.91)]. On the other hand, ondansetron showed an inferior efficacy to lidocaine regarding the incidence of no, moderate, and severe pain.

Conclusion:

Ondansetron is effective in reducing post-operative propofol-induced pain. However, lidocaine is more effective than it.
Both MLH1 deficiency and BRAFV600E mutation are a unique characteristic of colorectal medullary carcinoma: An observational study
Authors: Kaneko Masanao , Nakashima Mitsuko , Sugiura Kiichi , Ishida Natsuki , Tamura Satoshi , Tani Shinya , Yamade Mihoko , Hamaya Yasushi , Osawa Satoshi , Tatsuta Kyota , Kurachi Kiyotaka , Baba Satoshi , Iwashita Yuji , Arai Tomio , Sugimura Haruhiko , Maekawa Masato , Sugimoto Ken , Iwaizumi Moriya
Published: September 2023

Although immunohistochemistry (IHC) for mismatch repair (MMR) proteins (MMR IHC) is used to identify DNA MMR status, universal screening of all patients with colorectal cancer (CRC) using a combination of both MMR IHC and genetic testing for the BRAFV600E mutation is limited in Japan. This study aimed to better understand the histopathological characteristics of CRCs, which exhibit both deficient mismatch repair (dMMR) and BRAFV600E mutation. MMR IHC of formalin-fixed paraffin-embedded tissues from tumor areas obtained from 651 patients with CRC who underwent surgical resection at Hamamatsu University Hospital (Hamamatsu, Japan) between August 2016 and March 2022 were used to evaluate MMR status, which was determined by staining for the expression of 4 MMR proteins (MLH1, MSH2, PMS2, and MSH6). All dMMR tumors were additionally evaluated for BRAFV600 mutation status via Sanger sequencing. Patient clinical characteristics (age, sex, tumor location, size, and tumor pathology) were then classified using their dMMR and BRAFV600 mutation statuses. Among the 651 patients with CRC, 58 carried tumors with dMMR, of which 52 were deficiency in MLH1 (dMLH1). Interestingly, all 16 medullary carcinomas that were analyzed showed characteristics corresponding to the presence of both dMLH1 and BRAFV600E mutation (P = .01). These results suggest that colorectal medullary carcinomas can be diagnosed based on their unique characteristics of harboring the BRAFV600E mutation and exhibiting dMLH1 expression.
Interleukin-10 is not associated with obstructive sleep apnea hypopnea syndrome: A meta-analysis and meta-regression
Authors: Li Xiaoyan , Wu Lingyun , He Jie , Sun Qiuhua
Published: September 2023

Background:

This study was conducted to explore the potential relationship between interleukin-10 (IL-10) and obstructive sleep apnea hypopnea syndrome (OSAHS).

Methods:

All the related research articles published before October 2022 were retrieved through the online database (EMBASE, VIP, Wan Fang, Web of Science, PubMed, and CNKI). Stata 11.0 software was used to calculate the standard mean difference (SMD) of the continuous variable and 95% confidence interval (CI). Expression profiles GSE38792 and GSE135917 were acquired from Gene Expression Omnibus (GEO) database, respectively. The expression of IL-10 mRNA in subcutaneous adipose tissue and visceral adipose tissue of OSAHS patients and healthy subjects was extracted by R software to verify the difference in IL-10 between the 2 groups.

Results:

The IL-10 level in the plasma of people with and without OSAHS (STD Mean Difference (SMD) = −0.68, 95% CI = −1.58 to 0.21, I
2 = 94.3%, P = .136) was the same. There was also no difference in IL-10 levels in serum between people with and without OSAHS (SMD = −0.12, 95% CI = −0.55 to 0.32, I
2 = 94.4%, P = .591). In addition, the subjects were divided into different subgroups for meta-analysis according to race, body mass index, age, study type, and disease severity. Based on the outcomes, no notable difference was observed in the plasma/serum IL-10 level between the OSAHS subgroups and the control group. The results of bioinformatics analysis indicated that there was no significant difference in the expression of IL-10 mRNA in subcutaneous adipose tissue and visceral adipose tissue between patients with OSAHS and those in the control group.

Conclusion:

The current meta-analysis highlighted that IL-10 levels between patients with OSAHS and healthy people had no difference.
Effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injury
Authors: Ding Yang , Jiang Xixuan , Li Lunlan , Dai Qing , Tao Lei , Liu Jing , Li Zhen , Wang Jing , Liao Chenxia , Gao Xin
Published: September 2023

This study evaluated the effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injuries (SCIs). A total of 214 patients with SCIs treated in our hospital from October 2019 to October 2021 were included in the retrospective analysis and divided into a general care group (n = 107) and a comprehensive care group (n = 107), based on the care that they received. Patients in the general care group received general functional nursing, whereas those in the comprehensive care group received a comprehensive functional nursing intervention. The Rivermead Mobility Index (RMI), Barthel Index (BI), and Berg Balance Score (BBS) were used to evaluate patient neurobehavioral ability before and after nursing. Changes in cardiopulmonary function indexes, left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), vital capacity (VC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, and maximal voluntary ventilation (MVV) were measured before and after nursing. The number of micturition, maximum micturition volume, bladder volume, residual urine volume, and lower urinary tract symptom (LUTS) score were recorded, and the improvement in bladder function were measured before and after nursing. The Hamilton Anxiety Scale (HAMA) and Beck Depression Inventory (BDI) scores were used to evaluate patients’ emotional state. After nursing, the RMI, BI, BBS score, FEV1, FEV1/FVC, MVV, maximum micturition volume, bladder volume, and SF-36 scores of the comprehensive care group were significantly higher than those of the general care group, and the LVEDD, LVESD, micturition time, residual urine volume, and LUTS, HAMA, and BDI scores of the comprehensive care group were significantly lower than those of the general care group. In patients with SCIs, comprehensive functional nursing can promote the recovery of neurocognition, bladder function, and cardiorespiratory function, and improve their quality of life. Comprehensive functional nursing is worthy of clinical application.
Risk factors of prolonged intensive care unit stay following cardiac surgery for infective endocarditis
Authors: Huang Jing-Bin , Wen Zhao-Ke , Lu Chang-Chao , Yang Jian-Rong , Li Jun-Jun
Published: September 2023

Introduction:

Prolonged intensive care unit (ICU) stay is common in serious patients undergoing cardiac surgery. Prolonged ICU stay is associated with increased mortality and worse prognosis. This study was conducted to determine the risk factors for prolonged ICU stay after cardiac surgery for infective endocarditis (IE) and we try to decrease the operative risk of mortality and morbidity of cardiac surgery for IE.

Methods:

The retrospective study of patients with IE undergoing cardiac surgery between January 2006 and November 2022 at our hospital was performed.

Results:

896 patients undergoing cardiac surgery were divided into group of ICU stay ≤ 3d (n = 416) and group p of ICU stay > 3d (n = 480). There were 48 operative deaths (5.4%). Univariable and multivariable analyses showed that factors are associated with prolonged ICU stay following cardiac surgery for IE, including male (P < .001), age (P < .001), weight (P = .009), vegetation length (P < .001), paravalvular leak (P < .001), aortic cross-clamp time (P < .001), cardiopulmonary bypass (CPB) time (P < .001), mechanical ventilation time (P < .001), hospitalized time postoperative (P = .032), creatinine of serum before surgery (P < .001), creatinine of serum 24h after surgery (P = .005), creatinine of serum 48h after surgery (P < .001), fluid balance on operation day (P < .001), postoperative acute kidney injury (P < .001), left ventricular end diastolic dimension (LVEDD) preoperative (P < .001), LVEDD postoperative (P < .001), chest drainage (P = .032), frozen plasma (P = .016), preoperative aortic insufficiency (P < .001), and packed red cells (P < .001).

Conclusions:

In our study, shortness of ICU stay and optimization of pre-, peri-, and postoperative factors that can shorten ICU stay, therefore, contribute to a better postoperative outcome and leads to lower rates of mortality and morbidity.
Prolonged second stage of labor is associated with persistent urinary retention after forceps delivery: An observational study
Authors: Ye Dan , Yao Liang-Qing
Published: September 2023

The occurrence of urinary retention is significantly higher in women undergoing forceps-assisted midwifery. However, the majority of these women typically regain the ability to urinate spontaneously within 72 hours after delivery. Instances of persistent urinary retention beyond this timeframe are relatively uncommon and have been rarely documented. This study aimed to investigate the risk factors associated with the persistence of urinary retention after forceps-assisted midwifery. A retrospective analysis was conducted on women who underwent forceps-assisted deliveries at the Obstetrics and Gynecology Hospital of Fudan University (China) between August 1, 2019 and December 1, 2019. The study involved collecting general clinical information of these women. Based on the duration of ureter retention, women who had a retention time >72 hours were categorized into group A, while those with a retention time <72 hours were allocated to group B. After performing analysis on the risk factors of persistent urinary retention following forceps delivery, the t test was utilized for analyzing single factors, while logistic regression analysis was employed for assessing multiple factors. Univariate analysis revealed a significant difference in the duration of the second stage of labor between group A and group B. However, logistic regression analysis did not indicate any significant difference between the 2 groups. Further research is still required to determine whether the association between persistent urinary retention following forceps delivery and prolonged second stage of labor is significant, considering the limited number of cases available for analysis.
Increased intraoperative vein ligation in microsurgical varicocelectomy is associated with pain improvement
Authors: Huang Wei-Chun , Huang Chi-Ping , Lai Chun-Ming , Ku Fang-Yu , Hsu Hsu-Ning , Yang Chao-Tung , Wang Yun-Yi , Laih Chun-Yo
Published: September 2023

Varicocele is a major cause of male infertility. However, few studies have discussed the potential associations between the pain caused by varicocele and preoperative and intraoperative factors. The aim of this study was to evaluate factors potentially associated with changes in pain score after microsurgical varicocelectomy. This retrospective study was conducted between August 2020 and August 2022 at China Medical University Hospital in Taichung, Taiwan. Patient characteristics including age, body mass index, semen analysis, testicular volume, and the number of veins ligated were collected. Preoperative and intraoperative factors were analyzed to determine if they were correlated with changes in numeric rating scale (NRS) after microsurgical varicocelectomy. A total of 44 patients with clinical varicocele underwent subinguinal microsurgical varicocelectomy and were analyzed. The overall pain resolution rate was 91%, and the average satisfaction score after surgery was 9.2 according to their subjective feelings. Multivariate analysis revealed that severe varicocele grade (odds ratio [OR] 16.5, 95% confidence interval [CI] 3.01–90.47; P = .018) and the number of veins ligated (OR 6, 95% CI 1.6–22.48; P = .013), were significantly associated with changes in NRS after surgery. In addition, the area under the receiver operating characteristic curve for changes in NRS and the total number of veins ligated was 0.869. Microsurgical varicocelectomy had a high success rate for scrotal pain and satisfaction. Severe varicocele grade and the number of veins ligated in microsurgical varicocelectomy were associated with postoperative pain improvement.
Attitudes toward herbal medicine for COVID-19 in healthcare workers: A cross-sectional observational study
Authors: Güngör Ömür , Baykal Hüsnü
Published: September 2023

The coronavirus disease 2019 (COVID-19) pandemic has adversely affected working life all over the world, and the employees with the highest risk of transmission have been those in the health sector. Since there are currently no effective treatments for COVID-19, there have been numerous attempts to find alternative treatments for both the spread of the infection and its treatment. These efforts have included the use of herbal extracts to boost immunity and reduce the likelihood of contracting the infection. This study explored the attitudes of healthcare workers toward the consumption of COVID-19 herbal medicine (HM) products. This is an online, cross-sectional observational study. In total, 1335 participants were reached. It was observed that 722 (54%) of them preferred herbal treatments during the pandemic period. The attitudes of HM toward 327 (45.3%) healthcare workers and 395 (54.7%) general population participants were examined. Both groups had high rates of use of HM as a COVID-19 preventive measure (68.8 percent and 67.1 percent, respectively). While its use was higher among healthcare workers during infection (OR: 2.00, 95% CI: 1.32–3.03), its use was higher in the non-healthcare group for post-COVID problems (OR: 0.51, 95% CI: 0.35–0.74). The opinion of healthcare professionals was that HM was more efficient (OR: 1.59, 95% CI: 1.19–21.15). All participants’ main incentive to utilize HM was family advice (n = 194, 26.9%). A total of 90 (12.4%) participants reported side effects. Vomiting-nausea were the most typical adverse effects (38.9%). The herb most frequently utilized was ginger (54%). Healthcare workers use HM at rates that are the same as those of the general population. Both its use during infections and the idea that it is effective are more common among healthcare professionals than in the general population.
Investigation and analysis of training injury and its psychological effects on firefighters in Beijing A cross-sectional study
Authors: Gong Cheng , Gao Wentao , Zhang Bo , Tang Haifeng , Xie Ying
Published: September 2023

Firefighters’ high-intensity training often leads to injuries in the musculoskeletal system. Studies have found that these injuries in the musculoskeletal system may contribute to poor psychological issues. At the same time, low psychological well-being increases the risk of injuries, illness, and mortality. According to research reports, firefighters generally have a good psychological state. So this study aims to survey and analyze the training-related injuries and psychological states of firefighting and rescue personnel in Beijing. This cross-sectional study employed a questionnaire survey to gather data from a total of 214 firefighters in a certain city. The participants were required to complete a questionnaire about musculoskeletal injuries and psychological status, and then these data were statistically analyzed. The incidence of training-related injuries is relatively high among firefighting and rescue teams, with the highest proportions observed in the lower back, knees, and ankles. Overweight and obese firefighters are more prone to ankle injuries. In the group with injuries, the subjective well-being index is lower compared to the group without injuries. Firefighters experiencing moderate to severe pain due to injuries exhibit lower subjective well-being indices compared to those with mild pain. Psychological resilience and the impact of pain on training and sleep can predict the subjective well-being index of firefighters. It is recommended that firefighting and rescue teams enhance preventive measures for musculoskeletal injuries during training to elevate the subjective well-being of firefighters.
Risk factors for the development of postoperative atrial fibrillation after esophagectomy for esophageal cancer
Authors: He Feng , Wu Xi , Yang Ziheng , Tu Dehao , Li Fan , Deng Yu
Published: September 2023

Postoperative atrial fibrillation (POAF) is one of the most complications after esophagectomy. Thus, our study was conducted to explore risk factors that are associated with POAF following esophagectomy. In the current study, we retrospectively evaluated 511 patients with esophageal cancer who underwent esophagectomy at our center between May 2018 and December 2020. The incidence of POAF and clinical variables were collected and analyzed. POAF occurred in 62 (12.13%) of 511 patients. Increasing age (P = .004) and lower preoperative albumin level (P = .028) was significantly associated with POAF. The length of stay was significantly increased in patients with POAF when compared to patients without POAF (P = .003). Multivariate analysis suggested that age (odds ratio [OR] = 1.049, 95% confidence interval [CI] = 1.008–1.093, P = .020), hypertension (OR = 2.207, 95% CI = 1.221–3.987, P = .009), respiratory complications (OR = 2.015, 95% CI = 1.130–3.591, P = .018) and Ivor Lewis approach (OR = 3.001, 95% CI = 1.032–8.723, P = .044) were independent risk factors for POAF following esophagectomy. Increasing age, preoperative hypertension, respiratory complications and Ivor Lewis approach are independent risk factors for POAF after esophagectomy. POAF is associated with prolonged length of stay. This study suggests that older patients, patients with hypertension or patients underwent Ivor Lewis approach should be monitored more closely during the postoperative period.
Needs and influence factors of medical-nursing-pension of disabled elderly
Authors: Qin Yi , Yao Xiaoling , Ma Qiuping , Salvador Jordan Tovera , Pang Lingling
Published: September 2023

As the population ages, the incidence of disabled elderly persons increases, and the need for medical-nursing-pension services among disabled senior persons increases. The purpose of this study is to determine the needs and affecting factors of disabled elderly living in community homes in Nanning, Guangxi, China. The study utilized the descriptive comparative cross-sectional study. Stratified random sampling was utilized, based on inclusion and exclusion criteria, a total of 168 disabled elderly were randomly selected and investigated using a self-designed questionnaire which included basic nursing services domain, professional nursing services domain, rehabilitative nursing services domain, living nursing services domain, and spiritual nursing services domain. The t test, one-way ANOVA, and multivariate logistic regression were used to determine the influencing factors of medical-nursing-pension demands for community-dwelling disabled elderly. Majority of impaired seniors have a moderate to high-level of demand for medical-nursing-pension services. Age (t = 2.369, 95% confidence interval [CI]: 0.673–7.414), educational level (t = −16.946, 95% CI: −31.247 to −24.726), monthly income (t = −16.273, 95% CI: −22.104 to −17.320), economic source (t = 8.891, 95% CI: 16.850–26.470), time spent disabled (t = −11.151, 95% CI: −31.845 to −22.264), living with children (t = 10.852, 95% CI: 24.491–35.521), and medical insurance participation (t = 4.556, 95% CI: 9.032–22.848) all influence the demand for medical-nursing-pension services for disabled seniors in the community (P = .05). Majority of community-dwelling impaired seniors have a moderate to high demand for medical-nursing-pension services. Relevant departments and community nurses should pay increased attention to the elderly who are older, have a low educational level, a low monthly income, have an economic source of pension from their own, have been disabled for long period of time, are single, and do not have children, to improve the health care system for disabled elderly by implementing more personalized home visits in medical-nursing-pension on health education about oxygen inhalation and wound dressing.
Ghost cell odontogenic carcinoma: A rare case report and review of literature
Authors: Xia Yong , Song Zongchang , Zhang Xinlei , Guan Xinhong , Tan Guifang , Le Yi , Liu Shuang , Xue Hui , Li Jing , Zhang Yajun , Chen Jing , Jiang Huajuan , Jiang Xia , Cheng Yanxia , Zhou Chuchu , Sha Xu , Lou Jin-Xin
Published: September 2023

Rationale:

Ghost cell odontogenic carcinoma is a rare malignant odontogenic carcinoma characterized by the presence of ghost cells. It has a nonspecific clinical and radiographic presentation and can be locally destructive and invasive, sometimes with distant metastases. However, no effective systemic therapy is currently recommended for such patients.

Patient concerns:

The patient has been unable to undergo surgery or radiotherapy again. Therefore, he was referred to our department for a more aggressive, multimodal systematic treatment program.

Diagnoses:

The histopathological examination was morphologically suggestive of ghost cell odontogenic carcinomas.

Interventions:

We report a case of locally invasive primary inoperable odontogenic shadow cell carcinoma in a 31-year-old Chinese man who achieved treatment with Toripalimab and chemotherapy, followed by Toripalimab maintenance therapy after 6 cycles.

Outcomes:

He achieved partial remission after treatment. The quality of life significantly improved after treatment. There were no grade 3/4 treatment-related adverse events during treatment.

Lessons:

This case presented that Toripalimab and chemotherapy may be a safe and effective systemic therapy for ghost cell odontogenic carcinoma.
External application of dandelion combined with borneol effectively reduced pain and facial swelling after jaw surgery
Authors: Zhao Shengnan , Zhang Jinling , Liu Xia , Guo Kun , Wang Xiaorun
Published: September 2023

Background:

To explore the effects of the combination of dandelion with borneol on the maxillofacial region of patients after jaw surgery in reducing the acute inflammatory reaction after surgery, the degree of facial swelling, pain, and limitation of mouth opening, and increasing patient satisfaction.

Methods:

A total of 120 patients who met the inclusion criteria were randomly divided into 4 groups: group A: ice compress; Group B: dandelion; Group C: borneol; Group D: dandelion combined with borneol. Patients were evaluated on the day of the operation, the first day, and the second day after the operation.

Results:

External application of dandelion combined with borneol had a better controlling effect on facial swelling and limited mouth opening compared with the single treatment groups, and the satisfaction score was higher (P < .05).

Conclusion:

External application of dandelion combined with borneol was effective in the treatment of maxillofacial swelling and pain. This approach quickly relieved swelling, restored the limitation of mouth opening, and improved patient satisfaction.
Primary prevention of hepatic encephalopathy post-TIPS: A systematic review and meta-analysis
Authors: Liang Aileen , Brar Sukhman , Almaghrabi Majed , Khan Mohammad Qasim , Qumosani Karim , Teriaky Anouar
Published: September 2023

Background:

Transjugular intrahepatic portosystemic shunt (TIPS) can be an effective treatment for cirrhotic patients who develop variceal bleeding and ascites. However, TIPS placement is associated with an increased risk of developing hepatic encephalopathy (HE). Recently, there have been efforts to use the typical medical therapies prophylactically in patients undergoing TIPS placement to prevent post-TIPS HE.

Methods:

We conducted literature searches in MEDLINE, Embase, CINAHL, Scopus, and Cochrane to examine studies that use prophylactic medical therapy for preventing post-TIPS HE. A narrative synthesis and grading of recommendations assessment assessment were done for all studies. Meta-analysis was performed for eligible studies using the Mantel-Haenszel method random-effects model. Nine hundred twenty-one articles were screened and 5 studies were included in the study after 2 levels of screening. The medications studied were rifaximin, lactulose, lactitol, L-Ornithine-L-aspartate (LOLA), albumin, and combination therapies.

Results:

Narrative results showed that lactulose, lactitol, LOLA and albumin prophylaxis were not associated with reduction in HE occurrence or mortality. A combination of rifaximin and lactulose was found to be associated with lower occurrence of HE, and the results were not different when LOLA was added. Meta-analysis (n = 3) showed that rifaximin treatment was not associated with changes in HE occurrences.

Conclusion:

In conclusion, a vast majority of medications were not found to be effective post-TIPS HE prophylaxis when used alone. A rifaximin and lactulose combination therapy may be beneficial. Overall, there is significant limitation in the current data and more studies are needed to yield more robust meta-analysis results in the future.
miR-26b-5p promotes osteogenesis of bone mesenchymal stem cells via suppressing FGF21
Authors: Wang Bin , Li Zhenhui , Mai Caiyuan , Mou Penglin , Pan Lei
Published: September 2023

Background:

miR-26b-5p actively participates in the osteogenic differentiation of bone mesenchymal stem cells (BMSCs). The database showed that fibroblast growth factor (FGF)-21 is a potential binding site of miR-26b-5p. This study aimed to investigate the molecular osteogenic mechanisms of miR-26b-5p targeting FGF21.

Methods:

Bone marrow was aspirated from the anterior superior iliac spine during bone marrow puncture. BMSCs were used to establish an in vitro cell model, and BMSCs markers were analyzed by flow cytometry. miR-26b-5p were overexpressed for 48 hours, and then placed in an osteogenic induction medium for osteogenic induction culture, the expression of RNA was detected using RT-qPCR. On day 7 of induction, RT-qPCR was used to measure Runx2, Osterix (Osx), and target gene FGF21 expression levels in each group. RT-qPCR, the dual-luciferase reporter gene system and western blot were used to verify that FGF21 was a direct target of miR-26b-5p.

Results:

BMSCs were identified according to the antigenic characteristics. miR-26b-5p expression was significantly upregulated after the expression of miR-26b-5p mimics, and FGF21 expression was downregulated; in miR-26b-5p inhibitor, the opposite results were revealed. After overexpression of miR-26b-5p, the alkaline phosphatase activity and nodules of Alizarin red S in the culture medium was increased; the opposite results were revealed in miR-26b-5p inhibitor. The expressions of Runx2 and Osx in the miR-26b-5p group were also significantly higher; in the miR-26b-5p inhibitor group, the opposite results were revealed. Luciferase reporter assays demonstrated that FGF21 was a direct target of miR-26b-5p. The western blotting analysis showed that FGF21 expression was significantly downregulated in the miR-26b-5p overexpressed group. Finally, the expressions of the characteristic osteogenic factors in the miR-26b-5p control + FGF21 group was significantly lower, but then increased significantly in the miR-26b-5p mimics + FGF21 group; the expressions of the characteristic osteogenic factors in the miR-26b-5p control + si-FGF21 group was significantly higher.

Conclusions:

miR-26b-5p can regulate the osteogenic differentiation of BMSCs and participate in PMOP pathogenesis via suppressing FGF21.
Video-assisted thoracoscopic surgery for Andersson lesion in ankylosing spondylitis: A case report and literature review
Authors: Dong Wei-Xin , Chu Zhen-Tao , Hu Yong
Published: September 2023

Rationale:

Andersson lesion (AL), a phenomenon initially described by Andersson nearly 80 years ago, has been the subject of extensive research and various treatment modalities. The ongoing debate surrounding the need for anterior surgery in AL cases has spurred numerous proposed approaches. Despite the demonstrated efficacy of anterior surgery in achieving fusion and stabilization, its implementation is associated with prolonged operation time and heightened intraoperative bleeding.

Patient concerns:

A 32-year-old male patient presented at our hospital in February 2019 with a 2-month history of bilateral lower extremity weakness and sensory disturbances. These symptoms were exacerbated by a recent fall.

Diagnosis:

AL conbined with ankylosing spondylitis.

Interventions:

A 1-stage posterior fixation and decompression procedure was performed to ensure spinal stability, minimize deformities, and reduce surgical trauma. To achieve these goals, a 2-stage approach was employed, which included video-assisted thoracoscope-guided vertebrectomy, spinal canal decompression, and bone graft fusion.

Outcomes:

No recurrences of significant pain, limb numbness, or other symptoms were reported, ultimately leading to an improved quality of life for the patient.

Lessons:

We utilized video-assisted thoracoscopic surgery technology for anterior bone graft fusion in a patient with AL to minimize the trauma of secondary surgery. However, the 3-year follow-up showed insufficient bony fusion at the fracture site. Nevertheless, the patient maintained spinal stability with posterior internal fixation and no significant kyphosis or symptoms. Thus, standalone posterior fixation may suffice for favorable clinical outcomes in patients with AL.
The Hospital Frailty Risk Score Predicts Poor Prognoses in Middle-Aged and Older Patients With Acute Pancreatitis
Authors: Shimizu Akio , Tsuguma Yuma , Sakata Saya , Ito Mako , Okada Natsumi , Asai Wakana , Ushida Kenta , Tameda Masahiko , Momosaki Ryo
Published: September 2023

Objectives

Frailty risk may be associated with poor prognoses in acute pancreatitis patients. However, this has not been shown with adjustments for prognosis-related factors. This study aimed to determine whether frailty risk is associated with poor prognoses in acute pancreatitis patients, even after adjusting for prognosis-related factors.

Methods

The study included 7001 middle-aged and older patients (mean age, 66.2 ± 14.5 years, 65.3% male) 40 years or older who were registered in a Japanese nationwide database. Frailty risk was defined as a Hospital Frailty Risk Score ≥5 points. Outcomes were 30-day and in-hospital mortality, length of stay, and 30-day readmission rate.

Results

Frailty risk was independently positively associated with 30-day mortality (odds ratio [OR], 1.847; 95% confidence interval [CI], 1.118–3.051) and in-hospital mortality (OR, 2.504; 95% CI, 1.677–3.739) after adjustment for acute pancreatitis severity and patient characteristics. In addition, frailty risk was positively associated with a longer length of stay (coefficient, 11.393; 95% CI, 9.631–13.154). However, no association was found between frailty risk and the 30-day readmission rate (OR, 1.092; 95% CI, 0.793–1.504).

Conclusions

Our findings highlight the importance of rapid and automated frailty risk assessment using the Hospital Frailty Risk Score for the early identification of high-risk acute pancreatitis patients.
Predictive performance of SOFA (Sequential Organ Failure Assessment) and qSOFA (quick Sequential Organ Failure Assessment) for in-hospital mortality in ICU patients with COVID-19 of referral center in the north of Iran a retrospective study
Authors: Nikzad Jamnani Alireza , Gholipour Baradari Afshin , Kargar-soleimanabad Saeed , Javaheri Sepehr
Published: September 2023

Introduction:

Patients diagnosed with Coronavirus disease 2019 exhibit varied clinical outcomes, with a reported mortality rate exceeding 30% in those requiring admission to the ICU. The objective of this study was to assess the predictive capacity of Sequential Organ Failure Assessment (SOFA) and quick Sequential Organ Failure Assessment (qSOFA) scores in determining mortality risk among severe COVID-19 patients.

Method and materials:

This retrospective study was performed by analyzing the data of patients with COVID-19 who were hospitalized in the ICUs. Data collection of the parameters required to calculate the SOFA and qSOFA Scores were extracted from patient’s medical records. All data analysis was performed using SPSS V.25. Significance level considered as P less than 0.05.

Findings:

In this study, 258 patients were included. The results showed that the subjects ranged in age from 21 to 98 years with a mean and SD of 62.7±15.6. Of all patients, 127 (49.2%) were female and the rest were male. The mortality rate was 102 (39.5%). The underlying disease of diabetes mellitus with an odds ratio of 1.81 (CI=1.02–3.22) had a significant effect on mortality. In addition, a significant correlation was obtained between admission duration and SOFA score (r=0.147, P=0.018). The SOFA had a very high accuracy of 0.941 and at the cut-off point less than 5 had a sensitivity and specificity of 91.2% and 82.7%. In addition, qSOFA had high accuracy (0.914) and a sensitivity and specificity of 87.3% and 91.7% at the optimal cutting point of greater than 1.

Conclusion:

The findings of present study illustrated that deceased COVID-19 patients admitted to the ICU had higher scores on both SOFA and qSOFA scales than surviving patients. Also, both scales have high sensitivity and specificity for anticipating of mortality in these patients. The underlying diabetes mellitus was associated with an increase in patient mortality.
Alveolar cleft reconstruction using iliac bone graft: a clinical case report
Authors: Sleman Nadim
Published: September 2023

Introduction and importance:

Alveolar clefts are frequently occurring congenital anomalies that can significantly impact both the functional and aesthetic aspects of an individual’s life. Thus, reducing the quality of life. These clefts can give rise to difficulties in feeding, speech, and dental development. Furthermore, the presence of a gap in the alveolar ridge can disrupt the proper alignment and eruption of permanent teeth. Various techniques have been developed to effectively repair these defects and restore oral function and rehabilitation.

Case presentation:

An 18-year-old girl is presented with unilateral alveolar cleft which was successfully repaired by utilizing iliac bone grafting and augmenting the defect to restore proper bone architecture and gain suitable support for dental prostheses. Therefore, enhancing oral health by closing the oronasal fistula and improving aesthetics and functional abilities including speech.

Clinical discussion:

Having an alveolar cleft can lead to challenges which may require a multidisciplinary approach, including surgical intervention, orthodontic treatment, and dental rehabilitation. The primary goal is to close the cleft, restore normal speech and feeding functions, and promote proper dental development.

Conclusion:

Patients who suffer from alveolar clefts need appropriate treatment. This case report suggests a surgical technique of utilizing the combination of hard and soft tissue management to fix the problem for such individuals and achieve improved oral health, speech, and overall enhancement in quality of life.
Quantitative Assessment of Retinal and Choroidal Microvasculature in Asymptomatic Patients with Carotid Artery Stenosis
Authors: Monferrer-Adsuara Clara , Remolí-Sargues Lidia , Navarro-Palop Catalina , Cervera-Taulet Enrique , Montero-Hernández Javier , Medina-Bessó Pascual , Castro-Navarro Verónica
Published: September 2023

SIGNIFICANCE

Carotid disease contributes to 15 to 20% of all ischemic strokes, one of the leading causes of permanent disabilities and mortality globally. With its growing prevalence and the inflicted disability rates, screening for anomalies that precede the onset of its serious complications is of crucial global significance.

PURPOSE

This study aimed to assess the relationship between retinal and choroidal perfusion changes with the degree of stenosis using quantitative swept-source optical coherence tomography angiography in patients with internal carotid artery stenosis.

METHODS

A retrospective cohort study was conducted in 72 eyes with carotid stenosis. According to the degree of stenosis, the participants were divided into a healthy group (group 1: 34 eyes), a mild-moderate stenosis group (group 2: 22 eyes), and a severe stenosis group (group 3: 16 eyes). Swept-source optical coherence tomography angiography was performed to scan macular fovea. Capillary density values in the different retinal and choroidal layers were the major measurements for our study.

RESULTS

Mean vessel density in the midchoroid layer was significantly higher in groups 2 and 3 compared with group 1. Deep choroid disclosed significantly superior vascular density values in group 3 compared with groups 2 and 1. Superficial and deep capillary plexus showed decreased vascular density values when comparing group 3 with groups 1 and 2, although they were not significant.

CONCLUSIONS

Our report provides the first evidence that choroidal microvascular changes were correlated with severity of carotid artery stenosis. Optical coherence tomography angiography can sensitively detect subtle, early changes in the ocular blood in carotid disease representing a useful, noninvasive, and objective approach to the retinal microvasculature.
The Role of Novel Immunohistochemical Markers for Special Types of Breast Carcinoma
Authors: Grabenstetter Anne , D’Alfonso Timothy M.
Published: September 2023

Some histologic special types of breast carcinoma harbor specific recurrent genetic alterations that are not seen in other types of breast carcinoma (no special type), namely adenoid cystic carcinoma, secretory carcinoma, and tall cell carcinoma with reversed polarity. These tumors have unique morphologic features, are triple-negative, that is, do not express hormone receptors or HER2, and are generally associated with a favorable prognosis. Adenoid cystic carcinoma, like its counterpart in other organs, shows a MYB-NFIB fusion gene that is the result of a recurrent t(6;9)(q22-23;p23-24) translocation. Other MYB alterations have been described that result in overexpression of MYB. Secretory carcinoma is characterized by an ETV6-NTRK3 gene fusion that is the result of recurrent (12;15);(p13;q25) translocation, which is also seen in mammary analog secretory carcinoma of the salivary gland. Tall cell carcinoma with reversed polarity shows IDH2 p.Arg172 hotspot mutations. Immunohistochemical antibodies have emerged that identify the underlying genetic alterations in these tumors and serve as useful diagnostic tools. This review will provide an update on the molecular features and diagnostic immunohistochemical markers that have become increasingly popular to aid in diagnosing these uncommon triple-negative breast tumors.
Clinical Characteristics and Prognostic Value of Ro52/SSA Antibodies in Idiopathic Inflammatory Myopathies
Authors: Pepper Elizabeth , Vilar Lilian , Ward Ian M.
Published: September 2023

Background/Purpose

Anti-Ro52 are myositis-associated antibodies found in idiopathic inflammatory myopathies (IIMs). This chart review aims to evaluate the frequency, significance, and associated clinical characteristics of Ro52/SSA positivity in IIM patients.

Methods

We performed a chart review of IIM patients diagnosed between January 2006 and December 2020. All patients met either the 1975 Bohan and Peter or the European League Against Rheumatism/American College of Rheumatology classification criteria for probable or definite myositis. Demographics, clinical and serologic parameters, treatments, and outcomes were compared in patients with anti-Ro52/SSA antibodies and patients without anti-Ro52/SSA antibodies.

Results

One hundred eighty-nine patients with IIM were tested for either Ro52 or SSA, with 45 positive for Ro52/SSA (23.8%). Patients with IIM and Ro52/SSA+ were younger at age at onset of disease (44.8 vs. 51.2 years, p = 0.008). Ro52/SSA+ was more common in antisynthetase syndrome (p < 0.001; odds ratio [OR], 4.44; 95% confidence interval [CI], 2.11–9.33) and not frequently identified in clinically amyopathic dermatomyositis (CADM) (p = 0.02; OR, 0.13; 95% CI, 0.02–0.96) or immune-mediated necrotizing myopathy (p = 0.003; OR, 0.14; 95% CI, 0.03–0.63). Of the extraskeletal muscle manifestations, interstitial lung disease (ILD) was strongly associated with Ro52/SSA+ (p < 0.001; OR, 6.61; 95% CI, 3.15–13.86), as was dysphagia (p = 0.006; OR, 2.73; 95% CI, 1.31–5.71). Interstitial lung disease pattern and pulmonary function testing impairment did not differ based on antibody status. There was no significant difference in outcomes between groups.

Conclusion

In this myositis cohort, Ro52/SSA+ was present in nearly one-fourth of the population and had a strong association with the antisynthetase syndrome subtype, ILD, and dysphagia. Although these disease manifestations are associated with significant morbidity, in our cohort, they were not associated with increased mortality or more severe ILD.
Dominant cardiovascular diseases treated by traditional Chinese medicine: Clinical evidence and distinctive therapeutic characteristics
Authors: Wang Jie , Hu Jun , Liu Yongmei , Jiang Zhilin , Cheng Jiawen , Chen Cong , Liu Chao , Liu Lanchun
Published: September 2023

Traditional Chinese medicine (TCM) with a long history in China has demonstrated unique advantages in treating a variety of cardiovascular diseases, with promising prospects. We exemplify the TCM advantages with 3 major cardiovascular diseases: coronary heart disease, hypertension, and chronic heart failure. With both national and international guidelines, consensus, systematic reviews, and randomized controlled trials as evidence, we used the modified Jadad and AMSTAR-1 scales to evaluate the evidence quality and then systematically evaluated the clinical effects and benefits of TCM on cardiovascular diseases, aiming to provide fresh insights into the research methodologies and future development directions for TCM-dominant diseases.
OpenCell: A Low-cost, Open-Source, 3-in-1 device for DNA Extraction
Authors: Gupta Aryan , Yu Justin , Challita Elio J. , Standeven Janet , Bhamla M. Saad
Published: September 2023

High-cost DNA extraction procedures pose significant challenges for budget-constrained laboratories. To address this, we introduce OpenCell, an economical, open-source, 3-in-1 laboratory device that combines the functionalities of a bead homogenizer, a microcentrifuge, and a vortex mixer. OpenCell utilizes modular attachments that magnetically connect to a central rotating brushless motor. This motor couples to an epicyclic gearing mechanism, enabling efficient bead homogenization, vortex mixing, and centrifugation within one compact unit. OpenCell’s design incorporates multiple redundant safety features, ensuring both the device’s and operator’s safety. Additional features such as RPM measurement, programmable timers, battery operation, and optional speed control make OpenCell a reliable and reproducible laboratory instrument. In our study, OpenCell successfully isolated DNA fromSpinacia oleracea(spinach), with an average yield of 2.3 µg and an A260/A280 ratio of 1.77, demonstrating its effectiveness for downstream applications such as Polymerase Chain Reaction (PCR) amplification. With its compact size (20 cm x 28 cm x 6.7 cm) and lightweight design (0.8 kg), comparable to the size and weight of a laptop, OpenCell is portable, making it an attractive component of a ‘lab-in-a-backpack’ for resource-constrained environments in low-and-middle-income countries and synthetic biology in remote field stations. Leveraging the accessibility of 3D printing and off-the-shelf components, OpenCell can be manufactured and assembled at a low unit cost of less than $50, providing an affordable alternative to expensive laboratory equipment costing over $4000. OpenCell aims to overcome the barriers to entry in synthetic biology research and contribute to the growing collection of frugal and open hardware.