bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular Evidence for Altered Angiogenesis in Neuroinflammation-Associated Schizophrenia and Bipolar Disorder Implicate an Abnormal Midbrain Blood-Brain Barrier
Authors: Zhu Yunting , Webster Maree J , Mendez Victoriano Gerardo , Middleton Frank A , Massa Paul T , Weickert Cynthia Shannon
Published: October 2024

Background and Hypothesis

Angiogenesis triggered by inflammation increases BBB permeability and facilitates macrophage transmigration. In the midbrain, we have discovered molecular alterations related to the blood-brain barrier (BBB), including endothelial cell changes associated with macrophage diapedesis, in neuroinflammatory schizophrenia and bipolar disorder, but changes in angiogenesis are yet to be reported. Hypothesis: We expected to discover molecular evidence of altered angiogenesis in the midbrain in individuals with schizophrenia and bipolar disorder compared to controls, with these changes more evident in “high” inflammation schizophrenia as compared to “low” inflammation.

Study Design

In a case-control post-mortem cohort including schizophrenia (n = 35), bipolar disorder (n = 35), and controls (n = 33), we measured mRNA (RT-PCR) and protein (multiplex immunoassays) and performed immunohistochemistry to determine levels and anatomical distribution of angiogenesis-related molecules in the ventral midbrain.

Study Results

We found large changes in angiogenesis factors in bipolar disorder high inflammatory subgroup (increased angiopoietin-2 and SERPINE1 mRNAs, but decreased angiopoietin-1, angiopoietin-2, and TEK receptor proteins). In schizophrenia high inflammatory subgroup, we found a robust increase in SERPINE1 mRNA and protein levels. However, we found no significant changes in angiopoietins in schizophrenia. We found that VEGFA mRNA level was increased in high inflammation schizophrenia, but only reached statistical significance compared to one low inflammatory subgroup.

Conclusions

Thus, angiogenesis signaling pathways appeared to be involved in the BBB alterations when inflammation is also present in the midbrain of schizophrenia and bipolar disorder, with increased levels of SERPINE1 in schizophrenia high inflammatory subgroup and with a putative suppression of angiopoietin signaling in bipolar disorder high inflammatory subgroup.
Integrated Analysis of Gut Microbiome, Inflammation, and Neuroimaging Features Supports the Role of Microbiome–Gut–Brain Crosstalk in Schizophrenia
Authors: Wu Hui , Liu Yaxi , Han Yunwu , Liu Bingdong , Chen Shengyun , Ye Zhiye , Li Jianbo , Xie Liwei , Wu Xiaoli
Published: October 2024

Background and Hypothesis

Gut microbiota has been implicated in the pathogenesis of schizophrenia (SZ) and relevant changes in the brain, but the underlying mechanism remains elusive. This study aims to investigate the microbiota–gut–brain crosstalk centered on peripheral inflammation in SZ patients.

Study Design

We recruited a cohort of 182 SZ patients and 120 healthy controls (HC). Multi-omics data, including fecal 16S rRNA, cytokine data, and neuroimaging data, were collected and synthesized for analysis. Multi-omics correlations and mediation analyses were utilized to determine the associations of gut microbiome with inflammatory cytokines and neuroimaging characteristics. Additionally, machine learning models for effective SZ diagnosis were separately generated based on gut microbial and neuroimaging data.

Study Results

Gut microbial dysbiosis, characterized by a decrease in butyrate-producing bacteria and an increase in proinflammatory bacteria, has been identified in SZ patients. These key microbial taxa were associated with increased inflammatory cytokines, potentially through mediating lipid metabolic pathways such as steroid biosynthesis and linoleic acid metabolism. Further analysis revealed altered microbial genera to be correlated with disrupted gray matter volume and regional homogeneity in SZ patients. Importantly, certain inflammatory cytokines mediated the relationship between the SZ-enriched genus Succinivibrio and aberrant activity of anterior cingulate cortex and left inferior temporal gyrus in the SZ group. Moreover, the classification model based on gut microbial data showed comparable efficacy to the model based on brain functional signatures in SZ diagnosis.

Conclusions

This study presents evidence for the dysregulated microbiota–gut–brain axis in SZ and emphasizes the central role of peripheral inflammation.
Deprescribing strategies for proton pump inhibitors
Authors: Young Julia , Fuller Jordan A. , Guidry Corey M.
Published: October 2024

Proton pump inhibitors (PPIs) are widely used for a number of gastric-acid related diseases. Although these agents demonstrate enhanced efficacy and tolerability compared with other acid-suppressive therapies, long-term use is associated with a number of adverse reactions. This article summarizes appropriate indications for short- and long-term use of PPIs and describes deprescribing strategies that clinicians can use to reduce unnecessary PPI use in their patients.
Filling the void
Authors: Jones Rebecca B. , Mohammad Natalie F.
Published: October 2024

Palliative care, which focuses on symptom management, quality of life, and communication, is appropriate for patients at any age and any stage in the disease process. Because of increased patient demand, the United States faces a shortage of palliative care specialists. Expansion of palliative care curriculum in physician associate/assistant (PA) programs, on-the-job training, and improvement of regulatory practice guidelines can help PAs alleviate the shortage of palliative care professionals.
Painful polyneuropathy in people with diabetes
Authors: Allen Jodi
Published: October 2024

In 2022, the American Academy of Neurology (AAN) released an updated clinical practice guideline for the treatment of painful diabetic polyneuropathy. This article synthesizes the AAN recommendations, providing rationales and implementation considerations for them for primary care NP practice.
Diagnosis and management of diverticular disease in primary care
Authors: Pateneaude Cassandra , Lyden Catherine
Published: October 2024

Each year, more than 1 million ambulatory patient visits occur for diverticular disease, with nearly 75% of these patients seen in outpatient clinics. Although diverticulitis historically had been considered a disease of the older adult, it has become increasingly prevalent among the younger population. Likewise, in the past, antibiotics were considered first-line treatment for uncomplicated diverticulitis (Hinchey classification 0 and Ia); however, two large clinical trials compared treatment with antibiotics versus without antibiotics in uncomplicated cases of the disease and found no significant difference in patient outcomes. Based on these findings, first-line management now constitutes clear-liquid diet along with bowel rest for resolution of symptoms in these patients. Proper management with lifestyle modifications can help prevent complications and improve outcomes for patients with this condition; patient education is therefore critical.
Advancing preventive health care for men across the lifespan
Authors: Gallegos Julian L. , Serrano Carlos , Holly Cheryl , Nelson John
Published: October 2024

Historically, cisgender men have been found to be reluctant to utilize healthcare services, particularly preventive care services. NPs can bridge this gap to address health disparities among men, who are more likely to develop life-threatening conditions and who generally face higher mortality at younger ages than women. Focusing on advancing preventive care among men strengthens family, community, and societal health, and the NP is crucial in fostering a culture of preventive care in this population. To help drive this change, use of a life-stage approach that incorporates a preventive care mindset is critical. The NP should tailor health strategies to each life phase to ensure that men receive the best preventive care possible across the lifespan.
Surgical Treatment of Pediatric Foot and Ankle Fractures in a Freestanding Ambulatory Surgery Center is a Safe, Cost-effective Alternative to a Hospital
Authors: Chen Stephanie , Ritchie Jordan , Hernandez Jacob , Khan Nyma , Nolan Vikki , Sheffer Benjamin W. , Kelly Derek M.
Published: October 2024

Background:

In the United States, the number of pediatric fractures treated in ambulatory surgery centers (ASCs) continues to increase. Few studies have compared the outcomes and complications of treating these injuries in a freestanding ASC versus in a hospital setting. The purpose of this study was to compare clinical and radiographic outcomes, treatment times, and costs for treatment of pediatric foot and ankle fractures in the ASC and hospital.

Methods:

A retrospective review identified pediatric patients with isolated, closed, and acute (below 3 wk) distal tibia, ankle, or foot fractures who underwent closed reduction in an operating room or operative fixation between January 2015 and December 2019. The patients were divided into 2 groups: ASC and hospital. Medical records were reviewed for patient demographics, mechanism of injury, surgical time, facility time, costs for treatment, and complications. Preoperative and postoperative alignment was assessed on radiographs. Clinical outcomes included pain, weight-bearing, or deformity at final follow-up. Multivariable generalized linear models and logistic regression were used to determine the association between surgical setting and treatment outcomes, times, and costs.

Results:

Two hundred and twenty-three patients were identified; 115 treated in the ASC and 108 treated in the hospital. Adjusted for age at treatment, injury type, procedure performed, and preoperative alignment, there were no differences in surgical time, clinical or radiographic outcomes, or complications between groups. The mean total operating room time, total facility time, and total charges were significantly lower in patients treated in the ASC than in the hospital.

Conclusion:

Pediatric distal tibia, ankle, and foot fractures can be safely treated in an ASC with equivalent outcomes and complications compared with those in a hospital setting. Benefits include shorter total surgical and facility times as well as decreased cost of care. These findings could allow for patients to receive more timely and efficient treatment with less financial burden.

Level of Evidence:

Level III—therapeutic.
Enhancing Diagnostic Accuracy of Fresh Vertebral Compression Fractures with Deep Learning Models
Authors: Li Kai-Yu , Ye Hao-Bo , Zhang Yu-Long , Huang Jia-Wei , Li Hua-Lin , Tian Nai-Feng
Published: October 2024

Study Design:

Retrospective study.

Objectives:

The study aimed to develop and authenticated a deep learning model based on X-ray images to accurately diagnose fresh thoracolumbar vertebral compression fractures.

Summary of Background Data:

In clinical practice, diagnosing fresh vertebral compression fractures often requires MRI. However, due to the scarcity of MRI resources and the high time and economic costs involved, some patients may not receive timely diagnosis and treatment. Using a deep learning model combined with X-rays for diagnostic assistance could potentially serve as an alternative to MRI.

Methods:

In this study, the main collection included X-ray images suspected of thoracolumbar vertebral compression fractures from the municipal shared database between December 2012 and February 2024. Deep learning models were constructed using frameworks of EfficientNet, MobileNet, and MnasNet respectively. We conducted a preliminary evaluation of the deep learning model using the validation set. The diagnostic performance of the models was evaluated using metrics such as AUC value, accuracy, sensitivity, specificity, F1 score, precision, and ROC curve. Finally, the deep learning models were compared with evaluations from two spine surgeons of different experience levels on the control set.

Results:

This study included a total of 3025 lateral X-ray images from 2224 patients. The dataset was divided into a training set of 2388 cases, a validation set of 482 cases, and a control set of 155 cases. In the validation set, the three groups of DL models had accuracies of 83.0%, 82.4%, and 82.2%, respectively. The AUC values were 0.861, 0.852, and 0.865, respectively. In the control set, the accuracies of the three groups of DL models were 78.1%, 78.1%, and 80.7%, respectively, all higher than spinal surgeons and significantly higher than junior spine surgeon.

Conclusion:

This study developed deep learning models for detecting fresh vertebral compression fractures, demonstrating high accuracy.
Lip Augmentation with Soft Tissue Fillers: Social Media, Perceptual Adaptation, and Shifting Beauty Trends beyond Golden Standard Ideals
Authors: Atiyeh Bishara S. , Beaineh Paul T. , Hakim Christopher R. A. , Makkawi Kareem W. , Habr Natasha T. , Zeineddine Jana H. , Emsieh Saif E. , Issa Oussama B. , Gnaedinger Anika G. , Ibrahim Amir E.
Published: October 2024

Background:

Unfortunately, current beauty trends greatly advertised by social media are trespassing recognized cannons of beauty. Of particular interest are patients’ expectations of soft tissue volume augmentation of the face, specifically of the lips.

Methods:

An artificial intelligence picture of a White female face was generated. With the fixed standard golden upper-to-lower (U/L) lip ratio, a first set of pictures was generated with varying lip fullness. A second set of pictures was generated with various U/L ratios and lip fullness. In a survey format, the 2 sets of pictures were rated for attractiveness from the most to the least attractive by adult men and women.

Results:

Rating the first set of pictures clearly demonstrates that overinflation of lips with upper lip height in excess of 30% of hemi-lip width is highly regarded as unaesthetic and unattractive, with a net preference of 20%–25%. For the second set, U/L ratios between 0.618:1 and 1:1 are still regarded to be most aesthetic.

Conclusions:

Though social media have an influence on perception of beauty, data provided by the survey confirm that golden standards of aesthetics remain constant and that exaggerated requests of some patients may not be attributed solely to social media influence but probably to social media in combination with additional personal predisposing factors. Patients must be made aware that how they are perceived by others is essential for them to be satisfied with their appearance.
Efficacy of Liposuction of the Posterior Arm Fat Pad in Axillobrachioplasty after Massive Weigh Loss: A Pilot Study
Authors: Gunnarsson Gudjon Leifur , Gudjonsdottir Linda Regina , Koidil Amelia , Haukeland Lars , Berg Erik , Thomsen Jorn Bo
Published: October 2024

Background:

The topographic anatomical changes of the upper arms and axilla after massive weight loss (MWL) seem ill-described in the literature. The importance of the axilla in MWL brachioplasty and how the procedure differs from the postmenopausal “batwing” deformity of the upper arms is also unclear. Consideration of the underlying pathology seems imperative for a successful reconstruction. We aim to test a procedure specifically designed to mend the underlying pathology of obesity and MWL, liposuction-assisted axillobrachioplasty (LAAB).

Methods:

A prospective pilot study was designed to test the effect of LAAB on the axilla and evaluate the results comparative to patient’s preoperative complaints and well-being and allow for adjustments for future trials. We measured the diameter of the arm and axilla at three specific points, A, B and C, and applied the arm module of BODY-Q regarding body perception and psychosocial well-being.

Results:

Fifteen women, for a total of 30 arms, were included. Age average was 48 years (29–59) and showed a significant improvement in all measurements A–C, most significantly at point A in the axilla, where the reduction was associated with relief of preoperative ailments and great improvement on BODY-Q ratings. The procedure was uncomplicated, with high patient satisfaction.

Conclusions:

LAAB significantly improves the axilla and upper arm contour after MWL and correlates strongly with improvement of preoperative ailments. The study furthermore supports the clinical relevance of a posterior arm fat pad. The presented procedure seems to be uncomplicated and reproducible with a high patient satisfaction warranting a long-term clinical trial
Practical approach to diagnose and manage benign liver masses
Authors: Reguram Reshma , Ghonge Aishwarya , Tse Justin , Dhanasekaran Renumathy
Published: October 2024

Benign liver lesions are among the most commonly diagnosed abnormalities in liver imaging. They are often discovered incidentally during routine examinations or imaging conducted for unrelated reasons. These can be solid lesions, such as hemangiomas, focal nodular hyperplasia, hepatic adenomas, or cystic lesions. Recent advancements in MRI technology, particularly with hepatocyte-specific contrast agents, have enhanced the characterization of these lesions, reducing the reliance on invasive tissue sampling. Nevertheless, tissue sampling retains a crucial role in the evaluation of indeterminate lesions or those with malignant potential. While most benign liver lesions are asymptomatic, some can become symptomatic, causing discomfort, pain, or bleeding, particularly if the lesion is large. A deep understanding of the molecular underpinnings of the lesions is crucial for tailoring patient management strategies, particularly in distinguishing lesions that require surgical intervention from those that can be monitored. For instance, the molecular subclassification of hepatic adenomas has provided mechanistic insights and identified certain subtypes that are at higher risk of malignancy. Most benign liver lesions can be safely monitored; however, in patients with cirrhosis or a known primary malignancy, a high index of suspicion for cancer is required. It is crucial to carefully evaluate any liver lesion identified in these patients to ensure that indeterminate lesions are not overlooked. Effective management of benign liver lesions involves a multidisciplinary team, including hepatologists, surgeons, and radiologists, ensuring a comprehensive and individualized approach to patient care. This review outlines the clinical presentation of common benign liver lesions, providing a diagnostic and management framework. Emphasis is placed on a personalized approach to minimize patient distress and optimize outcomes by leveraging imaging advancements and multidisciplinary collaboration.
The co-location of MARCO+ tumor-associated macrophages and CTSE+ tumor cells determined the poor prognosis in intrahepatic cholangiocarcinoma
Authors: Fan Guangyu , Tao Changcheng , Li Lin , Xie Tongji , Tang Le , Han Xiaohong , Shi Yuankai
Published: October 2024

Background and Aims:

Intratumor immune infiltration plays a crucial role in interacting with tumor cells in intrahepatic cholangiocarcinoma (ICC). However, the specific phenotypes of immune cells and their spatial distribution within the tumor microenvironment remain unclear. This study aimed to address these limitations by providing a detailed analysis of immune infiltration patterns in ICC using combined spatial and single-cell transcriptomic data.

Approach and Results:

We analyzed 29,632 spots from 6 spatial transcriptomic samples and 21,158 cells from 35 single-cell samples of ICC. Two distinct immune infiltration patterns were identified: macrophage+ (characterized by CD68 and macrophage receptor with collagenous structure [MARCO]) and plasma cell+ (characterized by IGHG1 and JCHAIN). These patterns showed contrasting impacts on patient survival, with macrophage+ infiltration associated with poorer outcomes and plasma cell+ infiltration linked to better survival. MARCO+ tumor-associated macrophages (TAMs) were the predominant cell type in macrophage+ samples, indicative of an immune-resistant microenvironment. In MARCO+ TAMs, elevated epithelial-mesenchymal transition activity, angiogenesis, and hypoxia were observed. Spatial transcriptomics and bulk data also revealed co-location of MARCO+ TAMs with cathepsin E (CTSE+) tumor cells, a finding validated by multiplex immunofluorescence in 20 ICC samples. The co-location area was enriched with protumorigenic pathways and suppressed immune responses, and CTSE expression was associated with intrahepatic metastasis and vascular invasion. High infiltration of both MARCO+ TAMs and CTSE+ tumor cells correlated with the poorest survival outcomes. Within the co-location area, the galectin signaling pathway, particularly the LGALS9-CD44 ligand-receptor pair, was highly active in cell-cell communication.

Conclusions:

This study identifies 2 intratumor immune infiltration patterns, macrophage+ and plasma cell+, in ICC. Furthermore, the co-location of MARCO+ TAMs and CTSE+ tumor cells contributes to an immune-resistant microenvironment, highlighting potential targets for therapeutic intervention in ICC.
Narrative Thinking of Healthcare Providers in Medical Cases and Its Implications for Modern Medical Education
Authors: YANG Xiaolin , HUANG Qing
Published: October 2024

In the realm of Chinese narrative medicine, narrative thinking holds equal significance to evidence-based thinking within clinical practice, making substantial contributions to patient safety and medical quality. Ancient Chinese medical theories advocate forging a narrative bond with patients, urging healthcare practitioners to utilize Dao Shu Jie He (道术结合 integration of Dao and techniques) and Yi Dao Yu Shu (以道驭术 guiding techniques with Dao) during diagnosis, treatment, and rehabilitation. In this context, Dao (道) in traditional Chinese medicine (TCM) corresponds to narrative thinking (叙事思维) while Shu (术) aligns with scientific thinking (科学思维) in evidence-based medicine. This study adopts “narrative Chinese medicine” within the “discourse system of Chinese narrative medicine” as its framework, centering on medical stories that exemplify the application of narrative thinking in ancient Chinese diagnosis and treatment. It delves into the narrative thinking encapsulated in Chinese medicine, such as Guan Wu Qu Xiang (观物取象 observing things and extracting information), Can He Er Xing (参合而行 final examination and decision by integrating the four diagnoses), Xing Shen Bing Zhi (形神并治 body-spirit treatment), Xin Shen Jian Li (心身兼理 mind-body balance) and Bian Zheng Lun Zhi (辨证论治 treatment based on pattern differentiation). The study endeavors to inspire contemporary medical educators and clinicians to acknowledge the value of narrative thinking in TCM and fully incorporate it into daily medical practice.
Diagnostic accuracy of NT-proBNP to predict the incidence of CSA-AKI: A systematic review and meta-analysis
Authors: Zhang Jiaying , Li Xin , Yu Xiaofeng
Published: October 2024

Background:

Cardiac surgery–associated acute kidney injury (CSA-AKI) is a severe complication following cardiac surgery. Early identification and diagnosis are critical. In this study, we aim to systematically assess the diagnostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) for CSA-AKI.

Methods:

The PubMed, Embase, Web of Science, and Cochrane Library databases were searched from January 1971 to October 2023 to identify prospective observational and retrospective observational studies. Data extraction and study screening were carried out independently by 2 authors. The methodological quality of the included studies was evaluated by the Quality Assessment of Diagnostic Accuracy Studies 2 standards, and all statistical analyses were conducted by Stata 15.0.

Results:

Seven studies including 37,200 patients were identified. The pooled sensitivity of 0.67 (95% credible interval [CI] = 0.56–0.77), specificity of 0.55 (95% CI = 0.45–0.64), area under the summary receiver operating characteristic curve of 0.65 (95% CI = 0.60–0.69), positive likelihood ratio of 1.5 (95% CI = 1.2–1.8), negative likelihood ratio of 0.60 (95% CI = 0.46–0.79), and diagnostic odds ratio of 2 (95% CI = 2–4) suggested that patients with higher preoperative NT-proBNP levels (pg/mL) are at higher risk of developing acute kidney injury after cardiac surgery. However, NT-proBNP lacks sufficient sensitivity and specificity to reliably predict CSA-AKI.

Conclusion:

Our findings suggest that the diagnostic accuracy of NT-proBNP to predict the incidence of CSA-AKI is limited. However, we provide novel perspectives on the early detection of CSA-AKI biomarkers, and it is urgent to identify more precise and practical biomarkers for the early diagnosis of CSA-AKI.
Effectiveness of the re-engineered discharge (RED) care model in patients with rheumatoid arthritis
Authors: Chen Deli , Zhou Qing
Published: October 2024

This study aims to investigate whether the re-engineered discharge (RED) model can significantly improve the quality of life, enhance the health status, and reduce the levels of depression and anxiety in patients with rheumatoid arthritis during hospitalization. This study selected 108 rheumatoid arthritis patients treated at our facility between February 2023 and February 2024. Based on the different treatment methods, these patients were divided into a control group and an observation group, with 54 patients in each group. During hospitalization, both groups received standardized routine care provided by the hospital. After discharge, the control group continued with regular follow-up visits, while the observation group received a more comprehensive and multidimensional extended care based on the RED model. The intervention period for both groups was set to 3 months. The core observation indicators of this study focused on the emotional fluctuations, symptom improvement, and changes in self-care ability of the patients before and after the intervention. After the intervention, the scores of the Self-Rating Anxiety Scale and Self-Rating Depression Scale in both groups showed significant decreases, with the scores in the observation group being significantly lower than those in the control group, showing a highly significant statistical difference (P < .01). Additionally, the joint pain scores in both groups were alleviated, reflected by shorter morning stiffness times, reduced joint swelling, and increased grip strength. The observation group had lower joint pain scores, shorter morning stiffness times, fewer swollen joints, and stronger grip strength, all of which were statistically significant (P < .01). Furthermore, the distribution of self-care abilities in the observation group showed a significant difference compared to the control group (P < .05), with the observation group having a higher proportion of self-care abilities, which was also statistically significant (P < .05). For patients with rheumatoid arthritis, the implementation of the RED model nursing strategy can significantly alleviate negative emotions, reduce the distress caused by symptoms, and markedly improve their quality of life, providing a more comfortable and reassuring treatment experience.
Iron overload is positively associated with the incidence of osteoarthritis: A NHANES cross-sectional study
Authors: Liu Fei
Published: October 2024

With the aging of the global population and the increase in the number of people with conditions such as obesity, the incidence of osteoarthritis (OA) is increasing annually. Clinical studies have shown that excessive accumulation of iron in joints is associated with age-related OA. However, there have been no reports on the relationship between iron metabolism and osteoarthritis. A STROBE-compliant cross-sectional observational study, was carried out and analyzed from the National Health and Nutrition Examination Survey from 2001 to 2020, including data on serum iron, transferrin saturation, serum ferritin, total iron-binding capacity, and transferrin receptors, as well as data on osteoarthritis. This cross-sectional study was conducted to explore the relationship between serum iron levels, osteoarthritis, and related metabolic factors. By adjusting the model and using quantile logistic regression models, the interaction between human body iron content and the aforementioned variables was analyzed. A total of 56,323 participants over 5 cycles were assessed for iron levels. After adjusting the model for age, sex, race, education level, marital status, total energy intake, physical activity, drinking, BMI, smoking, hypertension, and diabetes, we found that in different quantile regression results, serum iron was associated with OA, Q4: OR = 1.231 (95%CI: 1.009–1.501, P < .05). Ferritin is associated with OA, Q2: OR = 1.309 (95%CI: 1.012–1.692, P < .05); Q3: OR = 1.424 (95%CI: 1.129–1.797, P < .01); Q4: OR = 1.280 (95%CI: 1.013–1.616, P < .05). This cross-sectional study found that serum iron and transferrin saturation levels were positively correlated with OA incidence, suggesting that iron overload is a risk factor for OA. Large-sample prospective cohort studies are needed to confirm the correlation between iron overload and OA.
Does T-tube indwelling prolong the procedure of endoscopic retrograde cholangiopancreatography for healing duct-to-duct anastomotic bile leakage after liver transplantation?
Authors: Ding Songming , Dong Shanjie , Zhu Hengkai , Zheng Shusen , Li Qiyong
Published: October 2024

Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred treatment for duct-to-duct anastomotic bile leakage (D-D aBL) after liver transplantation (LT). This study aimed to compare the time required for ERCP and D-D aBL recovery in post-LT patients with and without T-tube drainage. A total of 40 patients (11 with T-tube drainage and 29 without T-tube drainage) with confirmed D-D aBLs treated successfully with ERCP from July 2016 to September 2021 were reviewed. The mean interval from LT to initial ERCP was significantly longer in patients with T-tube drainage than in those without T-tube drainage (41.9 vs 25.1 days, P < .05). However, there was no significant difference in the time required for ERCP to result in D-D aBL healing between patients with T-tube drainage and those without T-tubes (33.4 vs 23.0 days). T-tube indwelling did not significantly prolong the course required for ERCP to resolve D-D aBL in post-LT patients.
Polymyalgia rheumatica following COVID-19 vaccination: Case series of 3 patients and literature review on polymyalgia rheumatica induced by various vaccines
Authors: Irani Laure , Bou Karroum Mira , Chehab Yara , Abi Saad Nesrine , Al Dailaty Ali , Husni Roula
Published: October 2024

Rationale:

Since the onset of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic in 2019, considerable resources have been devoted to developing vaccines to reduce related deaths and the burden of disease. Various vaccine formulations eventually became available and were approved for clinical use. In this article, we have conducted a review of polymyalgia rheumatica (PMR) cases induced by different COVID-19 vaccines [Pfizer: BNT162b2, AstraZeneca: ChAdOx1-S, Moderna: mRNA-1273, and Janssen: Ad26.COV2.S)], as well as non-COVID-19 vaccines, such as influenza, zoster, hepatitis B, and tetanus vaccines. Additionally, this article investigates 3 cases with clinical presentations suggestive of PMR following COVID-19 mRNA vaccination. This study aims to offer valuable insights through sharing diagnostic and therapeutic experiences.

Patient concerns:

Three patients presented with severe pain and stiffness in both shoulder and pelvic girdle muscles, following COVID-19 mRNA vaccination.

Diagnoses:

Clinical presentations, laboratory parameters, and echographic findings confirmed the diagnosis of PMR following COVID-19 mRNA vaccination.

Interventions:

Patients received Prednisone and/or Methotrexate adjusted to body weight.

Outcomes:

Polymyalgia rheumatica resolved successfully without any adverse events.

Lessons:

Although direct causality was not definitively established in this article, the BNT162b2 COVID-19 mRNA vaccine, similar to other vaccines, might be considered a potential trigger for PMR. This raises the need for further research into this issue and potentially other immunological outcomes.
Prevalence of misophonia and its association with depression and obsessive-compulsive disorder among medical students
Authors: Almadani Ahmad H. , Alabdulkarim Ibrahim M. , Akresh Mohammed I. , Alassaf Meshal I. , Alkathiri Mohammed A. , Alkublan Khalid M. , Aldoghmani Rakan A. , Alghtani Yazeed A. , Alwaily Sultan A.
Published: October 2024

Misophonia, a neurobehavioral syndrome, reduces tolerance to specific stimuli and impacts various domains of life. It is also strongly correlated with obsessive-compulsive disorder (OCD) and depression. This study aimed to investigate the prevalence of misophonia among medical students at King Saud University (KSU), Saudi Arabia, identify related sociodemographic factors, and assess misophonia association with OCD and depression. This cross-sectional study included 371 participants. The study tool was distributed electronically between November 19 and December 07, 2023. It consisted of 4 sections: a questionnaire developed by the research team, the Amsterdam Misophonia Scale (A-MISO-S), the Obsessive-Compulsive Inventory-Revised (OCI-R), and the Patient Health Questionnaire-9 (PHQ-9). The results indicated that 42.32% of the participants had previously experienced misophonia, with symptoms developing suddenly in 28.66%. The majority of participants had subclinical misophonia (71.16%) and minimal depression (37.47%), with a significant proportion experiencing mild-to-severe misophonia (28.84%) and varying degrees of depression (33.15%). Approximately 31.00% of the students exhibited likely OCD. The PHQ-9 and A-MISO-S scores showed weak positive correlations, whereas the OCI-R and A-MISO-S scores showed a moderate positive correlation. Furthermore, a moderate positive correlation was observed between the OCI-R and PHQ-9 scores. Multiple logistic regression analysis revealed that sex, family history of misophonia, depression severity, and OCD were significantly associated with clinical misophonia. This study underscores the significance of recognizing misophonia among medical students and its associated factors, such as OCD and depression. Further multicenter studies using more rigorous research methodologies are warranted.
Serum iron status and the risk of female infertility in European populations: A two-sample Mendelian randomization study
Authors: Liu Ziping , Zhang Zelin , Xie Ping
Published: October 2024

The relationship between iron status and female infertility has been observed in several studies, yet its causal nature remains ambiguous. We employed univariate Mendelian randomization (MR) analyses to explore the potential causal connection between these 2 factors. For our analysis, genetic instrumental variables pertaining to iron status were selected using data from the Iron Status Genetics Consortium, encompassing 48,972 individuals of European descent from 19 cohorts (11 discovery and 8 replication). For female infertility data, we referred to FinnGen Consortium Release 9, which includes 11,442 cases and 107,564 controls. Our MR approach utilized both a conservative strategy (involving single nucleotide polymorphisms pertinent to general iron status) and a liberal strategy (encompassing single nucleotide polymorphisms linked to any iron status indicator). The conservative approach relied on inverse variance-weighted methods, whereas the liberal strategy integrated inverse variance weighted with MR-Egger regression, the weighted median approach, and simple mode techniques. The conservative strategy did not reveal a significant link between iron status and female infertility risk. Conversely, the liberal strategy indicated a positive correlation specifically between serum iron levels and female infertility risk (odds ratio from MR: 1.225; 95% confidence interval: 1.064–1.410; P = .030), while no significant associations were found for other iron indicators (P > 0.05). Our MR investigation suggests a potential positive association between serum iron levels and the risk of female infertility, while other iron markers do not appear to significantly influence this risk. These findings highlight the need for further research into the possible connection between serum iron status and female infertility risk.
Identification and validation of novel genes related to immune microenvironment in polycystic ovary syndrome
Authors: Zhao Yuemeng , Liu Liying , Hao Jianheng , Wang Haijun , Cao Yuxia , Lan Ying , Ji Laixi
Published: October 2024

Polycystic ovary syndrome (PCOS) is one of the most complicated chronic inflammatory diseases in women of reproductive age and is one of the primary factors responsible for infertility. There is substantial dispute relating to the pathophysiology of PCOS. Consequently, there is a critical need for further research to identify the factors underlying the pathophysiology of PCOS. Three transcriptome profiles of granulosa cells from patients with PCOS and normal controls were obtained from the gene expression integration database. We also obtained relevant microarrays of granulocytes prepared from PCOS patients and normal controls from the gene expression integration database. Then, we used the R package to perform correlations and identify differences between PCOS and normal controls with regard to immune infiltrating cells and functionality. Subsequently, intersecting genes were identified and risk models were constructed. Finally, the results were validated by enzyme linked immunosorbent assay and real-time PCR. We identified 8 genes related to cuproptosis (SLC31A1, PDHB, PDHA1, DLST, DLD, DLAT, DBT, and ATP7A) and 5 genes related to m7G (SNUPN, NUDT16, GEMIN5, DCPS, and EIF4E3) that were associated with immune infiltration. Furthermore, the expression levels of DLAT (P = .049) and NUDT16 (P = .024) differed significantly between the PCOS patients and normal controls, as revealed by multifactorial analysis. Both DLAT and NUDT16 were negatively correlated with immune cell expression and function and expression levels were significantly lower in the PCOS group. Finally, real-time PCR and enzyme linked immunosorbent assay demonstrated that the expression levels of DLAT and NUDT16 were significantly reduced in the granulosa cells of PCOS patients. In conclusion, our findings shed fresh light on the roles of immune infiltration, cuproptosis, and m7G alternations in PCOS. We also provide a reliable biomarker for the pathological classification of PCOS patients.
How to determine the course of preoperative chemotherapy for spinal tuberculosis: A single-center clinical study
Authors: Liu Qiang , Ma Long , Yanga Zongqiang , Chu Dawei , Yang Pengyu , Wang Kun , Li Minyu , Zheng Jianping , Niu Ningkui , Shi Jiandang
Published: October 2024

This study aims to explore the clinical efficacy and feasibility of preoperative 1-week chemotherapy for patients with spinal tuberculosis (STB) undergoing complete lesion removal. Clinical data of 76 patients with STB who underwent complete focal debridement in our hospital were collected from June 2020 to September 2023. The patients were divided into 38 cases of preoperative 1-week chemotherapy group (Group A) according to the length of preoperative chemotherapy, and 38 cases of preoperative 2 to 4-week chemotherapy group (Group B). Perioperative related, imaging, and laboratory examination indices as well as postoperative neurological function recovery, postoperative pain recovery, related complications, and clinical efficacy were analyzed to compare the clinical efficacy of the 2 groups. All patients successfully completed the treatment of stage I complete lesion removal combined with bone grafting fusion and internal fixation. The difference in erythrocyte setting rate and C-reactive protein at the same postoperative observation time between the 2 groups was not statistically significant (P > .05). The visual analogue scale scores of patients in the 2 groups decreased significantly with prolonged time, and the difference was statistically significant (P < .05). All patients achieved satisfactory clinical efficacy (P < .05). All patients achieved good clinical outcomes, the difference between the groups was not statistically significant (P > .05). The difference in incision healing rate at 3 months postoperatively and bone graft fusion rate at 6 months postoperatively was not statistically significant between the 2 groups (P > .05). The dissemination and recurrence of Mycobacterium tuberculosis were not statistically significantly different between the 2 groups after surgery (P > .05). In summary, with complete lesion clearance, 1 week of preoperative chemotherapy is feasible in patients with STB with varying degrees of neurological dysfunction.
The effect of anesthesia methods on the neutrophil–lymphocyte ratio in patients undergoing forearm surgery: A monocentric and retrospective study
Authors: Köksal Bengü G. , Bollucuoğlu Keziban , Şahin Ercan , Bayram Mustafa Gökhan , Küçükosman Gamze , Ayoğlu Hilal
Published: October 2024

Surgical trauma can induce systemic inflammation. The selected anesthesia method may modulate the inflammatory response and surgical results in the inflammatory process that occurs during surgical trauma. In this retrospective study, we aimed to compare the anti-inflammatory effects of general anesthesia and peripheral nerve block (infraclavicular block). Demographic, clinical, and laboratory records (hemogram, total leukocyte count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume) were obtained from the archival data. The patients were divided into 2 groups: Group G, who received general anesthesia, and Group P, who received a peripheral nerve block (infraclavicular block) for forearm surgery. The amount of opioid consumed postoperatively was significantly lower in Group P. Infraclavicular block as an alternative to general anesthesia was found to be associated with a significant decrease in the neutrophil-to-lymphocyte ratio, total leukocyte count, and platelet-to-lymphocyte ratio levels compared to those observed after general anesthesia. Peripheral nerve blocks may play a role in reducing inflammation and alleviating stress.
Cancer Predisposition Syndromes in Children: Who, How, and When Should Genetic Studies Be Considered?
Authors: Camacho-Arias Mónica , Villa Marta , Álvarez de Andres Sara , Rivera Bárbara , Vázquez Paula , Letón Patricia , Martín-López Laura , Osuna-Marco Marta Pilar , López-Ibor Blanca
Published: October 2024

Early detection of cancer predisposition syndromes (CPS) is crucial to determine optimal treatments and follow-up, and to provide appropriate genetic counseling. This study outlines an approach in a pediatric oncology unit, where 50 randomly selected patients underwent clinical assessment, leading to 44 eligible for genetic testing. We identified 2 pathogenic or likely pathogenic variants in genes associated with CPS and 6 variants of uncertain significance (VUS) potentially associated with cancer development. We emphasize the importance of a thorough and accurate collection of family history and physical examination data and the full coordination between pediatric oncologists and geneticists.
Internalized Phobia, Community Connectedness, Outness, and Mental Health Risk and Protection in LGBTQ Persons
Authors: Graziano Teresa A. , Fitzgerald Holly N. , Ortiz José , Owen Christopher K. , Shook Natalie J.
Published: October 2024

Background

Community connectedness, outness, and internalized phobia are potential protective and risk factors for mental health in lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. However, these interrelated factors have generally been examined in isolation and for the LGBTQ community in aggregate. As such, there may be undetected effects of factors on mental health for each LGBTQ group.

Objectives

We examined the associations between mental health (i.e., depression and anxiety) and risk/protective factors (i.e., internalized phobia, community connectedness, outness) in each LGBTQ subgroup separately.

Method

A large national U.S. sample (N = 1,030) of individuals who identified as LGBTQ completed an anonymous Internet survey during fall 2019. Participants answered questionnaires about community connectedness, outness, internalized homophobia or transphobia, anxiety, and depression.

Results

On average, most subgroups reported symptoms of depression and anxiety above clinical cutoffs. Less outness and greater internalized phobia were associated with more severe depression and anxiety, but this pattern was not consistent across LGBTQ subgroups. Greater community connectedness was generally associated with more severe anxiety and depression.

Discussion

LGBTQ subgroups vary in how risk and protective factors relate to mental health outcomes. Our findings highlight the importance of examining LGBTQ subgroups separately and examining risk/protective factors simultaneously to identify the unique contribution of each factor. More research is needed to understand potential LGBTQ mental health risks and protective factors, and future researchers should examine the unique roles of risk and protective factors in separate LGBTQ subgroups.
Emerging integrase resistance in an international perinatal virtual clinic
Authors: Eni-Olotu Ayolola , Mackie Nicola E. , Glenn Jessica , Bailey Angela , Bamford Alasdair , Kenny Julia , Levin Leon , Lyall Hermione , Milheiro Silva Tiago , Simon Katie , Tickner Neil , Turkova Anna , Welch Steven , Foster Caroline
Published: October 2024

Objective:

The aim of this study was to identify the prevalence of emergent integrase drug resistance mutations (INSTI-DRMs) in international referrals to a perinatal virtual clinic (PVC).

Design:

A retrospective cohort study.

Setting:

Monthly multidisciplinary PVC reviewing complex case management for children and adolescents with perinatally acquired HIV (CAWHIV).

Participants:

One hundred fourteen cases referred for virological failure between October 2018 and January 2024.

Main outcome measures:

Data collected included age, sex, weight, country of residence, antiretroviral therapy (ART) history, HIV viral load, CD4+ cell count, and comorbidities. Resistance mutations were interpreted using the Stanford HIV Drug Resistance database with emergent major INSTI-DRMs described.

Results:

Of 114 referrals, 103 (90%) had resistance sequences available. Prior INSTI exposure was documented in 61/103 (59%) with 19/61 (31%) having INSTI-DRMs. For these 19, median (IQR) age was 11 years (6–14), weight 25 kg (17–50), CD4+ cell count 485 cells/μl (153–805), and viral load 84 000 copies/ml (2380–137 000). Twelve of 19 (65%) were from low/middle-income countries (LMIC), 6/19 (32%) had current AIDS diagnoses with 14/19 (74%) referred from 2022 onwards. There were a median three prior regimens with 13/19 (68%) having at least 3 class resistance. Two developed INSTI-DRMs on first-line dolutegravir (DTG)-based ART, 17 on second+ line therapy. PVC recommendations were for tenofovir+ lamivudine/emtricitabine (six split adult tablets) with boosted darunavir [19; six twice daily (b.i.d.)], with b.i.d. DTG (6), plus fostemsavir (1) and ibalizumab (1).

Conclusion:

Although uncommon, INSTI resistance is emerging, mainly in highly treatment experienced CAWHIV from LMIC, highlighting the global need for access to boosted protease inhibitors and novel classes, including formulations for children less than 35 kg.