bluuebunny/crossref_metadata_2025 huggingface dataset:
Disparities in end-of-life care and place of death in people with malignant brain tumors—A Swedish registry study
Authors: Ozanne Anneli , Öhlén Joakim , Nyblom Stina , Jakola Asgeir Store , Smits Anja , Larsdotter Cecilia
Published: November 2024

Background

Malignant brain tumors often lead to death. While improving future treatments is essential, end-of-life care must also be addressed. To ensure equitable palliative care, understanding the place of death is crucial, as disparities may lead to inequity of care. This study aims to identify the place of death in adults with malignant brain tumors in Sweden, and the potential associations with official palliative care status by the ICD-10 code Z51.5, sociodemographic factors, health service characteristics, and healthcare service utilization.

Methods

A population-level registry study examined the place of death among adults who died of malignant brain tumors in Sweden from 2013 to 2019. Descriptive statistics, univariable, and multivariable binary logistic regression analyses were performed.

Results

We identified 3,888 adults who died from malignant brain tumors. Of these, 64.4% did not receive an official palliative care status. Specialized palliative care was not utilized in 57.2% at the place of death and in 80% of nursing home deaths. In the last month of life, 53.5% of hospital deaths involved 1 transfer, while 41.8% had 2 or more transfers. The odds ratio (OR) of dying in hospital versus at home was higher, with 2 or more transfers (OR 0.63 [0.40, 0.99]). The OR of dying in a hospital versus at home showed significant regional differences.

Conclusions

Despite the severity of their diagnosis, only a minority of patients utilized specialized palliative services at death, and this varied by the place of death. Significant regional disparities were found between hospital and home deaths, indicating unequal end-of-life palliative care in this patient group.
Effects of Vitamin C Supplements on Clinical Outcomes and Hospitalization Duration for Patients with Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis
Authors: Qin Maorong , Xu Kun , Chen Zhuo , Wen Xiaojie , Tang Yifu , Gao Yangyu , Zhang Hao , Ma Xingming
Published: November 2024

Context

Vitamin C has been used as an essential antioxidant to reduce the inflammatory response associated with pneumonia and acute respiratory distress syndrome in patients with the 2019 coronavirus disease (COVID-19), but its effect on clinical outcomes remains controversial and inconclusive.

Objective

The purpose of this study was to conduct a meta-analysis and systematic review to assess the effects of vitamin C supplementation on the severity of COVID-19 in hospitalized patients.

Data Sources

Web of Science, Embase, Cochrane Library, PubMed, CNKI, CSTJ, Wan fang, and CBM databases were searched for publications between January 2020 and December 2023 that met the inclusion criteria.

Data Extraction

The meta-analyses of outcomes in more than one study were performed using Review Manager software. Heterogeneity was evaluated using the I2 statistic. A randomized controlled trial, cohort studies, and retrospective studies in which vitamin C supplementation was supplemented as monotherapy or in combination, compared with placebo, no treatment, or other standard treatment without vitamin C were included.

Data Analysis

After screening, 22 studies, with a total of 6831 patients, were selected for assessment. Odds ratios (ORs) with 95% CIs were calculated using fixed- and random-effects models. The meta-analysis showed significant effects of vitamin C on alleviating clinical outcomes in patients with COVID-19 (OR = 0.76, 95% CI = 0.65–0.89, P = .0007) but no shortening of the length of hospitalization (OR = 1.16, 95% CI = −0.13–2.44, P = .08) compared with the control group. Notably, vitamin C supplements significantly reduced the mortality risk (OR = 0.64, 95% CI = 0.51–0.80, P = .0001) and the incidence of severity (OR = 0.59, 95% CI = 0.43–0.80, P = .0006) in COVID-19 patients.

Conclusion

The findings suggest that vitamin C supplements may have a beneficial effect on clinical outcomes, as well as reducing severity and mortality in COVID-19 patients, but more clinical randomized controlled trials are needed to evaluate the role of vitamin C in treating COVID-19.

Systematic Review Registration

PROSPERO registration no. CRD42023491517.
Potato Intake and the Risk of Overweight/Obesity, Hypertension, Diabetes, and Cardiovascular Disease: A Systematic Review and Meta-analysis of Observational Studies
Authors: Su Yuhao , Liu Xiaoning , Jiang Bin , He Haitian , Li Fengjuan , Li Xinying , Wang Yanqi , Chen Xiaojuan , Wang Xiaojie , Luo Jun , Chen Lifang , Wu Jun , Hu Fulan , Zhang Ming , Hu Dongsheng , Ma Jianping , Qin Pei
Published: November 2024

Context

Results from observational studies and meta-analyses examining the relationship between total, fried, and nonfried potato intake and cardiometabolic disease remain conflicted.

Objective

The aim was to synthesize existing evidence on the relationships between total potato intake and specific types of potato intake with the risk of overweight/obesity, hypertension, diabetes, gestational diabetes mellitus (GDM), cardiovascular disease (CVD), coronary heart disease (CHD), and stroke.

Data Sources

Systematic searches were conducted in PubMed, Embase, and Web of Science until July 13, 2023.

Data Extraction

Data extracted from studies included first author, publication year, location, data source, follow-up duration (cohort studies only), demographics, sample size, cases, outcomes, exposure and outcome types, measurements, adjustments, study design, potato intake categories, and adjusted risk estimates (odds ratio, relative risk [RR], hazard ratio) with 95% CIs.

Data Analysis

Random-effects models were applied to estimate the summary RRs and 95% CIs.

Results

Fifty-one articles (103 studies) were identified in the current meta-analysis. Comparing the highest with the lowest categories of total potato intake, total potato intake was not associated with hypertension (summary RR = 1.07; 95% CI: 0.95, 1.21), diabetes (1.08; 95% CI: 0.96, 1.22), GDM (1.16; 95% CI: 0.86, 1.57), CHD (1.00; 95% CI: 0.99, 1.02), CVD (0.97; 95% CI: 0.91, 1.03), or stroke (0.97; 95% CI: 0.88, 1.06); fried potato intake was not associated with overweight/obesity (1.24; 95% CI: 0.90, 1.70) or GDM (1.03; 95% CI: 0.97, 1.09) but was significantly associated with increased diabetes risk (1.16; 95% CI: 1.04, 1.30); nonfried potato intake was significantly associated with increased diabetes risk (1.05; 95% CI: 1.01, 1.10) but not hypertension (1.06; 95% CI: 0.97, 1.15).

Conclusion

Total potato intake was not associated with an increased risk of hypertension, diabetes, GDM, or cardiometabolic disease, but both fried and nonfried potato intake may increase the risk of diabetes but not other cardiometabolic diseases. Future cohort studies are needed to explore the association between different types of potato intake and cardiometabolic disease. In addition, the limited number of studies on total potato intake and overweight/obesity/heart failure, fried potato intake and CHD/stroke/heart failure, and nonfried potato intake and overweight/obesity/GDM/CHD/CVD/heart failure prevented us from conducting an analysis.

Systematic Review Registration

PROSPERO registration no. RD42023454244.
Search for exoplanetary ring systems with TESS
Authors: Umetani Tsubasa , Aizawa Masataka , Ezoe Yuichiro , Ishisaki Yoshitaka
Published: November 2024

Photometric surveys for exoplanetary ring systems have not yet confirmed any object with Saturn-sized rings. We systematically analyse 308 TESS planet candidates, mainly comprising giant short-period planets orbiting nearby bright stars. These targets are selected based on the optimistic detectability of rings, assuming a favourable ring orientation. We develop a pipeline with a two-step noise reduction and compare the fitting results of both ringless and ringed transit models to the resulting phase-folded light curves. Although we identify six systems where ringed models are statistically favoured, visual inspection of the signals suggests that none of them is conclusively attributed to the presence of rings. Assuming the ring orientation favourable for detection, we determine the $3\sigma$ upper limits on ring sizes for 125 objects. Using these ring size limits, we derive upper limits on the ring occurrence rate, such as rings with an outer radius larger than 1.8 times the planetary radii occurring at rates lower than 2%. However, these limits can be relaxed if tidal alignment between the spin and orbital axes holds. We explore an alternative detection method using transit depth variations by ring precession and estimate that 10 and 13 systems are likely detectable in TESS and Kepler data, respectively.
The histone deacetylase RhHDA15 represses petal senescence by epigenetically regulating reactive oxygen species homeostasis in rose
Authors: Qin Meizhu , Wu Zhicheng , Zhang Chengkun , Jiang Yunhe , Jiang Cai-Zhong , Sun Xiaoming , Gao Junping
Published: November 2024

Epigenetic modifications play vital roles in many biological processes. Flower senescence involves epigenetic factors that influence the chromatin state and gene expression. However, the molecular mechanism underlying the role of histone deacetylation in regulating flower senescence has not been elucidated. Here, we demonstrate that histone deacetylation is involved in flower senescence by fine-tuning reactive oxygen species (ROS) homeostasis in rose (Rosa hybrida). Our data reveal that the histone lysine deacetyltransferase RhHDA15 inhibits ROS accumulation and petal senescence by downregulating the expression of NADPH OXIDASE/RESPIRATORY BURST OXIDASE HOMOLOG (RhRboh) genes. Furthermore, the transcription factor RELATED TO ABI3/VP1 2 (RhRAV2) recruits RhHDA15 and the co-repressor TOPLESS (RhTPL) to suppress flower senescence by reducing H3 lysine 9 acetylation (H3K9ac) at the RhRbohA1/2 promoter and thus directly inhibiting precocious RhRbohA1/2 expression. Our work sheds light on an epigenetic mechanism in which histone deacetylation plays a crucial role in controlling petal senescence by precisely fine-tuning ROS homeostasis, providing insights into the regulatory network of organ senescence.
Antibiotic contaminants and their impact in Gingee River, Puducherry: insights from SPE-UPLC–MS/MS and zebrafish study
Authors: Gokul Patharaj , Sobanaa Murugesan , Hari Krishna Kumar S , Prathiviraj Ragothaman , Pamanji Rajesh , Suseela Medapati Nikitha Lakshmi , Vallamkonda Bhaskar , Setia Aseem , Selvin Joseph , Muthu Madaswamy S
Published: November 2024

The accumulation of antibiotic residues in ecosystems is intricately tied to the proliferation of bacterial resistance to antibiotics, with far-reaching consequences for the health and welfare of both humans and animal well-being. The analytical approach integrates solid phase extraction (SPE) with ultra performance liquid chromatography-mass spectrometry (UPLC–MS/MS) for quantification of multiclass antibiotic residues. Upon applying the aforementioned method to analyse water samples collected from the Gingee River, revealed the existence of five distinct antibiotics. This is the first study reporting antibiotic concentration in the Gingee River, Puducherry. The concentrations of nalidixic acid, sulfamethoxazole, and tetracycline were determined to be 8.5, 6.9, and 4.8 μg/L, respectively. Metronidazole and trimethoprim were detected at concentrations below the quantifiable limit. The microbial study of water samples also indicated that Shigella sp. and Acinetobacter sp. were the most predominant bacterial species present. Our preliminary observation underscores the importance of comprehending the intricate relationship between the presence of antibiotics in water and the concurrent proliferation of antibiotic-resistant bacteria within bacterial populations in the Gingee River. Further, we evaluated the developmental toxicity of environmentally relevant concentrations of antibiotics in zebrafish. The zebrafish model confirms that these antibiotics are sublethally hazardous to human health at environmentally relevant concentrations. This integrated approach allows unique views on the environmental impact of antibiotic residues, their role in the evolution of antibiotic resistance, and their impact on human health.
Analog Serious Games for Medical Education: A Scoping Review
Authors: Edwards Sarah L. , Zarandi Aryana , Cosimini Michael , Chan Teresa M. , Abudukebier Monica , Stiver Mikaela L.
Published: November 2024

Purpose

Serious games are increasingly used in medical education to actively engage learners. Analog serious games are a nondigital subset of serious games with specific purposes that go beyond entertainment. This scoping review describes the literature pertaining to analog serious games and provides recommendations regarding gaps and emerging directions for future research.

Method

The authors conducted a scoping review following the Arksey and O’Malley framework, searching 3 databases (MEDLINE, Embase, and CINAHL) for studies of analog serious games designed for physician-track learners published from January 2013 through December 2023. Two authors independently screened the titles and abstracts, whereas 1 of 5 authors screened each full text and extracted data from eligible records. The authors iteratively analyzed the data within numerous categories and coded the findings to examine how the field has evolved during the past decade.

Results

The searches retrieved 3,955 records with 865 duplicates. The authors reviewed 3,090 title and abstract records and 202 full-text records. Eighty-eight records met the inclusion criteria, including research reports, conference abstracts, descriptive reports, and short innovation reports. The peak years for publications were 2019 and 2023 (15 publications each). Fewer abstracts and articles were published during the beginning of the COVID-19 pandemic (i.e., 2020–2022). The most common scholarship type was description studies (63 [72%]), whereas the dominant game formats were board games (51 [58%]) and card games (33 [38%]). Most studies tested analog serious games with medical students (60 [68%]) and/or residents and fellows (39 [44%]), with numerous studies including mixed study populations.

Conclusions

This scoping review demonstrates moderate growth within the field of analog serious games, along with numerous opportunities for future research. Although analog game–based learning cannot entirely replace traditional pedagogical approaches, analog serious games have potential to meaningfully complement education for physician-track learners in all medical training stages.
The climate crisis – actions to prioritize for anaesthesiologists
Authors: Lawin-O’Brien Roberta , Schwartz Elliot S. , Montgomery Hugh , Nurok Michael , Coburn Mark
Published: November 2024

Purpose of review

Climate change is the biggest threat to human health and survival in the twenty-first century. Emissions associated with healthcare contribute to climate change and there are many personal and professional actions that can reduce carbon emissions. This review highlights why action is necessary and what anaesthetists and healthcare workers can do.

Recent findings

Encouraging continuing research regarding sustainable anaesthesia and expanding education at all levels to include climate action is key. Professionally, actions include limiting use of single-use equipment, reducing reliance on volatile gas inhalational anaesthesia, and adopting low fresh gas flow techniques. Personal actions such as climate-conscious travelling, spending, and eating are important, especially when shared to create climate positive movements.

This article shows that, while patient safety and quality of care must remain healthcare's top priority, considering the climate implications of care is part of that duty. Many actions that reduce the carbon impact of care simultaneously improve the quality of care and reduce financial cost. More research into sustainable healthcare is needed. Departments and hospitals and must create environments in which climate conversations are welcomed and can result in positive advancements.
Patient-reported and Clinical Outcomes following Gender-affirming Chest Surgery: A Comparison of Binary and Nonbinary Transmasculine Individuals
Authors: Roblee Cole V. , Arteaga Rebecca , Taritsa Iulianna , Ascha Mona , Weissman Joshua P. , Hackenberger Paige , Perez Megan , Ellis Marco , Jordan Sumanas W.
Published: November 2024

Background:

Nonbinary individuals assigned female at birth are increasingly presenting for gender-affirming chest surgery (GCS). However, little is known about psychosocial outcomes in this group. We compare patient-reported and clinical outcomes after GCS between nonbinary and binary transmasculine individuals who underwent GCS.

Methods:

We performed an institutional retrospective chart review. Demographic information, medical comorbidities, history of gender-affirming medical care, operative details, and complications were collected and compared between nonbinary and binary patients. Two validated patient-reported outcomes measures, the Gender Congruence and Life Satisfaction (GCLS) scale and the chest dysphoria measure were administered postoperatively.

Results:

A total of 281 patients were included, of which 40.6% (114) identified as nonbinary and 59.4% (167) identified as binary transgender men. Fewer nonbinary patients used testosterone (P < 0.001). Nonbinary patients underwent a wider variety of masculinizing chest operations than binary patients, with fewer nonbinary patients electing for free nipple-areolar complex grafts (P < 0.001) and more nonbinary patients undergoing breast reduction (P = 0.001). A total of 137 (48.7%) patients responded to postoperative surveys. Nonbinary and binary respondents had comparable scores on the overall GCLS (P = 0.86), GCLS chest subscale (P = 0.38), and chest dysphoria measure (P = 0.40). The absence of nipple-areolar complex grafts was associated with higher GCLS chest scores (P = 0.004).

Conclusions:

Nonbinary individuals have similarly positive outcomes following GCS compared with binary individuals. Surgeons should be aware of greater medical and surgical heterogeneity in this population and seek to understand individual patients’ goals and priorities.
Isometric handgrip versus aerobic exercise: a randomized trial evaluating central and ambulatory blood pressure outcomes in older hypertensive participants
Authors: Jae Sae Young , Yoon Eun Sun , Kim Hyun Jeong , Cho Min Jeong , Choo Jina , Kim Jang-Young , Kunutsor Setor K.
Published: November 2024

Objective:

It remains unclear whether the hemodynamic effects of isometric handgrip exercise (IHG) are comparable to those of aerobic exercise (AE). This study investigated the efficacy of IHG in reducing central and ambulatory blood pressure in older hypertensive participants and compared its effects with AE.

Methods:

In a three-arm randomized controlled trial, 54 older hypertensive participants (age range: ≥60; mean age: 69 years) underwent 12 weeks of either IHG training (n = 17), AE training (n = 19), or were part of a no-exercise control group (n = 18). IHG participants engaged in bilateral handgrips using a digital device, four times for 2 min each at 30% of maximal voluntary contraction. AE participants undertook brisk walking and cycling exercises at moderate intensity for 30 min, thrice weekly. Baseline and postintervention measurements included resting office, central, and 24-h ambulatory blood pressures.

Results:

Both IHG and AE interventions led to significant reductions in office and ambulatory systolic blood pressure compared to control group (P < 0.05 for both), with no marked difference in the magnitude of systolic blood pressure reductions between the two groups. Notably, the IHG group exhibited greater reductions in office, central, and ambulatory diastolic blood pressure compared to the AE group and control group.

Conclusion:

While both IHG and AE effectively lowered ambulatory systolic blood pressure, IHG demonstrated superior efficacy in reducing central and ambulatory diastolic blood pressure. Consequently, IHG training presents a promising alternative antihypertensive therapy for hypertensive participants over the age of 60.
Case Report and Literature Review of Exophiala dermatitidis Fungal Endocarditis in a Prosthetic Aortic Valve
Authors: Whittaker George , Killingley Charlotte , Hawes David , Eades Christopher , Mushtaq Roofa , Ray Simon , Nwaejike Nnamdi
Published: November 2024

Prosthetic valve endocarditis is a rare complication following surgical aortic valve replacement, accounting for a small fraction of all endocarditis cases. This complication is typically caused by bacterial pathogens and carries a high mortality rate. In rare cases, prosthetic valve endocarditis may be attributed to fungal organisms. We present the case of a 47-year-old woman who developed prosthetic valve endocarditis from a fungus known as Exophiala dermatitidis. Prosthetic valve endocarditis caused by this pathogen is extremely rare, with only 3 previously reported cases of prosthetic valve endocarditis attributed to this fungus since 1969. Review of the previous literature revealed an additional 3 cases originating in native aortic valves. These cases tended to occur in relatively young patients and those with risk factors for infective endocarditis such as immunosuppression and intravenous drug use. Septic emboli to various organs, particularly the brain and spleen, appear to be a complication of fungal endocarditis caused by this organism. Management can be difficult due to the lack of guidelines to treat such rare infective complications, but replacement of the infected valve and a prolonged course of antifungal therapy appear to be effective in some cases.
Non-Pneuomophila Legionnaires' Disease in Cancer Patients
Authors: Pearson Emily M. , Shah Shivan M. , Wesolow Jacqueline T. , Yasukawa Kosuke , Greene John N.
Published: November 2024

Non-pneumophila Legionella species are rare atypical bacterial pathogens that are responsible for a minority of Legionnaires' disease cases. Compared to Legionella pneumophila, they are more likely to infect immunosuppressed patients, such as those undergoing treatment for hematological cancers. This paper describes 3 cases of cancer patients who were effectively treated for pneumonia caused by non-pneumophila species, definitively identified via culture or microbial cell-free DNA (mcfDNA) analysis. This paper also compiles a list of other reported cases of cancer patients diagnosed with non-pneumophila Legionnaires' disease. Although diagnosis of pneumonia by a non-pneumophila Legionella species is challenging with currently available techniques, recommended antibiotic regimens are well established in the literature. Although they statistically appear to be uncommon pathogens, non-pneumophila Legionella species should be considered as possible causes when treating immunosuppressed patients with unspecified pneumonia.
Enhancing healthcare professionals' biopsychosocial perspective to chronic pain: assessing the impact of implementing an interdisciplinary training program
Authors: Munneke Wouter , De Kooning Margot , Nijs Jo , Morin Carine , Berquin Anne , Meeus Mira , Hartvigsen Jan , Demoulin Christophe
Published: November 2024

Advancements in clinical science have shown the necessity for a paradigm shift away from a biomedical toward a biopsychosocial approach. Yet, the translation from clinical science into clinical practice is challenging. The aim of this study was to assess the short-term and mid-term changes in pain knowledge and attitudes and guideline-adherent recommendations of healthcare professionals (HCP) by means of an interdisciplinary training program (ITP) about chronic pain. Belgian HCPs, with a priority for medical doctors, physiotherapists, occupational therapists, nurses, psychologists, and pharmacists in primary care, participated in the ITP, which contained 2 e-learning modules and two 7-hour workshops provided in small interdisciplinary groups in 5 cities. The objective of ITP was to improve HCP's competencies for integrating biopsychosocial chronic pain management with a cognitive behavioral approach into clinical practice. Primary outcomes were changes in knowledge and attitudes about pain and guideline-adherent recommendations for continuation of physical activity, sports, and work; avoiding bed rest; and not supporting opioid usage measured through 2 clinical vignettes. They were measured before, immediately after, and 6 months after the ITP. Changes were analyzed using (generalized) linear mixed models. A total of 405 HCPs participated. The knowledge and attitudes about pain scores improved at post-training (Δ = 9.04, 95% confidence interval 7.72-10.36) and at 6-month follow-up (Δ = 7.16, 95% confidence interval 5.73-8.59). After the training program, HCPs provided significantly more recommendations in accordance with clinical guidelines. Thus, an ITP can improve the biopsychosocial perspective of chronic pain management among HCPs in the short-term and mid-term.
Tobacco use, cirrhosis, and age are predictors of readiness to change and continued drinking following brief alcohol intervention in veterans
Authors: Harris Spencer C. , Al-Yassin Sarmed , Chaudhari Rahul B. , Gallagher Mary Leslie , Davis Brian C. , Malpaya Zenaida , Puri Puneet , Lemmons Joelle , Fuchs Michael , Bajaj Jasmohan S.
Published: November 2024

Alcohol use disorder is prevalent within the Veterans Health System, especially in patients being seen in hepatology clinics, and needs a point-of-care strategy. A brief alcohol intervention based on AUDIT-C (Alcohol Use Disorders Identification Test) may be needed for the management of hazardous alcohol intake, but feasibility is unclear. We aimed to define predictors of readiness to cease alcohol intake (0–10, 10 being ready to quit now) and continued drinking after using a brief alcohol intervention in veterans seen in hepatology clinics cross-sectionally and longitudinally over 6 months. A total of 414 men with liver disease (average age of 61 y old, 48% with cirrhosis, 31% with concomitant psychiatric conditions, 44% with tobacco use, and 14% with prior alcohol use disorder therapy) were approached. One hundred forty-four patients (35%) had a positive AUDIT-C (8.9 ± 4.0) and were given the brief intervention. Eighty of these patients (56%) had a high readiness to change, listing “wanting to improve health” and “prior success at reducing alcohol intake” as their most frequent reasons. On regression analysis, concomitant tobacco use was associated with a significantly lower readiness to quit alcohol score. On longitudinal follow-up at 6 months, 34 (23%) patients were still drinking. These patients were older and more likely to have concomitant diagnoses of cirrhosis and anxiety. Overall, we found that in a large cohort of veterans seen in hepatology clinics in routine practice, a brief intervention targeted at alcohol use is feasible. Older patients with concomitant tobacco use, cirrhosis, and anxiety may need more longitudinal attention to ensure that the initial interest in reducing problem drinking is sustained.
Primary clear cell adenocarcinoma of the seminal vesicle with ovarian homology: A rare case report
Authors: Yuan Yang , Li Yunlong , Zhang Shihao , Hu Dingli , Xu Song , Gu Tingting
Published: November 2024

Rationale:

Primary seminal vesicle adenocarcinoma is a rare type of male reproductive system tumor, primarily manifesting as papillary adenocarcinoma. Meanwhile, clear cell adenocarcinoma (CCA) is a common malignancy in the female reproductive system. Therefore, the occurrence of CCA in the seminal vesicle, showing ovarian homology, is even rarer. This pathological type of seminal vesicle cancer has been seldom reported.

Patient concerns:

A 43-year-old male patient presented to the outpatient clinic with a decade-long history of intermittent hemospermia accompanied by a 2-month sensation of dragging in the left lower abdomen. Following an MRI scan that indicated a seminal vesicle mass, he was admitted for further treatment.

Diagnosis:

The MRI revealed 2 abnormal signal mass lesions located between the left side of the pelvic cavity, the prostate, and the left seminal vesicle, primarily exhibiting long T1 and long T2 cystic characteristics. The CT scan with enhancement showed mixed density mass shadows in the left seminal vesicle area of the pelvic cavity, with mild arterial phase enhancement and continued enhancement in the portal phase. Physical examination revealed mild tenderness in the lower left abdomen. Digital rectal examination detected a hard mass above the left prostate, with no bloodstain on the glove, and no other significant abnormalities were observed. Routine urinalysis and biochemistry did not reveal any notable abnormalities. Tumor markers were all within normal ranges.

Interventions:

The tumor was completely excised laparoscopically and sent for pathological examination. Nine days postoperatively, the patient was successfully discharged.

Outcomes:

Postoperative pathology indicated primary CCA of the seminal vesicle. During a 20-month follow-up via telephone, the patient reported a generally good condition without significant discomfort.

Lessons:

CCA occurring in the seminal vesicle is extremely rare, and radical surgical excision is the primary treatment method.
Successful treatment for a patient with antiphospholipid syndrome and decreased protein S activity exacerbated by heparin-induced thrombocytopenia: A case report
Authors: Nishihara Masahiro , Nagae Hiroto , Otake Shimon , Asatani Shinya , Nagasawa Yosuke , Akiya Kumiko , Inomata Hirotake , Kitamura Noboru , Nakamura Hideki
Published: November 2024

Rationale:

Antiphospholipid antibody syndrome and protein S/C deficiency are diseases that are sometimes complicated by thrombus, and heparin-induced thrombosis (HIT) has also been reported.

Patient Concerns:

A male patient in his 60s with elevated D-dimer and superior mesenteric thrombus and portal vein thrombus underwent partial small intestine resection and thrombectomy. After administration of heparin, aortic thrombosis and pulmonary embolism occurred along with rapid thrombocytopenia.

Diagnosis:

The patient was diagnosed with HIT combined with protein S deficiency and antiphospholipid antibody syndrome.

Interventions and outcomes:

Heparin administration was discontinued, and plasma exchange with fresh frozen plasma replacement and argatroban administration were started. These treatments reduced D-dimer, restored platelet counts, and improved thrombosis.

Lessons:

Although HIT alone can cause severe arteriovenous thrombosis, our case suggests that it is important to search for the underlying procoagulant factors.
Development and validation of a nomogram for predicting postpartum hemorrhage in women with preeclampsia: A retrospective case-control study
Authors: Zheng Yihan , Zhang Li , Wu Xizhu
Published: November 2024

This retrospective case-control study aimed to develop a nomogram for predicting postpartum hemorrhage in women with preeclampsia. This study was carried out at the Fujian Maternity and Child Health Hospital, involving 542 preeclampsia patients who underwent vaginal deliveries. The participants were split into 2 groups: a training cohort (85%, n = 460) and a validation cohort (15%, n = 82). Least absolute shrinkage and selection operator regression was applied to pinpoint relevant risk factors by selecting appropriate candidate variables. Subsequently, multivariate logistic regression analysis was conducted on the training set, leading to the creation of a nomogram as a visual risk prediction tool. The model’s performance was tested and verified internally and externally by examining receiver operating characteristic curves and calibration curves. The correlation heatmap revealed collinearity among variables, necessitating the use of least absolute shrinkage and selection operator regression to select 4 candidate variables. Multivariate logistic regression analysis identified significant associations with the following outcomes: white blood cell count (odds ratio [OR]: 2.485, 95% confidence interval [CI]: 1.483–4.166), third stage of labor (OR: 1.382, 95% CI: 1.182–1.616), anemia (OR: 9.588, 95% CI: 4.022–22.854), and labor analgesia (OR: 0.187, 95% CI: 0.073–0.477). These variables were utilized to construct the nomogram. The receiver operating characteristic curves demonstrated good predictive performance (area under the curve train = 0.867, area under the curve test = 0.882), and the calibration curve yielded a C-index of 0.867. The nomogram created in this study has good sensitivity and specificity to assess risk and support clinical decision-making for postpartum hemorrhage in women with preeclampsia.
Height below 154 cm is a risk factor for pulmonary edema in twin pregnancy: An observational study
Authors: Wan Bingen , Hu Sheng , Wang Silin , Wei Yiping , Xu Jianjun , Zheng Qiaoling
Published: November 2024

In recent years, twin pregnancies have become increasingly common. The aim of our study was to analyze the exposure to risk factors for postpartum pulmonary edema in twin pregnancies. We get all our data from the “DATADRYAD” database, which is available directly. We used a variety of statistical methods, including multivariate logistic regression analysis and smoothed curve fitting. The aim was to critically assess the relationship between height and the occurrence of postpartum pulmonary edema in pregnant women with twin pregnancies. Among pregnant women whose height was <154 cm, the risk of postpartum development of pulmonary edema gradually decreased with increasing height (OR = 0.65, P = .0104). There was no relationship between maternal height and postpartum development of pulmonary edema among pregnant women with height higher than 154 cm (P = .9142). Pregnant women who were taller than 154 cm had a 76% lower risk of developing pulmonary edema postpartum compared to pregnant women whose height was lower than 154 cm (P = .0005). Our study suggests that pregnant women with twin pregnancies whose height is <154 cm are more likely to suffer from postpartum pulmonary edema. Therefore, healthcare professionals and caregivers should pay closer attention to twin pregnancies with heights below 154 cm, be alert to the occurrence of pulmonary edema, and take preventive and therapeutic measures as early as possible. This will help prevent the development of pulmonary edema.
Migraine and the correlation between stroke: A systematic review and meta-analysis
Authors: Zhao Weiming , Wang Dong , Tan Yujie , Yang Ji , Zhang Shuning
Published: November 2024

Background:

This study aims to analyze and evaluate the correlation between migraines and the onset of stroke, and further explore whether migraines increase the risk of stroke.

Methods:

Two researchers independently conducted a comprehensive search of Chinese biomedical literature databases (CBM disc), PubMed, Embase, Cochrane Library, and Web of Science databases, using a combination of subject terms and free words. Literature that met the inclusion and exclusion criteria was selected, and quality assessment was performed using The Newcastle–Ottawa Scale (NOS). Data necessary for the study were extracted as effect size as needed, and meta-analysis was conducted using Review Manager 5.4 software and Stata 16 software to calculate the combined odds ratio and its 95% confidence interval. The relevant data were analyzed, and publication bias was evaluated.

Results:

After conducting a meta-analysis of the 9 final included articles, the heterogeneity test showed chi2 = 10.7, df = 8 (P = .22), I
2 = 25%. Therefore, a fixed-effect model was used for analysis. The combined odds ratio (OR) for the risk of stroke in migraine patients compared to non-migraine patients was 2.04, with a 95% confidence interval [1.73, 2.4], which was statistically significant. In the analysis of migraine with aura, the respective ORs were 2.32 with a 95% CI of [1.70–3.18] and 1.77 with a 95% CI of [1.34–2.33]. Subgroup analysis of female migraine patients and young migraine patients showed statistically significant results, with ORs of 2.26 (95% CI [1.67–3.05]) and 2.39 (95% CI [1.9–3.01]), respectively. The relevant literature and results were evaluated for publication bias and assessed using the NOS, indicating the reliability of the results.

Conclusion:

The results of the meta-analysis indicate that there is a certain relationship between migraine and the onset of stroke, and the results are relatively reliable. The analysis of migraine with aura shows that both the presence and absence of aura are associated with an increased risk of stroke. Subgroup analysis based on gender and age shows that the increased risk of stroke is associated with females and young individuals. However, due to the limited data in subgroup analysis, the above conclusions still require further research for validation.
Concurrent Guillain–Barre/acute transverse myelitis overlap syndrome after COVID-19 infection in a patient with ITP: A case report
Authors: Chen Ruomeng , Wang Liang , Wang Binbin , Song Xiujuan , Liu Xiaoyun
Published: November 2024

Rationale:

Patients with chronic immune diseases, such as idiopathic thrombocytopenic purpura (ITP), should be alert for Guillain–Barre/acute transverse myelitis (GBS/ATM) overlap syndrome after infection with coronavirus disease 2019 (COVID-19).

Patient concerns:

A 65-year-old male with an ITP history, who presented with limb numbness and weakness, urinary retention, right peripheral facial paralysis, and diplopia 2 weeks after being diagnosed with COVID-19.

Diagnosis:

GBS/ATM overlap syndrome secondary to COVID-19.

Interventions:

Five days intravenous immune globulin, methylprednisolone (500 mg) was added for treatment. He was discharged with medicine and continued to take Methylprednisolone tablets (60 mg/d), Eltrombopag olamine (25 mg 1/d), Mecobalamine tablets, vitamin B1, and rehabilitation treatment outside the hospital.

Outcomes:

The patient significantly improved after initial treatment, he returned to normal life after 8 weeks. Five months later, he was infected with COVID-19 for the second time, exhibiting only symptoms of upper respiratory tract infection and no other discomfort.

Lessons:

COVID-19 infection can lead to secondary myelitis and GBS, and GBS/ATM overlap syndrome is rare, but patients are significantly better after immunization and hormone therapy.
Diagnostic accuracy and image quality evaluation of ultrashort echo time MRI in the lungs
Authors: Wang Funan , Li Xiaoxia , Lin Chong , Zhu Liuhong
Published: November 2024

This study evaluates the diagnostic accuracy of ultrashort echo time (UTE)-MRI for detecting pulmonary nodules and image quality. A total of 46 patients at our hospital underwent unenhanced computed tomography (CT) and UTE-MRI. The image quality and number of nodules detected using CT were used as the gold standards. Three diagnostic radiologists independently recorded the image quality (visibility and sharpness of normal anatomical structures) of the CT and UTE images and the number of pulmonary nodules detected. The diagnostic accuracy, subjective image quality, and consistency between observations were statistically analyzed. Among 46 patients, 36 (78.2%) had pulmonary nodules on CT images, whereas 10 patients (21.7%) had no pulmonary nodules. A total of 48 lung nodules were detected, 3 of which were ground-glass opacities. UTE-MRI revealed 46 lung nodules. Compared with CT, the sensitivity of all MRI readers for detecting lung lesions was 95.8%, and the 3-observer agreement was nearly perfect (P < .001, Kendall Wa [Kender Harmonious Coefficient] = 0.913). The overall image quality score of the observers was high, ranging from good to excellent, and the consistency of the subjective UTE-MRI image quality was good (Kendall Wa = 0.877, P < .001). For tracheal display, the subsegment of the bronchus was displayed, and the wall of the tube was clearly displayed. The difference in the Wa values between the observers was 0.804 (P < .001), indicating strong consistency. For blood vessels, subsegment blood vessels could also be displayed with clear walls and uniform signals (Kendal Wa = 0.823, P < .001), indicating strong consistency. Compared to CT, UTE-MRI can detect pulmonary nodules with a high detection rate, relatively good image quality, and strong consistency between observers. The development of UTE-MRI can provide a novel imaging method for the detection and follow-up of pulmonary nodules and diagnosis of pneumonia by reducing ionizing radiation.
The effect of psychological intervention on the quality of life and rehabilitation outcome of stroke patients with anxiety and depression: A systematic review
Authors: Zhao Bingquan , Yao Yanyun , Gao Ting
Published: November 2024

Background:

To systematically evaluate the effects of psychological interventions on the quality of life and rehabilitation efficacy of patients with poststroke anxiety and poststroke depression.

Methods:

All randomized controlled trials of psychological interventions for the treatment of patients with poststroke anxiety combined with poststroke depression in China National Knowledge Infrastructure, Wan Fang Database, the Chongqing VIP Chinese Science and Technology Periodical Database (VIP), Chinese Biomedical Literature Database, Cochrane Library, Embase, Web of Science, and PubMed were searched. Literature was screened according to inclusion and exclusion criteria, systematic evaluation, and meta-analysis were performed using revman5.0 software.

Results:

Seventeen randomized controlled trials were included, which showed that the psychological intervention group was more effective than the control group in reducing anxiety and depression and improving patients’ ability to perform daily life and quality of life. Subgroup analyses were performed according to intervention time and assessment scale, and the results showed that the intervention group was more effective in reducing anxiety and depression.

Conclusion:

Psychological interventions can improve the ability of patients with stroke combined with anxiety and depression to perform their daily lives, improve their quality of life, reduce their levels of depression and anxiety, and improve functional impairment. The registration number in PROSPERO is CRD42023325594 (http://www.crd.york.ac.uk/PROSPERO/).
Large inferior vena cava thrombosis in a 25-year-old female patient: A case report
Authors: Yang Jiyoul , Bae Dae-Hwan , Yang Bumhee , Bak Minjung , Shin Yoon Mi
Published: November 2024

Rationale:

The incidence of venous thromboembolism is increasing, and it is more common in older than in younger patients. Inferior vena cava (IVC) thrombosis is a rare subtype of deep vein thrombosis, and it is associated with a high incidence of arterial and venous thrombosis in patients with systemic lupus erythematosus (SLE). We present the case of a 25-year-old female patient with a large IVC thrombosis caused by SLE that was intractable to thrombolytic therapy.

Patient concerns:

A 25-year-old previously healthy female patient presented to the emergency department with a 5-day history of fever.

Diagnoses:

Her computed tomography revealed a large thrombus with an approximate length 25 cm extending from the suprarenal IVC to the right common iliac vein and the left external and internal iliac veins.

Interventions:

We decided to perform intravenous thrombolysis (alteplase 65 mg) because of the massive thrombus burden followed by an infusion of intravenous heparin. However, the size of the thrombus did not showed reduction 3 days after treatment. For the next step, the catheter-directed thrombolysis (CDT) was performed; however, no changes were observed.

Outcomes:

She was diagnosed with SLE, and the large IVC thrombus gradually improved after primary treatment for SLE, including immunosuppressive drugs combined with anticoagulant.

Lessons:

We found a large IVC thrombus secondary to SLE in a young female patient. In this case, systemic thrombolysis or CDT did not improve the thrombus. The thrombus only improved after immunosuppressive treatment for SLE. Our case highlights the importance of treatment for etiologic disease in an intractable thrombosis developed by provoked cause.
What is the ideal thyroid-stimulating hormone (TSH) threshold value in congenital hypothyroidism screening? Twin study
Authors: Kurt Fatih , Olcay Oz Busra , Kaya Abdulkadir , Kocabay Kenan
Published: November 2024

Congenital hypothyroidism is the most common preventable cause of intellectual disability. Therefore, the majority of developed countries have aimed to diagnose cases early through screening programs. In these screening programs, levels of thyroid-stimulating hormone (TSH) and free thyroxine are examined in dried blood spots taken between days 3 and 5 of life. While many countries accept TSH threshold value of 8 mU/L, there is still no consensus on the ideal TSH threshold value. As no twin studies on the TSH threshold value have been conducted previously, this study was planned. Eight pairs of twins were included in the study, with one of the twins having plasma TSH value ≥8 mU/L and the other <8 mU/L, measured between days 3 and 5 of life. The study aimed to investigate whether determining threshold TSH value of 8 mU/L would be beneficial by comparing somatic growth, mental development, and neuromotor development between twins. The age, gender, gestational weeks, birth weights, height, weight, and initial TSH values taken between days 3 and 5 of all cases were recorded. The patients’ plasma Vitamin B12, folate, 25-OH Vitamin D, ferritin, and hemoglobin levels were measured. After that, they were evaluated by a child and adolescent psychiatry. Finally, the Denver Developmental Test was applied to the cases. There was no significant impairment in somatic growth, mental development, and neuromotor development in the long-term outcomes of cases with plasma TSH ≥ 8 mU/L compared to those with plasma TSH < 8 mU/L among the twins participating in our study.
Global research hotspots and trends of Buyang huanwu decoction: A visual analysis of the literature based on CiteSpace
Authors: Li Bowen , Du Maobo , Gao Weijuan
Published: November 2024

Background:

Buyang huanwu decoction (BYHWD) has shown significant clinical efficacy in the treatment of several diseases, particularly stroke. However, bibliometric research has not been comprehensive.

Methods:

BYHWD articles were collected from literature databases published from January 1, 1915, to March 31, 2024, including the China National Knowledge Infrastructure, Weipu, Wanfang, Pubmed, Scopus, and Web of Science Core Collection. Knowledge network graphs of annual publication volume, authors, institutions, countries, keywords, and references were constructed.

Results:

Nine thousand two hundred thirty-eight Chinese literature and 559 English articles published between 1915 and 2024 showed an overall upward trend. The countries, institutions, journals, and authors with the highest output were China, Hunan University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangxian Cai, and Changqing Deng, respectively. Research teams outside China were located at Daejeon University, Gachon University, Aga Khan University, Yale University, etc. The results of keyword co-occurrence and burst analysis included clinical applications, animal experiments, action mechanisms, clinical efficacy, and safety evaluations based on systematic reviews and meta-analyses. Literature co-citation analysis revealed that BYHWD was highly correlated with neuroprotection and reduction of cerebral ischemia/reperfusion injury.

Conclusion:

Both Chinese and English literature have shown overall growth trend since 1984 and 1989, respectively. Clinical applications, pharmacological effects, mechanisms, active ingredients, evaluation of clinical efficacy and safety, modified BYHWD, methods, and biological techniques may be hotspots and focus of future research on BYHWD. Hotspot analytical methods and biological techniques include systematic reviews, meta-analyses, data mining, network pharmacology, and molecular docking. Future valuable research fields may include studies on neuroprotection, anti-inflammatory activity, ischemic stroke, bioactive compounds, and their underlying mechanisms.