bluuebunny/crossref_metadata_2025 huggingface dataset:
Chylothorax in the Setting of Lung Malignancy
Authors: Vangara Avinash , Haroon Moeez , Kalafatis Kathleen , Kolagatla Sandhya , Ganti SubramanyaShyam , Prevatt Opal
Published: August 2023

Chylothorax refers to chyle within the pleural space, which frequently arises from an interruption in the thoracic duct or because of reduced lymphatic drainage. Pleural fluid that is white/milky in appearance, with a triglyceride concentration of greater than 110 mg/dL, strongly supports the diagnosis of chylothorax. Chylothorax is nearly always exudative. Transudative chylothorax is extremely rare and typically presents due to a secondary cause, such as liver cirrhosis, nephrotic syndrome, or congestive heart failure. We present a case of chylothorax that occurs in the setting of lung adenocarcinoma. A 65-year-old African American man with a past medical history of metastatic right lung adenocarcinoma presented with dyspnea and palpitations. He denied fever, orthopnea, and paroxysmal nocturnal dyspnea. Therapeutic drainage of the left pleural effusion resulted in 650 mL of milky-white fluid. Pleural fluid analysis demonstrated a triglyceride concentration of 520 mg/dL, a pleural/serum protein ratio of 0.41, a pleural/serum lactate dehydrogenase (LDH) ratio of 0.26, a total pleural LDH of 127 IU/L, and a cholesterol level of 58 mg/dL. This effusion can be classified as transudative as per Light’s criteria and exudative as per Heffner’s and pleural cholesterol criteria. A subsequent pleural fluid cytology found malignant cells consistent with lung adenocarcinoma. Malignancy is the most common cause of nontraumatic, exudative chylothorax. Light’s criteria misinterpret about 25% of transudative effusions as exudative. Therefore, to minimize this error, a combination of the 3-criterial consideration is ideal.
Cholesterol Granuloma of the Breast Mimicking Cancer: A Case Report and Review of the Literature
Authors: Lahbacha Bahaeddine , Chaabane Abir , Chelly Beya , Douggaz Amel , Mfarrej Mohamed Karim , Jbir Ichraf , Nechi Salwa , Chelbi Emna
Published: August 2023

Cholesterol granuloma of the breast is an infrequent benign lesion with clinical and radiological findings suggestive of cancer. Herein, we present the case of a 52-year-old woman with no significant past medical history, who presented to the outpatient department for her routine breast screening. Physical examination revealed a painless palpable nodule in the upper external quadrant of the left breast, measuring 0.7 cm. On imaging, the mass met the criteria for Breast Imaging Reporting and Data System (BI-RADS) category 4B. Subsequently, a core needle biopsy of the mass was performed. Despite the alarming radiologic features, microscopic findings were consistent with breast cholesterol granuloma.
Hip Arthroscopy for Femoroacetabular Impingement
Authors: Gwathmey F. Winston , Raghuwanshi Jasraj
Published: August 2023

Background:

Femoroacetabular impingement (FAI) is pain due to shape mismatch at the hip joint commonly affecting young athletes, and there are 2 main types depending on which bone has the underlying deformity: cam (femoral) and pincer (acetabular). Hip arthroscopy is an invaluable technique in the sports surgeon repertoire, and there is a need for a comprehensive tutorial that elucidates the best practices and nuances.

Indications:

Pain with evidence of FAI and labral tear on imaging, and failing conservative treatment, warrants arthroscopy.

Technique Description:

FAI surgery requires anatomical labral repair, thorough osteoplasty to correct the underlying deformity and prevent labral retearing, and careful treatment of soft tissues and capsular closure.

Results:

Reduced pain and improved hip function are the goals of treatment, with approximately 90% of patients returning to sport at 6 to 8 months postoperatively.

Discussion/Conclusion:

Hip arthroscopy is a safe and effective treatment for patients with FAI who failed conservative therapy.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Partial versus radical nephrectomy in pT2a renal cell carcinoma tumors: which is the superior surgical approach?
Authors: Basiri Abbas , Salehi Omran Hossein , Zahir Mazyar , Shakhssalim Nasser , Borumandnia Nasrin , Noghabaei Giti , Parvin Mahmoud
Published: August 2023

Background

Controversy persists regarding the superiority of partial nephrectomy (PN) versus radical nephrectomy (RN) in pT2a renal cell carcinoma (RCC) tumors. In this study we aimed to compare survival and clinical outcomes between these two techniques in Iran.

Methods

In this retrospective cohort, 96 patients who underwent either RN or PN for their pT2a RCC tumors were included. Overall survival (OS), cancer specific survival (CSS), recurrence free survival (RFS), major postoperative complications and postoperative renal function were compared, subsequently.

Results

During a mean follow-up time of 57.3 ± 24.0 months, OS, CSS, RFS, postoperative bleeding, postoperative urinary leak, postoperative prolonged wound drainage and length of hospital stay were not statistically different between RN versus PN patients (p = .09, .42, .09, .27, .27, .06 and .78, respectively). Nevertheless, post-operative creatinine was significantly lower in PN patients compared to RN patients (p = .01). Our multivariable cox regression models indicated that higher Fuhrman grade detrimentally affected CSS (p < .01) and increased the risk of recurrence (p = .02). Moreover, prior history of ischemic heart disease (IHD) was a significant determinant of lower OS (p = .03) and RFS (p = .02).

Conclusions

In conclusion, our data suggested that although OS, CSS, RFS and major postoperative complications were similar between PN and RN, PN may offer better postoperative renal function and can be thus regarded as the superior approach in pT2a tumors.
Effects of fungicides on aquatic fungi and bacteria: a comparison of morphological and molecular approaches from a microcosm experiment
Authors: Salis Romana K. , Schreiner Verena C. , Rozenberg Andrey , Ohler Katharina , Baudy-Groh Patrick , Schäfer Ralf B. , Leese Florian
Published: August 2023

Background

Fungicides are frequently used in agriculture and can enter freshwater ecosystems through multiple pathways. The negative impacts of fungicides on microorganisms, fungi in particular, and their functions such as leaf decomposition have been repeatedly shown. In our previous microcosm experiment with three consecutive cycles of fungicide exposure and colonisation of leaf substrate, we found clear functional changes, but no differences in fungal community structure could be detected using morphological identification by analysing the spores of aquatic hyphomycetes. In this study, we examined the effects on fungal and bacterial community composition in detail using ITS and 16S metabarcoding and comparing the results to morphologically assessed community composition.

Results

While we found fewer species with metabarcoding than with morphological identification, metabarcoding also enabled the identification of several fungal species that were otherwise unidentifiable morphologically. Moreover, by distinguishing individual amplicon sequence variants (ASVs) metabarcoding provided greater taxonomic resolution. In line with the morphological results, metabarcoding neither revealed effects of fungicides on the aquatic hyphomycetes nor on the total fungal or bacterial community composition. However, several ASVs responded significantly to fungicides, demonstrating variable tolerances within species.

Conclusions

Overall, the absence of detectable effects of fungicides on the community structure despite clear functional effects, suggests a complex relationship between community structure and the ecosystem function of leaf decomposition.
estimateR: an R package to estimate and monitor the effective reproductive number
Authors: Scire Jérémie , Huisman Jana S. , Grosu Ana , Angst Daniel C. , Lison Adrian , Li Jinzhou , Maathuis Marloes H. , Bonhoeffer Sebastian , Stadler Tanja
Published: August 2023

Background

Accurate estimation of the effective reproductive number ($$R_e$$Re) of epidemic outbreaks is of central relevance to public health policy and decision making. We present estimateR, an R package for the estimation of the reproductive number through time from delayed observations of infection events. Such delayed observations include confirmed cases, hospitalizations or deaths. The package implements the methodology of Huisman et al. but modularizes the$$R_e$$Reestimation procedure to allow easy implementation of new alternatives to the currently available methods. Users can tailor their analyses according to their particular use case by choosing among implemented options.

Results

The estimateR R package allows users to estimate the effective reproductive number of an epidemic outbreak based on observed cases, hospitalization, death or any other type of event documenting past infections, in a fast and timely fashion. We validated the implementation with a simulation study: estimateR yielded estimates comparable to alternative publicly available methods while being around two orders of magnitude faster. We then applied estimateR to empirical case-confirmation incidence data for COVID-19 in nine countries and for dengue fever in Brazil; in parallel, estimateR is already being applied (i) to SARS-CoV-2 measurements in wastewater data and (ii) to study influenza transmission based on wastewater and clinical data in other studies. In summary, this R package provides a fast and flexible implementation to estimate the effective reproductive number for various diseases and datasets.

Conclusions

The estimateR R package is a modular and extendable tool designed for outbreak surveillance and retrospective outbreak investigation. It extends the method developed for COVID-19 by Huisman et al. and makes it available for a variety of pathogens, outbreak scenarios, and observation types. Estimates obtained with estimateR can be interpreted directly or used to inform more complex epidemic models (e.g. for forecasting) on the value of$$R_e$$Re.
Comprehensive analysis of m6A regulators and relationship with tumor microenvironment, immunotherapy strategies in colorectal adenocarcinoma
Authors: Ji Jian , Liu Shichao , Liang Yongyuan , Zheng Guixi
Published: August 2023

Background

The N6-methyladenosine (m6A) RNA modification is the most prevalent and abundant type found in eukaryotic cells. It plays a crucial role in the initiation and progression of cancers. In this study, we aimed to comprehensively investigate the landscape of m6A regulators and their association with tumor microenvironment (TME), immunotherapeutic strategies in colon adenocarcinoma (COAD).

Results

The differential expression, mutation, CNV frequency and prognostic value of 27 m6A regulators were systematically analyzed in COAD. Patients were classified into two clusters based on m6A regulators through consistent clustering analysis, with cluster A showing significant survival benefits. Most of the m6A regulators were negatively correlated with immune cells, except for WTAP, IGF2BP3, FTO, ALKBH5, which showed a positive correlation. We developed an m6A scoring system to calculate the m6Ascore for each patient. Patients with a high-m6Ascore had a better outcome, with the AUC of 0.775. An independent cohort of 416 COAD patients acquired from GSE38832 database was used to validate the prognosis prediction ability of m6Ascore. Moreover, the m6Ascore was negatively correlated with infiltration of anti-tumor immune cells. Additionally, patients with a high-m6Ascore responded better to anti-PD1 and anti-CTLA4 therapies, and those with MSI-H had a higher m6Ascore. Finally, we investigated the value of m6Ascore in predicting the response of patients to 15 commonly used drugs.

Conclusions

We comprehensively analyzed m6A regulators in COAD, including RNA expression, CNV changes, mutations and their correlation with TME. Our results showed that the m6A scoring system had significant predictive power for the prognosis of COAD patients, potentially leading to new personalized immunotherapy strategies.
Assessment of renal function indexes in methamphetamine or tramadol intoxication adults to the emergency departments: a systematic review and meta-analysis
Authors: Amanollahi Alireza , Mehrabi Yadollah , Sedighi Mohsen , Basir Ghafouri Hamed , Zahedi Amir , Shadnia Shahin , Etemad Koorosh
Published: August 2023

Background

Renal dysfunction is one of the adverse effects observed in methamphetamine (MET) or tramadol abusers. In this study, we aimed to review articles involving intoxication with MET or tramadol to assess the occurrence of renal dysfunction.

Methods

Two researchers systematically searched PubMed, Scopus, Web of Sciences, and Google Scholar databases from 2000 to 2022. All articles that assessed renal function indexes including creatine, Blood Urea Nitrogen (BUN), and Creatine phosphokinase (CPK) in MET and tramadol intoxication at the time of admission in hospitals were included. We applied random effect model with Knapp-Hartung adjustment for meta-analysis using STATA.16 software and reported outcomes with pooled Weighted Mean (WM).

Results

Pooled WM for BUN was 29.85 (95% CI, 21.25–38.46) in tramadol intoxication and 31.64(95% CI, 12.71–50.57) in MET intoxication. Pooled WM for creatinine in tramadol and MET intoxication was respectively 1.04 (95% CI, 0.84–1.25) and 1.35 (95% CI, 1.13–1.56). Also, pooled WM for CPK was 397.68(376.42-418.94) in tramadol and 909.87(549.98-1269.76) in MET intoxication. No significance was observed in publication bias and heterogeneity tests.

Conclusion

Our findings showed that tramadol or MET intoxication is associated with a considerably increased risk of renal dysfunction that may result in organ failure.
Conducting the non-inferiority test for the means with unknown coefficient of variation in a three-arm trial
Authors: Lee Meng-Chih , Wu Wei-Ya , Lu Hung-Yi , Hsieh Hsin-Neng , Wu Wei-Hwa
Published: August 2023

Background

The non-inferiority test is a reasonable approach to assessing a new treatment in a three-arm trial. The three-arm trial consists of a placebo, reference, and an experimental treatment. The non-inferiority is often measured by the mean differences between the experimental and the placebo groups relative to the mean differences between the reference and the placebo groups.

Methods

To cope with possible estimation distortion due to the allowance of heteroskedasticity, we adjust the measurement of non-inferiority by the incorporation of coefficient of variation (CV) of the experimental, the reference and the placebo groups. In this research, we propose a generalized $$p$$
p
-value based method (GPV-based method) to facilitate non-inferiority tests for the means with unknown coefficient of variation in a three-arm trial.

Results

The simulation results show that the GPV-based method can not only adequately control type I error rate at nominal level better but also provide power higher than those from Delta method and the empirical bootstrap method, which verifies the feasibility of our adjustment.

Conclusions

We revise the measurement of non-inferiority by deducting the CV of each kind of treatment from the average effect of trials. CVs are included in the non-inferiority explicitly to help prevent possible estimating distortion if heteroskedasticity is allowed. Through the simulation study, the performance of GPV-based method for facilitating non-inferiority tests for the means with unknown CV in a three-arm trial is better than those from empirical bootstrap method and Delta method for small, medium and large sample sizes. Hence, the GPV-based method is recommended to be used to conduct the non-inferiority test for the means with unknown CV in a three-arm trial. The GPV-based method still performs well in non-normality cases.
Sevoflurane inhibits cholangiocarcinoma via Wnt/β-catenin signaling pathway
Authors: Cheng Hui , Li Qinfang
Published: August 2023

Background

Cholangiocarcinoma (CCA) is a refractory malignancy derived from bile duct epithelial cells. This study aimed to explore the role and molecular mechanisms of action of sevoflurane in CCA.

Methods

CCK-8 assay was used to assess the proliferation of cholangiocarcinoma cells, and flow cytometry was used to detect cholangiocarcinoma cell apoptosis. The effects of sevoflurane on TFK1 and QBC939 cell migration and invasion were investigated using a Transwell assay. Western blotting and RT-qPCR were used to assess the expression of apoptosis-related proteins and genes, and gene expression of the Wnt/β-catenin signaling pathway.

Results

Our study found that sevoflurane inhibited cholangiocarcinoma cell proliferation in a dose-dependent manner. In addition, sevoflurane induced cholangiocarcinoma cell apoptosis, inhibited cholangiocarcinoma cell migration and invasion, as well as the Wnt/β-catenin signaling pathway evidenced by decreased Wnt3a, β-catenin, c-Myc, and Cyclin D1 protein and mRNA expression, reduced p-GSK3β protein expression and p-GSK3β/GSK3β ratio. Further mechanistic studies revealed that Wnt/β-catenin pathway inducer SKL2001 reversed the inhibitory effect of sevoflurane on cholangiocarcinoma cells.

Conclusions

Sevoflurane induces apoptosis and inhibits the growth, migration, and invasion of cholangiocarcinoma cells by inhibiting the Wnt/β-catenin signaling pathway. This study not only revealed the role of sevoflurane in the development of CCA but also elucidated new therapeutic agents for CCA.
Magnetic-controlled capsule endoscopy performance in aging patients
Authors: Li Jiaxin , Li Li , Li Yueyuan , Chen Long , Liang Rongyue , Liu Meilin , Jiao Hongmei
Published: August 2023

Background

The increasing elderly population and wide use of magnetic capsule endoscopy (MCE) have led to more attention to elderly patients.

Aim

The aim of this study was to assess the performance (including transit time, cleanliness score, positive findings and safety) of MCE in aging patients (≥ 60 years), especially patients over 80 years old.

Methods

Consecutive patients of ≥ 60 years undergoing MCE at our center from August 2017 to August 2022 were classified into the oldest (≥ 80 years) and the older (60–79 years) groups. Esophageal transit time (ETT), gastric examination time (GET), small bowel transit time (SITT), and the quality of gastric preparation were compared. Information on examination indications, subjective discomforts, adverse events, and MCE outcomes were compared.

Results

Of 293 enrolled patients, 128 patients were in the oldest group and 165 patients were in the older group. ETT and GET were longer in the oldest group, whereas SITT was slightly longer in the oldest patients. Visualization scores were significantly lower in the body and antrum in the oldest patients. The total visualization score was lower in the older group compared with the oldest group; however, the difference was not significant. Cleanliness scores at the fundus and antrum and total cleanliness scores were lower in the oldest patients compared with the older patients. Positive findings and ulcers and erosions in the small intestine were more common in the oldest group. One patient had nausea during the gastric examination. Capsule retention in the cecum occurred in one case.

Conclusion

MCE was feasible and safe for aging patients. ETT and GET were markedly longer and gastric cleanliness and visualization were worse, while overall small intestine-positive findings were higher in the oldest patients compared with the older patients.
Virtual home visits during COVID-19 pandemic: mothers’ and home visitors’ perspectives
Authors: Al-Taiar Abdullah , Kekeh Michele A. , Ewers Stephanie , Prusinski Amy L. , Alombro Kimberly J. , Welch Nancy
Published: August 2023

Background

The experiences of mothers enrolled in Maternal, Infant and Early Childhood Home Visiting (MIECHV) program with virtual home visiting (VHV) during the pandemic remain mostly unknown. This study aimed to describe in detail the experience of home visitors and mothers with VHV during COVID-19 pandemic. This is a prerequisite for guiding future efforts to optimize MIECHV services that are provided through virtual operation.

Methods

Focus groups discussion were conducted with home visitors (n = 13) and mothers (n = 30) who were enrolled in BabyCare program in Virginia from January 2019 to June 2022. This included mothers who received in-person home visiting (IPHV), VHV, or both (hybrid IPHV and VHV). Inductive analysis was used to identify emergent themes from the transcripts, then coding was conducted following a codebook that was developed by the research team.

Results

Both mothers and home visitors considered IPHV necessary for a proper assessment of developmental milestones of children, for the assessment of the growth of the child through measuring the weight and height/length of the child, for the mothers to open up and discuss sensitive issues like domestic violence, for building a relationship between home-visitor and the parents, and for other potential benefits (comprehensive assessment of the environment around the child inside and outside the house from home visitors’ perspective and detecting abnormal health conditions in children from mothers’ perspective). Both mothers and home visitors see that VHV has some role to play but not to be a replacement for IPHV. If VHV is to be used, video conference is preferred by both mothers and home visitors, as it allows for some assessment.

Conclusion

Mothers and nurses considered IPHV critical for proper and comprehensive assessment of the child and the family and also essential to build the nurse-client relationship. Both mothers and home visitors considered VHV supplementary to IPHV that can be used from time to time particularly with busy mothers. VHV may have little room with parents with intellectual disabilities and the difficulty in dealing with technology seems to be no longer a major issue.
Radiotherapy in bone sarcoma: the quest for better treatment option
Authors: Locquet Marie-Anaïs , Brahmi Mehdi , Blay Jean-Yves , Dutour Aurélie
Published: August 2023

Bone sarcomas are rare tumors representing 0.2% of all cancers. While osteosarcoma and Ewing sarcoma mainly affect children and young adults, chondrosarcoma and chordoma have a preferential incidence in people over the age of 40. Despite this range in populations affected, all bone sarcoma patients require complex transdisciplinary management and share some similarities. The cornerstone of all bone sarcoma treatment is monobloc resection of the tumor with adequate margins in healthy surrounding tissues. Adjuvant chemo- and/or radiotherapy are often included depending on the location of the tumor, quality of resection or presence of metastases. High dose radiotherapy is largely applied to allow better local control in case of incomplete primary tumor resection or for unresectable tumors. With the development of advanced techniques such as proton, carbon ion therapy, radiotherapy is gaining popularity for the treatment of bone sarcomas, enabling the delivery of higher doses of radiation, while sparing surrounding healthy tissues. Nevertheless, bone sarcomas are radioresistant tumors, and some mechanisms involved in this radioresistance have been reported. Hypoxia for instance, can potentially be targeted to improve tumor response to radiotherapy and decrease radiation-induced cellular toxicity. In this review, the benefits and drawbacks of radiotherapy in bone sarcoma will be addressed. Finally, new strategies combining a radiosensitizing agent and radiotherapy and their applicability in bone sarcoma will be presented.
Prehabilitation in the lung cancer pathway: a scoping review
Authors: Wade-Mcbane Kelly , King Alex , Urch Catherine , Jeyasingh-Jacob Julian , Milne Andrew , Boutillier Clair Le
Published: August 2023

Background

Lung cancer is the third most common type of cancer in the UK. Treatment outcomes are poor and UK deaths from lung cancer are higher than any other cancer. Prehabilitation has shown to be an important means of preparing patients both physically and psychologically for cancer treatment. However, little is understood about the context and mechanisms of prehabilitation that can impact physiological and psychological wellbeing.

Our aim was to review and summarise primary research on prehabilitation in the lung cancer pathway using a realist approach.

Methods

A scoping review of empirical primary research was conducted. Five online medical databases from 2016 – February 2023 were searched. All articles reporting on prehabilitation in lung cancer were included in the review. For this review, prehabilitation was defined as either a uni-modal or multi-modal intervention including exercise, nutrition and/or psychosocial support within a home, community or hospital based setting. A realist framework of context, mechanism and outcome was used to assist with the interpretation of findings.

Results

In total, 31 studies were included in the review, of which, three were published study protocols. Over 95% of studies featured an exercise component as part of a prehabilitation programme. Twenty-six of the studies had a surgical focus. Only two studies reported using theory to underpin the design of this complex intervention. There was large heterogeneity across all studies as well as a lack of clinical trials to provide definitive evidence on the programme design, setting, type of intervention, patient criteria, delivery, duration and outcome measures used.

Conclusion

A standardised prehabilitation programme for lung cancer patients does not yet exist. Future lung cancer prehabilitation programmes should take into account patient led values, needs, goals, support structures and beliefs, as these factors can affect the delivery and engagement of interventions. Future research should consider using a conceptual framework to conceptualise the living with and beyond cancer experience to help shape and inform personalised prehabilitation services.
First-line induction chemotherapy with high-dose methotrexate versus teniposide in patients with newly diagnosed primary central nervous system lymphoma: a retrospective, multicenter cohort study
Authors: Zhong Kaili , Shi Yanyan , Gao Yuhuan , Zhang Huilai , Zhang Mingzhi , Zhang Qiaohua , Cen Xinan , Xue Mei , Qin Yan , Zhao Yu , Zhang Liling , Liang Rong , Wang Ningju , Xie Yan , Yang Yu , Liu Aichun , Bao Huizheng , Wang Jingwen , Cao Baoping , Zhang Wei , Zhang Weijing
Published: August 2023

Background

This study aimed to compare the efficacy and safety of high-dose methotrexate (HD-MTX) versus teniposide (TEN) in patients with newly diagnosed immunocompetent primary central nervous system lymphomas (PCNSLs).

Methods

The study included immunocompetent, adult patients with newly diagnosed PCNSL at 22 centers in China from 2007 to 2016. The patients received HD-MTX or TEN as first-line induction therapy. The objective response rate, progression-free survival, and overall survival were analyzed for each patient cohort.

Results

A total of 96 patients were eligible: 62 received HD-MTX, while 34 received teniposide. The overall response rate was 73.2% and 72.7% in the MTX and the TEN cohorts, respectively (P = 0.627). The median progression-free survival was 28.4 months [95% confidence interval (CI): 13.7–51.2] in the MTX cohort and 24.3 months (95% CI: 16.6–32.1) in the TEN cohort (P = 0.75). The median overall survival was 31 months (95% CI: 26.8–35.2) in the MTX cohort and 32 months (95% CI: 27.6–36.4) in the TEN cohort (P = 0.77). The incidence of any grade of coagulopathy/deep-vein thrombosis and gastrointestinal disorders was significantly higher in the MTX cohort than in the TEN cohort; no significant difference was found in the incidence of other adverse events between the two cohorts.

Conclusions

This was the first multicenter study using TEN as the main agent compared with HD-MTX in newly diagnosed primary CNS lymphoma. The TEN-based regimen was non-inferior to the HD-MTX-based regimen with similar overall responses.

Classification of evidence

This study provided Class III evidence that the teniposide-based regimen was non-inferior to high-dose methotrexate − based regimen with similar overall responses and long-time survival in immunocompetent patients with PCNSL.
Acceleration of sarcopenia in elderly patients who develop asymptomatic pneumonia shadow within one year after surgery for early gastric cancer
Authors: Kamiya Ayako , Hayashi Tsutomu , Sakon Ryota , Ishizu Kenichi , Wada Takeyuki , Otsuki Sho , Yamagata Yukinori , Katai Hitoshi , Yoshikawa Takaki
Published: August 2023

Background

Although early gastric cancer is curable with local treatment, the overall survival in elderly patients did not reach 80% at five years after surgery. The major cause of death in elderly patients with early gastric cancer is not cancer itself but is related to postoperative sarcopenia. Elderly patients frequently develop postoperative asymptomatic pneumonia shadow, which is associated with a poor prognosis. However, why asymptomatic pneumonia shadow worsens the prognosis remains unclear. We investigated whether sarcopenia is accelerated in patients who developed asymptomatic pneumonia shadow.

Methods

We retrospectively examined patients of > 75 years of age who underwent R0 gastrectomy for gastric cancer and were diagnosed with T1 disease at National Cancer Center Hospital between 2005 and 2012. The diagnosis of asymptomatic pneumonia shadow was defined by diagnostic findings of pneumonia (consolidation type, reticular type, and nodular type) which were newly observed on chest computed tomography performed one year after surgery in comparison to preoperative computed tomography. Postoperative muscle loss was assessed by a computed tomography-based analysis using the L3 skeletal muscle index before and two years after surgery and the rate of decrease was calculated. Patients were classified into two groups according to the rate of decrease (cut-off value: 10%).

Results

Of the 3412 patients who underwent gastrectomy in our hospital during the study period, 142 were included in this study. Asymptomatic pneumonia shadow was found in 26 patients (18%). Patients who developed asymptomatic pneumonia shadow showed a significantly greater loss of muscle volume in comparison to patients who did not develop asymptomatic pneumonia shadow. In the multivariate analysis, total gastrectomy and asymptomatic pneumonia shadow were the independent risk factors for severe muscle loss. However, there was no significant difference in prognosis between the two groups.

Conclusions

Sarcopenia was accelerated in elderly patients who developed asymptomatic pneumonia shadow after surgery for early gastric cancer. However, the poor prognosis in these patients may not be related to accelerated sarcopenia.
Dietary carbohydrate quality index (CQI), cardio-metabolic risk factors and insulin resistance among adults with obesity
Authors: Nikrad Negin , Hosseini Babak , Pakmehr Azin , Tousi Ayda Zahiri , Ardekani Abnoos Mokhtari , Farhangi Mahdieh Abbasalizad , Akhavan-Sigari Reza
Published: August 2023

Background

Metabolic syndrome (MetS), as a cluster of cardiometabolic risk factors, is a global public health concern due to its increasing prevalence. Considering the previous evidence of the association between carbohydrate quality and cardiometabolic risk factors, our study was aimed to evaluate any possible association between carbohydrate quality index (CQI) and cardiometabolic risk factors among obese adults.

Methods

In this cross-sectional study, 336 apparently healthy individuals with obesity were participated. Dietary intake was assessed by a semi-quantitative Food Frequency Questionnaire (FFQ), including 168 food items validated for the Iranian population. CQI was calculated with three components of solid carbohydrates to total carbohydrates ratio, dietary fiber intake, and dietary glycemic index (GI). Body composition was determined by bioelectrical impedance analysis (BIA). Blood pressure was measured by sphygmomanometer and enzymatic methods were used to evaluate serum lipid, glucose, and insulin concentrations.

Results

Subjects in the third quartile of CQI had significantly lower systolic blood pressure (SBP) (P = 0.03) and diastolic blood pressure (DBP) (P = 0.01). Participants in the higher quartiles of CQI had more intake of energy, carbohydrates, fat, saturated fatty acid (SFA), and mono-saturated fatty acid (MUFA) (P < 0.05). Moreover, the homeostasis model assessment of insulin resistance (HOMA-IR) was decreased in the second quartile of CQI [odds ratio (OR) = 0.146, P = 0.01) after adjustment for age, body mass index (BMI), sex, physical activity, socioeconomic status (SES) and energy intake.

Conclusion

According to our findings, a higher quality of dietary carbohydrates, determined by CQI, could be associated with a lower risk of hypertension.
Prevalence and risk factor of diabetes among the elderly people in West Bengal: evidence-based LASI 1st wave
Authors: Das Ujjwal , Kar Nishamani
Published: August 2023

Background

The complication of Diabetes is one of the important health issues among the older adult population in any region. The higher risks of diabetes prevalence among older adult people in the countries was due to social-cultural changes such as increasing urbanization, dietary changes, without physical activity, and unhealthy lifestyle behavior. The present study examines the prevalence and associated risk factors of diabetes among older adults in the state of West Bengal.

Methods

The first wave of the Longitudinal Ageing Study in India 2017-18 was used to achieve the study objectives. Descriptive statistics with multinomial logistic regression models were used to carry out crude and adjusted odds ratios with 95% confidence intervals and examine the associated risk factors of diabetes prevalence among older adults.

Results

The findings of the study indicate that the overall prevalence of diabetes among the study participants was found to be 12.4% which was significantly higher in urban areas (19%) compare to rural areas (6%). The socio-economic and bio-demographic factors like educational status, richest background family, marital status, obesity, and family history of diabetes were significantly associated with higher risks of diabetes prevalence among the older adult population in West Bengal. The risks of diabetes in the richest adult people were significantly higher than in the poorest adult people (OR = 2.78; 95% CI: 1.974–3.917). The higher risks of diabetes mellitus among the richest wealthy people are because of lifestyle behavior, smoking, and tobacco consumption respectively.

Conclusion

The study needs to policy and awareness program to reduce economic inequality and prevention of diabetes care and treatment-seeking behavior, especially for the older adult population in West Bengal.
Association between the severity of periodontitis, COVID-19, C-reactive protein and interleukin-6 levels in hospitalized patients: a case‒control study
Authors: Moradi Haghgoo Janet , Torkzaban Parviz , Farhadian Maryam , Moosavi Sedeh Sayed Ali
Published: August 2023

Background

The COVID-19 pandemic is perhaps one of the most important events of the 21stcentury. Periodontitis is one of the most prevalent diseases of the oral cavity. Due to possible pathways of interaction between these two diseases, we investigated their association.

Methods

The study population consisted of hospitalized patients with established COVID-19 diagnoses. Patients with mild to moderate COVID-19 were considered controls, while cases had severe to critical COVID-19. Periodontal examination and serum and saliva sampling were performed for each patient. Relevant medical data were extracted from patients’ hospital files.

Results

Of the enrolled patients, 122 were included in the statistical analyses. The severity of periodontitis was directly and significantly correlated with the severity of COVID-19 (P < 0.001). Patients with generalized stage III or IV periodontitis displayed an adjusted odds ratio of 4.24 for severe to critical COVID-19. Salivary and serum interleukin-6 levels were significantly associated with COVID-19 severity (Pvalues: 0.002 and 0.004, respectively). Hospitalization length was significantly associated with the severity of periodontitis (P = 0.004). Clinical attachment level and gingival index were associated with increased odds for adverse events (Pvalues: 0.004 and 0.035, respectively), while number of remaining teeth was associated with decreased odds for adverse events (P = 0.023).

Conclusions

This study showed that the severity of periodontitis is associated with the severity of COVID-19. This association might manifest as increased odds of adverse events. COVID-19 severity was associated with higher levels of salivary and serum interleukin-6 levels.
TNF-α, IL-1B and IL-6 affect the differentiation ability of dental pulp stem cells
Authors: Sonmez Kaplan Sema , Sazak Ovecoglu Hesna , Genc Deniz , Akkoc Tunc
Published: August 2023

Background

This in vitro study examined the effect of the inflammatory cytokines (tumour necrosis factor-α (TNF-α), interleukin (IL)-1β, and IL-6) on osteogenic, chondrogenic, and adipogenic differentiation of dental pulp stem cells (DPSCs) which have significant relevance in future regenerative therapies.

Methods

DPSCs were isolated from the impacted third molar dental pulp and determined with flow cytometry analysis. DPSCs were divided into into 5 main groups with 3 subdivisions for each group making a total of 15 groups. Experimental groups were stimulated with TNF-α, IL-1β, IL-6, and a combination of all three to undergo osteogenic, chondrogenic, and adipogenic differentiation protocols. Next, the differentiation of each group was examined with different staining procedures under a light microscope. Histological analysis of osteogenic, chondrogenic, and adipogenic differentiated pellets was assessed using a modified Bern score. Statistical significance determined using one-way analysis of variance, and correlations were assessed using Pearson’s test (two-tailed).

Results

Stimulation with inflammatory cytokines significantly inhibited the osteogenic, chondrogenic and adipogenic differentiation of DPSCs in terms of matrix and cell formation resulting in weak staining than the unstimulated groups with inflammatory cytokines. On contrary, the unstimulated groups of MSCs have shown to be highly proliferative ability in terms of osteogenic, chondrogenic, and adipogenic differentiation.

Conclusions

DPSCs have high osteogenic, chondrogenic, and adipogenic differentiation capabilities. Pretreatment with inflammatory cytokines decreases the differentiation ability in vitro, thus inhibiting tissue formation.
The self-care behaviors and health literacy can play important preventive roles in older female osteoporosis
Authors: Malekmirzaei Elahe , Farshbaf-Khalili Azizeh , Pakpour Vahid
Published: August 2023

Background

Osteoporosis is a common complication of aging and menopause. Self-care and health literacy are among the factors affecting health status. The purpose of this research was to determine the preventive roles of self-care behaviors and health literacy in older women with osteoporosis.

Methods

This cross‑sectional analytical research was conducted on 250 postmenopausal women consisting of 125 osteoporotic and 125 healthy people aged 60–70. They were selected by purposive sampling in Tabriz Sina Hospital from September 2021 to December 2021. Data collection instruments were a demographic questionnaire, a Menopausal Self‑Care Questionnaire, and a European Health Literacy Survey Questionnaire. Data were analyzed using SPSS 23 software.

Results

The mean (SD) total score of self-care in healthy women was 118.97 (19.92) and in women with osteoporosis was 84.7 (14.98) (p < 0.001). Also, healthy women all had sufficient health literacy (100%), but 52.8% of women with osteoporosis had insufficient health literacy. The odds of osteoporosis decreased significantly with the rise in the total score of self-care behaviors [Odds ratio 95% confidence interval (95% CI); p: 0.909 (0.880 to 0.939); p < 0.001] and its subdomains as well as with increasing health literacy level [OR (95% CI); p: 0.322 (0.266 to 0.383); p < 0.001]. There was a significant positive correlation between self-care behaviors and health literacy (r = 0.616, p < 0.001).

Conclusions

Self-care in aged women is particularly important in reducing the risk of osteoporosis, and empowering women in the field of health literacy is an important factor in improving self-care behaviors and ultimately the health of these people.
Relationship satisfaction and self-esteem in patients with breast cancer and healthy women: the role of expected and actual personal projects support from the partner
Authors: Csuka Sára Imola , Désfalvi Judit , Konkolÿ Thege Barna , Sallay Viola , Martos Tamás
Published: August 2023

Background

For breast cancer patients, the partner’s support for personal projects can serve as a means of adaptation. We aimed to investigate the associations between the intimate partner’s personal project support and women’s well-being.

Methods

A sample of 274 Hungarian women (breast cancer patients n = 137, control n = 137) took part in the study. Expected and actually received autonomy-, directive- and emotional project support was assessed by the procedure of Personal Project Assessment. Well-being was measured by the Relationship Assessment Scale and the Rosenberg Self-Esteem Scale. For investigating the associations between project support and well-being in a multivariate way, structural equation modelling was used.

Results

Except for autonomy support, participants expected more support than they received. A path model indicated multiple associations between types of project support and relationship satisfaction and self-esteem. The partner’s emotional project support was predictive of women’s relationship satisfaction and self-esteem, while directive support was predictive of self-esteem only. The associations showed similar patterns in the subgroups of patients with breast cancer and control.

Conclusions

Our results highlight the importance of involving women’s subjective perspectives regarding the partner’s project support while also have implications for praxis. Teaching women how to communicate their needs to their partner effectively (whether it is the need for autonomy or directive guidance) can help close the gap between expected and received support, which may in turn enhance relationship satisfaction and self-esteem.
The quantified analysis of the correlation between medical humanities curriculums and medical students’ performance
Authors: Huang Shiau‑Shian , Ho Chao-Chung , Chu Yeong-Ruey , Wu Jr-Wei , Yang Ying-Ying
Published: August 2023

Background

A high-quality medical humanities (MH) education program is essential to developing a successful medical practitioner and can influence clinical performance. It is also vital to improve the evaluation of MH education to restore harmonious mutual relationships in medical care. However, studies have yet to discuss the correlation between the learning quality and quantity of medical humanities curriculums (MHC) and medical students' scores of clinical curriculums and clinical performance. The study aimed to assess the correlation between the learning quality and quantity of MHC and medical students' performance.

Methods

We conducted a retrospective cohort study by analyzing a dataset of students' learning records. After excluding students with missing demographic information (n = 1) and overseas Chinese students (n = 15), the study included six- and seven-year program medical school students (n = 354) at National Yang-Ming University who were admitted between 2012 and 2014. The correlation between learning quality and quantity in MHC and students' following performance was evaluated by multivariable-adjusted regression analyses.

Results

After adjusting for potential confounders (gender, residential area, age at enrollment, type of administration, and school program), the number of MHC with good learning outcomes was significantly correlated with clinical curriculum scores (p < 0.05), clerkship performance (p < 0.001), and weighted average mark (p < 0.001).

Conclusions

Our study found a correlation between MHC with good learning outcomes and medical students' following performance. A future study of improving the quality of MH education is warranted.
“An invitation to think differently”: a narrative medicine intervention using books and films to stimulate medical students’ reflection and patient-centeredness
Authors: Leijenaar Elsemarijn , Eijkelboom Charlotte , Milota Megan
Published: August 2023

Background

Narrative medicine purports to improve medical students’ communication skills, self-reflection, empathy and professional development. These interpersonal skills and attitudes can facilitate more patient-centered care and positively impact patients’ treatment outcomes. However, current studies report mainly on small study populations, leaving the efficacy of narrative medicine in larger study groups unknown. Therefore, this study aimed to evaluate a mandatory narrative medicine lesson in a large sample of medical students. We assessed if this narrative medicine lesson stimulated meaningful self-reflection on patient-centeredness in medical students.

Methods

All fourth-year medical students of a Dutch medical school participated in this mandatory narrative medicine lesson. The four-step activity consisted of an introductory lecture, close reading and watching of a book and film, a discussion group and a short reflective writing exercise. Students were divided over three thematic pairings (or book and film combinations): ‘The doctor as a patient,’ ‘The mysterious brain,’ and ‘Until death do us part.’ A mixed-methods design was used. First, we qualitatively analyzed the content of 203 essays from the reflective writing exercise. A quantitative analysis of the reflective quality was conducted using a scoring-system based on the REFLECT rubric.

Results

Students demonstrated reflection on a professional level and connected this to future intentions as medical practitioners, for example to use specific communication strategies or to deliver healthcare in a broader sense. They also reflected on a personal level by questioning their own worldview or beliefs. Furthermore, they stressed the importance of individual patient stories to gain understaning of patients’ perspectives. Approximately half of the students showed an in-depth and authentic reflection, according to the REFLECT rubric. Additionally, reflection levels differed between book and film pairings.

Conclusions

This study supports the value of narrative medicine in the medical curriculum by validating its outcomes in a larger study population and in a mandatory course. Students reflected on themes related to the principles of patient-centeredness, namely personal attitudes towards patients and the uniqueness of patient stories. In additon, the majority of students demonstrated higher levels of reflection, which suggests that this exercise contributes to self-awareness and self-reflection, important qualities for delivering patient-centered healthcare.