bluuebunny/crossref_metadata_2025 huggingface dataset:
Automating Patient-reported Data Collection: Does it Work?
Authors: Bogor Sayah , Niknam Kian , Less Justin , Andaya Veronica , Swarup Ishaan
Published: April 2024

Objective:

There are several electronic patient-reported outcomes (ePROs) vendors that are being used at institutions to automate data collection. However, there is little known about their success in collecting patient-reported outcomes (PROs) and it is unknown which patients are more likely to complete these surveys. In this study, we assessed rates of PRO completion, as well as determined factors that contributed to the completion of baseline and follow-up surveys.

Methods:

We queried our ePRO platform to assess rates of completion for baseline and follow-up surveys for patients from October 2019 to June 2022. All baseline surveys were administered before pediatric orthopaedic procedures, and follow-up surveys were sent at 3 months, 6 months, 1 year, and 2 years after surgery to patients with baseline data. Descriptive statistics were used to summarize the data. Univariate and multivariate analyses were performed to assess differences in patients who did and did not complete surveys.

Results:

This study included 1313 patients during the study period. Baseline surveys were completed by 66% of the cohort (n = 873 patients). There was a significant difference in race/ethnicity and language spoken in the patients who did and did not complete baseline surveys (P < 0.01) with lower rates of completion in African American, Hispanic, and Spanish-speaking patients. At least one follow-up was obtained for 68% of patients with baseline surveys (n = 597 patients). There were significant differences in completion rates based on race/ethnicity (P = 0.03) and language spoken (P = 0.01). There were lower rates of baseline completion for patients with government insurance in our multivariate analysis (odds ratio: 0.6, P < 0.01).

Conclusion:

Baseline and follow-up PRO data can be obtained from the majority of patients using automated ePRO platforms. However, additional focus is needed on collecting data from traditionally underrepresented patient groups to better understand outcomes in these patient populations.

Level of Evidence:

Level III—retrospective cohort study.
The Combined Influence of Sleep Disturbance and Depression on 12-month Outcomes After Lumbar Spine Surgery
Authors: Coronado Rogelio A. , Pennings Jacquelyn S. , Master Hiral , Brintz Carrie E. , Cole Keith R. , Helmy Joseph , Oleisky Emily R. , Davidson Claudia , Abtahi Amir M. , Stephens Byron F. , Archer Kristin R.
Published: April 2024

Study Design.

Retrospective analysis of prospectively collected data.

Objective.

To examine the combined influence of preoperative sleep disturbance and depression on 12-month patient-reported outcomes after lumbar spine surgery (LSS).

Summary of Background Data.

Psychological and behavioral factors are considered major risk factors for poor outcomes after LSS. However, there is a need to explore the combined effects of preoperative factors such as sleep disturbance and depression. Understanding the influence of sleep disturbance and depression can inform evidence-based preoperative assessment and shared-decision making of preoperative and postoperative treatment.

Methods.

Data from 700 patients undergoing LSS were analyzed. Preoperative sleep disturbance and depression were assessed with PROMIS subscales. Established thresholds defined patients with moderate/severe symptoms. Outcomes for disability (Oswestry Disability Index) and back and leg pain (Numeric Rating Scales) were assessed preoperatively and at 12 months. Separate multivariable linear regressions examined the influence of each factor on 12-month outcomes with and without accounting for the other and in combination as a 4-level variable: (1) moderate/severe sleep disturbance alone, (2) moderate/severe depression alone, (3) both moderate/severe sleep disturbance and depression, (4) no moderate/severe sleep disturbance or depression.

Results.

Preoperative sleep disturbance and depression were associated with 12-month disability and pain (P<0.05). After accounting for depression, preoperative sleep disturbance remained associated with disability, while preoperative depression adjusting for sleep disturbance remained associated with all outcomes (P<0.05). Patients reporting both moderate/severe sleep disturbance and moderate/severe depression had 12.6 points higher disability and 1.5 points higher back and leg pain compared with patients without moderate/severe sleep disturbance or depression.

Conclusions.

The combination of sleep disturbance and depression impacts postoperative outcomes considerably. The high-risk group of patients with moderate/severe sleep disturbance and depression could benefit from targeted treatment strategies.

Level of Evidence.

Level II.
“Bubble Behind Iris” Technique in Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes
Authors: Igarashi Ami , Shimizu Toshiki , Yokogawa Hideaki , Kobayashi Akira , Yamagami Satoru , Hayashi Takahiko
Published: April 2024

Purpose:

Performing Descemet membrane keratoplasty (DMEK) in vitrectomized eyes can be challenging, owing to the compromised stability of the iris–lens diaphragm. This study presents a “bubble behind iris” technique in DMEK to achieve a shallower anterior chamber in vitrectomized and pseudophakic eyes.

Methods:

The patients with vitrectomized eyes who underwent DMEK between October 2022 and March 2023 were enrolled in this study. Following the insertion of the donor tissue into the anterior chamber, a 30-gauge blunt cannula was used to introduce an air bubble posterior to the iris. The depth of the anterior chamber was confirmed before unfolding the graft. Subsequently, the air bubble was carefully replaced with balanced salt solution insertion using the blunt cannula, and the anterior chamber was filled with gas for graft attachment.

Results:

This study included 3 eyes of 3 patients (3 men; mean age 62.3 ± 8.5 years). The best spectacle corrected visual acuity and central corneal thickness improved in all eyes with no notable complications.

Conclusions:

The “bubble behind iris” technique is a straightforward and minimally invasive approach for maintaining an optimal anterior chamber depth during DMEK in vitrectomized and pseudophakic eyes.
Influencing factors, surgical management, and predictors of posterior fossa tumors with hydrocephalus in children
Authors: Feng Jiaqi , Zhang Tianyi , He Dake , Mao Weiwei , Wang Weiping , Zhou Yabing , Wang Xiaoqiang
Published: April 2024

Background:

Hydrocephalus is a common disease in neurosurgery. In pediatric central nervous system tumors, the proportion of posterior fossa tumors (PFTs) in children is high, hydrocephalus is often the first manifestation, and some cases have de novo or aggravated hydrocephalus after surgery.

Objective:

To conclude some controversies about the treatment methods and timeline of PFT with hydrocephalus.

Methods:

This article reviews the latest progress in the literature and practical problems encountered in clinical practices.

Results:

For most children, surgical drainage is the most effective treatment; however, medical treatment can be performed before surgery or a definite diagnosis is made. In children with PFT, the risk of hydrocephalus can be initially predicted according to the condition of the child, which has clear clinical significance for the selection of treatment methods and the evaluation of related prognosis.

Conclusion:

PFT is a common site for CNS tumors in children, and its clinical manifestations are often hydrocephalus-related. According to the condition of pediatric patients, early prediction of the risk of hydrocephalus has clear clinical significance for the selection of treatment methods and the evaluation of related prognoses.
The progression of artificial intelligence technology and Parkinson’s disease
Authors: Meng Xianyue , Huang Anqi , Li Xueli
Published: April 2024

Parkinson’s disease is a neurodegenerative disease that seriously endangers the health of middle-aged and old people and is characterized by the degeneration of nigrostriatal dopaminergic neurons as its main pathologic feature. Due to its numerous influencing factors, unclear pathogenic mechanisms, and complex clinical manifestations, the diagnosis and treatment of Parkinson’s disease still face huge challenges. In recent years, artificial intelligence technology has developed rapidly and its application in the medical field has become increasingly widespread. This article reviews the achievements of artificial intelligence in the diagnosis and treatment of Parkinson’s disease, with a view to benefiting patients with Parkinson’s disease in the future.
The progression of surgical intervention for arterial reocclusion after mechanical thrombectomy for acute cerebral infarction
Authors: Jia Zhigang , Pang Zhicheng , Yang Nan , Huang Qing
Published: April 2024

Acute ischemic stroke, a prevalent cerebrovascular disease, significantly contributes to mortality and morbidity in modern society. Although early mechanical thrombectomy is beneficial for many patients, a subset still suffers from failed recanalization due to arterial occlusion (AR) post-thrombectomy, owing to a variety of factors. Therefore, minimizing vascular reocclusion rates is imperative in improving outcomes for patients with acute cerebral infarction. Recent surgical intervention studies have concentrated on vascular recanalization after mechanical thrombectomy. This review critically analyzes the pathophysiology and effective treatments for vascular reocclusion, providing insight into the latest developments and outlining challenges for future research.
Acute myeloid leukemia manifesting as pruritus: a case report
Authors: Johnston Danielle
Published: April 2024

Acute myeloid leukemia (AML) is considered a rare malignancy of the stem cell precursors in the bone marrow, resulting in only 1.2% of new malignancy diagnoses in the United States. Pruritus is a frequent complaint for dermatology providers, averaging up to 54% of adult outpatient dermatologic patients. Dermatologic manifestations, specifically pruritus, are not common in AML; however, AML is a potentially lethal malignancy that should be considered. Here, the author describes a case of a male patient with no past malignancy history. He presented to the outpatient dermatology clinic with complaints of generalized pruritus for 1–2 weeks. He was diagnosed with severe anemia and subsequently AML after direct admission to local inpatient hematology/oncology specialists. This case illustrates the importance of considering malignancy, specifically leukemia and AML, as a differential in patients with generalized pruritus.
Burden of illness and unmet needs in generalized pustular psoriasis: report of four cases
Authors: Christianson Ellie , Heim Jayme , Pansch Leigh Ann , Yu Henry
Published: April 2024

Generalized pustular psoriasis (GPP), the most severe form of pustular psoriasis, is a rare autoinflammatory skin disease that manifests with the rapid and widespread eruption of small, sterile pustules and surrounding skin erythema, often accompanied by systemic symptoms. GPP is frequently painful and distressing and adversely affects patients’ quality of life. Until recently, systemic treatment for GPP in the United States mainly involved the off-label use of agents approved to treat plaque psoriasis. In September 2022, spesolimab was approved in the United States as a first-in-class treatment for GPP flares in adults, making a GPP-specific therapy available. Here, we describe 4 cases from our respective clinical practices that highlight the difficulties faced by patients with GPP in receiving an accurate diagnosis and obtaining effective treatment and demonstrate the associated physical and psychological disease burdens. The potential severity and consequences of untreated GPP necessitate a prompt diagnosis, initiation of effective treatment, and regular follow-up and monitoring of patients’ conditions. When managing GPP, a multidisciplinary approach is recommended to ensure that patients receive appropriate social and emotional support and effective medical care.
Effectiveness and safety of Buzzy device in needle-related procedures for children under twelve years of age: A systematic review and meta-analysis
Authors: Jin Faguang , Wang Xiaofang , Qi Maomao , Zhang Wenhua , Zhang Yongfeng
Published: April 2024

Background:

Pain transcends simple physiology, encompassing biological, emotional, psychological, and social facets. Children show pronounced immediate and enduring responses to pain-related procedures. The aim of this meta-analysis is to investigate the efficacy and safety of the Buzzy device for needle-related procedures in children aged twelve years or younger.

Methods:

PubMed, Web of Science, and Embase were searched from inception to July 2023. Only randomized controlled trials utilizing the Buzzy device for needle-related procedures in children under twelve years old were included. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment. Random-effects models were utilized, and analyses were performed using mean differences or standardized mean differences as well as risk ratios.

Results:

A total of 19 studies were included, involving 2846 participants (Buzzy = 1095, Control = 1751). Compared to no intervention, the Buzzy device significantly reduced pain response [self-report SMD = −1.90 (−2.45, −1.36), parental SMD = −3.04 (−4.09, −1.99), observer SMD = −2.88 (−3.75, −2.02)] and anxiety scores [self-report SMD = −1.97 (−3.05, −0.88), parental SMD = −2.01 (−2.93, −1.08), observer SMD = −1.92 (−2.64, −1.19)]. Compared to virtual reality (VR), the Buzzy device reduced self-reported anxiety levels SMD = −0.47 (−0.77, −0.17), and compared to distraction cards, the Buzzy device reduced parental and observer-reported pain [parental SMD = −0.85 (−1.22, −0.48), observer SMD = −0.70 (−1.00, −0.40)] and anxiety [parental SMD = −0.96 (−1.46, −0.47), observer SMD = −0.91 (−1.40, −0.42)]. Subgroup analysis results showed that procedure type, patient age, measurement scales used, and distance of operation were not the reason of heterogeneity. The summarized first puncture attempt success rate did not differ from other interventions. There were no significant adverse events in the included studies.

Conclusion:

The Buzzy device reduces pain and anxiety in children during needle procedures, ensuring success and safety. Additionally, the effectiveness of the Buzzy device in reducing pain during venipuncture is superior when compared to its effectiveness during intramuscular injections.
Electrocardiogram prediction of atrial fibrillation risk after stroke: A protocol for systematic review and meta-analysis
Authors: Cheng Xiaoli , Wang Xiaoli
Published: April 2024

Background:

Atrial fibrillation (AF) is one of the most common clinical arrhythmias. This study aims to predict the risk of post-stroke AF through electrocardiographic changes in sinus rhythm.

Methods:

We searched the MEDLINE (PubMed) and EMBASE databases to identify relevant research articles published until August 2023. Prioritized items from systematic reviews and meta-analyses were screened, and data related to AF detection rate were extracted. A meta-analysis using a random-effects model was conducted for data synthesis and analysis.

Results:

A total of 32 studies involving electrocardiograms (ECG) were included, with a total analysis population of 330,284 individuals. Among them, 16,662 individuals (ECG abnormal group) developed AF, while 313,622 individuals (ECG normal group) did not. ECG patterns included terminal P-wave terminal force V1, interatrial block (IAB), advanced interatrial block, abnormal P-wave axis, pulse rate prolongation, and atrial premature complexes. Overall, 15,762 patients experienced AF during the study period (4.77%). In the ECG abnormal group, the proportion was 14.21% (2367/16,662), while in the control group (ECG normal group), the proportion was 4.27% (13,395/313,622). The pooled risk ratio for developing AF was 2.45 (95% confidence interval [CI]: 2.02–2.98, P < .001), with heterogeneity (I
2) of 95%. The risk ratio values of alAB, P-wave terminal force V1, interatrial block, abnormal P-wave axis, pulse rate prolongation and atrial premature complexes were 4.12 (95% CI, 2.99–5.66), 1.47 (95% CI, 1.19–1.82), 2.54 (95% CI, 1.83–3.52), 1.70 (95% CI, 0.98–2.97), 2.65 (95% CI, 1.88–3.72), 3.79 (95% CI, 2.12–6.76), respectively.

Conclusion:

There is a significant correlation between ECG patterns and the occurrence of AF. The alAB exhibited the highest level of predictability for the occurrence of AF. These indicators support their use as screening tools to identify high-risk individuals who may benefit from further examinations or empirical anticoagulation therapy following stroke.
Predictive value of TCM tongue characteristics for chemotherapy-induced myelosuppression in patients with lung cancer
Authors: Sun Jian-Rong , Lou Yan-Ni , Huang Rong , Li Kai-Xuan , Jia Li-Qun
Published: April 2024

This study aimed to investigate the clinical predictors, including traditional Chinese medicine tongue characteristics and other clinical parameters for chemotherapy-induced myelosuppression (CIM), and then to develop a clinical prediction model and construct a nomogram. A total of 103 patients with lung cancer were prospectively enrolled in this study. All of them were scheduled to receive first-line chemotherapy regimens. Participants were randomly assigned to either the training group (n = 52) or the test group (n = 51). Tongue characteristics and clinical parameters were collected before the start of chemotherapy, and then the incidence of myelosuppression was assessed after treatment. We used univariate logistic regression analysis to identify the risk predictors for assessing the incidence of CIM. Moreover, we developed a predictive model and a nomogram using multivariate logistic regression analysis. Finally, we evaluated the predictive performance of the model by examining the area under the curve value of the receiver operating characteristic, calibration curve, and decision curve analysis. As a result, a total of 3 independent predictors were found to be associated with the CIM in multivariate regression analysis: the fat tongue (OR = 3.67), Karnofsky performance status score (OR = 0.11), and the number of high-toxic drugs in chemotherapy regimens (OR = 4.78). Then a model was constructed using these 3 predictors and it exhibited a robust predictive performance with an area under the curve of 0.82 and the consistent calibration curves. Besides, the decision curve analysis results suggested that applying this predictive model can result in more net clinical benefit for patients. We established a traditional Chinese medicine prediction model based on the tongue characteristics and clinical parameters, which could serve as a useful tool for assessing the risk of CIM.
Deciphering age-specific molecular features in cervical cancer and constructing an angio-immune prognostic model
Authors: Zhao Xin , Fan Xichen , Lin Xiu , Guo Baozhu , Yu Yanqin
Published: April 2024

Cancer incidence is increasingly seen in younger individuals. Molecular distinctions between young and elderly patients at onset are understudied. This study used public databases to explore genomic, transcriptomic, and immune-related features across age groups in cervical cancer. Additionally, it aims to create a prognostic model applicable across diverse age cohorts, enabling precise patient stratification, and personalized therapies. Gene mutations, expression data, and clinicopathological information were obtained from 317 cervical cancer patients. These patients were divided into a young group and an old group based on the median age of onset. The characteristics of differential gene mutation, gene expression, and immune cells analysis were analyzed by R software. Finally, the prognostic model was constructed by univariate Cox, least absolute shrinkage and selection operator, and multivariate Cox regression analyses of angiogenic and immune gene sets. Its validity was further confirmed using an additional 300 cervical squamous cell carcinoma and endocervical adenocarcinoma tissues. Cervical cancer patients at elderly onset age exhibit a significantly higher frequency of NOTCH1 and TP53 driver mutations compared to young patients, along with a notably higher tumor mutational burden. However, there were no significant differences between the 2 groups in terms of genomic instability and age-related mutational signatures. Differential gene expression analysis revealed that the young group significantly upregulated interferon-alpha and gamma responses and exhibited significantly higher activity in multiple metabolic pathways. Immune microenvironment analysis indicated enrichment of dendritic cells and natural killer cells in the young group, while transforming growth factor-β signature was enriched in the elderly group, indicating a higher degree of immune exclusion. A multigene prognostic model based on angiogenesis and T cell immune gene sets showed excellent prognostic performance independent of clinical factors such as age. High-risk groups identified by the model exhibit significant activation of tumor-promoting processes, such as metastasis and angiogenesis. Our study reveals distinct patterns in cancer-driving mechanisms, biological processes, and immune system status between young and elderly patients at onset with cervical cancer. These findings shed light on the age-specific underlying mechanisms of carcinogenesis. Furthermore, an independent molecular prognostic model is constructed to provide valuable references for patient stratification and the development of potential drug targets.
Direct gastric invasion from the liver metastasis of colorectal origin: A case report
Authors: Nam Jun Yeb , Lee Jung Wook , Kim Jae Hyun , Jung Minjung , Park Moo In , Moon Won , Kim Sung Eun , Jung Kyoungwon , Park Seun Ja
Published: April 2024

Rationale:

Colorectal cancer is the third most common cancer diagnosed worldwide. At the time of diagnosis of colorectal cancer, one of the most common metastatic sites is liver. Gastric metastasis from colorectal origin is rare. Moreover, a direct invasion of the stomach, by hepatic metastasis from colorectal cancer, is particularly uncommon.

Patient concerns:

A 56-year-old male patient with hematochezia was referred to our hospital.

Diagnosis:

The patient was diagnosed with unresectable colorectal cancer because of the presence of >10 metastases involving both lobes of the liver.

Interventions and Outcomes:

After chemotherapy, the metastatic nodules in the liver nearly disappeared, except for a small nodule in segment VI. The patient underwent a radiofrequency ablation for the single lesion in the liver and laparoscopic low-anterior-resection for the primary tumor. Despite receiving various chemotherapy regimens, he experienced 6 recurrences, leading to 5 hepatectomies including a right hemi-hepatectomy, 1 pulmonary wedge resection, and 2 courses of radiation treatments. Lastly, a metastatic lesion in the liver was observed with invasion into the stomach. Subsequently, gastric wedge resection with resection of segments III and IV of the liver was performed. Direct invasion of the liver metastases into the stomach was confirmed histologically.

Lessons:

The patient is still alive, with a good quality of life, even after more than 8 years since the initial diagnosis. In the last instance of metastatic recurrence, direct invasion from the liver metastases into the stomach was observed, which is rare, and there are currently no reported cases.
Causal influence of celiac disease on the risk of sarcoidosis: A Mendelian randomization study
Authors: Zhou Zhangbing , Chen Yunfeng , Wang Liu
Published: April 2024

Observational research shows a link between celiac disease (CeD) and sarcoidosis, but the causal link between CeD and sarcoidosis is still unknown. A two-sample Mendelian randomization (MR) study was conducted to ascertain the causal connection between the 2 disorders. In our two-sample MR analysis, we identified independent genetic variants associated with CeD using publicly accessible GWAS data from people of European ancestry. Summary data for sarcoidosis were obtained from the FinnGen Consortium, the UK-Biobank, and a large GWAS dataset. To assess the association between CeD and sarcoidosis, our MR analysis used inverse variance weighted (IVW) as the primary method, incorporating the MR-Egger, weighted median (WM), and MR-PRESSO (outliers test) as a complementary method. In order to ensure that the findings were reliable, several sensitivity analyses were performed. Our study indicated that CeD had a significant causal relationship with sarcoidosis (IVW odds ratio (OR) = 1.13, 95% confidence interval (CI): 1.07–1.20, P = 5.58E-05; WM OR = 1.12, 95% CI: 1.03–1.23, P = 1.03E-02; MR-Egger OR = 1.07, 95% CI: 0.96–1.19, P = 2.20E-01). Additionally, we obtain the same results in the duplicated datasets as well, which makes our results even more reliable. The results of this investigation did not reveal any evidence of horizontal pleiotropy or heterogeneity. Our MR analysis showed a causal effect between CeD and an elevated risk of sarcoidosis. Further study is still needed to confirm the findings and look into the processes underlying these relationships.
Causal association between rheumatoid arthritis and an increased risk of age-related macular degeneration: A Mendelian randomization study
Authors: Zhang Mengzhu , Duan Lincheng , Feng Yue
Published: April 2024

This study’s goal is to evaluate if there is a causal connection between rheumatoid arthritis (RA) and age-related macular degeneration (AMD), despite past epidemiological studies suggesting an association between the 2 disorders. The impact of RA on AMD is still unknown. Mendelian randomization (MR) was utilized in this study to assess the two-sample causal relationship between RA and AMD. Summary data from GWAS for RA and AMD in individuals with all European ancestries were gathered using the IEU GWAS database. The GWAS summary statistics of RA (14,361 RA patients and 43,923 healthy controls) and AMD (14,034 AMD patients and 91,214 controls participated) were obtained from the IEU GWAS database. After identifying suitable instrumental variables in line with the 3 MR assumptions, we conducted MR using the Mendelian randomization-Egger (MR-Egger), weighted median, and inverse variance weighting techniques. The MR-Egger intercept and MR-Polyvalent Residuals and Outliers methods were used to investigate the effects of horizontal pleiotropy. The leave-one-out strategy was used to prevent bias caused by certain single nucleotide polymorphisms. Sensitivity analysis was used to detect the heterogeneity. Using 50 single nucleotide polymorphisms as instrumental variables, this study examined the relationship between RA and AMD and discovered that RA increased the risk of AMD (inverse variance weighting odds ratio [OR] = 1.056, 95% confidence interval [CI] = 1.02–1.09, P = 5.44E−04; weighted median OR = 1.085, 95% CI = 1.04–1.14, P = 4.05E−04; MR-Egger OR = 1.074, 95% CI = 1.01–1.14, P = 2.18E−2). The current investigation demonstrated a causal link between AMD and RA. RA increased the risk of AMD. It is advised that future research concentrate on the processes underlying the relationship between RA and AMD.
Parathyroid fine needle aspiration with PTH washout: Can it lead to parathyroid cell seeding in primary hyperparathyroidism?
Authors: Balbaloglu Hakan , Deniz Oguzhan , Ozaydin R. Yigit , Tasdoven Ilhan , Karadeniz Cakmak Guldeniz
Published: April 2024

Although parathyroid fine-needle aspiration (P-FNA) with parathyroid hormone (PTH) washout is effective in detecting preoperative parathyroid lesions, it also presents risks such as fibrosis, hematoma, and, in rare cases, tumor seeding. This study aimed to investigate whether P-FNA with PTH washout leads to the seeding of parathyroid cells along the path of the needle. A retrospective analysis was conducted on patients undergoing minimally invasive parathyroidectomy guided by preoperative PTH washout. Permanent pathology reports, imaging data, and postoperative serum parathyroid hormone and calcium levels were assessed to determine the effectiveness and safety of the procedure. Complications following P-FNA with PTH washout were also reviewed using data from the patient registration system of Bulent Ecevit University. The procedure accurately localized parathyroid adenomas in 87 patients who underwent ultrasound-guided parathyroidectomy following preoperative P-FNA and PTH washout. Postoperatively, 75 patients showed normal parathyroid hormone and calcium levels. Two patients required secondary surgery for contralateral adenomas. Critically, there was no evidence of P-FNA with PTH washout-induced parathyromatosis or seeding during the follow-up. Effective adenoma localization is crucial for successful minimally invasive surgery of hyperparathyroidism. Our study indicates that combining preoperative P-FNAB with PTH washout and imaging enhances adenoma detection, especially when intraoperative PTH measurements are not available, thus improving surgical outcomes. Notably, we found no evidence of cell implantation after P-FNA, suggesting the safety and efficacy of this method for preventing parathyroid cell seeding.
Prognostic role of lymph node micrometastasis in pN0 esophageal cancer: A meta-analysis
Authors: Yang Yanhui , Wang Yi , Li Xiaoliang , Xie Xiaoyang
Published: April 2024

Background:

To further identify the association between the lymph node micrometastasis (LNM) and long-term survival among pN0 esophageal cancer patients receiving the surgery.

Methods:

Several databases were searched for relevant studies up to June 22, 2023. The primary and secondary outcomes were separately overall survival (OS) and relapse-free survival (RFS) and hazard ratios (HRs) with 95% confidence intervals (CIs) were combined. Subgroup analysis based on pathological type and source of HR was further performed. All statistical analyses were conducted by STATA 15.0 software.

Results:

A total of 20 studies involving 1830 pN0 patients were included in this meta-analysis. The pooled results demonstrated that the presence of LNM indicated significantly worse OS (HR = 2.19, 95% CI = 1.77–2.70, P < .001) and RFS (HR = 2.15, 95% CI = 1.65–2.80, P < .001). Besides, subgroup analysis for the OS and RFS stratified by the pathological type (squamous cell carcinoma vs mixed esophageal cancer) and source of HR (reported vs estimated) further identified the significant relationship of LNM with prognosis in surgical esophageal cancer.

Conclusion:

The presence of LNM indicated significantly poorer long-term survival among operated pN0 esophageal cancer patients. LNM could serve as a novel and reliable prognostic indicator in surgical esophageal cancer.
Smokeless tobacco keratosis in oral mucosa with epithelial dysplasia: A case report
Authors: Kaabi Hassan Hamed
Published: April 2024

Rationale:

Smokeless tobacco use is a risk factor for the development of various oral lesions, among which is smokeless tobacco keratosis (STK). This condition is caused by constant frictional irritation of smokeless tobacco products against the oral mucosa and appears as a White-to-gray plaque with wrinkling.

Patient concerns:

A 50-year-old man who had been using smokeless tobacco for 24 years visited our clinic complaining of changes in the lower right sulcus of the oral cavity for 10 days. Clinical examination revealed a unilateral, nonhomogeneous White lesion in the area of the complaint. Histopathological examination showed hyperkeratosis, areas of keratin plugging, and mild dysplastic epithelial changes.

Diagnosis:

The clinico-histopathological correlation suggested a diagnosis of STK with focal mild epithelial dysplasia.

Intervention and outcome:

A comprehensive management plan included maintaining oral hygiene, education on the detrimental effects of smokeless tobacco, advice to cease smoking, and regular follow-up to monitor the potential for malignant transformation. The patient was referred to a tobacco cessation society for tailored advice and counseling. On follow-up visits, there was an improvement in the lesion after habitual cessation.

Lessons:

The diagnosis of tobacco-related oral lesions is often delayed, which may result in malignant transformation. This illustrates the need to train healthcare professionals to identify tobacco-related conditions at an early stage and to educate patients regarding the harmful effects of tobacco use.
Retrograde jejunoduodenogastric intussusception associated with fully functioning nonballoon nasojejunal feeding catheter: A case report
Authors: Lee Seung Soo
Published: April 2024

Rationale:

Retrograde jejunoduodenogastric intussusception refers to invagination of distal small intestine into the stomach. It is extremely rare. It is often associated with displaced feeding catheter in which its balloon tip migrates past the gastric pylorus. The intussusception is triggered by retraction of migrated catheter. It is often accompanied by feeding intolerance or catheter malfunction. This report describes a distinctive case of retrograde jejunoduodenogastric intussusception associated with a fully functioning nonballoon nasojejunal tube.

Patient concern:

A 19-year-old female was presented with repeated vomiting and abdominal distension for 5 days.

Diagnosis:

An abdominal computerized tomography revealed retrograde jejunoduodenogastric intussusception causing air/fluid-filled gastric distension. Immediate endoscopic examination revealed a loop of small intestine, protruding through the pylorus. Progressed ischemia of the migrated small bowel loop was confirmed.

Interventions:

At laparotomy, a jejunal loop migrating into the duodenum and stomach at the level of the ligament of Treitz was noticed. After manual reduction of migrated bowel, 2 segmental resections of necrotic segment were performed. A feeding jejunostomy was constructed in the proximal jejunum.

Outcomes:

Enteral feeding through the surgically constructed feeding jejunostomy was started on the 5th operative day and the patient was discharged on the 16th postoperative day.

Lessons:

When a patient under tube feeding exhibits abrupt intractable gastroesophageal reflux with a sign of catheter migration, we must consider the possibility of catheter-related intussusception. Having a fully functioning feeding catheter with nonballoon tip does not preclude retrograde jejunoduodenogastric intussusception.
Salivary and serum levels of lactate dehydrogenase in oral submucous fibrosis: A meta-analysis
Authors: Chen Xueru , Chen Tongqiang , Xie Hui , Guo Jincai
Published: April 2024

Background:

The occurrence of oral submucous fibrosis (OSF) is often accompanied by an increase in lactate dehydrogenase (LDH) levels. In this meta-analysis, we compared the salivary and serum levels of LDH levels between OSF patients and controls.

Material and methods:

A comprehensive search was conducted in PubMed, Embase, Web of Science, and Cochrane Library from the establishment of the database to June 2023, and the quality of the studies was checked by the Newcastle-Ottawa Quality Assessment scale. The mean difference (MD) and 95% confidence interval (CI) were calculated using RevMan 5.4 software.

Results:

A total of 28 studies were retrieved from the database, and we included 5 studies in this meta-analysis. The salivary LDH level of OSF patients was higher than healthy controls (MD: 423.10 pg/L 95%CI: 276.42−569.77 pg/mL, P < .00001), the serum LDH level of OSF patients was also higher than that of healthy controls (MD: 226.20 pg/mL, 95%CI: 147.71−304.69 pg/mL, P < .00001).

Conclusions:

This meta-analysis showed that salivary and serum LDH levels were higher in OSF patients than in healthy controls, suggesting that LDH may be a potential biomarker for OSF.
Advances in research on biomarkers associated with acute myocardial infarction: A review
Authors: Huang Xuelan , Bai Suwen , Luo Yumei
Published: April 2024

Acute myocardial infarction (AMI), the most severe cardiovascular event in clinical settings, imposes a significant burden with its annual increase in morbidity and mortality rates. However, it is noteworthy that mortality due to AMI in developed countries has experienced a decline, largely attributable to the advancements in medical interventions such as percutaneous coronary intervention. This trend highlights the importance of accurate diagnosis and effective treatment to preserve the myocardium at risk and improve patient outcomes. Conventional biomarkers such as myoglobin, creatine kinase isoenzymes, and troponin have been instrumental in the diagnosis of AMI. However, recent years have witnessed the emergence of new biomarkers demonstrating the potential to further enhance the accuracy of AMI diagnosis. This literature review focuses on the recent advancements in biomarker research in the context of AMI diagnosis.
Investigation of factors that may potentially affect anxiety in patients undergoing esophagogastroduodenoscopy and evaluation of sedation effect
Authors: Uçaner Burak , Buldanli Mehmet Zeki , Çimen Şebnem , Çiftçi Mehmet Sabri , Demircioğlu Mehmet Mert , Erten Ela , Hançerlioğullari Oğuz
Published: April 2024

Background:

As with any other invasive procedure, esophagogastroduodenoscopy (EGD) may lead to considerable anxiety in patients. This study aimed to investigate and compare the effects of sedated and non-sedated procedures on anxiety in patients undergoing EGD and to better recognize patient groups at risk for anxiety.

Methods:

In this prospective and 2-armed designed study, demographic data, including age, gender, comorbidities, height, weight, body mass index (BMI), and educational background, were collected. In this study, the Beck Anxiety Inventory (BAI) was administered to each patient before they were brought to the endoscopy unit. Subsequently, each patient who underwent EGD was telephoned on the seventh day after the procedure and the BAI was administered a second time.

Results:

Women population had higher pre-EGD and post-EGD BAI scores compared to men. No significant correlation was observed between educational background and BAI scores. Possible correlations between age, BMI, Charlson comorbidity index (CCI), and BAI scores were examined. There was a weak correlation between BMI and pre-EGD and post-EGD BAI scores. A strong and positive correlation was observed between the pre-EGD BAI score and post-EGD BAI and difference in BAI scores between groups (ΔBAI).

Conclusion:

Endoscopic procedures may cause anxiety in patients as with all other invasive procedures. Patients’ compliance with the procedure and having a lower level of anxiety are very significant for diagnostic and, if necessary, therapeutic success. In this study, the patient gender was evaluated as a predictor of anxiety level, whereas educational background was not a predictor.
Effect of connexin 43 in LPS/IL-4-induced macrophage M1/M2 polarization: An observational study
Authors: He Pengchen , Dai Mingxing , Li Zongpin , Wang Xiaoyi , Liu Hongyuan , He Yixiao , Jiang Han
Published: April 2024

Lipopolysaccharide (LPS) and interleukin-4 (IL-4) play important roles in inducing M1 and M2 macrophage polarization. Studies have shown that LPS can promote the polarization of macrophages to M1-type and produce many pro-inflammatory cytokines, while IL-4 can promote the polarization of macrophages to M2-type and produce many anti-inflammatory cytokines. Moreover, Connexin 43 (Cx43) is widely expressed in macrophages and has various regulatory functions. However, whether Cx43 is involved in the regulation of macrophage M1/M2 polarization has not been fully studied. This study examined the role of Cx43 and M2 polarization markers using Western blot, immunofluorescence, flow cytometry. Cx43 overexpression was induced using Cx43 overexpressing lentivirus. The statistical software SPSS 20.0 (IBM Corp.) and GraphPad Prism 8.0 (GraphPad Software, La Jolla, CA, United States) were used to analyze the results. P values < .05 were considered to indicate statistically significant differences. Our results showed that LPS promotes the polarization of macrophages to M1-type, which is accompanied by an increase in Cx43 expression from 0 to 24 hours. Moreover, the application of the Cx43-specific blockers Gap19 and Gap26 reduces the expression of macrophage M1-type polarization markers. Thus, the expression of Cx43 increases first, and then, due to the initiation of intracellular autophagy during LPS-induced macrophage M1 polarization. Cx43 is degraded and the expression of Cx43 decreases from 24 hours to 48 hours. IL-4 decreases the expression of Cx43 from 24 hours to 48 hours and promotes the transformation of macrophages to M2-type. The application of Cx43 overexpression lentivirus leads to a reduction in the expression of M2 polarization markers. IL-4-induced M2 polarization of macrophages inhibits cell autophagy, reducing Cx43 degradation and leading to an increase in Cx43 from 24 hours to 48 hours. Thus, Cx43 expression in M2-type polarization experiences a reduction at first and then an increase from 24 hours to 48 hours. The direction of macrophage polarization can be controlled by regulating the expression of Cx43, thus providing a theoretical basis for treating atherosclerosis, tumors, and other diseases associated with macrophage polarization.
Bibliometric and visual analysis on oxidative stress in gynecological and reproductive diseases: A systematic review
Authors: Wang Ling , Yang Sichen , Ma Xiaona , Yang Liuqing , Ma Jing , Zhao Xiaoxuan , Zhang Qin
Published: April 2024

Background:

The imbalance between the generation and elimination of reactive oxygen species (ROS) is defined as oxidative stress (OS). Elevated levels of OS are implicated in various diseases, especially in gynecological and reproductive disorders. The abundance of recent literature makes it challenging to assimilate all available information. This bibliometric analysis seeks to depict the research landscape of OS in gynecological and reproductive diseases and to identify future hotspots and trends.

Methods:

The Web of Science Core Collection served as the source for articles related to OS in gynecological and reproductive diseases. CtieSpace and VOSviewer software were utilized to analyzed countries/regions, institutions, journals, authors, and keywords of all eligible articles.

Results:

A total of 1423 articles were included. There was a gradual increase in the number of publications in this field. The USA maintained the highest number of publications, with 372 articles. Cleveland Clinic was the leading institution in terms of publication volume, contributing 67 articles. In total, 6925 authors were identified. Agarwal A as the most frequently co-cited author, received 812 citations across 43 publications. The predominant clusters included “placenta,” “polycystic ovary syndrome,” “male infertility,” and “oocyte quality.” Notably, “oocyte quality’” was identified as a current key research topic.

Conclusion:

There was an uptrend in the number of articles addressing OS in gynecological and reproductive diseases. However, international collaboration and exchange were limited. The topic of male infertility had remained a consistent area of interest, and research on oocyte quality is poised to become a potential focal point in the future.
Active substance and mechanisms of Actinidia chinensis Planch for the treatment of breast cancer was explored based on network pharmacology and in silico study
Authors: Xu Yujing , Yang Jinrong , Han Xiaoyu , Gan Chunchun , Wei Xiaopeng
Published: April 2024

In this paper, our objective was to investigate the potential mechanisms of Actinidia chinensis Planch (ACP) for breast cancer treatment with the application of network pharmacology, molecular docking, and molecular dynamics. “Mihoutaogen” was used as a key word to query the Traditional Chinese Medicine Systems Pharmacology database for putative ingredients of ACP and its related targets. DrugBank, GeneCards, Online Mendelian Inheritance in Man, and therapeutic target databases were used to search for genes associated with “breast cancer.” Using Cytoscape 3.9.0 we then constructed the protein–protein interaction and drug-ingredient-target-disease networks. An enrichment analysis of Kyoto encyclopedia of genes and genomes pathway and gene ontology were performed to exploration of the signaling pathways associated with ACP for breast cancer treatment. Discovery Studio software was applied to molecular docking. Finally, the ligand-receptor complex was subjected to a 50-ns molecular dynamics simulation using the Desmond_2020.4 tools. Six main active ingredients and 176 targets of ACP and 2243 targets of breast cancer were screened. There were 118 intersections of targets for both active ingredients and diseases. Tumor protein P53 (TP53), AKT serine/threonine kinase 1 (AKT1), estrogen receptor 1 (ESR1), Erb-B2 receptor tyrosine kinase 2 (ERBB2), epidermal growth factor receptor (EGFR), Jun Proto-Oncogene (JUN), and Heat Shock Protein 90 Alpha Family Class A Member 1 (HSP90AA1) selected as the most important genes were used for verification by molecular docking and molecular dynamics simulation. The primary active compounds of ACP against breast cancer were predicted preliminarily, and its mechanism was studied, thereby providing a theoretical basis for future clinical studies.
A practical guide to selecting and using new ulcerative colitis therapies
Authors: Nagaraj Tara , Shinn John , De Felice Kara
Published: April 2024

Purpose of review

Several new biologics (mirizikizumab) and small molecules (upadacitinib, ozanimod, etrasimod) are approved for the treatment of moderate-to-severe ulcerative colitis. To date, there are no head-to-head trials to guide positioning and use of these newer agents.

Recent findings

From phase III clinical trials, in the biologic experienced patient, induction with ozanimod, etrasimod, and mirizikizumab had lower clinical remission rates, whereas upadacitinib's clinical remission rates remained similar. Indirect evidence using network meta-analysis suggests upadacitinib may be more efficacious than other advanced therapies for the treatment of ulcerative colitis in both the bio-naive and experienced patient. Upadacitinib was found to have the highest risk for adverse events.

These newer agents add novel mechanisms of action to the expanding therapeutic armamentarium of advanced therapies to treat ulcerative colitis. Based on expert opinion and available data to date, we propose a practical guide on positioning of these new agents for the treatment of ulcerative colitis. In mild-to-moderate disease, one should consider using ozanimod or etrasimod as first-line agents. In moderate-to-severe disease, we favor using mirizikizumab as first-line agent. In patients who have failed an anti-tumor necrosis factor agent, upadacitinib or mirizikizumab should be considered using patient factors and safety to guide one's decision between these two agents.