bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Mortality in Adults With Calcium Channel Blocker Toxicity Receiving Extracorporeal Membrane Oxygenation Support: An Extracorporeal Life Support Organization Registry Analysis
Authors: Subramanian Rakeshkumar , Roebuck Amelia , Joshi Hariom , Drouin Michelle
Published: September 2024

Calcium channel blocker (CCB) toxicity presents a significant mortality risk, highlighting the need for effective treatment strategies such as extracorporeal membrane oxygenation (ECMO). This study analyzes Extracorporeal Life Support Organization (ELSO) registry data to determine the mortality rate in adults treated with ECMO for CCB toxicity and identifies clinical predictors of mortality. A retrospective analysis of the ELSO registry from January 2016 to April 2023 was conducted, focusing on adults diagnosed with CCB toxicity (ICD-10 T46.1) who received ECMO. Data collected included patient demographics, ECMO details (mode, duration, type), pre-ECMO clinical indicators (pH, lactate levels, cardiac arrest incidence), and in-hospital mortality. The analysis employed descriptive statistics to profile the patient population, with independent t-tests and chi-square tests comparing survivors to nonsurvivors. Logistic regression identified mortality predictors, integrating multiple imputations to remedy missing data, thus ensuring the analysis’s integrity. The mortality rate for ECMO-treated CCB toxicity was 40.6%. Severe acidosis and the need for pre-ECMO renal replacement therapy were identified as key predictors of mortality. Further research is needed to determine if early ECMO initiation before a significant pH drop improves outcomes.
Surgical refinements and sensory and functional outcomes of using thinned sensate anterolateral thigh perforator flaps for foot and ankle reconstruction: A retrospective study
Authors: Pan ZhaoHui , Zhao YuXiang , Ye XingHua , Wang JianBo , Li XingBo
Published: September 2024

To improve the use of sensate anterolateral thigh (ALT) flaps for foot and ankle reconstruction, we employed a thinned nerve-selective harvesting technique. The data of 31 patients in whom sensate ALT perforator flaps were transferred for reconstruction of soft-tissue defects in the foot and ankle were reviewed. Flaps were elevated with 2 refinements. The first is the initial selection of the “true” sensory branch in the medial incision on the suprafascial plane. The second is flap thinning by keeping a cuff of thin deep fat surrounding the point where the perforator or nerve branch inserts into the superficial fat layer. The recipient site assessment consisted of complications, monofilament touch perception, sharp–blunt discrimination, axial circumference, and American Orthopedic Foot and Ankle Society score. After a mean follow-up of 31.7 months, all flaps survived uneventfully, except for marginal necrosis in 1 patient, infection in 1 patient, ulceration in 2 patients, and secondary thinning in 3 patients. The sensation of each flap was restored. A total of 87% and 90% of the patients exhibited 5 or more positive response points in the Semmes–Weinstein monofilament touch and sharp–blunt discrimination testings, respectively. The mean axial circumference of the reconstructed foot was 27.4 cm (the unaffected side was 25.8 cm). All patients achieved mobility in ordinary shoes with a mean functional score of 74.6. The thinned nerve-selective sensate ALT perforator flap can be a favorable option for foot and ankle reconstruction. This method also offers the possibility of preserving the nerve branch at the donor thigh.
Identification of novel CDH23 variants linked to hearing loss in a Chinese family: A case report
Authors: Sun Jing , Ren Dawei , Gong Meiheng , Guo Xinyi , Zhang Yan , Du Bo
Published: September 2024

Rationale:

Deafness is associated with both environmental and genetic factors, with hereditary deafness often caused by mutations in deafness-related genes. Identifying and analyzing deafness-related genes will aid in early diagnosis and pave the way for treating inherited deafness through gene therapy in the future.

Patient concerns:

A 15-month-old girl underwent audiological examination at the outpatient clinic of the hospital due to hearing loss and her brother was diagnosed with profound bilateral sensorineural hearing loss at the age of 3.

Diagnoses:

The diagnosis was determined as extremely severe sensorineural hearing loss caused by genetic factors.

Interventions:

Clinical data of the patient were collected, and peripheral blood samples were obtained from both the patient and her family members for DNA extraction and sequencing.

Outcomes:

By utilizing targeted capture next-generation sequencing to further screen for deafness-related genes, 2 novel variants in CDH23 were identified as the causative factors for the patient's deafness.

Lessons:

This study identified 2 novel heterozygous mutations in a Chinese family. Both the proband and her sibling have non-syndromic hearing loss (NSHL) and carry distinct heterozygous mutations of cadherin-like 23 (CDH23). One mutation, CDH23:c.2651 A>G, originated from their mother and paternal family, affecting the exon23 domain of CDH23. The other mutation, CDH23:c.2113 G>T, was inherited from their paternal grandmother, impacting the exon19 domain of CDH23. These 2 novel mutations likely cause NSHL by affecting protein function. This finding suggests that identifying 2 novel mutations in CDH23 contributes to the genetic basis of NSHL.
Causal influence of plasma metabolites on age-related macular degeneration: A Mendelian randomization study
Authors: Wang Tao , Huang Chun , Li Jinshuai , Wu Xiangjian , Fu Xiaoyan , Hu Yimin , Wu Geping , Yang Chunfeng , Chen Sheng
Published: September 2024

Using genome-wide association study data from European populations, this research clarifies the causal relationship between plasma metabolites and age-related macular degeneration (AMD) and employs Metabo Analyst 5.0 for enrichment analysis to investigate their metabolic pathways. Employing Mendelian randomization analysis, this study leveraged single nucleotide polymorphisms significantly associated with plasma metabolites as instrumental variables. This approach established a causal link between metabolites and AMD. Analytical methods such as inverse-variance weighted, Mendelian randomization-Egger, and weighted median were applied to validate causality. Mendelian Randomization Pleiotropy Residual Sum and Outlier was utilized for outlier detection and correction, and Cochran’s Q test was conducted to assess heterogeneity. To delve deeper into the metabolic characteristics of AMD, metabolic enrichment analysis was performed using Metabo Analyst 5.0. These combined methods provided a robust framework for elucidating the metabolic underpinnings of AMD. The 2-sample MR analysis, after meticulous screening, identified causal relationships between 88 metabolites and AMD. Of these, 16 metabolites showed a significant causal association. Following false discovery rate correction, 3 metabolites remained significantly associated, with androstenediol (3 beta, 17 beta) disulfate (2) exhibiting the most potent protective effect against AMD. Further exploration using Metabo Analyst 5.0 highlighted 4 metabolic pathways potentially implicated in AMD pathogenesis. This pioneering MR study has unraveled the causal connections between plasma metabolites and AMD. It identified several metabolites with a causal impact on AMD, with 3 maintaining significance after FDR correction. These insights offer robust causal evidence for future clinical applications and underscore the potential of these metabolites as clinical biomarkers in AMD screening, treatment, and prevention strategies.
Mental distress and nutrition of family physicians, a European based cross-sectional study
Authors: Gokdemir Ozden , Gorgu Genco , Jotić Ivanović Marina , Woolley Angharad (Kate) , Öztürk Ahmet , Rey Seoane Miriam , Reczek Lukasz , Bakola Maria , Aygun Olgu , Küçükerdem Halime Seda , Toplu Hilal
Published: September 2024

Family physicians are a pillar of the primary healthcare system, and their own mental well-being is integral to their performance. However, many studies have suggested a high prevalence of mental distress. The contributing factors include the emotional demands of the profession, work overload, budgetary constraints, loss of autonomy, and erosion of professional values. Outbreaks such as the COVID-19 pandemic exacerbate distress due to a greater risk of exposure to the virus, increased working hours, and fear of infecting families. Thus, it is crucial to assess risks and provide preventive measures. This study aimed to evaluate the association between the dietary patterns of family physicians and their mood. This study used a cross-sectional descriptive method and a validated Food-Mood Questionnaire (FMQ), shared via social networks across 10 European countries, to collect data from family physicians. Permission to use the FMQ was obtained. The breakfast-pattern subscale had the highest mean score (14.670 ± 4.305). The other subscale mean scores were as follows: health pattern (13.317 ± 5.388), mental distress pattern (11.184 ± 3.824), and western diet pattern (9.827 ± 3.604). According to Pearson correlation test there was a positive correlation between breakfast and Western diet patterns and between breakfast and health patterns. There was a negative correlation between health and mental distress pattern. Evidence suggests that mental distress may arise from different dietary deficiencies. Physicians’ nutritional patterns have an impact on health indicators and are distributed in relation to sociodemographic factors, especially the regions they live in. Diet assessment is becoming a vital modifiable risk factor for mental health, but further research in this field is needed.
Bixie Fenqing decoction in the treatment of chronic prostatitis: A systematic review and meta-analysis
Authors: Li Hongying , Yang Yanfang , Shi Menghua , Xu Lei , Huang Ying , Hu Zhaodi , Qin Guozheng
Published: September 2024

Background:

Traditional Chinese medicine (TCM) posits that chronic prostatitis is associated with the accumulation of damp-heat pathogenic factors in the lower jiao. The Bixie Fenqing decoction (BFD) eliminates damp-heat pathogenic factors in the body, thereby alleviating inflammation and improving symptoms.

Methods:

Databases such as CNKI, WanFang, VIP, CBM, ClinicalKey, PubMed, Embase, and the Cochrane Library were searched. The search time ranged from the establishment of the database until March 30, 2024. RCTs that used BFD for chronic prostatitis were screened. The methodological quality of the studies was evaluated using the Cochrane Scoring System. Meta-analysis of outcome indicators was performed using RevMan 5.4 software, and Egger analysis of publication bias for the primary outcome indicators was conducted using Stata 16 software.

Results:

This analysis included 1104 patients. Meta-analysis showed that BFD significantly improved clinical efficacy in patients with chronic prostatitis, with a total effective rate (RR = 1.20, 95% CI: 1.13 to 1.26, P < .00001) and cure rate (RR = 1.52, 95% CI: 1.24 to 1.86, P < .00001). It significantly reduced the NIH-CPSI (National Institutes of Health-Chronic Prostatitis Symptom Index) scores, levels of inflammatory factors, white blood cell counts, and TCM syndrome scores in patients with chronic prostatitis. Specifically, the NIH-CPSI total scores (MD = −4.41, 95% CI: −5.27 to −3.55, P < .00001), NIH-CPSI pain scores (MD = −2.08, 95% CI: −2.93 to −1.23, P < .00001), NIH-CPSI urinary symptom scores (MD = −1.13, 95% CI: −1.69 to −0.57, P < .0001), NIH-CPSI quality of life scores (MD = −1.25, 95% CI: −1.76 to −0.75, P < .00001), levels of inflammatory factors TNF-α (MD = −11.18, 95% CI: −13.84 to −8.53, P < .00001) and IL-10 (MD = −20.60, 95% CI: −26.82 to −14.37, P < .00001) in prostatic fluid, white blood cell counts in prostatic fluid (MD = −2.91, 95% CI: −5.46 to −0.36, P = .03), and TCM syndrome scores (MD = −7.01, 95% CI: −8.13 to −5.90, P < .00001) were all significantly improved.

Conclusion:

BFD has a definite effect on the treatment of chronic prostatitis.
Gender differences in cardiovascular outcomes of kidney transplant recipients: A retrospective cohort study
Authors: Liu Jiang , Chen Siwei , Gao Wenqiang
Published: September 2024

The purpose of this study was to investigate gender differences in cardiovascular outcomes of kidney transplant recipients (KTRs). Here, a retrospective cohort study was conducted, and data from the National Health Insurance Research Database in Taiwan were used. In total, 2904 patients who had end-stage renal disease (ERSD) and received kidney transplantation (KT) were identified by propensity score matching (PSM) and were enrolled from 1997 to 2012, with follow-up ending in 2013. Besides, major adverse cardiovascular events (MACEs) were defined as a composite of all-cause mortality, nonfatal myocardial infarction, and nonfatal strokes. Apart from that, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated by Cox regression, while the Bayesian network model was constructed to assess the importance of risk factors for MACEs. Furthermore, the original cohort was a sensitivity analysis. Women had a lower risk of MACEs compared with men (hazard ratio [HR]: 0.84; 95% CI: 0.72–0.98; P = .024). Beyond that, stratified analysis of age and waiting time for KT showed that the risk of MACEs was significantly lower in women than in men among KTRs aged > 50 years (HR: 0.79; 95% CI: 0.62–1.0; P = .05) or waiting time for KT ≤ 6 years (HR: 0.85; 95% CI: 0.72–0.99; P = .04). Bayesian network indicated that age is an important determinant of cardiovascular outcomes in KTRs, regardless of gender. In Taiwan, women had a lower risk of adverse cardiovascular outcomes than men in KTRs aged > 50 years or with a waiting time for KT ≤ 6 years. Furthermore, age is an important independent determinant for the prognosis of KTRs.
Three-year outcomes following non-ST-segment elevation myocardial infarction and new-generation drug-eluting stent implantation, stratified by patient age (under and over 75 years) and left ventricular ejection fraction: A prospective cohort study
Authors: Kim Yong Hoon , Her Ae-Young , Rha Seung-Woon , Choi Cheol Ung , Choi Byoung Geol , Hyun Su Jin , Park Soohyung , Kang Dong Oh , Cho Jung Rae , Kim Min-Woong , Park Ji Young , Park Sang-Ho , Jeong Myung Ho
Published: September 2024

Due to limited published data, we investigated 3-year outcomes according to left ventricular ejection fraction (LVEF) in patients older and younger than 75 years with non-ST-segment elevation myocardial infarction (NSTEMI) who underwent successful newer-generation drug-eluting stent (DES) implantation. This research analyzed the data of 4558 patients (1032 older adults [≥75 years] and 3526 younger adults [<75 years]) from the Korea Acute MI Registry-NIH. We further divided the older group based on LVEF: heart failure (HF) with reduced EF (HFrEF, ≤40%, n = 196; group A), HF with mildly reduced EF (HFmrEF, 41–49%, n = 228; group B), and HF with preserved EF (HFpEF, ≥50%, n = 608; group C). Similarly, the younger group was divided into HFrEF (group D, n = 353), HFmrEF (group E, n = 577), and HFpEF (group F, n = 2596). The primary outcome was a composite of major adverse cardiac events (MACE) at 3 years, including all-cause death, recurrent MI, any repeat revascularization, or hospitalization for HF. MACE rates were highest in the HFrEF groups (A and D), followed by the HFmrEF groups (B and E), and lowest in the HFpEF groups (C and F) for both age groups. All-cause death, cardiac death (CD), all-cause death or MI, and hospitalization for HF rates were higher in group A than in groups B and C, and higher in group D than in groups E and F. Across all LVEF categories, MACE, all-cause death, CD, and non-CD, and all-cause death or MI rates were higher in the older group. This multicenter cohort study demonstrates that older patients have higher mortality rates compared to younger patients. Additionally, MACE rates were highest in the HFrEF group, followed by the HFmrEF group, and lowest in the HFpEF group across both age groups. Further research is needed to confirm these findings.
Relationship between sleep quality and duration and the incidence rate of arthritis: A prospective cohort study
Authors: Wu HaiTing , Yuan XinHua , Fu QingSong
Published: September 2024

Little is known about the relationship between sleep duration and quality and the risk of arthritis in the older adult population of China. The participants were a prospective cohort of adults aged 65 years and over who had not had arthritis at baseline and had participated in follow-up surveys from 2011 to 2018 in the Chinese Longitudinal Health and Longevity Survey (CLHLS). A Cox proportional-hazards regression model was established. The dose–response relationship between sleep duration and the incidence of arthritis was analyzed. The results of a Cox proportional-risk regression model revealed that sleep duration and quality were associated with the risk of arthritis in the participants. Specifically, compared with participants with good sleep quality, those with poor sleep quality had a 38% higher risk of developing arthritis (hazard ratio [HR] = 1.38, 95% confidence interval [CI] = 1.09–1.74), and compared with participants with a sleep duration of 5 to 10 hours, those with a sleep duration shorter than 5 hours had a higher risk of developing arthritis (HR = 1.56, 95% CI = 1.27–1.91). Moreover, the results of a restricted cubic spline Cox proportional-hazards regression model showed that there was an approximately non-linear dose–response relationship between sleep duration and the incidence rate of arthritis (P nonlinear < .0001). Participants with poor sleep quality and a sleep duration shorter than 5 hours had a higher risk of developing arthritis than those with better sleep quality and a longer sleep duration.
Efficacy and complication of keyhole surgery and open surgery for repairing fibular collateral ligament in the persistent lateral ankle joint instability treatment: A protocol for systematic review and meta analysis
Authors: Wang Ding , Yuan Jianhua , Wu Yongping
Published: September 2024

Background:

Over the past few years, there has been growing interest in identifying and treating persistent lateral ankle joint instability. Many medical professionals believe that early intervention is important to address this instability.

Methods:

Four databases on the outcomes of open and keyhole surgery for repairing the fibular collateral ligament in the treatment of chronic lateral ankle joint instability were acquired from the computer during controlled trials. Data analysis was conducted after the rigorous literature quality evaluation using Stata software.

Results:

This meta-analysis finally included 11 articles. Eleven studies reported complications were significantly lower in the treated group (odds ratio: 0.55; 95% confidence interval [CI]: 0.32–0.94; P < .05) compared to the untreated group, as were American Orthopedic Foot and Ankle Society scores (standard mean difference [SMD]: 3.77; 95% CI: 1.17–6.37; P < .01), visual analog scale scores (SMD: −0.69; 95% CI: −1.24 to −0.14; P < .05), Karlsson scores (SMD: 2.78; 95% CI: 0.35–5.21; P < .05), and Tegner scores (SMD: 0.41; 95% CI: −0.13 to 0.95; P = .139).

Conclusion:

According to complications, American Orthopedic Foot and Ankle Society scores, visual analog scale scores, and Karlsson scores, the study findings suggested that keyhole surgery may be beneficial in patients with persistent lateral ankle joint instability. Following this, the growing number of high-quality studies needs to confirm the results reported in this study.
Assessment of neutrophil/lymphocyte ratio and mean platelet volume values in patients with diabetes mellitus diagnosis: A case–control study
Authors: Aygün Kemal , Asma Sakalli Ayça , Küçükerdem Halime Seda , Aygün Olgu , Gökdemir Özden
Published: September 2024

Diabetes mellitus, fundamentally characterized by hyperglycemia, leads to significant metabolic disturbances. Type 2 diabetes mellitus is a chronic, inflammatory, preventable metabolic disease that is a significant health issue globally. The neutrophil-to-lymphocyte ratio (NLR) is an essential marker of systemic inflammation. We aimed to reveal the relationship between long-term glucose control and NLR, mean platelet volume (MPV), and red blood cell width in patients with type 2 diabetes. This was a retrospective case–control study. A total of 3532 applications in 2 years time were identified. Age, gender, medical history, white blood cell (WBC), hemoglobin, mean corpuscular volume (MCV), MPV, red blood cell width, NLR, hematocrit, platelet, C-reactive protein, Haemoglobin A1C data of the patients were analyzed. 1790 patients were included. A significant positive correlation was found between HbA1c and age, white blood cell, hematocrit, MCV, red blood cell width, NLR, and CRP. A statistically significant negative correlation was found between HbA1c and MCV. The results showed statistically significant differences between NLR, MPV, WBC, MCV, age, and HbA1c levels. Increased HbA1c levels are usually associated with an increase in these parameters. This is important for determining the risk of complications and protecting target organs in diabetic patients. A significant decrease in MCV levels was found as HbA1c levels increased. This suggests that evaluating red blood cells in routine controls of diabetic patients may indicate glycemic control. These findings may be valuable in early diagnosis of complications.
Causal relationship between immune cells and pulmonary arterial hypertension: Mendelian randomization analysis
Authors: Du Dan , Qiu Jia-Yong , Zhao Jing , Yuan Ya-Dong
Published: September 2024

Immunity and inflammation in pulmonary arterial hypertension (PAH) has gained more attention. This research aimed to investigate the potential causal connections between 731 immunophenotypes and the likelihood of developing PAH. We obtained immunocyte data and PAH from openly accessible database and used Mendelian randomization (MR) analysis to evaluate the causal association between each immunophenotype and PAH. Various statistical methods were employed: the MR-Egger, weighted median, inverse variance weighted (IVW), simple mode, and weighted mode. In the study of 731 different types of immune cells, it was found that 9 showed a potential positive connection (IVW P < .05) with increased risk of PAH, while 19 had a possible negative link to decreased risk. Following false discovery rate (FDR) adjustment, the analysis using the IVW method demonstrated that 5 immune phenotypes were significantly associated with PAH (FDR < 0.05, OR > 1). Conversely, there was a negative correlation between PAH and 4 immune cell types (FDR < 0.05, OR < 1). Sensitivity analyses suggested the robustness of all MR findings. This research, for the first time, has revealed indicative evidence of a causal link between circulating immune cell phenotypes and PAH through genetic mechanisms. These results underscore the importance of immune cells in the pathogenesis of PAH.
Risk factors and severity of melasma in patients attending dermatology outpatient department of a tertiary care hospital: A cross-sectional study
Authors: Shakya Sunil , Pathak Bishnu Deep , Lamichhane Ramesh , Ghimire Bhuwan , Devkota Sameeksha , Ghimire Sandesh , Shrestha Prosess , Acharya Sajana , Baniya Sunil , Bogati Kanchan , Pathak Indra Dev , Dhakal Bishal
Published: September 2024

Melasma is a chronic acquired dysfunction of melanogenesis characterized by dark brown irregular macules on skin. Genetic predisposition, pregnancy, sun exposure, and hormonal therapy are common risk factors. Prevalence of melasma is variable, ranging from 5% to 46%. This study aimed to assess the severity and potential risk factors of melasma in a tertiary care setting. An analytical cross-sectional study was conducted on patients with melasma visiting dermatology department of a tertiary care center in Nepal. Nonprobability consecutive sampling was adopted. Severity of melasma was assessed using the Modified Melasma Area and Severity Index score. Data analysis was performed using the Statistical Package for the Social Sciences, version-23. Bivariate analysis was done by using Student t test/Mann–Whitney U test, or Chi-square/Fischer exact test for continuous and categorical variables, respectively. The overall median Modified Melasma Area and Severity Index score was 5.40 (3.60–6.75). Most patients (168, 88.42%) had mild melasma. The severity score was significantly higher in older age (P = .024), women having parity more than 3 (P = .014), centrofacial pattern (P = .024), and patients having dermatological comorbidities (P = .014). Severity was significantly lower in those who used cosmetics at home. Moreover, the use of digital screens was not associated with an increase in melasma severity. Most of the cases had mild melasma. Severity was significantly associated with age, parity, pattern, practice of cosmetic use, and presence of dermatological comorbidities.
Effectiveness of acupuncture plus music therapy for post-stroke depression: Systematic review and meta-analysis
Authors: Zhang Junyan , Zhao Yaowei , Li Hongyu , Yang Yinyue , Tang Qiang
Published: September 2024

Background:

Post-stroke depression (PSD) is a prevalent complication of stroke that adversely affects patient outcomes. The etiology of PSD is complex, and no universally effective treatment exists. Acupuncture, with its historical use, combined with music therapy, presents a novel approach for PSD treatment. This study aims to systematically evaluate the clinical efficacy of combining acupuncture with music therapy for PSD through a meta-analysis.

Methods:

We systematically searched both Chinese and English literature in PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and the Chinese Science and Technology Periodical Database (VIP Database) for randomized controlled trials evaluating acupuncture combined with music therapy for PSD. Two independent evaluators conducted quality assessments and data extraction. Statistical analyses were performed using RevMan 5.4 and Stata 18.0 software.

Results:

This article contains 11 studies, involving a total of 698 patients. The results of the meta-analysis showed that, compared with the control group, the test group showed significant improvement on multiple outcome measures: HAMD score [mean difference (MD) = ‐3.18, 95% confidence interval (CI) (‐3.61, ‐2.76),P < .00001], Self-Rating Depression Scale score [MD = ‐5.12, 95% CI (‐6.61, ‐3.63),P < .00001], Pittsburgh sleep quality index score [MD = ‐2.40, 95% CI (‐2.96, ‐1.84),P < .00001], BI score [MD = 14.16, 95% CI (4.37, 23.94),P = .005] were all significantly lower, significantly higher effectiveness [risk ratio = 1.21, 95% CI (1.11, 1.33),P < .0001]. These differences were also statistically significant.

Conclusion:

The use of acupuncture combined with music therapy is effective in reducing depression in PSD patients.
Percutaneous endoscopic transforaminal decompression surgery for symptomatic double-level lumbar spinal stenosis with ossification
Authors: Li Jiadong , Xu Xiaoping , Shui Yunjing
Published: September 2024

This study aimed to explore the short-term effects of percutaneous endoscopic transforaminal decompression (PETD) for the treatment of symptomatic double-level lumbar spinal stenosis (LSS) with ossification. Twenty-eight patients diagnosed with double-level lumbar spinal stenosis who underwent double-level PETD surgery between January 2021 and January 2023 at our institution. General information, such as age, sex, disease duration, hospitalization time, and operation time, was recorded. Magnetic resonance imaging (MRI) dural sac cross-sectional area (DSCA) was recorded to assess the degree of spinal canal decompression. The White–Panjabi scoring system (WP) was used to assess preoperative and postoperative lumbar spine stability. Pre- and postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were recorded to assess symptom improvement, and surgical efficacy was evaluated using the modified Macnab evaluation criteria at the 1-year postoperative follow-up. The types and risks of complications were also recorded. The patient’s 1-year postoperative follow-up MRI showed that both L3/4 and L4/5 DSCA were significantly enlarged compared with preoperative values (P < .001). There was no significant difference in the WP scores at 3 months postoperatively compared with those preoperatively (P > .05). The VAS scores for hip and lower extremity pain at 3 days, 3 months, and 1 year postoperatively were significantly lower than those preoperatively (P < .001), and the ODI scores at 3 months and 1 year postoperatively were significantly lower than those preoperatively (P < .001). There were no significant differences in hip pain, lower extremity pain VAS scores, or ODI scores between the postoperative follow-up time points (P > .05). There was 1 case of lower limb numbness and 1 case of neuroedematous pain in the postoperative period, and all patients had no complications, such as dural sac tear, infection, or recurrence. The 1-year postoperative follow-up was assessed as excellent in 17 cases, good in 9 cases, and possible in 2 cases using the modified Macnab criteria, with an excellent rate of 92.9%. The efficacy of double-level PETD for symptomatic double-level LSS is clear, the local stability of the lumbar spine is less affected, and the risk is low, which can reduce the chances of reoperation in patients. Thus, it is a recommended surgical procedure.
Integrative Korean medicine treatment for low back pain with radiculopathy caused by Bertolotti syndrome: A CARE-compliant article and retrospective review of medical records
Authors: Cho Sohyun , Ahn Yong-Jun , Lee Yoon Jae , Ha In-Hyuk , Lee Ye-Seul
Published: September 2024

Rationale:

Bertolotti syndrome (BS) is characterized by radiculopathy caused by structural anomalies. Despite the structural deformity, conservative treatment is predominantly recommended due to surgery-related complications. Because of the diagnosis complexity, the incidence and contributing factors of BS, remain controversial. We report the case of a patient with BS who was treated with integrative Korean medicine (IKM). Moreover, we evaluated the epidemiological characteristics of lumbosacral transitional vertebrae (LSTV) from medical records of patients diagnosed with LSTV at 4 different medical clinics of Korean medicine.

Patient concerns:

A 33-year-old male patient with low back pain and severe radiculopathy was diagnosed with BS (Castellvi Type II) on magnetic resonance imaging at a local orthopedic clinic. Additionally, the medical records of patients with BS who had been treated with IKM in 4 different institutions of Korean medicine were analyzed, and the characteristics of patients suffering from BS were identified.

Diagnoses, interventions, and outcomes:

The patient underwent IKM treatment for 40 days as an inpatient. The patient’s condition was assessed using the Euroqol 5-dimension index and Oswestry Disability Index, and symptom severity was measured using the Numeric Rating Scale. IKM was effective in improving pain and functional disability without causing any adverse effects. In a retrospective review of medical records, the study identified symptom trends reported by patients with LSTV.

Lessons:

IKM demonstrates potential efficacy in BS management, with notable trends in LSTV-related symptomatology warranting further investigation.
Elucidation of the molecular mechanism of type 2 diabetes mellitus affecting the progression of nonalcoholic steatohepatitis using bioinformatics and network pharmacology: A review
Authors: Wu Bo , Lan Xiaohong , Gao Ming , Wei Wei , Wang Yuekun , Yang Yang , Yu Zhiyang , Huang Min , Wu Qinyan
Published: September 2024

Increasing evidence suggests that patients with diabetes are at increased risk of developing nonalcoholic steatohepatitis (NASH), but the underlying mechanisms that affect the progression of NASH remain unclear. In this study, we used bioinformatics and network pharmacology methods to explore the differentially expressed genes of NASH and the related genes of type 2 diabetes mellitus, and a total of 46 common targets were obtained. Gene ontology showed that the common targets were mainly involved in biological processes such as glucocorticoid, hormone, and bacterium responses. The Kyoto Encyclopedia of Genes and Genomes enrichment analysis signal pathways were mainly in colorectal cancer, amphetamine addition, the peroxisome proliferator-activated receptor signaling pathway, and the toll-like receptor signaling pathway. The protein–protein interaction network identified 8 hub genes, and the co-expression network was analyzed to obtain 7 related functions and mutual proportions of hub genes. A total of 120 transcription factors were predicted for hub genes. Hub genes were closely related to immune cells, including neutropils and eosinophils. In addition, we identified 15 potential candidate drugs based on hub genes that are promising for the treatment of NASH. Type 2 diabetes mellitus can affect the progression of NASH by changing hormone levels and inflammatory responses through multiple targets and signaling pathways. Eight hub genes are expected to be potential targets for subsequent treatment.
A bibliometric analysis of domestic and international research on hemorrhagic fever with renal syndrome over the past 2 decades
Authors: Zhou Wenfang , Dong Yonghai , Liu Xiaoqing , Ding Sheng , Si Hongyu , Yang Cheng
Published: September 2024

Background:

Bibliometrics and statistics were used to determine and analyze the research status of hemorrhagic fever with renal syndrome (HFRS) from 2004 to 2023, and objectively reflect the development and future trend of HFRS at home and abroad through comparison.

Methods:

To search the research literature on HFRS in China National Knowledge Network and Web of Science databases from January 2004 to December 2023, CiteSpace and VOSviewer were used to visually analyze the annual publication trends, authors, research institutions, countries, co-cited literature, keywords and other contents of the included literatures.

Results:

A total of 4460 Chinese literatures and 2372 foreign literatures were included. The number of HFRS published in the Web of Science database showed a trend of positive growth, while the number of HFRS published in China National Knowledge Network showed a trend of decline. Bai Xuefan and Wang Zhiqiang were the most published authors in China, and foreign scholars Vaheri, Antti, Ahlm, Clas. The main research institutions in the domestic literature were Zhejiang Provincial Center for Disease Control and Prevention, Liaoning Provincial Center for Disease Control and Prevention, while foreign research institutions concentrated on the University of Helsinki and Ministry of Health. The top 3 countries in the literature research of Web of Science are the USA, China, and Germany.

Conclusion:

The analysis results of hot spots and trends suggested that we need to develop more reliable tools and methods in the monitoring and spatio-temporal analysis of HFRS epidemic data in the future, so as to provide references for the surveillance and early warning of zoonotic diseases in the field of public health research.
Amlodipine-induced gingival hyperplasia in a Nepalese patient experiencing high dosages: a case report
Authors: Chaulagain Basanta , Jha Omkar , Mainali Sumina , Sharma Prakriti
Published: September 2024

Introduction and importance:

Amlodipine is a third-generation calcium channel blocker used in the treatment of hypertension. One of the side effects associated with amlodipine is gingival hyperplasia mostly occurring at a higher dose (10 mg). There are very few cases of gingival hyperplasia associated with amlodipine at a lower dose (5 mg) or short-term administration.

Case presentation:

A 51-year-old male patient with diagnosed hypertension sought medical attention for gingival swelling and bleeding from the gums while brushing. He had been under amlodipine 5 mg for 12 months, which was increased to 10 mg for the last 2 months. The history and physical examination were consistent with amlodipine-induced gingival hyperplasia. The first line of treatment consisted of discontinuation of amlodipine and substitution with another class of anti-hypertensive.

Clinical discussion and conclusion:

The presented case highlights the challenge of balancing economic considerations with potential side effects in the use of amlodipine for hypertension in low-income countries like Nepal. Given its availability at no cost or minimal expense, amlodipine is often initiated as a first-line therapy. However, the decision to increase the dosage to 10 mg/day, influenced by economic constraints and the drug’s affordability, raises the risk of gingival hyperplasia. This case emphasizes the importance of physicians being mindful of potential adverse effects when prescribing higher doses of amlodipine and underscores the need for continued vigilance in managing hypertension in resource-limited settings.
Idiopathic intracranial hypertension following childbirth: a case report and management strategies
Authors: Ibrahim Abdiwahid Ahmed , Sheikh Hassan Mohamed , Ahmed Abdirisak Abdikarin , Sidow Nor Osman , Farah Osman Hidig Mohamed , Kadiye Mohamed Salad , Adam Bakar Ali
Published: September 2024

Introduction:

A postpartum headache, also known as pseudotumor cerebri, is defined as a headache and shoulder or neck pain that occur in the first 6 weeks following childbirth. Common causes of headaches during puerperium include pre-eclampsia, subarachnoid hemorrhage, cerebral venous thrombosis, meningitis, brain tumors, cerebrovascular diseases, and posterior reversible encephalopathy syndrome. Pseudotumor cerebri is an extremely rare cause of postpartum severe headache with visual disturbance with or without papilledema.

Case presentation:

Here, the authors present a 32-year-old postpartum female patient who presented with a severe headache and visual disturbance for 10 days. Neurological examination did not show any focal or lateralizing deficit. However, a fundus examination showed severe bilateral papilledema. A contrast-enhanced brain MRI did not reveal a space-occupying mass lesion. MRV excluded venous occlusion. A lumbar puncture demonstrated a high opening pressure of 75 cmH2O with a normal cell count and protein and glucose levels. The patient was diagnosed with idiopathic intracranial hypertension. After 8 weeks of treatment with diazomid and topiramate, the patient improved clinically, and her papilledema regressed.

Clinical discussion:

The occurrence of IIH is very rare among postpartum females. To our knowledge, very few cases of postpartum IIH have been reported in the medical literature. Although rare, patients with postpartum headache with visual disturbances should have a fundoscopic examination. The patient was diagnosed and managed in time, which led to significant clinical improvement and salvage of her vision.

Conclusion:

As described in this case, idiopathic intracranial hypertension can cause severe headaches with and without visual disturbance during the postpartum period (despite being rare in this period), so it should be considered in the differential diagnosis.
Frontal bone resorption after fronto-facial monobloc advancement in FGFR-related craniosynostoses: predictive factors
Authors: Landart Matthieu , Benichi Sandro , James Syril , Arnaud Éric , Paternoster Giovanna , Khonsari Roman Hossein
Published: September 2024

Background:

Fronto-facial monobloc advancement with internal distraction (FFMBA) is a central procedure in the management of FGFR-related craniosynostoses. Children undergoing FFMBA may present with resorption of the frontal bony flap in the months or years following surgery. Here, we aimed at identifying the clinical factors associated with resorption and its extent in patients with Crouzon and Pfeiffer syndromes.

Methods:

We conducted a retrospective monocentric study of children with Crouzon and Pfeiffer syndromes who underwent FFMBA between May 2008 and October 2021, with available CT-scan data (1) early after surgery before the initiation of distraction, (2) at the end of distraction, (3) 2 years after surgery and optionally (4) 5 years or more after surgery. The following parameters were included: sex, age, mutation, number of previous craniofacial procedures, presence of tracheostomy or ventriculo-peritoneal (VP) shunt, FFMBA indication (raised ICP, OSAS, exorbitism, morphology), per-operative parameters (use of osteosynthesis, per-operative advancement, duration of surgery) and post-operative parameters (CSF leak, infection, distraction initiation, total advancement, persistence of a retro-frontal dead space).

Results:

63 patients were included, with a mean age of 2.91 years (SD=1.61) at the time of surgery, male/female sex ratio of 1.1, and a majority of Crouzon syndrome (84%). Two years after surgery (average: 622 days, SD=286.7), mean frontal bone flap resorption was 4.83 cm2 ([0-27.3], SD=5.35). Factors associated with more severe frontal bone resorption were the intraoperative use of absorbable sutures vs steel wires (9.83 vs. 3.99, p=0.04) and the persistence of a retro-frontal dead space at 2 years after surgery (13.12 vs. 3.63, p<0.001).

Conclusion:

The use of absorbable sutures for frontal bone fixation in FFMBA and the persistence of a retro-frontal dead space two years after surgery are risk factors for bone resorption. This report indicates that rigid osteosynthesis should be favored, and both per-operative and early post-operative distractor activation should be performed with care and follow-up of brain expansion.
Radical overlapping intravelar veloplasty during primary cleft palate repair results in decreased secondary speech surgery
Authors: Podolsky Dale J , Fischbach Simone , Wong Riff Karen WY , Saggaf Moaath , Klaiman Paula , Fisher David M
Published: September 2024

Background:

There is growing evidence that performing a radical intravelar veloplasty (IVV) improves speech outcomes. The aim of this study was to determine the impact of a radical IVV during primary palatoplasty on the rate of secondary speech surgery.

Methods:

This is a retrospective review of primary palatoplasty using an IVV performed by a single surgeon from the year 2000 to 2023. In 2008, the surgeon changed technique to involve a more radical IVV. The radical overlapping IVV involves release of the palatopharyngeus from the posterior hard palate and from the nasal component of the tensor veli palatini, release of the levator veli palatini to the levator tunnel, and overlapping of the palatopharyngeus-levator unit across the midline after retro-positioning. This separated the patients into a before and after technique change group. The rate of secondary speech surgery was compared between the two time periods.

Results:

An IVV was performed during straight line repairs 333 and 272 times during the first and second time periods, respectively. The second radical overlapping IVV group had significantly (p<0.05) less secondary speech surgery procedures at 43 (15.81%) compared to 83 (24.92%) amongst the first conservative IVV group (p<0.05).

Conclusions:

Precise anatomical dissection, extensive release, retro-positioning and overlap of the velar musculature during IVV results in significantly less secondary speech surgery.
Diagnostic Accuracy of Ultrasound Guidance in Transthoracic Needle Biopsy
Authors: Lemieux Simon , Pinard Lorence , Marchand Raphaël , Kali Sonia , Altmayer Stephan , Mai Vicky , Provencher Steeve
Published: September 2024

Purpose:

To perform a systematic review and meta-analysis of relevant studies to assess the diagnostic accuracy and safety outcomes of ultrasound (US)-guided transthoracic needle biopsy (TTNB) for peripheral lung and pleural lesions.

Materials and Methods:

A search was performed through Medline, Embase, Web of Science, and Cochrane Central from inception up to September 23, 2022 for diagnostic accuracy studies reporting US-guided TTNB (Prospero registration: CRD42021225168). The primary outcome was diagnostic accuracy, which was assessed by sensitivity, specificity, likelihood ratios (LR), and diagnostic odds ratio. Sensitivity and subgroup analyses were performed to evaluate inter-study heterogeneity. The secondary outcome was the frequency of complications. Random-effects models were used for the analyses. The risk of bias and the applicability of the included studies were assessed using the QUADAS-2 tool. Publication bias was assessed by testing the association between the natural logarithm of the diagnostic odds ratio and the effective sample size.

Results:

Of the 7841 citations identified, 83 independent cohorts (11,767 patients) were included in the analysis. The pooled sensitivity of US-TTNB was 88% (95% CI: 86%-91%, 80 studies). Pooled specificity was 100% (95% CI: 99%-100%, 72 studies), resulting in positive LR, negative LR, and diagnostic odds ratio of 946 (−743 to 2635), 0.12 (0.09 to 0.14), and 8141 (1344 to 49,321), respectively. Complications occurred in 4% (95% CI: 3%-5%) of the procedures, with pneumothorax being the most frequent (3%; 95% CI: 2%-3%, 72 studies) and resulting in chest tube placement in 0.4% (95% CI: 0.2%-0.7%, 64 studies) of the procedures.

Conclusions:

US-TTNB is an effective and safe procedure for pleural lesions and peripheral lung lesions.
Conservative Treatment of Chalazion in Pediatric Patients
Authors: Yang Seung Ahn , Chambers Christopher B. , Kang Min Seung , Ahn Jung Hyo
Published: September 2024

This study aims to assess the effectiveness of conservative treatment for chalazion in pediatric patients. The authors retrospectively reviewed 101 chalazions in 91 children aged younger than 15 years at the authors' clinic. Patients were divided into 3 groups by their ages at the time of conservative or surgical treatment: 30 patients aged 2 and under (group A), 38 patients aged 3 to 6 (group B), and 23 patients aged 7 to 15 (group C). Initially, conservative treatment was administered, then incision and curettage were performed if it proved ineffective. Data included sex, age, number of lesions, position of lesions, size of lesions, time to resolution after treatment, and presence of complications for each group; comparative analysis was conducted. The success rate of conservative treatment was 85.7% (78/91): 96.7% (29/30) in group A, 86.8% (33/38) in group B, and 69.7% (16/23) in group C (P = 0.022). The mean age of the patients and the mean lesion size showed a significant difference between the conservative group and the surgery group (P = 0.047 and 0.009, respectively). Conservative treatment of chalazion is an effective first-line treatment option for uncomplicated and small chalazion in pediatric patients. The authors should consider starting patients on a trial of conservative therapy versus invasive therapy based on the size of the lesion, the duration of conservative treatment, and age.