bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of remimazolam on postoperative inflammatory markers and complications in thoracoscopic pulmonary lobectomy patients: A retrospective analysis
Authors: Chen Xuan , Shi Mengying , Shi Hongwei
Published: November 2024

Remazolam is widely used for procedural sedation in intensive care units. It has been shown to have anti-inflammatory and organ-protecting properties. However, the changes in inflammatory markers and analgesic effects of remazolam after thoracoscopic pulmonary lobectomy remain unclear. This study aims to assess the effects of the novel drug remimazolam on inflammatory factor levels and postoperative complications in thoracoscopic pulmonary lobectomy patients, providing a scientific basis for clinical use. This retrospective study analyzed 200 thoracoscopic pulmonary lobectomy patients, who were divided into a control group and a remimazolam group based on their anesthesia method. Patients in ramazolam group were anesthetized with ramazolam, while patients in control group were anesthetized with propofol. All patients were performed by the same physician team and anesthesia team. Inflammatory factors (including interleukin-6 [IL-6], C-reactive protein [CRP], including interleukin-8) were measured preoperatively and postoperatively, and postoperative complication rates were compared between the 2 groups. The levels of IL-6 and CRP were significantly higher in the remimazolam group at 7 days postoperatively compared to the control group. No significant differences were observed in preoperative inflammatory factors or postoperative including interleukin-8 levels between the 2 groups. Additionally, there were no significant differences in the overall incidence of postoperative complications or in specific complications such as pulmonary infection, atelectasis, subcutaneous emphysema, pneumothorax, surgical site infection, and arrhythmia. Patients receiving remimazolam had higher postoperative IL-6 and CRP levels compared to the control group, without an increase in postoperative complications. In clinical use, attention should be paid to the control of inflammatory indicators in patients using remazolam. However, due to potential confounding factors and the retrospective design, we cannot establish a causal relationship between remimazolam and elevated inflammatory markers. These findings suggest a possible association that requires cautious interpretation. Further research is needed to assess the clinical relevance and explore the underlying mechanisms.
CT pulmonary angiography in the inpatients: A 5-year retrospective view at the end of COVID-19 public health emergency
Authors: Mugu Vamshi K. , Parikh Riddhi S. , Carr Brendan M. , Khandelwal Ashish
Published: November 2024

To retrospectively evaluate the trends in utilization and results of computed tomography pulmonary angiography (CTPA study) for detection of acute pulmonary embolism (PE) in the hospital inpatients during different phases of COVID-19 public health emergency. We conducted an Institutional Review Board (IRB)-approved retrospective review of CTPA studies for our hospital inpatients in the years from 2019 to 2023, ranging from the prepandemic year (2019) to the year coinciding with the end of public health declarations (2023). Collected characteristics included patient age, patient sex, and result of the study. The utilization of CTPA studies for inpatients was higher in 2020 to 2023, compared to 2019 (3.8% in 2023 compared to 2.4% in 2019, P < .001). The increase in utilization was also statistically significant in each group, when stratified by age and sex (OR = 1.46 for female, OR = 1.71 for male, OR = 1.93 for elderly, and OR = 1.29 for non-elderly inpatients in 2023, compared to 2019). The positivity rate of acute PE in the inpatients was overall higher in 2021, 2022, and 2023, compared to 2019 (for example, 18.5% in 2023 compared to 14.3% in 2019, P = .01). When stratified by age and sex, only the non-elderly patients continued to have a significantly higher rate of acute PE in 2023, compared to 2019 (OR = 1.39). While studies spanning longer time frames and involving multiple institutions are needed to understand and generalize this conclusion, we conclude that the utilization and positivity rates of CTPA studies in inpatients remains high at the end of the COVID-19 pandemic public health emergency.
The effect of ertugliflozin in patients with nonalcoholic fatty liver disease associated with type 2 diabetes mellitus: A randomized controlled trial
Authors: Khaliq Adil , Badshah Haroon , Shah Yasar , Rehman Inayat Ur , Khan Kashif Ullah , Ming Long Chiau , Cheng Maong Hui
Published: November 2024

Background:

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease associated with liver inflammation, fibrosis, and cirrhosis and is associated with a greater risk of hepatocarcinoma. Nonalcoholic steatohepatitis (NASH) is a persistent and progressive form of NAFLD. Recent evidence suggested that ertugliflozin, a sodium-glucose cotransporter 2 inhibitor (SGLT2), suppresses NAFLD development in patients with type 2 diabetes mellitus (T2DM). The objective of this study was to determine the impact of ertugliflozin on improving NAFLD in patients with T2DM and the function of liver enzymes.

Methods:

This prospective, randomized, double-blind, placebo-controlled, interventional study aimed to determine the effectiveness of 15 mg of ertugliflozin versus 30 mg of the standard therapy pioglitazone versus placebo in NAFLD patients with T2DM. The study was established based on patient randomization in three groups: ertugliflozin, pioglitazone, and a placebo. This study was registered under the Australian New Zealand Clinical Trial Registry (Trial ID: ACTRN12624000032550).

Results:

The impact of therapy was determined in the treatment groups by utilizing liver ultrasonography and biochemical parameters. After 24 weeks of clinical study, the results revealed significant improvement in the grades of fatty liver, especially in the ertugliflozin group. The number of patients with hepatic steatosis significantly decreased among the respective groups classified according to fatty liver grade. Among patients in the ertugliflozin and pioglitazone groups, 45% to 23.4% and 41.7% to 26.6%, respectively, decreased in the Grade 2 group. The aspartate aminotransferase and alanine aminotransferase levels were significantly lower in all the study groups, especially in the ertugliflozin group (P ≤ .001).

Conclusion:

The present study revealed that the concomitant use of ertugliflozin has favorable effects on liver enzymes, as it decreases liver fat intake and reduces complications in patients with NAFLD-associated T2DM. However, more in-depth studies will be required to observe every aspect of ertugliflozin.
Novel presentation of acalvaria with clavicular absence: A case report
Authors: Alhroub Wasef , Jabareen Maaweya , Humeedat Mousa , Anati Mosaikah , Qanaeer Bashar , Alhroub Asrar
Published: November 2024

Rationale:

Acalvaria is an exceptionally rare congenital disorder marked by the absence of flat bones of the cranial vault, dura mater, and associated muscles, while the facial bones and base of the skull remain intact. Typically, the central nervous system is unaffected. Due to their extreme rarity, reported cases in the literature are infrequent. This condition often results in fatalities, as newborns with this anomaly generally have short life expectancies. However, there are a few documented cases of prolonged survival.

Patient concerns:

A 1-day-old full-term Palestinian male born to first-cousin parents at 37 + 6 weeks gestational age presented with an excessively soft skull without scalp abnormalities. The mother experienced polyhydramnios during the last 7 weeks of pregnancy.

Diagnoses:

Head ultrasound and X-rays confirmed the absence of skull vault bones and clavicles with normal facial bones. A CT scan showed well-formed brain structures and foci of hemorrhage in the left frontal lobe.

Interventions:

Supportive care was the primary management approach. The patient received comprehensive care in the neonatal intensive care unit, with a focus on stabilization and monitoring.

Outcome:

After 3 weeks in the neonatal intensive care unit, the patient showed normal feeding and function, but the prognosis remained poor. The patient’s family was informed about the poor prognosis.

Lessons:

This case reveals a unique combination of acalvaria and absent clavicles. Early antenatal diagnosis is essential but was delayed here. More research is needed to understand and improve the diagnosis of these conditions.
Prognostic nomograms for locally advanced cervical cancer based on the SEER database: Integrating Cox regression and competing risk analysis
Authors: Zhang Ying , Meng Ya-Ping , Xu Xiao-Feng , Shi Qin
Published: November 2024

Locally advanced cervical carcinoma (LACC) remains a significant global health challenge owing to its high recurrence rates and poor outcomes, despite current treatments. This study aimed to develop a comprehensive risk stratification model for LACC by integrating Cox regression and competing risk analyses. This was done to improve clinical decision making. We analyzed data from 3428 patients with LACC registered in the Surveillance, Epidemiology, and End Results program and diagnosed them between 2010 and 2015. Cox regression and competing risk analyses were used to identify the prognostic factors. We constructed and validated nomograms for overall survival (OS) and disease-specific survival (DSS). Multivariate Cox regression identified key prognostic factors for OS, including advanced International Federation of Gynecology and Obstetrics stage, age, marital status, ethnicity, and tumor size. Notably, International Federation of Gynecology and Obstetrics stages IIIA, IIIB, and IVA had hazard ratios of 2.227, 2.451, and 4.852, respectively, significantly increasing the mortality risk compared to stage IB2. Ethnic disparities were evident, with African Americans facing a 39.8% higher risk than Caucasians did. Competing risk analyses confirmed the significance of these factors in DSS, particularly tumor size. Our nomogram demonstrated high predictive accuracy, with area under the curve values ranging from 0.706 to 0.784 for DSS and 0.717 to 0.781 for OS. Calibration plots and decision curve analyses further validated the clinical utility of this nomogram. We present effective nomograms for LACC risk stratification that incorporate multiple prognostic factors. These models provide a refined approach for individualized patient management and have the potential to significantly enhance therapeutic strategies for LACC.
Swertiamarin and sweroside are potential inhibitors of COVID-19 based on the silico analysis
Authors: Wang Wenxiang , Tan Ying , Mao Jingxin , Xiong Wei
Published: November 2024

The severity of the respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 has escalated rapidly in recent years, posing a significant threat to global health. Sweroside and swertiamarin are bioactive iridoid glycosides extracted mainly from Swertia davidii Franch. It remains unclear how Swertia davidii Franch. Specifically affects COVID-19 and its underlying mechanisms. We first employed network pharmacology and molecular docking techniques to investigate how sweroside and swertiamarin affect COVID-19 in order to explore its potential mechanism. We found that 35 potential target genes can be used for the treatment of COVID-19, with androgen receptor (AR), HSP90AA1, RAC-alpha serine/threonine–protein kinase, cyclin-dependent kinase 1, epidermal growth factor receptor, and glycogen synthase kinase-3 beta emerging as particularly promising candidates. Additionally, sweroside and swertiamarin demonstrated unambiguous interactions with the 3CL protease AR through molecular docking research. At the active site, sweroside and swertiamarin can bind to AR (1T65), the main protease (5R82), and 3CL protease (6M2N), showing therapeutic potential.
Bladder perforation due to laparoscopic peritoneal dialysis catheterization: A case report and literature review
Authors: Shao Xiaoyun , Zhang Yanling , Xu Weixing
Published: November 2024

Rationale:

Complications related to the peritoneal dialysis (PD) catheter are the primary cause of treatment failure in PD, and bladder perforation is a rare complication of PD catheter placement. To date, there have been no reported cases of bladder perforation occurring during laparoscopic PD catheter placement.

Patient concerns:

An 80-year-old woman was admitted to Shaoxing Second Hospital due to a decade-long history of high blood creatinine levels. She was diagnosed with end-stage renal disease and underwent laparoscopic PD catheter placement. On the third day post-operation, she experienced frequent urination and urgency during her initial peritoneal dialysis fluid exchange.

Diagnoses:

The urine analysis indicated sterility. Both ultrasound and computed tomography scans suggested that the PD catheter was positioned in the bladder. We suspect a bladder perforation following laparoscopic placement of the PD catheter.

Interventions:

The patient underwent emergency surgery, during which the PD catheter was removed and subsequently replaced using laparoscopy. Additionally, due to a bladder perforation, peritoneal dialysis was temporarily suspended for 10 days postoperatively.

Outcomes:

On the 11th postoperative day, the patient underwent a low-dose peritoneal dialysis, and the procedure was uneventful.

Lessons:

During laparoscopy, PD catheter placement still carries the risk of rare complications such as bladder perforation. If postoperative PD catheter patients experience urinary urgency and frequency, there should be a high suspicion of bladder perforation. Early diagnosis and surgical intervention are crucial for improving patient prognosis.
Effect of statin on long-term outcomes in persistent tobacco users receiving percutaneous coronary intervention: A longitudinal, retrospective cohort study
Authors: Lin Mao-Jen , Lin Hau-De , Cai Chuan-Zhong , Chuang Ming-Jen , Yang Feng-Ching , Chiang Kuo Feng , Wu Han-Ping
Published: November 2024

The role of statins in improving cardiovascular outcomes is well established, but little is known about their impacts on long-term outcomes in persistent tobacco users with stable coronary artery disease (CAD) who receive percutaneous coronary intervention (PCI). A population of persistent smokers with CAD treated by PCI was analyzed. From 2012 through 2019, a cohort of 907 persistent tobacco users with stable CAD undergoing PCI were enrolled from the inpatient department of Taichung Tzu Chi Hospital, Taiwan. We surveyed statin users and non-statin users after index PCI, and general characteristics, major risk factors, angiographic findings, and long-term clinical outcome were compared. Kaplan–Meier curve was used to compare the survival difference and Cox proportional hazard model was used to analyze the predictors for all-cause mortality and major adverse cardiovascular events, including cardiovascular (CV) mortality, myocardial infarction, and repeated PCI procedures. The statin group had a higher average total cholesterol (P < .01) and low-density lipoprotein cholesterol (LDL-C) level (P < .01) and was younger (P < .01) than the non-statin group. Ninety-six point one percent patients in the statin group had a LDL-C level below 100 mg/dL after treatment. They also had a more frequent history of acute coronary syndrome and lower prevalence of chronic kidney disease than the non-statin group (both P < .01). Freedom from all-cause and CV mortality were lower in the non-statin group than the statin group (both P < .01). After adjustment for age and chronic kidney disease, statin treatment no longer reduced the risk of CV mortality (hazard ratio: 0.32, 95% confidence interval = 0.07–1.49), but was still associated with a reduction in all-cause mortality (hazard ratio: 0.27, 95% confidence interval = 0.10–0.75). In persistent tobacco users undergoing PCI, patients treated with statin for LDL-C values above 100 mg/dL had a similar level of cardiovascular protection as those with LDL-C below 100 mg/dL and without statin treatment. Therefore, smoking attenuates pleiotropic effect of statin. Nevertheless, statin therapy was still associated with a reduction of all-cause mortality.
A review of the potential use of melatonin in cancer treatment: Data analysis from Clinicaltrials.gov
Authors: Alshehri Fahad S. , Althobaiti Yusuf S.
Published: November 2024

Background:

Melatonin’s antioxidative and immune effects suggest potential in cancer therapy. This review assesses related clinical trials on ClinicalTrials.gov.

Methods:

All ClinicalTrials.gov trials registered up to January 17, 2024 were examined, focusing on trials that involved use of melatonin in cancer treatment. A 46 trials were summarized by their study status, study phase, study type, funder type and study results in the use of melatonin in cancer treatment.

Results:

The examination of the research data revealed a collective count of 46 clinical trials enlisted on ClinicalTrials.gov, all focus around the utilization of melatonin in cancer treatment. Among these, 24 trials had reached completion, constituting 91.3% of the entire trials, while 5 trials were presently in the recruitment phase, making up 10.8% of the total. None of these trials had received approval for marketing yet. The majority focus of the analysis encompassed interventional studies, around 42 trials and representing 91.3% of the overall trials, thereby incorporating most enrolled patients. In contrast, observational studies are a smaller fraction, comprising 4 trials (8.6% of the total), with a correspondingly lower number of involved patients. Regarding funding sources, most registered studies secured funding from diverse entities such as individuals, universities, and organizations, constituting 95.6% of all trials. In comparison, a minority of studies received funding from the National Institutes of Health, comprising 5 trials and accounting for 10.8% of the total trials.

Conclusion:

The analysis of 46 clinical trials on melatonin’s use in cancer treatment reveals a significant importance on interventional studies. Overall, these findings contribute to the evolving understanding of melatonin’s role in cancer treatment.
Successful Development and Implementation of Communication Skills Simulation Training Within Pediatric Hematology-oncology Fellowship Education
Authors: Becktell Kerri , Rumler Sarah , Tower Richard L.
Published: November 2024

Difficult discussions with patients and families are a primary component of pediatric oncology care. We report our experience in the development and implementation of a longitudinal simulation-based Communication Skills Curriculum within a pediatric hematology-oncology fellowship training program. A 6-session simulation curriculum was created for fellows to practice difficult oncology related discussions with a standardized patient (SP). This program was implemented in 2017 and continues presently. Throughout fellowship training the scenarios progress in content and scope. Each simulation was observed and recorded, and written and verbal feedback was provided. The Gap-Kalamazoo Communication Skills Assessment Form was used to assess communication skills in each session. A total of 15 fellows (100% of possible participants) have participated in this curriculum to date. Across all domains of communication skills assessed, the ratings given by the physician evaluators and self-evaluations improved over the course of the scenarios completed throughout fellowship training. This type of simulation-based communication skills curriculum within a pediatric hematology-oncology fellowship training program is feasible to implement. This training is useful to fellows beyond training in improving communication skills, which has the potential to directly benefit the future patients they care for.
Frexalimab (SAR441344) as a potential multiautoimmune disorder tackling mAB targeting the CD40-CD40L pathway undergoing clinical trials: a review
Authors: Fatima Tehreem , Mirza Aeliya , Fatima Faiza , Karamat Riyan I. , Ahmad Bilal , Naeem Silla , Shahid Iqra , Akilimali Aymar
Published: November 2024

Autoimmune disorders exhibit intricate pathology. Their mechanisms are complex, which attenuates the need for novel therapeutic interventions. Frexalimab, a potent monoclonal antibody targeting the dysregulated CD40-CD40L pathway, stands out as a formidable weapon against the assault of inflammation and tissue devastation. Diverse electronic databases were searched using relevant keywords to extract data on the role of Frexalimab in combating various autoimmune diseases. This review highlights Frexalimab’s efficacy in improving various disability indicators of relapsing multiple sclerosis (RMS), alleviating fatigue in primary Sjögren’s syndrome (PSJS), and improving glycemic control in diabetic patients. Across multiple trials, its favorable safety profile has proven its superiority over first-generation drugs in minimizing side effects. Indeed, Frexalimab has become a harbinger of hope in the fight against autoimmune diseases and has pioneered a unique and unchallenging way for tackling complex autoimmune diseases in the clinical realm, however, further large-scale trials are needed to establish its therapeutic benefits across different autoimmune conditions.
Managing emotional and physical stress in sickle cell anemia: a review of effective strategies and approaches
Authors: Obeagu Emmanuel Ifeanyi , Obeagu Getrude Uzoma
Published: November 2024

Sickle cell anemia (SCA) is a genetic blood disorder characterized by recurrent pain episodes, chronic complications, and significant emotional and physical stress. This review article explores effective strategies for managing both the emotional and physical aspects of stress in SCA patients. A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, and Google Scholar, using keywords such as “sickle cell anemia,” “stress management,” “psychological support,” and “pain management.” Emotional stress in SCA arises from chronic pain, frequent hospitalizations, and disease uncertainty, leading to conditions such as anxiety and depression. Effective management of emotional stress involves a combination of psychological counseling, cognitive-behavioral therapy (CBT), and support groups, which help patients develop coping strategies and address the mental health challenges of living with a chronic illness. This review evaluates various psychological interventions and their impact on patient outcomes, emphasizing the need for integrated mental health support in the management of SCA. Physical stress in SCA is primarily due to acute vaso-occlusive crises and chronic pain, which require effective pain management and preventive measures. The review explores pharmacological treatments, such as opioids and hydroxyurea, as well as non-pharmacological approaches, including physical therapy and lifestyle modifications. Additionally, the article discusses innovative therapies like gene therapy and stem cell transplantation, which hold promise for long-term disease management.
Experiences of moral distress among health care professionals in oncology and palliative care in Australia: a qualitative investigation
Authors: Ratcliffe Sarah E. , Rosenberg Jodie , Stafford Lesley , Kelly Brian J. , Agar Meera , Best Megan , Boon Kym , Dhillon Haryana M. , Kissane David , Lobb Elizabeth A. , Milne Donna , Philip Jennifer , Turner Jane , Shaw Joanne M.
Published: November 2024

Background:

Cancer care involves challenging clinical problems requiring expertise of multiple disciplines and frequently necessitates nuanced decision-making. When decision-making and patterns of care conflict with the values of health care professionals (HCPs), moral distress may arise. Moral distress is defined as the unease resulting from the perceived violation of professional or personal values and ethical principles. It has been associated with increased burnout and lower workforce retention among HCPs. This study aimed to investigate moral distress among Australian oncology and palliative care HCPs to understand how, when, and why it is experienced.

Method:

We conducted a qualitative interview study, with an online survey to collect demographic, practice-related characteristics, and level of moral distress. Interviews were conducted with oncology and palliative care HCPs in Australia to explore participants' experiences of moral distress. Interviews were audio-recorded and transcribed. A thematic analysis was conducted using a framework analysis approach.

Results:

We interviewed 33 participants, who were predominantly female (78%) and nurses (42%) with 50% having 15 years or more experience in oncology/palliative care. Thematic analysis revealed one meta-theme, Power and Hierarchy, and four themes: (1) values and their conflicts; (2) moral distress and the system; (3) moral distress and interpersonal interactions; and (4) internalized moral distress. At the core of HCPs' experiences of moral distress were patient-centered and care-centered values and the imperative to not violate the oath to “Do No Harm.” Moral distress was perceived to be covert, primarily arising in response to day-to-day clinical dilemmas and resulted from interactions with other HCPs and structural factors. Moral distress appeared to be cumulative over time.

Conclusion:

Moral distress arises when there are conflicts between an individual's values and organizational culture, within teams, and within the HCPs themselves. Power and hierarchy within health care are critical elements contributing to moral distress where poor communication and limited recognition of differing views are present. There is a need for interventions facilitating open discussion of ethical concerns to reduce likelihood of moral distress and retain an experienced oncology and palliative workforce.
Management of Venoarterial Extracorporeal Membrane Oxygenation Cannulation-Associated Groin Wound Complications With Muscle Flaps at a High-Acuity Cardiac Referral Center
Authors: Kuonqui Kevin , Diaddigo Sarah E. , LaValley Myles N. , Dagi Alexander F. , Dugue David , Imahiyerobo Thomas A. , Bogue Jarrod T.
Published: November 2024

Background

The insertion of large bore cannulas into the femoral vessels for venous-arterial extracorporeal membrane oxygenation (VA-ECMO) administration has been associated with significant acute and chronic wound complications in patients with significant medical and surgical comorbidities, including vessel exposure and lymphocele development. In this series, we report our experience using muscle flap reconstruction in the management of post-ECMO groin wounds, with particular emphasis on groin lymphocele.

Methods

VA-ECMO patients at a high-acuity cardiac referral center who developed groin cannulation site complications requiring muscle flap closure were included for retrospective review. Preoperative, perioperative, and postoperative factors were analyzed.

Results

Fifteen patients were included. The most common comorbidities were hypertension (66.7%), diabetes (46.7%), and renal failure (60.0%). Eight (53.3%) patients were immunosuppressed. The most frequent indications for surgery were groin lymphocele (n = 8, 53.3%) and exposed femoral vessels (n = 7, 46.7%). Median time from ECMO decannulation to reconstruction was 49.0 days. Most reconstructions were performed using a rectus femoris flap (n = 13, 86.7%). Two (13.3%) shallow wounds were covered with a sartorius muscle flap. Intraoperative cultures were positive in 9 (60.0%) patients. Seven (46.7%) patients experienced complications, including hematoma (n = 5), dehiscence (n = 1), recipient site infection (n = 1), and donor site infection (n = 1). In both groups, there were no cases involving lymphocele recurrence following reconstruction. There were no flap-specific complications and no cases of amputation. Four patients died within 1 year from septic shock (n = 3) and heart failure (n = 1).

Conclusions

We report successful reconstruction in the majority of patients. In particular, muscle flap reconstruction is a useful technique for addressing ECMO-associated lymphocele development and recurrence. Future studies are needed to determine ideal timing of reconstruction and if early plastic surgeon involvement can reduce morbidity and mortality of these difficult to treat infections.
Repair of Radiation Ulcers After Breast Cancer Surgery With Simple Local Random Flaps
Authors: Wang Gaofei , Meng Jialin , Huang Wen
Published: November 2024

Background

Radiation ulcers that develop after breast cancer surgery are mainly repaired with pedicled flaps or free flaps rather than local random flaps or skin grafts due to large skin defects and poor wound healing. Complicated surgical techniques and donor site reconstruction increase the risk of failure. We report our experience of using the local random long neck reading man flap (LNRMF) to cover large chest wall radiation ulcers, achieving good outcomes.

Methods

Eight patients who developed chest radiation ulcers after breast cancer surgery and were treated between January 2024 and June 2024 were included. The duration of the wounds ranged from 8 to 35 days. Necrotic and ischemic tissues were completely surgically removed, and subsequent wounds were repaired with LNRMFs. The wounds ranged from 6 cm × 8 cm to 15 cm × 16 cm in size. Visual analog scale scores were recorded during therapy.

Results

Eight patients healed well after the first stage. The sutures were removed 10–17 days (average, 12.63 days) after surgery, and no infections, necrosis, or necrotic skin flaps were observed. The average Visual analog scale score was 2.5. The follow-up period was 2–6 months (mean, 4.7 months). Slight linear scarring was observed, and no limitations in shoulder elevation were observed in seven patients; however, 1 patient had slightly limited shoulder elevation. The average SCAR scale score was 3.88, and all sensation scores (according to the Medical Research Council scale) were S3+.

Conclusions

LNRMFs are easily created and effectively repair secondary wounds that develop after the resection of radiation ulcers that develop after breast cancer surgery and large skin defects. These flaps can be widely used and should be promoted at the grassroots level.
Application Discrepancies in the 2023–2024 Integrated Plastic Surgery Match
Authors: Godbe Kerilyn N. , Sinik Lauren M. , Guest Rachel , Nazir Niaman , Egan Katie , Mathes David , Farmer Rebecca , Butterworth James
Published: November 2024

Background

The Plastic Surgery Common Application (PSCA) was introduced in the 2020–2021 integrated plastic surgery match cycle. We investigated the accuracy of medical student–reported quantitative metrics in the PSCA.

Methods

Quantifiable data from 1 year of PSCA applications were compared between matched and unmatched students. Discrepancies were identified by reviewing publicly available data and from Electronic Residency Application Service (ERAS) applications.

Results

A total of 330 PSCAs were analyzed and divided into two groups: matched (n = 196) and unmatched (n = 134). Of the 71 medical schools with multiple applicants, 23.9% (17/71) and 31.0% (22/71) had contradicting reports of Alpha Omega Alpha and Gold Humanism Honor Society availability. Three matched applicants, with an average numeric Step 1 score of 228, reported scores as “pass.” Four applicants did not disclose a prior failing Step 1 score. More matched students had research discrepancies than unmatched students for first author (56%, 111/196; 50%, 67/132; P = 0.24) and total publications (66.8%, 131/196; 53%, 71/134; P = 0.011). The mean discrepancy number between matched and unmatched students was similar for first author (3.0 vs 3.2, P = 0.61) and total publications (4.3 vs 4.5, P = 0.61). Reasons for discrepancies included counting accepted articles (20.2%), submitted articles (7.5%), non–peer reviewed (3.1%) articles, and other endeavors (6.2%) in publication counts, with 52% of applicants having multiple reasons for discrepancies.

Conclusions

Matched and unmatched applicants applying to plastic surgery had honor society and Step 1 score discrepancies, and inaccurate research reporting. NBME score verification and PubMed indexing may be a warranted addition to PSCA applications to guarantee application consistency.
Circ_0068655 silencing ameliorates hypoxia-induced human cardiomyocyte injury by regulating apoptotic and inflammatory responses
Authors: You Ting , Peng Kang , Yi Jing , Du Yafang , Jiang Peiyong , Zeng Dianmei , Wu Ji , Liu Jian , Wu Songjiang
Published: November 2024

Background

There is growing evidence suggesting that the dysregulation of circular RNAs (circRNAs) plays a significant role in various myocardial disorders, including myocardial ischemia (MI). This study aimed to explore the function of hsa_circ_0068655 (circ_0068655) in hypoxia-induced cardiomyocyte injury.

Methods

Human AC16 cardiomyocyte cells were cultured under anaerobic condition to induce an in vitro model of MI. Cell apoptosis was assessed by Annexin V-fluorescein isothiocyanate staining and caspase-3 and caspase-9 activity assays. Cell proliferation was analyzed by 5-Ethynyl-2’-deoxyuridine (EdU) incorporation assay. Inflammation was evaluated by enzyme-linked immunosorbent assays. Circ_0068655, miR-370-3p and BCL-2-like 11 (BCL2L11) expression were detected by real-time quantitative polymerase chain reaction or western blotting. The target interactions among circ_0068655, miR-370-3p and BCL2L11 were predicted using bioinformatics tools and validated using dual-luciferase reporter assays and RNA immunoprecipitation assays.

Results

Hypoxia treatment led to upregulated expression of circ_0068655 and BCL2L11, and downregulated expression of miR-370-3p in AC16 cells. This treatment also resulted in reduced cell viability, increased apoptosis rate, elevated caspase-9/3 activities and cleavage, and enhanced production of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β. Notably, knockdown of circ_0068655 alleviated these detrimental effects. In addition, circ_0068655 silencing-mediated effects were restored by decreasing miR-370-3p expression in hypoxia-treated AC16 cells. Moreover, ectopic BCL2L11 expression remitted the effects of miR-370-3p overexpression on hypoxia-treated AC16 cells. Mechanistically, circ_0068655 was found to act as a sponge for miR-370-3p, thereby regulating BCL2L11 expression.

Conclusion

Circ_0068655 silencing ameliorated hypoxia-induced human cardiomyocyte injury through the miR-370-3p/BCL2L11 axis.
INHIBITING SIRT2 ATTENUATES SEPSIS-INDUCED ACUTE KIDNEY INJURY VIA FOXO1 ACETYLATION-MEDIATED AUTOPHAGY ACTIVATION
Authors: Yu Binmei , Weng Lijun , Li Jiaxin , Wang Tingjie , Qiu Weihuang , Li Yuying , Shi Menglu , Lin Bo , Lin Xianzhong , Chen Zhongqing , Zeng Zhenhua , Gao Youguang
Published: November 2024

Sepsis-associated acute kidney injury (SAKI), a common complication in intensive care units (ICUs), is linked to high morbidity and mortality. Sirtuin 2 (SIRT2), an NAD+-dependent deacetylase, has been shown to have distinct effects on autophagy regulation compared to other sirtuins, but its role in SAKI remains unclear. This study explored the potential of SIRT2 as a therapeutic target for SAKI. We found that inhibition of SIRT2 with the antagonist AGK2 improved the survival of septic mice. SIRT2 inhibition reduced kidney injury, as indicated by lower levels of KIM-1, NGAL, serum creatinine, blood urea nitrogen, and proinflammatory cytokines following cecal ligation and puncture. Pretreatment with AGK2 in septic mice increased autophagosome and autolysosome formation in renal tubular epithelial cells and upregulated LC3 II expression in the renal cortex. Consistent with in vivo findings, SIRT2 gene silencing promoted autophagy in LPS-treated HK-2 cells, whereas SIRT2 overexpression inhibited it. Mechanistically, SIRT2 inhibition increased FOXO1 acetylation, inducing its nuclear-to-cytoplasmic translocation, which promoted kidney autophagy and alleviated SAKI. Our study suggests SIRT2 as a potential target for SAKI therapy.
Respiratory variation of velocity time integral and peak velocity of left ventricular outflow tract for predicting hypotension after induction of general anesthesia in elderly patients
Authors: Wan Jingjie , Jin Xiaofei , Chen Jun , Peng Ke , Xie Jin
Published: November 2024

Background

Hypotension after induction of general anesthesia may lead to severe complications in elderly patients. This study investigated whether the respiratory variation of velocity time integral (ΔVTI) and peak velocity (ΔVpeak) of left ventricular outflow tract (LVOT) could predict hypotension after induction of general anesthesia in elderly patients.

Methods

120 elderly patients undergoing selective operation under general anesthesia were enrolled in this study. ΔVTI and ΔVpeak of LVOT were measured by transthoracic echocardiography before induction of general anesthesia. After induction, mean arterial pressure (MAP) was recorded every 1 minute for 15 min. Hypotension was defined as a decrease of more than 30% in MAP at baseline or MAP below 65 mmHg from the start of induction. Receiver operating characteristic curves with gray zone and multivariate logistic regression analysis were used to assess the ability of ΔVTI and ΔVpeak of LVOT to predict hypotension after induction of general anesthesia.

Results

Hypotension occurred in 64 (53.3%) patients after induction of general anesthesia. The area under receiver operating characteristic curves (AUC) for ΔVpeak of LVOT to predict hypotension after induction of general anesthesia was 0.811, and the optimal cutoff value was 13.1% with a gray zone of 9.9% to 13.8%, including 45.0% of patients. The AUC for ΔVTI of LVOT was 0.890, and the optimal cutoff value was 13.8% with a gray zone of 11.1% to 13.9%, including 25.8% of patients. After adjusting for confounders, ΔVTI (Odds ratio = 2.24) and ΔVpeak (Odds ratio = 2.09) of LVOT were two significant independent predictors of hypotension after induction of general anesthesia.

Conclusions

ΔVTI of LVOT was a reliable predictor of hypotension after the induction of general anesthesia in elderly patients. ΔVpeak of LVOT should be used cautiously to predict hypotension after induction of general anesthesia due to nearly half of elderly patients in the gray zone.

Trial registration

This study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR2300077117).
Single-port Thoracoscopic Laser Sympathicotomy for Primary Hyperhidrosis: A Safe and Minimally Invasive Approach With Favorable Short-term Outcomes
Authors: Do Tat Thanh , DOAN Quoc Hung , Cong Huu Nguyen , Nguyen Thi Minh Chinh , DOAN Vu Tu Quyen , Vuong Nguyen Lam
Published: November 2024

Objective:

Thoracoscopic sympathicotomy is a well-established treatment for severe palmar hyperhidrosis. This study evaluates the safety and efficacy of a novel one-stage, bilateral, single-port laser sympathicotomy with minimal dissection.

Methods:

We retrospectively reviewed 73 patients with severe palmar hyperhidrosis who underwent this novel surgical technique between June 2023 and October 2023. Outcomes included complications, recurrent hyperhidrosis, and compensatory hyperhidrosis (CH). Hyperhidrosis severity was assessed using the hyperhidrosis disease severity score (HDSS).

Results:

The mean patient age was 21.3 ± 7.7 years, with a female predominance (52.1%). Sympathicotomy was performed at the T3 level only in 46 patients (63%), with the remaining undergoing sympathicotomy at both T3 and T4 levels. Median cauterization and operating times were 78 seconds and 8.7 minutes, respectively. No complications occurred. Two patients experienced recurrent hyperhidrosis during a median follow-up of 9 months, both were mild (HDSS grade 1). CH developed in 41 patients (56.2%), with all occurring within the first month postoperatively. The most common sites for CH were the back (51.2%), chest (43.9%), thigh (41.5%), abdomen (36.6%), and lower leg (36.6%). The majority of patients with CH (95.1%) reported mild (HDSS grade 1) or moderate (HDSS grade 2) hyperhidrosis. A higher body mass index was a significant risk factor for CH (odds ratio: 1.36, 95% CI: 1.12-1.71 for every 1 kg/m2 increase).

Conclusions:

This minimally invasive, single-port thoracoscopic laser sympathicotomy appears to be safe and effective for patients with palmar primary hyperhidrosis. Future studies should investigate long-term outcomes and refine the technique to minimize invasiveness even further.
Differentiation of Horner Syndrome and Physiological Anisocoria by Automated Pupillometry
Authors: Disse Leah R. , Bockisch Christopher J. , Weber Konrad P. , Fierz Fabienne C.
Published: November 2024

Background:

The differentiation of Horner syndrome from physiological anisocoria is important yet clinically challenging. We investigated the diagnostic accuracy of pupillometry to discriminate Horner syndrome from physiological anisocoria compared to pharmacological testing with the alpha-2-agonist apraclonidine, which is considered the current gold standard.

Methods:

Forty-four adult patients, mostly referred to our neuro-ophthalmology service for evaluation of anisocoria, were included. Automated binocular pupillometry was performed under standardized light conditions before and >30 minutes after instillation of 1% apraclonidine eye drops. A positive apraclonidine test indicating unilateral Horner syndrome was defined as an increase of pupil size in the smaller pupil and decrease of size in the larger pupil. Receiver operator characteristic curves were calculated to find the best pupillometric parameter discriminating Horner syndrome from physiological anisocoria.

Results:

We found that the parameters measuring the pupillary dilation lag using pupillometry could reliably discriminate Horner syndrome from physiological anisocoria compared to pharmacological testing. Calculating the change of anisocoria at 3–4 seconds after light-off relative to the anisocoria at the end of the light-on period (Δ3-4) may be most suitable to rule out Horner syndrome reaching a sensitivity of 95% and specificity of 68% using a cutoff of 0.35 mm.

Conclusions:

Our results indicate that pupillometry is a robust tool to measure the dilation lag in Horner syndrome and, therefore, to distinguish pathological from physiological anisocoria obviating pharmacological testing. The high sensitivity of the test will allow to identify the patients with Horner syndrome requiring further investigation.
Aurantiacibacter flavus sp. nov. and Aurantiacibacter gilvus sp. nov., isolated from the mudflat of Suaeda japonica colonies
Authors: Park Sunho , Kim Inhyup , Woo Haejin , Lee Hyunji , Yook Subin , Seo Taegun
Published: November 2024

Two novel strains were isolated from the mudflat of Suaeda japonica colonies in Incheon, Republic of Korea. Designated as DGU5T and DGU6T, these strains were Gram-stain-negative, facultatively anaerobic and rod-shaped and had yellowish colonies. Both strains were determined to belong to the genus Aurantiacibacter through phylogenetic analysis of their 16S rRNA sequences and draft genomes. The cells of strain DGU5T were non-motile and grew at temperatures ranging between 7–45°C (optimum, 25–30°C), pH 6.0–10.0 (optimum, 7.0–8.0) and in the presence of 0–11.0% NaCl (optimum, 2.0%). The cells of strain DGU6T were non-motile and grew in temperatures ranging from 10–45 °C (optimum, 30–35°C), pH 3.0–10.0 (optimum, 7.0–8.0) and in the presence of 0–11.0% NaCl (optimum, 2.0%). Overall genome relatedness index calculations revealed average nucleotide identity values (72.3–88.6%) and digital DNA–DNA hybridization values (18.8–35.9%) aligning with those of the genus Aurantiacibacter. The major fatty acids in both strains were C17:1
ω6c and summed feature 8 (C18:1
ω6c/C18:1
ω7c), while the predominant polar lipids were sphingoglycolipid, phosphatidylglycerol, and diphosphatidylglycerol. Phylogenetic, average nucleotide identity, digital DNA–DNA hybridization, physiological, and biochemical data collectively demonstrated the distinctiveness of the novel strains from other members within the family Erythrobacteraceae. We propose the names A. flavus sp. nov. (type strain DGU5T = KACC 23720T = TBRC 19015T) and A. gilvus sp. nov. (type strain DGU6T = KACC 23721T = TBRC 19016T) for the two strains.
Efficacy and safety of stem cell therapy for diabetic kidney disease: a systematic review and meta-analysis
Authors: Du Hongyu , Xie Chen , Yuan Yiqin , Luo Yun , Cao Jinguo , Li Zhihai , Yuan Jiayi , Li Wei
Published: November 2024

Background/Objectives

Animal studies have demonstrated the ability of stem cell therapy (SCT) to treat diabetic kidney disease (DKD). However, the safety and efficacy of SCT in patients with DKD remain unclear. This systematic review and meta-analysis aimed to investigate the safety and efficacy of SCT in patients with DKD.

Methods

A comprehensive and systematic literature search was conducted using PubMed, EMBASE, Cochrane Library, and Web of Science to identify articles on SCT for DKD published up to March 2024. RevMan V.5.4 software was used for statistical analysis.

Results

We identified four studies that included 90 participants, 53 (58%) of whom underwent SCT. SCT improved estimated glomerular filtration rate (eGFR) (mean difference [MD] = 0.41, 95% confidence interval [CI]: 0.08–0.74; p < 0.05), serum creatinine (SCr) reduction (standardized MD = -0.65, 95%CI: -1.19 to -0.1, p < 0.05), and microalbuminuria (MAU) (MD = -32.10, 95% CI: -55.26–8.94; p < 0.05) compared to the control group, but did not improve urine microalbumin/creatinine ratio (UACR) (MD = -63.36, 95% CI: 194.52–67.79, p = 0.56) or blood sugar (MD = 0.49, 95% CI: 4.16–2.01, p = 0.49). In addition, the incidence of adverse events was significantly high in both groups (risk ratio = 0.93; 95% CI: 0.74–1.17; p = 0.54); there was no significant difference regarding I2= 0%).

Conclusions

SCT can safely and effectively improve eGFR and SCr levels by lowering the MAU but cannot improve UACR and blood sugar levels.