bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of surgical pleth index in the opioid-free anesthesia: A randomized controlled trial
Authors: Dai Jingwei , Wu Duozhi , Cui Xiaoguang , Li Shanliang , Xu Fengmei
Published: February 2024

Background:

Currently, there is no gold standard for monitoring noxious stimulation during surgery, and the surgical pleth index (SPI) is only one of many monitoring methods. It is commonly used in the monitoring of conventional opiate anesthesia, but its effectiveness in opioid-free anesthesia (OFA) has not been evaluated. Therefore, the aim of this study was to observe the guidance value of the surgical pleth index in opioid-free anesthesia for patients undergoing lower abdominal or pelvic surgery.

Methods:

A total of 122 patients who underwent lower abdominal or pelvic surgery in our hospital between March 2021 and July 2022 were selected and equally divided into OFA (F) and control (C) groups according to the random number table method. Both groups underwent ultrasound-guided unilateral/bilateral quadratus lumborum block in the supine position according to the surgical field. In group F, 0.50% lidocaine and 0.20% ropivacaine (in 20 mL of 0.9% normal saline) were injected on each side. In group C, 20 mL 0.9% normal saline was injected on each side. Group F received general anesthesia without opioids and group C received general anesthesia with opioids. BP, pulse oxygen saturation, PETCO2, reactionentropy, stateentropy, and SPI values; Steward score; dosage of propofol, dexmedetomidine, rocuronium, and diltiazem; extubation time; and awake time were monitored in both groups.

Results:

There were no significant differences in the general data between the 2 groups (P > .05). There were no significant differences in SPI values at T0, T1, T2, T3, T4, and T5 or the number of cases requiring additional remifentanil, propofol, and diltiazem between the 2 groups (P > .05). The stateentropy, reactionentropy, and Steward scores were higher in group F than in group C at T4 and T5, while the extubation and awake times were lower in group F than in group C (P < .05). The heart rate and SPI of group F were lower than that of group C at T3 (P < .05).

Conclusion:

The guiding value of SPI in OFA was similar to its use in opiated anesthesia. Its clinical efficacy is exact, vital signs are stable, enabling rapid, and complete regaining of consciousness.
Nurse-supported care versus rheumatologist-led care in patients with rheumatoid arthritis at high disease activity: A retrospective study of two Chinese centers
Authors: Wang Qian , Cao Yuqiong
Published: February 2024

The European League Against Rheumatism recommendations for the management of rheumatoid arthritis advised the involvement of clinical nurses for the management of rheumatoid arthritis. However, The European League Against Rheumatism recommendations are difficult to apply to Chinese institutes. In China, the rheumatology nursing service is not widely adopted because the feasibility and quality of rheumatology nursing service have not been confirmed in the Chinese population by the Chinese authorities. The objectives of the study were to compare 2.5 years clinical outcomes of patients of rheumatoid arthritis (6 months history) with disease activity score 28-joint count with C-reactive protein (DAS28-CRP) > 5.1 who received nurse-supported care against those of patients who received rheumatologist-led care. Patients received 30 minutes/day and 6 times/week nurse-supported care (NC cohort, n = 127) or Patients had received 20 minutes session at every 3 months of conventional outpatient-based rheumatologist-led care (n = 131). Both types of care have involved the history of patients, care regarding effects and adverse effects of pharmacological treatments, patients education, overall well-being, everyday life, counseling, clarifications, and rehabilitation. Additionally, there were a cohort in which patients did not receive any nontreatment care (NN cohort, n = 141). All patients have definite depression and anxiety (hospital anxiety and depression scale Chinese version score ≥ 11) before nontreatment interventions. At 2.5 years of treatments with or without nontreatment interventions (EL) DAS28-CRP, depression, and anxiety scores of patients of the NC cohort were decreased as compared to their before any type of nontreatment interventions conditions and those of patients of the RC and NN cohorts at EL (P < .001 for all). At EL numbers of patients with moderate disease activity, (DAS28-CRP score: 3.2–5.1) and borderline depression and anxiety (hospital anxiety and depression scales Chinese version score: 8–10) were greater in the NC cohort than those of the RC and NN cohorts (P < .001 for all). Outpatient care satisfaction scores of patients of the NC cohort were higher than those of the RC [23 (27–17) vs 17 (21–14)] and NN [23 (7–17) vs 15 [18–12]) cohorts (P < .001 for both). Physiological and psychological conditions of patients with rheumatoid arthritis with DAS28-CRP > 5.1 are required to improve. Nurse-supported care is superior nontreatment compared to rheumatologist-led care in rheumatoid arthritis patients with high disease activity (Level of Evidence: IV; Technical Efficacy: Stage 5).
Fecal calprotectin measurement to detect recurrence of solitary juvenile polyps: A case report
Authors: Kudoh Maika , Kakiuchi Toshihiko , Yoshiura Masato , Esaki Motohiro , Matsuo Muneaki
Published: February 2024

Rationale:

Juvenile polyps (JPs) are the most common polyp type and can be observed in 1% of all preschoolers. The peak incidence is observed at ages 3 to 5 years, constituting 90% of all polyps in children. Elevated levels of fecal calprotectin (FC) are often seen in children with JPs.

Patient concerns:

A 15-month-old girl was referred to our hospital for blood on the stool surface persisting for 3 months. She was healthy, with no abdominal pain, diarrhea, anorexia, or weight loss and no complaints other than hematochezia. Her physical examination, vital signs and laboratory date were unremarkable.

Diagnosis:

JPs

Intervention:

Total colonoscopy for her found 2 JPs in the sigmoid colon, which were subsequently resected endoscopically.

Outcomes:

At the age of 5 years, this patient again had bloody stools. Her FC measurement at that time was 1020 mg/kg, which normalized to 42 mg/kg 3 months after her second resection.

Lessons:

Single or multiple solitary JPs require follow-up that fully considers the possibility of recurrence. Establishing a method for early confirmation of JP recurrence based on bloody stools, fecal occult blood testing, and FC measurement is necessary.
Assessment of extremity dose for medical staff involved in positron emission tomography/computed tomography imaging: Retrospective study
Authors: Erdemir Rabiye Uslu , Abuzaid Mohamed Mahmoud , Cavli Baris , Tekin Huseyin Ozan , Elshami Wiam
Published: February 2024

There has been an increase in positron emission tomography (PET)/computed tomography (CT) imaging procedures, and medical workers involved in PET/CT are at increased risk of occupational exposure. Data on extremity dose exposure are limited globally. The current study aimed to evaluate the occupational radiation dose for extremities for medical workers (nurses, radiographers/radiologic technologists, and nuclear medicine physicians) working in PET/CT scanners at 5 large hospitals in Turkey. Optically stimulated luminescence (OSL) and Thermoluminescent dosimeter (TLD) ring dosimeters were used to measure equivalent dose values. Hospitals 1, 2, and 5 used OSL, and 3 and 4 used TLD. A total of 502 readings were obtained from 55 workers. In millisievert (mSv), the average annual effective dose for all workers was 14.5 ± 17.7 (0.2–157.2). A radiography technologist received a maximum dose of 157.21. Nurses received the highest average annual effective dose (15.2 ± 19.46) (0.32–65.58), followed by radiography technologists (14.7 ± 18.03) (0.4–157.2), and nuclear medicine physicians demonstrated the least dose (8.6 ± 10.5) (1.2–24.4). The results show that the extremity dose is well below the annual dose limit of 500 mSv. However, there is a wide variation in dose among the workers, underlining a need for careful assessment of working conditions to ensure safe practices for all workers.
Assessment of memory recognition using a smartphone-based test system: A pilot study
Authors: Saito Yukari , Kitamura Kazuki , Yokoyama Akane , Tabata Toshihide
Published: February 2024

Background:

Elucidation of the detailed nature of age-related memory decline requires analysis of memory performance in large populations of various ages. To promote large-scale studies, we developed a smartphone-based self-test for memory recognition. We examined whether this test could detect age-related memory decline and the effects of aerobic exercise on memory.

Methods:

Seventy-eight younger and 42 older participants were randomly divided into active and passive groups. Both groups took a memory recognition test (consisting of 2 sessions separated by a 48-hour interval) conducted on smartphones. The participants answered the positive and negative affect schedule questionnaire at the beginning and end of each session. In the first session, the participants performed cognitive tasks on 90 photographs displayed on a smartphone screen. Immediately after the cognitive tasks, the active group performed a bout of light aerobic exercise for 10 minutes, while the passive group remained calm for 10 minutes. In the second session, the participants were tested on the recognition of 90 previously observed photographs and 90 distractor photographs.

Results:

Passive older participants had ~40% to ~50% lower recognition scores (RSs) than passive younger participants did. Moreover, the aerobic exercise used in this study improved the RSs of active younger participants by up to ~40% compared with those of passive younger participants, while such an improvement was not observed in older participants. The RS did not depend on the affect levels evaluated using positive and negative affect schedule questionnaire.

Conclusions:

These results demonstrated that the smartphone-based test could detect age-related decline and could promote behavior modification that may lead to memory enhancement, as reported in previous studies using conventional laboratory tests. The results of the smartphone-based test were not influenced by the subjects affect. This indicates the possibility of large-scale memory studies and healthcare for memory performance by using personal mobile devices.
Prevalence of burnout and practice-related risk factors among Saudi Board dental residents using the Copenhagen Burnout Inventory: A survey-based cross-sectional study
Authors: Alqahtani Saeed M. , Chaturvedi Saurabh , Hezam Asma Ali , Alshahrani Ahmed , Alkhurays Mohammed , Al Moaleem Mohammed M. , Alqhtani Rahaf Ali Mohammad , Asiri Bashayer Mohammed Ali , Zahir Sarah Ebrahem Ali
Published: February 2024

Occupational burnout is a chronic psychological problem affecting professionals. The aim of this study was to assess the types and categories of burnout among Saudi Dental board residents at different levels of residency in different provinces of Saudi Arabia, using the Copenhagen Burnout Inventory. Questionnaires were sent to 170 Saudi Dental board residents via Email and WhatsApp. at various training centers in Saudi Arabia, in May 2022. A part of the questionnaire covered the socio-demographic characteristics of the participants such as gender, training level or center, number of working sessions or hours per week and day, dental speciality, and marital status. The second part consisted of the Copenhagen Burnout Inventory survey with 21 questions. Only 110 participants returned the answered questions. The overall significant type of burnout was present in 46.3% of the respondents while 53.7%, were for free or minimal burnout. Personal, work-related, and patient-related burnout recorded 62%/38%; 40% to 60%, and 60%:40% for free or minimal to significant burnout. The overall burnout types of values were equal in both gender as well as training levels with no significant differences and P-values ≤ .05. Burnout values were close to each other among the participants in different specialties, except for orthodontics residents which were the least. Analysis of variance, followed by chi-square tests showed a significant difference among participants in different specialties in type and categories of burnout with P-values between .002 to .029. Finally, the burnout value was higher among married participants. Overall burnout types were marginally similar between genders and training levels, while the significant was slightly higher in females, married, highest training level, restorative, and prosthodontic speciality participants.
COVID-19 studies involving machine learning methods: A bibliometric study
Authors: Baygül Eden Arzu , Bakir Kayi Alev , Erdem Mustafa Genco , Demirci Mehmet
Published: February 2024

Background:

Machine learning (ML) and artificial intelligence (AI) techniques are gaining popularity as effective tools for coronavirus disease of 2019 (COVID-19) research. These strategies can be used in diagnosis, prognosis, therapy, and public health management. Bibliometric analysis quantifies the quality and impact of scholarly publications. ML in COVID-19 research is the focus of this bibliometric analysis.

Methods:

A comprehensive literature study found ML-based COVID-19 research. Web of Science (WoS) was used for the study. The searches included “machine learning,” “artificial intelligence,” and COVID-19. To find all relevant studies, 2 reviewers searched independently. The network visualization was analyzed using VOSviewer 1.6.19.

Results:

In the WoS Core, the average citation count was 13.6 ± 41.3. The main research areas were computer science, engineering, and science and technology. According to document count, Tao Huang wrote 14 studies, Fadi Al-Turjman wrote 11, and Imran Ashraf wrote 11. The US, China, and India produced the most studies and citations. The most prolific research institutions were Harvard Medical School, Huazhong University of Science and Technology, and King Abdulaziz University. In contrast, Nankai University, Oxford, and Imperial College London were the most mentioned organizations, reflecting their significant research contributions. First, “Covid-19” appeared 1983 times, followed by “machine learning” and “deep learning.” The US Department of Health and Human Services funded this topic most heavily. Huang Tao, Feng Kaiyan, and Ashraf Imran pioneered bibliographic coupling.

Conclusion:

This study provides useful insights for academics and clinicians studying COVID-19 using ML. Through bibliometric data analysis, scholars can learn about highly recognized and productive authors and countries, as well as the publications with the most citations and keywords. New data and methodologies from the pandemic are expected to advance ML and AI modeling. It is crucial to recognize that these studies will pioneer this subject.
Prevalence, clinical profile, and risk factors of peripheral artery disease in an Iraqi cohort of chronic kidney disease
Authors: Sinjari Hussein Yousif
Published: February 2024

Peripheral artery disease (PAD) is prevalent in patients with chronic kidney disease (CKD) and is associated with substantial morbidity, mortality, and a lower quality of life. This study aimed to determine the prevalence of PAD, clinical profile, and related risk factors among patients with CKD in Iraq (a low-to middle-income country). A cross sectional study comprised 175 CKD patients, of them 60% were male, their mean age was 56 ± 12.5 years, attending Nephrology unit, Hawler Teaching Hospital, Erbil, Iraq between march 2022 and November 2022. Data on demographic and baseline characteristics were collected. Laboratory tests were performed. All participants underwent a detailed history and clinical examination. Vascular lesions in the lower limbs were assessed using the ankle-brachial index. PAD was diagnosed based on an ankle-brachial index value ˂ 0.9, relevant symptoms, and clinical findings. Forty-nine patients (28%) had PAD, and only 17 (34.7%) were symptomatic. PAD was significantly associated with older age (P = .008), male sex (P = .039), diabetes (P = .012), and hypertension (P = .023). In addition, PAD prevalence was significantly higher in patients with prior coronary artery disease (P < .001), advanced CKD stages (P .032), low estimated glomerular filtration rate (P .03), albuminuria (P .002), elevated glycated hemoglobin (P .04), and high sensitive C-reactive protein (P < .001). No significant association was detected between PAD and body mass index, smoking, CKD duration, cerebrovascular disease, dyslipidemia, albumin, creatinine, hemoglobin, total PTH, and phosphate. Peripheral artery disease was prevalent in patients with CKD in Iraq, and the most affected patients were asymptomatic. Older age, male sex, hypertension, diabetes, prior coronary artery disease, advanced CKD stages, albuminuria, higher glycated hemoglobin level, and increased high-sensitivity C-reactive protein level were identified as risk factors. Early detection of occult PAD might enhance efforts toward proper prevention and treatment.
Network pharmacology-based and molecular docking-based analysis of You-Gui-Yin for the treatment of osteonecrosis of the femoral head
Authors: Yao Zhi-Yuan , Fan Shu-Yao , Song Zhou-Feng , Li Zhan-Chun
Published: February 2024

You-Gui-Yin (YGY) is a classic prescription for warming up kidney-Yang and filling in kidney essence in traditional Chinese medicine, and has been used to treat osteonecrosis of the femoral head (ONFH) effectively. However, the underlying mechanisms are still unknown. This study is aimed at exploring the possible mechanisms of action of the YGY in the treatment of ONFH based on network pharmacology and molecular docking. TCMSP was used to screen the active components and targets of YGY. The disease targets of ONFH were collected in several public databases. The protein-protein interaction (PPI) Network was constructed using the STRING platform. The Metascape database platform was used for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. The key active components and core target proteins of YGY in the treatment of ONFH were verified by the molecular docking. 120 active components were obtained from YGY, among which 73 components were hit by the 117 drug-disease intersection targets. Key effective components included quercetin, kaempferol, beta-sitosterol, glycitein, beta-carotene, and so on. Core target proteins included ALB, AKT1, TNF, IL6, TP53, and so on. According to GO and KEGG analyses, there were 1762 biological processes, 94 cellular component, 138 molecular function and 187 signaling pathways involved. we selected the top 20 biological processes (BP), cellular components (CC), molecular functions (MF) and signaling pathways to draw the heat maps, showing that Lipid and atherosclerosis signaling pathway, IL-17 signaling pathway, HIF-1 signaling pathway, relaxin signaling pathway and MAPK signaling pathway and other pathways may play a key role in the treatment of ONFH by YGY. The results of molecular docking showed that key effective components and corresponding core target proteins exhibited the good binding activity. YGY can treat ONFH through multicomponents, multitargets, and multipathways, which provides a reference for the subsequent research, development of targeted drugs and clinical application.
Prevalence of the medical student syndrome among health professions students and its effects on their academic performance
Authors: Abdulghani Hamza Mohammad , Marwa Khaldoun , Alghamdi Nawaf Aali , Almasoud Rayan Nasser , Faraj Ahmed Turki , Alshuraimi Abdullatif Fahad , Mohamed Khalid Maher , Alnafisah Osama Saleh , Ahmad Tauseef , Ahmed Mohammad Z. , Khalil Mahmoud Salah
Published: February 2024

Medical student syndrome (MSS) is health-related anxiety while studying a specific disease that leads to stress and anxiety. The study aims to determine the prevalence of MSS among health professions students to identify its effect on the student academic performance and to recognize the awareness of MSS among health professions students. This is a descriptive cross-sectional study where 544 students from King Saud University health colleges were included and filled in a self-reported designed questionnaire. We used validated scale of short health anxiety inventory closed-ended items to measure the prevalence of MSS. All statistical analyses were performed using the statistical package for social sciences statistical software package. The results showed that 8.5% of the health colleges students were affected by MSS. The students with the medical syndrome had higher levels of anxiety (anxiety-odd ratio [OR] = 1.3, P = .35; anxiety-OR = 1.57, P = .27) and hypochondriac issues (hypochondria-OR = 2.93, P = .03; hypochondria-OR = 2.61, P = .14) than other students. Concerning to MSS negative consequences, students who experienced medical syndrome most of the time and always were 1.43 and 1.45 times more likely to experience anxiety. As a result of the medical syndrome, students with a grade point average decrease of <0.20 are 3.37 times more likely to develop a hypochondriac problem than students with no grade point average decrease (OR = 3.37; P = .04). Third-year students reported more anxiety and hypochondria symptoms than other-year students. In conclusion, MSS is a growing problem in health colleges. This study showed that, academic performance was affected for the students who have MSS. The prevention of this phenomenon may be greatly enhanced by reassurance and discussions about this syndrome.
The causal relationship between hypothyroidism and frozen shoulder: A two-sample Mendelian randomization
Authors: Deng Guanghua , Wei Yongkang
Published: February 2024

To investigate the causal relationship between hypothyroidism and frozen shoulder using a Mendelian randomization (MR) approach. Pooled data from a large-scale genome-wide association study (GWAS) were used. Genetic loci that were independent of each other and associated with hypothyroidism and frozen shoulder in populations of European ancestry were selected as instrumental variables. Inverse variance weighting (IVW) was used as the primary analysis method. Weighted median (WME) and MR-Egger were used as complementary analysis methods to assess causal effects. To explore the causal relationship between hypothyroidism and frozen shoulder. Sensitivity test analysis was performed using heterogeneity test, multiple validity test, and leave-one-out analysis to explore the robustness of the results. IVW results showed an OR (95% CI) of 1.07 (1.01–1.14), P = .024, indicating that hypothyroidism is a risk factor for a frozen shoulder. And no pleiotropy was found by the test, and sensitivity analysis also showed robust results. This study used 2-sample MR analysis to analyze and explore the genetic data, and the results showed a higher prevalence of frozen shoulder in patients with hypothyroidism, suggesting that active control of hypothyroidism may reduce the occurrence of frozen shoulder.
Electrocardiographic semi-spiked helmet sign in critically Ill patients: A case series
Authors: Sasmita Bryan Richard , Luo Suxin , Huang Bi
Published: February 2024

Rationale:

ST-segment elevation on electrocardiogram (ECG) is an alarming sign. Although acute myocardial infarction (AMI) is the most common cause of ST-segment elevation, many non-ischemic conditions may produce pseudo-ST segment elevation. Spiked Helmet (SH) sign is one of the pseudo-ST segment elevations that is associated with critical illness and high risk of death. SH sign was characterized by an upward shift starting before the onset of the QRS complex; however, we found some patients presented with a peculiar characteristic on ECG with an upward convex ST-segment elevation after the QRS wave but without elevation before the QRS wave, therefore called Semi-SH sign. Also, this electrocardiographic feature exists in patients with critical disease and is related to poor prognosis. The purpose of this case series is to describe the electrocardiographic Semi-SH sign and enhance the awareness of such electrocardiographic manifestation for clinicians.

Patients Concerns:

This case series explores the possibility of severe infection induced electrocardiographic changes resembling spiked-helmet sign.

Diagnoses:

Sepsis-induced secondary myocardial injury or coronary vasospasm.

Interventions:

Gastric decompression, antibiotics, diuretics, advanced life support.

Outcomes:

The outcome of this case series is the association of the electrocardiographic Semi-SH sign with the prognosis. All 3 patients died several days post manifestation of electrocardiographic Semi-SH sign.

Lesson:

Like SH sign, electrocardiographic Semi-SH sign is a life-threatening or deadly ECG sign, and therefore early recognition and aggressive treatment are important.
Roles of DSCC1 and GINS1 in gastric cancer
Authors: Hou Shiyang , Zhang Jie , Chi Xiaoqian , Li Xiaowei , Zhang Qijun , Kang Chunbo , Shan Haifeng
Published: February 2024

Gastric carcinoma is a common malignant tumor originating from gastric mucosal epithelium. However, role of DS-cell cycle-dependent protein 1 (DSCC1) and GINS1 in gastric carcinoma remains unclear. The gastric carcinoma datasets GSE79973 and GSE118916 were downloaded from gene expression omnibus. Multiple datasets were merged and batched. Differentially expressed genes (DEGs) were screened and weighted gene co-expression network analysis was performed. Functional enrichment analysis, gene set enrichment analysis and immune infiltration analysis were performed. Construction and analysis of protein-protein interaction Network. Survival analysis and comparative toxicogenomics database were performed. A heat map of gene expression was drawn. Target Scan screen miRNAs regulating DEGs. Two thousand forty-four DEGs were identified. According to gene ontology analysis, in biological process, they were mainly enriched in cell migration, transforming growth factor β receptor signaling pathway, angiogenesis, and steroid metabolism process. In cellular component, they were mainly enriched in extracellular vesicles, basement membrane, endoplasmic reticulum lumen, and extracellular space. In molecular function, they focused on extracellular matrix structural components, protein binding, platelet-derived growth factor binding, and catalytic activity. In Kyoto encyclopedia of genes and genomes, they were mainly enriched in protein digestion and absorption, metabolic pathways, fatty acid degradation, Glycerophospholipid metabolism, ether lipid metabolism. Gene set enrichment analysis showed that DEGs were mainly enriched in transforming growth factor β receptor signaling pathway, steroid metabolism process, basement membrane, endoplasmic reticulum lumen, structural components of extracellular matrix, platelet-derived growth factor binding, Glycerophospholipid metabolism, ether lipid metabolism. The results of immune infiltration analysis showed that expression of T cell CD4 memory resting was lower in the samples of gastric cancer. The core genes (TRIP13, CHEK1, DSCC1, GINS1) are protective factors, their expression shows a downward trend with increase of risk score. Comparative toxicogenomics database analysis showed that TRIP13, CHEK1, DSCC1, GINS1 were related to gastric tumors, gastric diseases, tumors, inflammation, and necrosis. DSCC1 and GINS1 are highly expressed in gastric cancer. Higher expression levels of DSCC1 and GINS1, worse the prognosis.
Clinical features, surgical treatment, and long-term outcomes of moyamoya disease in a single institution of Fujian, Southeast China: A retrospective study
Authors: Ding Yi-hang , Chen Jing-yi , Zheng En-shuang , Wang Zi-qing , Liang Ri-sheng , Shi Song-sheng , Tu Xian-kun
Published: February 2024

At present, detailed demographic and clinical data of moyamoya disease (MMD) in the population of Southeast China are lacking. Therefore, this study aimed to evaluate the epidemiological and clinical features of MMD in Southeast China. Our cohort included 170 patients diagnosed with MMD over the preceding 5 years. Clinical characteristics were obtained through a retrospective chart review, while follow-up information and outcomes were obtained through clinical visits and imaging. The median age at symptom onset was 49 years (range 4–73), with a peak in the age distribution observed at 41 to 60 years. The female-to-male ratio was 1.125 (90/80), and the ratio of the ischemic type to the hemorrhagic type was 2.33 (119/50). The most common initial symptom was an ischemic event. The 5-year Kaplan–Meier risk of stroke was 4.9% for all patients treated with surgical revascularization. Of all patients, 83.9% were able to live independently with no significant disability, and 89.8% showed improved cerebral hemodynamics. Our study provided detailed demographic and clinical data on Southeastern Chinese patients with MMD, which was consistent with findings in other parts of China. Raising clinical awareness of MMD in primary hospitals is important to facilitate early diagnosis and timely treatment of MMD patients.
Predictive value of systemic immune inflammation index (SII) and prognostic nutritional index (PNI) on mortality after below-knee amputation
Authors: Yilmaz Selçuk , Kurt Mehmet , Dülgeroğlu Turan Cihan , Üzümcügil Alaaddin Oktar
Published: February 2024

This retrospective cross-sectional study aimed to evaluate the predictive value of SII (Systemic Immune Inflammation Index) and PNI (Prognostic Nutritional Index) with blood ratios on mortality in diabetic foot patients who underwent below-knee amputation. A total of 231 living (n = 71; 30.7%) and exitus (n = 160; 69.3%) patients were evaluated. The mortality group was divided into 3 groups: 30-day mortality (n = 62; 38.8%), 1-year mortality (n = 62; 38.8%), and over-1-year mortality (n = 36; 22.5%). The hemogram, SII, and PNI parameters of the patients were evaluated. Age, some blood count parameters and SII were significantly higher in the exitus group (P < .05). The lymphocyte, monocyte, eosinophil, albumin, and PNI levels were significantly higher in the living group (P < .05). Mortality was significantly predicted by age (B [regression coefficient] = 0.026, P < .05), NLR (neutrophil lymphocyte ratio) (B = −0.065, P < .05), PNI (B = −0.100, P < .01), and SII (B = 0.00000024, P < .01). The predictive values of CAR (C reactive protein albumin ratio), PNI, and SII were 77.3%, 77.0%, and 76.1%, respectively. For CAR of 30.88 cutoff value, the sensitivity and specificity were 79.4% and 64.8%, respectively. For the PNI 22.0143 cutoff value, the sensitivity and specificity were 66.9% and 5.6%, respectively. For the SII 732249.2481 cutoff value, the sensitivity and specificity were 91.9% and 31.0%, respectively. The predictive value of the PNI was significant for mortality time (B = 0.058; P < .01). The predictive value of PNI for 30-day mortality was significant (AUC (area under curve):0.632; P < .01), whereas its predictive value for 1-year mortality and over-1-year mortality after below-knee amputation was statistically insignificant (P > .05). Both the SII and PNI may be evaluated and used to predict mortality after below-knee amputation. The SII had a significant predictive value for 30-day mortality after below-knee amputation.
Effects of a two meals-a-day ketogenic diet on newly diagnosed obese patients with type 2 diabetes mellitus: A retrospective observational study
Authors: Li Sumei , Yuan Shouping , Lin Guoxin , Zhang Jintian
Published: February 2024

To investigate the effects of a two-meals-a-day energy-restricted ketogenic diet (KD) on newly diagnosed obese patients with type 2 diabetes mellitus. In total, 60 obese patients with newly diagnosed type 2 diabetes mellitus were divided into 2 groups: 1 group followed a 2-meals-a-day KD and the other group followed a conventional diabetic diet. Changes in weight, blood glucose, blood lipids, insulin resistance, and uric acid levels were observed before and after 2 months of adhering to the respective diets under energy restriction. Both groups showed significant reductions in weight, waist circumference, body mass index, total cholesterol, triglycerides, high-density lipoproteins, low-density lipoproteins, fasting blood glucose, fasting insulin, and glycated hemoglobin (P < .05). The twice-daily KD group showed more significant improvements in these parameters compared to the conventional diabetic diet group. In addition, the 2-meals-a-day KD group showed a slight increase in uric acid levels compared to the conventional diabetic diet control group (P < .05). The 2-meals-a-day KD can significantly improve weight, blood glucose, and lipid control in newly diagnosed obese patients with type 2 diabetes mellitus.
Primary mesenteric abscess caused by Klebsiella pneumoniae: A case report
Authors: Wang Peng , Zhu Fengfeng , Wang Mingming , Niu Bingxu , Ma Bin , Du Jundong
Published: February 2024

Rationale:

Mesenteric abscess, a rare abdominal infection, is regularly mostly secondary to inflammatory bowel disease, diverticula of the small intestine, or tuberculosis. Primary mesenteric abscesses are extremely rare. If not diagnosed and treated in a timely manner, it may lead to serious consequences; computerized tomography is highly beneficial for the diagnosis of this disease; timely surgical intervention, judicious use of antibiotics, and adequate nutritional support are crucial in the management of this disease.

Patient concerns:

A 59-year-old male patient from China was admitted to hospital for intermittent abdominal pain accompanied by poor appetite for 10 days. One week before admission, the patient had been infected with corona virus disease 2019. Past history includes type 2 diabetes and post-operative gastric cancer.

Diagnosis:

The emergency abdominal computerized tomography examination results of the patient suggested that the mesentery was cloudy with a large amount of effusion and visible bubble. Mesentery abscess was considered, but duodenal perforation could not be excluded.

Interventions:

We adopted exploratory laparotomy to further clarify the diagnosis. Intraoperatically, after fully exposing the duodenum, we found extensive abscess formation in the mesentery, but no duodenal perforation. After operation, the patient developed duodenal leakage and was treated with gastric tube and jejunal nutrition tube.

Outcomes:

Postoperatively, due to poor general condition, the patient was transferred to intensive care unit; after anti-infective treatment, the condition improved on the 5th postoperative day, and duodenal leakage appeared on the 9th postoperative day, and conservative treatment was ineffective, and the patient eventually died.

Lessons:

Primary mesenteric abscess is a local tissue infectious disease. Whereas we should consider the physical basic condition of the patient during therapeutic process. We believe adequate postoperative drainage, rational use of antibiotics based on bacterial culture, early ambulation after surgery, and adequate nutritional support might be key points for successful therapy.
Meningitis and sepsis caused by Streptococcus suis in an elderly woman: A CARE-compliant case report
Authors: Li Kuangyi , Li Shilan , Hong Jiana , Cheng Weiyin , Zhang Yingjian , Liang Zhangrong , Tang Qi , Shen Bisheng
Published: February 2024

Rationale:

Streptococcus suis (S suis)-associated infections are uncommon but life-threatening diseases. The clinical manifestations vary from general symptoms of bacterial infection to fatal meningitis. The clinical manifestation and routine diagnostic testing is not specific enough to obtain well-time diagnosis.

Patient concerns and diagnosis:

We report a case of meningitis and sepsis caused by S suis infection. A 70-year-old woman presented to our emergency department with generalized pain. After hospital admission, her condition rapidly deteriorated to fever, intracranial hypertension, and disturbance of consciousness. Examination of the blood and cerebrospinal fluid with metagenomic next-generation sequencing and bacterial cultures revealed S suis infection.

Interventions and outcomes:

After anti-infection therapy with meropenem and vancomycin, the patient recovered and was discharged from the hospital with no residual effects.

Lessons:

Human infections with S suis are extremely rare. If clinicians encounter a patient with fever, disturbance of consciousness, and intracranial hypertension, especially those who have been exposed to raw pork, S suis infection should be considered. Metagenomic next-generation sequencing can be a useful adjunct for the rapid diagnosis of S suis infection and aid in the planning of clinical treatment. Meanwhile, public health awareness is necessary to limit the risk of S suis infection.
Effect of elbow carrying angle on lateral epicondylitis development
Authors: Yolaçan Hakan , Güler Serkan
Published: February 2024

Lateral epicondylitis is one of the most common elbow joint injuries and elbow anatomy is a risk factor. Our study aims to evaluate whether the elbow carrying angle affects the development of lateral epicondylitis by considering sex differences. Elbow radiographs of 211 people (aged 18–65 years) diagnosed with lateral epicondylitis and having anteroposterior radiographs of the elbow taken in the appropriate position in the imaging archive of our hospital between January 1, 2021 and January 1, 2022 were retrospectively analyzed. The control group comprised elbow radiographs of 113 people in the same age range. The study evaluated the age, sex, and side and elbow carrying angles of the participants in the patient and control groups. The average elbow carrying angle was calculated as 14.6 (7.8–22.1). No significant relationship was found between the lateral epicondylitis and control groups based on sex (P = .383), side (P = .634) and age (P = .189). The mean elbow carrying angle was 13.8 ± 3.7 in the group with lateral epicondylitis and 15.9 ± 3.6 in the control group and was significantly lower in the group with lateral epicondylitis (P < .05). A decrease in the elbow carrying angle namely cubitus varus, may lead to the development of lateral epicondylitis.
The utility of systemic immune inflammatory index in discriminating between gallbladder cancer and xanthogranulomatous cholecystitis: A single-tertiary center experience
Authors: Dincer Hilmi Anil , Cennet Omer , Dogrul Ahmet Bulent
Published: February 2024

Xanthogranulomatous cholecystitis (XGC) and gallbladder carcinoma (GBC) are rare diseases with several similarities. This study aimed to evaluate the utility of the systemic immune inflammatory index (SII), a novel index that more accurately depicts inflammatory and immunological balance, in distinguishing between XGC and GBC. This retrospective study included 33 XGC, 22 GBC patients diagnosed according to histopathological findings and 33 age-sex-matched healthy controls at Hacettepe University Faculty of Medicine, General Surgery Department. The demographic, clinical and laboratory findings were recorded. Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, monocyte to lymphocyte ratio and SII were calculated from preoperative complete blood count parameters. The receiver operating characteristic curve was performed to evaluate the utility of SII in differentiating GBC and XGC. A P value < .05 was accepted as statistically significant. The preoperative neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, platelet to lymphocyte ratio and SII were significantly higher in patients with GBC compared to XGC patients and healthy controls (P < .001, P = .001, P = .001, P < .001, respectively). When receiver operating characteristic analysis was made, the optimal cutoff value of SII was 640 for differential diagnosis of XGC and GBC preoperatively with a sensitivity of 77.3% and a specificity of 66.7%, among which the positive likelihood ratio was 2.32, and Youden index was 0.44 (P = .006). The positive predictive value was 60.7%, the negative predictive value was 81.5%, and the diagnostic accuracy was 79.9%. SII may be a valuable, practical, and affordable method to differentiate between XGC and GBC, in addition to clinical and radiological signs, prior to surgery. When supported by prospective trials with a larger study population, distinguishing GBC from XGC using SII preoperatively may lead to a change in the management practice of GBC.
Difficulty in the diagnosis of pancreatic cancer based on the initial CT report: A retrospective study
Authors: Shionoya Kento , Koizumi Kazuya , Masuda Sakue , Makazu Makomo , Kubota Jun , Jinushi Ryuhei , Kimura Karen
Published: February 2024

The role of computed tomography (CT) in the initial diagnosis of pancreatic cancer (PC) is well-known. CT reports made by radiologists are important as not all patients with PC are examined by specialists; however, some cases are not identified based on CT reports. Diagnosis via imaging of PC is sometimes difficult, and the diagnostic rate of PC and other pancreatic diseases can vary across radiologists. This study aimed to examine the diagnostic rate of PC in initial CT reports and the details of cases with diagnostic difficulties. This single-centered, retrospective study collected clinical data of 198 patients with histologically diagnosed PC between January 2018 and April 2022. Out of these contrast-enhanced CT was performed in 192 cases. PC was not reported as the main diagnosis in 18 patients (9.4%; 11 men and 7 women). Among these 18 cases, intrapancreatic mass lesions were detected in 3 (1.6%), indirect findings such as bile/pancreatic duct stenosis or dilation were detected in 5 (2.6%), and no PC-related findings were found in 10 (5.2%). The specialists suspected PC in 15 of these 18 cases based on initial CT reports. 17 cases were confirmed by endoscopic ultrasound-fine needle aspiration and one by biopsy after upper gastrointestinal endoscopy. To improve accuracy of its diagnosis, it is important that specialists provide feedback to diagnostic radiologists regarding the findings they did not report. Endoscopic ultrasound-fine needle aspiration should be performed by specialists when there is clinical information which indicates pancreatic disease of any kind.
Growth differentiation factor-15 may be a novel biomarker in pancreatic cancer: A review
Authors: Guo Meng , Zhao Hui
Published: February 2024

Pancreatic cancer is a highly malignant and invasive gastrointestinal tumor that is often diagnosed at an advanced stage with a poor prognosis and high mortality. Currently, carbohydrate antigen199(CA199) is the only biomarker approved by the FDA for the diagnosis of pancreatic cancer, but it has great limitations. Growth differentiation factor-15 (GDF-15) is expected to be a novel biomarker for the diagnosis, efficacy prediction, and prognosis assessment of pancreatic cancer patients. In this paper, we searched the keywords GDF-15, macrophage inhibitory cytokine-1 (MIC-1), CA199, pancreatic cancer, and tumor markers in PubMed and Web of Science, searched related articles, and read and analyzed the retrieved papers. Finally, we systematically described the characteristics, mechanism of action, and clinical value of GDF-15, aiming to provide help for the detection and treatment of pancreatic cancer.
Predictive value of stromal tumor-infiltrating lymphocytes in patients with breast cancer treated with neoadjuvant chemotherapy: A meta-analysis
Authors: Xia Guangfa , Zhang Ziran , Jiang Qin , Wang Huan , Wang Jie
Published: February 2024

Background:

The predictive value of tumor-infiltrating lymphocytes (TILs) in response to neoadjuvant chemotherapy (NAC) for breast cancer (BC) has received increasing attention. Here, a meta-analysis was conducted to evaluate the correlation between the expression of stromal TILs and pathological complete response (pCR) after NAC in BC patients.

Methods:

The PubMed, Embase, Cochrane Library, and Web of Science databases were searched online by using a combination of keywords and free words to screen literature on the expression of stromal TILs and pCR after NAC in patients with BC. The data were extracted and evaluated for quality. Relative risk (RR) was used to evaluate the relationship between the expression of stromal TILs before NAC and pCR in BC patients. Meta-analysis was performed with Review Manager 5.3 and STATA 14.0 software.

Results:

Eleven studies involving 6039 BC patients were included in the meta-analysis. The results showed a generally high expression of stromal TILs in BC patients, and the pCR rate after NAC in BC patients with a high expression of stromal TILs was significantly higher than that in BC patients with a low expression of stromal TILs [RR = 1.83, 95% confidence interval (CI): 1.69–1.97]. Subgroup analysis based on the molecular subtypes of BC showed that the pCR rate was significantly higher in patients with a high expression of stromal TILs in hormone receptor (HR)-positive BC [RR = 3.23, 95% CI: 2.43–4.30], human epidermal growth factor receptor 2 (HER-2)-positive BC [RR = 1.41, 95% CI: 1.25–1.60], and triple-negative BC [RR = 1.70, 95% CI: 1.53–1.90] than in those with a low expression of stromal TILs. Subgroup analysis based on expression threshold showed that the pCR rate was higher in patients with a high expression of stromal TILs than in patients with a low expression of stromal TILs at different expression thresholds (10% [RR = 1.99, 95% CI: 1.55–2.55], 20%/30% [RR = 1.57, 95% CI: 1.37–1.81], 50%/60% [RR = 1.91, 95% CI: 1.73–2.11].

Conclusion:

TILs can be used as a predictor of pCR after NAC in patients with BC, and the appropriate high expression threshold of stromal TILs should be selected as the predictive value according to the molecular subtype of BC.
Long-term follow-up of inpatients with meniscus tears who received integrative Korean medicine treatment: A retrospective analysis and follow-up survey
Authors: Lee June Haeng , Song Jin Young , Park Kyoung Sun , Lee Jinho , Ha In-Hyuk , Lee Yoon Jae
Published: February 2024

Evidence regarding the use of Korean medicine (KM) for the conservative treatment of meniscus tears remains lacking. We aimed to evaluate clinical effectiveness and long-term follow-up outcomes in patients undergoing integrative KM treatment for meniscus tears. We analyzed the electronic medical records (EMRs) of 86 patients with meniscus tears and administered a follow-up survey. Patients treated at 1 of 4 KM hospitals between June 1, 2015, and June 30, 2020, were reviewed. KM treatment comprised herbal medicine, acupuncture, pharmacopuncture, bee venom pharmacopuncture, Chuna therapy, and KM physiotherapy. The primary outcome was the numeric rating scale (NRS) score for knee pain; secondary outcomes were the Western Ontario and McMaster Universities Arthritis Index (WOMAC), EuroQol 5-dimension (EQ-5D) score, range of motion, and patient global impression of change. The NRS for knee pain was reduced by an average of 2.49 (95% confidence interval [CI]: 2.03–2.95) at discharge and 1.97 (95% CI: 2.03–2.95) at follow-up. The WOMAC decreased by an average of 15.52 (95% CI: 10.14–20.89) during hospital stay and 30.72 (95% CI: 24.58–36.87) at follow-up. The EQ-5D score increased by an average of 0.06 (95% CI: −0.14 to 0.02) at discharge and 0.19 (95% CI: −0.29 to −0.09) at follow up. KM treatment effectively reduced knee pain, improved knee joint function, and enhanced the quality of life in patients with a meniscus tear for a relatively long period after treatment.