bluuebunny/crossref_metadata_2025 huggingface dataset:
Transformation of lung adenocarcinoma to small cell lung cancer following osimertinib treatment: a case report and literature review
Authors: Kuang Linwu , Wang Peng , Zhou Lin , Li Yangkai
Published: January 2025

Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) effectively treat EGFR-mutant lung adenocarcinoma, demonstrating initial efficacy but eventually leading to acquired resistance. Small cell transformation is a rare resistance mechanism to EGFR-TKIs in lung adenocarcinoma, which can complicate clinical diagnosis and treatment. We present a patient with lung adenocarcinoma who underwent a prior pneumonectomy and adjuvant chemotherapy and was treated with osimertinib after the recurrence of lung cancer. Small cell transformation occurred approximately 20 months after starting osimertinib treatment. After this transformation, the patient underwent lung radiotherapy and cisplatin–etoposide chemotherapy, which stabilized the disease. Following the confirmation of small cell lung cancer (SCLC) via thyroid puncture, treatments with irinotecan, irinotecan plus atezolizumab, thyroid radiotherapy, adrenal radiotherapy, and head radiotherapy were sequentially administered, yet the disease continued to progress. The patient succumbed to the disease in May 2023 because of progression and organ failure, with an overall survival of 52.7 months, including 16 months post small cell transformation. This case highlights the possibility of osimertinib causing lung adenocarcinoma to transform into SCLC and underscores rebiopsies’ importance in identifying resistance mechanisms to EGFR-TKIs. Increased levels of neuron-specific enolase and pro-gastrin releasing peptide can signal early transformation into SCLC.
An Objective Assessment of Long-term Postoperative Hyperpigmentation in Patients With Apocrine Gland-eliminated Osmidrosis Surgery
Authors: Ho Wen-Tsao
Published: January 2025

Background:

Radical surgery is the best treatment for axillary osmidrosis to eliminate the apocrine glands. However, marked postoperative hyperpigmentation may occur. Clinicians need an objective skin pigmentation examination to identify and treat hyperpigmentation. In this study, we aimed to use the Taylor Hyperpigmentation Scale (an objective visual scale) for evaluating long-term hyperpigmentation after osmidrosis surgery.

Methods:

Twenty female patients with Fitzpatrick skin type III–IV who had undergone osmidrosis surgery were included in this study.

Results:

The findings demonstrated that although there is an initial variation in the intensity of hyperpigmentation, in the majority of patients, there is a peak in hyperpigmentation between the third and sixth months after surgery. This is then followed by a gradual decline over the ensuing months. Some patients resolve hyperpigmentation completely, suggesting reversibility.

Conclusions:

These results can help guide patient expectations and provide suitable postoperative management, thereby improving patient satisfaction and overall quality of life.
The “Arrow Factor” in Gluteoplasty and Brazilian Butt Lift
Authors: Raposio Edoardo , Morello Alice , Raposio Giorgio
Published: January 2025

The gluteal region has become a rising area of interest in plastic surgery in recent years, as reflected in body contouring surgery trends. In this study, the authors explain what the arrow effect consists of and how to highlight it during a Brazilian butt lift or a gluteal liposculpture: liposuction of the sacral triangle, fat grafting of the upper gluteal quadrants, liposuction of the dimples of Venus and of the midline superficially to the spinal column, and fat grafting of the erector spinae muscles.
Ubiquitination of TFEB increased intestinal permeability to aggravate metabolic dysfunction-associated steatohepatitis
Authors: Liu Donghai , Chen Lang , Wang Zai , Li Zecheng , Liu Lihong , Peng Liang
Published: January 2025

Background and Aims:

Increased intestinal permeability exacerbates the development of metabolic dysfunction associated steatohepatitis (MASH), but the underlying mechanisms remain unclear. Autophagy is important for maintaining normal intestinal permeability. Here, we investigated the impact of intestinal transcription factor EB (TFEB), a key regulator of autophagy, in intestinal permeability and MASH progression.

Methods:

TFEB expression was analyzed in the proximal colon of 45 individuals with metabolic dysfunction associated steatotic liver disease and 23 healthy controls. We utilized immunoprecipitation-mass spectrometry toidentify TFEB-interacting proteins. Intestine-specific Tfeb knockout mice were generated by mating Tfeb
fl/fl mice with Villin-Cre mice. The mice were fed a high-fat, high-sucrose diet, and assessments were performed to evaluate intestinal permeability and MASH progression.

Results:

Intestinal TFEB levels were reduced in MASH patients and negatively correlated with intestinal permeability and hepatic toxicity. Intestine-specific TFEB deficiency increased intestinal permeability and worsened MASH severity, whereas moderate TFEB overexpression conferred protective effects. Mechanistically, the E3 ligase TRIP12 promotes the ubiquitination and degradation of nuclear TFEB, thereby inhibiting autophagic flux to aggravate intestinal barrier impairment and subsequently promote MASH progression. Importantly, a peptide PT1 designed to block the TRIP12-TFEB interaction reduced MASH progression.

Conclusions:

The ubiquitination of TFEB plays a pivotal role in increasing intestinal permeability and promoting the progression of MASH by inhibiting autophagy. Intestinal TFEB may represent a novel therapeutic target for the treatment of MASH.
Paternal alcohol exposure affected offspring mesenteric artery via ROS-Cacna1c and DNA hypomethylation
Authors: He Yun , Zhang Ze , Zheng Qiutong , Su Hongyu , Liu Mingxing , Chen Xueyi , Qi Linglu , Zhang Yumeng , Xu Zhice , Tang Jiaqi
Published: January 2025

Background:

Paternal preconception alcohol exposure affects fetal development; however, it is largely unknown about the influences on offspring vasculature and mechanisms.

Methods:

Offspring born form paternal rats treated with alcohol or water before pregnant was raised until 3 months of age. Vessel tone of mesenteric arteries was detected using myograph system; whole-cell calcium channel current in smooth muscle cells was tested using patch-clamp; molecule expressions were detected with real-time PCR, western blotting, and Dihydroethidium (DHE); DNA methylations were determined using targeted bisulfate sequencing assay. Following 5-aza-2′-deoxycytidine incubation, vessel tone in offspring mesenteric artery and Cacna1c expression in A7r5 was tested.

Results:

When comparing with the control, stress–strain curve was left-shifted in alcohol. There was lower incremental distensibility and endothelium-dependent dilation associated with endothelial nitric oxide synthase. Agonists-induced constrictions were greater in alcohol offspring than that in control, associated with higher expression of AT1R, Cacna1c, and reactive oxygen species (ROS). Baseline and Ang II-stimulated calcium channel currents were higher in alcohol group. Tempol and apocynin could restore Ang II-increased constriction and calcium channel current in alcohol offspring. When comparing with the control, there was lower DNA methylation of Cacna1c promotor in alcohol offspring mesenteric artery and in paternal sperm. 5-aza-2′-deoxycytidine increased contraction in control offspring mesenteric artery and Cacna1c expression in A7r5.

Conclusion:

Paternal preconception alcohol exposure-affected offspring mesenteric artery was via ROS-Cacna1c. Abnormal offspring vascular functions might be inherited via DNA hypomethylation of Cacna1c promotor from paternal sperm exposed to alcohol. These data gained provided important clues for cardiovascular disorders at germ cell origin.
Depression and Distress Screening in Oncology Patients: A Descriptive Analysis
Authors: Ali Chelsey R. , Litvintchouk Alexander M. , Moeller Patrick , Davis Raegan , Hannan Emma , Maio Vittorio , Csik Valerie P.
Published: January 2025

This retrospective study aimed to describe the characteristics of cancer patients undergoing depression and distress screening at the Sidney Kimmel Cancer Center and to assess factors associated with their screening results. Data were retrieved from electronic medical records of adult Sidney Kimmel Cancer Center patients with at least one oncology encounter between January 2021 and June 2022, who underwent both depression and distress screening using the Patient Health Questionnaire-2/9 for depression and the National Comprehensive Cancer Network distress thermometer for distress during the encounter. Demographics, clinical factors, and screening results were analyzed using descriptive statistics and binary logistic regression. A total of 1954 cancer patients were screened for psychological needs. Of these, 110 (5.6%) screened positive for depression and 830 (42.5%) screened positive for distress. About 69.1% of patients who screened positive for depression also screened positive for distress. Conversely, 9.2% of patients who screened positive for distress also screened positive for depression. Cancer patients >65 years old were found significantly less likely to screen positive for both distress and depression, while males were found significantly less likely to screen positive for distress. African American patients were found to be significantly more likely than White patients to screen positive for both distress and depression (odds ratio: 2.58; confidence interval: 1:53–4.34). In this study, a higher proportion of cancer patients were found to be distressed than depressed, suggesting that the National Comprehensive Cancer Network distress thermometer may be a more useful tool in identifying psychosocial concerns in this population. Differences in depression and distress scores were significantly associated with age, sex, and race. These findings highlight the need for the implementation of effective screening strategies to better address the psychosocial needs of cancer patients. Further research is warranted to validate these findings and assess the impact of distress screening on patient outcomes across various oncology settings.
Comparing the Accuracy and Reliability of ABC/2 and Planimetry for Vestibular Schwannoma Volume Assessment
Authors: Singh Kanwar P. , Abdou Hisham , Panth Neelima , Chiang Veronica , Buono Frank D. , Schwartz Nofrat , Mahajan Amit
Published: January 2025

Background

Vestibular schwannoma (VS) is a common intracranial tumor that affects patients' quality of life. Reliable imaging techniques for tumor volume assessment are essential for guiding management decisions. The study aimed to compare the ABC/2 method to the gold standard planimetry method for volumetric assessment of VS.

Methods

A retrospective review was conducted on patients with VS diagnosed between 2007 and 2022 at Yale New Haven Hospital. Both ABC/2 and planimetry methods were used for tumor volume assessment, and their correlations were evaluated.

Results

Among 140 patients, the mean tumor volumes using the planimetry and ABC/2 methods were 1307.99 ± 142.13 and 1482.76 ± 165.75 mm3, respectively. A strong correlation was observed between the methods (r = 0.99, p < 0.0001). For patients who underwent follow-up scans, the ABC/2 method accurately detected tumor volume changes over time. Subgroup analysis based on tumor size also displayed a significant positive correlation across all size categories.

Conclusion

The ABC/2 method demonstrates a high correlation with the planimetry method for VS volume assessment and can be a reliable, less time-intensive alternative in clinical settings. However, it generally overestimates tumor volume compared to planimetry. Subgroup-specific correction formulae were provided to enhance the accuracy of ABC/2-derived measurements. Future studies may explore the integration of these methods for improved clinical decision making.
Long-Term Clinical Outcomes for Bone-Anchored Hearing Implants: 3-Year Comparison Between Minimally Invasive Ponto Surgery and the Linear Incision Technique With Tissue Preservation
Authors: Teunissen Emma , Caspers Coosje , Kruyt Ivo , Mylanus Emmanuel , Hol Myrthe
Published: January 2025

Objective

To compare the 3-year outcomes of the modified minimally invasive Ponto surgery (m-MIPS) to both the original MIPS (o-MIPS) and linear incision technique with soft tissue preservation (LIT-TP) for inserting bone-anchored hearing implants (BAHIs).

Study design

Prospective study with three patient groups: m-MIPS, o-MIPS, and LIT-TP.

Setting

Tertiary referral center.

Patients

In the m-MIPS group, 24 patients with 25 implants were enrolled. The o-MIPS and LIT-TP groups included 25 patients (25 implants) each.

Interventions

The patients underwent BAHI surgery using m-MIPS, o-MIPS, or LIT-TP.

Main outcome measures

Implant survival and implant stability were compared between all groups. Soft tissue status, skin sensibility, subjective numbness, and hearing-related quality of life (HRQoL) were compared between m-MIPS and LIT-TP and o-MIPS and LIT-TP, respectively.

Results

Implant survival was comparable between m-MIPS and LIT-TP (96 versus 100%), with o-MIPS showing nonsignificant lower survival (88%). Both MIPS groups exhibited fewer (adverse) skin reactions, better skin sensibility, and less subjective numbness than LIT-TP throughout visits. At 3 years, soft tissue status, sensibility, and numbness were comparable between groups. Device use was consistent among groups (83–86% daily users). All groups demonstrated significant improvement in HRQoL post-surgery based on GBI, GHSI, and APHAB total scores.

Conclusions

Compared with LIT-TP, m-MIPS showed comparable long-term implant survival, fewer (adverse) skin reactions, and earlier sensibility and numbness recovery. M-MIPS resulted in favorable clinical and QoL outcomes with low intra- and postoperative complication rates until 3 years after surgery. It is therefore considered a safe technique for BAHI insertion. Moreover, with a shorter surgery time and the ability to operate under local anesthesia in a controlled outpatient setting, m-MIPS appears to be a more efficient alternative to LIT-TP.
Comparative genomic analysis unveiling the mutational landscape associated with premalignant lesions and early-stage gastric cardia cancer
Authors: Wang Guangda , Liu Liang , Zhao Yang , Lin Yan , Er Limian
Published: January 2025

This study enrolled 10 patients diagnosed with premalignant lesions and early-stage gastric cardia adenocarcinoma (GCA), confirmed through endoscopic examination. These patients were subjected to next-generation sequencing (NGS) using a customized 1123-gene panel to identify genetic alterations and signaling pathways. The results were compared to stage IIB to IV GCA samples from the cancer genome atlas (TCGA) and a cohort of Hong Kong patients. The study provides insights into the molecular drivers of GCA progression, with potential therapeutic implications. A total of 10 patients diagnosed with premalignant and early-stage GCA were subjected to NGS targeted 1123-panal testing. Genetic alterations characteristics and signaling pathways were defined and analyzed. These findings were compared with the mutation features of stage IIB to IV GCA samples from the TCGA and another GCA cohort of HongKong patients (HK cohort). Additionally, therapeutic implications were also evaluated. In premalignant lesions and early-stage GCA, driver genes, such as TP53, ARIDA and LRP1B were found to have high mutation rates and showed no significantly different in driver gene mutation and tumor mutational burden with stage IIB to IV GCA in both the HK and TCGA-GCA cohorts. However, EPHA2 showed a significantly higher mutation rate in premalignant and early-stage GCA compared to IIB to IV GCA. The majority of 10 cancer-related signaling pathways were found to be activated in premalignant and early-stage GCA. Furthermore, 80% patients had corresponding potential therapeutic inhibitors based on molecular mutation results in our cohort. Certain mutational characteristics involved in the occurrence and progression of GCA are already present in premalignant lesions and early-stage GCA, which can be assessed and prevented through early molecular testing. Additionally, EPHA2 mutations are more common in premalignant lesions and early-stage GCA, which provided potential biomarkers for the diagnosis and detection of premalignant lesions and early-stage GCA.
Tailoring glaucoma education using large language models: Addressing health disparities in patient comprehension
Authors: Spina Aidin C. , Fereydouni Pirooz , Tang Jordan N. , Andalib Saman , Picton Bryce G. , Fox Austin R.
Published: January 2025

This study evaluates the efficacy of GPT-4, a Large Language Model, in simplifying medical literature for enhancing patient comprehension in glaucoma care. GPT-4 was used to transform published abstracts from 3 glaucoma journals (n = 62) and patient education materials (Patient Educational Model [PEMs], n = 9) to a 5th-grade reading level. GPT-4 was also prompted to generate de novo educational outputs at 6 different education levels (5th Grade, 8th Grade, High School, Associate’s, Bachelor’s and Doctorate). Readability of both transformed and de novo materials was quantified using Flesch Kincaid Grade Level (FKGL) and Flesch Reading Ease (FKRE) Score. Latent semantic analysis (LSA) using cosine similarity was applied to assess content consistency in transformed materials. The transformation of abstracts resulted in FKGL decreasing by an average of 3.21 points (30%, P < .001) and FKRE increasing by 28.6 points (66%, P < .001). For PEMs, FKGL decreased by 2.38 points (28%, P = .0272) and FKRE increased by 12.14 points (19%, P = .0459). LSA revealed high semantic consistency, with an average cosine similarity of 0.861 across all abstracts and 0.937 for PEMs, signifying topical themes were quantitatively shown to be consistent. This study shows that GPT-4 effectively simplifies medical information about glaucoma, making it more accessible while maintaining textual content. The improved readability scores for both transformed materials and GPT-4 generated content demonstrate its usefulness in patient education across different educational levels.
Advancements in the treatment of cerebral ischemia-reperfusion injury: Acupuncture combined with mesenchymal stem cells transplantation
Authors: Li Huan , Zhang Jiaxin , Ma Kewen , Ji Jie , An Chengfei , Jiang Hailun , Qu Hui , Tang Ruohan , Ren Xuesong , Du Yuzheng , Zhao Qi
Published: January 2025

Cerebral ischemia-reperfusion injury (CIRI) constitutes a significant etiology of exacerbated cerebral tissue damage subsequent to intravenous thrombolysis and endovascular mechanical thrombectomy in patients diagnosed with acute ischemic stroke. The treatment of CIRI has been extensively investigated through a multitude of clinical studies. Acupuncture has been demonstrated to be effective in treating CIRI. Recent 5 years studies have identified potential mechanisms of acupuncture, including regulation of autophagy, promotion of angiogenesis, inhibition of inflammation and apoptosis, modulation of cell activation, neuroplasticity regulation, and promotion of nerve regeneration. The transplantation of mesenchymal stem cells (MSCs) can effectively suppress apoptosis, modulate immune responses, and enhance the proliferation and migration of endogenous neural stem cells (NSCs), thereby compensating for the NSCs deficiency following cerebral ischemia/reperfusion injury. The combination of acupuncture and MSCs transplantation demonstrates superiority over individual treatments, significantly enhancing the survival rate of MSCs. Moreover, it facilitates the secretion of various cytokines to promote their homing and differentiation into functional neurons, thereby providing a novel approach for clinical treatment of CIRI.
Study on mechanism of Spatholobi Caulis in the treatment of the hand-foot skin reaction induced by targeted drug therapy based on network pharmacology and molecular docking: An observational study
Authors: Li Quan-yao , Meng Huan-nan , Yao Li-qiu , Liu Hui , Tan He-xin , Lin Dan , Shi Jun
Published: January 2025

Based on network pharmacology and molecular docking methods, this study explored its active compounds and confirmed its potential mechanism of action against Hand-foot skin reaction induced by tumor-targeted drugs. Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and UniProt Database were used to obtain the active ingredients and target proteins of Spatholobi Caulis. All hand-foot skin reaction (HFSR)-related targets were obtained with the help of the Human Gene Database, Online Mendelian Inheritance in Humans (OMIM), DisGeNET and DrugBank databases. Cytoscape 3.7.1 software was used to construct the active ingredient-target visualization network of Spatholobi Caulis, and the common target network of Spatholobi Caulis and HFSR. And through the BisoGenet plug-in in Cytoscape, PPI network topology analysis was performed. The Metescape database and online mapping tool platform were used for Gene Ontology (GO) function and Kyoto Encyclopedia of Genes Genomes (KEGG) pathway enrichment analysis to identify the key pathways of Spatholobi Caulis. Finally, Autodock Vina software and PyMol 2.5 software were used for molecular docking verification. There were 24 active components of Spatholobi Caulis and 244 target genes, 1635 disease-related target genes, 51 common target genes of Spatholobi Caulis and Hand-foot skin reaction, and key targets included NTRK1, epidermal growth factor receptor (EGFR), APP, TP53, HSP90AB1, HSP90AA, CUL3, etc. GO functional analysis involved a total of 66 molecular functions, 39 cellular components, and 817 biological processes. KEGG pathway analysis found 154 related signaling pathways, mainly enriched in Pathways in cancer, Human cytomegalovirus infection, Kaposi arcoma-associated herpesvirus infection, panic cancer, EGFR tyrosine kinase inhibitor resistance, P13K-Akt signaling pathway, Proteoglycans in cancer, HIF-1 signaling pathway and Ras signaling pathway, etc. Molecular docking results showed that luteolin, the active component of Spatholobi Caulis, had a high affinity with EGFR. Medicagol, the active components of Spatholobi Caulis, is proved in the Hand-foot skin reaction induced by lung cancer targeted therapy by regulating multiple signaling pathways through EGFR. It is confirmed that the treatment of Hand-foot skin reaction has the characteristics of multi-component, multi-target and multi-pathway regulation.
Functional cure of a young child with chronic hepatitis B cirrhosis treated by pegylated interferon α combination therapy: A case report
Authors: Gan Yu , Zhang Hongfei
Published: January 2025

Rationale:

Current research on antiviral treatment in children is relatively limited, especially in children under 1 year old.

Patient concerns:

Liu XX, an 8-month-old infant (case number: 3001120473), presented to the hospital in August 2016 with a chief complaint of being “hepatitis B surface antigen positive for 8 months and experiencing abnormal liver function for 5 months.”

Diagnoses:

The patient was diagnosed as chronic hepatitis B cirrhosis (G3S3-4) with active compensatory phase.

Interventions:

The treatment regimen commenced with lamivudine (LAM) for the initial 8 weeks, followed by the addition of interferon α (IFNα) after 1 year of age. At 2 years old, LAM was substituted with entecavir, and at 3 years old, IFNα was replaced with pegylated interferon α (PEG IFNα).

Outcomes:

After 8 weeks of LAM monotherapy, Liu XX experienced hepatitis B e antigen loss. Subsequently, after 36 weeks of IFNα add-on therapy, hepatitis B virus DNA became undetectable, and after 48 weeks of switching to PEG IFNα treatment, hepatitis B surface antigen loss was observed. Remarkably, following 50 weeks of drug discontinuation, the child remained functionally cured.

Lessons:

Chronic hepatitis B virus-infected infants and young children can achieve durable functional cure with PEG IFNα-based individualized therapy. This case provides a valuable reference for the diagnosis and treatment of such patients.
Hearing loss in patients with Morquio A syndrome: A scoping review
Authors: Diaz-Ordoñez Lorena , Duque-Cordoba Paola Andrea , Silva-Cuero Katherine , Gutierrez-Medina Juan David , Saldarriaga Wilmar , Murgašová Lenka , Magner Martin , Candelo Estephania , Pachajoa Harry
Published: January 2025

Background:

Hearing impairment is a prevalent clinical feature in Morquio syndrome (mucopolysaccharidosis IVA or MPS IVA) patients, often presenting in diverse forms: conductive, sensorineural, or a combination known as mixed hearing loss. The mixed form entails a blend of both conductive and sensorineural elements, typically exhibiting a progressive trajectory. This scoping review aimed to comprehensively analyze available evidence pertaining to the pathophysiology, classification, epidemiology, and clinical management of hearing loss in individuals with MPS IVA.

Methods:

Targeted literature was searched using MEDLINE, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Web of Science, the Cochrane Library, Trip Medical Database, Embase, ScienceDirect, and Google Scholar, with a second search cycle to identify gray literature. A systematic search strategy using Medical Subject Headings keywords was implemented: “Hearing Disorders” OR “Hearing Loss” AND “Mucopolysaccharidosis IV” or “Hearing Disorders” OR “Hearing Loss” AND “Mucopolysaccharidosis IV.” The identified bibliography was uploaded to COVIDENCE platform for information management. Articles were screened by 3 independent reviewers following the eligibility criteria.

Results:

Twenty-seven articles met the inclusion criteria, spanning information from 568 patients across 16 different countries. None of the studies had complete epidemiological information. Only 2 studies provided sufficient data to address the pathophysiology, while 3 addressed management and treatment. Hearing loss was reported in 210 of 568 patients. A total of 19.2% of patients reported recurrent ear infections. None of the studies reported vertigo, tinnitus, or dizziness in the patients. Pure-tone audiometry was the primary test used to diagnose and monitor auditory impairment in patients with Morquio syndrome.

Conclusions:

Five hundred sixty-eight patients with MPS IVA were identified, of whom 210 (37%) developed hearing loss, the most common of which was moderate. Despite the lack of information on the diagnosis and management of hearing loss in Morquio syndrome, this study found that approximately one-third of participants exhibited some form of auditory impairment, with the majority of these cases being sensorineural in nature.
The application value of dynamic electroencephalography combined with brainstem auditory evoked potential in evaluating the degree of vascular stenosis and prognosis in patients with ischemic stroke: A retrospective analysis
Authors: Xiong Yan , Pu Di
Published: January 2025

The aim was to explore the application value of dynamic electroencephalography (EEG) combined with brainstem auditory evoked potential (BAEP) in evaluating the degree of vascular stenosis and prognosis in patients with ischemic stroke (IS). This was a retrospective study using clinical data of patients with IS admitted to the First Affiliated Hospital of Chongqing Medical and Pharmaceutical College from March 2020 to March 2022. The degree of vascular stenosis and prognosis of patients were analyzed. In addition, the correlation between EEG, BAEP examination and the degree of vascular stenosis was studied. A total of 105 patients met the inclusion and exclusion criteria were included in this study. Among them, 43 cases were mild stenosis, 42 cases were moderate stenosis, and 20 cases were severe stenosis; 32 cases had poor prognosis and 73 cases had good prognosis. The quantitative electroencephalogram index (delta + theta)/(alpha + beta) ratio (DTABR), peak latency (PL) of waves I and V, and interval PL (IPL) of waves III to V and I to V in patients with moderate stenosis or severe stenosis were significantly higher than those in patients with mild stenosis (P < .05). Moreover, the above indicators were significantly higher in patients with severe stenosis than in patients with moderate stenosis (P < .05). According to Spearman test, the patients’ DTABR, PL of wave I and wave V, and IPL of wave III to V and wave I to V were positively correlated with the degree of vascular stenosis, respectively (P < .05). The DTABR, wave I, wave V, wave III to V, and wave I to V of patients with poor prognosis were higher than those with good prognosis (P < .05). The DTABR, PL of waves I and V, and IPL of waves III to V and I to V in patients with poor prognosis were significantly higher than those in patients with good prognosis (P < .05). EEG combined with BAEP has high value in assessing the degree of vascular stenosis and prognosis in patients with IS, which provides a reference basis for clinical development or adjustment of subsequent intervention plans.
Refractory small cell lung cancer with pancreatic metastasis: A case report
Authors: Xiao Zhimin , Gu Yan
Published: January 2025

Rationale:

The occurrence of refractory small cell lung cancer (rSCLC) with pancreatic metastasis is a relatively rare clinical condition, which is typically accompanied by a poor prognosis and rapid disease progression.

Patient Concerns:

A 65-year-old male farmer from China was diagnosed with limited-stage small cell lung cancer (SCLC) 8 months ago. Following 6 cycles of EP chemotherapy, the patient’s tumor response showed partial relief. He discontinued chemotherapy for 2 months and subsequently experienced abdominal pain for 1 month.

Diagnoses:

A computed tomography scan revealed a malignant tumor in the lower lobe of the right lung, as well as low vascular nodules in the pancreas, which are suspected to be metastases. Laboratory tests indicated elevated levels of amylase and lipase, along with abnormalities in 5 indicators associated with lung cancer.

Interventions:

Upon admission, the patient received active treatment for pancreatitis. Given the progression of the tumor, salvage chemotherapy was initiated, combining albumin with paclitaxel and attilizumab, in consultation with a multidisciplinary team (MDT).

Outcomes:

Abdominal pain was significantly reduced, and levels of amylase and lipase returned to normal, while neuron-specific enolase levels decreased. However, during subsequent follow-up, enlarged pancreatic lesions were identified, necessitating a reevaluation of treatment strategies.

Lessons:

This case study highlights the challenges associated with treating rSCLC that has metastasized to the pancreas. Although targeted therapy for metastasis-induced pancreatitis and systemic chemotherapy can alleviate symptoms and enhance patients’ quality of life, continuous monitoring and optimization of treatment plans are essential for managing this aggressive disease. The findings emphasize the importance of a multidisciplinary approach in diagnosing and treating such complex cases, underscoring the necessity for personalized treatment strategies to address both the primary cancer and its metastatic complications.
Hyperprolactinemia complicated with peliosis hepatis: One case report and review of literature
Authors: Li Xun , Lv Yang , Xia Yu , Lai Yulian , Chen Shangbin , Xie Yinzi , Tang Ziwei , Cheng Qingfeng
Published: January 2025

Rationale:

Peliosis hepatis (PH) is a rare disease with few clinical reports and complex etiology. However, there have been no reports of hyperprolactinemia (HPRL) leading to PH at present. This paper, through case reports, expands the understanding of the etiology of PH and the pathological damage effect of prolactin (PRL).

Patient Concerns:

The patient reported in this paper had jaundice, menstrual disorders, menopause, weight gain, and other symptoms. Laboratory examination found increased levels of PRL and transaminase in liver function, and imaging examination indicated pituitary tumor and PH.

Diagnoses:

Comprehensive patient history and auxiliary examination, the clinical diagnosis was pituitary PRL tumor and PH.

Interventions and Outcomes:

After treatment with bromocriptine, menstruation recovered and liver function returned to normal. In addition, the follow-up imaging examination indicated that pituitary tumors and PH lesions were shrinking, and clinical phenomena indicated that HPRL caused by pituitary prolactinoma was correlated with PH occurrence.

Lessons:

Since there is no report of HPRL causing PH, the specific pathogenesis is unknown. This paper reviews the relevant literature and puts forward the theoretical consideration of the pathogenesis. Through this case, for clinically similar patients, it is warned that we need to consider the possibility of PH and further improve the examination, evaluation and treatment in time.
ATRX mutation modifies the DNA damage response in glioblastoma multiforme tumor cells and enhances patient prognosis
Authors: Yu Rou , Huang Keru , He Xinyan , Zhang Jingwen , Ma Yushan , Liu Hui
Published: January 2025

The presence of specific genetic mutations in patients with glioblastoma multiforme (GBM) is associated with improved survival outcomes. Disruption of the DNA damage response (DDR) pathway in tumor cells enhances the effectiveness of radiotherapy drugs, while increased mutational burden following tumor cell damage also facilitates the efficacy of immunotherapy. The ATRX gene, located on chromosome X, plays a crucial role in DDR. The aim of this research is to elucidate the correlation between ATRX mutations and GBM. Dataset obtained from TCGA-GBM were conducted an analysis on the genomic features, biological characteristics, immunopathological markers, and clinical prognosis of patients carrying ATRX mutations. Our findings revealed a significantly elevated level of microsatellite instability in individuals with ATRX mutants, along with significant alterations in the receptor-tyrosine kinase (RTK)-ras pathway among patients exhibiting combined ATRX mutations. TCGA-GBM patients with concurrent ATRX mutations exhibited sensitivity to 26 chemotherapeutic and anticancer drugs, which exerted their effects by modulating the DDR of tumor cells through highly correlated mechanisms involving the RTK-ras pathway. Additionally, we observed an enrichment of ATRX mutations in specific pathways associated with DDR among TCGA-GBM patients. Our model also demonstrated prolonged overall survival in patients carrying ATRX mutations, particularly showing strong predictive value for 3- and 5-year survival rates. Furthermore, additional protective factors such as younger age, female gender, combined IDH mutations, and TP53 mutations were identified. The results underscore the protective role and prognostic significance of ATRX mutations in GBM as a potential therapeutic target and biomarker for patient survival.
All-positive HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb in a patient with hepatitis B: A case report
Authors: Wang Fenfang , Zhang Qianchun , Zhang Ju , Yang Penghui , Pan Fei , Ren Xuefang , Yuan Hang , Chang Zhongbao
Published: January 2025

Rationale:

Mass vaccination, low cost of immunoglobulins, and new drugs led to the emergence of new, unusual patterns of hepatitis B serum markers. This study reported a rare case of hepatitis B with all 5 positive serum markers, including HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb.

Patient concerns:

A 30-year-old female patient was admitted due to abnormal liver function. The 5 serum markers were all positive (+), including HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb. After antiviral therapy, she was discharged with normal liver function and decreased hepatitis B virus-DNA levels, but all 5 serum markers were still positive. Regular follow-up was conducted every 3 months.

Diagnoses:

Abnormal liver function.

Interventions:

The patient received antiviral treatment and liver protection therapy using entecavir dispersive tablet 0.5 mg po qd and glycyrrhizate diamine enteric capsule 150 mg po tid.

Outcomes:

The patient’s liver function was normal, hepatitis B virus-DNA continued to decline, and HBeAb turned negative at 6 months. After 9 and 12 months of follow-up, the results of hepatitis B markers in the patient were stable in HBsAg positive (+), HBeAb positive (+), and HBcAb positive (+).

Lessons:

The rare pattern of all 5 positive hepatitis B markers may occur in patients with chronic hepatitis B. Improvements can be achieved using first-line drugs and conventional treatment. Nevertheless, more attention should be paid to the patient’s condition.
Gitelman syndrome with diabetes and kidney stones: A case report
Authors: Wu Huishan , Ye Xiongwei , Li Meng
Published: January 2025

Rationale:

Gitelman syndrome (GS) is a rare hereditary electrolyte disorder caused by mutations in the SLC12A3 gene. There is limited literature on the role of hydrochlorothiazide (HCT) testing and the SLC12A3 single heterozygous mutation in the diagnosis and management of patients with GS. In addition, cases of GS with concomitant kidney stones are rare.

Patient concerns:

A 48-year-old male patient suffered from unexplained hypokalemia for >10 years.

Diagnoses:

The patient was diagnosed with GS, type 2 diabetes mellitus, and kidney stones.

Interventions:

He was given potassium chloride sustained-release tablets and potassium magnesium aspartate tablets.

Outcomes:

His irregular potassium supplementation and hypoglycemic therapy resulted in poor control of potassium and blood glucose levels.

Lessons:

When unexplained hypokalemia is observed, the HCT test can help with the diagnosis of GS. When genetic testing reveals that a patient only carries only 1 SLC12A3 mutant allele, he requires further genetic evaluation. The patient’s combination of kidney stones and cysts could not exclude the diagnosis of GS. Patients with GS and diabetes should be monitored for the development of diabetic ketoacidosis.
Large recurrent sialoliths in a residual Wharton duct after sialoadenectomy: Two case reports and literature review
Authors: Su Li-Wen , Sun Huan , Zhang Hong-Yu , Wu Yang
Published: January 2025

Rationale:

When gland-preserving treatments are unsuccessful, sialoadenectomy is typically conducted for patients afflicted with submandibular gland diseases. The definitive treatment modality for these individuals is the removal of both the gland and the associated ducts. During surgery, the gland and the majority of the ducts can be excised utilizing the lateral transcervical approach, with residual ducts unlikely to develop pathology. After sialoadenectomy, the recurrence of salivary gland stones is extremely rare. Although there are some relevant speculations, to the best of our knowledge, there are no comprehensive reports of larger recurrent stone-related cases available.

Patient concerns:

We present 2 instances of recurrent sialoliths in the residual Wharton duct following sialoadenectomy. In our cases, it was not until several years later that both patients presented with symptoms. The patients, a 51-year-old male and a 28-year-old female, presented with swelling and purulent discharge in the right floor of the mouth.

Diagnoses:

Computed tomography scans revealed irregular high-density masses in the floor of the mouth, indicative of sialolithiasis.

Interventions:

The intraoral incision exposed the recurrent sialoliths, which were successfully removed along with the residual duct.

Outcomes:

There were no complications in both cases.

Lessons:

This report aims to clarify potential mechanisms behind recurrent sialoliths in residual Wharton ducts after submandibular gland excision, warranting further investigation to improve patient management. New stones may form again in the residual duct even if the glands were removed. With the risk of recurrent sialoliths after resection of the gland, multiway preventive management can optimize outcomes.
Analysis of influencing factors for complications of anterior thoracolumbar tuberculosis surgery in adults
Authors: Lin Wei , Liu Jinzhu , Zhan Zirui
Published: January 2025

This study analyzes the risk factors related to the complications of anterior thoracolumbar tuberculosis in adults and to provide clinical reference. A total of 98 adult patients with thoracolumbar tuberculosis undergoing anterior surgery in our hospital from February 2020 to December 2023 were selected, and the clinical data and postoperative complications were collected. The clinical characteristics were analyzed, and the risk factors related to surgical complications were analyzed by univariate analysis and multi-factor logistic regression model. A total of 54 patients had 75 postoperative complications of different degrees. Univariate analysis showed that patient age, preoperative hemoglobin (Hb) level, bone graft fusion method, intraoperative blood loss, and postoperative neurological function [Asian neurological function classification] were correlated with the occurrence of postoperative complications (P < .05). Multivariate Logistic regression analysis showed that age over 60 years old, preoperative Hb < 100 g/L, blood loss ≥ 800 mL, bone graft fusion method were independent risk factors for anterior postoperative complications of thoracolumbar tuberculosis (P < .05). The independent risk factors for surgical complications of anterior thoracolumbar tuberculosis were age over 60 years old, preoperative Hb < 100 g/L, blood loss ≥ 800 mL, titanium cage by bone graft fusion. Controlling these variable factors before operation can reduce the incidence of postoperative complications.
Audio-Based Care for Managing Diabetes in Adults
Authors: Reddy Shivani , Booth Graham , Coker-Schwimmer Manny , Kugley Shannon , Rodriguez-Borja Ivette , Patel Sheila V. , Fujita Miku , Philbrick Sarah , Ruwala Richa , Albritton Jordan A. , Crotty Karen
Published: January 2025

Objectives:

We compared the effectiveness of audio-based care, as a replacement or a supplement to usual care, for managing diabetes.

Background:

Diabetes is a chronic condition afflicting many in the United States. The impact of audio-based care on the health of individuals with diabetes is unclear, particularly for those at risk for disparities—many of whom may only be able to access telehealth services through telephone.

Methods:

We used systematic review methods to synthesize available evidence. We systematically searched for English-language articles from 2012 reporting randomized controlled trials of adults diagnosed with diabetes. We abstracted data on clinical outcomes (including A1c), patient-reported health and quality-of-life, health care access and utilization, care quality and experience, and patient safety.

Results:

Evidence for replacing in-person care with audio care was limited (n = 2), with low certainty of evidence for greater and comparable effectiveness for A1c and harms, respectively. Supplemental audio care (n = 23) had a positive effect on A1c (pooled mean difference A1c −0.20%; n = 8763; 95% CI: −0.36% to −0.04%), with moderate certainty of evidence. Stratified results indicated that audio interventions supplementing usual care performed more favorably in individuals with A1c ≤ 9%; populations not at risk of disparities; interventions with at least monthly contact; and interventions using remote monitoring tools.

Conclusions:

This evidence base reveals some promise for managing diabetes with audio-based care as a supplement to in-person care. Future studies could further investigate the effectiveness of audio-based care as a replacement and modify interventions to better serve individuals with poor glucose control and those at risk for disparities.
A Survey of Sedation Practices for Adolescents and Young Adults With Acute Lymphoblastic Leukemia Undergoing Lumbar Puncture
Authors: Salik Irim , Blizard Aaron J. , Abramov Rozalia , Khan Aleena , Drugge Elizabeth , Rosenblum Jeremy
Published: January 2025

Purpose:

Lumbar puncture is a frequently performed procedure for patients undergoing treatment for acute lymphoblastic leukemia. This brief procedure is frequently performed with sedation in young patients but with only local anesthesia in adults. Adolescent and young adult patients may be cared for by physicians with different training backgrounds and sedation preferences, making the utilization of sedation for lumbar punctures variable among providers. The benefits of sedation for young adults with leukemia undergoing lumbar puncture (analgesia, anxiolysis, safety) must be weighed against the obligate fasting interval, hospital cost, and resource allocation that is required.

Methods:

We conducted a survey of pediatric and medical oncologists who care for patients with acute lymphoblastic leukemia to assess their use of sedation for adolescents and young adults undergoing lumbar punctures as part of their cancer therapy. (see Supplemental Digital Content 1, http://links.lww.com/JPHO/A723).

Results:

Twenty-six percent of pediatric oncologists and 28% of medical oncologists completed the survey. Pediatric oncologists were more likely to perform lumbar punctures under sedation as compared with medical oncologists. This pattern remained consistent across all patient age ranges surveyed, despite no significant difference in the expected cumulative number of lumbar punctures that a patient was to undergo. Medical oncologists reported topicalization with local anesthetics before lumbar puncture more often than pediatric oncologists.

Conclusion:

Sedation practices for lumbar puncture during acute lymphoblastic leukemia treatment varies by specialty of treating oncologist.
Knowledge, Attitude, and Practice of Patients Suffering From Sickle Cell Disease in an Endemic Zone
Authors: Nirmal Garima , Pendharkar Dinesh , Gupta Neha , Raj Abhishek
Published: January 2025

Background and Objective:

Sickle cell disease (SCD) is a genetically inherited disorder that is associated with morbidity and mortality.

Methods:

This cross-sectional study was conducted on patients diagnosed with SCD to evaluate the knowledge, attitude, and practice of patients/guardians using a pretested questionnaire.

Results and Discussion:

Of the 111 participants, 56 (50.4%) were male. Forty-five participants reported SCD as a hereditary disease, and only 31 (37%) subjects reported that SCD could be prevented. Fourteen (70%) married patients reported that their children had been screened. Ninety-three (84%) children reported fatigue in the past 1 year. Seventy-four of them reported no absence from work/school in the past 1 year. Fifty-seven participants (52%) experienced 1 to 4 episodes of pain in the past 1 year, 62 and the majority (55.86%) of them visited a nearby doctor for the pain episode. Ninety-four participants were taking regular hydroxyurea as medication, and 72% had not missed any dose in the past 1 month, while 14.4% missed 1 to 2 doses in the past 1 month. Only 19 participants (17%) were aware that transplantation was a curative option. The majority (78%) reported undergoing blood and other investigations irregularly in the preceding year.

Conclusions:

The knowledge and attitude of patients/guardians regarding the nature of the disease, preventive measures, curative options for transplantation, and screening of family members are low. At the same time, most people are educated. In contrast to the world data, adherence to hydroxyurea is extremely good. Patient and family education and counseling are the needs of the hour.