bluuebunny/crossref_metadata_2025 huggingface dataset:
Overcoming the Boundaries of Heart Warm Ischemia in Donation After Circulatory Death: The Padua Case
Authors: Gerosa Gino , Zanatta Paolo , Angelini Annalisa , Fedrigo Marny , Bianco Roberto , Pittarello Demetrio , Lena Tea , Pepe Alessia , Toscano Giuseppe , Zanella Fabio , Feltrin Giuseppe , Pradegan Nicola , Tarzia Vincenzo
Published: February 2024

A 45 year old male obese patient with a previous history of repaired congenital heart disease developed worsening heart failure making heart transplantation listing mandatory. Unfortunately, due to his anthropometric measures, the search for a suitable brain-dead donor was unsuccessful. For this reason, he accepted to be enrolled in the controlled donation after circulatory death (cDCD) program. According to the Italian Law regulating death declaration after cardiac arrest (no-touch period of 20 minutes—one of the longest in the world), we faced a 34 minute cardiac asystole, after which the heart was recovered through a thoraco-abdominal normothermic regional perfusion excluding the epiaortic vessels. The heart was then preserved by means of cold static storage. Heart transplantation was performed successfully without any signs of primary graft failure. Postoperative endomyocardial biopsies were negative for acute cellular and antibody-mediated rejection. Furthermore, echocardiographic and cardiac magnetic resonance evaluation of the heart did not show any functional abnormalities. The patient was discharged on post-operative day (POD) #39 in good clinical conditions.
Case report: Lateral medullary syndrome with eight-and-a-half syndromes
Authors: Zuo Chun , Zhao Mingmin , Zhao Lei , Meng Nan , Xing Xing , Li Na
Published: February 2024

Rationale:

Lateral medullary syndrome is caused by atherosclerosis or embolism of the vertebral artery and its branches or the posterior inferior cerebellar artery (PICA).The eight-and-a-half syndrome is a rare pontocerebellar nerve-ocular syndrome presenting as a one-and-a-half syndrome plus ipsilateral seventh cerebral nerve palsy. The dorsolateral medullary syndrome combined with the eight-and-a-half syndromes is even rarer, so it is important to recognize the features of the classical brainstem syndrome and the eight-and-a-half syndromes.

Patient concerns:

Most patients with dorsolateral medullary syndrome combined with eight-and-a-half syndromes have a good prognosis, with recovery occurring within a few weeks to a few months, although a few patients may take longer to recover.

Diagnosis interventions:

In the course of disease development, the patient developed dysarthria, dysphagia, hypothermia, ipsilateral Horner sign and ataxia. Computed tomography was performed which showed cerebral infarction in the left brainstem. Cranial diffusion-weighted imaging + magnetic resonance angiography showed acute infarction in the left cerebellar hemisphere, with a high probability of severe stenosis or occlusion in the intracranial and proximal segments of the basilar arteries. This supports the diagnosis of dorsolateral medullary syndrome. The patient’s limited adduction and abduction of the left eye and limited adduction of the right eye, combined with peripheral paralysis of the affected lateral nerve, supported the diagnosis of eight-and-a-half syndromes. The administration of antiplatelet and anti-ester fixation treatment can effectively improve the symptoms and shorten the course of the disease.

Outcomes:

After antiplatelet and anti-ester fixation treatment, the symptoms improved and the patient was discharged.

Lessons:

Dorsolateral medullary syndrome combined with eight-and-a-half syndromes is a rare clinical condition, and therefore more attention should be paid to the early diagnosis and treatment of such patients.
A case report and literature review of rectal lipoma
Authors: Gao Wenguang , Zhang Kun , You Feng
Published: February 2024

Rationale:

Colonic lipomas are uncommon benign submucosal adipose tumors that are usually asymptomatic. In principle, large lipomas can cause symptoms that require further treatment. Here, we report a case of prolapsed giant rectal lipoma and transanal mass resection.

Patient concerns:

A 65-year-old male developed rectal mass prolapse with bloody stool for 1 day.

Diagnoses:

The pathological findings were rectal lipoma.

Intervention:

After resection of the anal tumor, the patient postoperative symptoms quickly disappeared.

Outcomes:

No recurrence of the condition was observed after 6 months of follow-up after surgery.

Lessons:

It is safe and feasible for us to perform transanal mass resection for giant rectal lipomas that protrude outside the anus.
Causal association of metformin and osteoporosis: A 2-sample Mendelian randomization study
Authors: Wei Yong-Kang , Chen Ping-Bo , Ju Ling-Ling , Deng Guang-Hua
Published: February 2024

To investigate the causal relationship between metformin use and osteoporosis and different subtypes of osteoporosis using a 2-sample Mendelian randomization method. Data from genome-wide association studies were analyzed, with the exposure factor being metformin and the outcome variables being osteoporosis and different subtypes. Mendelian randomization was performed using Inverse Variance Weighted (IVW), MR-Egger, and weight median (WM) methods, and heterogeneity tests, horizontal multivariate analyses, and sensitivity analyses were performed. The IVW method analysis with metformin and osteoporosis showed P = 1.53E-04, OR (95%CI) = 1.81E-02 (2.27E-02-1.44E-01); the IVW method analysis with metformin and postmenopausal osteoporosis with pathologic fracture showed P = 2.22E-01, OR (95%CI) = 4.89E-02 (3. 83E-04-6.23E + 00); the IVW method using metformin with osteoporosis with pathological fracture showed that P = 2.14E-01, OR (95%CI) = 1.64E + 00(5.78E-02-6.44E-04); the IVW method using metformin with pharmacological osteoporosis with pathological fracture showed that P = 9. 83E- 01, OR (95%CI) = 1.11E + 00 (3.99E-05-3.11E + 04); IVW method of metformin use and pharmacological osteoporosis showed that P = 5.99E-01, OR (95%CI) = 2.27E + 01 (2.00E-04-2.57E + 06); there is a causal relationship between metformin use and osteoporosis, but there is no causal relationship between metformin use and postmenopausal osteoporosis with pathological fracture, osteoporosis with pathological fracture, pharmacological osteoporosis, and pharmacological osteoporosis with pathological fracture, and metformin use is a protective factor for osteoporosis.
The phenotypic heterogeneity of obese and nonobese patients with severe asthma and comparison of omalizumab–mepolizumab treatment efficiency in these patients
Authors: Özden Şeyma , Tepetam Fatma Merve , Örçen Cihan , Yakut Tuğçe
Published: February 2024

In obese severe asthmatics, the degree of type 2 inflammation may vary according to their atopic status and past smoking history. In this study, we aimed to analyze the clinical and physiopathological features of obese and nonobese severe asthmatics treated with omalizumab or mepolizumab treatment. In addition we aimed to compare the clinical, spirometric outcomes and total peripheral eosinophilic count (TEC) changes after treatment with these 2 biologic agents in obese and nonobese groups. In this retrospective, cross sectional study, 121 severe asthmatic treated with biologic agents (omalizumab = 88 or mepolizumab = 33) for at least 16 weeks were included. Obese (n: 44) and nonobese severe asthmatics (n: 77) were analyzed according to whether they provided a ≥ 10 pack/years (p/y) or <10 p/y smoking history and were found to be atopic. Obese and nonobese groups were compared in terms of the change in the asthma control test, asthma attacks, TEC, and forced expiratory volume in the first second (FEV1) after treatment. In patients with ≥10 p/y smoking history, nonobese group had a significantly higher TEC compared to obese group [median (min–max) 660 cells/μL (200–1500) vs 300 cells/μL (110–770); p: 0.013]. Within the nonobese group, nonatopic patients had a significantly higher TEC compared to atopic patients [median (min–max) 1200 cells/μL (100–2100) vs 310 cells/μL (0–2730); p: 0.021]. Both biologic agents had similar effects on improving asthma control test and in reducing asthma attacks; however, mepolizumab was more effective in suppressing TEC. The improvement in FEV1 in obese group following biologic 2 agents was very similar but in nonobese group, mepolizumab was found to be superior (510 mL vs. 295 mL; p: 0.034). In our real-life study, nonobese severe asthmatics with ≥10 p/y smoking history and those that were nonatopic had higher TEC. Compared to omalizumab, mepolizumab was superior at reducing TEC in all asthmatics and in improving FEV1 in nonobese group.
Exploring the action mechanism of Jinxin oral liquid on asthma by network pharmacology, molecular docking, and microRNA recognition
Authors: Chen Jing , Zhu Qiaozhen , Mo Yanling , Ling Hao , Wang Yan , Xie Huihui , Li Lan
Published: February 2024

Using network pharmacology, molecular docking, and microRNA recognition, we have elucidated the mechanisms underlying the treatment of asthma by Jinxin oral liquid (JXOL). We began by identifying and normalizing the active compounds in JXOL through searches in the traditional Chinese medicine systems pharmacology database, SwissADME database, encyclopedia of traditional Chinese medicine database, HERB database, and PubChem. Subsequently, we gathered and standardized the targets of these active compounds from sources including the encyclopedia of traditional Chinese medicine database, similarity ensemble approach dataset, UniProt, and other databases. Disease targets were extracted from GeneCards, PharmGKB, OMIM, comparative toxicogenomics database, and DisGeNET. The intersection of targets between JXOL and asthma was determined using a Venn diagram. We visualized a Formula-Herb-Compound-Target-Disease network and a protein-protein interaction network using Cytoscape 3.9.0. Molecular docking studies were performed using Schrodinger software. To identify pathways related to asthma, we conducted gene ontology functional analysis and Kyoto encyclopedia of genes and genomes pathway enrichment analysis using Metascape. MicroRNAs regulating the hub genes were obtained from the miRTarBase database, and a network linking these targets and miRNAs was constructed. Finally, we found 88 bioactive components in JXOL and 218 common targets with asthma. Molecular docking showed JXOL key compounds strongly bind to HUB targets. According to gene ontology biological process analysis and Kyoto encyclopedia of genes and genomes pathway enrichment analysis, the PI3K-Akt signaling pathway, the MAPK signaling pathway, or the cAMP signaling pathway play a key role in treating of asthma by JXOL. The HUB target-miRNA network showed that 6 miRNAs were recognized. In our study, we have revealed for the first time the unique components, multiple targets, and diverse pathways in JXOL that underlie its mechanism of action in treating asthma through miRNAs.
Delayed discharge from post-anesthesia care unit: A 20-case retrospective series
Authors: Liu Xiaohui , Zhang Yimin , Cai Xingzhi , Kan Huili , Yu Ailan
Published: February 2024

Objective:

To summarize the characteristics of patients with delayed discharge from the post-anesthesia care unit and to analyze the factors and outcomes of delayed discharge.

Methods:

Twenty cases of delayed discharge from the PACU (PACU stay >2 hours after surgery) of the main operating room in Liaocheng People’s Hospital, a class A tertiary comprehensive hospital, between January 1, 2021, and December 31, 2022, among 28,084 patients who were transferred to the PACU from the operating rooms after surgery, were retrospectively analyzed. The collected data included patient characteristics, American society of anesthesiologists grade, information related to surgery and anesthesia, and outcomes. The factors for delay were assigned to 1 of 6 groups: delayed recovery from anesthesia, surgical complications, cardiovascular instability, hypoxia, inadequate analgesia, and waiting for the operating room.

Results:

The incidence of delayed discharge from PACU was 0.7‰. Among 20 patients, more than half of the patients were over 65 years of age, American society of anesthesiologists grade II~III, body mass index <30 kg/m2, and urological surgery (7, 35%), liver surgery (4, 20%), thoracic surgery (4, 20%) accounted for a relatively high proportion. Nineteen (95%) patients received general anesthesia with or without peripheral nerve block. The main factors included delayed recovery from anesthesia (6, 30%), surgical complications (5, 25%), cardiovascular complications (4, 20%), hypoxia (3,15%). After discharge from the PACU, 1 (5%) died in the intensive care unit, and the other 19 (95%) patients were safely discharged from the hospital.

Conclusion:

The incidence of delayed discharge from the PACU was low, and it was more likely to occur in the elderly, during major operations, and under general anesthesia. Delayed recovery from anesthesia was the most common factor. Most patients were safely discharged from the hospital.
Kinesin superfamily member KIFC2 as an independent prognostic biomarker of colon adenocarcinoma associated with poor immune response
Authors: Chen Tao , Chu Yunqian , Xu Haiyuan , Dai Hanjue , Zhou Yuxi , Du Haiwei , Zhu Wenyu
Published: February 2024

Clinical outcomes of colon adenocarcinoma (COAD) exhibit heterogeneity among different patients, highlighting the need for novel prognostic biomarkers. Kinesin superfamily members have been shown to play a crucial role in tumors and can predict cancer diagnosis and prognosis. However, the role of kinesin family member C2 (KIFC2) in tumors, particularly its prognostic value in COAD, remains poorly understood. Our bioinformatics analysis of the cancer genome atlas and GEO databases revealed significantly higher expression of KIFC2 in COAD, correlating with a worse prognosis in the cancer genome atlas-COAD and GSE17536 cohorts. Additionally, differentially expressed genes in COAD were enriched in immune-related pathways, and patients with higher KIFC2 expression showed fewer activated CD4 + T cells. These findings suggest KIFC2 as a potential prognostic biomarker for COAD, warranting further validation in clinical studies.
Effect of repetition of rTMS at different frequencies on the efficacy of swallowing disorders after stroke: A systematic review and meta-analysis
Authors: Sun Meixia , Chen Kang , He Yanwen , Zhang Yukun , Zhuo Yue , Zhuang He
Published: February 2024

Background:

To systematically evaluate the curative effect of repeated transcranial magnetic stimulation at different frequencies on swallowing disorders after stroke.

Methods:

A search was conducted for randomized controlled trials of repeated transcranial magnetic stimulation for stroke patients in CNKI, Wanfang, VIP, ProQuest, PubMed, Cochrane Library, Scopus, and Web of Science databases until December 2022. The 2 researchers strictly screened and checked the included documents, extracted relevant data, assessed the risk quality of the literature using the Cochrane manual, and conducted a network meta-analysis of the data using State16.0.

Results:

Eighteen studies included 680 participants. The results of the reticular meta-analysis showed that in the leakage-aspiration scale (PAS) indicators, 1 Hz, 3 Hz, 5 Hz, and 10 Hz were all better treatment effects compared with the control group, and there was a statistically significant difference (P < .05). In the standard swallowing function assessment (SSA) index, 3 Hz, 5 Hz, and 10 Hz compared with the control group were statistically significant (P < .05); there was no difference between 1 Hz and the control group (P > .05). The cumulative probability ranking results showed that the intervention effect of 3 Hz was the best in the PAS index, much greater than that of other frequencies, and the intervention effects of 10 Hz and 5 Hz were similar. For the SSA index, the intervention effect was optimal at 10 Hz, followed by 5 Hz. Note that the treatment effect of 1 Hz ranked last, even lower than that of the control group. The results of the 5 Hz treatment site grouping analysis showed that the affected side was > bilateral > healthy in PAS and > bilateral > healthy in SSA.

Conclusion subsections:

Based on the current study, the optimal frequency and site selection results of the 2 evaluation indicators are not uniform, but from the combination of the 2 evaluation indicators, the treatment effect of 10H is good, and the effect of bilateral stimulation for the selection of stimulation sites is good. The above conclusions need to be verified in high-quality studies.
Usage trends of colorectal endoscopic submucosal dissection according to hospital types based on nationwide claims data
Authors: Eun Na Ji , Kim Bohyoung , Hoon Jung Sung , Choi Arum , Kim Sukil , Kim Tae-Oh
Published: February 2024

Although the use of colorectal endoscopic submucosal dissection (ESD) for colorectal lesions has increased, there is a lack of analysis of the recent usage trends of ESD. Thus, this study aimed to identify changes in the annual utilization of ESD and determine the proportion of surgeries after ESD according to hospital types. Using Health Insurance Review and Assessment data from 2012 to 2019, 26,502 colorectal ESD cases were analyzed to assess the annual usage trends of ESD according to hospital type, additional early and late surgeries after ESD, changes in the distribution of colorectal lesions, and factors associated with early and late surgery. Trend analysis was performed using the chi-squared test for trend in proportions. Colorectal ESD increased from 2046 in 2012 to 5319 in 2019. Additional early and late surgeries rose from 135 (6.6%) in 2012 to 441 (8.2%) in 2019 (P < .05) and from 9 (0.3%) in 2013 to 52 (1.0%) in 2019 (P < .05), respectively. In tertiary and general hospitals, the proportion of submucosal cancers decreased, whereas the proportion of intramucosal cancers increased. Submucosal cancer was associated with early (odds ratio: 108.90, 95% confidence interval: 61.67–192.35) and late surgery (odds ratio: 3.55, 95% confidence interval: 2.27–5.56). Using nationwide data, our study identified the clinical usage trends of colorectal ESD based on the annual increase in utilization and the proportion of additional surgeries after ESD.
Associations between triglyceride glucose index and depression in middle-aged and elderly adults: A cross-sectional study
Authors: Zhang Shipan , Hou Zhaowei , Fei Di , Zhang Xueru , Gao Chenyang , Liu Jing , Jin Man , Zhai Xiaoyan , Zhou Yaqing , Ni Aihua , Lv Peiyuan
Published: February 2024

The pathogenesis of depression is unclear, and it responds poorly to treatment. It is thus urgent to identify the pathogenesis of depression and possible therapeutic targets. There may be interactions between insulin resistance (IR) and depression. The purpose of this study was to explore the relationship between depression, triglyceride glucose (TyG) index. The study participants were 198 middle-aged and elderly patients who were admitted to the Hebei General Hospital between January 1, 2021, and August 31, 2022, together with 189 healthy adults as controls. Depression was diagnosed according to ICD-10 diagnostic criteria for depression. IR was assessed by the TyG index. Compared with the control group, patients suffering from depression had higher TyG index (P = .00); There were significant differences in the sex ratio (P = .00), family history (P = .00), body mass index (P = .008), total cholesterol (P = .00), fasting blood glucose (P = .004), high-density lipoprotein (P = .00), and low-density lipoprotein (P = .001) levels between the 2 groups. After excluding other confounding factors, the TyG index was found to be independently associated with depression, with an OR of 2.75. These data support an association of depression with the TyG index. IR thus appears to be a risk factor for depression.
Factors affecting the intensity of chronic musculoskeletal pain in patients with cardiovascular disease and evaluation of the efficacy of magnesium emulsion cream for muscle cramps
Authors: Su Hung-Chi , Lin Chia-Pin , Ho Wan-Jing , Chou Shing-Hsien , Wu Chia-Tung , Chiang Hou-Yu , Chu Pao-Hsien
Published: February 2024

Chronic musculoskeletal pain (CMP) is associated with an increased risk of cardiovascular disease (CVD). This study aimed to determine the factors associated with the intensity of CMP in patients with underlying CVD and to evaluate the efficacy of Ice Power Magnesium In Strong Cream in patients with muscle cramps. We investigated 396 patients with or without CMP who visited an outpatient cardiology clinic and analyzed the features of CMP and factors associated with pain intensity and specific types of CVD in study 1. We also analyzed 73 patients who had muscle cramps in the lower extremities in study 2 to evaluate the efficacy of Ice Power Magnesium In Strong Cream in reducing pain intensity. In study 1, multivariable linear regression analysis showed that older age (regression coefficient [B] = 0.66, 95% confidence interval [CI], 0.07–1.24), female sex (B = 1.18, 95% CI, 0.59–1.76), presence of hypertension (B = 0.69, 95% CI, 0.05–1.33), and use of calcium supplements (B = 1.27, 95% CI, 0.31–2.24) were significantly associated with a higher intensity of CMP. In study 2, the mean pain scores at baseline, week 2 and week 4 after treatment were 5.99 ± 2.12, 2.92 ± 2.63, and 1.90 ± 2.41, respectively, and the reductions were significant at both week 2 and week 4 after treatment (P < .05). Older age, female sex, hypertension, and use of calcium supplements were associated with an increased intensity of CMP. Ice Power Magnesium In Strong Cream was effective in reducing the pain intensity of muscle cramps in the lower extremities.
The impact of diabetes in cognitive impairment: A review of current evidence and prospects for future investigations
Authors: Aderinto Nicholas , Olatunji Gbolahan , Abdulbasit Muili , Ashinze Patrick , Faturoti Olamide , Ajagbe Abayomi , Ukoaka Bonaventure , Aboderin Gbolahan
Published: February 2024

Cognitive impairment in individuals with diabetes represents a multifaceted and increasingly prevalent health concern. This review critically examines the current evidence regarding the intricate relationship between diabetes and cognitive decline. It highlights the existing knowledge on the impact of diabetes on cognitive function, spanning from mild cognitive impairment to dementia, including vascular and Alzheimer dementia. The review underscores the need for a standardized diagnostic paradigm and explores research gaps, such as the implications of cognitive impairment in younger populations and various diabetes types. Furthermore, this review emphasizes the relevance of diabetes-related comorbidities, including hypertension and dyslipidemia, in influencing cognitive decline. It advocates for a comprehensive, interdisciplinary approach, integrating insights from neuroscience, endocrinology, and immunology to elucidate the mechanistic underpinnings of diabetes-related cognitive impairment. The second part of this review outlines prospective research directions and opportunities. It advocates for longitudinal studies to understand disease progression better and identifies critical windows of vulnerability. The search for accurate biomarkers and predictive factors is paramount, encompassing genetic and epigenetic considerations. Personalized approaches and tailored interventions are essential in addressing the substantial variability in cognitive outcomes among individuals with diabetes.
Neuromyelitis optica spectrum disorder with herpes simplex viral infection presenting with syndrome of inappropriate antidiuretic hormone: A case report
Authors: Chung Ji Yeon , Lee Chang Ju , Bong Jeong Bin , Shin Byoung-Soo , Ryu Han Uk , Kang Hyun Goo
Published: February 2024

Rationale:

Neuromyelitis optica spectrum disorder (NMOSD) is a demyelinating disease that causes lesions in areas with abundant aquaporin-4 (AQP4) channels, including the hypothalamus. Hypothalamic lesions can disrupt antidiuretic hormone regulation, resulting in hyponatremia due to syndrome of inappropriate antidiuretic hormone (SIADH). Various factors can trigger NMOSD, including viral infections. We report the case of a young female patient who presented with hyponatremia due to SIADH and was found to have bilateral hypothalamic lesions along with positive serum herpes simplex virus immunoglobulin M.

Patient concerns:

An 18-year old female patient presented with fever and nausea that had persisted for 5 days. Three days after hospitalization, the patient complained of blurred vision, hiccups, and excessive daytime sleepiness.

Diagnosis:

The patient hyponatremia was attributed to SIADH. Magnetic resonance imaging revealed bilateral lesions in the hypothalamus, and serum laboratory tests were positive for herpes simplex virus immunoglobulin M. On the 15th day of admission, the anti-AQP4 antibody test result was positive, leading to the diagnosis of NMOSD.

Interventions:

On the initial suspicion of herpes encephalitis, treatment with acyclovir was initiated. However, upon the confirmation of after anti-AQP4 antibody, the patient was additionally treated with a high-dose intravenous steroid for 5 days.

Outcomes:

The patient fever, nausea, visual disturbances, and other complaints improved within 1 week of initiating steroid treatment.

Lessons:

In young patients presenting with hyponatremia and suspected SIADH accompanied by neurological abnormalities, it is crucial to differentiate central nervous system diseases, including NMOSD, which can involve lesions in AQP4-abundant areas, such as the hypothalamus.
Long-term effects of angiotensin receptor neprilysin inhibitor therapy in heart failure patients with reduced ejection fraction: A retrospective cohort study
Authors: Koçak Ajar , Aydin Saadet , Alibaşiç Hayrudin , Çiçek Melis , Ekici Berkay
Published: February 2024

Heart failure is an increasing public health issue with substantial morbidity and mortality rates. This study aimed to evaluate the efficacy, safety, and long-term outcomes of angiotensin receptor neprilysin inhibitor (ARNi) in the treatment of heart failure with reduced ejection fraction (HFrEF) 5 years after treatment initiation. This retrospective study analyzed a cohort of 75 patients diagnosed with HFrEF over a period of 5 years after the initiation of ARNi therapy. The initial clinical condition, laboratory and echocardiographic measurements including left ventricular ejection fraction (LVEF), New York Heart Association functional classes (NYHA-FC) and the prognostic nutritional index were compared to the corresponding values obtained after a 5-year period of ARNi therapy. In addition, the number of annual hospitalizations, mortality rates and any history of adverse effects during the follow-up period were recorded. The N-terminal pro-brain natriuretic peptide (NT-proBNP) level, LVEF, and NYHA-FC values demonstrated significant improvement at the end of the 5-year follow-up period (all parameters, P < .001). Although the observed increase in the prognostic nutritional index was not statistically significant (P = .077), it is worth noting. A significant reduction in daily diuretic doses and hospitalizations due to heart failure was observed following the use of ARNi (all comparisons, P < .001). The prevalence of hypotension was around 16% (being symptomatic in 4%), making it the most frequently observed adverse event. The 5-year cardiovascular mortality rate was 17.3%. The use of ARNi in HFrEF patients was associated with a notable improvement in NYHA-FC, LVEF, and NT-proBNP levels in the long-term, while also leading to a better nutritional status and reduced need for diuretics and annual hospitalization. Additionally, ARNi usage has been associated with improved nutritional status, decreased reliance on diuretics, and reduced frequency of annual hospitalizations. These effects were associated with a lack of significant increase in adverse effects. These results may contribute to a better understanding of ARNi’s long-term effects on patient outcomes.
Efficacy of immune nutrients in severe acute pancreatitis: A network meta-analysis
Authors: Tao Xin , Yang Yurui , Xu Shanshan , Xiong Qing
Published: February 2024

Background:

The use of immune nutrients in the treatment of severe pancreatitis remains controversial. No study has yet compared the effects of different immune nutrients on patients with severe acute pancreatitis. This study aimed to compare the effects of different immune nutrients in treating severe acute pancreatitis through a network meta-analysis.

Methods:

PubMed, Embase, Cochrane Library, Web of Science, and Scopus were used to search randomized controlled trials from the inception to July 2023. Information was collected from patients with severe acute pancreatitis and their intervention methods, which included the administration of glutamine, omega-3 polyunsaturated fatty acids, arginine, and nucleotides. The evaluated outcomes included mortality, infection, the length of the hospital stay (LOH), the length of intensive care unit stay (LOI), and C-reactive protein (CRP). Risk ratio (95% confidence interval [CI]) and mean difference (MD) (95% CI) were calculated using a network meta-analysis random-effects model. The ranking between interventions was calculated using the surface under the cumulative ranking curve. The Cochrane Risk of Bias tool 2 was used to assess the risk of bias. The sources of heterogeneity were assessed using sensitivity analysis and network meta-regression. The credibility of the evidence was assessed using grading of recommendations assessment, development, and evaluation.

Results:

Nineteen studies with 1035 patients were included in this network meta-analysis. Parenteral glutamine was more effective in reducing mortality, infection, LOH, and LOI, as well as in the downregulation of CRP compared to the control. Risk ratio (95%CI) or MD (95%CI) were 0.38 (0.16, 0.90), 0.35 (0.14, 0.90), −3.32 (−4.90, −1.75), −2.53 (−4.46, −0.61), and −17.78 (−28.77, −6.78), respectively. Parenteral omega-3 polyunsaturated fatty acids was more effective in reducing LOH and LOI, as well as in the downregulation of CRP. MD (95%CI) were −6.77 (−11.40, −2.14), −5.19 (−7.80, −2.57), and −26.20 (−39.71, −12.68), respectively. Immune nutrients in the other groups did not exert any effect compared to the control regarding all the outcomes. Parenteral glutamine ranked best in reducing infections. Parenteral omega-3 polyunsaturated fatty acids ranked best in reducing mortality, LOH, and LOI, as well as in the downregulation of CRP.

Conclusion:

Some immune nutrients were beneficial for patients with severe acute pancreatitis. Parenteral administration could be better than enteral administration.
Association between urine caffeine metabolites and bone mineral density: A population-based study
Authors: Tan Ning , Shen Wenjia , Tang Meiling , Liu Mingjiang , Zhang Ya
Published: February 2024

The association between coffee intake and bone mineral density (BMD) remains a subject of debate in epidemiological research. Furthermore, the potential relationship between BMD and urine caffeine or caffeine metabolites has not yet been explored. Therefore, the present study aimed to investigate the possible association between BMD and urine caffeine and its metabolites in U.S. adults. We employed multivariate linear and logistic regression models to analyze the relationship between urine caffeine and caffeine metabolites and lumbar BMD using data from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014. Additionally, fitted smoothing curves and generalized additive models were used. After adjusting for several factors, we found no significant association between urine caffeine and its metabolites and BMD. However, subgroup analyses stratified by gender and ethnicity showed that the relationship between urine caffeine and its metabolites and lumbar BMD remained consistent. Our investigation revealed that the inflection points for the U-shaped relationship between urinary theophylline and paraxanthine and BMD were observed at levels of 0.006 mmol/L for theophylline and 0.052 mmol/L for paraxanthine. In this cross-sectional study, we found no significant correlation between urine caffeine and its metabolites and BMD. However, more research is required to confirm our findings, as well as to investigate the underlying mechanisms.
Effects of hip brace on coxa valga in nonambulatory children with cerebral palsy: A randomized controlled trial
Authors: Woo Hyeonseong , Kim Bo Ryun , Yoon Jin A. , Jung Han Hyun , Yoon Young Il , Lee Seung U. , Cho Seon , Shin Yong Beom , Lee Hyun Jung , Suh Jee Hyun , Lim Jiwoon , Beom Jaewon , Park Yulhyun , Ryu Ju Seok
Published: February 2024

Background:

Coxa valga, measured as the neck-shaft angle (NSA) or head-shaft angle (HSA), is regarded as a potential risk factor for hip dislocation in patients with cerebral palsy. We investigated the effects of a novel hip brace on coxa valga.

Methods:

A prospective, multicenter, assessor-blinded, randomized controlled trial was conducted from July 2019 to November 2021. Children with cerebral palsy aged 1 to 10 years with Gross Motor Function Classification System levels IV and V were recruited. The study group wore a hip brace for at least 12 hour a day. A lower strap of the hip brace was designed to prevent coxa valga biomechanically. The effectiveness of the hip brace on coxa valga was assessed by measurement of the NSA and head-shaft angle at enrollment and 6 and 12 months after enrollment.

Results:

Sixty-six participants were enrolled, and 33 patients were assigned to each group. Changes in the mean NSA of both sides and the NSA of left side showed significant differences between the 2 groups over 12 months (mean NSA of both sides, −1.12 ± 3.64 in the study group and 1.43 ± 3.75 in the control group, P = .023; NSA of the left side, −1.72 ± 5.38 in the study group and 2.01 ± 5.22 in the control group, P = .008).

Conclusions:

The hip brace was effective in preventing the progression of coxa valga and hip displacement, suggesting that the prevention of coxa valga using hip brace is a contributing factor in prevention of hip displacement.
Prenatal and postnatal diagnosis of congenital hymen prolapse: A case report
Authors: Zhang Maochun , Wang Xueying , Chen Jiao , Wang Shichun , Luo Menglin
Published: February 2024

Rationale:

Female genital tract abnormalities are relatively uncommon and usually discovered accidentally. And hymen prolapse is even rarer, which is asymptomatic and is commonly found during the examination of the baby external genitals.

Patient concerns:

Here, we report a case of fetal genital abnormality detected at 32 weeks of gestation.

Diagnoses:

At 32+1 weeks of pregnancy, ultrasound showed taht an iso-echoic mass of about 8 mm × 5 mm was protruding from the genitalia, and at 36 weeks, ultrasound showed that an iso-echoic mass of about 9 mm × 5 mm could be seen protruding from the genitalia, and its morphology was similar to the result of the 32-week data. At 39 weeks a baby girl was naturally delivered. Physical examination showed the female external genitalia, part of the hymen protruded into the vaginal orifice. Finally, the clinical diagnosis was hymen prolapse.

Interventions and outcomes:

No treatment was carried out. Reexamination at 11 days after birth revealed a significantly smaller prolapse than before. Since the postpartum follow-up, the baby has been in good condition, the hymen has gradually returned, and the genitals are all normal.

Lessons:

Regardless of the confidentiality of prenatal tests regarding the sex of the fetus, prenatal ultrasound should be used to fully evaluate the morphology and structure of each system including the reproductive system of the fetus when screening fetal malformations. The purpose of this case is to remind doctors of the rigorous degree of genital examination, increase the detection rate, and save the life of the fetus.
The effects of different inner pressures of air insoles and walking durations on peak plantar pressure
Authors: Haris Fahni , Jan Yih-Kuen , Liau Ben-Yi , Hsieh Chang-Wei , Shen Wei-Cheng , Tai Chien-Cheng , Shih Yin-Hwa , Lung Chi-Wen
Published: February 2024

Background:

Exercise reduces chronic complications in individuals with diabetes and peripheral vascular diseases. In clinical practice, the use of air insole may reduce peak plantar pressure (PPP), and risk for diabetic foot ulcers (DFUs). However, there is no guideline on selecting air insole pressure for effectively reducing PPP. Therefore, this study aimed to investigate the effects of different air insole pressure on PPP at different walking durations.

Methods:

We tested 13 participants using repeated measures study design, including 3 air insole pressures (80, 160, and 240 mm Hg) and 2 walking durations (10 and 20 minutes) for 6 walking conditions. PPP values at the first toe, first metatarsal head, and second metatarsal head were calculated.

Results:

The one-way ANOVA showed significant pairwise differences of PPP at 20 minutes duration in the first metatarsal head between 80 and 240 mm Hg (P = .007) and between 160 and 240 mm Hg (P = .038); in the second metatarsal head between 80 and 240 mm Hg (P = .043). The paired t test confirmed that walking duration significantly has lower PPP at 10 minutes than 20 minutes with 240 mm Hg air insole in the first metatarsal head (P = .012) and the second metatarsal head (P = .027).

Conclusion:

People at risk of foot ulcers are suggested to wear shoes with 80 mm Hg of air insole for reducing PPP in the first metatarsal head and the second metatarsal head. Moreover, people may avoid wearing the stiffer insole (240 mm Hg) for more than 20 minutes.
Effect of manual hyperinflation with versus without positive end-expiratory pressure on dynamic compliance in pediatric patients following congenital heart surgery: A randomized controlled trial
Authors: Guimarães Jéssica Câmara , da Silva Thalis Henrique , Aragon Davi Casale , Johnston Cintia , Gastaldi Ada Clarice , Carlotti Ana PCP
Published: February 2024

Background:

We aimed to compare the effect of manual hyperinflation with versus without positive end-expiratory pressure (PEEP) on dynamic compliance of the respiratory system in pediatric patients undergoing congenital heart surgery; to assess the safety of the technique in this population.

Methods:

This was a randomized controlled trial conducted at the pediatric intensive care unit (PICU) of a tertiary-care hospital. Patients admitted to the PICU following cardiac surgery and receiving postoperative mechanical ventilation were randomized to the experimental or control group. Patients in the experimental group (n = 14) underwent manual hyperinflation with a PEEP valve set at 5 cm H2O, once daily, during the first 48 hours after surgery. Patients allocated to the control group (n = 16) underwent manual hyperinflation without PEEP, at the same time points. Lung mechanics was assessed before (T0) and 5 minutes (T5) after manual hyperinflation. The primary endpoint was dynamic compliance. Secondary outcomes included oxygen saturation index, duration of mechanical ventilation, length of stay, 28-day mortality and safety.

Results:

Demographic and clinical characteristics were comparable in both groups. There was no significant difference in dynamic compliance between times in each group (Day 1: (mean) 0.78 vs 0.81 and 0.70 vs 0.77; Day 2: 0.85 vs 0.78 and 0.67 vs 0.68 mL/kg/cm H2O, in experimental and control groups, respectively; P > .05). Mean deltas of dynamic compliance were not significantly different between groups. The proportion of patients extubated <72 hours after surgery was similar in experimental and control groups (43% vs 50%, respectively; P = .73). Oxygen saturation index, length of stay, and 28-day mortality were not significantly different between groups. None of the patients had hemodynamic instability.

Conclusions:

Manual hyperinflation was safe and well tolerated in pediatric patients following surgery for congenital heart disease. No significant change in dynamic compliance of the respiratory system or in oxygenation was observed with the use of manual hyperinflation with or without PEEP in this population.
Renal cortical necrosis – a rare manifestation of dengue fever: A case report
Authors: Rehman Fazal ur , Rehan Syeda Tayyaba , Yousaf Fatima , Rathore Navin , Rind Bakhtawar Jamal , Mahmmoud Fadelallah Eljack Mohammed , Asghar Muhammad Sohaib , Omair Farruk
Published: February 2024

Rationale:

Dengue fever is a widespread mosquito-borne viral disease, most prevalent in the tropical and subtropical areas of the world. There has been a significant rise in the incidence and number of outbreaks of dengue in recent years, which has made it a matter of global concern. It may be associated with a number of renal complications, ranging from hematuria, proteinuria, glomerulonephritis, and acute tubular necrosis. However, renal cortical necrosis (RCN) is a rare renal complication of this disease.

Patients concerns:

We report the case of a young gentleman who presented with fever, vomiting, and anuria. On workup, he was found to be having complicated Dengue fever with RCN resulting in acute renal failure.

Diagnosis:

To the best of our knowledge, RCN is not a reported renal complication of dengue fever.

Interventions and outcomes:

Our report highlights the importance of early consideration of renal cortical necrosis in patients with dengue fever and persistent anuria.

Lesson:

This would allow for better disease prognostication while enabling physicians to develop more effective treatment strategies.
A novel anoikis-related gene signature predicts prognosis in patients with breast cancer and reveals immune infiltration
Authors: Tang Chaoyi , Qin Liuqing , Li Jiehua
Published: February 2024

Breast cancer (BRCA) is a common malignancy worldwide that is associated with a high mortality rate. Despite recent improvements in diagnosis and treatment, there is an urgent need to investigate the processes underlying cancer progression and identify novel prognostic indicators. Anoikis, which plays a role in the development of human malignant tumors, has been gaining increasing interest from researchers. However, the potential role of anoikis-related genes (ANRGs) in the advancement of BRCA remains unknown. In this study, we aimed to assess the predictive value of ANRGs in BRCA, construct a prognostic model based on ANRGs, and explore the tumor microenvironment in different prognostic score groups. This study utilized data from the Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases to collect clinical information and RNA sequencing data from patients with BRCA. Information on ANRGs was gathered from GeneCards and Harmonizome portals. A risk score model based on ANRGs was created using least absolute shrinkage and selection operator Cox (LASSO) regression analysis. Additionally, the study explored the tumor microenvironment and enriched pathways in different risk groups. Finally, a novel ANRG-based nomogram is developed. A total of 142 differentially expressed genes associated with survival were identified, of which 5 genes were selected to create the ANRG signature. The risk score based on this signature proved to be an independent prognostic factor. Further analysis revealed that different risk subgroups exhibited variations in the tumor microenvironment and drug sensitivities. Subsequently, a nomogram was developed using risk scores and clinicopathological factors. The decision curve analysis results suggest that patients with BRCA might derive clinical treatment benefits from utilizing this prognostic model. Based on the results of this study, the ANRG signature and nomograph established can be used for clinical decision-making in patients with BRCA.
Risk factor of residual leg numbness after lumbar microdiscectomy for lumbar disc herniation
Authors: Shi Liang , Ji Xianqun , Tian Fangtao , Shi Yihua , Lou Pan
Published: February 2024

Although patients with lumbar disc herniation (LDH) can achieve significant relief from lower back and leg pain after lumbar microdiscectomy, a few patients complain of discomfort due to residual leg numbness (RLN). This study aimed to identify potential risk factors for RLN after lumbar microdiscectomy. We prospectively collected and analyzed patients with LDH who underwent microdiscectomy between September 2016 and December 2020. All included patients had preoperative LN symptoms. Patients with RLN were defined as those with LN at the last follow-up. The relationships between RLN and sex, age, body mass index (BMI), current smoking status, diabetes mellitus, revision surgery, preoperative LN Numeric Rating Scale (NRS) score, duration of preoperative LN, RLN at discharge, sagittal range of motion (SROM), Modic change, disc Pfirrmann grade were analyzed. The RLN was observed in 33.5% (112/334) of patients at the last follow-up. No significant differences were observed in age, sex, BMI, current smoking status, or diabetes between the RLN and non-RLN groups. The preoperative LN NRS score, preoperative LN duration, rate of RLN at discharge, and revision surgery were significantly higher in the RLN group than those in the non-RLN group. Multivariate logistic regression analysis identified the preoperative LN NRS score, duration of preoperative LN, RLN at discharge, revision surgery, and SROM as risk factors for RLN in the long-term follow-up. Patients with higher preoperative LN NRS scores and SROM, longer preoperative LN duration, RLN at discharge, and revision surgery were more likely to experience RNL after lumbar microdiscectomy.
Analgesic effects of perioperative acupuncture methods: A narrative review
Authors: Liu Ling , Zhao Guoqing , Dou Yuchang , Li Longyun , Chen Peng , Li Tao , Gao Ming
Published: February 2024

Postoperative pain occurs immediately after surgery. The most common perioperative analgesic methods are nerve block, patient-controlled intravenous analgesia, and patient-controlled epidural analgesia. However, overuse of opioid analgesics can cause many adverse reactions including excessive sedation, respiratory inhibition, postoperative nausea, and vomiting. In recent years, many clinical trials have shown that perioperative acupuncture has unique advantages in patients. Perioperative acupuncture can relieve intraoperative pain, improve postoperative pain management, reduce postoperative nausea and vomiting, and shorten the length of hospital stay. This study aimed to confirm the analgesic effect of perioperative acupuncture by reviewing studies on the different methods of perioperative acupuncture and their analgesic effects. The cited literature was searched in English and Chinese from PubMed, China National Knowledge Infrastructure, and Wanfang data, using the following keywords: “perioperative pain,” “acupuncture,” “electroacupuncture,” and “perioperative analgesia.” Studies published from 2005 to 2023 were included. All retrieved papers were read in detail. Perioperative acupuncture has benefits in reducing postoperative pain and opioid need. Although analgesic drugs are still the primary means of postoperative pain control, acupuncture provides a safe analgesic supplement or alternative. This review aimed to assist practitioners in choosing appropriate perioperative acupuncture methods by summarizing the recent literature on the role of different acupuncture approaches for perioperative pain management.