bluuebunny/crossref_metadata_2025 huggingface dataset:
Takotsubo Syndrome Following Catheter Ablation for Atrial Fibrillation: A Systematic Review and Metasummary of Case Reports/Series
Authors: Desai Rupak , Gudiwada Mohan Chandra Vinay Bharadwaj , Jasti Jaswanth Rao , Jitta Sahas Reddy , Guddeti Ananth Vallabh , Vuddandam Dinesh Kumar , Gujjari Mounika , Varala Saicharan , Janga Chaitra , Ganipineni Vijay Durga Pradeep , Merugu Bhavyasri , Bandaru Revanth Reddy , Puli Srikanth , Venkata Vikramaditya Samala
Published: December 2024

Atrial fibrillation (AF) catheter ablation is safe and effective, though rare cases of takotsubo syndrome (TTS) have been observed without proven causation. This review synthesizes TTS following AF ablation case reports and series. Until October 2024, PubMed/Medline, SCOPUS, and Google Scholar were searched for AF ablation and TTS case reports and series. This study examines TTS incidence, clinical features, and prognosis after AF catheter ablation. Thirteen articles detailing 18 patients were included in the review. The study population had a mean age of 65 ± 9.18 years and 77.77% were female. Of the 18 patients, 6 patients (33.3%) underwent radiofrequency catheter ablation and 5 patients (27.7%) underwent cryoablation. All the patients developed TTS within 4 days of the procedure. Heart palpitations and breathlessness are predominant symptoms. Eight patients had T-wave inversion. Dyskinesia was the most prevalent echocardiography finding among the reported cases. Left ventricular ejection fraction was moderately reduced in 5 cases (35.7%) and severely reduced (left ventricular ejection fraction <30%) in 6 cases (42.8%). Of the 15 patients in whom a pattern of ballooning was reported, 13 patients had apical ballooning and 2 had atypical ballooning pattern. Of the 8 cases (44.44%) with complications, 1 had ventricular fibrillation and 2 patients had pulseless electrical activity. Left ventricular function is completely recovered among 17 patients whereas one patient died due to numerous cardiac electromechanical dissociation events. This systematic investigation highlights the need for TTS vigilance after AF ablation, especially in postmenopausal women having catheter ablation. More research is required to fully understand the prevalence, etiology, and risk factors of TTS after AF ablation.
Successful Treatment of Primary Acanthamoeba Cutis in a Patient With Chronic Lymphocytic Leukemia on Acalabrutinib
Authors: Erem Anna Sarah , McAllister Josephine Chu , Quattrochi Brian , Gru Alejandro A.
Published: December 2024

Primary cutaneous amoebiasis is rare, and typically affects immunocompromised patients and presents with unique clinical and histopathologic changes. Untreated, the infection could progress to involve the central nervous system, which is almost universally fatal. We present a case of primary cutaneous acanthamoebiasis in a patient with chronic lymphocytic leukemia on acalabrutinib. Timely diagnosis and treatment resulted in complete resolution of lesions and a disease-free status at the 14-month follow-up. A 76-year-old man presented with a 2-month history of multiple, nonhealing, ulcerated, erythematous, painful, crusted nodules on his trunk, and upper and lower extremities. Two punch biopsies showed mixed inflammatory infiltrate with a histiocytic reaction and microabscesses extending into the deep dermis. Rare, unusual structures with cytoplasmic vacuolations and round nuclei were seen on repeated biopsies. Gomori methenamine silver delineated wrinkled double-walled cytoplasm of rare parasites, concerning for amoebic infection. Molecular workup (polymerase chain reaction) came back positive for Acanthamoeba castellanii. Initial treatment involved flucytosine and fluconazole, followed by fluconazole and miltefosine, but both were discontinued because of nausea and replaced with single-agent voriconazole. Acanthamoeba cutis poses unique diagnostic challenges in a setting of novel agents for chronic lymphocytic leukemia and may be underrecognized. With the expanding population of immunocompromised patients, rare cutaneous infections should enter the differential early on along with early consideration of molecular ancillary testing. The long-term immunomodulating properties of acalabrutinib remain to be elucidated.
Histopathologic Comparison Among Drug Eruptions Induced by Enfortumab Vedotin, Brentuximab Vedotin, and Taxanes
Authors: Iwahashi Yoshifumi , Goto Keisuke , Ohe Shuichi , Bun Shota , Kido Kansuke , Matsui Takahiro , Morii Eiichi , Honma Keiichiro
Published: December 2024

Microtubule-stabilizing agents (enfortumab vedotin and brentuximab vedotin) and microtubule-disrupting agents (docetaxel and paclitaxel) are used as anticancer agents but can also induce drug eruptions. Recently, mitotic arrest figures have been reported in various non-neoplastic cells as the histopathologic side effect of these drug eruptions. Therefore, we performed a comparative analysis of drug eruptions associated with these microtubule-targeting agents. Enfortumab vedotin-, brentuximab vedotin-, docetaxel-, and paclitaxel-associated drug eruptions were retrieved from 4 hospitals in 5, 5, 5, and 7 patients, respectively. Ring mitotic and other mitotic arrest figures were observed in the epidermis in all types of drug eruption but were most frequently (100%) observed in enfortumab vedotin-induced eruptions. Such a finding was also occasionally observed in the sweat ductoglandular units but not in the follicular epithelium. Keratinocyte multinucleation and apoptotic keratinocytes distributed predominantly in the upper part of the epidermis were also observed in these eruptions, particularly in enfortumab vedotin-induced eruptions (4/5, 80%). In conclusion, drug eruptions associated with microtubule-targeting agents, particularly enfortumab vedotin, can often exhibit mitotic arrest figures, keratinocyte multinucleation, and apoptotic keratinocytes predominantly observed in the upper part of the epidermis. These characteristic histopathologic features can be the diagnostic clues of drug eruptions induced by microtubule-targeting agents.
Clinical significance of the albumin-to-globulin ratio in overweight or obese elderly patients with cancer: A multicenter observational study
Authors: Zhang Xi , Dai Xiang-Ting , Huang Jia-Xin , Tang Meng , Shi Han-Ping , Cong Ming-Hua
Published: December 2024

Background

Elderly patients with cancer who are overweight or obese tend to show signs of inflammation or malnutrition. The albumin-to-globulin ratio (AGR) is a clinical indicator of the nutritional status and presence of systemic inflammation in cancer patients. However, its predictive value in this specific population has not yet been elucidated.

Methods

This study, comprising 917 overweight or obese elderly cancer patients, was conducted as a multicenter clinical trial. The relationship between the AGR and survival outcome was assessed using Kaplan-Meier survival curve analyses and the Cox regression model for HRs. Additionally, the prognostic value of the pretreatment AGR was validated by performing a propensity score matching analysis.

Results

The optimal cutoff value for a low AGR was 1.25. A notable decrease in the risk of all-cause mortality was observed with each increase in the AGR value. Specifically, for every SD increase, the HR was 0.83 (95% CI: 0.74–0.93, P = 0.001). After adjustment, it was determined that a decreased AGR was independently linked to a worse prognosis among elderly cancer patients who were overweight or obese (HR: 1.79, 95% CI: 1.40–2.27, P < 0.001). In addition, a reduced AGR is correlated with poorer outcomes in the context of certain malignancies, particularly lung, upper gastrointestinal, and colorectal malignancies. Notably, the effect of the AGR on the overall survival was influenced by the Eastern Cooperative Oncology Group performance status. The validity of our primary findings was confirmed through a propensity score matching analysis, which accounted for potential confounding factors.

Conclusions

A reduced AGR is linked to a poor prognosis, particularly when concurrent with a poor Eastern Cooperative Oncology Group performance status in overweight or obese elderly cancer patients.
Impact of milk and dairy consumption on the development and progression of breast cancer
Authors: Patnaik Kakoli , Sharma Nitin , Thadani Deepa
Published: December 2024

Recent studies have shown a link between the consumption of bovine milk and human breast cancer, apparently by agonizing the estrogen receptor (ER), which results in the proliferation of the breast tissues, leading to formation of a tumor. Bovine milk may also promote tumor formation via insulin-like growth factor-1 (IGF-1) signaling. In addition, numerous potentially carcinogenic compounds have been found in bovine milk, including exosomal microRNAs (miR-148a-3p, miR-21-5p), aflatoxin M1, bisphenol A, pesticides, and micro- and nanoplastics. Subjects with specific genetic mutations (e.g., BRCA1 loss-of-function) and polymorphisms (e.g., FTO and IGF-1 upregulation) that enhance IGF-1/mTORC1 signaling might be especially susceptible to ER+ breast cancer promoted by the consumption of bovine dairy products. However, in the previous large-scale meta-analyses, data about the milk processing methods, such as pasteurization and ultra-high temperature treatment, are lacking, thus limiting the accuracy of risk assessments. Clearer and more convincing evidence, detailed milk processing information, and data regarding the timing of exposure (consumption) are required because the current evidence suggests that the dietary recommendations regarding milk and dairy consumption may need to be reevaluated.
Integrating Worker Health Education in Community Agencies to Address Immigrant Worker Health: A Pilot Implementation Trial
Authors: Tsai Jenny Hsin-Chun , Herting Jerald R.
Published: December 2024

Objective

This pilot trial aimed to determine implementation processes and outcomes to integrate Basic Worker Health Education (WHEB) in co-ethnic, not directly worker-focused, community agencies that function as cultural-linguistic brokers and service providers to immigrants.

Methods

A Chinese WHEB prototype was developed and implemented at Chinese, Pan-Asian, and nonprofit community-based and Chinese faith-based organizations (N = 8). The implementation process (delivery model choice and areas for change) and outcomes (suitability and adoption sustainability) were evaluated qualitatively.

Results

The agencies selected four delivery models. Five agencies reached ≥70% of their target goal. Respondents described the chosen delivery models as suitable for the varying agency contexts. Three agencies continued WHEB; reasons for continuing or not continuing were identified.

Conclusions

Findings highlight strategies to enhance the uptake and diffusion of worker health educational interventions in community settings.
Rapid COVID-19 Testing of Symptomatic Health Care Personnel: A Strategy for Safely Maintaining the Workforce
Authors: McNicholas James E. , Whitman Jeffrey D. , Tulsky Jacqueline P. , Villanueva Allyson H. , Kang Joy , Blanc Paul D. , Solomon Gina M. , Jacobson Mark A.
Published: December 2024

STRUCTURED ABSTRACT

Objective

Determine performance characteristics and safety outcomes of two rapid COVID-19 screening methods to inform immediate return to work (RTW) decisions while (health care personnel) HCP await results of pending confirmatory laboratory test.

Methods

Retrospective, occupational health quality improvement study comparing screening with rapid SARS-CoV-2 nucleic acid amplification (NAAT) and antigen test.

Results

531 mildly symptomatic HCP screened over 16 months.

Conclusion:

Until more accurate affordable NAAT tests become available, antigen test screening alone addresses simultaneous needs to minimize COVID-19 transmission from symptomatic HCP and maintain an adequate workforce.
Impact of Left Ventricular Size on Outcomes Following HeartMate 3 Left Ventricular Assist Device Implantation: Analysis of the European Registry for Patients With Mechanical Circulatory Support (EUROMACS)
Authors: Nersesian Gaik , Jaiswal Abhishek , Stein Julia , Pillai Ashwin , de By Theo M. M. H. , Potapov Evgenij , Baran David A.
Published: December 2024

We investigated the association of preimplant left ventricular end-diastolic diameter (LVEDD) with outcomes after HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation. Patients from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) registry who underwent HM3 implantation from August 2014 to February 2023 (n = 834) were analyzed according to preoperative LVEDD: less than or equal to 65 (n = 251), 65–80 (n = 441), and greater than or equal to 80 mm (n = 142). The mean age was 54.4 ± 12.4 years, body surface area (BSA) 2.0 ± 0.23 m2, body mass index (BMI) 27.3 ± 5.0 kg/m2; 87.9% were male and 40% had ischemic cardiomyopathy. Patients with LVEDD less than or equal to 65 mm were older (56.1 ± 11.0 vs. 53.8 ± 13.0 vs. 53.0 ± 12.3 years; p = 0.015), more female (17.9% vs. 11.6% vs. 4.9%; p < 0.001), smaller BSA (1.95 ± 2.03 vs. 2.01 ± 0.22 vs. 2.08 ± 0.22 m2; p < 0.01) and lower BMI (26.6 ± 4.8 vs. 27.4 ± 5.1 vs. 28.2 ± 5.0; p = 0.01) compared to LVEDD 65–80 and greater than or equal to 80 mm, respectively. One year survival was associated with increasing LVEDD (75.7% vs. 84.6% vs. 89.5%; p = 0.003). Patients with LVEDD less than or equal to 65 mm had a higher risk of postoperative right heart failure (14.7% vs.10.4% vs. 6.8%; p = 0.03), the risk for postoperative stroke was similar (10% vs. 12.8% vs. 9.5%; p = 0.4). A small left ventricular (LV) size (LVEDD ≤ 65 mm) was associated with an increase in postoperative right heart failure and unadjusted 1 year mortality in adults who underwent HM3 LVAD implantation.
Clinical and economic outcomes associated with fidaxomicin in comparison to vancomycin, metronidazole, and FMT: A systematic literature review
Authors: Li Qinghua , Obi Engels , Marciniak Anne , Newman Rebecca , Whittle Isabelle , Kufakwaro Jason
Published: December 2024

Background:

There are an estimated half a million cases of Clostridioides difficile infection (CDI), in the United States annually. Fidaxomicin, vancomycin, and metronidazole are commonly used for CDI treatment, with fidaxomicin recommended by clinical guidelines as the preferred treatment for initial and recurrent CDI. This systematic literature review aimed to explore clinical and economic outcomes associated with fidaxomicin use with or without comparison to vancomycin, metronidazole, or fecal microbiota transplantation (FMT).

Methods:

The EMBASE, Medline, EconLit, and Evidence Based Medicine Reviews databases were searched from January 1st, 2012 to December 6th, 2022, as fidaxomicin was first approved for adult use in 2011. Identified publications were assessed and extracted by 2 independent reviewers.

Results:

Seventy-nine publications were included. Articles reporting at least 50 patients with follow-up ≤90 days were selected to obtain comparable outcome definitions (N = 14). Sustained clinical cure rate at 30- and 60-days follow-up was higher among fidaxomicin-treated patients (70.0–75.1% and 63.2–78.9%; N = 3) than vancomycin (45.1–58.2% and 38.9–50.0%; N = 3). Lower recurrence rates were reported post-fidaxomicin treatment compared to vancomycin, however the ranges overlapped at 30-, 60-, and 90-days follow-up. Limited outcomes for comparators metronidazole and FMT were identified. Healthcare resource use data were limited, with 2 studies reporting direct costs finding that fidaxomicin use-associated savings were driven by reduced hospital admission-related costs. Fidaxomicin was cost-effective in 14 of 21 economic analyses (11 vs vancomycin). Three studies reported vancomycin or FMT as more cost-effective than fidaxomicin. Fidaxomicin was consistently cost-effective or cost-saving among patients receiving concomitant antibiotics, and patients with cancer or renal impairment. Ten publications reported that the higher acquisition cost of fidaxomicin was offset by reduced recurrence and hospital readmission costs.

Conclusions:

Fidaxomicin was clinically effective compared to vancomycin. Fidaxomicin is often reported as cost-effective, consistently within high-risk subpopulations.
Impact of a multimodal health education combined with teach-back method on self-management in hemodialysis patients: A randomized controlled trial
Authors: Liu Yan , Luo Xi , Ru Xue , Wen Caijin , Ding Ning , Zhang Jing
Published: December 2024

Background:

To explore the impact of multimodal health education combined with the teach-back method in the self-management of hemodialysis patients.

Methods:

Using the convenience sampling method and random number table method, 112 patients who received treatment in the hemodialysis center of a tertiary hospital in Sichuan Province from January 2023 to October 2023 were selected and divided into a control group (n = 56) and an experimental group (n = 56). The control group was given routine care and traditional health education for maintenance hemodialysis patients, of which 31 were male and 25 were female; the average age was (56.04 ± 11.26) years old. The experimental group was given multimodal health education combined with the teach-back method based on the control group, of which 37 cases were male and 19 cases were female; the average age was (53.71 ± 12.72) years old. The changes in self-management score, quality of survival score, and health literacy score were compared between the 2 groups.

Results:

Before the intervention, the differences in self-management scores, survival quality scores, and health literacy scores between the 2 groups were not statistically significant (P > .05). After the intervention, the total self-management score (96.91 ± 3.02) and the total survival quality score (96.59 ± 4.27) of the experimental group were higher than those of the control group, and the difference was statistically significant (P < .05); the total health literacy score of the experimental group (80.30 ± 6.11) was higher than those of the control group, and the difference was statistically significant (P < .05); in which, the willingness of financial support of the experimental group score (3.27 ± 4.13) improved, but the difference was not statistically significant (P > .05).

Conclusion:

Multimodal health education combined with the teach-back method can effectively enhance the self-management level and health knowledge of hemodialysis patients, improve the quality of patients’ survival and disease prognosis, and improve the level of patients’ disease health literacy.
Exploring the potential mechanism of Polygonatum sibiricum for Alzheimer’s disease based on network pharmacology and molecular docking: An observational study
Authors: Luo Liangliang , Pan Yao , Chen Fang , Zhang Zhihong
Published: December 2024

Alzheimer’s disease (AD) is a neurodegenerative disease, and there have been no systematic studies of Polygonatum against Alzheimer’s disease. Therefore, our study will elucidate the mechanism of Polygonatum against AD based on network pharmacology and molecular docking. The active ingredients and corresponding targets of Polygonatum were identified using the traditional Chinese medicine systematic pharmacology database and analysis platform. Disease targets of AD were retrieved from the therapeutic target database, Online Mendelian Inheritance in Man, GeneCards, and Disgenet databases. Using the STRING database, we constructed protein interaction networks and performed gene ontology functional enrichment analysis as well as Kyoto encyclopedia of genes and genomes pathway enrichment analysis on common targets. We then drew drug-component-target-pathway-disease network maps using Cytoscape 3.10.1 software and validated the molecular docking using AutoDock4. A total of 10 active ingredients and 108 common targets were screened from Polygonatum, 29 genes (including AKT1 and STAT3) were identified as core genes. According to gene ontology analysis, the core targets were found to be mainly involved in signal transduction, positive regulation of gene expression, negative regulation of the apoptotic process, and so on. The Kyoto encyclopedia of genes and genomes analysis revealed that the signaling pathways comprised pathways in cancer, pathways of neurodegeneration – multiple diseases, and PI3K-Akt signaling pathway. The molecular docking results indicated that 10 of active ingredients from Polygonatum exhibited strong binding affinity with the 6 core targets that were screened before. The activity of Polygonatum against AD could be attributed to the regulation of multiple biological effects via multi-pathways (pathways in cancer, pathways of neurodegeneration – multiple diseases, and PI3K-Akt signaling pathway). The binding activities were estimated as good level by molecular docking. These discoveries disclosed the multi-component, multi-target, and multi-pathway characteristics of Polygonatum against AD, providing a new strategy for such medical problem.
The effects of coagulation factors on the risk of autoimmune diseases: A Mendelian randomization study
Authors: Li Shuxuan , Zhou Chunlei , Li Wenjing , Kang Lichun , Mu Hong
Published: December 2024

The objective of this study was to investigate the potential causal relationship between coagulation factors and autoimmune diseases (ADs). We employed Mendelian randomization to investigate the associations between selected 7 coagulation factors and 10 ADs, leveraging genetic variants as instrumental variables to assess causal relationships between exposures of interest and outcomes. Within the scope of this investigation, coagulation factors were designated as the exposure source, while ADs were observed to manifest as the consequent outcome. Our analysis using the inverse-variance weighted (IVW) method revealed that Factor VIII (FVIII) (P = .0067) exhibited significant causal associations with a reduced risk of multiple sclerosis. In contrast, fibrinogen (P = .0004) was associated with an increased risk of multiple sclerosis. The analysis also indicated that activated partial thromboplastin time (P = .0047) was implicated in elevating the risk of urticaria. The results also showed that protein C (P = .0188) was inversely associated with the risk of systemic lupus erythematosus. The results unveiled a significant positive correlation between fibrinogen (P = .0318) and the risk of rheumatoid arthritis. Similarly, Factor VII (P = .0119), FVIII (P = .0141), and von Willebrand Factor (P = .0494) were also found to be positively associated with the risk of inflammatory bowel disease. The IVW analysis demonstrated a causal relationship between von Willebrand Factor (P = .0316) and FVIII (P = .0408) and a decreased risk of primary sclerosing cholangitis. IVW results confirmed that protein C (P = .0409) had a protective effect on vitiligo. No significant associations were found between psoriatic arthritis, rosacea, and the 7 coagulation factors in this study. This is of significant importance for advancing the prevention, diagnosis, and treatment of ADs.
Exploring causal relationship between the lipids, immune cells, and leiomyosarcoma: A Mendelian randomization and mediation analysis
Authors: Jin Xuemei , Jiang Chaoyang , Gan Xia , Zou Xinyun , Li Hua , Zhang Ling
Published: December 2024

This study aimed to delineate the causal nexus between lipids and leiomyosarcoma (LMS), with a particular emphasis on delineating the mediating role of immune cells. Employing a 2-sample Mendelian randomization (MR) framework, we scrutinized the potential association of 179 lipid species with LMS across 179 cases and 314,193 controls. The analysis was underpinned by summary-level data derived from genome-wide association studies. The inverse variance weighting method constituted our primary analytical strategy, augmented by supplementary techniques including MR-Egger, simple mode, weighted median, and weighted mode. To ensure the integrity of our MR inferences, we conducted rigorous horizontal multiplicity, heterogeneity, and Bayesian assessments. Furthermore, a nuanced 2-step Mendelian analysis was undertaken to quantify the extent of immune cell-mediated effects of lipids on LMS. Our comprehensive MR evaluation of 179 lipids species unveiled a significant association between genetically inferred triglyceride levels and an elevated risk of LMS (odds ratio = 2.11, 95% confidence interval = 1.38–3.23, P < .001), while inversely showing no effect of LMS on triglyceride levels (odds ratio= 0.99, 95% confidence interval = 0.94–1.04, P = .83). Additionally, the examination of 731 immune cell phenotypes highlighted CD8+ natural killer T cells as contributing a 6% mediation in the causal pathway from triglycerides to LMS.
Effects of 2 consecutive badminton matches on motor and cognitive abilities among adult elite badminton players: An observational study
Authors: Sántha Gergely , Reinhardt-Varga Emese , Áfra György , Bíró Eszter , Tollár József
Published: December 2024

The goal of our study was to investigate the effect of 2 consecutive badminton matches among elite badminton players on visuomotor integration, dynamic balance ability, inhibitory control, short-term memory capacity, and changes in cardiovascular fitness. Badminton is the fastest racket sport regarding the speed of the shuttle leaving the racket. The play with open move skills is characterized by series of short range and high intensity workload phases. The effectiveness is affected by the execution of the specific movement techniques within a certain time period and the optimal function of decision-making techniques. The experiment included a tournament with 2 simulated matches among elite, adult, male badminton players. The quality of visuomotor integrity and dynamic balance task were measured with Blazepod modified adapted Y-Balance Test induced reactive balance test, pre and post matches. Stroop test was used to evaluate the inhibition capability, and Digit Span Test was applied to measure the cognitive short-term capacity. Remarkable changes could not be detected in the visuomotor reaction in each time points. Gradual increase was observed in balance errors due to the dominant leg (right) support. Digit Span Test decreased between pre and post match measurements, however, significant changes (P < .01) could be detected after the restitution period between pre and post match. No alteration could be seen with Stroop test in each time points, nevertheless, notable increase in false results were observed at the 4th measurements points. Heart rate did not remarkably differ. In summary, the intensive, consecutive strength had a negative effect on peripheral system, and therefore on dynamic balance control. Cognitive ability indicated gradual deterioration, but showed optimal regeneration between loads.
Isolated pulmonary epithelioid hemangioendothelioma: A case report
Authors: Xuan Rong , Cui Zhengsen , Zhao Liuyan
Published: December 2024

Rationale:

Pulmonary epithelioid hemangioendothelioma (P-EHE), initially named “intravascular bronchoalveolar tumor,” is an exceptionally rare malignant tumor with an incidence of <1 in a million. Diagnosis depends primarily on pathological and immunohistochemical findings, and currently, there is no established treatment standard.

Patient concerns:

A 50-year-old woman had a physical examination that revealed a lung shadow, followed by a cough and sputum. A chest computed tomography (CT) scan displayed a mass shadow in the upper lobe of the left lung. 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT indicated increased uptake of a clumped shadow.

Diagnosis:

The patient underwent a wedge resection of the left upper lung and pleural biopsy, confirming P-EHE.

Interventions:

Following P-EHE diagnosis, chemotherapy, targeted therapy, and immunosuppressive therapy are administered.

Outcomes:

The patient and his family gave up the treatment because it was not satisfactory. Later, we conducted a phone follow-up and learned that the patient passed away on May 18, 2023.

Lessons:

The scarcity of P-EHE complicates its diagnosis and treatment, underscoring the importance of ongoing research to enhance our understanding of this condition.
Classification and diagnosis model for Alzheimer’s disease based on multimodal data fusion
Authors: Fu Yaqin , Xu Lin , Zhang Yujie , Zhang Linshuai , Zhang Pengfei , Cao Lu , Jiang Tao
Published: December 2024

Alzheimer disease (AD) is the most commonly occurring neurodegenerative disease. However, current diagnostics for AD primarily rely on invasive tests, which limit the application of diagnostic procedures in early screening. Speech, as a noninvasive biomarker, is closely associated with AD but has not been fully leveraged as a diagnostic tool. This study develops a novel early AD diagnosis method that uses primitive speech and explores its potential application in community screening. Moreover, the study proposes an innovative multimodal method for speech feature fusion that combines acoustic and semantic information to differentiate patients with AD from normal controls. This method uses the ImageBind audio encoder to extract acoustic features and the Embeddings from Language Model to extract semantic features, thereby effectively integrating the features by mid-level fusion. The training set comprises 166 speech recordings, which comprise 87 samples from individuals with AD and 79 samples from healthy control subjects. The ratio of training set to test set is 7:3. Evaluation of the Alzheimer dementia recognition through spontaneous speech only dataset showed that the proposed model achieved a classification accuracy of 0.903 and a recall rate of 1, and it considerably outperformed existing baseline models, thereby confirming the effectiveness of the proposed approach to AD diagnosis. This study applies the multimodal fusion of speech features to an early AD diagnostic procedure and achieves excellent performance. The findings of this study not only provide a new approach to noninvasive AD screening but also open new pathways to the early diagnosis of other neurodegenerative diseases.
Solitary lung cavities on CT imaging: Differentiating malignant and nonmalignant diseases
Authors: Cosgun Zeliha
Published: December 2024

This study aims to investigate the contribution of radiological findings in differentiating benign from malignant diseases in patients with solitary cavitary lesions detected on computed tomography (CT). In this study, lesion size, cavity wall thickness, and the presence of additional parenchymal findings were retrospectively evaluated to distinguish between benign and malignant diseases and examine the etiology of solitary pulmonary cavities. CT scans were reviewed by a radiologist specialized in thoracic radiology. The study was conducted using a 64-multidetector CT system, and measurements of lesion size and cavity wall thickness were recorded on axial images. The presence of consolidation and centrilobular nodules was also assessed. Receiver operating characteristic curves were generated to determine optimal cutoff points for distinguishing benign from malignant lesions based on cavity wall thickness. Benign lesions accounted for 47.9% of the cases, with active pulmonary tuberculosis being the most common diagnosis. In the malignant group, primary lung cancer predominated, with squamous cell carcinoma being the most frequent subtype. There were significant differences between benign and malignant cases regarding the mean maximum wall thickness and lesion diameter. Additionally, the presence of consolidation and centrilobular nodules was assessed. Maximum wall thickness thresholds of 7.2 mm and 23 mm were found to be the most accurate indicators of benign and malignant etiologies, respectively. In conclusion, CT findings revealed significant differences between malignant and benign solitary pulmonary cavities; benign lesions generally presented with smaller and thinner cavity walls, and perilesional parenchymal findings were observed in benign lesions of infectious origin but not in malignant lesions.
Temporal trends, gender, and ethnoracial disparities in mortality from pulmonary emphysema: A retrospective nationwide analysis
Authors: Saeed Humza , Arshad Muhammad Khubaib , Shahnoor Syeda , Abdullah  , Wasay Abdul , Mahmood Hareem , Zabeehullah  , Singh Ajeet , Daoud Mohamed
Published: December 2024

Emphysema, a significant global health issue, involves abnormal lung enlargement and wall destruction, affecting 9% to 12% of people worldwide. In the United States (US), 2 million people live with emphysema, with numbers expected to rise. Data on mortality trends and disparities associated with demographic factors is limited, underscoring our study’s focus on analyzing these patterns in US adults. This study examined death certificates from the CDC WONDER database for individuals aged 25 and older who died with emphysema (J43) between 1999 and 2020. Age-adjusted mortality rates (AAMRs) and annual percent change were calculated by year, gender, age group, race/ethnicity, geographic region, and urbanization status. Between 1999 and 2020, there were 484,095 reported deaths among emphysema patients. The overall AAMR decreased from 18.5 to 7.2 per 100,000 population, with an annual decrease of 8% from 2008 to 2015, followed by a slight recent increase. Analyzing by age groups, older adults had the highest AAMR of 42. Men had significantly higher AAMRs than women (13.4 vs 7.8). By race, non-Hispanic (NH) White patients had the highest AAMRs (11.3), followed by NH American Indian or Alaska Native (8.2), NH Black (7.7), Hispanic (3.9), and NH Asian or Pacific Islander patients (3.1). Nonmetropolitan areas had higher AAMRs compared to metropolitan areas (11.7 vs 9.8). Emphysema mortality has decreased overall but recently increased slightly. Higher rates are seen among older adults, men, NH White patients, and nonmetropolitan residents. Policies are needed to continue reducing these death rates and to address these disparities.
Atrial fibrillation and the risk of bone fractures: A meta-analysis of prospective cohort studies
Authors: Wang Yuexiao , Wang Zhaoyan , Gu Weipeng , Zhang Mingliang , Zheng Guanlin , Yang Libo
Published: December 2024

Background:

Some observational studies have suggested that atrial fibrillation (AF) might be associated with an increased risk of bone fracture, but the results remain inconsistent. Therefore, we aimed to evaluate the relationship between them by performing a meta-analysis of prospective cohort studies.

Methods:

We identified relevant studies through PubMed and Embase databases up to the end of October 2023. Study characteristics and outcomes were abstracted for each included study. Pooled relative risks (RRs) and 95% confidence intervals (CIs) for associations of AF with fracture risk were calculated with fixed- or random-effects models.

Results:

Six prospective cohort studies were finally included in the analysis. The pooled RRs of any type of fractures for AF were 1.53 (95% CI: 1.26–1.86, P = .026) with substantial heterogeneity (I2
 = 87.9%, P = .000). For the specific type of fracture, a statistically significant association of AF with hip fracture was found (RR = 1.71, 95% CI: 1.25–2.34, P = .001, n = 5). No evidence of publication bias was observed.

Conclusion:

Our results demonstrated that AF was significantly and independently associated with a higher risk of bone fracture, especially for hip fracture.
Women’s experience, satisfaction, and continuation with the levonogestrel-containing intrauterine system: A cross-sectional study
Authors: Dönmez Ayşegül , Yeşil Yeşim
Published: December 2024

The levonorgestrel-containing intrauterine system (LNG-IUS) is a safe, long-acting, reversible contraceptive method. This study aimed to examine women’s experiences, satisfaction, and continuation with the levonorgestrel-containing intrauterine system. This cross-sectional study examined women who had previously used or were still using LNG-IUS at a research hospital between October 2023 and March 2024. The study included 627 randomly sampled women who visited the Women’s Health Outpatient Clinic of a Training and Research Hospital in Izmir Province. Inclusion criteria were age between the ages of 18 to 55, using/used LNG-IUS, and no diagnosis of any mental illness. LNG-IUS users were grouped according to the reasons for their use (treatment or contraception), and comparisons were made. A questionnaire was administered to the women after the outpatient examination. Women who did not meet the inclusion criteria and who did not speak Turkish were excluded from the study. A statistically significant difference was found between women’s age, educational status, fertility goal, and previous contraceptive method and those who used LNG-IUS for treatment or contraception (P < .05). When the reasons for women’s use of LNG-IUS are examined; It was determined that women used it due to menometrorrhea (48.2%), contraception (25.2%), dysmenorrhea (9.4%), myoma uteri (13.4%), and endometriosis (3.8%) Both groups who used LNG-IUS for treatment and contraception were very satisfied (83.6% and 86.1%, respectively) and would consider using LNG-IUS again (96.8%; 94.3%, respectively). The results showed that Women were satisfied with the use of LNG-IUS as both a treatment and contraceptive method. In this regard, conducting multicenter, quantitative, and qualitative studies that can also reflect the cultural characteristics of women’s experiences with LNG-IUS may be recommended.
Heparin-free veno-venous ECMO for airway obstruction: A case report and review of literature
Authors: Sun Bin , Zhou Meiyan , Wang Rongguo , Liu Qian , Yan Li , Zhang Yan , Zhang Jinghao , Wang Liwei
Published: December 2024

Rationale:

Life-threatening airway obstructions caused by tumors demand prompt and effective intervention. Traditional surgical methods are often complicated by bleeding risks, especially with the use of anticoagulation during extracorporeal membrane oxygenation (ECMO). This report investigates the innovative application of heparin-free veno-venous ECMO (VV-ECMO) to minimize bleeding risks while maintaining effective oxygenation during airway obstruction surgeries, thereby offering a safer alternative in high-risk scenarios.

Patient concerns:

A 44-year-old female with a history of recurrent synovial sarcoma presented with severe dyspnea, requiring a forced lateral position to breathe. A chest CT scan revealed a complete obstruction of the left mainstem bronchus by a tumor.

Diagnoses:

The patient was diagnosed with airway obstruction secondary to metastatic synovial sarcoma.

Interventions:

Preemptive heparin-free VV-ECMO was initiated before general anesthesia to maintain oxygenation. Surgical resection of the obstructing tumor was performed using rigid bronchoscopy and high-frequency electrocautery, followed by argon plasma coagulation to control bleeding.

Outcomes:

Postoperatively, the patient showed significant improvement in respiratory status. VV-ECMO was successfully weaned off, and the patient was extubated shortly after surgery. She was discharged in stable condition 4 days later.

Lessons:

Heparin-free VV-ECMO is an effective strategy for managing airway obstructions in patients at high-risk of bleeding. This case supports the use of ECMO without anticoagulation in airway surgeries, offering a balance between maintaining oxygenation and reducing bleeding complications.
Prevalence and clinical significance of hypouricemia in the emergency department
Authors: Şengüldür Erdinç , Demir Mehmet Cihat , Selki Kudret
Published: December 2024

Hypouricemia prevalence has been reported in different clinical settings, but its prevalence and characteristics in the emergency department (ED) are limitedly studied. This study aimed to assess hypouricemia prevalence and clinical significance in the ED of a Turkish tertiary-care hospital. It was a retrospective, single-center observational study. Patients aged 18 years and older who presented to the ED between June 1, 2022 and June 1, 2023 were included. Data including age, gender, comorbid disease, final diagnosis, serum electrolytes, albumin, and serum uric acid (SUA) levels were obtained. SUA <2 mg/dL was considered as hypouricemia. The study included 35,923 patients, 362 of whom had SUA <2 mg/dL. The prevalence of hypouricemia was 1.008% and was higher in women (1.4% vs 0.4%, P < .001). Hypouricemic patients were younger than non-hypouricemic ones (34.5 [26–57] vs 50 [31–68], P < .001). Hypouricemic patients had a higher 6-month mortality rate than non-hypouricemic patients (5.2% vs 2.8%, P = .006). Among hypouricemic patients, men had a higher mortality rate than women (12.9% vs 3.4%, P = .004). A total of 33.7% of hypouricemic patients were pregnant, and the most common final diagnosis in the ED was abortus imminens, with 17.7%. The prevalence of hypouricemia in ED patients differs between genders. Hypouricemia increases 6-month mortality, more so in men. Obstetric pathologies are the most common final diagnosis of ED in hypouricemic patients. SUA can be monitored as a useful biomarker to ensure a healthy pregnancy and has a warning role in predicting mortality risk. Further studies are needed on hypouricemia.
Causal relationship between gut microbiota and androgenetic alopecia: A Mendelian randomization study
Authors: Liu Jinyue , Luo Wenrong , Hu Zheyuan , Zhu Xiaohai , Zhu Lie
Published: December 2024

Recent studies have found a strong correlation between gut microbiota and the risk of skin diseases and proposed a “gut-skin axis.” Androgenetic alopecia (AGA) is the most common type of alopecia, and androgen plays an important role in its pathogenesis. It has been found that the gut microbiome is closely related to androgens; however, whether this relationship is causal or merely coincidental remains uncertain. To address this issue, Mendelian randomization (MR) analysis was performed to explore the association between gut microbiota and AGA. Genome-wide association studies (GWAS) have compiled summary statistics of the gut microbiota, including 211 taxa (131 genera, 35 families, 20 orders, 16 classes, and 9 phyla), with data from MiBioGen’s comprehensive study. We collected genetic associations with AGA from the IEU OpenGWAS project. We performed MR Analyses to assess the causal relationship between the genetically predicted gut microbiota and AGA. In order to verify the reliability of the findings, we systematically performed sensitivity analyses and heterogeneity tests and performed a heterogeneity test. MR Analysis provides important evidence for the causal relationship between genetically predicted gut microbiota and AGA. Lachnospiraceae UCG008 (OR = 0.939, 95%CI 0.175–0.775, P < .01), Oxalobacte (OR = 0.932, 95%CI 0.896–0.969, P < .01) would reduce the risk of AGA. Eubacterium rectale group (OR = 1.102, 95%CI 1.025–1.186, P < .01), Roseburia (OR = 1.183, 95%CI 1.048–1.336, P < .01) would increase the risk of AGA. Further sensitivity and heterogeneity analyses confirmed the robustness of these results. The results of this study indicate that there is a potential genetic susceptibility between gut microbiota and AGA, and screen out protective and risk factors. These results provide a theoretical basis for the prevention and treatment of AGA by regulating gut microbiota.
The prevalence of incontinence and its impact on quality of life
Authors: Güler Sönmez Tuğba , Uğraş Ebru , Gül Şahin Eda , Fidanci Izzet , Aksoy Hilal , Ayhan Başer Duygu
Published: December 2024

The study set out to find out how common urine incontinence was in the community and how it affected people’s quality of life and other relevant characteristics. Patients who applied to Family Medicine Outpatient Clinics were asked to complete a questionnaire as part of the study. Participants who consented to participate in the study were given access to a questionnaire that included the Incontinence Quality of Life Scale (I-QOL), the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Three Incontinence Questions (3IS) form. There were 18.5% of male participants and 81.5% of female participants in terms of gender distribution. It was found that urine incontinence affected 29.9% of the individuals. The median ICIQ-SF Score values varied statistically significantly depending on whether incontinence was present (P < .001). The ICIQ-SF Score median values according to incontinence types showed a statistically significant difference (P < .001). The total score of the incontinence quality of life scale showed a statistically significant variation based on the presence of incontinence (P < .001). For people without incontinence, the median overall score on the incontinence quality of life scale was 82, whereas for people with incontinence, it was 67. Urinary incontinence (UI) is a frequent health issue that can have a significant negative impact on a person’s quality of life because of the psychosocial impacts, lifestyle limits, and social effects. As a result, it is critical to comprehend the impacts of urine incontinence, create support and treatment plans, and strive toward early patient detection to enhance quality of life.
Point-of-care ultrasound as the first imaging strategy in young infants aged under 90 days presenting with gastrointestinal manifestations at the emergency department
Authors: Chun Min Kyo , Kim Dahyun , Han Jeeho , Choi Seung Jun , Lee Jeong-Yong , Lee Jong Seung , Ryu Jeong-Min , Park Jun Sung
Published: December 2024

This study compared the emergency department (ED) flow of young infants under 90 days old presenting with gastrointestinal symptoms who underwent point-of-care ultrasound (POCUS) versus X-ray (XR) as their primary imaging test. The study retrospectively enrolled infants under 90 days old with gastrointestinal (GI) symptoms who visited a tertiary university-affiliated hospital ED from January 2019 to September 2022. The patients were divided into 2 groups based on whether they received XR or POCUS as their first imaging test. Out of 440 patients, 352 (80%) were enrolled in the XR-first group and 88 (20%) in the POCUS-first group. No significant differences exist in demographics, clinical characteristics, or the prevalence of surgical abdomen between the groups. The time-to-disposition and ED length of stay (EDLOS) were significantly shorter in the POCUS-first group as compared to those in the XR-first group (86 min vs 127 min, P = .013; 121 min vs 157 min, P = .049; respectively). In the POCUS-first group, only 30.7% of the cases required an additional XR. The performance of POCUS in screening for surgical abdomen showed a sensitivity and specificity of 95.8% and 95.3%, respectively. In young infants under 90 days presenting with GI symptoms at the ED, using POCUS as the first imaging test instead of XR can shorten time-to-disposition and EDLOS, improving ED flow with acceptable screening performance for surgical emergencies.