bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Psychiatric Hospitalization After Discharge From Inpatient Neurorehabilitation for Traumatic Brain Injury
Authors: Silva Marc A. , Fox Michelle E. , Klocksieben Farina , Hoffman Jeanne M. , Nakase-Richardson Risa
Published: September 2024

Objective: To examine, among persons discharged from inpatient rehabilitation for traumatic brain injury (TBI), the degree to which pre-TBI factors were associated with post-TBI hospitalization for psychiatric reasons. The authors hypothesized that pre-TBI psychiatric hospitalization and other pre-TBI mental health treatment would predict post-TBI psychiatric hospitalization following rehabilitation discharge, up to 5 years post-TBI. Setting: Five Veterans Affairs Polytrauma Rehabilitation Centers. Participants: Participants with nonmissing rehospitalization status and reason, who were followed at 1 year (N = 1006), 2 years (N = 985), and 5 years (N = 772) post-TBI. Design: A secondary analysis of the Veterans Affairs TBI Model Systems, a multicenter, longitudinal study of veterans and active-duty service members with a history of mild, moderate, or severe TBI previously admitted to comprehensive inpatient medical rehabilitation. This study examined participants cross-sectionally at 3 follow-up timepoints. Main Measures: Psychiatric Rehospitalization was classified according to Healthcare Cost and Utilization Project multilevel Clinical Classifications diagnosis terminology (Category 5). Results: Rates of post-TBI psychiatric hospitalization at years 1, 2, and 5 were 4.3%, 4.7%, and 4.1%, respectively. While bivariate comparisons identified pre-TBI psychiatric hospitalization and pre-TBI mental health treatment as factors associated with psychiatric rehospitalization after TBI across all postinjury timepoints, these factors were statistically nonsignificant when examined in a multivariate model across all timepoints. In the multivariable analysis, pre-TBI psychiatric hospitalization was significantly associated with increased odds of post-TBI psychiatric hospitalization only at 1-year post-TBI (adjusted odds ratio = 2.65; 95% confidence interval, 1.07-6.55, P = .04). Posttraumatic amnesia duration was unrelated to psychiatric rehospitalization. Conclusions: Study findings suggest the limited utility of age, education, and pre-TBI substance use and mental health utilization in predicting post-TBI psychiatric hospitalization. Temporally closer social and behavior factors, particularly those that are potentially modifiable, should be considered in future research.
One case of spinal bulbar muscular atrophy misdiagnosed as polymyositis: Case report
Authors: Mu Yv-sen , Yao Jia-yi , Li Fang
Published: September 2024

Rationale:

Spinal bulbar muscular atrophy (SBMA) is a rare X-linked recessive motor neuron degenerative disease. Due to the lack of specificity in its early clinical manifestations, SBMA is easily misdiagnosed. Herein, we present a case in which SBMA was misdiagnosed as polymyositis.

Patient concerns:

A 58-year-old patient began to develop symptoms of limb weakness 20 years ago and was admitted to the Second Hospital of Hebei Medical University 10 years ago without special treatment. Two years ago, the above symptoms worsened and he was admitted to Peking Union Medical College Hospital. The patient was misdiagnosed as polymyositis. According to the gene mutation characteristics of SBMA, the patient was diagnosed with SBMA.

Diagnoses:

The result of the Kennedy gene test was positive, and the patient was diagnosed with Kennedy disease.

Interventions:

After the diagnosis of SBMA, the patient was given symptomatic treatment to alleviate the condition.

Outcomes:

Conservative treatment after discharge was requested. It is recommended that patients avoid bucking to prevent complications.

Lessons:

This is a case of milder SBMA being misdiagnosed as polymyositis. For patients with weak limbs, the possibility of SBMA should be considered.
Adult patients with severe respiratory syncytial virus infections in the emergency department
Authors: Fistera David , Kramer Christian M. , Manegold Randi Katrin , Elsner Carina , Dittmer Ulf , Taube Christian , Kill Clemens , Risse Joachim
Published: September 2024

Respiratory syncytial virus (RSV) is a seasonal virus known to cause significant morbidity in pediatric patients; however, morbidity in adult patients has not been well investigated. We aimed to characterize adult patients with RSV infection in the emergency department (ED) and their clinical course. During the winter term 2022/23, all adult ED patients were screened for RSV, severe acute respiratory syndrome coronavirus type 2, and influenza infection using point-of-care polymerase chain reaction tests. All symptomatic RSV+ patients were further characterized based on their clinical presentation and course. A group comparison between RSV+ inpatients and RSV+ outpatients was conducted. The potential risk factors for inpatient treatment were evaluated using univariate and multivariate analyses. Of the 135 symptomatic RSV+ patients, 51.9% (70/135) were inpatients. Their length of stay were 9.4 (±10.4) days. Inpatients had a significantly higher mean age, lower oxygen saturation, higher leukocyte count, and higher C-reactive protein levels than outpatients. Among the preconditions, pulmonary diseases, tumors, and immunosuppression were significantly more frequent in the inpatient group. Thirty percent (21/70) of the inpatients required ICU treatment, 11% (8/70) required mechanical ventilation, and 9% (6/70) died. Malaise (P = .021, odds ratio 8.390) and detection of pulmonary infiltrations (P < .001, odds ratio 12.563) were the only independent predictors of inpatient treatment in the multivariate analysis. Our data show that RSV is a medically relevant pathogen among adult ED patients, often requiring inpatient treatment. In particular, elderly patients with some medical preconditions seem to be more prone to a severe course of infection requiring inpatient treatment. Lower respiratory tract involvement, proven by pulmonary infiltrates, seems to be crucial for a more severe disease course.
Study on correlation between Chinese medicine syndromes in stroke and neurological deficits during recovery phase: Perspective
Authors: Ren Hao , Yang Ai-hua , Cai Yi-sheng , Qin Yi , Luo Tong-you
Published: September 2024

Stroke is a leading cause of long-term disability and mortality worldwide, necessitating effective rehabilitation strategies for successful recovery. Traditional Chinese medicine (TCM) has gained recognition as a complementary and alternative approach in stroke rehabilitation, owing to its unique syndromes that offer valuable insights for personalized treatment plans. This study aims to elucidate the correlation between TCM syndromes observed during the recovery phase of stroke and the associated neurological deficits. Syndromes such as Blood stasis, Phlegm-dampness, Qi deficiency, and Yin deficiency were systematically examined, while standardized neurological assessments, encompassing motor function, sensory perception, and cognitive abilities, were employed to evaluate the extent of neurological impairment. Rigorous statistical analyses were conducted to discern potential correlations between TCM syndromes and the severity of neurological deficits. The results revealed statistically significant positive associations between certain TCM syndromes, particularly Blood stasis and Phlegm-dampness, and heightened neurological deficits during the recovery phase post-stroke. These findings suggest that these syndromes may serve as indicators of more severe brain injury post-stroke, thereby guiding the development of tailored rehabilitation strategies. By establishing robust connections between TCM syndromes and neurological deficits, this study contributes to advancing our understanding of stroke recovery through an integrated approach that incorporates TCM principles. Moreover, it underscores the potential benefits of integrating TCM into conventional rehabilitation protocols, offering valuable insights for healthcare professionals and potentially improving patient outcomes.
Warning of severe pulmonary embolism after cerebral angiography: A case report and literature review
Authors: Zhang Xiaolin , Zhang Wenjing , Yu Wangfang , Yu Wei , Shen Wei , Wu Qi , Huang Zhiping , Zhang Yonghua
Published: September 2024

Rationale:

Acute pulmonary embolism (PE), which can lead to cardiac and respiratory arrest, is a rare complication of cerebral angiography. However, neurologists do not pay attention to this.

Patient concerns:

A 47-year-old male with a history of type 2 diabetes was admitted to our hospital for evaluation of surgical indications for unruptured ophthalmic aneurysms. After cerebral angiography, a fatal PE occurred. Through rapid identification and effective drug treatment, the patient recovered and was discharged.

Diagnoses:

A diagnosis of fatal PE was made based on the bedside ultrasonography and blood d-dimer level.

Interventions:

Cardiopulmonary resuscitation and intravenous thrombolysis of “50 mg alteplase” for continuous intravenous drip for 2 hours.

Outcomes:

The patient was recovered and no special discomfort was reported.

Lessons:

PE is a rare complication of cerebral angiography, but the fatality rate is very high. Neurologists must not only early identify and effectively treat this complication, but more importantly, pay attention to this complication, prevent it in advance, and reduce the occurrence of catastrophic events.
A retrospective comparative study of robot-assisted unilateral biportal endoscopic lumbar decompression and fusion surgery versus percutaneous endoscopic lumbar decompression and fusion surgery
Authors: Liu Yan dong , Deng Qiang , Han Li xia , Zhang Kai dong , Zhang Yan jun , Peng Ran dong , Yang Hai yun , Guo Tie feng , Li Jun jie , Chen Bo , Tan Sheng
Published: September 2024

The objective of this study is to illustrate the advantages of robot-assisted unilateral biportal endoscopy in lumbar decompression fusion and internal fixation surgery. According to the different surgical methods, we divided the 26 patients into 2 groups, robot-assisted unilateral biportal endoscopy for lumbar interbody fusion (R-ULIF) group and percutaneous endoscopic lumbar decompression and interbody fusion (Endo-LIF) group, with a 1:1 ratio. Gender, disease course, lesion site, fluoroscopy times, operative time, blood loss, postoperative hospital stay, screw placement success rate, fusion rate, complications rate, postoperative pain visual analog scale (VAS) (The VAS score is used only to evaluate pain in the lower back and legs.) Oswestry Disability Index (ODI) (The ODI score can serve as a reference indicator for evaluating the effectiveness of treatment for patients with low back pain, and has good responsiveness in assessing patients with chronic low back pain), and MacNab (The MacNab standard is divided into 4 levels: excellent, good, fair, and poor, which can be used to evaluate the therapeutic efficacy of certain spinal surgeries) standard efficacy evaluation were analyzed and compared between the 2 groups. All patients successfully completed the surgery. Compared with the Endo-LIF group, the R-ULIF group had fewer fluoroscopy procedures, less intraoperative blood loss, and shorter postoperative hospital stay (P < .05). The VAS scores and ODI scores of both groups significantly decreased at all-time points (P < .05). The ODI scores of the R-ULIF group were better than the Endo-LIF group at 1 month and 3 months after surgery (P = .017/P = .047), but there was no statistically significant difference between the groups before surgery and 1 week after surgery (P > .05). The efficacy was evaluated using the MacNab criteria at 6 months after surgery. The R-ULIF group has an excellent and good rate of 84.6%, while the Endo-LIF group has an excellent and good rate of 76.9% (P = 1.000). Robot-assisted unilateral biportal endoscopy for lumbar interbody and fusion surgery has shown short-term clinical efficacy in the treatment of lumbar disc herniation combined with lumbar instability, surpassing endoscopic lumbar interbody fusion surgery. Robot-assisted unilateral biportal endoscopy for lumbar interbody and fusion surgery has demonstrated high success rate in screw placement, minimal radiation exposure, less intraoperative blood loss, shorter hospital stay, and thus deserves further clinical promotion.
Successful treatments of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome–related macular edema and exudation by intravitreal aflibercept injection in a senile patient: A case report
Authors: Tung Hsiao-Fan , Wu Jian-Sheng , Chen San-Ni
Published: September 2024

Rationale:

The prevalence of idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is <1/1,000,000, and it tends to occur in young women. Panretinal photocoagulation, focal laser photocoagulation, peripheral cryopexy, vitrectomy, and corticosteroid therapy are the traditional treatments. We reported a case of a senile patient with IRVAN syndrome who presented with severe exudation in both eyes and macular edema in the left eye, successfully treated by serial intravitreal aflibercept injections.

Patient Concerns:

A 77-year-old Taiwanese woman complained of progressive blurred vision in the left eye and ocular examinations revealed a visual acuity of 20/125 in the left eye.

Diagnosis:

Indirect fundoscopy and fluorescein angiography showed bilateral multiple aneurysms, vasculitis, optic nerve staining, and neovascularizations. In addition, optical coherence tomography demonstrated macular edema with subretinal fluid and exudations in the left eye.

Interventions:

Monthly intravitreal injections of antivascular endothelial growth factor with aflibercept 2.0 mg were administered in the left eye.

Outcomes:

The visual acuity in the left eye improved to 20/50 after 18 months of treatment. Macular edema and subretinal fluid regressed. Furthermore, vessel leakage and optic disc staining also improved.

Lessons:

This case is the first to demonstrate successful treatment of IRVAN syndrome-related central macular edema and exudations, in the absence of neovascularization, using a series of intravitreal aflibercept injections as monotherapy.
A case of alternating hemiplegia in 2-month-old children with nystagmus as the first symptom: A case report
Authors: Qiao Qicheng , Li Qiubo
Published: September 2024

Rationale:

This case report delves into the rare neurological condition known as alternating hemiplegia of childhood (AHC), focusing on its clinical manifestations, diagnostic approaches, and treatment options. AHC typically presents in infants under the age of 18 months with intermittent episodes of hemiplegia, often triggered by stressors such as environmental changes, bathing, or emotional stress. Recognizing the clinical features of AHC is crucial for early identification and intervention.

Patient concerns:

The paper presents a case of a 2-month-old child with nystagmus as the initial symptom, followed by limb movement disorder in the left upper limb and weakness in the right limbs. The child's condition did not improve with treatment at an external hospital, highlighting the complexity of the disease and the need for specialized care.

Diagnoses:

After a comprehensive review of the patient's medical history, physical examination, and imaging studies, the child was diagnosed with AHC. The diagnosis was confirmed through video electroencephalogram and whole-exome gene detection, which revealed a de novo mutation in the ATP1A3 gene, identified as pathogenic according to the American College of Medical Genetics and Genomics guidelines.

Interventions:

The child was admitted to Peking University First Hospital and treated with levetiracetam and flunarizine oral administration. These medications were chosen for their efficacy in managing the symptoms of AHC, particularly the hemiplegic episodes.

Outcomes:

Post-treatment, the child experienced a reduction in the frequency and intensity of hemiplegic attacks compared to the initial stage. However, the child still exhibited paroxysmal symptoms and abnormal eye movements, and developmental milestones were delayed, indicating the need for ongoing care and monitoring.

Lessons:

This case underscores the importance of early recognition and prompt intervention in managing children with AHC. The varied clinical presentations of AHC necessitate vigilance for early differential diagnosis. Although AHC is currently incurable, appropriate treatment can mitigate the impact of complications and improve the long-term quality of life for affected children, facilitating better societal integration.
Identification of ferroptosis biomarkers and immune infiltration landscapes in atrial fibrillation: A bioinformatics analysis
Authors: Peng Shaoyi , Li Kaiyuan , Man Yilong , Liu Peng
Published: September 2024

Ferroptosis has been recognized as a critical factor in the development of atrial fibrillation (AF), but its precise mechanisms remain unclear. We downloaded the GSE115574 dataset from the gene expression omnibus database to analyze the expression levels of ferroptosis-related genes (FRGs) and identify differentially expressed genes (DEGs). Least absolute shrinkage and selection operator (LASSO) and support vector machine-recursive feature elimination (SVM-RFE) machine learning techniques were employed to identify key genes associated with AF. The diagnostic performance of these genes was evaluated using Receiver operating characteristic curves (ROC) and validated in an independent AF dataset. miRNA and lncRNA predictions for potential binding to these key genes were conducted using miRBase, miRDB, and TargetScan. Furthermore, gene set enrichment analysis (GSEA) enrichment analysis, immune cell infiltration analysis, and targeted drug prediction were performed. The intersection of LASSO regression and SVM-RFE analyses identified 7 DEGs significantly associated with AF. Validation through ROC and an additional dataset confirmed the importance of MAPK14, CAV1, and ADAM23. Significant infiltration of memory B cells, regulatory T cells, and monocytes was observed in atrial tissues. Seventy-two miRNAs were predicted to potentially target MAPK14, and 2 drugs were identified as targeting CAV1. This study underscores the involvement of FRGs in AF through machine learning and validation approaches. The observed immune cell infiltration suggests a potential link between immune response and AF. The predicted ceRNA network offers new insights into gene regulation, presenting potential biomarkers and therapeutic targets for AF.
Chain mediating role of moral values identification and positive psychological capital in the relationship between meaning in life and crisis vulnerability
Authors: Liu Qin , Chang Renjie , Fang Shengju , Peng Junjie
Published: September 2024

To explore the relationship between meaning in life and vulnerability to crisis among undergraduate nursing students and the chain mediating effect between moral values identification and positive psychological capital (PsyCap). A total of 330 undergraduate nursing students majoring in traditional Chinese medicine in ethnic minority areas of Yunnan Province were administered the Meaning in Life Questionnaire, Moral Values Identification Identity Questionnaire, Positive PsyCap Questionnaire, and Crisis Vulnerability Scale. Meaning in life was negatively correlated with crisis vulnerability and positively correlated with moral values identification and positive PsyCap. Crisis vulnerability was negatively correlated with moral values and positive PsyCap. Moral values was positively correlated with positive PsyCap. Chain mediation effect analysis demonstrated that meaning in life cannot directly predict crisis vulnerability, but it can predict crisis vulnerability through 3 indirect paths: the mediating role of moral values identification, the mediating role of positive PsyCap, and the chain mediating role of moral values identification and positive PsyCap. Meaning in life can indirectly reduce crisis vulnerability among undergraduate nursing students by enhancing moral values identification and positive PsyCap.
Application of liver biopsy in etiological diagnosis of unexplained portal hypertension: Porto-sinusoidal vascular disease should not be ignored
Authors: Zhang Yu , Liu Hongli , Xiong Qingfang , Zhong Yandan , Liu Duxian , Chen Wei , Yang Yongfeng
Published: September 2024

The diagnostic value of liver biopsy has been confirmed in patients with abnormal liver test results; however, little data are available on its application in patients with portal hypertension. This study aimed to investigate the utility of liver biopsy for the etiological diagnosis of unexplained portal hypertension, and explore the clinical and pathological characteristics of each etiology. A retrospective observational analysis was conducted on 1367 patients who underwent liver biopsy at the Second Hospital of Nanjing from 2017 to 2019. Of these, 188 patients with unexplained portal hypertension were enrolled. The clinical and pathological characteristics were collected and reassessed in a multidisciplinary team meeting. Among these patients, 174 (92.6%, 174/188) had a definite etiological diagnosis through liver biopsy. The main etiologies were autoimmune hepatitis in 47 patients (25%, 47/188), autoimmune hepatitis-primary biliary cirrhosis overlap syndrome in 41 patients (21.8%, 41/188), and porto-sinusoidal vascular disease (PSVD) in 40 patients (21.3%, 40/188). Compared to liver cirrhosis, PSVD patients were younger and the liver function damage of which was subtler. The widths of portal vein diameter were widest in PSVD but the liver stiffness measurement were almost normal. Splenomegaly was common in PSVD, but ascites were less frequent than in autoimmune hepatitis (25.0% vs 51.1%, P = .013). Based on the histological patterns, we found that cholestatic liver diseases such as primary biliary cirrhosis, autoimmune hepatitis-primary biliary cirrhosis overlap syndrome, and progressive familial intrahepatic cholestasis could lead to non-cirrhotic portal hypertension, while vascular liver diseases such as PSVD and Budd-Chiari syndrome could also show fibrous proliferation as the disease progresses. Liver biopsy is safe and valuable for etiological diagnosis of unexplained portal hypertension. Cirrhosis is the leading cause of portal hypertension, and porto-sinusoidal vascular diseases should also be considered. Clinical features may be helpful in suggesting the cause; however, pathological examination is still indispensable for disease diagnosis and progression assessment.
Transactivation DNA-binding protein–related genes were associated with salivary gland injury in primary Sjögren syndrome
Authors: Zhang Naidan , Zhang Hongsheng , Bao Xiao , Yuan Chengliang
Published: September 2024

The purpose was to identify transactivation DNA-binding protein–related genes in salivary gland injury in primary Sjögren syndrome (pSS) in southwest China.

We downloaded the datasets of GSE7451, GSE23117, and GSE40611. In order to screen the candidate genes, 2 kinds of machine learning algorithms were used. We collected blood from 28 patients and 20 controls to verify the expression of candidate genes using quantitative real-time polymerase chain reaction. The receiver operating characteristic curve was used to evaluate the diagnostic efficiency. Correlations between candidate genes and immune cells were examined.

A total of 31 differentially expressed genes were obtained. Through different algorithms, 6 genes including IFIT1, CSF2RB, TRIM22, PPM1H, VAMP7, and C21orf2 were getted. Validation results suggested that the expression of CSF2RB, VAMP7, IFIT1, C21orf2, and TRIM22 was significantly increased in pSS. The area under the curve of CSF2RB was 0.937 and that of TRIM22 was 0.915. Immune infiltration analysis showed that the percentage of activated mast cells was lower than the controls (P = .025). Correlation analysis suggested that CSF2RB was associated with immune cell infiltration. The expression of CSF2RB was significantly upregulated, which could be related to the increase of γδ T cells.

We revealed that CSF2RB could be the candidate gene of pSS. CSF2RB was involved by regulating various immune cells. The expression of CSF2RB was significantly upregulated, which was related to the increase of γδ T cells.
Analysis of related factors influencing the sleep quality in patients with rotator cuff tear after arthroscopic surgery
Authors: Zhang Qian , Li Yanjun , Li Yongwang , Wang Chunguang , Yao Yichao , Li Qiuping
Published: September 2024

Recent studies have reported a prevalence of sleep disturbance in patients undergoing arthroscopic rotator cuff repair. The purpose of our study was to explore patient-reported factors correlated with sleep disturbance in patients with arthroscopic rotator cuff repair. We retrospectively evaluated 133 patients who underwent arthroscopic rotator cuff repair for 6 months. We obtained the Pittsburgh Sleep Quality Index (PSQI) scores, the visual analog scale (VAS) pain score, the University of California-Los Angeles Shoulder Rating Scale score (UCLA score), the Hospital Anxiety and Depression Scale (HADS), and patient demographics. According to the PSQI scores, participants were divided into a sleep disorder group (A group, PSQI ≥5) and a normal sleep group (B group, PSQI <5). Statistical analyses included Student t test, Mann–Whitney U test, chi-square test, and binary logistic regression analysis to determine which patient-reported factors were associated with sleep disturbance. The mean VAS, UCLA score, UCLA Flexion, HADS-Anxiety (HADS-A), and HADS-Depression (HADS-D) scores in group A were 3.54, 26.36, 3.25, 5.43, and 5.93, respectively; in group B, the mean scores were 1.49, 30.72, 4.50, 2.11, and 1.79, respectively. There were statistically significant differences in the VAS, UCLA, UCLA Flexion, HADS-A, HADS-D scores between the 2 groups (P < .05). In the categories of sex, age, body mass index, and tear size, there was no statistical significant difference between the 2 groups. (P > .05). HADS-D and UCLA Flexion were independent factors affecting sleep disturbance after arthroscopic rotator cuff repair at 6 months (P < .05). Our study demonstrated that patients with sleep disturbances after arthroscopic shoulder surgery had a close relationship with the HADS-D, UCLA Flexion scores and had more pain, more dysfunction, and more pronounced psychological abnormalities. Therefore, more emphasis on psychotherapy and rehabilitation is required for patients with sleep disturbance.
Secondary diabetes mellitus in acromegaly: Case report and literature review
Authors: Wang Jinlin , Zhang Zaidong , Shi Yaru , Wang Wentao , Hu Yanli , Chen Zonglan
Published: September 2024

Rationale:

Acromegaly, predominantly resulting from a pituitary adenoma, is marked by excessive secretion of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). However, normalization of blood glucose levels posttreatment is rarely achieved. This case study aims to highlight the diagnostic challenges posed by overlapping symptoms of acromegaly and diabetes, emphasizing the importance of precise diagnosis and effective treatment strategies for optimal patient outcomes.

Patient concerns:

A 22-year-old male was hospitalized for diabetic ketoacidosis and exhibited classic signs of acromegaly, such as enlarged hands and feet, and distinct facial changes.

Diagnoses:

The patient’s diagnosis of acromegaly, attributed to a pituitary adenoma, was confirmed through clinical observations, laboratory findings (notably raised serum GH and IGF-1 levels, and absence of GH suppression after glucose load during an OGTT), and pituitary MRI scans.

Interventions:

The patient underwent 2 surgical tumor resections followed by gamma knife radiosurgery (GKRS). After treatment, GH, IGF-1, and blood glucose levels normalized without further need for hypoglycemic intervention.

Outcomes:

Posttreatment, the patient achieved stable GH, IGF-1, and blood glucose levels. The hyperglycemia was attributed to the GH-secreting tumor, and its resolution followed the tumor’s removal.

Lessons:

This case emphasizes the need for comprehensive assessment in patients with acromegaly to address coexisting diabetic complications. Surgical and radiotherapeutic management of acromegaly can lead to significant metabolic improvements, highlighting the importance of interdisciplinary care in managing these complex cases.
Gut microbiota and eye diseases: A review
Authors: Zhao Yue , Qiu Peijin , Shen Ting
Published: September 2024

Recent studies reveal that alterations in gut microbiota play a significant role in the progression of various diseases, including those affecting the eyes. The association between gut microbiota and eye health is an emerging focus of research. This review seeks to summarize the connection between the gut microbiome and specific eye conditions, such as ocular surface diseases, funduscopic disorders and immune-mediated eye diseases. Gut microbiota may influence these conditions by regulating the immune system or altering metabolites, thereby contributing to disease development. Strategies like probiotics, antibiotics, dietary modifications, and fecal transplants show promise in addressing these issues. This review examines how the gut microbiome may be linked to the pathogenesis of eye diseases, providing fresh therapeutic perspectives for ophthalmology.
Identification of a novel PANoptosis-related gene signature for predicting the prognosis in clear cell renal cell carcinoma
Authors: Yue Dezhi , Ren Congzhe , Li Hu , Liu Xiaoqiang
Published: September 2024

PANoptosis has been shown to play an important role in tumorigenesis and gain more attention. Yet, the prognostic significance of PANoptosis-related genes has not been investigated more in clear cell renal cell carcinoma (ccRCC). The aim of this research was designed to identify and create a signature of PANoptosis-related genes which was expected to predict prognosis of ccRCC more effectively. The transcriptome data and clinical information were collected from The Cancer Genome Atlas database and the Gene Expression Omnibus database. Optimal differentially expressed PANoptosis-related genes, which were closely associated with prognosis and employed to construct a risk score, were extracted by univariate Cox analysis, least absolute shrinkage and selection operator Cox regression and multivariate Cox analysis. We performed Kaplan–Meier survival analysis and time-dependent receiver operating characteristic curves to complete this process. By adopting univariate and multivariate analysis, the constructed risk score was assessed to verify whether it could be taken as an independent contributor for prognosis. Moreover, we created a nomogram in order to predict overall survival (OS) of ccRCC. Five differentially expressed PANoptosis-related genes were screened out and used to construct a risk score. Our results showed that ccRCC patients with high risk score had a poor prognosis and shorter OS. The results of Kaplan–Meier curves and the area under the receiver operating characteristic curves of 1-, 3-, and 5-year OS indicated that the prediction performance was satisfactory. Additionally, the risk model could be taken as an independent prognostic factor in training and validation cohorts. The nomogram exhibited excellent reliability in predicting OS, which was validated by calibration curves. We identified 5 PANoptosis-related genes, which were used to construct a risk score and a nomogram for prognostic prediction with reliable predictive capability. The present study may provide new potential therapeutic targets and precise treatment strategies for ccRCC.
Combination of diethylpropion with dietary intervention results in body weight and fat loss with preserved muscle mass in obese patients
Authors: Nugraha Gaga Irawan , Amalia Fiki , Imadudda’wah Fata , Ariyanto Eko Fuji , Ghozali Mohammad , Fatimah Siti Nur
Published: September 2024

Combining pharmacotherapy with lifestyle intervention is recommended for obese class II patients who fail lifestyle therapy and for obese class I patients. Diethylpropion, an obesity medication, has been approved for use in Indonesia, which is an Asia-Pacific country. This retrospective study aimed to assess the short-term effects of diethylpropion on weight and fat loss in obese patients in Indonesia. Secondary data were collected from 142 patients’ medical records with a body mass index ≥ 25 kg/m2 who underwent short-term diethylpropion treatment for 84 days between January 2022 and November 2023 at the Kimia Farma Nutrition Clinic in Bandung, Indonesia. Blood pressure, body weight, height, waist circumference, and body composition were assessed at each follow-up visit to determine the fat and muscle mass. Patients were prescribed diethylpropion 25 mg 3 times daily every 2 weeks together with dietary intervention. Kruskal–Wallis test was used to analyze the changes in body weight, skeletal muscle, fat mass, and waist circumference after the diethylpropion therapy. Mann–Whitney test was used for the relation between age, sex, and body mass index with weight loss on the last day of follow-up. Simple linear regression analysis was also performed to identify the correlation between weight loss and therapy duration. This study showed body weight reduction of up to 9.5 ± 3 kg (10 ± 0.0%) (P = .008) on 84 days of treatment. Significant fat loss 11.5 ± 4.6 kg (20.5 ± 0.0%) (P = .005) was also reported in our study without significant loss of muscle mass ‐2.4 ± 4.6 kg (3.6 ± 1.3%) (P = .58). Waist circumference was insignificantly reduced by 5.6 ± 0.0 cm (4.9 ± 2.8%) (P = .21) after 84 days of diethylpropion therapy. This study revealed no significant changes in patient systolic and diastolic pressures despite showing mild increases after 70 days. The combination of diethylpropion and an appropriate diet resulted in weight loss accompanied by significant fat loss and preserved muscle mass without an increase in blood pressure during the 12-week treatment period.
Association between Type D personality, illness perception, and coping strategies in patients undergoing open-heart surgery
Authors: Dolapoglu Nazan , Dolapoglu Ahmet , Tug Tuba
Published: September 2024

Backgrounds:

A combination of social inhibition and negative affectivity characterizes Type D personality. Type D, or distressed personality, is an established risk factor for the development and prognosis of coronary heart disease. It occurs in approximately 1 in 4 patients with coronary heart disease. This study aimed to investigate the relationship between Type D personality, illness perception, and coping strategies in patients undergoing open-heart surgery.

Methods:

This retrospective and cross-sectional study was conducted in a university hospital psychiatry and cardiovascular surgery clinics between February 2022 and April 2022. Seventy-one volunteered patients over the age of 18 who underwent open-heart surgery in the cardiovascular surgery clinic were included in the study. Cardiovascular surgeons recorded the sociodemographic and clinical data of the patients and referred them to the psychiatry clinic for further evaluation. Subsequently, patients underwent psychiatric evaluation and were assessed using the Type D Personality Scale, Coping Attitudes Assessment Scale, Hospital Anxiety and Depression Scale, and Illness Perception Questionnaire.

Results:

According to this study, individuals with Type D personality tended to have higher scores on the Hospital Anxiety and Depression Scale. Analysis of the subdimensions of the Stress Coping Styles Scale revealed that individuals with Type D personalities showed a significantly lower optimistic approach and a considerably higher helpless approach. In terms of the subdimensions of the Illness Perception Questionnaire, it was found that individuals with Type D personality had a statistically lower treatment control approach and a statistically higher emotional representations approach.

Conclusions:

Identifying Type D personality traits in patients undergoing open-heart surgery can help manage negative illness perceptions through effective coping mechanisms.
Abortion Care Services and Restrictions in Teaching Hospitals
Authors: Steinauer Jody E. , Claymore Emily , Simonson Kristin , Steele Heather , Turk Jema K.
Published: September 2024

The overturning of Roe v. Wade has resulted in substantial abortion access restrictions and clinic closures, highlighting the crucial role of hospital preparedness in delivering abortion and pregnancy loss care. This study explores the capacities of teaching hospitals in providing such care. Although most programs can manage health- and life-threatening situations, there are significant regional differences in service limitations and colleague support. For example, compared with faculty members in programs in protective states, those in restrictive states are more likely to report restrictions on first-trimester care (69.4% vs 10.9%, P<.001) and second-trimester care (75.0% vs 12.7%, P<.001). These findings underscore the vital role of teaching hospitals in ensuring abortion care access, emphasizing the need for enhanced integration of abortion services and training in hospital settings.
Does increased fracture comminution affect femoral version after intramedullary nailing? An analysis of 307 intramedullary femoral nails
Authors: Menken Luke G. , Galos David K. , Patel Neeraj M. , Yoon Richard S. , Liporace Frank A.
Published: September 2024

Objectives:

Does degree of comminution affect femoral version after intramedullary nailing of femoral shaft fractures?

Design:

Retrospective.

Setting:

Standard of care, Level II Trauma Center, Hospital.

Patients/Participants:

We reviewed electronic medical records of consecutive patients from 2000 to 2009 with diaphyseal femoral shaft fractures treated with intramedullary nailing and with available early postoperative computed tomography scanograms. Four hundred seventeen patients were identified, and 307 met inclusion criteria.

Intervention:

Intramedullary nailing of the femur.

Main Outcome Measurements:

Our primary study measure, determined before data collection, was the difference in femoral version between the uninjured limb and the injured limb. Femoral version was determined on postoperative computed tomography scanograms and reviewed by a fellowship trained musculoskeletal radiologist and a senior orthopaedic surgeon.

Results:

Fractures were classified by an experienced orthopaedic trauma attending surgeon. OTA/AO type A fractures were the most common (51.5%), followed by type B (30.0%) and type C (18.5%). When categorized according to the Winquist system, 49.5% were type 1, 14.7% were type 2, 21.2% were type 3, and 14.7% were type 4. In univariate analysis, none of the classification systems were predictive of postoperative difference in femoral version (OTA/AO types and subtypes, OTA/AO types only, all Winquist types, and low-grade vs. high-grade Winquist; P > 0.05 for all). Subsequently, multivariate models did not yield any significant predictors.

Conclusions:

Increasing degree of comminution based on fracture classifications had no significant impact on obtaining acceptable femoral version after intramedullary nailing.

Level of Evidence:

Level III.
Managing Vital and Nonvital Tooth Bleaching Among Endodontists and General Dental Practitioners: A Knowledge, Attitude, and Practice Study
Authors: Halasabalu Kalgeri Sowmya , Mull Paras , Shivakumar Ashwini Tumkur , Doddawad Vidya G. , Doggalli Nagabhushana , Balaraj SunilKumar Bheemasamudra
Published: September 2024

Tooth bleaching has become increasingly popular in recent times. It is the preferred conservative approach for lightening discolored teeth. The primary objective of tooth bleaching is to whiten teeth using oxidizing chemicals that work on both enamel and dentin. The noninvasive nature of modern bleaching systems allow for effective treatment options that meet the high expectations of patients. The objective of this study was to investigate the knowledge, attitude, and practices of dental practitioners in South India for managing discolored upper front teeth. We created and distributed a structured, validated questionnaire about bleaching discolored anterior teeth to South Indian dental practitioners and analyzed the data. We found a statistically significant relationship between endodontists and general dentists in their preferences for isolation techniques, choice of materials for vital bleaching, management of intact nonvital teeth, and management of postbleaching sensitivity. Women exhibit a greater preference for teeth-whitening procedures than men, with 74% opting for whitening treatments. The predominant method for addressing tooth discoloration is bleaching, which makes up approximately 63.8% of the whitening procedures. In-office bleaching is the preferred method for both vital and nonvital bleaching procedures, demonstrating its widespread acceptance and preference among practitioners.
A Personalized Protocol for Facial Rejuvenation Using Two Soft Hyaluronic Acid Fillers With High Cohesivity
Authors: Buttura da Prato Editta , Molina Beatriz , Tanzini Laura , Cigni Clara , Bellia Gilberto
Published: September 2024

Minimally invasive injectable dermal fillers are one of the most commonly used aesthetic treatments for facial soft tissue restoration. Different formulations may be used simultaneously to target multiple areas of concern. Due to differences in their rheological properties that directly impact the recommended injection technique and overall result, the formulations in the Aliaxin®
line are each designed to target different soft facial tissues. This case series addresses two potential treatment approaches and a combination approach specifically developed to achieve harmony and promote a full but soft facial appearance. To reach this goal, we used two different formulations: Aliaxin®
Shape and Restore (ASR) and Aliaxin®
Global Performance (AGP). Four patients, 35–55 years received treatments with ASR, AGP, or both products. Utilizing the two protocols simultaneously achieved targeted support, lift, and volume, along with effective full facial softening and an authentic aesthetic outcome.
Descriptive Epidemiology and Management of Perilunate Injuries
Authors: Patel Alap U. , Thiara Jack , Rivas Zuivanna , Hansen Scott L.
Published: September 2024

Introduction

Perilunate injuries and dislocations, typically caused by high-impact trauma, can lead to acute compression of the median nerve and subsequent complications if left untreated. This study examines the epidemiology, injury mechanisms, immediate treatment, and need for carpal tunnel release in such cases.

Methods

Perilunate injuries at a single level 1 trauma center were retrospectively reviewed from 2014 to 2023. Data on patient demographics, injury mechanism, initial management, and operative management were collected.

Results

Thirty-three cases were analyzed, averaging 33.9 years in age. Injury mechanisms included falls (24% each from 0 to 10 feet and >10 feet, and motor vehicle accidents), bicycle-auto collisions or assaults (10%), pedestrian-auto collisions (5%), and 1 crush injury (3%). Most cases involved trans-scaphoid perilunate dislocation (predominantly Mayfield 3). Initial reduction in the emergency department succeeded in 60% of cases, with 48% showing median nerve paresthesias. Thirty-three percent underwent surgery within 24 hours, and 95% required operative intervention, including open reduction internal fixation (56%), open reduction with percutaneous pinning (30%), and closed reduction with percutaneous pinning (7%). Fifty-two percent needed carpal tunnel release.

Conclusions

Prompt evaluation and treatment are crucial for perilunate injuries. If initial reduction fails, urgent operative intervention is warranted, although delayed management may be appropriate in some cases. Various operative fixation methods exist for realigning carpal bones, emphasizing the importance of tailored approaches to individual cases.
Interhospital variability of risk-adjusted mortality rates and associated structural factors in patients undergoing emergency laparotomy: England and Wales population-level analysis
Authors: Darbyshire Alexander R. , Mercer Stuart J. , Arora Sonal , Pucher Philip H.
Published: September 2024

BACKGROUND

Emergency surgical admissions represent the majority of general surgical workload. Interhospital variations in outcomes are well recognized. This analysis of a national laparotomy data set compared the best- and worst-performing hospitals according to 30-day mortality and examined differences in process and structural factors.

METHODS

A retrospective multicenter cohort study was performed using data from the England and Wales National Emergency Laparotomy Audit (December 2013 to November 2020). The data set was divided into quintiles based on the risk-adjusted mortality calculated using the National Emergency Laparotomy Audit score risk prediction model. Primary outcome was 30-day mortality. Hospital-level factors were compared across all five quintiles, and logistic regression analysis was conducted comparing the lowest with the highest risk-adjusted mortality quintiles.

RESULTS

Risk-adjusted 30-day mortality in the poorest performing quintile was significantly higher than that of the best performing (11.4% vs. 6.6%) despite equivalent predicted mortality (9.4% vs. 9.7%). The best-performing quintile was more likely to be a tertiary surgical (49.5% vs. 37.1%, p < 0.001) or medical school-affiliated center (26.4% vs. 18.0%, p < 0.001). In logistic regression analysis, the strongest associations were for surgery performed in a tertiary center (odds ratio, 0.690 [95% confidence interval, 0.652–0.731], p < 0.001) and if surgery was performed by a gastrointestinal specialist (0.655 [0.626–0.685], p < 0.001). Smaller differences were seen for postoperative intensive care stay (0.848 [0.808–0.890], p < 0.001) and consultant anesthetist involvement (0.900 [0.837–0.967], p = 0.004).

DISCUSSION

This study has identified significant variability in postoperative mortality across hospitals. Structural factors such as gastrointestinal specialist delivered emergency laparotomy and tertiary surgical center status appear to be associated with improved outcomes.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.