bluuebunny/crossref_metadata_2025 huggingface dataset:
Bergenin, the main active ingredient of Bergenia purpurascens, attenuates Th17 cell differentiation by downregulating fatty acid synthesis
Authors: He Yue , Xu Danlei , Zhang Jing , Liu Yan , Liao Minghui , Xia Yufeng , Wei Zhifeng , Dai Yue
Published: October 2024

Bergenin is the main active ingredient of Bergenia purpurascens, a medicinal plant which has long been used to treat a variety of Th17 cell‐related diseases in China, such as allergic airway inflammation and colitis. This study aimed to uncover the underlying mechanisms by which bergenin impedes Th17 cell response in view of cellular metabolism. In vitro, bergenin treatment reduced the frequency of Th17 cells generated from naïve CD4+ T cells of mice. Mechanistically, bergenin preferentially restrained fatty acid synthesis (FAS) but not other metabolic pathways in differentiating Th17 cells, and exogenous addition of either palmitic acid (PA) or oleic acid (OA) and combination with acetyl‐CoA carboxylase 1 (ACC1) activator citric acid dampened the inhibition of bergenin on Th17 cell differentiation. Bergenin inhibited FAS through downregulating the expression of SREBP1 via restriction of histone H3K27 acetylation in the SREBP1 promoter, and SREBP1 overexpression weakened the inhibition of bergenin on Th17 differentiation. Furthermore, bergenin was shown to directly interact with SIRT1 and result in activation of SIRT1. Either combination with SIRT1 inhibitor EX527 or point mutation plasmid of SIRT1 diminished the inhibitory effect of bergenin on FAS and Th17 cell differentiation. Finally, the inhibitory effect of bergenin on Th17 cell response and SIRT1 dependence were verified in mice with dextran sulfate sodium‐induced colitis. In short, bergenin repressed Th17 cell response by downregulating FAS via activation of SIRT1, which might find therapeutic use in Th17 cell‐related diseases.
Factors Related to Rehabilitation Adherence in Pediatric Cancer: A Systematic Review
Authors: Tanner Lynn , Schorr Erica
Published: October 2024

Background: Rehabilitation is crucial for improving the functional outcomes of children and adolescents with cancer. An understanding of factors related to rehabilitation adherence is needed to improve intervention design and effectiveness, and decrease healthcare costs. Therefore, this systematic review aims to identify factors related to pediatric cancer rehabilitation adherence. Methods: Based upon the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a search of MEDLINE and CINAHL was completed in January 2023, including terms of pediatrics, cancer, rehabilitation, and adherence. Study eligibility included: (1) published after 2011, (2) English language, (3) a physical therapy, occupational therapy, speech-language pathology, cognitive or exercise intervention or service, (4) mean age ≤18 years old, within 5 years of a cancer diagnosis, and (5) measurement and reporting of adherence factors. Study quality was evaluated using the Joanna Briggs Critical Appraisal Tools. Results: The review included 13 studies providing interventions to 318 children. Most of the interventions were related to exercise. Adherence levels of supervised sessions ranged from 61% to 91%. Unsupervised intervention adherence was not a common outcome, but the reported measurements ranged widely (<1-72%). The classification of factors associated with adherence included organizational, treatment, and personal factors. Common barriers to adherence were fatigue, illness, time and motivation. Facilitators of adherence included peer or caregiver support and supervision. Conclusion: Additional research is needed to investigate the factors related to rehabilitation intervention adherence, especially factors beyond exercise and those associated with unsupervised interventions. Standardized measures are crucial to ensure the reliability and comparability of findings.
Age-Related Listening Performance Changes Across Adulthood
Authors: Lunardelo Pamela P. , Fukuda Marisa T. H. , Zanchetta Sthella
Published: October 2024

Objectives:

This study compares auditory processing performance across different decades of adulthood, including young adults and middle-aged individuals with normal hearing and no spontaneous auditory complaints.

Design:

We assessed 80 participants with normal hearing, at least 10 years of education, and normal global cognition. The participants completed various auditory tests, including speech-in-noise, dichotic digits, duration, pitch pattern sequence, gap in noise, and masking level difference. In addition, we conducted working memory assessments and administered a questionnaire on self-perceived hearing difficulties.

Results:

Our findings revealed significant differences in auditory test performance across different age groups, except for the masking level difference. The youngest group outperformed all other age groups in the speech-in-noise test, while differences in dichotic listening and temporal resolution emerged from the age of 40 and in temporal ordering from the age of 50. Moreover, higher education levels and better working memory test scores were associated with better auditory performance as individuals aged. However, the influence of these factors varied across different auditory tests. It is interesting that we observed increased self-reported hearing difficulties with age, even in participants without spontaneous auditory complaints.

Conclusions:

Our study highlights significant variations in auditory test performance, with noticeable changes occurring from age 30 and becoming more pronounced from age 40 onward. As individuals grow older, they tend to perceive more hearing difficulties. Furthermore, the impact of age on auditory processing performance is influenced by factors such as education and working memory.
Patellar Tendon Reconstruction Using Quadriceps, Semitendinosus, and Gracilis Autografts With Ultra-high Molecular Weight Polyethylene Tape Augmentation: A Novel Technique
Authors: Goodwin Tyler M. , Hughes Austin G. , Pumphrey Conor M. , Smith Chadwick A. , Bruce Jeremy R.
Published: October 2024

Background:

Chronic patellar tendon ruptures are challenging injuries to treat and can be debilitating to patients. Optimal treatment of these extensor mechanism injuries occurs in the acute postinjury period. When these injuries become chronic, they are increasingly difficult to treat effectively.

Purpose:

We present a case of chronic patellar tendon rupture in a young athletic male who was treated with quadriceps, semitendinosus, and gracilis autograft. To our knowledge, there have been no other reports of using a quadriceps autograft with a bone plug to reconstruct a chronic patellar tendon injury.

Patients and Methods:

A healthy male under the age of 18 presented in a delayed manner to our clinic with complaints of left knee pain and inability to straighten the knee. His imaging and clinical exam found that he had a patellar tendon rupture, ∼15-degree extensor lag, flexion to 140 degrees, and was unable to straight leg raise or perform any active extension of the knee. He had significant atrophy of his vastus musculature at the knee. The rupture was treated with quadriceps, semitendinosus, and gracilis autograft.

Results:

At 6 months follow-up, our patient had achieved full extension, flexion to 135 degrees, and 4 of 5 quadriceps strength. He returned to routine physical activity and was satisfied with his results to date. At 1 year’s follow-up, the patient had full extension and flexion to 140 degrees and had resumed playing recreational soccer.

Conclusion:

Treating chronic patellar tendon rupture with quadriceps, semitendinosus, and gracilis autograft resulted in a positive outcome for this difficult-to-treat injury.
Combination of anlotinib and sintilimab for the treatment of recurrent or metastatic head and neck squamous cell carcinoma: a single-arm prospective study
Authors: Wang Tianxiao , Wang Jiaxin , Zhang Yabing , Song Yuntao , Xu Guohui , Zhang Bin
Published: October 2024

To investigate whether blocking both programmed cell death protein and vascular endothelial growth factor receptor could offer superior anticancer activity in these patients without compromising safety. In this study, patients were administered oral anlotinib (12 mg/day) on days 1–14 and intravenous sintilimab (200 mg) on day 1 of a 3-weekly cycle. The primary endpoints included the objective response rate and disease control rate. The secondary endpoints included overall survival (OS) and safety. Ten eligible patients were enrolled between June 2019 and May 2022, and eight patients underwent radiographic assessments. The results showed an objective response rate of 50% (partial and complete response in four and zero patients, respectively) and a disease control rate of 100%; four patients demonstrated stable disease for at least 8 weeks. The median OS was 4.37 (in our study, the score was 7), and the OS rate at 12 months was 37.5%. The Kaplan–Meier survival curve showed that the group with high blood glucose levels had a significantly shorter duration of survival than those with normal blood glucose levels. Adverse events of grade 3 and higher occurred in 50% of patients, and the most common severe adverse events included tumor pain (50%), hypertension (37.5%), tumor hemorrhage (25%), and decreased appetite (25%). The combination of anlotinib and sintilimab showed promising efficacy in controlling tumor size. However, the disappointing OS rate suggests that anti-vascular endothelial growth factor receptor agents should be used cautiously after radical radiation therapy. The combination used in this study demonstrated a toxicity profile comparable to that of other agents used in this setting. These findings warrant further investigation into the potential clinical utility of this combination.
Associations Between Physical Activity, Systemic Inflammation, and Hospital Admissions in Adults With Heart Failure
Authors: Gore Shweta , Beyer Victoria , Collelo Joseph , Melton Chloe
Published: October 2024

Purpose:

Among individuals with diagnosed heart failure (HF), the impact of physical activity on systemic inflammation and risk of hospital admissions remains unclear. Therefore, the purpose of this study was to examine the associations between physical activity and (1) systemic inflammation measured through C-reactive protein (CRP) levels and (2) frequency of hospital admissions in those with HF.

Methods:

We used data from the National Health and Nutrition Evaluation Survey in this observational cross-sectional study to include 377 community-dwelling adults with HF. Demographic, clinical, and functional variables were extracted from the data and included in the regression models as covariates during analysis. Associations between activity and hospital admissions were examined using Poisson regression. Multivariable logistic regression analysis was used for association between CRP and physical activity.

Results:

We found a direct linear relationship between CRP levels and hospital admissions, with higher levels of CRP significantly associated with greater number of hospital admissions in HF (incidence rate ratio [IRR] = 1.18, P < .001). Similarly, participating in vigorous activity was significantly associated with decreased expected rate of hospital admissions (IRR = 0.38, P = .013 (C.I. = 0.18–0.80) and with a significant decrease in the CRP levels (B = −0.44, P = .018 (C.I. = −0.80 to −0.83).

Conclusion:

To the best of our knowledge, this is the first study using population-level data to examine the association between physical activity level, systemic inflammation, and hospitalizations in individuals with HF. The findings of this study demonstrate that irrespective of sex, engagement in physical activity at higher intensity levels is strongly associated with favorable health outcomes in older adults with HF.
Research progress in inflammation and reward mechanisms and traditional Chinese medicine regulation of depression
Authors: Tong Ge , Chen Yanhan , Liang Yuan
Published: October 2024

This paper summarizes the pathogenesis of impaired inflammation and reward function in depression with the therapeutic potential of traditional Chinese medicine (TCM). Depression has become one of the most common severe psychiatric disorders. The midbrain DA system includes the dopaminergic (DAergic) center of the VTA and several inner brain regions, including NAc, PFC, hippocampus, etc., which are often found to have abnormal functions in depression. Inflammatory mechanisms of depression, including cytokines and other inflammation-related mechanisms. Studies also found that inflammation can promote depression by affecting reward function. Depression belongs to the categories of “stagnation disease” in TCM, with syndromes of TCM, including liver depression and qi stagnation, liver stagnation with spleen deficiency, qi stagnation transforming into fire, intermingled phlegm and qi, deficiency of the heart and spleen, as well as kidney deficiency and liver stagnation. TCM regulates inflammation and reward function that ameliorates depression. This summary provides new perspectives and approaches for the treatment of depression.
From biological potency absorbed components to artificial intelligence mining: a review of analytical strategies for the discovery and validation of quality marker in traditional Chinese medicine in the past decade
Authors: Li Ziting , Dai Yi
Published: October 2024

Quality control of traditional Chinese medicine (TCM) is fundamental to ensuring its clinical efficacy, with TCM formulas being the primary form used in clinical practice. Current quality control methods for TCM formulas often rely on pharmacopoeial standards for individual medicinal materials, typically encompassing only characteristic or partial active ingredients. These methods fail to fully reflect the clinical efficacy of TCM formulas. Consequently, exploring the multiple efficacious components in TCM formulas and establishing the correlation between multicomponent content and efficacy has become an urgent issue in the modern quality assessment of TCM formulas. The quality marker has emerged as a crucial standard in this field, achieving notable success in recent years. This paper reviews recent progress in the development of the quality marker system in TCM by highlighting strategies based on the correlation between efficacy and constituents, using analytical techniques to investigate the material basis and efficacy of TCM. However, the aforementioned methods inevitably involve human selection factors. With the widespread application of artificial intelligence learning algorithms, it is now possible to develop a modern quality evaluation method for the multicomponent “efficacy-quality” correlation in TCM formulas. This approach leverages artificial intelligence techniques to explore novel and quantifiable methods for scientific and rational quality control in TCM formulas. In this paper, important future directions and questions in this field are also discussed.
Erosive pustular dermatosis of the scalp
Authors: Otter Elizabeth
Published: October 2024

This case of an elderly woman with a rapidly growing lesion of her scalp that developed several months after treatment of a squamous cell carcinoma with Mohs micrographic surgery illustrates a known precipitating trigger of erosive pustular dermatosis of the scalp. This report describes the clinical stages of the disease and their corresponding histologic findings. It reviews the epidemiology and proposed etiology of this erosive pustular dermatosis of the scalp. The differential diagnoses of scalp disease are extensive. An approach to evaluating scalp dermatoses through physical examination, laboratory testing and pathology findings will be discussed. Finally, treatment of this chronic condition, including both patient education and medical management, is detailed.
Assessing Doula Preparedness for Supporting Clients in a Hospital-Based Volunteer Doula Program
Authors: Lanning Rhonda K. , Locke Emily L. , Eaves Lauren A. , Desrosiers Tania A.
Published: October 2024

Purpose and Background: The purpose of this evaluation was to assess doulas’ sense of preparedness after completing birth doula training. The extent to which doulas feel prepared to serve clients after training is unknown. Methods: This program evaluation took place within a hospital-based volunteer doula program in the southeastern United States. The analysis focused on comparing the self-reported preparedness of volunteer doulas trained through the Partners in Birth Training program, a doula training created by the doula program, with preparedness of volunteer doulas trained by nationally recognized training programs. A survey assessed doulas’ preparedness to provide physical, emotional, and informational support. Results: Of the 100 doulas active in the program at the time of survey administration, 48 had completed the Partners in Birth Training program, 26 (54%) of whom completed the survey. Of the 32 doulas who entered the doula program following training with national organizations, 19 (59%) completed the survey. The remaining 20 doulas in the program completed a third training option and were excluded from this evaluation. In comparing doulas’ overall sense of preparedness between the 2 groups, results were similar, with the median response for both groups being mostly prepared (4 on a Likert scale from 1 to 5). Conclusions: Results suggest that localized doula training offered by hospital-based doula programs may be as effective at preparing doulas to serve in such programs as Other training organizations. Implications for Practice and Research: Systematic evaluations can help researchers and doulas identify topics and pedagogical approaches to training that increase preparedness.
Neonatal Bilirubin Assessment After Implementation of Enhanced Recovery After Caesarean Section
Authors: Resmi Dian C. , Ruswantriani  , Farhan Muhammad , Achmad Elsa Anjani , Handayani Nining , Wulandari Tri Aprilliana , Sundari Ayu Mulia , Sini Ivan
Published: October 2024

Objective: The implementation of Enhanced Recovery After Cesarean (ERAC) is associated with significant improvement in maternal outcomes; however, its impact on neonatal outcomes remains limited. This study aims to evaluate the impact of ERAC protocol on neonatal outcomes. Methods: A retrospective cross-sectional study was conducted at Bunda Women and Children Hospital, Jakarta, Indonesia between 2021 and 2022 on women who performed cesarean delivery at 37 weeks and above. The primary outcome was neonatal bilirubin level and the secondary outcome was neonatal length of stay and breastfeeding rate. Results: Differences between outcomes were analyzed by comparing each parameter in non-ERAC (n = 356) and the ERAC groups (n = 331). The median bilirubin levels and neonatal length of stay did not exhibit significant differences between the non-ERAC and the ERAC group (9.5 mg/dL vs 9.5 mg/dL, P = .545, for bilirubin levels, and 3 days vs 3 days, P = .060 for neonatal length of stay). However, the ERAC group demonstrated a significantly higher breastfeeding rate compared to the non-ERAC group (3 hours vs 5 hours, P < .001, respectively). Conclusions: The implementation of the ERAC protocol does not influence neonatal bilirubin levels and the length of neonatal hospital stays but it increases breastfeeding rate.
Sutureless FOCUS harmonic scalpel versus clamp-and-tie techniques for thyroidectomy: a meta-analysis of 43 randomized controlled trials
Authors: Cirocchi Roberto , Matteucci Matteo , Lori Eleonora , D’Andrea Vito , Arezzo Alberto , Pironi Daniele , Avenia Stefano , Randolph Justus , Tiraboschi Ileana , Tebala Giovanni Domenico , Popivanov Georgi I. , Sorrenti Salvatore
Published: October 2024

Background:

One of the most important surgical steps during thyroidectomy is the safe ligation of vessels. In fact, it is crucial to avoid postoperative bleeding and nerves’ injury. The “clamp and tie” technique was first introduced in the 19th century. Since then, a lot of other techniques have been adopted to facilitate the safe ligation and sectioning of thyroidal vessels; however, one of the most relevant advances is the introduction of energy-based devices (EBDs), which occurred three decades ago.

Purpose:

The aim of this systematic review and meta-analysis is to evaluate the safety and effectiveness of sutureless FOCUS harmonic scalpel (second-generation EBDs) versus conventional clamps-and-tie technique) in total thyroidectomy.

Results:

This systematic review and meta-analysis represent the largest comparison in the literature between the thyroidectomy procedure with the second-generation advanced harmonic scalpel ultrasonic focus (UAS FOCUS) versus the conventional clamp-and-tie (CT) technique: as a matter of fact, it includes 43 randomized controlled trials (RCTs) and a total of 10 361 patients. The incidence of transient recurrent laryngeal nerve palsy was statistically lower in patients undergoing UAS (3.99%) rather than CT (5.23%) (RR 0.79, 95% CI 0.63–0.99). The incidence of transient hypocalcemia was 11.3% in patients who underwent thyroidectomy with UAS FOCUS and 15.4% in those who underwent thyroidectomy with CT.

Conclusion:

Sutureless EBD is associated with a lower risk of damage to the laryngeal nerves and parathyroid glands. The rate of hypocalcemia and nerve paresis is indeed lower due to less thermic damage. Sutureless EBD can also diminish the rate of postoperative bleeding and cervical hematoma, a rare but potentially fatal complication.
Serum ACSL4 levels in prostate cancer patients and its relationship between patient prognosis: A prospective observational study
Authors: Wang Hao , Xu Hanfeng , Yang Yuan
Published: October 2024

In this prospective observational study, our objective was to investigate the serum levels of Acyl-CoA synthetase long-chain family member 4 (ACSL4) in prostate cancer (PCa) patients and examine its association with other serum biomarkers, and the clinical outcomes of PCa patients. This prospective observational study was conducted from January 2019 to October 2021, including 103 cases of PCa patients and 101 cases of benign prostate hyperplasia (BPH) patients who received treatment at our hospital. All patients had their serum ACSL4 levels measured using enzyme-linked immunosorbent assay before treatment. The clinical outcomes included age, body mass index, gender, systolic blood pressure, diastolic blood pressure, tumor node metastasis stage, Gleason scores, and prostate volume and serum biomarkers were collected. All patients were followed up for 36 months, the overall survival and disease-free survival were recorded for all patients. All data used SPSS 26.0 for analysis. The phosphorus (P) and serum low-density lipoprotein cholesterol levels were significantly higher in PCa patients compared to BPH patients. Furthermore, compared to the BPH patients, the serum ACSL4 and free prostate-specific antigen levels were significantly decreased while serum total prostate-specific antigen (tPSA) levels were significantly elevated in PCa patients. Pearson correlation analysis showed a positive correlation between ACSL4 levels and free prostate-specific antigen levels, while a negative correlation was observed with P and tPSA levels. ACSL4 might serve as a biomarker for diagnosing PCa with the AUC was 0.747, cutoff value of 33.68 ng/mL, sensitivity of 70.3%, and specificity of 60.2%. Finally, we found that ACSL4, tPSA, and P were identified as risk factors associated with PCa patients. Our findings indicated that the serum levels of ACSL4 were significantly decreased in PCa patients compared to BPH patients. Serum ACSL4 could be used as a potential biomarker for early PCa diagnosis and prognosis.
Symmetrical peripheral gangrene caused by urosepsis: Case reports and literature review
Authors: Chen Yuanyuan , Liu Kai , Xu Xiujuan , Wu Gaofei , Zhu Lianghua , Zha Junjing , Cheng Chuji
Published: October 2024

Rationale:

Symmetrical peripheral gangrene (SPG) is a serious and rare complication in patients with urosepsis, characterized by distal limb symmetry impairment.

Patient concerns:

In this study, 3 cases of SPG caused by urosepsis were reported, and the Chinese and English literature on SPG caused by urosepsis was reviewed. The demographic, clinicopathological, treatment, and follow-up data of the patients were summarized and analyzed.

Diagnosis:

SPG was diagnosed with clinical symptoms.

Interventions:

We conducted urological invasive surgery, administered anti-infective therapy, implemented fluid resuscitation and blood product transfusion, provided mechanical ventilation support, optimized myocardial contractility, administered heparin and B vitamins, utilized papaverine for vasodilation, performed hemodialysis and plasma exchange, peripheral skin warming along with other treatment modalities.

Outcomes:

Two patients died and 1 patient underwent autoamputation.

Lessons:

Our cases and literature review demonstrate that timely and accurate diagnosis, effective infection control, correction of hypoperfusion, organ function support, early management of disseminated intravascular coagulation, avoidance of premature amputation, and multidisciplinary comprehensive treatment are crucial for the successful treatment of SPG caused by urosepsis.
Effects of scapular motion control training on treatment of patients with scapular fractures: An observational study
Authors: Lu Jianshu , Cheng Shuai , Dai Hongmei , Zhao Gang , Jiang Shanyong , Wang Zhitao , Jiang Baoen
Published: October 2024

To explore the effect of scapula motion control training on the rehabilitation effect of patients with scapular fracture. According to the random number table method, 61 patients were evenly divided into observation group 30 cases and control group 31 cases. The control group received routine postoperative functional exercise, and the observation group received functional exercise by adding scapula motion control training to the routine postoperative functional exercise. The pain, daily activity, range of shoulder movement, strength test, and total score were compared between the 2 groups of patients at 4 and 12 weeks after surgery. After 4 and 12 weeks of treatment, compared with the control group, the daily activities, range of shoulder movements, and total scores of the observation group increased, and there were no significant differences in pain and strength tests. After 12 weeks of treatment, compared with the control group, the daily activity, range of shoulder movements, and total score of the observation group were higher than those of the control group. Scapular motion control training can effectively improve the treatment of patients with scapular fractures and has clinical application value.
An unusual case of recurrent traumatic spinal epidural hematoma accompanied by osteoporotic vertebral compression fractures: Case report
Authors: Meng Yake , Su Kai , Dai Yaojun , Chang Xiaopan , Yang Yong , Mei Wei , Zhang Wei , Pan Hao
Published: October 2024

Rationale:

Traumatic spinal epidural hematoma (SEH) is a rare clinical condition. Here, we present an extraordinary case of recurrent SEH accompanied by thoracolumbar spine fractures resulting from minor trauma, and provide evidence-based recommendations for the surgical management strategies in this unique scenario.

Patient concerns:

A 71-year-old female patient presented with back pain after a fall. Magnetic resonance imaging revealed an SEH with L2 vertebral compression fracture. Following unsuccessful conservative treatment, percutaneous vertebroplasty was performed at the 2nd lumbar vertebra under local anesthesia. Two years later, the patient experienced another fall and was diagnosed with spinal hematoma with L1 vertebral compression fractures.

Diagnoses:

The patient was diagnosed with recurrent osteoporotic vertebral compression fracture accompanying SEH.

Outcomes:

After 1 week of conservative treatment, notable improvement of limbs numbness was observed. The patient ultimately underwent L1 vertebroplasty surgery. The patient was discharged smoothly on the third postoperative day and made a full recovery after 4 months.

Lessons:

SEH is a rare clinical finding that can occur even after a minor trauma in the elderly. It is worth noting that osteoporotic vertebral compression fractures with asymptomatic or stable intraspinal hematoma, is not considered to be a contraindication for percutaneous vertebroplasty. And percutaneous vertebroplasty is a safe and effective treatment for osteoporotic compression fractures with asymptomatic SEH.
Transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty for corneal ulcer perforation in Graves’ ophthalmopathy: A case report
Authors: Wang Pei , Han Zijian , Li Xiuhong , Lin Ru , Yuan Hongfeng
Published: October 2024

Rationale:

To report a unique case of corneal ulcer perforation associated with a severe manifestation of Graves’ ophthalmopathy that was treated with unilateral transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty.

Patient concerns:

A 66-year-old male with Graves’ disease experiencing unilateral corneal ulcer perforation, a rarity in medical literature. He presented with a 9-month history of bilateral exophthalmos accompanied by decreased vision, and over the past month, he experienced loss of vision and painful swelling in the right eye (RE).

Diagnoses:

After a series of examinations, he was diagnosed with Graves’ ophthalmopathy.

Interventions:

Through local anti-infective treatment, the RE corneal ulcer showed no signs of infection. Once the patient’s thyroid function and heart rate were stable and his overall condition was stable, he underwent RE unilateral transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty under general anesthesia.

Outcomes:

The patient underwent successful unilateral transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty, resulting in a significant 4 mm reduction in orbital proptosis and it improved the vision and saved the eyes.

Lessons:

Transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty is an effective method for treating corneal ulcer perforation caused by Graves’ ophthalmopathy. This method can not only greatly improve the appearance but also save the patient’s eyeball and improve visual function.
Primary gastric epithelioid angiosarcoma: A case report of diagnostic biopsy pitfall
Authors: Zhou Ning , Yang Li , Li Tao , Chen Liqiao , Jia Ruiqi , Chen Ying
Published: October 2024

Rationale:

Angiosarcoma is an aggressive neoplasm derived from endothelial cells that may develop anywhere within the body. Here, we report a case of primary gastric epithelioid angiosarcoma initially misdiagnosed as poorly differentiated adenocarcinoma from the preoperative biopsy.

Patient concerns:

The patient was a 60-year-old male admitted to the hospital due to abdominal discomfort. The gastroscopy examination suggested advanced gastric cardia carcinoma. Subsequent biopsy pathology examination confirmed the diagnosis of poorly differentiated adenocarcinoma. Therefore, the patient underwent radical resection for proximal gastric cancer. Histopathology showed that the tumor cells were epithelioid with rich, eosinophilic cytoplasm. Immunohistochemical examination indicated that the tumor cells were CD34, CD31, and ERG.

Diagnoses:

Based on clinical, morphological, and immunophenotypic evidence, primary gastric epithelioid angiosarcoma diagnosis was confirmed.

Interventions:

The postoperative Tumor Node Metastasis staging was considered T4aN1Mx. The patient did not receive chemotherapy.

Outcomes:

The patient died 3 months after the operation.

Lessons:

Primary gastric epithelioid angiosarcoma is a rare gastric tumor. Given the epithelioid cell features displayed by tumor cells and the high expression of epithelial markers in tumor cells (83%), preoperative diagnosis is difficult and should be differentiated from adenocarcinoma or gastrointestinal stromal tumor.
Proton pump inhibitor-induced hypomagnesemia, a rare cause of reversible delirium: A case report with literature review
Authors: Zhao Wanxia , Zhang Jing , Jia Hongwei , He Qing , Cui Jingqiu , Ding Li , Liu Ming
Published: October 2024

Rationale:

Hypomagnesemia is associated with multiple electrolyte disturbances such as hypokalemia, hypocalcemia and hypoparathyroidism. Proton pump inhibitors (PPIs) are widely used in gastrointestinal disorders and are generally considered safe by clinicians. However, it is unusual side effect of hypomagnesemia is potentially under-recognized. Delirium is usually thought to be a clue of cerebrovascular disease, and the association between delirium and hypomagnesemia is unexpected. We describe a patient used PPI with hypomagnesemia showed normal parathyroid hormone (PTH) despite hypocalcemia and reversible delirium. To enhance clinicians’ vigilance, we performed a literature review on cerebellar syndromes due to hypomagnesemia.

Patient concerns:

A 74-year-old woman was admitted to our hospital with intermittent nausea, vomiting, hand tremors, and delirium.

Diagnosis:

Laboratory analysis showed hypokalemia, hypomagnesemia, and normal parathyroid hormone despite hypocalcemia, physical examination showed horizontal nystagmus and the brain MRI was negative. Surprising, detailed medical history revealed that the etiology was the usage of omeprazole.

Interventions:

Omeprazole was discontinued and oral supplementation with magnesium, calcium, and potassium was administered.

Outcomes:

Delirium quickly disappeared and the serum potassium, magnesium, and calcium levels gradually normalized; at discharge, nystagmus gradually disappeared, and plasma electrolyte levels were stable at follow-up.

Lessons:

Hypomagnesemia is associated with a variety of neurological symptoms up to life-threatening conditions if left untreated; as Mg is not present in routine electrolyte panels, hypoparathyroidism, hypokalemia, and delirium may be a clue, and physicians must be alert to consider PPI as a potential cause of unexplained hypomagnesemia, and timely treatment to avoid sequelae.
Uterine carcinosarcomas: A case series of 9 cases from a low-income country
Authors: Efared Boubacar , Koura Halidou Hamadou , Bako Aïchatou Balaraba Abani , Boubacar Idrissa , Boureima Habiba Salifou , Mahamadou Garba , Nouhou Hassan
Published: October 2024

Rationale:

Uterine carcinosarcomas (UCS) are rare aggressive biphasic tumors classified as a subtype of high-grade uterine carcinomas. However, these tumors have particular histopathological features and clinical behavior with worse prognosis than high-grade uterine carcinomas.

Patient concerns:

The incidence of UCS is increasing and more studies are required to elucidate their clinical and histopathological characteristics. Herein, we report clinicopathological features of 9 cases of UCS in a low-income country.

Diagnoses:

We retrospectively collected all cases of UCS at our Pathology Department over a period of 4 years. The diagnosis was performed on formalin-fixed, paraffin-embedded and hematoxylin and eosin–stained surgical specimens.

Interventions:

Nine surgically treated cases of UCS have been registered, representing 12.67% of all uterine malignancies with a mean age of 58.88 years (range: 50–65 years). Abdominal pain and metrorrhagia were the main clinical presentations. The epithelial component of UCS was often a serous carcinoma (66.66%) and patients presented with large tumors (mean size of 9.24 cm, range of 5–19 cm), with advanced FIGO stages (stages III–IV) in 5/9 patients (55.55%).

Outcomes:

Follow-up data were available in 5/9 patients among which only 2 were alive 2 and 25 months after the surgical treatment (overall survival of 40%).

Lessons:

UCS are rare and aggressive uterine tumors with very poor prognosis especially in low-income countries.
Combined traditional Chinese medicine and anti-hypertensive treatments for renal hypertension: A network meta-analysis and systematic review
Authors: Guo Jinjing , Jiang Zhibing , Yang Siyu , Meng Bin , Tang Qun
Published: October 2024

Background:

Traditional Chinese medicine (TCM) demonstrates significant effects on renal function, yet it remains unclear which TCM treatment yields the best clinical outcomes for renal hypertension (RH) management. This study aims to evaluate the safety and effectiveness of various TCM treatments for RH compared to conventional Western medicine (CWM).

Methods:

Randomized controlled trials (RCTs) of TCM for RH were screened from 9 databases, covering the period up to July 2023. The Cochrane Risk of Bias tool was utilized to assess the risk of bias in the included RCTs. Network meta-analysis was conducted using RevMan 5.3 and Stata 14.0 software. Sensitivity analyses and meta-regression were performed to identify sources of heterogeneity and assess result robustness.

Results:

This study encompassed 3879 patients from 44 investigations involving 29 TCM interventions. The quality of the studies ranged from moderate to excellent, with well-defined inclusion criteria and generally low potential for biases related to outcome data and selective reporting. Tianma Gouteng Yin combined with Qiju Dihuang Wan + CWM demonstrated the highest total effective rate (relative risk = 1.31, 95% confidence interval (CI): 1.03, 1.66) compared to CWM alone. Bailing capsule + CWM was optimal for improving serum creatinine (mean difference (MD) = −53.78, 95% CI: −96.59, −10.98). Ziyin Pinggan Huayu decoction + CWM had the highest likelihood (surface under the cumulative ranking curves = 56.2%) of improving blood urea nitrogen. Zishen Pinggan prescription + CWM showed the greatest improvement in systolic blood pressure (MD = −46.29, 95% CI: −73.19, −19.38), while Ye Ren Gao decoction + CWM demonstrated the best improvement in diastolic blood pressure (MD = −13.13, 95% CI: −20.12, −6.13). Xifeng Qingnao decoction + CWM achieved the best improvement in 24-hour urinary protein (MD = −2.00, 95% CI: −3.26, −0.74). The combination of TCM and CWM was associated with a lower incidence of adverse effects.

Conclusion:

Combination therapy of TCM with CWM surpasses CWM alone in treating renal hypertension. This study identifies the most effective combination treatment for RH, as well as optimal treatments for lowering blood pressure (Zishen Pinggan prescription + CWM) and improving renal function (Bailing capsule + CWM).
Construction and validation of an immune-related gene signature predictive of survival and response to immunotherapy for colorectal cancer
Authors: Li Chen , Chen Mingyang , Liu Miao , Yuan Zhiyong
Published: October 2024

Colorectal cancer is a common malignant tumor with the second incidence rate and the third mortality rate worldwide. In this study, we identified and validated an immune-related gene signature, explored the clinical and molecular characteristics of the signature-defined risk groups, and assessed its ability in predicting prognosis, immune cell infiltration and immunotherapy responses. The Cancer Genome Atlas database was used as the training set while GSE39582 database as the validation set. Immune-related hub genes were selected by the Least Absolute Shrinkage and Selection Operator-penalized Cox regression model, and the signature was then constructed by the selected genes and their relevant coefficients. Prognostic performance of the signature and the signature-base nomogram models were assessed by time-dependent receiver operating characteristic curves and calibration plots in both training and validation cohorts. Clinical and mutation-related data were downloaded and analyzed to explore their associations with signature-defined risk groups. Proportions of infiltrated immune cells was estimated via CIBERSORT algorithm and immunotherapy response was evaluated by immunophenoscore and tumor immune dysfunction and exclusion scores. Seven among 790 immune-related differentially-expressed genes were selected and use to construct the signature. The signature and signature-base nomograms showed promising prognostic performance in both training and validation cohorts. Signature-defined high-risk group was associated with advanced disease, poor pathological prognostic factors and less active immune infiltration microenvironment. Besides, the response to immunotherapy of high-risk group was predicted to be poorer by immunophenoscore and tumor immune dysfunction and exclusion scores. Our signature proved its efficacy in predicting prognosis, tumor immune microenvironment and responses to immunotherapy in colorectal cancer.
The effect of copper and vitamin D on osteoarthritis outcomes: A Mendelian randomization study
Authors: Luo Huan , Zhang Yue , Meng Chen , Li Chuan , Jia Daqi , Xu Yongqing
Published: October 2024

This study aimed to explore the causal relationship between trace elements and osteoarthritis (OA). The results showed a relatively weak association between copper and OA, while vitamin D showed a significant positive association with OA. Mendelian randomization (MR) analysis was used to investigate the causal relationship between copper and vitamin D and OA. A variety of MR methods including inverse variance weighting, weighted median, MR-Egger, simple model, and multi-text mixed model were analyzed to confirm the consistency of these results. Sensitivity analysis further confirmed the reliability of these causal relationships and excluded the interference of pleiotropy. These findings add to the understanding of the potential role of micronutrients in the prevention and treatment of OA and support the idea of vitamin D as a potential therapy for the prevention and treatment of OA. Future studies should further explore the specific biological mechanisms of these trace elements and the differences in their effects in different populations in order to develop more effective treatment strategies to reduce the health burden of degenerative joint diseases.
Splenic rupture following endoscopic mucosal resection: A case report and literature review
Authors: Ye Yusong , Yang Rui , Peng Shicheng , Xiang Qilang , Chen Yuexi , Lü Muhan , Yang Weixing
Published: October 2024

Rationale:

This study aims to highlight the rare but severe complication of splenic rupture following colorectal endoscopic mucosal resection (EMR), advocating for increased vigilance during procedures near the splenic flexure.

Patient concerns:

We present a case report of a 66-year-old woman who experienced persistent abdominal pain after undergoing EMR for an adenomatous lesion in the distal transverse colon.

Diagnoses:

The diagnosis of splenic rupture was established following her symptoms and clinical evaluation.

Interventions:

Active conservative management was implemented after diagnosis.

Outcomes:

The patient’s recovery underscores the importance of prompt diagnosis and careful monitoring.

Lessons:

Although splenic rupture after EMR is extremely rare, it is a serious and potentially life-threatening complication. When obtaining informed consent, it is important to emphasize not only common complications like bleeding and perforation but also the risk of splenic injury. Physicians should select appropriate instruments and carefully adjust the angle and force of needle insertion, avoiding excessively long needles and vertical insertion. The procedure should be performed gently to minimize the risk of splenic rupture. For lesions near the splenic flexure, if postoperative abdominal pain occurs, regardless of left shoulder pain, splenic rupture should be considered, and a computed tomography scan promptly performed. Postoperatively, physicians should closely monitor vital signs and repeatedly check blood counts and coagulation parameters. Treatment should be tailored to the splenic injury’s extent and the patient’s overall condition, with immediate surgery if necessary. High-risk patients should be regularly followed up and instructed to monitor for physical changes. Endoscopists should remain vigilant during procedures, fully understanding potential complications, and closely monitoring the patient’s condition postoperatively. This vigilance is key to preventing severe complications and ensuring optimal outcomes.
Causal relationship between lymphocyte subsets and the risk of sepsis: A Mendelian randomization study
Authors: Chen Jing , Wang Rong Hui , Xie Sheng , Xiang Jun Jun , Zheng Fu Kui , Huang Qiao Ming , Mo Qiu Lan , Wei Qiu Gui , Liu Zu Lu
Published: October 2024

Recent empirical research posits a link between lymphocyte subgroups and both the incidence and prognosis of sepsis. Nevertheless, the potential influence of multiple confounding variables obscures any clear causative correlation. Utilizing a 2-sample Mendelian randomization approach, we conducted a meta-analysis of lymphocyte subgroups. In a genome-wide association study, flow cytometry was applied to a lymphocyte subgroup comprising 3757 Sardinians to identify genes influenced by blood immune cells. The sepsis meta-analysis data were sourced from the UK Biobank database, including 11,643 treatment groups and 47,841 control groups. Inverse variance-weighted, Mendelian randomization-Egger regression, weighted median, simple mode, and weighted mode methods were deployed to ascertain the causative relationship between lymphocyte subgroup and sepsis. Cochran Q test, the Mendelian randomization-Egger intercept test, and funnel plots were leveraged to assess the robustness of study findings. The inverse variance-weighted analysis disclosed that the absolute count of CD4 regulatory T cells (CD4 Treg AC) within the lymphocyte subgroup has a causative link to an elevated risk of sepsis, with an odds ratio of 1.08 and a 95% confidence interval of 1.02 to 1.15 (P = .011). Compared to individuals not subjected to this factor, those exposed to CD4 Treg AC have a marginally elevated sepsis risk by approximately 0.08%. No causative relationships were observed between sepsis risk and the absolute counts of other lymphocyte subgroups such as CD8+ T cells, CD4+ CD8dim T cells, natural killer T cells, B cells (B cell absolute count), and HLA DR+ natural killer cells. The 2-sample Mendelian randomization study indicated a causal relationship between the level of CD4 Treg AC and the increased risk of sepsis. The elevation in circulating lymphocyte subgroups suggests higher susceptibility to sepsis, affirming the immune susceptibility inherent to this condition. The findings from our study may propose potential targets for diagnosis and intervention of sepsis.