bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric macular hole associated with vitreoretinal traction on epiretinal lesions – a case report and literature review
Authors: Said Reeda Bou , Kraker Jessica A. , Trejo-Lopez Jorge , Salomao Diva R. , Scruggs Brittni A.
Published: October 2024

Purpose:

We describe a case of non-traumatic macular hole in a pediatric patient associated with numerous epiretinal lesions throughout the macula.

Methods:

A healthy 9-year-old girl presented to retina clinic with several months of blurry vision in the right eye. Clinically, there was a full-thickness macular hole with serous detachment and white epiretinal tufts. Spectral-domain optical coherence tomography confirmed the presence of the full-thickness macular hole with hyperreflective epiretinal proliferations in the right eye and an unremarkable left eye. Systemic work-up was negative. After a short period of observation, the patient underwent vitrectomy with internal limiting membrane peel and 14% C3F8 gas tamponade in the right eye. Multiple intraoperative samples were sent for further testing, which were also negative.

Results:

At one and six-month postoperative visits, examination showed successful closure of the full-thickness macular hole with resolution of the subretinal fluid and improved visual acuity.

Conclusion:

Non-traumatic macular holes in pediatric patients warrant systemic and ocular work-up, including fluorescein angiography and lab testing. Good anatomic and visual outcomes are generally seen with spontaneous and surgical closures of macular holes in this age group. Early vitrectomy with histological analysis of ocular samples should be considered in pediatric macular hole cases associated with vitreoretinal traction, especially those with epiretinal abnormalities.
Spontaneous and Surgical Resolution of Maculopathy in Bilateral Optic Disc Pit After Posterior Vitreous Detachment: A Case Report
Authors: Eker Serhat , Gonul Saban
Published: October 2024

Purpose:

To report a case of bilateral optic disc pit (ODP) maculopathy using a different treatment approach.

Methods:

Observational case report.

Results:

A 17-year-old male presented with blurred vision in both eyes. His visual acuity was 20/400 in the right eye and 20/200 in the left eye. Fundus examination revealed bilateral temporal ODP and maculopathy. Optical coherence tomography scans showed severe intraretinal schisis-like changes, subretinal fluid, and parafoveal vitreomacular traction due to posterior hyaloid thickening in both eyes. Pars plana vitrectomy, in combination with internal limiting membrane peeling and gas tamponade, was performed on his left eye. A conservative approach was preferred due to high myopia and milder maculopathy in the right eye. Regressed maculopathy was found after spontaneous posterior vitreous detachment in the right eye.

Conclusion:

Our case report may contribute to the knowledge regarding the role of vitreomacular abnormalities in the pathogenesis of ODP maculopathy.
Early Results of Preserflo MicroShunt for Primary Open Angle Glaucoma in White Patients
Authors: Pillunat Karin R. , Herber Robert , Jamke Melanie , Jasper Carolin S. , Haase Maike A. , Manseck Anna S. , Pillunat Lutz E.
Published: October 2024

Précis:

The Preserflo MicroShunt effectively lowered intraocular pressure in primary high and normal pressure open angle glaucoma.

Purpose:

To evaluate the efficacy and safety of the Preserflo MicroShunt in patients with primary open angle glaucoma (POAG) and the 2 variants high (HPG) and normal pressure glaucoma (NPG) after 1 year.

Methods:

Single-center prospective interventional case series consecutively including eyes of White/European patients with POAG, who received the Preserflo MicroShunt as a primary and standalone glaucoma intervention. Primary outcome measures: change in mean 24-hour IOP (mdIOP, mean of 6 measurements), peak IOP, IOP fluctuations, antiglaucoma medications, and success rates. Secondary outcome measures include visual acuity, visual fields, complications, surgical interventions, and adverse events.

Results:

Forty-two eyes of 42 patients with POAG, 29 in the HPG and 13 in the NPG group, were analyzed after 1-year follow-ups. Median [Q25, Q75] medicated mdIOP (mm Hg) dropped by 30% from 16.5 [13.7–27.3] to 12.8 [10.2–14.5] in the HPG and by 40% from 14.3 [13.3–16.0] to 9.5 [8.3–11.1] in the NPG group, with a median postoperative medication use of 0 [0–0] in both groups. At 1 year, 92.5% of eyes were medication-free versus 0% preoperatively. The reduction of mdIOP (P=1.0), peak IOP (P=0.932), IOP fluctuations (P=0.142), and the rate of interventions (P=0.298) were not statistically significantly different between the HPG and NPG group. None of the patients experienced severe adverse events or loss of vision.

Conclusions:

Effective and safe intraocular pressure lowering was observed 1 year following MicroShunt implantation for primary HPG and NPG in White patients of European descent.
Pain and development: interacting phenomena
Authors: Boerner Katelynn E. , Schechter Neil L. , Oberlander Tim F.
Published: October 2024

For decades, clinicians and researchers have observed bidirectional relationships between child development and the pain experience in childhood. Pain in childhood is an inherently developmental phenomenon, embedded in an iterative, time-dependent process that reflects individual biological, behavioral, social, psychological, and environmental characteristics that unfold across the early life span. Childhood pain can have wide ranging effects on brain development in ways that contribute—for better and worse—to social, emotional, and cognitive well-being in childhood and on into adulthood. Atypical trajectories of development in the context of disorders such as autism, cerebral palsy, ADHD, and mood/anxiety disorders also contribute to unique childhood pain experiences. In this paper, pain will be considered as a determinant of development, and conversely development will be considered as a key determinant of a child's pain experience. We will discuss how intersectional identities (eg, gender, race, socioeconomic status) and associated social, structural, systemic, and physical environments influence the relationship between development and pain. Finally, we will identify what might be needed to think “developmentally” in ways that extend from the “bench side” in the lab to the “curb side” in the community, integrating a developmental perspective into research and clinical practice to achieve health accessibility and equity in pain care for all children across the developmental spectrum.
“Neuroinflammation”: does it have a role in chronic pain? Evidence from human imaging
Authors: Loggia Marco L.
Published: October 2024

Despite hundreds of studies demonstrating the involvement of neuron-glia-immune interactions in the establishment and/or maintenance of persistent pain behaviors in animals, the role (or even occurrence) of so-called “neuroinflammation” in human pain has been an object of contention for decades. Here, I present the results of multiple positron emission tomography (PET) studies measuring the levels of the 18 kDa translocator protein (TSPO), a putative neuroimmune marker, in individuals with various pain conditions. Overall, these studies suggest that brain TSPO PET signal: (1) is elevated, compared to healthy volunteers, in individuals with chronic low back pain (with additional elevations in spinal cord and neuroforamina), fibromyalgia, migraine and other conditions characterized by persistent pain; (2) has a spatial distribution exhibiting a degree of disorder specificity; (3) is parametrically linked to pain characteristics or comorbid symptoms (eg, nociplastic pain, fatigue, depression), as well as measures of brain function (ie, functional connectivity), in a regionally-specific manner. In this narrative, I also discuss important caveats to consider in the interpretation of this work (eg, regarding the cellular source of the signal and the complexities inherent in its acquisition and analysis). While the biological and clinical significance of these findings awaits further work, this emerging preclinical literature supports a role of neuron-glia-immune interactions as possible pathophysiological underpinnings of human chronic pain. Gaining a deeper understanding of the role of neuroimmune function in human pain would likely have important practical implications, possibly paving the way for novel interventions.
When thinking about pain contributes to suffering: the example of pain catastrophizing
Authors: Haythornthwaite Jennifer A. , Campbell Claudia M. , Edwards Robert R.
Published: October 2024

The extensive literature on the potent role negative thoughts about pain have on the experience of pain and pain-related suffering has documented associations with important neurobiological processes involved in amplifying nociceptive signals. We focus this review on pain catastrophizing (pCAT)— appraisals of pain as threatening, overwhelming, and unmanageable— and review the evidence that these thoughts are learned in childhood through experience and observation of others, particularly caretakers and parents. For children who have learned pCAT, repeated exposures to pain over time activate pCAT and likely contribute to further amplification of pain through changes in the neurobiological pain regulatory systems, which overlap with those regulating the stress response. We propose that repeated pain and stress exposures throughout childhood, adolescence, and into adulthood alter the neurobiology of pain via a repetitive positive feedback loop that increases risk for heightened pain sensitivity over time with repeated exposures. At some point, often precipitated by an acute episode of pain and possibly influenced by allostatic load, pCAT contributes to persistence of episodic or acute pain and exacerbates pain-related suffering. This developmental trajectory is not inevitable, as the impact of pCAT on pain and pain-related suffering can be influenced by various factors. We also present future directions for work in this area.
NEWS, NEWS2, and qSOFA accuracy in predicting sepsis-related mortality in acute myeloid leukemia: a retrospective single-center analysis
Authors: Meireles Ana M. , Moço Leonardo M. , Moreira Cláudia S. , Brás Gil P. , Santo Ana E. , Mariz Mário
Published: October 2024

Acute myeloid leukemia (AML) treated with intensive chemotherapy carries a high risk of severe infection. The development of reliable assessment tools to promptly identify patients at risk of developing critical illness is essential to prevent delays in intensive care unit (ICU) admission. This study evaluated the accuracy of quick Sequential Organ Failure Assessment (qSOFA) score, National Early Warning Score (NEWS), and NEWS2 score in predicting ICU admission and sepsis-related mortality in this population. A retrospective analysis was conducted, including 365 episodes of febrile neutropenia in 126 patients. The results showed that all three scores—qSOFA, NEWS, and NEWS2—demonstrated good accuracy for all outcomes, with area under the receiver-operating characteristic curve values for sepsis-related mortality of 0.812, 0.858, and 0.848, respectively. In addition, the scores exhibited excellent accuracy in predicting ICU admission and the composite outcome of ICU admission or sepsis-related mortality. To our knowledge, this is the first study to evaluate the accuracy of NEWS in a population of patients with AML who did not undergo stem cell transplantation. These findings suggest that NEWS and NEWS2 are effective tools for identifying patients with AML at high risk of clinical deterioration during febrile neutropenia, supporting their use in clinical practice.
Variation among venous thromboembolism risk assessment tools for postcesarean patients: a retrospective cohort study
Authors: Ahmed Alshaima Fraoug Eltayeb , Zachariah Seeba , Ismail Amal Hassan , Gibson Caitlin M.
Published: October 2024

Venous thromboembolism (VTE) risk in pregnant women is four to five-fold higher than in nonpregnant women, and the risk of VTE is an additional four-fold higher after Cesarean section compared to normal vaginal delivery. Recommendations regarding anticoagulant prophylaxis are inconsistent across international guidelines, and VTE remains one of the leading causes of maternal morbidity and mortality. This study aimed to compare the need for postcesarean anticoagulation for VTE prophylaxis based on three major guidelines and our own institutional protocol.

It was a retrospective cohort study that reviewed the medical records of patients who underwent a cesarean section at a tertiary-level care hospital in the United Arab Emirates (UAE). The need for anticoagulation was assessed using clinical tools from the American College of Obstetricians and Gynecologists (ACOG), Royal College Obstetricians and Gynecologists (RCOG), American College of Chest Physicians (ACCP), and the study site hospital protocol.

A total of 1134 postcesarean women, aged 18–55 years, were included in the study. Most patients (87%) were at moderate risk for VTE. According to the study site hospital tool, 90.7% qualified for anticoagulant prophylaxis, while the ACOG, RCOG, and ACCP tools indicated that 0.5, 90.9, and 36.7% qualified, respectively. Enoxaparin was the primary anticoagulant used in 95% of cases. Only one patient developed VTE during the follow-up period.

Anticoagulation needs assessment tools vary extensively in their estimations, highlighting the need for a uniform tool across multiple societies to establish a consistent standard of care and guide the development of evidence-based, site-specific protocols.
The nexus between appendicitis and chronic inflammatory bowel diseases: Unraveling an intriguing association
Authors: Roderburg Christoph , Loosen Sven H. , May Petra , Yaqubi Kaneschka , Luedde Tom , Kostev Karel
Published: October 2024

Appendicitis is 1 of the most frequent diseases worldwide. In general, it is treated with appendectomy, which, in almost all cases, leads to the healing of the disease and averts acute complications. However, only limited data regarding long-term sequalae, including inflammatory bowel diseases following appendicitis are available. We therefore investigated the association between appendicitis and both Crohn disease (CD) and ulcerative colitis (UC). The present study included 23,991 patients with a history of appendicitis and 23,991 that did not have such a history. Patients were identified within the Disease Analyzer (IQVIA) database in Germany between 2010 and 2020. After a follow-up period of up to 10 years, 0.74% of patients with a history of appendicitis and 0.45% of those in the nonappendicitis cohort were diagnosed with CD (P < .001). Our regression analysis revealed a robust and statistically significant association between appendicitis and the incidence of CD in the entire study population (Hazard ratio: 1.82; 95% confidence interval [CI]: 1.31–2.53). Importantly, this association remained largely consistent across all age groups and both genders. In contrast, no statistically significant link was observed between appendicitis and the subsequent development of UC (Hazard ratio: 1.24; 95% CI: 0.90–1.71). The present study presents novel data from a large cohort of outpatients in Germany, providing strong evidence for an association between appendicitis and the development of CD (but not UC). These findings contribute to the existing body of literature and may facilitate the recognition of appendicitis as a risk factor for the development of chronic inflammatory bowel diseases.
Prospective cohort study on the clinical significance of interferon-γ, D-dimer, LDH, and CRP tests in children with severe mycoplasma pneumonia
Authors: Zhang Yu-xiang , Li Yang , Wang Yong , Ren You-feng , Yang Yue , Qi Jing , Yang Hui , Liang Xuan , Zhang Rong-fang
Published: October 2024

Background:

Mycoplasma pneumoniae is a significant cause of respiratory infections in children, often leading to severe pneumonia. This study aimed to assess the clinical relevance of interferon-gamma (interferon-γ), D-dimer, lactate dehydrogenase (LDH), and C-reactive protein (CRP) as biomarkers in the severity of mycoplasma pneumonia in pediatric patients.

Methods:

In this prospective study, 203 pediatric patients with mycoplasma pneumonia were classified into mild (123 patients) and severe (80 patients) groups. Biomarkers including interferon-γ, D-dimer, LDH, and CRP were measured and analyzed. Statistical methods employed included Pearson and Spearman correlation analyses, logistic regression, and receiver operating characteristic curve analysis.

Results:

The severe group exhibited significantly higher median and interquartile ranges for interferon-γ, D-dimer, LDH, and CRP compared to the mild group. Logistic regression identified IL-10, IL-6, interferon-γ, tumor necrosis factor-alpha, D-dimer, and LDH as independent predictors of severity, with the model achieving 92% accuracy. Receiver operating characteristic curve analysis showed optimal diagnostic efficacy for interferon-γ, D-dimer, and LDH, with the best threshold values being 8.11, 0.64, and 379, respectively. A significant positive correlation was observed between IL-6 and LDH, as well as between interferon-γ and D-dimer.

Conclusion:

This study showed that interferon-γ >8.11, D-dimer >0.64, and LDH >379 have an important role in the assessment of severe mycoplasma pneumonia.
Identification of prognostic biomarkers related to retinoic acid metabolism in gliomas and analysis of their impact on the immune microenvironment
Authors: Xu Suiyun , Yang Gao , Xu Fangli , Yang Yuting , Wang Juan
Published: October 2024

Glioma is a primary tumor of the central nervous system. Numerous investigations have demonstrated that retinoic acid (RA) signaling plays an important role in glioblastoma. This research aimed to develop a RA metabolism–related gene signature associated with glioma. The RA metabolism–related differentially expressed genes were obtained through differential analysis of RA metabolism–related genes in GSE4290. The univariate Cox and least absolute shrinkage and selection operator regression analysis were adopted to build a RA metabolism–related glioma prognostic signature. We further conducted immune feature estimation and functional enrichment analysis between 2 risk subgroups. Finally, the potential drug-targeting prognostic genes were predicted through the DrugBank database. A sum of 10 RA metabolism–related differentially expressed genes between normal and tumor groups were identified. Then, a RA metabolism–related prognostic signature was built based on the 7 prognostic genes (ADH4, DHRS3, DHRS9, LRAT, RDH10, RDH12, and RDH5). Glioma patients were separated into 2 risk subgroups (low-risk vs high-risk) based on the median value of the risk score. We found that monocytes were negatively correlated with DHRS9, while activated naive CD4+T cell was positively correlated with RDH10. These prognostic genes participated in some immune-related processes, such as “B cell–mediated immunity.” Finally, 4 drugs targeting DHRS3, LRAT, and RDH12 were predicted, including vitamin A, nicotinamide adenine dinucleotide, ethanol, and cyclohexylformamide. The prognostic signature comprised of ADH4, DHRS3, DHRS9, LRAT, RDH10, RDH12, and RDH5 based on RA metabolism was established, which provided a theoretical basis and reference value for the research of glioma.
Causal relationship and mediation effects of immune cells and plasma metabolites in atopic dermatitis: A Mendelian randomization study
Authors: Yang Kaiwen , Zhong Jianqiao , Xian Dehai
Published: October 2024

Atopic dermatitis (AD) is a chronic inflammatory skin condition with complex etiology involving genetic, environmental, and immunological factors. This study employs Mendelian randomization to explore the causal relationships between immune cell phenotypes and AD, and the mediating effects of plasma metabolites. Using data from European cohorts, we identified 7 immune cell phenotypes significantly associated with AD. Mediation analysis revealed that the alpha-ketobutyrate to 4-methyl-2-oxopentanoate ratio negatively regulates CCR2 on monocytes, while the glycerol to carnitine ratio positively regulates HLA-DR on CD14− CD16− cells. These findings underscore the critical role of metabolic pathways in modulating immune responses and suggest potential dietary and therapeutic interventions for AD management. Further research should consider more diverse populations to validate these findings.
Diagnosis of schizophrenia by integrated saccade scores and associations with psychiatric symptoms, and functioning
Authors: Zhu Jiahui , Zhou Li , Zhou Yuanyuan , Lin Yunhan , Cai Yumei , Wu Jiayuan , Shi Chuan
Published: October 2024

Eye movement as a neurobiological biomarker of schizophrenia. We aim to estimate diagnostic accuracy of integrated pro/antisaccade eye movement measurements to discriminate between healthy individuals and schizophrenic patients. We compared the eye movement performance of 85 healthy individuals and 116 schizophrenia-stable patients during prosaccade and antisaccade tasks. The difference eye movement measurements were accumulated by stepwise discriminant analysis to produce an integrated score. Finally, the diagnostic value of the integrated score was calculated by the receiver operating characteristic (ROC) area under the curve (AUC), and the best sensitivity and specificity were calculated based on the given cutoff values. Using discriminant analysis, an integrated score included the residual gain and latency (step) during the prosaccade test, the error rate, and the corrected error rate during the antisaccade test. We found that the integrated score could well classify schizophrenia patients and healthy individuals with an accuracy of 80.6%. In the ROC, Youden’s index was 0.634 (sensitivity = 81.0%, specificity = 82.4%) and AUC was 0.871. There were significant difference patterns of correlation between the severity of psychiatric symptoms and daily functioning and diagnostic eye movement measurements. Using only 2 saccade tasks to discriminate well between schizophrenia patients and healthy controls, suggesting that abnormalities in saccade behavior is a potential biomarker and efficient diagnostic tool for identifying schizophrenia. The underlying neuropathologic mechanisms associated with abnormal saccades may provide insights into the intervention and diagnosis of schizophrenia.
Comparative outcomes of cemented versus cementless stems in bipolar hemiarthroplasty for femoral neck fractures
Authors: Ono Tomoya , Watanabe Nobuyuki , Hayakawa Kazuo , Kainuma Shingo , Yamada Hiroki , Waseda Yuya , Kanda Yoshihiro , Fukuoka Muneyoshi , Tokuda Haruhiko , Murakami Hideki , Kuroyanagi Gen
Published: October 2024

We aimed to compare the clinical and surgical outcomes of cemented vs uncemented bipolar hemiarthroplasty in the treatment of femoral neck fractures in the elderly. Patients (n = 99) without preoperative cardiopulmonary problems undergoing bipolar hemiarthroplasty for femoral neck fracture between August 2015 and February 2019 were randomly divided into cemented (group C) and uncemented (group U) stem fixation groups. Mean operative time, mean intraoperative blood loss, and percentage of intraoperative use of vasopressors, pre- and postoperative activities of daily living (ADL), incidence of postoperative complications, and radiological evaluation of stem alignment were evaluated. A total of 99 patients were included (group C, n = 42; group U, n = 57). Group C had a significantly longer mean operative time (P < .001) and a significantly higher percentage of intraoperative vasopressor use as compared to group U (P < .05). In contrast, the amount of intraoperative blood loss was similar between the 2 groups (P = .30). Likewise, there was no statistically significant difference in pre- and postoperative ADL performance between the groups (P = .70 and .44, respectively). Postoperative computed tomography revealed that stem anteversion was higher in group C than in group U (P < .05). Cemented and uncemented stems were equivalent in terms of blood loss and postoperative complications in patients with femoral neck fractures. Uncemented stem showed advantages in reducing operative time and intraoperative vasopressor administration. Also, fixation method was not investigated in this study.
Efficacy of radial incision combined with tunnel floating line drainage in the treatment of high posterior horseshoe anal fistula and perianal flora: Randomized control trial
Authors: Yi Hang , Zheng Yong , Yan Zhengqing
Published: October 2024

Background:

Due to the high prevalence of posterior horseshoe anal fistula and causing numerous complications, this study aimed to investigate the clinical effect of radial incision combined with tunnel floating line drainage (RCTD) and arc incision internal drainage in the treatment of the disease and the influence on perianal flora.

Methods:

Ninety-six subjects treated with high posterior horseshoe anal fistula were stochastically assigned to a joint group (RCTD), and control group (arc incision internal drainage). The operation-related conditions, complication rate, anal function, and recurrence rate of 6 months after operation were compared, and perianal secretions were collected before operation and 1 day after operation to detect the changes of microbial flora.

Results:

After operation, it was corroborated notable difference between joint group and control group in operation time, intraoperative blood loss, wound healing time, visual analogue scale score 6 hours after operation and phase I cure rate. Chi square test analysis showed notable difference between control group (27.08%) and joint group (10.40%) in incidence of complications, in terms of number of pathogens detected around anus, significantly smaller of the incremental change for the joint subgroup versus the control subgroup 1 day after operation.

Conclusion:

RCTD can be the best choice for patients with high posterior horseshoe anal fistula. This operation method has the advantages of short operation time, less trauma, fewer complications, fast recovery of anal function, and can also reduce perianal pathogenic bacteria infection.
C-arm-guided versus ultrasound volumetric navigation-guided percutaneous transforaminal endoscopic discectomy for the treatment of lumbar disc herniation: A retrospective study
Authors: Guo Yafeng , Pei Honglei , Dong Yufei , Sun Qi , Kang Kai , Gao Hongyang
Published: October 2024

To compare the clinical efficacy of lumbar percutaneous transforaminal endoscopic discectomy (PTED) for lumbar disc herniation (LDH) guided by C-arm fluoroscopy and ultrasound volumetric navigation (UVN). Fifty patients with LDH treated with PTED were retrospectively evaluated in this study. Groups A (n = 25) and B (n = 25) had intervertebral foramina punctures guided by C-arm fluoroscopy and UVN, respectively. The age, gender, height, weight, and body mass index of patients were recorded. We compared the puncture time, number of punctures, and puncture accuracy of patients in both groups. We also evaluated the clinical effectiveness of PTED surgery using the visual analog scale (VAS) and the Oswestry Disability Index (ODI). In addition, we recorded the duration of surgery, hospitalization, medical costs, and surgical complications in both groups. The average follow-up time of the 50 patients was 18.5 ± 4.3 months. The mean puncture time in groups A and B was 25.76 ± 5.28 and 14.34 ± 4.96 minutes, respectively, and the difference was statistically significant (P < .05). The mean number of fluoroscopies was significantly lower in group B than in group A, with 15.82 ± 2.29 versus 4.52 ± 0.51 times (P < .05). The puncture accuracy rate was 100% in both groups, with no statistical difference (P > .05). The VAS and ODI scores of patients in group A were similar to group B at all 3-time points: preoperatively, at 3 months postoperatively, and at 1 year postoperatively. However, both VAS and ODI were significantly improved postoperatively compared to preoperatively (P < .05). Moreover, group B has shorter operative time and higher medical cost than group A (P < .05). There was no significant difference in the length of hospitalization and surgical complication rate (P > .05). Both C-arm-guided and the UVN-guided PTED are safe and effective methods for the treatment of LDH. UVN-guided technique has the advantage of reducing puncture time and the number of punctures. However, UVN also has the disadvantage of high hospitalization costs.
Bilateral carotid and vertebral rete mirabile with aneurysm misdiagnosed as Moyamoya disease: A case report
Authors: Chen Xiuen , Xiao Chao , Qin Chao
Published: October 2024

Rationale:

Rete mirabile (RM) is rare in humans, normally existing in lower mammalian arteries. To study its clinical and imaging features, we report an extremely rare case that occurred in humans and review the literature.

Patient concerns:

A 43-year-old female patient was admitted to our hospital because of recurrent dizziness and headache for 4 years.

Diagnoses:

The computed tomography angiography (CTA) of the head and neck indicated that the normal structure of the bilateral cervical and vertebral arteries disappeared, and the microvascular network formed, misdiagnosed as Moyamoya disease.

Interventions:

She underwent cerebral digital subtraction angiography examination and was finally diagnosed as carotid and vertebral RM with aneurysm.

Outcomes:

Following the administration of symptomatic treatment, all of her symptoms dissipated, and she was successfully discharged from the hospital.

Lessons:

RM involving in both anterior and posterior circulation is an extremely rare clinical abnormality of cerebrovascular morphology. The radiologists and clinicians should deepen their awareness of the specific CTA feature of RM. When individual CTA examination is insufficient, the utility of digital subtraction angiography is crucial for making a clear diagnosis.
Assessment of solitary pulmonary nodules using dual-layer spectral detector computed tomography
Authors: Ko Tse-Pang , Chang Yu-Pin , Chai Jyh-Wen
Published: October 2024

We aim to quantitatively investigate the difference between benign and malignant solid pulmonary nodules that appeared on dual-energy spectral computed tomography, and assess the diagnostic accuracy of several parameters derived from computed tomography in differentiating malignant from benign pulmonary nodules. Between September 2021 and December 2022, spectral images of 71 patients (male:female = 44:27, mean age = 71.0 years) confirmed by pathology were retrospectively analyzed in the venous phase. Patients were classified into the malignant group and the benign group. The iodine concentration values of the nodules, normalized iodine concentration of the nodules to the neighboring vessels, virtual monochromatic images of 40 and 80 keV, and slope of the spectral curve were calculated and compared between the benign and malignant groups. Receiver operating characteristic curves and the area under the curve were performed to assess the diagnostic performance of the above parameters. Both virtual monochromatic images and iodine concentration maps prove to be highly useful in differentiating benign and malignant pulmonary nodules. The malignant pulmonary nodules have higher iodine density and slope of the spectral curve than the benign lesions. The combined model of iodine density and curve slope with an optimal cutoff of 0.39 (area under the curve = 0.82) yielded a sensitivity of 95% and a specificity of 63%. Contrast-enhanced dual-energy spectral computed tomography allows promising capability of distinguishing malignant from benign lesions, potential for avoiding unnecessary invasive procedure or surgery.
A case report of effective treatment of intracranial atherosclerotic stenosis treated with the integration of traditional Chinese medicine and Western medicine
Authors: Hu Wen-Wen , Chen Yiran , Cai Cheng-Ke , Li Jian , Chen Zheng-Guang , Zhong Li-Qun
Published: October 2024

Rationale:

Intracranial atherosclerotic stenosis (ICAS) represents a prevalent global cause of stroke, posing a notably higher risk of stroke recurrence than other stroke etiologies. Herein, we report a case of a 39-year-old male patient diagnosed with ICAS, treated through an integrated approach incorporating Chinese and Western medicine with significant efficacy and satisfied clinical safety.

Patient concerns:

This patient presented with 1 transient ischemic attack and prolonged headache, dizziness and poor sleep quality. In addition, the patient refused to undergo surgery due to the high cost and postoperative risks.

Diagnoses:

Diagnostic methods used to identify ICAS include conventional cerebral angiography, magnetic resonance angiography (MRA), CT angiography (CTA), transcranial Doppler ultrasound (TCD), and High-Resolution Magnetic resonance imaging. Considering the cost and risks associated with conventional angiography, noninvasive imaging has emerged as the method of choice for diagnosing ICAS. After a series of noninvasive examinations (CTA, TCD, and HR-MRI), the patient was diagnosed with ICAS.

Interventions:

The western medical regimen includes antiplatelet coagulation, blood pressure control, lipid regulation, plaque stabilization, and lifestyle modifications such as exercise, weight loss, and adherence to low-salt, low-fat diets. Complementing this, traditional Chinese medicine (TCM) treatment was guided by the principle of strengthening the spleen, resolving dampness, nourishing blood and harmonizing ying, resolving blood stasis and clearing collaterals. This involved the administration oral Chinese medicine such as modified Shenling Baizhu powder and modified Si Wu decoction.

Outcomes:

The efficacy of the treatment was assessed by evaluating the degree of luminal stenosis and peak systolic blood flow velocity in the M1 segment of the left middle cerebral artery (MCA) before and after the intervention. Encouragingly, posttreatment results demonstrated the disappearance of the plaque in the left MCA-M1 segment, with no significant lumen stenosis observed. Moreover, a notable and smooth reduction in blood flow velocity was achieved in the left MCA, indicating positive outcomes from the integrated traditional Chinese and Western medicine approach.

Conclusion:

This case report shows that a combination of traditional Chinese and Western medicine is safe and effective in the treatment of ICAS and is worthy of promotion in the clinic.
Individual heart failure patient variability in nocturnal hypoxia and arrhythmias
Authors: Gardner Cubby L. , Burke Harry B.
Published: October 2024

Traditional heart failure research often uses daytime population parameter estimates to assess hypoxia and arrhythmias. This approach might not accurately represent heart failure patients as nighttime cardiac behaviors offer crucial insights into their health, especially regarding oxygen levels and heart rhythms. We conducted a prospective study on nocturnal oxygen saturation and heart rate in home-dwelling heart failure patients over 6 nights. Patients were recruited from the Walter Reed National Military Medical Center heart failure clinic. Criteria included a clinical diagnosis of heart failure, a New York Heart Association (NYHA) classification of I to III, ages between 21 to 90, cognitive intactness, capability to use the wearable device, and willingness to use the device for 6 consecutive nights. Average oxygen saturation was 92% with individual readings ranging from 40% to 100%. The mean heart rate was 72 beats per minute (bpm), but individual rates ranged from 18 bpm to a high of 296 bpm. A significant drop in oxygen levels and sleep arrhythmias were consistently observed among participants. Heart failure patients demonstrate notable and variable desaturations and arrhythmias across multiple nights. A single-night sleep study or a 24-hour heart rate monitor may not comprehensively depict patients’ oxygenation and heart rate irregularities. Our research highlights wearable devices’ potency in medical research for capturing essential nocturnal data. In only 6 nights, we gleaned invaluable clinical insights for optimizing patient care. This study is pioneering, being the first to intensively examine nighttime oxygen levels and heart rates in home-based heart failure patients.
Mendelian randomization study reveals a causal relationship between body mass index in children and risk of autoimmune diseases
Authors: He Jiahui , Yang Yun , Zhang Ting , Wu Chuyan , Bao Yunlei , Wang Jimei , Jiang Feng
Published: October 2024

Newly emerging evidence indicates that body mass index (BMI) is a potential risk factor for autoimmune diseases (ADs). Nevertheless, the exact causal connection between ADs and BMI in children remains uncertain. To investigate the relationship between BMI in children and ADs, a 2-sample Mendelian randomization (MR) analysis was conducted. In this analysis, several regression methods were utilized, including the inverse-variance weighted (IVW), weighted mode, weighted median, and MR-Egger regression. Publicly available summary statistics datasets from meta-analyses of genome-wide association studies (GWAS) were employed, specifically focusing on BMI in children of European descent (n = 39,620) from the UK Biobank (ebi-a-GCST90002409) as the exposure group. The outcomes were derived from individuals included in the Finnish biobank study FinnGen, with 42,202 cases and 176,590 controls representing the ADs group (finngen_R5_AUTOIMMUNE). For instrumental variables, we carefully selected 16 single nucleotide polymorphisms (SNPs) from GWAS on BMI in children. Our analysis implemented the IVW method, which demonstrated supporting evidence for a causal association between BMI in children and ADs. The results indicated a significant effect with a beta coefficient of 0.22, standard error (SE) of 0.05, odds ratio (OR) of 1.25, and a 95% confidence interval (CI) ranging from 1.13 to 1.38, with a P-value of <.05. We also utilized the weighted median method, which yielded similar findings to the IVW method. The OR estimates from the weighted median analysis showed a beta coefficient of 0.20, SE of 0.06, OR of 1.22, and a 95% CI ranging from 1.08 to 1.36, with a P-value of <.05. No significant association was observed in the MR-Egger and Weighted mode analyses. The findings from the MR analysis suggest that there is evidence supporting a potential causal link between BMI in children and an increased susceptibility to ADs.
Effect of stressors during COVID-19 lockdown on malnutrition and health-risk behaviors among Jordanian college students: A cross-sectional study
Authors: Alkhalidy Hana , Al-Shami Islam , Alnaser Khadeejah , Alkharabsheh Ana’am , Nawaiseh Hala , Liu Dongmin
Published: October 2024

A stressful condition such as the emergence of the coronavirus and its related lockdown measures might trigger alterations in college students’ behaviors. This cross-sectional study aimed to identify the changes in college students’ dietary and lifestyle behaviors during the lockdown and the effect of lockdown-related stressors on health-risk behaviors. A web-based survey was conducted among undergraduate college students in Jordan. Weight and height were reported by the students. The students’ dietary and lifestyle behaviors and their changes during 1 month of the countrywide lockdown were assessed. The Perceived Stress Scale-4 was utilized to assess stress levels. Results indicated that 77.2% of the students reported weight changes. Notably, 45.9% increased their intake of unhealthy food, while and 38% opted for healthier food choices. Most students experienced alterations in physical activity (80.0%), screen time (86.2%), smoking, and sleep patterns (85.4%), with a higher tendency toward adopting health-risk behaviors. Perceptions of curfew-related stress were associated with distance learning-related stress (OR = 2.73, CI: 1.08–6.90, P = .034), and a greater change in physical activity (OR = 3.59, CI: 1.36–9.48, P = .010). Additionally, weight changes were associated with perception of other types of stressors (OR = 3.39, CI: 1.39–8.28, P = .007). Overall, there was a considerable increase in malnutrition and health-risk behaviors among students during the lockdown. Understanding students’ responses to these stressful conditions and the role of stress in driving behavioral changes are crucial for developing interventions that enhance college students’ adaptation to such changes and maintaining healthy dietary and lifestyle behaviors in the future.
Adjuvant non-opioid analgesics decrease in-hospital mortality in targeted patients with acute pancreatitis receiving opioids
Authors: Zeng Jiahui , He Hairong , Song Yiqun , Wei Wanzhen , Han Yimin , Su Xinhao , Lyu Weiqi , Zhao Jinpeng , Han Liang , Wu Zheng , Wang Zheng , Wei Kongyuan
Published: October 2024

Objectives

Opioid administration in acute pancreatitis (AP) exacerbates its severity, prompting concerns regarding the increased requirement for intensive care and its potential impact on patient survival. We aimed to elucidate the influence of analgesic patterns on mortality among patients with AP hospitalized in the ICU.

Methods

We included 784 patients (198 receiving opioid monotherapy and 586 receiving opioid polytherapy) from the Medical Information Mart for Intensive Care database. The primary outcome was in-hospital mortality. Propensity score matching was used to account for baseline differences. We used Kaplan–Meier survival curves and multivariate regression models to indicate survival discrepancies and potential associations.

Results

Polytherapy group exhibited prolonged hospital survival (79.8 vs. 57.3 days, P < 0.001); polytherapy was associated with decreasing in-hospital mortality adjusted for confounders (HR = 0.49, 95% CI: 0.26–0.92; P = 0.027). Stratification analysis indicated that patients receiving adjunctive acetaminophen had prolonged hospital survival (opioid vs. opioid + acetaminophen, P < 0.001; opioid vs. opioid + NSAIDs + acetaminophen, P = 0.026). Opioid polytherapy benefited patients with APACHE III scores >83 and those with mean oral morphine equivalent >60 mg/day (HR = 0.17, 95% CI: 0.1–0.3, P < 0.001 and HR = 0.32, 95% CI: 0.2–0.52, P < 0.001, respectively).

Conclusion

Our findings suggest that an opioid-based analgesic regimen offers a survival advantage for patients with AP, particularly those in critical condition or with concerns about opioid use. This approach provides a viable clinical strategy for pain management. Further randomized clinical trials are warranted to validate these results.
Intensity of Social Needs Case Management Services and Changes in Hospital and Emergency Department Use Among Adult Medicaid Beneficiaries
Authors: Guo Crystal , Brown Timothy T. , Rodriguez Hector P. , Knox Margae , Fleming Mark D. , Hernandez Elizabeth A. , Brown Daniel M. , Brewster Amanda L.
Published: October 2024

Objectives:

We identify the association between high- and low-intensity case management services on hospital and emergency department (ED) use among CommunityConnect patients.

Background:

Social needs case management services vary in intensity, including the modality, workforce specialization, and maximum caseload. CommunityConnect is a social needs case management program implemented by Contra Costa Health, a county safety-net health system in California’s San Francisco Bay Area.

Methods:

Due to the endogeneity of high-intensity services assigned to high-risk patients, we instrument for service intensity using the number of specialist case managers hired each month of enrollment. Zero-inflated negative binomial models with 2-stage residual inclusion estimated total and avoidable hospital admissions and ED visits 12 months post-enrollment for adult Medicaid beneficiaries enrolled between August 2017 and December 2018 (n = 19,782).

Results:

Compared with low-intensity case management, high-intensity services were associated with a reduction in the incidence rates of inpatient admissions [incidence rate ratio (IRR) = 0.341, 95% CI: 0.106–1.102; P = 0.072], ED visits (IRR = 0.608, 95% CI: 0.188–1.965; P = 0.058), and avoidable ED visits (IRR = 0.579, 95% CI: 0.179–1.872; P = 0.091). No significant association was found between service intensity and the likelihood of an event being an excess zero.

Conclusions:

High-intensity social needs case management may be more effective than low-intensity service at reducing health care use for individuals with non-zero use, suggesting that intensive case management may be especially helpful in supporting discharge and transitions of care.
Organizational Climate Related to Patient-Perpetrated Sexual Harassment
Authors: Fenwick Karissa M. , Frayne Susan M. , Shekelle Jeanette , Carney Diane V. , Yano Elizabeth M. , Klap Ruth , Hamilton Alison B.
Published: October 2024

Background:

Patient-perpetrated sexual harassment toward health care providers is common and adversely affects provider well-being, workforce outcomes, and patient care. Organizational climate for sexual harassment—shared perceptions about an organization’s practices, policies, and procedures—is one of the strongest predictors of harassment prevalence. We conducted a pilot survey assessing provider perceptions of the Veterans Health Administration (VA)’s climate related to patient-perpetrated sexual harassment.

Research Design:

Responding providers completed a survey assessing: (1) experiences with patient-perpetrated sexual harassment; (2) beliefs about VA’s responses to patient-perpetrated sexual harassment of staff; and (3) perceptions of VA’s organizational climate related to sexual harassment for each of 4 perpetrator-target pairings (patient-perpetrated harassment of staff, patient-perpetrated harassment of patients, staff-perpetrated harassment of staff, and staff-perpetrated harassment of patients).

Subjects:

Respondents included 105 primary care providers (staff physicians, nurse practitioners, and physician assistants) at 15 facilities in the VA Women’s Health Practice-Based Research Network.

Results:

Seventy-one percent of responding providers reported experiencing patient-perpetrated sexual harassment in the past 6 months. Respondent perceptions of VA’s responses to patient-perpetrated harassment of staff were mixed (eg, indicating that VA creates an environment where harassment is safe to discuss but that it fails to offer adequate guidance for responding to harassment). Respondents rated organizational climate related to patient-perpetrated harassment of staff as significantly more negative compared with climate related to other perpetrator-target pairings.

Conclusions:

Future work with representative samples is needed to corroborate these findings, which have potential ramifications for VA’s ongoing efforts to create a safe, inclusive environment of care.
AI Applications for Nutrition and Food Security Research
Authors: Naumova Elena N.
Published: October 2024

Data analytics (DA) and artificial intelligence (AI) play increasingly vital roles in food, nutrition, environment, and public health research and practice. With the continued successful development, professionals in these fields could rely on data analytics and AI for tasks such as data collection, decision-making, and policy development. Proficiency in research methods, statistical analysis, and ethical considerations is crucial. As AI applications grow in complexity, it is essential for professionals and the public to embrace and regulate them effectively. This review outlines AI’s diverse applications in nutrition research, including data analysis, prediction, personalized recommendations, and food safety monitoring. Select illustrative examples demonstrate its potential across various domains and highlight common challenges. The narrative underscores the importance of integrating data science and AI competencies into graduate education to equip the modern workforce.