bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased Postoperative Opioid Consumption in the Presence of Coadministration of 5-Hydroxytryptamine Type 3 Antagonists with Acetaminophen: A Hospital Registry Study
Authors: Ratajczak Nikolai , Munoz-Acuna Ricardo , Redaelli Simone , Suleiman Aiman , Seibold Eva-Lotte , von Wedel Dario , Shay Denys , Ashrafian Sarah , Chen Guanqing , Sundar Eswar , Ahrens Elena , Wachtendorf Luca J. , Schaefer Maximilian S.
Published: May 2024

Background

Acetaminophen and 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are administered as standard prophylaxes for postoperative pain, nausea, and vomiting. Preclinical studies, however, suggest that 5-HT3 antagonists may compromise acetaminophen’s analgesic effect. This hospital registry study investigates whether 5-HT3 antagonists mitigate the analgesic effect of prophylactic acetaminophen in a perioperative setting.

Methods

This study included 55,016 adult patients undergoing general anesthesia for ambulatory procedures at a tertiary healthcare center in Massachusetts from 2015 to 2022. Using binary exposure variables and a comprehensive selection of preplanned patient- and procedure-related covariates for confounder control, the authors investigated whether intraoperative 5-HT3 antagonists affected the association between pre- or intraoperative acetaminophen and postoperative opioid consumption, gauged by opioid dose in milligram oral morphine equivalents (OME) administered in the postanesthesia care unit. A multivariable, zero-inflated negative binomial regression model was applied.

Results

A total of 3,166 patients (5.8%) received only acetaminophen, 15,438 (28.1%) only 5-HT3 antagonists, 31,850 (57.9%) both drugs, and 4,562 (8.3%) neither drug. The median postanesthesia care unit opioid dose was 7.5 mg OME (interquartile range, 7.5 to 14.3 mg OME) among 16,640 of 55,016 (30.2%) patients who received opioids, and the mean opioid dose was 3.2 mg OME across all patients (maximum cumulative dose, 20.4 mg OME). Acetaminophen administration was associated with a –5.5% (95% CI, –9.6 to –1.4%; P = 0.009; adjusted absolute difference, –0.19 mg OME; 95% CI, –0.33 to –0.05; P = 0.009) reduction in opioid consumption among patients who did not receive a 5-HT3 antagonist, while there was no effect in patients who received a 5-HT3 antagonist (adjusted absolute difference, 0.00 mg OME; 95% CI, –0.06 to 0.05; P = 0.93; P for interaction = 0.013).

Conclusions

A dose-dependent association of pre- or intraoperative acetaminophen with decreased postoperative opioid consumption was not observed when 5-HT3 antagonists were coadministered, suggesting that physicians might consider reserving 5-HT3 antagonists as rescue medication for postoperative nausea or vomiting when acetaminophen is administered for pain prophylaxis.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Research Progress of miRNA in Heart Failure: Prediction and Treatment
Authors: Hou Bingyan , Yu Dan , Bai Haotian , Du Xiaowei
Published: May 2024

This review summarizes the multiple roles of microRNAs (miRNAs) in the prediction and treatment of heart failure (HF), including the molecular mechanisms regulating cell apoptosis, myocardial fibrosis, cardiac hypertrophy, and ventricular remodeling, and highlights the importance of miRNAs in the prognosis of HF. In addition, the strategies for alleviating HF with miRNA intervention are discussed. On the basis of the challenges and emerging directions in the research and clinical practice of HF miRNAs, it is proposed that miRNA-based therapy could be a new approach for prevention and treatment of HF.
Eye involvement in patients with rheumatoid arthritis: a cross-sectional study
Authors: Obaid Hassnah Hashem A. , Haidar Ghina , Kudsi Maysoun , Azmeh Arwa
Published: May 2024

Background:

Rheumatoid arthritis (RA) is a systemic immune disease. The authors aimed to report the characteristics of ocular manifestations in patients with RA.

Methods:

Demographic and clinical characteristics were collected including: age, sex, and BMI. Disease data included the duration, the present main complaint, including the number of painful and swollen joints, duration of morning stiffness, and the patient’s self-evaluation form had also been applied and registered. Eye symptom including pain, dryness, redness, photophobia, discharge, and blurred vision was asked and registered, in addition to full medical history, treatment, and evaluation of clinical disease activity index. Rheumatologic examination included: the number of tender and swollen joints in patients was done. All study subjects underwent complete ophthalmological examination in the following manner: visual acuity assessment by Snellen’s chart, evaluation of pupil diameter and reflexes as well as eyeball movements, tear film evaluation by using Schirmer’s test, intraocular pressure measurement, slit-lamp evaluation of the anterior segment with concentration on ocular surface assessment, followed by installation of topical mydriatic/cycloplegic eyedrops for posterior eye segment exam and fundoscopy. Laboratory tests included rheumatic factor, anti cytoplasmic citrulinted peptide, C-reactive protein, and erythrocyte sedimentation rate were performed and analyzed.

Results:

Mean age of study group was 41.5±10 years,78.59% of which were females. Ocular manifestations were present in 31.14%. Dry eye was diagnosed in (36.71%), among which burning sensation was found in (35.15%), and photophopia in (27.34%). The most frequent ocular manifestation was episcleritis (66.40%), while scleritis was diagnosed in (22.65%), and keratoconjuctivitis was present in (7.04%).

Discussion:

The most common manifestations of ocular involvement in our RA patients was episcleritis, dry eye, and scleritis.

Positive serum rheumatoid factor and anticitrulinated peptide antibody significantly increased the risk of having ocular manifestations, especially dry eyes, and the ocular manifestations prevalence was higher among male patients, long disease duration and treatment with biologics and disease-modifying antirheumatic drugs.

Conclusion:

Ocular symptoms are relatively frequent manifestation of RA. Regular ophthalmological examinations are essential among patients with RA.
Chronic multiarticular tophaceous gout with abnormally large tophi, case of surgical intervention: a case report from Nepal
Authors: Bhattarai Kritika , Acharya Ashish , Gyawali Kamal
Published: May 2024

Introduction and importance:

Gout is an inflammatory disease caused by the deposition of monosodium urate monohydrate crystals around the synovial joints, affecting the first metatarsophalangeal joints followed by ankle and knees. It is found to be more prevalent among men and older women. Tophi tends to develop if the acute phase of the disease is not controlled. In contrast, our patient had an unusual presentation of multiple tophi affecting several joints accompanied by deformities.

Case presentation:

Here, the authors present a case of a 63 years old male with chronic multiarticular tophaceous gout with a history of more than 30 years. He presented with multiple joint deformities and prior surgical history of excision of tophi. Laboratory reports revealed elevated serum uric acid, and X-ray showed joint deformities with tophi. However, the parameters of renal function test were normal. Surgical excision of the tophi was done.

Clinical discussion:

Gout is one of the most common inflammatory arthritis, which if untreated can progress to tophi formation. The diagnosis can be made clinically and by several investigations including serum uric acid estimation and aspiration of the joint to reveal monosodium urate monohydrate crystals. A long standing case of multiarticular tophi causing joint deformities does require surgical intervention.

Conclusion:

Early treatment and diagnosis of hyperuricemia prevent the progression to gouty arthritis and tophi formation. Long history of multiple tophaceous gout is an unusual presentation, which we intend to present here as a novel case report. Nevertheless, such cases require surgical interventions.
Novel Percutaneous Areola Reduction
Authors: Wiesman Irvin M. , Rabin Daniel A.
Published: May 2024

We present a novel percutaneous areola reduction technique that, to our knowledge, has never been used or published in the past. This technique is a useful solution to the downsides of the current most commonly used technique for areola reductions that uses a circumareolar incision. Our current technique utilizes a percutaneous approach, which is a minimally invasive procedure, and produces a virtually scarless result.
Sclerodermiform Cell Epithelioma of the Palpebromalar Region
Authors: Gerin Manon , Tooulou Monika , Zielonka Elisabeth
Published: May 2024

This report describes a recurrent sclerodermiform basal cell epithelioma of the malar region next to the inferior eyelid in a 57-year-old woman. Three interventions were necessary to obtain a clear margin of resection. The area of resection was closed with a local cutaneous flap. We report a rare basal cell carcinoma subtype underestimated in its aggressiveness with often inadequate medical and surgical management. This tumor, generally localized in the face, often requires aggressive surgery, and aesthetic results can be poor. The patients require close long-term follow-up even when margins are clear. General practitioners, dermatologists, and surgeons should be aware of sclerodermiform basal cell carcinoma, which is a malignant, aggressive, and recurrent tumor.
Long-term outcomes of corneal crosslinking
Authors: Cehelyk Eli K. , Syed Zeba A.
Published: May 2024

Purpose of review

This manuscript summarizes contemporary research from 2018 to 2023 evaluating long-term (≥2 years) outcomes of corneal crosslinking (CXL) for progressive keratoconus (KCN).

Recent findings

The standard Dresden protocol (SDP) has been utilized clinically since the early 2000 s to treat ectatic disorders, primarily progressive KCN and postrefractive ectasia. Various modifications have since been introduced including accelerated and transepithelial protocols, which are aimed at improving outcomes or reducing complications. This review summarizes data demonstrating that the SDP halts disease progression and improves various visual and topographic indices (UDVA, CDVA, Kmax, K1, K2) up to 13 years postoperatively. Accelerated and transepithelial protocols have been found to be well tolerated alternatives to SDP with similar efficacy profiles. Studies focusing on pediatric populations identified overall higher progression rates after CXL. All protocols reviewed had excellent safety outcomes in adults and children.

Recent studies revealed that SDP successfully stabilizes KCN long term, and a variety of newer protocols are also effective. Pediatric patients may exhibit higher progression rates after CXL. Further research is required to enhance the efficacy and ease of these protocols.
Associations of Blood Cadmium Levels With Osteoarthritis Among US Adults in NHANES 2013–2018
Authors: Li Lijun , Cao Jiangang , Li Lin , Wu Guang , Xiao Junhui
Published: May 2024

Background

Osteoarthritis (OA) is a global public health problem, and limited information is available on the effects of Cd on OA. The purpose of this study is to explore the relationship between Cd and OA.

Method

Weighted multivariable logistic regression model, trend test, restricted cubic spline, and stratified analysis were used to study the association between BCd and OA.

Results

In the two regression models of weighted multivariable logistic regression analysis, the correlation between BCd and OA was positive. Compared with the lowest quartile of BCd exposure, the highest quartile had a 2.03-fold (95% confidence interval, 1.67 to 2.47), displaying a dose-response relationship (P for trend <0.00001). The restrictive cubic spline shows a positive linear relationship between BCd and OA.

Conclusion

There was a positive linear relationship between BCd and OA and a dose-response relationship.
Proposed Framework for Developing and Evaluating Total Worker Health® Education and Training Programs
Authors: Kenigsberg Tat’Yana A. , Childress Adele M. , Fletcher Williams Donjanea , Lioce Maria , Chosewood L. Casey
Published: May 2024

Objective

Propose a framework for developing and evaluating Total Worker Health® (TWH) education and training efforts by implementing institutions.

Methods

This is a review of TWH information from symposia, workshops, academic offerings, and publications, along with a review of education and training development and evaluation resources applicable across various disciplines.

Results

Examples of knowledge, skills, and abilities (KSAs) are provided for each TWH core competency, and a framework for developing and evaluating a TWH competency-based education or training program.

Conclusions

The proposed set of KSAs and framework for developing and evaluating TWH education or training programs may inform future pilot testing of KSAs and framework by implementing institutions and help standardize practices across the discipline. Academic, business, community, labor, and government stakeholders are encouraged to provide further input to assist in its maturation and uptake.
Three-Dimensional Bio-Printed Tubular Tissue Using Dermal Fibroblast Cells as a New Tissue-Engineered Vascular Graft for Venous Replacement
Authors: Hayasaka Makoto , Kokudo Takashi , Kaneko Junichi , Chiyoda Takehiro , Nakamura Anna , Itoh Manabu , Endo Kazuhiro , Nakayama Koichi , Hasegawa Kiyoshi
Published: May 2024

The current study was a preliminary evaluation of the feasibility and biologic features of three-dimensionally bio-printed tissue-engineered (3D bio-printed) vascular grafts comprising dermal fibroblast spheroids for venous replacement in rats and swine. The scaffold-free tubular tissue was made by the 3D bio-printer with normal human dermal fibroblasts. The tubular tissues were implanted into the infrarenal inferior vena cava of 4 male F344-rnu/rnu athymic nude rats and the short-term patency and histologic features were analyzed. A larger 3D bio-printed swine dermal fibroblast-derived prototype of tubular tissue was implanted into the right jugular vein of a swine and patency was evaluated at 4 weeks. The short-term patency rate was 100%. Immunohistochemistry analysis showed von Willebrand factor positivity on day 2, with more limited positivity observed on the luminal surface on day 5. Although the cross-sectional area of the wall differed significantly between preimplantation and days 2 and 5, suggesting swelling of the tubular tissue wall (both p < 0.01), the luminal diameter of the tubular tissues was not significantly altered during this period. The 3D bio-printed scaffold-free tubular tissues using human dermal or swine fibroblast spheroids may produce better tissue-engineered vascular grafts for venous replacement in rats or swine.
The relationship between triglyceride/high-density lipoprotein cholesterol ratio and the severity of coronary artery disease in patients presenting with acute coronary syndrome
Authors: Demir Ömer Furkan , Koca Fatih
Published: May 2024

Background

The SYNTAX score is a score that grades the severity and complexity of coronary lesions. In this study, we aimed to investigate the relationship between triglyceride/high-density lipoprotein cholesterol (triglyceride/HDL-C) ratio and SYNTAX scores in patients presenting with non-ST elevation myocardial infarction (NSTEMI).

Methods

This prospective study included 258 patients who presented at our center with STEMI, and underwent coronary angiography (CAG). The triglyceride/HDL-C ratio was calculated, and the relationship of this ratio with the SYNTAX score was determined with univariate and multivariate linear regression analyses.

Results

The patients were separated into two groups according to the triglyceride/HDL-C ratios as low (<3.88) and high (≥3.88). The SYNTAX scores of the group with a high triglyceride/HDL-C score were determined to be significantly high (P < 0.001). When the SYNTAX scores were separated into two groups as low (≤22) and high (>23), a statistically significant correlation was determined between a high SYNTAX score and a high triglyceride/HDL-C ratio (P < 0.001). Logistic regression analysis was performed for the SYNTAX score, and the BMI value [odds ratio (OR) = 0.91, 95% confidence interval (CI): 0.85–0.98] and the triglyceride/HDL-C ratio (OR = 6.86, 95% CI: 3.45–13.65) alone were determined to be independent determinants of the SYNTAX score.

Conclusion

The most important result obtained from this study was that the triglyceride/HDL-C ratio, which is an index that has recently started to be frequently used, was a marker of greater coronary anatomic complexity (SYNTAX score >22), independently of other parameters in patients who presented with NSTEMI and underwent CAG.
Spontaneous renal rupture caused by factor VII deficiency: A case report
Authors: Yang Chao , Luo Mingjun , Li Langlang , Yang Qizhi
Published: May 2024

Rationale:

Spontaneous renal rupture is an uncommon disease, it usually occurs after upper urinary calculi-related operation treatment or renal tumor. This disease caused by factor VII deficiency has rarely reported.

Patient concerns:

A 49-year-old woman came to our hospital with on the left flank pain and gross hematuria that had persisted for 10 days. The patient had no recent history of waist and abdominal trauma or surgical history recently.

Diagnoses:

An outside computed tomography (CT) examination revealed left renal rupture before arriving at our hospital, but she was not treated. Further laboratory examination revealed that the patient condition was turned out to be hemophilia caused by factor VII deficiency.

Intervention:

We have used both internal and external drainage methods, and supplemented with coagulation factor.

Outcome:

After 9 months of follow-up, it was observed that the left renal hematoma and urinary extravasation was completely absorbed.

Lessons:

Spontaneous renal rupture for hemophilia is a clinical emergency. When spontaneous renal rupture is associated with abnormal coagulation function, and the coagulation function cannot be corrected by conventional treatment, the possibility of hemophilia needs to be considered, and the type of hemophilia needs to be further defined. This case indicates a successful resolution of spontaneous renal rupture, it can provide guiding value for our clinical practice.
Using targeted second-generation sequencing technique to guide clinical diagnosis and the effect of medication on the therapeutic effect and prognosis of respiratory tract infection in children: An observational study
Authors: Lian Di , Tang Qiuyu , Wu Ling , Liao Xing
Published: May 2024

To explore the effect of targeted second-generation sequencing technique to guide clinical diagnosis and medication on the therapeutic effect and prognosis of respiratory tract infection (RTI) in children. During January 2021 to June 2022, 320 children with RTI cured were selected in our hospital as the object of this retrospective study. The control group accepted empirical broad-spectrum antibacterial therapy and the observation group accepted targeted second-generation sequencing technique to guide diagnosis and medication. The therapeutic effect, improvement time of clinical symptom index, laboratory-related index, level of inflammatory factors, incidence of complications, and parents’ treatment satisfaction were compared. The observation group was considerably more efficacious (91.25%) versus the controlled group (72.50%). The duration of enhancement of fever, nasal congestion, tonsillar congestion, and cough symptoms was shorter in the observation group (P < .05). Serum levels of iron, IgA, IgG as well as IgM were substantially elevated in the observation group. The levels of IL-4 and IL-10 were markedly reduced in the observation group after treatment. The prevalence of complications was considerably below that of the comparison group (21.25%) in the observation group (8.75%). Parental satisfaction with therapy was markedly higher in the observation group (92.50%) than in the control group (66.25%). The application of targeted second-generation sequencing technology to guide clinical diagnosis and drug use can elevate the RTIs efficacy and prognosis in childhood. Targeted second-generation sequencing can achieve precise treatment, reduce drug resistance of drug-resistant strains, and improve the efficacy. It has high promotion and application value.
Bioinformatics analysis of PANoptosis regulators in the diagnosis and subtyping of steroid-induced osteonecrosis of the femoral head
Authors: Ding Qiang , Xiong Bo , Liu Jinfu , Rong Xiangbin , Tian Zhao , Chen Limin , Tao Hongcheng , Li Hao , Zeng Ping
Published: May 2024

In this study, we aimed to investigate the involvement of PANoptosis, a form of regulated cell death, in the development of steroid-induced osteonecrosis of the femoral head (SONFH). The underlying pathogenesis of PANoptosis in SONFH remains unclear. To address this, we employed bioinformatics approaches to analyze the key genes associated with PANoptosis. Our analysis was based on the GSE123568 dataset, allowing us to investigate both the expression profiles of PANoptosis-related genes (PRGs) and the immune profiles in SONFHallowing us to investigate the expression profiles of PRGs as well as the immune profiles in SONFH. We conducted cluster classification based on PRGs and assessed immune cell infiltration. Additionally, we used the weighted gene co-expression network analysis (WGCNA) algorithm to identify cluster-specific hub genes. Furthermore, we developed an optimal machine learning model to identify the key predictive genes responsible for SONFH progression. We also constructed a nomogram model with high predictive accuracy for assessing risk factors in SONFH patients, and validated the model using external data (area under the curve; AUC = 1.000). Furthermore, we identified potential drug targets for SONFH through the Coremine medical database. Using the optimal machine learning model, we found that 2 PRGs, CASP1 and MLKL, were significantly correlated with the key predictive genes and exhibited higher expression levels in SONFH. Our analysis revealed the existence of 2 distinct PANoptosis molecular subtypes (C1 and C2) within SONFH. Importantly, we observed significant variations in the distribution of immune cells across these subtypes, with C2 displaying higher levels of immune cell infiltration. Gene set variation analysis indicated that C2 was closely associated with multiple immune responses. In conclusion, our study sheds light on the intricate relationship between PANoptosis and SONFH. We successfully developed a risk predictive model for SONFH patients and different SONFH subtypes. These findings enhance our understanding of the pathogenesis of SONFH and offer potential insights into therapeutic strategies.
Echocardiographic manifestations of mitochondrial disease with GTPBP3 gene mutations: A case report
Authors: Tong Qiaoli , Miao Yajing , Yin Hongning
Published: May 2024

Rationale:

Mitochondrial diseases are a group of disorders in which mutations in mitochondrial DNA or nuclear DNA lead to dysfunctional oxidative phosphorylation of cells, with mutations in mitochondrial DNA being the most common cause of mitochondrial disease, and mutations in nuclear genes being rarely reported. The echocardiographic findings of mitochondrial diseases with nuclear gene mutations in children’s hearts are even rarer. Even more valuable is that we followed up the patient for 4 years and dynamically observed the cardiac echocardiographic manifestations of mitochondrial disease. Provide ideas for the clinical diagnosis and prognosis of mitochondrial diseases.

Patient concerns:

The patient was seen in the pediatric outpatient clinic for poor strength and mental retardation. echocardiography: mild left ventricular (LV) enlargement and LV wall thickening. Nuclear genetic testing: uanosine triphosphate binding protein 3 (GTPBP3) gene mutation. Diagnosis of mitochondrial disease.

Diagnoses:

Mitochondrial disease with GTPBP3 gene mutations.

Outcomes:

After receiving drug treatment, the patient exhibited a reduction in lactate levels, an enhanced physical condition compared to prior assessments, and demonstrated average intellectual development.

Lessons subsections:

For echocardiographic indications of LV wall thickening and LV enlargement, one needs to be alert to the possibility of hereditary cardiomyopathy, especially in children.
Resistant ovary syndrome: Two case reports and a literature review of effective controlled ovarian stimulation in IVF
Authors: Zhao Shanfei , Zheng Wenling , Gu Xinru , Liang Guanglin , Long Guanyun
Published: May 2024

Introduction:

Resistant ovary syndrome (ROS) represents a rare reproductive endocrine disorder that is predominantly associated with infertility, characterized by heightened endogenous gonadotropin levels in the presence of a normal ovarian reserve. Patients with ROS typically exhibit a poor response to exogenous gonadotropins during controlled ovarian stimulation (COS). Due to the absence of a universally accepted effective COS protocol, this study aims to contribute to the existing body of literature by detailing 2 successful pregnancies achieved through conventional in vitro fertilization (c-IVF) in patients with ROS, and through retrospective analysis, seeks to elucidate the factors contributing to the successful ovarian stimulation in these cases, with the ultimate goal of establishing clinical guidelines for ROS management.

Patient Concerns:

The central challenge addressed in this study pertains to the effective induction of oocyte maturation during c-IVF COS in ROS patients.

Diagnosis:

The study focuses on 2 infertile women diagnosed with ROS who sought to conceive via c-IVF.

Interventions:

The patients were subjected to a COS protocol involving pituitary downregulation followed by ovarian stimulation using recombinant follicle-stimulating hormone (r-FSH) and human menopausal gonadotropin (HMG), preceded by 3 cycles of hormone replacement therapy (HRT) pretreatment.

Outcomes:

The proposed protocol elicited a favorable ovarian response, culminating in the retrieval of numerous mature oocytes and the development of multiple viable embryos via c-IVF, ultimately leading to successful live births post-embryo transfer.

Conclusions:

Our study suggests that the outlined COS protocol may serve as a viable treatment option for ROS patients aspiring to conceive through c-IVF, thereby potentially expanding the therapeutic repertoire for this challenging condition.
Self-inflicted very-low-velocity penetrating head injury: A CARE-compliant case report
Authors: Ota Koshi , Kobata Hitoshi , Tomonishi Shunsuke , Ota Kanna , Takasu Akira
Published: May 2024

Rationale:

Low-velocity penetrating head injury (PHI) is rare, comprising 0.2% to 0.4% of head traumas, but can be devastating and is associated with significant morbidity and mortality. No previous case of very-low-velocity PHI due to self-inflicted stabbing with a gimlet has been reported.

Patient concerns:

A 62-year-old man was admitted to the hospital with bleeding head and abdominal wounds after stabbing his abdomen with a gimlet, and then hammering the same gimlet into his forehead and removing the gimlet himself.

Diagnoses:

Upon examination at admission, stab wounds were present on the forehead and the right upper quadrant. Computed tomography (CT) of the head revealed a bone defect in the left frontal bone and showed the intracranial path of the gimlet surrounded by mild hemorrhage and pneumocephalus. Magnetic resonance imaging (MRI) confirmed a small amount of hemorrhage with pneumocephalus but no vascular injury.

Interventions:

Conservative treatment without surgery.

Outcomes:

Follow-up MRI on hospital day 58 showed no abscess or traumatic intracranial aneurysm. The patient achieved full recovery of motor and mental functions with conservative treatment and was discharged on hospital day 69.

Lessons:

Very-low-velocity PHI might be successfully treated with conservative treatment.
Clinical characteristics and prognostic factors of adult brainstem gliomas: A retrospective analysis of histologically-proven 40 cases
Authors: Li Shan , Zhao Yanjie , Huang Hongyan
Published: May 2024

To illustrate the clinical characteristics and prognostic factors of adult patients pathologically confirmed with brainstem gliomas (BSGs). Clinical data of 40 adult patients pathologically diagnosed with BSGs admitted to Beijing Shijitan Hospital from 2009 to 2022 were recorded and retrospectively analyzed. The primary parameters included relevant symptoms, duration of symptoms, Karnofsky performance status (KPS), tumor location, type of surgical resection, diagnosis, treatment, and survival. Univariate and multivariate analyses were evaluated by Cox regression models. The gliomas were located in the midbrain of 9 patients, in the pons of 14 cases, in the medulla of 5 cases, in the midbrain and pons of 6 cases and invading the medulla and pons of 6 cases, respectively. The proportion of patients with low-grade BSGs was 42.5%. Relevant symptoms consisted of visual disturbance, facial paralysis, dizziness, extremity weakness, ataxia, paresthesia, headache, bucking, dysphagia, dysacousia, nausea, dysphasia, dysosmia, hypomnesia and nystagmus. 23 (57.5%) patients accepted stereotactic biopsy, 17 (42.5%) patients underwent surgical resection. 39 patients received radiotherapy and 34 cases were treated with temozolomide. The median overall survival (OS) of all patients was 26.2 months and 21.5 months for the median progression-free survival (PFS). Both duration of symptoms (P = .007) and tumor grading (P = .002) were the influencing factors for OS, and tumor grading was significantly associated with PFS (P = .001). Duration of symptoms for more than 2 months and low-grade are favorable prognostic factors for adult patients with BSGs.
Superacute onset of Guillain–Barré syndrome after elective spinal surgery: A case report and literature review
Authors: Zhang Xinyu , Yu Deshui
Published: May 2024

Rationale:

Guillain–Barré syndrome (GBS) epitomizes an acute peripheral neuropathy hallmarked by an autoimmune retort directed at the myelin sheath enwrapping peripheral nerves. While it is widely acknowledged that a majority of GBS patients boast a history of antecedent infections, the documentation of postoperative GBS occurrences is progressively mounting. Drawing upon an exhaustive compendium of recent case reports, the disease’s inception spans a gamut from within 1 hour to 1.2 years.

Patient concerns:

At this juncture, we proffer a singular case: an instance involving a 51-year-old gentleman who underwent lumbar spine surgery, only to encounter immediate debilitation of limb and respiratory musculature.

Diagnoses:

Post elimination of variables linked to anesthetic agents, encephalon, and spinal cord pathologies, a potent suspicion of superacute GBS onset emerged.

Interventions:

Subsequent to immunoglobulin therapy, plasmapheresis, and adjunctive support, the patient’s ultimate demise became manifest.

Outcomes:

No progress was found to date.

Lessons:

Given GBS’s potential to instigate paralysis, respiratory collapse, and autonomic nervous system aberrations, alongside other pernicious sequelae, coupled with the exceptional rarity of the temporal onset in this particular instance, it undeniably proffers an imposing conundrum for anesthetists in the realm of differential diagnosis and therapeutic conduct. During the postoperative convalescence phase under anesthesia, should the patient evince deviant limb musculature vigor and compromised respiratory sinews, the prospect of GBS must not be consigned to oblivion. Precision in diagnosis conjoined with apt therapeutic measures could well be the harbinger of a divergent denouement for the afflicted patient.
Impact of intraoperative dexmedetomidine on postoperative delirium and pro-inflammatory cytokine levels in elderly patients undergoing thoracolumbar compression fracture surgery: A prospective, randomized, placebo-controlled clinical trial
Authors: Ye Caimin , Shen Jian , Zhang Chengcheng , Hu Cuiyun
Published: May 2024

Background:

This study evaluates the efficacy of dexmedetomidine (DEX) in reducing postoperative delirium (POD) and modulating pro-inflammatory cytokines in elderly patients undergoing thoracolumbar compression fracture surgery.

Methods:

In this randomized, double-blind, placebo-controlled trial conducted from October 2022 to January 2023 at Anting Hospital in Shanghai, 218 elderly patients were randomized into DEX (n = 110) and normal saline (NS, n = 108) groups. The DEX group received 0.5 µg/kg/h DEX, and delirium incidence was assessed using the Confusion Assessment Method (CAM) on days 1 to 3 post-surgery. Levels of interleukins IL-1β, IL-6, and tumor necrosis factor-α (TNF-α) were measured pre-operation (T0) and on postoperative days 1 (T1) and 3 (T3). Preoperative (T0) and postoperative day 1 (T1) cerebrospinal fluid (CSF) samples were treated with varying concentrations of olanzapine or DEX to observe their regulatory effects on the expression of Phospho-ERK1/2 and Phospho-JNK.

Results:

Dexmedetomidine significantly lowered the incidence of POD to 18.2%, compared to 30.6% in the NS group (P = .033). While all patients showed an initial increase in cytokine levels after surgery, by T3, IL-6 and TNF-α levels notably decreased in the DEX group, with no significant change in IL-1β levels across groups. The adverse events rate was similar between groups, demonstrating the safety of DEX in this population. In postoperative CSF samples, treatment with 0.5 mM DEX significantly downregulated Phospho-JNK and upregulated Phospho-ERK1/2 expression, demonstrating a dose-dependent modulation of inflammatory responses.

Conclusion:

Dexmedetomidine is effective in reducing early POD in elderly patients post-thoracolumbar compression fracture surgery. It also decreases IL-6 and TNF-α levels, indicating its potential in managing postoperative inflammatory responses. Treatment with 0.5 mM DEX significantly modulated Phospho-ERK1/2 and Phospho-JNK expressions in postoperative CSF samples, indicating a dose-dependent effect on reducing inflammation. This study contributes to understanding DEX’s role in improving postoperative outcomes in elderly patients.
Identification and validation of oxidative stress-related genes in sepsis-induced myopathy
Authors: Zhang Ning , Huang Dan , Li Xiang , Yan JinXia , Yan Qi , Ge WeiXing , Zhou Jun
Published: May 2024

Background:

Sepsis-induced myopathy (SIM) a complication of sepsis that results in prolonged mechanical ventilation, long-term functional disability, and increased patient mortality. This study was performed to identify potential key oxidative stress-related genes (OS-genes) as biomarkers for the diagnosis of SIM using bioinformatics.

Methods:

The GSE13205 was obtained from the Gene Expression Omnibus (GEO) database, including 13 SIM samples and 8 healthy samples, and the differentially expressed genes (DEGs) were identified by limma package in R language. Simultaneously, we searched for the genes related to oxidative stress in the Gene Ontology (GO) database. The intersection of the genes selected from the GO database and the genes from the GSE13205 was considered as OS-genes of SIM, where the differential genes were regarded as OS-DEGs. OS-DEGs were analyzed using GO enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways, and protein-protein interaction (PPI) networks. Hub genes in OS-DEGs were selected based on degree, and diagnostic genes were further screened by gene expression and receiver operating characteristic (ROC) curve. Finally, a miRNA-gene network of diagnostic genes was constructed.

Results:

A total of 1089 DEGs were screened from the GSE13205, and 453 OS-genes were identified from the GO database. The overlapping DEGs and OS-genes constituted 25 OS-DEGs, including 15 significantly upregulated and 10 significantly downregulated genes. The top 10 hub genes, including CD36, GPX3, NQO1, GSR, TP53, IDH1, BCL2, HMOX1, JAK2, and FOXO1, were screened. Furthermore, 5 diagnostic genes were identified: CD36, GPX3, NQO1, GSR, and TP53. The ROC analysis showed that the respective area under the curves (AUCs) of CD36, GPX3, NQO1, GSR, and TP53 were 0.990, 0.981, 0.971, 0.971, and 0.971, which meant these genes had very high diagnostic values of SIM. Finally, based on these 5 diagnostic genes, we found that miR-124-3p and miR-16-5p may be potential targets for the treatment of SIM.

Conclusions:

The results of this study suggest that OS-genes might play an important role in SIM. CD36, GPX3, NQO1, GSR, and TP53 have potential as specific biomarkers for the diagnosis of SIM.
Primary care clinic visits in formerly evacuated areas due to radiation disaster following the Great East Japan Earthquake: A retrospective descriptive study
Authors: Nonaka Saori , Odaka Masaaki , Takada Akemi , Senoo Yuki , Sawano Toyoaki , Ozaki Akihiko , Murakami Michio , Yoshida Makoto , Uchi Yuna , Onoda Katsuko , Oikawa Tomoyoshi , Tsubokura Masaharu
Published: May 2024

Radiation disasters pose distinctive medical challenges, requiring diverse care approaches. Beyond radiation exposure assessment, addressing health impacts due to lifestyle changes, especially among vulnerable populations, is vital. Evacuation orders issued in radiation-affected areas introduce unique healthcare dynamics, with their duration significantly influencing the recovery process. Understanding evolving patient demographics and medical needs after lifting evacuation orders is crucial for post-disaster care planning. Minamisoma Municipal Odaka Hospital, located 13 to 20 km from Fukushima Daiichi Nuclear power plant in a post-evacuation zone, was greatly affected by the Great East Japan Earthquake and subsequent radiation disaster. Data were retrospectively collected from patient records, including age, gender, visit date, diagnoses, and addresses. Patient records from April 2014 to March 2020 were analyzed, comparing data before and after the July 2016 evacuation order lift. Data was categorized into pre and post-evacuation order lifting periods, using International Classification of Diseases, Tenth Edition codes, to identify the top diseases. Statistical analyses, including χ-square tests, assessed changes in disease distributions. Population data for Odaka Ward and Minamisoma City fluctuated after lifting evacuation orders. As of March 11, 2011, Odaka Ward had 12,842 residents (27.8% aged 65+ years), dropping to 8406 registered residents and 2732 actual residents by April 30, 2018 (49.7%). Minamisoma City also saw declines, with registered residents decreasing from 71,561 (25.9%) to 61,049 (34.1%). The study analyzed 11,100 patients, mostly older patients (75.1%), between 2014 and 2020. Post-lifting, monthly patient numbers surged from an average of 55.2 to 213.5, with female patients increasing from 33.8% to 51.7%. Disease patterns shifted, with musculoskeletal cases declining from 23.8% to 13.0%, psychiatric disorders increasing from 9.3% to 15.4%, and trauma-related cases decreasing from 14.3% to 3.9%. Hypertension (57.1%) and dyslipidemia (29.2%) prevailed post-lifting. Urgent cases decreased from 1.3% to 0.1%. This study emphasizes the importance of primary care in post-evacuation zones, addressing diverse medical needs, including trauma, noncommunicable diseases, and psychiatric disorders. Changing patient demographics require adaptable healthcare strategies and resource allocation to meet growing demands. Establishing a comprehensive health maintenance system tailored to these areas’ unique challenges is crucial for future disaster recovery efforts.
Exploring the casual association between gut microbiome, circulating inflammatory cytokines and chronic pancreatitis: A Mendelian randomization analysis
Authors: Yang Xiaoqiu , Xu Hao , Liang Xiaolu , Yuan Guojia , Gao Qiaoping , Tan Xiaoyu , Yang Yongguang , Xiao Yi , Huang Zhanren , Dai Wei , Liu Xiaoguang
Published: May 2024

It has been established that gut dysbiosis contributed to the pathogenesis of digestive disorders. We aimed to explore the causal relationships between intestinal microbiota, circulating inflammatory cytokines and chronic pancreatitis (CP). Summary statistics of genome-wide association studies (GWAS) of intestinal microbiome was retrieved from the MiBioGen study and the GWAS data of 91 circulating inflammatory cytokines and CP were obtained from the GWAS catalog. The 2-sample bidirectional Mendelian randomization (MR) analysis was performed between gut microbiota, circulating inflammatory cytokines and CP, in which the inverse variance weighted (IVW) method was regarded as the primary analysis approach. To prove the reliability of the causal estimations, multiple sensitivity analyses were utilized. IVW results revealed that genetically predicted 2 genera, including Sellimonas and Eubacteriumventriosumgroup, and plasm C-C motif chemokine 23 (CCL23) level were positively associated with CP risk, while genus Escherichia Shigella, Eubacteriumruminantiumgroup and Prevotella9, and plasma Caspase 8, Adenosine Deaminase (ADA), and SIR2-like protein 2 (SIRT2) level, demonstrated an ameliorative effect on CP. Leave-one-out analysis confirmed the robustness of the aforementioned causal effects and no significant horizontal pleiotropy or heterogeneity of the instrumental variables was detected. However, no association was found from the identified genera to the CP-related circulating inflammatory cytokines. Besides, the reverse MR analysis demonstrated no causal relationship from CP to the identified genera and circulating inflammatory cytokines. Taken together, our comprehensive analyses offer evidence in favor of the estimated causal connections from the 5 genus-level microbial taxa and 4 circulating inflammatory cytokines to CP risk, which may help to reveal the underlying pathogenesis of CP.
Acupuncture and moxibustion treatment for myasthenia gravis: A systematic review and meta-analysis
Authors: Lu Ying , Li Jian , Yu Ting , Wu Chunlan , You Yi , Wang Changde , Liu Xiaoying
Published: May 2024

Background:

Myasthenia gravis (MG) is a common autoimmune disease that often involves the skeletal muscle of the whole body and seriously affects patients’ quality of life. Acupuncture and moxibustion treatment of MG has unique advantages, the aim is to evaluate the clinical effect of acupuncture and moxibustion on MG.

Methods:

The literature on acupuncture and moxibustion treating MG in PubMed, CochraneLibrary, EMBASE, SCI, China Academic Journals full-text database, China Biology Medicine disc, VIP and Wanfang database were searched through computers from the establishment of the database to December 2022.

Results:

A total of 11 studies were included, involving 658 patients, where 330 in the treatment group and 328 in the control group. The results of the meta-analysis showed that the treatment group performed better than the control group in improving the total clinical response rate (OR = 3.26, 95%[2.04,5.21], P < .01). Additionally, the treatment group outperformed the control group in raising the absolute clinical score (MD = −3.48, 95%CI[−5.17, −1.78], P < .01). However, there was no significant difference between the treatment group and the control group in improving the level of serum interleukin-6 receptor (MD = −1.45,95%CI[−6.85,3.95], P > .05) and OMG quantitative score (MD = −2.16,95%CI[−4.85,0.52], P > .05). The total clinical effective rate was tested for publication bias, which showed that the 2 sides of the funnel plot were asymmetrical, suggesting the possible existence of publication bias.

Conclusion:

Acupuncture and moxibustion has a good effect on MG, which is better than conventional Western medicine in improving the total clinical effective rate and absolute clinical score.
Exploring the association between multiple factors and urolithiasis: A retrospective study and Mendelian randomization analysis
Authors: Yin Kexin , Yin Zhikang , Liu Zhenyu , Yao Junjie , Wu Yuzhou , Su Shuai
Published: May 2024

To investigate the relationship between several factors and urinary stone as well as different stone compositions. To guide the diagnosis, treatment, and prevention of urinary stone recurrence. We used bidirectional Mendelian randomization to analyze the causal relationship between hypertension and urinary stones, diabetes and urinary stones, and body mass index (BMI) and urinary stones. We retrospectively analyzed the medical records of patients with urinary stones admitted to a tertiary care hospital in Chongqing, China, from July 2015 to October 2022. Patients were included when they were first diagnosed with urinary stones. The odds ratio of calculi on hypertension estimated by inverse variance weighted was 8.46 (95%CI: 4.00–17.90, P = 2.25 × 10−8). The stone composition analysis showed that there were 3101 (67.02%) mixed, 1322 (28.57%) calcium oxalate monohydrate, 148 (3.20%) anhydrous uric acid, 16 (0.35%) magnesium ammonium phosphate hexahydrate, 11 (0.24%) dicalcium phosphate dihydrate, 10 (0.22%) carbonate apatite, 8 (0.17%) L-cystine, 4 ammonium uric acid (0.09%), and 7 other stone types (0.15%). Mendelian randomization studies have proven that urinary stones may be a potential risk factor for hypertension, while there is no causal relationship between diabetes and stones, BMI, and stones. Our retrospective study has shown that urinary stone components are closely associated with sex, age, hypertension, diabetes, and BMI. It is reasonable to suspect that treating a single stone component is ineffective in preventing recurrence. We also found that the peak incidence of urinary stones was at the most active stage of most people’s working lives.
Safety of deer antler extract in children: A 12-week randomized controlled clinical trial
Authors: Kim Hye Yeon , Seo Hae Sun , Seo Hee Ae , Doh Tae Yun , Chang Gyu Tae , Lee Jin Yong , Lee Sun Haeng
Published: May 2024

Background:

Deer antlers have been used as strong tonifying medicine in Asian countries, especially for the growth and development of children in pediatrics of Korean medicine. The safety of deer antler in adults cannot be applied directly to children because of their physiological characteristics. To accumulate reliable data on the safety of deer antler in pediatric populations, well-designed clinical studies are required.

Methods:

This research is a 12-week, randomized, double-blind, placebo-controlled clinical trial evaluating the safety of deer antler extract (DAE) in children. The DAE group received an intervention containing 1586 mg of DAE, whereas the control group received a placebo for 12 weeks. The safety was assessed by monitoring adverse drug reactions (ADRs) and laboratory test results.

Results:

One hundred participants were included in the safety analysis. Three and 2 participants in the DAE and control groups, respectively, reported ADRs. There was no significant difference in incidence between the 2 groups. ADRs are categorized into gastrointestinal and skin-related symptoms. No serious ADR was observed throughout the study. The laboratory test results were within or outside the normal range at clinically insignificant levels.

Conclusion:

The research discovered that the DAE is safe in terms of ADRs and laboratory parameters under the conditions studied. Further studies are required to accumulate safety data about DAE dosage adjustment and potential interactions with other medicines.