bluuebunny/crossref_metadata_2025 huggingface dataset:
Bloodletting at the ear apex for acute stroke: A systematic review and meta-analysis of randomized controlled trials
Authors: Kim Mikyung , Han Chang-ho
Published: December 2024

Background:

Stroke is a major cause of death and disability worldwide. Despite innovative developments in acute stroke treatment techniques in modern society, many stroke survivors still experience complications, leading to a demand for complementary and alternative medicines, including traditional medicine. Bloodletting at the ear apex (BLEA) is a nonpharmacological intervention used for various diseases, including acute stroke, in traditional medicine in East Asian countries, including China and Korea. This study aimed to evaluate the clinical efficacy of BLEA for acute stroke recovery.

Methods:

We searched PubMed, Embase, CENTRAL, AMED, CNKI, KoreaMed, ScienceOn, and OASIS databases for randomized controlled trials (RCTs) evaluating the effect of BLEA on acute stroke recovery. We systematically reviewed the literature published in academic journals up to September 8, 2024 and synthesized the data extracted from the final selected literature. The results of the meta-analysis are presented as mean differences (MDs) with 95% confidence intervals (CIs). The Cochrane Risk of Bias 2 tool and GRADE methodology were used for quality assessment.

Results:

Six RCTs with 530 participants were included in this meta-analysis. In patients with acute stroke receiving conventional Western medical treatment, the addition of BLEA significantly improved neurological deficits assessed by the National Institute of Stroke Scale (MD, −2.83; 95% CIs, −4.48 to −1.17), consciousness impairment measured by the Glasgow Coma Scale (MD, 2.75. 95% CIs, 1.72 to 3.78), and motor function assessed by the Fugl-Meyer Assessment (MD, 5.31. 95% CIs, 3.04 to 7.58). It also significantly reduced the length of hospital stay (MD, −7.39; 95% CIs. −8.85 to −5.93).

Conclusion:

BLEA may be a promising intervention that provides additional benefits to patients with acute stroke receiving standard western medical care. However, the supporting evidence comes from a few small studies with a high risk of bias and low reporting quality. Future studies with appropriate population sizes and more rigorous methodology are warranted.
Lactate, lactate clearance, and lactate-to-albumin ratio in predicting mortality in patients with critical polytrauma: A retrospective observational study
Authors: Arslan Kadir , Sultan Sahin Ayca
Published: December 2024

Lactate is a product of anaerobic metabolism used to determine prognosis in critically ill trauma patients. This study investigates the mortality-predictive performance of lactate, lactate clearance, and lactate-to-albumin ratio (LAR) on admission in patients with polytrauma in a tertiary center’s intensive care unit (ICU). Polytrauma patients in the ICU between June 2019 and June 2022 were evaluated. The diagnosis of polytrauma was made according to the Berlin criteria, a widely accepted and comprehensive system for classifying the severity of multiple injuries. Patients were classified into survivor and mortality groups. The predictive performance of lactate, lactate clearance (24th hour), and LAR for 28-day mortality was compared. The study included 176 patients. The median age of the entire population was 35 (24–50) years, and 78.4% (n = 138) were male. Motor vehicle accidents were the most common cause of polytrauma in patients (48.9%, n = 86). The most common head injuries were detected in the patients (59.1%, n = 104). In the mortality group, median lactate and lactate (24th hour) levels were significantly higher (P < .001). Median albumin and LAR values were significantly lower (P < .001). Although 24-hour lactate clearance was lower in the mortality group, no significant difference was detected (36.1% vs 42.3%, P = .052). In multivariate regression analysis, LAR was an independent predictor of mortality (P < .001). In receiver operating characteristics curve analysis, the cutoff value of lactate was ≥5.4, the area under the curve (AUC) was 0.75 (95% confidence interval [CI], 0.66–0.84), the cutoff value of lactate clearance was ≤39.2, AUC was 0.60, (95% CI, 0.51–0.69), and the cutoff value of LAR was value ≥1.50, AUC 0.83 (95% CI, 0.75–0.90). In critically ill polytrauma patients, LAR on ICU admission is an independent predictor of mortality and has acceptable prognostic value. LAR is superior to lactate and 24-hour lactate clearance in predicting mortality.
Evaluation of retinal microvascular changes with OCT-A in Parkinson disease and essential tremor
Authors: Erdem Miray , Soker Elif Banu , Ozdogru Derya , Balal Mehmet , Ciloglu Emine
Published: December 2024

This study aimed to evaluate the presence and comparison of microvascular abnormalities in essential tremor (ET) and Parkinson disease (PD) using optical coherence tomography angiography (OCT-A) and to show the relationship between retinal microvascular changes and disease stage in the patient group. A total of 176 eyes, including 26 PD diagnosed according to the United Kingdom PD Society Brain Bank criteria, 31 ET diagnosed according to the Washington heights-inwood genetic study of ET (WHIGET) criteria and 31 healthy controls, were included in the study. Unified PD assessment scale (UPDRS) motor scores, non-motor symptom scale (NMS), modified Hoehn&Yahr stages (mH&Y) and Fahn–Toloso–Marin grading scale were recorded. All patients were evaluated in terms of visual acuity, fundus examination, intraocular pressure measurements, and refractive errors in Ophthalmology department. Deep macular vascular density was significantly decreased in PD compared to both the controls and ET(P < .05). In the measurements in the inferior quadrant of the retinal nerve fiber layer (RNFL) of the optic disc (OD), the values of the controls were significantly higher than those of PD in both eyes (P = .014 and P = .010). Radial peripapillary capillarity density in the left eye was substantially lower in ET than in controls (P = .045). In both eyes, OD radial peripapillary capillarity inside the disc small values of PD were significantly lower than those of ET and controls (P < .05). In our study, deep macular vascular density, RNFL and radial peripapillary capillarity were significantly lower in PD compared with ET and control groups, and radial peripapillary capillarity was lower in ET compared with control group. This study provides valuable information regarding the potential of OCT-A as a diagnostic tool for PD and ET.
Construction and validation of a prediction model for acute ischemic stroke patients with concomitant deep vein thrombosis
Authors: Xu Hai , Yin Qin
Published: December 2024

The aim was to investigate the independent risk factors for complications of deep vein thrombosis (DVT) in patients with acute ischemic stroke (AIS), and to establish a nomogram prediction model accordingly. The data of AIS patients in our hospital were collected from January 2021 to December 2023, and single-factor and multifactorial logistic regression analyses were used to determine the independent risk factors for the complication of DVT in patients with AIS and to establish the corresponding nomogram. The receiver operating characteristic curves were plotted the area under the curve was calculated, and the calibration and decision curves were plotted to evaluate the model performance. Five hundred twenty-seven AIS patients were included in the study, and 42 AIS patients were complicated with DVT, with an incidence rate of 7.97%. After univariate and multivariate logistic regression analyses, a total of 5 variables were identified as independent risk factors for the complication of DVT in patients with AIS: age > 70 years (OR, 1.551; 95% CI, 1.189–2.751), diabetes (OR, 2.543; 95% CI, 1.322–4.265), the national institutes of health stroke scale > 16 (OR, 3.124; 95% CI, 1.314–7.003), D-dimer > 0.5 mg/L (OR, 2.303; 95% CI, 1.250–3.645), and fibrinogen > 4 g/L (OR, 1.918; 95% CI, 1.532–6.369). The nomogram constructed in this study for AIS patients with concomitant DVT has good predictive accuracy and helps physicians to intervene in advance in patients at high risk of acute AIS patients with concomitant DVT.
Prevalence and risk factors of cognitive frailty in patients with cardiovascular disease: A hospital-based cross-sectional study
Authors: Guo Jinhua , Zhang Yi , Yang Yi , Lin lixia , Shen Tiemei
Published: December 2024

The prevalence of the cognitive frailty is increasing in China. Screening for this condition is crucial for its early detection, prevention, and treatment. This study was designed to explore the incidence of cognitive frailty among hospitalized elderly patients suffering from cardiovascular disease. It also aimed to analyze the factors influencing its occurrence, thereby providing substantial evidence for the development of early prevention and intervention strategies.

From March 2022 to October 2023, under cardiovascular care program, the cardiovascular patients (n = 1190) were subjected to standardized questionnaires to collect demographical characteristics. Also, nutritional and psychosocial assessments tests were performed for the enrolled patients. Multivariate logistic regression analysis was used to evaluate factors associated with cognitive frailty.

A total of 1190 (755 males and 435 females) were included. The mean age was 73.36 ± 7.37 years. The prevalence of cognitive frailty in the study population was 33.9% (404/1190). The prevalence of cognitive frailty was 40.7% in men, 22.3% in women. In terms of specific cardiovascular diseases, the prevalence of cognitive frailty was 28.5% in coronary heart disease, 20.5% in arrhythmia, 36.8% in valvular disease, 53% in heart failure, and 13.7% in hypertension. The multivariable analysis showed that age (OR = 1.13, 95% CI: 1.10–1.15, P < .001), anxiety (OR = 1.01, 95% CI: 1.03–1.11, P = .001), female sex (OR = 1.83, 95% CI: 1.10–1.16, P < .001), education level (college and above, OR = 0.27, OR = 0.12–0.64, P = .003), polypharmacy (OR = 2.29, 95% CI: 1.62–3.23, P < .001), comorbidity (OR = 1.93 95% CI: 1.37–2.71, P < .010), region (rural, OR = 1.77, 95% CI: 1.36–2.30, P < .001), sarcopenia (OR = 1.60, 95% CI: 1.16–2.19, P = .004), and nutritional status (risk of malnutrition, OR = 1.66, 95% CI: 1.17–2.35, P = .004; malnutrition exists, OR = 3.24, 95% CI: 1.85–5.83, P < .001) were independently associated with cognitive frailty.

The prevalence of cognitive frailty was 33.9% in hospitalized elderly cardiovascular patients in Guangzhou. heart failure, hypertension, age, anxiety, female sex, education level, polypharmacy, comorbidity, region, sarcopenia, and nutritional status were independent risk factors for cognitive frailty.
Relationship between diastolic blood pressure and Alzheimer disease: A 2-sample Mendelian randomization study based on an automated screening method for exposure factors and empirical validation
Authors: Ren JiaJu , Ye Yitian , Zhang Yichun , Zhu Yanbo , Ge Pu , Luo Yuhao , Wang Jia
Published: December 2024

This study investigates the causal relationship between diastolic blood pressure (DBP) and Alzheimer disease (AD) using 2-sample Mendelian randomization (MR) analysis with publicly available genome-wide association study (GWAS) data and empirical validation. Automated screening identified DBP as a factor related to AD. Two-sample MR analyses were conducted using inverse variance weighting (IVW), MR-Egger regression, weighted median, simple mode, and weighted mode methods. Tests for pleiotropy, heterogeneity, and stability of genetic variants were performed. Data included DBP from Europeans (n = 422,713) and AD cases (n = 753) and controls (n = 736) of European ancestry. An empirical sample of 125 patients with cardiovascular disease in Chinese was used to verify the possibility of the above relationship by restricted cubic spline method. Thirty-seven genome-wide significant nucleotide polymorphisms from DBP GWAS were used as instrumental variables. IVW showed a causal relationship between DBP and AD (β = −1.594, SE = 0.580, P = .006). MR-Egger regression indicated minimal pleiotropy (intercept = 0.037; P = .736) and confirmed the causal relationship (β = −3.110, SE = 1.376, P = .030). The weighted median method also supported this relationship (β = −1.868, SE = 0.856, P = .029). The simple and weighted mode methods did not find significant relationships (P > .1). No heterogeneity or asymmetry was detected by Cochran Q test or the funnel plot, and the leave-one-out method showed stable results. The validation results indicate that the aforementioned findings are stable within the normal range of DBP. MR analysis supports a potential causal link between higher DBP and a lower risk of AD. The screening exposure method used could enhance MR study efficiency.
Evaluation of risk factors for postpartum cerebral venous sinus thrombosis, a multicenter retrospective observational study
Authors: Dinc Yasemin , Demir Bilge Cetinkaya , Sigirli Deniz , Akarsu Emel Oguz , Saridas Furkan , Hakyemez Bahattin , Bakar Mustafa , Güllü Gizem , Güneş Aygül , Haki Cemile , Koc Emine Rabia , Akesen Selcan , Eryildiz Ezgi Sezer , Aykac Özlem , Uysal Zehra Kocabaş , Özdemir Atilla Özcan , Kamisli Suat
Published: December 2024

The postpartum period is a well-defined risk factor for cerebral venous sinus thrombosis (CVST). However, it is unclear which patients are at risk for CVST in the postpartum period. Thus, determining some CVST risk factors in postpartum patients may be useful for preventing the disorder in this population. Previous studies have shown that preeclampsia (PE) is a risk factor for pulmonary thromboembolism and deep vein thrombosis, but whether it is related to postpartum CVST has not yet been evaluated. This study aimed to determine if this relationship exists. This study was a case–control study of retrospectively screened patients diagnosed with CVST between 2018 and 2023 at the Uludağ University Faculty of Medicine Department of Neurology, the Eskişehir Osmangazi University Faculty of Medicine and the Bursa City Hospital Health Sciences University Department of Neurology. All of the women who delivered between 2018 and 2023 at the Uludağ University Faculty of Medicine Department of Obstetrics and Gynaecology were included in the control group. In total, 57 out of 322 cases and 4299 out of 4452 controls were included in this study. A nonsignificant relationship was found between CVST and spinal anesthesia, but a significant relationship was found between PE and stillbirth. Women with PE who had recently delivered were found to be at increased risk of developing CVST. The primary limitation of this study is that it was retrospective, and the control group was hospital-based. We recommend that these findings be confirmed by multicenter prospective international studies.
Association of red blood cell distribution width–albumin ratio with in-hospital mortality in abdominal aortic aneurysm patients
Authors: Weng Chao , Yu Cong , Yang Guang-Wei , Jiang Jin-Song , Wu Hao
Published: December 2024

To explore whether red blood cell distribution width–albumin ratio (RAR) is relevant to in-hospital mortality among abdominal aortic aneurysm (AAA). This is a retrospective study retrieving data from the MIMIC-IV database. Patients were divided into survivor or non-survivor groups by the in-hospital mortality. Receiver operating characteristic curve analysis, logistic regression models, subgroup analysis, interaction analysis, and restricted cubic spline analysis were conducted to analyze the correlation between RAR and in-hospital mortality. Then, we divided patients into 2 groups by an optimal cutoff value of RAR to identify the factors independently linked to RAR. Following this, the mediation analysis was conducted to reveal the potential regulatory path. Finally, we assessed the clinical value of RAR in secondary outcomes containing length of hospital stay, intensive care unit (ICU) admission, and ICU stay. Totally 770 participants with AAA were enrolled: 722 survivors and 48 non-survivors. Higher RAR was observed in the non-survivor group and its level performed satisfactorily in predicting in-hospital mortality. AAA patients were more likely to die during in-hospital with the increase of RAR (P < .05) and this linear correlation was revealed by restricted cubic spline (P non-linear > .05). Additionally, urea nitrogen and creatinine were independently related to RAR. RAR served as a mediator in the association of urea nitrogen/creatinine with in-hospital mortality. Finally, the length of hospital stay and ICU stay were longer in the RAR ≥ 4.658 group (P < .05). RAR is a potential risk predictor for in-hospital mortality in AAA patients. Further, RAR upregulation was significantly correlated with prolonged length of hospital stay and ICU stay.
Efficacy of Jiangzhi Mai’an Granules in the treatment of stable angina pectoris with phlegm and blood stasis obstruction and carotid artery plaque: A prospective randomized study
Authors: Fan Jianhua , Yu Chang , Tang Huan , Zhang Zhuang , Wu Qiong , Lu Licheng , Xu Cun , Xia Zhaochen , Xu Haixiang , Wen Jiasheng , Pan Wen
Published: December 2024

Background:

Stable angina pectoris, resulting from coronary artery atherosclerosis, significantly affects quality of life and carries a high risk of cardiovascular events. Despite modern therapies, managing this condition remains challenging. Traditional Chinese medicine (TCM) views it as a syndrome of heart meridian obstruction by phlegm and blood stasis, necessitating improved circulation and phlegm resolution. This study aims to evaluate the efficacy of Jiangzhi Mai’an Granules, a TCM formulation, in treating stable angina pectoris and carotid atherosclerosis, with the goal of integrating TCM with Western medicine to enhance clinical outcomes and patients’ quality of life.

Methods:

A total of 120 patients diagnosed with stable angina pectoris and carotid atherosclerotic plaques of the phlegm and blood stasis types were randomly divided into 2 groups. The control group (n = 60) received standard Western medical treatment, whereas the treated group (n = 60) received JZMA in addition to the standard regimen. The treatment duration in both the groups was 3 months. The outcomes measured included carotid intima-media thickness (CIMT), carotid plaque dimensions, TCM syndrome scores, and serum lipid profiles (total cholesterol [TC], triglycerides [TG], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], apolipoprotein B [Apo B], and non-HDL-C) and lipoprotein phospholipase A2 (Lp-PLA2) levels before and after treatment.

Results:

The treated group achieved a total efficacy rate of 93.3% (56/60), which surpassed the control group rate of 78.3% (47/60). The CIMT, carotid plaque thickness, and area in the treated group were significantly reduced posttreatment compared to baseline (P < .05) and were also lower than those in the control group (P < .05). Serum lipid levels, including TC, TG, LDL-C, ApoB and non-HDL-C were significantly decreased in both groups posttreatment (P < .05), and the treated group showed a further increase in HDL-C levels (P < .05). The treated group exhibited lower serum lipid levels than the control group posttreatment (P < .05). The TCM syndrome scores improved significantly in both groups after treatment (P < .05), with the treated group demonstrating a more pronounced reduction in scores than the control group (P < .05). The incidence of adverse events did not differ significantly between the 2 groups.

Conclusions:

JZMA combined with standard treatment effectively reduced CIMT, plaque size, and serum lipid levels, thereby enhancing clinical outcomes in patients with stable angina and carotid atherosclerosis.
Procalcitonin, C-reactive protein, and white blood cell count levels in end-stage cancer patients: A retrospective study on inflammatory markers and their prognostic value
Authors: Zhou Qihao , Lu Xuefen , Qian Liping , Yu Chaochao , Xie Jingru , Kong Dexia
Published: December 2024

Procalcitonin (PCT), C-reactive protein (CRP), and white blood cell count (WBC) are commonly recognized as inflammatory markers. Some studies showed that these markers were also related to some cancers. This study aimed to investigate whether these markers were exhibited aberrations in end-stage cancer patients and to assess their correlation with infection and prognosis. The study underscores the potential of inflammatory markers as prognostic indicators in end-stage cancer, proposing that routine monitoring of these markers could substantially enhance patient management and improve outcomes. The medical records of 116 cancer patients were retrospectively reviewed. Data from end-stage cancer patients were collected during the week preceding their death. The control group consisted of cancer patients with a performance status score of 3 to 4 and clinical stage of III to IV. Normally distributed continuous data (mean ± SD) were analyzed using t-test. Non-normally distributed data (median [M] with interquartile range [P25, P75]) were analyzed using Wilcoxon rank-sum test. Numerical data were subjected to Chi-square test. Logistic regression analysis was employed to assess the correlation between inflammatory markers and patient prognosis. There were significant differences between the 2 groups for PCT, WBC, CRP, platelet count, and body mass index. However, subgroup analysis indicated that there were no significant differences in PCT, CRP, and WBC levels between infected and noninfected patients within the deceased group. It is worth noting that elevated levels of PCT (OR = 7.13, 95% confidence interval [CI] = 1.68–30.36, P = .008) and WBC (OR = 2.47, 95% CI = 1.13–1.13, P = .024) were ultimately identified as independent risk factors associated with poor prognosis in cancer patients, as demonstrated by further logistic regression analysis. In the subgroup analysis of noninfected patients, the univariate analysis revealed that both PCT (OR = 11.612, 95% CI = 1.217–110.776, P = .033) and WBC (OR = 3.077, 95% CI = 1.004–9.427, P = .049) had a statistically significant difference in outcomes between the alive group and the deceased group. The PCT, WBC, and CRP levels of end-stage cancer patients were significantly elevated, regardless of infection. An increase in PCT and WBC was associated with an increased risk of death. These findings suggest that monitoring PCT and WBC levels in end-stage cancer patients may provide valuable prognostic information, aiding in clinical decision-making.
Visualization and analysis of PM2.5 health effects, 2013 to 2023: Bibliometrics of PM2.5 and health effects
Authors: Huang Feifei , Zhou Lin , Lu Yao , Liao Ruiwei , Li Yan , Li Ming
Published: December 2024

Background:

To analyze the current status, hotspots, and cutting-edge trends of PM2.5 health effects of PM2.5, using CiteSpace.

Methods:

The Web of Science Core Collection Science Citation Index Expanded was searched for relevant articles from January 1, 2013, to December 31, 2023. Network maps identifying authors, institutions, countries, keywords, co-cited authors, journals, references, and research trends were then created using CiteSpace.

Results:

A total of 2174 articles on the health effects of PM2.5 were identified between 2013 and 2023, with an increasing trend in annual publications. The United States had the highest number of articles on this topic, followed by China. The Chinese Academy of Sciences (CAS) is the leading institute in terms of paper production. Hoek was the most prolific author, focusing on the health consequences of air pollution. Among referenced journals, ENVIRON HEALTH PERSP ranked first, while Pope Ca was the most cited author. Current research focuses on reactive oxygen species (ROS), inflammation, oxidative stress, cardiovascular and respiratory diseases, PM2.5 sources, and chemical composition. The field is currently experiencing a phase of rapid expansion.

Conclusion:

The findings of this bibliometric analysis offer insight into the status and direction of research on PM2.5 and its health impacts, which aid scientists in coming up with new directions for their investigation.
The therapeutic effects of Paeoniae Radix Rubra on chronic hepatitis through network pharmacology and molecular docking
Authors: Yu Chunlei , Yang Fan , Zou Yu , Zhang Yingbo , Pan Siwen
Published: December 2024

Backgrounds:

Chronic hepatitis (CH) refers to liver inflammation lasting at least 6 months caused by various factors, significantly impacting patients’ daily lives. Paeoniae Radix Rubra (CS) is a classic blood-activating and stasis-dissolving herb known for its protective effects on the liver. This research seeks to investigate the underlying mechanisms by which CS treat CH, employing network pharmacology and molecular docking.

Methods:

The active constituents of CS for CH treatment were identified through the TCMSP database. Targets associated with CH were gathered from GeneCards, the Therapeutic Target Database, and OMIM databases. The intersecting genes between these targets and the components of CS were considered potential therapeutic targets. Protein–protein interaction analysis was performed with the use of the STRING database and Cytoscape software, leading to the identification of core targets. These core targets underwent KEGG and GO enrichment analysis, and the top 10 pathways were chosen for building a drug–compound–target–pathway–disease’ network. Finally, molecular docking was utilized to evaluate the binding affinities between the compounds and the core targets.

Results:

From the TCMSP database, 29 compounds were screened, and 101 potential intersection targets of CS for treating CH were identified. The protein–protein interaction network analysis revealed that the core targets included EGFR, HSP90AA1, SRC, TNF, ALB, ESR1, CASP3, PTGS2, ERBB2, and FGF2. Pathway analysis indicated that CS’s treatment of CH is mainly associated with the pathway in cancer. Molecular docking results indicated that Paeoniflorin and Baicalin exhibited strong binding affinity with EGFR and HSP90AA1.

Conclusion:

This research uncovers the possible mechanisms of CS in CH treatment, offering new avenues for future studies.
Revealing the core active pharmaceutical ingredients and targets of Jie-gu capsules for fracture treatment through network pharmacology and mendelian randomization
Authors: Wang Ying , Ding Shuang , Gao Feng , Jia Yuyan , Wang Xukai
Published: December 2024

Jie-gu capsules are widely used for the treatment of fractures in China. However, the core active pharmaceutical ingredients of Jie-gu capsules and the potential mechanisms for treating fractures remain unclear. This study aims to preliminarily elucidate the potential mechanisms of Jie-gu capsules in the treatment of fractures through network pharmacology and mendelian randomization methods. Data of fracture patients were obtained from the GEO database (GSE93215), and the active pharmaceutical ingredients and therapeutic targets of Jie-gu capsules were retrieved from the TCMSP and TCMID databases to identify the intersection genes. Subsequently, a protein-protein interaction network of the intersection genes was constructed using the STRING database. Then, GO and KEGG analyses were conducted on the intersection genes. In addition, mendelian randomization was employed to identify core targets. Finally, molecular docking techniques were used to perform molecular docking of the core active pharmaceutical ingredients and core targets for Jie-gu capsules in the treatment of fractures. In this study, a total of 65 intersection genes involved in Jie-gu capsule treatment of fractures were identified. GO and KEGG results indicated that these 65 intersection genes were primarily associated with biological processes such as response to tumor necrosis factor and are involved in signaling pathways, especially the regulation of the MAPK signaling pathway. We identified 5 core active ingredients of Jie-gu capsules (quercetin, baicalein, kaempferol, luteolin, and succinic acid). Mendelian randomization confirmed 2 core targets (ALOX12 and EGF). Molecular docking results demonstrated that the core active pharmaceutical ingredients (quercetin, baicalein, kaempferol, luteolin, and succinic acid) exhibit high affinities with the core targets (ALOX12 and EGF). This study has unveiled the core active pharmaceutical ingredients and potential action targets of the Jie-gu capsules in treating fractures, offering valuable insights for subsequent foundational research and the development of new medications.
The association between weight-adjusted-waist index and psoriasis: A cross-sectional study based on NHANES 2009 to 2014
Authors: Tuo Yanan , He Junchen , Guo Tao
Published: December 2024

Weight-adjusted-waist index (WWI) is an anthropometric indicator of central obesity, which is calculated by dividing the waist circumference (WC) by the squared weight. The purpose of this study was to investigate the association between WWI and psoriasis in adults. Multivariate logistic regression and smoothing curve fitting were used to investigate the relationship between WWI and psoriasis based on data from the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014. Subgroup analysis and interaction tests were employed to examine the population-level stability of this connection. There was a positive association between WWI and psoriasis in 15,932 participants > 20 years of age. In the fully adjusted model, each 1-unit increase in WWI was associated with a 14% increase in the risk of developing psoriasis [1.14 (1.01, 1.32)]. Participants in the highest quartile of WWI had a 38% higher risk of developing psoriasis than those in the lowest quartile [1.38 (1.01, 1.94)]. This positive association was more pronounced in males. WWI is positively associated with psoriasis in US adults. Our findings imply that WWI has the potential to improve psoriasis prevention in the general population.
Clinical manifestations and misdiagnosis factors of pulmonary embolism patients seeking treatment in cardiology
Authors: Yao Doudou , Cao Wenjuan , Liu Xiaoyan
Published: December 2024

To explore the clinical manifestations and factors leading to misdiagnosis in pulmonary embolism (PE) patients in a cardiology department. We retrospectively analyzed 74 patients diagnosed with PE at our hospital from March 2018 to March 2022, comparing them to 136 patients suspected of PE but excluded by computed tomography pulmonary angiography during the same period. Both groups received the same basic care, including disease counseling, nutritional planning, and monitoring. We compared general information, clinical manifestations, risk factors, and auxiliary examinations to identify correlations between specific manifestations and misdiagnosis factors. The male-to-female ratio in the PE group was approximately 3:4, which was statistically significant compared to the control group (P < .05), though its impact on PE incidence was low. Common symptoms in the PE group included chest tightness, shortness of breath, sweating, and chest pain, with no significant difference from the control group (P > .05). Notable risk factors included deep vein thrombosis (DVT) (43.24%), prolonged bed rest (32.43%), lower limb varicose veins (18.92%), trauma (21.62%), pulmonary infections (62.16%), coronary heart disease (37.84%), respiratory failure (32.43%), and chronic obstructive pulmonary disease (13.51%). DVT was significantly associated with PE (P < .05). Multivariate logistic regression identified DVT (OR = 118.528, 95% CI: 6.959–2018.906, P = .001) and lower limb varicose veins (OR = 212.766, 95% CI: 6.584–6875.950, P = .003) as independent predictive factors for suspected PE. Clinical manifestations strongly correlated with PE included pulmonary rales, cyanosis, tachycardia, hypotension, elevated D-dimer, positive N-terminal pro-brain natriuretic peptide, and sinus tachycardia on echocardiogram. PE in cardiology patients may present with pulmonary rales, hypotension, shortness of breath, and abdominal symptoms, warranting reexamination for PE. Misdiagnosis factors typically involve chest pain, tightness, and shortness of breath. Lower limb varicose veins and DVT are reliable predictors of suspected PE.
Management of anterior and posterior crossbites with lingual appliances and miniscrew-assisted rapid palatal expansion: A case report
Authors: Nguyen Viet Anh , Nguyen Ngoc Anh , Doan Hong Le , Pham Thi Hanh , Doan Bich Ngoc
Published: December 2024

Rationale:

Current literature describes only 2 cases combining miniscrew-assisted rapid palatal expansion (MARPE) with lingual appliances. These cases require 2 impressions, 1 before and 1 after palatal expansion, to ensure accurate lingual appliance placement, potentially increasing treatment time and cost. This case report aimed to demonstrate a modified workflow of combining MARPE and lingual appliances in managing an adult patient with anteroposterior and transversal discrepancies, requiring only a single digital impression for both fabrication and positioning.

Patient concerns:

A 29-year-old female presented with anterior and posterior crossbites, a class III skeletal relationship, and maxillary constriction. The patient desired a nonsurgical and esthetic treatment approach.

Diagnoses:

The patient was diagnosed with a class III malocclusion with anterior and posterior crossbite on a skeletal hypodivergent class III relationship and upper posterior constriction.

Interventions:

Treatment included MARPE for skeletal expansion, digitally planned lingual appliances for tooth alignment, and lower arch distalization for class III correction. A modified appliance sequence was utilized for optimal expansion retention and lingual bracket transfer accuracy.

Outcomes:

The treatment successfully corrected the crossbites, improved dental and facial esthetics, and achieved partial skeletal correction.

Lessons:

The combination of MARPE and lingual appliances offers a viable treatment alternative that prioritizes both esthetics and effective skeletal expansion for nonsurgical and esthetic management of adult class III malocclusion with maxillary constriction. The modified workflow, employing a single digital impression, may offer several advantages, including reduced treatment duration and associated costs, prolonged postexpansion retention, and minimized aesthetic impact of midline diastema.
Association between oral loop diuretics duration before discharge and hospital readmission in acute decompensated heart failure: A multicenter retrospective cohort study
Authors: Alshibani Mohannad , Alshehri Samah , Fatani Nayyra , Aljahdali Seba A. , Melibari Nawal A. , Aljabri Adnan F. , Alsubaie Norah S. , Althagafi Abdulhamid , Alfayez Osamah M. , Al Yami Majed S.
Published: December 2024

There are uncertainties when to start patients on oral loop diuretics after managing acute decompensated heart failure (ADHF) before discharge. This study aims to investigate the impact of prolonging observation duration on hospital readmissions following the switch to oral loop diuretics before discharge in patients with ADHF. A multicenter retrospective study that included adult patients (>18 years) diagnosed with ADHF and discharged on oral loop diuretics in Saudi Arabia. Patients who received oral loop diuretics were divided into 2 groups based on the observation duration before discharge. The primary outcome was a 30-day readmission rate for all causes; the secondary outcomes were 60- and 90-day readmission rates for all causes; and 30-, 60-, and 90-day readmission rates for heart failure. A total of 400 ADHF patients were included in the final analysis. Patients in group 1 (n = 142; < 24 hours) and group 2 (n = 258; ≥ 24 hours) had similar baseline characteristics (P > .05), except for the length of hospital stay (P = .03) and total observation time (P 
= <.01). ADHF patients with <24 hours observation durations were significantly associated with higher all-cause 30-day readmissions compared to those with ≥24 hours observations (odds ratio = 1.83, 95% confidence interval = 1.11–3.02, P = .017). Our study showed a significant decrease in all-cause 30-day readmissions for ADHF patients who received oral loop diuretics at discharge with a longer duration of observation. This study emphasizes the significance of standardizing the observational period when initiating oral loop diuretics before discharge following admission to ADHF.
Simple ab externo lens capsule removal in intraocular lens reuse and intrascleral fixation for intracapsular lens dislocation: A case report
Authors: Nakagawa Suguru , Ishii Kiyoshi
Published: December 2024

Background:

This study aimed to report and recall a simple method to remove the lens capsule ab externo when performing intrascleral fixation of an intracapsular intraocular lens (IOL) dislocation with reuse of the IOL.

Case presentation:

A 43-year-old Japanese male patient underwent pars plana vitrectomy, phacoemulsification, and IOL fixation for rhegmatogenous retinal detachment in the right eye 10 years prior. A 3-piece IOL was intraocularly fixed during the initial procedure. In December 2023, the patient presented with intracapsular IOL dislocation in his right eye, causing the IOL to descend into the vitreous cavity enveloped by its entire capsule. During surgery, an intravitreal dislocated IOL was placed over the iris with the entire capsule. The haptics on 1 side of the IOL were placed outside the eye through the corneoscleral wound. Subsequently, the lens capsule and Soemmerring’s ring surrounding the haptics were removed. After the haptics were placed back over the iris, the same extraction procedure was performed for the remaining haptics. The IOL was intrasclerally fixed using a flange technique through the intrascleral tunnel at the 4 and 10 o’clock positions. One week postsurgery, the best-corrected visual acuity of the right eye was 20/16, and the corneal endothelial cell density was recorded as 2923 cells/mm2 (preoperative: 1650 cells/mm2).

Discussion and conclusions:

In cases of 3-piece IOL dislocation, employing the ab externo technique for lens capsule extraction has been proven to be a straightforward and efficient method. This approach facilitates the removal of the lens capsule around the IOL. If subsequent damage to the IOL is identified, it allows for easy conversion to replacement.
Sarcomatoid hepatocellular carcinoma with subdiaphragmatic metastasis misdiagnosed as liver abscess: A case report
Authors: Liu Xue-Wu , Yang Chun-Yuan , Liu Xue-Ping , Lei Nan
Published: December 2024

Rationale:

Sarcomatoid hepatocellular carcinoma (SHC) is a rare subtype of hepatocellular carcinoma. Its imaging findings often resemble those of liver abscess, making preoperative diagnosis particularly challenging. To date, there have been no documented cases of SHC with subdiaphragmatic metastases. In this report, we present a case of SHC with subdiaphragmatic metastasis that was initially misdiagnosed as hepatic abscess. In addition, we conducted a retrospective analysis of the clinical and imaging findings to improve the clinical understanding of this disease.

Patient concerns:

A 74-year-old woman was admitted to our hospital with recurrent right upper abdominal pain and discomfort, chills, and fever for >1 month.

Diagnoses:

The patient underwent abdominal computed tomography and magnetic resonance imaging, which revealed multiple nodules and masses in the left lobe of the liver. Furthermore, a thick-walled irregular cystic solid mass was identified in the anterior and subdiaphragmatic regions. Based on these findings, the patient was diagnosed with an abscess. The postoperative pathology confirmed SHC in both the left lobe of the liver and subdiaphragmatic mass.

Interventions:

The patient underwent a left external liver lobectomy.

Outcomes:

The patient’s condition deteriorated after surgery, and hepatic encephalopathy developed 1.5 months postoperation, ultimately leading to death.

Lessons:

To the best of our knowledge, cases of SHC with subdiaphragmatic metastases are rare, and the preoperative diagnosis presents a significant challenge in clinical practice. More comprehensive case analyses of SHC are needed to enhance the accuracy of clinical and imaging diagnoses.
Management of a severe skeletal Class II hyperdivergent patient with asymmetric missing teeth with lingual appliances and mandibular osteotomy: A case report
Authors: Tran Thi Ngoc Anh , Nguyen Thuy Anh , Nguyen Giao Hoang , Nguyen Viet Anh
Published: December 2024

Rationale:

Orthognathic surgery cases are inherently challenging to treat with lingual appliances due to the complexities of orthodontic management and difficulties in achieving intermaxillary fixation during surgery. This challenge is further amplified in cases involving asymmetric space closure, such as those with a missing molar on one side and a premolar on the other, a scenario not yet documented in the literature. This case report presents the orthodontic–orthognathic management of an adult patient requiring space closure of asymmetric missing lower teeth.

Patient concerns:

A 30-year-old female patient presented with a severe skeletal Class II patient with a retruded mandible, hyperdivergent facial pattern, excessive overjet and overbite, and asymmetric missing lower teeth.

Diagnosis:

The patient was diagnosed with a Class II malocclusion and asymmetric missing mandibular posterior teeth on a skeletal hyperdivergent Class II relationship.

Interventions and outcomes:

The treatment involved orthodontic decompensation with fixed lingual appliances in combination with mandibular advancement osteotomy and genioplasty. Mini-screws were utilized for anchorage control during asymmetric space closure in the presurgical stage and entire lower arch distalization in the postsurgical stage. A significant facial esthetic and functional improvement was achieved posttreatment.

Lessons:

The combination of mini-screws and lingual appliances may offer effective anchorage management in both presurgical and postsurgical orthodontic stages for optimal orthodontic–orthognathic treatment outcomes. This approach allows for precise tooth movement and control during space closure in the presence of challenging asymmetric missing tooth patterns.
Prognostic significance of LOXL2 enzyme activity in primary myelofibrosis
Authors: Lv Guoqing , Lv Wenting
Published: December 2024

Primary myelofibrosis (PMF) is characterized by bone marrow fibrosis, but the underlying molecular mechanisms remain incompletely understood. Here, we investigated the role of lysyl oxidase-like 2 (LOXL2), an enzyme involved in extracellular matrix remodeling, in PMF pathogenesis. Analysis of bone marrow cells from PMF patients revealed significantly elevated LOXL2 mRNA expression compared to healthy controls, which was further validated using 2 independent Gene Expression Omnibus datasets (GSE26049 and GSE12234). Serum LOXL2 protein levels were markedly increased in PMF patients (n = 38) compared to controls (n = 15) (P < .01), accompanied by significantly enhanced enzymatic activity (P < .05). Clinical analysis demonstrated that high LOXL2 enzyme activity correlated with adverse clinical features, including higher risk scores in both International Prognostic Scoring System (P = .029) and Dynamic International Prognostic Scoring System (P = .012) systems, and increased peripheral blood blast percentages (≥1%, P = .019). Notably, elevated LOXL2 enzyme activity emerged as an independent adverse prognostic factor in multivariate analysis. Gene set enrichment analysis revealed LOXL2’s association with multiple biological processes, including extracellular matrix remodeling, inflammatory responses, and JAK-STAT signaling pathways. Using CellMiner drug prediction analysis, we identified several FDA-approved drugs, particularly kinase inhibitors, as potential LOXL2-targeting therapeutics. Our findings demonstrate LOXL2’s critical role in PMF pathogenesis and suggest its potential as both a prognostic marker and therapeutic target in PMF treatment.
Outcomes Associated With Wound Care Nurses’ Practice for the Management of Venous Leg Ulcers
Authors: Monaco Dario , Iovino Paolo , Turci Carlo , Marchini Roberta , Scarozza Stefania , Matranga Cristina , Ursino Simona , Savini Serenella
Published: December 2024

Introduction

The role of the wound care nurse is identified as a key element in the management of patients with venous leg ulcers (VLUs). However, the literature offers fragmented knowledge of the outcomes associated with their practice.

Aims

To identify, summarize, and map all available evidence based on the wound care nurses practice for the treatment of VLUs.

Methods

A scoping review was conducted in May 2024 on PubMed, CINAHL, Scopus, and Cochrane Library databases. Observational or experimental studies related to patients affected by VLUs and cared for by wound care nurse specialists were included.

Results

Of the 1562 articles reviewed, 9 studies met the inclusion criteria. The most frequently measured outcomes were clinical responses and included healing rate and ulcer recurrence. Less frequent outcomes were patient-reported and resource utilization measures.

Conclusion

This review indicates a general predominance of outcomes related to objective clinical responses. Future studies should broaden the types of outcomes by also including patient-reported parameters (eg, pain, quality of life, stress) in order to gain greater evidence on the impact of wound care nurse specialists in the care of patients affected by VLUs.
Feasibility Testing of a Nurse-Invented Urinary Drainage Bag Securement Device
Authors: Meade Karen , Kreuz Bridgette , Sinnott Loraine , Kuhn Michelle , Potts Barbara , Ring Lindsay , Brown Carlton G.
Published: December 2024

Purpose/Aims

To determine the feasibility of a nurse invention called the Bag Below Bladder (B3) Buddy using validated usability and acceptability tools, in securing urinary drainage bags while patients ambulate.

Design

An intervention study was implemented in a participant dyad consisting of a patient and clinician. Each dyad used the B3 Buddy in 1 encounter, ambulating at least 90 ft in an inpatient unit.

Methods

After the ambulation experience, patients completed the Acceptability of Implementation Measure tool, and clinicians completed the System Usability Scale (SUS) tool. Data analyses were performed using SAS version 9.4 for Windows (SAS Institute, Cary, North Carolina).

Results

All 21 patient participants found the B3 Buddy device acceptable, with a 95% confidence interval of 83.9% to 100%, exceeding the 70% acceptability threshold. Among the 20 clinicians, the average SUS score was 90.1, with a 95% confidence interval of 84.9 to 95.3, indicating high usability. Statistically significant differences in SUS scores were observed, with higher scores for clinicians with at least a bachelor’s degree and registered nurses.

Conclusion

This B3 Buddy device was found to be acceptable and usable to the end-users who participated in this study. The inventors are now seeking a manufacturer partnership for further development.