bluuebunny/crossref_metadata_2025 huggingface dataset:
Educational Values of Latino Families Participating in a School Readiness Intervention: Hopes and Implications for Pediatrics
Authors: Peterson Jaime W. , Robles Alejandro , Underwood Carrasco Veronica Ilene , Zavala Julia , Almanzar Nicole , Zuckerman Katharine E. , Bruce Janine
Published: June 2024

Objective:

To explore Latino parents' educational values and hopes for their preschool-aged children after a clinic school readiness (SR) intervention.

Methods:

Qualitative analysis of semi-structured interviews of Latino parents regarding their perceptions of a novel SR coaching intervention (2016–2017). Parents who received the intervention were approached for interview (n = 74); 59 postintervention interviews were completed in English or Spanish, audio recorded, transcribed, and translated into English. Iterative team-based coding and inductive thematic analysis of 47 interviews were conducted by 3 team members using Dedoose.

Results:

Children were on average 4.5 years old, with the majority speaking Spanish at home (57%), and having preschool experience (81%). Mothers mostly had no paid employment (53%) and limited formal education. Four domains emerged: 1) education is valued and seen as a pathway to a successful life for children, and 2) while structural and cultural barriers exist, 3) Latino families are motivated and 4) trust providers to offer SR support. Parents suggested pediatricians could provide more SR knowledge to families and offer programs within primary care. Integration of findings are summarized in a framework for clinical practice.

Conclusion:

Latino parents' trust in their pediatric providers, combined with their strong educational aspirations for their children, offers the pediatric clinic an opportunity to partner with families to reduce systemic SR barriers. Pediatric providers can support Latino parents in preparing their children for school through culturally responsive, strengths-based approaches that build on their educational aspirations, value existing SR efforts, offer SR knowledge around early literacy and math, and build connections to early childhood programs.
Trends in Pediatric Attention-Deficit Hyperactive Disorder Diagnoses and Prescription Utilization: 2016 to 2019
Authors: Kazarov Christina , Peasah Samuel K. , McConnell Erin , Fischer Kavita K. , Good Chester B.
Published: June 2024

Objective:

Attention-deficit hyperactive disorder (ADHD) is one of the most common psychiatric disorders among children, with estimated prevalence of 7% to 15% worldwide. The aim of this analysis was to update and summarize trends in diagnosis, demographics, and drug utilization of pediatric patients with ADHD.

Methods:

We used the Agency for Health care Research and Quality Medical Expenditure Panel Survey (MEPS), a survey of US individuals, families, their medical providers, and employers, using datasets from 2016 to 2019. The data sources from the MEPS database included the full-year consolidated files, medical conditions files, prescribed-medicines files, and condition-event link files for each year. We summarized trends in the proportion of children, ages 17 years and younger, with a diagnosis of ADHD, demographic information and a prescription for medication known to treat ADHD. In addition, we further stratified ADHD medication use by stimulant/nonstimulant categories.

Results:

There was a 1.6% and 4.7% absolute increase in children with an ADHD diagnosis and those prescribed ADHD medications, respectively, from 2016 to 2019. Most of these children were male, non-Hispanic, and on public insurance. Of the children prescribed an ADHD medication and concomitant behavioral medications, stimulants-only use was the highest (60%–67%), followed by stimulants/nonstimulants (13%–15%), stimulant/antidepressants (6%–9%), and nonstimulants only (5%–9%). The proportion of patients with ADHD in the high-income and near-poor categories increased by 4% from 2016 to 2019.

Conclusion:

Diagnosis of ADHD among children is trending upward in the United States. Central nervous system stimulants, especially methylphenidate formulations, are the most prescribed ADHD medications for children 17 years and younger.
Pregnancy outcomes as related to in utero exposure to air pollution and greenness: The Life-GAP Project
Authors: Sinsamala Robin M. , Johannessen Ane , Bertelsen Randi J. , Accordini Simone , Brandt Jørgen , Frohn Lise M. , Geels Camilla , Gislason Thorarinn , Holm Mathias , Janson Christer , Markevych Iana , Orru Hans , Real Francisco Gómez , Sigsgaard Torben , Skulstad Svein M. , Svanes Cecilie , Marcon Alessandro
Published: June 2024

Background:

Lower birth weight and preterm birth may increase the risk of adverse health outcomes later in life. We examined whether maternal exposure to air pollution and greenness during pregnancy is associated with offspring birth weight and preterm birth.

Methods:

We analyzed data on 4286 singleton births from 2358 mothers from Respiratory Health in Northern Europe, a prospective questionnaire-based cohort study (1990–2010). Mixed-effects regression models with random intercepts for mothers and centers were used to estimate the association of exposures to particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), ozone (O3), black carbon (BC), and greenness (Normalized Difference Vegetation Index in 300m-buffers [NDVI300m]) with birth outcomes, adjusting for potential confounders.

Results:

Median (interquartile range [IQR]) exposures to PM2.5, PM10, NO2, O3, BC, and NDVI300m during pregnancy were 8.4(5.0) µg/m3, 14.4(8.3) µg/m3, 14.0(11.0) µg/m3, 54.7(10.2) µg/m3, 0.47(0.41) µg/m3, and 0.31(0.20), respectively. IQR increases in air pollution exposures during pregnancy were associated with decreased birth weight and the strongest association was seen for PM2.5 (−49g; 95% confidence interval [CI] = −83, −16). However, O3 showed an opposite association. IQR increase in NDVI300m was associated with an increase in birth weight of 25 g (95% CI = 7, 44). Preterm birth was not associated with the exposures.

Conclusion:

Increased greenness and decreased air pollution may contribute to healthier pregnancies and improve overall health in the next generation. This emphasizes the need to adopt policies that target the reduction of air pollution emissions and exposure of the population.
The SAEORA Flap for Prosthetic Breast Reconstruction: A Novel Flap Design without the Use of Acellular Dermal Matrices
Authors: Sachal Sukhmeet S. , Golin Andrew P. , Gordon Travis , Williamson J. Scott
Published: June 2024

Background:

The gold standard for implant-based breast reconstruction uses acellular dermal matrices (ADMs). They provide improved inferolateral pole coverage, reduced capsular contracture rates, and increased primary expander fill volumes. However, ADMs are costly and have been associated with increased rates of postoperative infection, seroma, hematoma, implant malposition, and mastectomy flap necrosis (MFN). This study describes a novel autologous flap without the need of ADM, the serratus anterior external oblique rectus abdominis (SAEORA) flap, as an alternative in prosthetic-based breast reconstruction.

Methods:

A retrospective study was conducted on all patients who underwent SAEORA flap breast reconstruction by a single surgeon between January 1, 2013 and May 31, 2020 at a single institution. Patient demographics, diagnosis, treatment, tissue expander (TE) volume, implant size, complications, and results were assessed.

Results:

Forty-seven patients underwent 78 SAEORA flaps. Sixty-two had TEs placed, and 14 were direct-to-implant. Mean body mass index was 23.1 kg per m². Median primary TE fill volume was 150 mL, and final implant volume average was 450 mL. Mean follow-up was 14.5 months. Complications included infection/cellulitis (7.9%), seroma (6.6%), hematoma (5.2%), and MFN (7.9%).

Conclusions:

The SAEORA flap is a novel autologous flap and is a viable option for prosthetic-based breast reconstruction, with an acceptable complication profile relative to ADM-based reconstructions. Additionally, SAEORA is MFN-resistant and has been used effectively in salvage of exposed implants or ADM, and in double-bubble deformity correction.
Left main revascularization guidelines: navigating the data
Authors: Vallée Aurelien , Rahmouni Kenza , Ponnambalam Menaka , Issa Hugo , Ruel Marc
Published: June 2024

Purpose of review

This article explores recent developments in left main revascularization, with a focus on appraising the latest American and European guidelines.

Recent findings

Recent pooled data analysis from four major randomized controlled trials (RCTs) for left main coronary artery stenosis indicate an advantage for CABG over PCI in regard to freedom from major adverse cardiovascular events, despite no significant difference in mortality observed at 5 years. Additional data support the use of CABG for patients with left ventricular dysfunction, complex left main lesions, diffuse coronary disease, and diabetes.

The data underpinning the guidelines on each revascularization modality (PCI versus CABG) must consider factors such as lesion complexity, diabetes, and left ventricular dysfunction. Additionally, the findings of the four major RCTs upon which the guidelines are based must be ascertained in light of the latest advancements in these revascularization techniques.
Modulation of monocyte activity by hepatocellular MicroRNA delivery through HBsAg particles: Implications for pathobiology of chronic hepatitis B
Authors: Li Jin , Ma Xiao , Xuan Qinkao , Li Qiang , Wu Min , Shi Bisheng , Fang Zhong , Chen Liang , Chen Jieliang , Wen Yumei , Zhu Chuanwu , Zhu Li , Zhang Xiaonan , Yuan Zhenghong
Published: June 2024

Background and Aims:

HBsAg serves as an important immune-modulatory factor in chronic hepatitis B. One aspect of such modulation may act through monocytes, which are the major Ag-presenting cells taking up HBsAg. There is evidence for the encapsulation of hepatocellular microRNAs (miRNAs) by HBsAg particles, while its pathobiological significance is unclear. Here, we characterized the miRNA profile in patients with chronic hepatitis B and probed their association with liver inflammation.

Approaches and Results:

We collected plasma from patients that are treatment-naive with chronic hepatitis B (n = 110) and quantified total/HBsAg-enveloped miRNAs by qRT-PCR and plasma cytokines by ELISA. The biological effects of HBsAg-delivered miRNAs in monocytes were evaluated using multiple approaches. The clinical significance of candidate miRNAs and cytokines was corroborated in patients with HBV-associated advanced liver diseases. The plasma miRNA profile showed 2 major clusters, one significantly associated with HBsAg titer and the other correlated with liver inflammation. Among HBsAg-carried miRNAs, miR-939 displayed the most significant correlation with IL-8. Mechanistically, miR-939 in subviral particles enters monocytes and significantly augments IL-8 production through the mitogen-activated protein kinase (MAPK) p38 signaling pathway. Finally, the findings that miR-939 positively correlated with IL-8 level and inflammation/fibrosis stage in the cohort of HBV-associated advanced liver diseases support its causative role in the progression of liver diseases.

Conclusions:

HBsAg particles carry hepatocellular miRNAs, including miR-939, which enter monocytes and alter their functional status, such as IL-8 secretion. Our findings demonstrate that the HBsAg-miR-939-IL-8 axis may play a crucial role in HBV-induced hepatic necro-inflammation and the progression of advanced liver diseases.
Bisphosphonate Liposomes for Cobalt and Strontium Decorporation?
Authors: Landon Géraldine , Phan Guillaume , Fay François , Suhard David , Broggio David , Bô Raphaël , Bouvier-Capely Céline , Fattal Elias
Published: June 2024

During a nuclear/radiological incident or an accident involving internal intakes with radioactive cobalt or strontium, the recommended treatments, consisting of the administration of diethylenetriaminepentaacetic acid for 60Co and calcium gluconate for 90Sr, are of low specificity, and their effectiveness can be enhanced. In this manuscript, a liposomal formulation was developed to deliver potential chelating agents to the main retention organs of both radionuclides. A bisphosphonate, etidronate, has been selected as a possible candidate due to its satisfying decorporation activity for uranium, bone tropism, and potential affinity with cobalt. Pre-clinical studies have been carried out on rats using radionuclide contamination and treatment administration by the intravenous route. The effectiveness of free or liposomal etidronate was evaluated, with an administration at 30 min, 48 h post-contamination with 60Co. Regarding 85Sr, a more extended experiment with etidronate liposomes was performed over 6 d. The results were compared to those performed with reference treatments, diethylenetriaminepentaacetic acid for cobalt and calcium gluconate for strontium. Unexpected results were found for the reference treatments that were significantly less effective than previously reported or showed no effectiveness. Free etidronate revealed no significant efficacy after 48 h, but the liposomal form suggested an interaction with radionuclides, not sufficient to change the biokinetics. This study emphasizes the need for early treatment administration and further research to provide a more effective medical countermeasure.
An Estimation of the Monetary Value of the Person-Sievert Useful for Occupational Radiological Protection within the Healthcare System of Sweden
Authors: Engström Andreas , Isaksson Mats , Javid Reza , Larsson Per-Anders , Lundh Charlotta , Båth Magnus
Published: June 2024

The As Low As Reasonably Achievable (ALARA) principle includes taking into account economic and societal factors. To consider these factors, decision-aiding techniques such as cost-benefit analysis were introduced by the International Commission on Radiological Protection (ICRP) 50 y ago. Over the years, developments in health economics have led to new ways of deriving the concept of a value of a statistical life (VSL), which now is influencing the monetary value assigned to a unit of collective dose for radiological protection purposes (the α value) used in cost-benefit analyses. The aim of the present study was to estimate an α value useful for occupational radiological protection within the healthcare system of Sweden. A survey based on the stated preference approach was developed and sent to staff who are exposed to ionizing radiation at their work in Region Västra Götaland (Sweden). The survey essentially contained two scenarios: the respondents’ willingness to pay for measures against radon exposure at home and their willingness to accept compensation for x-ray exposure at work. Answers from 718 respondents were collected. In the sensitivity analysis of the survey, the overall median VSL based on the two scenarios was calculated to be $50 million (IQR $10 to 363 million). The corresponding α value was established to $1,600 person-mSv−1 ($2,100 person-mSv−1 if excess burden of taxes is excluded). The recommended α value is in the high end compared to other studies but within the interval of values being used by nuclear utilities today. The α value should be seen in the light of ICRP’s recommendation about stakeholder involvement as an important part of the optimization process.
COMPARISON OF CHOROIDAL VASCULATURE BETWEEN CENTRAL SEROUS CHORIORETINOPATHY WITH AND WITHOUT THICK CHOROID USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Zeng Qiaozhu , Yao Yuou , Tu Shu , Zhao Mingwei
Published: June 2024

Purpose:

To distinguish between central serous chorioretinopathy (CSC) with and without thick choroid and to elucidate their characteristics of choroidal vasculature.

Methods:

This prospective observational study enrolled 76 eyes with treatment-naive CSC and 76 normal eyes. Mean + 2 times SD of subfoveal choroidal thickness of healthy individuals was set as the upper limit of normal choroidal thickness to divide patients with CSC into two groups: the thick-choroid and non–thick-choroid groups. Their choroid blood flow was compared using widefield swept-source optical coherence tomography angiography.

Results:

According to the discrimination value of subfoveal choroidal thickness as 326.8 µm, 76 eyes with CSC were divided into the thick-choroid (55, 72.4%) and non–thick-choroid (21, 27.6%) groups. Higher proportions of vortex vein anastomosis were found in the thick-choroid group (81.8% vs. 33.3%, P < 0.001). Choroid thickness, three-dimensional choroidal vascularity index, and mean choroidal stroma volume per 1 mm2 were higher in the thick-choroid group. In multivariate analysis, younger age, higher percentages of vortex vein anastomosis, and double layer sign were the independent predictors of choroid thickening in CSC.

Conclusion:

There are discrepancies in the degree of choroidal congestion and distribution of vortex veins in the CSC with different choroidal thicknesses.
Risk Factors for Persistent Staphylococcus aureus Bacteremia in Children
Authors: Thornley Erin M. , Alexander Robin , Popelka Jill , Montgomery Christopher P.
Published: June 2024

Background:

Staphylococcus aureus is a leading cause of pediatric bacteremia. Persistent S. aureus bacteremia (SAB) is associated with increased morbidity and mortality in adults and children. Risk factors for S. aureus bacteremia have been well established, but there is a limited understanding of the factors that contribute to the development of persistent SAB in children.

Methods:

This is a single-center retrospective secondary analysis of a prospective observational study of pediatric patients hospitalized with S. aureus infection over a 3.5-year period at a large, quaternary, children’s hospital.

Results:

Two hundred fifty-nine children with confirmed S. aureus infection were enrolled in the study. Sixty-five of these were found to have bacteremia, with 28 (43%) developing persistent bacteremia. Patients with persistent SAB were culture-positive for a median of 3.5 days compared with 1 day for those without (P ≤ 0.001). Children with persistent SAB were more likely to have an identified osteoarticular source of infection (93%, n = 26 vs. 62%, n = 23; P = 0.008) and had a shorter median duration to culture positivity than those without persistent SAB (16 hours vs. 20 hours; P ≤ 0.001). In addition, children with persistent SAB had higher median values of presenting erythrocyte sedimentation rate, peak erythrocyte sedimentation rate, presenting C-reactive protein and peak C-reactive protein. Not surprisingly, hospital length of stay was longer in children with persistent SAB compared with those without.

Conclusions:

These findings suggest that a shorter time to culture positivity, osteoarticular infection, and higher presenting and peak values for select inflammatory markers are potential risk factors for persistent SAB in children.
Neutrophil-to-lymphocyte ratio as a predictor for outcomes in patients with short-term emergency department revisits
Authors: Ho Tai-Hung , Lin Jin-Wei , Chi Yu-Chi , How Chorng-Kuang , Chen Chung-Ting
Published: June 2024

Background:

Analysis of short-term emergency department (ED) revisits is a common emergency care quality assurance practice. Previous studies have explored various risk factors of ED revisits; however, laboratory data were usually omitted. This study aimed to evaluate the prognostic significance of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), and systemic immune-inflammation index (SII) in predicting outcomes of patients revisiting the ED.

Methods:

This retrospective observational cohort study investigated short-term ED revisit patients. The primary outcome measure was high-risk ED revisit, a composite of in-hospital mortality or intensive care unit (ICU) admission after 72-hour ED revisit. The NLR, PLR, and SII were investigated as potential prognostic predictors of ED revisit outcomes.

Results:

A total of 1916 encounters with short-term ED revisit patients were included in the study; among these, 132 (6.9%) encounters, comprising 57 in-hospital mortalities and 95 ICU admissions, were high-risk revisits. High-risk revisit patients had significantly higher NLR, PLR, and SII (11.6 vs 6.6, p < 0.001; 26.2 vs 18.9, p = 0.004; 2209 vs 1486, p = 0.002, respectively). Multiple regression analysis revealed revisit-NLR as an independent factor for predicting poor outcomes post-ED revisits (odds ratio: 1.031, 95% CI: 1.017–1.045, p < 0.001); an optimal cut-off value of 7.9 was proven for predicting high-risk ED revisit.

Conclusion:

The intensity of the inflammatory response expressed by NLR was an independent predictor for poor outcomes of ED revisits and should be considered when ED revisits occur. Future prediction models for ED revisit outcomes can include revisit-NLR as a potential predictor to reflect the progressive conditions in ED patients.
Machine learning to predict lymph node metastasis in T1 esophageal squamous cell carcinoma: a multicenter study
Authors: Huang Xu , Wang Qingle , Xu Wenyi , Liu Fangyi , Pan Liangwei , Jiao Heng , Yin Jun , Xu Hongbo , Tang Han , Tan Lijie
Published: June 2024

Background:

Existing models do poorly when it comes to quantifying the risk of lymph node metastases (LNM). This study aimed to develop a machine-learning model for LNM in patients with T1 esophageal squamous cell carcinoma (ESCC).

Methods and results:

The study is multicenter and population based. Elastic net regression (ELR), random forest (RF), extreme gradient boosting (XGB), and a combined (ensemble) model of these were generated. The contribution to the model of each factor was calculated. The models all exhibited potent discriminating power. The elastic net regression performed best with an externally validated the area under the curve (AUC) of 0.803, whereas the NCCN guidelines identified patients with LNM with an AUC of 0.576 and the logistic model with an AUC of 0.670. The most important features were lymphatic and vascular invasion and depth of tumor invasion.

Conclusions:

Models created utilizing machine learning approaches had excellent performance estimating the likelihood of LNM in T1 ESCC.
Comparison of learning curves and related postoperative indicators between endoscopic and robotic thyroidectomy: a systematic review and meta-analysis
Authors: Wang Jian-Peng , Li Da-Peng , Liu Yu-Chen , Zhang Lei , Fu Zi-Yue , Liang Bing-Yu , Yin Si-Yue , Yang Yi-Pin , Fan Min , Ding Zhao , Chen Shan-Wen , Zhang Liang , Wu Kai-Le , Liu Ye-Hai , Cao Fan , Pan Hai-Feng , Han Yan-Xun
Published: June 2024

Background:

Endoscopic thyroidectomy (ET) and robotic thyroidectomy (RT) yield similar perioperative outcomes. This study investigated how the learning curve (LC) affects perioperative outcomes between ET and RT, identifying factors that influence the LC.

Materials and methods:

Two researchers individually searched PubMed, EMBASE, Web of Science, and Cochrane Library for relevant studies published until February 2024. The Newcastle–Ottawa Scale assessed study quality. A random-effects model was used to compute the odds ratio and weighted mean difference (WMD). Poisson regression comparison of the number of surgeries (NLC) was required for ET and RT to reach the stable stage of the LC. Heterogeneity was measured using Cochran’s Q. Publication bias was tested using funnel plots, and sensitivity analysis assessed findings robustness. Subgroup analysis was done by operation type and patient characteristics.

Results:

This meta-analysis involved 33 studies. The drainage volume of ET was higher than that of RT (WMD=−17.56 [30.22, −4.49]). After reaching the NLC, the operation time of ET and RT was shortened (ET: WMD=28.15 [18.04–38.26]; RT: WMD=38.53 [29.20–47.86]). Other perioperative outcomes also improved to varying degrees. Notably, RT showed more refined central lymph node resection (5.67 vs. 4.71), less intraoperative bleeding (16.56 ml vs. 42.30 ml), and incidence of transient recurrent laryngeal nerve injury (24.59 vs. 26.77). The NLC of RT was smaller than that of ET (incidence-rate ratios [IRR]=0.64 [0.57–0.72]). CUSUM analysis (ET: IRR=0.84 [0.72–0.99]; RT: IRR=0.55 [0.44–0.69]) or a smaller number of respondents (ET: IRR=0.26 [0.15–0.46]; RT: IRR=0.51 [0.41–0.63]) was associated with smaller NLC. In RT, transoral approach (IRR=2.73 [1.96–4.50]; IRR=2.48 [1.61–3.84]) and retroauricular approach (RAA) (IRR=2.13 [1.26–3.60]; IRR=1.78 [1.04–3.05]) had smaller NLC compared to bilateral axillo-breast and transaxillary approach (TAA). In ET, the NLC of RAA was smaller than that of TAA (IRR=1.61 [1.04–2.51]), breast approach (IRR=1.67 [1.06–2.64]), and subclavian approach (IRR=1.80 [1.03–3.14]).

Conclusions:

Rich surgical experience can improve surgical results of ET and RT. After reaching the NLC, the perioperative outcomes of RT are better than those of ET. Study subjects, surgical approaches, and analysis methods can affect NLC.
Analysis of toxicity and mechanisms of DEHP in prostate cancer with network toxicology and molecular docking strategy
Authors: Yin Zhaofa , Jin Xi , Mao Congling , Kang Le , Gong Can , Feng Shijian , Yang Jijun
Published: June 2024

Recent decades have seen a significant increase in the use of industrial chemicals, introducing numerous environmental pollutants with uncertain health impacts. Among these, di(2-ethylhexyl) phthalate (DEHP), a key plastic industry component, has raised concerns due to its carcinogenic and endocrine-disrupting potential, particularly its association with tumorigenesis. The current study focused on DEHP’s implications for prostate cancer (PCa), a leading health issue for men worldwide. DEHP’s endocrine-disrupting properties, which interfere with hormone functions crucial for PCa development and progression, prompted our investigation into its specific role in PCa. Utilizing network toxicology and molecular docking strategies, we aimed to uncover the molecular targets implicated in DEHP-induced PCa. Our research successfully identified 88 targets linked to DEHP’s influence on prostate carcinogenesis, with a focus on genes within focal adhesion and cancer pathways, such as SRC, MMP9, MMP2, PTGS2, and CCND1. These findings revealed the molecular mechanisms by which DEHP may contribute to PCa, providing a foundation for future therapeutic strategies to counteract DEHP’s adverse effects on prostate health.
Impella RP Flex: Rescue for the Failing Right Ventricle After Heart Transplantation—Case Report
Authors: Agrawal Akanksha , Shoemaker Joel , Bommareddi Swaroop , Dumitru Ioana
Published: June 2024

Right ventricular (RV) dysfunction (RVD) after orthotopic heart transplantation (OHT) is a common cause of morbidity and mortality. Impella RP Flex was recently approved for RV support as a temporary mechanical circulatory device. We present the first case of its use in managing RVD in a patient after OHT. Here, a 40 year old male patient with familial dilated cardiomyopathy and factor V Leiden mutation presented with Society for Cardiovascular Angiography & Interventions (SCAI) stage B cardiogenic shock. Hemodynamics at admission were indicative of need for intra-aortic balloon pump (IABP) support. Hemodynamics improved and patient underwent OHT. Postoperative day (POD) 1, IABP support was changed to 1:2 and eventually removed. Hemodynamics deteriorated quickly, requiring pharmacologic RV support and diuresis, but refractory RV failure persisted. Impella RP Flex was chosen due to the patient’s small size and was placed via the right internal jugular vein on POD 12. The procedure was well tolerated, with the patient ambulatory the following day (POD 13). Impella was removed on POD 25 after 13 days of support. Patient achieved normal kidney, intrinsic rhythm improved sinus rhythm, and ultimately discharged on POD 50. Impella RP flex has emerged as a promising future indication as single or biventricular support postcardiac transplantation.
Immunofluorescence Protocol for Characterization of Platelet and Leukocyte Binding in Extracorporeal Membrane Oxygenation (ECMO) Circuits
Authors: Cai Tengyi , Burton Matthew , McCafferty Conor , Van Den Helm Suelyn , Letunica Natasha , Attard Chantal , Horton Stephen , Bottrell Steve , Schultz Bradley , MacLaren Graeme , Chiletti Roberto , Best Derek , Johansen Amy , Newall Fiona , Butt Warwick , d’Udekem Yves , Monagle Paul , Ignjatovic Vera
Published: June 2024

The continuous contact between blood and the foreign surface of the extracorporeal membrane oxygenation (ECMO) circuit contributes to hemostatic, inflammatory, and other physiological disturbances observed during ECMO. Although previous studies have extensively investigated blood samples from patients on ECMO, cell adsorption to the ECMO circuit as an additional factor that could potentially influence clinical outcomes, has largely been overlooked. Here we provide a detailed immunofluorescence (IF) protocol designed to characterize cellular binding on ECMO circuits collected from patients. Extracorporeal membrane oxygenation circuits were collected from three pediatric patients and an albumin primed-only ECMO circuit was used as control. Circuit samples from five different sites within each ECMO circuit were collected and processed for the IF protocol. CD14 and CD42a antibodies were used to identify platelets and leukocytes bound to each ECMO circuit sample and images captured using inverted fluorescence microscopy. The protocol enables the comprehensive characterization of platelet and leukocyte binding to ECMO circuits collected from patients, which could in turn extend our knowledge of the characteristics of circuit binding and may provide guidance for improved ECMO circuit design.
Pure 46, XY gonadal dysgenesis and 46, XY complete androgen insensitivity syndrome: A case report
Authors: Yu Tengge , Liu Li
Published: June 2024

Background:

Disorders of sex development (DSD) are congenital conditions characterized by atypical development of chromosomal, gonadal, and phenotypic sex. 46, XY DSD can result from disorders of testicular development or androgen synthesis.

Methods:

We present 2 rare cases of 46, XY DSD, specifically XY pure gonadal dysgenesis and complete androgen insensitivity syndrome.

Results:

Both cases underwent prophylactic gonadectomy due to the elevated risk of gonadal malignancy. Bilateral gonadoblastoma and dysgerminoma were diagnosed on one side, while Leydig cell hyperplasia and only Sertoli cells were diagnosed in the seminiferous tubules on both sides. The normal menstruation for the pure gonadal dysgenesis patient only as CAIS patients never menstruate. Estrogen replacement therapy was administered periodically to promote the development of secondary sexual characteristics and menstruation in pure gonadal dysgenesis case, as well as to prevent osteoporosis. Follow-up examinations revealed no tumor recurrence, and the patient with Swyer syndrome had regular menstrual cycles.

Conclusion:

Laparoscopic bilateral prophylactic gonadectomy and long-term hormone therapy with patient counseling and support are recommended.
Exploring the action mechanism of Gegensan in the treatment of alcoholic liver disease based on network pharmacology and bioinformatics
Authors: Yang Jiakai , Zhuang Qianqian , Tang Ke , Liu Xinli
Published: June 2024

Gegensan (GGS) has been reported for the treatment of alcoholic liver disease (ALD), but its therapeutic mechanism is still unclear. This paper aims to determine the therapeutic mechanism and targets of action of GGS on alcoholic liver disease utilizing network pharmacology and bioinformatics. The active ingredients in GGS were screened in the literature and databases, and common targets of ALD were then obtained from public databases to construct the network diagram of traditional Chinese medicine-active ingredient targets. Based on the common targets, Gene Ontology enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were performed to find target enrichment pathways, and the core targets were screened out by combining differential analysis and protein–protein interaction network analysis. Molecular docking was performed to verify the binding effect between the core targets and the corresponding active ingredients. ALD and GGS have 84 common targets, corresponding to 91 active ingredients. After subsequent differential analysis and protein–protein interaction network analysis, 10 core targets were identified. Gene Ontology and KEGG enrichment analyses showed that the main BPs corresponding to the common targets included the response to lipopolysaccharide, inflammatory response, etc. The KEGG pathways involved in the regulation of the common targets included the lipid-atherosclerosis pathway and the alcoholic liver disease pathway, etc. Further molecular docking showed that the core targets CYP1A1, CYP1A2, CXCL8, ADH1C, MMP1, SERPINE1, COL1A1, APOB, MMP1, and their corresponding 4 active ingredients, Naringenin, Kaempferol, Quercetin, and Stigmasterol, have a greater docking potential. The above results suggest that GGS can regulate lipid metabolism and inflammatory response in the ALD process, and alleviate the lipid accumulation and oxidative stress caused by ethanol. This study analyzed the core targets and mechanisms of action of GGS on ALD, which provides certain theoretical support for the further development of GGS in the treatment of ALD, and provides a reference for the subsequent research on the treatment of ALD.
Exploring awareness of cataract and associated risk factors: A cross-sectional study among the adult population in Jazan, Saudi Arabia
Authors: Ghulaysi Saleh , Abuallut Ismail , Alaqsam Abdulaziz A. , Kirat Omar E. , Hurissi Eman , Ayoub Saleha , Madkhali Abdullah , Abuageelah Bandar M. , Hamzi Yazeed A. , Alharbi Ali I. , Albarr Ali A. , Sabyani Bandar M.
Published: June 2024

Cataracts are a leading cause of visual impairment globally and significantly affect quality of life. In the Jazan region of Saudi Arabia, an area characterized by unique environmental and socioeconomic factors, the awareness of the cataract and its associated risk factors remain poorly understood. Therefore, assessing the knowledge about this problem in our region is the initial step to mitigate the impact of cataracts in the region. This descriptive cross-sectional study evaluated the prevalence of cataracts and the associated risk factors among adults in the Jazan region of Saudi Arabia. The study employed an online questionnaire divided into the sociodemographic characteristics and cataract knowledge sections. Data were analyzed using Statistical Package for Social Sciences for descriptive statistics. The study included 701 participants, predominantly young males (64.2%, aged 18–30 years). The participant profile included students (35.7%) and teachers (16.4%), and the majority held university degrees (69.2%). The preferred sources of information were TV and social media (23.8%), the Internet (23.3%), and academic studies (10.9%). Regarding cataract awareness, 57.6% correctly identified cataracts, 64.9% recognized blurred vision as a symptom, and 68.8% were aware of surgical treatment. Notable associations were found with sex (84.1% of females with higher education, P = .039), age (90.4% of those with >50 years of education, P = .002), and occupation (93.2% of students, P < .001). Overall, there were significant associations between the knowledge level and age (67.3%, P < .001) and occupation (77.6%, P < .001). This study revealed a moderate level of awareness of cataracts in Jazan, with significant variations based on sex, age, and occupation. These findings highlight the need for targeted educational interventions, particularly among certain demographic groups, to enhance understanding and management of cataracts in the region.
Gastroscopic observation and dose-volume histogram parameter study on gastrointestinal mucous injury for pancreatic cancer treated with TOMO
Authors: Wei Hualin , Han Wei , Zhang Xianbo , Zhang Ming
Published: June 2024

To explore the relationships between gastrointestinal radiation injuries of pancreatic cancer patients treated with TOMO and dose-volume histogram parameters prospectively. Seventy patients with pancreatic cancer who underwent TOMO were enrolled in this prospective study from February 2015 to May 2020. The clinical and dose-volume histogram parameters of the patients were collected. The optimal dose parameters for gastrointestinal radiation ulcers were confirmed based on the receiver operating characteristic curve (ROC) and the area below the ROC curve. Acute gastrointestinal tract toxic and side effect and injury grading correlation analyzed by Kruskal-Wallis rank sum test. Gastrointestinal injury often occurs during radiotherapy for pancreatic cancer, as observed using gastroscopy. The main adverse reactions were radioactive gastrointestinal inflammation (58.5%), radioactive gastrointestinal ulcers (41.4%), active bleeding (10%), newly-developed gastric retention (8.6%), and gastric varices (5.7%). As for the stomach, Dmean and V10 were related to radiation ulcer injury. ROC curve indicated that for stomach a Dmean of 13.39 Gy (area under ROC curves = 0.74, P = .048) and a V10 of 72.21% (area = 0.74, P = .048) was the tolerated dose for the injury of stomach radiation ulcer. As for duodenum, aV20 and aV25 are related to radiation ulcer injury. ROC curve indicated that aV20 of 22.82 cm3 (area = 0.68, P = .025) and aV25 of 32.04 cm3 (area = 0.66, P < .047) was the tolerated dose for the injury of duodenum radiation ulcer. The acute gastrointestinal tract toxic and side effects have no significant correlation with injury grading under gastroscope. Dmean > 13.39 Gy and V10 > 72.21% were the key dosimetric indices for predicting radiation-induced gastric ulcer, and aV20 > 22.82 cm3 and aV25 > 32.04 cm3 were for duodenal. Gastrointestinal reactions cannot be used as an overall basis for the diagnosis of gastrointestinal injury, and gastroscopy is recommended as a review item after radiotherapy.
Prevalence of anemia in patients with rheumatoid arthritis and its association with dietary inflammatory index: A population-based study from NHANES 1999 to 2018
Authors: Song Jingjing , Zhang Yujun , Li Ao , Peng Jie , Zhou Chulin , Cheng Xifu , Wu Yang , Zhao Wentao , Zong Zhen , Wu Rui , Li Hui
Published: June 2024

Anemia is common in patients with rheumatoid arthritis (RA), and it is unknown whether the dietary inflammatory index (DII) is linked to anemia. This study aimed to clarify the prevalence of anemia in RA patients and its association with the DII. The data utilized in this study were collected from the National Health and Nutrition Examination Survey database from 1999 to 2018. The prevalence of anemia in RA patients was estimated by ethnicity, sex, and age. Weighted multivariate logistic regression was utilized to explore the correlation between anemia risk and DII. The most crucial dietary factors related to the risk of anemia in RA patients were screened by stepwise regression. A nomogram model was established according to key dietary factors. A total of 10.25% (confidence interval, 8.58–11.92%) of RA patients will develop anemia, with the lowest prevalence around the age of 60. In addition, higher DII levels were discovered in anemic patients than in nonanemic patients. In multivariate regression models, an important positive association was revealed between anemia and growing quartiles of DII (Q4 vs Q1: odds ratio = 1.98; confidence interval, 1.25–3.15). In the subgroup analysis, the adjusted relation of DII with anemia in females, Mexicans, smokers, nondrinkers, and age groups ≥ 60 years was statistically significant. The same association was observed in the sensitivity analysis. A nomogram model based on stepwise regression screening of key dietary factors showed good discriminatory power to identify anemic risk in RA patients (area under the curve: 0.707). In patients with RA, high DII levels were associated with the risk of anemia. More attention should be given to controlling dietary inflammation to better prevent and treat anemia.
Dietary factors and risk for amyotrophic lateral sclerosis: A two sample mendelian randomization study
Authors: Jing Zhaoyi , Qi Xianghua , Teng Jing
Published: June 2024

Correlations between dietary factors and amyotrophic lateral sclerosis (ALS) have been found in previous observational studies. However, no further studies have used Mendelian randomization to further explore the causal relationship between dietary factors and ALS. Clarifying these relationships is a crucial part of developing nutritional recommendations for ALS prevention. The exposure and outcome datasets employed in this study were extracted from the IEU Open GWAS project (https://gwas.mrcieu.ac.uk/). The exposure datasets involved in our Mendelian analyses consisted of meat intake (processed meat intake, poultry intake, beef intake, pork intake, non-oily fish intake, and oily fish intake), staple foods intake (bread intake and cereal intake), vegetable intake (cooked vegetable intake, salad/raw vegetable intake), fruit intake (fresh fruit intake and dried fruit intake), and beverage intake (coffee intake and tea intake). The weighted median, MR-Egger, Inverse Variance Weighted, Simple mode and Weighted mode methods were all utilized. And we applied Inverse Variance Weighted method as the main judgement criterion for Mendelian randomization analysis. Heterogeneity and pleiotropy analyses were conducted to confirm the validity of the outcomes. Genetically predicted that oily fish intake (OR: 0.7648; 95% CI: 0.5905–0.9904; P = .0420), coffee intake (OR: 0.7385; 95% CI: 0.5660–0.9637; P = .0256), and fresh fruit intake (OR: 0.6165; 95% CI: 0.4007–0.9487; P = .0278) were causally associated with a decreased risk of ALS. Negative results (P > .05) were received for all other dietary factors. This study found that oily fish intake, coffee intake and fresh fruit intake reduced the risk of developing ALS. Additionally, other factors were not associated with ALS.
Explore the mechanism of Astragalus membranaceus and Poria cocos drug pair in improving immunity based on network pharmacology
Authors: Bai Yuting , Ning Na , Zhao Jianjun , Chen Guoqing , Du Yuhua , Huang Shicong , Jiang Xilong , Feng Xuelan , Feng Yuanyuan , Nan Yi , Yuan Ling
Published: June 2024

The aim of this study was to investigate the key targets and molecular mechanisms of the drug pair Astragalus membranaceus and Poria cocos (HFDP) in the treatment of immunity. We utilized network pharmacology, molecular docking, and immune infiltration techniques in conjunction with data from the GEO database. Previous clinical studies have shown that HFDP has a positive impact on immune function. We first identified the active ingredients and targets of HFDP from the Traditional Chinese Medicine Systems Pharmacology database and the Swiss Target Prediction database, respectively. Next, we retrieved the differentially expressed genes (DEGs) related to immunity from the GEO databases. The intersection targets of the drugs and diseases were then analyzed using the STRING database for protein-protein interaction (PPI) network analysis, and the core targets were determined through topological analysis. Finally, the intersection genes were further analyzed using the DAVID database for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes analyses. Subsequently, by analyzing the expression and prognostic survival of 12 core targets, 5 core target genes were identified, and molecular docking between the hub genes and immunity was performed. Finally, we used the CIBERSORT algorithm to analyze the immune infiltration of immunity genes In this study, 34 effective ingredients of HFDP, 530 target genes, and 568 differential genes were identified. GO and KEGG analysis showed that the intersection genes of HFDP targets and immunity-related genes were mainly related to complement and coagulation cascades, cytokine receptors, and retinol metabolism pathways. The molecular docking results showed that the 5 core genes had obvious affinity for the active ingredients of HFDP, which could be used as potential targets to improve the immunity of HFDP. Our findings suggest that HFDP is characterized by “multiple components, multiple targets, and multiple pathways” in regulating immunity. It may play an essential role in regulating immunity by regulating the expression and polymorphism of the central target genes ESR1, JUN, CYP3A4, CYP2C9, and SERPINE1.
Validation of the China mortality prediction model in trauma based on the ICD-10-CM codes
Authors: Zhang Zi-Xiao , Wang Yan-Hua , Liu Zhong-Di , Wang Tian-Bing , Huang Wei
Published: June 2024

The China mortality prediction model in trauma, based on the International Classification of Diseases, Tenth Revision, Clinical Modification lexicon (CMPMIT-ICD-10), is a novel model for predicting outcomes in patients who experienced trauma. This model has not yet been validated using data acquired from patients at other trauma centers in China. This retrospective study used data retrieved from the Peking University People’s Hospital discharge database and included all patients admitted for trauma between 2012 and 2022 for model validation. Model performance was categorized into discrimination and calibration. In total, 23,299 patients were included in this study, with an overall mortality rate of 1.2%. CMPMIT-ICD-10 showed good discrimination and calibration, with an area under the curve of 0.84 (95% confidence interval: 0.82–0.87) and a Brier score of 0.02. The performance of the CMPMIT-ICD-10 during validation was satisfactory, and the application of the model will be scaled up in future studies.
From seizures to cognitive dysfunction: A case report of Fahr syndrome in an Afghan patient
Authors: Madadi Shekiba , Alami Kawsar , Kaneda Yudai , Sediqi Pazhman
Published: June 2024

Rationale:

Fahr syndrome is a rare, degenerative neurological condition characterized by bilateral idiopathic calcification of the periventricular region, especially the basal ganglia. This condition is often misdiagnosed as other neurological or psychiatric disorders due to its rarity and overlapping symptoms.

Patient concerns:

A 34-year-old man had been experiencing seizures and cognitive dysfunction for few years, which were further compounded by slurred speech and motor difficulties as acute conditions.

Diagnosis:

After investigations, severe hypocalcemia, and hypoparathyroidism were detected and his brain computed tomography showed extensive bilateral calcifications in basal ganglia, thalamus, dentate nuclei, and some parts of subcortical white matter, suggestive of Fahr syndrome. Although, the patient was initially misdiagnosed due to a lack of information and the rarity of this disease.

Intervention:

The patient was treated with intravenous calcium gluconate, vitamin D3, l-ornithine l-aspartate syrup, and levetiracetam, replacing carbamazepine.

Outcome:

His symptoms, including slurred speech, muscle pain, and stiffness improved, serum calcium normalized, and he was discharged with medications for memory deficit and depression.

Lessons:

This case underscores the importance of raising awareness among physicians, especially in areas with limited medical resources, about the significance of prompt diagnosis and appropriate symptomatic treatment in enhancing patient prognosis and quality of life.