bluuebunny/crossref_metadata_2025 huggingface dataset:
World Federation of Acupuncture-Moxibustion Societies (WFAS) clinical practice guideline on acupuncture and moxibustion: smoking cessation recommendation summaries
Authors: Chen Shumin , Chang Jin , Tan Chaoren , Liu Zhenyu , Zhang Miao , Zhu Hao , Yang Jinsheng , Wang Yingying
Published: February 2025

The Clinical Practice Guideline on Acupuncture and Moxibustion: Smoking Cessation (WFAS 007.2-2023), released by the World Federation of Acupuncture Societies (WFAS) on 9 October 2023, is the first clinical practice guideline dedicated to smoking cessa using acupuncture. The core of the guideline lies in its recommendations, which provide direct clinical answers. Therefore, this article focuses on the recommendations of the guideline.The recommendations in this guideline are based on the latest systematic evaluations, developed through the modified Delphi Consensus Method and the GRADE Method, and provide 7 recommendations for 7 clinical questions.The dissemination and implementation of this guideline is expected to facilitate the standardisation of acupuncture practice for smoking cessation and contribute positively to the advancement of acupuncture as a treatment modality for this condition. It provides evidence-based recommendations and practical therapeutic protocols for acupuncture practitioners worldwide and serves as a reference for the development of subsequent acupuncture smoking cessation guidelines.
Aptamer-directed, nanovesicle-mediated targeting of undruggable molecules in preclinical cholangiocarcinoma models
Authors: Yu Mincheng , Sample Jack W. , Yan Irene K. , Takaichi Shohei , Tomlinson Jennifer L. , Loeuillard Emilien J. , Watkins Ryan D. , Werneburg Nathan W. , Abdelrahman Amro M. , Carlson Danielle , Kuipers Hendrien , Cai Meina , Ozmert Enis H. , Kimball Brooke , Yang Jinchun , Ilyas Sumera I. , Gores Gregory J. , Patel Tushar , Smoot Rory L.
Published: February 2025

Background and Aims:

Cholangiocarcinoma (CCA) is an aggressive malignancy arising from the biliary epithelium with limited therapeutic options and poor long-term survival rates. To address the limitations in CCA treatment, we investigated cell-targeted nanovesicles as a delivery platform for transcriptome-targeting therapeutics.

Approach & Results:

Milk-derived nanovesicles (MNVs) were loaded with short interfering RNAs targeting YAP, the downstream effector of the Hippo pathway; LCK, an upstream regulator of YAP; and tafazzin, a protein critical for the integrity of the inner mitochondrial membrane. These transcriptome-targeting nanovesicles (tMNVs) were decorated with a lipid-coupled RNA aptamer to epithelial cell adhesion molecule (EpCAM), including a tracking fluorophore. In vitro studies were conducted using multiple CCA cell lines. In vivo studies were performed using C57BL/6 and NOD/SCID mice to evaluate delivery and efficacy in both an immunocompetent syngeneic murine and a patient-derived xenograft (PDX) model. We demonstrated that tMNVs were selectively taken up by liver tumor cells, which was augmented by the incorporation of a targeting aptamer, and that MNVs loaded with siRNA effectively downregulated target gene expression, both in vitro and in vivo. Downstream effects of target gene inhibition were observed, including downregulation of YAP-TEAD target genes and an increase in reactive oxygen species production at the mitochondrial level. Administration of tMNVs targeting YAP, LCK, and tafazzin inhibited CCA growth and further synergized with chemotherapy in two preclinical CCA models.

Conclusions:

Herein, we show that aptamer-directed, nanovesicle-mediated targeting of YAP, LCK, and tafazzin potentiates chemosensitivity in two CCA models when delivered using aptamer-guided milk-derived nanovesicles.
Tissue engineering of the vitreous body: recent progress and future trends
Authors: Schulz André , Boneva Stefaniya K. , Lange Clemens , Sebag J.
Published: February 2025

Purpose of review

In contrast to current clinically used tamponades including oils and gases, hydrogels offer a vitreous replacement that has the potential to present a niche for vitreous cells and elevate vitreous substitutes to the level of tissue engineering. This article, therefore, highlights and discusses recent hydrogel-based vitreous replacement strategies as well as the latest progress on vitreous cells, towards the development of a cellularized vitreous substitute.

Recent findings

A variety of different crosslinked hydrogel systems have been recently investigated as preformed and in situ forming vitreous substitutes, based on biopolymers and/or synthetic polymers. In addition, a comprehensive understanding of the precise function and immunological significance of hyalocytes as vitreous macrophages has recently emerged using advanced imaging techniques and high-throughput transcriptional and protein analyses.

Tissue engineering offers transformative potential for vitreous replacement by combining advanced hydrogel systems with hyalocytes as vitreous cells to further replicate the versatile characteristics and functions of the native vitreous.
Ovarian cancer causing hyperprolactinemia: A case report and narrative review
Authors: Šakinienė Sandra , Veličkienė Džilda
Published: February 2025

The most common cause of hyperprolactinemia is prolactinoma. In addition, it is necessary to exclude potential physiological and pharmacological factors as well as health disorders to determine the cause of hyperprolactinemia. However, few studies have linked elevated prolactin (PRL) levels to ovarian cancer (OC). OC cells can ectopically release PRL, which then attaches to PRL receptors (PRLRs) in ovarian tissue and initiates signaling cascades that induce OC carcinogenesis. Therefore, we can consider PRL as a biomarker or tumorigenesis factor for OC. Furthermore, both PRL and PRLRs are potential therapeutic targets. A 50-year-old female presented with complaints of breast enlargement, soreness, and hyperprolactinemia, in addition to advanced OC. Hyperprolactinemia along with advanced high-grade serous ovarian carcinoma. Due to the patient’s fear of confined spaces, magnetic resonance imaging of the pituitary gland under general anesthesia was prescribed to rule out pituitary pathology. Magnetic resonance imaging was not performed due to the deterioration of the underlying condition, and the patient died 2.5 years after the diagnosis of OC. Hyperprolactinemia caused by OC is a rare condition for which there is a lack of literature and case studies. PRL produced by OC tissue binds to PRLRs in an autocrine or paracrine manner, initiating signaling cascades that induce OC tumorigenesis. In combination with other biomarkers, PRL may serve as a biomarker for OC. To establish the relation between OC and elevated PRL levels, additional large-scale population studies are required, with diagnostic and treatment procedures coming first.
Glucagon-like peptide-1 receptor agonists therapy to attenuate the risk of knee osteoarthritis and total knee replacement in type 2 diabetes mellitus: A nation-wide population-based cohort study
Authors: Lin Chih-Ping , Chung Chi-Hsiang , Lu Chieh-Hua , Su Sheng-Chiang , Kuo Feng-Chih , Liu Jhih-Syuan , Li Peng-Fei , Huang Chia-Luen , Ho Li-Ju , Chen Kuan-Chan , Chang Chun-Yung , Lin Ming-Shiun , Liu Yi-Chen , Cheng An-Che , Lin Hong-Han , Kuo Shi-Wen , Lee Chien-Hsing , Hsieh Chang-Hsun , Hung Yi-Jen , Liu Hsin-Ya , Guo Lan-Yuen , Chien Wu-Chien
Published: February 2025

Type 2 diabetes mellitus (T2DM) is an independent risk factor of knee osteoarthritis (KOA). This study was mainly based on data from the Taiwan National Health Insurance Database. Using big data analysis, we showed that glucagon-like peptide-1 receptor agonist (GLP-1RA) treatment is helpful for patients with T2DM who have a lower risk of KOA or total knee replacement (TKR). A total of 35,762 patients with T2DM were included in this study. We divided these patients into 988 patients with T2DM without KOA and 372 patients with T2DM with KOA who received GLP-1RA treatment and those who did not receive GLP-1RA treatment. The patients were matched for sex, age, and inclusion date by 1:1 propensity score, which was included in the control group. Cox proportional hazards analyses were performed to compare KOA risk and TKR rate during a maximum follow-up period of 5 years. There were 1976/744 patients with T2DM without/with KOA who received and did not receive GLP-1RA treatment, including 1052/322 men (53.24/43.28%) and 924/422 women (46.76/56.72%). At the end of follow-up, there were 46/39 (4.66/10.48%) patients with T2DM without/with KOA who received GLP-1RA treatment and underwent KOA/TKR were lower than those without GLP-1RA treatment 87/70 (8.81/18.82%). Cox proportional hazard regression analysis showed a lower rate of KOA/TKR among patients with GLP-1RA treatment (adjusted hazard ratio [HR] = .852; 95% confidence interval [CI] = .784–.930, P < .001/ adjusted HR = .913; 95% CI = .885–.977, P = .015, respectively). Kaplan–Meier analysis showed that the cumulative risk of KOA/TKR in patient with/without GLP-1RA was significantly different (log-rank test, P < .001/P < .001, respectively). This study aimed to provide clinicians with the option of GLP-1RA as a treatment for patients with T2DM with or without KOA to reduce the risk of KOA or TKR among such patients.
Identification of diagnostic biomarkers related to the efferocytosis pathway and immune cell infiltration characteristics in pediatric sepsis by bioinformatics analysis
Authors: Guo Linlin , Wang Yangzhen , Qiu Xiaodan , Su Wenfang , Chen Yixuan , Chen Yuanqing
Published: February 2025

Pediatric sepsis is a serious disease characterized by multiple organ failure. Due to its unique pathogenesis, its clinical mortality rate is very high. This study systematically evaluated the value of efferocytosis related genes in the diagnosis of sepsis in children. We downloaded gene expression profiles related to pediatric sepsis from the gene expression omnibus database, identify differentially expressed genes (DEGs) by limma R package, and retrieve adult sepsis gene expression profiles to determine the specificity of pediatric sepsis biomarkers. Selected pediatric sepsis specific genes from these profiles and used clusterProfiler for Kyoto Encyclopedia of Genes and Genomes (KEGG), gene ontology, and Reactome databases for functional enrichment. Genesets related to Efferocytosis was searched in the KEGG database, and the intersection with pediatric sepsis specific genes was considered as pediatric sepsis-efferocytosis genes. Immune infiltration analysis was performed using the CIBERSORT package. Constructed a protein–protein interaction (PPI) network and screened for hub genes in pediatric sepsis-efferocytosis genes. Further select diagnostic markers through gene expression and receiver operating characteristic (ROC) curve. We identified a total of 281 DEGs specific to pediatric sepsis, which are enriched in pathways such as phagosome, autophagy and efferocytosis. We found that the efferocytosis pathway is significantly up-regulated in pediatric sepsis, while this pathway is not significant in adult sepsis. We noticed that 12 types of immune cells infiltration levels including macrophages in pediatric sepsis patients. We selected the top 20 hub genes with PPI network. By overlapping hub genes with pediatric sepsis-efferocytosis genes, we obtained 2 hub pediatric sepsis-efferocytosis genes (ALOX5, CD36). The ROC curve suggested that these genes may be potential diagnostic markers for pediatric sepsis. We have identified ALOX5 and CD36 as efferocytosis related genes associated with pediatric sepsis, which can reliably identify pediatric sepsis and provide prospective clinical references for the pathogenesis of pediatric sepsis.
Salivary duct carcinoma presenting with unilateral multiple cranial nerve lesions and concurrent intracranial metastasis: A case report
Authors: Zhu Bo , Zhang Qing-Zi , Guo Kun , Gu Nai-Bing , Di Zheng-Li , Liu Zhi-Qin , Yang Xiang-Chun , Chai Li-Li , Yang Yan-Ping , Jia Xiao-Tao
Published: February 2025

Rationale:

Salivary gland ductal carcinoma (SDC) is a rare malignant tumor of the head and neck, accounting for 1% to 3% of salivary gland malignancy. SDC usually occurs in parotid gland, has a high malignancy degree, poor prognosis, and is prone to distant metastasis. In particular, intracranial metastasis accompanied by multiple cranial nerve lesions is very rare, and early diagnosis is difficult, which easily leads to missed diagnosis and misdiagnosis. Therefore, the diagnosis and treatment of SDC face major challenges. We report a unique case of SDC, which initially presented with progressive facial paralysis followed by progressive intracranial metastases and multiple cranial nerve lesions. After surgery and pathological examination, SDC was finally diagnosed.

Patient concerns:

A previously healthy 53-year-old male with persistent facial paralysis gradually developed symptoms of ipsilateral multiple cranial nerve lesions, and was hospitalized 8 months after onset.

Diagnoses:

Brain magnetic resonance imaging enhancement showed multiple irregular intracranial T1 and T2 with uneven signal intensity. Brain computed tomography showed intracranial space-occupying lesions, the largest of which was about 55 × 42 × 38 mm, with extensive bone destruction. Pathological findings showed malignant cell mass in the left temporal lobe tumor. Immunohistochemical: (++), CK7(+++), AR(++), Brg-1(+), Her-2(2+), Ki67(+, approximately 80%), consistent with high-grade ductal carcinoma, considering salivary gland origin. The final diagnosis was SDC.

Interventions:

The space-occupying lesions in the left cavernous sinus region and temporal lobe were partially resected. Local radiotherapy was recommended, but the patient refused.

Outcomes:

Postoperative symptoms did not improve significantly. Follow-up after 4 months showed no improvement in the extensive cranial nerve lesions on the left side.

Lessons:

In clinical practice, in the face of persistent facial palsy symptoms that gradually spread to other cranial nerves, the possibility of secondary facial nerve injury and malignant salivary gland tumors, especially SDC, cannot be easily ruled out even if imaging studies do not reveal any space-occupying intracranial lesions. Through the comprehensive use of imaging, pathology and immunohistochemistry and other diagnostic methods, the early detection and accurate diagnosis of SDC can be achieved, so as to provide the best treatment strategy for patients and improve the prognosis.
Study on PD-1 inhibitor combined with recombinant human endostatin and chemotherapy followed by IMRT in the treatment of advanced NSCLC
Authors: Ma FaQiang , Qi ZhengJun , Liao GuangHui , Zhao LiLi , Su XiaLu , Dong ChangFen , Lu FangYang , Sun Yi
Published: February 2025

Although chemotherapy, targeted therapy, and antiangiogenic drugs have become the cornerstones of treatment for advanced non-small-cell carcinoma (NSCLC) in clinical practice, the emergence of immune checkpoint inhibitors (such as PD-1 inhibitors) in recent years has also provided new options for the treatment of NSCLC. To explore whether PD-1 inhibitors combined with recombinant human endostatin and chemotherapy followed by IMRT have a certain curative effect in the treatment of advanced NSCLC. We retrospectively analyzed 47 patients with stage IIIB, IIIC, and IV NSCLC admitted to our hospital from August 2022 to June 2023. According to the treatment method, the patients were divided into an observation group (24 cases) and a control group (23 cases). The control group only received recombinant human endostatin 105 g and chemotherapy followed by IMRT; the observation group received domestic PD-1 inhibitors, 200 mg, and chemotherapy followed by IMRT on the basis of the treatment plan of the control group. After treatment, the objective response rate (ORR), disease control rate, overall survival, progression-free survival (PFS), duration of response, and incidence of adverse reactions were compared. After treatment, the ORR and disease control rate of the observation group were higher than those of the control group; compared with the control group, the PFS, overall survival, and duration of response period of the observation group were longer (P < .05); the incidence of adverse reactions in the observation group was significantly lower than that in the control group (P < .05). After chemotherapy, the CD3+ and CD4+ index of the observation group was significantly increased, the CD3+ CD8+ was slightly lower than that of the control group, without statistical significance, and the ratio of CD4/CD8 was higher than that of the control group, and the interleukin-2 index was significantly better than that of the routine group, P < .05. PD-1 inhibitor combined with recombinant human endostatin and chemotherapy followed by IMRT in the treatment of advanced NSCLC can significantly improve the ORR and prolong the PFS of patients, and the adverse reactions are controllable. The results of our study may provide help for the treatment strategies of patients with refractory advanced NSCLC, and are worthy of promotion and use.
Immunosuppressive treatment in autoimmune decompensated cirrhosis, when to say enough: A retrospective analysis
Authors: Barbero Manuel , Burgos Stefania , Roca Ignacio , Navarro Lucia , Cairo Fernando
Published: February 2025

Immunosuppressive therapy in decompensated cirrhotic patients with an indication for liver transplantation (LT) is controversial. This study aims to evaluate transplant-free survival rates in patients diagnosed with decompensated autoimmune hepatitis (AIH) with and without immunosuppressants (IS) treatment, and to identify predictors of mortality or LT. We retrospectively analyzed LT-evaluated consecutive patients with decompensated AIH at a single center, between 2013 and 2021. Patients were categorized into IS (IS Group) and non-IS (No IS Group). Survival curves for the 2 groups were evaluated using the Kaplan–Meier method, and differences were compared using the Log-rank test. Multiple regression analysis was conducted using Cox test. A total of 125 consecutive patients (mean age: 36.4 years; 81.6% female) were evaluated. The median transplant-free survival in the IS Group (72/125) were 22.6 months vs 6.57 months in the No IS Group (53/125) (P = .002). Cox-regression analysis revealed associations between moderate/severe ascites (hazard ratio [HR] = 2.37, 95% CI = 1.48–3.80, P = <.001) and MELD-Na (HR = 1.12, 95% CI = 1.08–1.16, P = <.001) with transplantation or death, while immunosuppression treatment acted protectively (HR = 0.55, 95% CI = 0.86–0.85, P = .008). Analyzing patients with MELD >22 (27/125) showed a loss of IS protective effect (OR = 0.45, 95% CI = 0.17–1.20, P = .11), and the presence of moderate/severe ascites increased the risk of death/LT (HR = 5.86, 95% CI = 1.26–27.2, P = .02). Autoimmune decompensated cirrhosis is associated with high overall mortality, and IS improves the transplant-free survival rate. In patients with MELD-Na >22, treatment ceases to be beneficial, especially if they have moderate/severe ascites. These patients, if receiving immunosuppression, may be disadvantaged in the possibility of accessing LT.
High prevalence of primary aldosteronism in a tertiary care hospital in Lebanon
Authors: Jambart Isabelle , Kassab Rebecca , Gannagé-Yared Marie-Hélène , Kassab Roland , Naim Charbel , El Ghorayeb Nada
Published: February 2025

Primary aldosteronism (PA) is a frequent cause of secondary hypertension. Studies on the prevalence of PA are lacking in the Middle East region. To determine the proportion of patients with high aldosterone-to-renin ratio (ARR) among Lebanese patients with hypertension screened for PA and to compare their clinical and biological characteristics with patients with essential hypertension. A retrospective review of medical charts of patients with hypertension undergoing sampling of serum aldosterone and plasma renin concentration at a tertiary care center between October 2022 and 2023 was conducted. Of 144 patients with hypertension screened for PA, 23 (16%) had an ARR higher than 3.7 ng/dL/mU/L and serum aldosterone above 15 ng/dL. The mean age of the screened population was 51 ± 15 years, 56% were men. The median duration of hypertension was 4 years and the median number was 2 of antihypertensive medications. Patients with a positive screening test were mostly men (88%, P = .0001), and more frequently had diabetes (50%, P < .0001) than those with essential hypertension. Only 22% had hypokalemia. Of the 23 patients, 11 underwent intravenous saline suppression testing; PA was confirmed in all of them. The high frequency of PA in our center is comparable to other countries. More studies are needed to determine how to reduce healthcare disparities and overcome the barriers to appropriate diagnosis and treatment.
A real-world study to observe the efficacy and safety of Lutai Danshen Baishao Granules for improving melasma
Authors: Lv Mei-Yu , Yang Yi , Fei Wen-Ting , Liu Jin-Lian , Zhang Rui , Zhou Lan-Hua , Zhang Feng-Hong , Wang Chun , Wang Lin-Yuan , Zhang Jian-Jun
Published: February 2025

Background:

Traditional Chinese Medicine categorizes melasma into various syndromes, one of which is the kidney-deficiency and blood-stasis syndrome. Different Chinese medicines are used for each syndrome to achieve a personalized treatment approach, resulting in a more effective outcome. The study aimed to investigate the efficacy and safety of Lutai Danshen Baishao Granules (LDBG) in alleviating melasma and to compare the effects of LDBG in patients with and without kidney-deficiency and blood-stasis syndrome through a real-world, large-sample investigation.

Methods:

A multicenter, prospective, nonrandomized, observational trial was conducted from December 2021 to May 2023, recruiting 1000 female participants with melasma. After enrollment, participants were divided into Group A (kidney-deficiency and blood-stasis syndrome) and group B (non-kidney-deficiency and blood-stasis syndrome) based on the traditional Chinese medicine (TCM) syndrome scale. General physical signs, melasma indicators, Dermatology Life Quality Index, and TCM syndrome scores were recorded before and after the intervention. The long-term effectiveness was assessed 2 months after the intervention ended.

Results:

Following the intervention, melasma-related indicators and TCM syndrome scores were significantly lower than those before the intervention (P < .001). Compared to Group B, Group A showed a more significant reduction in the total area of melasma and the Melasma Area and Severity Index score (P < .05). The reduction in melasma area was also more pronounced in Group A (group A: 425.00 vs group B: 312.50, P < .001). Two months after the intervention, intergroup and intragroup comparisons revealed that LDBG had a long-term effect with a lower tendency for recurrence, and the long-term effect in Group A was better than in group B (P < .05). The overall incidence of adverse events during the trial was 1.2%.

Conclusion:

LDBG can reduce facial melasma and improve TCM syndromes, particularly in cases of melasma associated with kidney-deficiency and blood-stasis syndrome, with high safety and low risk of relapse.
A risk factor prediction model for moderate-to-severe postoperative pain in patients undergoing laparoscopic sleeve gastrectomy
Authors: Yang Yaning , Zhang Chengzhen , Chi Wenying , Zheng Bin , Yu Xiaoqian , Zhang Kaiyun , Junzuo Guo , Meng Fanjun
Published: February 2025

The primary goal of this study was to identify the risk factors contributing to moderate-to-severe postoperative pain in patients undergoing laparoscopic sleeve gastrectomy (LSG) and to create a predictive model for these risk factors. A retrospective analysis was performed on a cohort of 375 patients who underwent LSG at Jinan Central Hospital from January 2017 to June 2023. Data for this study was extracted using medical databases. Patients were classified into 2 groups based on their postoperative pain levels: those experiencing moderate-to-severe pain and those not experiencing moderate-to-severe pain. Univariate and multivariate logistic regression analyses were employed to determine which variables were significantly associated with moderate-to-severe pain. Receiver operating characteristic curves were utilized to assess the diagnostic efficacy of different indicators. Additionally, calibration curves and clinical decision curves were applied for model validation. Multifactorial logistic regression analysis identified age, body mass index (BMI), and the modified frailty index (mFI) as independent risk factors for moderate-to-severe postoperative pain in LSG patients. Based on the regression analysis, a predictive model was constructed. The receiver operating characteristic curve for this model demonstrated an area under the curve of 0.96 (95% CI: 0.94–0.97), indicating excellent discriminatory ability between patients likely and unlikely to experience moderate-to-severe pain post-surgery. A scoring system was developed from the predictive model, assigning points to each risk factor. BMI was the most significant predictor (100 points), followed by mFI (30 points) and age (15 points). Calibration analysis showed that the predicted values closely matched the actual values, with a mean error of 0.008, indicating high accuracy of the model. Clinical decision analysis demonstrated a positive net benefit when the threshold probability ranged from 0.001 to 0.999, suggesting broad applicability of the model in clinical decision-making. Age, BMI, and mFI are significant predictors of moderate-to-severe postoperative pain in patients undergoing LSG.
Efficacy comparison of two doses of dezocine on preventing sufentanil-induced cough in patients undergoing coronary artery bypass grafting surgery: A prospective, randomized controlled trial
Authors: Xie Chun-mei , He Li-xian , Shen Meng-qi , Yao Yun-tai ,   The Evidence in Cardiovascular Anesthesia (EICA) Group
Published: February 2025

Background:

Sufentanil-induced cough (SIC) is a common but irritating phenomenon during general anesthesia (GA) induction; studies have reported that high doses of dezocine can effectively prevent it. The aim is to explore the efficacy and safety of low-dose dezocine in preventing SIC during GA induction in coronary artery bypass grafting (CABG) surgery.

Methods:

81 elective CABG surgery patients were randomly and equally divided into 2 dezocine groups of different doses and 1 control group. Before GA induction, the patients received “pre-injection” solution: 0.1 mg/kg dezocine in the high-dose (HD) group, 0.05 mg/kg dezocine in the low-dose (LD) group or an equal volume of saline in the control (C) group. The primary outcome was the incidence of SIC within 1 minute after sufentanil administration. The secondary outcomes included the severity of SIC, the adverse reactions within 1 minute after injection of the “pre-injection” solution, and the vital signs at various time points.

Results:

One patient had moderate SIC in the HD group (3.7%), 3 patients (11.1%) had SIC (1 mild and 2 severe) in the LD group, and 8 patients (29.6%) had SIC (3 mild, 1 moderate, and 4 severe) in the C group. The difference between the HD and the C groups was statistically significant (P = .01). In contrast, in comparing the LD and the C groups, the LD and the HD groups had no statistically significant difference (P > .017).

Conclusion:

The current study suggested that pretreatment of 0.05 mg/kg dezocine neither prevented SIC occurrence nor attenuated SIC severity during GA induction in CABG surgery, but 0.1 mg/kg dezocine did.
The efficacy of Sijunzi on immune function in patients with gastrointestinal cancers after surgery: Integrating systematic review and network pharmacology
Authors: Wu Zhulin , Zhang Weiqing , Miao Wangdong , Li Siyi , Xie Jing , Lu Wensong , Yan Yuting , Peng Lisheng , Luo Weijun
Published: February 2025

Background:

Patients with gastrointestinal cancer often have impaired immune function after surgery. This study aimed to assess the efficacy of Sijunzi decoction (SJZD) on immune function in patients with gastrointestinal cancers after surgery.

Methods:

The electronic databases, including CNKI, Wanfang, SinoMed, Weipu, PubMed, Web of Science, EMBASE, and Cochrane databases were retrieved (March 1, 2024), and the randomized controlled trials (RCTs) that met the criteria were included. Methodologic quality assessment of RCTs was performed using the Cochrane risk of bias tool. The data of RCTs were acquired and analyzed by meta-analysis by Review Manager 5.3, and the quality of the evidence followed the Grading of Recommendations, Assessment, Development and Evaluations approach. This research was registered in the International Platform of Registered Systematic Review and Meta-analysis, 202440001. Based on the network pharmacology, relationships between key genes of SJZD and tumor-infiltrating immune cells in gastrointestinal cancers were explored.

Results:

Thirteen articles (RCTs) were included, containing 1010 patients with gastrointestinal cancers after surgery. The results of meta-analysis revealed that SJZD with conventional therapies could improve CD3+ T lymphocyte (mean difference [MD] = 5.73, 95% confidence interval [CI]: 2.07–9.39, P = .002), CD4+ T lymphocyte (MD = 5.86, 95% CI: 3.90–7.82, P < .00001), CD4+/CD8+ (MD = 0.29, 95% CI: 0.15–0.43, P < .0001), and reduce CD8+ T lymphocyte (MD = −2.44, 95% CI: −4.03 to −0.85, P = .003) compared with conventional therapies alone. In addition, the funnel plot showed the included RCTs might have publication bias. The Grading of Recommendations, Assessment, Development and Evaluations classification showed low-quality evidence for CD4+, CD8+, and CD4+/CD8+, and very low-quality evidence for other indicators. The network pharmacology results suggested that SJZD may exert effects by regulating the immune cells in the microenvironment of gastrointestinal cancers.

Conclusion:

SJZD could enhance the immune function of patients with gastrointestinal cancers after surgery. Due to the low quality of articles, more high-quality RCTs are needed to improve the level of evidence.
The impact, prevalence, and association of different forms of hair loss among individuals with anxiety disorder: Systematic review and meta-analysis
Authors: Almudimeegh Almuntsrbellah , Alajlan Ahmed Hamad , Alrasheed Abdulelah Ibrahim , Alrasheed Mansour Ibrahim , Alqahtani Abdullah Khalid , Idris Reem Bin , Alomar Muhannad Abdullah , Alobaid Shaden Ahmad , Alotaibi Nouf Ali
Published: February 2025

Background:

Hair loss is a serious health concern, with individuals having to bear the associated psychological impact of the condition. Alopecia has been linked to emotional and psychological anguish in relationships, career, and personal life.

Objective:

This study aimed to elucidate the intricate association, prevalence, and impact of hair loss with anxiety disorders, distinguished from other psychological impacts of alopecia.

Methods:

The current review and meta-analysis were performed in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) framework. A comprehensive search was performed using the Cochrane, PubMed, and Google Scholar electronic databases studies published in English and conducted between January 2014 and September 2024. Statistical analysis was performed using STATA version 16.0 (StataCorp LLC), and the Newcastle-Ottawa Scale and RoB 2 tools were used for critical quality appraisal.

Results:

A total of 24 eligible articles were included in the current study, with a cumulative of 5553 patients presenting with 1 or more forms of hair loss. Anxiety disorder was significantly prevalent among patients with alopecia event rate (ER) 0.47 (95% CI: 0.39–0.54). Anxiety severity analysis also showed a significant relationship between anxiety and hair loss, with ERs of 0.35 (95% CI: 0.10–0.60), 0.15 (95% CI: 0.01–0.29), and 0.05 (95% CI: 0.03–0.29), respectively. Statistical significance was also demonstrated by a mean HADS-A score of 7.87 (95% CI: 6.85–8.88). However, considerable heterogeneity was observed in various statistical analyses.

Conclusion:

In summary, our study showed that among people with hair loss-related diseases, alopecia was substantially linked to anxiety disorders, with the frequency of anxiety among those affected being noticeably higher.
Molecular mechanism of the effect of BixiezelanYin on knee osteoarthritis based on network pharmacology and molecular docking
Authors: Huang Renkun , Lu Jiehua , Yang Xueyi , Sheng Guanyun , Qin Fangyi , Yang Xiongwu
Published: February 2025

The BixizelanYin (BXZLY) is a traditional herbal formula for treating damp-heat type knee osteoarthritis (KOA). This study aimed to investigate the potential therapeutic effects of BXZLY on KOA by using network pharmacology and molecular docking. Active ingredients and their corresponding targets of BXZLY were screened through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform. The known disease targets of KOA were retrieved from GeneCards and the Online Mendelian Inheritance in Man database. The effective targets of BXZLY for treating KOA were obtained with the Venny platform. A drug-component-target network diagram was constructed using Cytoscape 3.7.2 software, and a protein–protein interaction network was established via the STRING database. The protein–protein interaction network was visualized by Cytoscape 3.7.2 software. The biological functions of the targets wereanalyzed through Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis with the DAVID database. The Gene Ontology enrichment and KEGG pathway visualization bubble charts were generated using the OmicShare online platform to explore the biological functions of BXZLY in treating KOA. The main signaling pathways of BXZLY in treating KOA were investigated by KEGG pathway enrichment analysis. Finally, AutoDockTools software was used for molecular docking validation of the key molecules of the drug and the key proteins of the disease. A total of 108 active compounds and 280 target proteins of BXZLY were identified. There were 2816 disease-related targets related to KOA, among which 99 were targeted by BXZLY for KOA treatment. Key compounds included β-sitosterol, stigmasterol, campesterol, quercetin, and dioscin. Core target proteins consisted of STAT3, ESR1, EGFR, JUN, and PTGS2. The pathways mainly involved the advanced glycation end products – receptor for advanced glycation end products, estrogen, HIF-1, and relaxin signal pathways. Molecular docking showed a strong binding affinity between active ingredients and core target proteins. Docking candidates were selected based on oral bioavailability ≥ 30%, drug-likeness ≥ 0.18, and degree values in Cytoscape. This strategy ensured a reliable selection of compounds with high therapeutic relevance. BXZLY provides a comprehensive therapeutic strategy for KOA treatment by regulating cell proliferation and alleviating inflammation through its multi-component, multi-target, and multi-pathway effects.
Experiences of maternity care: Is the perspective of health care professionals respectful care while that of women obstetric violence?: A qualitative study
Authors: Çamlibel Merve
Published: February 2025

Women and health professionals may experience a number of barriers and difficulties related to maintaining and improving respectful maternity care (RMC). The aim of this study is to determine the perceptions of women who had vaginal delivery and nurses and midwives as health professionals about RMC in the care process from the perspectives of both groups. A descriptive qualitative design was used, analyzing data from semistructured interviews conducted with 11 women who had vaginal deliveries and 12 midwives and nurses. Data were analyzed using content analysis. Three main themes emerged from the content analysis: “barriers to RMC,” “RMC practices,” and “demands (expectations and suggestions) for RMC.” The study underscores the importance of health professionals and women viewing each other as collaborators. However, there should be a conducive environment that motivates healthcare professionals and provides opportunities for professional development and evidence-based practice. Government and hospital management should acknowledge these barriers and support efforts to empower both women and their caregivers (midwives, nurses, or physicians) to address them. Furthermore, the research results could aid in formulating national and international clinical recommendations designed to prevent obstetric violence.
Rechallenge of trastuzumab-based therapy in HER2-positive breast cancer patients who progressed after lapatinib plus capecitabine
Authors: Khanmammadov Nijat , Doğan Izzet , Khishigsuren Bayarmaa , Azizy Abdulmunir , Saip Pinar , Aydiner Adnan
Published: February 2025

Data regarding the use of rechallenge trastuzumab (RTmab)-based therapies in the management of heavily pretreated patients with HER2-positive breast cancer (BC) in the literature are limited. This study aimed to evaluate the efficacy of trastuzumab-based therapy in patients who experienced disease progression after receiving lapatinib plus capecitabine (LC). In this retrospective study, the data of thirty three HER2 positive metastatic BC patients who progressed after LC treatment and subsequently received trastuzumab-based treatment were evaluated. Trastuzumab was administered at an initial loading dose of 8 mg/kg followed by a maintenance dose of 6 mg/kg every 21 days. The average age of patients is 47 years (range 25–72 years). The predominant histopathological subtype was invasive ductal carcinoma, which was observed in 23 (70%) patients. Estrogen receptor (ER) positivity was also noted in 16 (48%) patients. All patients had received palliative trastuzumab plus chemotherapy (Cht) before the lapatinib. In conjunction with trastuzumab-based therapy, vinorelbine was administered to 14 (42%) patients, paclitaxel to 12 (36%), and other chemotherapeutic agents to 4 (12%). For all patients, the objective response and disease control rates were 27% and 69%, respectively. Furthermore, the median progression-free survival (PFS) was 8.8 months (95% confidence interval [CI]: 6.6–11), and the median overall survival was 20 months (95% CI: 15.1–25.8). There were no statistically significant differences in PFS rates based on several factors, including age, ER status, denovo metastasis, brain metastasis, perioperative Cht, pre-Rtmab hormone therapy, and which Cht was used along with Rtmab (P > .05). Mild to moderate adverse events were observed in 17 (52%) patients, whereas only 4 (12%) patients had Grade 3 to 4 toxicity. This study demonstrated that RTmab-based therapy is effective in patients who progressed after LC. These findings contribute to the literature by suggesting that RTmab is a viable treatment option for patients with HER2-positive metastatic BC.
APOC3 as a potential prognostic factor for hepatitis B virus-related acute-on-chronic liver failure
Authors: Wang Bo , Qiang Li , Zhang Geng , Chen Wen , Sheng Yunjian , Wu Gang , Deng Cunliang , Zeng Shan , Zhang Qian
Published: February 2025

Acute-on-chronic liver failure (ACLF) is the major cause of mortality in patients infected with the hepatitis B virus (HBV); however, early determination of the prognosis of patients with HBV-ACLF is insensitive or limited. This study aimed to analyze differentially expressed proteins in the plasma of patients with HBV-ACLF using data-independent acquisition mass spectrometry to provide a reference for short-term prognosis. Fifty HBV-ACLF patients and 15 healthy controls were enrolled in this study. Of these, 10 patients with HBV-ACLF and 5 healthy volunteers participated in data-independent acquisition-based proteomics and the potential core proteins were screened out via bioinformatics. Apolipoprotein C3 (APOC3) was selected and quantified by enzyme linked immunosorbent assays in all patients. And the area under the curve (AUC) was calculated to evaluate the value of APOC3 in the diagnosis and prognosis of patients with HBV-ACLF. A total of 247 differentially expressed proteins were identified in the serum of patients in the HBV-ACLF and normal control groups. A total of 148 proteins were upregulated and 99 proteins were downregulated in the HBV-ACLF group compared with those in the normal group. The expression level of APOC3 was 1.65 ± 0.44 mg/mL in patients with HBV-ACLF, which was obviously lower than the normal controls (2.04 ± 0.22 mg/mL) (P < .001) (AUC was 0.766, with a sensitivity of 62%, and specificity of 93.3%). The expression level of APOC3 was 1.38 ± 0.44 mg/mL in the non-survival group, which was obviously lower than the survival group (1.83 ± 0.35 mg/mL) (P < .0001) (AUC was 0.780, with a sensitivity of 50%, and specificity of 96.7%). APOC3 is associated with short-term prognosis of patients with HBV-ACLF and can be used as a potential prognostic biomarker in patients with HBV-ACLF.
Suction pressure levels during bronchial obstruction are related to bronchoalveolar lavage recovery failure: A clinical trial
Authors: Shimoda Masafumi , Kodama Tatsuya , Ito Masashi , Morimoto Kozo , Yoshimori Kozo , Ohta Ken , Tanaka Yoshiaki
Published: February 2025

Background:

Bronchoalveolar lavage (BAL) is a valuable diagnostic tool, with an optimal recovery rate of ≥ 30% for effective diagnosis. The primary cause of BAL recovery failure is bronchial collapse due to negative pressure, which is potentially influenced by bronchial wall weakness. This study aimed to measure suction pressure levels during bronchial collapse to explore their relationship with BAL recovery rates.

Methods:

We included 103 patients who underwent BAL procedures at Fukujuji Hospital from May 2024 to July 2025. Suction pressure levels during bronchial obstruction were evaluated and compared between patients with a BAL recovery rate < 30% (the failure group) and those with a BAL recovery rate ≥ 30% (the success group).

Results:

Of the 103 patients, 13 were categorized into the failure group, and 90 into the success group. The median age of patients in the failure group was 74 years (range 47–86), with 7 males (53.8%), which was not significantly different from that of patients in the success group (median age 72 years [range 18–90], P = .290; male n = 56 [62.2%], P = .560). Patients in the failure group had significantly lower suction pressure levels during bronchial obstruction than those in the success group did (median 8 hPa [95% confidence interval: 3–13] vs 10 hPa [4–22], P < .001). The area under the receiver operating characteristic curve for suction pressure levels during bronchial obstruction for predicting BAL recovery failure was 0.807 (95% confidence interval: 0.687–0.927). A cutoff value of <9.5 hPa was identified as a predictable suction pressure level causing bronchial obstruction, with a sensitivity of 67.8% and a specificity of 92.3%.

Conclusion:

Suction pressure levels during bronchial obstruction were predictive of BAL recovery rate failure, suggesting that a weak bronchial wall may be more prone to collapse under suction pressure.
Association between self-reported sleep apnea and albuminuria among middle age and elderly population: Results from National Health and Nutrition Examination Survey
Authors: Chen Li-Da , Lin Xiao-Fen , Xu Qiao-Zhen , Cai Zhi-Ming , Zhou Ji-Guang , Lin Li , Zhang Xiao-Bin
Published: February 2025

The prevalence of both obstructive sleep apnea (OSA) and albuminuria increase with advanced age. The data on the association between OSA and albuminuria in subjects with advanced age were limited. Hence, the present study aimed to assess the association between sleep apnea (SA) and albuminuria in middle age and elderly population. Data on participants with age ≥ 40 years during 2005 to 2008 and 2015 to 2020 National Health and Nutrition Examination Survey were analyzed. SA was evaluated based on the sleep questionnaire and albuminuria was assessed by albumin-to-creatinine ratio. The independent relationship between SA and albuminuria was explored by using multivariate logistic regression. A total of 13,902 subjects with 11,788 cases of normoalbuminuria and 2114 cases of albuminuria were included for data analysis. The proportion of albuminuria increased as SA severity aggravation. Univariate logistic analysis showed that frequently SA was positively associated with albuminuria (OR = 1.301, 95% CI = 1.089–1.547, P = .003). In multivariate logistic analysis, frequently SA was independently associated with increased risk of albuminuria after adjusting for confounding factors (OR = 1.309, 95% CI = 1.010–1.683, P = .039). The present study suggested that self-reported frequently SA was independently associated with increased risk of albuminuria in middle age and elderly population.
Value of Prenatal 3D HD-Live Flow in the Evaluation of True and False Knots of the Umbilical Cord
Authors: Zheng Lipeng , Liu Ying , Gong Lili , Wang Yingluan , Chang Hongbo
Published: February 2025

In this study, 3D HD-live Flow was used to differentiate true and false knots. The study involved 9161 fetuses who underwent ultrasound during the 13th to 40th week of pregnancy. Among them, 38 cases of true knots of umbilical cord were found, with 24 cases correctly identified by 3D HD-live Flow, representing a detection rate of 63.2%. There were 19 cases of false knots of umbilical cord, with 13 cases correctly identified by 3D HD-live Flow, representing a detection rate of 68.4%.

The detection rates of true knots of umbilical cord by 2D ultrasound and color Doppler ultrasound were significantly lower than that of 3D HD-live Flow (P < 0.05). However, there was no significant difference in detection rate between color Doppler ultrasound and 2D ultrasound (P > 0.05).

This study demonstrates that 3D HD-live Flow is an effective imaging technique for distinguishing true and false knots of the umbilical cord in the prenatal period. It has the potential to improve the accuracy of diagnosis and provide valuable information for clinical management.
Overcoming Political Upheaval to Deliver Pediatric Surgical Care in Afghanistan: A Prospective Analysis of the First 1000 Procedures
Authors: Moghul Dunya , Hsu Phillip J , Bryce Emma , Obaidy Yalda , Hellman Zane , Sherzad Ajmal , Poenaru Dan , Cheung Maija
Published: February 2025

Background:

Pediatric surgical care is limited in Afghanistan. Few details are known about the state of pediatric surgery in Afghanistan. We explore the impact of a newly installed pediatric operating room by a children’s charity on the provision of pediatric surgery in Afghanistan.

Study Design:

Following the opening in March 2023 of the new KidsOR operating room at Ataturk Hospital in Kabul, Afghanistan, perioperative clinical data was prospectively collected until December 2023. All children (age <14 years) undergoing surgical procedures were included in a REDCap database, and descriptive analyses were performed.

Results:

1,014 operations were performed during the study period. The patients originated (73%) from Kabul Province; 80% were male. 34% of the surgeries were emergencies. Mean age was 6.5 years old. Those who received elective surgery were on average younger (age 5.2 years) compared to those receiving emergency surgery (age 7.6 years (p<0.0001). The most common emergent diagnoses were appendicitis (52%), intussusception (9%), genitourinary pathologies (8.7%), and neurosurgical trauma (6.1%). The most common elective cases were hernias 27%, undescended testes (18%), hypospadias/epispadias (9%), urinary tract stones (8%), hydrocele/spermatocele/varicocele (7%), gastrointestinal pathologies (7%), and neurosurgical disorders (6%). The most frequent procedures were appendectomy (18%), inguinal hernia repair (17%), and orchidopexy (13%). Mortality and infectious complication rates were both 0.3%.

Conclusions:

This is the largest study on the provision of pediatric surgical care in Afghanistan, demonstrating the successful implementation of infrastructure for surgical capacity in a low-resource setting with a complex political status. Future efforts to quantify the burden of untreated pediatric surgical disease in this setting should assist advocacy efforts towards resource allocation and public health initiatives.

Level of Evidence:

Level 3 retrospective review