bluuebunny/crossref_metadata_2025 huggingface dataset:
Glial cell response and microthrombosis in aneurysmal subarachnoid hemorrhage patients: An autopsy study
Authors: Koopman Inez , van Dijk Bart J , Zuithoff Nicolaas P A , Sluijs Jacqueline A , van der Kamp Marije J , Baldew Zelonna A V , Frijns Catharina J M , Rinkel Gabriel J E , Hol Elly M , Vergouwen Mervyn D I
Published: July 2023

Neuroinflammation and microthrombosis may be underlying mechanisms of brain injury after aneurysmal subarachnoid hemorrhage (aSAH), but they have not been studied in relation to each other. In postmortem brain tissue, we investigated neuroinflammation by studying the microglial and astrocyte response in the frontal cortex of 11 aSAH and 10 control patients. In a second study, we investigated the correlation between microthrombosis and microglia by studying the microglial surface area around vessels with and without microthrombosis in the frontal cortex and hippocampus of 8 other aSAH patients. In comparison with controls, we found increased numbers of microglia (mean ± SEM 50 ± 8 vs 20 ± 5 per 0.0026 mm³, p < 0.01), an increased surface area (%) of microglia (mean ± SEM 4.2 ± 0.6 vs 2.2 ± 0.4, p < 0.05), a higher intensity of the astrocytic intermediate filament protein glial fibrillary acidic protein (GFAP) (mean ± SEM 184 ± 28 vs 92 ± 23 arbitrary units, p < 0.05), and an increased GFAP surface area (%) (mean ± SEM 21.2 ± 2.6 vs 10.7 ± 2.1, p < 0.01) in aSAH tissue. Microglia surface area was approximately 40% larger around vessels with microthrombosis than those without microthrombosis (estimated marginal means [95% CI]; 6.1 [5.4–6.9] vs 4.3 [3.6–5.0], p < 0.001). Our results show that the microglial and astrocyte surface areas increased after aSAH and that microthrombosis and microglia are interrelated.
Impact of Metagenomic Next-Generation Sequencing of Plasma Cell-free DNA Testing in the Management of Patients With Suspected Infectious Diseases
Authors: Linder Kathleen A , Miceli Marisa H
Published: July 2023

Metagenomic next-generation sequencing (mNGS) of cell-free DNA is an emerging modality for the diagnosis of infectious diseases, but studies on its clinical utility are limited. We conducted a retrospective single-center study including all patients who had plasma mNGS sent at the University of Michigan between 1 January 2021 and 25 July 2022. Test results were assessed for clinical impact. A total of 71 tests were sent on 69 patients; the mean ± SD age was 52 ± 19 years; and 35% of patients were immunocompromised. Forty-five (63%) mNGS test results were positive and 14 (31%) had clinical impact—from starting new antimicrobials (n = 7), discontinuing antimicrobials (n = 4), or changing antimicrobial duration (n = 2) or by affecting surgical decision making (n = 1). Twenty-six (37%) mNGS test results were negative and only 4 (15%) were impactful, leading to discontinuation of antimicrobials. Overall, just 25% of mNGS tests were clinically relevant. There was no significant difference in the proportion of tests that were clinically relevant between negative and positive results (P = .16) or if patients were immunocompromised (P = .57). Plasma mNGS was most frequently impactful (in 50% of patients) when included in the diagnostic workup of cardiovascular infection but less impactful in other clinical syndromes, including fever of unknown origin and pulmonary infection. Our findings underscore the need to further study this testing modality, particularly with prospective research including negative controls, before it is considered for widespread use.
Visceral Adiposity Index as a Measure of Cardiovascular Disease in Persons With Human Immunodeficiency Virus
Authors: Thomas Teressa S , Dunderdale Carolyn , Lu Michael T , Walpert Allie R , Shen Grace , Young Michele C H , Torriani Martin , Chu Jacqueline T , Haptu Hanna H , Manandhar Monica , Wurcel Alysse , Adler Gail K , Grinspoon Steven K , Srinivasa Suman
Published: July 2023

Background

Persons with well-treated human immunodeficiency virus (HIV) demonstrate a 2-fold higher risk of cardiovascular disease (CVD), which may be related to excess visceral adipose tissue (VAT). The visceral adiposity index (VAI) is a score to approximate VAT by combining biochemical measures with anthropometrics without quantification by imaging. We evaluated VAI in association with cardiometabolic factors among persons with HIV (PWH).

Methods

Forty-five PWH on antiretroviral therapy and virologically controlled with increased abdominal VAT (VAT area >110 cm2 on CT) and no known CVD were included. VAI was calculated using standard sex-specific formulas. Coronary plaque was assessed using coronary CT angiography.

Results

Participants were predominantly male (73%), white (53%), and non-Hispanic (84%), with a mean age of 55 (standard deviation, 7) years. Among PWH, median VAI was calculated to be 4.9 (interquartile range [IQR], 2.8–7.3). Log VAI correlated with log VAT (r = 0.59, P < .0001) and anthropometric measures (body mass index: r = 0.36, P = .02; waist circumference: r = 0.43, P = .004; waist-to-hip ratio: r = 0.33, P = .03). Participants with coronary plaque had a higher VAI compared to those without coronary plaque (median, 5.3 [IQR, 3.4–10.5] vs 2.8 [IQR, 1.8–5.0]; P = .004). VAI (area under the curve = 0.760, P = .008) performed better than the atherosclerotic CVD risk score to predict the presence of plaque in receiver operating characteristic analyses.

Conclusions

VAI may be a useful biomarker of metabolic dysfunction and increased CVD risk that may occur with VAT accumulation in PWH.

Clinical Trials Registration

NCT02740179.
“What’s My Line?”: Pseudo-Improvised Teaching When the Clinical Teaching Script Is Blank
Authors: Jarrett Elizabeth S. , Allen Katherine A. , Marmet Jordan , Klein Melissa , Moerdler Scott , Pitt Michael B.
Published: July 2023

Commitment to clinical education often requires significant forethought and attention to provide a comprehensive learning experience for trainees. In these settings, teaching is typically time-limited, prompted by a clinical scenario, and requires preparation. However, it is not uncommon for teachers to have insufficient time to prepare or to encounter a clinical scenario in which they have not yet developed a teaching script.

In this article, the authors share 5 categories of teaching techniques that instructors can pull from regardless of the prompt or busyness of the clinical setting and that are ideal for using when the teaching script is “blank.” They call this approach of having scenario-independent teaching techniques ready to be applied with minimal preparation, “pseudo-improvised teaching.”

Drawing from the literature, their own experience, and borrowing from improvisational theater, the authors share a toolkit of pseudo-improvised teaching techniques spanning from pathophysiology to clinical skills to work–life integration. In addition to highlighting several techniques, they describe models of meta-structure for teaching in which the use of themes for the day (i.e., longitudinal themes) and routines can ease some of the cognitive load felt by both learners and educators.
Bacterial biomarkers: new aspects of colorectal tumors diagnosis: reality or fantasy
Authors: Shahbazi Tayebe , Bakhshi Bita , Sadegh Fazeli Mohammad , Derakhshan-Nezhadc Elahe
Published: July 2023

As one of the most common cancers, colorectal cancer (CRC) is considered as a significant leading cause of cancer-related deaths worldwide. Gut microbiota is part of a complex microbial-based ecosystem in the human body so that changes in the microbiota could lead to a variety of diseases. A growing number of studies have shown that bacteria are both individually and collectively involved in the progression of CRC. The present review study provided a summary of some of the available data on the advantages and limitations of current CRC screening methods as well as gut biomarkers including genetic, epigenetic, and protein markers. Moreover, a summary of the applications and limitations in the detection of gut microbiota markers as well as their role in early diagnosis and timely treatment response in CRC patients was provided.
Identification of an immune-related 6-lncRNA panel with a good performance for prognostic prediction in hepatocellular carcinoma by integrated bioinformatics analysis
Authors: Lu Shan , Liu Xinkui , Wu Chao , Zhang Jingyuan , Stalin Antony , Huang Zhihong , Tan Yingying , Wu Zhishan , You Leiming , Ye Peizhi , Fu Changgeng , Zhang Xiaomeng , Wu Jiarui
Published: July 2023

Hepatocellular carcinoma (HCC) is one of the most malignant tumors with a poor prognosis. The long non-coding RNA (lncRNA) has been found to have great potential as a prognostic biomarker or therapeutic target for cancer patients. However, the prognostic value and tumor immune infiltration of lncRNAs in HCC has yet to be fully elucidated. To identify prognostic biomarkers of lncRNA in HCC by integrated bioinformatics analysis and explore their functions and relationship with tumor immune infiltration. The prognostic risk assessment model for HCC was constructed by comprehensively using univariate/multivariate Cox regression analysis, Kaplan–Meier survival analysis, and the least absolute shrinkage and selection operator regression analysis. Subsequently, the accuracy, independence, and sensitivity of our model were evaluated, and a nomogram for individual prediction in the clinic was constructed. Tumor immune microenvironment (TIME), immune checkpoints, and human leukocyte antigen alleles were compared in high- and low-risk patients. Finally, the functions of our lncRNA signature were examined using Gene Ontology, Kyoto Encyclopedia of Genes and Genomes enrichment analysis, and gene set enrichment analysis. A 6-lncRNA panel of HCC consisting of RHPN1-AS1, LINC01224, CTD-2510F5.4, RP1-228H13.5, LINC01011, and RP11-324I22.4 was eventually identified, and show good performance in predicting the survivals of patients with HCC and distinguishing the immunomodulation of TIME of high- and low-risk patients. Functional analysis also suggested that this 6-lncRNA panel may play an essential role in promoting tumor progression and immune regulation of TIME. In this study, 6 potential lncRNAs were identified as the prognostic biomarkers in HCC, and the regulatory mechanisms involved in HCC were initially explored.
Physical workplace violence in the health sector in Saudi Arabia
Authors: Alhassan Aseel Khaled , Alsaqat Reem Tarik , Al Sweleh Fahad Saleh
Published: July 2023

Physical workplace violence (WPV) occurs worldwide, causing psychological and physical injuries. However, reports from Saudi Arabia investigating which specialty is the most exposed are scarce. This study aimed to determine the prevalence and circumstances related to physical WPV among all healthcare providers in Saudi Arabia in 12 months, as well as the consequences for both attackers and targets of physical WPV. This cross-sectional study included all healthcare providers registered with the Saudi Commission for Health Specialties who had worked for more than 1 year in the health sector in Saudi Arabia until May 2019. Researchers distributed the questionnaire to the participants via email. Descriptive statistics were used to describe the basic features of the data. Correlations between the categorically measured variables were explored using a chi-square test of independence. Overall, 7398 healthcare workers (HCWs) voluntarily participated in the study, 51.3% being men and 48.7% being women. The mean age was 40 ± 8.62 years), and most participants were of non-Saudi origin. Overall, 9.3% HCWs had encountered physical violence. Male HCWs, pharmacists, nurses, and HCWs of non-Saudi origin were significantly more exposed to physical violence. Furthermore, those with direct physical contact with patients and those working with male patients only were more exposed to physical violence. Physical WPV is an important issue faced by HCWs, particularly those who work night shifts or have direct contact with patients. Results showed that more support, specific strategies and policies to reduce violence occurrence, and protection for healthcare providers are required.
TCM monotherapy achieves significant efficacy in crizotinib-refractory advanced NSCLC with brain metastasis
Authors: Qin Jiqiu , Li Ru , Ma Hong , Ding Peng , Yang Qin , Hu Lilai , Wu Deliu , Xiong Shaoquan
Published: July 2023

Rationale:

The morbidity and mortality of lung cancer rank the first among all kinds of cancer. In China, anaplastic lymphoma kinase-positive pulmonary tumors account for nearly 5% of non-small cell lung cancer (NSCLC), and these patients are quite likely to develop brain metastases, as high as around 45%. Although anaplastic lymphoma kinase-tyrosine kinase inhibitors crizotinib and alectinib have proved effective for controlling tumor metastases to the brain, drug resistance and disease progression cannot be ignored in the course of treatment.

Patient concerns:

Most of the literature reports that traditional Chinese medicine (TCM) has produced satisfactory results in the treatment of cancer patients as an adjuvant treatment for various malignancies in a 53-year-old male patient who developed advanced NSCLC with brain metastases. As first-line crizotinib and erlotinib treatments were ineffective and the intracranial lesions progressed extensively, the patient chose to receive TCM treatment alone in the hope of prolonging his life and improving his quality of life.

Diagnoses:

A 53-year-old male patient who developed advanced NSCLC with brain metastasis. Because first-line crizotinib and alectinib have failed, and the intracranial lesions progressed in a large area.

Interventions:

The patient requested that the final therapeutic strategy be Chinese medicine as monotherapy for long-term treatment. The patient took 30 mL of the decoction 1 hour after a meal, 3 times a day. The patient was not treated with dehydrating agents or diuretics during the TCM treatment.

Outcomes:

The improvement was obvious after 3 months of treatment, and significant reduction of cranial lesions. During the follow-up period, the patient developed neither severe liver damage nor kidney damage.

Lessons:

This case is the first 1 in the world where TCM was introduced as monotherapy for severe conditions with extensive brain metastases and achieved remarkable efficacy.
Clinicopathological and prognostic significance of SMAD4 in non-small cell lung cancer: A meta-analysis and database validation
Authors: Li Zhiqiang , Huang Yunfei , Zhou Rongsheng , Li Zhicheng , Yan Qitao
Published: July 2023

Background:

The relationship between SMAD family member 4 (SMAD4) and the clinicopathological and prognostic significance of non-small cell lung cancer (NSCLC) patients is unclear. Our aim was to investigate the association between SMAD4 expression and clinicopathological parameters and NSCLC prognosis.

Methods:

We searched articles in databases from inception to July 2022 to retrieve literature related to SMAD4 expression and the clinicopathological and/or prognostic significance of NSCLC patients. Odds ratios (ORs), hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. We evaluated the expression of SMAD4 and overall survival (OS) in NSCLC using the Kaplan–Meier plotter database.

Results:

Eight articles with 1461 NSCLC patients were included. SMAD4 expression was related to tumor differentiation (OR = 0.359, 95% CI: 0.238–0.543, P = .000), lymph node metastasis (OR = 0.469, 95% CI: 0.04–0.725, P = .001), tumor node metastasis stage (OR = 0.238, 95% CI: 0.156–0.362, P = .000) and good OS (HR = 0.592, 95% CI: 0.332–0.853, P = .000) in NSCLC. There was no significant association between SMAD4 expression and age (OR = 0.822, 95% CI: 0.515–1.312, P = .411) or sex (OR = 1.056, 95% CI: 0.675–1.653, P = .811). Furthermore, SMAD4 expression was lower in NSCLC, and a good prognosis in NSCLC (HR = 0.6, 95% CI = 0.51–0.72, P = 4.2 e-9) was shown to correlate with higher SMAD4 expression using the Kaplan–Meier Plotter database.

Conclusion:

SMAD4 expression is lower in NSCLC and correlated with lymph node metastasis, tumor differentiation, tumor node metastasis stage and good OS for NSCLC patients.
Polyarteritis nodosa initially presenting as concomitant peripheral neuropathy and myositis in unilateral limb: A case report
Authors: Han In Jun , Jeong Chang Hyeon , Choi Hyoseon
Published: July 2023

Rationale:

We report the case of a patient who initially presented with peripheral neuropathy and myositis without typical organ involvement, such as the kidneys, skin, or gastrointestinal system, but was ultimately diagnosed with polyarteritis nodosa (PAN).

Patient concerns:

A 62-year-old man presented with radicular pain in his right lower extremity. One week later, he complained of right ankle motor weakness and pain in the right posterior thigh, which led to admission. After 6 weeks of hospitalization, he newly experienced pain in his right testicle and anterior thigh.

Diagnosis:

The patient was initially diagnosed with polymyositis combined with sciatic neuropathy using magnetic resonance imaging, electrodiagnostic tests, and muscle biopsy. However, with the emergence of other systemic symptoms such as testicular pain, vasculitis was suspected, and the patient was reclassified as PAN using the 2007 European Medicines Agency algorithm and the American College of Rheumatology criteria.

Interventions:

The patient was treated with glucocorticoids for more than 6 months, and antiviral medication was prescribed to prevent hepatitis B virus reactivation.

Outcomes:

The patient’s radicular pain and pain in the right anterior and posterior thighs and testicle improved, and there were no signs of recurrence.

Lessons:

In patients presenting with radicular and focal muscle pain, it is crucial to consider the potential for PAN, as observed in this case report.
The relationship of coping skills with psychache in patients with depressive disorder
Authors: Yeşiloğlu Caner , Tamam Lut , Demirkol Mehmet Emin , Namli Zeynep , Karaytuğ Mahmut Onur , Şenbayram Güzelbaba Şilan
Published: July 2023

Suicide is a leading cause of death and disability worldwide. Psychache (psychological pain) and diminished tolerance of psychaches are important risk factors for suicide. People experiencing psychaches of similar severity may not demonstrate the same levels of tolerance because of various coping skills. This study aimed to determine the relationship between psychache, tolerance for psychache, and coping skills in individuals with depression and healthy controls. We included 73 patients with depressive disorders without comorbid mental disorders and 65 healthy controls. We applied beck depression inventory, beck hopelessness scale, beck suicidal ideation scale, psychache scale, tolerance for mental pain scale (TMPS), and coping attitudes evaluation scale (COPE) to all participants. People with depression had significantly higher COPE dysfunction scores than those in the control group did. Patients who had previously attempted suicide attempt(s) previously had significantly higher beck hopelessness scale, beck depression inventory, COPE dysfunction, and psychache scale scores, and lower TMPS-10 scores than those who did not attempt suicide. Mediation analyses revealed that dysfunctional coping skills played a partial mediating role in the relationship between psychache and the TMPS. The study revealed that dysfunctional coping skills were related to suicidal ideation and previous suicide attempts. These findings suggest that improving coping skills could help reduce the severity of suicidal ideation.
Imposter phenomenon among health professionals and students: A protocol for systematic review and meta analysis
Authors: Iktidar Mohammad Azmain , Ara Rifat , Roy Simanta , Ahmed Mashrur , Chowdhury Sreshtha , Eva Fahima Nasrin , Trisha Sadia Mahmud , Sharif Azaz Bin
Published: July 2023

Health professionals and medical students are at increased risk of the imposter phenomenon (IP) in other words, the imposter syndrome, due to the challenging nature of their professions. It is particularly concerning since it is linked to a higher incidence of burnout and suicidal ideation. We must first thoroughly grasp its prevalence and associated factors to address this issue. However, no published review of the data includes a meta-analysis to help understand the character and associated factors of IP among medical workers and medical students. This study aims to investigate IP prevalence and risk factors among healthcare personnel. Five online databases will be searched for papers published in English between January 2000 and December 2022, and 2 independent reviewers will filter, select studies, extract data, and evaluate the risk of bias in each piece. The retrieved articles will be included based on strict inclusion and exclusion criteria. A third reviewer will decide on any disagreements between the 2 reviewers. Where appropriate, a meta-analysis will be conducted using the random-effects model. The heterogeneity of the studies will be examined, and a sensitivity analysis will be done depending on the study quality. The purpose of this review is to determine the prevalence and risk factors for IP among healthcare personnel. The review’s findings will emphasize the severity and contributing factors of the problem, therefore guiding policy for future actions.
Development of a prognostic signature based on anoikis-related genes in hepatocellular carcinoma with the utilization of LASSO-cox method
Authors: Yu Zhe , Shi Fang-e , Mao Yuanpeng , Song Aqian , He Lingling , Gao Meixin , Wei Herui , Xiao Fan , Wei Hongshan
Published: July 2023

To develop a signature based on anoikis-related genes (ARGs) for predicting the prognosis of patients with hepatocellular carcinoma (HCC), and to elucidate the molecular mechanisms involved. In this study, bioinformatic algorithms were applied to integrate and analyze 777 HCC RNA-seq samples from the cancer genome atlas and international cancer genome consortium repositories. A prognostic signature was developed via the least absolute shrinkage and selection operator-cox regression method. To evaluate the accuracy of the signature in predicting events, multi-type technical means, such as Kaplan–Meier plots, receiver operating characteristic curve analysis, nomogram construction, and univariate and multivariate Cox regression studies were performed. We investigated the underlying molecular biological mechanisms and immune mechanisms of the signature using gene set enrichment analysis and the CIBERSORT R package, respectively. Meanwhile, immunohistochemical staining acquired from the human protein atlas was used to confirm the differential expression levels of hub genes involved in the prognostic signature. We developed an HCC prognostic signature with a collection of 5 ARGs, and the prognostic value was successfully assessed and verified in both the test and validation cohorts. The risk scores calculated by the prognostic signature were proved to be an independent negative prognostic factor for overall survival. A set of nomograms based on risk scores was established and found to be effective in predicting OS. Further investigation of the underlying molecular biological mechanisms and immune mechanisms indicated that the signature may be relevant to metabolic dysregulation and infiltration of gamma delta T cells in the tumor. The survival prognosis of HCC patients can be predicted by the anoikis-related prognostic signature, and it serves as a valuable reference for individualized HCC therapy.
Genetic analysis of potential biomarkers and therapeutic targets associated with ferroptosis from bronchopulmonary dysplasia
Authors: Ma Xiaoxue , Tao Ziyu , Chen Leiming , Duan Shaozhi , Zhou Guoping , Ma Yunxia , Xiong Zhenqin , Zhu Lan , Ma Xuejiao , Mao Yan , Hu Yifang , Zeng Ni , Wang Jimei , Bao Yunlei , Luo Fei , Wu Chuyan , Jiang Feng
Published: July 2023

Ferroptosis is a recently identified form of cell death that is distinct from the conventional modes such as necrosis, apoptosis, and autophagy. Its role in bronchopulmonary dysplasia (BPD) remains inadequately understood. To address this gap, we obtained BPD-related RNA-seq data and ferroptosis-related genes (FRGs) from the GEO database and FerrDb, respectively. A total of 171 BPD-related differentially expressed ferroptosis-related genes (DE-FRGs) linked to the regulation of autophagy and immune response were identified. Least absolute shrinkage and selection operator and SVM-RFE algorithms identified 23 and 14 genes, respectively, as marker genes. The intersection of these 2 sets yielded 9 genes (ALOX12B, NR1D1, LGMN, IFNA21, MEG3, AKR1C1, CA9, ABCC5, and GALNT14) with acceptable diagnostic capacity. The results of the functional enrichment analysis indicated that these identified marker genes may be involved in the pathogenesis of BPD through the regulation of immune response, cell cycle, and BPD-related pathways. Additionally, we identified 29 drugs that target 5 of the marker genes, which could have potential therapeutic implications. The ceRNA network we constructed revealed a complex regulatory network based on the marker genes, further highlighting their potential roles in BPD. Our findings offer diagnostic potential and insight into the mechanism underlying BPD. Further research is needed to assess its clinical utility.
Role of SNAP25 on the occurrence and development of eosinophilic gastritis
Authors: Zhang Jie , Hou Shiyang , Chi Xiao-qian , Shan Hai-feng , Li Xiao-wei , Zhang Qi-jun , Wang Jin-lei , Kang Chun-bo
Published: July 2023

Eosinophilic gastritis is characterized by gastrointestinal symptoms accompanied by peripheral eosinophilia. This study aims to explore the association between eosinophilic gastritis and Synaptosome Associated Protein 25 (SNAP25), and provide a new direction for the diagnosis and treatment of eosinophilic gastritis. GSE54043 was downloaded from the gene expression omnibus database. Differentially expressed genes (DEGs) were screened. The functions of common DEGs were annotated by Database for Annotation, Visualization and Integrated Discovery and Metascape. The protein–protein interaction network of common DEGs was obtained by Search Tool for the Retrieval of Interacting Genes and visualized by Cytoscape. Significant modules were identified from the protein–protein interaction network. A total of 186 patients with eosinophilic gastritis were recruited. The clinical data were recorded and the expression levels of CPE, SST, PCSK2, SNAP25, and SYT4 were detected. Pearson chi-square test and Spearman correlation coefficient were used to analyze the relationship between eosinophilic gastritis and related parameters. Univariate and multivariate Logistic regression were used for further analysis. 353 DEGs were presented. The top 10 genes screened by cytoHubb were shown, and Veen diagram figured out 5 mutual genes. Pearson’s chi-square test showed that SNAP25 (P < .001) was significantly associated with eosinophilic gastritis. Spearman correlation coefficient showed a significant correlation between eosinophilic gastritis and SNAP25 (ρ = −0.569, P < .001). Univariate logistic regression analysis showed that SNAP25 (OR = 0.046, 95% CI: 0.018–0.116, P < .001) was significantly associated with eosinophilic gastritis. Multivariate logistic regression analysis showed that SNAP25 (OR = 0.024, 95% CI: 0.007–0.075, P < .001) was significantly associated with eosinophilic gastritis. The low expression of SNAP25 gene in eosinophilic gastritis is associated with a higher risk of eosinophilic gastritis.
The efficacy of aprepitant for the prevention of postoperative nausea and vomiting: A meta-analysis
Authors: Liu Yingchao , Chen Xinli , Wang Xiaohua , Zhong Huohu , He Hefan , Liu Yibin , Liao Yuewen , Pan Zhigang , Hu Weipeng , Liu Weifeng , Zheng Feng
Published: July 2023

Background:

Postoperative nausea and vomiting (PONV) is one of the common adverse reactions after surgery. Recent randomized controlled trials (RCTs) investigating antiemetic drugs suggest that aprepitant has the strongest antiemetic effect of any single drug. This meta-analysis aimed to explore the efficacy of aprepitant for preventing PONV based on the existing literature.

Methods:

To identify RCTs investigating the use of aprepitant for PONV prevention, we searched PubMed, Embase, and Cochrane Library databases for articles published prior to March 20, 2022. Seventeen RCTs were identified, with 3299 patients, meeting the inclusion criteria. PONV incidence, complete response, 80 mg aprepitant combined with dexamethasone and ondansetron, vomiting, nausea, and analgesic dose-response were the main outcomes measured.

Results:

Compared with the control group, PONV incidence was significantly reduced among those receiving aprepitant (odds ratio [OR]: 0.34; 95% confidence interval [CI]: 0.26, 0.44; P < .0001), with a more complete response (OR: 1.35; 95% CI: 1.14, 1.59; P = .0004). Supplementation of 80 mg aprepitant in combination with dexamethasone and ondansetron substantially improved the effects of PONV (OR: 0.36; 95% CI: 0.16, 0.82; P = .01). Further, administration of 80 mg aprepitant was better at preventing vomiting than nausea (OR: 8.6; 95% CI: 3.84, 19. 29; P < .00001). No statistically significant difference between the dose-response of analgesics was identified (mean difference: −1.09; 95% CI: −6.48, 4.30; P = .69). The risk of bias was assessed independently by paired evaluators.

Conclusion:

Aprepitant effectively reduces the incidence of PONV; however, the effects of postoperative analgesia require further exploration.
The efficacy of Chinese herbal ointment in treating perianal eczema: A systematic review and meta-analysis
Authors: Zhang Hui , Lin Minghao , Zhang Yiwen , Liu Shilin , Li Andong , Li Guofeng
Published: July 2023

Background:

Traditional Chinese herbal ointment has significant curative effect and few side effects in the treatment of perianal eczema (PE). Currently, there is no systematic evaluation on the treatment of PE with traditional Chinese medicine ointment. The current aim is to systematically evaluate the efficacy of traditional Chinese medicine ointment in the treatment of PE through meta-analysis.

Methods:

Randomized controlled trials on the treatment of PE with Chinese herbal plaster were included in the meta-analysis, which was searched in Chinese and English databases up to March 1, 2023. The search will be conducted in accordance with the object of PICOS framework. Two research will independently use EndnoteX9 to extract the data and evaluate the quality assessment of included trails. Meta-analysis was performed using Revman5.4.1 provided by Cochrane Collaboration; when the outcome indicator is a dichotomous variable, relative risk (RR) was used as the effect size; when the outcome indicator is a continuous variable, weighted mean difference (MD) was used as the effect size, each effect size should be expressed as 95% confidence interval (CI).

Results:

The results of meta-analysis showed that: The total effective rate of PE (RR: 1.22, 95% CI: 1.15, 1.30, P < .01; I
2 = 32%, Q = 0.17). The cure rate of PE (RR: 3.37, 95% CI: 2.30, 4.94, P < .01; I
2 = 21% Q = 0.26). The recurrence rate of PE (RR: 0.25, 95% CI: 0.13, 0.48, P < .01; I
2 = 31%Q = 0.23). Itchy points (MD: 0.04, 95% CI: −0.19, 0.27; I
2 = 26%) Skin damage area (MD: −0.37, 95% CI: −0.56, −0.19; I
2 = 26%). Skin damage form (MD: −0.59, 95% CI: −0.81. −0.36; I
2 = 0%).

Conclusion:

A total of 11 articles were included in this study for meta-analysis, and the results showed that Chinese medicine ointment is more helpful in improving the skin lesion area and skin damage form, significantly improve the response rate and cure rate, reduce the recurrence rate. Chinese herbal ointment has guiding significance for clinical practice which deserve to use ointments by further experimental and clinical investigation.
The role of artificial neural networks in prediction of severe acute pancreatitis associated acute respiratory distress syndrome: A retrospective study
Authors: Zou Kang , Ren Wensen , Huang Shu , Jiang Jiao , Xu Huan , Zeng Xinyi , Zhang Han , Peng Yan , Lü Muhan , Tang Xiaowei
Published: July 2023

Early identification and intervention of acute respiratory distress syndrome (ARDS) are particularly important. This study aimed to construct predictive models for ARDS following severe acute pancreatitis (SAP) by artificial neural networks and logistic regression. The artificial neural networks model was constructed using clinical data from 214 SAP patients. The patient cohort was randomly divided into a training set and a test set, with 149 patients allocated to the training set and 65 patients assigned to the test set. The artificial neural networks and logistic regression models were trained by the training set, and then the performance of both models was evaluated using the test set. The sensitivity, specificity, PPV, NPV, accuracy, and AUC value of artificial neural networks model were 68.0%, 87.5%, 77.3%, 81.4%, 80.0%, 0.853 ± 0.054 (95% CI: 0.749–0.958). The sensitivity, specificity, PPV, NPV, accuracy and AUC value of logistic regression model were 48.7%, 85.3%, 65.5%, 74.4%, 72.0%, 0.799 ± 0.045 (95% CI: 0.710–0.888). There were no significant differences between the artificial neural networks and logistic regression models in predictive performance. Bedside Index of Severity in Acute Pancreatitis score, procalcitonin, prothrombin time, and serum calcium were the most important predictive variables in the artificial neural networks model. The discrimination abilities of logistic regression and artificial neural networks models in predicting SAP-related ARDS were similar. It is advisable to choose the model according to the specific research purpose.
Sunshine duration and solar radiation contributed to severe Bell’s palsy: An 11-year time series analysis based on a distributed lag non-linear model model
Authors: Zhang Cuiyi , Dong Fang , Wu Qi , Jin Jinlan , Li Mengtao , Xu Xiaojuan , Peng Zhihua , Chen Yuanting , Ye Meixia , Liu Xingli , Wang Lijun , Zhong Yinqin
Published: July 2023

Although previous studies have suggested that meteorological factors are associated with Bell’s palsy, articles on this topic are rare and the results are inconsistent. We aim to reveal the relationship between exposure to different meteorological factors and the onset of severe Bell’s palsy (SBP) with daily data. A case-crossover study based on time-series data was applied, and the minimum risk value of each climatic factor was set as the reference value. We fitted a distributed lag non-linear model (DLNM) which applied quasi-Poisson regression to evaluate the exposure-response association and the lag-response association of meteorological factors on the occurrence of SBP. The mode value and per-decile interval value of each meteorological factor were all included in the analysis. Sensitivity analyses were conducted to test the robustness of results. A total of 863 SBP patients (474 males and 389 females) from 7 hospitals in the Shenzhen Futian District were selected from January 2009 to February 2020. The highest relations effect was tested in the cumulative exposure-response result shown as follows; mean temperature at the minimum value 15.3°C with RR of 10.370 (1.557–69.077) over lag 0 to 13; relative humidity at the 30th value 71% with RR of 8.041 (1.016–63.616) over lag 0 to 14; wind speed at the 90th value 31 (0.1 m/s) with RR of 1.286 (1.038–1.593) over lag 0; mean air pressure at the 30th value 1001.4 (pa) with RR of 9.052 (1.039–78.858) over lag 0 to 5; visibility at the 80th value 26.5 (km) with RR of 1.961 (1.005–1.423) over lag 0 to 2; average total cloud cover at the max value 100 (%) with RR 1.787 (1.014–3.148) over lag 0 to 2; sunshine duration at the 10th value 0.1 (h) with RR of 4.772 (1.018–22.361); daily evaporation shows no relationship in the cumulative result; daily average solar radiation at the minimum value 0 (W/m2) with RR of 5.588 (1.184–26.382). There is a relationship between wind speed and the onset of SBP, while mean air pressure, visibility, and average total cloud cover, especially sunshine duration and solar radiation which showed a strong effect, may be associated with severe clinical symptoms of SBP. Mean temperature and relative humidity may affect the course of SBP.
Prevalence and clinical characteristics of low skeletal muscle index among adults visiting a health promotion center: Cross-sectional study
Authors: Yun Jungmi , Kwon Ryuk Jun , Kim Taehwa
Published: July 2023

Sarcopenia causes a variety of functional impairments and is associated with all-cause mortality, but once it occurs, it is difficult to treat and reverse. However, the prevalence of sarcopenia in healthy people has never been investigated due to the low awareness of sarcopenia in healthy people. This cross-sectional study was conducted in a single health promotion center from the January 1st 2020 to the December 31st 2021. Adults aged 18 years and older with an Inbody as part of their health checkup were included, and all data was collected from the EMR. Obesity was defined as a body mass index (BMI) of 23 (kg/m2) or more by Korean standards, and low skeletal muscle mass was defined as a skeletal muscle index (SMI) of <0.789 for men and <0.512 for women. 60.5% of the total participants (n = 5993) had low skeletal muscle mass. The low SMI group had lower BMI, waist circumference, and abdominal skinfold than the normal SMI group (low SMI group vs normal SMI: BMI; 25.47 ± 2.96 vs 22.98 ± 3.05, P < .001, waist circumference; 90.31 ± 8.80 cm vs 82.69 ± 9.71 cm, P < .001, abdominal skinfold; 18.78 ± 2.44 mm vs 15.99 ± 2.12 mm, P < .001). The body fat percentage was higher in the low SMI group than in the normal SMI group 25.30 ± 6.23% versus 29.82 ± 7.07%, P < .001. Triglyceride and uric acid levels were low in the low SMI group (TG; 147.69 ± 97.27 vs 115.86 ± 68.31, P < .001, uric acid level; 6.30 ± 1.38 vs 5.23 ± 1.30, P < .001) and high-density lipid (HDL) was high (HDL; 53.17 ± 11.41 vs 59.89 ± 14.72, P < .001). The odds ratio of low SMI prevalence for age, sex, BMI, fat body percent, and triglycerides relative to normal SMI was 1.05 (P = .031), 0.14 (P < .001), 0.12 (P < .001), 2.05 (P < .001), and 0.99 (P = .003), respectively. Of those who visited the Health Promotion Center, more than 60% had low SMI identified through Inbody. Low BMI and high body fat percentage increase the risk of low SMI. Compared to normal and low SMI based on obesity, Sex, height, BW, abdominal skinfold, and waist circumflex showed significant P values in both groups. The factors related to low SMI were TG, HDL, and uric acid levels.
Conditional Effects of Race on Operative and Nonoperative Outcomes of Emergency General Surgery Conditions
Authors: Roberts Sanford E. , Rosen Claire B. , Keele Luke J. , Kaufman Elinore J. , Wirtalla Christopher J. , Syvyk Solomiya , Reilly Patrick M. , Neuman Mark D. , McHugh Matthew D. , Kelz Rachel R.
Published: July 2023

Introduction:

Many emergency general surgery (EGS) conditions can be managed both operatively or nonoperatively; however, it is unknown whether the decision to operate affects Black and White patients differentially.

Methods:

We identified a nationwide cohort of Black and White Medicare beneficiaries, hospitalized for common EGS conditions from July 2015 to June 2018. Using near-far matching to adjust for measurable confounding and an instrumental variable analysis to control for selection bias associated with treatment assignment, we compare outcomes of operative and nonoperative management in a stratified population of Black and White patients. Outcomes included in-hospital mortality, 30-day mortality, nonroutine discharge, and 30-day readmissions. An interaction test based on a t test was used to determine the conditional effects of operative versus nonoperative management between Black and White patients.

Results:

A total of 556,087 patients met inclusion criteria, of which 59,519 (10.7%) were Black and 496,568 (89.3%) were White. Overall, 165,932 (29.8%) patients had an operation and 390,155 (70.2%) were managed nonoperatively. Significant outcome differences were seen between operative and nonoperative management for some conditions; however, no significant differences were seen for the conditional effect of race on outcomes.

Conclusions:

The decision to manage an EGS patient operatively versus nonoperatively has varying effects on surgical outcomes. These effects vary by EGS condition. There were no significant conditional effects of race on the outcomes of operative versus nonoperative management among universally insured older adults hospitalized with EGS conditions.
Stroke Volume Measurements by Echocardiography and Ultrasonic Cardiac Output Monitor in Children
Authors: Fremuth Jiri , Huml Michal , Pomahacova Tereza , Kobr Jiri , Kormunda Stanislav , Sykora Josef
Published: July 2023

Objectives

Stroke volume (SV) and cardiac output monitoring is a cornerstone of hemodynamic assessment. Noninvasive technologies are increasingly used in children. This study compared SV measurements obtained by transcutaneous Doppler ultrasound techniques (ultrasonic cardiac output monitor [USCOM]), transthoracic echocardiography jugular (TTE-J), and parasternal (TTE-P) views performed by pediatric intensivists (OP-As) with limited training in cardiac sonography (20 previous examinations) and pediatric cardiologists (OP-Bs) with limited training in USCOM (30 previous examinations) in spontaneously ventilating children.

Methods

A single-center study was conducted in 37 children. Each operator obtained 3 sets of USCOM SV measurements within a period of 3 to 5 minutes, followed with TTE measurements from both apical and jugular views. The investigators were blinded to each other's results to prevent visual and auditory bias.

Results

Both USCOM and TTE methods were applicable in 89% of patients. The intraobserver variability of USCOM, TTE-J, and TTE-P were less than 10% in both investigators. The SV measurements by OP-As using USCOM, TTE-J, and TTE-P were 46.15 (25.48) mL, 39.45 (20.65) mL, and 33.42 (16.69) mL, respectively. The SV measurements by OP-Bs using USCOM, TTE-J, and TTE-P were 43.99 (25.24) mL, 38.91 (19.98) mL, and 37.58 (19.81) mL, respectively.

The percentage error in SV with USCOM relative to TTE-J was 36% in OP-As and 37% in OP-Bs. The percentage error in SV with TTE-P was 33% relative to TTE-J in OP-As and 21% in OP-Bs.

Conclusions

Our findings show that the methods are not interchangeable because SV values by USCOM are higher in comparison with the SV values obtained by TTE. Both methods have low level of intraobserver variability. The SV measurements obtained by TTE-P were significantly lower compared with the TTE-J for the operator with limited training in echocardiography. The TTE-P requires longer practice compared with the TTE-J; therefore, we recommend to prefer TTE-J to TTE-P for inexperienced operators.
Deep Learning–Based Motion Correction in Projection Domain for Coronary Computed Tomography Angiography: A Clinical Evaluation
Authors: Shuai Tao , Zhong Sihua , Zhang Guozhi , Wang Ziwei , Zhang Yu , Li Zhenlin
Published: July 2023

Objective

This study aimed to evaluate the clinical performance of a deep learning-based motion correction algorithm (MCA) in projection domain for coronary computed tomography angiography (CCTA).

Methods

A total of 192 patients who underwent CCTA examinations were included and divided into 2 groups based on the average heart rate (HR): group 1, 82 patients with HR of <75 beats per minute; group 2, 110 patients with HR of ≥75 beats per minute. The CCTA images were reconstructed with and without MCA. The subjective image quality was graded in terms of vessel visualization, sharpness, diagnostic confidence, and overall image quality using a 5-point scale, where cases with all scores of ≥3 were deemed interpretable. Objective image quality was measured through signal-to-noise ratio and contrast-to-noise ratio in regions relative to the vessels. The image quality scores for 2 reconstructions and effective dose between 2 groups were compared.

Results

The mean effective dose was similar between 2 groups. Neither group showed significant difference on objective image quality for 2 reconstructions. Images reconstructed with and without MCA were both found interpretable for group 1, whereas the subjective image quality was significantly improved by the MCA for all 4 metrics in group 2, with the interpretability increased from 80.91% to 99.09%. Compared with group 1, group 2 showed similar interpretability and diagnostic confidence, despite inferior overall image quality.

Conclusions

In CCTA examinations, the deep learning–based MCA is capable of improving the image quality and diagnostic confidence for patients with increased HR to a similar level as for those with low HR.
Minimum and Optimal CA19-9 Response After Two Months Induction Chemotherapy in Patients with Locally Advanced Pancreatic Cancer
Authors: Seelen Leonard W.F. , Doppenberg Deesje , Stoop Thomas F. , Nagelhout Anne , Brada Lilly J.H. , Bosscha Koop , Busch Olivier R. , Cirkel Geert A. , den Dulk Marcel , Daams Freek , van Dieren Susan , van Eijck Casper H.J. , Festen Sebastiaan , Groot Koerkamp Bas , Haj Mohammad Nadia , de Hingh Ignace H.J.T. , Lips Daan J. , Los Maartje , de Meijer Vincent E. , Patijn Gijs A. , Polée Marco B. , Stommel Martijn W.J. , Walma Marieke S. , de Wilde Roeland F. , Wilmink Johanna W. , Molenaar I. Quintus , van Santvoort Hjalmar C. , Besselink Marc G. ,   for the Dutch Pancreatic Cancer Group
Published: July 2023

Objective:

This nationwide multicenter study aimed to define clinically relevant thresholds of relative serum CA19-9 response after 2 months induction chemotherapy in patients with locally advanced pancreatic cancer (LAPC).

Summary Background Data:

CA19-9 is seen as leading biomarker for response evaluation in patients with LAPC, but early clinically useful cut-offs are lacking.

Methods:

All consecutive patients with LAPC after 4 cycles (m)FOLFIRINOX or 2 cycles gemcitabine-nab-paclitaxel induction chemotherapy (±radiotherapy) with CA19-9 ≥5 U/mL at baseline were analyzed (2015–2019). The association of CA19-9 response with median OS (mOS) was evaluated for different CA19-9 cut-off points. Minimum and optimal CA19-9 response were established via log-rank test. Predictors for OS were analyzed, using cox regression analysis.

Results:

Overall, 212 patients were included of whom 42 (19.8%) underwent resection. Minimum CA19-9 response demonstrating a clinically significant mOS difference (12.7 vs. 19.6 mo) was seen at ≥40% CA19-9 decrease. The optimal cut-off for CA19-9 response was ≥60% decrease (21.7 vs. 14.0 mo, P=0.021). Only for patients with elevated CA19-9 levels at baseline (n=184), CA19-9 decrease ≥60% (HR=0.59, 95%CI 0.36–0.98, P=0.042) was independently associated with prolonged OS, as were SBRT (HR=0.42, 95%CI 0.25–0.70; P=0.001), and resection (HR=0.25, 95%CI 0.14–0.46, P<0.001), and duration of chemotherapy (HR=0.75, 95%CI 0.69–0.82, P<0.001).

Conclusion:

CA19-9 decrease of ≥60% following induction chemotherapy as optimal response cut-off in patients with LAPC is an independent predictor for OS when CA19-9 is increased at baseline. Furthermore, ≥40% is the minimum cut-off demonstrating survival benefit. These cut-offs may be used when discussing treatment strategies during early response evaluation.