bluuebunny/crossref_metadata_2025 huggingface dataset:
LAG‐3—An incompletely understood target in cancer therapy
Authors: Leitner Judith , Aigner‐Radakovics Katharina , Steinberger Peter
Published: November 2024

LAG‐3 is a member of the immunoglobulin superfamily expressed on activated T cells, but also on other immune cells. It has significant homology to CD4. Both molecules have four extracellular Ig‐like domains with similar structural motifs but the sequence identity between LAG‐3 and CD4 is low. Furthermore, unlike CD4 LAG‐3 restrains T cell responses and antibodies targeting this receptor are emerging drugs in cancer immunotherapy. A combination of LAG‐3 and PD‐1 antibodies has already been approved for the treatment of metastatic melanoma. Despite this success, its biology is still not well understood. Here we summarize the current knowledge on expression, ligands, and function of LAG‐3. We point to the differences between LAG‐3 and other inhibitory immune checkpoints and describe obstacles to study the role of this receptor in T cell activation processes. Finally, we discuss future directions for scientific efforts to come to a more complete understanding of the biology of this eminent immune checkpoint.
Recommendations for the Design and Implementation of Alcohol Pharmacotherapy Trials: Perspectives of Women With HIV Participating in the WHAT-IF Study
Authors: Fisk-Hoffman Rebecca J. , Ranger Sashaun , Gracy Abigail , Siuluta Nanyangwe , Parisi Christina E. , Payton Isaac , Cook Robert L. , Canidate Shantrel
Published: November 2024

Objectives

Naltrexone for alcohol reduction has been poorly studied in women with HIV (WWH), for whom heavy alcohol use is associated with negative HIV outcomes. This study offers recommendations for researchers conducting alcohol pharmacotherapy trials among PWH as suggested by WWH who participated in an alcohol pharmacotherapy trial in Florida.

Methods

The WHAT-IF? Study enrolled WWH with a history of heavy alcohol use in Miami, Florida, into a clinical trial where participants were randomized to receive naltrexone or placebo to assess effectiveness among WWH. Twenty participants (mean age, 49 years; 85% Black/African American) completed interviews that included questions about barriers to participation and recommendations for future researchers and WWH. Interviews were analyzed using a reflexive thematic approach.

Results

We identified six recommendations: 1) increasing opportunities for study engagement, 2) fostering positive relationships to support change, 3) addressing medication concerns, 4) considering structural barriers to participation, 5) improving alcohol-related education, and 6) preventing fraudulent participation. Positive relationships included both study staff and external support. Medication concerns included cost, accessibility, and adherence. Structural barriers included transportation, substance use, and mental health conditions. Better education included information on the risks of alcohol use and encouraging women to quit. Overall, women reported having positive experiences in the WHAT-IF? trial, and many recommended that the study continue.

Conclusion

Future alcohol pharmacotherapy studies could consider these recommendations when working with women from underserved communities, including WWH. Additionally, these recommendations could be applied to increase alcohol pharmacotherapy uptake and adherence in clinical practice.
The Associations of Kratom (Mitragynine), Opioids, Other Substances, and Sociodemographic Variables to Drug Intoxication–related Mortality
Authors: Suriaga Armiel A. , Tappen Ruth M. , McCurdy Christopher R. , Newman David , Grundmann Oliver , Kelly John F.
Published: November 2024

Introduction

The US age-adjusted drug overdose rate increased by 298%, with fentanyl being the main contributor to drug overdose deaths. The contribution of kratom to drug overdoses or intoxication is seldom reported despite its increasing use and detection among overdose decedents.

Methods

Our cross-sectional study utilized deidentified data from the Florida Department of Law Enforcement, 2020–2021 (N = 30,845). The medical examiners ascertained the exposures of interest (kratom, opioids, and other substances) and the outcome variable of drug intoxication–related mortality (DIRM) through autopsies and toxicology results. DIRM refers to any death from a substance identified as drug toxicity or intoxication. We used regression modeling to examine the association of exposure with DIRM.

Results

Five hundred fifty-one cases were confirmed kratom (mitragynine) exposures. More males died of DIRM (81.5%), primarily White (95.1%) and 35–44 years old (40.5%). Among mitragynine exposures, 484 (87.8%) died of DIRM; 36 decedents (6.5%) used kratom as the sole substance, and 515 (93%) used multiple substances; 437 (79.3%) used at least 1 opioid. The odds of dying of DIRM were 7.6 times higher among those mitragynine exposed compared with non–mitragynine exposed (univariate model) and 5.6 times higher after adjusting for confounders (multivariate model) (adjusted odds ratio = 5.6; 95% confidence interval, 4.1–7; P < 0.001). Opioid use increased the odds of dying of DIRM (adjusted odds ratio = 11.7; 95% confidence interval, 10.9–12.7; P < 0.001).

Conclusion

Our results indicate that dozens of decedents died of kratom (mitragynine) exposures alone, which has safety implications. Co-using opioids with kratom further increased the odds of dying of DIRM, indicating that kratom may not always work as a harm-reduction agent.
Analysis of YouTube Videos on Endotracheal Tube Aspiration Training in Terms of Content, Reliability, and Quality
Authors: Kalkan Ugurlu Yasemin , Durgun Hanife , Kucuk Alemdar Dilek
Published: November 2024

This descriptive study aims to investigate the content, quality, and reliability of YouTube videos containing content related to endotracheal tube aspiration. The study was scanned using the keywords “endotracheal aspiration” and “endotracheal tube aspiration,” and 22 videos were included in the study. The contents of the selected videos were measured using the Endotracheal Tube Aspiration Skill Form, their reliability was measured using the DISCERN Survey, and their quality was measured using the Global Quality Scale. Of the 22 videos that met the inclusion criteria, 18 (81.8%) were educational, and four (18.2%) were product promotional videos. When pairwise comparisons were made, the coverage score of open aspiration videos was higher for educational videos than for product promotion videos (P < .005). Useful videos had higher reliability and quality scores than misleading videos (P < .05). In addition, the reliability and quality scores of videos uploaded by official institutions were significantly higher than those of videos uploaded by individual users (P < .05). This study found that the majority of endotracheal tube aspiration training videos reviewed in the study were published by individual users, and a significant proportion of these videos had low levels of reliability and quality.
Perceptions and Attitudes of Registered Nurses and Nursing Students Toward Advanced Technology and Artificial Intelligence
Authors: Abdelaziz Omar , Lee Sohye , Howard Sheri , Lefler Leanne
Published: November 2024

The use of technology in healthcare and healthcare education settings has increased rapidly across the United States and accelerated due to the COVID-19 pandemic. However, perceptions of new technologies in clinical nursing and nursing education are not well understood. Yet, understanding perceptions of registered nurses and nursing students toward advanced technology and artificial intelligence in clinical care and education is crucial if we are to implement these care delivery and educational innovations. This literature review investigates existing literature on registered nurses' and nursing students' attitudes toward advanced technology and artificial intelligence in nursing, including nursing education. Ten peer-reviewed studies published between 2017 and 2022 were reviewed. Findings revealed positive perceptions, such as improved patient care, efficiency, and reduced human error, but also concerns about job displacement, loss of human touch, and ethical/legal issues. Challenges in implementation, adequate training in technologies, and how technologies may reduce the human connection aspect of nursing care were identified. By recognizing the attitudes and perceptions of registered nurses and nursing students toward these advanced technologies, we can better ensure that it is ethically, effectively, and responsibly integrated into nursing practice and education.
Chinese guidelines for the diagnosis and treatment of human immunodeficiency virus infection/acquired immunodeficiency syndrome (2024 edition)
Authors:   Acquired Immunodeficiency Syndrome Professional Group, Society of Infectious Diseases, Chinese Medical Association; Chinese Center for Disease Control and Prevention
Published: November 2024

The Acquired Immunodeficiency Syndrome Professional Group of the Society of Infectious Diseases of the Chinese Medical Association formulated the first edition of the Chinese Guidelines for the Diagnosis and Treatment of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (referred to as the Guidelines) in 2005. The 2024 edition of the Guidelines has been compiled by updating the 2021 fifth edition, incorporating the latest research advancements in antiviral therapy, comprehensive management, opportunistic infections, concurrent tumors, and the prevention and intervention of HIV infection. The new edition also introduces a new section on “Incomplete immune reconstitution”, proposes the concept of “HIV vulnerable populations” for the first time with recommendations for their diagnosis and treatment. This edition of the Guidelines covers 14 sections: epidemiology, pathogenic characteristics, laboratory tests, pathogenesis, clinical presentation and staging, diagnostic criteria, common opportunistic infections, antiretroviral therapy, immune reconstitution inflammatory syndrome, incomplete immune reconstitution, AIDS-related neoplasms, prevention of mother-to-child transmission and conception in serodiscordant couples, pre- and post-exposure prophylaxis, and whole-course management of HIV infection. This edition of the Guidelines aims to assist clinical physicians in making informed decisions in the diagnosis, treatment, and management of HIV/AIDS and will be periodically revised and updated based on domestic and international research progress.
Unearthing Culture to Support Health Promotion
Authors: Johanson Linda S. , Claypool Carol
Published: November 2024

This ethnographical qualitative study focused on health perceptions and practices of rural Guatemalan women. Researchers gathered data through interviews and observations in health, school, and village settings. Three themes emerged in data analysis: health practices are related to the situation of poverty; knowledge gaps exist related to healthcare; and natural remedies are a prevalent practice in rural communities. The findings can help structure sustainable health programs not only for rural Guatemalan communities but where poverty and/or lack of knowledge influence health, as well as point to the importance of nurses practicing cultural humility and providing collaborative care.
Densitometry Changes After Corneal Collagen Cross-Linking With Riboflavin and UVA Light in Patients With Keratoconus
Authors: Peskina Marina , Kaufman Dan Arreaza , O'Brien Connor , Miele Andrew , Lym Claire , Kruh Jonathan
Published: November 2024

Purpose:

The aim of this study was to determine if quantitative changes in corneal densitometry, pachymetry, and age at the time of corneal cross-linking (CXL) correlate with CXL effectiveness.

Methods:

Electronic medical records of 148 eyes of patients who had CXL done at Vision NYC between 10/2016 and 03/2021 were analyzed. Data collected from preprocedure visit, 6 weeks, 3 months, 6 months, 12 months, and 18 months of follow-ups. A change in maximal keratometry from preprocedure visit to 18 months after CXL was used as a measure of CXL effectiveness. Age, preprocedure pachymetry, change in densitometry, and pachymetry from preprocedure values at each visit were checked for correlation with CXL effectiveness.

Results:

Age of CXL did not correlate with CXL effectiveness. There was a statistically significant negative correlation between initial pachymetry and final change in keratometry. We found a moderate positive correlation of densitometry change in superficial central and paracentral zones at 6 months, 12 months, and 18 months with CXL effectiveness. Change in densitometry in central central zone at 3 and 6 months and posterior central and paracentral zones at 3 months also positively correlated with CXL effectiveness.

Conclusions:

Our study demonstrates the natural history of densitometry, pachymetry, and keratometry values in patients with keratoconus after CXL. We also demonstrated a correlation between change in densitometry and CXL effectiveness with stronger correlation in more central and superficial corneal zones. Our data suggest that CXL may lead to a greater flattening of the cornea in patients with more advanced keratoconus.
Advances in the mathematical modeling of posttreatment control of HIV-1
Authors: Vemparala Bharadwaj , Guedj Jérémie , Dixit Narendra M.
Published: November 2024

Purpose of review

Several new intervention strategies have shown significant improvements over antiretroviral therapy (ART) in eliciting lasting posttreatment control (PTC) of HIV-1. Advances in mathematical modelling have offered mechanistic insights into PTC and the workings of these interventions. We review these advances.

Recent findings

Broadly neutralizing antibody (bNAb)–based therapies have shown large increases over ART in the frequency and the duration of PTC elicited. Early viral dynamics models of PTC with ART have been advanced to elucidate the underlying mechanisms, including the role of CD8+ T cells. These models characterize PTC as an alternative set-point, with low viral load, and predict routes to achieving it. Large-scale omic datasets have offered new insights into viral and host factors associated with PTC. Correspondingly, new classes of models, including those using learning techniques, have helped exploit these datasets and deduce causal links underlying the associations. Models have also offered insights into therapies that either target the proviral reservoir, modulate immune responses, or both, assessing their translatability.

Advances in mathematical modeling have helped better characterize PTC, elucidated and quantified mechanisms with which interventions elicit it, and informed translational efforts.
Long-acting antiretroviral therapy in the context of viral suppression
Authors: Ring Kyle , Orkin Chloe
Published: November 2024

Purpose of review

Long-acting antiretroviral therapy (ART), such as with cabotegravir and rilpivirine, is a new and exciting paradigm shift that could change the face of HIV treatment if it were universally available to all who want it. In countries where there is access, uptake has been slow – partly because of capacity issues and partly because of hesitancy around remaining clinical questions. We summarized clinical trial data and emerging real-world evidence to shed light on these questions.

Recent findings

Phase 2b/3/3b clinical trials have shown CAB+RPV injections to be both well tolerated and efficacious. Real-world cohort (RWC) studies with larger numbers of people demonstrate high levels of adherence and persistence, and low rates of virological failure in clinical practice.

Although the risk of virological failure in the context of CAB+RPV is low, it remains a pertinent issue because of the high risk of developing two-class resistance. The use of multiple definitions of virological failure in RWC studies currently makes understanding the available evidence difficult and could have deleterious effects on clinical decision-making. Longer term real-world evidence in diverse populations is needed to better understand the durability of CAB+RPV and its suitability in different contexts.
Long-acting antiretroviral therapy in low-income and middle-income countries: considerations for roll-out
Authors: Tembo Angela , Venter Willem Daniel Francois , Sokhela Simiso
Published: November 2024

Purpose of review

Long-acting ART (LA-ART) in low-income and middle-income countries (LMICs) may address specific issues that affect people living with HIV (PWH) and people at substantial risk of HIV infection. We reviewed products in use and under consideration in LMICS, current and anticipated challenges for implementation, and offer strategies for effective rollout.

Recent findings

Factors to consider for effective implementation of LA-ART in LMICs are: managing co-conditions (pregnancy) and comorbidities (TB and hepatitis B); medication access, both cost and supply-related; and health systems delivery mechanisms for products.

LA-ART present promising new alternatives in LMICs. Although they may tackle certain adherence concerns and systemic issues, which impact delivery of services, significant obstacles remain before their widespread implementation in people that require them most, particularly in countries most affected by HIV. We offer best practices from prior experiences and implementation studies for effective coordination of multiple stakeholders, critical for effective rollout.
Trpv1-lineage neuron-expressing Kcnq4 channel modulates itch sensation in mice
Authors: Wang Qiong , Zhao Guodun , Ding Huijuan , Wang Zihan , Wu Jianwei , Huang Han , Cao Liang , Wang Hongli , Gao Zhaobing , Feng Jing
Published: November 2024

Voltage-gated potassium channel subfamily q member 4 (Kcnq4) is predominantly expressed by hair cells and auditory neurons and regulates the neuronal excitability in the auditory pathway. Although it is further detected in myelinated large-diameter dorsal root ganglia (DRG) neurons in the periphery, the expression and function of Kcnq4 channel in nociceptors remains unknown. Here we showed that Kcnq4 is substantially expressed by unmyelinated small-diameter DRG neurons in both human and mouse. In spite of a dispensable role in acute pain and chronic skin inflammation, Kcnq4 is specifically involved in the regulation of scratching behavior through controlling action potential firing properties, evidenced by the increased neuronal excitability in small-diameter DRG neurons isolated from Kcnq4 deficient mice. Moreover, genetic ablation of Kcnq4 in Trpv1-positive neurons exacerbates both acute and chronic itch behavior in mice. Taken together, our results uncover a functional role of Trpv1-lineage neuron-expressing Kcnq4 channel in the modulation of itch-specific neuronal excitation in the periphery.
Gait Speed, Mobility, Balance, and Dual-Tasking Deficits Among People Living With HIV Globally: A Systematic Review and Meta-Analysis
Authors: Amiro Kaylie , Bowser Miranda , Connell Madison , Desrosiers Remi , MacAlpine Evangeline , Shahzadi Anita , McArthur Caitlin , Quigley Adria
Published: November 2024

People living with HIV (PLWH) may experience premature physical deficits, including walking, mobility, and balance problems. The purpose was to measure deficits in walking, mobility, balance, and dual tasking in PLWH. The secondary objective was to make recommendations regarding the use of rehabilitation outcome measures. CINAHL, PubMed, and SPORTDiscus databases were searched. Two independent reviewers screened titles/abstracts and full-text articles, extracted data, and performed a quality assessment. Fifty-six articles with 14,053 PLWH and 8,454 uninfected controls were included. A meta-analysis revealed significantly worse performance among PLWH on the five times sit to stand mobility test versus controls (Cohen d = 0.68, 95% confidence interval [CI 0.08–1.29], p = .03). Meta-analyses revealed no differences between PLWH and controls for usual gait speed (Cohen d = −0.47, 95% CI [−1.10 to 0.15], p = .14) and fast gait speed (Cohen d = −0.39, 95% CI [−0.87 to 0.08], p = .10). Ten of 12 studies comparing PLWH with controls found differences in balance outcomes. PLWH have significantly worse mobility than uninfected controls.
Mediating Effects of Depressive Symptoms and Uncertainty on Physical Symptoms and Self-Care in Korean Older Men With Heart Failure
Authors: YU Sooyeon , LEE Hanyi
Published: November 2024

Background

Heart failure is prevalent among aging populations. Given the increasing median age in many countries, sustainably improving self-care behaviors in heart failure patients is crucial. Physical symptoms predict self-care in patients with heart failure, whereas psychological factors such as depressive symptoms and uncertainty negatively affect disease management efficacy.

Purpose

The mediating and indirect effects of depressive symptoms and disease uncertainty regarding the relationship between physical symptoms and self-care behaviors were examined in older South Korean men with heart failure.

Methods

A descriptive correlational survey design was used to collect data from 185 older men with heart failure. Data were obtained from medical records and self-reported questionnaires addressing physical symptoms, depressive symptoms severity (Patient Health Questionnaire-9), illness uncertainty (Mishel Uncertainty in Illness Scale-Community Form), and self-care behaviors (European Heart Failure Self-care Behavior Scale). The mediating effects of depressive symptoms and disease uncertainty were assessed using a bootstrapping method via PROCESS Model 4, a parallel mediation model, in SPSS.

Results

The mean age of the participants was 77.41 (SD = 5.35) years. Half (50.8%) had a diagnosis of New York Heart Association Class II heart failure, and 21.6% had a diagnosis of New York Heart Association Class III/IV heart failure. Self-care behaviors were found to correlate negatively with physical symptoms, depressive symptoms, and uncertainty. Depressive symptoms (B = −0.10, 95% confidence interval [CI] [−0.18, −0.01]) and uncertainty (B = −0.05, 95% CI [−0.09, −0.01]) were found to mediate the relationship between physical symptoms and self-care behaviors.

Conclusions/Implications for Practice

The findings reveal depressive symptoms and disease uncertainty significantly mediate the relationship between physical symptoms and self-care behaviors in older South Korean men with heart failure. In light of this, cardiovascular nurses should join in targeted educational initiatives tailored to address the unique needs of older men with heart failure that consider psychological factors such as depressive symptoms and uncertainty as well as physical symptom management.
Influence of the Nursing Work Environment on Job Satisfaction in Male Nurses: The Mediating Effect of Social Support
Authors: KIM DongHyun , OH Hyunjin
Published: November 2024

Background

Although the proportion of male nurses in the nursing profession has risen in recent years, their turnover rate remains higher than their female counterparts. Male nurses tend to report lower levels of job satisfaction. However, there has been a dearth of research examining the relation among perceptions of work environment, social support, and job satisfaction in male nurses.

Purpose

The aim of this study was to investigate the associations among work environment, social support, and job satisfaction in male nurses in Korea. In addition, the potential mediating effect of social support on the relationship between work environment and job satisfaction was explored.

Methods

A cross-sectional design was employed to investigate the research questions. The study was conducted in a metropolitan area in South Korea, and self-administered questionnaires were distributed to participants. Hierarchical multiple regression analysis was utilized to explore the potential associations among work environment, social support, and job satisfaction.

Results

Work environment was found to correlate positively with job satisfaction (r = .53, p < .001) and social support (r = .57, p < .001) in the participants, whereas a positive correlation was also found between social support and job satisfaction (r = .57, p < .001). Social support was shown to partly mediate the relationship between work environment and job satisfaction.

Conclusions

The findings of this study suggest that social support partially mediates the relationship between work environment and job satisfaction in male nurses as well as confirm the importance of both work environment and social support as factors that can positively influence job satisfaction in this group.
Balint Groups: A Novel Approach to Address Doctor of Physical Therapy Student Affective Domain Development
Authors: Clock Christopher , Arrigo Monica , McCarthy Jacobson Anne , Baldwin Jane , Boutin Emile R.
Published: November 2024

Recent calls for Doctor of Physical Therapy (DPT) education to cultivate the affective domain or “habits of the heart” have highlighted a gap in curricula, where cognitive and psychomotor learning domains are often the focus. Balint groups, traditionally used in medical education, offer a potential method for addressing this gap. These small peer discussion groups provide a space for students to reflect on the emotional and interpersonal complexities of providing patient care through practicing perspective-taking. The authors share information addressing implementation of Balint in DPT education and benefits experienced by students, including perceived improvements in empathy, emotional awareness, and therapeutic patient relationships. By developing these “habits of the hear,” future physical therapists will be better equipped to attend to the humanistic aspects of patient care.
Utilization of biomarkers for alcohol use in candidates for liver transplantation with alcohol-associated liver disease
Authors: Lynch Marie-Josée , Carrique Lauren , Hendershot Christian S. , Wozniak Hannah , Kulasingam Vathany , Le Foll Bernard , Don Caitlin , Abbey Susan , Sales Isabel , Lilly Les , Bhat Mamatha , Tsien Cynthia , Tan Adrienne , Koshy Dilip , Selzner Nazia
Published: November 2024

Although a set period of abstinence is no longer a requirement for transplant consideration in many liver transplantation programs, it is imperative to use valid monitoring tools to detect ongoing alcohol use in candidates for transplant. Urinary ethyl glucuronide (EtG) is an objective measure of alcohol use. This single-center retrospective study aims to describe the psychosocial characteristics of patients with alcohol-associated liver disease (ALD) who provided positive EtG tests in the pretransplant phase. Data were collected between May 1, 2018, and November 30, 2021, for all patients with ALD referred to our transplantation program (n = 497). Psychosocial characteristics and transplant outcomes were recorded for all patients. Patients with a positive EtG test were compared to patients who did not have a positive EtG test. A backward logistic regression analysis was performed to assess the factors associated with a positive EtG test. Of the 497 patients evaluated, 40 (8%) provided a positive EtG test, including at the initial clinic visit (n = 20), during medical evaluation (n = 14), and while on the waitlist (n = 6). Severe alcohol use disorder (p < 0.01), consuming <10 daily standard drinks (p = 0.011), and longer duration of daily alcohol use (p = 0.028) were significantly associated with a positive EtG test. Psychiatric comorbidity, and previous treatment for alcohol use disorder were not significantly associated with positive tests. A minority of patients with ALD provided a positive urine EtG in the pretransplant phase. Alongside clinical interviews, biomarker testing is an objective tool to identify ongoing alcohol use in patients with ALD.
How to prevent and how to treat dyspnea in critically ill patients undergoing invasive mechanical ventilation
Authors: Kemoun Gabriel , Demoule Alexandre , Decavèle Maxens
Published: November 2024

Purpose of review

To summarize current data regarding the prevalence, risk factors, consequences, assessment and treatment of dyspnea in critically ill patients receiving invasive mechanical ventilation.

Recent findings

In intubated patients, dyspnea is frequent, perceived as intense, and associated with unfavorable outcomes such as immediate and unbearable distress (e.g. fear of dying), prolonged weaning, and delayed severe psychological consequences ( i.e. posttraumatic stress disorders). In noncommunicative patients, dyspnea is named respiratory-related brain suffering (RRBS) and can be detected using dyspnea observations scales. Before initiating pharmacological treatments, nonpharmacological interventions may be tried as they are efficient to alleviate dyspnea.

As opposed to pain, dyspnea has often been overlooked in terms of detection and management, resulting in its significant underestimation in daily practice. When it is diagnosed, dyspnea can be relieved through straightforward interventions, such as adjusting ventilator settings. Assessing dyspnea in patients undergoing invasive mechanically ventilated may be challenging, especially in noncommunicative patients (RRBS). Implementing a systematic dyspnea assessment in routine, akin to pain, could serve as a first step to reduce RRBS and prevent potential severe psychological consequences. In addition to pharmacological treatments like opioids, a promising approach is to modulate both the sensory (air on the face, trigeminal nerve stimulation) and the affective (relaxing music, hypnosis, directed empathy) components of dyspnea.
How to protect the diaphragm and the lung with diaphragm neurostimulation
Authors: Pellegrini Mariangela , Parfait Mélodie , Dres Martin
Published: November 2024

Purpose of review

In the current review, we aim to highlight the evolving evidence on using diaphragm neurostimulation to develop lung and diaphragm protective mechanical ventilation.

Recent findings

Positive-pressure ventilation (PPV) causes stress and strain to the lungs which leads to ventilator-induced lung injury (VILI). In addition, PPV is frequently associated with sedatives that induce excessive diaphragm unloading which contributes to ventilator-induced diaphragmatic dysfunction (VIDD). The nonvolitional diaphragmatic contractions entrained by diaphragm neurostimulation generate negative pressure ventilation, which may be a beneficial alternative or complement to PPV. Although well established as a permanent treatment of central apnea syndromes, temporary diaphragm neurostimulation rapidly evolves to prevent and treat VILI and VIDD. Experimental and small clinical studies report comprehensive data showing that diaphragm neurostimulation has the potential to mitigate VIDD and to decrease the stress and strain applied to the lungs.

Scientific interest in temporary diaphragm neurostimulation has dramatically evolved in the last few years. Despite a solid physiological rationale and promising preliminary findings confirming a beneficial effect on the diaphragm and lungs, more studies and further technological advances will be needed to establish optimal standardized settings and lead to clinical implementation and improved outcomes.
Comparison of Carvedilol and Propranolol in Reducing the Portal Vein Pressure
Authors: Hu Window , Yao Shunyu , Qiao Min
Published: November 2024

Introduction and Objectives:

The portal vein pressure higher than 10 mm Hg in patients with hepatic cirrhosis is more likely to have serious complications and poor prognosis. Nonselective receptor blockers (NSBBs) can reduce the portal vein pressure; however, the efficacy and safety of different NSBBs in reducing portal vein pressure were unconsistent. A systematic review and meta-analysis was conducted to evaluate the efficacy and safety of carvedilol versus propranolol in reducing portal vein pressure in this study.

Materials and Methods:

We assessed Randomized controlled trials (RCTs) through PubMed, Web of science, Embase, and Cochrane library up to January 2024. Data from eligible studies were pooled in fixed-effect or random-effect meta-analysis models, using RevMan software. Two researchers screened articles, extracted data, and assessed the study quality independently according to the PRISMA guidelines. The primary outcomes were the reduction of hepatic venous pressure gradient (HVPG), the hemodynamic response rate, and the incidence of adverse events. Secondary outcomes were mean artery pressure (MAP) and heart rate (HR).

Results:

A total of 7 RCTs, including 351 patients, were included in our meta-analysis. The results indicated that the magnitude of reduction in HVPG was greater in carvedilol compared with propranolol (MD: 1.08; 95% CI: 0.61 to 1.54; I
2=0%, P<0.00001) in short-term follow-up. Carvedilol’s hemodynamic response rate was higher than that of propranolol (OR: 0.44; 95% CI: 0.27 to 0.72; I
2=0%, P = 0.001)

Conclusions:

Our meta-analysis indicated that compared with propranolol, carvedilol was better in lowering portal hypertensive and had higher response rate in patients with hepatic cirrhosis. There was no obvious difference in safety between the 2 medications.
Fecal Calprotectin as a Biomarker for Disease Activity in Microscopic Colitis
Authors: Sasson Alexa N. , Ananthakrishnan Ashwin N.
Published: November 2024

Background:

Microscopic colitis (MC) is an intestinal inflammatory disorder. An objective biomarker to assess ongoing disease activity has not been previously examined. We aimed to examine the utility of fecal calprotectin (FC) measurement in symptomatic individuals with microscopic colitis.

Methods:

This cohort study included patients with a confirmed diagnosis of MC who had a calprotectin level measured in the setting of ongoing symptoms. We examined the frequency of elevation of FC in the setting of symptomatic microscopic colitis. Univariate and multivariate logistic regression models examined the independent predictors of elevated FC levels.

Results:

Our study included a total of 166 subjects, yielding 234 independent instances of FC measurement during symptomatic MC. Of all 234 FC measurements, 68 (29.0%) levels were >150 mcg/g and 43 (18.4%) FC level>250 mcg/g. Those with elevated FC levels>150 mcg/g were older than those below this cutoff (54.7 vs. 61.5 y, P=0.011, respectively). A higher fraction of those with elevated FC (> 150 mcg/g) had nocturnal bowel movements (41.2 vs. 24.1%, P=0.009) and fecal incontinence (25.0 vs. 13.3%, P=0.029) compared with those with normal FC levels. This association was further evidenced on multivariate analysis. There was no difference in FC levels between those who were responsive or refractory to steroids (138 mcg/g vs. 249 mcg/g, P=0.45).

Conclusions:

Elevated calprotectin concentrations were noted in over a quarter of patients with symptomatic microscopic colitis and were associated with more severe symptoms. However, FC levels did not indicate the likelihood of treatment response.
Efficacy of acupuncture treatment for diarrhea-predominant irritable bowel syndrome with comorbid anxiety and depression: A meta-analysis and systematic review
Authors: Wang Zhen , Hou Yi , Sun Hongwei , Wang Zhengwen , Zhang Haiyan
Published: November 2024

Background:

Presently, a diverse range of Western medical interventions are accessible for the management of irritable bowel syndrome with diarrhea (IBS-D) concomitant with comorbid anxiety and depression. However, the concomitant adverse effects have also surfaced, exerting strain on healthcare resources and the socio-economic structure. In recent times, the benefits of acupuncture in the management of IBS-D with coexisting anxiety and depression have become progressively evident. Nevertheless, a paucity of evidence-based medicine exists to substantiate the utilization of acupuncture for the treatment of IBS-D with anxiety and depression. The objective of this study is to examine the effectiveness of acupuncture as an intervention for IBS-D with comorbid anxiety and depression.

Methods:

We searched 7 databases, including the Chinese Journal Full-text Database, Wanfang Academic Journals Full-text Database, VIP Chinese Scientific Journals Full-text Database, China Biomedical Literature Database, PubMed, Embase, and Cochrane Library, for randomized controlled trials (RCTs) related to acupuncture treatment for IBS with anxiety and depression, published from database inception to August 1, 2023. RevMan 5.4 and Stata 17.0 software were used for meta-analysis of relevant outcome measures.

Results:

This study included a total of 16 RCTs, involving 1305 IBS-D patients (691 in the experimental group and 614 in the control group). The meta-analysis results showed that compared to oral medication, acupuncture therapy improved HAMD scores (MD = 0.88, 95% CI = [0.68, 1.07], P < .00001), HAMA scores (MD = 2.32, 95% CI = [1.70, 2.93], P < .00001), self-rating anxiety scale scores (MD = 11.67, 95% CI = [10.85, 12.49], P < .00001), SDS scores (MD = 9.84, 95% CI = [8.52, 11.16], P < .00001), IBS-SSS scores (MD = 37.48, 95% CI = [12.17, 62.78], P = .004), overall response rate (MD = 1.27, 95% CI = [1.20, 1.35], P < .00001), and relapse rate (MD = 0.27, 95% CI = [0.16, 0.47], P < .00001) in patients with IBS-D comorbid with anxiety and depression.

Conclusion:

Acupuncture treatment has a definite and beneficial effect on IBS-D patients with comorbid anxiety and depression.
Mendelian randomization analysis to explore the relationship between cathepsins and malignant ovarian tumors
Authors: Ying Jiaqi , Chen Xia , Lv Tian , Jie Fang , Tian Huanyong
Published: November 2024

Cysteine cathepsins are a family of lysosomal proteases that are often overexpressed in several human malignancies and haves been linked to cellular genomic alterations, disturbances in genomic stability, and the onset and spread of cancer. Recent studies have shown alterations in cysteine cathepsins in malignant ovarian tumors. However, it remains unclear whether there is a causal relationship between ovarian cancer, and its subtypes, and the cathepsin family. This study utilized two-sample Mendelian randomization (MR) analysis to examine this potential causal relationship. Genetic instruments derived from publicly available genetic summary data were used for the analyses. For MR analysis, the inverse-variance weighted method, weighted median method, and MR-Egger regression were employed. Multivariate MR analysis was performed concurrently. Univariate MR analysis indicated a strong correlation between decreased incidence of low-grade serous ovarian cancer and elevated levels of cathepsin L2 (odds ratio = 0.803, 95% confidence interval = 0.685–0.942, P = .007), whereas clear cell ovarian cancer showed a strong correlation with elevated levels of cathepsin H (odds ratio = 1.149, 95% confidence interval = 1.036–1.274, P = .008). Multivariate analysis, adjusted for 9 different cathepsins as covariates, confirmed the genetic relationships between cathepsin L2 and low-grade serous ovarian cancer and between cathepsin H and clear cell ovarian cancer. Our results suggest a causal relationship between cathepsins and ovarian malignancy and its subtypes. Cathepsin L2 has a protective effect on low-grade serous ovarian cancer, whereas cathepsin H is an adverse risk factor for clear cell ovarian cancer.
Central retinal artery occlusion following surgery for thyroid eye disease: A case report
Authors: Dai Baozhu , Gu Kaiming , Tan Feng , Zhu Suhui , Dai Yan
Published: November 2024

Rationale:

Thyroid eye disease (TED) is the most common orbital disorder in adults and significantly affects patient health. Orbital decompression surgery is an important treatment option. Central retinal artery occlusion (CRAO) after orbital medial wall decompression is rare in patients with TED. Therefore, the earlier the identification and treatment, the more likely it is to reduce visual impairment.

Patient concerns:

This paper examines a case of CRAO occurring postoperatively in a patient who underwent medial wall orbital decompression for TED.

Diagnoses:

Central retinal artery occlusion.

Interventions:

During the operation, the pupil was dilated, and eye massage and peribulbal injection of atropine were performed immediately. Fundus fluorescein angiography suggested the possibility of CRAO. Intravenous methylprednisolone 1000 mg, mannitol 50 g, ginkgo biloba extract 20 mL, nimodipine 20 mg tid, cobamamide 0.5 mg tid, and oral citicoline 0.2 g tid, along with periocular injection of atropine and hyperbaric oxygen therapy were also administered.

Outcomes:

Fifteen days after onset, the patient’s retinal edema and retinal blood perfusion greatly improved. The patient’s visual acuity recovered from counting fingers to 0.6.

Lessons:

Retinal vascular obstruction is a serious threat to vision; therefore, early detection and treatment are very important.
Neoadjuvant chemo-radiotherapy combined with immune checkpoint inhibitors: A case report of rectal small-cell undifferentiated carcinoma achieved pathological complete response
Authors: Zhou Chaoxi , Xiao Linlin , Qu Fuyin , Liu Ming , Gao Chao , Wang Yi , Xiao Yuting , Gao Yuanhang , Wu Fengpeng , Wang Xuan
Published: November 2024

Rationale:

Small-cell undifferentiated carcinoma (SmCC), as an aggressive malignancy, are most commonly arising in lung. Extrapulmonary SmCC is rare. It was reported that SmCC accounts for only 0.1% to 0.2% of colorectal cancers. Currently, no standard treatment regimen is recommended. Here, we presented a case of SmCC from rectum. The patient achieved pathological complete response (pCR) after surgery, which makes us feel gratified, and we are also eager to share this successful case with more peers to provide more references for clinical decision-making.

Patient concerns:

A 32-year-old male patient presented himself to our outpatient clinic with defecation difficulty for more than 1 month in November 2021.

Diagnoses:

Colonoscopy revealed a rectal mass 4 cm from the anal margin. Pelvic magnetic resonance imaging revealed a mass in the rectal wall, consistent with the appearance of rectal carcinoma. Cancer cell was found after several biopsies and the immunohistochemistry indicated rectal SmCC.

Interventions:

Considering that the patient is very young and the malignancy of SmCC is very high, our treatment plan is also very cautious. Many literatures were also searched, but the literature on rectal SmCC is few and the prognosis is poor. Subsequently, we combined the treatment principles of rectal cancer and small cell lung cancer to develop an individualized treatment plan for patients. The patient received neoadjuvant chemoradiotherapy (nCRT) (short-course radiotherapy: 25 Gy/5 fractions, chemotherapy: etoposide + nedaplatin) combined with immune checkpoint inhibitors (ICIs) (tislelizumab). Then, the patient received laparoscopic radical transabdominal resection of rectal carcinoma with a temporary stoma on June 27, 2022.

Outcomes:

Postoperative pathology showed that there was chronic inflammation in the rectal mucosa without residual cancer, which meant that the patient achieved pCR after nCRT combined with ICIs. On August 15, 2024, the patient returned to our hospital for review, and no signs of recurrence and metastasis were found. By the time this article is submitted, the patient has survived for more than 35 months.

Lessons:

This is the first to be reported in a rectal SmCC patient who achieved pCR after nCRT combined with ICIs, which may provide supporting data for using this treatment option for rectal SmCC.
Research focus and emerging trends of cancer-related fatigue in nursing arena: A bibliometric analysis from 2012 to 2021
Authors: Zheng Rong , Chen Xi , Xu Xiuzhi , Song Yongxia , Ju Xiaodi , Wang Wenru , Hong Jingfang
Published: November 2024

Background:

To explore distributed characteristics and identify research focus and emerging trends related to cancer-related fatigue (CRF) in the nursing field.

Methods:

Data were collected from the Web of Science Core Collection database between January 2012 and December 2021 using an advanced search strategy. Data were extracted and analyzed using CiteSpace and Microsoft Excel.

Results:

A total of 967 articles were included in this study. The number of published nursing studies on CRF has increased with slight fluctuations. Keyword co-occurrence analysis and timeline view indicated that CRF is closely related to quality of life, and there is a correlation between CRF and other symptoms. Moreover, increasing attention has been paid to CRF nursing interventions. The assessment tools and their different language versions, risk factors and reviews of CRF were the research frontiers in recent years with citation bursts.

Conclusions:

In the field of nursing, the focus of CRF research is still on risk factors, adverse outcomes and nursing management. Assessment tools will continue to be developed and additional risk factors will be studied in the future.
Diagnostic utility of Cyttel-Tech in identifying meningeal metastases from malignant solid tumors: An observational study
Authors: Gao Yangjun , Fan Wenxuan , Liu Xiaojing , Ma Ning , Yang Bo , Yang Wei , Zhao Jun
Published: November 2024

To investigate the value of circulating tumor cell (CTC) in cerebrospinal fluid (CSF) by Cyttel-Tech detection in patients with suspected leptomeningeal metastasis (LM) from malignant solid tumors. We collected CSF from 12 patients with suspected LM from malignant solid tumors at our hospital. Twelve milliliters (mL) of CSF were collected from each patient through the first lumbar puncture: 5 mL was for CTC detection by Cyttel-Tech method, 5 mL for CSF cytopathology examination, and 2 mL for cytology and biochemical analysis of the CSF. Additionally, all patients underwent cranial brain magnetic resonance imaging with both plain and contrast-enhanced scans. Among the 12 patients with suspected LM, CTC detection yielded a positivity rate of 11/12 (91.7%). The positivity rate for CSF cytopathology examination was 4/12 (33.3%). However, none of the patients showed positive findings on cranial brain magnetic resonance imaging with both plain and contrast-enhanced scans (0/12, 0%). The difference between CTC detection and cytopathology detection was statistically significant (P < .05). CTC detection may have a high positivity rate in diagnosing LM from malignant solid tumors. It potentially serves as a supplementary diagnostic method for patients with negative pathology results and be used for rapid and accurate adjunctive diagnosis of LM.
New ultrasound-guided L5 selective nerve root block puncture approach for the treatment of pain due to high-iliac-crest lumbar disc herniation: A case report
Authors: Gao Weiwei , Zeng Jie , Wang Min , Tang Li , Yang Hao , Wang Yanan , Li Wei
Published: November 2024

Rationale:

Lumbar 5 (L5) selective nerve root block is a common treatment for lumbar 4/5 disc herniation. It is difficult to perform real-time ultrasound-guided targeted L5 nerve root block because of the deep structure of the L5/S1 intervertebral foramen and the occlusion of the sacrum and ilium. Therefore, the safe and efficient implementation of L5 nerve root block is very important for improving the clinical promotion and use of this procedure.

Patient concerns:

A 43-year-old male, who presented with a 1-month history of lumbosacral and left lower limb pain.

Diagnoses:

The characteristic manifestation of pain symptoms was continuous and distending-like pain, accompanied by numbness on the posterior side of the left lower limb. The pain could be exacerbated by prolonged standing, sedentary behavior, and turning over while being relieved by lying down to rest. The visual analog score was 7 triggered by innocuous stimuli, configuring a clinical picture of typical protrusion of the lumbar intervertebral disc. Physical examination: muscle tenderness, straight leg-raising test of the left lower limb was 60° (+), test of supinating and throwing out one’s belly (+), and Achilles tendon reflex (‐).

Interventions:

The patient underwent an ultrasound-guided L5 nerve root block with a modified puncture approach technique called the “transverse process-zygapophysis separation method.”

Outcomes:

The patient had a successful nerve blockade characterized by significant reduction in pain after the operation.

Lesson:

The innovative puncture approach method may be considered a therapeutic option in patients with chronic pain.