bluuebunny/crossref_metadata_2025 huggingface dataset:
A novel mechanism of ferroptosis inhibition‐enhanced atherosclerotic plaque stability: YAP1 suppresses vascular smooth muscle cell ferroptosis through GLS1
Authors: Chen Yanyu , Cui Yuting , Li Man , Xia Mengdie , Xiang Qiong , Mao Yu , Li Hengjuan , Chen Jialin , Zeng Wen , Zheng Xilong , Peng Juan , Dai Xiaoyan , Tang Zhihan
Published: August 2024

Atherosclerosis is a leading cause of cardiovascular diseases (CVDs), often resulting in major adverse cardiovascular events (MACEs), such as myocardial infarction and stroke due to the rupture or erosion of vulnerable plaques. Ferroptosis, an iron‐dependent form of cell death, has been implicated in the development of atherosclerosis. Despite its involvement in CVDs, the specific role of ferroptosis in atherosclerotic plaque stability remains unclear. In this study, we confirmed the presence of ferroptosis in unstable atherosclerotic plaques and demonstrated that the ferroptosis inhibitor ferrostatin‐1 (Fer‐1) stabilizes atherosclerotic plaques in apolipoprotein E knockout (Apoe−/−) mice. Using bioinformatic analysis combining RNA sequencing (RNA‐seq) with single‐cell RNA sequencing (scRNA‐seq), we identified Yes‐associated protein 1 (YAP1) as a potential key regulator of ferroptosis in vascular smooth muscle cells (VSMCs) of unstable plaques. In vitro, we found that YAP1 protects against oxidized low‐density lipoprotein (oxLDL)‐induced ferroptosis in VSMCs. Mechanistically, YAP1 exerts its anti‐ferroptosis effects by regulating the expression of glutaminase 1 (GLS1) to promote the synthesis of glutamate (Glu) and glutathione (GSH). These findings establish a novel mechanism where the inhibition of ferroptosis promotes the stabilization of atherosclerotic plaques through the YAP1/GLS1 axis, attenuating VSMC ferroptosis. Thus, targeting the YAP1/GLS1 axis to suppress VSMC ferroptosis may represent a novel strategy for preventing and treating unstable atherosclerotic plaques.
Assessment of Clinical Reasoning in Undergraduate Medical Education: A Pragmatic Approach to Programmatic Assessment
Authors: Guth Todd A. , Wolfe Rachel M. , Martinez Ofelia , Subhiyah Raja G. , Henderek Jerusha J. , McAllister Caroline , Roussel Danielle
Published: August 2024

Purpose

Clinical reasoning, a complex construct integral to the practice of medicine, has been challenging to define, teach, and assess. Programmatic assessment purports to overcome validity limitations of judgments made from individual assessments through proportionality and triangulation processes. This study explored a pragmatic approach to the programmatic assessment of clinical reasoning.

Method

The study analyzed data from 2 student cohorts from the University of Utah School of Medicine (UUSOM) (n = 113 in cohort 1 and 119 in cohort 2) and 1 cohort from the University of Colorado School of Medicine (CUSOM) using assessment data that spanned from 2017 to 2021 (n = 199). The study methods included the following: (1) asking faculty judges to categorize student clinical reasoning skills, (2) selecting institution-specific assessment data conceptually aligned with clinical reasoning, (3) calculating correlations between assessment data and faculty judgments, and (4) developing regression models between assessment data and faculty judgments.

Results

Faculty judgments of student clinical reasoning skills were converted to a continuous variable of clinical reasoning struggles, with mean (SD) ratings of 2.93 (0.27) for the 232 UUSOM students and 2.96 (0.17) for the 199 CUSOM students. A total of 67 and 32 discrete assessment variables were included from the UUSOM and CUSOM, respectively. Pearson r correlations were moderate to strong between many individual and composite assessment variables and faculty judgments. Regression models demonstrated an overall adjusted R
2 (standard error of the estimate) of 0.50 (0.19) for UUSOM cohort 1, 0.28 (0.15) for UUSOM cohort 2, and 0.30 (0.14) for CUSOM.

Conclusions

This study represents an early pragmatic exploration of regression analysis as a potential tool for operationalizing the proportionality and triangulation principles of programmatic assessment. The study found that programmatic assessment may be a useful framework for longitudinal assessment of complicated constructs, such as clinical reasoning.
Informed Inclusion Model: Medical Student Wheelchair User in an Obstetrics and Gynecology Clerkship
Authors: Brown-Young Diane , Papich Theresa A. , Jhaveri Stacie , Nielsen Craig , Pardee Marcy , Betchkal Rylee , Porter Eboni , Meeks Lisa M.
Published: August 2024

Students with physical disabilities are underrepresented in medicine, driven in part by ableist beliefs about the ability of individuals with disabilities to complete procedure-based or surgically oriented clerkships, including obstetrics and gynecology (Ob/Gyn). There is a growing commitment to disability inclusion by medical and specialty training associations. Yet published case studies and accommodation protocols for medical student wheelchair users navigating an Ob/Gyn clerkship are absent in the literature. This article describes successful disability inclusion for an Ob/Gyn clerkship, including accommodations for medical student wheelchair users. The authors share mechanisms to address and combat ableist assumptions and facilitate access for future medical students by working collaboratively with student and key stakeholders to develop an inclusive and accessible training experience.

These recommendations are shared through the story of a third-year medical student who rotated through the longitudinal clerkships at the Cleveland Clinic Lerner College of Medicine. The student, an individual with osteogenesis imperfecta who uses a power wheelchair with a seat elevator, completed third-year rotations and thrived in her clinical experiences. The authors describe her journey through a robust 4-week Ob/Gyn clerkship, in which she fulfilled the required clinical core conditions and observation skills with reasonable accommodation. Given the high acuity, surgery, and outpatient demands in Ob/Gyn—and the transferrable skills to other clerkships—the student’s experience is an excellent exemplar for demonstrating disability inclusion and reasonable accommodation.

Ob/Gyn clerkship directors and clinical faculty can broadly use the recommended timelines and communication protocols to create accessible training environments. With student input, minor scheduling adjustments, ongoing communication, reasonable accommodations, and an open mind, medical students on the clinical wards who are wheelchair users can successfully navigate the required expectations of medical training.
“We're Not Valued, We're Not Heard”
Authors: Tribby Kessa V. , Isaacson Mary J.
Published: August 2024

The COVID-19 crisis shone a spotlight on long-standing issues in the nursing profession. Currently, nurses feel overworked, unsupported, and undervalued. This interpretive phenomenological study shares the perspectives of 10 seasoned nurses. The overarching theme is “My job doesn't love me back,” supported by “Enough pizza already,” “Band-Aid on a hemorrhage,” “We were heroes and now no one remembers us,” “We used to be so trusted,” and “Nursing is psychological warfare.” It is imperative that systems and leaders listen to the concerns of nurses and provide avenues for nurses to take action to collaborate and convene organizational culture change.
Aesthetics in Nursing Practice as Experienced by Children During Hospitalization in Philippines
Authors: Kongsuwan Waraporn , Galvez Barbara , Betriana Feni
Published: August 2024

This study aimed to describe the meaning of aesthetics in nursing practice as experienced by children during hospitalization. A hermeneutic phenomenological approach was used. Fifteen children who met the inclusion criteria participated in the study conducted from June to August 2021. Data were collected by drawing and interviewing. Kongsuwan's approach was used to analyze the data. Six thematic categories that revealed aesthetics in nursing practice were identified, namely, Enjoyment; Kindness; Creating impressive care; Appreciation of safeness; Intention to know children; and Connecting to others. The study findings present useful knowledge to inform nurses regarding special approaches to implementing aesthetic nursing care for children.
Current Status of Translational Science in Nursing Across Four Countries
Authors: Tsai Hsiu-Min , Wang Hsiu-Hung , Sakashita Reiko , Oh Eui Geum , Chen Ching-Min , Im Eun-Ok
Published: August 2024

The raison d’être of nursing is caring for human beings. Mainly due to its close link to the nursing discipline’s raison d’être, “caring,” translational science is recently getting more attention from nursing scientists across the globe. This paper is to discuss the current status of translational science in nursing across four countries (the USA, Taiwan, South Korea, and Japan). The data used in this discussion paper included: (a) written notes on issues related translational research/science in individual countries; (b) written memos on exemplars/cases from their own experiences; and (c) summaries of literature reviews. The data analysis was conducted using a simple content analysis. Four themes reflecting the current status of translational science across the countries were identified: (a) “contextualized in unique culture and history of nursing”; (b) “connecting basic science to clinical practice”; (c) “an extension of evidence-based practice”; and (d) “highly promoted, but still minimal translation of nursing knowledge.”
Decreased Long-Term Survival of Patients With Newly Diagnosed Cancer Discharged Home After Unplanned ICU Admission: A Prospective Observational Study
Authors: Praça Ana Paula Agnolon , Nassar Junior Antônio Paulo , Ferreira Alexandre Miras , Caruso Pedro
Published: August 2024

IMPORTANCE AND OBJECTIVES:

To compare the 18-month survival between patients with newly diagnosed cancer discharged home after early unplanned ICU admission and those without early unplanned ICU admission; we also evaluated the frequency and risk factors for early unplanned ICU admission.

DESIGN:

Observational study with prospectively collected data from September 2019 to June 2021 and 18 months follow-up.

SETTING:

Single dedicated cancer center in São Paulo, Brazil.

PARTICIPANTS:

We screened consecutive adults with suspected cancer and included those with histologically proven cancer from among 20 highly prevalent cancers.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The exposure was early unplanned ICU admission, defined as admission for medical reasons or urgent surgery during the first 6 months after cancer diagnosis. The main outcome was 18-month survival after cancer diagnosis, and the main analysis was Cox’s proportional hazards model adjusted for confounders and immortal time bias. Propensity score matching was used in the sensitivity analysis. We screened 4738 consecutive adults with suspected cancer and included 3348 patients. Three hundred twelve (9.3%) had early unplanned ICU admission, which was associated with decreased 18-month survival both in the unadjusted (hazard ratio, 4.03; 95% CI, 2.89–5.62) and adjusted (hazard ratio, 1.84; 95% CI, 1.29–2.64) models. The sensitivity analysis confirmed the results because the groups were balanced after matching, and the 18-month survival of patients with early ICU admission was lower compared with patients without early ICU admission (87.0% vs. 93.9%; p = 0.01 log-rank test). Risk factors for early unplanned ICU admission were advanced age, comorbidities, worse performance status, socioeconomic deprivation, metastatic tumors, and hematologic malignancies.

CONCLUSIONS:

Patients with newly diagnosed cancer discharged home after early unplanned ICU admission have decreased 18-month survival compared with patients without early unplanned ICU admission.
OUTER RETINAL COLUMNAR ABNORMALITIES
Authors: Grimaldi Gabriela , Menghini Moreno , Mahroo Omar A. , Webster Andrew R. , Michaelides Michel , Peng Claudia Liang , Egan Catherine , Tufail Adnan
Published: August 2024

Purpose:

To report a novel optical coherence tomography sign in the context of CRB1-related maculopathy termed outer retinal columnar abnormalities (ORCA).

Methods:

Retrospective, multicenter, observational case series of 14 eyes of eight patients with molecularly confirmed CRB1-related maculopathy and ORCA. Multimodal imaging scans and medical records of patients with CRB1-related maculopathy were reviewed. Outcome measures included best-corrected visual acuity, central subfield thickness on spectral-domain optical coherence tomography, presence of ORCAs, and analysis of their change in appearance over time.

Results:

At baseline, mean age was 18±10 years (range 9–36 years). All patients had an isolated macular dystrophy except for 1 case harboring a triallelic pathogenic variant. Variant c.498_506del was found in 9 cases (88%). At presentation, ORCA were visible on macular spectral-domain optical coherence tomography in all cases as multiform, vertical, hyperreflective, columnar alterations extending from the ellipsoid to the outer plexiform layer, with a variable degree of hyporeflective cystic spaces in the outer and inner nuclear layers. Over 6±4.7 follow-up years, the presence of ORCA varied greatly with a decrease in ORCA associated with sequential development of retinal atrophy.

Conclusion:

A high suspicion for CRB1-associated retinal dystrophy should arise in the presence of ORCA on spectral-domain optical coherence tomography, prompting genetic testing.
RB1 CIRCULATING TUMOR DNA IN THE BLOOD OF PATIENTS WITH RETINOBLASTOMA INCREASES IN UNTREATED PATIENTS
Authors: Silverman Rebecca F. , Francis Jasmine H. , Robbins Melissa A. , Dunkel Ira J. , Abramson David H.
Published: August 2024

Purpose:

Circulating tumor DNA (ctDNA) in plasma has been identified in many cancers, including retinoblastoma at diagnosis. It has previously been shown that with treatment (enucleation or ophthalmic artery chemosurgery), all ctDNA disappears; if there is persistent plasma ctDNA after treatment, metastases develop. The purpose of this study was to determine how the ctDNA RB1 variant allele frequency changes in patients with retinoblastoma who have delayed treatment.

Methods:

Circulating tumor DNA RB1 was detected, and variant allele frequency was measured at diagnosis and again before any intervention at some time later ranging from 2 days to 28 days.

Results:

Four patients with five ctDNA RB1 mutations were detected at diagnosis, and variant allele frequency was increased on reevaluation of the same RB1 mutations in ctDNA.

Conclusion:

In this small cohort, every patient (4) and every RB1 mutation (5) plasma level VAF% increased when measured at two time periods before treatment was initiated suggesting that growing tumors demonstrate increasing plasma ctDNA.
PROGRESSION OF PERIPAPILLARY AND MACULAR CHORIORETINAL ATROPHY IN MULTIFOCAL CHOROIDITIS IS ASSOCIATED WITH PERIATROPHIC INFLAMMATORY PLUMES
Authors: Ossewaarde-van Norel Jeannette , Spaide Richard F.
Published: August 2024

Purpose:

To investigate peripapillary atrophy and macular chorioretinal scars in eyes affected by multifocal choroiditis and panuveitis.

Methods:

This retrospective cohort study reviewed the medical records, fundus photographs, and spectral-domain optical coherence tomographic scans of 31 eyes from 19 patients.

Results:

Patients had a mean age of 45 years (range 24–69 years). The average follow-up duration was 7 years (range, 2.5–14.5 years), with 14 patients undergoing immunosuppressive treatment. In the group of 31 eyes, 20 showed peripapillary plumes of ill-defined hyperreflectivity at the termination border of the retinal pigment epithelium. These plumes, extending from bare Bruch membrane to the outer nuclear layer, sometimes undermined the adjacent retinal pigment epithelium. They responded to corticosteroid treatment and resembled the material under the retinal pigment epithelium in acute lesions. Among 20 eyes with these peripapillary inflammatory lesions, 16 (80%) experienced increased atrophy, in contrast to none in the eyes without these lesions (P < 0.001). Similar patterns were observed at the edges of macular chorioretinal atrophy. This observation occurred in patients using immunosuppressive medication who were otherwise thought to be under adequate control.

Conclusion:

In patients with multifocal choroiditis and panuveitis, previously unrecognized plumes of smoldering inflammatory activity at the borders of chorioretinal atrophy appears to be linked to atrophy expansion. The recognition of this phenomenon may require a reappraisal of treatment of multifocal choroidopathies to help mitigate the expansion of atrophy in these eyes.
Secondary Multiple Evanescent White Dot Syndrome Following Blunt Trauma
Authors: Goldburg Samantha R. , Adeghate Jennifer , Barile Gaetano R. , Kaden Talia R.
Published: August 2024

Purpose:

To report a case of secondary unilateral MEWDS following blunt trauma to the eye.

Methods:

Observational case report of one patient.

Results:

A 25-year-old male initially presented after being hit in the left eye with a football, with visual acuity of 20/50, traumatic iritis, commotio retinae, vitreous hemorrhage, and a large pigment epithelial detachment in the superior macula. He was lost to follow-up for two years before presenting with a sudden decrease in vision. On exam, best corrected VA (BCVA) was counting fingers and clinical exam demonstrated fibrosis in the superior macula, small white lesions around the optic disc and throughout the posterior pole, and ellipsoid zone disruption on OCT. Given the clinical appearance, a diagnosis of Multiple Evanescent White Dot Syndrome was made and the decision was made to observe. Two months later, without treatment, BCVA improved to 20/20, and there was resolution of the white lesions in the posterior pole as well as improved continuity of the ellipsoid zone on OCT.

Discussion:

We describe a case of Multiple Evanescent White Dot Syndrome two years after blunt trauma to the eye; a far longer latency than previously reported cases of MEWDS secondary to blunt trauma.
Long-Term Outcome After Canaloplasty and Phacocanaloplasty in Primary Open Angle Glaucoma
Authors: Ennerst Christoph D. , Fischinger Isaak R. , Tetz Manfred R.
Published: August 2024

Précis:

Canaloplasty and phacocanaloplasty achieve a statistically significant intraocular pressure (IOP)-reduction for up to 11 years and decrease the long-term need for glaucoma medications. Both procedures have a low long-term complication rate.

Purpose:

To evaluate the long-term outcome of canaloplasty with and without cataract surgery in primary open angle glaucoma (POAG) patients.

Patients and Methods:

In all, 48 eyes of 34 patients with POAG who successfully received canaloplasty alone (group A, n=28) or with phacoemulsification (group B, n=20) were retrospectively analyzed. Demographic data, IOP, and IOP-lowering medication were recorded presurgery and postsurgery with a follow-up of up to 14 years.

Results:

The mean follow-up time in group A was 91.4±45.0 months. Mean IOP dropped from 22.0±3.8 mm Hg at baseline to 14.0±3.3, 14.3±3.1, 14.4±3.8, and 16.5±1.2 mm Hg at 1, 4, 7, and 10 years, respectively. IOP-lowering medication count decreased from 1.5±1.0 at baseline to 0.1±0.4, 0.3±0.6, 0.6±0.9, and 0.9±1.1 at 1, 4, 7, and 10 years, respectively. The mean follow-up time in group B was 109.1±25.7 months. Mean IOP dropped from 24.5±6.0 at baseline to 13.8±2.9, 14.9±3.6, 15.3±2.9, and 14.8±2.0 mm Hg at 1, 4, 7, and 10 years, respectively. IOP-lowering medication count decreased from 2.2±1.2 before surgery to 0.0, 0.1±0.3, 0.1±0.2, and 0.5±0.9 at 1, 4, 7, and 10 years, respectively.

Conclusion:

Canaloplasty and phacocanaloplasty achieved a comparable decrease in IOP and glaucoma medication count with a low complication rate. Both procedures showed a high long-term success rate.
Global burden and trends in pre- and post-menopausal gynecological cancer from 1990 to 2019, with projections to 2040: a cross-sectional study
Authors: Liang Yuanhao , Dai Xingzhu , Chen Jiaqing , Zeng Xueqing , Qing Xingrong , Huang Jing , Ren Liangliang , Zhang Xin , Zhang Weijian , Ruan Xiaohong
Published: August 2024

Background:

The global burden and trends in gynecological cancer (GC) by menopausal status worldwide remain unclear.

Methods:

Data on the number of incident cases and deaths, as well as age-standardized rates (ASR) and risk factors for GC in pre- and post-menopausal women were obtained from the Global Burden of Disease (GBD) Study 2019. The estimated annual percent change was calculated to quantify the temporal trend of GC burden by menopausal status between 1990 and 2019. The Bayesian age-period-cohort model was used to predict the trends in age-standardized incidence and mortality rates for pre- and post-menopausal GC during 2020–2040.

Results:

In 2019, an estimated 400 146 pre-menopausal and 879 476 post-menopausal GC cases were newly diagnosed worldwide, with ~111 420 and 442 821 GC-related deaths occurring in each menopausal group, respectively. The majority of both pre- and post-menopausal GC cases in low-to-middle-SDI regions was due to cervical cancer. In high- and high-middle-SDI regions, pre-menopausal GC was primarily attributed to cervical cancer, while post-menopausal GC was mainly attributed to uterine cancer. Additionally, the contribution of uterine cancer to GC was higher among post-menopausal women than pre-menopausal women, across all SDI levels and geographical regions. ASIRs either remained stable or increased from 1990 to 2019 worldwide for both pre- and post-menopausal GC [an average change of 0.03% (95% CI –0.02 to 0.08) and 0.09% (0.05–0.13) per year, respectively]. However, the age-standardized mortality rates (ASMRs) declined by an annual average of 0.86% (95% CI –0.92 to –0.8) and 0.63% (95% CI –0.66 to –0.6) globally during the same period. The risk-attributable proportion of post-menopausal GC deaths was higher than that of pre-menopausal GC and increased with increasing SDI. The projections indicate an increasing trend in the burden of pre-menopausal GC from 2020 to 2040, while the burden of post-menopausal GC is expected to decline.

Conclusions:

GC continues to be a significant public health concern worldwide, with notable regional and demographic disparities in the burden based on menopausal status. Policymakers and healthcare providers must be proactively aware of these evolving trends and tailor age-appropriate and region-specific screening strategies, as well as allocate resources accordingly.
Comparison of resection, ablation, and stereotactic body radiation therapy in treating solitary hepatocellular carcinoma ≤5 cm: a retrospective, multicenter, cohort study
Authors: Fu Yizhen , Yang Zhoutian , Liu Shiliang , Guan Renguo , Wang Xiaohui , Chen Jinbin , Wang Juncheng , Pan Yangxun , Liu Mengzhong , Chen Minshan , Xi Mian , Zhang Yaojun
Published: August 2024

Background:

Few studies have focused on the efficacy of stereotactic body radiation therapy (SBRT) in treating early hepatocellular carcinoma (HCC) for curative intention. This study aims to determine the best option among resection, ablation, and SBRT in dealing with single HCC no more than 5 cm.

Materials and methods:

This multicenter retrospective cohort study included 985 patients from 3 hospitals: 495, 335, and 155 in the resection, ablation, and SBRT groups, respectively, between January 2014 and December 2021. Subgroup analysis and propensity score matching (PSM) were performed.

Results:

The SBRT group had unfavorable clinical features including larger tumor size, poorer liver function, and more relapsed tumors. The 1-year, 3-year, and 5-year recurrence-free survival (RFS) rates were 84.3%, 66.8%, and 56.2% with resection, 73.3%, 49.8%, and 37.2% with ablation and 73.2%, 56.4%, and 53.6% with SBRT, respectively (P<0.001). The 3-year overall survival (OS) rates were 89.0%, 89.2%, and 88.8% in the resection, ablation, and SBRT group, respectively (P=0.590). The three modalities resulted in similar RFS and OS after adjusting for clinical factors. Resection provided ideal local tumor control, successively followed by SBRT and ablation. SBRT led to comparable RFS time compared to resection for tumors <3 cm (HR=0.75, P=0.205), relapsed tumors (HR=0.83, P=0.420), and patients with poor liver function (HR=0.70, P=0.330). In addition, SBRT was superior to ablation regarding RFS when tumors were adjacent to intrahepatic vessels (HR=0.64, P=0.031). SBRT were more minimally invasive, however, gastrointestinal disorders, hepatic inflammation, and myelosuppression occurred more frequently.

Conclusion:

All three approaches could be applied as curative options. Resection remains the best choice for preventing tumor recurrence, and SBRT showed advantages in treating small, recurrent and vascular-type lesions as well as patients with relatively poor liver function.
New-Onset Gaze Palsy in a Sports-Related Concussion
Authors: Howard Hilary , Mularoni P. Patrick
Published: August 2024

Concussions are a common injury in pediatric sports medicine clinics. Occasionally, a patient presenting for concussion will demonstrate abnormal neurologic findings, but in this case, a gaze palsy was witnessed during the initial 2 weeks following closed head injury with subsequent complete resolution of symptoms. There are limited available studies or case reports demonstrating this atypical presentation; thus, this case study aims to provide sports medicine physicians a reference for future similar atypical presentations.
Cannula-Associated Deep Vein Thrombosis Following Extracorporeal Membrane Oxygenation Decannulation: Incidence and Risk Factors
Authors: Trieu Ngan Hoang Kim , Pham Huy Minh , Mai Tuan Anh , Huynh Dai Quang , Tran Linh Thanh , Phan Xuan Thi , Pham Thao Thi Ngoc
Published: August 2024

Thrombotic complications during and after extracorporeal membrane oxygenation (ECMO) are commonly observed clinically. The incidences of cannula-associated deep vein thrombosis (CaDVT) post-ECMO support have predominantly focused on Caucasian demographics. This study aims to determine the incidence and risk factors for CaDVT in Vietnamese patients following ECMO decannulation. The retrospective study from January 2019 to February 2020 observed ECMO weaning patients and screened for CaDVT using Doppler ultrasonography. Data were collected on patient demographics, ECMO parameters, and transfusion and coagulation profiles during ECMO support. Of the 82 patients successfully weaned ECMO, 89% were assessed for CaDVT. We observed a CaDVT incidence of 24.7%, and only one patient (5.6%) had a pulmonary embolism in the CaDVT group. Noteworthy is that the anticoagulation goals, transfusion during ECMO, and hospital mortality showed no significant difference between the CaDVT and non-CaDVT groups. The findings showed that the duration of ECMO support is a risk factor for CaDVT. The incidence of CaDVT following ECMO decannulation was 24.7%, and the diagnosis of CaDVT can be underestimated. Therefore, we suggest routine screening for CaDVT after cannula removal.
Outcomes after acute kidney injury and critical illness
Authors: Jeong Rachel , Haines Ryan , Ostermann Marlies
Published: August 2024

Purpose of review

Acute kidney injury (AKI) in critical illness is common, and survivors are faced with a host of adverse outcomes. In this article, we review the current landscape of outcomes and care in survivors of AKI and critical illness.

Recent findings

Follow-up care of survivors of AKI and critical illness is prudent to monitor for and mitigate the risk of adverse outcomes. Observational data have suggested improvement in outcomes with nephrology-based follow-up care, and recent interventional studies demonstrate similar findings. However, current post-AKI care is suboptimal with various challenges, such as breakdowns in the transition of care during hospital episodes and into the community, barriers for patients in follow-up, and lack of identification of high-risk patients for nephrology-based follow-up. Tools predictive of renal nonrecovery and long-term outcomes may help to identify high-risk patients who may benefit the most from nephrology-based care post-AKI.

Follow-up care of survivors of AKI and critical illness may improve outcomes and there is a need to prioritize transitions of care into the community. Further research is needed to elucidate the best ways to risk-stratify and manage post-AKI survivors to improve outcomes.
The efficacy and safety of antiangiogenesis tyrosine kinase inhibitors in patients with advanced anaplastic thyroid cancer: A meta-analysis of prospective studies
Authors: Cao Ru-Bo , Ge Yao , Zhang Wen-Xuan , Lin Guo-He , Kuang Bo-Hua , Wang Bi-Cheng
Published: August 2024

Background:

The poor prognosis of anaplastic thyroid cancer (ATC) patients is associated with limited effective therapeutic strategies. Multiple antiangiogenesis tyrosine kinase inhibitors (TKIs) have been applied in later-line treatment of ATC; however, the results reported in clinical trials were controversial. In this study, we reconstructed the patient-level data to pooled-analyze the survival data, responses, and adverse events.

Methods:

Online databases (PubMed, Web of Science, Embase, and Cochrane CENTRAL) were searched on September 03, 2023. R software combined with the “metaSurvival” and “meta” packages were used to reconstruct the survival curves and summarize the response rates. The primary endpoints were progression-free survival (PFS) and overall survival (OS). The secondary endpoints were survival rate, objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events.

Results:

Six prospective clinical trials involving 140 ATC patients were enrolled. Four types of TKIs (imatinib, pazopanib, sorafenib, and lenvatinib) were included. When advanced ATC patients were treated with the TKIs, the median OS was 4.8 months and the median PFS was 2.6 months. The pooled ORR and DCR were 9% and 53%. Hypertension, decreased appetite, rash, and lymphopenia were the most common grade ≥ 3 treatment-related adverse events.

Conclusion:

Mono-anitangiogenesis TKI therapy showed limited improvements in treating advanced ATC patients. Combining antiangiogenesis TKI therapy with chemotherapy, radiotherapy, or immunotherapy could be the direction of future studies.
Interaction between microglial cells and CD1C+ B dendritic cells leads to CD8+ T cells depletion during the early stages of renal clear cell carcinoma
Authors: Lin Zixuan , Wang Liping , Niu Yaozong , Xie Zhaopeng , Zhao Xiaohan
Published: August 2024

Renal clear cell carcinoma (RCC) is a type of malignant tumor, which, in addition to surgical resection, radiotherapy, and chemotherapy, has been widely treated through immunotherapy recently. However, the influence of the tumor microenvironment and the infiltrating immune cells within it on immunotherapy remains unclear. It is imperative to study the interactions between various immune cells of RCC. The scRNA-seq dataset from GEO’s database was used to analyze the immune cells present in tumor tissue and peripheral blood samples. Through quality control, clustering, and identification, the types and proportions of infiltrating immune cells were determined. The cellular differences were determined, and gene expression levels of the differentially present cells were investigated. A protein-protein interaction network analysis was performed using string. KEGG and GO analyses were performed to investigate abnormal activities. The microglia marker CD68 and CD1C+ B dendritic cells marker CD11C were detected using multiplex immunofluorescence staining. Many depleted CD8+ T cells (exhausted CD8+ T cells) appeared in tumor tissues as well as microglia. CD1C+ B dendritic cells did not infiltrate tumor tissues. HSPA1A was correlated with DNAJB1 in microglia. Compared with Paracancer tissues, microglia increased while CD1C+ B dendritic cells decreased in pathological stages I and I-II in cancerous tissues. An altered tumor microenvironment caused by increases in microglia in RCC in the early stage resulted in an inability of CD1C+ B dendritic cells to infiltrate, resulting in CD8+ T cells being unable to receive the antigens presented by them, and in turn being depleted in large quantities.
Association between high-sensitivity C-reactive protein and renal function in Korean adults: A sex-specific analysis of Korea National Health and Nutrition Examination Survey 2015 to 2018 data
Authors: Choi Ji-Young , Yang Young-Mo
Published: August 2024

This study aimed to investigate the association between high-sensitivity C-reactive protein (hs-CRP) levels, as a surrogate marker of systemic inflammation, and renal function among Korean adults grouped by age, sex, and body mass index. This study analyzed data obtained from the Korea National Health and Nutrition Examination Survey 2015 to 2018, a cross-sectional and nationally representative survey conducted by the Korean Centers for Disease Control and Prevention. Of the 22,451 subjects included in this study, 19,607 (87.3%) and 2844 (12.7%) had normal kidney function and incident chronic kidney disease, respectively. Reduced renal function was more frequently observed in subjects with high hs-CRP levels than in those with low hs-CRP levels (odds ratio [OR], 1.438; 95% confidence interval [CI], 1.234–1.674). In the group aged ≥ 65 years, the odds of reduced renal function were higher among subjects with a high hs-CRP level compared to those with a low hs-CRP level (OR, 1.528; 95% CI, 1.191–1.960). The association between hs-CRP level and renal function was observed only in women (OR, 2.485; 95% CI, 1.779–3.470) and further stratified by age and sex, the odds of reduced renal function were likely higher in women aged ≥ 65 years with a high hs-CRP level (OR, 2.338; 95% CI, 1.622–3.369). Moreover, reduced renal function was more observed in subjects aged ≥ 65 years and those with a body mass index < 25 kg/m2 (OR, 1.502; 95% CI, 1.087–2.075). This study showed that a high hs-CRP level likely contributes to the increased prevalence of reduced renal function. This association may aid the identification of individuals at high risk for reduced renal function, especially elderly women, in clinical or public health practice.
Prevalence of human papilloma virus among cervical cancer patients in India: A systematic review and meta-analysis
Authors: Satapathy Prakasini , Khatib Mahalaqua Nazli , Neyazi Ahmad , Qanawezi Laila , Said Saida , Gaidhane Shilpa , Zahiruddin Quazi Syed , Rustagi Sarvesh , Al-Hajeili Marwan , Abdulkhaliq Altaf A. , Alsayyah Ahmed , Alrasheed Hayam A. , Al-Subaie Maha F. , Al Kaabi Nawal A. , Rabaan Ali A.
Published: August 2024

Background:

Cervical cancer, predominantly caused by the human papillomavirus (HPV), is a major health challenge in India, with high morbidity and mortality rates. Given India’s vast geographic and socio-economic diversity, understanding regional variations in HPV prevalence is crucial for developing targeted and effective public health interventions. This systematic review and meta-analysis were conducted to elucidate the prevalence of HPV among cervical cancer patients in India.

Methods:

A literature search was executed across PubMed, EMBASE, and Web of Science up to December 07, 2023. Observational studies reporting HPV prevalence among cervical cancer patients in India are included. A Modified Newcastle-Ottawa scale was used for quality assessment. A random-effects meta-analysis was used to determine pooled HPV prevalence, and heterogeneity was evaluated using the I² statistic. Subgroup and sensitivity analyses were performed to assess result stability and investigate heterogeneity sources. All statistical analyses were performed using R software version 4.3.

Results:

The meta-analysis included 17 studies with a total of 2529 cervical cancer cases, of which 1977 were HPV-positive. The pooled HPV prevalence was 85% (95% CI: 71–92%), with substantial heterogeneity (I² = 94%). Subgroup analysis by geographic zones showed notable differences: South (88%, 95% CI: 76–95%), North (73%, 95% CI: 1–100%), East (99%, 95% CI: 1–100%), Central (71%, 95% CI: 54–84%), and West (77%, 95% CI: 0–100%). Sensitivity analysis demonstrated the consistency of the results, and a reanalysis, excluding influential studies, yielded a prevalence of 82% (95% CI: 67–91%).

Conclusion:

Our analysis reveals a high prevalence of HPV in cervical cancer patients in India, with significant regional variations. The observed heterogeneity highlights the complexity of HPV epidemiology in India and necessitates further research to explore underlying causes and regional characteristics. Future studies should aim to expand geographic representation and deepen understanding of the factors contributing to the variability in HPV prevalence.
A novel mutation in the ATP7B gene causing hepatolenticular degeneration in a Chinese family: A case report
Authors: Zhou Zhibo , Zhang Sainan , Bi Yunjiao , Duan Wenyuan , Gao Hainv
Published: August 2024

Introduction:

Hepatolenticular degeneration (Wilson disease) is an autosomal recessive monogenic disorder caused by mutations in the ATPase copper transporting beta (ATP7B) gene located on human chromosome 13. This gene encodes a copper-transporting P-type ATPase (ATP7B). Recent studies have revealed that the ATP7B gene is predominantly affected by a few hotspot mutations, with the His1069Gln mutation in exon 14 accounting for 50 to 80% of cases. In China, the Arg778Leu mutation in exon 8 is the most prevalent. However, the discovery of novel mutant genes persists.

Case presentation:

A 56-year-old Chinese female was referred to our hospital with a liver injury and cirrhosis. Her parents, 2 younger brothers, and children exhibited no signs of liver function impairment. Whole-exome sequencing was conducted on the proband’s genomic DNA, and Sanger sequencing was performed on 6 family members for first-generation verification.

Conclusions:

We identified a novel c.3715G > T (p.Val1239Phe) variant mutation in the ATP7B gene in the patient. The ATP7B c.3715G > T (p.Val1239Phe) variant is predicted to impact the copper transport P-type ATPase. When combined with another mutant gene to form a compound heterozygous mutation, it can lead to hepatolenticular degeneration. This discovery broadens the range of pathogenic genes in the ATP7B gene.
Nomophobia, loneliness and depressive symptom levels of adults living in a district of Türkiye
Authors: Güveli Rifat , Balci Elçin , Bayraktar Muhammet
Published: August 2024

This study was conducted to evaluate whether smart cell phones detach people from social life, make them lonely, cause depressive symptoms and whether there is a relationship between them. This is a cross-sectional study using face-to-face survey method. The sample was determined as 376 participants, with 95% confidence interval, 50% probability depending on the probability of having a smartphone or not. Participants in the sample were determined by systematic random sampling from adults aged 20 and over in Çiftlik district of Niğde province. The NMP-Q, DASS-42 and UCLA-LS were used. The median age of the 376 participants (192 male, 184 female) was 30 and the mean age was 32.0 (±10.94) years. Participants that had social media accounts were 68.9% of the population. Over 70% of the participants had mild, moderate or severe nomophobia. Nomophobia status of the participants was affected by the mean duration of the first-time smartphone use (P = .017), the mean daily smartphone usage time of the participants (P < .001), the mean number of smartphone users in the participants’ families (P = .003), the mean depression and stress scores of the participants (P < .001), having social media account (P = .001), and declaration of smart phone dependency (P = .005). Nomophobia status was not affected by participants’ gender, mean age, educational level, employment status, economic status and marital status (P > .05). The duration of daily smartphone use, the duration of first-time smartphone use, and having multiple smartphone users in family increased nomophobia. Also, having active social media accounts and self-reported smartphone addiction found correlated to nomophobia. Smartphone addiction increases depression, anxiety, and stress scores of the participants.
National trends in musculoskeletal urgent care centers: Improved Medicaid access from 2019 to 2023
Authors: Dlott Chloe C. , O’Marr Jamieson M. , Jain Sanjana , Metcalfe Tanner , Kayani Jehanzeb , Bahel Anchal , Wiznia Daniel
Published: August 2024

Musculoskeletal urgent care centers (MUCCs) are an increasingly common alternative to emergency departments for patients with orthopedic injuries. As there is a lack of longitudinal data regarding MUCCs’ impact on the emergency health care system, our study seeks to understand recent trends in MUCC growth and their acceptance of Medicaid insurance. Over the last 6 years, at 2-year intervals (2019, 2021, and 2023), we performed a search to identify all MUCCs in the United States. We determined the affiliation and Medicaid acceptance status of all MUCCs, including those that closed/opened between 2019, 2021, and 2023, to analyze trends in MUCC availability and Medicaid acceptance. In 2019, there were 558 MUCCs, which increased to 596 MUCCs in 2021 and then decreased to 555 MUCCs in 2023, representing a growth and then decline of approximately 7%. Overall, since June 2019, 90 MUCCs have opened and 95 MUCCs have closed. Medicaid acceptance increased nationally between 2019 and 2023, from 58% to 71%. Medicaid acceptance increased for both nonaffiliated and privately affiliated MUCCs. Medicaid acceptance has increased nationally from 2019 to 2023, while MUCC availability has gone through a period of growth and then reversion to 2019 levels. As MUCCs have demonstrated limited Medicaid acceptance previously, it is promising that Medicaid acceptance has improved and MUCCs are providing patients with an additional avenue to access orthopedic care.
Influence of male body mass index on semen analysis parameters and in vitro fertilization outcomes
Authors: Nikolic Ana Z. , Dragojevic-Dikic Svetlana , Kocic Jovana , Babic Uros , Joksimovic Ana , Radakovic-Cosic Jovana , Gerginic Vladimir , Spasic Danijela , Dugalic Stefan , Petrovic Aleksandra , Mandic-Rajcevic Stefan , Perovic Milan
Published: August 2024

Concurrent global increase of prevalence of obesity and male fertility implies link between overweight and obesity with male subfertility. This hypothesis is supported by numerous population-based epidemiological studies. Increase in body mass index (BMI) is associated with poor sperm quality in fertile, and more noticeable in infertile men. Nevertheless, some studies disprove damaging effect of BMI on semen quality. To examine the influence of men’s BMI in infertile couples undergoing in vitro fertilization (IVF) on semen analysis parameters and IVF outcomes. Study encompassed all couples who underwent IVF at Gynecology and Obstetrics Clinic Narodni Front in Belgrade during 2018 and 2019. Exclusion criteria were azoospermia, conditions and diseases that could affect the semen analysis parameters (diabetes, malignant diseases treated with radiation and/or chemotherapy, trauma or surgery of the genital organs, mumps or undescended testicles in childhood). Evaluated semen analysis parameters included semen ejaculate volume, sperm pH, sperm count, sperm motility, and sperm morphology. IVF outcomes comprised total number of embryos, number and percentage of obtained good-quality embryos and clinical pregnancy rates. Based on BMI value, participants were divided into a group of underweight (Group 1), normally weight (Group 2), overweight (Group 3), and obese men (Group 4). After applying inclusion and exclusion criteria, 411 men (couples) were included in the analysis. The largest number of men were overweight, while the smallest belonged to the group of underweight participants. There are no significant differences in the semen analysis parameters between study groups. Correlation analysis shown weak and insignificant correlation between BMI and semen analysis parameters. The number and proportion of good quality embryos is significantly lower in overweight and obese study groups compared to normal weight and underweight groups (2.89, 2.91, 2.42, and 2.36, respectively, P = .041). The differences in other IVF outcomes: total number of embryos (3.61, 3.74, 3.21, and 3.37, respectively) and clinical pregnancy rates (41.26%, 43.09%, 42.78%, and 39.95%, respectively) between study groups were not significant (P > .05). BMI does not significantly affect semen analysis parameters, but a higher BMI is associated with a lower number and proportion of good quality embryos in IVF outcomes.
Generative artificial intelligence and the personalization of health professional education: A narrative review
Authors: Almansour Mohammed , Alfhaid Fahad Mohammad
Published: August 2024

This narrative review examined the intersection of generative artificial intelligence (GAI) and the personalization of health professional education (PHE). This review aims to the elucidate the current condition of GAI technologies and their particular uses in the field of PHE. Data were extracted and analyzed from studies focusing on the demographics and professional development preferences of healthcare workers, the competencies required for personalized precision medicine, and the current and potential applications of artificial intelligence (AI) in PHE. The review also addressed the ethical implications of AI implementation in this context. Findings indicated a gender-balanced healthcare workforce with a predisposition toward continuous professional development and digital tool utilization. A need for a comprehensive educational framework was identified to include a spectrum of skills crucial for precision medicine, emphasizing the importance of patient involvement and bioethics. AI was found to enhance educational experiences and research in PHE, with an increasing trend in AI applications, particularly in surgical education since 2018. Ethical challenges associated with AI integration in PHE were highlighted, with an emphasis on the need for ethical design and diverse development teams. Core concepts in AI research were established, with a spotlight on emerging areas such as data science and learning analytics. The application of AI in PHE was recognized for its current benefits and potential for future advancements, with a call for ethical vigilance. GAI holds significant promise for personalizing PHE, with an identified need for ethical frameworks and diverse developer teams to address bias and equity in educational AI applications.