bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the Effect of the White Noise and Sound Reduction on Behavioral Responses of Premature Infants Under Noninvasive Ventilation
Authors: Mohseni Hasti , Ramezani Monir , Saki Azadeh , Poor-Alizadeh Nasim
Published: January 2025

Background:

With the increasing survival rates of premature infants and their associated respiratory problems, noninvasive ventilation has gained popularity in neonatal intensive care units. On the other hand, this equipment can be stressful for infants. Objective: This study aimed to compare the effects of white noise and sound reduction on the behavioral responses of premature infants under noninvasive ventilation. Methods: This study was a randomized controlled crossover trial. Forty-two infants who met the inclusion criteria received white noise and noise reduction in a randomized sequence with a 30-minute washout period between conditions. During the noise reduction condition, infants were placed in the fetal position with earplugs. During the white noise condition, nature sounds from the White Noise Baby Sleep app were played into the incubator. Infant behavioral responses were recorded using the Anderson Behavioral State Scale on 3 consecutive days before, during, and after the intervention. Results: The independent t test showed no statistically significant difference between the 2 groups at baseline. The repeated measures analysis of variance test showed that the mean behavioral response scores of preterm infants in the sound reduction group and the white noise group differed significantly across the 3 stages on all 3 days. However, the results of mixed-effects model indicated that the sound reduction group experienced a significant decrease in behavioral response compared to the white noise group. Conclusion: Therefore, the present study suggests that sound reduction is a more effective nonpharmacological method for improving behavioral responses and reducing restlessness of premature infants under noninvasive ventilation.
GPX8 as a potential prognostic marker in gastric and colorectal cancer
Authors: Zou Ya-Wen , Cheng Yun , Liu Zhi-Lin , Wang Hai-Tao
Published: January 2025

Gastric and colorectal cancers are common malignancies with high incidence and mortality worldwide. Early detection and individualized treatment are crucial to improving patient outcomes. Glutathione peroxidase-8 (GPX8), a member of the glutathione peroxidase family, emerges as a potential target for intervention in the treatment of various cancers. This study investigated the potential of GPX8 as a prognostic marker in patients with gastric and colorectal adenocarcinoma. The study employed a multi-omics approach to analyze GPX8 expression in both tumor and adjacent normal tissue of stomach adenocarcinoma (STAD), colon adenocarcinoma (COAD) and rectum adenocarcinoma patients. The Cancer Genome Atlas database was used to download the microarray data of GPX8 and clinical information for cancer patients. The TIMER database and TNMplot database were used to systematically evaluate the association of GPX8 with tumor-infiltrating lymphocytes in adenocarcinoma. Immunohistochemistry is used to detect GPX8 expression in clinical tumors and adjacent normal tissues. Univariate Cox analysis was performed to explore the relationship between GPX8 expression, immune cell levels, and the prognosis in cancer patients. GPX8 was significantly upregulated in tumor tissue and was associated with a poor prognosis in STAD and COAD patients. Furthermore, high GPX8 expression was found to be correlated with a higher degree of CD4+ T cell-infiltrating in COAD and neutrophil-infiltrating in STAD, indicating that GPX8 may play a role in immune evasion in cancer progression. This study highlights the potential of GPX8 as a prognostic marker in STAD and COAD, providing valuable insight into the development of personalized treatment strategies for cancer patients.
Postural crisis in patients undergoing canalith repositioning procedures for posterior canal benign paroxysmal positional vertigo: A systematic review and meta-analysis
Authors: Kim Yee-Hyuk , Park Hee-Jun , Yoo Jae-Ho
Published: January 2025

Background:

The Epley or Semont maneuver is performed for posterior canal benign paroxysmal positional vertigo (PC-BPPV). The postural crisis indicates the phenomenon that the patient experiences severe dizziness, is unable to maintain the sitting posture, and suddenly falls backward or sideways on the examination table when returning to the sitting position, which is the final step of the canalith repositioning procedure (CRP). The postural crisis increases the risk of falls during CRP. This meta-analysis aimed to determine the incidence of postural crisis among patients who underwent CRP for PC-BPPV.

Methods:

Literature searches were conducted on PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar. The random-effects model was utilized based on the results of the heterogeneity using the Tau2 test and I2 statistic.

Results:

We included 5 nonrandomized studies that reported the total number of cases of CRP for PC-BPPV and postural crisis. In each study, postural crisis occurred in 4.0% to 14.9% of the subjects. Of a total of 1177 cases, the incidence of postural crisis in all CRP cases was 10% (95% confidence interval = 6%–15%).

Conclusion:

BPPV is the most common among peripheral vestibular diseases, usually occurring in the posterior semicircular canal. Therefore, 10% of cases with CRP for PC-BPPV is significant. When performing CRP for PC-BPPV, considering that the postural crisis related to increasing the risk of falls may occur, preparations for the phenomenon should be made in advance.
Different treatment for humeral shaft fractures: A network meta-analysis
Authors: Guo Jiankuo , Ma Hua
Published: January 2025

Background:

The main treatment methods for humeral shaft fractures include minimally invasive plate osteosynthesis (MIPO), intramedullary nailing (IMN), open reduction and internal fixation (ORF), and non-operative treatment (NonOP). However, the optimal treatment plan remains unclear. This article utilizes a network meta-analysis to compare the therapeutic effects of MIPO, IMN, ORF, and NonOP for the treatment of humeral shaft fractures.

Methods:

We searched electronic databases, including the PubMed, Embase, The Cochrane Library, and the Web of Science Databases, from inception to June 1, 2024. The “Risk of Bias Assessment” tool recommended by the Cochrane Collaboration was used to evaluate the quality of the included literature. RevMan 5.4 software and R software with gemtc package was used for the graphical representation and data analysis of the network meta-analysis.

Results:

A total of 23 randomized controlled trials were finally included. The results indicated that the efficacy of disabilities of the arm, shoulder and hand score was significantly higher in the MIPO group than in the open reduction and internal fixation (ORIF) group (weighted mean difference = 4.7, 95% confidence intervals, 1.8–7.75). IMN was associated with a decrease of the constant-Murley scores score than NonOP (weighted mean difference = ‐4.4, 95% confidence intervals, ‐8.7 to ‐0.068). IMN, MIPO, and ORIF was associated with a decrease of the fracture healing time than NonOP. The difference for nonunion rate and iatrogenic radial nerve injuries between any 2 groups was not statistically significant (P > .05).

Conclusion:

The evidence from current meta-analysis indicated that ORIF provides the best recovery effects for upper limb and shoulder joint function after the treatment of humeral shaft fractures, with the drawback of a relatively higher incidence of complications. To ensure the reliability of this study’s results, more high-quality randomized controlled trials are needed in the future to verify these findings.
Monocyte count as an independent predictor of high thrombus burden in ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis
Authors: ul Hussain Hassan , Ashok Kumar Kanwal , Zahid Marium , Husban Burney Muhammad , Asif Muqaddus , Tayyaba Rehan Syeda , Abbasher Hussien Mohamed Ahmed Khabab , Ullah Irfan
Published: January 2025

Background:

Due to the lack of a prior comprehensive review and meta-analysis, the relationship between monocyte count and thrombus load in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) has not been adequately established.

Methods:

This was a systematic review and meta-analysis of multiple cohorts (retrospective and prospective) and cross-sectional studies.

We queried electronic databases (PubMed, Google Scholar, and Cochrane Central) from their inception to April 2022. The included studies had patients who had undergone PCI treatment and were classified using thrombolysis in myocardial infarction thrombus grading. Dichotomous outcomes from the studies were presented as odds ratios with 95% confidence intervals while means ± standard deviation were presented for continuous outcomes. Means ± standard deviation of monocyte levels and odds ratios were pooled using an inverse variance-weighted random-effects model. I² statistics are used to evaluate heterogeneity across studies and subgrouping was performed to reduce the heterogeneity.

Results:

Five eligible studies, consisting of 1426 patients were included, out of which 776 had a high thrombus burden. Pooled results after subgroup analysis showed a significant relationship between raised monocyte count and high thrombus burden (odds ratios = 1.44; 95% confidence interval = 1.06–1.96; P = .02; I2 = 71%). Post-subgroup pooled analysis revealed a statistically significant correlation between high thrombus burden and raised monocyte count.

Conclusion:

STEMI patients with a high thrombus burden show an increased monocyte count. A high monocyte count upon admission is a major indication of increased intracoronary thrombus burden in STEMI patients with PCI procedures.
Effects of physical activity on patients with posttraumatic stress disorder: A systematic review and meta-analysis of randomized controlled trials
Authors: Yuan Zhichao , Peng Chenggen , Yang Linlin , Chen Houjin
Published: January 2025

Background:

Although it is often known that physical activity can effectively reduce anxiety and despair, differing results have been found for patients with posttraumatic stress disorder (PTSD) symptoms. This study sought to comprehensively examine how physical activity affected the quality of sleep, anxiety, sadness, and PTSD in individuals suffering from PTSD.

Methods:

The Cochrane Library, PubMed, Web of Science, EMBASE, and Scopus databases in English were examined. Included were all randomized controlled trials (RCTs) that examined physical activity as a psychosocial remedy for PTSD sufferers. By the time of the meta-analysis search (February 2024), we had 12 RCT studies that met the eligibility requirements.

Results:

The study’s findings demonstrated that physical activity improved sleep quality (standardized mean differences [SMD] = −0.38, 95% CI [−0.59, −0.18], Z = 3.65, P = .0003), anxiety (SMD = −0.26, 95% CI [−0.47, −0.06], Z = 2.5, P = .01), depression (SMD = −0.19, 95% CI [−0.37, −0.01], Z = 2.09, P = .04), and PTSD (SMD = −0.34, 95% CI [−0.50, −0.17], Z = 3.99, P < .0001). Each intervention ≤ 60 (SMD = −0.52, I2 = 0%, P < .00001), frequency of interventions ≤ 2 per week (SMD = −0.44, I2 = 7%, P = .0004), intervention cycles > 10 (SMD = −0.46, I2 = 8%, P < .0001), and the yoga group (SMD = −0.44, I2 = 7%, P = .0004) had the best impact, according to subgroup analyses. Veterans with PTSD responded most significantly to physical activity (SMD = −0.60, I2 = 0%, P = .002).

Conclusions:

It was discovered that people with PTSD can benefit from physical activity as an adjuvant method to enhance their PTSD, anxiety, despair, and sleep quality. Yoga has been found through research to help the symptoms of people with PTSD more than other sports. Due to limitations such as small sample size and some heterogeneity in this meta-analysis, further confirmation through more scientific and objective RCTs is needed in order to obtain definitive conclusions on physical activity for patients with PTSD.
Impact of lifestyle interventions on reproductive and psychological outcomes in women with polycystic ovary syndrome: A systematic review
Authors: Mohamed Amal H. , Albasheer Osama , Ghoniem Manar Ahmed , Abdalghani Nagla , Ayish Fatma , Abdelwahab Siddig Ibrahim , Abdelmageed Maha Murtada , Hakami Ahlam Mohammed S. , Khormi Ali Hassan , Altraifi Ahmed Abdallah , Medani Isameldin , Chourasia Uma , Ali Suhaila A. , Abdelmola Amani , Ahmed Anas E.
Published: January 2025

Background:

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting ≈8% to 13% of women of reproductive age. PCOS has multifaceted effects that extend beyond reproductive health. Women with PCOS are at an elevated risk for various metabolic conditions, including obesity, type 2 diabetes, and cardiovascular disease, as well as psychological challenges, such as anxiety, depression, and reduced quality of life. This systematic review examined the effectiveness of lifestyle interventions, including dietary, exercise, and behavioral modifications, in improving reproductive outcomes, mental well-being, and quality of life in women with PCOS.

Methods:

A comprehensive search was conducted using MEDLINE, EMBASE, Cochrane Library, and Web of Science databases, identifying observational and interventional studies published in English through December 2022. Studies were evaluated for methodological quality and categorized according to the type of lifestyle intervention and outcome measures.

Results:

Of the 24 studies reviewed, with 16 focusing on reproductive outcomes, 4 on quality of life, and 4 on combined outcomes, encompassing 1373 participants with the mean age in the included studies ranged from 21.7 to 36.5 years. Dietary modifications, either alone or in combination with exercise, resulted in significant improvements in reproductive health, including a 5% reduction in body weight (P < .001), increased menstrual regularity, higher pregnancy rates, and decreased testosterone levels (P < .01). Exercise interventions further contributed to positive outcomes; a 20-week exercise program improved ovulation rates by 49.1% and significantly reduced testosterone and free androgen indices (P < .001). In addition, structured exercise programs increased menstrual regularity by 60% and reduced body mass index and testosterone levels.

Conclusion:

This review underscores the efficacy of integrated lifestyle interventions, including dietary, exercise, and behavioral approaches, in improving reproductive health, psychological well-being, and quality of life in women with PCOS. These findings highlight the potential of comprehensive nonpharmacological management strategies to address the multifaceted health challenges posed by PCOS. Future research should prioritize long-term studies to assess sustained outcomes and examine personalized intervention strategies that account for the clinical diversity and heterogeneity of PCOS presentations.
Comparison of long-term clinical and radiologic outcomes of AperFix and fixed loop device fixation in anterior cruciate ligament reconstruction: A retrospective study
Authors: Kaya Sehmuz , Guven Necip , Unal Yunus Can , Ozkan Sezai , Adanas Cihan , Turkozu Tulin , Danisman Ferhat , Ismailov Ulan , Dundar Abdulrahim , Akdemir Zulkuf , Gokalp Mehmet Ata
Published: January 2025

Anterior cruciate ligament reconstruction aims to improve knee stability and range of motion. The AperFix system consists of polymer components, and fixed-loop fixation is an established endoscopic technique. Our aim in this study was to compare the long-term clinical and radiological results of AperFix and fixed-loop fixation and to prove that the long-term results of the AperFix fixation method are at least as good as those of the fixed loop device. This retrospective study included 109 patients who underwent primary anterior cruciate ligament reconstruction using single bundled hamstring tendon grafts. Patients under 16 years of age, patients with incomplete follow-up, bilateral or other ligament injuries, inflammatory arthropathy, previous knee surgery, or concurrent meniscal treatment were excluded. Participants were divided into 2 groups according to femoral fixation methods: AperFix fixation (group 1, n = 55) and fixed loop device fixation (group 2, n = 54). All operations were performed by senior surgeons under general or spinal anesthesia. Postoperative rehabilitation started on day 1 and allowed patients to resume normal activities at 6 months. Outcomes were evaluated during follow-up, including knee range of motion, clinical scores [Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee] and radiographic measurements of femoral tunnel width and length. Measurements were performed by 2 orthopedic surgeons to ensure reliability. This study evaluated 109 patients (55 in group 1, 54 in group 2) and found no statistically significant differences in demographic variables such as age, sex, body mass index, follow-up duration, or side distribution. Clinical outcomes, including anterior drawer test, Lachman test results, knee flexion-extension degrees, and Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee scores, were similar between the groups (P > .05). Complications occurred in 8 cases (rerupture, infection, and deep vein thrombosis), with no significant correlation to the fixation method used (P = .506). Radiographic analysis revealed no significant differences in femoral tunnel width or length between the groups (P > .05). In our current study, no meaningful disparity was found between the AperFix and fixed loop device methods in terms of long-term clinical outcomes. As there are no long-term studies on the results of AperFix fixation in the literature, more studies on this subject are needed.
Ahmed glaucoma valve implantation for congenital ectropion uveae with glaucoma: A case report
Authors: Sha Fang , Du Xiujuan , Gao Yane , Wang Beibei , Sun Xuan , Tang Kai , Bi Hongsheng
Published: January 2025

Rationale:

Congenital ectropion uveae (CEU) is a rare, nonprogressive anomaly characterized by the proliferation of the iris pigment epithelium on the anterior surface of the iris, often associated with glaucoma. Due to its rarity and complexity, standardized glaucoma surgical management is limited. To our knowledge, the application of glaucoma drainage devices in CEU is rarely documented. Here, we report a case of Ahmed glaucoma valve (AGV) implantation for unilateral CEU associated with glaucoma.

Patient concerns:

A 26-year-old female initially presented with blunt ocular trauma with an intraocular pressure (IOP) of 37 mm Hg in the right eye. After starting glaucoma medication, IOP promptly decreased to 21 mm Hg. However, the patient was subsequently lost to follow-up.

Diagnoses:

A definitive diagnosis was not made due to the limited understanding of CEU at the first visit. Nearly 3 years later, the patient was referred to our hospital again with decreased vision for 6 months and mild distending pain in the right eye. The best-corrected visual acuity was 20/25, IOP was 51 mm Hg, and the cup-to-disc ratio was 0.8. Slit-lamp examination of the right eye revealed 360° ectropion uveae, extending around the pupil to the mid-periphery of the iris, which was an unaltered condition since the first visit. Thus, the patient was diagnosed with CEU and unilateral glaucoma.

Interventions:

The AGV implantation surgery with mitomycin C was performed in the right eye.

Outcomes:

The best-corrected visual acuity of the right eye improved to 20/20. IOP stabilized without medications during the entire period of follow-up for 3 years.

Lessons:

Although CEU is rare, ophthalmologists should remain vigilant to avoid missed diagnoses due to its high association with glaucoma. AGV implantation with mitomycin C may be considered an effective surgical management for adult patients with late-onset glaucoma secondary to CEU.
A Systematic Literature Review on the Burden of Disease for Patients With Moderate to Severe Acute Ischemic Stroke
Authors: Quinn Terry , Kitagawa Kazuo , Leung Thomas , Molina Carlos , Rabinstein Alejandro , Bentley Roy , Henry Owen , Heuser Maria , Nair Vedes , Saver Jeffrey
Published: January 2025

Background:

A vast amount of literature is available on the burden of acute ischemic stroke (AIS). Yet, most information on AIS burden does not stratify by stroke severity, and the inclusion of mild strokes (National Institute of Health Stroke Scale < 5) might obscure the true impact of moderate-to-severe AIS. Therefore, it is important to understand the literature as it pertains to the epidemiological, clinical, humanistic, and economic burden of moderate-to-severe AIS from a global perspective.

Methods:

A systematic literature review (SLR) was conducted, including articles published between January 2015 and June 2023. The clinical burden search focused on patients with moderate or severe AIS. Due to the paucity of evidence, the humanistic and economic burdens were evaluated based on overall AIS studies. Abstract and full-text screening were conducted by 2 reviewers, with data extraction completed by 1 reviewer. In all, 136 studies were included in the SLR.

Results:

AIS caused a substantial burden for patients and the healthcare system. The clinical burden of AIS (specifically severe AIS) resulted in high mortality and worse functional outcomes across multiple demographics (female sex, older age, and patients with comorbidities). The economic burden of overall AIS was substantial, with inpatient costs as the primary driver (a mean or median stay of 7 days). The highest inpatient costs were reported in South Korea ($45,180) and the United States ($38,470).

Conclusions:

The review highlighted the huge burden of moderate-to-severe AIS, with patients experiencing worse outcomes with increased stroke severity. Further focus is needed on outcomes relating to moderate-to-severe AIS to fully understand the burden of stroke in this patient population.
Hypomagnesemia in adults with type 2 diabetes mellitus in Riyadh, Saudi Arabia: A cross-sectional study
Authors: Al-Daghri Nasser M. , Yakout Sobhy M. , Hussain Syed Danish , Alnaami Abdullah M. , Veronese Nicola , Barbagallo Mario , Sabico Shaun
Published: January 2025

This study investigates the prevalence of hypomagnesemia in adults with type 2 diabetes mellitus (T2DM) in Riyadh, Saudi Arabia, and examines its association with various metabolic parameters. Conducted as a cross-sectional study at King Saud University, Riyadh, it included 294 Saudi adults aged 25 to 65 years, comprising 119 T2DM patients, 80 prediabetics, and 95 nondiabetic controls. Participants underwent physical examinations, and fasting blood samples were analyzed for glucose, glycated hemoglobin (HbA1c), lipid profile, and serum magnesium levels. Statistical analysis revealed that lower magnesium levels were significantly more prevalent in T2DM patients (1.65 ± 4.9 mg/L) compared to prediabetes (2.48 ± 5.2 mg/L) and controls (2.9 ± 5.4 mg/L; P < .001). T2DM patients with magnesium deficiency exhibited higher levels of fasting glucose (11.2 ± 3.9 mmol/L), HbA1c (8.6 ± 2.1 mmol/L), and triglycerides (2.1 ± 0.9 mmol/L), along with increased insulin resistance (Homeostatic Model Assessment of Insulin Resistance = 6.6) and decreased insulin sensitivity (Quantitative Insulin Sensitivity Check Index = 0.29). Magnesium levels correlated negatively with glucose (R = −0.58) and HbA1c (R = −0.61). The area under the curve for serum magnesium in predicting HbA1c > 5.7 was 0.88, and for HbA1c ≥ 6.5, it was 0.91, indicating high diagnostic accuracy. These findings suggest that magnesium deficiency significantly impacts the metabolic profile of T2DM patients in Riyadh. Therefore, routine monitoring of magnesium levels is crucial in diabetes management, and further research is needed to explore the benefits of magnesium supplementation in T2DM care.
Test-retest reliability of the Arabic version of the Pittsburgh Sleep Quality Index
Authors: Alqarni Rayan Ahmed , Almutairi Nawaf Saqer , Albalawi Abdullah Saleh , Alsulami Musab Buwayti , Alhashrani Mohammed Abdullah , Bin Abdulrahman Khalid A.
Published: January 2025

This study aimed to assess the test-retest reliability and validity of the Arabic version of the Pittsburgh Sleep Quality Index (A-PSQI), a 19-item sleep evaluation tool, in a population of medical students and interns in Saudi Arabia. Following a 16-person pilot study, 202 participants completed 2 A-PSQI questionnaires with a 2-week test-retest interval to avoid a carryover effect. Statistical analysis using RStudio included Cronbach alpha, Spearman rank correlation, and the intraclass correlation coefficient (ICC). The ICC results showed moderate to strong correlations in most PSQI components. The “Sleep efficiency” component had the lowest ICC (0.460), while “Sleep latency” had the highest (0.730). Overall, the PSQI reliability score is 0.694. Gender (sex assigned at birth) and academic level had no significant impact on the PSQI scores. The sleep quality categories (poor quality, good quality, and acute sleep disturbance) remained stable over time. The A-PSQI demonstrates varying internal consistency across components, with some displaying lower reliability. Nevertheless, it exhibits moderate to strong reliability, and the study confirms the stability of sleep quality categories over time among medical students and interns. This serves as a final validation step to set the stage for large-scale research in the region. This pioneering study is the first test-retest reliability investigation of the A-PSQI, addressing a critical gap in sleep assessment tools tailored to clinical practices in Arabic-speaking communities. It follows the pathway set by previous studies and serves to validate the A-PSQI in this demographic, providing a vital foundation for more catered sleep medicine in the region, targeting better reach to overlooked monolinguals. These findings advance our understanding of sleep quality among medical trainees and contribute to the development of culturally relevant sleep assessment tools.
Investigation of the sclerosing effect of increasing doses of polidocanol on pulmonary vessels: Experimental study
Authors: Zorlu Duygu , Özdemir Imran , Bayar Muluk Nuray , Güngör Enes , Yilmaz Evrim , Cingi Cemal
Published: January 2025

Background:

Percutaneous sclerotherapy as endovascular treatment may cause severe complications beside the target area. Pulmonary embolism and thrombosis may occur. In this regard, our study aimed to reveal whether increasing systemic doses of polidocanol affects the coronary or pulmonary alveolar levels.

Methods:

Twenty-one Albino New Zealand rabbits, 7 rabbits per group, were used. The first group served as a control and received a 0.5 mL injection of saline; the second group received a single injection of 0.5 mL 1% polidocanol; and the third group received a single injection of 0.5 mL 2% polidocanol via the femoral vein. After anesthesia-induced decapitation on day 3, the experimental rabbits’ lungs were removed in their entirety and sent to pathology for analysis. Micron-thick slices.

Results:

In all lung specimens of the first 2 groups, no narrowing or obstruction was detected in the pulmonary vessels in macroscopic and microscopic evaluation. No emphysematous changes or congestion were observed. In the third group’s animal lungs, congestion in pulmonary vessels, emphysematous changes, and intra-alveolar hemorrhage were found.

Conclusion:

In our study, a single injection of 0.5 mL 2% polidocanol via the femoral vein. Animal lungs, congestion in pulmonary vessels, emphysematous changes, and intra-alveolar hemorrhage were found. As a result, our study demonstrated pulmonary vascular damage with increasing doses of polidocanol. So, the dose of polidocanol should be used in a limited manner.
Effectiveness of non-invasive ultrasound-guided electrical stimulation of genicular nerves for chronic knee pain: A case report
Authors: Ikuta Futoshi , Matsuzaki Masashi , Kajitani Kotaro
Published: January 2025

Rationale:

Chronic knee pain is a common health issue that requires effective and noninvasive treatment. We devised a novel noninvasive approach using ultrasound-guided electrical nerve reactivation (ENR) in which ultrasound is used to identify the genicular nerve (GN). Then, transcutaneous low-frequency stimulation is applied for 10 seconds. The aim of this study was to clarify the pain-relieving effects of ENR on the GN innervating the knee joint.

Patient concerns:

Patients had visited our hospital with the complaint of knee joint pain.

Diagnoses:

This study included 21 osteoarthritic knees from 16 patients with a mean age of 78.3 ± 8.5 years.

Interventions:

Baseline measurements included the range of motion of the knee joint, Visual Analogue Scale (VAS) scores for pain, and maximum knee flexion angle during squatting. A therapist conducted an interview to locate the painful area of the knee and then performed ultrasound-guided ENR by targeting the GN.

Outcomes:

The preintervention VAS score was 49.3 (95% confidence interval: 41.0, 57.5). Postintervention VAS scores showed significant reductions: 27.0 (19.0, 35.1) immediately after the intervention (P < .0001), 27.7 (22.6, 32.8) at 1-day postintervention (P = .002), and 29.0 (22.9, 35.1) at 1-week postintervention (P = .001). The knee flexion angle during squatting significantly improved from 108.1° (101.6, 114.5) preintervention to 121.9° (115.1, 128.7) postintervention (P < .001). There was a significant increase in flexion angle preintervention and postintervention (P = .02); however, no significant change was observed in the extension angle. In addition, no adverse events were reported.

Lessons:

This study is the first to demonstrate the effects of ultrasound-guided low-frequency stimulation of the GN for knee osteoarthritis. Although the exact mechanism of pain relief is unclear, we hypothesize that alterations in neurotransmission, with or without endorphin release, may play a role. Moreover, ENR may improve nerve entrapment by causing contraction of surrounding muscles.

This study demonstrated that ultrasound-guided ENR targets the GN and effectively reduces pain without complications. This treatment addresses the limitations of invasive methods, such as hydrorelease and radiofrequency ablation. Furthermore, ultrasound-guided ENR has diverse applications in diagnostics, physical therapy, and pre-exercise pain management and will greatly benefit patients and healthcare professionals.
Delayed Stevens–Johnson syndrome induced by combined administration of carbamazepine and botulinum toxin: A case report
Authors: Liu Weiqian , Gao Bo , Yuan Ye , Xie Shaowei , Jiao Shengxian , Feng Wenhui , Yan Dongrui , Yin Yu
Published: January 2025

Rationale:

Steven–Johnson syndrome (SJS) is characterized by severe illness, rapid progression, and high mortality rates, with the vast majority of cases induced by medications. Botulinum toxin, a neurotoxin produced by Clostridium botulinum, has not been reported in the literature as a causative agent of SJS.

Patient concerns:

A 56-year-old male patient, who underwent surgery for cerebral hemorrhage, developed widespread patchy annular papules following the injection of botulinum toxin into the masseter muscle. Some lesions exhibited a target-like appearance, and all major organ systems were affected.

Diagnoses:

Consider the delayed SJS induced by the combination of carbamazepine and botulinum toxin.

Interventions:

Intravenous administration of methylprednisolone in conjunction with immunoglobulin is indicated. For ocular lesions, topical treatment includes tobramycin-dexamethasone and sodium hyaluronate eye drops; for ulcerated areas, local application of lactulose-iodoquinol is recommended, while non-ulcerated regions should be treated with halometasone ointment topically.

Outcomes:

The patient has been discharged, and there has been a noticeable improvement in their symptoms.

Lessons:

In order to prevent severe adverse reactions, patients using carbamazepine in conjunction with other medications should be vigilant for the early symptoms of serious drug rashes.
Extensive small cell lung cancer treated by integrated traditional Chinese and Western medicine: A case report
Authors: Yang Yuanqing , Li Si
Published: January 2025

Rationale:

Patients with extensive small cell lung cancer (SCLC) generally have a dismal survival rate and are conventionally treated with chemotherapy. This study aimed to explore an alternative treatment approach by combining traditional Chinese medicine (TCM) with radiotherapy and chemotherapy.

Patient concerns:

A 68-year-old male was diagnosed with extensive-stage SCLC. Positron emission tomography/computed tomography scans indicated a high metabolism mass in the left hilar region, along with multiple lymph node metastases and metastatic tumors in both lungs. A left lung biopsy verified small cell carcinoma.

Diagnoses:

The patient was confirmed to have extensive stage SCLC based on imaging and biopsy results.

Interventions:

The patient received a comprehensive treatment regimen. TCM herbal prescriptions such as Qianjin Weijing Decoction, Wuwei Xiaodu Decoction, Xiaoxianxiong Decoction, and Xiaochengqi Decoction were administered. In parallel, standard Western medicine therapies, including chemotherapy (intravenous cisplatin and etoposide) and radiotherapy, were carried out. Oral ondansetron was given to alleviate nausea and vomiting caused by chemotherapy and radiotherapy.

Outcomes:

After 30 months, follow-up positron emission tomography/computed tomography demonstrated the complete disappearance of all cancerous lesions. The patient regained normal daily activities and experienced a substantially enhanced quality of life. Four years after the initial treatment, there has been no recurrence, and the patient persists in taking the original TCM decoction.

Lessons:

The combination of TCM and Western medicine in treating SCLC proves effective in managing systemic symptoms, mitigating bone marrow suppression, gastrointestinal reactions, immunosuppression, and other chemotherapy-induced adverse reactions. It also significantly prolongs the survival period, suggesting it as a preferable treatment option for SCLC.
Prenatal phenotype of PNKP-related microcephaly, seizures, and developmental delay: A case report and literature review
Authors: Xie Jin-Long , Jiang Chun-Yan , Sun Ping-Ping , Zhang Yan , Sun Na , Luan Su-Xian
Published: January 2025

Rationale:

Microcephaly, epilepsy, and developmental delay (MCSZ) is a rare neurodevelopmental disorder associated with autosomal recessive inheritance of mutations in the polynucleotide kinase 3’-phosphatase (PNKP) gene. Prompt identification and management are essential, as delayed diagnosis or intervention may result in severe complications or mortality. In this case, prenatal screening in the second trimester detected fetal microcephaly with a gradual decline in head circumference, prompting the decision to terminate the pregnancy. Subsequent genetic analysis of the fetal tissue confirmed the presence of compound heterozygous mutations in the PNKP gene.

Patient concerns:

The patient, a 34-year-old remarried female with no history of consanguineous marriage, underwent 2 mid-trimester termination procedures due to fetal microcephaly and sought counseling for reproductive assistance.

Diagnoses:

The patient’s carrier status for PNKP mutations was ascertained through whole-exome sequencing of the termination tissue and molecular genetic testing for monogenic disorders. The terminated fetus was diagnosed with MCSZ, a condition associated with compound heterozygous mutations in the PNKP gene.

Interventions:

Fetal microcephaly was identified via mid-trimester prenatal ultrasound, leading to the termination of the pregnancy during the same trimester. Subsequent genetic analysis of the immediate family revealed compound heterozygous mutations in the PNKP gene as the underlying cause of MCSZ. Genetic counseling was provided, followed by 1 cycle of preimplantation genetic testing for monogenic.

Outcomes:

The patient carried the heterozygous c.1188 + 1G > A PNKP mutation, whereas her husband carried the heterozygous c.976G > A PNKP mutation. The fetus was found to have compound heterozygous mutations c.976G > A and c.1188 + 1G > A. After counseling, the couple underwent 1 cycle of preimplantation genetic testing for monogenic, unfortunately, no pregnancy occurred after the 2 embryos were transferred.

Lessons:

MCSZ, a condition caused by PNKP mutations, is exceedingly rare. Women with a history of adverse pregnancy outcomes should undergo close monitoring during prenatal checkups. If fetal microcephaly is detected, it is essential to strictly follow obstetric guidelines for prenatal care, such as comprehensive cranial magnetic resonance imaging and genetic testing for confirmation. Avoidance of consanguineous marriages is advised. Early detection and timely intervention are key to preventing adverse pregnancy outcomes.
A novel basement membrane-related gene signature for predicting prognosis of HNSCC
Authors: Wang Xia , Wang Zhiming
Published: January 2025

In recent years, a notably heterogeneous malignant tumor, squamous cell carcinoma of the head and neck (HNSCC), has received increasing attention, with no significant improvement in its survival rate. The rapid increase in the number of prognostic models associated with HNSCC has been observed due to its accuracy, which offers crucial clinical benefits. The 10 genes were selected from 222 human genes associated with the basement membrane in the analysis of this article. The gene pool was narrowed through different classifications and intersections, followed by univariate Cox regression analysis. Genes with statistical significance underwent further Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis, resulting in the final selection of 10 genes. The data and images extracted from the Human Protein Atlas database were utilized to confirm the differential expression of the corresponding genes. Multivariate Cox regression analysis was employed to develop a nomogram, and the nomogram was assessed by additional decision curve analysis (DCA). The Gene Expression Omnibus validation set was used to validate the established model. Finally, between the high- and low-risk score groups, Gene Set Enrichment Analysis, immune correlation analysis, and drug sensitivity analysis were conducted in this paper. ITGA5, SPOCK1, EVA1C, TINAGL1, LAMB4, ADAMTS1, EGFL6, GPC2, BGN, and ITGA2B were successfully developed as basement membrane-associated risk models. The time-dependent receiver operating characteristic (timeROC) curve illustrated that the risk score prediction accuracy outperformed indicators, which were commonly adopted in clinical practice, consisting of age, stage, gender, T-staging, and N-staging. The 3-year risk score timeROC area under the curve value was 0.679. This model demonstrates a reliable ability to assess the prognosis of HNSCC patients. In addition, the specific potential biomarkers associated with the basement membrane were explored in this research.
Epidemiological feature of imported malaria in Taiwan during the 2014-to-2020 period
Authors: Lin Fu-Huang , Chou Yu-Ching , Hsieh Chi-Jeng , Huang Yao-Ching , Yu Chia-Peng
Published: January 2025

Although the World Health Organization (WHO) certified Taiwan as being malaria-free in 1965, there are reports of a few imported cases each year by travelers who visit malaria-endemic areas. This study examined the epidemiology of imported malaria cases in Taiwan from 2014 to 2020, utilizing national surveillance data from the Taiwan Centers for Disease Control. Malaria cases were confirmed through the application of standard laboratory methods. Passenger data came from the Tourism Bureau, Ministry of Transportation and Communication, Taiwan (TBMTC). All data were analyzed using SPSS version 21. The analysis included a dataset comprising 64 cases of imported malaria. Of the total cases, 77.8% were acquired from Africa, and 17.5% from Asia. Plasmodium falciparum was responsible for more than half (57.1%) of the cases, Plasmodium vivax malaria for 25.4% of cases, Plasmodium malariae malaria for 6.3%, Plasmodium ovale malaria for 4.8%, and unspecified pathogen malaria for 6.3% of the cases. Majority of the patients were male (75%) and were predominantly aged 20 to 59 years (70.3%). Most cases of imported malaria occurred during the fall season, and 51.6% of cases occurred in 8 cities during the period of 2014 to 2020. No evidence exists to indicate that indigenous malaria transmission occurs in Taiwan. Anopheles minimus was found in 4 cities (counties), namely Tainan City and Pingtung County in Southern Taiwan; Hualien County and Taitung County in Eastern Taiwan. The findings of this study highlight the necessity for robust surveillance systems, effective vector control measures, and targeted interventions for travelers and immigrants to prevent malaria outbreaks and maintain Taiwan’s malaria-free status.
Fertility problems in men carrying chromosome 7 inversion: A retrospective, observational study
Authors: Song Zhiqiang , Wang Qiuyu , Wu Jianchen , Li Ranwei
Published: January 2025

Infertility is a worldwide public health issue. Fifty percent of infertile couples are male-only. A number of male infertility etiologies are significantly influenced by chromosomal abnormalities. Clinical manifestations, however, differ according to the presence of aberrant chromosomes and distinct breakpoints. The reproductive effects of inversion are evident in those who carry it. The influence of inverted carriers on male infertility may be explained by the interchromosomal effect, although further research is still needed to determine the precise mechanism. Furthermore, selecting clinical reproductive technology presents difficulties for both physician and patients. The aim of this study is to determine the clinical characteristics of 4 males who have an inversion of chromosome 7, and to investigate the connection between the breakpoints of this chromosome and male infertility. For each patient, cytogenetic and semen analyses were carried out. Using PubMed or Online Mendelian Inheritance in Man, relevant research and genes on breakpoints on chromosome 7 were found. This study includes 4 male infertile patients, all of whom had chromosome 7 inversions. 46,XY,inv(7)(p22q22), 46,XY,inv(7)(p21q11.2), 46,XY,inv(7)(p21q21), and 46,XY,inv(7)(p15q36) were the results of the cytogenetic analysis. Three cases of aberrant semen parameters were detected by semen detection. After a literature search, 21 cases of chromosome 7 inversion carriers were found. These carrier couples have varying reproductive histories. Among the 5 cases where semen parameters are available, 1 is azoospermia and 1 is oligoasthenozoospermia. Five significant genes on chromosome 7 have been linked to male infertility. Changes in semen parameters may be connected to the breakpoints 7q11, 7q21, 7q22, and 7q36. Physicians should take into account the relevant breakpoints when offering genetic counseling to patients who have chromosome 7 inversion.
Prognostic value of serum cholinesterase and 18F-FDG PET/CT-derived metabolic parameters in non-small cell lung cancer patients: a retrospective cohort study
Authors: Hu Na , Yan Gang , Tang Maowen , Yuan Shengmei , Xia Xing , Lei Pinggui
Published: January 2025

Purpose

The primary objective of this study was to explore the prognostic significance of serum cholinesterase (CHE) and metabolic parameters obtained from 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) scans in patients with nonsmall cell lung cancer (NSCLC).

Methods

A retrospective observational cohort study was conducted with 202 NSCLC patients. Serum CHE was evaluated alongside metabolic tumor volume (MTV) and total lesion glycolysis (TLG) derived from PET/CT scans. The correlation between these parameters and overall survival (OS) was analyzed using log-rank tests, as well as univariate and multivariate Cox regression analyses. A nomogram prediction model was developed and assessed using time-dependent receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA).

Results

High MTV (≥16) and TLG (≥108) were found to be significantly correlated with worse OS outcomes (both P < 0.001), whereas lower CHE levels (<6818) were associated with worse OS (P = 0.002). A multivariate analysis revealed that MTV, TLG, serum CHE, and the presence of distant metastasis were independent prognostic factors for OS. The nomogram prediction model, incorporating these variables, exhibited strong predictive performance, as indicated by area under the curve values of 0.826, 0.796, and 0.845 for 1-, 3-, and 5-year OS predictions, respectively. Calibration curves demonstrated good concordance between predicted and observed survival rates, and DCA confirmed clinical relevance.

Conclusions

Serum CHE and 18F-FDG PET/CT metabolic parameters may serve as important prognostic indicators for patients with NSCLC. The integration of these factors into a nomogram prediction model can assist in clinical decision-making and patient risk stratification.
More Than a Game
Authors: Madison Jessica , Ansari Marwa , Casey Debbie , Dimalibot Devi , Dominguez Alanna , King Gabrielle , Kooyenga Chelsea , Markus Heidi , Mattison Effie , Olidan Kevin , Olidan Shiella , Rodolfa Criselda , Tinnemeyer Marissa , Vaughn Jeanine
Published: January 2025

This article describes an interactive heparin drip learning exercise for nurse residents using concepts similar to “The Amazing Race.” The goal of the exercise was to strengthen critical thinking related to heparin drip setup and maintenance in the acute care setting. The game consisted of a start line and five pit stops to solve a puzzle, perform a skill, perform a medication calculation, perform an intervention, and complete a short quiz.
Clinical Experience with TNF Inhibition and Longitudinal Image Monitoring in Osseous Sarcoidosis
Authors: VanDerVeer Seth J. , Hill Erica M.
Published: January 2025

Background

In this case series, we present longitudinal imaging surveillance of 6 cases of osseous sarcoidosis, each of which was effectively treated with tumor necrosis factor (TNF) inhibition.

Methods

We identified 6 patients from Brooke Army Medical Center with osseous sarcoidosis, who were treated with TNF inhibition and followed with longitudinal imaging studies. Cases of osseous sarcoidosis were defined as having pathologic evidence of noncaseating granulomas on bone biopsy and evidence of osseous lesions on imaging attributable to sarcoidosis by the radiologist, treating clinician, and reviewer. Clinical data were obtained through review of the military electronic medical record.

Results

Longitudinal imaging with positron emission tomography/computed tomography, magnetic resonance imaging, and bone scintigraphy assisted in the identification of active disease and clinical remission. Imaging progression of asymptomatic lesions was associated with the eventual development of bone pain 1 to 3 years later. Clinical remission was achieved in all six cases of osseous sarcoidosis and effective doses for TNF inhibition were adalimumab 40 mg subcutaneously every 1 to 2 weeks and infliximab 5 mg/kg every 6 to 8 weeks. Time to complete imaging response ranged from 3 to 8 months.

Conclusions

Longitudinal imaging with bone scintigraphy, positron emission tomography/computed tomography, and magnetic resonance imaging demonstrated several benefits including evaluation for occult disease, surveillance of asymptomatic lesions, and evaluation of treatment response. TNF inhibition with adalimumab or infliximab was successful in all cases, and complete resolution of osseous lesions was demonstrated in 5 of 6 patients. Discontinuation of TNF inhibition led to disease recurrence in 2 cases, which prompted the use of long-term immunosuppressive therapy in all treated patients.