bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Resuscitated Cardiac Arrest in the Brain-dead Donors on the Outcome of Liver Transplantation: A Retrospective and Propensity Score Matching Analysis
Authors: Mei Shengmin , Xiang Jie , Wang Li , Xu Yuan , Li Zhiwei
Published: November 2024

Objective:

To evaluate the impact of cardiac arrest time (CAT) in brain-dead donors on graft and recipient outcomes following liver transplantation.

Background:

The outcome of livers from brain-dead donors with a history of cardiac arrest (CA) remains controversial, and the duration of the CAT has never been evaluated.

Methods:

A retrospective review of data from the Scientific Registry of Transplant Recipients between 2003 and 2022 was conducted. Propensity score matching was performed to minimize confounding effects.

Results:

A total of 115,202 recipients were included, 7364 (6.4%) and 107,838 (93.6%) of whom were of the CA and non-CA group, respectively. After 1:1 propensity score matching, each group consisted of 7157 cases. The CA group demonstrated shorter hospital stay (15.5 ± 20.0 days vs. 16.2 ± 21.3 days, P = 0.041), with comparable incidence of early graft failure (EGF, 5.8% vs. 6.2%, P = 0.161). The CA group demonstrated slightly higher graft survival rates (1 year, 90% vs. 88%; 5 years, 76% vs. 74%; and 10 years, 61% vs. 58%, P < 0.001). CAT positively correlated with EGF [odds ratio (OR) = 1.03, 95% confidence interval (CI) = 1.02–1.04, P < 0.001], with a sensitivity and specificity of 73% and 86% at a cutoff of 30 minutes. The CAT <30 minutes group demonstrated significantly lower incidence of EGF (5.0%), compared with 7.8% of the CAT >30 minutes group and 6.2% of the non-CA group (P < 0.001).

Conclusions:

The use of brain-dead donors with a history of CA did not increase the risk of liver graft failure in our study. A downtime of <30 minutes may confer protective effects on transplanted grafts.
Comparison of LS CE-Chirp and Click Stimuli in Auditory Brainstem Responses in High-Frequency Hearing Loss
Authors: Belet Uğur , Akşit Ateş Mehmet , Kösemihal Ebru
Published: November 2024

Objectives:

The auditory brainstem response (ABR) is an evoked potential used to estimate the hearing thresholds and identify potential auditory pathologies. Although a click stimulus is generally used as an auditory stimulus in diagnostics, recent reports show that the Level-Specific CE-Chirp (LS CE-Chirp) stimulus can also be used for clinical diagnosis. In this study, we compared the auditory brainstem test outcomes of the LS CE-Chirp stimulus and the click stimulus in individuals with high-frequency hearing loss (HFHL).

Design:

Patients with HFHL (n = 30) and individuals with normal hearing (n = 30) were included in the study. Audiometric pure-tone thresholds were determined for all subjects at 250 to 8000 Hz. For individuals with normal hearing, the pure-tone thresholds were required to be ≤20 dB HL for all frequencies. HFHL cases were selected from people with at least 5 years of hunting experience. All subjects were tested with ABR at 80 and 60 dB nHL. The ABR test was performed using click and LS CE-Chirp stimuli at a rate of 11.1/sec. ABR wave I, III, and V peak latencies and I to V interpeak latency values were compared within and among the groups.

Results:

Longer latency values were obtained with the LS CE-Chirp stimulus at 80 dB nHL intensity and 11.1/sec stimulus frequency than with the click stimulus in the control group. No significant difference was detected between the LS CE-Chirp and click stimuli at the 80 dB nHL intensity level in the HFHL group (p > 0.005). When the HFHL patients were classified according to the 4000 Hz threshold, the click stimulus was found to be more compatible with the behavioral 4000 Hz threshold.

Conclusions:

The wave latency values obtained with the LS CE-Chirp stimulus in the HFHL group, unlike with the click stimulation, were less affected by the level of hearing loss in the HFHL group. For this difference to have a diagnostic value, further studies would be needed on patients with different pathologies and hearing loss configurations.
How to Estimate the Minimal Clinically Important Difference
Authors: Roca Hernan , Maughan Gretchen , Karamian Brian
Published: November 2024

The minimal clinically important difference (MCID) is a threshold above which a score change would represent a change in symptoms that is noticeable by patients, and it has become a standard approach in the interpretation of clinical relevance of changes in PROMs at a population level. Given the lack of a methodological gold standard, high variability is the main limitation of MCID. Reporting both anchor and distribution-based MCID estimates is a strategy that guarantees both patient-perceived clinical relevance and statistical significance.
Diagnostic Uncertainty Among Critically Ill Children Admitted to the PICU: A Multicenter Study
Authors: Cifra Christina L. , Custer Jason W. , Smith Craig M. , Smith Kristen A. , Bagdure Dayanand N. , Bloxham Jodi , Goldhar Emily , Gorga Stephen M. , Hoppe Elizabeth M. , Miller Christina D. , Pizzo Max , Ramesh Sonali , Riffe Joseph , Robb Katharine , Simone Shari L. , Stoll Haley D. , Tumulty Jamie Ann , Wall Stephanie E. , Wolfe Katie K. , Wendt Linder , Ten Eyck Patrick , Landrigan Christopher P. , Dawson Jeffrey D. , Reisinger Heather Schacht , Singh Hardeep , Herwaldt Loreen A.
Published: November 2024

OBJECTIVES:

This study aimed to identify the prevalence of and factors associated with diagnostic uncertainty when critically ill children are admitted to the PICU. Understanding diagnostic uncertainty is necessary to develop effective strategies to reduce diagnostic errors in the PICU.

DESIGN:

Multicenter retrospective cohort study with structured medical record review by trained clinicians using a standardized instrument to identify diagnostic uncertainty in narrative clinical notes. Diagnoses and diagnostic uncertainty were compared across time from PICU admission to hospital discharge. Generalized linear mixed models were used to determine patient, clinician, and encounter characteristics associated with diagnostic uncertainty at PICU admission.

SETTING:

Four academic tertiary-referral PICUs.

PATIENTS:

Eight hundred eighty-two randomly selected patients 0–18 years old who were nonelectively admitted to participating PICUs.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

PICU admission notes for 228 of 882 patients (25.9%) indicated diagnostic uncertainty. Patients with uncertainty decreased over time but 58 (6.6%) had remaining diagnostic uncertainty at hospital discharge. Multivariable analysis showed that diagnostic uncertainty was significantly associated with off hours admission (odds ratio [OR], 1.52; p = 0.037), greater severity of illness (OR, 1.04; p = 0.025), an atypical presentation (OR, 2.14; p = 0.046), diagnostic discordance at admission between attending intensivists and resident physicians/advanced practice providers (OR, 3.62; p < 0.001), and having a neurologic primary diagnosis (OR, 1.87; p = 0.03). Older patients (OR, 0.96; p = 0.014) and those with a respiratory (OR, 0.58; p = 0.009) or trauma primary diagnosis (OR, 0.08; p < 0.001) were less likely to have diagnostic uncertainty. There were no significant associations between diagnostic uncertainty and attending intensivists’ characteristics.

CONCLUSIONS:

Diagnostic uncertainty at PICU admission was common and was associated with off hours admission, severe illness, atypical presentation, diagnostic discordance between clinicians, and a neurologic primary diagnosis. Further study on the recognition and management of diagnostic uncertainty is needed to inform interventions to improve diagnosis among critically ill children.
Primary Epithelioid Angiosarcoma of the Penis: A Case Report With a Brief Review of the Literature
Authors: Caputo Valentina , Cazzato Gerardo , Brambilla Lucia , Rongioletti Franco
Published: November 2024

Angiosarcoma of the penis is an exceptionally rare mesenchymal tumor, with only about 30 cases documented in the literature. Because of its rarity and the often nonspecific clinical presentation, histopathological examination plays a critical role in accurate diagnosis. Angiosarcoma of the penis typically arises in the corpus cavernosum but has also been reported in the glans and urethra, often presenting with metastases. This report details a case of epithelioid angiosarcoma of the penis in an 84-year-old man, who presented with a rapidly enlarging, violaceous nodule on the glans penis. Histopathology revealed atypical epithelioid endothelial cells with pleomorphism and mitotic activity, and immunohistochemical markers such as CD31, Erythroblast transformation-specific [ETS]-related gene, and cellular myelocytomatosis oncogene confirmed the malignant endothelial neoplasm. The differential diagnosis excluded conditions such as epithelioid hemangioendothelioma and Kaposi sarcoma. Because of the rarity, standardized treatment protocols are lacking; however, wide excision with tumor-free margins and the potential for targeted therapies based on gene amplification are considered important. The review highlights the diagnostic challenges, prognostic factors, and current therapeutic approaches, emphasizing the need for further research to develop standardized treatment protocols.
Temple Volumization: A Review of Anatomy and Optimal Injection Techniques
Authors: Friedmann Daniel P. , Hinchee-Rodriguez Kathryn , Verma Kritin K.
Published: November 2024

BACKGROUND

Cosmetically unappealing temporal volume loss can develop as a result of facial aging.

OBJECTIVE

 To present an evidenced-based approach towards safe and effective temple filling.

METHODS

We review the underlying anatomy of the temple and optimal anatomy-driven injection techniques associated with temple volumization.

RESULTS

Multiple safe injection planes exist to achieve temporal volumization.

CONCLUSION

A thorough understanding of optimal injection techniques based on the underlying anatomy mitigates the incidence and severity of adverse events, enhancing treatment success.
Fine particulate matter and intima media thickness: Role of endothelial function biomarkers
Authors: Torrico-Lavayen Rocio , Posadas-Sánchez Rosalinda , Osorio-Yáñez Citlalli , Sanchez-Guerra Marco , Texcalac-Sangrador José Luis , Ortiz-Panozo Eduardo , De Vizcaya-Ruiz Andrea , Botello-Taboada Viridiana , Hernández-Rodríguez Elihu Alexander , Gutiérrez-Avila Iván , Vargas-Alarcón Gilberto , Riojas-Rodríguez Horacio
Published: November 2024

Background:

Ambient fine particulate matter (PM2.5) is a risk factor for atherosclerosis disease. We aimed to assess whether nitric oxide stable metabolites (NOx) and l-arginine mediate the association between PM2.5 and carotid intima media thickness (cIMT) increase.

Methods:

We selected 251 participants from the control group of GEA (Genetics of Atheroslerosis Disease Mexican) study (2008–2013) in Mexico City. Mediation models were carried out using pathway analyses, a special case of structural equation models.

Results:

The median concentration of PM2.5 area under the curve (auc) was 25.2 µg/m3 (interquartile range: 24.2–26.4 µg/m3). Employing participants with observed values for both biomarkers (n = 117), the total effect of PM2.5auc on mean cIMT at bilateral, right, and left was 19.27 µm (95% confidence interval [CI]: 5.77, 32.78; P value = 0.005), 12.69 µm (95% CI: 0.67, 24.71; P value = 0.039), and 25.86 µm (95% CI: 3.18, 48.53; P value = 0.025) per each 1 µg/m3 increase of PM2.5auc. The direct effect of PM2.5auc (per 1 µg/m3 increase) was 18.89 µm (95% CI: 5.37, 32.41; P value = 0.006) for bilateral, 13.65 µm (95% CI: 0.76, 26.55; P value = 0.038) for right, and 24.13 µm (95% CI: 3.22, 45.03; P value = 0.024) for left. The indirect effects of NOx and l-arginine were not statistically significant showing that endothelial function biomarkers did not mediate PM2.5 and cIMT associations. Although l-arginine was not a mediator in the PM2.5 and cIMT pathway, a decrease in l-arginine was significantly associated with PM2.5auc.

Conclusions:

In this study of adults from Mexico City, we found that PM2.5 was associated with an increase in cIMT at bilateral, left, and right, and these associations were not mediated by endothelial function biomarkers (l-arginine and NOx).
Overexpression of TNFα in TNF∆ARE+/− mice increases hepatic periportal inflammation and alters bile acid signaling in mice
Authors: Shearn Colin T. , Anderson Aimee L. , Devereaux Michael W. , Koch Samuel D. , Larsen Leigha D. , Spencer Lisa A. , Orlicky David J. , Colgan Sean P. , Steiner Calen A. , Sokol Ronald J.
Published: November 2024

Background:

Intestinal inflammation is a common factor in ~70% of patients diagnosed with primary sclerosing cholangitis. The TNF∆ARE+/− mouse overexpresses TNFα and spontaneously develops ileitis after weaning. The aim of this study was to examine the influence of ileitis and TNFα overexpression on hepatic injury, fibrosis, inflammation, and bile acid homeostasis.

Methods:

Using serum, hepatic, and ileal tissue isolated from 24- to 26-week-old C57BL/6 and TNF∆ARE+/− mice, hepatic injury and fibrosis, inflammation, ductal proliferation, and regulation of bile acid synthesis were assessed by immunohistochemical and quantitative PCR methods.

Results:

Compared to age-matched C57BL/6 mice, TNF∆ARE+/− mice exhibited increased serum AST, ALT, and serum bile acids, which corresponded to increased hepatic picrosirius red staining, and an increase in hepatic mRNA expression of Tgfb, Timp1, Col1a1, and MMP9 supporting induction of fibrosis. Examining inflammation, immunohistochemical staining revealed a significant periportal increase in MPO+ neutrophils, CD3+ lymphocytes, and a panlobular increase in F4/80+ macrophages. Importantly, periportal inflammation corresponded to significantly increased proinflammatory chemokines as well as hepatic cytokeratin 7 staining supporting increased ductular proliferation. In the liver, increased mRNA expression of bile acid transporters was associated with suppression of classical but not alternative bile acid synthesis. In the ileum, increased inflammation correlated with suppression of Nr1h4 and increased Fgf15 and Nr0b2 mRNA expression.

Conclusions:

Increased TNFα expression is sufficient to promote both intestinal and hepatobiliary inflammation and fibrotic injury and contributes to hepatic dysregulation of FXR signaling and bile acid homeostasis. Overall, these results suggest that the TNF∆ARE+/− mouse may be a useful model for studying chronic hepatic inflammation.
INCIDENCE AND RISK FACTORS FOR PROGRESSION OF PACHYCHOROID DISEASE SPECTRUM
Authors: Fong Angie Hon Chi , Zhao Jinzhi , Wong Wendy Meihua , Fenner Beau , Sim Shaun , Tan Anna C. S. , Su Xin Yi , Teo Kelvin Y. C. , Cheung Chui Ming Gemmy
Published: November 2024

Purpose:

To report the 1-year progression rate and associated risk factors in an Asian cohort of patients with pachychoroid disease spectrum phenotype.

Methods:

The authors report the 1-year findings from a prospective observational study, recruiting subjects with subfoveal choroidal thickness of ≥300 µm. Each eye was evaluated at baseline and at month 12 according to a standardized protocol including visual acuity and multimodal imaging.

Results:

A total of 223 eyes of 133 participants (mean age 59.23 ± 9.18 years, 27.1% female) finished 1-year follow-up. Distribution of baseline diagnosis was uncomplicated pachychoroid (43 eyes), pachychoroid pigment epitheliopathy (108 eyes), central serous chorioretinopathy (54 eyes), and pachychoroid neovasculopathy (18 eyes). There was no significant change in the mean best-corrected visual acuity or subfoveal choroidal thickness. Fourteen eyes (6.3%) evolved to a different pachychoroid disease spectrum diagnosis, but there was no significant change in the mean best corrected visual acuity (BCVA) Logarithm of the minimum angle of resolution 0.15 ± 0.18 (Snellen equivalent 20/30) versus 0.07 ± 0.11 (Snellen equivalent 20/25), (P = 0.18) or subfoveal choroidal thickness (426.8 ± 59.2 vs. 456.3 ± 89.5, P = 0.49). Incident neovascularization developed in eight eyes (3.6%, five from pachychoroid pigment epitheliopathy, three from central serous chorioretinopathy). Seven patients received treatment (three anti-vascular endothelial growth factor [VEGF] and four photodynamic therapy). Factors associated with developing neovascularization include older age, smoking, and the presence of shallow irregular retinal pigment epithelium elevation on optical coherence tomography.

Conclusion:

At 1 year, pachychoroid disease spectrum remains relatively stable with low progression rate. Older age, smoking, and the presence of shallow irregular retinal pigment epithelium elevation were associated with higher rates of neovascular complications.
Glaucoma Screening and Referral Risk Factors in a High-Risk Population: Follow-Up Study of the Manhattan Vision Screening Study
Authors: Wang Qing , Valenzuela Ives A. , Harizman Noga , Gorroochurn Prakash , Torres Desiree R. , Maruri Stefania C. , Diamond Daniel F. , Horowitz Jason D. , Friedman David S. , De Moraes C. Gustavo , Cioffi George A. , Liebmann Jeffrey M. , Hark Lisa A.
Published: November 2024

Précis:

Community-based eye health screenings that incorporated fundus photography and optometric exams in a high-risk NYC population effectively identified a higher than average number of participants that required an in-office glaucoma evaluation.

Purpose:

To report glaucoma screening rates and risk factors associated with referral for in-office glaucoma evaluation in the Manhattan Vision Screening and Follow-up Study (NYC-SIGHT).

Methods:

In this 5-year, cluster-randomized clinical trial, eligible individuals aged 40 and older were recruited from affordable housing developments and senior centers. Visual acuity with correction, intraocular pressure (IOP) measurements, and nonmydriatic fundus photography were conducted. Images were graded by a glaucoma specialist; those with an abnormal image were referred; those who failed the screening or had an unreadable fundus image were examined by the study optometrist. χ2 tests and stepwise multivariate logistic regression analyses were conducted to determine factors associated with glaucoma referral.

Results:

Totally, 708 participants were screened; 189 (26.6%) were referred for an in-office glaucoma evaluation due to an abnormal optic disc image (n=138) or abnormal optometric exam (n=51). Those referred had a mean age 68.5±11.7 years and were 60% female, 57% Black, and 37% Hispanic. Stepwise multivariate logistic regression showed participants with self-reported glaucoma (OR: 8.096, 95% CI: 4.706–13.928, P=0.000), IOP >23 mm Hg at the screening (OR: 3.944, 95% CI: 1.704–9.128, P=0.001), or wore prescription eyeglasses (OR: 1.601, 95% CI: 1.034–2.48, P=0.035) had higher odds of being referred for an in-office glaucoma evaluation. Of those referred, 106 (56%) attended, 36 participants (34%) were diagnosed with glaucoma and 38 participants (35.8%) as glaucoma suspects.

Conclusion:

Our findings support public health approaches that focus on community-based eye health screenings in high-risk populations and prioritize underserved communities.
Risk Factors for Infections Caused by Extended-Spectrum Beta-Lactamase Producing and Carbapenem-Resistant Enterobacterales in Pediatric Critical Care Settings: A Case-Control Study
Authors: Omar Amr , Asmar Basim I. , Ang Jocelyn , Salimnia Hossein , Thomas Ronald A. , Abdel-Haq Nahed
Published: November 2024

Background:

Infections due to Gram-negative resistant bacterial pathogens are a major concern in intensive care units (ICUs). Risk factors for extended-spectrum beta-lactamase (ESBL)–producing enterobacterales (ESBL-PE) and carbapenem-resistant enterobacterales (CRE) infections in pediatric critical care settings remain unclear.

Methods:

This was a retrospective case-control study of infections due to ESBL-PE and CRE during a 5-year period (2016–2021). Control cases were matched for age, infection site and year of infection, but their cultures grew enterobacterales that were non-ESBL or carbapenemase producers.

Results:

A total of 57 patients with ESBL-PE or CRE infections (cases) and 59 control patients were included. The majority of organisms were Escherichia coli and Klebsiella species recovered from the respiratory tract. There was no difference in prior hospital admission, pediatric ICU, or neonatal ICU stay during the previous 6 months, indwelling devices, comorbid conditions, or surgery in the last 6 months (P > 0.3). Risk factors evaluated by univariate analysis included the history of antibiotic use in the last 6 months, antibiotic treatment with cephalosporins including cefepime, cephalosporins treatment duration ≥7 days, treatment with trimethoprim/sulfamethoxazole and carbapenems and vancomycin use ≥ 7 days. However, multivariate logistic regression analysis showed that cefepime use ≥ 7 days was the single best predictor for cases with an odds ratio of 2.205-fold (95% confidence interval, 1.403–3.466; P < 0.001).

Conclusions:

Cefepime use ≥ 7 days was the most predictive risk factor of ESBL-PE and CRE acquisition. The study further underscores the need for optimizing antimicrobial stewardship practices to limit unnecessary and prolonged use of antibiotics to prevent the emergence of resistant pathogens.
Acute Kidney Injury and Outcomes in Infants, Children, and Adolescents, Supported With Extracorporeal Life Support for Cardiopulmonary Failure
Authors: Beshish Asaad G. , Qian Joshua , Keane-Lerner Kasey , Rodriguez Morales Paola , Shamah Rebecca , Zinyandu Tawanda , Nayi Pranay , Davis Joel , Rosenblum Joshua M. , Viamonte Heather K.
Published: November 2024

In neonatal and pediatric patients who require extracorporeal life support (ECLS), 60–70% develop acute kidney injury (AKI). Acute kidney injury has been associated with increased morbidity and mortality. We sought to describe our center’s experience with AKI in patients requiring ECLS and its effect on outcomes. We conducted a retrospective single-center study at an academic children’s hospital. All patients 0–18 years of age who required ECLS between January 2014 and December 2019. During the study period, there were 313 ECLS runs. The majority were neonates (66.8%) and 68.7% of runs were veno-arterial. Using Kidney Disease Improving Global Outcomes (KDIGO) criteria, 227 patients (72.5%) developed stage 2 or 3 AKI. The AKI group were younger (median age: 0.9 vs. 11.7 months, p < 0.001), more likely to experience a hemorrhagic complication (46.9% vs. 31.9%, p = 0.0298), and had higher mortality rates (44.9% vs. 24.4%, p = 0.0009). Neonates who required ECLS were more likely to develop stage 2 or 3 AKI (78%) than pediatrics (63%) (p = 0.005). Adjusting for confounders, patients who developed AKI had 2.38 times higher odds of mortality (95% confidence interval [CI]: 1.34–4.25, p = 0.003). We conclude that the majority of patients requiring ECLS develop stage 2 or 3 AKI. Those with AKI were twice as likely to die when controlling for confounding variables. Multicenter and prospective evaluation of this modifiable risk factor is imperative to improve the care of this high-risk cohort.
The effect of green tea on patients with type 2 diabetes mellitus: A meta-analysis
Authors: Jia Ming-Jie , Liu Xing-Ning , Liang Ying-Chao , Liu De-Liang , Li Hui-Lin
Published: November 2024

Background:

To systematically evaluate the effect of green tea on patients with type 2 diabetes.

Methods:

A computer search Cochrane, PubMed, Embase, CNKI, Wanfang, VIP, and other Chinese and English databases were conducted for randomized controlled trials of green tea in the treatment of patients with type 2 diabetes. The duration of these trials spanned from the establishment of the database to January 10, 2024. The obtained data were subjected to meta-analysis using Stata15.1 software. A total of 15 articles were included, encompassing 722 patients.

Results:

The meta-analysis results showed that compared to the control group, green tea intervention significantly improved the improvement of fasting blood glucose (SMD = −0.41, 95% CI: −0.67 to −0.19, P = .001), glycated hemoglobin (SMD = −0.68, 95% CI: −1.15 to 0.21, P = .004) and insulin resistance index (SMD = −0.70, 95% CI: −1.18 to −0.22, P = .005) in the experimental group compared to the control group. The differences were statistically significant (P < .05).

Conclusion:

Green tea significantly improves fasting blood glucose, glycated hemoglobin and insulin resistance in patients with type 2 diabetes.
The correlation of shift work and CLOCK, BMAL1, and PER1 gene polymorphisms with hypertension in healthcare workers: A cross-sectional study
Authors: Min Qiang , Hu Wanglin , Lei Dan , He Xinhao , Liu Chaoyi , Li Qing , Tian Weihua
Published: November 2024

This study aimed to investigate the polymorphisms of circadian clock genes and the association of shift work and gene polymorphisms with hypertension in healthcare workers. This study recruited 222 healthcare workers, of whom 76 had primary hypertension (Hyp group) and 146 served as controls (Control group). General information and working hours were collected through questionnaires. Next, the identification of specific single nucleotide polymorphism (SNP) loci related to the Circadian locomotor output cycles kaput (CLOCK), brain and muscle arnt-like 1 (BMAL1), and PER1 genes was conducted by literature and PDGene database search. Venous blood samples were then collected for DNA extraction, and polymerase chain reaction-restriction fragment length polymorphism techniques were used to analyze the genotyping and allele frequency of the SNP sites. Finally, multivariate logistic regression was employed to analyze the association between various risk factors and hypertension in healthcare workers. Compared to the control group, the Hyp group had significantly higher proportions of alcohol consumption and family history of hypertension, while the average sleep duration and average exercise time were significantly lower. Shift work analysis showed that the Hyp group had a significantly lower average number of evening shifts per month while a much higher average number of night shifts per month compared to the control group. The GG genotype at the CLOCK rs1801260 locus was associated with a lower risk of hypertension (OR = 0.446), and the TT genotype of the BMAL1 rs11022775 locus also showed a similar protective effect (OR = 0.426). However, the genotype distribution of the PER1 rs2735611 locus was not significantly associated with the risk of hypertension. Multivariate regression analysis revealed that a family history of hypertension and insufficient sleep were significantly associated with the risk of hypertension, and the average number of night shifts per month was positively correlated with the risk of hypertension. Specific polymorphisms in the CLOCK and BMAL1 genes may have a protective effect against hypertension in healthcare workers, while polymorphisms in the PER1 gene are not significantly associated with the risk of hypertension. Additionally, a family history of hypertension, insufficient sleep, and shift work patterns may be significant risk factors for hypertension.
Bioinformatics-based analysis of the role of immune-related genes in acute rejection after kidney transplantation and renal cancer development
Authors: Huang Shan , Yin Hang
Published: November 2024

Acute rejection (AR) is a common complication in the early stage after kidney transplantation. Some studies have shown that the occurrence of AR after kidney transplantation may further affect the development of tumors, and both AR and tumor development are related to immune cells and immune genes, so it is particularly important to diagnose the occurrence of AR at an early stage and to analyze the correlation between AR and tumors. In this study, we applied bioinformatics techniques for differential expression analysis and weighted gene co-expression network analysis analysis of AR patients to obtain differentially expressed genes and modular genes significantly associated with AR, respectively, so as to obtain their intersecting genes with immune-related genes; 21 intersecting genes were screened by lasso regression and Boruta algorithm to obtain the genes, and finally, the feature genes that were significantly associated with the dependent variable were further obtained by single-factor and multi-factor logistic regression. Then the best diagnostic model for AR was screened by 10 machine learning methods, and we evaluated the model in various aspects, such as receiver operator characteristic curve, decision curve analysis. We then focused on the role of FAM3C in renal cancer. We finally screened 4 feature genes (CD1D, FPR2, FAM3C, and HMOX1) to construct the AR diagnostic model; through comparative evaluation, we believe that logistic regression shows a better advantage in the construction of diagnostic models for AR. FAM3C may become a potential biological marker for AR diagnosis and plays an important role in the development of renal cancer. In summary, immune-related genes play an important role in the diagnosis of AR after kidney transplantation, and the gene FAM3C may be a potential therapeutic target for AR and renal cancer.
Evidence from Mendelian randomization analysis combined with meta-analysis for the causal validation of the relationship between 91 inflammatory factors and lumbar disc herniation
Authors: Yang Jingze , Xu Wanxian , Chen Daolei , Liu Yichen , Hu Xingbo
Published: November 2024

Lumbar disc herniation (LDH) is a common spinal disease. In recent years, an increasing number of observational studies have reported the impact of inflammatory factors on LDH. By conducting Mendelian randomization (MR) analysis on 91 inflammatory factors, it is possible to reveal their causal relationship with LDH, providing new insights for prevention and treatment strategies. In this study, a two-sample MR analysis was performed, using 91 inflammatory factors as exposure data, and LDH data from 2 different sources as outcome data. Subsequently, the most significant results from the inverse-variance weighted analysis were subjected to meta-analysis, with multiple corrections applied to the thresholds to ensure result accuracy. Finally, reverse causality MR analysis was conducted to validate the causal relationship between the identified positive inflammatory factors and LDH. Ninety-one cytokines were analyzed in relation to LDH using MR with data from the Finngen and UK Biobank databases. The inverse-variance weighted results from both analyses were then meta-analyzed, and multiple corrections were applied to the significance threshold of the meta-analysis results. Ultimately, only 1 cytokine, tumor necrosis factor-beta levels (genome-wide association study ID: GCST90274840), showed a significant association after the combined MR analysis and multiple corrections, with an odds ratio of 1.073 (95% confidence interval: 1.034–1.113, P = .0154). Furthermore, this positive cytokine did not display any reverse causality with LDH from either data source. Tumor necrosis factor-beta levels are a risk factor for LDH, potentially increasing the risk of developing the condition and exacerbating its symptoms.
Transcription factors in tanshinones: Emerging mechanisms of transcriptional regulation
Authors: Pan Yanyun , Dai Jin , Jin Minwei , Zhou Qiujun , Jin Xiaoliang , Zhang Jinjie
Published: November 2024

Transcription factors play a crucial role in the biosynthesis of tanshinones, which are significant secondary metabolites derived from Salvia miltiorrhiza, commonly known as Danshen. These compounds have extensive pharmacological properties, including anti-inflammatory and cardioprotective effects. This review delves into the roles of various transcription factor families, such as APETALA2/ethylene response factor, basic helix-loop-helix, myeloblastosis, basic leucine zipper, and WRKY domain-binding protein, in regulating the biosynthetic pathways of tanshinones. We discuss the emerging mechanisms by which these transcription factors influence the synthesis of tanshinones, both positively and negatively, by directly regulating gene expression or forming complex regulatory networks. Additionally, the review highlights the potential applications of these insights in enhancing tanshinone production through genetic and metabolic engineering, setting the stage for future advancements in medicinal plant research.
A novel predictive model for Intensive Care Unit admission in Emergency Department patients with upper gastrointestinal bleeding
Authors: Yang Jinmo , Han Sangsoo , Nah Sangun , Chung Sung Phil
Published: November 2024

Acute upper gastrointestinal bleeding (UGIB) is a critical emergency. Conventional scoring models for patients with UGIB have limitations; thus, more suitable tools for the Emergency Department are necessary. We aimed to develop a new model that can identify significant predictors of Intensive Care Unit (ICU) admission in Emergency Department patients with UGIB and to compare its predictive accuracy with that of existing models. We retrospectively analyzed data from patients with UGIB treated between January 2020 and July 2022 at the Emergency Department of a single tertiary medical center. Using multivariable logistic regression and the area under the receiver operating characteristic curve (AUROC), we developed a new model to predict the probability of ICU admission. Among 433 patients, multiple logistic regression analysis identified sex, systolic blood pressure, diastolic blood pressure, hemoglobin level, platelet count, alanine transaminase level, and prothrombin time as significant predictors of ICU admission. Our model demonstrated superior predictive accuracy with an AUROC of 0.8539 (95% confidence interval [CI]: 0.8078–0.8999), outperforming the Glasgow–Blatchford score and AIMS65 score, which had AUROCs of 0.7598 (95% CI: 0.7067–0.8130) and 0.6930 (95% CI: 0.6324–0.7537), respectively. We implemented this model in a user-friendly calculator for clinical use. We identified key predictors of ICU admission that are crucial for hemodynamic stabilization in patients with UGIB. Our model, combined with this probability calculator, will enhance clinical decision-making and patient care for UGIB in emergency settings.
Liver disease-linked metabolic and behavioral factors associated with cognitive performance in an observational study of community dwelling adults
Authors: Weinstein Ali A. , de Avila Leyla , Fadahunsi Adetokunbo I. , Price Jillian K. , Golabi Pegah , Escheik Carey , Gerber Lynn H. , Younossi Zobair M.
Published: November 2024

Modifiable risk factors associated with cognitive functioning are important for identifying potential targets for intervention development. Although there are a few recognized modifiable risk factors (e.g., diabetes mellitus, diet, physical activity), there are limitations in the conclusions that can be drawn due to limited data. Therefore, this study examined the relationship between modifiable liver disease-linked metabolic and behavioral factors in a sample of community dwelling adults who do not currently experience functional limitations due to cognitive abilities. Individuals aged 19 to 69 were recruited to participate in this cross-sectional study in the Washington, DC area. Participants were assessed using anthropometric measures, ultrasound of the liver, glycated hemoglobin A1C, self-reported fatigue, clinical history, and 7 domains of cognitive function: processing speed, short- and long-term visual memory, working memory, inhibition, shifting, and abstract reasoning. The study included 104 participants (44% female, 51.1 ± 13.5 years old). The modifiable factors that were most consistently related to cognitive performance were waist-to-height ratio, which was related to a decrease in performance in 4 of the domains (short-term and long-term visual memory, working memory, and abstract reasoning), and the presence of nonalcoholic fatty liver disease, which was related to an increase in performance in the same 4 domains. This study suggests that liver disease-linked modifiable factors are associated with cognitive performance, even in middle-aged individuals without self-reported cognitive dysfunction. Further research is needed to explore the mechanisms that impact cognitive performance in relation to these factors to establish early intervention targets for reducing future cognitive deficits.
Efficacy and safety of several common drugs in the treatment of acute respiratory distress syndrome: A systematic review and network meta-analysis
Authors: Liu Qing-Kuo , Xiang Guo-Han , Liu Wen-Li , Dong Jin-Yan , Wen Yu-Qi , Hao Hao
Published: November 2024

Background:

This study aimed to compare the effectiveness and safety of neuromuscular blockers, mesenchymal stem cells (MSC), and inhaled pulmonary vasodilators (IV) for acute respiratory distress syndrome through a network meta-analysis of randomized controlled trials (RCTs).

Methods:

We searched Chinese and English databases, including China National Knowledge Infrastructure, The Cochrane Library, PubMed, and EMbase, with no time restrictions. We conducted a network meta-analysis and reported the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We included 27 clinical RCTs, all of which were two-arm trials, totaling 3492 patients. We selected 28-day mortality as the primary outcome measure, whereas 90-day mortality, ventilator-free days, and oxygenation served as secondary outcome measures for analysis and comparison.

Results:

We selected 3 treatment modalities and evaluated their clinical trials in comparison with the standard control group. For the 28-day in-hospital mortality, we included 21 RCTs, involving 2789 patients. Compared to standard treatment, neuromuscular blockers were associated with reduced 28-day hospital mortality (odds ratios [OR] 0.52, 95% confidence intervals [CI] (0.31, 0.88)), while IV and MSC were not associated with reduced hospital mortality (OR 0.89, 95% CI (0.50, 1.55); OR 0.90, 95% CI (0.49, 1.66)). In terms of 90-day mortality, days free of mechanical ventilation, and improvement in oxygenation, there were no significant differences compared to standard treatment with neuromuscular blockers, MSC, and IV.

Conclusion:

Neuromuscular blockers significantly reduced the 28-day mortality rate in acute respiratory distress syndrome patients. However, in terms of 90-day mortality, ventilator-free days, oxygenation improvement, IV, MSC, and neuromuscular blockers did not significantly improve.
Primary care research on hypertension: A bibliometric analysis using machine-learning
Authors: Yasli Gökben , Damar Muhammet , Özbiçakci Şeyda , Alici Serkan , Pinto Andrew David
Published: November 2024

Hypertension is one of the most important chronic diseases worldwide. Hypertension is a critical condition encountered frequently in daily life, forming a significant area of service in Primary Health Care (PHC), which healthcare professionals often confront. It serves as a precursor to many critical illnesses and can lead to fatalities if not addressed promptly. Our study underscores the importance of this critical issue by analyzing articles related to hypertension in the PHC research area from the Web of Science Core Collection using bibliometric methods and machine learning techniques, specifically topic analyses using the latent Dirichlet allocation method. The analysis was conducted using Python Scikit-learn, Gensim, and Wordcloud Libraries, the VosViewer program, and the Bibliometrix R Biblioshiny library. Our findings revealed a steady increase in publication output in hypertension-related research. Analysis shows that hypertension-related research in the PHC research area is clustered into 8 groups: (1) management of hypertension in PHC, risk factors, and complications; (2) psychiatric disorders and hypertension; (3) pediatric and pregnancy hypertension; (4) environmental factors and living conditions; (5) sex and age effects on hypertension; (6) COVID-19 and hypertension; (7) behavioral risk factors, quality of life, and awareness; and (8) current treatment methods and guidelines. Research on hypertension has focused intensively on kidney disease, obesity, pregnancy, cardiovascular risk, heart disease, calcium channel blockers, body mass index, amlodipine, mortality, risk factors, hyperlipidemia, depression, and resistant hypertension. This study represents the first and comprehensive bibliometric analysis of hypertension in the PHC research area. Annual publication volumes have steadily increased over the years. In recent years, topics such as social determinants, patient attendance, self-management, diabetes mellitus, COVID-19, telemedicine, type 2 diabetes, and noncommunicable diseases have garnered significant interest in the field of PHC services.
Research status, hotspots, and implications of seasonal affective disorder: A bibliometric analysis based on CiteSpace and VOSviewer
Authors: Zhu Shuaibo , Zhan Wanghui , Jin Wei , Xu Zitong , Yang Hongji , Tao Ming , Li Lihong
Published: November 2024

The objective was to determine the research status and hotspots of seasonal affective disorders (SAD) based on bibliometric tools, which will contribute to the further research in this field. We used bibliometric tools CiteSpace and VOSviewer to conduct visual quantitative analysis on 465 SAD literatures in the Web of Science core database from 2008 to 2023 from multiple perspectives such as collaboration network, keywords, and literature citations. At the same time, we used Microsoft Word to make relevant tables. The publication of SAD-related literature has been on the rise in the past 15 years, countries with high production of SAD literature are mainly concentrated in the United States, Austria, and Canada, and certain cooperative relationships have been established between various institutions and scholars. Research keywords in our study are mainly limited to pathogenesis (“Photoperiod,” “exposure,” “winter,” “serotonin transporter,” and “creb”) and treatment measures (“light therapy” and “melatonin”). In recent years, literature research hotspots mainly focus on the treatment of SAD with light therapy, the application of exogenous drugs, the biological clock mechanism of SAD pathogenesis, the relationship between SAD and inflammation, etc. The correlation between SAD and sleepiness and alternative treatments to light therapy may be future research hotspots. The research results reveal the future research focus of SAD. There is a considerable interest in the photoperiodic pathogenesis of SAD, light therapy and its alternative therapies, and there is still hope for further exploration. Substantial research into evidence-based prevention as well as treatment strategies is necessary to improve outcomes.
Analysis of risk factors for negative emotions in patients with thyroid nodules: A cross-sectional study
Authors: Wang Mengxuan , Wang Shuo , Yuan Guoshan , Gao Mingzhou , Wang Jieqiong , Chu Zhenhan , Ren Lv-Ning , Gao Dongmei
Published: November 2024

Investigations have indicated that there is a correlation between thyroid nodules and patients’negative emotions. Nevertheless, the risk factors contributing to the development of negative emotions in thyroid nodule patients remain unidentified. This cross-sectional study recruited 150 patients diagnosed with thyroid nodules through ultrasound examination from January 2022 to January 2023 at Jinan Central Hospital, the Second Affiliated Hospital of Shandong First Medical University, and Qingyun County Maternal and Child Health Hospital as the case group, which were categorized based on their levels of anxiety and depression. Simultaneously, 150 individuals with normal thyroid ultrasound findings were selected as the control group. The researchers chose a self-administered general information questionnaire and 6 psychological scales as the assessment tools for the patients. SPSS 26.0 was used to analyze the risk factors for negative emotions in patients with thyroid nodules. The scores of the self-rating anxiety scale were higher in the case group than in the control group (40.90 ± 9.490 vs 38.37 ± 6.836, P = .028), as were the scores of the self-rating depression scale (44.35 ± 9.180 vs 41.48 ± 8.297, P = .004). There is a positive correlation between thyroid nodules and degrees of anxiety and depression (R = 0.176, P = .002; R = 0.206, P = .000). The results of the binary logistic regression analysis revealed that both fatigue state (P = .013) and negative life events (P = .001) exerted independent effects on anxiety, whereas negative life events (P = .002) had independent effects on depression. This study enhances the understanding of the relationship between thyroid nodules and anxiety and depression. It reveals that thyroid nodules are associated with negative emotions and that negative life events have a significant influence on anxiety and depression in these individuals, which may contribute to the development of strategies for preventing and treating thyroid nodules in clinical practice.
Long-term outcome and antitumor immune activation response in prostate cancer treated with low-dose-rate brachytherapy
Authors: Wang Zengzeng , Wang Li , Zhang Qiang , Xu Yong , Zhang Changwen
Published: November 2024

To evaluate the long-term clinical outcomes of iodine-125 low dose-rate brachytherapy (LDR-BT)-based treatment approaches for ≤ cT3 prostate cancer (PC) patients in China, as well as the effects on the PC immune microenvironment. Data was retrospectively collected from 237 patients with ≤ cT3 PC who were treated with radical prostatectomy (RP) or LDR-BT alone or in combination with androgen deprivation therapy (ADT), and biochemical progression-free survival (bPFS), prostate cancer-specific survival (PCSS) and overall survival (OS) rates were compared. In 63 cases, PC patients received RP after biopsy, received at least 6 months of ADT before RP, or received LDR-BT and deferred limited transurethral resection of the prostate (TURP). Immunohistological analyses and expression comparisons of programmed death-ligand 1 (PD-L1) and tumor-infiltrating lymphocytes (TILs, expressing CD3, CD4, CD8, and PD-1) on tissue sections from archival prostate biopsy samples with corresponding TURP or RP history were performed by paired t test. The 8-year bPFS, PCSS, and OS rates for LDR-BT and RP were 53.4% and 63.6%, 84.9% and 86.8%, and 63.8% and 70.2%, respectively, although these differences were not statistically significant. PD-L1 was expressed in 35 of 63 cases. The average infiltration scores of TILs (expressing CD3, CD4, and CD8) were 3.6 (1–5), 2.90 (1–5), and 2.46 (1–5), respectively. PD-1 + T cells were seen in 55.6% of cases, with an average score of 0.89 (range: 0–3). In TURP tissue samples from 23 patients, CD3+, CD4+, and CD8 + T cells increased significantly. PD-1 + T cells exhibited a moderate increase, with conversion to positive PD-1 expression in T cells observed in 13 out of 14 cases. The PD-L1 expression score of PC cells was significantly elevated, with conversion to positive in 8 of 9 cases. LDR-BT monotherapy and combination therapy with external beam radiotherapy (EBRT) and ADT are suitable treatment approaches for low-risk and intermediate- or high-risk PC, respectively. Most TILs in PC are not tumor antigen-specific T-cells. LDR-BT can stimulate anti-tumor immunity during a narrow time window and should be combined with immunotherapy as an auxiliary therapy.