bluuebunny/crossref_metadata_2025 huggingface dataset:
Increasing discrepancy of MR imaging and CSF study in patients with leptomeningeal seeding from lung adenocarcinoma after targeted therapy using a tyrosine kinase inhibitor
Authors: Seong Minjung , Park Sehhoon , Kim Sung Tae , Goo Park Sung , Kim Yikyung , Cha Jihoon , Yeop Kim Eung , Kim Hyung-Jin , Ahn Myung-Ju
Published: October 2023

Purpose:

To evaluate the correlation between contrast-enhanced (CE) MRI and cerebrospinal fluid (CSF) cytology for the evaluation of leptomeningeal metastasis (LM) on MRI after targeted therapy with tyrosine kinase inhibitors.

Methods:

We retrospectively reviewed the data of nonsmall cell lung cancer patients registered with NCT03257124 from May 2017 to December 2018, with progressive disease despite targeted therapy. Twenty-nine patients whose MRI scans exhibited LM at the time of registration were enrolled. During the targeted therapy with osimertinib, MRI scans, and subsequent CSF examinations were performed in every 2 months. In total, 113 MRI scans and CSF cytology data after treatment were collected. For each CE MRI scan, LM positivity was evaluated on 3D T1-weighted image (T1WI) and 2D FLAIR. The correlation between MRI and CSF cytology results and the diagnostic performance of MRI with CSF cytology as a reference standard were evaluated.

Results:

After treatment, MRI revealed positivity for LM in 81 and negativity in 32. CSF results were positive in 69 examinations and negative in 44. The diagnostic accuracy of CE 3D T1WI and 2D FLAIR was 0.52 and 0.46, respectively. After targeted therapy, discrepancy in the CSF and MRI results tended to increase over time. The proportions of concordant MRI and CSF cytology results after targeted therapy were 66%, 58%, 62%, and 47% at the first, second, third, and fourth follow-up, respectively.

Conclusion:

The discrepancy of MRI in evaluation of LM and CSF cytology increases over time after targeted therapy with osimertinib. LM positivity on MRI could be a surrogate imaging marker in the pre- and immediate posttargeted-treatment with Osimertinib but not after sessions of osimertinib.
Research progress on the correlation between MRI and impairment caused by cerebral small vessel disease: A review
Authors: Wang Yang , Liu Zhirong
Published: October 2023

Cerebral small vessel disease (CSVD) is a chronic global brain disease mainly involving small blood vessels in the brain. The disease can be gradually aggravated with the increase of age, so it is the primary cause of brain dysfunction in the elderly. With the increasing aging of the world population and the high incidence of cerebrovascular risk factors, the incidence of CSVD is increasing day by day. CSVD is characterized by insidious onset, slow progression, diverse clinical manifestations, and difficult early diagnosis. CSVD can lead to cognitive impairment, gait impairment, affective impairment, and so on. however, it has not received enough attention from researchers in the past. In recent years, some studies have shown that CSVD patients have a high proportion of related impairment, which seriously affect patients daily life and social functions. Currently, no clear preventive measures or treatments exist to improve the condition. With the development of magnetic resonance imaging, CSVD has become more and more recognized and the detection rate has gradually improved. This paper reviews the research progress of magnetic resonance imaging and cognitive impairment, gait impairment, affective impairment, urination disorder, swallowing disorder, and other disorders to provide a useful reference for the early diagnosis and treatment of CSVD and expand new ideas.
Clinical strategies for securing negative proximal margin in early gastric cancer
Authors: Chung Jae Hun , Im Dong Won , Ryu Dae-Gon , Choi Cheol Woong , Kim Su Jin , Hwang Sun-Hwi , Lee Si-Hak
Published: October 2023

Securing an appropriate proximal resection margin (PRM) is crucial for oncological safety in treating gastric cancer. This study investigated the clinicopathological characteristics of patients with incomplete PRM length of <2 cm in early gastric cancer. Clinicopathological data of 1,493 patients who underwent subtotal gastrectomy for early gastric cancer in 2012 to 2021 were retrospectively reviewed. Patients were divided into the PRM length of <2 cm and ≥2 cm groups based on pathological results. Univariate and multivariate analyses evaluated factors for incomplete PRM length. Factors related to patients with a relative PRM positive were also analyzed. The proportion of patients with a PRM length of <2 cm was 17.9% (267/1,493). Multivariate regression analysis revealed that age <50, preoperative endoscopic size of ≥3 cm, size discrepancy of ≥2 cm, and midbody tumor with a lesser curvature significantly contributed to the PRM length of <2 cm. Twenty-four patients had a relative PRM positive (24/1493, 1.6%). An incomplete PRM was the only risk factor for a positive relative PRM. Surgical treatment for early gastric cancer requires an accurate preoperative endoscopic tumor size and location evaluation. A more aggressive resection is recommended for patients with age <50, preoperative endoscopic size of ≥3 cm, size discrepancy of ≥2 cm, and midbody tumor with a lesser curvature.
Case report: Successful treatment of Chidamide in a refractory/recurrent SPTCL with ARID1A mutation on the basis of CHOP plus auto-HSCT
Authors: Zhang Nan , Zhang Shan , Ma Lei , Qiu Ling , Meng Qing-Li , Cai Jiao , Xu Zhen , Yao Hao , Fan Fang-Yi
Published: October 2023

Rationale:

Subcutaneous panniculitis like T-cell lymphoma (SPTCL) is a rare primary cutaneous lymphoma that belongs to peripheral T cell lymphomas, of which the overall prognosis is poor. Chidamide, a deacetylase inhibitor, has been approved for the treatment of peripheral T cell lymphomas. However, due to the rare occurrence of SPTCL, it is currently unknown whether Chidamide is effective for all SPTCL patients and whether there are molecular markers that can predict its therapeutic effect on SPTCL.

Patient concerns and diagnoses:

The patient was a sixteen-year-old male and underwent subcutaneous nodule biopsy which showed SPTCL. Next-generation sequencing revealed AT-rich interaction domain 1A (ARID1A) mutation, and positron emission tomography/computed tomography showed scattered subcutaneous fluorodeoxyglucose metabolic lesions throughout the body.

Interventions and outcomes:

During the first 3 CHOP (cyclophosphamide, doxorubicin, vindesine, and prednisone) treatment, the patient relapsed again after remission, and the successive addition of methotrexate and cyclosporine did not make the patient relapsing again. Then, after adding Chidamide to the last 3 CHOP treatment, the patient was relieved again. The patient underwent autologous hematopoietic stem cell transplantation (auto-HSCT) after completing a total of 8 cycles of chemotherapy, and continued maintenance therapy with Chidamide after auto-HSCT. Currently, the patient has been in continuous remission for 35 months.

Lessons subsections:

This case is the first report of a refractory/recurrent SPTCL with ARID1A mutation treated with Chidamide. The treatment of Chidamide on the basis of CHOP plus auto-HSCT therapy achieved good results, suggesting that ARID1A may act as a molecular marker to predict the therapeutic effect of Chidamide on SPTCL patients, which helps to improve the precision of SPTCL treatment and the overall prognosis of SPTCL patients.
Flash’O real-world evidence programme – Attitude and practices toward the use of omega-3 FA by physicians from Middle East Countries
Authors: Kinsara Abdulhalim Jamal , Sabbour Hani
Published: October 2023

The Flash’O project was designed to provide insights into the current use of prescription omega-3 and their perceived benefits by physicians in real-world clinical practice, in Russia, Saudi Arabia, Thailand, and Gulf countries, and to determine the adherence of physicians to dyslipidemia management guidelines. The present study focuses on Flash’O’s process and results in Middle East countries.

A total of 338 physicians and specialists completed the online questionnaire. Most responding physicians were male (91.7%), general practitioners (42.6%) with more than 5 years of seniority (80.4%) and saw more than 50 patients a week (71.5%). Most surveyed physicians (64.2%) reported using guidelines in their daily practice for the management of their patients with dyslipidemia. They mostly followed national guidelines (68.6%). American or European ones were less commonly used.

Responding physicians thought that omega-3 supplementation could be more beneficial in all types of dyslipidemia, except high non- hight density lipoproteins, and for patients suffering from obesity, type 2 diabetes mellitus, acute coronary syndrome with ST-segment elevation myocardial infarction and high cardiovascular diseases risk (score ≥ 5% and < 10%), but less beneficial in chronic kidney disease. Respondents recommended omega-3 to their patients mainly after statin treatment in patients with dyslipidemia and for the treatment of dyslipidemia.

This survey confirmed that omega-3 fatty acids are at the heart of the cardiovascular medical strategy.
Construction of a novel disulfidptosis-related signature for improving outcomes in hepatocellular carcinoma: Observational study
Authors: Chen Xi , Liang Qun , Zhou Yongan
Published: October 2023

Disulfidptosis is a novel form of metabolic-related regulated cell death (RCD) that is caused by disulfide stress caused by the accumulation of excess cystine in the cell. Targeting disulfide metabolism imbalance is an emerging strategy for the treatment of cancer. However, it is undetermined how disulfidptosis-related genes (DRGs) influence hepatocellular carcinoma (HCC). Unsupervised clustering analysis was performed on the TCGA-LIHC cohort to identify various phenotypes of disulfidptosis. GSVA was used to measure the activation of characteristic gene sets, while CIBERSORT was employed to estimate the infiltration of immune cells. Disulfidptosis-related signature was generated to quantify the phenotype of disulfidptosis in HCC patients. Next, we examined the disparities among the high and low disulfidptosis score categories by considering clinical characteristics, infiltration of immune cells, functions related to the immune system, sensitivity to chemotherapeutic drugs, and effectiveness of immunotherapy. Two different disulfidptosis phenotypes with different prognoses, clinical traits, biological pathways, and immune cell infiltration were identified. Based on differently expressed genes (DEGs) among 2 disulfidptosis phenotypes, a disulfidptosis-related signature was built. The prognostic value of this signature was then evaluated in the TCGA and GEO datasets. Low disulfidptosis score indicated favorable clinical outcomes, higher levels of immune cell infiltration, lower tumor purity, and enhanced immune responses. Furthermore, we noticed a clear disparity in tumor mutation load and drug responsiveness when comparing the high and low disulfidptosis score categories. Finally, a quantitative nomogram was built with disulfidptosis score and several clinical characteristics. The disulfidptosis-related signature provides new insights into the tumor immune microenvironment and complexity in HCC. The disulfidptosis score can serve as a promising tool for personalized prognostic prediction of HCC patients and for customizing more effective immunotherapeutic strategies.
CONUT can be a predictor of postoperative complications after laparoscopic-assisted radical gastrectomy for elderly gastric cancer patients
Authors: Lin Jian , Liang Huiping , Zheng Huanhuan , Li Shengqi , Liu Huaying , Ge Xiaolong
Published: October 2023

Compared with young patients, elderly patients with gastric cancer usually have lower muscle mass, poorer nutritional status, lower immunity, and worse cardiopulmonary function. Therefore, how to improve the prognosis of elderly gastric cancer patients after laparoscopic-assisted radical gastrectomy is the focus and difficulty of clinician. The aim of our study was to investigate the risk factors for postoperative complications of these patients. The data of gastric cancer patients aged ≥ 60 years who underwent laparoscopic-assisted radical gastrectomy were analyzed. Univariate was used to determine the potential risk factors and then multivariate analyses was used to determine the independent risk factors for postoperative complications. Univariate analysis showed that age, preoperative red blood cell (RBC), preoperative albumin (ALB), preoperative C-reactive protein (CRP), preoperative hemoglobin (Hb), preoperative blood transfusion, preoperative lymphocytes, total cholesterol, CRP-to-ALB ratio, controlling nutritional status (CONUT) score, TNM stage were all the potential risk factors for postoperative complications. Binary logistic regression showed that CONUT, age and preoperative RBC were correlated with postoperative complications. For elderly gastric cancer patients after laparoscopic-assisted radical gastrectomy, CONUT, age and preoperative RBC were all the independent risk factors for overall postoperative complications and could be used as reliable indicators for judging the short-term prognosis.
Failed reintubation during resuscitation after posterior occipito-cervical spinal fusion: A case report
Authors: Huang Fan , Zhong Qing , Wang Yan , Weng Yan
Published: October 2023

Rationale:

Posterior occipito-cervical spinal fusion (OCF) is a common surgical method for atlantoaxial dislocation, but postoperative airway complications may occur. Reintubation has been reported in the past, but the failure of reintubation is rare.

Patient concerns:

A 54-year-old woman who underwent OCF due to rheumatoid cervical spondylosis and atlantoaxial dislocation. In the postanesthesia care unit, the patient developed upper respiratory tract obstruction after extubation.

Diagnoses and interventions:

It is an upper respiratory tract obstruction due to anatomical changes because of surgery. Emergency airway management was activated, but it did not work.

Outcomes:

Emergency reintubation failed, and the patient was finally saved after tracheotomy.

Lessons:

For patients who underwent OCF due to cervical spondylosis caused by rheumatoid arthritis, great attention should be paid to the perioperative airway management, especially during the recovery period. And more important, adequate reintubation preparatory work should be done before extubation.
Laparoscopic cholecystectomy for giant gallbladder: A case report
Authors: Gao Yi , He Diancai , Feng Wenqi , Yue Jing , Jian Zhiyuan
Published: October 2023

Rationale:

An overdistended gallbladder is usually observed in cases of distal bile obstruction due to malignancy. The gallbladder may also become enlarged and distended during cystic duct or gallbladder neck obstruction due to gallstones. However, a grossly distended gallbladder ( > 14 cm in length) without any pathology is rare. We present the case of a 46-year-old female patient who suffered from acute right lower quadrant pain for 4 days. Initially, a liver cyst and a choledochal cyst were diagnosed by the local hospital. Then, the diagnosis of giant gallbladder (measuring approximately 20.0 cm × 7.0 cm and containing more than 30 gallbladder stones) was made by magnetic resonance cholangiopancreatography at our hospital. Finally, we successfully performed a laparoscopic cholecystectomy and the patient had an uneventful recovery.

Patient concerns:

A 46-year-old female patient presented with acute right lower quadrant pain lasting 4 days. At first, the abdominal pain was severe and paroxysmal, and then it subsided spontaneously. Computed tomography of the abdomen at another hospital revealed a hepatic cyst and a choledochal cyst. Come to our hospital for surgical treatment.

Diagnoses:

giant gallbladder with gallstones.

Interventions:

Laparoscopic cholecystectomy was successfully performed in this patient after decompressing the gallbladder.

Outcomes:

On the third postoperative day, the patient recovered well, and the abdominal pain resolved following the operation. At the 3-year postoperative follow-up, the patient was symptom-free, with no obvious abnormalities seen in liver function and hepatobiliary color Doppler ultrasound.

Lessons:

The patient was successfully treated using laparoscopic cholecystectomy. This rare case may contribute to the development of mechanisms for treating giant gallbladders.
NIFK as a potential prognostic biomarker in colorectal cancer correlating with immune infiltrates
Authors: Tan Lin , He Yuqi , Wu Linhui , Liu Shiquan , Peng Peng , Huang Jiean
Published: October 2023

Background:

Immune-related initiation, progress, metastasis and sensitivity to treatment associated with poor prognosis of patients with colorectal cancer (CRC). The role of Nucleolar protein interacting with the FHA domain of MKI67 (NIFK) in CRC remained to be investigated. We explore whether NIFK correlates with tumor immune infiltration and plays an important role in CRC patient prognosis.

Methods:

The data of samples involved in our study was obtained from TCGA and GEO and samples for protein expression detection and clinical information analysis were obtained from our hospital. NIFK expression, association with patient prognosis, correlation with infiltration of immune cells and its correlated genes involved in signaling pathways were analyzed using bioinformatics method along with experimental validation and clinical correlation analysis.

Results:

Results indicated that the expression of NIFK in tumor tissues was significantly increased compared with normal samples. colon and rectal cancer patients with high NIFK expression have poor survival compared with those with low NIFK expression. Results of cell experiments indicated that NIFK is positively correlated with cell proliferation and migration in CRC. NIFK negatively correlated with T cell CD8+, Tregs, Neutrophil and macrophage significantly. DARS and NKRF were positively correlated with NIFK and DARS correlated with CD8 + T cell, CD4 + T cell, macrophage and Neutrophil, NKRF correlated with CD8 + T cell, CD4 + T cell and macrophage in colon and rectal cancer. NIFK along with its correlated genes as DARS and NKRF were involved in Wnt, PI3K-Akt, NF-κB signaling and Intestinal immune network for lgA production.

Conclusions:

Our results suggested that NIFK might be a biomarker associated with poor prognosis of CRC patients, and it would be a potential target for CRC therapy.
A case report: Unilateral biportal endoscopic revision for adjacent segmental disease: Case presentations and literature review
Authors: Zhu Chengyue , Zhang Yujun , Sun Susu , Shao Rongxue , Liang Jiaming , Cheng Wei , Pan Hao , Zhang Wei
Published: October 2023

Rationale:

Biportal endoscopic revision surgery for adjacent segmental disease (ASD) after lumbar arthrodesis is seldomly reported. Herein, we present 3 cases of ASD with radiculopathy wherein satisfactory results were obtained using unilateral biportal endoscopic (UBE) decompression.

Patient concerns:

Case 1 was of a 56-year-old male who presented with a chief complaint of Intermittent claudication since 2-year. Case 2 involved a 78-year-old female who was admitted to the hospital with a chief complaint of radiating pain and weakness in the left leg for at least 1 year. Case 3 was a 67-year-old woman who visited our hospital because of radiating leg pain for 5 months. All the cases had a history of L4 to L5 lumbar interbody fusion surgery.

Diagnoses:

Computed tomography and magnetic resonance imaging showed the spinal epidural lipomatosis at the L3 to L4 level in case 1, the up-migrated lumbar disc herniation at L3 to L4 level in case 2 and unilateral foraminal stenosis at the L5 to S1 level in case 3.

Interventions:

Under UBE guidance, the ipsilateral approach was used to treat adjacent lumbar stenosis caused by spinal epidural lipomatosis. The contralateral approach was used to remove the up-migrated herniated disc. The paraspinal approach was applied to decompress the foraminal stenosis.

Outcomes:

Postoperative parameters were improved clinically, and nerve roots were decompressed radiologically. No complications were developed.

Lessons:

UBE revision surgery showed a favorable clinical and radiological result without complications and may be a safe and effective alternative technique for ASD.
Early treatment for benign paroxysmal positional vertigo secondary to sudden sensorineural hearing loss
Authors: Li Gui Fang , Liu Man , Zhang Yan Zhuo , Wang Yue Tang , Su Lan , Liu Ran Ran
Published: October 2023

Sudden sensorineural hearing loss (SSNHL) accompanied by benign paroxysmal positional vertigo (BPPV) is relatively common in the clinic. There are unified standards for the treatment of primary BPPV with good reduction effect, while there are few studies on the treatment of BPPV secondary to SSNHL within 1 week of onset. The study was to investigate the treatment of BPPV secondary to SSNHL and compare its manual reduction with that of primary BPPV. We selected 90 patients with BPPV accompanied by SSNHL within a week of onset and 210 primary BPPV patients at Hebei Provincial Eye Hospital from June 2020 to December 2022. The former group was divided into the medicine group and manual reduction plus medicine group. The medicines used were extract of Ginkgo biloba leaves injection, betahistine hydrochloride injection and oral prednisone. We contrasted the efficacy respectively for posterior semicircular canal BPPV (psc-BPPV), horizontal semicircular canal BPPV (hsc-BPPV) and multiple semicircular canal BPPV (msc-BPPV). In addition, we compared the manual reduction effect for primary BPPV and manual reduction group, and the evaluation of efficacy are the intensity of nystagmus and the clinical symptoms. In the secondary BPPV group, there was no difference in efficacy between the medicine group and manual reduction group at the 7th-day after reduction for psc-BPPV, hsc-BPPV, and msc-BPPV (P > .05). The immediate effect of reduction was significantly different between the primary BPPV group and the group with SSNHL and BPPV for both psc-BPPV and hsc-BPPV (P < .05), and the effect of the primary BPPV group was better, but it was no difference for msc-BPPV (P > .05). For the treatment of BPPV accompanied by SSNHL within 1 week of onset, the additional reduction therapy showed no benefit, so we need to apply medication for SSNHL.
ART and Serum albumin are influencing factors of the 5-year survival rate of people living with HIV undergoing maintenance hemodialysis caused by HIV: A cohort study
Authors: Su Chunxiong , Ma Yuting , Liang Huiping , Huang Aixian , Deng Wenhai , Zhou Jia , Liu Huaying
Published: October 2023

Human immunodeficiency virus (HIV) infection is one of the most prominent public health problems worldwide. The 5-year survival rate of people living with HIV undergoing maintenance hemodialysis (MHD) and the factors related to the survival rate have not been widely studied. This study calculated the 5-year survival rate of people living with HIV who were undergoing MHD and determined the risk factors that may affect the 5-year survival rate. All enrolled participants were followed up for more than 5 years from the first round of MHD. The survival rate of them was calculated, the Cox proportional hazards model was used for multivariate analysis, the Kaplan–Meier method was used to draw the survival curve, and the log-rank test was used to compare the survival time of different groups. A total of 121 participants were included in the study. Statistical analysis showed that the overall 5-year survival rate was 19.0%. The 6-, 12-, 24-, and 36-month survival rates were 71.90%, 56.20%, 41.32%, and 30.58%, respectively. Infection was the leading cause of death, accounting for 55.37%. The Cox proportional hazards model revealed that antiretroviral therapy (ART) and the serum albumin level after dialysis were independent protective factors for patient survival. The log-rank test showed that there was a significant difference in survival time between the ART and non-ART groups.
Impact of forced diuresis at two different time points on pelvic imaging in prostatic carcinoma with 68Ga-PSMA PET/CT
Authors: Raju Shobhana , Sharma Akshima , Kumar Sanjay , Seth Amlesh , Sharma Anshul , Pandey Anil Kumar , Kumar Rakesh
Published: October 2023

Objective

We compared diagnostic quality of 68Ga-PSMA PET/CT imaging focused on the pelvic structures using two furosemide protocols in two different groups of patients.

Material and methods

A total of 55 patients with prostate cancer were retrospectively enrolled in the study. Out of 55, 31 patients were in group 1 (median age: 66 years, Range 44–78 years) in which furosemide injection was given after completion of whole-body 68Ga-PSMA PET/CT scan and 24 patients were in group 2 (median age: 63.5 years, range: 50–82 years) in which it was given along with the 68Ga-PSMA injection. In both groups, an initial time point scan (T0 scan) and a delayed time point scan (T1scan) were done. The images were analyzed qualitatively as well as quantitatively.

Results

Quantitatively there was no statistically significant difference between the SUVmax and T:B of prostatic lesion and seminal vesicle invasion (SVI) in both the groups at two time points (P > 0.05). Early furosemide injection caused a washout of the urinary bladder radiotracer concentration in significantly higher number of patients in group 2 (62.5% vs. 6.45% patients, P < 0.001). There was significant clearance of radiotracer activity from the ureters in group 2 (SUVmax: 9.28 vs. 3.09, P = 0.002).

Conclusion

The simultaneous furosemide and 68Ga-PSMA injection can reduce the urinary excretion of the tracer and improve the diagnostic confidence of prostatic lesion, SVI and lymph nodal metastasis, along with reducing the scanning time and radiation burden, making this protocol an effective alternative to the present protocol of delayed furosemide injection.
Novel cell-based strategies for immunomodulation in vascularized composite allotransplantation
Authors: Siemionow Maria , Kulahci Yalcin , Zor Fatih
Published: October 2023

Purpose of review

Vascularized composite allotransplantation (VCA) has become a clinical reality in the past two decades. However, its routine clinical applications are limited by the risk of acute rejection, and the side effects of the lifelong immunosuppression. Therefore, there is a need for new protocols to induce tolerance and extend VCA survival. Cell- based therapies have emerged as an attractive strategy for tolerance induction in VCA. This manuscript reviews the current strategies and applications of cell-based therapies for tolerance induction in VCA.

Recent findings

Cellular therapies, including the application of bone marrow cells (BMC), mesenchymal stem cells (MSC), adipose stem cells, regulatory T cells (Treg) cells, dendritic cells and donor recipient chimeric cells (DRCC) show promising potential as a strategy to induce tolerance in VCA. Ongoing basic science research aims to provide insights into the mechanisms of action, homing, functional specialization and standardization of these cellular therapies. Additionally, translational preclinical and clinical studies are underway, showing encouraging outcomes.

Cellular therapies hold great potential and are supported by preclinical studies and clinical trials demonstrating safety and efficacy. However, further research is needed to develop novel cell-based immunosuppressive protocol for VCA.
Bullous pemphigoid in a previously healthy adolescent: a case report and literature review
Authors: Giacaman Narmeen , Abusaada Rawan Sami N. , Tos Salem M. , Ibdah Mohammad G. , Reid Mahagney Adam M. , Rjoob Asmaa , Abukhalil Musallam , Salim Hamza , Musmar Basel , Zuwahreh Sufyan
Published: October 2023

Introduction:

Bullous pemphigoid (BP) is considered the most common bullous autoimmune disorder, characterized by autoantibodies directed against hemidesmosomes in the skin and mucous membranes. It usually affects elderly individuals in the sixth through eighth decades of life, with an average age at onset of 65 years. Only a few cases have been reported in children and teenagers.

Case presentation:

Herein, we report a 17-year-old boy who presented with a pruritic vesicular rash on his arms and legs accompanied by erythema. He was treated at the beginning with topical lotion and acyclovir, but the rash kept deteriorating and eventually bullae appeared, involving also his mouth. A dermatologist was consulted and diagnosed him with BP, and he was treated accordingly.

Discussion:

BP is the most prevalent autoimmune bullous illness, caused by autoantibodies against hemidesmosomes in the basement membrane of skin and mucosal surfaces, which in turn attract immune cells, including T-cells and neutrophils, and activate them, which causes damage to and separation of keratinocytes, resulting in the bullous formation. Diagnosis can be accomplished by recognizing clinical symptoms supported by histopathological and immunofluorescence testing. Steroids, whether topical or systemic, are the cornerstone treatment; depending on the extent of the disease, other immunosuppressant drugs can be used as a second line.

Conclusion:

BP manifestations are polymorphic; physicians should keep in mind that they may present with non-bullous, pruritic lesions, which may persist for some days to several months before bullae appear. Although this disease is rare in the young population, it should be considered in the differential diagnosis of bullous lesions.
Ketorolac-induced anaphylaxis following oral administration: a case series
Authors: Yogi Tek N. , Bhusal Amrit , Kafle Rijan , Labh Sujal , Pokhrel Sagar
Published: October 2023

Background:

Ketorolac is a commonly used non-steroidal anti-inflammatory drug for reducing pain and inflammation. Anaphylaxis is a medical emergency that occurs after exposure to an allergen, with a varied clinical presentation requiring prompt and appropriate measures to prevent or manage it. Although uncommon, ketorolac can cause anaphylaxis requiring immediate medical care. The authors present two cases of anaphylaxis in females induced after oral intake of ketorolac with successful outcomes.

Case presentations:

The cases involve two adult women who experienced an allergic reaction to ketorolac. The first woman, aged 36, and the second woman, aged 26, on her second postpartum day, both developed similar types of symptoms like periorbital swelling, itching, and difficulty breathing after taking oral ketorolac. The second woman had a history of allergic rashes. They received immediate treatment with epinephrine, oxygen therapy, intravenous fluids, and other medications. They showed a rapid improvement and were discharged after observation.

Clinical discussion:

Anaphylactic reactions to ketorolac, a commonly used pain management drug, have been reported. Symptoms include swelling, difficulty breathing, and hypotension. Treatment involves medications like epinephrine, hydrocortisone, and pheniramine. A detailed medical history, laboratory investigations, appropriate medication, oxygen therapy, and follow-up care are important in managing anaphylactic reactions, which can be life-threatening.

Conclusion:

Although rare, ketorolac can cause anaphylactic reactions in patients with or without a history of drug allergy. Immediate recognition and management are essential, along with a detailed medical history and follow-up care.
A potential protective role of congenital peritoneal encapsulation coexisting with metastatic colon cancer: a rare case report
Authors: Ahmad Youssef , Fahed Joud , Mousa Jebrail , Souleiman Fadi
Published: October 2023

Introduction and importance:

Congenital peritoneal encapsulation (CPE) is a rare condition in which the small intestine is encased within a mesothelial-lined sac. The following case is an extremely rare description of the co-existence of both colon cancer and peritoneal encapsulation, highlighting the potential role of this co-existence in preventing the spread of metastases and tumor implantation.

Case-presentation:

A 60-year-old female was diagnosed with metastatic colon cancer. During the operation, a thin fibrous membrane was found covering the small intestine, which suggested CPE. The tumor was removed, and the additional membrane was totally excised. The patient is currently receiving chemotherapy for metastatic treatment and is in good health.

Clinical discussion:

CPE is a medical condition that results from abnormal peritoneal development, and it is often confused with other differential diagnoses resulting from inflammatory causes. It can occur at different ages and remains asymptomatic for the majority of cases. However, it can be a potential cause of bowel obstruction. An intraoperative diagnosis can easily differentiate the case. The co-existence with colon cancer has been described only once in the literature.

Conclusion:

Peritoneal encapsulation is a rare, mostly asymptomatic condition. However, it may play a protective role in preventing metastatic colon cancer from affecting the small intestine, thus potentially opening up new avenues for the treatment of cancer metastases.
CD8+ T-cell priming is quantitatively but not qualitatively impaired in people with HIV-1 on antiretroviral therapy
Authors: Cabral-Piccin Mariela P. , Briceño Olivia , Papagno Laura , Liouville Benjamin , White Eoghann , Perdomo-Celis Federico , Autaa Gaëlle , Volant Stevenn , Llewellyn-Lacey Sian , Fromentin Rémi , Chomont Nicolas , Price David A. , Sáez-Cirión Asier , Lambotte Olivier , Katlama Christine , Appay Victor
Published: October 2023

Background:

The induction of de novo CD8+ T-cell responses is essential for protective antiviral immunity, but this process is often impaired in people with HIV-1 (PWH). We investigated the extent to which the immune competence of naive CD8+ T cells, a key determinant of priming efficacy, could be preserved or restored in PWH via long-term antiretroviral therapy (ART).

Methods:

We used flow cytometry, molecular analyses of gene transcription and telomere length, and a fully validated priming assay to characterize naive CD8+ T cells ex vivo and evaluate the induction of antigen-specific effector/memory CD8+ T cells in vitro, comparing age-matched healthy uninfected donors (HUDs), PWH on ART, and natural HIV-1 controllers (HICs).

Results:

We found that naive CD8+ T cells were numerically reduced and exhibited a trend toward shorter telomere lengths in PWH on ART compared with HUDs and HICs. These features associated with impaired priming efficacy. However, we also found that naive CD8+ T cells were fully equipped proliferatively and transcriptionally in PWH on ART, enabling the generation of antigen-specific effector/memory CD8+ T cells with functional and phenotypic attributes comparable to those primed from HUDs.

Conclusion:

Our data suggest that naive CD8+ T cells in PWH on ART are intrinsically capable of generating functionally and phenotypically intact effector/memory CD8+ T cells in response to antigen, despite evidence of senescence and an overall numerical reduction that compromises priming efficacy relative to HUDs and HICs.
Increased 68Ga-FAPI Uptake in Pulmonary Sclerosing Pneumocytoma
Authors: Li Hongyan , Li Chongjiao , Tian Yueli , Wen Bing , He Yong
Published: October 2023

Pulmonary sclerosing pneumocytoma is a rare benign neoplasm arising from the primitive respiratory epithelium. Here, we report 68Ga-FAPI PET/CT findings of pulmonary sclerosing pneumocytoma in a 55-year-old woman. The images showed a solitary pulmonary mass in the left lower lobe with intense 68Ga-FAPI uptake. Our case illustrates that the sclerosing pneumocytoma should be taken into consideration as one of the differential diagnoses in lung nodules/masses with intense 68Ga-FAPI uptake.
Association between Surgeon/anesthesiologist Sex Discordance and One-year Mortality Among Adults Undergoing Noncardiac Surgery
Authors: Etherington Cole , Boet Sylvain , Chen Innie , Duffy Melissa , Mamas Mamas A. , Eddeen Anan Bader , Bateman Brian T. , Sun Louise Y.
Published: October 2023

Objective:

To investigate the association between surgeon-anesthesiologist sex discordance and patient mortality after noncardiac surgery.

Summary Background Data:

Evidence suggests different practice patterns exist amongst female and male physicians. However, the influence of physician sex on team-based practices in the operating room and subsequent patient outcomes remains unclear in the context of noncardiac surgery.

Methods:

We conducted a population-based, retrospective cohort study of adult Ontario residents who underwent index, inpatient noncardiac surgery between January 2007 and December 2017. Primary exposure was physician sex discordance (i.e., surgeon and anesthesiologist were of the opposite sex). The primary outcome was 1-year mortality. The association between physician sex discordance and patient outcomes was modeled using multivariable Cox proportional hazard regression with adjustment for relevant physician, patient, and hospital characteristics.

Results:

Of 541,209 patients, 158,084 (29.2%) were treated by sex-discordant physician teams. Physician sex discordance was associated with a lower rate of mortality at 1 year (5.2% vs. 5.7%; adjusted HR 0.95 [0.91-0.99]). Patients treated by teams composed of female surgeons and male anesthesiologists were more likely to be alive at 1 year than those treated by all-male physician teams (adjusted HR 0.90 [0.81-0.99]).

Conclusions:

Noncardiac surgery patients had a lower likelihood of 1-year mortality when treated by sex discordant surgeon-anesthesiologist teams. The likelihood of mortality was further reduced if the surgeon was female. Further research is needed to explore the underlying mechanisms of these observations and design strategies to diversify OR teams to optimize performance and patient outcomes.
Management of Pericardial Effusion in Patients with Solid Tumor
Authors: Choe Jennie K. , Byun Alexander J. , Robinson Eric , Drake Lauren , Tan Kay See , McAleer Eileen P. , Schaffer Wendy L. , Liu Jennifer E. , Chen Leon L. , Buchholz Tara , Yohannes-Tomicich Joanna , Yarmohammadi Hooman , Ziv Etay , Solomon Stephen B. , Huang James , Park Bernard J. , Jones David R. , Adusumilli Prasad S.
Published: October 2023

Objective:

This study compared outcomes in patients with solid tumor treated for pericardial effusion with surgical drainage vs. interventional radiology (IR) percutaneous drainage and compared incidence of paradoxical hemodynamic instability (PHI) between cohorts.

Summary Background Data:

Patients with advanced-stage solid malignancies may develop large pericardial effusions requiring intervention. PHI is a fatal and underreported complication that occurs following pericardial effusion drainage.

Methods:

Clinical characteristics and outcomes were compared between patients with solid tumors who underwent surgical drainage or IR percutaneous drainage for pericardial effusion from 2010 to 2020.

Results:

Among 447 patients, 243 were treated with surgical drainage, of which 27 (11%) developed PHI, compared with 7 of 204 patients (3%) who were treated with IR percutaneous drainage (P=0.002); overall incidence of PHI decreased during the study period. Rates of reintervention (30-day: 1% vs. 4%; 90-day: 4% vs. 6%, P=0.7) and mortality (30-day: 21% vs. 17%, P=0.3; 90-day: 39% vs. 37%, P=0.7) were not different between patients treated with surgical drainage and IR percutaneous drainage. For both interventions, OS was shorter among patients with PHI than among patients without PHI (surgical drainage, median [95% confidence interval] OS, 0.89 mo [0.33–2.1] vs. 6.5 mo [5.0–8.9], P<0.001; IR percutaneous drainage, 3.7 mo [0.23–6.8] vs. 5.0 mo [4.0–8.1], P=0.044).

Conclusions:

With a coordinated multidisciplinary approach focusing on prompt clinical and echocardiographic evaluation, triage with bias toward IR percutaneous drainage than surgical drainage and post-intervention intensive care resulted in lower incidence of PHI and improved outcomes.
Combining Treg Therapy With Donor Bone Marrow Transplantation: Experimental Progress and Clinical Perspective
Authors: Weijler Anna Marianne , Wekerle Thomas
Published: October 2023

Donor-specific tolerance remains a goal in transplantation because it could improve graft survival and reduce morbidity. Cotransplantation of donor hematopoietic cells to achieve chimerism is a promising approach for tolerance induction, which was successfully tested in clinical trials. However, current protocols are associated with side effects related to the myelosuppressive recipient conditioning, which makes it difficult to introduce them as standard therapy. More recently, adoptive cell therapy with polyclonal or donor-specific regulatory T cells (Treg) proved safe and feasible in several transplant trials, but it is unclear whether it can induce tolerance on its own. The combination of both approaches—Treg therapy and hematopoietic cell transplantation—leads to chimerism and tolerance without myelosuppressive treatment in murine models. Treg therapy promotes engraftment of allogeneic hematopoietic cells, reducing conditioning requirements and enhancing regulatory mechanisms maintaining tolerance. This review discusses possible modes of action of transferred Treg in experimental chimerism models and describes translational efforts investigating the potent synergy of Treg and chimerism.
Anti-Ma2 Antibody-Mediated Paraneoplastic Cerebellar Degeneration and Myeloneuropathy Secondary to Lymphoma
Authors: Handzic Armin , Brossard-Barbosa Natalie , Mandell Daniel , Lou Si Kei , Margolin Edward
Published: October 2023

A 61-year-old woman with a history of untreated low-grade B-cell lymphoma presented with blurry vision, unsteadiness, and worsening pain on touching skin of the upper trunk was enrolled. Blurry vision was attributed to oscillopsia from downbeat nystagmus, which later evolved into macrosaccadic oscillations. MRI brain and spine showed mild, longitudinally extensive T2 hyperintensity in the central gray matter of the spinal cord extending from the medulla to T11 level. Serum paraneoplastic panel was negative; however, she had very high titers of anti-Ma2 antibodies in cerebrospinal fluid. The diagnosis of paraneoplastic neurological syndrome was made. Empiric treatment with high dose of intravenous steroids followed by intravenous immunoglobulin infusions did not improve her symptoms. An extensive search for an underlying tumor commenced and was initially unrevealing. However, two-month follow-up positron emission tomography scan showed increased uptake in a right pulmonary nodule, which when biopsied confirmed diagnosis of extranodal marginal zone lymphoma. The final diagnosis was anti-Ma2 antibody-mediated paraneoplastic cerebellar degeneration and myeloneuropathy secondary to lymphoma.
A data-driven yield criterion for porous ductile single crystals containing spherical voids via physics-informed neural networks
Authors: Wu Liujun , Fu Jiaqi , Sui Haonan , Wang Xiaoying , Tao Bowen , Lv Pengyu , Chen Mohan , Yuan Zifeng , Duan Huiling
Published: October 2023

Yield criteria for porous material have been widely used to model the decrease of yield strength caused by porosity during ductile failure which deserves long-term efforts in modelling to remedy the current drawbacks. To improve their accuracy, a method of building yield criteria for porous single crystals based on physics-informed neural networks (PINNs) has been developed, and the newly well-trained yield functions are capable of predicting the yield stress of porous single crystals with different porosity, stress states and crystal orientations. The reliability of the yield functions is guaranteed by the precise datasets generated by the crystal plasticity finite-element method. In particular, through embedding the associated flow rule into the training process, the PINN-based yield function not only achieves higher accuracy in comparison with the analytical methods (e.g. variational nonlinear homogenization or limit analysis) but also avoids the improper appearance of grooves that happens in feed-forward neural networks. The proposed framework enjoys an excellent portability as the yield functions can be rebuilt in the similar non-trivial procedure when new influencing factors must be introduced, which makes us believe in its potential to be extended.
Showing the limitations of available phenotypic assays to detect B. pseudomallei from clinical specimens in Nigeria
Authors: Orababa Oluwatosin Qawiyy , Adesida Solayide A. , Peters Rebecca F. , AbdulGanniyu Zainab , Olakojo Olawale , Abioye Adefunke
Published: October 2023

Burkholderia is a genus comprising Gram-negative bacteria that are metabolically complex and versatile, thriving in frequently hostile settings. Burkholderia pseudomallei, the causative agent of melioidosis, is a prominent member of the genus and a clinical pathogen of tropical and sub-tropical regions. This pathogen is well known for its multidrug resistance nature and possible bioweapon potential. There is currently no report of the pathogen from clinical specimens in Nigeria, this might be due to misdiagnosis with phenotypic assays. This study aims to explore the accuracy in the use of phenotypic assays to accurately diagnose B. pseudomallei in Nigeria. Two hundred and seventeen (217) clinical samples and twenty-eight (28) Gram-negative clinical isolates were collected and analysed using Ashdown selective agar and monoclonal antibody-based latex agglutination. The species-level identification was achieved using the Analytical profile index (API) 20NE system. The susceptibility of the isolates to nine different antimicrobial agents was determined using the disk diffusion method. Sixty-seven (74) culture-positive isolates were obtained using Ashdown selective agar. Twenty-two isolates were believed to be B. pseudomallei through the monoclonal antibody-based latex agglutination test and API 20NE system subsequently identified 14 isolates as Burkholderia. The predominant Burkholderia species was B. cepacia with isolation rate of 30.8% (8/26).  No isolate was distinctively identified as B. pseudomallei but five isolates were highly suspected to be B. pseudomallei with similarity indices ranging from 81.9 – 91.3%. Other bacterial species with definitive identity include Aeromonas sp., Sphingomonas sp. and Pseudomonas aeruginosa. The antibiotic susceptibility results revealed an overall resistance to amoxicillin-clavullanic acid (71.4%), cefepime (33.3%), trimethoprim-sulfamethoxazole (38.1%), piperacillin-tazobactam (33.3%), imipenem (66.7%), doxycycline (57.1%), and ceftazidime (66.7%). The highest intermediate resistance was observed for cefepime and piperacillin-tazobactam with a value 66.7% each while no intermediate-resistance for gentamicin, colistin and imipenem. Our findings, therefore, show that phenotypic assays alone are not enough in the diagnosis of melioidosis. Additionally, it provides a robust basis for supporting present and future decisions to expand diagnostic capability for melioidosis beyond phenotypic assays in low-resource settings.