bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of gluten on dyspeptic symptoms: a systematic review and meta-analysis of clinical trials
Authors: Hosseinian Seyedeh-Zeynab , Haghighatdoost Fahimeh , Hajihashemi Parisa , Adibi Peyman
Published: April 2023

Context

Research on the effects of gluten on dyspeptic symptoms has shown conflicting results.

Objective

The aim of this systematic review and meta-analysis of clinical trials was to assess the effects of gluten on dyspeptic symptoms.

Data Sources

A systematic search of the PubMed, ISI Web of Science, Scopus, Cochrane, and Embase online databases was performed up to May 2022.

Data Extraction

Randomized controlled trials (RCTs) and non-RCTs that examined the impact of a gluten-free diet, a low-gluten diet, or a gluten challenge on dyspeptic symptoms, including early satiety, epigastric pain, bloating, and nausea, were selected independently by 2 authors. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework was used to assess the certainty of the evidence. Results were pooled using a random-effects model and expressed as weighted mean differences (WMDs) and 95%CIs.

Data Analysis

Of the 7641 citations retrieved, 27 articles (18 RCTs and 9 non-RCTs) were included in the systematic review. Of those, 5 RCTs were eligible for the meta-analysis. The pooled results indicated that gluten challenge significantly increased the severity of bloating (WMD = 0.67; 95%CI, 0.37–0.97; I2 = 81.8%; n = 6), early satiety (WMD = 0.91; 95%CI, 0.58–1.23; I2 = 27.2%; n = 5), and epigastric pain (WMD = 0.46; 95%CI, 0.17–0.75; I2 = 65.8%; n = 6). However, the effect of gluten challenge on the severity of nausea (WMD = 0.13; 95%CI, −0.17 to 0.43; I2 = 0.0%, n = 5) was nonsignificant.

Conclusion

Gluten challenge significantly worsened dyspeptic symptoms, including bloating, early satiety, and epigastric pain, but did not affect nausea. These findings suggest that gluten restriction could be efficient in reducing dyspeptic symptoms. Well-designed large RCTs recruiting homogenous groups of patients with functional dyspepsia are needed to clarify the effectiveness of gluten restriction on dyspeptic symptoms.
Physical Therapist Management of Glenohumeral Joint Osteoarthritis: A Clinical Practice Guideline from the American Physical Therapy Association
Authors: Michener Lori A , Heitzman Jill , Abbruzzese Laurel D , Bondoc Salvador L , Bowne Kristin , Henning Phillip Troy , Kosakowski Heidi , Leggin Brian G , Lucado Ann M , Seitz Amee L
Published: April 2023

A clinical practice guideline on glenohumeral joint osteoarthritis was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists, an occupational therapist, and a physician. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for physical therapist management of glenohumeral joint osteoarthritis.

This clinical practice guideline is available in Spanish and Chinese; see Supplementary Appendix 8 for Spanish Translation and Supplementary Appendix 9 for Chinese Translation.
Suppression of Phytophthora capsici in Chile Pepper Using Brassica juncea and Hordeum vulgare Cover Crop Residues and Trichoderma harzianum as a Biocontrol Agent
Authors: Mason Makane , Lehnhoff Erik A. , Trainor Patrick J. , Sanogo Soum
Published: April 2023

Phytophthora blight, caused by Phytophthora capsici, is a serious disease of many vegetable crops worldwide. In New Mexico, U.S.A., the disease affects chile pepper (Capsicum annuum L.), a major crop in the state. There is no single tool that effectively controls the disease. Continuous research is needed in identifying combination of tools that can reduce the impact of Phytophthora blight. We explored the potential of combining cover crops and biocontrol agents to reduce soilborne diseases. This study aimed to evaluate the effects of Indian mustard (Brassica juncea L.) cover crop on the antagonistic ability of Trichoderma harzianum against P. capsici in vitro and to quantify the impacts of combining soil amendment with residues from B. juncea and barley (Hordeum vulgare L.) cover crops and plastic covering on infection of chile pepper seedlings by P. capsici under greenhouse conditions. Volatiles from macerated tissue of B. juncea significantly reduced P. capsici and T. harzianum growth in the absence of soil by 89.0 and 79.0%, respectively. When incorporated in soils, volatiles from macerated tissue of B. juncea significantly reduced P. capsici and T. harzianum by 33.4 and 7.8%, respectively. T. harzianum was more resilient to B. juncea biofumigation than P. capsici. Significant reduction in disease incidence was observed with B. juncea-fumigated soil, while no disease suppression was observed with soil incorporation of H. vulgare residues. Covering soil with plastic was necessary for increasing the efficacy of B. juncea biofumigation.
Evidence in support of the bone marrow as the primary lesion in axial spondyloarthritis
Authors: Maksymowych Walter P.
Published: April 2023

Purpose of review

Over the past several decades, the concept that the primary lesion accounting for the development of axSpA is an enthesopathy has been widely accepted. However, the hallmark abnormality of axSpA occurs in the sacroiliac joint at the interface of cartilage and bone at a location remote from any anatomical enthesis. Both imaging and histopathological data from the sacroiliac joint point to immunopathogenetic events in the bone marrow as being of primary importance. Here, we discuss new developments in our understanding of immune events in the bone marrow relevant to axSpA that reinforce the need for a change in our conceptual paradigm for the pathogenesis of axSpA.

Recent findings

Human spinal enthesis samples contain myeloperoxidase-expressing cells, a marker of neutrophils, and mucosal-associated invariant T cells in the perientheseal bone marrow, which may be activated by stromal cells and circulating microbial products to express IL-17A and IL-17F and tumor necrosis factor (TNF). Evaluation of transcriptomes of monocytes from patients with axSpA demonstrates a lipopolysaccharide/TNF signature characterized by the expression of genes associated with granulocytopoietic bone marrow cells. This neutrophil-like phenotype is more evident in established and more severe axSpA and may be activated by microbial products from the gut. A similar expansion of granulocyte-monocyte progenitor-driven hematopoiesis occurs in the SKG mouse driven by granulocyte-macrophage colony-stimulating factor. Mesenchymal stem cells (MSCs) from ankylosing spondylitis patients are more likely to exhibit osteogenic differentiation than MSCs from healthy donors, which may be mediated by the formation of specific clusters of transcriptional factors, super enhancers, regulated by axSpA-associated single nucleotide polymorphisms located mostly in noncoding regions. TNF-α may enhance directional migration of AS-MSC compared with MSC from healthy controls from the bone marrow to entheseal soft tissue, which is mediated by increased expression of engulfment and cell motility protein 1 (ELMO1). TNF and IL-17A display differential effects on adipogenesis and osteogenesis of MSC in perientheseal bone marrow and soft tissue.

Bone marrow has the capacity to undergo rapid adaptation in terms of cell composition, differentiation, and immune function, resulting in inflammation and osteogenesis in axSpA.
Research progress of metabolomics in psoriasis
Authors: Guo Lan , Jin Hongzhong
Published: April 2023

Psoriasis is a chronic inflammatory skin disease with significant physical and psychological burdens. The interplay between the innate and adaptive immune systems is thought to contribute to the pathogenesis; however, the details of the pathogenesis remain unclear. In addition, reliable biomarkers for diagnosis, assessment of disease activity, and monitoring of therapeutic response are limited. Metabolomics is an emerging science that can be used to identify and analyze low molecular weight molecules in biological systems. During the past decade, metabolomics has been widely used in psoriasis research, and substantial progress has been made. This review summarizes and discusses studies that applied metabolomics to psoriatic disease. These studies have identified dysregulation of amino acids, carnitines, fatty acids, lipids, and carbohydrates in psoriasis. The results from these studies have advanced our understanding of: (1) the molecular mechanisms of psoriasis pathogenesis; (2) diagnosis of psoriasis and assessment of disease activity; (3) the mechanism of treatment and how to monitor treatment response; and (4) the link between psoriasis and comorbid diseases. We discuss common research strategies and progress in the application of metabolomics to psoriasis, as well as emerging trends and future directions.
Reverse effect of Semaphorin-3F on rituximab resistance in diffuse large B-cell lymphoma via the Hippo pathway
Authors: Li Qiong , Ma Naya , Li Xinlei , Yang Chao , Zhang Wei , Xiong Jingkang , Zhu Lidan , Li Jiali , Wen Qin , Gao Lei , Yang Cheng , Rao Lingyi , Gao Li , Zhang Xi , Rao Jun
Published: April 2023

Background:

Exploring the underlying mechanism of rituximab resistance is critical to improve the outcomes of patients with diffuse large B-cell lymphoma (DLBCL). Here, we tried to identify the effects of the axon guidance factor semaphorin-3F (SEMA3F) on rituximab resistance as well as its therapeutic value in DLBCL.

Methods:

The effects of SEMA3F on the treatment response to rituximab were investigated by gain- or loss-of-function experiments. The role of the Hippo pathway in SEMA3F-mediated activity was explored. A xenograft mouse model generated by SEMA3F knockdown in cells was used to evaluate rituximab sensitivity and combined therapeutic effects. The prognostic value of SEMA3F and TAZ (WW domain-containing transcription regulator protein 1) was examined in the Gene Expression Omnibus (GEO) database and human DLBCL specimens.

Results:

We found that loss of SEMA3F was related to a poor prognosis in patients who received rituximab-based immunochemotherapy instead of chemotherapy regimen. Knockdown of SEMA3F significantly repressed the expression of CD20 and reduced the proapoptotic activity and complement-dependent cytotoxicity (CDC) activity induced by rituximab. We further demonstrated that the Hippo pathway was involved in the SEMA3F-mediated regulation of CD20. Knockdown of SEMA3F expression induced the nuclear accumulation of TAZ and inhibited CD20 transcriptional levels via direct binding of the transcription factor TEAD2 and the CD20 promoter. Moreover, in patients with DLBCL, SEMA3F expression was negatively correlated with TAZ, and patients with SEMA3F lowTAZ high had a limited benefit from a rituximab-based strategy. Specifically, treatment of DLBCL cells with rituximab and a YAP/TAZ inhibitor showed promising therapeutic effects in vitro and in vivo.

Conclusion:

Our study thus defined a previously unknown mechanism of SEMA3F-mediated rituximab resistance through TAZ activation in DLBCL and identified potential therapeutic targets in patients.
Intratumoral microbial heterogeneity affected tumor immune microenvironment and determined clinical outcome of HBV-related HCC
Authors: Li Shengnan , Xia Han , Wang Zeyu , Zhang Xiehua , Song Tianqiang , Li Jia , Xu Liang , Zhang Ningning , Fan Shu , Li Qian , Zhang Qiaoling , Ye Yingnan , Lv Jiayu , Yue Xiaofen , Lv Hongcheng , Yu Jinpu , Lu Wei
Published: April 2023

Background and Aims:

The intratumoral microbiome has been reported to regulate the development and progression of cancers. We aimed to characterize intratumoral microbial heterogeneity (IMH) and establish microbiome-based molecular subtyping of HBV-related HCC to elucidate the correlation between IMH and HCC tumorigenesis.

Approach and Results:

A case-control study was designed to investigate microbial landscape and characteristic microbial signatures of HBV-related HCC tissues adopting metagenomics next-generation sequencing. Microbiome-based molecular subtyping of HCC tissues was established by nonmetric multidimensional scaling. The tumor immune microenvironment of 2 molecular subtypes was characterized by EPIC and CIBERSORT based on RNA-seq and verified by immunohistochemistry. The gene set variation analysis was adopted to explore the crosstalk between the immune and metabolism microenvironment. A prognosis-related gene risk signature between 2 subtypes was constructed by the weighted gene coexpression network analysis and the Cox regression analysis and then verified by the Kaplan-Meier survival curve.

IMH demonstrated in HBV-related HCC tissues was comparably lower than that in chronic hepatitis tissues. Two microbiome-based HCC molecular subtypes, defined as bacteria- and virus-dominant subtypes, were established and significantly correlated with discrepant clinical-pathologic features. Higher infiltration of M2 macrophage was detected in the bacteria-dominant subtype with to the virus-dominant subtype, accompanied by multiple upregulated metabolism pathways. Furthermore, a 3-gene risk signature containing CSAG4, PIP4P2, and TOMM5 was filtered out, which could predict the clinical prognosis of HCC patients accurately using the Cancer Genome Atlas data.

Conclusions:

Microbiome-based molecular subtyping demonstrated IMH of HBV-related HCC was correlated with a disparity in clinical-pathologic features and tumor microenvironment (TME), which might be proposed as a biomarker for prognosis prediction of HCC.
ROK and RSK2-kinase pathways differ between senescent human renal and mesenteric arteries
Authors: Lubomirov Lubomir T. , Mantke René , Enzmann Thomas , Metzler Doris , Korotkova Tatiana , Hescheler Jürgen , Pfitzer Gabriele , Grisk Olaf
Published: April 2023

Objective:

Small arteries from different organs vary with regard to the mechanisms that regulate vasoconstriction. This study investigated the impact of advanced age on the regulation of vasoconstriction in isolated human small arteries from kidney cortex and periintestinal mesenteric tissue.

Methods:

Renal and mesenteric tissues were obtained from patients (mean age 71 ± 9 years) undergoing elective surgery. Furthermore, intrarenal and mesenteric arteries from young and aged mice were studied. Arteries were investigated by small vessel myography and western blot.

Results:

Human intrarenal arteries (h-RA) showed higher stretch-induced tone and higher reactivity to α1 adrenergic receptor stimulation than human mesenteric arteries (h-MA). Rho-kinase (ROK) inhibition resulted in a greater decrease in Ca2+ and depolarization-induced tone in h-RA than in h-MA. Basal and α1 adrenergic receptor stimulation-induced phosphorylation of the regulatory light chain of myosin (MLC20) was higher in h-RA than in h-MA. This was associated with higher ROK-dependent phosphorylation of the regulatory subunit of myosin light-chain-phosphatase (MLCP), MYPT1-T853. In h-RA phosphorylation of ribosomal S6-kinase II (RSK2-S227) was significantly higher than in h-MA. Stretch-induced tone and RSK2 phosphorylation was also higher in interlobar arteries (m-IAs) from aged mice than in respective vessels from young mice and in murine mesenteric arteries (m-MA) from both age groups.

Conclusion:

Vasoconstriction in human intrarenal arteries shows a greater ROK-dependence than in mesenteric arteries. Activation of RSK2 may contribute to intrarenal artery tone dysregulation associated with aging. Compared with h-RA, h-MA undergo age-related remodeling leading to a reduction of the contractile response to α1 adrenergic stimulation.
The Buffalo Concussion Treadmill and Bike Tests in People With Mild-to-Moderate Traumatic Brain Injury: An Exploratory Clinical Audit
Authors: Vuu Sally , Barr Christopher J. , Killington Maggie , Howie Joanne , Hutchins Selena , van den Berg Maayken E. L.
Published: April 2023

Objective:

To assess the performance on the Buffalo Concussion Treadmill and Bike Tests in nonathletic people following a mild-to-moderate traumatic brain injury.

Setting:

An outpatient rehabilitation clinic.

Participants:

Forty-nine patients with mild-to-moderate traumatic brain injury who underwent the Buffalo Concussion Treadmill or Bike Test as usual clinical care.

Design:

A retrospective clinical audit.

Main Measures:

Demographics and brain injury-specific clinical data, Depression Anxiety Stress Scale; Rivermead Post-Concussion Symptom Questionnaire, and performance outcomes on the Buffalo Concussion Treadmill or Bike Test.

Results:

Forty-nine patients (mean age: 33.7 ± 13.0 years), on average 56.2 ± 36.4 days post-injury, completed the Buffalo Concussion Treadmill or Bike Test. Fourteen patients stopped the test due to symptom exacerbation with a mean test duration of 8.1 ± 4.5 minutes, reaching an age-predicted maximum heart rate of 72.9% ± 12.4% and reporting a rating of perceived exertion of 13.4 ± 2.2. Those who terminated the test for other reasons had a significantly longer test duration (14.0 ± 4.7 minutes, P = .01), with a higher age-predicted maximum heart rate (83.3% ± 12.8%, P = .01) and rating of perceived exertion (17.0 ± 2.5, P = .01). Within the group who stopped for other reasons, 10 were due to symptoms deemed unrelated to the injury at the time of the test and 2 were stopped by the therapist for safety reasons. A significant but weak correlation between heart rate and rating of perceived exertion existed only for those who terminated the test for other reasons (r = 0.38, P = .02). Overall, a shorter test duration was associated with higher scores of both self-reported depression (r = −0.41, P < .01) and late postconcussion symptoms (r = −0.40, P < .01).

Conclusion:

The Buffalo Concussion Treadmill or Bike Test can be used in the nonathletic mild-to-moderate traumatic brain injury population to differentiate between those who experience symptom exacerbation during exercise and those who do not based on symptom exacerbation, test duration, and poor perception of exertion. Further research is required to determine whether other reasons for test termination are related to the injury.
THE ROLE OF GENETIC TESTING IN AVOIDING DIAGNOSTIC DELAYS IN INHERITED RETINAL DISEASE
Authors: Shah Arth H. , Park Elisse , Luke Tamara , Xu Qingguo , Jewell Ann , Couser Natario L.
Published: April 2023

Purpose:

To identify and highlight potential delays in diagnosis and improve the characterization of the providers referring individuals affected with suspected inherited retinal diseases for specialty care, the authors performed an analysis of the patients with inherited retinal diseases seen by an ophthalmic genetics specialty service. In addition, the authors analyzed the diagnostic yield of genetic testing in patients with inherited retinal disease in our series and compared this information with other previous studies.

Methods:

The authors analyzed 131 consecutive patients with suspected inherited retinal diseases referred to an ophthalmic genetics specialty service at a tertiary hospital. Provider referral patterns, delays in diagnosis, and the diagnostic yield of genetic testing were evaluated.

Results:

Mean age in the cohort was 24 years. From the 51 patients who underwent genetic testing, the diagnostic yield was 69%. Of these, genetic testing revealed that 51% of patients had an incorrect initial referral clinical diagnosis. The average delay to reach a correct diagnosis was 15 years. Ophthalmologists represented the largest referral base at 80%, followed by neurologists representing 5% of referrals. Pediatric and retinal specialists were the largest referral of ophthalmic subspecialties at 44% and 35%, respectively.

Conclusion:

A significant number of patients experienced a prolonged delay in reaching a correct diagnosis largely because of a delay in initiating the genetic evaluation and testing process. The initial suspected clinical diagnosis was incorrect in a significant number of cases, revealing that affected patients were potentially denied from appropriate recurrence risk counseling, relevant educational resources, specialty referrals in syndromic cases, and clinical trial eligibility in a timely manner.
Wellens syndrome during chemotherapy for cholangiocarcinoma: A case report of cardiovascular toxicity associated with gemcitabine-containing regimen
Authors: Liang Xufei , Geng Xuhong , Gong Xiaohong , Yin Xi , Chen Yongzhen
Published: April 2023

Rationale:

Wellens syndrome is a comprehensive electrocardiographic (ECG) diagnosis that combines medical history with characteristic ECG changes. These changes, characterized by biphasic T-wave inversions or symmetric and deep T-wave inversions in the anterior precordial leads, often indicate that the left anterior descending coronary artery is at a high risk of severe stenosis. Chemotherapy-related cardiovascular toxicity refers to damage to the cardiovascular system caused by chemotherapeutic drugs, which is unpredictable and may occur during or after chemotherapy.

Patient concerns:

In this case report, a 41-year-old male patient with cholangiocarcinoma received sequential adjuvant chemotherapy with gemcitabine/nanoparticle albumin–bound paclitaxel and gemcitabine/cisplatin. This patient presented with recurrent brief chest pain episodes after the third dose of gemcitabine/cisplatin, and the characteristic T-wave morphological changes were captured in routine ECG monitoring prior to the 6th dose.

Diagnoses:

Acute coronary syndrome due to chemotherapy-related cardiovascular toxicity was diagnosed on the basis of characteristic ECG changes.

Interventions:

The patient underwent coronary angiography, which revealed diffuse stenosis of up to 95% in the middle segment of the left anterior descending coronary artery. Stents were implanted in the stenotic segment for vascular reconstruction.

Outcomes:

The patient’s chest pain was completely resolved, and electrocardiography returned to normal.

Lessons:

Cardiovascular toxicity during chemotherapy in patients with cancer may be life threatening. This rare case highlights the importance of identifying the characteristic ECG pattern of the Wellens syndrome by monitoring electrocardiography during chemotherapy. Immediate and accurate identification of the morphological ECG features of Wellens syndrome with a slight elevation of the ST-segment is related to patient prognosis.
Percutaneous left atrial appendage closure in patients with hypertrophic cardiomyopathy and persistent atrial fibrillation: 3-year-followed case series
Authors: Liu Ying , Chen Chunyu , Chen Yuyi , Su Xi , Li Zhen , Chen Yanhong
Published: April 2023

Hypertrophic cardiomyopathy (HCM) patients with atrial fibrillation (AF) are at high risk for stroke. Left atrial appendage closure (LAAC) is a promising alternative for stroke prevention in AF patients. We aimed to review the clinical outcomes of patients with AF and HCM at our center. We reviewed 673 patients who underwent LAAC implantation from 2014 to 2021 in a tertiary center, of whom 15 had HCM. AF Patients with HCM were compared with sex and age matched controls who also underwent LAAC. From 2014 to 2021, 673 AF patients received LAAC in a single center, of whom, 15 patients had HCM. LAAC devices were successfully implanted in 14 HCM patients and 59 patients in the control group. During the follow-up period (median 1151 days range: 132–2457 days), 2 HCM patient had ischemic strokes. There were another 2 HCM patients who had sudden cardiac death (SCD). Compared with the control, HCM patients had higher cumulative rate of combined death and stroke (26.67% vs 3.33%, P = .024). In our initial clinical experience, the cumulative stroke and death rate of the HCM patients was significantly higher than that of the non-HCM patients.
MicroRNA profiling reveals effects of Erzhi Tiangui granules on kidney deficiency diminished ovarian reserve: A randomized trial
Authors: Liu Dan-Qi , Wei Chao-Feng , Zhang Xing , Xiang Shan , Lian Fang
Published: April 2023

Background:

Diminished ovarian reserve (DOR) is a danger signal of reduced fertility. The clinical incidence is increasing yearly, exhibiting a gradual low-age trend. Traditional Chinese medicine theory suggests that kidney deficiency is the basic pathogenesis. Erzhi Tiangui granules (ETG), a kidney-tonifying prescription, have been clinically shown to improve ovarian reserve function. The purpose of this study was to investigate the microRNA (miRNA) markers of kidney deficiency DOR and the potential mechanism of ETG on in vitro fertilization outcomes in DOR patients.

Methods:

Experiment 1: Granulosa cells from 5 normal ovarian reserves and 5 kidney deficiency DOR patients were subjected to miRNA sequencing. Experiment 2: Eighty DOR patients were randomly divided into treatment and control groups (40 subjects each), then treated with ETG and placebo, respectively. granulosa cells were collected and subjected to quantitative polymerase chain reaction for analyzing the expression of specific miRNA found in experiment 1. We also compared fertilization rates, high-quality embryos, and clinical pregnancy rates between the 2 groups.

Results:

miRNA sequencing revealed differential expression of 81 miRNAs, of which 39 were downregulated, specially miR-214-3p and miR-193a-5p, whereas 42 were upregulated, specially let-7e-5p and miR-140-3p. In the second experiment, we found that miR-214-3p was significantly upregulated whereas let-7e-5p and miR-140-3p were significantly downregulated in the treatment group, relative to the control group (P < .05). Patients in the ETG treatment group exhibited a significantly higher fertilization rate than those in the control group (P < .05).

Conclusion:

ETG significantly increased fertilization rates in DOR patients with kidney deficiency syndrome and affected the expression of miR-214-3p, let-7e-5p, and miR-140-3p, the potential biomarkers.
STAT2 act a prognostic biomarker and associated with immune infiltration in kidney renal clear cell carcinoma
Authors: Zeng Tao , Ye Jianzhong , Wang Heng , Tian Wen
Published: April 2023

Renal clear cell carcinoma (KIRC) is a malignancy of the renal epithelial cells with poor prognosis. Notably, the JAK-STAT pathway mediates cell proliferation and immune response. Accumulating evidence suggests that STATs act as immune checkpoint inhibitors in various cancers. Nonetheless, the role of STAT2 in KIRC remains elusive. Herein, analyses were performed using a series of interactive web databases including Oncomine, GEPIA and TIMER. In sub-group analyses, STAT2 was upregulated at both the mRNA and protein levels in KIRC patients. Besides, KIRC patients with high STAT2 expression exhibited a poor overall survival. Moreover, Cox regression analysis revealed that STAT2 expression, nodal metastasis and clinical stage were independent factors affecting the prognosis of KIRC patients. There was a significant positive correlation between STAT2 expression, and the abundance of immune cells as well as the expression of immune biomarker sets. In addition, STAT2 was found to be implicated in immune response, cytokine-cytokine receptor interaction, and Toll-like receptor signaling pathways. Also, several cancer-related kinases, miRNAs, and transcription factors associated with STAT2 were identified. Conclusively, we revealed that STAT2 is a potential prognosis biomarker and associated with immune infiltration in kidney renal clear cell carcinoma. This study offers additional data that will help in further research on the roles of STAT2 protein in carcinogenesis.
Case report on intervention of sedative drug dependence with “simple and quick reconstruction method” in psychological crisis assistance
Authors: Liang Yi-qun , Yu Bao-dong
Published: April 2023

Introduction:

In the past, the problem of sedation drug dependence has been reported in psychological counseling cases, but it is rare to use the rapid reconstruction method for psychological emergency intervention. This article reports the applying of rapid reconstruction method in the intervention of sedation drug dependence during psychological emergency in the context of the Corona Virus Disease-2019 public health events.

The main therapeutic interventions:

Firstly present the problem including presenting experiences related to psychological stress, troubles of events, core problems and self-assessment based on a score of 0 to 10, secondly transfer information including normalizing relevant reactions and providing useful knowledge, thirdly cope with strategies of seeking internal and external resources, reassessing and making improvement plans, at last improve the summary which includes reviewing the process to summarize gains, initiate actions and commit.

Outcomes:

The author discussed the current psychological crisis with the patient, scored the tense and anxious situation, normalized the response to the patient and passed on the knowledge about controlling Corona Virus Disease-2019 prevention and sedative drugs, helped him find the method to adjust himself and the social resources he confided to his friends during the similar period, scored again, put forward the plan, reviewed the conversation process and made a commitment to not use sedative drugs.

Conclusions:

Through the “simple and quick reconstruction method,” the patient was able to solve the problem of dependence on sedative drugs, relieve tension and anxiety, find resources, and keep living.
Survival outcomes of minimally invasive versus open radical hysterectomy in patients with early-stage IB1 to IIA2 cervical cancer: A single-center retrospective study
Authors: Yeon Choi Hwa , Park Jung-Woo
Published: April 2023

This study aimed to investigate the survival outcomes and prognostic factors associated with the surgical approach in patients with early-stage cervical cancer. We retrospectively analyzed 245 patients with stage IB1 to IIA2 cervical cancer who underwent radical hysterectomy with pelvic lymphadenectomy between 2004 and 2019 at Dong-A University Hospital. A total of 59 patients underwent minimally invasive surgery (MIS), and 186 patients underwent open surgery. There were no significant differences between the 2 groups, except for stromal invasion (P < .001), lymphovascular invasion (P = .001), and requirement for adjuvant therapy (P < .001). There were no significant differences in disease-free survival (DFS) and overall survival (OS) based on the surgical approach. However, multivariate analyses showed MIS was an independent poor prognostic factor of DFS (adjusted hazard ratio [HR]: 230; 95% confidence interval [CI]: 086–0.614, P = .003) and OS (adjusted HR: 135; 95% CI: 041–0.451, P = .001). Adjuvant therapy was a poor prognostic factor for DFS (adjusted HR: 6.546; 95% CI: 1.384–30.952; P = .018), and deep stromal invasion was a poor prognostic factor for OS (adjusted HR: 8.715; 95% CI: 1.636–46.429; P = .01). MIS may be an independent poor prognostic factor for DFS and OS in patients who undergo radical hysterectomy for early-stage cervical cancer.
Accuracy of ultrasonographic fatty liver index using point-of-care ultrasound in stratifying non-alcoholic fatty liver disease patients
Authors: Sourianarayanane Achuthan , McCullough Arthur J
Published: April 2023

Background

The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in the USA. Some of these patients develop non-alcoholic steatohepatitis (NASH), which can progress to cirrhosis. Ultrasound imaging is one of the most used modalities for diagnosing hepatic steatosis. Primary care providers are increasingly using point-of-care ultrasound (POCUS), which could increase the number of subjects diagnosed with NAFLD. This study evaluates the accuracy of POCUS in identifying patients with NASH.

Methods

Patients with hepatic steatosis without excess alcohol intake or other liver diseases undergoing liver biopsy were included in this study. These patients underwent POCUS and vibration-controlled transient elastography (VCTE) evaluations within 3 months of a liver biopsy. A comparison of POCUS data with liver histology and VCTE were made to assess the validity of POCUS evaluation in diagnosing NAFLD and NASH.

Results

The steatosis score from the liver histology had a low correlation with the controlled attenuation parameter score from VCTE (r = 0.27) and a moderate correlation with the grade of steatosis detected by the POCUS exam (r = 0.57). The NAFLD activity score on histology was found to correlate with the ultrasonographic fatty liver index (USFLI) from the POCUS exam (r = 0.59). A USFLI ≥ 6 diagnosed NASH with a sensitivity of 81%, and a value of ≤3 ruled out the diagnosis of NASH with a sensitivity of 100%.

Conclusion

The provider can use the POCUS exam in clinical practice to diagnose NAFLD and reliably stratify patients who have NASH.
Outcome of pharmacological thromboprophylaxis in hospitalized patients with cirrhosis – a systematic review and meta-analysis
Authors: Giri Suprabhat , Singh Ankita , Varghese Jijo , Ingawale Sushrut , Roy Akash
Published: April 2023

Background

Portal hypertension in cirrhosis brings about a complex interplay in the risks of bleeding and thrombosis. It is unclear whether hospitalized patients with cirrhosis need pharmacological prophylaxis for venous thromboembolism (VTE), as it may increase the risk of bleeding. We aimed to compare the outcome of hospitalized patients with cirrhosis with and without pharmacological thromboprophylaxis.

Methods

A comprehensive search of three databases was conducted from inception to August 2022 for studies comparing the outcome of hospitalized patients with cirrhosis with and without pharmacological prophylaxis for VTE. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated for the outcomes of VTE or bleeding.

Results

Overall, 12 studies were included in the final analysis. The pooled incidence of VTE in patients with and without thromboprophylaxis was 1.9% (95% CI: 0.8–2.9) and 1.9% (95% CI: 0.9–2.9), respectively. The odds of VTE were comparable between the groups with OR 1.11 (95% CI: 0.76–1.62). The pooled incidence of bleeding events in patients with and without thromboprophylaxis was 6.7% (95% CI: 3.6–9.8) and 10.4% (95% CI: 6.6–14.1), respectively. There was no significant difference in the odds of overall bleeding (OR 0.68; 95% CI: 0.30–1.52) or major bleeding (OR 1.18; 95% CI: 0.55–2.56) between the groups. There was no significant difference in the relative effects on sensitivity analysis.

Conclusion

The present analysis could not demonstrate the benefit of pharmacological thromboprophylaxis in reducing in-hospital VTE in patients with cirrhosis. Future studies are required to assess the role of risk prediction models in hospitalized patients with cirrhosis.
Correlation between individual autoantibodies and clinical features in primary biliary cholangitis: results of a retrospective longitudinal study
Authors: Dias Beatriz , Aguiar Ana , Morais Cátia Iracema , Nery Filipe Gaio
Published: April 2023

Background and aims

Primary biliary cholangitis (PBC) is an immune-mediated liver disease. The immunological profile seems to relate to clinical prognosis. This study aims to determine the role of autoantibodies in the course of liver disease and in the response to ursodeoxycholic acid.

Methods

Between January 2016 and December 2020, 143 patients with PBC who underwent immunological liver profile evaluation were enrolled. All data were extracted retrospectively from electronic clinical records. Chi-square test, Fisher’s exact test and Mann–Whitney test were used to evaluate the relationship between autoantibodies and biochemical parameters, clinical outcomes and therapeutic response scores. A significance level of 0.05 was used.

Results

Antimitochondrial antibodies were present in 91.6%, antiglycoprotein-210 antibody (anti-gp210) in 18.2% and anti-Sp100 in 19.6% of patients. The incidence of liver-related death was higher in patients with autoimmune hepatitis variants. The occurrence of cirrhosis or portal hypertension was not linked to the presence of any of the autoantibodies tested. No relationship was found with the probability of dying or being transplanted. Patients with anti-Sp100 antibodies had higher baseline levels of aspartate aminotransferase and alanine aminotransferase and lower immunoglobulin M levels. Patients with anti-gp210 were more likely to have a lower median transplant-free survival rate and higher median risk of liver transplant or liver-related death using the GLOBE and UK-PBC scores.

Conclusion

Our findings confirm a strong association between anti-gp210 antibodies and a worse outcome. The association between anti-Sp100 and hepatic lesions requires further elucidation.
Regulatory approval pathway for COVID-19 vaccine in USA, Europe and India
Authors: Narasimhan Jaipratap , Maanvizhi Saba
Published: April 2023

The coronavirus disease-2019 (COVID-19) outbreak has confused everyone, including healthcare experts, physicians and frontline workers. Monoclonal antibodies, anticoagulants and immunomodulatory therapy were initially used to treat COVID-19. However, they can only inhibit the virus from replicating, which is not enough to provide a lasting cure. As each month passes, a growing number of companies are working on vaccinations that will aid in the development of resistance against the corona virus. As a result, all regulatory bodies have stated that if a vaccine has high efficacy and low risk of adverse events, it will be approved through an emergency use application. However, there is one major hindrance: After completing phase II clinical trials with an emergency use application, the product can be released to the market. However, the firm should conduct phase III and phase IV trials at the same time, with peer review occurring after each cycle of clinical trials and also market data to be presented simultaneously to track adverse events. In this article, the author has compared the standard approval process (i.e. Standard Biological License application) with the emergency use application to describe how the COVID-19 vaccine was approved by the different regulatory bodies.
Outpatient Treatment of Lyme Disease
Authors: Fuchs Susan
Published: April 2023

Lyme disease, also called Lyme borreliosis, is caused by the spirochete Borrelia burgdorferi sensu stricto (B burgdorferi) in the Upper Atlantic Coast and Borrelia mayonii in the Upper Midwest and West Coast. It can cause a range of manifestations including erythema migrans, cranial nerve palsies, meningitis, carditis, and arthritis. Recent guidelines advocate for outpatient treatment for many of these conditions. Scenarios will be presented that outline treatment of these manifestations.
Where Have All the Rhinoplasties Gone? A Call to Action for Academic Plastic Surgeons to Focus on Increasing Rhinoplasty Procedures Before It Is Too Late
Authors: Jordan Ashley , Tashmia Alexis , Wang Shengxuan , Cederna Paul S. , Kauffman Christian A.
Published: April 2023

Background

The armamentarium of a plastic surgeon is vast, consisting of an array of surgical procedures from head to toe. Unfortunately, plastic surgeons have been losing portions of their operative domain to other surgical subspecialties for years. The number of subspecialties invading our niche is bothersome, but more concerning is the fact that losing the reins of these core procedures results in less surgical exposure and competency for plastic surgery residents.

Lately, in academic institutions, otolaryngologists seem to be performing most rhinoplasty procedures, resulting in fewer surgeries performed by plastic surgeons. Trainees must perform 10 rhinoplasties to fulfill graduation requirements but, more importantly, residents should graduate feeling competent and confident performing rhinoplasties. The aims of this study are to determine the number of rhinoplasties being performed at academic centers each year and to evaluate the trend with regard to which specialties are performing these procedures.

Methods

Three academic institutions with plastic surgery and otolaryngology residency programs searched medical records for rhinoplasty Current Procedural Terminology codes from January 1, 2009, to December 31, 2019. The total numbers of rhinoplasties performed each year, by each specialty, were tallied.

Results

Growth rate in rhinoplasty volume among participating institutions ranged from 27% to 149%. At these institutions, plastic surgeons performed less than one third of all rhinoplasties. In 2009, 10% of rhinoplasties were performed by plastic surgeons at institution 1, 22% at institution 2, and 18% at institution 3. In 2019, the volume of rhinoplasties performed by plastic surgeons was 5%, 12%, and 27%, respectively. The 3 ENT departments had statistically significant increasing trends in rhinoplasty volume. Institutions 1 and 2's plastic surgery departments showed that negative volume trends, however, were not statistically significant. Institution 3's plastic surgery department has had an increasing trend, which was statistically significant.

Conclusions

Otolaryngology is performing most rhinoplasties at several academic institutions. This is concerning for the education of plastic surgery trainees. Academic plastic surgeons must focus on increasing the number of rhinoplasties performed to adequately train residents this core procedure. If rhinoplasties are not made a priority now, this surgery may become a historic operation instead of a vital skill in plastic surgeons' armamentarium.
Perilunate and Lunate Dislocations
Authors: Ramponi Denise R. , Good Anthony E.
Published: April 2023

Lunate and perilunate dislocations, although somewhat uncommon, are serious injuries and can be easily missed. The mechanism of injury is hyperextension of the wrist, often associated with a fall on the outstretched hand (FOOSH) injury, falls from height, or motor vehicle crash with a high-energy traumatic injury to the wrist. Perilunate dislocations typically present with pain and swelling over both the dorsal and volar aspects of the wrist and limited range of motion of the wrist. Perilunate dislocations result in disruption of the relationship between the lunate and the capitate, whereas lunate dislocations result in a disruption of the lunate bone, both from the radius and the capitate, primarily diagnosed on the lateral view of the wrist radiograph. These injuries require emergent reduction and stabilization either via a closed or open surgical reduction by an orthopedic specialist. Lunate dislocations can lead to long-term pain and disability if overlooked in their initial assessments.
Recognizing a Peritonsillar Abscess in Pediatric Patients
Authors: Joint Major Leila
Published: April 2023

A peritonsillar abscess (PTA) is a localized collection of pus in the peritonsillar space, between the palatine tonsillar capsule and the superior pharyngeal constrictor muscle (G. Gupta & R. McDowell, 2022). It is the most commonly occurring abscess in the head and neck region. Patient presentation usually includes odynophagia, unilateral otalgia, trismus, and voice changes. Managing a pediatric patient may be challenging, as children may not be able to describe their history of illness and symptoms. The management of a PTA can also differ between pediatric and adult patients (S. Ahmed Ali et al., 2018). It is important for practitioners to consider all aspects when providing treatment. This article describes the encounter and individualized treatment plan of an 11-year-old nonverbal autistic child who presented with fever, decreased oral intake, and left neck swelling. It also provides a general overview of PTAs and procedural steps to perform drainage through needle aspiration and incision and drainage.
A Possible Case of Opioid-Induced Hypoglycemia and the Potential Role of Naloxone
Authors: Weant Kyle A. , Embertson Kyle E. , Fisher Daniel W.
Published: April 2023

Literature has found that individuals with opioid use disorders have increased fasting insulin levels and that antagonism of the μ-receptor with naloxone blunted this hypoglycemic effect. We describe a 35-year-old woman with no history of diabetes who presented after being found unconscious where she was given naloxone and became awake and combative. Her blood glucose (BG) on presentation was 175 mg/dl, which declined to 40 mg/dl, and dextrose was administered. Subsequently, it declined to 42 mg/dl and was again given dextrose. Later her BG fell to 67 mg/dl and she was given dextrose and started on a dextrose infusion. She was then administered IV naloxone and 1 hr later the infusion was discontinued and she had no further hypoglycemic events. Clinicians should consider altering monitoring parameters in the setting of acute overdoses to include repeated glucose assessment to ensure early identification of hypoglycemia and the potential influence of naloxone.
The Use of Activated Charcoal in Toxicology and Implications for APRN Practice
Authors: Bhimani Alisha , Frenkel Tova Safier , Evans Dian Dowling
Published: April 2023

This Research to Practice article is designed to help aid advanced practice registered nurses (APRNs) with up-to-date research guidelines in order to establish evidence-based changes in clinical practice within emergency medical care. The article, “Activated Charcoal and Poisoning: Is It Really Effective?” by Aksay et al. (2022), examines whether the usage of activated charcoal (AC) in current treatment protocols for ingested poisonings adds benefits, given recent controversies in its use. Study variables included clinical findings in relation to the drug being ingested, the frequency and usage of an antidote, the rate of being intubated, and the duration of being hospitalized comparing poisoned patients who received AC with those who did not. APRNs need to be aware of the current guidelines to help establish the appropriateness of use when administering AC and be able to evaluate patients during and after the administering of AC. Improved awareness and education regarding the different treatment modalities for toxicology patients such as AC can help with certain kinds of poisonings in the emergency department.
Public and animal health risks associated with spillover of Brucella melitensis into dairy farms
Authors: Bardenstein Svetlana , Grupel Daniel , Blum Shlomo E. , Motro Yair , Moran-Gilad Jacob
Published: April 2023

Brucellosis is a worldwide zoonosis with important public health, animal health and economic implications.

Brucella melitensis

, commonly associated with small ruminants, is an emerging bovine pathogen in dairy farms. We analysed all

B. melitensis

outbreaks affecting dairy farms in Israel since 2006, combining traditional and genomic epidemiology to explore the public health implications of this One Health challenge. Whole-genome sequencing was applied to bovine and related human

B. melitensis

isolates from dairy farm outbreaks. cgMLST-based and SNP-based typing was integrated with epidemiological and investigation data. A secondary analysis combining the bovine-human isolates with endemic human isolates from southern Israel was performed. A total of 92 isolates from dairy cows and related human cases originating from 18 epidemiological clusters were analysed. Most genomic and epi-clusters were congruent, but sequencing showed relatedness between apparently unrelated farm outbreaks. Nine secondary human infections were also genomically confirmed. The bovine-human cohort appeared intermixed with 126 endemic human isolates in southern Israel. We show a persistent and widespread circulation of

B. melitensis

in dairy farms in Israel with secondary occupational human infection. The genomic epidemiology also uncovered cryptic connections between outbreaks. A regional connection between bovine and endemic human brucellosis cases points to a common reservoir, most probably local small ruminant herds. Control of humans and bovine brucellosis is inseparable. Epidemiological and microbiological surveillance and implementation of control measures across the entire range of farm animals is needed to mitigate this public health challenge.