bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcriptome analysis revealed a novel nine-gene prognostic risk score of clear cell renal cell carcinoma
Authors: Al Sharie Ahmed H. , Al Masoud Eyad B. , Jadallah Rand K. , Alzghoul Saja M. , Darweesh Reem F. , Al-Bataineh Rania , Lataifeh Leen N. , Salameh Shatha T. , Daoud Majd N. , Rawashdeh Tariq H. , El-Elimat Tamam , Alali Feras Q.
Published: September 2024

Clear cell renal cell carcinoma (ccRCC) continues to pose a significant global health concern, with rising incidence and high mortality rate. Accordingly, identifying molecular alternations associated with ccRCC is crucial to boost our understanding of its onset, persistence, and progression as well as developing prognostic biomarkers and novel therapies. Bulk RNA sequencing data and its associated clinicopathological variables of ccRCC were obtained from The Cancer Genome Atlas Program. Atypical differential gene expression analysis of advanced disease states using the extreme categories of staging and grading components was performed. Upregulated differentially expressed genes shared across the aforementioned components were selected. The risk-score construction pipeline started with univariate Cox logistic regression analysis, least absolute shrinkage and selection operator, and multivariate Cox logistic regression analysis in sequence. The generated risk score classified patients into low- vs high-risk groups. The predictive power of the constructed risk score was assessed using Kaplan–Meier curves analysis, multivariate Cox logistic regression analysis, and receiver operator curve of the overall survival. External validation of the risk score was performed using the E-MTAB-1980 cohort. The analysis work scheme established a novel nine-gene prognostic risk score composed of the following genes: ZIC2, TNNT1, SAA1, OTX1, C20orf141, CDHR4, HOXB13, IGFL2, and IGFN1. The high-risk group was associated with shortened overall survival and possessed an independent predictive power (hazard ratio: 1.942, 95% CI: 1.367–2.758, P < .0001, area under the curve = 0.719). In addition, the high-risk score was associated with advance clinicopathological parameters. The same pattern was observed within the external validation dataset (E-MTAB-1980 cohort), in which the high-risk score held a poor prognostic signature as well as independent predictive potential (hazard ratio: 5.121, 95% CI: 1.412–18.568, P = .013, area under the curve = 0.787). In the present work, a novel nine-gene prognostic risk score was constructed and validated. The risk score correlated with tumor immune microenvironment, somatic mutation patterns, and altered molecular pathways involved in tumorigenesis. Further experimental data are warranted to expand the work.
Sjögren’s syndrome complicated with hypothyroidism and osteomalacia: A case report
Authors: Chen Runtian , Fang Lihua , Fang Xiaokang , Ning Jie
Published: September 2024

Rationale:

Sjögren syndrome (SS) is a prevalent autoimmune disorder targeting exocrine glands, causing symptoms such as dry eyes and mouth. It often goes underdiagnosed due to its varied presentations, emphasizing the importance of early and accurate diagnosis.

Patient concerns:

A 22-year-old female presented with atypical symptoms of hypokalemic paralysis and severe bone pain, which are not commonly associated with SS.

Diagnoses:

Extensive diagnostic workup, including serological tests, ophthalmological assessments, and a lip biopsy, confirmed the diagnosis of distal renal tubular acidosis as a complication of SS.

Interventions:

The patient was treated with an intensive inpatient regimen designed to stabilize her potassium levels and alleviate her symptoms.

Outcomes:

The comprehensive therapeutic intervention was successful, with the patient’s symptoms being alleviated within 2 weeks.

Lessons:

This case underscores the importance of being aware of SS in younger demographics and the necessity for a prompt and multifaceted treatment approach to manage systemic effects and improve quality of life.
Multimodal ultrasound imaging for patent foramen ovale and pulmonary arteriovenous malformation in patients with cryptogenic stroke or migraine: A prospective diagnostic study
Authors: Xu Jianping , Cui Faping , Zhang Hui
Published: September 2024

Right-to-left shunt (RLS) caused by patent foramen ovale (PFO) and pulmonary arteriovenous malformations (PAVM) have been associated with a variety of diseases, and reliable techniques for detecting RLS are essential for diagnosis. This study aimed to compare the diagnostic accuracy of multimodal ultrasound imaging, including transthoracic echocardiography (TTE) plus contrast transthoracic echocardiography (CTTE) and transesophageal echocardiography (TEE) plus contrast transesophageal echocardiography (CTEE) for PFO and PAVM in patients with cryptogenic stroke or migraine. This prospective study enrolled patients with cryptogenic stroke or migraine admitted to First Hospital of Shanxi Medical University between July 2018 and April 2023. The TTE + CTTE + TEE + CTEE multimodal ultrasound imaging was defined as the gold standard. A total of 230 patients with cryptogenic stroke (108) or migraine (122) were enrolled. The TEE + CTEE generated a better area under the receiver operator characteristic (ROC) curves (AUC) than TTE + CTTE [0.995 (0.988–1.000) vs 0.975 (0.767–0.984), P < .001], indicating better identification of PFO and PAVM. The sensitivity and specificity of the TTE + CTTE were 89.4% and 85.7%, respectively, whereas the sensitivity and specificity of TEE + CTEE were 99.1% and 100%, respectively. The missed diagnosis rate of TTE + CTTE and TEE + CTEE was 65.7 % and 12.5%, respectively. The combination of TEE + CTEE may be a more reliable and sensitive tool to detect PFO and PAVM than TTE + CTTE in patients with cryptogenic stroke or migraine.
The impact of high-intensity interval training on women’s health: A bibliometric and visualization analysis
Authors: Li Youyou , Fang Jingqian
Published: September 2024

Background:

High-intensity interval training (HIIT) can significantly improve health indicators such as cardiopulmonary function, metabolic efficiency, and muscle strength in a short period. However, due to significant physiological and metabolic differences between males and females, the effects of HIIT vary between genders. Therefore, exploring the specific impacts of HIIT on women’s health is crucial. Although there is a considerable amount of individual research on the impact of HIIT on women’s health, a systematic bibliometric analysis is still lacking.

Methods:

Publications related to HIIT in women’s health were retrieved from the Web of Science Core Collection database, and tools like Microsoft Office Excel 2021, VOSviewer, and Citespace were used to create visualized tables and views.

Results:

The study included 808 publications distributed across 1234 institutions in 61 countries, authored by 3789 researchers. The United States, Australia, and Canada lead in this domain. Researchers like Astorino TA and Gibala MJ are notably influential in this field. The research has been prominently published in specific academic journals and widely cited by high-impact journals. Highly cited and bursting documents primarily discuss the effects of HIIT on metabolic adaptation, muscle adaptation, cardiovascular health, insulin sensitivity, and exercise performance. Frequent keywords include “aerobic exercise,” “sprint interval training,” “resistance training,” “obesity,” “body composition,” “aging,” and “insulin resistance.” Keyword burst analysis reveals that early studies focused primarily on basic concepts and training models, which then expanded to specific physiological responses, applications in particular populations, and impacts on specific diseases.

Conclusion:

This field has emerged as a research hotspot with international characteristics and extensive academic productivity. Journals and cited journals hold high academic influence, with highly cited and bursty references laying a solid theoretical and practical foundation for the field. In the rapid development of the past decade, research hotspots and frontier directions such as metabolic adaptation, muscle adaptation, cardiovascular health, exercise performance, and personalized training plans have been formed.
The effect of total size, area, and volume of lesions in multifocal/multicentric breast cancers and unifocal breast cancers on survival: An observational study
Authors: DAL Fatih , ÖKMEN Hasan , ULUSAN Kivilcim , BATTAL HAVARE Semiha , SARI Serkan
Published: September 2024

In this study, we aimed to investigate the prognostic effect of the classifications made according to the stage of the largest lesion diameter (T-max stage) and of the sum of the longest diameters of the lesions (T-sum stage), the largest area stage (A-max stage), the sum of the largest areas (A-sum stage), the highest volume stage (V-max stage), the sum of the highest volume (V-sum stage) on disease-free survival, and overall survival (OS) in multifocal/multicentric breast cancers (MMBCs) and unifocal breast cancers (UBCs). The study included a total of 769 patients either with MMBC (n = 128) or UBC (n = 641) who underwent surgery between 2006 and 2015. In the analysis, the median age of 769 patients was 53.0 (20.0–94.0) years, and 16.6% of these 769 patients were MMBC and 83.4% were UBC. In multivariate analysis, lymphovascular invasion (LVİ), estrogen receptor, and nodal status were common independent prognostic factors, whereas T-max stage [(HR: 1.17) (CI 95%: 1.03–1.33) (P = .018)] was a prognostic factor for OS. In multivariate analysis, the T-max stage is an independent risk factor for OS. Therefore, T-max should be continued to be used for measurement and T-stage should be used for classification in MMBCs/UBCs.
Application of traditional Chinese medicine nursing technology: Traditional Chinese medicine ironing combined with traditional Chinese medicine massage in improving functional constipation in elderly patients
Authors: Tan Lili , Qin Wei , Liao Jiaquan , Liu Yinglong , Yan Lianmei
Published: September 2024

To explore the therapeutic effect of traditional Chinese medicine (TCM) nursing technology combined with TCM massage on elderly patients with functional constipation (FC). Ninety elderly patients with FC admitted to our hospital from January 2022 to February 2023 were selected and randomly divided into 3 groups. The control group was treated with conventional Western medicine, observation group 1 was treated with TCM massage on the basis of the control group, and observation group 2 was treated with medicine ironing combined with TCM massage on the basis of the control group. Compare 3 groups of TCM syndrome scores, clinical efficacy, complete spontaneous bowel movements (CSBM) per week, Bristol fecal trait scale, and safety. There was a statistically significant difference in clinical effective rates among the 3 groups (96.67%, 83.33%, 66.67%) (P < .05), and the observation group 2 was higher than the observation group 1 and higher than the control group. After treatment, the TCM syndrome scores of the 2 groups were lower than those of the observation group 1 and the control group; And observation showed that the TCM syndrome score of group 1 was lower than that of the control group (P < .05). After treatment, the increase in scores of CSBM and Bristol fecal traits in the 2 groups was higher than that in the observation group and control group, and the increase in scores of CSBM and Bristol fecal traits in the observation group was higher than that in the control group (P < .05). There was no statistically significant difference in the incidence of adverse reactions among the 3 groups (10.00%, 6.67%, 20.00%) (P > .05). The application of TCM nursing techniques such as TCM ironing and TCM massage in elderly patients with FC has a significant clinical effect, which can effectively improve clinical symptoms, defecation frequency, and fecal characteristics, and has high safety.
Two complicated cases of severe scrub typhus, eschar- a non-negligible sign: Case reports and literature review
Authors: Cai De-Han , Fang Xiao-Lin
Published: September 2024

Rationale:

Scrub typhus is a mite-borne, acute febrile disease caused by Orientia tsutsugamushi. The endemic areas of scrub typhus are expanding, both globally and in China. Patients who are not treated promptly, are likely to die of multiple organ dysfunction syndrome.

Patient concerns:

Case I A 61-year-old female patient complained of sudden chest tightness and shortness of breath accompanied by fever for 6 days. Case II A 54-year-old male patient complained of fever and cough for 4 days and renal insufficiency for 2 days.

Diagnoses:

Scrub typhus, multiple organ dysfunction syndrome.

Interventions:

After the definite diagnosis, both patients were treated with doxycycline and various organ supports.

Outcomes:

The patient in case I was ultimately not salvageable. The patient in case II was successfully cured by the prompt administration of doxycycline along with continuous renal replacement therapy.

Lessons:

With early diagnosis and treatment, patients can completely recover. Eschar, a characteristic sign of scrub typhus, is often overlooked, leading to delayed diagnosis and regrettable outcomes.
Legal implications for clinicians in cybersecurity incidents: A review
Authors: Elendu Chukwuka , Omeludike Eunice K. , Oloyede Praise O. , Obidigbo Babajide T. , Omeludike Janet C.
Published: September 2024

Cybersecurity incidents in healthcare present significant legal implications for clinicians, necessitating careful consideration of technological advancements and regulatory frameworks. This literature examines the healthcare cybersecurity landscape, emphasizing clinicians’ challenges, and legal responsibilities. It explores the impact of advanced technologies such as artificial intelligence and quantum computing, highlighting the potential benefits and risks, including biases and ethical dilemmas. The review addresses international regulatory differences, offering a comparative analysis of how various countries handle cybersecurity incidents. This analysis provides insights into best practices and identifies areas for improvement. Practical recommendations are provided, tailored to different healthcare settings, including large hospitals and small clinics, to enhance cybersecurity preparedness. Case studies illustrate real-world scenarios, offering practical guidance for clinicians in managing cybersecurity challenges. The review also identifies critical gaps in the literature, particularly concerning artificial intelligence ethics and international regulatory frameworks, suggesting specific areas for future research. These findings underscore the need for robust cybersecurity policies, comprehensive training for healthcare professionals, and a nuanced understanding of the legal landscape. This review informs policymakers, clinicians, and researchers about the evolving nature of cybersecurity challenges in healthcare, addressing key concerns raised by reviewers and contributing to a comprehensive understanding of the field.
Risk factors for cerebral infarction and cerebrovascular stenosis in antiphospholipid antibody-positive patients: A retrospective single-center study with propensity score matching analysis
Authors: Ha Seung Hyun , Kim Sang-Uk , Huh Joon , Huh Choon-Woong
Published: September 2024

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by the presence of antiphospholipid antibodies (aPLA), such as anticardiolipin (aCL), anti-β2-glycoprotein I (aβ2GPI), or lupus anticoagulant (LA). Although cerebrovascular events are commonly associated with APS, comprehensive studies on risk factors for cerebral infarction in aPLA-positive patients remain sparse. In this retrospective single-center study, data from 9844 patients tested for aPLA between January 2017 and March 2023 were analyzed. A total of 647 aPLA-positive patients were included, with assessments of various factors including age, gender, hypertension, diabetes, dyslipidemia, smoking history, and cardiac disease. Propensity score matching was employed to create 2 matched groups of 202 patients each, comparing those with and without cerebral infarction. Logistic regression analyses were conducted to identify risk factors for cerebral infarction and progression of cerebrovascular stenosis. The mean age of the study cohort was 65.8 years, with 60% being male. LA was positive in 95.2% of the cases, aCL in 8.8%, and aβ2GPI in 5.3%. High-risk aPLA profiles were identified in 7.1% of the cases. In the cerebral infarction group, both smoking history and aCL positivity were significantly associated with an increased risk (OR = 1.543; 95% CI: 1.020–2.334; P = .040 and OR = 3.043; 95% CI: 1.426–6.491; P = .040, respectively). Male gender and posterior circulation involvement were significant risk factors for exacerbation of cerebrovascular stenosis (OR = 3.73; 95% CI: 1.16–16.69; P = .046 and OR = 5.41; 95% CI: 1.80–16.05; P = .002, respectively). Smoking history and aCL positivity are prominent risk factors for cerebral infarction in aPLA-positive patients, while male gender and involvement of the posterior circulation emerge as significant risk factors for the progression of cerebrovascular stenosis. Further comprehensive prospective studies are necessary to deepen understanding of aPLA-related cerebrovascular diseases.
The causal association between type 2 diabetes and spinal stenosis: A Mendelian randomization analysis
Authors: Fan Zhaopeng , Chen Bohong , Ding Le , Guo Hua
Published: September 2024

Spinal stenosis is a prevalent degenerative spinal disease and one of the main causes of pain and dysfunction in older adults. Substantial evidence indicates a potentially relevant association between type 2 diabetes mellitus (T2DM) and spinal stenosis. However, the causality between these 2 disorders remains unclear. Therefore, we intended to elucidate this relationship using Mendelian Randomization (MR) analysis in this study. Based on genome-wide association study (GWAS) data on T2DM and spinal stenosis, we performed a bidirectional 2-sample MR analysis to evaluate the causality of T2DM and spinal stenosis. We assessed heterogeneity using Cochran’s Q statistic and horizontal pleiotropy using the MR-Egger-intercept. “Leave-one-out” analysis was performed to determine the reliability of causal relationships. In addition, we conducted multivariate MR to clarify the direct influence of T2DM on spinal stenosis after accounting for the effect of body mass index (BMI) on spinal stenosis. Our results indicated that Individuals with T2DM had a heightened risk of spinal stenosis (odds ratio [OR]: 1.050; 95% CI: 1.004–1.098, P = .031). Moreover, no reverse causality existed between T2DM and spinal stenosis. The results of the sensitivity analysis suggest that causality is steady and robust. Multivariate MR results demonstrated that the causality of T2DM on spinal stenosis was not related to BMI (OR, 1.047; 95% CI: 1.003–1.093; P = .032). MR analyses demonstrated a possible positive causal relationship between T2DM and spinal stenosis and that this causality was unrelated to BMI.
Effect of “He Tiao Du Ren An Shen Acupuncture” on restless leg syndrome: A randomized trial
Authors: Guan Xin-Rui , Chen Ying-Hua , Li Jun-Feng , Su Xiao-Qing , Sun Wei
Published: September 2024

Background:

This study aimed to observe the clinical effects of “He Tiao Du Ren An Shen Acupuncture” (HTDRAS Acupuncture) for treating restless leg syndrome (RLS).

Methods:

We randomly divided 66 RLS patients into 2 groups: the observation group received “He Tiao Du Ren An Shen Acupuncture” and the control group received conventional acupuncture. All participants were treated once a day, 6 days a week, with 1 day off, for a total of 1 month. Clinical effectiveness of the 2 groups was compared, neurotransmitter levels, the International Restless Leg Syndrome Scale and the Hamilton Anxiety Scale were assessed in both groups.

Results:

The curative effect in the observation group was better than that in the control group (P < .05). After treatment, the expression of 5-hydroxytryptamine in the observation group was higher than in the control group (P < .05). The International Restless Leg Syndrome Scale and Hamilton Anxiety Scale scores in observation group were lower than those in control group (P < .05).

Conclusion:

“He Tiao Du Ren An Shen Acupuncture” for RLS is significantly effective and safe. It can effectively improve the levels of 5-hydroxytryptamine in RLS patients, alleviate clinical symptoms and reduce anxiety. This treatment has a high clinical application value and is worthy of clinical promotion.
Reporting quality of meta-analyses in acupuncture: Investigating adherence to the PRISMA statement
Authors: Qin Chu , Ma Huan , Mandizadza Oscar Onayi , Xu Xiujuan , Ji Conghua
Published: September 2024

Although Systematic Reviews and Meta-Analyses (PRISMA) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Acupuncture (PRISMA-A) checklists had been in use for several years, compliance rate was still not optimistic. We investigated the quality of reporting for meta-analyses of acupuncture published in PubMed. We compared the compliance rate for the quality of reporting following the publication of both the PRISMA and PRISMA-A recommendations. We searched PubMed for articles published between January 1st, 2020 and December 31st, 2022, after Endnote X9 document management software and manual screening, 180 meta-analyses of acupuncture were selected as samples. The PRISMA, and PRISMA-A checklists were used to evaluate the quality of the literature. Data were collected using a standard form. Pearson χ
2 test and/or Fisher exact test were used to assess differences in reporting among groups. Logistic regression is used to calculate OR and its 95% CI. The total reported compliance rate of all items in the PRISMA list was 61.3%, and the reported compliance rate of the items with a compliance rate of <50% accounted for 35.71% of the total items. The total reported coincidence rate of all items in the PRISMA-A was 56.9%, and the reported coincidence rate of the items with a reported coincidence rate of <50% accounted for 31.25% of all the items. The compliance rate of the published research to PRISMA or PRISMA-A has no statistical difference between the Journal Citation Reports partition (Quarter1–Quarter2) and Journal Citation Reports partition (Quarter3–Qurater4) (P > .05). Regardless of the level of journals published, have obvious deficiencies in the details of the study, the reference basis for the design of the study, the analysis method, the degree of strictness, the scientific nature, and other aspects. We must strengthen education on the standardization of research reports.
Application of placing the anterior end of endotracheal tube at the glottis in laryngeal mask airway positive ventilation during general anesthesia: A prospective, randomized, controlled trial
Authors: Chen Zheng , Ma Xiao-Dong , Mao Zu-Min , Chen Lei , Chen Yuan-Feng , Shao Dong-Hua
Published: September 2024

Background:

Glottic contraction and closure causes ventilation obstruction and laryngeal mask airway (LMA) leakage during positive pressure ventilation using LMA. This study aimed to assess the effect of placing the anterior end of the endotracheal tube (ET) at the glottis through the LMA ventilation conduit on treating LMA leakage following glottic contraction and closure.

Methods:

In this prospective, randomized, controlled trial, patients with non-minor surgery using LMA ventilation were randomly allocated to the i-gel group (group L) and the i-gel combined with ET group (group LE). The tip of ET was placed 2 cm under glottis guided by fiberoptic bronchoscope through i-gel ventilation conduit in group LE. The perioperative incidence of i-gel leakage, the changes of systolic blood pressure (SBP) and heart rate (HR) following artificial airway insertion, and adverse events were recorded.

Results:

Perioperative i-gel leakage was observed in 7 of 48 patients (14.6%) in group L and 1 of 49 patients (2.0%) in group LE. There was significant difference in the incidence of leakage between the 2 groups (P = .031). SBP and HR after ET insertion in group LE increased significantly compared to those in group L (P < .05/5). The values of both SBP and HR after ET insertion did not exceed the basic values in group LE (P > .05/4). There were no significant differences in the incidence and severity of postoperative sore pain and hoarseness, cough during i-gel and ET removal between the 2 groups (P > .05).

Conclusion:

Placing the anterior end of ET at the glottis reduced LMA air leakage related to glottic contraction and closure in non-minor surgery. The ET placing had low stress response and did not significantly increase postoperative complications.
Facilitators and Barriers of Implementing Expanded Sexually Transmitted Infection Screening in California Family Planning Clinics
Authors: Ehlers Ellen , Kovaleski Laura , Devaskar Sangita , Kennedy Sara , Plotzker Rosalyn E.
Published: September 2024

Background

Reportable sexually transmitted infections (STIs) have increased in California, with dramatic rises in prenatal and congenital syphilis. In response, in 2018 Planned Parenthood Northern California implemented 2 opt-out screening protocols: (1) HIV, chlamydia, gonorrhea, and syphilis co-screening for pregnant patients at pregnancy diagnosis and (2) linking HIV and syphilis screening for all patients.

Methods

Using qualitative analyses, we explored implementation barriers and facilitators that can be addressed by clinical leadership and staff to expand uptake of enhanced screening protocols. Sixteen staff were interviewed across 3 Planned Parenthood Northern California clinics. Primary thematic analysis followed by secondary subanalysis identified themes. Analyses of questions were only included for each interviewee if answered and applicable.

Results

Five themes of commentary emerged, featuring both facilitators and barriers for protocol implementation: patient education/communication, staff education/communication, workflow; patient willingness, and (for protocol 1 only) visit complexity at the time of pregnancy diagnosis. Additional findings included the following: 93% (13 of 14) stated protocols increased syphilis screening and identification; 100% (12 of 12) reported positive impacts on patient care; 42% (5 of 12) noted increases in staff workload, 25% (3 of 12) reported workload improvements over time, and 33% (4 of 12) reported no workload-related impacts; and 86% (13 of 15) reported decreased screening during the COVID-19 pandemic.

Conclusion

Addressing patient and staff education during the beginning stages of implementation may have positive impacts on willingness to adopt new protocols. Consideration of workflow and visit complexity at pregnancy diagnosis may also aid in successful implementation of expanded STI screening protocols in family planning clinics.
Effect of Adding Diaphragmatic Myofascial Release to Corrective Exercise on the Thoracic Curvature Angle and Pulmonary Function Testing in Hyperkyphotic Adolescent Girls
Authors: Elabd Omar M. , Elsamahy Sara A. , Abdelmutilibe Sahar M. , Mohammed Amira H. , Ali Faten , Elabd Aliaa M.
Published: September 2024

Objective

The aim of the study was to investigate whether adding diaphragmatic release to corrective exercise could improve the Cobb angle and pulmonary function more than corrective exercise alone in hyperkyphotic adolescent girls.

Design

This is a single-blinded, randomized, controlled trial.

Methods

One hundred eighteen adolescent hyperkyphotic girls were allocated randomly into two equal groups. Control group received only corrective exercise, while study group received diaphragmatic release in addition to corrective exercise. Primary outcome was Cobb angle, assessed by lateral radiographs. Secondary outcomes were pulmonary function testing, assessed by computerized spirometery. Outcomes were assessed before and after treatment, after 3 mos of interventions, in both groups.

Results

Two-way analysis of variance revealed that both Cobb angle and pulmonary function testing significantly improved after treatment in both groups (P < 0.001). Time*group interaction revealed that the study group had a superior improvement in Cobb angle and pulmonary function testing compared to the control group (P < 0.003 and P < 0.001, respectively).

Conclusions

Adding diaphragmatic release to 3 mos of multimodal corrective exercise program showed superior improvements in Cobb angle and pulmonary function testing than corrective exercise alone in hyperkyphotic adolescent girls within a shorter timeframe compared to previous studies. These results strengthen the hypothesis of its potential as a beneficial addition to the treatment of thoracic hyperkyphosis.

To Claim CME Credits

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives

Upon completion of this article, the reader should be able to: (1) Recognize poor habits that play a significant role in developing hyperkyphosis in adolescents; (2) Construct the link between diaphragm malfunction and adolescent hyperkyphosis and its associated disorders of the cervical and thoracic spine and pulmonary function testing; (3) Carry out diaphragmatic myofascial release and corrective exercise for the spine; (4) Design a multimodal program to improve the Cobb angle and pulmonary function testing in hyperkyphotic adolescents; and (5) Measure the improvement of the Cobb angle and pulmonary function testing after treatment in hyperkyphotic adolescents.

Level

Advanced

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Consensus Recommendations for Treatment of the Upper Face With LetibotulinumtoxinA
Authors: Choi Ho-Sung , Wang Jimmy , Tauber Dahlia , Brown Aemillia , Chang Kathleen , Liew Steven , Yi Kyu-Ho
Published: September 2024

One of the authors (K-H. Y.) convened a panel of seven aesthetic experts from South Korea and Australia to create guidelines for treating facial lines of the upper face with letibotulinumtoxinA. The panel members provided recommendations for injection sites, dosage, and injection techniques for using letibotulinumtoxinA and also considered relevant anatomy, patient assessment and selection, and individual variations to evaluate clinical strategies for minimizing complications. The panelists provided recommendations for treating forehead horizontal lines, glabellar frown lines, and lateral canthal lines. The guidelines developed by the panel will support clinical practitioners of all skill levels in providing safe and effective aesthetic treatments of the forehead, glabellar complex, and lateral canthal lines with letibotulinumtoxinA.
Clinical Treatment Progress for Large Metacarpal and Phalangeal Bone Defects
Authors: Liu Zeng-Bing , Liu Wen-Xia , Li Xin-Hai , Ma Kai , Huo Yu-Bao
Published: September 2024

Large metacarpal and phalangeal bone defects are a hot topic for orthopedic surgeons due to its high clinical incidence, disability rate, and postsurgical amputation rate, along with its difficult treatment, long treatment course, high cost, and poor effect, all of which have a negative impact on the appearance and function of the patient’s hands. There are currently a variety of treatment options for large metacarpal and phalangeal bone defects, each with its own benefits and drawbacks. However, there is no treatment method capable of perfectly resolving all the problems of patients with these defects. In this paper, the authors introduce several common plans for and progress of large metacarpal and phalangeal bone defect treatment.
Psychosocial Issues Related to Speech and Hearing in Patients With Clefts
Authors: Osorio Camila , Persson Martin
Published: September 2024

Introduction:

Individuals with cleft lip and palate often face persistent challenges related to speech and hearing disorders, impacting various aspects of their lives. These challenges can lead to additional mental health issues such as attention-deficit/hyperactivity disorder, anxiety, and depression, as well as heightened psychosocial challenges, including appearance-related issues, bullying, workplace discrimination, and impaired social interactions. Children and adolescents with these disorders commonly experience loneliness, peer rejection, and challenges in forming friendships, particularly during adolescence, while voice disorders can diminish the quality of life in older individuals.

Case description:

This case study focuses on a 17-year-old male with unilateral cleft lip and palate undergoing treatment in Medellin, Colombia, aiming to provide insights into the intricate psychosocial challenges linked to speech and hearing difficulties in individuals with cleft conditions.

Discussion and Evaluation:

Clinical evaluations identified significant challenges concerning speech difficulties and self-perception, influenced by the patient’s cleft condition, which impacts his self-esteem, confidence, and social skills development. The interconnectedness between speech and hearing challenges underscores the necessity for comprehensive care to address the multifaceted psychosocial aspects experienced by individuals with cleft conditions.

Conclusions:

This case study used as an example, indicates that speech difficulties and psychosocial challenges related to cleft conditions are experienced from childhood and may persist into adulthood. These challenges can have profound effects on various aspects of life, including school, social interactions, family dynamics, and even romantic relationships. Consequently, the lack of confidence, social isolation, and limited social skills may delay patients from reaching their fullest potential.
Trends of Overactive Bladder and Pharmacologic Treatment Among U.S. Women
Authors: King Lauren A. , Pruszynski Jessica E. , Wai Clifford Y. , Florian-Rodriguez Maria E.
Published: September 2024

Importance

To evaluate and consider how prescribing practices have changed in relation to high-risk overactive bladder (OAB) medications.

Objective

The objective of this study was to evaluate trends in the prevalence of OAB and pharmacologic treatment over time in the United States.

Study Design

Data from the National Health and Nutrition Examination Survey (NHANES, 2001–2018, n = 30,478) and the National Ambulatory Medical Care Survey (NAMCS, 2003–2019, n = 251,330) were used to identify women with symptomatic incontinence and overactive bladder (OAB) (NHANES) as well as determine the frequency of prescription use for OAB medications (NHANES and NAMCS) using sampling-based weights. Joinpoint regression was used to determine adjusted annual percent change (APC, adjusting for race, age, body mass index, and insurance status). Trends were assessed overall and by race, age, body mass index, and insurance status.

Results

The prevalence of OAB was 31.2% in the final survey year of NHANES (2017–2018). Women aged >65 years had the highest prevalence of OAB at 54% compared with other age groups. There was an overall increase in OAB (APC 1.24 [0.64, 1.84], P = 0.002) over time. Overall, only 3.5% of patients with symptoms of OAB reported pharmacologic treatment in NHANES. The NAMCS demonstrated a significant decrease in anticholinergic prescriptions from 2003 until 2019 (APC −6.44 [−9.77, −2.98], P = 0.001). However, in NHANES, there was no significant change in anticholinergic use (APC 0.62 [−20.2, 26.8], P = 0.944). There was a stable prevalence of β3-adrenergic agonist prescriptions since they were introduced to market (APC 0.65 [−2.24, 3.62], P = 0.616).

Conclusion

This study demonstrates an increasing prevalence of OAB and highlights the likely undertreatment of symptomatic patients. The high and increasing prevalence coupled with the relative undertreatment of OAB underscores the importance of screening for this condition.
Organizational models and patient-reported outcomes for palliative care across five tertiary hospitals in Nigeria: an Environmental Scan
Authors: Ogbenna Ann A. , Caputo Matthew , Onyeka Tonia C , Ohanete Debora O. , Johnson Lyra S. , Sam-Agudu Nadia A. , Obiezu-Umeh Chisom , Akodu Babatunde , Drane Denise , Evans Charlesnika , Akinwale Mukaila O. , Ndukwu Geraldine U. , Kolawole Israel K. , Ayilara Saheed A. , Eke Gracia K. , Akinsete Adeseye M. , Ogunseitan Adeboye , Doobay-Persaud Ashti
Published: September 2024

Background

Palliative care (PC) is an essential, effective, and affordable component of health care. Global need is rising, with the greatest burden in low-and-middle-income countries. This is especially true in Nigeria where the need is growing rapidly, as are PC services; however, current organizational models have not yet been examined.

Methods

This was a cross-sectional, descriptive study of five PC sites at tertiary hospitals in four of Nigeria’s six geopolitical zones. Surveys, informed by a Centre for Palliative Care, Nigeria (CPCN) needs assessment checklist and the Consolidated Framework for Implementation Research (CFIR), were administered at each site to leadership, frontline workers, patients, and caregivers. Surveys varied by participant group and inquired about organizational models and personal experiences of both providers and recipients of care.

Results

Across five sites, there was a total of 282 survey respondents: five leaders, nine frontline workers, 132 patients, and 136 caregivers. The most common diagnoses of PC patients were cancer, sickle cell disease, and HIV. Most sites reported sub-optimal administrative support (80%), hospital management support (60%), and building space (60%). Leadership responses highlighted variations in PC training requirements and opportunities. Frontline workers desired additional training, sponsorship, and governmental support. Most patients and their caregivers reported satisfaction with PC, though high levels of worry and hopelessness were reported.

Conclusion

Increased organizational support appears necessary to facilitate improvements in administrative resources, staffing, and training. Emotional and spiritual wellbeing likely require prioritization when designing palliative care delivery services in Nigeria. Further research is needed to refine current services and inform implementation efforts.
ChatGPT-o1 and the Pitfalls of Familiar Reasoning in Medical Ethics
Authors: Soffer Shelly , Sorin Vera , Nadkarni Girish N , Klang Eyal
Published: September 2024

Large language models (LLMs) like ChatGPT often exhibit Type 1 thinking—fast, intuitive reasoning that relies on familiar patterns—which can be dangerously simplistic in complex medical or ethical scenarios requiring more deliberate analysis. In our recent explorations, we observed that LLMs frequently default to well-known answers, failing to recognize nuances or twists in presented situations. For instance, when faced with modified versions of the classic “Surgeon’s Dilemma” or medical ethics cases where typical dilemmas were resolved, LLMs still reverted to standard responses, overlooking critical details. Even models designed for enhanced analytical reasoning, such as ChatGPT-o1, did not consistently overcome these limitations. This suggests that despite advancements toward fostering Type 2 thinking, LLMs remain heavily influenced by familiar patterns ingrained during training. As LLMs are increasingly integrated into clinical practice, it is crucial to acknowledge and address these shortcomings to ensure reliable and contextually appropriate AI assistance in medical decision-making.
A Differential Ion Mobility Acoustic Ejection Mass Spectrometer System for Screening Isomerization-Mediating Enzyme Drug Targets
Authors: Bazargan Samad , Dranchak Patricia , Liu Chang , Inglese James , Janiszewski John , Schneider Bradley B. , Covey Thomas R.
Published: September 2024

We report the first implementation of ion mobility mass spectrometry combined with an ultra-high throughput sample introduction technology for high throughput screening (HTS). The system integrates differential ion mobility (DMS) with acoustic ejection mass spectrometry (AEMS), termed DAEMS, enabling the simultaneous quantitation of structural isomers that are the sub-strates and products of isomerase mediated reactions in intermediary metabolism. We demonstrate this potential by comparing DAEMS to a luminescence assay for the isoform of phosphoglycerate mutase (iPGM) distinctively present in pathogens offering an opportunity as a drug target for a variety of microbial and parasite borne diseases. The metabolome consists of many structural isomers that require for separation a mobility resolving power of more than 300. Resolving powers measured in collision cross section space of 1588 and 1948 for 2- and 3-phosphoglycerate and the citrate/isocitrate isomeric pairs respectively are shown. These are the highest reported ion mobility resolving powers for molecules from the metabolome reported to date. The potential for DAEMS as a generalized screening tool is demonstrated with the separation of the substrates and products of two additional isomerases that present as potential therapeutic targets, chorismate mutase and triosephosphate isomerase. The separations are achieved at speeds compatible with the sample introduction rates of AEMS providing sufficient data points to integrate the peaks for quantitation without the use of internal standards. DMS hyphenated with acoustic sample ejection MS provides a unique solution to high throughput mass spectrom-etry applications where isomer and other types of separations are required.
Four-dimensional label-free live cell image segmentation for predicting live birth potential of mouse embryos
Authors: Kanazawa Taichi , Yao Tatsuma , Takeshita Sora , Hirai Tatsuki , Suenaga Ryo , Yamada Takahiro G , Tokuoka Yuta , Yamagata Kazuo , Funahashi Akira
Published: September 2024

1

Selection of high-quality embryos is critical in assisted reproductive technology (ART), but it relies on visual assessment by experts, and the birth rate remains low. We previously developed a deep learning method to predict the birth of mouse embryos by quantifying the morphological features of cell nuclei. This method involves cell nuclear segmentation on fluorescence microscopy images, but fluorescence labeling of nuclei is not feasible in medical applications. Here, we developed FL2-Net, a nuclear segmentation method for time-series three-dimensional bright-field microscopy images of mouse embryos without fluorescence labeling. FL2-Net outperformed existing state-of-the-art segmentation methods. We predicted the birth potential of mouse embryos from the nuclear features quantified by bright-field microscopy image segmentation. Birth prediction accuracy of FL2-Net (81.63%) exceeded those of other methods and experts (55.32%). We expect that FL2-Net, which can quantify nuclear features of embryos non-invasively and with high accuracy, might be useful in ART.
Somatic mtDNA Mutation Burden Shapes Metabolic Plasticity in Leukemogenesis
Authors: Li-Harms Xiujie , Lu Jingjun , Fukuda Yu , Lynch John , Sheth Aditya , Pareek Gautam , Kaminski Marcin , Ross Hailey , Wright Christopher W. , Wu Huiyun , Wang Yong-Dong , Neal Geoff , Smith Amber , Vogel Peter , Pounds Stanley , Schuetz John , Ni Min , Kundu Mondira
Published: September 2024

The role of somatic mitochondrial DNA (mtDNA) mutations in leukemogenesis remains poorly characterized. To determine the impact of somatic mtDNA mutations on the process, we assessed the leukemogenic potential of hematopoietic progenitor cells (HPCs) from mtDNA mutator mice (Polg D257A) with or without NMyc overexpression. We observed a higher incidence of spontaneous leukemogenesis in recipients transplanted with heterozygous Polg HPCs and a lower incidence of NMyc-driven leukemia in those with homozygous Polg HPCs compared to controls. Although mtDNA mutations in heterozygous and homozygous HPCs caused similar baseline impairments in mitochondrial function, only heterozygous HPCs responded to and supported altered metabolic demands associated with NMyc overexpression. Homozygous HPCs showed altered glucose utilization with pyruvate dehydrogenase inhibition due to increased phosphorylation, exacerbated by NMyc overexpression. The impaired growth of NMyc-expressing homozygous HPCs was partially rescued by inhibiting pyruvate dehydrogenase kinase, highlighting a relationship between mtDNA mutation burden and metabolic plasticity in leukemogenesis.

TEASER

Somatic mtDNA mutations as drivers of metabolic change in the development of leukemia.
Water use efficiency ofCupressus giganteais higher in mountain slope habitats compared to riverside habitats
Authors: Jiang Yueliang , Luan Li , Zuo Youlu , Liu Shengyun , He Qiaoling , He Jingyu , Wu Ruru , Jiang Gaoming , Liu Meizhen
Published: September 2024

Cupressus giganteais an endemic species of the Yarlung Zangbo River in Tibet, China, and is designated as a national key protected wild plant. It is only distributed in the narrow area along Yarlung Zangbo River from Jiacha County to Danniang village Milin City in various habitats such as the waterline along the Yarlung Zangbo River, terraces, and mountain slopes. In this study, we utilized stable isotope technology (δD, δ18O, and δ13C), combined with the IsoSource model, to quantitatively determined the sources of water absorption and the water use efficiency ofC. giganteain various habitats, including riverside area, terraces and mountain slopes. The results showed that the content of soil total nitrogen, soil nitrate nitrogen, soil ammonium nitrogen, and soil organic carbon are significantly higher on mountain slope than in the other two habitats, while the total carbon content, water content, and total nitrogen content ofC. gigantealeaves are significantly lower on mountain slope than in the other two habitats (P<0.05). The water use efficiency (WUE) ofC. giganteain the mountain slope habitats is 107.8 μmol mol-1, which is significantly higher than that of other habitats (P<0.05), with the WUE ofC. giganteain the riverside habitat being the lowest at 35.7 μmol mol-1.C. giganteadistributed on the mountain slope and terrace uses soil water as the main water source. During the normal rainy season, the proportion of soil water utilization is the highest, accounting for more than 60%; in the dry season, the utilization of river water and groundwater increases, while soil water utilization decreases.C. giganteadistributed along the riverside mainly absorbs water from the Yarlung Zangbo River, about 63%. In August when the rainfall increases in the rainy season, the use of soil moisture increases, and in the dry season, river water becomes the main water source. This indicates that with the alternation of rainy and dry seasons, the water absorption sources and strategies ofC.giganteaadjusted accordingly. The research results provide an important scientific basis for the protection and management measures of theC. giganteapopulation.