bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of ticagrelor and clopidogrel dual antiplatelet therapy on MPVLR, MAADP, and AA inhibition rate in acute coronary syndrome patients after percutaneous coronary intervention
Authors: Gao Song-Tao , Wang Yu , Ma Lei 
Published: September 2023

Objective:
To explore the effects of ticagrelor and clopidogrel dual antiplatelet therapy on the mean platelet volume-to-lymphocyte ratio (MPVLR), maximum amplitude of adenosine diphosphate-induced platelet-fibrin clots (MAADP), and arachidonic acid (AA) inhibition rates in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).

Methods:
A total of 120 patients with ACS undergoing elective PCI in our hospital between March 2020 and November 2021 were recruited. Patients were divided into 2 groups using the random number table method, with 60 patients in each group. The control group received clopidogrel + aspirin dual antiplatelet therapy, while the study group received ticagrelor + aspirin dual antiplatelet therapy. MPVLR, MAADP, and AA inhibition rates were compared between the 2 groups. Platelet activation indices, platelet micro PNA-223, and platelet gelsolin levels were measured before and 4 weeks after PCI. Changes in cardiac function indices, bleeding rates, and major adverse cardiovascular events (MACE) were compared between groups.

Results:
The MAADP score of the study group was lower than that of the control group 3 days after surgery (P < .05). Compared with before surgery, CD62p, CD63, miR-223, PAC-1, platelet membrane glycoprotein IIb/IIIa complex, and gelsolin levels markedly decreased in both groups 4 weeks after surgery (P < .05). The platelet activation index and platelet miR-223 and gelsolin levels were significantly lower in the study group than in the control group 4 weeks after surgery (P < .05). The overall platelet inhibition effect was significantly better in the study group than in the control group (P < .05). Compared with before surgery, the left ventricular ejection fraction and stroke volume were significantly increased, and the left ventricular end-diastolic volume and left ventricular end-diastolic diameter significantly decreased in both groups 4 weeks after surgery (P < .05). No significant differences were found between the 2 groups in terms of the incidence of bleeding events or MACE (P > .05).

Conclusion:
Ticagrelor is more effective than clopidogrel for platelet inhibition after PCI in patients with ACS and is worthy of clinical recommendation.
Effect of esketamine on inflammatory factors in opioid-free anesthesia based on quadratus lumborum block: A randomized trial
Authors: Dai Jingwei , Li Shanliang , Zheng Riyue , Li Juan 
Published: September 2023

Background:
As strong analgesics, opioids provide the analgesic component of general anesthesia, but they have bidirectional effects on the immune system, promoting the production of pro-inflammatory factors. The idea of opioid-free anesthesia is to replace the analgesic effect of opioids in the treatment of acute pain with comparably effective drugs that do not affect the immune system and thereby decrease the production of inflammatory factors. Therefore, this study aims to observe the effect of opioid-free esketamine anesthesia based on quadratus lumborum block on inflammatory factors in patients undergoing lower abdominal or pelvic surgery.

Methods:
A total of 122 patients who underwent lower abdominal or pelvic surgery in our hospital from March 2021 to June 2022 were selected and divided into the esketamine (E) group (n = 62) and control (C) group (n = 60) according to the random number table method. According to the surgical field, the 2 groups underwent unilateral/bilateral quadratus lumborum block in the supine position under ultrasound guidance. In addition, both groups received a target controlled infusion of propofol 3 to 3.5 μg/mL and intravenous rocuronium 0.8 mg/kg. Group E was given opioid-free anesthesia, group C was given opioid-based anesthesia. A 3 to 5 laryngeal mask was inserted according to body weight, and rocuronium 0.5 mg/kg was added intermittently. The levels of interleukin-6 (IL-6), interleukin-8 (IL-8), C-reactive protein (CRP), procalcitonin, tumor necrosis factor-α (TNF-α), numeric rating scales, dosage of propofol, dexmedetomidine and rocuronium, as well as the numeric rating scales score and analgesic complications were monitored in the 2 groups.

Results:
There was no significant differences in general outcomes between the 2 groups (P > .05). The blood pressure in group E was higher than in group C at T1 (P < .05). The levels of IL-6, TNF-α, CRP and IL-8 in group E were significantly lower than in group C at T1, T2, T3, and T4 (P < .05). The levels of IL-6, TNF-α, procalcitonin, CRP and IL-8 in the 2 groups at T1, T2, T3, and T4 were significantly higher than at T0 (P < .05).

Conclusion:
Opioid-free esketamine anesthesia based on quadratus lumborum block achieved perfect postoperative analgesia with little effect on inflammatory factors in patients undergoing lower abdominal or pelvic surgery.
Viewpoint: Patient safety in primary care – patients are not just a beneficiary but a critical component in its achievement
Authors: Kavanagh Kevin T. , Cormier Lindsay E. 
Published: September 2023

Promoting and maintaining patient safety in primary care requires different strategies and monitoring than utilized in large healthcare delivery systems. Maintenance of a culture of safety is key to providing patient safety but has been difficult to measure in primary care. This is particularly true in rural settings where practice size is a major barrier to measurement reliability.
Primary care evaluates a wide range of patients, including those who are immunocompromised and others who have infectious diseases. Providing a safe environment with proper wearing of N95 masks, clean examination rooms, and adequate ventilation is important. Patients with infectious diseases should be separated from other patient populations.
Primary care is often less bureaucratic than hospitals, but also has fewer resources to implement patient safety initiatives, along with detecting safety lapses and adverse events. However, monitoring the practice’s safety practices and the culture of safety is of utmost importance and should be performed using both outcome and process measures. Because of the small size of many rural practices, effective monitoring of adverse events and maintenance of safety protocols should include patients. Patients are an important resource for reporting of adverse events and medical treatment outcomes.
The aim of this manuscript is to underscore the importance of patient safety in primary care and to stimulate future research in developing a metric for the culture of safety in primary care, which also incorporates the patient perspective. Patients should be viewed not only as beneficiaries of patient safety but also as a critical component of its maintenance.
Comprehensive analysis of the oncogenic and immunological role of SPON2 in human tumors
Authors: Tang Jiali , Huang Qing , Li Xuanwen , Gu Shinong 
Published: September 2023

Background:
Sapiens spondin-2 (SPON2) is a protein found in the extracellular matrix that plays a role in a number of processes, including immune reactions and cell adhesion, and is closely linked to the emergence of a number of tumor types. However, we know very little about Sapiens spondin-2. Therefore, we performed a systematic pan-carcinogenic analysis to explore the relationship between Sapiens spondin-2 and cancers.

Materials and methods:
By comprehensive use of datasets from TCGA, GEO, GTEx, HPA, CPTAC, GEPIA2, TIMER2, cBioPortal, STRING, we adopted bioinformatics methods to dig up the potential carcinogenesis of SPON2, including dissecting the correlation between SPON2 and gene expression, prognosis, gene mutation, Immunohistochemistry staining, immune cell infiltration, and constructed the interaction network of a total of 54 SPON2-binding proteins as well as explored the enrichment analysis of SPON2-related partners.

Results:
The expression of Sapiens spondin-2 in most tumor tissues was higher than that of normal tissues. In addition, SPON2 showed the early diagnostic value in 33 kinds of tumors and was positively or negatively associated with the prognosis of different tumors. It also validates that SPON2 is the gene associated with the majority of immune-infiltrating cells in pan-cancer. High SPON2 expression is associated with tumor progression related pathways.

Conclusion:
We found and validated the potential use of SPON2 in cancer detection for the first time through pan-cancer analysis. The expression levels of SPON2 in various tumors were quite different from those in normal tissues. Furthermore, the performance of SPON2 in tumorigenesis and tumor immunity verified our hypothesis. At the same time, it has high specificity and sensitivity in cancer detection. Therefore, SPON2 can be employed as an auxiliary index for the initial diagnosis of tumors and a prognostic marker for various types of tumors.
The effect of Caudal Epidural Injection on healing in the treatment of chronic anal fissure
Authors: Gökçek Erhan , Gökçe Recep , Kaçar Cem Kivilcim 
Published: September 2023

Background:
Chronic anal fissure is called the reaching the muscle layer under the skin by deepening of the fissure in the breech skin. Our purpose is to enable the tissue to heal by relaxing the anal sphincter with caudal epidural injection.

Methods:
One hundred twenty cases were included in this randomized, controlled study. The cases were categorized into 2 groups; Under ultrasound guidance, the first group, caudal epidural injection group (Group CE, n = 60) was treated with 5 cc bupivakain + 5 cc isotonic from a caudal epidural for a total of 3 sessions at the beginning, 1 week and 2 weeks later; the second group, control group (Group C, n = 60) were provided medical treatment (cream, pill etc.) every day for 2 weeks. Wexner’s constipation score was used to assess constipation severity and visual analog scale was used to assess pain severity. Short Form-36 was used to determine the patient’s quality of life.

Results:
This study was conducted with 2 groups of 60 people and a total of 120 patients. There was no statistically significant difference between the groups in terms of demographic characteristics (age, body mass index, gender, American Society of Anesthesiologist, mean blood pressure, heart rate) (P > .05). Out of the detected fissures, 32 (26.7%) were located anteriorly and 88 (73.3%) were located posteriorly. The groups were statistically same in terms of fissure location (P = .423). When groups were compared with pain, Wexner constipation and visual analog scale scores decreased significantly in Group CE compared to Group C after 2.and 3.sessions (P = .001 and P = .002, respectively). In Group CE, the Short Form-36 subscales increased significantly (P = .003).

Conclusion:
Caudal epidural injection has a potential to be an alternative treatment option for chronic anal fissure.
Liver retransplantation: Timing is equally important
Authors: Li Le , Zhang Yuhong , Xiao Fei , Qu Wei , Zhang Haiming , Zhu Zhijun 
Published: September 2023

Background and aim:
To evaluate the effect of transplantation interval on patient and graft survival in liver retransplantation (reLT) using meta-analytical techniques.

Methods:
Literature search was undertaken until January 2022 to identify comparative studies evaluating patient survival rates, graft survival rates, and the interval time. Pooled hazard ratio (HR) or risk ratio (RR) and 95% confidence intervals (95% CI) were calculated with either the fixed or random effect model.

Results:
The 12 articles were included in this meta-analysis. The late reLT survival rate is better than the early reLT in the 30 days group, and there is no statistical significance in other time groups. The patient survival was significantly higher in late reLT than early reLT at 1 and 5 years (respectively: RR, 0.81 [95% CI, 0.73–0.89]; RR, 0.64 [95% CI, 0.46–0.88]). The graft survival was significantly higher in late reLT than early reLT at 1 year (RR, 0.75 [95% CI, 0.63–0.89]). The risk of death after reLT in early group was 1.43 times higher than that in late group (HR, 1.43 [95% CI, 1.21–1.71]).

Conclusions:
Late reLT had significantly better survival rates than early reLT, and the transplantation interval was more reasonable to divide the early or late groups by 30 days.
Effects of suprahyoid muscle strengthening exercise using kinesiology taping on muscle activation and thickness in community-dwelling elderly: A randomized controlled trial
Authors: Cho Young-Seok , Yoon Tae-Hyung , Park Ji-Su 
Published: September 2023

Background:
Recently, swallowing resistive exercise using kinesiology taping (KT) has been reported as a novel method for dysphagia rehabilitation However, clinical evidence is still unclear, and effects in the elderly have not been confirmed.

Objective:
This study aimed to investigate the effects of suprahyoid muscle strengthening exercise using KT on muscle activation and thickness in community-dwelling elderly.

Methods:
A total of 24 healthy older people were enrolled in this study and randomly assigned to an experimental group and a placebo group. In the experimental group, KT was attached to the front of the neck with a tension of about 70% to 80%, and a resistive swallowing exercise was performed. In the placebo group, the tape was applied similarly but without tension. Both groups performed resistive swallowing exercises 10 times a day (50 swallows per day) for 6 weeks. The activation and thickness of the suprahyoid muscles were measured using portable ultrasound equipment and an surface electromyelograph device.

Results:
The experimental group showed a significant increase in suprahyoid muscle activation (mean and peak) and muscle thickness (digastric and mylohyoid) than the placebo group (all, P < .05).

Conclusion:
This study confirmed that suprahyoid muscle strengthening exercise using KT had a positive effect on the suprahyoid muscles in healthy older adults, thus suggesting the possibility of a therapeutic exercise method for dysphagia rehabilitation.
Gas embolism during surgical hysteroscopy leading to cardiac arrest and refractory hypokalemia: A case report and review of literature
Authors: Xu Rong , Zhou Xuefei , Wang Longfei , Cao Yunfei 
Published: September 2023

Rationale:
One of the catastrophic complications of surgical hysteroscopy is venous gas embolism (VGE), and this event could cause morbidity and in serious cases may even lead to death. However, in cases of VGE accompanied by refractory hypokalemia is rare and can significantly increase the difficulty of treatment and resuscitation. Here, we successfully treated a patient with fatal VGE during surgical hysteroscopy, accompanied by difficult resuscitation with refractory hypokalemia.

Patient concerns:
We report a rare case of sudden cardiac arrest due to VGE during surgical hysteroscopy, followed by difficult resuscitation with refractory hypokalemia.

Diagnosis:
VGE was diagnosed by a sudden decrease in EtCO2, a loud mill wheel murmur in the thoracic area, and a small number of air bubbles evacuated from the internal jugular catheter. And refractory hypokalemia was diagnosed by serum potassium levels dropping frequently to as low as 2.0 mmol/L within 36 hours of resuscitation after cardiac arrest.

Interventions:
Our vigilant anesthesiologist noticed the early sign of VGE with a sudden drop in EtCO2, and as the cardiac arrest occurred, interventional maneuvers were implemented quickly including termination of the surgical procedure, adjustment of the patient’s position, cardiac resuscitation, continuous chest compression, and correction of electrolyte disturbances, particularly refractory hypokalemia during the early stage of resuscitation.

Outcomes:
The patient regained consciousness 4 days after the cardiac arrest and was discharged 1 month later without any neurological deficits.

Lessons:
As a relatively simple procedure, surgical hysteroscopy may have catastrophic complications. This case demonstrates the full course of fatal gas embolism and difficult resuscitation during hysteroscopic surgery, and emphasizes the importance of early detection, prompt intervention, and timely correction of electrolyte disturbances, such as refractory hypokalemia.
Bone resorption of vertebral bodies at the operative segment after prevail cervical interbody fusion: A case report
Authors: Shen Shufeng , Hu Yong , Chu Zhentao , Dong Weixin 
Published: September 2023

Background:
We report an interesting case of bone resorption of vertebral bodies at the operative segment after Peek Prevail cervical interbody fusion. Instability of cervical vertebrae is likely to occur due to increased stress in Peek Prevail implant body for bone resorption. The finite element analysis was used to clarify the biomechanical effects of bone resorption and stress distribution in Peek Prevail implant body.

Methods:
We reported the case of a 48-year-old male patient who underwent Peek Prevail cervical interbody fusion and exhibited bone resorption 1 month after the surgery in X-ray of cervical vertebra. The degree of bone resorption was aggravated 2 months after surgery. Bone resorption in 3 months was similar to that in 2 months. We established a 3D reconstruction of the surgical segment in this case using Mimics software (vision 20.0) to generate basic boss resorption model. We simulated models of bone resorption using Ansys 17.0. The stress distribution of the contact surface between the screw and bone was analyzed under 6 conditions: flexion, extension, left and right flexion, and left and right rotation.

Results:
The loading conditions affected the stress distribution in the implant body. When bone resorption occurred, the stress distribution of the contact surface between screw and bone focus in the tip of the screw increased sharply.

Conclusion:
Bone resorption of vertebral bodies in the operative segment may be a potential complication after Peek Prevail cervical interbody fusion. Great attention must be paid when bone resorption was occurred in order to avoid screw loosening before vertebral fusion.
Partial isolated tear of the popliteus tendon following an in-car traffic accident: A rare cause of knee pain: A CARE-compliant case report
Authors: Choi Gyu-Sik , Chang Min Cheol 
Published: September 2023

Rationale:
Lesions caused by traffic accidents are often microscopic and minimal; therefore, their diagnosis can be easily overlooked. Moreover, when it is a rarely reported type of lesion, it can be even more easily undiagnosed. Isolated popliteal injuries are uncommon and have rarely been reported.

Patient concerns:
In this case study, we describe a right partially isolated popliteus tendon rupture that was undiagnosed for 2 years in a patient with posterior knee pain after an in-car traffic accident. A 49-year-old female patient presented with right knee pain that had persisted for 2 years and was initiated after an in-car traffic accident. The patient’s right knee pain aggravated while standing and walking. Six months after the accident, her pain was confined to the posterolateral aspect of the knee and subsequently spread throughout her right knee. The pain score was 4 on a numerical rating scale. Physical examination revealed tenderness in the posterolateral corner of the right knee. Additionally, right knee pain was reported in the terminal range of knee flexion during the passive range of motion test. Radiographs of the right knee showed normal findings.

Diagnoses:
A T2-weighted proton density sagittal and coronal knee magnetic resonance imaging revealed a partial-thickness tear with intrasubstance ganglion cysts at the musculotendinous junction of the popliteus tendon. No other abnormalities were observed in the patient.

Intervention:
Conservative treatment involved strengthening exercises and functional rehabilitation programs.

Outcomes:
Six months later, the knee pain almost completely subsided.

Lessons:
Musculoskeletal injuries caused by traffic accidents are frequently overlooked. Therefore, a detailed examination should be conducted for an accurate diagnosis. Clinicians should consider the possibility of popliteal tendon injuries in patients with posterior knee pain.
Smith c/b ratio and teardrop figure measurements; Can it be used in the follow-up of patients who underwent salter innominate osteotomy?
Authors: Dere Kadir Ismail , Topak Duran , Bilal Ökkeş , Doğar Fatih , Özdemir Mustafa Abdullah , Kuşcu Burak 
Published: September 2023

Background:
This study aimed to investigate the effectiveness of radiological parameters used in the follow-up of patients who underwent salter innominate osteotomy (SIO) for the treatment of developmental dysplasia of the hip.

Methods:
Acetabular index, c/b ratio, teardrop width, femoral head teardrop distance (TDD), and acetabular teardrop angle were measured on anteroposterior pelvic radiographs of patients who underwent SIO between 2017 and 2020. The patients were divided into 2 groups according to their preoperative Tönnis stage. Twenty-five (51%) hips of 23 patients with Tönnis stage 2 were classified into group 1, and 24 (49%) of 17 patients with Tönnis stages 3 and 4 were classified into group 2. Changes in radiologic parameters over time and between the groups were statistically evaluated.

Results:
The study included 49 hips of 40 patients (37 female and 3 male). The age at surgery was 26.53 (18–53) months. After a mean follow-up period of 33.7 ± 12.8 months, there was no statistically significant difference between Groups 1 and 2 in terms of clinical, radiological and femoral head avascular necrosis results (P = .591, P = 956, P = .492). The changes in radiological parameters over time and between groups were statistically significant. (P < .001). Only the TDD and c/b ratio were significantly different between groups 1 and 2 (P = .002 and P < .001, respectively).

Conclusion:
In our study, along with acetabular index, the c/b ratio, teardrop width, TDD, and acetabular teardrop angle significantly changed after SIO and could be used as a guide for patient follow-up.
Social Determinants modulate NK cell activity via obesity, LDL, and DUSP1 signaling
Authors: Baumer Yvonne , Singh Komudi , Baez Andrew S. , Gutierrez-Huerta Christian A. , Chen Long , Igboko Muna , Turner Briana S. , Yeboah Josette A. , Reger Robert N. , Ortiz-Whittingham Lola R. , Bleck Christopher K.E. , Mitchell Valerie M. , Collins Billy S. , Pirooznia Mehdi , Dagur Pradeep K. , Allan David S.J. , Muallem-Schwartz Daniella , Childs Richard W. , Powell-Wiley Tiffany M. 
Published: September 2023

SummaryAdverse social determinants of health (aSDoH) are associated with obesity and related comorbidities like diabetes, cardiovascular disease, and cancer. Obesity is also associated with natural killer cell (NK) dysregulation, suggesting a potential mechanistic link. Therefore, we measured NK phenotypes and function in a cohort of African-American (AA) women from resource-limited neighborhoods. Obesity was associated with reduced NK cytotoxicity and a shift towards a regulatory phenotype.In vitro, LDL promoted NK dysfunction, implicating hyperlipidemia as a mediator of obesity-related immune dysregulation. Dual specific phosphatase 1 (DUSP1) was induced by LDL and was upregulated in NK cells from subjects with obesity, implicating DUSP1 in obesity-mediated NK dysfunction.In vitro, DUSP1 repressed LAMP1/CD107a, depleting NK cells of functional lysosomes to prevent degranulation and cytokine secretion. Together, these data provide novel mechanistic links between aSDoH, obesity, and immune dysregulation that could be leveraged to improve outcomes in marginalized populations.