Stress hyperglycemia ratio: a novel predictor of left ventricular dysfunction in peripartum cardiomyopathy

OBJECTIVE

This study aims to assess the predictive value of the stress hyperglycemia ratio (SHR) for left ventricular (LV) systolic dysfunction in patients with peripartum cardiomyopathy (PPCM).

METHODS

We conducted a retrospective analysis of 78 consecutive PPCM patients from January 2007 to March 2023. Their clinical, laboratory, and auxiliary examination data were collected. The estimated average glucose (eAG) was calculated using the formula: eAG = [1.59 × hemoglobin A1c (%) -%2.59]. The SHR was determined by the formula: SHR = (blood glucose at admission)/eAG. The primary outcome measured was the recovery of LV systolic function. A receiver operating characteristic (ROC) curve was used to evaluate the SHR. Logistic regression analysis was performed to identify risk factors for LV systolic dysfunction in PPCM patients.

RESULTS

The mean random blood glucose level in the PPCM patients was 6.38 mmol/L, with an SHR of 1.16. Among these patients, 37 (47.4%) exhibited persistent LV systolic dysfunction during follow-up. The SHR was significantly higher in the non-recovery group than in the recovery group (1.45 vs. 0.91, p < .001). An SHR cutoff of 1.079 predicted persistent LV systolic dysfunction with a sensitivity of 81.1% and a specificity of 90.2%, yielding a Youden index of 0.713. Logistic regression identified an SHR ≥ 1.079, a left ventricular end-diastolic diameter (LVEDD) > 55 mm, and digoxin usage as risk factors for LV systolic dysfunction.

CONCLUSIONS

PPCM patients with an SHR of 1.079 or higher should receive increased scrutiny for persistent LV systolic dysfunction.

Atherogenic index of plasma and the clinical outcome of patients with acute coronary syndrome: a meta-analysis

BACKGROUND

The atherogenic index of plasma (AIP) has been related to an increased risk of coronary artery disease. However, previous studies evaluating the prognostic role of AIP for acute coronary syndrome (ACS) showed inconsistent results. This meta-analysis was conducted to systematically evaluate the association between AIP and the risk of major cardiovascular adverse events (MACE) of patients with ACS.

MATERIALS AND METHODS

Relevant cohort studies were retrieved by searching electronic databases, including PubMed, Web of Science, and Embase. A random-effects model was used to combine the data by incorporating the influence of between-study heterogeneity.

RESULTS

Thirteen datasets from nine cohort studies, involving 10,861 patients with ACS were included in the meta-analysis. Of them, 1546 (14.2%) developed MACE during follow-up. Pooled results suggested that a high AIP at admission was associated with an increased risk of MACE during follow-up (risk ratio [RR]: 1.54, 95% confidence interval [CI]: 1.30-1.82, p < 0.001; I2 = 48%). Subgroup analyses suggested a stronger association between a high AIP and an increased risk of MACE in older patients (mean age ≥60 years, RR: 2.26, 95% CI: 1.78-2.87, p < 0.001; I2 = 0%) than the younger ones (mean age <60 years, RR: 1.30, 95% CI: 1.17-1.44, p < 0.001; I2 = 0%; p for subgroup difference <0.001), which fully explained the heterogeneity.

CONCLUSION

A high AIP is associated with an increased risk of MACE in patients with ACS, particularly for older patients.

Advanced diffusion-weighted imaging-derived quantitative parameters as biomarkers of fibrosarcoma-cell proliferation in nude mice: A study based on precise imaging-pathology correlation

PURPOSE

To determine whether quantitative parameters derived using diffusion kurtosis imaging (DKI) and intravoxel incoherent motion (IVIM) imaging reflect pathological changes in fibrosarcoma.

METHODS

Thirty nude mouse models of fibrosarcoma underwent T1/T2-weighted imaging, DKI, and IVIM imaging on a 3.0-T scanner. Immunohistochemistry was utilized for the hematoxylin and eosin, aquaporin 1 (AQP1), aquaporin 4 (AQP4), and Ki-67 staining of fibrosarcoma tissue, and AQP1 and AQP4 staining of normal muscle tissue (NMT). The independent-sample t-test was used to compare AQP1 and AQP4 expression in fibrosarcoma and NMT. Pearson and Spearman correlation analyses were conducted to evaluate the correlation between imaging parameters and pathological indicators. Multiple linear regression analysis was employed to identify the pathological indicators independently associated with quantitative DKI and IVIM parameters.

RESULTS

Apparent diffusion coefficient (ADC), D, f, and mean kurtosis (MK) indicated cell density and Ki-67 and AQP1 expression intensity. D values reflected AQP4 expression intensity, while MD reflected cell density and AQP1 expression intensity. Cell density (CD) independently influenced ADC and f values, while CD and AQP1 independently influenced D values.

CONCLUSION

CD and Ki-67 independently influenced MK. DKI- and IVIM imaging-derived ADC, D, f, MD, and MK were correlated with AQP1, AQP4, Ki-67, and CD in nude mice with fibrosarcoma.

Screening tools for subjective cognitive decline and mild cognitive impairment based on task-state prefrontal functional connectivity: a functional near-infrared spectroscopy study

BACKGROUND

Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) carry the risk of progression to dementia, and accurate screening methods for these conditions are urgently needed. Studies have suggested the potential ability of functional near-infrared spectroscopy (fNIRS) to identify MCI and SCD. The present fNIRS study aimed to develop an early screening method for SCD and MCI based on activated prefrontal functional connectivity (FC) during the performance of cognitive scales and subject-wise cross-validation via machine learning.

METHODS

Activated prefrontal FC data measured by fNIRS were collected from 55 normal controls, 80 SCD patients, and 111 MCI patients. Differences in FC were analyzed among the groups, and FC strength and cognitive scale performance were extracted as features to build classification and predictive models through machine learning. Model performance was assessed based on accuracy, specificity, sensitivity, and area under the curve (AUC) with 95 % confidence interval (CI) values.

RESULTS

Statistical analysis revealed a trend toward more impaired prefrontal FC with declining cognitive function. Prediction models were built by combining features of prefrontal FC and cognitive scale performance and applying machine learning models, The models showed generally satisfactory abilities to differentiate among the three groups, especially those employing linear discriminant analysis, logistic regression, and support vector machine. Accuracies of 92.0 % for MCI vs. NC, 80.0 % for MCI vs. SCD, and 76.1 % for SCD vs. NC were achieved, and the highest AUC values were 97.0 % (95 % CI: 94.6 %-99.3 %) for MCI vs. NC, 87.0 % (95 % CI: 81.5 %-92.5 %) for MCI vs. SCD, and 79.2 % (95 % CI: 71.0 %-87.3 %) for SCD vs. NC.

CONCLUSION

The developed screening method based on fNIRS and machine learning has the potential to predict early-stage cognitive impairment based on prefrontal FC data collected during cognitive scale-induced activation.

A Mixed-Methods Study to Evaluate Depression and Anxiety Among Undergraduate Nursing Students

INTRODUCTION

As the backbone of future healthcare delivery, the mental health of undergraduate nursing students can have a direct impact on patients' perceptions of health and the quality of their healthcare learning. However, there has been little qualitative research on the factors influencing the mental health of undergraduate nursing students.

AIM

This study investigated the current status and factors influencing depression and anxiety in undergraduate nursing students.

METHODS

Questionnaires were administered to third-year nursing students at a medical college university using the Self-Assessment Scale for Anxiety (SAS) and the Self-Depression Scale (SDS). The students who suffered from anxiety or depression were selected for qualitative interviews and the results of the interviews were analysed by using the seven-step Koretz analysis.

RESULTS

(1) SAS and SDS scores of undergraduate nursing students were higher than the national average. (2) The qualitative interviews revealed that five themes, including childhood experience, body image, interpersonal relationships, professional identity and career planning, influenced mental health.

DISCUSSION

Undergraduate nursing students exhibited a high prevalence of anxiety and depression. The colleges should establish a proactive educational model centred on teaching quality, professional identity, career planning and mental health.

IMPLICATION FOR PRACTICE

This study found that the mental health of undergraduate nursing students was influenced by a variety of factors, which require diverse and constant interventions. School, family and social resources should collaborate to develop a systematic approach for better mental health education in undergraduate nursing students.

Prognosticating WHO/ISUP grade in clear cell renal cell carcinoma: Insights from amide proton transfer-weighted MRI

BACKGROUND

Preoperative prediction of clear cell renal cell carcinoma (ccRCC) grade can support optimal selection of surgical resection strategies. Currently, there is no effective preoperative method for accurately assessing the histologic grade of ccRCC. More precise, non-invasive prediction methods are needed.

PURPOSE

To investigate the parameter of amide proton transfer-weighted (APTw) MRI for prediction of pathological ccRCC grade and whether the combination of the APTw, Diffusion-Weighted Imaging (DWI), and mDixon MRI techniques can improve the prediction performance.

MATERIALS AND METHODS

This prospective study included ccRCC patients who underwent multiparametric MRI examinations (including APTw, DWI, and mDixon) along with contrast-enhanced CT or MRI examinations from March 2021 to June 2024. The mean, maximum, minimum, and standard deviation (SD) values from APTw and apparent diffusion coefficient (ADC) imaging of the solid tumor portions and the fat fraction (FF) values from mDixon imaging were measured. The area under the receiver operating characteristic curve (AUC) values for the parameters were calculated to evaluate the diagnostic performance.

RESULTS

A total of 48 ccRCC patients (mean age, 65 years; 32 males) were included, of whom 10 had high-grade ccRCC and 38 had low-grade ccRCC. Compared with low-grade ccRCC, high-grade ccRCC exhibited higher APTwmean (2.28 % vs. 4.17 %; P < .05), APTwmax (4.97 % vs. 8.48 %; P < .01), and APTwSD (1.10 vs. 1.75; P < .01) values as well as lower ADCmin values (1.23 × 10-3 mm2/s vs. 0.94 × 10-3 mm2/s; P < .05). The AUC values for the ability of APTwmean, APTwmax, APTwSD, ADCmin, and these factors combined to distinguish between low-grade and high-grade ccRCC were 0.728, 0.786, 0.832, 0.741, and 0.858, respectively.

CONCLUSION

APTwmean, APTwmax, APTwSD, and ADCmin values are potential indicators for preoperative prediction of ccRCC pathologic grade. APTw parameters offer certain advantages for use alone or in combination with other parameters.

The YTHDF3-DT/miR-301a-3p /INHBA axis attenuates autophagy-dependent ferroptosis in lung adenocarcinoma

YTHDF3-DT, a long non-coding RNA (lncRNA) significantly upregulated in lung adenocarcinoma (LUAD), is associated with poor patient prognosis and plays critical roles in LUAD progression. Clinical data and in vitro analyses revealed that YTHDF3-DT expression correlates with worse overall survival and increased lymph node metastasis in LUAD patients. Functional studies demonstrated that YTHDF3-DT activates the TGF-β and PI3K/Akt/mTOR signaling pathways via INHBA, a key target influenced by YTHDF3-DT. Mechanistically, YTHDF3-DT stabilizes INHBA mRNA by acting as a competing endogenous RNA (ceRNA) for miR-301a-3p, forming a YTHDF3-DT/miR-301a-3p/INHBA axis. This axis regulates ferroptosis in an autophagy-dependent manner in LUAD cells, with YTHDF3-DT promoting cell survival by altering autophagic activity and mitigating ferroptosis-induced cell death. In vivo experiments further validated the role of YTHDF3-DT in tumor growth and ferroptosis regulation, highlighting its potential as a therapeutic target in LUAD. Our data contribute toward a significant mechanistic understanding of the molecules involved in the crosstalk between ferroptosis and autophagy, providing potential therapeutic targets to complement the existing therapies for overcoming the developed resistance in patients with LUAD.

Effect of using a trephine to extract bone at the insertion point of the intramedullary nails and graft bone at the fractured ends in the treatment of tibial shaft fractures with intramedullary nail

Objective: To explore the effect of using a trephine to extract bone at the insertion point of the intramedullary nails (IMN) and graft bone at the fractured ends in the treatment of tibial shaft fractures with IMN. Methods: In this single-center retrospective study, patients who underwent treatment for tibial shaft fracture using IMN between January 2016 and December 2019 at Fudan University Jinshan Hospital were retrospectively analyzed. There were two groups. In the study group, a trephine was used to extract bone chips at the insertion point of the IMN, which were grafted at the fractured ends. The control group comprised sex- and age-matched patients with similar fracture location and classification, but without bone graft at the fractured ends. The surgery time, fracture healing time, and frequency of IMN dynamic surgery were compared between the two groups. Furthermore, the Johner-Wruhs score, WHO-QOL score, and knee joint range of motion at six and 12 months after surgery were compared. Results: Both groups had 99 matched patients (69 male and 30 female). The median healing time was significantly shorter in the study group (z=-2.86, p=0.004). Five cases (5.05%) in the study group and 10 cases (10.10%) in the control group underwent IMN dynamic surgery; the between-group difference in this respect was not statistically significant (c2=1.803, p=0.179). There was no significant between-group difference regarding the other parameters. Conclusions: The surgical technique can promote healing of tibial shaft fractures with no adverse effect on postoperative functional recovery. doi: https://doi.org/10.12669/pjms.41.4.10259 How to cite this: Xu Z, Cai G, He X, Li D. Effect of using a trephine to extract bone at the insertion point of the intramedullary nails and graft bone at the fractured ends in the treatment of tibial shaft fractures with intramedullary nail. Pak J Med Sci. 2025;41(4):1176-1180.  doi: https://doi.org/10.12669/pjms.41.4.10259 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Analgesic effect of ropivacaine combined with methylene blue in fascia Iliaca block for patients undergoing hip arthroplasty

BACKGROUND

The duration of a single fascia iliaca compartment block (FICB) with ropivacaine is limited. This study investigated whether methylene blue as an adjuvant anesthetic in FICB can enhance the postoperative analgesic effect following total hip arthroplasty (THA).

METHODS

Patients who planned to undergo THA were recruited for this randomized clinical trial from June 2023 to February 2024. Ninety elderly patients undergoing THA were randomly divided into two groups that received ultrasound-guided FICB with either ropivacaine and methylene blue (MB + R group, n = 45) or ropivacaine only (R group, n = 45) before induction of general anesthesia. The primary outcomes were postoperative Visual Analog Scale (VAS) scores. Secondary outcomes included inflammatory factor levels, heart rate (HR), mean arterial pressure (MAP), postoperative analgesic use, postoperative activity, and adverse events.

RESULTS

The MB + R group had significantly lower VAS scores at both rest and with activity at 24 and 48 h postoperatively than the R group (P < 0.001). Additionally, the hypersensitive C-reactive protein, procalcitonin, and neutrophil-to-lymphocyte ratio values were significantly lower in the MB + R group than in the R group on the first and second days after surgery (P < 0.05). The number of patients requiring supplemental analgesia postoperatively was significantly lower in the MB + R group (P = 0.020). Additionally, the MB + R group had a significantly longer walking distance on the first time out of bed and a higher number of out-of-bed activities within 48 h postoperatively (P < 0.001).

CONCLUSION

Compared to ropivacaine alone, the combination of ropivacaine and methylene blue in FICB provided better analgesic effects over a longer duration. Additionally, the addition of methylene blue reduced the postoperative production of inflammatory markers and promoted patients' functional recovery.

TRIAL REGISTRATION

ClinicalTrials.gov, Registration number: NCT06284941, Retrospectively registered, Date of registration: February 04, 2024.

Short-term recurrent coronary artery thrombosis with acute myocardial infarction in a patient with aplastic anemia-paroxysmal nocturnal hemoglobinuria syndrome: a case report

Background

Acute myocardial infarction commonly occurs in patients with coronary artery disease, but rarely, it can develop under a hypercoagulable state. Aplastic anemia can be accompanied by paroxysmal nocturnal hemoglobinuria clones or transform into paroxysmal nocturnal hemoglobinuria with a significantly elevated prothrombotic state. These thrombotic complications predominantly arise in veins rather than in arteries. Coronary artery thrombosis in these patients, especially with short-term recurrent arterial thrombosis after initial successful treatment, is exceedingly rare.

Case presentation

A 39-year-old man with a history of aplastic anemia with paroxysmal nocturnal hemoglobinuria clones for 8 years presented with chest pain, and was diagnosed with acute inferior wall myocardial infarction on November 21, 2022. Despite standardized coronary intervention and anticoagulant/antiplatelet therapy, the patient reported intermittent chest discomfort with persistently elevated cardiac troponin and d-dimer levels 20 days after initial treatment. Repeat coronary angiography confirmed recurrent thrombosis in the right coronary artery. He underwent repeated balloon dilation and thrombus aspiration with intensified anticoagulation, which alleviated his clinical symptoms and normalized his cardiac troponin and d-dimer levels. The patient was finally confirmed to have aplastic anemia-paroxysmal nocturnal hemoglobinuria syndrome.

Conclusion

Patients with aplastic anemia-paroxysmal nocturnal hemoglobinuria syndrome can have thrombosis in arteries, such as coronary arteries, leading to acute myocardial infarction. Recurrent coronary artery thrombosis can occur after initial successful revascularization and anticoagulant/antiplatelet therapy. Close monitoring of clinical symptoms, repeated electrocardiogram and laboratory tests, coronary angiography, strengthened anticoagulation, and precautions for bleeding risks should be considered in patients with aplastic anemia-paroxysmal nocturnal hemoglobinuria syndrome.

Early venous filling is associated with unfavorable outcomes in acute ischemic stroke with large vessel occlusion after mechanical thrombectomy: a real-world analysis

BACKGROUND

The presence of early venous filling (EVF) post-mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients has been observed, yet its prognostic value for clinical outcomes remains underexplored. This study aimed to assess the correlation between EVF and poor clinical outcomes in AIS patients who underwent MT.

MATERIALS AND METHODS

This retrospective analysis included AIS patients with large vessel occlusions treated with MT at the First Affiliated Hospital of Xi'an Jiaotong University from January 2018 to June 2023. The primary outcome was mRS at 90 days, secondary outcomes included hemorrhagic transformation, symptomatic intracranial hemorrhage, and malignant brain edema. The study used inverse probability weighting for balancing baseline characteristics and employed univariate and multivariate logistic regression analyses to explore the association between EVF and clinical outcomes. G*Power was used to calculate the sample size.

RESULTS

Among 307 patients, 75 (24.4%) presented with EVF. Patients with EVF had significantly higher rates of unfavorable outcomes at 90 days (76.00% vs. 46.12%, P < 0.001). Multivariate analysis revealed significant associations between EVF and unfavorable outcome (odds ratio [OR] = 2.69, 95%CI [1.37-5.26], P = 0.004), hemorrhagic transformation (OR = 3.11, 95%CI [1.73-5.62], P < 0.001), symptomatic intracranial hemorrhage (OR = 3.24, 95%CI 1.42 to 7.37, P = 0.005), and malignant brain edema (OR = 3.06, 95%CI [1.56-6.01], P = 0.001). Stratified analysis showed EVF group with a baseline Alberta Stroke Program Early CT (ASPECT) score of ≤ 8 exhibited a higher risk of unfavorable outcomes compared with patients in the non-EVF group (OR = 2.64, 95%CI [1.03-6.73], P = 0.042). Mediation analysis indicated that malignant brain edema accounted for 35.42% of the correlation between EVF and unfavorable outcomes.

CONCLUSIONS

This study establishes EVF as an independent risk factor for unfavorable outcomes after MT in AIS. Therefore, EVF in conjunction with a low ASPECT score provides essential insights for identifying patients at high risk for unfavorable outcomes.

Mizoribine or Cyclophosphamide for Lupus Nephritis: A Randomized Clinical Trial

Importance

Lupus nephritis is typically treated with intravenous cyclophosphamide, which is associated with serious adverse effects. Oral mizoribine may be an alternative for induction therapy of lupus nephritis. However, large-scale, long-term, randomized clinical studies of mizoribine are lacking.

Objective

To assess the efficacy and safety of oral mizoribine vs intravenous cyclophosphamide as induction therapy for Chinese patients with lupus nephritis.

Design, Setting, and Participants

This prospective, multicenter, parallel-group, open-label, phase 3 randomized clinical trial recruited patients with class III, III+V, IV, IV+V, or V lupus nephritis aged 18 to 70 years from 40 centers in China. Inclusion criteria included 24-hour urinary protein level of 1.0 g or higher and systemic lupus erythematosus disease activity index of 8 or higher. The first patient was enrolled on November 29, 2014, and the study finished March 14, 2019. The follow-up period was 52 weeks. Data were analyzed from September 4, 2019, to January 21, 2020.

Interventions

Oral mizoribine (50 mg, 3 times a day) or cyclophosphamide (6 intravenous doses at 0.5-1.0 g/m2 body surface area, with a maximum dose of 1.0 g/d) for 52 weeks plus oral glucocorticoid.

Main Outcomes and Measures

Total remission rate (complete remission rate plus partial remission rate) after 52 weeks (prespecified).

Results

A total of 250 patients were randomized, and 243 patients (mean [SD] age, 34.6 [10.7] years, 213 women [87.7%]) were treated (123 patients [50.6%] in the mizoribine group and 120 patients [49.4%] in the cyclophosphamide group). The total remission rate at 52 weeks was 66.1% (76 of 115 patients) in the mizoribine group and 76.8% (86 of 112 patients) in the cyclophosphamide group, and the relative risk ratio (mizoribine vs cyclophosphamide) was 0.861 (95% CI, 0.729-1.016). The lower limit of this 2-sided 95% CI was greater than the noninferiority margin of 0.726, indicating that mizoribine was noninferior to cyclophosphamide. Changes in other immune parameters and kidney function were generally similar between the groups. The incidence of any treatment-related treatment-emergent adverse events was 80.5% (99 of 123 patients) in the mizoribine group and 78.7% (96 of 122 patients) in the cyclophosphamide group, and the most frequent adverse event in both groups was upper respiratory tract infection (41 patients [33.3%] and 37 patients [30.3%], respectively).

Conclusions and Relevance

This randomized clinical trial shows that compared with intravenous cyclophosphamide, oral mizoribine was noninferior and well tolerated when used with glucocorticoid for induction therapy of active lupus nephritis. Mizoribine can be used as an alternative to intravenous cyclophosphamide as induction therapy for lupus nephritis.

Trial Registration

ClinicalTrials.gov Identifier: NCT02256150.

CircRNA-miRNA-mRNA regulatory network in high-altitude hypobaric hypoxia-induced hearing impairment and hearing acclimatization

OBJECTIVE

High altitude hypobaric hypoxia can induce hearing impairment and hearing acclimatization, but few studies have been performed to decipher the potential transition between the two states. To decipher transition-related circular RNAs (circRNAs)-microRNAs (miRNAs)-messenger RNA (mRNAs) regulatory network.

METHODS

Wistar rats were airlifted from plain to high altitude and maintained for 30 days and 60 days. Hearing acclimatization was determined using the Auditory Brainstem Response (ABR) test. Cochlea tissues were isolated, and high-throughput circRNA analysis and mRNAs-sequencing were performed. Differentially Expressed circRNAs (DEcircRNAs) and Differentially Expressed mRNAs (DEmRNAs) were obtained, and circRNA-miRNA and miRNA-mRNA regulation were predicted. A circRNA-miRNA-mRNA competing endogenous RNA (ceRNA) network was also constructed. The DEmRNAs in this network were functionally annotated using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses based on Metascape.

RESULTS

The ABR assay indicated that hearing impairment happened on day 30 and hearing acclimatization occurred on day 60. Hearing impairment-related circRNAs (64 upregulated and 147 downregulated) and genes (572 upregulated and 757 downregulated) were identified. Hearing acclimatization-related circRNAs (79 upregulated and 142 downregulated) and genes (690 upregulated and 751 downregulated) were also identified. Hearing impairment and hearing acclimatization ceRNA networks were also constructed after integrating the predicted miRNA regulation analyses. Anterograde trans-synaptic signaling (GO:0098916) and negative regulation of cellular response to growth factor stimulus (GO:0090288) were regulated by hearing impairment ceRNA networks, and embryonic organ development (GO:0048568) was regulated by hearing acclimatization ceRNA networks.

CONCLUSION

Hearing impairment- and hearing acclimatization-associated circRNAs and ceRNA networks were identified, which contribute new knowledge to our understanding of acclimatization transition.

Impact of pre-examination video education in Gd-EOB-DTPA-enhanced liver MRI: A comparative study

INTRODUCTION

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, and early diagnosis via gadolinium ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) significantly impacts patient outcomes. However, patient anxiety during MRI can affect image quality. This study investigates the impact of pre-examination video education on anxiety, satisfaction and image quality in Gd-EOB-DTPA-enhanced liver MRI.

METHODS

We prospectively enrolled 480 patients who underwent Gd-EOB-DTPA-enhanced liver MRI from January 2022 to May 2023 at our hospital. Patients were divided into study and control groups in order of odd and even days, with 240 cases in each group. Before the examination, the radiology staff provided routine verbal guidance and breathing training to the patients in the control group, while the study group was given additional video education. The state anxiety scores, satisfaction scores of the provided information and motion artefact scores of the images before and after the examination were compared between the two groups.

RESULTS

The state anxiety scores of both groups of patients were lower than before the examination (all P < 0.05), but the change value of the study group was significantly greater than that of the control group (P = 0.004). The satisfaction rate of the information provided before the scan in the study group was significantly higher (P < 0.001). The image quality scores of the arterial phase were similar between the two groups (P = 0.403), but the image quality of the study group in the pre-contrast, portal phase, transitional phase and hepatobiliary phase was significantly better than that of the control group (all P < 0.05).

CONCLUSION

Supplementing routine pre-scan care with video guidance for Gd-EOB-DTPA-enhanced liver MRI offers several benefits, including reduced patient anxiety, increased satisfaction and improved image quality. These results suggest the potential for widespread application of video-based interventions to enhance the MRI experience for patients.

A comparative analysis of survival outcomes and adverse effects between preoperative brachytherapy with radical surgery and concurrent chemoradiotherapy in patients with locally advanced cervical cancer

Background

To compare the long-term efficacy and adverse effects of preoperative brachytherapy combined with radical surgery versus concurrent chemoradiotherapy (CCRT) in patients with locally advanced cervical cancer (LACC).

Methods

This retrospective study analyzed 161 patients with LACC treated at the Affiliated Hospital of North Sichuan Medical College between January 2015 and December 2020. Of these, 76 patients underwent preoperative brachytherapy combined with radical surgery (study group), while 85 received CCRT (control group). After propensity score matching (PSM) to minimize confounding, 124 patients (62 per group) were included in the analysis. Survival outcomes and prognostic factors were evaluated using Kaplan-Meier survival analysis and Cox regression models. Adverse effects of treatment were compared between the groups.

Results

After PSM, the 5-year progression-free survival (PFS) rate in the study group was significantly higher than that in the control group (81.2% vs. 62.7%, P<0.05). There was no significant between-group difference regarding the 5-year overall survival (OS) rate (81.4% vs. 74.9%, P=0.41). Multivariate analysis identified treatment modality (preoperative brachytherapy combined with radical surgery vs. CCRT) as an independent prognostic factor for PFS (HR: 0.458, 95% CI 0.221-0.945, P=0.035). The study group had significantly lower rates of grade 2 acute radiation enteritis, grade 3-4 leukopenia, and anemia compared to the control group (P<0.05), with no significant differences observed in other adverse effects (P>0.05).

Conclusion

Preoperative brachytherapy combined with radical surgery may help improve the PFS of patients with LACC, with fewer adverse effects, making it a potentially viable treatment option for these patients.

A comprehensive dataset of germinoma on MRI/CT with clinical and radiomic data

Intracranial germ cell tumors (GCTs) are rare neoplasms with a peak incidence in adolescents. Germinoma is the most common histological subtype of intracranial GCTs. Its symptoms include intracranial hypertension, visual field defects, and hormonal disorders, affecting the physical health of adolescents. Germinoma is sensitive to chemo-radiotherapy, and most patients do not require neurosurgical resection. Therefore, improving the accuracy of germinoma diagnosis helps to avoid unnecessary surgery. At present, the application of artificial intelligence (AI) in medical imaging has improved the accuracy of disease diagnosis. However, few studies focused on the AI model to diagnosis germinoma and there are no publicly available imaging datasets for germinoma. This study aimed to create a comprehensive dataset for germinoma using magnetic resonance imaging/computed tomography findings with clinical and radiomic data to train and validate AI models. Featuring 65 pathologically confirmed germinomas, the dataset included axial T2-weighted imaging, T2-weighted fluid-attenuated inversion recovery, T1-weighted imaging, T1-weighted imaging with contrast enhancement, diffusion-weighted MR imaging, CT images, clinical data, and morphological and radiomic-based features obtained by segmentation.

Association between Life's essential 8 and mortality among individuals with hypertension

The "Life's Essential 8" (LE8) score is an assessment of cardiovascular health recently introduced by the American Heart Association. This study aimed to explore the correlation of the total LE8 score and its individual metrics with all-cause and cardiovascular disease (CVD) mortality in patients with hypertension. Data from 10,556 hypertension adults were retrieved from National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. After a median follow-up of 6.75 years, patients with high LE8 scores (≥ 75 points) showed significantly lower mortality rates from all causes and CVD (P < 0.001). Cox regression analysis indicated that high LE8 scores were associated with a 40% lower risk of all-cause [0.60(0.50-0.73)] and CVD mortality [0.60(0.43-0.83)] compared to low scores. As the total LE8 score increased linearly, the likelihood of all-cause and CVD mortality decreased, with a potential threshold at 60 points. Subgroup analyses revealed that diet, sleep, nicotine exposure, physical activity, and blood glucose control affected both types of mortality. The LE8 score was negatively correlated with the risks of all-cause and CVD mortality in hypertensive patients. Life interventions and management of physical indicators based on the LE8 score may be an effective way to improve mortality in hypertensive patients.

Fucoidan ameliorates lipid accumulation, oxidative stress, and NF-κB-mediated inflammation by regulating the PI3K/AKT/Nrf2 signaling pathway in a free fatty acid-induced NAFLD spheroid model

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. Previous studies have reported that fucoidan can relieve obesity and hepatic steatosis in vivo, although the molecular mechanism remains unclear. This study aimed to explore the effect and potential molecular mechanism of fucoidan in NAFLD using the free fatty acid (FFA)-induced NAFLD spheroid model.

MATERIALS AND METHODS

The spheroids were constructed by fusing the HepG2 and LX-2 cells. Spheroids and HepG2 cells were stimulated with FFAs and fucoidan, then the intracellular lipid contents and the oxidative stress levels (ROS/MDA/GSH/GR/GPx/NQO1/GCLC/HO-1) were detected. Furthermore, the regulation of PI3K/AKT/Nrf2 pathway and the expression of inflammatory factors (TNF-α and IL-6) were measured.

RESULTS

Fucoidan markedly reduced FFA-induced intracellular lipid accumulation in spheroids and HepG2 cells. Notably, fucoidan relieved FFA-induced oxidative stress by reducing the levels of ROS and MDA, and elevating the levels of GSH, GR, and GPx. Furthermore, fucoidan reduced FFA-induced oxidative stress by activating the PI3K/AKT/Nrf2 signaling pathway and by inhibiting ROS-induced P65 NF-κB activation and inflammatory responses via Nrf2 pathway activation.

CONCLUSIONS

Our results demonstrated that fucoidan ameliorated FFA-induced lipid accumulation, oxidative stress, and NF-κB-mediated inflammation through the PI3K/AKT/Nrf2 signaling pathway in the spheroid and HepG2 cells model of NAFLD. These results provided new evidence for the clinical use of fucoidan in the treatment of NAFLD and its potential molecular mechanism of action.

C16 peptide and angiopoietin-1 alleviate the side effects of glucocorticoids in a rat multiple sclerosis model

BACKGROUND

Natural glucocorticoids (GCs) have been widely used to treat acute multiple sclerosis (MS) attacks. However, they also cause significant side effects related to immunosuppression. Our previous study found that C16 peptide combined with angiopoietin-1 (Ang-1) inhibited inflammatory cell infiltration and protected blood vessels in animal models of inflammatory neurodegenerative diseases.

METHODS

An acute experimental autoimmune encephalomyelitis model was established in Lewis rats to explore the effects of these drugs on MS. One hundred rats were equally and randomly assigned into five groups: normal control, vehicle, low-dose methylprednisolone (MP), high-dose MP, and C16 + Ang-1 (C+A). Histological examinations, behavioral tests, and high-throughput 16S rRNA gene sequencing were conducted to determine inflammation levels in the central nervous system, neuronal survival, functional recovery and gut microbiota.

RESULTS

The results illustrated that C+A exerted a neuroprotective effect in MS rats, with fewer side effects observed in the C+A group than in the high-dose MP group. The abundance of Campylobacter was increased in vehicle-treated rats, indicating an imbalance of the gut microbiota after MS. The abundance of probiotic Lactobacillus plantarum was increased in the C+A group. Low-dose MP failed to reverse the gut microbiota imbalance, whereas both the C+A and high-dose MP groups exhibited gut microbiota profiles more similar to those of the normal controls, with C+A displaying superior efficacy.

CONCLUSIONS

C16 plus Ang-1 might serve as a complement to GCs for the treatment of MS. Changes in the abundance of Campylobacter and L. plantarum suggest their essential roles in the pathogenesis of MS.

Identification of early predictors and model for bacterial infection in diabetic ketoacidosis patients: A retrospective study

PURPOSE

The purpose of this report was to identify effective indicators capable of predicting bacterial infection during the early stages of diabetic ketoacidosis (DKA) and to establish a diagnostic model suitable for clinical application.

METHODS

This was a retrospective cross-sectional study. Between February 2018 and May 2023, Yuhuangding Hospital admitted 101 DKA patients, of whom 45 were diagnosed with bacterial infections. A confirmed bacterial infection was defined as documented bacteriological evidence in any bacterial sample. Clinical parameters and biological markers (including cortisol, C-reactive protein (CRP), procalcitonin, etc.) were recorded during the initial DKA phase. Multivariate regression analysis was employed to construct a diagnostic model.

RESULTS

CRP (OR = 1.014, 95% CI: 1.002-1.026, p = 0.017) and cortisol (OR = 1.007, 95% CI: 1.002-1.012, p = 0.003) were found to have an independent association with bacterial infection in DKA patients. The area under the receiver operating characteristic curve (AUC) for CRP in identifying bacterial infection was 0.855 (95% CI, 0.771-0.917), with a sensitivity of 76.1% and a specificity of 83.6%. The AUC for cortisol in identifying bacterial infection was 0.847 (95% CI, 0.761-0.911), with a sensitivity of 71.7% and a specificity of 89.1%. A joint diagnostic model based on cortisol and CRP was developed through multifactor regression analysis. The AUC of this diagnostic model was 0.930 (95% CI, 0.862-0.972), resulting in a sensitivity of 93.5% and a specificity of 80.0%.

CONCLUSION

CRP and cortisol are early indicators of bacterial infection in DKA patients. Furthermore, based on their combination, the regression diagnostic model exhibits enhanced diagnostic performance.

Improved early postoperative cognition in elderly gastrointestinal patients: a randomized controlled trial on the role of ultrasound-guided stellate ganglion block

Background

This study evaluates the impact of ultrasound-guided stellate ganglion block (SGB) on early postoperative cognitive dysfunction (POCD) in elderly patients who underwent laparoscopic gastrointestinal (GI) surgery, as well as its potential effect on oxidative stress and inflammatory responses.

Methods

In this randomized controlled trial, 104 elderly patients scheduled for elective laparoscopic GI surgery were randomized to receive ultrasound-guided SGB before general anesthesia (SGB group) or general anesthesia alone (control group). A total of 98 patients completed the study. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) preoperatively, and on postoperative days one and three. The perioperative recordings included mean arterial pressure, heart rate, and the bispectral index. Blood samples were analyzed for interleukin-6 (IL-6), superoxide dismutase (SOD), and malondialdehyde (MDA).

Results

The SGB group had a significantly lower incidence of POCD on postoperative day one (p < 0.05). IL-6 and MDA levels were significantly lower, while SOD levels were higher in the SGB group, when compared to the control group (p < 0.05). MDA levels were notably lower on postoperative day three in the SGB group (p < 0.05). Both groups showed significant changes in IL-6, SOD and MDA levels, when compared to preoperative values. The hemodynamic indicators showed a slight reduction in intraoperative blood pressure and decreased numerical rating scale scores on the first postoperative day without significant differences in other indicators.

Conclusion

Preoperative SGB reduces early POCD in elderly patients who undergo laparoscopic GI surgery, possibly through the inhibition of oxidative stress and inflammatory responses.

Combined morphology and radiomics of intravoxel incoherent movement as a predictive model for the pathologic complete response before neoadjuvant chemotherapy in patients with breast cancer

Background

To develop a predictive model using baseline imaging of morphology and radiomics derived from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) to determine the pathologic complete response (pCR) to neoadjuvant chemotherapy (NACT) in breast cancer patients.

Methods

A total of 265 patients who underwent 3.0 T MRI scans before NACT were examined. Among them, 113 female patients with stage II-III breast cancer were included. The training data set consisted of 79 patients (31/48=pCR/Non-PCR, npCR), while the remaining 34 cases formed the validation cohort (13/21=pCR/npCR). Radiomics and conventional magnetic resonance imaging features analysis were performed. To build a nomogram model that integrates the radiomics signature and conventional imaging, a logistic regression method was employed. The performance evaluation of the nomogram involved the area under the receiver operating characteristic curve (AUC), a decision curve analysis, and the calibration slope.

Results

In an assessment for predicting pCR, the radiomics model displayed an AUC of 0.778 and 0.703 for the training and testing cohorts, respectively. Conversely, the morphology model exhibited an AUC of 0.721 and 0.795 for the training and testing cohorts, respectively. The nomogram displayed superior predictive discrimination with an AUC of 0.862 for the training cohort and 0.861 for the testing cohort. Decision curve analyses indicated that the nomogram provided the highest clinical net benefit.

Conclusion

Performing a nomogram consisting of integrated morphology and radiomics assessment using IVIM-DWI before NACT enables effective prediction of pCR in breast cancer. This predictive model therefore can facilitate medical professionals in making individualized treatment decisions.

Development, validity, and reliability testing of a research readiness self-evaluation scale with nurses: A cross-sectional study

Nurse research readiness determines research outcomes. Understanding of nurse knowledge, attitude, and behaviors on research preparation can better prepare them for medical search. To develop a nurse research readiness self-evaluation scale and test its validity and reliability. This cross-sectional study was performed between January and October, 2023. Based on the knowledge-attitude-practice model, we first created a draft version of a nurse research readiness scale via a literature review and semi-structured interviews with registered nurses. After a Delphi expert consultation and pilot survey, a second version of the nurse research readiness scale was developed. We then tested the validity and reliability of the scale to develop its final version. A total of 20 experts and 400 nurses were invited to participate in the study, and valid responses were subsequently obtained from 16 experts and 390 nurses. The draft version of the scale had 3 dimensions and 35 items, which was finalized to 3 dimensions and 28 items after expert consultation and validity and reliability tests. The 3 dimensions were extracted using the principal component analysis method, which includes knowledge, belief, and behavior, and this could explain 70.672% of the total variation. The content validity test showed moderate satisfaction, with content validity indexes for each item and an overall scale of 0.833 to 1.000 and 0.878, respectively. The construct validity test was performed using exploratory factor analysis, which showed satisfactory concept measurement, with a loading value > 0.4 in all 28 final items. The criterion-related validity showed a correlation coefficient of 0.893 between the research readiness scale and a previously published research capability scale for nurses, suggesting the consistency of the present scale. The Cronbach α coefficient, Spearman-Brown coefficient, split-half reliability, and test-retest reliability were 0.964, 0.886, 0.940, and 0.824, respectively, thus demonstrating satisfactory reliability of the scale. A nurse research readiness self-evaluation scale was created with satisfactory validity and reliability, which could help nurses to determine their preparations for medical search and identify areas for improvements, with the ultimate goal to improve nursing research and evidence-based nursing practice.

Cervical cancer burden and attributable risk factors across different age and regions from 1990 to 2021 and future burden prediction: results from the global burden of disease study 2021

Background

Cervical cancer (CC) is a global public health problem. We aimed to evaluate the global and regional CC burden between 1990 and 2021, identify the attributable risk factors, and project its burden up to 2035.

Methods

Data were extracted from the Global Burden of Disease Study 2021, and the CC incidence, mortality, age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), age-standardized disability-adjusted life years (DALYs), and attributable risk factors from 1990 to 2021 were analyzed. The impacts of geographical variations, different age groups, and the socio-demographic index (SDI) on CC morbidity and mortality measurements were assessed. The attributable risk factors to CC death and DALY were evaluated, and the incidence, mortality, and DALYs to 2035 were projected.

Results

Globally, the number of CC cases has increased from 409,548.49 cases in 1990 to 667,426.40 cases in 2021. However, the ASIR decreased from 18.11 to 15.32 per 100,000, with the greatest ASIR decrease in high SDI regions (estimated annual percentage change: -1.41). Between 1990 and 2021, the global ASDR decreased from 9.68 to 6.62 per 100,000, and the rate of age-standardized DALYs decreased from 330.11 to 226.28 per 100,000. However, these improvements were not consistent across different SDI regions. The CC incidence was the highest in the 55-59 age group, globally. The risk factors, which included unsafe sex and smoke, significantly varied by region. The global ASIR exhibited a downward trend from 2021 to 2035.

Conclusion

From 1990 to 2021, although the overall trend in incidence, mortality, and DALYs of CC exhibited a global and regional downward trend, there were significant disparities among areas with different socioeconomic development. More efficient targeted prevention and management strategies, easy access to health care in less developed regions, and risk factor modifications should be promoted, in order to reduce the global burden of CC.