Association between osteoarthritis and cognitive function: results from the NHANES 2011-2014 and Mendelian randomization study

Background

Previous meta-analyses have demonstrated osteoarthritis (OA) is associated with an increased risk of dementia, but these studies were prone to bias based on residual confounding factors and reverse causality.

Objectives

We aimed to investigate associations between OA and cognitive function using data from the National Health and Nutrition Examination Survey (NHANES) and to investigate the causality using Mendelian randomization (MR).

Design

This is a cross-sectional study and MR study.

Methods

Data from the NHANES 2011-2014 were used. Multiple linear, logistic regressions and stratified analyses were used to determine the association between OA status and cognitive function. Sample weights were used to ensure result generalizability. Two-sample MR analysis was conducted to examine the association between OA and dementia. Mediation analyses were performed to investigate the mediating effects of depression.

Results

We did not demonstrate a significant association between OA and cognitive performance after adjusting for relevant covariates (p > 0.05), and the population of individuals with both OA and depression was associated with higher odds of low total word recall cognitive performance (odds ratio (OR) = 4.74, 95% confidence interval (CI): 1.09-20.63; p = 0.04). Genetically predicted specific-site OA was not significantly associated with the risk of dementia (OR = 1.12; 95% CI: 0.96-1.32; p = 0.16), Alzheimer's disease (OR = 0.95, 95% CI: 0.68-1.31, p = 0.74), vascular dementia (OR = 1.32, 95% CI: 0.82-2.13, p = 0.25) with accepted heterogeneity and no evidence of directional pleiotropy. Furthermore, major depression was found to mediate the pathway between OA and vascular dementia (β = 0.044, 95% CI: -0.391 to 0.479, p < 0.05).

Conclusion

Our findings indicate that there is no significant association or causal relationship between OA and cognitive decline. However, depression may serve as an important factor influencing cognitive outcomes. Future research should further explore the bidirectional causal relationship and underlying mechanisms.

Concussion and the Autonomic, Immune, and Endocrine Systems: An Introduction to the Field and a Treatment Framework for Persisting Symptoms

A significant proportion of patients who sustain a concussion/mild traumatic brain injury endorse persisting, lingering symptoms. The symptoms associated with concussion are nonspecific, and many other medical conditions present with similar symptoms. Medical conditions that overlap symptomatically with concussion include anxiety, depression, insomnia, chronic pain, chronic fatigue, fibromyalgia, and cervical strain injuries. One of the factors that may account for these similarities is that these conditions all present with disturbances in the optimal functioning of the autonomic nervous system and its intricate interactions with the endocrine system and immune system-the three primary regulatory systems in the body. When clinicians are working with patients presenting with persisting symptoms after concussion, evidence-based treatment options drawn from the literature are limited. We present a framework for the assessment and treatment of persisting symptoms following concussion based on the available evidence (treatment trials), neuroanatomical principles (research into the physiology of concussion), and clinical judgment. We review the research supporting the premise that behavioral interventions designed to stabilize and optimize regulatory systems in the body following injury have the potential to reduce symptoms and improve functioning in patients. Foundational concussion rehabilitation strategies in the areas of sleep stabilization, fatigue management, physical exercise, nutrition, relaxation protocols, and behavioral activation are outlined along with practical strategies for implementing intervention modules with patients.

Umbrella review of social inequality in digital interventions targeting dietary and physical activity behaviors

Digital interventions are increasingly utilized as a lever to promote population health, yet not everyone may equally benefit from them. This umbrella review pooled the insights from available systematic and scoping reviews regarding potential social inequalities in digital intervention uptake, engagement and effectiveness, focusing on the promotion of weight-related behaviors (diet, physical activity, sedentary behavior) and weight loss (maintenance) in adults. Six databases were searched from 1970 to October 2023. Forty-six reviews were included, of which most focused on physical activity and intervention effectiveness. Age and gender/ sex differences were most frequently studied. Most reviews found digital interventions to be effective irrespective of age, while men benefitted more from digital interventions than women. Other inequality indicators (e.g., income, education) were rarely studied, despite them being potential causes of a digital divide. A more systematic and thorough exploration of inequalities in digital health is required to promote health for all.

Triple soil transmitted helminths in a case of aluminium phosphide poisoning

Soil transmitted helminth (STH) infections remain prevalent in India despite the ongoing deworming program. Here, we report a case of triple infection of Ascaris lumbricoides, Ancylostoma duodenale, and Strongyloides stercoralis, in a young asymptomatic and apparently immunocompetent female presenting with aluminium phosphide poisoning. Except for severe anaemia, the only other indicators of chronic infection were occasional abdominal pain and self-limiting loose stools. She was successfully treated for her conditions. This case highlights that despite regular deworming programs in children, STH may continue to infect adults in endemic areas and may be relevant to their well-being.

A longitudinal cohort study demonstrating the beneficial effect of moderate consumption of green tea and coffee on the prevention of dementia: The JPHC Saku Mental Health Study

BACKGROUND

While the preventive effects of green tea and coffee on cognitive decline have been demonstrated, their long-term effects on cognition remain unclear.

OBJECTIVE

This study aims to investigate the effect of green tea and coffee consumption in middle age on the prevention of dementia.

METHODS

This population-based cohort study included 1155 participants (aged 44-66 in 1995). Participants' consumption of green tea and coffee was assessed using questionnaires in 1995 and 2000. Their cognitive levels were neuropsychologically evaluated in 2025-2015. Logistic regression analyses were conducted with significant cognitive decline (defined as multi-domain cognitive decline and more severe conditions) as the dependent variable. Stratified analyses were also conducted by sex and age.

RESULTS

Individuals who consumed 2-3 cups of green tea daily had a significantly reduced risk of cognitive decline (OR = 0.56, 95%CI: 0.35-0.91) after adjusting potential confounders. However, this effect was not significant with consumption of 4 or more cups. This protective effect was particularly observed in males (OR = 0.38, 95%CI: 0.19-0.76). A significant risk reduction was also observed in individuals consuming one or more cups of coffee daily (OR = 0.54, 95%CI: 0.34-0.84) in the older subjects (median age [53 years old] and older in 1995) in the same fully adjusted model, but not in the entire sample.

CONCLUSIONS

Our findings suggest that moderate green tea consumption in midlife may have a beneficial effect on preventing dementia, particularly in males. The effects of coffee consumption may be more advantageous for older individuals.

Copeptin associates with major adverse cardiovascular events in patients on maintenance hemodialysis

BACKGROUND

End-stage renal disease (ESRD) necessitating hemodialysis pose substantial cardiovascular risks, with cardiovascular disease (CVD) as a leading cause of mortality. Biomarkers like copeptin have emerged as potential indicators of cardiovascular stress and prognosis in CKD populations.

OBJECTIVE

This study aimed to assess the prognostic value of copeptin in predicting major adverse cardiovascular events (MACEs) among hemodialysis patients, alongside traditional cardiac biomarkers.

METHODS

ESRD patients undergoing maintenance hemodialysis were enrolled. Copeptin levels were measured, and patients were followed for MACEs, defined as cardiovascular deaths, myocardial infarction, stroke, or heart failure-related hospitalizations. Cox proportional-hazards models were used to evaluate the association between copeptin and outcomes, adjusting for relevant covariates.

RESULTS

Among 351 patients followed for a median of 22.7 months, elevated copeptin levels were significantly associated with an increased risk of MACEs (HR 1.519, 95 % CI 1.140 to 2.023; p = 0.00425). Copeptin demonstrated predictive capability across multiple statistical tests (Log-rank p = 0.024; Gehan p < 0.001; Tarone-Ware p < 0.001; Peto-Peto p = 0.027), although significance was attenuated in pairwise comparisons post-adjustment for multiple testing. Combining copeptin with NT-proBNP or hs-cTnT further enhanced risk stratification for MACEs.

CONCLUSION

Elevated copeptin levels independently predict adverse cardiovascular outcomes in hemodialysis patients. Integrating copeptin with traditional cardiac biomarkers may refine risk stratification and guide personalized therapeutic strategies in this high-risk population.

Identification of Cannabidiolic and Cannabigerolic Acids as MTDL AChE, BuChE, and BACE-1 Inhibitors Against Alzheimer's Disease by In Silico, In Vitro, and In Vivo Studies

Cannabidiolic (CBDA) and cannabigerolic (CBGA) acids are naturally occurring compounds from Cannabis sativa plant, previously identified by us as dual PPARα/γ agonists. Since the development of multitarget-directed ligands (MTDL) represents a valuable strategy to alleviate and slow down the progression of multifactorial diseases, we evaluated the potential ability of CBDA and CBGA to also inhibit enzymes involved in the modulation of the cholinergic tone and/or β-amyloid production. A multidisciplinary approach based on computational and biochemical studies was pursued on selected enzymes, followed by behavioral and electrophysiological experiments in an AD mouse model. The β-arrestin assay on GPR109A and qPCR on TRPM7 were also carried out. CBDA and CBGA are effective on both acetyl- and butyryl-cholinesterases (AChE/BuChE), as well as on β-secretase-1 (BACE-1) enzymes in a low micromolar range, and they also prevent aggregation of β-amyloid fibrils. Computational studies provided a rationale for the competitive (AChE) vs. noncompetitive (BuChE) inhibitory profile of the two ligands. The repeated treatment with CBDA and CBGA (10 mg/kg, i.p.) improved the cognitive deficit induced by the β-amyloid peptide. A recovery of the long-term potentiation in the hippocampus was observed, where the treatment with CBGA and CBDA also restored the physiological expression level of TRPM7, a receptor channel involved in neurodegenerative diseases. We also showed that these compounds do not stimulate GPR109A in β-arrestin assay. Collectively, these data broaden the pharmacological profile of CBDA and CBGA and suggest their potential use as novel anti-AD MTDLs.

Magnesium-Impregnated Membrane Promotes Bone Regeneration in Rat Skull Defect by N-Linked Glycosylation of SPARC via MagT1

Autograft has long been the gold standard for various bone surgeries. Nevertheless, the increasing usage of synthetic implants is taking over the operation rooms due to biosafety and standardized protocols. To fulfill such tremendous needs, a magnesium-impregnated membrane is devised that steadily releases magnesium ions to stimulate osteogenesis. The compatibility of Magnesium oxide (MgO) particles is enhanced through hydration and grafting, characterized by scanning electron microscopy (SEM), thermogravimetric analysis (TGA), and differential scanning calorimetry (DSC). With detailed degradation profiles, an in-depth investigation of Magnesium transporter 1 (MagT1) for magnesium intake is carried out and engaging in the N-linked glycosylation by using RNAi and inhibitors. The glycosylation of secreted protein acidic and rich in cysteine (SPARC) affected extracellular secretion and mineral deposition, demonstrated by immunostaining and density-dependent color-SEM (DDC-SEM). Skull defects are treated by implanting magnesium-impregnated membranes in rats and evaluated them by micro-CT and histological exams. This study revealed the compatible integration of grafted magnesium hydroxide (g-MH) particles is the key to functional performance and critical to applicability in vivo; meanwhile, it opens the door to a biological rationale for designing biomimetic materials.

Self-Trephination Resulting in Exposed Brain Matter and Cerebral Abscess in a Schizophrenic Patient With Delusions

A 56-year-old woman with schizophrenia presented with persistent foreign body delusions, who chronically excavated her scalp and skull, resulting in a large cranial wound with granulation tissue, purulent discharge, and pneumocephalus. CT scans revealed bilateral subdural hematomas (SDH), polymicrobial osteomyelitis, and a brain abscess causing cerebral edema. The neurosurgical intervention involved cranial washout, debridement, and scalp reconstruction via rotational flap closure, followed by broad-spectrum antibiotics tailored to culture results. Hyperbaric oxygen therapy (HBOT) was employed to promote faster healing and lower postoperative complications and potential reinfection. Psychiatric stabilization with antipsychotics addressed medication noncompliance, improving the patient's engagement with care. Postoperatively, she regained functional independence and was transitioned to inpatient rehabilitation for mobility and activities of daily living. This case highlights the critical role of integrated care involving neurosurgery, psychiatry, infectious disease, and rehabilitation in managing rare and complex presentations of self-trephination. HBOT is noted for its efficacy in promoting healing under challenging conditions.

The Association between Gallstone Disease and Cardiovascular Disease: A Systematic Review and Meta-Analysis

BACKGROUND

Gallstone Disease (GSD) is a multifactorial risk factor for various complications.

OBJECTIVE

This study aimed to examine the relationship between GSD and Cardiovascular Disease (CVD) through a systematic review and meta-analysis approach.

METHODS

A thorough search was conducted across Web of Science, Scopus, MEDLINE/PubMed, Cochrane Library, and Embase databases. Only studies published between 1980 and December 2023 were included. Chi-square, I2, and forest plots were used to assess heterogeneity. Begg's and Egger's tests were used to evaluate publication bias. Statistical significance was considered at p <0.05, and all analyses were performed using Stata 17.

RESULTS

This meta-analysis involved 21 studies and comprised 2,138,282 participants; there has been a significant association found between GSD and an increased risk of CVD (with a relative risk of 1.46, 95% confidence interval: 1.32-1.63, p <0.001). The analysis found no evidence of publication bias based on Begg's test (p =0.085) and Egger's test (p =0.231). Subgroup analysis of the studies showed a higher risk of CVD in studies with a sample size of less than 10,000 participants, conducted in 2016 or later, utilizing a cross-sectional design, in Asian countries; the analysis had a moderate quality score, with a follow-up period of equal to or less than ten years.

CONCLUSION

There has been a significant association found between GSD and CVD and their incidence is related to each other. Taking proactive steps to implement targeted interventions for individuals with gallstone disease could potentially reduce the risk of cardiovascular disease within this population.

Advancements of Endoscopic Surgery for Spontaneous Intracerebral Hemorrhage

OBJECTIVE

Spontaneous intracerebral hemorrhage (sICH) is a severe cerebrovascular disease with high mortality and disability. And its treatment strategies have always been a hotspot in clinical research. Endoscopic surgery (ES) is widely used for treating sICH. A comprehensive review of ES for sICH is warranted to provide better understanding and guidance for clinicians. We provide an updated overview of the surgical equipment, surgical indications and timing, and technical advancements, as well as therapeutic effects and future directions.

METHODS

A narrative review of current literature in ES for sICH was performed based on publications from the databases of PubMed, Scopus, and Google Scholar databases up to December 2023.

RESULTS

ES has shown promising safety and efficacy, emerging as a favorable minimally invasive alternative to conventional craniotomy. It reduces perioperative risks associated with long procedures and significant intraoperative bleeding. Recent advancements in ES techniques have led to superior outcomes in mortality reduction and functional recovery. Scholars' systematic studies and summaries underscore ES's role in improving long-term outcomes for sICH patients. However, its limitations, including reduced depth perception, difficulty in managing deep hematomas, and reduced ability to control rapid bleeding control, should be noted.

CONCLUSIONS

ES represents a significant advancement in the treatment of sICH. Its minimally invasive features, coupled with continuous methodological refinement, contribute to a lower mortality rate and better functional recovery compared to traditional methods. ES should be considered a significant option in the surgical management of sICH, necessitating further research and standardization to enhance patient care and outcomes.

Polyunsaturated Fatty Acids and Human Health: A Key to Modern Nutritional Balance in Association with Polyphenolic Compounds from Food Sources

Polyunsaturated fatty acids (PUFAs) are vital dietary elements that play a significant role in human nutrition. They are highly regarded for their positive contributions to overall health and well-being. Beyond the fact that they provide a substantial supply of energy to the body (a role that saturated fats can also perform), these unsaturated fatty acids and, especially, the essential ones are involved in cell membrane structure, blood pressure regulation, and coagulation; participate in the proper functioning of the immune system and assimilation of fat-soluble vitamins; influence the synthesis of pro- and anti-inflammatory substances; and protect the cardiovascular system. Modern diets like the Western diet and the American diet are rich in saturated fats found especially in fast food products, sweets, and processed foods, a fact that has led to an increase in the prevalence of metabolic diseases worldwide (obesity, type II diabetes, gout, cardiovascular disease). Nutritionists have drawn attention to the moderate consumption of saturated fats and the need to increase the intake of unsaturated fats to the detriment of saturated ones. This paper examines the biochemical roles of polyunsaturated fats, particularly essential fatty acids, and contrasts their benefits with the detrimental effects of saturated fat overconsumption. Furthermore, it highlights the necessity for dietary shifts towards increased PUFA intake to mitigate the global burden of diet-related health issues. The co-occurrence of PUFAs and polyphenols in plant-based foods highlights the sophistication of nature's design. These bioactive compounds are not randomly distributed but are present in foods humans have consumed together historically. From traditional diets like the Mediterranean, which pairs olive oil (PUFAs and polyphenols) with vegetables and legumes, to Asian cuisines combining sesame seeds with turmeric, cultural practices have long harnessed this natural synergy.

A comparative analysis of heme vs non-heme iron administration: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND PURPOSE

Bioavailability studies and observational evidence suggest that heme iron (HI) may have greater impact on iron status indicators compared with non-heme iron (NHI). This systematic review and meta-analysis aimed to review the current evidence on the effect of the administration of HI compared with NHI for improving iron status in non-hospitalized population groups.

METHODS

We searched Pubmed, CENTRAL, Scopus, Web of Science, and LILACS from inception to July 2024. There was no language restriction or exclusion based on age or iron status. Only randomized controlled trials comparing HI with NHI were considered. A random-effects meta-analysis was performed to compare the effect of treatments for iron status indicators and total side effects (including gastrointestinal side effects). We measured the certainty of the evidence (CoE) using GRADE assessment.

RESULTS

After screening 3097 articles, 13 studies were included. Most of the interventions used HI in low doses combined with NHI. The meta-analysis showed higher hemoglobin increases in children with anemia or low iron stores receiving HI (MD 1.06 g/dL; 95% CI: 0.34; 1.78; CoE: very low). No statistically significant difference between interventions were found for any iron status indicator in the other population subgroups (CoE: very low). Participants receiving HI had a 38% relative risk reduction of total side effects compared to NHI (RR 0.62; 95% CI 0.40; 0.96; CoE: very low).

CONCLUSION

The current evidence comparing HI with NHI is very limited, preliminary findings suggest that interventions using HI may result in fewer side effects and may be superior in children with iron deficiency or anemia. However, given the very low certainty of the evidence, these results need further investigation through high-quality clinical trials.

PROTOCOL REGISTRATION

CRD42023483157.

Analysis of the use of digital technologies in the preliminary diagnosis of dermatological diseases: a systematic review

Dermatological diseases are a significant global health concern, and advanced technologies have demonstrated considerable potential to improve the diagnosis and treatment of these conditions. The overall objective of this systematic review is to analyze and evaluate the use of preliminary digital diagnostic technologies in the field of dermatological diseases. The PRISMA methodology was used to collect approximately 50 products to support the article. The results obtained reveal several key findings. First, we investigate for which dermatological diseases these specialized technologies are used, finding that conditions such as skin cancer, rosacea and acne are the most diagnosed using advanced tools. Second, the technologies used to improve preliminary diagnosis are explored, with neural networks standing out, contributing to more accurate and efficient diagnosis. Third, the benefits of these technologies are evaluated, highlighting diagnostic accuracy, early detection and improved quality of patient care. In conclusion, this review highlights the crucial role of technologies in dermatology, not only improving diagnostic accuracy and treatment efficiency, but also optimizing resources and improving the patient experience.

Clinical and swallowing characteristics of tracheostomized patients with post-intubation acquired tracheal or laryngotracheal stenosis

OBJECTIVE

To investigate the clinical and swallowing profiles of patients with post-intubation tracheal or laryngotracheal stenosis requiring tracheostomy prior to surgical or corrective airway interventions.

METHODS

A retrospective cohort clinical study. Patients who met the inclusion criteria underwent a swallowing evaluation, as well as imaging studies of the neck and chest. At 6 and 12-months after the initial assessment, all patients participated in follow-up speech pathology consultations to evaluate the current state of swallowing and the progress of airway stenosis treatment.

RESULTS

Twenty-five patients with a median tracheostomy duration of 30.52 months were assessed. The study found a female predominance (68%) and a high prevalence of subglottic stenosis (44%). Most patients required intubation due to severe acute respiratory failure and airway protection due to a decreased level of consciousness. Imaging revealed additional airway abnormalities, including laryngotracheobronchitis and laryngeal edema. Swallowing assessments showed that 20% had significant dysphagia. After one year, only two patients were successfully decannulated, while others remained tracheostomy dependent.

CONCLUSION

The study underscores the need for personalized, multidisciplinary care for these patients. It finds that while treatments like reconstructive surgeries and the Montgomery T-tube can be effective, complications such as clinical instability and dysphagia can worsen outcomes and extend the need for tracheostomy.

Artificial Intelligence in the Non-Invasive Detection of Melanoma

Skin cancer is one of the most prevalent cancers worldwide, with increasing incidence. Skin cancer is typically classified as melanoma or non-melanoma skin cancer. Although melanoma is less common than basal or squamous cell carcinomas, it is the deadliest form of cancer, with nearly 8300 Americans expected to die from it each year. Biopsies are currently the gold standard in diagnosing melanoma; however, they can be invasive, expensive, and inaccessible to lower-income individuals. Currently, suspicious lesions are triaged with image-based technologies, such as dermoscopy and confocal microscopy. While these techniques are useful, there is wide inter-user variability and minimal training for dermatology residents on how to properly use these devices. The use of artificial intelligence (AI)-based technologies in dermatology has emerged in recent years to assist in the diagnosis of melanoma that may be more accessible to all patients and more accurate than current methods of screening. This review explores the current status of the application of AI-based algorithms in the detection of melanoma, underscoring its potential to aid dermatologists in clinical practice. We specifically focus on AI application in clinical imaging, dermoscopic evaluation, algorithms that can distinguish melanoma from non-melanoma skin cancers, and in vivo skin imaging devices.

Giant cystic Intradural extramedullary tumor of the lumbar spine mimicking arachnoid cyst: A case report

INTRODUCTION

Schwannoma, also known as neurilemmoma, is a benign tumor commonly found around the spinal nerve roots. Large, solitary cases of cystic degeneration within the extramedullary intradural compartment (IDEM) can be challenging for preoperative diagnosis. Furthermore, these cases are not extensively documented in the medical literature.

CASE PRESENTATION

We report a case of giant invasive IDEM schwannoma in a 28-year-old man who presented with intermittent pain radiating to the left thigh without numbness. Magnetic resonance imaging (MRI) showed a complex cystic lesion within the spinal canal from the inferior end plate of L4 to the mid-body of S1.

CLINICAL DISCUSSION

The patient underwent a series of surgical procedures, including laminectomy and decompression at the L4-L5 level for resection of the tumor. Histopathological examination confirmed the diagnosis of schwannoma. The patient had a favorable postoperative recovery and experienced a resolution of symptoms.

CONCLUSION

The giant cystic lumbar schwannoma, although rare, necessitates careful diagnosis and management. The utilization of contrast-enhanced MRI aids in distinguishing it from other lesions. In cases of cystic spinal schwannoma, the lesion walls tend to be thicker and more irregular compared to other cysts, including arachnoid cysts. Histopathological examination should be utilized to identify these lesions intraoperatively. Surgical excision is the primary treatment, and complete excision should be attempted whenever feasible.

CDK: A novel high-performance transfer feature technique for early detection of osteoarthritis

Knee osteoarthritis (OA) is a prevalent condition causing significant disability, particularly among the elderly, necessitating advancements in diagnostic methodologies to facilitate early detection and treatment. Traditional OA diagnosis, relying on radiography and physical exams, faces limitations in accuracy and objectivity. This underscores the need for more advanced diagnostic methods, such as machine learning (ML) and deep learning (DL), to improve OA detection and classification. This research introduces a novel ensemble learning approach for image data feature extraction which ingeniously combines the strengths of 2 advanced (ML) models with a (DL) method to substantially improve the accuracy of OA detection from radiographic images. This innovative strategy aims to address the limitations of traditional diagnostic tools by leveraging the enhanced sensitivity and specificity of combined ML and DL models. The methodology deployed in this study encompasses the application of 10 ML models to a comprehensive publicly available Kaggle dataset with a total of 3615 samples of knee X-ray images. Through rigorous k-fold cross-validation and meticulous hyperparameter optimization, we also included evaluation metrics like accuracy, receiver operating characteristic, precision, recall, and F1-score to assess our models' performance effectively. The proposed novel CDK (convolutional neural network, decision tree, K-nearest classifier) ensemble approach for feature extraction is designed to synergize the predictive capabilities of individual models, thereby significantly improving the detection accuracy of OA indicators within radiographic images. We applied several ML and DL approaches to the newly created feature set to evaluate performance. The CDK ensemble model outperformed state-of-the-art studies with a high-performance score of 99.72% accuracy. This remarkable achievement underscores the model's exceptional capability in the early detection of OA, highlighting its superiority in comparison to existing methods.

The incidence and outcomes of traumatic cauda equina syndrome in Victoria, Australia

Background

Little is known about the incidence, management or long-term outcomes of traumatic cauda equina syndrome (CES), with few cohort studies. The purpose of this study is to establish the incidence and long-term outcomes of traumatic CES in Victoria, Australia. This study is a registry-based cohort study, and people with a diagnosis of traumatic CES from 2010 to 2022 were recruited from the Victorian State Trauma Registry.

Methods

An incidence rate was calculated by dividing the amount of new cases each year by the estimated population in Victoria. Demographic, injury and hospital admission details were extracted from the Victorian State Trauma Registry. Routine follow-up occurred at 6, 12- and 24- months postinjury, with a focus on health-related quality of life outcomes using the EuroQol EQ-5D scale, level of disability using the World Health Organization Disability Assessment Schedule (WHODAS) score and return to work outcomes. An additional telephone interview undertaken at a median 6.8 years postinjury collected the EQ-5D, bowel and bladder outcomes. Descriptive statistics were used to analyse data. Mixed effects regression modelling was used to model change in EQ-5D outcomes over time.

Results

Of the 94 participants, most were men (67%), the median age at injury was 41 years, and the most common cause was road trauma (35%). The incidence rate ranged from 0.56 to 2.51 per million per year. Most people reported problems on the EQ-5D at all 4 follow-up time points, with no clear improvement over time. 47% of people had not returned to work 24 months after injury. Of the survivors who completed the additional follow-up, 41% of people experienced constipation and 51% reported almost losing bladder continence at least once per week.

Conclusions

While the incidence rate of traumatic CES was low, most people experienced long-term sequelae, highlighting the impact of this injury on peoples' lives. Multijurisdictional studies may be needed to comprehensively measure the impacts of this injury.

Clinical and radiographic outcomes after subduro-peritoneal shunt insertion in adults

BACKGROUND

Subdural collections consist amongst others of cerebrospinal, inflammatory, haemorrhagic or infective fluid. While these accumulations can be treated with conservative or surgical measures, such as burr hole evacuation or craniotomy, clinicians may resort to implantation of a subduro-peritoneal shunt, due to their high recurrence rates. While this treatment option is widely used in the pediatric population, its efficacy and safety in adults is scarcely reported.

METHODS

This project is a retrospective case series of 25 adult patients, who underwent subduro-peritoneal shunt (SDPS) implantation between December 2008 and June 2021. The indications included symptomatic subdural collections following trauma, tumor resection or bone flap reimplantation. In general, adjustable valves were used. All patients received a pre- and postoperative computed tomography (CT) scan. We evaluated patients' postoperative clinical outcomes as well as radiographic criteria, including midline shift, frontal horn width and collection volume. Additionally, we analyzed shunt-related complications.

RESULTS

Impaired consciousness was the commonest presenting symptom. We report a significant reduction in volume and width of the subdural collection after SDP shunt implantation. Furthermore, the midline shift decreased significantly. While 60 % (N=15) of the patients improved clinically, only 12 % (N=3) deteriorated. Complications comprised infection in 12 % (N=3) of patients and valve dysfunction in 1 patient.

CONCLUSIONS

Our study shows that SDPS in adults is an effective treatment to eliminate or reduce subdural collections, that improves clinical outcomes in the majority of patients. Hence, it should be utilised more widely in this patient population. However, further studies are necessary to validate the treatment and identify eligible patients.

Ecg signal watermarking using QR decomposition

This study introduces a novel watermarking technique for electrocardiogram (ECG) signals. Watermarking embeds critical information within the ECG signal, enabling data origin authentication, ownership verification, and ensuring the integrity of research data in domains like telemedicine, medical databases, insurance, and legal proceedings. Drawing inspiration from image watermarking, the proposed method transforms the ECG signal into a two-dimensional format for QR decomposition. The watermark is then embedded within the first row of the resulting R matrix. Three implementation scenarios are proposed: one in the spatial domain and two in the transform domain utilizing discrete wavelet transform (DWT) for improved watermark imperceptibility. Evaluation on real ECG signals from MIT-BIH Arrhythmia database and comparison to existing methods demonstrate that the proposed method achieves: (1) higher Peak Signal-to-Noise Ratio (PSNR) indicating minimal alterations to the watermarked signal, (2) lower bit error rates (BER) in robustness tests against external modifications such as AWGN noise (additive white Gaussian noise), line noise and down-sampling, and (3) lower computational complexity. These findings emphasize the effectiveness of the proposed QR decomposition-based watermarking method, achieving a balance between robustness and imperceptibility. The proposed approach has the potential to improve the security and authenticity of ECG data in healthcare and legal contexts, while its lower computational complexity enhances its practical applicability.

Differential gene expression analysis supports dysregulation of mitochondrial activity as a new perspective for glioblastoma's aggressiveness

Brain cancer is considered one of the most aggressive and lethal types of cancer, including primary tumors, being subdivided into milder forms such as low-grade gliomas and glioblastoma, considered the most aggressive form with higher invasion. Among the hallmarks of glioblastoma, the deregulation of mitochondrial metabolism has not yet been fully elucidated. Therefore, the search for mitochondrial biomarkers that can be used as indicators of the progression of this type of cancer is necessary. The aim of this study was to investigate the difference in gene expression between astrocytoma-type gliomas and glioblastomas, and how genes involved in mitochondrial metabolism can influence the proliferative cascade and be associated with tumor invasion. From the differential analysis of glioblastoma expression when compared to the milder form, 11 differentially expressed genes (DEGs) were found in our study, six of which were upregulated (ATP5MGL, C15orf48, MCUB, TERT, AGXT and CYP27B1) and four downregulated (SLC2A4, GK2, SLC25A48, ETNPPL and HMGCS2). To validate the findings, we used other independent bulk RNA-seq datasets and evaluated the number of normalized counts of the DEGs founded. Among these genes, we highlight that none of them had been reported in glioblastoma until this research, and we suggest these genes as possible biomarkers to be further explored, since they are associated with essential pathways for the tumor, such as glucose metabolization, gluconeogenesis, calcium and vitamin D metabolism, tumor progression and activation of the invasion cascade.

Exercise: a non-drug strategy of NK cell activation

Natural killer (NK) cells are a critical component of the innate immune system and one of the immune cells most sensitive to exercise. So far, it is widely believed that moderate exercise can significantly enhance the proliferation and activity of NK cells, strengthening immune function. However, the impact of exercise on NK cells is a dynamic and complex process. In addition to the type of exercise, the frequency, intensity, and duration of exercise are also key factors. This article not only briefly summarizes the activation mechanisms of NK cells but also delves into the potential importance of exercise as a non-pharmacological strategy in modulating NK cell activity and enhancing the immune system. Emerging studies have indicated that the timing and regularity of exercise bouts might also influence NK cell responses. Moreover, the interaction between exercise and other components of the immune system, such as cytokines and chemokines, could further modulate the functionality of NK cells. The above research is of crucial significance for achieving a deeper understanding of the intricate connection between exercise and NK cell function, as well as the development of effective health promotion strategies. In addition, further research is needed to investigate the effects of long-term exercise on NK cell function and the interaction between exercise and NK cell-mediated immune responses. Translating these research findings into precisely tailored exercise programs for specific populations, taking into account factors like age, health status, and genetic predisposition, could potentially offer unprecedented prospects for further advancements in this burgeoning field of study.

The causal relationship between type 2 diabetes mellitus and isolated REM sleep behavior disorder: results from multivariable and network Mendelian randomization analysis

Objectives

To investigate the causal relationship between type 2 diabetes mellitus (T2DM, exposure) and isolated REM sleep behavior disorder (iRBD, outcome).

Methods

Genome-wide association study (GWAS) data for iRBD comprised 9,447 samples, including 1,061 iRBD cases from the International RBD Study Group. Initially, we performed linkage disequilibrium score regression (LDSC) to explore the genetic correlation between T2DM and iRBD. Then the two-sample univariate MR (UVMR) analysis was conducted to examine the effects of T2DM and blood sugar metabolism-related factors on iRBD. Subsequently, we applied multivariable MR (MVMR) methods to further adjust for confounders. Lastly, we executed a network MR analysis, with cytokines and immune cell characteristics as potential mediators, aiming to investigate indirect effect of T2DM on iRBD.

Results

Results from LDSC suggest a genetic correlation between T2DM and iRBD (rg=0.306, P=0.029). UVMR analysis indicates that both T2DM (Odds Ratio [95% Confidence Interval] = 1.19 [1.03, 1.37], P = 0.017) and high blood glucose levels (1.55 [1.04, 2.30], P = 0.032) are risk factors for iRBD. Even after adjusting for confounders in MVMR, the association between T2DM and iRBD remains robust. Finally, results from network MR analysis suggest that T2DM may indirectly promote the development of iRBD by reducing levels of Stromal Cell-Derived Factor 2 in circulation and by increasing BAFF-receptor expression in IgD- CD38- B cells.

Conclusions

T2DM may promote the onset of iRBD by influencing immune-inflammatory responses. Our findings provide valuable insights and directions for understanding the pathogenesis of iRBD, identifying high-risk groups, and discovering new therapeutic targets.

Dementia and Emergency Department Use in Older Adults With Systemic Lupus Erythematosus: An Administrative Claims Data Analysis of Medicare Beneficiaries

BACKGROUND/OBJECTIVE

Systemic lupus erythematosus (SLE) is associated with increased dementia risk. Whether this association is present among older adults with SLE is unclear. Further, whether individuals with concomitant SLE and dementia are at increased risk of emergency department (ED) use has not been explored. Using US Centers for Medicare & Medicaid Services (2006-2015) administrative claims data, we (1) quantified long-term all-cause dementia prevalence in adults with SLE ≥65 years of age and (2) determined whether dementia duration is associated with risk of ED visits in a cohort of older adults with SLE relative to comparators.

METHODS

Medicare beneficiaries ≥65 years of age with SLE and age- and sex-matched comparators (1:4) with osteoarthritis were identified at baseline (2006). Dementia was considered a time-varying exposure, updated annually. Mixed-effect Poisson regression was used to estimate the effect of dementia duration on risk of multiple ED visits for the study period (January 2006 to September 2015), adjusting for relevant covariates.

RESULTS

Baseline dementia prevalence was similar among beneficiaries with SLE (n = 1338 [4.6%]) and non-systemic rheumatic disease (non-SRD) comparators (n = 5352 [5.7%]). Stronger association between dementia duration and ED use was observed in older adults with SLE, including after adjustment for covariates (SLE: incidence rate ratio, 1.10; 95% confidence interval, 1.07-1.13; non-SRD: incidence rate ratio, 1.05; 95% confidence interval, 1.03-1.06).

CONCLUSIONS

Although dementia prevalence was similar between older adults with SLE and non-SRD comparators, dementia duration had a greater impact on ED use in aging adults with SLE versus non-SRD comparators. Geriatric assessment may be especially important in older adults with SLE.

Brain function assessment of acupuncture for chronic insomnia disorder with mild cognitive dysfunction based on fNIRS: protocol for a randomized controlled trial

Background

Chronic Insomnia Disorder (CID) is highly prevalent among older adults and impairs cognitive function. Insomnia accelerates the progression of mild cognitive impairment (MCI) and increases the risk of developing dementia. Acupuncture has been demonstrated in improving sleep quality and cognitive function. This study aims to explore the functional brain characteristics of CID with MCI patients and to assess the effects of acupuncture therapy using functional near-infrared spectroscopy (fNIRS).

Methods and design

This study is a single-center randomized controlled trial. Participants will be randomly assigned to the manual acupuncture group or the placebo acupuncture group for an 8-week intervention period. fNIRS data will be collected during resting test and working memory test at baseline and at end of the intervention. The primary outcome is the change of the Montreal Cognitive Assessment (MoCA) score, secondary outcomes include the change of Mini-Mental State Examination (MMSE), Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Apathy Evaluation Scale-Informant (AES-I).

Discussion

The results of the study will provide insights into the effects of acupuncture on sleep quality and cognitive performance in CID with MCI patients. By utilizing fNIRS technology, we will elucidate the neural functional characteristic underlying the therapeutic benefits of acupuncture.

Clinical trial registration

https://ClinicalTrials.gov, identifier ChiCTR2300076182.

Pre-admission opioid use disorder as a new predictor of in-hospital mortality and six-month outcomes in traumatic brain injury patients: a retrospective longitudinal cohort study

BACKGROUND

The present study aimed to investigate the effect of pre-admission Opioid Use Disorder (OUD) on in-hospital mortality and 6-month follow-up TBI outcomes.

DESIGN

This study included 2804 patients with TBI admitted to the Intensive Care Unit of Emtiaz (Rajaee) Hospital, a referral trauma center in Shiraz, Iran. Finally, 1087 eligible participants were selected from included patients. Then, 872 discharged patients were followed for six months. Subsequently, unfavorable neurological outcomes (Glasgow Outcome Scale-Extended ≤ 4) and the mortality rate were compared among the patients with and without OUD.

RESULTS

The mean age of the patients was 38.0 ± 18.9 years old (84.7% men). About 9.2% of patients had OUD. Opioid users had a slightly lower risk of in-hospital mortality (OR = 0.62, 95% CI = [0.328, 1.183], P-value = 0.148). In contrast, 6-month follow-up mortality significantly increased in the survived patients with a history of pre-admission OUD (OR = 2.49, 95%CI= [1.29, 2.80], P-value = 0.007). Moreover, 6-month unfavorable outcomes were raised in OUD, though it was not significant (OR = 1.59, 95%CI= [0.89, 2.84], P-value = 0.121).

CONCLUSIONS

Our results revealed that patients with OUD are at increased risk of 6-month follow-up complications and also death following moderate to severe TBI. Although OUD decreased in-hospital mortality, 6-month follow-up indicated that mortality and unfavorable outcomes were increased in the OUD group. Based on the existing evidence, this effect is probably not only due to the destructive impact of pre-admission OUD on brain physiology. However, it may also be due to an increase in opioid consumption to alleviate pain and withdrawal symptoms after hospital discharge.

QTc interval prolongation impact on in-hospital mortality in acute coronary syndromes patients using artificial intelligence and machine learning

BACKGROUND

Prediction of mortality in hospitalized patients is a crucial and important problem. Several severity scoring systems over the past few decades and machine learning models for mortality prediction have been developed to predict in-hospital mortality. Our aim in this study was to apply machine learning (ML) algorithms using QTc interval to predict in-hospital mortality in ACS patients and compare them to the validated conventional risk scores.

RESULTS

This study was retrospective, using supervised learning, and data mining. Out of a cohort of 500 patients admitted to a tertiary care hospital from September 2018 to August 2020, who presented with ACS. Prediction models for in-hospital mortality in ACS patients were developed using 3 ML algorithms. We employed the ensemble learning random forest (RF) model, the Naive Bayes (NB) model and the rule-based projective adaptive resonance theory (PART) model. These models were compared to one another and to two conventional validated risk scores; the Global Registry of Acute Coronary Events (GRACE) risk score and Thrombolysis in Myocardial Infarction (TIMI) risk score. Out of the 500 patients included in our study, 164 (32.8%) patients presented with unstable angina, 148 (29.6%) patients with non-ST-elevation myocardial infarction (NSTEMI) and 188 (37.6%) patients were having ST-elevation myocardial infarction (STEMI). 64 (12.8%) patients died in-hospital and the rest survived. Performance of prediction models was measured in an area under the receiver operating characteristic curve (AUC) ranged from 0.83 to 0.93 using all available variables compared to the GRACE score (0.9 SD 0.05) and the TIMI score (0.75 SD 0.02). Using QTc as a stand-alone variable yielded (0.67 SD 0.02) with a cutoff value 450 using Bazett's formula, whereas using QTc in addition to other variables of personal and clinical data and other ECG variables, the result was 0.8 SD 0.04. Results of RF and NB models were almost the same, but PART model yielded the least results. There was no significant difference of AUC values after replacing the missing values and applying class balancer.

CONCLUSIONS

The proposed method can effectively predict patients at high risk of in-hospital mortality early in the setting of ACS using only clinical and ECG data. Prolonged QTc interval can be used as a risk predictor of in-hospital mortality in ACS patients.

First report of salmonella Dublin subdural empyema: A rare presentation of CNS infection

Subdural empyema can be precipitated by a range of pathogens. Common clinical symptoms include fever, headache, seizures, and changed mental status. Yet, cerebral infections caused by Salmonella are relatively uncommon as it is rare for Salmonella to invade the central nervous system. We present the first reported case of Salmonella enterica serovar Dublin causing subdural empyema in an 83-year-old female, which was successfully managed with surgical burr hole and drainage in addition to prolonged targeted antimicrobial therapy consisting of 2 g of intravenous Ceftriaxone twice daily for a total of 56 days. This report demonstrates the course of her illness and the corresponding treatment plan; which may help guide medical providers when encountering similar cases.

Anemia, blood cell indices, genetic correlations, and brain structures: A comprehensive analysis of roles in Parkinson's disease risk

INTRODUCTION

Anemia may contribute significantly to the onset of Parkinson's disease (PD). Current research on the association between anemia and PD risk is inconclusive, and the relationships between anemia-related blood cell indices and PD incidence require further clarification. This study aims to investigate the relationships between anemia, blood cell indicators, and PD risk using a thorough prospective cohort study.

METHODS

We used data from the UK Biobank, a prospective cohort study of 502,649 participants, and ultimately, 365,982 participants were included in the analysis. Cox proportional hazards models were utilized to adjust for confounding factors, aiming to thoroughly explore the associations between anemia and blood cell indices with the risk of incident PD. The interaction between anemia and Polygenic Risk Score (PRS) for PD was also examined. Linear regression and mediation analyses assessed potential mechanisms driven by brain structures, including grey matter volume.

RESULTS

During a median follow-up of 14.24 years, 2513 participants were diagnosed with PD. Anemia considerably increased PD risk (hazard ratio [HR] 1.98, 95 % confidence interval [CI]: 1.81-2.18, P < 0.001) after adjustments. Those with high PRS for anemia had an 83 % higher PD incidence compared to low PRS participants. Sensitivity analyses confirmed result robustness. Linear regression showed that anemia correlated with grey matter volumes and most white matter tracts. Furthermore, mediation analyses identified that the volume of grey matter in Thalamus mediates the relationship between anemia and PD risk.

CONCLUSION

In summary, we consider there to be a substantial correlation between anemia and increased PD risk.

Role of Mandukparni (Centella asiatica Linn Urban) in neurological disorders: Evidence from ethnopharmacology and clinical studies to network enrichment analysis

Centella asiatica Linn Urban (C. asiatica), aka Mandukparni, is one of the flagship herbs used in traditional medicines to effectively manage neurological problems. Although this plant has a wealth of comprehensive preclinical pharmacological profiles, further clinical research and execution of its molecular mode of action are still required. We searched electronic databases (Google Scholar, SciFinder, MEDLINE, Scopus, EMBASE, Science Direct, and PubMed) using relevant key words to retrieve information pertaining to C. asiatica till June 2023 and performed network pharmacology to understand the mechanism related to their neurobiological roles. This study extensively analyses its pharmacological properties, nutritional profile, ethnomedical uses, safety, and mechanistic role in treating neurological and neurodegenerative disorders. Additionally, a network pharmacology study was performed which suggests that its phytomolecules are involved in different neuroactive ligand-receptor pathways, glial cell differentiation, gliogenesis, and astrocyte differentiation. Hopefully, this report will lead to a paradigm shift in medical practice, research, and the creation of phytopharmaceuticals derived from C. asiatica that target the central nervous system.

Understanding the role of machine learning in predicting progression of osteoarthritis

Aims

Machine learning (ML), a branch of artificial intelligence that uses algorithms to learn from data and make predictions, offers a pathway towards more personalized and tailored surgical treatments. This approach is particularly relevant to prevalent joint diseases such as osteoarthritis (OA). In contrast to end-stage disease, where joint arthroplasty provides excellent results, early stages of OA currently lack effective therapies to halt or reverse progression. Accurate prediction of OA progression is crucial if timely interventions are to be developed, to enhance patient care and optimize the design of clinical trials.

Methods

A systematic review was conducted in accordance with PRISMA guidelines. We searched MEDLINE and Embase on 5 May 2024 for studies utilizing ML to predict OA progression. Titles and abstracts were independently screened, followed by full-text reviews for studies that met the eligibility criteria. Key information was extracted and synthesized for analysis, including types of data (such as clinical, radiological, or biochemical), definitions of OA progression, ML algorithms, validation methods, and outcome measures.

Results

Out of 1,160 studies initially identified, 39 were included. Most studies (85%) were published between 2020 and 2024, with 82% using publicly available datasets, primarily the Osteoarthritis Initiative. ML methods were predominantly supervised, with significant variability in the definitions of OA progression: most studies focused on structural changes (59%), while fewer addressed pain progression or both. Deep learning was used in 44% of studies, while automated ML was used in 5%. There was a lack of standardization in evaluation metrics and limited external validation. Interpretability was explored in 54% of studies, primarily using SHapley Additive exPlanations.

Conclusion

Our systematic review demonstrates the feasibility of ML models in predicting OA progression, but also uncovers critical limitations that currently restrict their clinical applicability. Future priorities should include diversifying data sources, standardizing outcome measures, enforcing rigorous validation, and integrating more sophisticated algorithms. This paradigm shift from predictive modelling to actionable clinical tools has the potential to transform patient care and disease management in orthopaedic practice.

Explainable Machine Learning Models for Brain Diseases: Insights from a Systematic Review

In recent years, Artificial Intelligence (AI) methods, specifically Machine Learning (ML) models, have been providing outstanding results in different areas of knowledge, with the health area being one of its most impactful fields of application. However, to be applied reliably, these models must provide users with clear, simple, and transparent explanations about the medical decision-making process. This systematic review aims to investigate the use and application of explainability in ML models used in brain disease studies. A systematic search was conducted in three major bibliographic databases, Web of Science, Scopus, and PubMed, from January 2014 to December 2023. A total of 133 relevant studies were identified and analyzed out of a total of 682 found in the initial search, in which the explainability of ML models in the medical context was studied, identifying 11 ML models and 12 explainability techniques applied in the study of 20 brain diseases.

The efficacy of neuroendoscopic surgery treating patients with thalamic hemorrhage accompanied by intraventricular hematoma

Objective

Neuroendoscopic surgery (NES) has been proven to be safe and effective in hematoma evacuation for cerebral hemorrhage. However, its efficacy for thalamic hemorrhage accompanied by intraventricular hematoma (THAVH) remains unclear. The aim of this study is to determine the efficacy of NES in treating THAVH.

Method

A retrospective study was carried out. The data of patients diagnosed with THAVH were collected from January 1st, 2019, to January 1st, 2022. Patients received the NES or external ventricle drainage (EVD) treatment were assigned to the NES or EVD group, respectively. As primary outcomes, the hematoma evacuation volume, residual hematoma volume, and hematoma clearance rate were separately calculated based on the hematoma site; and the 180-day-mRS score was assessed. As secondary outcomes, the length of stay in the ICU and hospital, and the adverse events were also compared.

Results

Thirty-five patients, aged 66.37 ± 6.62 years, were in the NES group; and 40 patients, aged 68.75 ± 7.22 years, were in the EVD group. The baseline characteristics in the two groups were similar (P > 0.05). The gross hematoma evacuation volume, volume of hematoma evacuated in the thalamus or the ventricle, and the hematoma clearance rate were greater in the NES group than in the EVD group on the 1st day after surgery (P < 0.05). The patients had a better rank of mRS in the NES group (P < 0.05). Compared with patients with mRS > 3, the mean residual hematoma volume in the thalamus of patients with mRS ≤3 on the 1st and 7th day were less in each group (P < 0.05), respectively. A residual hematoma volume in the ventricle of patients with mRS ≤3 was less than that of patients with mRS >3 in the EVD group on the 1st day after surgery (P < 0.05). GCS score on the 3rd day was greater in the NES group (P < 0.05). The incidence of lung infection was lower in the NES group (P < 0.05). The length of stay in the ICU and hospitalization duration were shorter in the NES group (P < 0.05).

Conclusions

Neuroendoscopic surgery has a greater hematoma clearance rate, a lower lung infection rate and a shorter duration in the hospital. Neuroendoscopic surgery might improve patients' prognosis. Neuroendoscopic surgery is a safe and effective procedure for treating thalamic hemorrhage accompanied by intraventricular hematoma.

Consensus on the prevention and repair of titanium mesh exposed wound after cranioplasty (2024 edition)

Titanium mesh exposure after cranioplasty is the most serious complication of this procedure. Although some clinical experience has been gradually accumulated over the years in the diagnosis and treatment of titanium mesh exposure, the treatment is often not standardized and it is difficult to achieve satisfactory repair results due to insufficient understanding of its pathogenesis and concurrent infections. To normalize the diagnosis and treatment of titanium mesh exposed wounds after cranioplasty and improve the therapeutic effect and the quality of life of patients, the Wound Repair Professional Committee of Chinese Medical Doctor Association organized an expert discussion based on the literature and current diagnosis and treatment status of titanium mesh exposed wounds after cranioplasty at home and abroad, and reached a consensus on the pathogenesis, preventive measures, and diagnosis and treatment strategies of titanium mesh exposed wounds after cranioplasty to provide reference for relevant clinicians.

Skin Cancer Image Classification Using Artificial Intelligence Strategies: A Systematic Review

The increasing incidence of and resulting deaths associated with malignant skin tumors are a public health problem that can be minimized if detection strategies are improved. Currently, diagnosis is heavily based on physicians' judgment and experience, which can occasionally lead to the worsening of the lesion or needless biopsies. Several non-invasive imaging modalities, e.g., confocal scanning laser microscopy or multiphoton laser scanning microscopy, have been explored for skin cancer assessment, which have been aligned with different artificial intelligence (AI) strategies to assist in the diagnostic task, based on several image features, thus making the process more reliable and faster. This systematic review concerns the implementation of AI methods for skin tumor classification with different imaging modalities, following the PRISMA guidelines. In total, 206 records were retrieved and qualitatively analyzed. Diagnostic potential was found for several techniques, particularly for dermoscopy images, with strategies yielding classification results close to perfection. Learning approaches based on support vector machines and artificial neural networks seem to be preferred, with a recent focus on convolutional neural networks. Still, detailed descriptions of training/testing conditions are lacking in some reports, hampering reproduction. The use of AI methods in skin cancer diagnosis is an expanding field, with future work aiming to construct optimal learning approaches and strategies. Ultimately, early detection could be optimized, improving patient outcomes, even in areas where healthcare is scarce.

Cardiac Troponin Levels in Patients with Chronic Kidney Disease: "Markers of High Risk or Just Noise''?

Kidney disease is linked to the development of cardiovascular disorders, further increasing morbidity and mortality in this high-risk population. Thus, early detection of myocardial damage is imperative in order to prevent devastating cardiovascular complications within this patient group. Over the years, cardiac biomarkers have been identified and are now widely used in everyday clinical practice. More specifically, available data suggest that cardiac troponin and its regulatory subunits (TnT, TnI, and TnC) reflect the injury and necrosis of myocardial tissue. While cTnC is identical in cardiac and skeletal muscle, TnT and TnI constitute cardiac-specific forms of troponin, and, as such, they have been established by international societies as biomarkers of cardiac damage and diagnostic indicators for acute myocardial infarction. Elevations in the levels of both cardiac troponins (cTnT and cTnI) have been also reported in asymptomatic patients suffering from chronic kidney disease. Therefore, if abnormal, they often generate confusion among clinicians regarding the interpretation and clinical significance of their numerical values in emergency settings. The aim of this review is to explore the reasons behind elevated troponin levels in patients with chronic kidney disease and identify when these elevated levels of biomarkers indicate the need for urgent intervention, considering the high cardiovascular risk in this patient group.

Association of Hypertension with Different Cognitive Disorders

This literature review explores the association between hypertension and major neurocognitive disorders, including delirium, Alzheimer's disease, vascular dementia, Lewy body dementia, and frontotemporal dementia, which contribute significantly to global mortality and morbidity. Hypertension is a potentially modifiable risk factor for cognitive decline, as it contributes to the progression of neurodegenerative pathologies via vascular damage, inflammation, and the disruption of the blood-brain barrier. Despite this, the effectiveness of antihypertensive treatments in preventing or alleviating cognitive decline remains contentious. While some research highlights the potential benefits of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, other studies show inconsistent results, complicated by variations in hypertension definitions, diagnostic criteria for cognitive disorders, and confounding factors like medication adherence. Furthermore, the complex bidirectional relationship between hypertension and major neurocognitive disorders warrants more investigation, as cognitive decline can exacerbate cardiovascular risks through heightened inflammatory responses and compromised autonomic regulation. This review underscores the need for prospective, long-term studies to elucidate the relationships between hypertension and cognitive disorders and to evaluate the potential therapeutic benefits of antihypertensive treatments.

Important functions and molecular mechanisms of aquaporins family on respiratory diseases: potential translational values

Aquaporins (AQPs) are a subgroup of small transmembrane transporters that are distributed in various types of tissues, including the lung, kidney, heart and central nervous system. It is evident that respiratory diseases represent a significant global health concern, with a considerable number of deaths occurring worldwide. Recent researches have demonstrated that AQPs play a pivotal role in respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, acute respiratory distress syndrome (ARDS), and particularly non-small cell lung cancer (NSCLC). In the context of NSCLC, the overexpression of AQP1, AQP3, AQP4, and AQP5 has been demonstrated to facilitate tumor angiogenesis, as well as the proliferation, migration, and invasiveness of tumor cells. This review concisely explores the role of AQP family on respiratory diseases, to assess their clinical and translational significance for understanding molecular pathogenesis. However, the potential translation of AQPs biomarkers into clinical applications is promising and the understanding of the precise mechanisms influencing respiratory diseases is still ongoing. Addressing the challenges and outlining the future perspectives in AQPs development is essential for clinical progress in a concise manner.

Effects of Tai Chi and Qigong on Heart Rate Variability: A Systematic Review and Meta-Analysis

Background:

Intervention studies examining meditative movement (MM) often demonstrate benefits on physiological and psychological health. A potential mechanism associated with these outcomes is heart rate variability (HRV), an important neurophysiological biomarker of optimal and resilient health and functioning.

Objective:

We aimed to synthesize existing literature on the effects of two related forms of MM, Tai Chi (TC) and Qigong (QG) on HRV parameters in adult populations.

Methods:

Following PRISMA guidelines and Cochrane Collaboration recommendations, four databases (MEDLINE, Google Scholar, Academic Search Premier, and PubMed) were searched for articles (through December 15, 2023) that included TC and/or movement-based QG intervention versus any control condition (active or inactive) and reported at least one HRV outcome. Two reviewers independently completed study selection, data extraction, and risk-of-bias assessment.

Results:

We identified 148 for potential inclusion. After removing 61 duplicates, 87 full-text reviews yielded 23 articles, and 16 qualified for meta-analysis based on common HRV outcomes. Meta-analyses indicated a significant overall effect of TC/QG interventions on high-frequency power and standard deviation of the beat-to-beat intervals (SDNN), two critical HRV parameters, compared with control conditions: for HF power, standardized mean difference (SMD) = 0.29, P = 0.003, 95% Confidence interval (CI) [0.10, 0.48]; heterogeneity: I 2 = 46%, χ2 (8) = 14.89, P = 0.06; and for SDNN: SMD = 0.83, P = 0.02, 95% CI [0.16, 1.51]; heterogeneity: I 2 = 90%, χ2 (7) = 71.62, P < 0.001. Other HRV parameters did not demonstrate significant changes upon meta-analyses, but overall effect sizes showed a trend toward the expected direction.

Conclusion:

Based on the strength of the evidence, we conclude TC/QG interventions may shift HRV parameters toward improved health status and resilience. In addition, we offer suggestions to improve the design and measurement of future TC/QG research interventions exploring HRV.

Feasibility, Clinical Potential, and Limitations of Trans-Burr Hole Ultrasound for Postoperative Evaluation of Chronic Subdural Hematoma: A Prospective Pilot Study

BACKGROUND AND OBJECTIVES

Chronic subdural hematoma (CSDH) is commonly managed through burr hole surgery. Routine follow-up using computed tomography (CT) imaging is frequently used at many institutions, contributing to significant radiation exposure. This study evaluates the feasibility, safety, and reliability of trans-burr hole sonography as an alternative postoperative imaging modality, aiming to reduce radiation exposure by decreasing the frequency of CT scans.

METHODS

We conducted a prospective pilot study on 20 patients who underwent burr hole surgery for CSDH. Postoperative imaging included both CT and sonographic examinations through the burr hole. We assessed the ability to measure residual subdural fluid thickness under the burr hole sonographically compared with CT, the occurrence of complications, and the potential factors affecting sonographic image quality. The Pearson correlation coefficient was used to demonstrate relationships between CT and ultrasound and axial and coronal ultrasound.

RESULTS

Sonography through the burr hole was feasible in 73.5% of cases, providing measurements of residual fluid that closely paralleled CT findings, with an average discrepancy of 1.2 mm for axial and 1.4 mm for coronal sonographic views. A strong positive correlation was found between axial and coronal ultrasound ( r = 0.955), CT and axial ultrasound ( r = 0.936), and CT and coronal ultrasound ( r = 0.920). The primary obstacle for sonographic imaging was the presence of air within the burr hole or the subdural space, which typically resolved over time after surgery.

CONCLUSION

Trans-burr hole sonography emerges as a promising technique for postoperative monitoring of CSDH, with the potential to safely reduce reliance on CT scans and associated radiation exposure in selected patients. Our results support further investigation into the extended use of sonography during the follow-up phase. Prospective multicenter studies are recommended to establish the method's efficacy and to explore strategies for minimizing air presence postsurgery.

Dexmedetomidine mitigates lidocaine-induced spinal cord injury by repressing ferritinophagy-mediated ferroptosis by increasing CISD2 expression in rat models

Dexmedetomidine (DEX) has been confirmed to exert neuroprotective effects in various nerve injury models by regulating ferroptosis, including spinal cord injury (SCI). Although it has been established that CDGSH iron sulfur domain 2 (CISD2) can regulate ferroptosis, whether DEX can regulate ferroptosis by CISD2 in SCI remains unclear. Lidocaine was used to induce PC12 cells and stimulate rats to establish SCI models in vitro and in vivo. MTT assays were performed to analyze cell viability. Ferroptosis was assessed by determining the levels of cellular reactive axygen species (ROS), malondialdehyde (MDA), glutathione (GSH), and Fe2+. Ferritinophagy was analyzed by LysoTracker staining, FerroOrange staining, and immunofluorescence. Western blotting was carried out to quantify the levels of several proteins. Fluorescence microscopy was also used to observe cell autophagy. The morphology of mitochondria within the tissue was observed under transmission electron microscopy (TEM). DEX treatment weakened lidocaine-induced elevation of ROS, Fe2+, and MDA and reduced GSH in PC12 cells, indicating that DEX treatment weakened lidocaine-induced ferroptosis in PC12 cells. Similarly, lidocaine promoted autophagy, Fe2+, and microtubule-associated protein 1 light chain 3 (LC3) in PC12 cells and suppressed ferritin and p62 protein levels, indicating that DEX could weaken lidocaine-induced ferritinophagy in PC12 cells. DEX treatment improved the BBB score, reduced tissue damage, increased the number of neurons, and alleviated mitochondrial damage by inhibiting ferroptosis and ferritinophagy in lidocaine-induced SCI rat models. The decreased CISD2, ferritin heavy chain 1 (FTH1), solute carrier family 7-member 11-glutathione (SLC7A11), and glutathione peroxidase 4 (GPX4) protein levels and the elevated nuclear receptor coactivator 4 (NCOA4) protein levels in rat models in the lidocaine group were weakened by DEX treatment. Moreover, CISD2 inhibition reversed the inhibitory effects of DEX treatment on lidocaine-induced ferroptosis and ferritinophagy in PC12 cells significantly. Taken together, DEX treatment could impair lidocaine-induced SCI by inhibiting ferroptosis and ferritinophagy by upregulating CISD2 in rat models.

Validity of the Cost-Effectiveness of Middle Meningeal Artery Embolization Following Hematoma Evacuation for Initial Chronic Subdural Hematoma

BACKGROUND

Despite numerous articles about middle meningeal artery embolization (MMAE) highlighting its efficacy and safety for recurrent chronic subdural hematoma (CSDH), the appropriateness of adjunctive MMAE after hematoma evacuation for initial CSDH remains unclear from a cost-effectiveness perspective.

METHODS

Patients with CSDH were enrolled in this study and were prospectively divided into 2 groups: the "conventional treatment" group, which was treated with hematoma evacuation alone, and the "MMAE" group, which was treated with adjunctive MMAE after hematoma evacuation. The proportion of patients requiring retreatment, length of hospital stay, economic costs, and modified Rankin Score were compared between the 2 groups.

RESULTS

In this study, 53 cases were included, with 30 classified into the conventional treatment group and 23 classified into the MMAE group. In the conventional treatment group, the proportion of patients who required surgical retreatment was higher than that in the MMAE group (16.7% vs. 8.7%). The relative risk was 0.522 (95% confidence interval, 0.111-2.45). Although the addition of MMAE increased the cost per hospitalization by 26%, the increase in cost per patient was limited to 12%, owing to the reduction in patients who relapsed and required a second hospitalization. The increase in cost was not statistically significant. The MMAE group had a significantly higher proportion of patients with favorable outcomes (modified Rankin Score 0-2) (56.7% vs. 87.0%, P = 0.0328).

CONCLUSIONS

By minimizing the increase in hospitalization days and procedure costs, MMAE following hematoma evacuation for initial CSDH could decrease the retreatment rate and balance the total medical costs associated with MMAE.

Cholecystectomy and risk of cardiovascular disease, all-cause and cause-specific mortality: a systematic review and updated meta-analysis

OBJECTIVE

Questions remain about the association among cholecystectomy, cardiovascular disease, all-cause and cause-specific mortality. We performed a systematic review and meta-analysis to clarify these associations.

METHODS

PubMed, Web of Science, Embase, and Cochrane Library databases were searched up to February 2024. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a DerSimonian-Laird random effects model.

RESULTS

We screened 16,595 articles and included 14 studies. No significant association was found between cholecystectomy and cardiovascular disease (CVD), with RR being 1.03 (95% CI [0.77-1.37], p = 0.848, I 2 = 99.6%), even in results with high heterogenous studies excluded (RR 1.20, 95% CI [0.97-1.49], p = 0.095, I 2 = 77.7%). Same result was proved in its subtype, coronary heart disease (RR 1.06, 95% CI [0.84-1.33], p = 0.633, I2 = 96.6%). Cholecystectomy increased CVD risk compared with healthy controls without gallstones (RR 1.19, 95% CI [1.05-1.35], p = 0.007, I 2 = 83.3%) and lowered CVD risk compared with gallstone carriers (RR 0.62, 95% CI [0.57-0.67], p < 0.001, I 2 = 82.1%). As for mortality, increase in the risk for all-cause (RR 1.17, 95% CI [1.03-1.34], p = 0.020, I 2 = 51.6%) and cardiovascular (RR 1.24, 95% CI [1.06-1.47], p = 0.009, I 2 = 20.7%) mortality, but not for cancer mortality (RR 1.18, 95% CI [0.95-1.47], p = 0.131, I 2 = 0.0%), were observed after cholecystectomy.

CONCLUSION

Cholecystectomy may not be associated with the overall development of CVD, as well as CHD. Cholecystectomized patients showed increased CVD risk compared with healthy controls without gallstones, but decreased CVD risk compared with gallstone patients. Increased risk for all-cause and cardiovascular, but not cancer mortality was observed following cholecystectomy.

The pharmacological landscape of chronic subdural hematoma: a systematic review and network meta-analysis of randomized and non-randomized controlled studies

Background

There are various treatment modalities for chronic subdural hematoma (CSDH) and there is extensive debate surrounding pharmaceutical interventions. There is no consensus regarding the relative efficacy and safety of multiple treatment modalities. This study aims to investigate this issue and offer potential clinical recommendations.

Methods

We searched PubMed, Web of Science, Embase and the Cochrane Library from January 2000 to May 2023 to identify randomized and nonrandomized controlled studies reporting one or more outcomes associated with the pharmacologic management of CSDH. The primary outcomes of interest included recurrence, favorable prognosis and adverse events, while the secondary outcomes included a reduction in hematoma volume and mortality. Pooled estimates, credible intervals and odds ratios were calculated for all outcomes using a fixed effects model. Confidence in network meta-analysis judgments were employed to stratify the evidential quality. This study was registered with PROSPERO: CRD42023406599.

Results

The search strategy yielded 656 references; ultimately, 36 studies involving 8082 patients fulfilled our predefined inclusion criteria. The findings suggested that statins + glucocorticoids (GCs) ranked highest for preventing recurrence, improving prognosis and facilitating hematoma absorption. Tranexamic acid ranked second highest for preventing recurrence. Statins were found to be the preferred drug intervention for decreasing mortality and preventing adverse events. Antithrombotic agents ranked lowest in terms of decreasing mortality and improving prognosis.

Conclusions

Our findings indicate that statins + GCs may be the most effective treatment modality for preventing recurrence, improving patient prognosis and facilitating hematoma absorption. In terms of reducing mortality and preventing adverse events, statins may be superior to other pharmacological interventions. Routine use of GCs is not suggested for patients with CSDH. Further prospective research is needed to directly compare the efficacy and superiority of various pharmaceutical interventions targeting CSDH to reinforce and validate our findings.