Background and Objectives: Idiopathic Thrombocytopenic Purpura (ITP) is an acquired disorder characterized by isolated thrombocytopenia with otherwise normal CBC and peripheral smear. This study aimed to determine the frequency of splenomegaly and anemia among hospitalized patients with confirmed ITP. Methods: This descriptive-analytical cross-sectional study was conducted in 2024, utilizing five years of hospital records, and included 150 adult patients with a final diagnosis of ITP. Statistical analysis was performed using STATA 14, applying descriptive statistics, chi-square or Fisher's exact tests, and logistic regression, with a significance level of P < 0.05. Results: Our study included 150 patients with a mean age of 38.0 +/- 13.5 years, comprising 87 females (58.0%) and 63 males (42.0%). The prevalence of splenomegaly was 8%, anemia was 46.7 %, and the prevalence of concurrent splenomegaly and anemia was 4%. Anemia was present in 41.3% of males and 50.6% of females, and splenomegaly was present in 14.29% of males and 3.45% of females. Gender and hospital stay were significantly associated with splenomegaly (male gender: OR = 6.452, 95% CI: 1.18-35.17, P = 0.031; hospital stay: OR = 1.254, 95% CI: 1.02-1.53, P = 0.028). Conclusion: The prevalence of splenomegaly was 8%, which is lower than reported in many studies, while anaemia occurred in 46.7%, consistent with previous findings. No significant association was observed between splenomegaly and anemia, though studies differ on this relationship. Further research is recommended.
Background and Objectives: In order to apply VR technology to the field of diabetes prevention, diagnosis and treatment, and fill the gap in the application of VR technology in diabetes health education, this study will explore the impact of virtual reality (VR) technology based on protection motivation theory (PMT) combined with complication experience education in patients with type 2 diabetes mellitus (T2DM). Methods: This study is an experimental study that included a total of 84 patients with T2DM hospitalized in Shaanxi Provincial People's Hospital, who were randomly divided into control group (receiving usual care) and intervention group (receiving PMT-based nursing intervention) according to the ward. Fasting blood glucose (FPG), 2 h postprandial blood glucose level (2h PG), glycosylated hemoglobin (HbA1c), Diabetes Knowledge Scale (ADKnowl), Management Self-Efficacy Scale (C-DMSES), Self-Management Behavior Scale (SDSCA) were measured in both groups before intervention and at 1 and 3 months of intervention. The data between the two groups were then compared. Results: This study included 40 interventions and 40 control cases. The cognitive and self-efficacy scores at one and three months of intervention significantly differed between the two groups (P < 0.05). At 1 and 3 months of intervention, the two groups showed improvement in diet, exercise, blood glucose monitoring, foot care score, and total score compared to the baseline data. However, the intervention group had significantly lower FPG, 2h PG, and HbA1c levels at 1 and 3 months (P < 0.05). Conclusion: VR technology based on PMT combined with educational complications can enhance blood glucose control in patients with T2DM by improving their understanding of diabetes, promoting healthy behaviors, reinforcing self-management, and reducing blood glucose levels, thus improving their quality of life.
Background and Objectives: Severe asthma (SA) is a complicated disorder, and its pathogenesis involves various contributing factors. This study is to identify and validate the hub genes associated with SA, in order to determine new biomarkers and therapeutic targets. Methods: We conducted weighted gene co-expression network analysis (WGCNA) using the GSE63142 dataset to identify key modules and genes that might be associated with SA. Furthermore, we used LASSO regression and random forest to determine the hub genes, and constructed a nomogram prediction model for the risk of SA based on the hub genes. Finally, we verified the predictive value of hub genes using the GSE43696. Results: We identified the gray module, and the genes of the gray module are mainly related to Asthma and cytokine-cytokine receptor interactions. This article screened out 16 hub genes from the grey module, including FCER1A, HLA-DPB1, MAOB, FKBP5, TPRXL, SYT8, SLCO1B3, IL20RB, KCNA1, OXTR, SCGB1A1, PROS1, TCN1, C7orf26, IL1R2, SEC14L3. Taking 16 hub genes as predictors, a nomogram model of the SA occurrence risk was constructed. ROC curve analysis revealed that the model demonstrated a predictive specificity of 0.838, the sensitivity was 0.875, and AUC was 0.911 (0.866-0.955). The model's diagnostic effect was further verified using the GSE43696 dataset. The AUC in the validation set was 0.901 (0.846-0.956), the specificity and sensitivity were 0.771 and 0.921. Conclusion: The SA prediction model constructed based on these 16 hub genes has superior predictive efficacy and can be used as a powerful tool for clinical diagnosis.
Background and Objectives: Iliac vein compression syndrome is a peripheral venous disease that has attracted much attention in recent years. Severe iliac vein compression syndrome can lead to secondary deep vein thrombosis, aggravate chronic venous insufficiency of lower limbs, and lead to pain, swelling and other symptoms of affected limbs, which can be life-threatening if not treated in time. It aimed to assess the outcome of endovascular intervention (EVI) on the levels of inflammatory factors in patients with MayThurner syndrome (MTS) complicated with acute left lower extremity deep vein thrombosis (LEDVT). Methods: The medical records of 180 MTS subjects with acute left LEDVT undergoing EVI in Chongqing Dongnan Hospital from October 2020 to March 2024 were collected for research. All subjects were tested for blood routine, coagulation function, and inflammatory factors before and following remedy. Results:Following remedy, the levels of inflammatory factors C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), IL-6, and IL-10 were markedly decreased as against those before remedy (P<0.05). Moreover, the decrease of CRP level was positively correlated with the improvement of D-Dimer (D-D) and fibrinogen (FIB) levels. Only 8.33% of patients recurred within one year after operation, and the venous patency and Villalta score were markedly stable at 3 and 12 months after operation. Conclusion:This article shows that EVI can not only directly relieve vascular compression, but also positively affect the disease process by regulating the inflammatory response. It provides a scientific basis for the application of EVI in such diseases.
Background and Objectives: Non-small cell lung cancer (NSCLC) is the main type of lung cancer, with postoperative recurrence limiting long-term survival. Traditional staging systems (e.g., TNM) focus on tumor size, lymph node involvement, and metastasis but ignore respiratory function and detailed pathological features (e.g., differentiation), leading to insufficient prediction accuracy of individual recurrence risk, necessitating integrated models. Objective: To construct and validate a Nomogram integrating clinical risk factors, pathological parameters, and respiratory function (FEV1/FVC ratio) for predicting NSCLC postoperative recurrence, aiming to improve accuracy vs. traditional staging and highlight respiratory function's value. Methods: A retrospective analysis of 244 NSCLC surgical patients (2021-2023) was conducted, with random division into training (n=157) and validation (n=87) sets (7:3). Independent risk factors were identified via multivariate Logistic regression. The Nomogram was evaluated using ROC (AUC), calibration curves (Hosmer-Lemeshow test), and DCA. Results: No significant differences in recurrence rate or clinical data between the two sets (all P>0.05). Seven independent risk factors were identified: TNM stage III-IV, mediastinal lymph node metastasis, adenocarcinoma, poor differentiation, >= 3 lymph node metastases, large tumor size, and decreased FEV1/FVC (all P<0.05). The Nomogram performed excellently: C-index 0.884 (training) and 0.913 (validation); good calibration (Hosmer-Lemeshow: P=0.138, 0.051); AUC 0.881 (95%CI:0.808-0.955) and 0.907 (95%CI:0.724-1.000). Conclusion: The Nomogram, integrating clinical, pathological, and respiratory factors, shows high accuracy in predicting NSCLC postoperative recurrence, outperforming traditional staging. It aids personalized treatment but requires multi-center prospective validation with postoperative therapeutic and molecular factors.
Background and Objectives: Insulin resistance is a major metabolic disorder linked to type 2 diabetes and cardiovascular diseases. Emerging evidence suggests that vitamin D may influence glucose metabolism and insulin sensitivity, while adherence to the Mediterranean diet could support metabolic health. This study examines the association between vitamin D levels, insulin resistance, and adherence to the Mediterranean diet in individuals residing in Northern Cyprus. Methods: A cross-sectional study was conducted with 117 participants attending the Central State Hospital in Northern Cyprus. Data collection included demographic, anthropometric, and biochemical parameters such as vitamin D levels, insulin resistance (HOMA-IR), and dietary habits assessed using the Mediterranean Diet Quality Scale (KIDMED). Statistical analyses were performed using independent samples t-tests, Chi-Square tests, and correlation analyses via IBM SPSS Statistics 21.0, with significance set at P < 0.05. Results: A significant association was observed between vitamin D supplementation and insulin resistance (P < 0.001). Among insulin-resistant individuals, 80% reported using vitamin D supplements, whereas 73.7% of non-insulin-resistant individuals did not use supplements. While adherence to the Mediterranean diet was high (77.8% of participants demonstrated optimal adherence), no statistically significant correlation was found between vitamin D levels and dietary adherence. Conclusion: The findings suggest a potential link between vitamin D supplementation and insulin resistance, warranting further investigation into causality and underlying mechanisms. While adherence to the Mediterranean diet was generally high among participants, its direct effect on vitamin D levels remains inconclusive. Future research should explore longitudinal effects and intervention strategies to optimize metabolic health outcomes.
Background and Objectives: Flexible bronchoscopy (FB) carries risks such as haemodynamic instability and oxygen desaturation related to sedation. The selection of sedative-analgesic agents can influence patient safety and procedural outcomes, making optimal sedation strategies a key area of research. This retrospective single-center study aimed to compare three sedative-analgesic regimens used during FB with respect to haemodynamic and oxygenation outcomes. Methods: Medical records of 648 adult patients undergoing FB between 2020 and 2023 were analyzed. Patients were categorized into three groups: midazolam alone (M), midazolam plus fentanyl (MF) and midazolam plus fentanyl plus propofol (MFP). Pre- and post-procedural systolic blood pressure, heart rate and oxygen saturation were compared using appropriate statistical tests and p-values were calculated to determine significance. Results: A total of 648 patients were analyzed (57.3% female; mean age 61.8 +/- 13.9 years). Procedures were performed with the M group (42.3%), MF group (31.2%), or MFP group (26.5%). Mean midazolam doses were 3.4 +/- 1.2 mg, 2.5 +/- 0.9 mg and 2.3 +/- 0.9 mg in M, MF and MFP groups, respectively (P = 0.001). SBP increased by +14.2 mmHg in M, +6.8 mmHg in MF and +11.1 mmHg in MFP (P < 0.001), while HR rose by +8.3, +13.5 and +10.4 bpm, respectively (P < 0.001). SpO(2) declined by 1.1 +/- 4.5% in M, 0.14 +/- 2.7% in MF and 0.65 +/- 3.2% in MFP (P = 0.021). Hypoxia occurred in 5.4%, 1.6% and 1.8% of patients, respectively (P < 0.001). After adjustment for age and sex, the MF group showed a smaller SBP increase and higher HR rise versus M (P < 0.05) Conclusion: Combined sedation was associated with better hemodynamic stability, fewer hypoxia episodes, and improved procedure tolerance compared to midazolam alone.
Background and Objectives: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast whose pathogenesis is not yet fully understood. While the literature reports an association between IGM and arthritis and/or erythema nodosum (EN) in a small number of patients, the diagnosis and treatment of these individuals are not well-documented. The objective of this study is to present our case series of patients with IGM and EN and/or arthritis, to discuss the incidence, characteristics, and treatment approaches of these cases in more detail. Methods: We performed a retrospective analysis of patients who were treated for histologically confirmed IGM at our medical center between 2015 and 2022. Additionally, patients who exhibited concurrent symptoms of EN and arthritis were identified and grouped for further analysis of their treatment regimens and outcomes. Statistical comparisons were performed using chi-square and Fisher's exact tests; a P < 0.05 was considered statistically significant. Results: Our general surgery clinic followed up with 153 patients diagnosed with IGM, who had a mean age of 38.2 +/- (8.84) and were mostly women of reproductive age. The definitive diagnosis was confirmed through incisional biopsy and core needle biopsies. EN was present in 31 (20.2%) patients, and inflammatory arthritis was present in 28 (18.3%) patients. In the 13 patients with this triple association, recurrence rates were higher despite a response to antibiotics and steroids. Conclusion: IGM is a challenging disease to diagnose and manage due to its complexity. It can occur concomitantly with EN and arthritis, and we suspect its frequency is higher than previously anticipated. Recognizing these distinct entities emphasizes the need for a multidisciplinary approach to diagnosing the condition.
Background and Objectives: Sepsis has high morbidity and mortality, and survivors often suffer from cognitive impairment, while the gut microbiota'slink to neurological diseases has prompted investigation into whether probiotics improve sepsis-related cognitive impairment. This study aimed to explore the effect of probiotics on sepsis-related cognitive impairment. Methods: 135 sepsis patients in recovery (after antibiotic discontinuation) from Jan 2021 to Jun 2023 were enrolled in this retrospective study, and divided into control group (n = 67) and observation group (n = 68). The control group received conventional treatment plus placebo, while the observation group received probiotic + prebiotic preparations instead of placebo, in addition to conventional treatment. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) at three time points: enrollment (T0), 6 months (T1), and 1 year (T2) post-treatment. Complications were monitored during the intervention, and complications were evaluated at T1 and T2. Independent/paired t-tests and chi-square test were performed. Results: The follow-up loss rate was 16.42% in the control group and 19.12% in the observation group. At enrollment, cognitive function was similar (chi 2=0.072, P=0.788). Six months after treatment, the observation group had a lower prevalence of abnormal cognitive function than the control group and at the start (chi 2=4.763, P=0.029). One year later, the two groups had no significant difference in abnormal cognitive function prevalence (chi 2=3.319, P=0.069), but it was lower than at the start. For complications, there was no difference in cardio-respiratory and kidney diseases (all P>0.05), while the observation group had a lower prevalence of digestive diseases (chi 2=6.682, P=0.010). Conclusion: Sepsis, cognitive impairment and the gut microbiota are closely related. Microbial therapies offer new treatment directions, but this study needs larger samples and multi-center verification.
Background and Objectives: Accurate estimation of intraoperative blood loss is essential for safe perioperative management in spinal surgery. Although visual estimation remains widely practiced due to its simplicity, rapidity, and lack of need for special equipment, it is prone to considerable inaccuracy. These limitations can influence transfusion decisions and postoperative outcomes. Therefore, evaluating more objective yet feasible alternatives, such as gravimetric assessment, is clinically important. This study aimed to compare the accuracy of visual estimation and the gravimetric method in assessing intraoperative blood loss and to evaluate their correlation with the reduction in hemoglobin levels 24 hours after surgery. Methods: In this diagnostic study, 75 adults scheduled for posterior spinal surgery were randomly assigned using a computer-generated sequence. Visual estimation was performed by blinded surgical staff based on suction volumes and soaked materials, while gravimetric measurement was conducted by weighing blood-soaked sponges and suction canisters before and after use. The actual blood loss reference was defined as the postoperative hemoglobin decline measured 24 hours after surgery. Accuracy of each method was evaluated by comparing estimated blood loss against this reference standard using appropriate statistical tests. Results: Among patients with postoperative hemoglobin < 12 g/dL, the mean estimated blood loss was 721.5 f 556.5 mL by visual estimation and 844.5 f 704.3 mL by the gravimetric method. For those with hemoglobin >= 12 g/dL, respective values were 321.8 f 282.1 mL and 337.9 f 286.1 mL. The gravimetric approach estimated on average 72 mL higher blood loss than the visual method (mean difference = 72 mL; 95% CI: 21-123 mL; P < 0.001). Diagnostic indices confirmed the superior accuracy of the gravimetric technique (LR+= 2.04, LR-= 0.42, AUC= 0.81), showing improved discrimination of clinically significant intraoperative bleeding compared with visual estimation. Conclusion: The gravimetric method provides a more accurate and reliable estimation of intraoperative blood loss compared to visual assessment. Its implementation in spinal surgery could improve patient monitoring and support more informed clinical decision-making. However, further studies with larger, multicenter cohorts are warranted to validate and generalize these findings.
Background and Objectives: The abnormal spindle-like microcephaly-associated gene (ASPM) plays a crucial role in the formation of the mitotic spindle and neurogenesis. ASPM may also contribute to the development of various cancers. Investigate the role of ASPM in bladder urothelial carcinoma (BLCA). Methods: The expression differences of ASPM between unmatched samples were analyzed with the Welch T-test and between paired samples with the paired sample t-test. Evaluating the effectiveness of ASPM in diagnosing BLCA with ROC analysis. Determining the prognostic factors in the ASPM highexpression group and the low-expression group with Cox regression analysis. The relationship between ASPM and immune cells was analyzed through Spearman correlation. Results: The ROC curve showed that ASPM had a high diagnostic ability for BLCA. Patients with high expression of ASPM had a shorter progression-free interval (PFI). GO and KEGG analyses revealed that ASPM-related DEGs were associated mainly with ubiquitin-mediated proteolysis. ASPM expression in BLCA was positively correlated with the infiltration of Th2 cells and T helper cells. ASPM was negatively correlated with the infiltration of pDC, NK CD56bright cells and Mast cells. The above findings are merely correlational studies and require further in vitro or in vivo experiments for functional validation. Conclusion: ASPM is an effective biomarker for diagnosing and predicting PFI in patients with BLCA. Therefore, ASPM is expected to become a potential target for the treatment of BLCA. Further research is still needed to confirm these conclusions, such as conducting in vitro knockout experiments, carrying out prospective cohort studies, or using immunohistochemistry (IHC) for verification.
Background and Objectives: Hospital reimbursement is a critical component of the hospital financial system that directly impacts hospital cash flow and profitability. Given the increasing medical costs and financial pressures, reducing deductions due to errors and mistakes in reimbursement processes is of great importance. The purpose of this study is to accurately and transparently analyze the factors affecting deductions and identify weaknesses in hospital financial and administrative processes. Methods: This study was conducted to examine the extent and causes of deductions in inpatient files and to improve the hospital reimbursement process for patients who encountered deductions during the years 20222023. The research community includes experts involved in hospital deductions and handling hospital bills, including hospital supervisors and revenue unit experts or financial affairs experts in a selected teaching general hospital in Tehran in 2023. It used the Six Sigma approach as a process optimization method. The intervention was carried out by implementing the phases of the Six Sigma method in the hospital. Results: In this study, the reimbursement process was examined from the time of patient admission, recording medical information, calculating costs, sending information to insurance, and finally receiving payments. By implementing the phases of the Six Sigma method, the number of cases examined and the total amount of deductions in the year 2023 have decreased significantly. These changes have also caused the average monthly deduction percentage to decrease from 1.33% in 2022 to 0.82% in 2023. Conclusion: The results of this study showed that the use of Six Sigma in improving the hospital reimbursement process significantly reduced financial deductions. Also, by improving the speed of processes, the time for reimbursements was reduced, which led to increased patient satisfaction and reduced financial pressure on the hospital. Overall, the results of the study indicate that the careful implementation of Six Sigma methods can significantly increase hospital productivity and reduce unnecessary costs, while maintaining the quality of services to patients.
Background and Objectives: Breast cancer patients in Saudi Arabia present with earlier onset, advanced-stage, and aggressive subtypes, highlighting the need for targeted biomarker research. The antigen TAG-72 has shown inconsistent prognostic associations in Middle Eastern populations. This study analyzed TAG-72 expression in breast cancer tissues from a large Saudi cohort to assess its clinicopathological associations and prognostic significance. Methods: We analyzed 577 breast cancer specimens from King Abdulaziz University Hospital (1996-2012) using clinicopathological variables from medical records. Tissue microarrays were created with validated cores, and TAG-72 expression was assessed via immunohistochemistry (Cell Marque antibody, 1:100 dilution) with standardized scoring (>= 5% staining). Statistical analyses included descriptive statistics, logistic regression, and Cox models to evaluate TAG-72's associations. Results: Among 577 breast cancer patients (mean age 50.7 +/- 13.3 years), 86% exhibited no TAG-72 expression, while 14% demonstrated low to high staining. Elevated TAG-72 levels were significantly associated with positive HER2 status (OR (95% CI):1.92 (1.07, 3.45), P=0.028) and non-ductal histology (OR (95% CI): 2.03 (1.01, 4.08), P=0.046). In survival analysis, HER2 positivity (HR (95% CI): 2.30 (1.16, 4.57), P = 0.018), non-ductal subtypes (HR (95% CI): 2.17 (1.06, 4.46), P=0.035), and distant metastasis (HR (95% CI): 4.42 (2.51, 7.78), P<0.001) independently predicted higher mortality risk, while TAG-72 expression showed no significant prognostic association (P=0.190). Conclusion: TAG-72's clinical utility is limited, showing no significant association with death or most breast cancer parameters, except HER2. This suggests that TAG-72 interpretation in immunohistochemistry for breast cancer should consider HER2's clinical significance in patient management.
Background and Objectives: Intertrochanteric fractures are prevalent in the elderly, contributing significantly to morbidity and healthcare costs. Proximal femoral locking plates (PF-LPs) are used for fixation, particularly in osteoporotic bone, but their outcomes remain debated. This study evaluates the clinical outcomes and complications of PF-LP fixation in elderly patients, emphasizing the role of posteromedial cortex reduction. Methods: This retrospective study included patients over 60 years with intertrochanteric fractures treated with PF-LP between April 2021 and March 2024. Patients with polytrauma, end-stage disease, or incomplete follow-up were excluded. Analyzed variables included demographics, AO/OTA classification, reduction quality, posteromedial cortex status, and postoperative complications. Treatment failure was defined as the need for revision surgery due to complications like infection, nonunion, varus collapse, implant failure, or screw cut-out. Results: A total of 197 patients (mean age: 74.3 +/- 9.2 years) were analyzed. Treatment failure occurred in 48 patients (24.4%), with higher rates in females, those with type 31A2 fractures, and osteoporotic patients. Negative posteromedial cortex alignment was strongly associated with mechanical failure. Varus collapse and screw cut-out were the most common complications. Conclusion: PF-LP fixation in elderly intertrochanteric fractures has a significant failure rate, especially in osteoporotic bone with poor posteromedial support. Achieving proper reduction with positive cortical alignment is critical. Surgeons should consider optimized reduction techniques or alternative fixation methods in high-risk cases. Future studies should include control groups using devices like dynamic hip screws or intramedullary nails to compare efficacy.
Background and Objectives: Hypotension in elderly patients with acute decompensated heart failure (ADHF) limits vasodilator use. Recombinant human brain natriuretic peptide (rhBNP) may improve cardiac function, and combining it with low-dose norepinephrine could maintain perfusion. This study evaluated the efficacy and safety of this approach. Methods: In this single-center, open-label randomized exploratory trial, 70 elderly patients were assigned to norepinephrine alone or rhBNP plus norepinephrine. Hemodynamics, biomarkers, echocardiography, and short-term outcomes were assessed over 3-7 days, with 30-day follow-up. Results: The study group showed significant increases in SBP (mean +7 mmHg), DBP (+6 mmHg), MAP (+9 mmHg), SpO(2) (+2%), and LVEF (+5%), and reductions in HR (-6 bpm), RR (-7 bpm), and NT-proBNP (-2000 ng/L; all P<0.05, as assessed by t-test or Wilcoxon rank-sum test). Total bilirubin levels showed a significant reduction (-3 mu mol/L; P<0.05). While serum sodium changes were statistically significant, the clinical relevance of the absolute difference was negligible. The study group had increased 24-hour fluid intake and urine output, shorter hospital stays, and higher ARNI prescription rates and dosages at discharge (P<0.05). Overall treatment efficacy at discharge was higher in the study group (94.29% vs. 88.57%, P=0.006), with a significantly lower 30-day readmission rate (14.71% vs. 36.36%, P=0.042). No significant differences were observed in adverse drug reactions or 30-day mortality. Statistical analyses were performed using t-tests, ANOVA, Wilcoxon rank-sum, and chi-square tests, with P<0.05 considered significant. Conclusion: rhBNP combined with low-dose norepinephrine improved short-term hemodynamics without increasing risk; larger trials are warranted.
Background and Objectives: The detection of pediatric extremity fractures on initial X-rays (XR) in emergency departments can be challenging, particularly in anatomically complex regions such as the ankle, wrist, knee, and elbow. The aim of this study is to determine the accuracy rate of XR compared to computed tomography (CT) in the identification of trauma-related extremity fractures in the pediatric population. Methods: Patients aged 0-18 years were included in this retrospective study. Patients who were admitted to the emergency department due to extremity trauma between July 1, 2020 and March 31, 2023 and underwent XR and CT imaging were included. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of XR in detecting fractures compared to CT were calculated. Results: A total of 217 patients were included in the study. Fractures were detected in 57 patients (26%) on XR images and in 62 patients (29%) on CT images. The sensitivity, specificity, PPV and NPV of XR in detecting fracture compared to CT were 87%, 98%, 95%, and 95%, respectively (area under the curve [AUC]: 0.926, CI: 0.875-0.977). The sensitivity of XR was calculated to be below 60% in adjacent bone fractures, epiphyseal line fractures, and extension of the fracture into the joint space. Conclusion: In the pediatric population, the sensitivity of XR is low in detecting epiphyseal line fractures, extension of the fracture into the joint space, and adjacent bone fractures.
Background and Objectives: Crush syndrome (CS) is a significant metabolic disorder commonly observed after earthquakes, with inflammatory processes playing a key role in its pathophysiology. This study aimed to evaluate the clinical utility of inflammatory indices, including the Systemic Inflammatory Index (SI), Systemic Inflammation Response Index (SIRI), and Pan-Immune-Inflammatory Value (PIV). Methods: Our study was conducted retrospectively at a single centre. A total of 278 patients admitted to the emergency department due to post-earthquake trauma were included in the study as the trauma group. This group was further divided into two subgroups: the non-crush trauma group (n=115) and the CS group (n=163). Additionally, 168 patients admitted to the emergency department for non-traumatic causes during the same period were included as the control group. The three groups were retrospectively compared based on SI, SIRI, and PIV values, as well as their predictive ability for key clinical outcomes, including the need for hemodialysis, hospitalization, prediction of CS and mortality. Receiver operating characteristic (ROC) analysis was used to determine the predictive values. Results: SIRI demonstrated the highest accuracy in predicting CS (AUC = 0.829, P < 0.001). SI was the best predictor of hospitalization (AUC = 0.778, P < 0.001), while SIRI showed superior performance in predicting the need for hemodialysis (AUC = 0.799, P < 0.001). Conclusion: SI, SIRI and PIV can help clinicians in predicting CS, the need for hemodialysis, critical care and therefore the need for hospitalization.
Background and Objectives: The global epidemic of childhood obesity is escalating, with China reporting the highest incidence among children. Obesity is associated with respiratory health impairments; however, its relationship with lung function in pediatric populations remains controversial. This study aims to investigate the correlation between lung function and childhood obesity. Methods: This retrospective study enrolled 666 Chinese children with obesity aged 5 to 17 years, admitted to a tertiary pediatric hospital in China, comprising 471 boys and 195 girls. Lung function was assessed using standardized spirometry, with abnormalities defined according to American Thoracic Society (ATS)/European Respiratory Society (ERS) recommendations. Multifactorial linear regression analysis and multivariable logistic regression were employed to analyze the correlations between obesity indices and lung function. Results: The prevalence of abnormal lung function in children with obesity was 32.88% with a peak in the 10 to 14 age group. Children with severe obesity had higher rates of lung function abnormalities compared to those with mild obesity (41.24% vs. 32.48%, P < 0.05). Obstructive ventilatory defects were more common, particularly in boys. Metabolic comorbidities were frequent, with dyslipidemia (65.75%), hyperuricemia (59.36%), and type 2 diabetes mellitus (T2DM) (45.66%) being the most prevalent. In boys, body composition indices, such as waist circumference instead of BMI, were closely associated with lung function parameters, while in girls, this association was not observed. In boys, severe obesity and hypertension were independently associated with the risk of abnormal lung function; in girls, liver injury, triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) showed independent associations. Conclusion: The high prevalence of abnormal lung function (32.88%) among Chinese children with obesity underscores its clinical significance. Importantly, gender-specific screening-focusing on abdominal obesity in boys and lipid profiles in girls-may enhance the early detection of obesity-related pulmonary impairment.
Background and Objectives: Hypertension and bladder cancer are frequently co-diagnosed in individuals who require blood pressure management and anti-cancer therapies. Immunotherapy has revolutionized cancer treatment. However, the role and clinical significance of the first-line anti-hypertensive drug amlodipine in immunotherapy outcomes remains largely elusive. To evaluate the role of amlodipine in enhancing the efficacy of anti-PD1 immunotherapy and its underlying mechanisms in bladder cancer. Methods: Basic research methods were used in the present work. A murine syngeneic bladder cancer and melanoma model was employed to evaluate the therapeutic effect of the combination of amlodipine with anti-PD1. Additionally, immunohistochemistry was utilized to quantify CD8+ T cells and Ki67+ cells. Finally, several in-vitro and in-vivo assays were performed to explore the effects of amlodipine on human bladder cancer cells, and bioinformatics analysis and qPCR were conducted to explore the underlying mechanism. Results: Amlodipine enhanced the tumor-inhibitory effects of anti-PD1 therapy, in line with the results in the melanoma model. Furthermore, the results of in-vitro and in-vivo experiments utilizing UMUC3 human bladder cancer cells revealed that amlodipine significantly suppressed tumor progression. Meanwhile, the results of in-vitro and in-vivo experiments demonstrated that amlodipine regulated NFAT2 expression, with the loss of inhibition following NFAT2 knockdown. Conclusion: These results indicated that amlodipine suppresses tumor growth by regulating NFAT2 expression and enhancing anti-PD1 therapy effects. Indeed, these findings position amlodipine as an effective adjunctive therapy in bladder cancer treatment. Nevertheless, further mechanistic studies and clinical trials are warranted.
Background and Objectives: The unexpected presence of antibodies is a crucial concern for the safety of blood transfusions and can complicate compatibility testing, possibly delaying the identification of a suitable blood unit. This retrospective study aimed to assess the prevalence of unexpected antibodies and their association with patient characteristics within the general population in Taif City, Saudi Arabia. Methods: Antibody screening was performed on 21,183 patients from January 1, 2022 to December 31, 2023. Patient demographics, results of unexpected antibody identification, and blood groups were collected from medical records. Chi-square tests were used to evaluate the associations between unexpected antibodies and various factors. Results: Of 21,183 patients screened, 105 (0.50%) had positive results. Among those, 7 (6.7%) had autoantibodies and 98 (93.3%) had alloantibodies in their plasma. The majority of patients were female (94, 89.5%), with only 11 (10.5%) being male. The most common antibody was anti-E, in 25 (23.8%) patients, followed by anti-K, anti-c, and anti-M at 19 (18.1%), 9 (8.6%), and 8 (7.6%) patients, respectively. Multiple antibodies (anti-E and anti- N) were detected in one patient (1%). Associations were identified between the presence of the unexpected antibodies and gender, history of pregnancy, history of transfusion, and Rh Conclusion: In our study, the frequency of unexpected antibodies was 0.50%. We suggest implementing a mandatory extended phenotyping policy (Rh and Kell) for patients who need multiple transfusions.
