Pub Date : 2024-09-19eCollection Date: 2024-01-01DOI: 10.3389/fmed.2024.1486414
Tao Zhu, Zhihong Chen
{"title":"Editorial: Women in science - pulmonary medicine 2023.","authors":"Tao Zhu, Zhihong Chen","doi":"10.3389/fmed.2024.1486414","DOIUrl":"10.3389/fmed.2024.1486414","url":null,"abstract":"","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19eCollection Date: 2024-01-01DOI: 10.3389/fmed.2024.1449919
Sanxi Ai, Qiuyu Xu, Gang Chen, Ke Zheng, Yan Qin, Xuemei Li
Introduction: Previous studies on hemodialysis adequacy primarily focused on the association between Kt/V and survival, and low Kt/V is associated with increased mortality. There is a paucity of research on the correlation between Kt/V and chronic kidney disease (CKD) complications.
Methods: The retrospective study was conducted in the blood purification center of a tertiary hospital in China from July 2020 to September 2022. It aimed to analyze the association between latent Kt/V trajectory categories and CKD complications (hypertension, anemia, mineral and bone disorder) and inflammatory markers. The latent class trajectory model was established to describe the different patterns of Kt/V changes over the observation period.
Results: During the 2-year study period, 93 patients on thrice-weekly hemodialysis with residual kidney function <2 mL/min were included. In the 3-class Kt/V trajectory model, 21 patients were in class 1 with a Kt/V trajectory that declined from a higher to lower levels (from >1.6 to <1.4), 59 patients were in class 2 with Kt/V consistently in a relatively low range (around 1.4), and 13 patients were in class 3 with Kt/V stabilized around 1.6. No significant difference in CKD complications or inflammation markers was observed among the three Kt/V trajectories.
Conclusion: Under the premise of adequate Kt/V, neither a stable higher Kt/V nor a declined Kt/V significantly influenced CKD complications or inflammatory markers.
{"title":"Effects of hemodialysis adequacy on chronic kidney disease complications using latent class trajectory modeling: a real-world study based on long-term observation of Kt/V.","authors":"Sanxi Ai, Qiuyu Xu, Gang Chen, Ke Zheng, Yan Qin, Xuemei Li","doi":"10.3389/fmed.2024.1449919","DOIUrl":"10.3389/fmed.2024.1449919","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies on hemodialysis adequacy primarily focused on the association between Kt/V and survival, and low Kt/V is associated with increased mortality. There is a paucity of research on the correlation between Kt/V and chronic kidney disease (CKD) complications.</p><p><strong>Methods: </strong>The retrospective study was conducted in the blood purification center of a tertiary hospital in China from July 2020 to September 2022. It aimed to analyze the association between latent Kt/V trajectory categories and CKD complications (hypertension, anemia, mineral and bone disorder) and inflammatory markers. The latent class trajectory model was established to describe the different patterns of Kt/V changes over the observation period.</p><p><strong>Results: </strong>During the 2-year study period, 93 patients on thrice-weekly hemodialysis with residual kidney function <2 mL/min were included. In the 3-class Kt/V trajectory model, 21 patients were in class 1 with a Kt/V trajectory that declined from a higher to lower levels (from >1.6 to <1.4), 59 patients were in class 2 with Kt/V consistently in a relatively low range (around 1.4), and 13 patients were in class 3 with Kt/V stabilized around 1.6. No significant difference in CKD complications or inflammation markers was observed among the three Kt/V trajectories.</p><p><strong>Conclusion: </strong>Under the premise of adequate Kt/V, neither a stable higher Kt/V nor a declined Kt/V significantly influenced CKD complications or inflammatory markers.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19eCollection Date: 2024-01-01DOI: 10.3389/fmed.2024.1436533
Zhenkui Hu, Chao Song, Jinhui Zhang
Background: The aim of this study was to examine the prognostic significance of serum albumin-to-creatinine ratio (ACR) in critically ill patients with sepsis.
Methods: This retrospective study analyzed sepsis cases admitted to the Affiliated Hospital of Jiangsu University between January 2015 and November 2023. The patients were divided into four groups based on their ACR upon admission to the intensive care unit (ICU). Laboratory data were collected at the time of ICU admission, and the primary outcome measure was in-hospital all-cause mortality. Kaplan-Meier survival curves were generated to illustrate the differences in 30-/60-day mortality among the various groups. Multivariate Cox regression models and restricted cubic splines (RCS) were utilized to explore the association between ACR and all-cause mortality in sepsis patients. Subgroup analyses were conducted to examine the impact of other covariates on the relationship between ACR and all-cause mortality.
Results: A total of 1,123 eligible patients were included in the study, with a median ACR of 0.169. The in-hospital mortality rate was 33.7%, the ICU mortality rate was 31.9%, and the 30-day mortality rate was 28.1%. Kaplan-Meier survival analysis demonstrated that patients with higher ACR had a significantly lower risk of 30-/60-day mortality (log-rank p < 0.001). Multivariable Cox proportional hazards analyses revealed that ACR was an independent predictor of in-hospital death (HR: 0.454, 95% CI 0.271-0.761, p = 0.003), ICU death (HR: 0.498, 95% CI 0.293-0.847, p = 0.010), and 30-day death (HR: 0.399, 95% CI 0.218-0.730, p = 0.003). For each 1-unit increase in ACR, there was a 1.203-fold decrease in the risk of death during the hospital stay. The RCS curve illustrated a non-linear negative correlation between ACR and in-hospital mortality (p for non-linear =0.018), ICU mortality (p for non-linear =0.005), and 30-day mortality (p for non-linear =0.006). Sensitivity analysis indicated consistent effect sizes and directions in different subgroups, confirming the stability of the results.
Conclusion: Low ACR levels were identified as independent risk factors associated with increased in-hospital, ICU, and 30-day mortality in sepsis patients. ACR can serve as a significant predictor of the clinical outcome of sepsis.
研究背景本研究旨在探讨血清白蛋白与肌酐比值(ACR)在脓毒症重症患者中的预后意义:这项回顾性研究分析了2015年1月至2023年11月期间江苏大学附属医院收治的败血症病例。根据患者进入重症监护室(ICU)时的 ACR 将其分为四组。在患者进入重症监护室时收集实验室数据,主要结局指标为院内全因死亡率。研究人员绘制了卡普兰-梅耶生存曲线,以说明不同组别在 30 天/60 天死亡率方面的差异。利用多变量 Cox 回归模型和限制性立方样条(RCS)来探讨脓毒症患者 ACR 与全因死亡率之间的关系。还进行了分组分析,以研究其他协变量对 ACR 与全因死亡率之间关系的影响:研究共纳入了 1,123 名符合条件的患者,ACR 中位数为 0.169。院内死亡率为 33.7%,重症监护室死亡率为 31.9%,30 天死亡率为 28.1%。Kaplan-Meier 生存分析显示,ACR 越高的患者 30/60 天死亡风险(log-rank p p = 0.003)、ICU 死亡风险(HR:0.498,95% CI 0.293-0.847,p = 0.010)和 30 天死亡风险(HR:0.399,95% CI 0.218-0.730,p = 0.003)显著降低。ACR 每增加 1 个单位,住院期间的死亡风险就会降低 1.203 倍。RCS 曲线显示 ACR 与院内死亡率(非线性 p =0.018)、ICU 死亡率(非线性 p =0.005)和 30 天死亡率(非线性 p =0.006)之间存在非线性负相关。敏感性分析表明,不同亚组的效应大小和方向一致,证实了结果的稳定性:结论:低 ACR 水平是与脓毒症患者院内、重症监护室和 30 天死亡率增加相关的独立风险因素。ACR 可作为脓毒症临床结局的重要预测指标。
{"title":"Elevated serum albumin-to-creatinine ratio as a protective factor on clinical outcomes among critically ill patients with sepsis: a retrospective study.","authors":"Zhenkui Hu, Chao Song, Jinhui Zhang","doi":"10.3389/fmed.2024.1436533","DOIUrl":"10.3389/fmed.2024.1436533","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to examine the prognostic significance of serum albumin-to-creatinine ratio (ACR) in critically ill patients with sepsis.</p><p><strong>Methods: </strong>This retrospective study analyzed sepsis cases admitted to the Affiliated Hospital of Jiangsu University between January 2015 and November 2023. The patients were divided into four groups based on their ACR upon admission to the intensive care unit (ICU). Laboratory data were collected at the time of ICU admission, and the primary outcome measure was in-hospital all-cause mortality. Kaplan-Meier survival curves were generated to illustrate the differences in 30-/60-day mortality among the various groups. Multivariate Cox regression models and restricted cubic splines (RCS) were utilized to explore the association between ACR and all-cause mortality in sepsis patients. Subgroup analyses were conducted to examine the impact of other covariates on the relationship between ACR and all-cause mortality.</p><p><strong>Results: </strong>A total of 1,123 eligible patients were included in the study, with a median ACR of 0.169. The in-hospital mortality rate was 33.7%, the ICU mortality rate was 31.9%, and the 30-day mortality rate was 28.1%. Kaplan-Meier survival analysis demonstrated that patients with higher ACR had a significantly lower risk of 30-/60-day mortality (log-rank <i>p</i> < 0.001). Multivariable Cox proportional hazards analyses revealed that ACR was an independent predictor of in-hospital death (HR: 0.454, 95% CI 0.271-0.761, <i>p</i> = 0.003), ICU death (HR: 0.498, 95% CI 0.293-0.847, <i>p</i> = 0.010), and 30-day death (HR: 0.399, 95% CI 0.218-0.730, <i>p</i> = 0.003). For each 1-unit increase in ACR, there was a 1.203-fold decrease in the risk of death during the hospital stay. The RCS curve illustrated a non-linear negative correlation between ACR and in-hospital mortality (p for non-linear =0.018), ICU mortality (<i>p</i> for non-linear =0.005), and 30-day mortality (<i>p</i> for non-linear =0.006). Sensitivity analysis indicated consistent effect sizes and directions in different subgroups, confirming the stability of the results.</p><p><strong>Conclusion: </strong>Low ACR levels were identified as independent risk factors associated with increased in-hospital, ICU, and 30-day mortality in sepsis patients. ACR can serve as a significant predictor of the clinical outcome of sepsis.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19eCollection Date: 2024-01-01DOI: 10.3389/fmed.2024.1393778
Philomène Lavis, Ani Garabet, Alessandra Kupper Cardozo, Benjamin Bondue
Idiopathic pulmonary fibrosis (IPF) is a rare, chronic, and progressive interstitial lung disease with an average survival of approximately 3 years. The evolution of IPF is unpredictable, with some patients presenting a relatively stable condition with limited progression over time, whereas others deteriorate rapidly. In addition to IPF, other interstitial lung diseases can lead to pulmonary fibrosis, and up to a third have a progressive phenotype with the same prognosis as IPF. Clinical, biological, and radiological risk factors of progression were identified, but no specific biomarkers of fibrogenesis are currently available. A recent interest in the fibroblast activation protein alpha (FAPα) has emerged. FAPα is a transmembrane serine protease with extracellular activity. It can also be found in a soluble form, also named anti-plasmin cleaving enzyme (APCE). FAPα is specifically expressed by activated fibroblasts, and quinoline-based specific inhibitors (FAPI) were developed, allowing us to visualize its distribution in vivo by imaging techniques. In this review, we discuss the use of FAPα as a useful biomarker for the progression of lung fibrosis, by both its assessment in human fluids and/or its detection by imaging techniques and immunohistochemistry.
{"title":"The fibroblast activation protein alpha as a biomarker of pulmonary fibrosis.","authors":"Philomène Lavis, Ani Garabet, Alessandra Kupper Cardozo, Benjamin Bondue","doi":"10.3389/fmed.2024.1393778","DOIUrl":"10.3389/fmed.2024.1393778","url":null,"abstract":"<p><p>Idiopathic pulmonary fibrosis (IPF) is a rare, chronic, and progressive interstitial lung disease with an average survival of approximately 3 years. The evolution of IPF is unpredictable, with some patients presenting a relatively stable condition with limited progression over time, whereas others deteriorate rapidly. In addition to IPF, other interstitial lung diseases can lead to pulmonary fibrosis, and up to a third have a progressive phenotype with the same prognosis as IPF. Clinical, biological, and radiological risk factors of progression were identified, but no specific biomarkers of fibrogenesis are currently available. A recent interest in the fibroblast activation protein alpha (FAPα) has emerged. FAPα is a transmembrane serine protease with extracellular activity. It can also be found in a soluble form, also named anti-plasmin cleaving enzyme (APCE). FAPα is specifically expressed by activated fibroblasts, and quinoline-based specific inhibitors (FAPI) were developed, allowing us to visualize its distribution <i>in vivo</i> by imaging techniques. In this review, we discuss the use of FAPα as a useful biomarker for the progression of lung fibrosis, by both its assessment in human fluids and/or its detection by imaging techniques and immunohistochemistry.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19eCollection Date: 2024-01-01DOI: 10.3389/fmed.2024.1450091
Harri Hemilä, Elizabeth Chalker
{"title":"Vitamin C for patients with sepsis?","authors":"Harri Hemilä, Elizabeth Chalker","doi":"10.3389/fmed.2024.1450091","DOIUrl":"10.3389/fmed.2024.1450091","url":null,"abstract":"","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19eCollection Date: 2024-01-01DOI: 10.3389/fmed.2024.1453043
Zhongfeng Niu, Lujiao Chen, Yanhua Zhang, Li Zhao
A 20-year-old male patient with a 15-month history of recurrent cough and hemoptysis presented at our hospital with suspected pulmonary sparganosis. Computed Tomography (CT) revealed migratory and variable lesions ranging from patchy shadows to nodular and cavernous foci. Additionally, the location and morphology of the cavities changed rapidly. The patient's peripheral blood eosinophil count remained within the normal range throughout the course of the infection, and antibiotics (moxifloxacin) alleviated the symptoms. At the early stage of admission, there was a slight increase in neutrophil and basophil counts. Initial treatment with a standard dose of praziquantel led to a significant improvement in symptoms, but the symptoms soon relapsed. However, doubling the dose 4 months later eventually cured the disease. The migratory nature of the CT lesion and the presence of tunnel signs were key to diagnosing a parasitic infection. The variability and rapid changes in the lesion further facilitated the differentiation of the disease, which rarely manifests as a granulomatous cavity.
{"title":"Case report: A suspected case of chronic pulmonary sparganosis characterized by migrating cavities and tunnel sign.","authors":"Zhongfeng Niu, Lujiao Chen, Yanhua Zhang, Li Zhao","doi":"10.3389/fmed.2024.1453043","DOIUrl":"10.3389/fmed.2024.1453043","url":null,"abstract":"<p><p>A 20-year-old male patient with a 15-month history of recurrent cough and hemoptysis presented at our hospital with suspected pulmonary sparganosis. Computed Tomography (CT) revealed migratory and variable lesions ranging from patchy shadows to nodular and cavernous foci. Additionally, the location and morphology of the cavities changed rapidly. The patient's peripheral blood eosinophil count remained within the normal range throughout the course of the infection, and antibiotics (moxifloxacin) alleviated the symptoms. At the early stage of admission, there was a slight increase in neutrophil and basophil counts. Initial treatment with a standard dose of praziquantel led to a significant improvement in symptoms, but the symptoms soon relapsed. However, doubling the dose 4 months later eventually cured the disease. The migratory nature of the CT lesion and the presence of tunnel signs were key to diagnosing a parasitic infection. The variability and rapid changes in the lesion further facilitated the differentiation of the disease, which rarely manifests as a granulomatous cavity.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19eCollection Date: 2024-01-01DOI: 10.3389/fmed.2024.1433120
Samuel Gakinya, Allan Njau, Abdulkarim Abdallah, Ancent Nzioka, James Ogutu
Introduction: Colorectal carcinoma is a leading cause of cancer morbidity and mortality globally. Its management includes the use of targeted therapy which require assessment for biomarkers to choose eligible patients. KRAS and BRAF mutations are biomarkers predictive of response to anti-EGFR therapy. This study aimed at determining the frequency of BRAF V600E and KRAS exon 2,3,4 mutations in colorectal carcinoma patients at the Aga Khan University Hospital Nairobi, Kenya.
Methods: Study participants were patients who had colectomy for colorectal carcinoma. They were identified from the laboratory information system. The patients age, gender and tumor location were determined from the medical records. The histological diagnosis, pathological tumor and nodal stage were confirmed by examining hematoxylin and eosin-stained slides prepared from the colectomy specimen. DNA was extracted from the specimens using Qiagen QIAamp DNA FFPE Tissue Kit and PCR performed using EntroGen KRAS/BRAF mutation analysis kit following manufacturer's protocol.
Results: One hundred fourteen patients were enrolled. Colorectal carcinoma was significantly more common in males than females. The mean age at diagnosis was 58 years. Majority of the tumors were in the right colon, were of pathological tumor stage T3 and had nodal involvement. Forty six percent (46%) of the cases had KRAS mutations while 5.3% had BRAF V600E mutation. KRAS mutation was associated with a high pathological tumor stage and nodal involvement.
Conclusion: Colorectal carcinoma in our patients is more common in males and tend to occur at a younger age. The patients tend to have a high tumor pathological stage and nodal involvement at diagnosis. The high frequency of KRAS exon 2,3,4 mutation and low frequency of BRAF V600E mutations is similar to what has been reported in literature.
导言:结直肠癌是全球癌症发病率和死亡率的主要原因。其治疗方法包括使用靶向疗法,这需要对生物标志物进行评估,以选择符合条件的患者。KRAS和BRAF突变是预测抗EGFR疗法反应的生物标志物。本研究旨在确定肯尼亚内罗毕阿迦汗大学医院结直肠癌患者中 BRAF V600E 和 KRAS 外显子 2、3、4 突变的频率:研究参与者为接受结直肠癌切除术的患者。这些患者的身份是从实验室信息系统中确认的。根据病历确定患者的年龄、性别和肿瘤位置。通过检查从结肠切除术标本中制备的苏木精和伊红染色切片,确认组织学诊断、病理肿瘤和结节分期。使用Qiagen QIAamp DNA FFPE组织试剂盒从标本中提取DNA,并按照制造商的方案使用EntroGen KRAS/BRAF突变分析试剂盒进行PCR分析:结果:共招募了114名患者。男性结直肠癌患者明显多于女性。确诊时的平均年龄为 58 岁。大多数肿瘤位于右侧结肠,病理分期为 T3 期,并有结节受累。46%的病例有KRAS突变,5.3%有BRAF V600E突变。KRAS突变与肿瘤病理分期高和结节受累有关:结论:结直肠癌多见于男性,且发病年龄较轻。结论:我国结直肠癌患者以男性居多,发病年龄较轻,确诊时肿瘤病理分期和结节受累程度较高。KRAS外显子2、3、4突变频率高,BRAF V600E突变频率低,这与文献报道相似。
{"title":"Frequency of <i>KRAS</i> and <i>BRAF</i> mutations in colorectal carcinoma and their association with clinical-pathological characteristics in a tertiary hospital in Kenya.","authors":"Samuel Gakinya, Allan Njau, Abdulkarim Abdallah, Ancent Nzioka, James Ogutu","doi":"10.3389/fmed.2024.1433120","DOIUrl":"10.3389/fmed.2024.1433120","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal carcinoma is a leading cause of cancer morbidity and mortality globally. Its management includes the use of targeted therapy which require assessment for biomarkers to choose eligible patients. <i>KRAS</i> and <i>BRAF</i> mutations are biomarkers predictive of response to anti-EGFR therapy. This study aimed at determining the frequency of <i>BRAF V600E</i> and <i>KRAS</i> exon 2,3,4 mutations in colorectal carcinoma patients at the Aga Khan University Hospital Nairobi, Kenya.</p><p><strong>Methods: </strong>Study participants were patients who had colectomy for colorectal carcinoma. They were identified from the laboratory information system. The patients age, gender and tumor location were determined from the medical records. The histological diagnosis, pathological tumor and nodal stage were confirmed by examining hematoxylin and eosin-stained slides prepared from the colectomy specimen. DNA was extracted from the specimens using Qiagen QIAamp DNA FFPE Tissue Kit and PCR performed using EntroGen <i>KRAS/BRAF</i> mutation analysis kit following manufacturer's protocol.</p><p><strong>Results: </strong>One hundred fourteen patients were enrolled. Colorectal carcinoma was significantly more common in males than females. The mean age at diagnosis was 58 years. Majority of the tumors were in the right colon, were of pathological tumor stage T3 and had nodal involvement. Forty six percent (46%) of the cases had <i>KRAS</i> mutations while 5.3% had <i>BRAF V600E</i> mutation. <i>KRAS</i> mutation was associated with a high pathological tumor stage and nodal involvement.</p><p><strong>Conclusion: </strong>Colorectal carcinoma in our patients is more common in males and tend to occur at a younger age. The patients tend to have a high tumor pathological stage and nodal involvement at diagnosis. The high frequency of <i>KRAS</i> exon 2,3,4 mutation and low frequency <i>of BRAF V600E</i> mutations is similar to what has been reported in literature.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19eCollection Date: 2024-01-01DOI: 10.3389/fmed.2024.1373460
Emma Warinton, Zubair Ahmed
Introduction: Endotracheal intubation is an uncommon procedure for children in the emergency department but can be technically difficult and cause significant adverse effects. Videolaryngoscopy (VL) offers improved first-pass success rates over direct laryngoscopy (DL) for both adults and children undergoing elective surgery. This systematic review was designed to evaluate current evidence regarding how the effectiveness and safety of VL compares to DL for intubation of children in emergency departments.
Methods: Four databases (MEDLINE, Embase, CENTRAL and Web of Science) were searched on 11th May 2023 for studies comparing first-pass success of VL and DL for children undergoing intubation in the emergency department. Studies including adult patients or where intubation occurred outside of the emergency department were excluded. Quality assessment of included studies was carried out using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Meta-analysis was undertaken for first-pass success and adverse event rate.
Results: Ten studies met the inclusion criteria representing 5,586 intubations. All included studies were observational. Significantly greater first-pass success rate was demonstrated with VL compared to DL (OR 1.64, 95% CI [1.21-2.21], p = 0.001). There was no significant difference in risk of adverse events between VL and DL (OR 0.79, 95% CI [0.52-1.20], p = 0.27). The overall risk of bias was moderate to serious for all included studies.
Conclusion: VL can offer improved first-pass success rates over DL for children intubated in the emergency department. However, the quality of current evidence is low and further randomised studies are required to clarify which patient groups may benefit most from use of VL.
导言:气管内插管在急诊科的儿童中并不常见,但在技术上却很困难,而且会造成严重的不良影响。对于接受择期手术的成人和儿童来说,视频喉镜(VL)比直接喉镜(DL)的首次成功率更高。本系统性综述旨在评估急诊科为儿童插管时 VL 与 DL 的有效性和安全性比较的现有证据:方法:2023 年 5 月 11 日,在四个数据库(MEDLINE、Embase、CENTRAL 和 Web of Science)中搜索了在急诊科为儿童插管时比较 VL 和 DL 首次插管成功率的研究。包括成人患者或在急诊科外进行插管的研究均被排除在外。采用干预措施非随机研究中的偏倚风险(ROBINS-I)工具对纳入的研究进行质量评估。对首次插管成功率和不良事件发生率进行了 Meta 分析:10项研究符合纳入标准,代表了5586次插管。所有纳入的研究均为观察性研究。与 DL 相比,VL 的首次插管成功率明显更高(OR 1.64,95% CI [1.21-2.21],p = 0.001)。VL 和 DL 的不良事件风险无明显差异(OR 0.79,95% CI [0.52-1.20],p = 0.27)。所有纳入研究的总体偏倚风险为中度至严重偏倚:结论:对于急诊科插管的儿童,VL 比 DL 可提高首次插管成功率。然而,目前的证据质量较低,需要进一步的随机研究来明确哪些患者群体可能从使用VL中获益最多。系统综述注册:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=415039,标识符为CRD42023415039。
{"title":"Comparing the effectiveness and safety of videolaryngoscopy and direct laryngoscopy for endotracheal intubation in the paediatric emergency department: a systematic review and meta-analysis.","authors":"Emma Warinton, Zubair Ahmed","doi":"10.3389/fmed.2024.1373460","DOIUrl":"10.3389/fmed.2024.1373460","url":null,"abstract":"<p><strong>Introduction: </strong>Endotracheal intubation is an uncommon procedure for children in the emergency department but can be technically difficult and cause significant adverse effects. Videolaryngoscopy (VL) offers improved first-pass success rates over direct laryngoscopy (DL) for both adults and children undergoing elective surgery. This systematic review was designed to evaluate current evidence regarding how the effectiveness and safety of VL compares to DL for intubation of children in emergency departments.</p><p><strong>Methods: </strong>Four databases (MEDLINE, Embase, CENTRAL and Web of Science) were searched on 11<sup>th</sup> May 2023 for studies comparing first-pass success of VL and DL for children undergoing intubation in the emergency department. Studies including adult patients or where intubation occurred outside of the emergency department were excluded. Quality assessment of included studies was carried out using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Meta-analysis was undertaken for first-pass success and adverse event rate.</p><p><strong>Results: </strong>Ten studies met the inclusion criteria representing 5,586 intubations. All included studies were observational. Significantly greater first-pass success rate was demonstrated with VL compared to DL (OR 1.64, 95% CI [1.21-2.21], <i>p</i> = 0.001). There was no significant difference in risk of adverse events between VL and DL (OR 0.79, 95% CI [0.52-1.20], <i>p</i> = 0.27). The overall risk of bias was moderate to serious for all included studies.</p><p><strong>Conclusion: </strong>VL can offer improved first-pass success rates over DL for children intubated in the emergency department. However, the quality of current evidence is low and further randomised studies are required to clarify which patient groups may benefit most from use of VL.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=415039, Identifier CRD42023415039.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19eCollection Date: 2024-01-01DOI: 10.3389/fmed.2024.1449496
Weida Lu, Honggang Dai, Yunyi Li, Xiao Meng
Pulmonary arteriovenous malformations (PAVMs) are direct pulmonary artery-to-vein connections without pulmonary capillaries that result in intrapulmonary right-to-left blood shunts. Although most patients with PAVMs may be entirely asymptomatic, PAVMs can induce a series of complications involving the neurological, cardiovascular, and respiratory systems that can lead to catastrophic and often fatal clinical sequelae. In this study we review the available literature and summarize the reported PAVM-related complications among patients with PAVMs. The reviewed studies included observational studies, case studies, prospective studies, and cohort studies, and we provide an overview of PAVM-related neurological and cardiopulmonary manifestations, including stroke, cerebral abscess, transient ischemic attack, cerebral hemorrhage, migraine, seizure, dizziness, cardiac failure, arrhythmia, myocardial infarction, cough, hypoxemia, dyspnea, respiratory failure, hemoptysis, and hemothorax. Identifying and treating PAVMs before the presentation of major complication is important because this can prevent the occurrence of complications and can result in better outcomes. PAVM patients should thus be better evaluated and managed by a multidisciplinary team because they may be in a treatable phase prior to their condition becoming life-threatening.
{"title":"Neurological and cardiopulmonary manifestations of pulmonary arteriovenous malformations.","authors":"Weida Lu, Honggang Dai, Yunyi Li, Xiao Meng","doi":"10.3389/fmed.2024.1449496","DOIUrl":"10.3389/fmed.2024.1449496","url":null,"abstract":"<p><p>Pulmonary arteriovenous malformations (PAVMs) are direct pulmonary artery-to-vein connections without pulmonary capillaries that result in intrapulmonary right-to-left blood shunts. Although most patients with PAVMs may be entirely asymptomatic, PAVMs can induce a series of complications involving the neurological, cardiovascular, and respiratory systems that can lead to catastrophic and often fatal clinical sequelae. In this study we review the available literature and summarize the reported PAVM-related complications among patients with PAVMs. The reviewed studies included observational studies, case studies, prospective studies, and cohort studies, and we provide an overview of PAVM-related neurological and cardiopulmonary manifestations, including stroke, cerebral abscess, transient ischemic attack, cerebral hemorrhage, migraine, seizure, dizziness, cardiac failure, arrhythmia, myocardial infarction, cough, hypoxemia, dyspnea, respiratory failure, hemoptysis, and hemothorax. Identifying and treating PAVMs before the presentation of major complication is important because this can prevent the occurrence of complications and can result in better outcomes. PAVM patients should thus be better evaluated and managed by a multidisciplinary team because they may be in a treatable phase prior to their condition becoming life-threatening.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19eCollection Date: 2024-01-01DOI: 10.3389/fmed.2024.1399913
Ya-Nan Ge, Yan Shao, Shu-Chen Dong, Xing-Bin Ma, Wei Wang
Introduction: Adult diffuse hepatic hemangiomatosis (DHH) is an extremely rare disease. Consequently, its characteristics are poorly understood. Herein, we report a case of adult DHH involving both liver lobes but without extrahepatic involvement. To the best of our knowledge, this the largest reported adult DHH to date.
Case presentation: A 51-year-old man was admitted due to abdominal distension and dyspnea. Physical examination revealed marked liver enlargement. Color Doppler, plain and contrast-enhanced computed tomography, and contrast-enhanced magnetic resonance imaging revealed a hepatic lesion sized 35.1 × 32.1 × 14.1 cm occupying nearly the entire abdominal and pelvic cavities. Diagnosis was established by liver puncture biopsy. The patient exhibited clinical signs of portal hypertension and hypersplenism, but remains free of serious DHH-related complications. He is followed up regularly, with proactive evaluation for future liver transplantation.
Conclusion: This case will contribute to the current knowledge on the clinical and imaging features of this rare entity.
{"title":"Adult diffuse hepatic hemangiomatosis lesion occupying the entire abdominal and pelvic cavities: a case report.","authors":"Ya-Nan Ge, Yan Shao, Shu-Chen Dong, Xing-Bin Ma, Wei Wang","doi":"10.3389/fmed.2024.1399913","DOIUrl":"10.3389/fmed.2024.1399913","url":null,"abstract":"<p><strong>Introduction: </strong>Adult diffuse hepatic hemangiomatosis (DHH) is an extremely rare disease. Consequently, its characteristics are poorly understood. Herein, we report a case of adult DHH involving both liver lobes but without extrahepatic involvement. To the best of our knowledge, this the largest reported adult DHH to date.</p><p><strong>Case presentation: </strong>A 51-year-old man was admitted due to abdominal distension and dyspnea. Physical examination revealed marked liver enlargement. Color Doppler, plain and contrast-enhanced computed tomography, and contrast-enhanced magnetic resonance imaging revealed a hepatic lesion sized 35.1 × 32.1 × 14.1 cm occupying nearly the entire abdominal and pelvic cavities. Diagnosis was established by liver puncture biopsy. The patient exhibited clinical signs of portal hypertension and hypersplenism, but remains free of serious DHH-related complications. He is followed up regularly, with proactive evaluation for future liver transplantation.</p><p><strong>Conclusion: </strong>This case will contribute to the current knowledge on the clinical and imaging features of this rare entity.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}