Journal of Investigative Medicine最新文献

While pediatric mental health emergencies are increasing in frequency and severity, psychiatric resources remain concentrated in tertiary care facilities. Telepsychiatry has successfully mitigated these challenges in rural emergency departments (EDs), suggesting potential benefits for urban EDs that lack psychiatric resources. We implemented telepsychiatry in an urban ED to reduce ED length of stay and the need for transferring pediatric patients with mental and behavioral health complaints. We conducted a retrospective review of patients aged 0-17 presenting from July 1, 2018 to May 31, 2020 (PRE-intervention) and from June 1, 2020 to June 30, 2023 (POST-intervention) for psychiatric evaluation, suicidal ideation, homicidal ideation, behavioral issues, intentional ingestion, or altered mental status. Our outcomes of interest were ED length of stay, proportion transferred, and proportion with a repeat visit within 30 days for a mental health complaint. There were 199 patients; 74 PRE and 125 POST. Post-intervention, 91% (114 patients) were evaluated completely via telepsychiatry; thus only 11 (9%) required transfer. The median age was 14 years (range 8-17). The most common complaints were suicidal ideation, intentional ingestion, and behavioral problems. Seventy-four percent of patients (n = 84) evaluated by telepsychiatry were discharged from the satellite ED. The median length of stay decreased significantly from 473 min (95% CI: 431-733) to 275 min (95% CI: 316-462) after implementation. Repeat visits for mental health complaints within 30 days decreased from 23% to 10%. Implementing a telepsychiatry evaluation program in an urban pediatric satellite ED reduced transfers and decreased patient length of stay.

Combined administration of two or more drugs is emerging as a new strategy in triple-negative breast neoplasms. This is the first study to investigate the combination of the histone deacetylase inhibitor mocetinostat and the antimetabolite drug capecitabine in triple-negative mammary neoplasms in a preclinical mouse model. Thirty-five female mice were grouped into the control group, capecitabine group, mocetinostat group, and combined drugs group. At the end of the experimental period, body weight, and tumor weight were measured and tumor tissue and lung tissue were histologically examined. The results showed that the body weight of mice in the drug-treated groups was reduced by about 18%. Tumor weights were also reduced by 21% in the mocetinostat group, 27.5% in the capecitabine group, and 45% in the combined group. The combination of mocetinostat and capecitabine decreased the formation of tumors and metastases in lung tissue. In summary, the combination of mocetinostat and capecitabine was more effective than either drug alone in reducing the size of triple-negative breast neoplasms in a mouse model.

Pancreatic cancer is characterized by occult onset, low early diagnosis rate, rapid progress, and poor prognosis. Due to the low response rate and low programmed cell death ligand 1 (PD-L1) expression in pancreatic cancer, the therapeutic application of PL-L1 inhibitors in pancreatic cancer is greatly limited. In vitro studies showed that the expression of PD-L1 increased in pancreatic cancer cells stimulated by fluorouracil (5-FU). We aim to explore the combined effect of 5-FU and anti-PD-L1 antibodies and to provide a reference for the clinical application of PD-L1 antibodies in pancreatic cancer. In the current study, male BALB/c mice were adopted to construct a tumor-bearing model of pancreatic cancer cells. 5-FU and anti-mouse PD-L1 antibodies were combined and administered to evaluate their synergistic effects. The enhancing immune cytotoxicity effect of 5-FU sensitizing the anti-PD-L1 antibody in vivo and in vitro was analyzed by immunohistochemistry and western blot assays. Results showed that 5-FU and anti-PD-L1 antibody combination increased the expression of PD-L1 and IFN-γ, and infiltration of CD8⁺ T lymphocytes in pancreatic xenograft tumor tissues, which was proven by immunohistochemistry and western analysis. Moreover, the combination with the 5-FU remarkably enhanced the immune cytotoxicity of anti-PD-L1 antibodies in mice. In vitro analysis demonstrates that 5-FU increases the expression of PD-L1 on the surface of pancreatic cancer cell lines via up-regulating nuclear factor kappa B (NF-κB) and Protein kinase B (AKT) pathways. This synergistic effect could be abolished by NF-κB and AKT inhibitors.

This study investigates the combined efficacy of orthokeratology lenses and 0.01% atropine in controlling the progression of pediatric progressive myopia. The study, conducted retrospectively on 33 children aged 8-14, measured key parameters, including axial length growth, uncorrected visual acuity (UCVA), intraocular pressure (IOP), tear film breakup time (TBUT), and pupil diameter. The results revealed a significant reduction in axial length growth with the combined treatment compared to orthokeratology alone, while UCVA and IOP remained stable. TBUT decreased, and pupil diameter increased post-treatment. The findings suggest that combining orthokeratology with low-dose atropine offers a safe and effective strategy for managing pediatric myopia, particularly in younger patients.

Autoimmune thyroid disorders (AITD) are the most common autoimmune human disorders as the thyroid gland is a main target for autoimmunity. The association between rheumatologic and thyroid disorders has long been known, the most common being the association with rheumatoid arthritis. Our study was conducted to screen for the presence of symptoms, signs, and immune markers suggesting the presence of Sjogren's syndrome among patients with autoimmune thyroid disorders. Eighty AITD patients (46 patients with Hashimoto's thyroiditis and 34 patients with Graves' disease) were included in the study and 40 healthy subjects matched age and sex as a control group. The two groups were compared according to 2002 the American-European Consensus Group (AECG) criteria for diagnosis of primary Sjogren's syndrome. 12.5% of AITD patients (n = 10 patients) were diagnosed with Sjogren's syndrome (AITD-SS). Eight out of ten of AITD-SS had Hashimoto's disease while only two had Grave's disease. Anti-Ro was detected in serum of seven patients of the AITD patients with Sjogren syndrome while anti-La was detected in serum of eight patients. The most independent predictors of Sjogren's syndrome in AITD patients are anti-La, ESR, and salivary gland sonographic change. Sjogren's syndrome has been found in patients with AITD, and also patients with AITD have symptoms that mimic sicca disease despite not fulfilling the criteria for diagnosis.

This study examined inflammatory bowel disease (IBD) trends over the last 10 years, including their nationwide patterns, and the outcomes of the utilization of total parental nutrition (TPN). Nationwide inpatient sample (NIS) database from 2010 to 2020, was used to identify IBD hospitalization and discharges and investigate outcomes, including in-hospital mortality and hospital resource utilization. The hospitalizations for IBD combining both Crohn's disease (CD) and ulcerative colitis (UC) initially noted a rising trend until 2016 followed by a decreasing trend with statistical significance (p < 0.001). A decreasing trend in TPN utilization in CD dropped from 6.2 to 5.4% (p = 0.07). The prevalence of malnutrition in CD cases significantly increased from 11.6 to 16.6% (p < 0.001), and the use of TPN in malnutrition cases decreased from 25.0 to 20.0% with statistical significance (p = 0.002). TPN in UC cases also exhibited a downward trend, declining from 5.3 to 3.1% with statistical significance (p < 0.001). However, there was a noteworthy increase in malnutrition rates, rising from 13.5 to 17.3% (p = 0.087). Similarly, the utilization of TPN in malnutrition cases among UC cases displayed a significant decrease from 19.9 to 11.3% (p < 0.001). The combined use of TPN in IBD showed a decreased trend from 5.9 to 4.3% with statistical significance (p < 0.001). There is a decline in the trend in TPN usage in both CD and UC. The hospital costs and malnutrition trend has increased, while the inpatient mortality, length of stay, and TPN use decreased over the year.

Immunotherapy with checkpoint inhibitors has improved the outcomes of patients with metastatic lung cancer in recent years. Despite improved prognosis, not all patients respond to treatment. Therapeutic interventions to build on the success of immune checkpoint inhibitors are needed. A retrospective review of patient records for patients who had received immune checkpoint inhibitors in a single cancer center over 4 years was undertaken. Demographic and disease characteristics of patients with metastatic non-small cell lung cancer were recorded. Data on other treatments including chemotherapy and radiation therapy were extracted, and survival outcomes were calculated. Most (81.8%) of the 77 metastatic lung cancer patients examined had received palliative radiation therapy within 3 months of starting immune checkpoint inhibitors. While the survival outcomes of these patients did not differ from patients who had not received radiotherapy, patients who had undergone hypofractionated radiotherapy (defined as one or more fractions of 700 cGy or higher) displayed a better overall survival (OS) than the rest of the cohort. Palliative radiation therapy administered in proximity with immune checkpoint inhibitors immunotherapy had no effect on the OS of metastatic lung cancer patients. However, patients receiving palliative radiotherapy with fractions above 700 cGy showed better OS. Further studies are needed to optimize a combination strategy.

To investigate the impact of vaccines on sociodemographic characteristics, clinical profiles, and outcomes of SARS-CoV-2 infection among healthcare workers in South China during the period of Omicron variant dominance, a retrospective, analytical cross-sectional study was conducted. The findings revealed that while full vaccination could not prevent Omicron variant infection efficiently (26.51% uninfected vs 14.29% uninfected between vaccinated and unvaccinated participants, p = 0.506), it did substantially reduce the length of viral clearance significantly (p < 0.05), potentially facilitating quicker patient recovery. Unvaccination was found to be an independent risk factor for slow clearance when a linear regression analysis model was used (Coefficient: -3.516; 95% CI: -6.425 to -0.607; p = 0.020). Therefore, all eligible individuals should be fully vaccinated to get prepared for a potential wave of epidemic in the future.