Annals of Medicine and Surgery最新文献

Background: This study investigates the gene expression characteristics of glioma-initiating cells (GIC), an important subgroup of glioblastoma (GBM), after knockdown of PBK (PDZ-binding kinase). Differentially expressed genes (DEGs) between PBK knockdown GIC and control groups were screened through bioinformatics methods. The authors analyzed the mechanisms and roles of these DEGs in GBM tumorigenesis and patient prognosis.

Methods: Microarray data (GSE53800) were obtained from the Gene Expression Omnibus (GEO) database, selecting 18 GIC cell line samples with or without PBK knockdown. Each control and knockdown group contained three samples. DEGs were screened using R software. GO enrichment analysis, KEGG pathway analysis, PPI network analysis, and hub gene identification were conducted to explore DEG mechanisms. Western blot analysis was also performed to detect EIF4E protein expression, one of the key hub genes, after PBK knockdown in the HS683 glioma cell line.

Results: A total of 175 upregulated and 145 downregulated genes were identified. GO analysis showed that DEGs were mainly enriched in the positive regulation of cell proliferation, cell adhesion, and angiogenesis. KEGG pathway analysis revealed that DEGs were mainly involved in neuroactive ligand-receptor interactions, calcium signaling, and HIF-1 signaling pathways. Western blot results indicated that EIF4E was downregulated after PBK knockdown.

Conclusion: A group of genes, such as EIF4E, were closely associated with PBK expression and functions. These findings may provide insight into the molecular mechanism of PBK in GBM.

Introduction and importance: The nerves in the legs and feet are most frequently damaged by diabetic neuropathy. The COVID-19 infection is associated with a high risk of neuropathy symptoms.

Case presentation: On 12 July 2022, a 58-year-old black female retiree with significant symptoms of numbness and muscle weakness in the hands and legs was brought into the emergency room. Seventeen years prior, she was diagnosed with type 2 diabetes mellitus. Metformin 1.5 g twice a day and glibenclamide 10 mg twice a day were part of her therapy regimen. When she was admitted to the emergency room, she described a one-day history of shortness of breath, frequent urination, excessive thirst, hyperglycemia, excessive appetite, fever, headache, and dehydration. A chest radiograph showed bilateral diffuse, patchy airspace opacities that could be caused by multifocal pneumonia or viral pneumonia. She started receiving 1000 ml of fluid resuscitation (0.9% normal saline) as soon as she was moved to an ICU, along with a drip-in insulin infusion.

Clinical discussion: Diabetes, infections like COVID-19, poor vitamin levels, and other factors can all contribute to diabetic neuropathies. According to the Centers for Disease Control and Prevention, patients with type 2 diabetes mellitus are much more likely to experience severe morbidity and death from coronavirus disease.

Conclusion: Symptoms of diabetic neuropathy continued for months after a COVID-19 infection test resulted in a positive result.

Background: Cardiovascular diseases (CVDs) are the leading causes of death globally. The use of single-cell RNA sequencing (scRNA-seq) in CVDs has gained significant attention in recent years, and there is a growing body of literature on the subject. However, a thorough and impartial analysis of the existing state and trends of scRNA-seq in CVDs is lacking. This study aims to examine the development of scRNA-seq in CVDs using bibliometric and visualized analysis.

Methods: Global publications on scRNA-seq and CVDs from 2009 to 2023 were extracted from the Web of Science Core Collection (WoSCC) database. The R package "Bibliometrix", VOSviewer, and CiteSpace were employed to perform a bibliometric study.

Results: After applying the screening criteria and omitting documents that met exclusive criteria, this bibliometric study included 1170 papers. These were authored by 8595 scholars from 1565 organizations in 57 countries or regions and were published in 369 journals, with 51 073 co-cited references included. Publication volume, citations, and relative research interest index focusing on this field have dramatically increased since 2019. The cooperation network showed that the USA, the Chinese Academy of Medical Sciences, and Qingbo Xu were the most active countries, institutes, and authors in this field, respectively. Circulation Research was the journal with the most publications, which was confirmed to be the top core source by Bradford's law. The hotspots and emerging direction in the field manifest in (1) three CVDs (atherosclerosis, myocardial infarction, and heart failure) and (2) three cell types (macrophage, fibroblast, and smooth muscle cell).

Conclusions: Our study provides a systematic visualization of the research literature on scRNA-seq in CVDs and provides guidance and reference for understanding the current research status and discovering new research directions.

Introduction and importance: Malaria continues to be a significant global public health problem, particularly in endemic nations. The most common cause of acute renal failure is a Plasmodium falciparum infection.

Case presentation: A 28-year-old male was brought into the emergency room with significant complaints of fatigue, chills, fever, and a lack of appetite. The patient had no prior history of malaria. He was not given any antimalarial medication as prophylaxis while traveling to his workplace. As a result of laboratory investigations to identify malarial parasites in peripheral blood using thin and thick smears, malaria parasites were found in the patient's blood. At the border of the colitis, the liver was palpable. Both the chest radiograph and abdominal ultrasonography were clear. His level of consciousness assessment indicated a Glasgow coma scale reading of 10 out of 15. He received 1000 ml of normal saline solution with 40% glucose solution as part of his supportive care. He received intravenous artesunate 60 mg (2.4 mg/kg) when he was admitted to an ICU, and then every 12 and 24 h for the next 3 days (a total of three doses, 540 mg).

Clinical discussion: A typical symptom of severe malaria is acute kidney injury, which also carries its own risk of death. In regions with active transmission, Plasmodium falciparum is recognized as a significant contributor to acute renal damage.

Conclusion: The mechanism proposed for kidney injury by severe malaria is hemodynamic dysfunction, followed by inflammation and immunological dysregulation in the patient in this study. He had reduced serum sodium levels within the red blood cells, which led to calcium influx into the cell, altering the red blood cell's deformability.

Background: Degloving soft-tissue injuries are underreported in Sudan and are potentially devastating. They require early recognition and diagnosis with early and systemic management to reduce the complications that may arise, and to minimize delay for proper intervention by a multidisciplinary team that is usually needed to ensure the effective rehabilitation of these patients and a better outcome.

Objective: To assess the degloving soft tissue injuries of the upper limb and their management in Khartoum.

Material and methods: A cross-sectional hospital-based study is multicentric (Khartoum North Teaching Hospital, Association Specialized Hospital, East Nile Hospital) in Khartoum - Sudan. A study was conducted on 82 patients with degloving soft tissue injuries of the upper limbs during the period from 2021 to 2022. Patients with different age groups were included whereas patients with close degloving injuries and degloving injuries of fingers were excluded.

Results: Eighty-two patients were studied. The male-to-female ratio was 4.8:1, with a mean age of 31.5. The common (59.8%) injury site was the dominant upper limb, with 58.5% distal UL injuries. The main etiology of injury was road traffic accidents (52.4%), followed by occupational injuries (20.7%). 51.2% of the injury was a noncircumferential single-plane degloving soft tissue injury. Degloving soft tissue injuries of the upper limbs are associated with deep structure injuries in 61% of patients (bone fracture in 43.9%). Serial debridement before reconstruction as a staged procedure was done in 61% of patients. The most common reconstruction method performed was skin grafts (57.3%), followed by flaps (32.9%). Half (52.4%) of the patients developed complications postoperatively, and the most frequent complication was wound infection (23.1%).

Conclusion: Upper limb degloving soft tissue injuries are complex life-threatening injuries that, if present late or poorly managed, lead to devastating complications ranging from local infection to major disabilities, amputation, and death.

Background: Triage is an essential function in the emergency department. Knowledge of nurses working in triage has been cited as an influential factor in triage decision-making. As there are increased numbers of clients with life-threatening traumatic injuries and medical patients in the emergency department in Addis-Ababa, triage knowledge and skill are essential competencies required for the nurses working in the emergency department.

Objective: To assess nurses' knowledge and perceived skills towards triage and associated factors among nurses working in the adult emergency department of selected public hospitals in Addis-Ababa, Ethiopia, 2023.

Methods: A multicentre cross-sectional study design was used. Three hospitals were purposefully selected. A census sampling technique was used to obtain the required sample size. Data was collected by an open data kit (ODK) version 2022.1.2. Then, it was exported to SPSS version 27 for final analysis. Bivariate analysis at a P-value of 0.25 and multivariable analysis at a P-value of 0.05 were applied. Results were presented using tables, figures, and texts.

Results: A total of 384 participants were included in this study. The proportions of poor triage knowledge and perceived poor triage skills among nurses were 58.1 and 50.3%, respectively. Educational level, triage experience, training experience, and the availability of triage equipment were significant predictors of triage knowledge and perceived triage skill, respectively.

Conclusion and recommendation: The triage knowledge and skill levels were found to be low. As nurses' knowledge about triage is a key tool in triage decision-making, there is a need to improve nurses' knowledge and skills in triaging at the ED.

Background: This study aims to analyze the diagnosis and treatment conditions of polytrauma patients with spinal injuries, to clarify the site of the first surgical intervention, the timing of the surgery, and factors influencing prognosis.

Methods: This study collected and analyzed data on polytrauma patients with spinal injuries who were treated from January 2017 to January 2023. Data collected primarily included basic patient information, treatment strategy-related information, clinical scoring systems, imaging parameters, and prognosis. The impacts of relevant variables on postoperative survival outcomes were analyzed.

Results: This study included 60 patients. There was no significant change in the number of patients rated ASIA grade E after 90 days of admission, while there was a significant increase in those rated grade D (P<0.001). Among the groups, patients operated on within less than 12 h had the highest number of ASIA grade A, while those operated on after more than 48 h had the highest number of ASIA grade E (P=0.003). The survival rate of patients who underwent their first spinal surgery between 12 and 48 h was significantly better than those operated earlier than 12 h or later than 48 h (P=0.047). Patients who experienced hemorrhagic shock postsurgery had the lowest survival rate (P<0.001). Only age (P=0.004) and the number of surgeries outside the spine (P=0.033), as covariates, were significantly correlated with patient mortality (R²=0.519).

Conclusions: Performing spinal surgery too early or too late can adversely affect patient outcomes; the appropriate timing of surgery should be chosen based on the specific characteristics of the patient. In polytrauma patients under emergency conditions, the use of combined surgical treatments should be minimized to prevent the occurrence of a 'second hit'. Patients who experience hemorrhagic shock have the worst postsurgical survival; targeted treatment should be administered upon hospital admission.

Background: Germ cell tumors (GCTs) are common solid tumors in young men, originating in the testicles or outside the gonads. Choriocarcinoma, a rare and aggressive subtype, primarily affects females but can also occur in males. Treatment options depend on the stage and location of the tumor, with early recognition being crucial for better outcomes. Comparative studies between testicular and nontesticular choriocarcinoma are crucial for understanding distinct features and prognoses.

Methods: The study utilized SEER*Stat software to extract data and applied statistical methods such as χ ² analysis and Kaplan-Meier method. Inclusion criteria focused on patients diagnosed with choriocarcinoma between 2000 and 2018, while exclusion criteria eliminated cases without histological confirmation or with other tumors.

Results: Among 363 patients, 270 (74.4%) had testicular CC, and 93 (25.6%) had nontesticular CC. Notably, testicular CC was more common in white patients, which could indicate demographic or environmental factors at play. Patients with testicular CC were more likely to undergo surgery, suggesting a significant treatment trend. It is worth exploring whether patient preferences or observed postsurgery improvements contribute to this pattern. Testicular CC had a higher 5-year OS rate of 54% versus 29%, and a higher 5-year CSS rate of 56.3% versus 31.9%, respectively.

Conclusion: This study reveals distinct characteristics and treatment responses in testicular and nontesticular choriocarcinoma, emphasizing the need for personalized management based on subtype. Our findings highlight racial disparities in incidence and the efficacy of surgical intervention for both types, while chemotherapy benefits extragonadal cases and radiotherapy's role requires further evaluation.

Introduction and importance: Bartter syndrome is a rare autosomal recessive disorder affecting renal tubular function leading to disturbances in electrolyte and volume homeostasis. It can also manifest as Bartter-like syndrome (BLS), a rare side effect of certain medications. Polymyxin-B, an antibiotic used to treat multidrug-resistant infections is infrequently associated with BLS. Hence, early diagnosis of this adverse effect is crucial to prevent severe electrolyte imbalances.

Case presentation: A 73-year-old female with coronary artery disease, chronic obstructive pulmonary disease, and hyperlipidemia, presented with fever, respiratory distress, and hypoxia on mechanical ventilation. Initial labs showed leukocytosis, anemia, and normal potassium. Despite receiving broad-spectrum antibiotics there was no improvement in her clinical condition. A sputum culture revealed pandrug-resistant Acinetobacter baumannii, sensitive only to Polymyxin-B. After six days of receiving polymyxin-B, the patient developed fever, hypotension, hypokalemia, hypomagnesemia, and polyuria. Urine studies indicated increased potassium excretion. A diagnosis of BLS was made. Polymyxin-B was discontinued, and the patient's electrolytes normalized. She was discharged with daily potassium and magnesium supplements.

Clinical discussion: BLS can result from polymyxin-B-induced tubular dysfunction characterized by hypokalemia and hypomagnesemia. Early recognition allowed for the timely discontinuation of polymyxin-B, which rapidly reversed her electrolyte disturbances.

Conclusion: This case underscores the importance of recognizing polymyxin-B-induced BLS. Clinicians should be vigilant for electrolyte disturbances in patients receiving treatment with polymyxin-B, ensuring timely interventions to mitigate adverse outcomes.