Annals of Medicine and Surgery最新文献

Background: Accurately diagnosing thyroid nodules is vital for preventing unnecessary surgeries and providing prompt therapy. Although fine-needle aspiration cytology (FNAC) and ultrasonography (US) are widely used diagnostic methods, their reliability is questioned. This study investigates the effectiveness of US and FNAC in thyroid nodule diagnosis and differentiates benign from malignant nodules in relation to final histopathological diagnosis.

Method: A retrospective study including 307 adult patients with thyroid diseases who underwent neck US and FNAC before surgery was conducted between April 2019 and May 2023. The diagnostic efficacy of US, FNAC, and their combination usage was compared to histopathological results.

Result: Histopathological findings revealed that 187 (61%) cases were benign, while 120 (39%) were malignant. The US features of 'taller-than-wider' forms and hypoechoic appearance had the highest diagnostic accuracy in characterizing malignant thyroid nodules, with 83 and 73% accuracy, respectively. The combination of US parameters demonstrated high sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 88.33, 63.10, 60.6, and 89.4%, with a statistically significant area under the ROC curve (AUC: 0.828, P<0.001) than individual parameters. FNAC's sensitivity, specificity, PPV NPV, and accuracy in detecting malignant lesions were 50, 95, 86, 75, and 77%, respectively, with acceptable discrimination and statistical significance (AUC: 0.723, P<0.0001). The combination of US parameters and FNAC significantly improved the AUC value (AUC: 0.878, P<0.0001), sensitivity (83.33%), and specificity (79.14%). Univariate analysis showed that hypoechoic appearance, heterogenicity, large mass size (>4 cm), 'taller-than-wider', infiltrative margins, and microcalcifications were risk factors for malignancy in thyroid nodules and were statistically significant (all P-values <0.05).

Conclusion: Combining US characteristics with FNAC results can afford the maximum analytical accuracy in distinguishing benign from malignant thyroid nodules. This strategy is practical due to its simplicity, minimal invasiveness, and cost-effectiveness, enabling robust management regimens and avoiding additional surgical procedures.

Objective: The aim of this study was to investigate the potential inflammatory cytokines and chemokines markers for temporomandibular joint osteoarthritis (TMJOA) diagnosis using a bioinformatics analysis.

Methods: The differentially expressed genes of mRNA (DEGs) and transcripts of lncRNA (DETs) were identified between TMJOA samples and normal controls curated from GSE205389 by the "DESeq. 2" R package. KEGG and GO were conducted using the R package "ggplot2" and "clusterProfiler". A PPI network was constructed to identify hub genes by using the STRING and Cytoscape. The co-expression network was constructed between mRNA and lncRNA to check the potential regulation and function of lncRNA on protein-coding genes. Finally, the immune cell infiltration analysis was conducted with CIBERSORTx and confirmed with xCells.

Results: The authors identified 171 DEGs and DETs, of which the DEGs were closely related to immune response, T-cell activation, cytokine-cytokine-receptor interaction, and the muscle system process. PPI network of the DEGs screened the top 10 hub genes, including IL6, IL1B, IL10, CCL2, CCL5, CXCL1, CXCL10, ICAM1, CSF1 and MMP1. Additionally, the immune cell infiltration analysis showed that CD8⁺ T cells, M1 macrophage and B cells infiltration were increased in TMJOA samples. Finally, the authors demonstrated that the co-expression between mRNA and lncRNA was mainly enriched in inflammatory and muscle-related pathways.

Conclusions: The authors found that immune and muscle system-related pathways as well as the immune infiltration played a significant role in the TMJOA development. Additionally, inflammatory cytokines and chemokines could be crucial markers for early-stage TMJOA diagnosis and personalized treatment strategies.

Introduction: Thymus is a primary lymphoid organ which has an important role in humoral and cellular immunity. It can be a site for various neoplasms including thymomas.

Case presentation: The authors report a case of a 55-year-old patient presenting with weight loss, night sweats and sensation of heat. After thorough evaluation his histopathology analysis revealed the rare presence of Hodgkin lymphoma in a background of type B2 thymoma.

Discussion: Thymoma is one of the well-known thymic tumors that is encountered in clinical practice. It has diverse associations with other autoimmune diseases and malignancies. The concurrent diagnosis of thymoma with thymic Hodgkin lymphoma is extremely rare.

Conclusion: Although this association is very rare, it is crucial to distinguish between thymic Hodgkin lymphoma and thymoma and manage them appropriately.

Background: The increasing use of double J ureteral stents (DJS) has increased the risk of early intolerance and long-term complications. Studies have reported stent colonization rates ranging from 19 to 90% with various bacterial profiles in the colonization of stents.

Objectives: To identify the risk factors associated with bacterial colonization of DJS and report the common micro-organisms isolated and drug susceptibility pattern.

Methods: This study is a prospective study of patients who underwent DJS. A total of 48 patients from our institution were studied between March 2022 and August 2023. After the removal of DJS with a sterile technique, the tips of both ends (renal end and bladder end) of the stent were cut and processed in the microbiology lab.

Results: Bacterial colonies were detected in 56.25% (27 out of 48) of the stents. Among the pathogens identified, Enterococcus species, Pseudomonas aeruginosa and E. coli were the most frequently isolated. The colonization rate increased with the duration of stent placement and albuminuria.

Conclusions: The study indicated that prolonged indwelling time and albuminuria are a risk factor for bacterial colonization on the stent therefore, it is advisable to use double J ureteral stent only when absolutely necessary and to remove them promptly.

Background: Autism spectrum disorder (ASD) is characterized by social disabilities and stereotyped behaviors. There is a relevant social impact on autistic people's lives and, therefore, biomarkers have become relevant for understanding neurobiological mechanisms.

Objective: This study aims to review current knowledge about the role of biomarkers and their main scientific evidence in autism.

Methods: The authors performed a non-systematic literature review through the PubMed database, using the keywords "biomarkers", "autism" and "autism spectrum disorder". The search was restricted to articles written in English, in the last 10 years.

Results: Analyzing the articles found, it is possible to delimit the biomarkers according to the development of ASD, from the prenatal period with exposure to diseases or association of autism with other genetic diseases, through the immune and nutritional factors exposed during pregnancy, and for end those associated with diagnoses phase in which there is the presence of symptoms in which these markers can be used to aid in the diagnosis.

Conclusion: Although preliminary, biomarkers may hold promise for prenatal and presymptomatic screening. It may also be used as predictors of treatment for autism spectrum disorder.

Introduction and importance: Deep-located glomangiomas are rarely reported. Because of their scarcity, treatment strategy is hard to establish. Herein, the authors report the first case to our knowledge of pre-sacral glomangioma.

Case presentation: A 34-year-old female patient, with no previous medical history, consulted for 2-month-old pelvic abdominal pain, vomiting and delayed menstruation. Her physical and biological parameters were with no abnormalities. MRI of the pelvis demonstrated a 14 cm mixed heterogeneous pre-sacral lesion pushing the rectum anteriorly. She was operated on via a laparoscopic approach. Division of Douglas' pouch and pelvic peritoneum laterally to the bladder showcased a cystic lesion of 13×8 cm occupying the pelvis while deviating the rectum anteriorly. Its content was aspirated and left membrane was extracted in a sac. The postoperative course was uneventful.

Discussion: Pre-sacral masses are hard to treat because of their large heterogeneity. Surgical resection should be tempted to retrieve the definitive histological diagnosis and relieve the patient. However, the surgical route is controversial as each approach has its advantages. Thus, the surgical route should take into consideration the lesion's size, height and surrounding contacts, the patient's functional state and surgeon's expertise.

Conclusion: Pre-sacral glomangiomas carries a low malignant pattern but should be resected to offer histological diagnosis. The surgical route remains at the surgeon's decision, with the main objective to totally resect the encountered lesion without causing functional and sexual complications or harm to surrounding viscera.

Introduction: Subvalvular aortic stenosis (SAS) is a rare heart condition that can cause LVOT obstruction and lead to serious complications. While surgery is the main treatment, recurrence is a concern. This case series highlights the challenges in managing SAS in young patients.

Case series: Three young brothers presented with symptoms of shortness of breath and chest tightness. All were diagnosed with membranous SAS through echocardiography and Doppler ultrasound. Surgical intervention was performed to remove the obstruction, but all three patients experienced recurrence within 2 years.

Discussion: This case series of three brothers suggests a genetic predisposition. Symptoms included exertional dyspnea and chest tightness, diagnosed via echocardiography. Surgical intervention is the primary treatment, but its timing is debated due to recurrence risks and complications.

Conclusions: This case series suggests a possible genetic predisposition to SAS. Despite successful initial surgery, the high recurrence rate highlights the need for improved management strategies and long-term follow-up. Further research is crucial to understand the causes of recurrence and optimize treatment for children with SAS.

Being an extremely high mortality rate condition, cardiac arrest cases have rightfully been evaluated via various studies and scoring factors for effective resuscitative practices and neurological outcomes postresuscitation. This narrative review aims to explore the role of artificial intelligence (AI) in predicting neurological outcomes postcardiac resuscitation. The methodology involved a detailed review of all relevant recent studies of AI, different machine learning algorithms, prediction tools, and assessing their benefit in predicting neurological outcomes in postcardiac resuscitation cases as compared to more traditional prognostic scoring systems and tools. Previously, outcome determining clinical, blood, and radiological factors were prone to other influencing factors like limited accuracy and time constraints. Studies conducted also emphasized that to predict poor neurological outcomes, a more multimodal approach helped adjust for confounding factors, interpret diverse datasets, and provide a reliable prognosis, which only demonstrates the need for AI to help overcome challenges faced. Advanced machine learning algorithms like artificial neural networks (ANN) using supervised learning by AI have improved the accuracy of prognostic models outperforming conventional models. Several real-world cases of effective AI-powered algorithm models have been cited here. Studies comparing machine learning tools like XGBoost, AI Watson, hyperspectral imaging, ChatGPT-4, and AI-based gradient boosting have noted their beneficial uses. AI could help reduce workload, healthcare costs, and help personalize care, process vast genetic and lifestyle data and help reduce side effects from treatments. Limitations of AI have been covered extensively in this article, including data quality, bias, privacy issues, and transparency. Our objectives should be to use more diverse data sources, use interpretable data output giving process explanation, validation method, and implement policies to safeguard patient data. Despite the limitations, the advancements already made by AI and its potential in predicting neurological outcomes in postcardiac resuscitation cases has been quite promising and boosts a continually improving system, albeit requiring close human supervision with training and improving models, with plans to educate clinicians, the public and sharing collected data.

Background: Depression is prevalent among patients with end-stage renal disease (ESRD) undergoing dialysis, with significant implications for their quality of life and treatment compliance. Traditional treatments for depression, including various therapies and pharmacological interventions, have limitations due to their adverse effects. Sertraline, a selective serotonin re-uptake inhibitor (SSRI), offers a promising alternative, but its efficacy and safety in this population require thorough evaluation.

Objective: This meta-analysis aims to assess the effectiveness and adverse effects of sertraline in treating depressive episodes in dialysis patients compared to placebo.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors conducted a comprehensive search of databases, including PubMed, Cochrane Library, and Science Direct, up to 20 June 2024. The authors included randomized controlled trials (RCTs) that compared sertraline with placebo in dialysis patients with depression. Two researchers independently performed data extraction and risk of bias assessment. Statistical analysis was conducted using ReviewManager 5.4.1, employing a random effects model.

Results: Four RCTs involving 468 participants were included. Sertraline significantly reduced depressive symptoms, as measured by the Quick Inventory of Depressive Symptomatology (QIDS) and Beck Depression Inventory-II (BDI-II) scores, at 6 and 12 weeks compared to placebo. Improvements in kidney disease-specific quality of life (KDQOL-36) scores were also noted. However, sertraline was associated with a higher risk of adverse events compared to placebo.

Conclusions: Sertraline effectively reduces depressive symptoms and improves the quality of life in dialysis patients with ESRD. Despite the increased risk of adverse events, the overall benefits make sertraline a viable treatment option for this population. Larger, more comprehensive studies are needed to confirm these findings and optimize sertraline use in clinical practice.