World journal of methodology最新文献

Hepatic ischemia-reperfusion injury is an important mechanism of liver failure that occurs in many clinical conditions, including massive hemorrhage, major hepatectomy and liver transplantation, and leads to poor outcomes. The underlying cellular and molecular reactions are extremely complex and not completely understood. Anaerobic metabolism, ATP depletion, intracellular acidosis, calcium overload, mitochondrial dysfunction, oxidative stress, activation of Kupffer cells and neutrophils, platelet aggregation, nitric oxide production, activation of the complement system and overexpression of cytokines and chemokines constitute the main pathophysiological actions and pathways for possible therapeutic strategies. Prostaglandins (PGs) are a group of biologically active lipid compounds called eicosanoids with many physiological activities. Prostacyclin (PGI₂) is a member of the PGs family with an unstable chemical structure and a very short half-life. PGI₂ has potent vasodilating activity, inhibits platelet activation and exerts anti-inflammatory effects. PGI₂ has been evaluated in chronic liver disease as a mediator of hepatic stellate cell function, an antiproliferative and antifibrotic agent and a regulator of the hepatic microcirculation. In recent decades, the cytoprotective effects of PGI₂ analogs on hepatic ischemia-reperfusion injury have been experimentally and clinically studied. Moreover, the administration of synthetic PGI₂ analogs to patients who underwent liver transplantation produced very encouraging results. The downregulation of PGE₂ production, reduction of neutrophil aggregation in liver lobules, regulation of local microcirculatory homeostasis, improvement in mitochondrial function, alleviation of hepatic oxidative stress, suppression of the c-Jun N-terminal kinase and p38 cascades and downregulation of tumor necrosis factor-alpha and interleukin-1β production constitute some of the underlying physiological mechanisms of the beneficial effects of PGI₂ on hepatic ischemia-reperfusion injury. Thus, PGI₂ analogs appear to hold great promise for the management of hepatic ischemia-reperfusion injury, but further research is needed.

Background: Meta-analysis is a critical tool in evidence-based medicine, particularly in cardiology, where it synthesizes data from multiple studies to inform clinical decisions. This study explored the potential of using ChatGPT to streamline and enhance the meta-analysis process.

Aim: To investigate the potential of ChatGPT to conduct meta-analyses in interventional cardiology by comparing the results of ChatGPT-generated analyses with those of randomly selected, human-conducted meta-analyses on the same topic.

Methods: We systematically searched PubMed for meta-analyses on interventional cardiology published in 2024. Five meta-analyses were randomly chosen. ChatGPT 4.0 was used to perform meta-analyses on the extracted data. We compared the results from ChatGPT with the original meta-analyses, focusing on key effect sizes, such as risk ratios (RR), hazard ratios, and odds ratios, along with their confidence intervals (CI) and P values.

Results: The ChatGPT results showed high concordance with those of the original meta-analyses. For most outcomes, the effect measures and P values generated by ChatGPT closely matched those of the original studies, except for the RR of stent thrombosis in the Sreenivasan et al study, where ChatGPT reported a non-significant effect size, while the original study found it to be statistically significant. While minor discrepancies were observed in specific CI and P values, these differences did not alter the overall conclusions drawn from the analyses.

Conclusion: Our findings suggest the potential of ChatGPT in conducting meta-analyses in interventional cardiology. However, further research is needed to address the limitations of transparency and potential data quality issues, ensuring that AI-generated analyses are robust and trustworthy for clinical decision-making.

We report a unique case of bilateral femoral stem fractures in a patient with Dorr A femoral morphology, underscoring the need for a critical reassessment of implant selection strategies. The initial failure involved a cemented revision stem placed using the cement-within-cement technique combined with an extended trochanteric osteotomy (ETO). A second revision was subsequently performed using a cortical window osteotomy and a distally fixed uncemented stem, which resulted in successful recovery. A similar approach was used to treat a subsequent contralateral stem fracture, also with favorable outcomes. This case emphasizes three key considerations: First, that standard-length cemented stems may lead to oversizing and increased stress concentration in Dorr A femurs with narrow canals; second, that ETO may compromise femoral integrity and contribute to implant failure; and third, that cortical window osteotomy enables safer implant removal and reimplantation. Based on these findings, we advocate for an individualized approach to implant selection that may include cemented short stems, uncemented short stems, or modular solutions depending on femoral anatomy and patient-specific factors, and we encourage further investigation into optimal fixation strategies for patients with Dorr A femoral morphology.

The World Medical Association's Declaration of Helsinki (DoH) serves as a key document of ethical guidance advocating principles of medical research involving human participants. Since its inception in 1964, the DoH has undergone several revisions, reflecting a dynamic evolution in our understanding of research ethics, spurred by gaps identified within the document, harms discovered, challenges identified during ongoing research activities, scientific advancements and societal shifts in values. The DoH addresses a challenge and a conflict that may arise between two key aspects of medical research: On one hand, the fundamental obligation of physicians to do no harm, and on the other, the essential need to ensure the efficacy and safety of medical interventions by testing them on human research participants or healthy volunteers. With each revision, increasing emphasis is given to distributive justice and beneficence and not only to patient autonomy. Despite being a comprehensive and concise document, occasional criticism is reported, such as with regards to the impracticability of obtaining informed consent amongst other challenges. This essay will examine the key changes across the DoH's iterations, highlighting the progressive strengthening of participant protection and the evolving relationship between research, societal benefit, and individual rights.

The authors employed inappropriate search keywords and strategies in their published bibliometric papers within volume 29 of the World Journal of Gastroenterology. The comment highlights the identified issues, provides evidence, and suggests improved study methodologies. Subsequent results with more appropriate search strategies were presented to address the shortcomings.

Background: Gastrointestinal (GI) manifestations are prevalent in genetic myopathies, posing significant diagnostic and management challenges.

Aim: To synthesize evidence on the diagnostic approaches, management strategies, patient perspectives, and future research directions regarding GI symptoms in genetic myopathies.

Methods: A systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. We searched PubMed, Scopus, EMBASE, and Web of Science from inception to December 2024. Eligible studies reported GI manifestations in genetic myopathies, including clinical evaluations, imaging, physiological tests, histopathology, and genetic analyses. Inclusion criteria encompassed original research studies, review articles, case reports, and clinical guidelines published in peer-reviewed journals. Exclusion criteria included conference abstracts without full-text availability and non-peer-reviewed sources. Two independent reviewers screened studies and extracted data. They assessed methodological quality using the Newcastle-Ottawa Scale for observational studies, A MeaSurement Tool to Assess Systematic Reviews for systematic reviews, and the Joanna Briggs Institute checklist for case reports. A systematic narrative synthesis was employed to summarize the findings.

Results: A total of 234 studies met the inclusion criteria. GI manifestations varied widely, with dysphagia, gastroesophageal reflux, abdominal pain, constipation, diarrhea, and fecal incontinence being the most frequently reported symptoms. The included studies highlighted a multidisciplinary diagnostic approach incorporating clinical assessment, imaging, physiological testing, histopathology, and genetic testing. Management strategies ranged from dietary interventions and rehabilitative therapies to pharmacological treatments and surgical procedures. Patient perspectives underscored the significant impact of GI symptoms on quality of life, social interactions, and emotional well-being. The main limitations of the included studies were high heterogeneity in study design, small sample sizes, and the potential risk of bias due to limited methodological rigor in some reports.

Conclusion: This review underscores the complexity of GI manifestations in genetic myopathies and the need for a comprehensive, multidisciplinary management approach. Future research should focus on elucidating molecular mechanisms, identifying biomarkers, and developing targeted therapies to improve patient outcomes. The findings have implications for both clinical practice and public health, emphasizing the necessity of early diagnosis and personalized management strategies.

Background: Dry eye disease (DED) represents a multifactorial condition characterized by ocular discomfort and visual disturbances. The management of DED relies heavily on accurate diagnosis to tailor effective treatments. Diagnostic approaches encompass both subjective and objective assessments.

Aim: To review the diagnostic methods used in the process of dry eye disease management.

Methods: A comprehensive review of diagnostic approaches for dry eye was performed using scientific databases. Studies published within the last four years were considered. Studies were excluded if a full text was absent or the article was not written in English. Articles were assessed for relevancy, and a total of 107 studies were selected. The selection method used a systematic methodology, which guaranteed an exhaustive assessment of the diagnostic techniques reported in current literature. The study adheres to principles for systematic reviews ensuring dependability and accuracy. The studies were assessed for emphasize on both novel traditional and diagnostic methods for dry eye disease management.

Results: Key objective tests include tear break-up time, which evaluates tear film stability; fluorescein and lissamine green staining, which assess ocular surface damage and inflammation; tear osmolarity measurement, indicative of tear film quality; and tear volume assessment via Schirmer's test, which evaluates tear production. Advanced imaging techniques such as optical coherence tomography and meibography offer detailed anatomical insights into the ocular surface and meibomian glands, aiding in the diagnosis of underlying structural abnormalities. Moreover, emerging technologies such as matrix metalloproteinase-9 testing and inflammatory biomarkers provide additional diagnostic precision, particularly in identifying inflammatory components of DED.

Conclusion: Integrating a combination of subjective and objective diagnostic tools allows clinicians to comprehensively assess the condition, tailor treatment plans, and monitor therapeutic efficacy. Continued advancements in diagnostic technologies promise to enhance our understanding and management of this prevalent ocular condition.

Background: Neoadjuvant therapy can reduce the size of gastroesophageal tumors to the extent that they are no longer macroscopically visible. This may increase the risk of microscopic-positive resection margins. One potential method to reduce this uncertainty could be the preoperative endoscopic marking of proximal tumor margins with BioXmark^®, a novel liquid fiducial marker. This study aimed to report the initial experiences of the first ten patients marked with BioXmark^®.

Aim: To evaluate the visibility of BioXmark^® on ultrasound after preoperative marking of the proximal resection line of an esophageal tumor.

Methods: The circumference of the esophagus was endoscopically marked preoperatively with a fiducial marker in four quadrants, 5 cm proximal to the tumor. During the surgery, the surgeon's proposed proximal resection line was marked. Next, an ultrasound probe was used to identify the previously placed fiducial markers, and its placement was marked. The difference between the surgeon's proposed resection line and the fiducial marker was measured intraoperatively and subsequently examined with respect to the resection margin and status.

Results: BioXmark^® was implanted in ten patients, 5 cm proximal to the tumor. The surgeon's proposed resection line was positioned 2-6 cm proximally to the surgical marker line. Technical success of injecting the fiducial marker was achieved in all ten patients. In six patients, the marker was successfully identified intraoperatively on ultrasound. No peri- or postoperative adverse events related to BioXmark^® implantation were found.

Conclusion: Excellent technical success with the implantation of the fiducial surgical marker was achieved, but limited intraoperative visibility on ultrasound was achieved. Further studies are required to optimize its clinical application.

Background: Nikethamide, a respiratory stimulant, is used to treat hypoxemia caused by coronavirus disease 2019 (COVID-19), but it carries a risk of convulsions. Magnesium sulfate (MgSO₄), a seizure inhibitor, might serve as a rescue agent against nikethamide-induced seizures.

Aim: To investigate the therapeutic effect of MgSO₄ on nikethamide -induced seizures in COVID-19 patients through animal experiments, providing experimental support for the clinical application of MgSO₄ in preventing and treating seizures caused by nikethamide.

Methods: Forty mice were randomly divided into four groups: (1) Physiological saline; (2) Low-dose MgSO₄ (50 mg/kg); (3) Medium-dose MgSO₄ (100 mg/kg); and (4) High-dose MgSO₄ (200 mg/kg). After 15 minutes of intraperitoneal injection of different doses of MgSO₄ or an equal volume of physiological saline, the mice were injected with nikethamide (250 mg/kg).

Results: Compared to the normal saline group, all doses of MgSO₄ significantly prolonged the seizure latency and reduced the severity of convulsions. However, they also extended the duration of seizures and correspondingly increased survival time (P < 0.05). The incidence of seizures and mortality rate in the MgSO₄-treated groups were significantly lower than those in the normal saline group (P < 0.05).

Conclusion: MgSO₄ can prevent and treat seizures caused by nikethamide in mice. This finding has implications for the application of MgSO₄ in treating and preventing seizures caused by nikethamide in COVID-19 treatment.