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Background: Hypersensitivity reactions (HSRs) can occur unexpectedly and be life-threatening when gadolinium-based contrast agents (GBCAs) are used. Gadolinium deposition disease (GDD) and symptoms associated with gadolinium exposure (SAGE) have been controversial for a long time. However, similar studies are currently incomplete or outdated. Therefore, comparing the safety of different GBCAs in terms of HSRs and GDD/SAGE using the latest post-marketing safety data should yield further insights into safely using GBCAs., Methods: The safety differences between all GBCAs to GDD and the spectrum of GBCA-related HSRs were all compared and analyzed by using the World Health Organization database VigiBase and the FDA Adverse Event Reporting System (FAERS) database in this study. A further analysis of SAGE was also conducted using FAERS data. The lower limit of the reporting odds ratio (ROR) 95% confidence interval was used for signal detection. Moreover, the frequency of HSRs was calculated by dividing the number of reports in VigiBase by the total sales volume (measured in millions) from 2008 to 2022 in the IQVIA Multinational Integrated Data Analysis System. All adverse events were standardized using the Medical Dictionary for Drug Regulatory Activities (MedDRA) 26.0., Results: This study shows that all GBCAs have the potential to induce HSRs, with nonionic linear GBCAs exhibiting a comparatively lower signal. According to standardized MedDRA query stratification analysis, gadobutrol had a greater ROR 025 for angioedema. The ROR 025 of gadobenate dimeglumine and gadoteridol is larger for anaphylactic/anaphylactoid shock conditions. Regarding severe cutaneous adverse reactions, only gadoversetamide and gadodiamide showed signals in FAERS and VigiBase. There were also differences in the frequency of HSRs between regions. Regarding GDD, gadoterate meglumine, and gadoteridol had a lower ROR 025 . An analysis of the 29 preferred terms linked to SAGE indicated that special consideration should be given to the risk of skin induration associated with gadoversetamide, gadopentetate dimeglumine, gadobenate dimeglumine, gadodiamide, and gadoteridol. Additionally, gadodiamide and gadoteridol pose a greater risk of skin tightness compared to other GBCAs., Conclusions: The risk differences among GBCAs using data from several sources were compared in this study. However, as a hypothesis-generating method, a clear causal relationship would require further research and validation., (© 2024. The Author(s).)

Objective: The escalating prevalence of chronic pain poses a substantial socio-economic burden. Chronic pain primarily stems from musculoskeletal and nervous system impairments. Given cadmium's known toxicity to these systems, our study sought to investigate the correlation between blood cadmium levels and chronic pain., Methods: The cross-sectional study was conducted from the National Health and Nutrition Examination Survey (NHANES, 1999-2004), and comprised US adults who participated in a chronic pain interview. We employed logistic regression models and smooth curve fitting to elucidate the relationship between blood cadmium levels and chronic pain., Results: Our findings revealed a linear association between blood cadmium levels and chronic pain. Compared to the lower blood cadmium tertile 1 (<0.3 ug/dL), the adjusted odds ratios (ORs) for tertile 2 (0.3-0.4 ug/dL), and tertile 3 (≥0.5 ug/dL), were 1.11 (0.96-1.29) and 1.2 (1.03-1.39), respectively. Sensitivity analyses corroborated these results., Conclusion: Elevated levels of blood cadmium are associated with a heightened risk of chronic pain among adults in the United States. Mitigating cadmium exposure could potentially decrease the risk of chronic pain, thereby enhancing strategies for chronic pain prevention and management., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mi, Dong, Chen, Gao, Cao, Liu, Wang and Fan.)

Endovascular therapy (EVT) is effective in the treatment of large vascular occlusive stroke. However, many factors are associated with the outcomes of acute ischemic stroke (AIS) after EVT. This study aimed to identify the main factors related to the prognosis of AIS patients after EVT. We analyzed the clinical data of AIS patients in the neurology department of our medical center from June 2017 to August 2021 following treatment with EVT. The data included the patients' blood pressure upon admission, blood glucose concentration, National Institutes of Health Stroke Scale (NIHSS) score, 90-day modified Rankin scale (mRs) score follow-up data, and time from LKN to the successful groin puncture (GP). A good outcome was defined as a 90-day mRs score of 0-2, and a poor outcome was defined as a 90-day mRs score of 3-6. A total of 144 patients were included in the study. Admission, smoking, and LKN-to-GP time, NIHSS score of 6-12 was found to be relevant to the prognosis. The results of multivariate analysis showed that prognosis was significantly influenced by baseline NIHSS (odds ratio = 3.02; 95% confidence interval, 2.878-4.252; P = 0.001), LKN-to-GP time (odds ratio = 2.17; 95% confidence interval, 1.341-2.625; P = 0.003), and time stratification (6-12 h) (odds ratio = 4.22; 95% confidence interval, 2.519-5.561; P = 0.001). Our study indicated that smoking, baseline NIHSS score, and LKN-to-GP time were the risk factors for a poor outcome in stroke patients following an EVT. Quitting smoking and shortening LKN time to GP should improve the outcome of AIS after EVT., (© 2024. The Author(s).)

Background: Acetaminophen overdose is one of the leading causes of acute liver failure in the USA. In this study, we investigated the impact of race and gender on the hospital outcomes of patients admitted with acetaminophen-induced acute liver failure., Methods: From the National Inpatient Sample between the years 2016 and 2019, patients with acetaminophen-induced acute liver failure were selected and stratified based on gender (Male and Female) and race (White, Black and Hispanic). The cases were propensity score-matched to controls (male and Whites) and were compared along the following endpoints: mortality, length of stay, hospitalization costs, and hepatic complications., Results: Among patients with acetaminophen-induced acute liver failure, females experienced higher rates of mortality (16.60% vs. 11.70%, P = 0.004) and clinical illness, including hypotension (11.80% vs. 7.15%, P = 0.002) and ventilator use (40.80% vs. 30.00%, P < 0.001). When stratified by race, Black patients had longer hospital stays (Black vs. White, 8.76 days vs. 7.46 days, P = 0.03). There were no significant differences in outcomes between Hispanic and White patients. No significant differences in mortality were shown between races., Conclusion: We found that females had a higher rate of mortality and incidence of hepatic encephalopathy compared to males. When stratified by race, Blacks were shown to have longer hospital stay. Females and racial minorities were also affected by special healthcare needs after discharge compared to their male and White cohorts, respectively., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

To determine the association between hearing loss and environmental Pb, Cd and Se exposure, a total of 1503 American adults from National Health and Nutrition Examination Survey (NHANES) (2011-2012) were assessed. The average of four audiometric frequencies (0·5, 1, 2 and 4 kHz) was used to identify speech-frequency hearing loss (SFHL), while the average of 3 audiometric frequencies (3, 4 and 6 kHz) was used to identify high-frequency hearing loss (HFHL). HFHL adjusted OR determined by comparing the highest and lowest blood Pb and Cd quartiles were 1·98 (95 % CI: 1·27, 3·10) and 1·81 (95 % CI: 1·13, 2·90), respectively. SFHL was significantly associated with blood Cd with the OR = 2·42 for the highest quartile. When further stratified by age, this association appeared to be limited to adults aged 35-52 years. After stratified by gender, except for Pb and Cd, we observed that blood Se showed a dose-dependent association with SFHL in men. In women, only Cd showed a dose-dependent association with speech and high-frequency hearing loss. Hearing loss was positively associated with blood levels of Pb and Cd. Additionally, our study provided novel evidence suggesting that excessive Se supplement would increase SFHL risk in men.

Objectives: To investigate the correlation between lymph node metastasis (LNM) and various clinicopathological features of pancreatic neuroendocrine tumors (pNETs) and its impact on prognosis., Methods: We searched the Surveillance Epidemiology and End Results database (2004-2015) for patients with surgically treated pNETs. Factors correlated with LNMs were analyzed by logistic regression and by Cox analysis., Results: For tumors of 1 to 4 cm, age (P < 0.001, P = 0.014), grade (P < 0.001, P < 0.001), LNMs (P = 0.008, P < 0.001), and size (P = 0.038, P = 0.002) predicted overall survival (OS) and disease-specific survival (DSS). For tumor greater than 4 cm, age (P < 0.001, P = 0.001) and grade (P = 0.011, P = 0.048) were independent prognostic factors of OS and DSS. Lymph node metastasis modestly predicted DSS (P = 0.028) but not OS (P = 0.218)., Conclusions: In pNETs greater than 4 cm, LNM is not a predictor of OS and modestly predicts DSS, and lymphadenectomy may be unhelpful in these patients. For pNETs 1 to 4 cm, LNM predicts poor OS and DSS, which supports lymphadenectomy in these patients. Pancreas-sparing resection with only limited peripancreatic node sampling needs to be questioned.

Aim: To conduct a scientometric assessment of the research activities of spinal fusion in various subspecialties carried out by different surgeons., Material and Methods: All articles regarding spinal fusion research on Web of Science from the year 1994 to 2015 were identified and analyzed in the following aspects: year of publication, publication journal, number of times cited, Hirsch index (H-index), spine surgeon specialty, and country/territory., Results: A total of 15060 articles were identified, and the research productivity of spinal fusion has grown steadily over the last two decades. The average research productivity of spinal fusion each year was 109.09 ± 23.26 articles for cervical spine, 90.09 ± 52.56 articles for thoracic spine, and 304.91 ± 181.63 articles for lumbar. The research productivity of spinal fusion by neurosurgeons was 9474 articles published, while the orthopedic surgeons published 8263 articles. The average number of citations for spinal fusion articles was 19.61 times for neurosurgeons, and 20.36 times for orthopedic surgeons. In most countries neurosurgoens published more spinal fusion articles than orthopedic surgeons or at least the same amount, but orthopedic surgeons in China and Germany published far more spinal fusion articles ( > 100) than neurosurgeons. The United States published the greatest number of articles (6819/15060, 45.28%), followed by China (1280/15060, 8.50%) and Germany (1252/15060, 8.31%), and had the highest total citations (164378) and H-index (144)., Conclusion: Neurosurgeons tend to publish more articles regarding spinal fusion, but orthopedic surgeons seem to have higher citations. North America, West Europe and East Asia were the most productive regions in spinal fusion research, and the United States made the most academic contributions to this area.

Objectives: To assess bone marrow (BM) sampling in academic medical centers., Methods: Data from 6,374 BM samples obtained in 32 centers in 2001 and 2011, including core length (CL), were analyzed., Results: BM included a biopsy (BMB; 93%) specimen, aspirate (BMA; 92%) specimen, or both (83%). The median (SD) CL was 12 (8.5) mm, and evaluable marrow was 9 (7.6) mm. Tissue contraction due to processing was 15%. BMB specimens were longer in adults younger than 60 years, men, and bilateral, staging, and baseline samples. Only 4% of BMB and 2% of BMB/BMA samples were deemed inadequate for diagnosis. BM for plasma cell dyscrasias, nonphysician operators, and ancillary studies usage increased, while bilateral sampling decreased over the decade. BM-related quality assurance programs are infrequent., Conclusions: CL is shorter than recommended and varies with patient age and sex, clinical circumstances, and center experience. While pathologists render diagnoses on most cases irrespective of CL, BMB yield improvement is desirable.

This work studies retinal image registration in the context of the National Institutes of Health (NIH) Early Treatment Diabetic Retinopathy Study (ETDRS) standard. The ETDRS imaging protocol specifies seven fields of each retina and presents three major challenges for the image registration task. First, small overlaps between adjacent fields lead to inadequate landmark points for feature-based methods. Second, the non-uniform contrast/intensity distributions due to imperfect data acquisition will deteriorate the performance of area-based techniques. Third, high-resolution images contain large homogeneous nonvascular/texureless regions that weaken the capabilities of both feature-based and area-based techniques. In this work, we propose a hybrid retinal image registration approach for ETDRS images that effectively combines both area-based and feature-based methods. Four major steps are involved. First, the vascular tree is extracted by using an efficient local entropy-based thresholding technique. Next, zeroth-order translation is estimated by maximizing mutual information based on the binary image pair (area-based). Then image quality assessment regarding the ETDRS field definition is performed based on the translation model. If the image pair is accepted, higher-order transformations will be involved. Specifically, we use two types of features, landmark points and sampling points, for affine/quadratic model estimation. Three empirical conditions are derived experimentally to control the algorithm progress, so that we can achieve the lowest registration error and the highest success rate. Simulation results on 504 pairs of ETDRS images show the effectiveness and robustness of the proposed algorithm.