Empathic pain: Exploring the multidimensional impacts of biological and social aspects in pain.

Empathic pain refers to an individual's perception, judgment, and emotional response to others' pain. This complex social cognitive ability is crucial for healthy interactions in human society. In recent years, with the development of multidisciplinary research in neuroscience, psychology and sociology, empathic pain has become a focal point of widespread attention in these fields. However, the neural mechanism underlying empathic pain remain a controversial and unresolved area. This review aims to comprehensively summarize the history, influencing factors, neural mechanisms and pharmacological interventions of empathic pain. We hope to provide a comprehensive scientific perspective on how humans perceive and respond to others' pain experiences and to provide guidance for future research directions and clinical applications. This article is part of the Special Issue on "Empathic Pain".

Post intensive care syndrome: A review of clinical symptoms, evaluation, intervention.

Post intensive care syndrome (PICS) is a typical complication of critically ill patients during or after their stay in intensive care unit (ICU), characterized by a high incidence and impairment rate. It significantly impacts the quality of life of patients and their families, as well as consumes a substantial amount of medical resources. Therefore, early intervention and assessment of PICS is crucial. This paper aims to provide clinical professionals with a reference base by focusing on the clinical symptoms, diagnostic assessment, and preventative measures of PICS.

Depression in maintenance hemodialysis patients: What do we need to know?

Chronic kidney disease (CKD) is now recognized as a major public health problem in the world. The global prevalence of CKD is estimated at 13.4% (11.7-15.1%), with an estimated 490.2 to 7.083 million patients with End stage renal disease requiring renal replacement therapy. Hemodialysis is the main treatment for End stage renal disease patients because of its high safety and efficiency. The survival time of these patients was significantly prolonged, but many psychological problems followed. Depression is a type of mood disorder caused by a variety of causes, often manifested as disproportionate depression and loss of interest, sometimes accompanied by anxiety, agitation, even hallucinations, delusions and other psychotic symptoms. Depression has become the most common mental disorder in maintenance hemodialysis (MHD) patients according to the meta-analysis. In recent years, depression has seriously affected the quality of life and prognosis of MHD patients from dietary, sleep, treatment adherence, energy and other dimensions. This article reviews the epidemiology, etiology, diagnosis and treatment of depression in MHD patients.

The role of hormones in the pathogenesis and treatment mechanisms of delirium in ICU: The past, the present, and the future.

Delirium is an acute brain dysfunction. As one of the common psychiatric disorders in ICU, it can seriously affect the prognosis of patients. Hormones are important messenger substances found in the human body that help to regulate and maintain the function and metabolism of various tissues and organs. They are also one of the most commonly used drugs in clinical practice. Recent evidences suggest that aberrant swings in cortisol and non-cortisol hormones might induce severe cognitive impairment, eventually leading to delirium. However, the role of hormones in the pathogenesis of delirium still remains controversial. This article reviews the recent research on risk factors of delirium and the association between several types of hormones and cognitive dysfunction. These mechanisms are expected to offer novel ideas and clinical relevance for the treatment and prevention of delirium.

Desulfovibrio confers resilience to the comorbidity of pain and anxiety in a mouse model of chronic inflammatory pain.

BACKGROUND: Patients with chronic pain frequently suffer from anxiety symptoms. It has been well established that gut microbiota is associated with the pathogenesis of pain and anxiety. However, it is unknown whether the gut microbiota, particularly the specific bacteria, play a role in the comorbidity of chronic pain and anxiety. METHODS: Chronic inflammatory pain was induced in mice by a single injection of complete Freund's adjuvant (CFA). Mice were then separated into anxiety-susceptible and anxiety-resilient phenotypes by hierarchical clustering analysis of behaviors. Fecal samples were collected to perform 16S rRNA gene sequencing. Chronic diazepam intervention served as a therapeutic strategy and its effect on the composition of gut microbiota was also determined. RESULTS: α-Diversity and ß-diversity both showed significant differences among the groups. A total of 12 gut bacteria were both altered after CFA injection and reversed by chronic diazepam treatment. More importantly, the pain hypersensitivity and anxiety-like behaviors were relieved by chronic diazepam treatment. Interestingly, we also found that Desulfovibrio was increased in anxiety-resilient group compared to control and anxiety-susceptible groups. CONCLUSION: Abnormal composition of gut microbiota plays an essential role in chronic pain as well as in anxiety. Besides, the increased level of Desulfovibrio in anxiety-resilient mice indicated its therapeutic effects on the comorbidity of pain and anxiety. Collectively, targeting gut microbiota, especially increasing the Desulfovibrio level, might be effective in the alleviation of chronic pain-anxiety comorbidity.

Double contrast-enhanced ultrasound for the preoperative gross classification of gastric cancer: a comparison with multidetector computed tomography.

PURPOSE: To compare the diagnostic performance of double contrast-enhanced ultrasound (DCEUS) and multi-detector row computed tomography (MDCT) in the gross classification of gastric cancer (GC) preoperatively. METHODS: 54 patients with histology proved GC were included in this retrospective study. The sensitivity and specificity of DCEUS and MDCT for the gross classification of GC was calculated and compared. The area under the curve (AUC) from a receiver operating characteristic curve analysis was used to evaluate the difference of the diagnostic performance between these two methods. RESULTS: There were no significant differences between DCEUS and MDCT in terms of AUC for early gastric cancer (EGC), Borrmann I, II, III and Borrmann (III + IV) (P = 0.248, 0.317, 0.717, 0.464 and 0.594, respectively). The accuracy of DCEUS in diagnosing EGC, Borrmann I, II and Borrmann (III + IV) was higher than that of MDCT (96% vs 92%; 96% vs 94%; 87% vs 80%; 83% vs 73%), while in determining Borrmann III and IV, that of DCEUS was lower than that of MDCT (72% vs 74%; 89% vs 96%). CONCLUSION: Considering the revolution in clinical decision, prognosis evaluation, safety and non-invasion aspects, DCEUS can be used as the main alternative method for Borrmann classification of GC preoperatively.

Risk factors and prediction model of sleep disturbance in patients with maintenance hemodialysis: A single center study.

Objectives: This study aimed to explore the risk factors and develop a prediction model of sleep disturbance in maintenance hemodialysis (MHD) patients. Methods: In this study, 193 MHD patients were enrolled and sleep quality was assessed by Pittsburgh Sleep Quality Index. Binary logistic regression analysis was used to explore the risk factors for sleep disturbance in MHD patients, including demographic, clinical and laboratory parameters, and that a prediction model was developed on the basis of risk factors by two-way stepwise regression. The final prediction model is displayed by nomogram and verified internally by bootstrap resampling procedure. Results: The prevalence of sleep disturbance and severe sleep disturbance in MHD patients was 63.73 and 26.42%, respectively. Independent risk factors for sleep disturbance in MHD patients included higher 0.1*age (OR = 1.476, 95% CI: 1.103-1.975, P = 0.009), lower albumin (OR = 0.863, 95% CI: 0.771-0.965, P = 0.010), and lower 10*calcium levels (OR = 0.747, 95% CI: 0.615-0.907, P = 0.003). In addition, higher 0.1*age, lower albumin levels, and anxiety were independently associated with severe sleep disturbance in MHD patients. A risk prediction model of sleep disturbance in MHD patients showed that the concordance index after calibration is 0.736, and the calibration curve is approximately distributed along the reference line. Conclusions: Older age, lower albumin and calcium levels are higher risk factors of sleep disturbance in MHD, and the prediction model for the assessment of sleep disturbance in MHD patients has excellent discrimination and calibration.

Post-Intensive Care Syndrome: A Problem Cannot Be Ignored in ICU. Comment on Inoue et al. Prevalence and Long-Term Prognosis of Post-Intensive Care Syndrome after Sepsis: A Single-Center Prospective Observational Study. J. Clin. Med. 2022, 11, 5257.

Recently, we read with great interest the article by Inoue et al. [...].

Effect of the size of benign thyroid degenerative nodules on ACR TI-RADS categories.

PURPOSE: Our study aimed to identify ultrasound characteristics of benign thyroid degenerative nodules and reveal the correlation between their sizes and 2017 ACR Thyroid Imaging Reporting and Data System (TI-RADS) categories. METHODS: A total of 174 thyroid degenerative nodules were divided into three groups: 0.5-1 cm group (70 nodules), 1-2 cm group (27 nodules), and > 2 cm group (77 nodules). The ultrasound appearance of each nodule was evaluated, and the ACR TI-RADS scores and levels of the nodules were also calculated and compared among the three groups. RESULTS: The ultrasound appearance of degenerative nodules of different sizes is diversified, and the 0.5-1 cm group tended to have more malignant features and higher TI-RADS scores and categories. The scatterplot of Spearman correlation showed a significant negative correlation between the nodule sizes and TI-RADS categories. CONCLUSION: The 2017 ACR TI-RADS, which recommends fine-needle aspiration according to the nodule size and category, is still useful in managing these nodules, and following the clinical recommendations of ACR TI-RADS is necessary.

Evaluation of thyroid micro-carcinoma using shear wave elastography: Initial experience with qualitative and quantitative analysis.

PURPOSE: We aimed to assess the diagnostic performance of shear wave elastography (SWE) to assess perinodular stiffness before fine needle aspiration (FNA) of thyroid nodules with a maximum diameter of 1.0 cm. METHOD: This retrospective study included 69 thyroid nodules in 68 patients who underwent conventional ultrasound and SWE before ultrasound-guided FNA or surgical excision. The stiffness of perinodular regions was evaluated using wave patterns. Quantitative SWE features were also assessed. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were calculated using conventional ultrasound and conventional ultrasound with SWE. RESULTS: Of the 69 nodules, 57(82.6 %)were malignant and 12(17.4 %)were benign. The maximum elastic modulus (Emax) was higher for malignant nodules(P＜ 0.05). There was no significant difference in mean elastic modulus or minimum elastic modulus between malignant and benign nodules. The Emax≥ 28.2 kPa was the best cut-off value for malignant base on receiver operating curve. Perinodular stiffness was significantly greater for malignant nodules compared with benign nodules according to shear wave patterns. Compared with ultrasound alone, the rate of benign lesions recommended for FNA decreased from 75.0 % (9/12) to 25.0 % (3/12) with conventional ultrasound plus SWE. CONCLUSION: SWE provides quantitative and qualitative information when used with conventional ultrasound. SWE has the potential to reduce the number of unnecessary FNA procedures.

Overview of the ultrasonography techniques in the diagnosis of appendicitis - elaboration of a novel anatomy scanning method.

This article aims to introduce a novel anatomical scanning method which requires scanning according to varied anatomic positions of the appendix based on the widely used graded compression method. We suggest placing the probe longitudinally in the region of the terminal cecum and moving it laterally to explore the sub-cecal appendix. The probe should be placed transversely on the medial side of the cecum to explore the pre-ileal appendix or post-ileal appendix. Placing the probe perpendicularly along external iliac vessels can help explore the pelvic appendix. The probe should be placed transversely on the paracolic sulci, and moved along the paracolic sulci to observe the extra-peritoneal appendix. Using the cephalic end of the probe as a pivot, push and squeeze the cecum to make it move bilaterally as much as possible, in order to expose the retrocecal appendix behind the air-filled cecum. It is our belief that this anatomical scanning method will greatly improve appendix detection rate and diagnostic accuracy, and provide guidance for surgical localization.

Abnormalities in gut microbiota and serum metabolites in hemodialysis patients with mild cognitive decline: a single-center observational study.

RATIONALE: Although a growing body of evidence indicates that the scores of cognitive function in hemodialysis patients are significantly lower than those of healthy individuals, underlying mechanisms have not been fully elucidated. OBJECTIVES: To investigate the roles of gut microbiota and serum metabolites in hemodialysis patients with mild cognitive decline (MCD). METHODS: A total of 30 healthy individuals and 77 hemodialysis patients were enrolled and were classified into healthy control (HC), normal cognitive function (NCF), and MCD groups by evaluation of Montreal Cognitive Assessment. Fecal samples were analyzed by 16S rRNA and serum samples were analyzed by gas chromatography-mass spectrometry from all subjects. RESULTS: The 16S rRNA study demonstrated that the gut microbiota profiles, including α- and ß-diversity, and a number of 16 gut bacteria were significantly altered in the MCD group compared with those in HC or those with NCF. A metabonomics study showed that a total of 29 serum metabolites were altered in the MCD group. Receiver operating characteristic curves showed that Genus Bilophila and serum putrescine might be sensitive biomarkers to indicate MCD in patients with hemodialysis. CONCLUSIONS: These findings demonstrate gut microbiota and serum metabolites were probably involved in the pathogenesis of hemodialysis-related MCD. Therapeutic strategies targeting abnormalities in gut microbiota and serum metabolites may facilitate the beneficial effects for hemodialysis patients with MCD.

Subcapsular Injection of Ultrasonic Contrast Agent Distinguishes between Benign and Malignant Lymph Node Lesions Exhibiting Homogeneous Enhancement in Intravenous Contrast-Enhanced Ultrasound Images.

We aimed to evaluate whether subcapsular injection of ultrasonic contrast agent (UCA) can distinguish between benign and malignant lymph node (LN) lesions exhibiting homogeneous enhancement in intravenous contrast-enhanced ultrasound (CEUS) images. From November 2012 to July 2015, 32 patients with superficial lymphadenopathy exhibiting homogeneous enhancement after intravenous CEUS were enrolled. A small amount of UCA was injected into LNs using a subcapsular approach, and perfusion characteristics were recorded. Using the pathology identified via core needle biopsy as the gold standard, we calculated the sensitivity, specificity and accuracy of the technique in terms of distinguishing between benign and malignant LN lesions. Pathology revealed 23 cases of true benign and 9 cases of true malignant LN lesions; the former included 2 cases of tuberculosis and 21 cases of reactive hyperplasia, and the latter included 7 lymphomas and 2 metastases. Subcapsular CEUS diagnosed 24 benign and 8 malignant LN lesions. Most lymphomas (6 of 7, 85.7%) exhibited heterogeneous perfusion, with lymphatic tract distortion in the absence of interruption. Reactive hyperplasia LNs manifested as diffuse homogeneous or brush-like perfusion from the subcapsular region to the center, without lymphatic tract distortion. Metastatic LNs had lymphatic tract interruptions. The sensitivity, specificity, consistency and positive and negative predictive values were 77.8%, 95.6%, 90.6%, 87.5% and 91.7%, respectively. For LNs exhibiting uniform enhancement in intravenous CEUS imaging, subcapsular CEUS may help to distinguish between benign and malignant lesions. In particular, lymphatic distortion without interruption may specifically indicate a lymphoma.

Preoperative Tumor Staging of Gastric Cancer: Comparison of Double Contrast-Enhanced Ultrasound and Multidetector Computed Tomography.

OBJECTIVES: The purpose of this study was to compare the sensitivity and specificity of double contrast-enhanced ultrasound (CEUS) and multidetector computed tomography (MDCT) in the preoperative tumor staging of gastric cancer (GC) to stratify patients for suitable treatment. METHODS: Fifty-four patients with GC proved by histologic findings were included. The sensitivity and specificity of double CEUS and MDCT for tumor staging were calculated and compared. The differences between these methods were evaluated by using the area under the curve (AUC) from a receiver operating characteristic curve analysis. RESULTS: There were no significant differences in AUC values for T1 and T2 stages between double CEUS and MDCT (P = .190 and .256, respectively). However, the sensitivity of double CEUS in the detection of the T1 stage was higher than that of MDCT (88% versus 75%). The AUC values of MDCT for T3 and T4 stages were 0.833 and 0.905, which were both significantly higher than those of double CEUS (0.759 and 0.696; P < .05). The sensitivities of double CEUS and MDCT for the T3 stage were both 89%, but the accuracy and specificity of double CEUS were lower than those of MDCT (76% versus 83% and 63% versus 78%). The specificities of double CEUS and MDCT for the T4 stage were both 98%, but the accuracy and sensitivity of double CEUS were lower than those of MDCT (85% versus 94% and 42% versus 83%). CONCLUSIONS: Multidetector CT is superior to double CEUS for T3 and T4 GC, and double CEUS may be regarded as an important complementary method to MDCT.