Etomidate-induced hypokalemia in electronic cigarette users: two case reports and literature review.

Hypokalemia is a common clinical condition that can lead to muscle weakness, difficulty breathing, malignant arrhythmias, and even death. This report describes two cases of severe hypokalemia resulting from the use of electronic cigarettes containing etomidate, both accompanied by varying degrees of adrenal hyperplasia. In both cases, the patients were admitted to the hospital with lower limb weakness and difficulty walking. Relevant examinations revealed low blood potassium, low cortisol, high adrenocorticotropic hormone, low renin, and low aldosterone levels in the patients, with Case 2 also having significant hypertension. In both cases, adrenal CT scans showed thickening of the adrenal glands. After the delivery of potassium supplementation in both cases, blood potassium levels gradually returned to normal and muscle strength gradually improved. The case reports are followed by a review of the literature on etomidate and its related mechanisms of action with discussion of its association with hypokalemia.

A morphology-based integrated teaching mode combining pathology and radiology with the aid of teaching media: A randomized controlled trial.

OBJECTIVE: The integration of curriculum is an important approach for enhancing medical education and facilitating interdisciplinary connections among students. This study aimed to develop a new morphological integrated teaching mode for undergraduate stomatology education by combining stomatological pathology and radiology courses with instructional media. METHODS: In total, 63 undergraduates were included in this study and divided into three groups: traditional (Group T; the control group) and two experimental groups: KoPa WiFi EDU (Group K), and KoPa WiFi EDU-cone beam computed tomography (CBCT) (Group K-C). All participants attended a 2-h lecture on periapical cysts and completed the first theoretical test. Subsequently, they underwent a 4-h experimental training session on the pathology and radiology of periapical cysts using different teaching methods. Following the training, participants completed the second theoretical test and underwent the first image-reading skill evaluation. After a 3-month period, participants completed the third theoretical test and underwent the second image-reading skill evaluation. The effectiveness of the teaching methods was assessed by analyzing the differences in theoretical test and experimental skill evaluation scores. RESULTS: There were no significant differences in the first theoretical outcomes among three groups (p > 0.05). However, the second theoretical scores, the first objective evaluation scores, and the first subjective evaluation scores were significantly higher in the integrated teaching mode (3D teaching mode with the KoPa WiFi EDU and CBCT: 89.29 ± 4.55, 81.00 ± 8.15, and 61.57 ± 5.52, respectively; 2D teaching mode with the KoPa WiFi EDU system: 80.43 ± 3.41, 73.00 ± 8.01, and 55.67 ± 5.66, respectively) than in the traditional teaching mode (72.57 ± 3.84, 69.38 ± 4.91, and 48.67 ± 5.54, respectively) (p < 0.05). Moreover, the long-term teaching effect of the integrated mode was better than that of the traditional mode (p < 0.05). CONCLUSIONS: The morphology-based integrated teaching mode combining pathology and radiology aroused student enthusiasm for learning, and resulted in enhanced learning outcomes in dental experimental education.

Predictive value of angiopoietin-like protein 8 in metabolic dysfunction-associated fatty liver disease and its progression: A case-control study.

BACKGROUND: The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) is rapidly increasing, currently affecting approximately 25% of the global population. Liver fibrosis represents a crucial stage in the development of MAFLD, with advanced liver fibrosis elevating the risks of cirrhosis and hepatocellular carcinoma. Simple serum markers are less effective in diagnosing liver fibrosis compared to more complex markers. However, imaging techniques like transient elastography face limitations in clinical application due to equipment and technical constraints. Consequently, it is imperative to identify a straightforward yet effective method for assessing MAFLD-associated liver fibrosis. AIM: To investigate the predictive value of angiopoietin-like protein 8 (ANGPTL8) in MAFLD and its progression. METHODS: We analyzed 160 patients who underwent abdominal ultrasonography in the Endocrinology Department, Xiaogan Central Hospital affiliated to Wuhan University of Science and Technology, during September 2021-July 2022. Using abdominal ultrasonography and MAFLD diagnostic criteria, among the 160 patients, 80 patients (50%) were diagnosed with MAFLD. The MAFLD group was divided into the liver fibrosis group (n = 23) and non-liver fibrosis group (n = 57) by using a cut-off fibrosis-4 index ≥ 1.45. Logistical regression was used to analyze the risk of MAFLD and the risk factors for its progression. Receiver operating characteristic curves were used to evaluate the predictive value of serum ANGPTL8 in MAFLD and its progression. RESULTS: Compared with non-MAFLD patients, MAFLD patients had higher serum ANGPTL8 and triglyceride-glucose (TyG) index (both P < 0.05). Serum ANGPTL8 (r = 0.576, P < 0.001) and TyG index (r = 0.473, P < 0.001) were positively correlated with MAFLD. Serum ANGPTL8 was a risk factor for MAFLD [odds ratio (OR): 1.123, 95% confidence interval (CI): 1.066-1.184, P < 0.001). Serum ANGPTL8 and ANGPTL8 + TyG index predicted MAFLD [area under the curve (AUC): 0.832 and 0.886, respectively; both P < 0.05]. Compared with MAFLD patients without fibrosis, those with fibrosis had higher serum ANGPTL8 and TyG index (both P < 0.05), and both parameters were positively correlated with MAFLD-associated fibrosis. Elevated serum ANGPTL8 (OR: 1.093, 95%CI: 1.044-1.144, P < 0.001) and TyG index (OR: 2.383, 95%CI: 1.199-4.736, P < 0.013) were risk factors for MAFLD-associated fibrosis. Serum ANGPTL8 and ANGPTL8 + TyG index predicted MAFLD-associated fibrosis (AUC: 0.812 and 0.835, respectively; both P < 0.05). CONCLUSION: The serum levels of ANGPTL8 are elevated and positively correlated with MAFLD. They can serve as predictors for the risk of MAFLD and liver fibrosis, with the ANGPTL8 + TyG index potentially exhibiting even higher predictive value.

A review on nondiabetic hypoglycemia from various causes: Case series report.

RATIONALE: Hypoglycemia is common in patients with glucose regulation disorders and related diabetic treatments but is rare in nondiabetic patients. Severe hypoglycemia can cause harm to patients' cognition, consciousness, central nervous system, cardiovascular and cerebrovascular system, and even death. However, the most fundamental way to control hypoglycemia is to identify the cause and deal with the primary disease. This article introduces 3 cases of nondiabetic hypoglycemia with different causes, aiming to improve our understanding of nondiabetic hypoglycemia and improve the ability of early diagnosis and differential diagnosis. PATIENT CONCERNS: Case 1 is a 19-year-old female with a history of recurrent coma, and magnetic resonance imaging and endoscopic ultrasound of the pancreas suggest insulinoma. Case 2 is a 74-year-old male with a history of viral hepatitis, and computerized tomography shows multiple nodules in the liver, which is diagnosed as liver cancer. Case 3 is a 39-year-old female with a history of taking methimazole, who tested positive for insulin antibodies, and was diagnosed with insulin autoimmune syndrome. DIAGNOSIS: All 3 patients were diagnosed with nondiabetic hypoglycemia, but the causes varied, and included insulinoma, non-islet cell tumor-induced hypoglycemia, and insulin autoimmune syndrome. INTERVENTIONS: Case 1 underwent pancreatic tail resection; case 2 refused anti-tumor treatment and received glucose injections for palliative treatment only; and case 3 stopped taking methimazole. OUTCOMES: After surgery, the blood sugar in case 1 returned to normal, and the blood sugar in case 2 was maintained at about 6.0 mmol/L. The symptoms of hypoglycemia gradually improved in case 3 after stopping the medication. LESSONS: Non-diabetic hypoglycemia requires further examination to clarify the cause, and the correct differential diagnosis can provide timely and effective treatment, improving the patient's prognosis.

Immune checkpoint inhibitor- and phosphatidylinositol-3-kinase inhibitor-related diabetes induced by antineoplastic drugs: two case reports and a literature review.

Immune checkpoint inhibitor (ICI)- and phosphatidylinositol-3-kinase inhibitor (PI3Ki)-related diabetes mellitus are common side effects of anti-tumor drug use that present mainly as hyperglycemia. Here, we present two case reports of diabetes mellitus caused by the use of tremelimumab and apalutamide, respectively, in cancer treatment, and a comprehensive, comparative review of the literature on these forms of diabetes. Case 1 presented with diabetic ketoacidosis and was diagnosed with ICI-related diabetes mellitus and treated with insulin. Case 2 was diagnosed with PI3Ki-related diabetes mellitus, and her blood glucose level returned to normal with the use of metformin and dapagliflozin. We systematically searched the PubMed database for articles on ICI- and PI3Ki-related diabetes mellitus and characterized the differences in clinical features and treatment between these two forms of diabetes.

miR-874 ameliorates retinopathy in diabetic rats by NF-κB signaling pathway.

BACKGROUND: Increased activity of the NF-κB signaling pathway boosts the progression of retinopathy in diabetic rats. OBJECTIVES: Using a bioinformatics website, we identified a site where miR-874 binds to the NF-κB p65. Therefore, we speculated that miR-874 might improve retinopathy in diabetic rats by inhibiting the NF-κB signaling pathway. MATERIAL AND METHODS: Ten healthy rats were taken as the control group. Sixty streptozotocin (STZ; 60 mg/kg)-induced diabetes model rats were randomly divided into the model group (injection of normal saline), negative control (NC) agomir group (injection of NC mimic), miR-874 agomir group (injection of miR-874 mimic), miR-874 anti-agomir group (injection of miR-874 inhibitor), EVP4593 group (injection of NF-κB signaling pathway antagonist EVP4593), and miR-874 anti-agomir+EVP4593 group (injection of miR-874 inhibitor and EVP4593). All injections were administered into the caudal vein. RESULTS: miR-874 could target the degradation of p65. Compared with the control group, model rats had reduced miR-874 expression, increased vascular endothelial growth factor (VEGF) and Ang2 protein expression, lowered end-diastolic velocity (EDV) and peak systolic velocity (PSV) of the central retinal artery (CRA) and blood velocity of central retinal vein (CRV) and CRA, heightened plasma viscosity (PV), blood viscosity (BV) and erythrocyte sedimentation rate (ESR) at all shear rates, decreased capillary pericytes (IPCs), increased vascular endothelial cells (VECs), and ascended p65 expression in the retina (all p < 0.05). Thus, it was shown that pathological changes appeared in the retina of diabetic rats. These indices improved in diabetic rats injected with the miR-874 mimic or EVP4593, but deteriorated in those injected with miR-874 inhibitor (all p < 0.05). EVP4593 also could alleviate the aggravation of retinopathy that was caused by miR-874 inhibition in diabetic rats. CONCLUSIONS: miR-874 modulates the NF-κB signaling pathway by targeting the degradation of p65 to further improve the retina of diabetic rats, thus demonstrating the beneficial effect of miR-874 on diabetic retinopathy in rats.

The association between serum resistin and PPARγ Pro12Ala polymorphism in patients with gestational diabetes mellitus.

PPARγ Pro12Ala polymorphism is associated with the expression level of resistin and can induce insulin resistance. However, the possible effects of PPARγ Pro12Ala polymorphism for the origin of gestational diabetes mellitus are still unclear. A total of 156 patients with GDM and 160 normal pregnancy women were recruited. The serum parameters, resistin and genomic DNA were detected. We collected the patients with gestational diabetes mellitus and found that genotype Pro/Pro and Pro/Ala existed in the patients and controls. Moreover, the genotype Pro/Ala group had a higher level of serum parameters and resistin. Our observations suggest that PPARγ Pro12Ala polymorphism may elevate the expression of resistin and it may be involved in the pathogenesis of gestational diabetes mellitus.

Involvement of NORAD/miR-608/STAT3 axis in carcinostasis effects of physcion 8-O-ß-glucopyranoside on ovarian cancer cells.

We planned to dig the carcinostasis activity of physcion 8-O-ß-glucopyranoside (PG) in ovarian cancer cells and explored whether long non-coding RNA NORAD was the potential cause of the carcinostasis impact of PG. The impacts of PG on the tumour cell behaviours (including cell viability, apoptosis, migration and invasion) of SKOV3 cells were grabbed. The levels of NORAD in cancer tissues and cell lines were determined; afterwards, the impacts of abnormal expression of NORAD on the tumour cell behaviours of SKOV3 cells were assessed. Moreover, we explored whether NORAD modulated the level of STAT3 by competitively sponging miR-608, thus mediating the antineoplastic effects of PG on ovarian cancer cells. PG suppressed cell viability, enhanced apoptosis and lessened migration and invasion of SKOV3 cells. NORAD was upregulated in ovarian cancer tissues and cells. Silencing of NORAD lessened cell viability, migration and invasion, but induced apoptosis of SKOV3 cells, whereas overexpression of NORAD had opposite effects. Moreover, PG decreased the expression of NORAD. Overexpression of NORAD reversed the effects of PG treatment on the cell biological performances of SKOV3 cells, which were further reversed after overexpression of miR-608 simultaneously. Furthermore, STAT3 was tested as a target gene of miR-608, and the impact of NORAD in PG-treated SKOV3 cells were through the miR-608-mediated STAT3. Our findings reveal that NORAD/miR-608/STAT3 axis is pivotal in mediating the antineoplastic impacts of PG on ovarian cancer cells, which may offer a novel explanation in the therapy of ovarian cancer.