bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect assessment of methotrexate in combination with other chemotherapeutic agents for osteosarcoma in children
Authors: Yan Jun-Ping , Xiang Rong-Mei
Published: May 2021

Background:

Osteosarcoma is a primary form of malignant bone tumor. It is commonly prevalent among children. Treating osteosarcoma with chemotherapy has had limited clinical outcomes due to side effects and the formation of drug resistance. Presently, a mixture of doxorubicin, cisplatin, ifosfamide, epirubicin methrotrexate, and other supplementary medications are used in osteosarcoma chemotherapy. Therefore, this study aims to investigate the clinical therapeutic effects of combining methotrexate with other chemotherapeutic agents to treat osteosarcoma in children.

Methods:

The search of several electronic databases will lead to source related published studies. The electronic databases include both English (PubMed, EMBASE, Web of Science, and the Cochrane Library) and Chinese (China National Knowledge Infrastructure, WanFang, and China Biomedical Database) databases. All studies published from inception to November 19, 2020 are searched. Study selection, extraction of data, and evaluation of the bias risk in included studies are carried out by two authors independently. The software, RevMan 5.3, is used to analyze the data.

Results:

This study provides evidence of substantial quality for the clinical therapeutic effects of methotrexate combined with other chemotherapeutic agents for treating osteosarcoma in children.

Conclusion:

The results of this study provide conclusive evidence with regards to the clinical application of methotrexate combined with other chemotherapeutic agents for treating osteosarcoma in children.

Ethics and dissemination:

Since this study will use published data, ethical approval is not required.

Systematic review registration number:

This protocol has been registered on INPLASY202110024.
Corticosteroid therapy for COVID-19
Authors: Pulakurthi Yashwitha Sai , Pederson John M. , Saravu Kavitha , Gupta Nitin , Balasubramanian Prasanth , Kamrowski Shelby , Schmidt Megan , Vegivinti Charan Thej Reddy , Dibas Mahmoud , Reierson Natalie L. , Pisipati Sailaja , Joseph Betsy Ann , Selvan Pragadeesh Thamarai , Dmytriw Adam A. , Keesari Praneeth Reddy , Sriram Varsha , Chittajallu Spandana , Brinjikji Waleed , Katamreddy Rewanth R. , Chibbar Richa , Davis Amber R. , Malpe Manashree , Mishra Hemant K. , Kallmes Kevin M. , Hassan Ameer E. , Evanson Kirk W.
Published: May 2021

Background:

Corticosteroid treatment is an effective and common therapeutic strategy for various inflammatory lung pathologies and may be an effective treatment for coronavirus disease 2019 (COVID-19). The purpose of this systematic review and meta-analysis of current literature was to investigate the clinical outcomes associated with corticosteroid treatment of COVID-19.

Methods:

We systematically searched PubMed, medRxiv, Web of Science, and Scopus databases through March 10, 2021 to identify randomized controlled trials (RCTs) that evaluated the effects of corticosteroid therapies for COVID-19 treatment. Outcomes of interest were mortality, need for mechanical ventilation, serious adverse events (SAEs), and superinfection.

Results:

A total of 7737 patients from 8 RCTs were included in the quantitative meta-analysis, of which 2795 (36.1%) patients received corticosteroids plus standard of care (SOC) while 4942 (63.9%) patients received placebo and/or SOC alone. The odds of mortality were significantly lower in patients that received corticosteroids as compared to SOC (odds ratio [OR] = 0.85 [95% CI: 0.76; 0.95], P = .003). Corticosteroid treatment reduced the odds of a need for mechanical ventilation as compared to SOC (OR = 0.76 [95% CI: 0.59; 0.97], P = .030). There was no significant difference between the corticosteroid and SOC groups with regards to SAEs and superinfections.

Conclusion:

Corticosteroid treatment can reduce the odds for mortality and the need for mechanical ventilation in severe COVID-19 patients.
An extremely atypical presentation of esophageal squamous cell carcinoma with pancreatic and hepatic metastases
Authors: Zhang Lei , Long Xin , Hu Zheng-Nan , Wu Yu , Song Jia , Zhang Bi-Xiang , Chen Wei-Xun
Published: May 2021

Rationale:

Esophageal carcinoma is an aggressive cancer with extremely poor therapeutic outcomes due to its high metastatic potential and a significant risk of recurrence after radical resection. Liver is the most common metastatic target organ of esophageal carcinoma, followed by the lungs, bones, and brain. Few cases of solitary pancreatic and hepatic metastases of esophageal carcinoma have been reported.

Patient concerns:

We report the case of a 67-year-old male presenting with pancreatic and hepatic lesions. In addition, a friable lesion with an irregular nodular surface in the distal esophagus was detected by esophagogastroduodenoscopy.

Diagnosis:

Pathohistological examination confirmed esophageal squamous cell carcinoma. The pancreatic lesion was also biopsied via ultrasound-guided fine needle aspiration, which also revealed squamous cell carcinoma. The hepatic lesion was also identified as metastatic carcinoma by magnetic resonance imaging, most likely of the same origin.

Interventions:

Due to comorbidities that precluded surgery, the patient was administered adjuvant therapy and a multidisciplinary decision was made for palliative care.

Outcomes:

The patient died 1 month later due to multiorgan failure caused by hemorrhage from a peptic ulcer.

Conclusion:

To our knowledge, this is only the sixth case of pancreatic metastasis of esophageal squamous cell carcinoma. This case report suggests to clinicians the importance of considering potential comorbidities in every patient with advanced cancer, such as gastric ulcer and cachexia.
The value of the signal intensity of peritumoral tissue on Gd-EOB-DTPA dynamic enhanced MRI in assessment of microvascular invasion and pathological grade of hepatocellular carcinoma
Authors: Wang Li-Li , Li Jun-Feng , Lei Jun-Qiang , Guo Shun-Lin , Li Jin-Kui , Xu Yong-Sheng , Dou Yu
Published: May 2021

The aim of the study was to assess the potential role of preoperative gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) dynamic enhanced MR imaging for diagnosing microvascular invasion (MVI) and pathological grade of hepatocellular carcinoma (HCC).

A total of 113 consecutive HCC patients confirmed by histopathology underwent preoperative Gd-EOB-DTPA dynamic enhanced MRI were included. Signal intensity (SI) of peritumoral, normal liver tissue and tumor parenchyma during arterial phase and hepatobiliary phase (HBP) were analyzed. The receiver operating characteristic (ROC) curves were performed to assess the potential diagnostic capability for MVI and pathological grade of HCC. Kaplan–Meier method was performed to estimate the recurrence-free survival rate and compared using the log rank test.

SI ratio of peritumoral tissue to normal liver in arterial phase (SIAp/Al) was independently associated with MVI [odds ratio (OR) = 3.115, 95% confidence interval (CI): 1.867–5.198] and pathological grades (OR = 1.437, 95% CI: 1.042–1.981). The area under the curve (AUC) of SIAp/Al was equivalent to the SI of tumor parenchyma on arterial phase (SIAt) in distinguishing low and high pathological grades. However, the AUC of SIAp/Al (0.851) was larger than peritumoral hypointensity on HBP (0.668) for distinguishing MVI. The recurrence-free survival rate of HCC patients with SIAp/Al<1.1 was higher than HCC with SIAp/Al≥1.1(P = .025).

The SIAp/Al in preoperative Gd-EOB-DTPA dynamic enhanced MR imaging is a potential diagnosis marker for MVI and pathological grade of HCC noninvasively. The higher SIAp/Al may predict the poor prognosis of HCC after surgery.
Low nutritional status links to the prevalence of pre-metabolic syndrome and its cluster in metabolically high-risk Korean adults
Authors: Kim Jieun , Jeong Kyoungsik , Lee Siwoo , Seo Bok-Nam , Baek Younghwa
Published: May 2021

Diet plays a crucial role as a modifiable risk factor related to the development of metabolic syndrome (MetS) and its cluster. Constitution type of traditional Korean medicine has shown accuracy to predict the risk for MetS. We attempted to examine the association between nutritional status, pre-MetS, and its cluster in Korean adults by their constitution type.

Participants aged 30 to 55 years who had no cancer or cardiovascular diseases (CVDs) were assigned to join in the present study. Pre-MetS was defined as ≥2 of the following factors: abdominal obesity; elevated triglycerides (TG); reduced high-density lipoprotein cholesterol (HDL-C); elevated blood pressure (BP); and elevated fasting plasma glucose (FPG). Constitution type was categorized into Tae-Eumin (TE) or non-TE. Dietary assessment of the subjects were surveyed using a short-form of the food frequency questionnaire (FFQ) and the nutrition quotient (NQ), which uses 4 factors, namely, balance, diversity, moderation, and dietary behavior.

A total of 986 subjects were evaluated by constitution type with MetS status. Of these subjects, 48.6% had pre-MetS, 89.5% were obese and had the highest waist circumference (WC) in Pre-MetS TE. BP, FPG, TG were higher, while HDL-C was lower, than normal TE or non-TE both in Pre-MetS TE and non-TE. The prevalence of pre-MetS was positively associated with lower status of dietary behavior (odds ratio [ORs]: 2.153, 95% confidence interval [CI]: 1.179–3.931) while negatively related to higher vegetables and fruits intakes (ORs: 0.594, 95% CI: 0.359–0.983) in TE. Lower status of NQ had about 2 times higher risk of Pre-MetS (ORs: 1.855, 95% CI: 1.018–3.380) and abdominal obesity (ORs: 2.035, 95% CI: 1.097–3.775) in TE compared with higher status of NQ after controlling for covariates.

Poor diet was a key contributor to the development of Pre-MetS and abdominal obesity in Korean adults with TE. Customized nutrition care and integrated medicinal approaches are strongly suggested to conduct optimal preventive care for people who are vulnerable to health risk.
Assessment of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker on the split renal function in the patients with primary hypertension
Authors: Zhang Jingsi , Wang Mingyu , Sun Kehui , Ding Yanchun
Published: May 2021

Bilateral kidney damage in hypertensive patients is not parallel. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), as a commonly used antihypertensive drug, could protect kidney function and delay its deterioration. Most studies focused on overall renal function, but the researches on split renal function (SRF) are rare. We investigated the effects of ACEI/ARB on the SRF in patients with primary hypertension.

Patients with primary hypertension (n = 429; male: 213; female: 216) admitted to our department between January 2014 and December 2016 were included in this study. The glomerular filtration rate (GFR) of split and total renal function were determined using diethylenetriaminepentaacetic acid tagged with 99mTc renal dynamic imaging method. For the same patient, the side with high GFR was considered as higher GFR kidney, whereas that with a low GFR was considered as lower GFR kidney. The split function score (Q value) was utilized to evaluate the differences of bilateral renal function. The patients were divided into 3 groups based on the Q values (Group 1, Q value <5%; Group 2, Q value of 5%–10%; Group 3, Q value ≥10%). All the patients received antihypertensive therapy based on ACEI/ARB. The renal dynamic imaging was performed in the 1-year follow-up to investigate the changes of the SRF.

Compared with the baseline level, significant decline was noticed in the serum creatinine (Scr) in Group 2 and Group 3 (P < .05). The cystatin C in Group 3 showed significant decline (P < .05). Compared with the baseline, there was significant decline in the Q value in Group 2, whereas the GFR of lower GFR kidney showed significant increase (P < .05). No statistical differences were noticed in the Q value and split GFR in Group 1 and Group 3 (P > .05).

In primary hypertension patients, ACEI/ARB therapy could improve the SRF of lower GFR kidney in the presence of certain differences between the SRF. As a result, the SRF difference was reduced. In case of Q value in a range of 5% to 10%, ACEI/ARB could improve the renal function effectively. It may be significant for the design of antihypertensive drugs.
High expression of PDGFA predicts poor prognosis of esophageal squamous cell carcinoma
Authors: Han Na , Zhang Yan-Yan , Zhang Zhong-Mian , Zhang Fang , Zeng Teng-Yuan , Zhang Yi-Bing , Zhao Wen-Chao
Published: May 2021

Platelet-derived growth factor A (PDGFA), the most known member of PDGF family, plays a crucial role in occurrence and progression of different tumors. However, PDGFA expression and its clinical significance in esophageal squamous cell carcinoma (ESCC) are not clear. The present study aimed to assess the expression and prognostic value of PDGFA in ESCC.

The Gene Expression Omnibus databases (GSE53625, GSE23400, and GSE67269) and fresh clinical samples were employed for detecting PDGFA messenger RNA expression in ESCC. The associations of PDGFA expression with clinicopathological characteristics were evaluated by chi-square test. Kaplan–Meier analysis and Cox proportional hazard regression model were performed to determine the prognostic value of PDGFA in ESCC patients. PDGFA-related signaling pathways were defined by gene set enrichment analysis based on Gene Expression Omnibus databases.

The PDGFA messenger RNA expression was upregulated in ESCC tissues compared with paired adjacent noncancerous tissues (P < .05) and was positively correlated with T stage (P < .05). Kaplan–Meier survival analysis suggested that ESCC patients with high PDGFA expression were associated with poorer overall survival compared to those with low PDGFA expression (P < .05), especially in advanced T stage (P < .05). Cox analyses showed that high expression of PDGFA was an independent predictor for poor prognosis in ESCC patients. Gene set enrichment analysis identified 3 signaling pathways (extracellular matrix receptor interaction, focal adhesion, and glycosaminoglycan biosynthesis chondroitin sulfate) that were enriched in PDGFA high expression phenotype (all P < .01).

PDGFA may serve as an oncogene in ESCC and represent an independent molecular biomarker for prognosis of ESCC patients.
Primary hyperparathyroidism presenting as a brown tumor with hypercalcemia crisis in a second-trimester pregnant woman
Authors: Xu Yun , Yu Yingying
Published: May 2021

Introduction:

Primary hyperparathyroidism (PHPT) in pregnancy is rare and unrecognized because the maternal physiological adaptations blurs the symptoms. There is no standard treatment strategy for maternal PHPT. Early diagnosis and interventions can prevent catastrophic consequences to the mother and fetus.

Patient concerns:

A 31-year-old Chinese woman was admitted, due to a lump on the left lower leg for 4 months. The patient complained of mild pain in the left lower leg following exercise that could be relieved after a short rest. The patient was at 18 weeks of gestation, and the growth of the fetus was normal. The patient has a 3-year history of hypercalcemia and a 2-year history of nephrolithiasis. No family history of hypercalcemia and endocrine tumors were present.

Diagnosis:

Laboratory tests demonstrated high serum calcium level of 3.84 mmol/L, parathyroid hormone 1393 pg/mL, alkaline phosphatase 488 μ/L. Ultrasound showed a 22.4 mm × 7.8 mm solid nodule in the left lower lobe of the thyroid gland. Based on these findings, the patient was diagnosed with PHPT.

Interventions:

The patient accepted continuous renal replacement to reduce ironized calcium level. Parathyroidectomy was performed at the 19th week of gestation. Threatened abortion occurred 2 days after the surgery, and magnesium sulfate was used to prevent the abortion. Calcium gluconate, calcium carbonate and vitamin D3 were used to treat the hypocalcemia that occurred 5 days after the surgery.

Outcomes:

Pathology examination demonstrated the parathyroid adenoma. Abortion was prevented using magnesium sulfate and hypocalcemia was cured with calcium gluconate, calcium carbonate and vitamin D3. At 38-week of gestation, the patient (ionized calcium level: 2.16 mmol/L) delivered a healthy female baby weighing 2700 g with 10/10 Apgar. Till now, both the mother and infant showed no complications.

Conclusion:

Maternal PHPT is rare and challenging to diagnose, causing life-threatening complications to mother and fetus. Any decision regarding surgery for a pregnant woman with primary hyperparathyroidism is more complex than in men or nonpregnant women. The decision should be made based on the severity of hypercalcemia and symptoms.
Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as treatment for upper vaginal leiomyoma
Authors: Liu Jian-Hong , Zheng Ying , Wang Ya-Wen
Published: May 2021

Introduction:

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging technique in the area of minimally invasive surgery. Vaginal leiomyoma is a rare benign tumor, with only a few cases being reported in the literature. we demonstrate a novel approach for excision of a vaginal leiomyoma via vNOTES. To ensure reproducibility and replicability akin to a standardized procedure, we have provided a step-by-step video description of the use of vNOTES for upper anterior vaginal myomectomy.

Patient concerns:

A 35-year-old female (G2P0A2) presented with a tumor in the upper anterior vaginal wall, which gradually increased in size.

Diagnosis:

A vaginal examination revealed a swollen area approximately 3-cm in diameter on the upper anterior vaginal wall. The swelling was mobile and solid. All other vitals were normal. Transvaginal ultrasound detected a 3.0 × 3.4 cm hypoechogenic mass on the superior vaginal wall, and a preoperative diagnosis of the vaginal tumor was confirmed.

Interventions:

The upper vaginal leiomyoma treated using transvaginal natural orifice transluminal endoscopic surgery.

Outcomes:

The procedure lasted for 20 min, and the postoperative course was uneventful.

Conclusions:

vNOTES can be a promising alternative to traditional vaginal surgery for upper vaginal disease due to advantages such as excellent exposure, easy access and precise suturing. However, more studies are needed to assess its long-term efficacy.
Study on acupuncture improving insomnia comorbid with depression and anxiety based on rs-fMRI
Authors: Yao Lin , Li Mengyuan , Cao Jiazhen , Liu Yanze , Zheng Haizhu , Huang Haipeng , Wang Hongfeng
Published: May 2021

Background:

Long term insomnia and low sleep quality often lead to depression, anxiety and other negative emotions, and often interact with each other. Many studies have confirmed the effectiveness of acupuncture in the treatment of insomnia comorbid with emotional disorders, but its specific mechanism needs to be further explored. Resting-state functional magnetic resonance (rsfMRI) is an important means to study the changes of brain activity. However, the results are inconsistent and lack of systematic evaluation and analysis.

Methods:

Nine databases will be searched, including PubMed, EMBASE, EBSCOhost-medline, Web of Science, Cochrane Library, China National Knowledge Infrastructure, VIP Database and Wan-Fang Database, Chinese Biomedical Literature Database from inception to January 2021. And screening clinical registration platform related research, in order to obtain more relevant studies. The outcomes include the change of rs-fMRI, sleep quality, depression, and anxiety. Quality assessment of the included studies will be performed according to the Cochrane Risk of Bias tool. Evidence quality will be assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. RevMan software (Version 5.3) and stata13.1will be used for statistical analyses. Subgroup analysis will be performed if necessary. If the data is insufficient, qualitative synthesis will be conducted instead of quantitative synthesis.

Results:

This study will analyze the effect of acupuncture on the brain activity changes, improvement of sleep quality and clinical symptoms of anxiety and depression with insomnia comorbid with emotional disorders.

Conclusion:

This study used meta-analysis method to explore the characteristics of acupuncture on brain activity changes in insomnia comorbid with emotional disorders, so as to provide effective evidence for clarifying its pathogenesis.
Diagnostic accuracy and value of chromosomal microarray analysis for chromosomal abnormalities in prenatal detection
Authors: Huang Hailong , Wang Yan , Zhang Min , Lin Na , An Gang , He Deqin , Chen Meihuan , Chen Lingji , Xu Liangpu
Published: May 2021

Chromosomal microarray analysis (CMA) has emerged as a primary diagnostic tool for the evaluation of developmental delay and structural malformations in children. The aim of this study was to compare the accuracy and value of CMA and karyotyping on diagnosis of chromosomal abnormalities in Fujian province of South China.

In the study, 410 clinical samples were collected from pregnant women between March 2015 and December 2016, including 3 villus (0.73%, 3/410), 296 amniotic fluid (72.20%, 296/410), and 111 umbilical cord blood (27.07%, 111/410). All samples were screening for chromosomal abnormalities by both using CMA and karyotyping.

The success rate of CMA and karyotyping was 100% (410/410) and 99.27% (407/410), respectively. Sixty-one (14.88%, 61/410) samples were presented with chromosomal abnormalities by using CMA, whereas 47 (11.55%, 47/407) samples were shown with chromosomal abnormalities by using karyotyping. Thirty-one (8.61%, 31/360) samples with normal karyotypes were found to exist chromosomal abnormalities by using CMA. Receiver operating characteristic analysis showed that the area under the curve of karyotyping on the diagnosis of chromosomal abnormalities was 0.90 (95% confidence interval: 0.87–0.93), the sensitivity and specificity was 87.56% and 91.22%, respectively. The area under the curve of CMA on the diagnosis of chromosomal abnormalities was 0.93 (95% confidence interval: 0.90–0.95), with 90.68% sensitivity and 94.40% specificity. Notably, the combination of CMA and karyotyping could improve the diagnosis of chromosomal abnormalities.

CMA has a better diagnostic value for screening chromosomal abnormalities, especially for those pregnant women with normal karyotypes. This study has guiding value for prenatal diagnosis in Fujian province of South China.
Cardiovascular mortality in liver and kidney transplant recipients
Authors: Sertić Zrinka , Letilović Tomislav , Kanižaj Tajana Filipec , Knotek Mladen , Hadžibegović Irzal , Starovečki Inga , Jerkić Helena
Published: May 2021

Previous studies have demonstrated cardiovascular causes to be among the leading causes of death after liver (LT) and kidney transplantation (KT). Although both recipient populations have unique pre-transplant cardiovascular burdens, they share similarities in post-transplant exposure to cardiovascular risk factors. The aim of this study was to compare cardiovascular mortality after LT and KT.

We analyzed causes of death in 370 consecutive LT and 207 KT recipients from in-hospital records at a single tertiary transplant center. Cardiovascular causes of death were defined as cardiac arrest, heart failure, pulmonary embolism, or myocardial infarction.

After a median follow-up of 36.5 months, infection was the most common cause of death in both cohorts, followed by cardiovascular causes in KT recipients and graft-related causes in LT recipients in whom cardiovascular causes were the third most common. Cumulative incidence curves for cardiovascular mortality computed with death from other causes as the competing risk were not significantly different (P = .36). While 1-year cumulative cardiovascular mortality was similar (1.6% after LT and 1.5% after KT), the estimated 4-year probability was higher post-KT (3.8% vs. 1.6%). Significant pre-transplant risk factors for overall mortality after KT in multivariable analysis were age at transplantation, left ventricular ejection fraction <50%, and diastolic dysfunction grade 2 or greater, while significant risk factors for cardiovascular mortality were peripheral artery disease and left ventricular ejection fraction <50%. In the LT group no variables remained significant in a multivariable model for either overall or cardiovascular mortality.

The present study found no significant overall difference in cardiovascular mortality after LT and KT. While LT and KT recipients may have similar early cardiovascular mortality, long-term risk is potentially lower after LT. Differing characteristics of cardiovascular death between these two patient populations should be further investigated.
Effects of myofascial release on frequency of joint bleedings, joint status, and joint pain in patients with hemophilic elbow arthropathy
Authors: Cuesta-Barriuso Rubén , Pérez-Llanes Raúl , Donoso-Úbeda Elena , López-Pina José Antonio , Meroño-Gallut Javier
Published: May 2021

Background:

Chronic joint injury of the elbow joint is common in patients with hemophilia. Myofascial release is used for the management of pain and functionality in patients with chronic restrictions.

Objective:

To evaluate the effectiveness of myofascial release in patients with hemophilic elbow arthropathy.

Methods:

Sixty-nine patients with hemophilia took part in this randomized controlled trial. They were recruited from 10 hemophilia patient Associations. They were randomly allocated to experimental (n = 35) or control group (n = 34). The intervention consisted of three 50-min sessions of fascial therapy over a 3-week period. The intervention included 11 bilaterally administered maneuvers in both upper limbs (from shoulder girdle to forearm). The study variables were frequency of elbow bleeding (self-report), joint status (Hemophilia Joint Health Score), and joint pain (visual analog scale) at baseline, after the intervention, and at the 3-month follow-up.

Results:

There were significant changes (P < .001) in the repeated measures factor in the frequency of hemarthrosis (F = 20.64), joint status (F = 31.45), and perceived joint pain (F = 30.08). We found group interaction with the (P < .001) in the frequency of hemarthrosis (F = 21.57), joint status (F = 99.98), and perceived joint pain (F = 44.26). There were changes (P < .01) in the pairwise comparison analysis between the pretreatment assessment and the posttreatment and follow-up assessments.

Conclusions:

Myofascial release decreases frequency of elbow bleedings, and improved joint status and perception of elbow pain in patients with hemophilic elbow arthropathy. Myofascial release may be recommended to improve joint status and joint pain in patients with hemophilic elbow arthropathy.
The value of anti-rods and rings antibodies in patients with nonhepatitis virus infection
Authors: Zhang Naidan , Ji Chaixia , Yang Hao , Liu Lihong , Bao Xiao , Zhou Yusha , Yuan Chengliang
Published: May 2021

The aim of this study was to retrospectively investigate the clinical significance of anti-rods and rings (anti-RR) antibodies in nonhepatitis virus infection patients from Southwest China.

Anti-RR antibodies were determined by indirect immunofluorescence assay in a group of 19,935 individuals with antinuclear antibodies test from January 2017 to December 2019. The laboratory and clinical data were collected. Finally, 66 samples with anti-RR antibodies (0.33%) were detected.

In Wilcoxon rank sum test, gamma glutamyl transferase (Z = −3.364, P = .001), alpha-l-fucosidase (AFU) (Z = −2.312, P = .021), uric acid (Z = −1.634, P = .047) and red blood cell distribution width (Z = −2.285, P = .022) were higher in metabolic disease group than nonmetabolic disease group. In independent-samples t test, endogenous creatinine clearance was higher in metabolic disease group than nonmetabolic disease group (t = 2.061, P = .045). During the follow-up period of 37 patients with anti-RR antibodies for 1 to 60 months, the titers of anti-RR were significantly increased in the metabolic disease group (Z = −2.346, P = .019). In binary logistic regression analysis, triglycerides (odds ratio 3.679, 95% confidence interval 1.467–24.779, P = .048) was associated with elevated titers of anti-RR antibodies.

In summary, anti-RR in non-hepatitis patients may be a manifestation of metabolic disorders, and has a certain correlation with routine laboratory indicators, which is worthy of the attention from clinicians.
Effects of smoking on delayed neuropsychiatric sequelae in acute carbon monoxide poisoning
Authors: Nah Sangun , Choi Sungwoo , Lee Sun-Uk , Kim Gi Woon , Lee Young Hwan , Han Sangsoo
Published: May 2021

Smoking is a well-known risk factor for cardio-cerebrovascular disease. However, several studies have reported the “smoker's paradox” whereby smokers have a better prognosis for cardio-cerebrovascular diseases. Similar to cardio-cerebrovascular diseases, hypoxia is one of the major mechanisms of injury in carbon monoxide (CO) poisoning. This study investigated the association between smoking and delayed neuropsychiatric sequelae (DNS) in acute CO poisoning.

This study involved patients with CO poisoning treated at a university hospital in Bucheon, Korea between September 2017 and March 2020. The exclusion criteria were age <18 years, discharge against medical advice, loss to follow-up, persistent neurological symptoms at discharge, transfer from another hospital 24 hours after exposure, and transfer from another hospital after hyperbaric oxygen therapy. Logistic regression analysis was performed to find factors associated with DNS.

Two hundred sixty three patients visited the hospital due to CO poisoning and of these, 54 were excluded. DNS was evaluated up to 3 months after discharge, and until this time, DNS occurred in 35 (16.8%) patients. And the incidence rate of DNS was lower in smokers than non-smokers (15, 12% vs 20, 23.8%, P = .040). Multivariable logistic regression analysis revealed that CO exposure time (odds ratio [OR] 1.003; confidence interval [CI] 1.001–1.005; P = .003), the Glasgow coma scale (GCS) (OR 0.862; CI 0.778–0.956; P = .005), and pack-years (OR 0.947; CI 0.903–0.993; P = .023) were statistically significant for DNS development.

These results indicate that more pack-years smoked were associated with reduced risk of the development of DNS in acute CO poisoning, and that CO exposure time and GCS is a predictive factor for DNS occurrence.
A phase II study of gemcitabine plus nab-paclitaxel as first-line therapy for locally advanced pancreatic cancer
Authors: Fukahori Masaru , Miwa Keisuke , Murotani Kenta , Naito Yoshiki , Ushijima Tomoyuki , Sakaue Takahiko , Tanaka Toshimitsu , Nagasu Sachiko , Suga Hideya , Kakuma Tatsuyuki , Okabe Yoshinobu , Torimura Takuji
Published: May 2021

Gemcitabine plus nab-paclitaxel (GnP) is widely used in clinical practice, despite a lack of prospective data to validate its efficacy in locally advanced pancreatic cancer (LAPC). We conducted a phase II study of GnP for LAPC to assess its efficacy and safety.

We performed a single-arm, single-institution study with GnP in 24 patients with LAPC. The treatment protocol included successive administration of gemcitabine (1000 mg/m2) and nab-paclitaxel (125 mg/m2). The primary endpoint was the tumor overall response rate (ORR), and secondary endpoints were overall survival (OS), progression-free survival (PFS), and adverse events (AEs).

The median PFS was 11.0 months, median OS was 21.2 months, ORR was 62.5%, and 37.5% of the patients had stable disease. Four (16.7%) of the patients were converted to surgical resection; 3 of these achieved R0 resection. Grade 3 to 4 AEs included hematological (neutropenia, 64%; thrombocytopenia, 12%), nonhematological (cholangitis, 16%), and sensory neuropathy (4%). These AEs were manageable and tolerable.

The GnP treatment in patients with LAPC showed favorable tumor shrinkage, good toxicity profile, and enabled conversion to surgical resection in a subset of patients; therefore, GnP is an option for first-line chemotherapy in patients with LAPC.
Postoperative contact dermatitis caused by skin adhesives used in orthopedic surgery
Authors: So Sang Pil , Yoon Jae Youn , Kim Ji Wan
Published: May 2021

Skin adhesives are used to close clean surgical wounds. We aimed to investigate the incidence of skin adhesive-related contact dermatitis and the characteristics that differentiate it from a surgical site infection.

We retrospectively analyzed patients whose surgical wound was closed using a liquid skin adhesive (Dermabond Prineo skin closure system, Ethicon, NJ) by a single surgeon between March 2018 and June 2020. Medical records were reviewed to evaluate complications indicating contact dermatitis, including wound infections and hematomas.

We included 143 patients (men, 59; women, 84; mean age, 60.8 years). No patient had an early surgical site infection or wound dehiscence, but 4 (2.8%) developed postoperative contact dermatitis (week 7, 1; week 4, 2; day 9, 1). Manifestations included eczema and pruritus, without local heat or wound discharge. All cases resolved without complications, including infection.

Contact dermatitis occurred in 2.8% of patients who received liquid skin adhesive, and the symptoms differed from those of surgical site infection. Patients should be informed about the risk of contact dermatitis before applying a liquid skin adhesive.
Conservative management of avascular necrosis of the metacarpal head: Retraction
Authors: Fan Xiao-Lei , Wang Wen-Tao , Wang Jian , Liao Yi , Xiao Rui , Hu Yi-He
Published: May 2021

Rationale:

Avascular necrosis (AVN) of the metacarpal head is rare, and there is no clear consensus on treatment. The main aim of this study was to discuss the possible pathologic-mechanics of its development, epidemiology, radiographic features, and outcome after conservative treatment.

Patient concerns:

A 14-year-old male with a history of fractures in little finger complained of right-hand pain with a limited range of motion for 1 month. Diagnosis: Imaging examination confirmed the diagnosis of AVN in the long metacarpal finger and ring finger.

Interventions:

The patient was treated using non-surgical management, such as splint immobilization, non-steroidal anti-inflammatory drugs, and physiotherapy.

Outcomes:

At the last follow-up 26 months later, the patient was in complete remission with no residual symptoms. Magnetic resonance imaging (MRI) confirmed excellent remodeling and regeneration in the metacarpal head.

Lessons:

Metacarpal head necrosis typically occurs in adolescent patients with a history of trauma. Conservative treatment may sometimes have an excellent prognosis.
Anti-glomerular basement membrane disease associated with thin basement membrane nephropathy
Authors: Jung Chi Young , Lee Sun-Jae , Kim Min-Kyung , Ahn Dong Jik , Lee In Hee
Published: May 2021

Rationale:

Simultaneous occurrence of anti-glomerular basement membrane (anti-GBM) disease and thin basement membrane nephropathy (TBMN), both of which invade the type IV collagen subunits, is very rare. Here, we present the case of a 20-year-old male patient diagnosed with both anti-GBM disease and TBMN upon presenting dyspnea and hemoptysis.

Patient concerns:

No laboratory abnormalities, except arterial hypoxemia (PaO275.4 mmHg) and microscopic hematuria, were present. Chest computed tomography revealed bilateral infiltrations in the lower lung fields; thus, administration of empirical antibiotics was initiated. Gross hemoptysis persisted nonetheless, and bronchoscopy revealed diffuse pulmonary hemorrhage with no endobronchial lesions. Broncho-alveolar lavage excluded bacterial pneumonia, tuberculosis, and fungal infection.

Diagnosis:

Enzyme-linked immunosorbent assay of his serum was positive for anti-GBM antibody (95.1 U/mL). Human leukocyte antigen (HLA) test was positive for both HLA-DR15/-DR04. Other than diffuse thinning of the GBM (average thickness, 220 nm), index kidney biopsy did not demonstrate any specific abnormalities such as crescent formation.

Interventions:

Methylprednisolone was administered intravenously for 7 consecutive days (500 mg/day), followed by the daily dose of oral prednisolone (80 mg). Cyclophosphamide was also orally administered every day for 3 months (250 mg/day). Following 6 sessions of plasmapheresis, the anti-GBM antibody in serum became negative.

Outcomes:

There was no clinical evidence suggesting recurrence of pulmonary hemorrhage or azotemia during hospitalization and 12-month follow-up period. Twelve months after hospital discharge, oral prednisolone was discontinued.

Lessons:

The patients with concurrent anti-GBM disease and TBMN will have a favorable prognosis after proper therapy. However, further research is needed to elucidate the pathogenesis and long-term outcome of the comorbidity of these 2 diseases.
Treatment of bone fragility in patients with diabetes: antiresorptive versus anabolic?
Authors: Shah Meghna , Appuswamy Anusha Veeravanallur , Rao Sudhaker D. , Dhaliwal Ruban
Published: May 2021

Purpose of review

The pathogenesis of bone fragility in diabetes has not been fully characterized. The antifracture efficacy of available therapies remains unproven in patients with diabetes. We aim to collate current evidence of the treatment of diabetic bone fragility, and to provide a rationale for considering optimal therapeutic option in patients with diabetes.

Recent findings

The antifracture efficacy of antiresorptive and anabolic therapies is well established in patients without diabetes. Studies in patients with osteoporosis have shown that anabolic therapies lead to faster and larger benefits to bone mineral density and offer greater protection against fracture than antiresorptive therapies. Available data suggest that antiresorptive and anabolic therapies have similar effect on bone density and fracture risk reduction in patients with and without diabetes. However, the evidence in diabetes is limited to observational studies and post hoc analyses of osteoporosis studies.

There are no specific guidelines for the treatment of bone fragility in patients with diabetes. We offer a rationale for use of anabolic therapies in diabetes which is a low bone formation state, in contrast to postmenopausal osteoporosis that is characterized by increased bone turnover. Prospective studies evaluating the effect of available therapies on bone quality and fracture outcomes in patients with diabetes are needed.
Application of the Risk Stratification Index to Multilevel Models of All-condition 30-Day Mortality in Hospitalized Populations Over the Age of 65
Authors: Saini Vikas , Gopinath Valérie
Published: May 2021

Background:

The Risk Stratification Index (RSI) is superior to Hierarchical Conditions Categories (HCC) in patient-level regressions but has not been applied to assess hospital effects.

Objective:

The objective of this study was to measure the accuracy of RSI in modeling 30-day hospital mortality across all conditions using multilevel logistic regression.

Subjects and Data Sources:

A 100% sample of Medicare inpatient stays from 2009 to 2014, restricted to patients greater than 65 years of age in general hospitals, resulting in 64 million stays at 3504 hospitals.

Research Design:

We calculated RSI and HCC scores for patient stays using multilevel logistic regression in 3 populations: all inpatients, surgical, and nonsurgical. Correlations of risk-standardized mortality rates with rates of specific case types assessed case-mix balance. Patient stay volume was included to assess smaller hospitals.

Results:

We found a negligible correlation of all-conditions risk-standardized mortality rates with hospitals’ proportions of orthopedic, cardiac, or pneumonia cases. RSI outperformed HCC in multilevel regressions containing both patient and hospital-level effects. C-statistics using RSI were 0.87 for the all-inpatients group, 0.87 for surgical, and 0.86 for nonsurgical stays. With HCC they were 0.82, 0.82, and 0.81. Akaike Information Criteria and Bayesian Information Criteria values were higher with HCC. RSI shifted 41% of hospitals’ rankings by >1 decile. Hospitals with smaller volumes had higher 30-day observed and standardized mortality: 11.2% in the lowest volume quintile versus 8.5% in the highest volume quintile.

Conclusion:

RSI has superior accuracy and results in a significant shift in rankings compared with HCC in multilevel models of 30-day hospital mortality across all conditions.
Contemporary patterns of presentation, diagnostics and management of upper tract urothelial cancer in 101 centres: the Clinical Research Office of the Endourological Society Global upper tract urothelial carcinoma registry
Authors: Baard Joyce , Cormio Luigi , Cavadas Vitor , Alcaraz Antonio , Shariat Shahrokh F. , de la Rosette Jean , Laguna Maria P.
Published: May 2021

Purpose of review

To assess patterns of presentation, diagnostics and treatment in patients with upper tract urothelial carcinoma (UTUC), a multicentre registry was launched. Clinical data of UTUC patients were prospectively collected over a 5-year period.

Recent findings

Data from 2380 patients were included from 2014 to 2019 (101 centres in 29 countries). Patients were predominantly male (70.5%) and 53.3% were past or present smokers. The majority of patients (58.1%) were evaluated because of symptoms, mainly macroscopic hematuria. Computed tomography (CT) was the most common performed imaging modality (90.5%). A ureteroscopy (URS) was part of the diagnostic process in 1184 (49.7%) patients and 488 (20.5%) patients were treated endoscopically. In total, 1430 patients (60.1%) were treated by a radical nephroureterectomy, 59% without a prior diagnostic URS. Eighty-two patients (3.4%) underwent a segmental resection, 19 patients (0.8%) were treated by a percutaneous tumour resection.

Our data is in line with the known epidemiologic characteristics of UTUC. CT imaging is the preferred imaging modality as also recommended by guidelines. Diagnostic URS gained a stronger position, however, in almost half of patients a definitive treatment decision was made without complete endoscopic information. Only one-third of patients with UTUC are currently treated with kidney sparing surgery.
Radiogenomics in prostate cancer evaluation
Authors: Thenault Ronan , Gasmi Anis , Khene Zine-Edine , Bensalah Karim , Mathieu Romain
Published: May 2021

Purpose of review

Radiogenomics, fusion between radiomics and genomics, represents a new field of research to improve cancer comprehension and evaluation. In this review, we give an overview of radiogenomics and its most recent and relevant applications in prostate cancer management.

Recent findings

Literature about radiogenomics in prostate cancer emerged last 5 years but remains scarce. Radiogenomics in prostate cancer mainly rely on MRI-based features. Several imaging biomarkers, mostly based on the identification of radiomic features from deep learning studies, have been studied for the prediction of genomic profiles, such as PTEN Decipher Oncotype DX or Prolaris expression. However, despite promising results, several limitations still preclude any integration of radiogenomics in daily practice.

In the future, the emergence of artificial intelligence in urology, with an increasing use of radiomics and genomics data, may enable radiogenomics to assume a growing role in the evaluation of prostate cancer, with a noninvasive and personal approach in the field of personalized medicine. Further efforts are necessary for integration of this promising approach in prostate cancer decision-making.
Patients Who Failed to Conceive Following an In Vitro Fertilization Cycle Can Be Clustered Into Different Failure Causes Using Gene Expression Hierarchical Analysis
Authors: Fortin Chloé S. , Hamilton Scot , Laforest Martin , Léveillé Marie-Claude , Sirard Marc-André
Published: May 2021

(Abstracted from Biol Reprod 2020;103:599–607)

The efficacy of in vitro fertilization (IVF) with embryo transfer and other assisted reproductive technologies has dramatically improved since their introduction, resulting in current multiple pregnancy rates lower than 10%. Despite advancements, an overall success rate of 30% could be improved by further exploration of why treatment response remains highly variable between patients.
Efficacy of Distraction for Reducing Pain and Distress Associated With Venipuncture in the Pediatric Posttransplant Population
Authors: Grabinski Zoe G. , Boscamp Nicholas S. , Zuckerman Warren A. , Zviti Ronald , O'Brien Ann , Martinez Mercedes , Tsze Daniel S.
Published: May 2021

Objective

Distraction can reduce pain and distress associated with painful procedures but has never been studied in children with solid organ transplants. We aimed to determine whether there is a difference in pain and distress associated with venipuncture in pediatric posttransplant patients who receive distraction compared with those who do not.

Methods

Randomized controlled trial of children aged 4 to 17 years with solid organ transplants undergoing venipuncture in the outpatient setting. Patients were randomized to receive distraction or no distraction. The primary outcome was the Faces Pain Scale–Revised. Secondary outcomes were the Observational Scale of Behavioral Distress–Revised; Faces, Leg, Activity, Cry, Consolability; and Children's Hospital of Eastern Ontario Pain Scale. Exploratory outcomes included the number of venipuncture attempts, time to successful venipuncture, and satisfaction of phlebotomists and parents.

Results

Median age of the 40 children enrolled was 11.5 years. Type of transplants included the heart (67.5%), kidney (22.5%), liver (7.5%), and more than 1 organ (2.5%). There was no difference between the Faces Pain Scale–Revised scores in distraction and no distraction groups (1.4; 95% confidence interval, 0.9–1.9; and 1.3, 95% confidence interval, 0.5–2.1, respectively). There was also no difference in the Observational Scale of Behavioral Distress–Revised; Faces, Leg, Activity, Cry, Consolability; and Children's Hospital of Eastern Ontario Pain Scale scores, number of venipuncture attempts, or time to successful venipuncture. Phlebotomists were more satisfied with the venipuncture when distraction was implemented.

Conclusions

In children with solid organ transplants, there was no difference in pain and distress associated with venipuncture between those who did and did not receive distraction. There was also no difference in other procedure-related outcomes except for greater phlebotomist satisfaction when distraction was implemented.
Maintenance Strategies for Myeloma
Authors: Nooka Ajay K. , Joseph Nisha S.
Published: May 2021

Over the last decade, several very important prospective randomized controlled trials have confirmed the significant survival benefit conferred by maintenance therapies. Owing to these developments, the role of continued maintenance in the optimal management strategies of newly diagnosed myeloma patients (both transplant-eligible and transplant-ineligible) has been strongly cemented. In dealing with an incurable disease such as myeloma, whether to offer maintenance is no longer as relevant a question as it was before, but which antimyeloma agent or agents to use, as maintenance remains more pertinent today. More importantly, a personalized risk-stratified maintenance approach for an individual patient to yield the best benefit for that specific patient is yet to be uniformly adapted. In this article, we review the available and evolving clinical data leading to our current-day practices, and we make an effort to describe what lies ahead.