bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comprehensive Characterization of Ecological and Epidemiological Factors Driving Perennation of Podosphaera macularis Chasmothecia on Hop (Humulus lupulus)
Authors: Weldon William A. , Marks Michelle E. , Gevens Amanda J. , D’Arcangelo Kimberly N. , Quesada-Ocampo Lina M. , Parry Stephen , Gent David H. , Cadle-Davidson Lance E. , Gadoury David M.
Published: April 2021

Hop powdery mildew, caused by the ascomycete fungus Podosphaera macularis, is a consistent threat to sustainable hop production. The pathogen utilizes two reproductive strategies for overwintering and perennation: (i) asexual vegetative hyphae on dormant buds that emerge the following season as infected shoots; and (ii) sexual ascocarps (chasmothecia), which are discharged during spring rain events. We demonstrate that P. macularis chasmothecia, in the absence of any asexual P. macularis growth forms, are a viable overwintering source capable of causing early season infection two to three orders of magnitude greater than that reported for perennation via asexual growth. Two epidemiological models were defined that describe (i) temperature-driven maturation of P. macularis chasmothecia; and (ii) ascosporic discharge in response to duration of leaf wetness and prevailing temperatures. P. macularis ascospores were confirmed to be infectious at temperatures ranging from 5 to 20°C. The organism’s chasmothecia were also found to adhere tightly to the host tissue on which they formed, suggesting that these structures likely overwinter wherever hop tissue senesces within a hop yard. These observations suggest that existing early season disease management practices are especially crucial to controlling hop powdery mildew in the presence of P. macularis chasmothecia. Furthermore, these insights provide a baseline for the validation of weather-driven models describing maturation and release of P. macularis ascospores, models that can eventually be incorporated into hop disease management programs.
Implementing a COVID-19 Discharge Pathway to Improve Patient Safety
Authors: Patel Hemali , Virapongse Anunta , Baduashvili Amiran , Devitt Jessica , Barr Rachelle , Bookman Kelly
Published: April 2021

The posthospital discharge period is vulnerable for patients with coronavirus disease 2019 (COVID-19). The authors implemented a COVID-19 discharge pathway in the electronic medical record for UCHealth, a 12-hospital health care system, including an academic medical center (University of Colorado Hospital [UCH]), to improve patient safety by standardizing discharge processes for COVID-19 patients. There were 3 key elements: (1) building consensus on discharge readiness criteria, (2) summarizing discharge criteria for disposition locations, and (3) establishing primary care follow-up protocols. The discharge pathway was opened 821 times between April 20, 2020, and June 7, 2020. Of the 436 patients discharged from the hospital medicine service at UCH from April 20, 2020, and June 7, 2020, 18 (4%) were readmitted and 13 (3%) had a 30-day emergency department visit. The main trend observed was venous thromboembolism. This pathway allowed real-time integration of clinical guidelines and complex disposition requirements, decreasing cognitive burden and standardizing care for a complex population.
Acute Kidney Injury Recovery Patterns in Critically Ill Patients: Results of a Retrospective Cohort Study*
Authors: Abdel-Nabey Moustafa , Ghrenassia Etienne , Mariotte Eric , Valade Sandrine , Morel Guillaume , Lemiale Virginie , Zafrani Lara , Azoulay Elie , Darmon Michael
Published: April 2021

OBJECTIVES:

Acute kidney injury, acute kidney injury severity, and acute kidney injury duration are associated with both short- and long-term outcomes. Despite recent definitions, only few studies assessed pattern of renal recovery and time-dependent competing risks are usually disregarded. Our objective was to describe pattern of acute kidney injury recovery, change of transition probability over time and their risk factors.

DESIGN:

Monocenter retrospective cohort study. Acute kidney injury was defined according to Kidney Disease Improving Global Outcomes definition. Renal recovery was defined as normalization of both serum creatinine and urine output criteria. Competing risk analysis, time-inhomogeneous Markov model, and group-based trajectory modeling were performed.

SETTING:

Monocenter study.

PATIENTS:

Consecutive patients admitted in ICU from July 2018 to December 2018 were included.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Three-hundred fifty patients were included. Acute kidney injury occurred in 166 patients at ICU admission, including 64 patients (38.6%) classified as acute kidney disease according to Acute Disease Quality Initiative definition and 44 patients (26.5%) who could not be classified. Cumulative incidence of recovery was 25 % at day 2 (95% CI, 18–32%) and 35% at day 7 (95% CI, 28–42%). After adjustment, need for mechanical ventilation (subdistribution hazard ratio, 0.42; 95% CI, 0.23–0.74) and severity of the acute kidney injury (stage 3 vs stage 1 subdistribution hazard ratio, 0.11; 95% CI, 0.03–0.35) were associated with lack of recovery. Group-based trajectory modeling identified three clusters of temporal changes in this setting, associated with both acute kidney injury recovery and patients’ outcomes.

CONCLUSIONS:

In this study, we demonstrate Acute Disease Quality Initiative to allow recovery pattern classification in 75% of critically ill patients. Our study underlines the need to take into account competing risk factors when assessing recovery pattern in critically ill patients.
Exhalation Spreading During Nasal High-Flow Therapy at Different Flow Rates
Authors: Dellweg Dominic , Kerl Jens , Gena Amayu Wakoya , Alsaad Hayder , Voelker Conrad
Published: April 2021

OBJECTIVES:

Severe acute respiratory syndrome coronavirus 2 is transmitted through aerosols and droplets. Nasal high-flow therapy could possibly increase the spreading of exhalates from patients. The aim of this study is to investigate whether nasal high-flow therapy affects the range of the expiratory plume compared with spontaneous breathing.

DESIGN:

Interventional experiment on single breaths of a healthy volunteer.

SETTING:

Research laboratory at the Bauhaus-University Weimar.

Subjects:

A male subject.

INTERVENTIONS:

Videos and images from a schlieren optical system were analyzed during spontaneous breathing and different nasal high-flow rates.

MEASUREMENTS AND MAIN RESULTS:

The maximal exhalation spread was 0.99, 2.18, 2.92, and 4.1 m during spontaneous breathing, nasal high-flow of 20 L/min, nasal high-flow of 40 L/min, and nasal high-flow of 60 L/min, respectively. Spreading of the expiratory plume in the sagittal plane can completely be blocked with a surgical mask.

CONCLUSIONS:

Nasal high-flow therapy increases the range of the expiratory air up to more than 4 meters. The risk to pick up infectious particles could be increased within this range. Attachment of a surgical mask over the nasal high-flow cannula blocks the expiratory airstream.
An Unusual Complication following Gluteal Fat Grafting: A Case Report
Authors: Neiman Ariel , Sadeh Omer , Dudaie Shay , Shoufani Aziz
Published: April 2021

Subfascial abscess of the lateral thigh is a relatively uncommon complication following gluteal fat grafting due to their subclinical presentation. Despite its rarity, subfascial abscesses can be dangerous and life-threatening when diagnosis is delayed. In this case report, we present a 28-year-old woman who presented to our hospital with swelling and erythema following a gluteal fat grafting procedure performed abroad. Our initial treatment which included transcutaneous drainage and systemic antibiotics was unsuccessful. This conservative approach was influenced by the patient’s initial procedure and attempt to conserve aesthetic appearance. The severity of the complication was not entirely known until advanced radiological imaging (computer tomography imaging) was performed several days after hospitalization and revealed large subfascial abscess. Surgical drainage with fasciotomy was required due to a persisting high fever and fluid accumulation in the lateral thigh. Approximately 1 L of purulent fluid was collected, containing large bulks of fat particles and blood clots that drained from the subfascial space. The wound was left open and treated with vacuum-assisted closure. Direct penetration of cannula through fascial layer, insertion of harvested fat that exceeds intrinsic properties of fascia, or unknown intercompartment connections can lead to deep subfascial migration of fat. Aggressive measures that include immediate advanced radiological imaging should be performed when the severity of damage and migration of injected fat are unknown. Transcutaneous drainage is not effective for subfascial abscesses due to formation of large fat particles and blood clots that cannot be drained. Immediate incision and drainage should be considered for similar cases.
The comparison of ketamine with tramadol for postoperative pain relief on children following adenotonsillectomy or tonsillectomy
Authors: Wang Lifeng , Guo Yongkang , Tian Jun
Published: April 2021

Introduction:

The comparison of ketamine with tramadol for pain control remains controversial in pediatric adenotonsillectomy or tonsillectomy. We conduct a systematic review and meta-analysis to explore the efficacy of ketamine vs tramadol for pain relief in children following adenotonsillectomy or tonsillectomy.

Methods:

We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2019 for randomized controlled trials (RCTs) assessing the effect of ketamine vs tramadol for pediatric adenotonsillectomy or tonsillectomy. This meta-analysis is performed using the random-effects model.

Results:

Six RCTs are included in the meta-analysis. Overall, compared to ketamine group for pediatric adenotonsillectomy or tonsillectomy, tramadol is associated with substantially lower CHEOPS at 1 h (SMD = 1.56; 95% CI = 0.20–2.92; P = .02; low quality) and longer first time of additional pain medication (SMD = −0.47; 95% CI = −0.74 to −0.19; P = .0008; low quality), but demonstrates no obvious effect on CHEOPS at 6 h (SMD = 0.51; 95% CI = −1.17 to 2.19; P = .55; low quality), sedation scale at 1 h (SMD = −0.80; 95% CI = −3.07 to 1.48; P = .49; low quality) or additional pain medication (RR = 1.31; 95% CI = 0.85–2.02; P = .23; moderate quality).

Conclusions:

Tramadol may be better to alleviate the postoperative pain after pediatric adenotonsillectomy or tonsillectomy.
H. pylori negative gastric MALT lymphoma with API2-MALT1 translocation treated by endoscopic submucosal dissection
Authors: Tahara Tomomitsu , Horiguchi Noriyuki , Terada Tsuyoshi , Yoshida Dai , Okubo Masaaki , Funasaka Kohei , Nakagawa Yoshihito , Shibata Tomoyuki , Ohmiya Naoki
Published: April 2021

Rationale:

API2-MALT1 positive gastric mucosa-associated lymphoid tissue (MALT) lymphomas are considered to have favorable prognosis. We report a case of API2-MALT1 positive gastric MALT lymphoma, treated by endoscopic submucosal dissection (ESD).

Patient concerns:

A 51-year-old man underwent esophagogastroduodenoscopy (EGD) for the annual health checkup examination.

Diagnoses:

The EGD showed a reddish depressed lesion with small reddish spots in the lower gastric body. There was no endoscopic atrophy in the entire stomach and Helicobacter pylori (H. pylori) serum test was negative. Infiltration of small lymphocytes was shown in the gastric tissues obtained by the endoscopic biopsy. The fluorescence in situ hybridization using the biopsy samples confirmed the presence of genetic translocation of API2-MALT1, suggesting that the lesion is API2-MALT1 positive MALT lymphoma.

Interventions:

Since endoscopic ultrasound suggested that the lesion was localized within the lamina propria mucosae, we performed ESD to achieve the en bloc resection of the lesion.

Outcomes:

Conclusive diagnosis of gastric MALT lymphoma was made based on the resected specimen. Lateral and vertical margins were negative. No lymphoma cells were detected using endoscopic biopsy after 5 years.

Lessons:

Our report suggests that ESD can be considered as alternative treatment for API2-MALT1 positive gastric MALT lymphoma if the lesion was localized within the gastric mucosa.
Mortality-related factors in patients with OXA-48 carbapenemase-producing Klebsiella pneumoniae bacteremia
Authors: Rodríguez O. Lima , Sousa A. , Pérez-Rodríguez María Teresa , Martínez-Lamas L. , Suárez R. Longueira , Martínez C. Taboada , Pino C. Portela , Vidal F. Vasallo , Pérez-Landeiro A. , Casal M. Crespo
Published: April 2021

Carbapenemase-producing Enterobacterales constitute a serious public health threat; however, information on the oxacilinasa (OXA-48)-type is limited. The objective of the study was to evaluate the risk factors associated with 14-day mortality for patients with bacteremia due to OXA-48 carbapenemase-producing Klebsiella pneumoniae.

We conducted a retrospective, single-center observational study of adult patients with K. pneumoniae bacteremia, classifying the strains as carbapenem-susceptible K. pneumoniae (CSKp) and carbapenem-resistant K. pneumoniae (CRKp). All of the CRKp strains were the OXA-48-type.

The study included 202 cases of bacteremia: 114 due to CSKp and 88 due to CRKp. The clinical cure rate was higher for the patients with CSKp (85% vs 69% for CSKp and CRKp, respectively; P = .010), while the 14-day mortality rate was lower (13% vs 30%, P = .005). An INCREMENT-CPE score ≥7 (HR 3.05, 95% CI 1.50–6.25, P = .002) was the only independent factor associated with 14-day mortality for the patients with Klebsiella spp. bacteremia. Other factors related to 14-day mortality were a rapidly fatal prognosis (McCabe) (HR 7.1, 95% CI 2.75–18.37, P < .001), dementia (HR 5.9, 95% CI 2.0–7.43, P = .001), and a high-risk source of infection (HR 2.7, 95% CI 1.06–6.82, P = .038).

The most important factors associated with 14-day mortality for the patients with K. pneumoniae bacteremia was an INCREMENT-CPE score ≥7, dementia, a McCabe score indicating a rapidly fatal prognosis and a high-risk source of infection. We found no relationship between a poorer outcome and CRKp isolation or inadequate antibiotic therapy.
Photodynamic therapy for radiation maculopathy
Authors: Baba Taro , Hirooka Kazuyuki , Yuasa Yuki , Ihara Noriko , Takenaka Joji , Okumichi Hideaki , Kiuchi Yoshiaki
Published: April 2021

Rationale:

The best treatment protocol for radiation maculopathy in children has not been determined. The purpose of this study was to determine the effect of photodynamic therapy (PDT) on radiation maculopathy.

Patient concerns:

An 11-year-old boy who was originally diagnosed with orbital rhabdomyosarcoma when he was 1 year old, in October 2008. The lesion improved after peripheral blood stem cell transplantation, chemotherapy and radiation therapy. A cataract was detected in his right eye in May 2011, and he underwent cataract surgery in July 2011. Continuous amblyopia training maintained his visual acuity in his right eye. In January 2017, his visual acuity was reduced and macular edema was detected with optical coherence tomography.

Diagnoses:

We diagnosed radiation maculopathy, from the history of radiation therapy, macular edema by optical coherence tomography, and hyperfluorescent site by fluorescein angiography.

Interventions:

We performed PDT in June 2017.

Outcomes:

Treatment with PDT improved macular edema and his visual acuity.

Lessons:

Radiation retinopathy is progressive disorder with poor prognosis. PDT could be considered to treat radiation maculopathy.
Severe hypercalcemia in a patient with chronic lymphocytic leukemia and non-small cell lung carcinoma
Authors: Shacham Elena Chertok , Marshak Dafna Chap , Brikman Shay , Dori Guy , Ishay Avraham
Published: April 2021

Rationale:

Hypercalcemia is a common finding in patients with advanced-stage cancers. Paraneoplastic hypercalcemia is commonly associated with dismal prognoses, with survival rates of about 3 months. In this paper, we report on a patient with advanced chronic lymphocytic leukemia and non-small cell lung carcinoma who developed severe hypercalcemia and discuss the diagnosis and treatment of this metabolic complication.

Patient concerns:

A 56-year old male with a 2-year history of Rai stage IV chronic lymphocytic leukemia presented with life-threatening hypercalcemia. Positron emission tomography/computed tomography revealed a suspicious lung lesion. A transbronchial biopsy was performed from the upper left lobe. Due to the small size of the specimen, immunohistochemical markers were performed and revealed positive staining for cytokeratin 7 and negative for TTF-1, napsin A and p 40, which were consistent with non-small cell lung carcinoma.

Diagnosis:

Humoral hypercalcemia of malignancy was diagnosed.

Intervention:

The patient was treated with saline infusion, calcitonin, intravenous pamidronate, followed with denosumab.

Outcomes:

The hypercalcemia was successfully treated and the patient's calcium levels returned to normal. Further evaluation revealed a non-small cell lung carcinoma as a second primary malignancy. The patient was treated with venetoclax for his refractory CLL and received chemotherapy and immunotherapy for lung adenocarcinoma. Several days after starting venetoclax, he developed Legionella pneumonia and short time after the second course of chemotherapy, a severe sepsis occurred and he passed away.

Lessons:

Coexistence of 2 unrelated malignancies, whichever could be a reason for hypercalcemia of malignancy is a rare event. Severe hypercalcemia, which is possible but rare feature of CLL should be a reason for further prompt evaluation.
Factors associated with the progression and prevention of noncommunicable diseases in community-dwelling Filipino adults
Authors: Yamaguchi Yuko , Tuliao Maria Teresa Reyes , Matsuo Hiroya
Published: April 2021

Noncommunicable diseases (NCDs) are an important cause of disability and death in Muntinlupa, Manila, Philippines. However, there is little community-based research on lifestyle behaviors that affect the progression of NCDs or on the hindrances to NCD prevention.

This cross-sectional study investigated the lifestyle behaviors associated with the progression and prevalence of NCDs and clarified factors associated with health promotion for the NCDs prevention among 168 Filipino adults aged 50 years and above in the community setting.

The prevalence of diabetes, cardiovascular disease, cancer, chronic respiratory disease, hypertension, and overweight/obesity found 13.1%, 8.9%, 1.8%, 4.2%, 59.5%, and 36.9%, respectively. Of 63 adults who underwent blood tests, high blood glucose and abnormal lipids found 20.6% and 80.9%, respectively. Filipino adults ate breakfast, lunch, and dinner more than 5 days a week, Merienda 4.2 days a week, and a midnight snack 1.7 days a week. The mean frequencies of physical activity at vigorous, moderate, and light intensity levels were 2.6 times a week, 1.9 times a week, and 3.8 times a week, respectively. Men were more likely to be smokers than women. Mean frequencies of alcohol consumption were 0.6 days a week. Filipino adults who practiced diet control, regular physical activities, no smoking, limited alcohol intake, stress control, and regular health checkups were 68.3%, 34.1%, 35.9%, 35.3%, 32.9%, and 24.6%, respectively. Hypertension was positively associated with the duration of tobacco use and frequency of salt intake. Overweight/obesity was positively associated with the frequency of Merienda. Diet control was positively related with internal Multidimensional Health Locus of Control scale. Smoking and alcohol control were significantly related with income level.

Community-dwelling Filipino adults in this study had a high prevalence of NCD progression and insufficient awareness of preventative behaviors. Diet control is associated with self-awareness of health and smoking and alcohol control are associated with economic status. These findings ought to contribute to develop the effective strategies for NCD prevention in community-dwelling Filipino adults.
Accuracy of the highly sensitive C-reactive protein/albumin ratio to determine disease activity in inflammatory bowel disease
Authors: Liu Ailing , Lv Hong , Tan Bei , Shu Huijun , Yang Hong , Li Ji , Qian Jiaming
Published: April 2021

Persistent disease activity is associated with a poor prognosis in patients with inflammatory bowel disease (IBD). This study aims to explore the accuracy of the highly sensitive C-reactive protein/albumin ratio (CAR) in determining IBD activity.

The clinical data of 231 IBD patients treated at Peking Union Medical College Hospital from 2012 to 2018 were analyzed retrospectively. The patients were classified as having active disease or remission according to the Crohn disease activity index scores for patients with Crohn disease (CD) and partial Mayo scores for patients with ulcerative colitis (UC).

This study included 231 IBD patients (137 CD and 94 UC). From these groups, 182 patients had active disease, while 49 patients were in remission. The platelet counts, erythrocyte sedimentation rates, high-sensitivity C-reactive protein levels, and CAR scores were significantly higher, while hemoglobin levels, ALB, and body mass indexes were significantly lower in patients with active disease (P < 0.01). The hsCRP, CAR, and ALB significantly correlated with disease activity for both CD and UC (P < 0.001). The area under the curve (AUC) of CAR was highest among the laboratory indexes at 0.829, and the AUC of CAR in the UC patients was larger than that of the CD patients. Also, CAR with cutoff value of 0.06 displayed the highest sensitivity among the indexes for IBD activity at 83.05%.

CAR is a useful biomarker for identifying disease activity in patients with CD and UC. Higher CAR levels are indicative of increased IBD activity. CAR may be more valuable in UC than that in CD for assessing the degree of IBD activity.
Comparing the diagnostic value of bronchoalveolar lavage fluid galactomannan, serum galactomannanan, and serum 1,3-β-d-glucan in non-neutropenic respiratory disease patients with invasive pulmonary aspergillosis
Authors: Dai Zhang , Cai Minjing , Yao Yihui , Zhu Jianhui , Lin Lingqing , Fang Lili , Li Zhimeng , Yi Huochun , Chen Bo , Liang Xianming
Published: April 2021

The incidence of invasive pulmonary aspergillosis (IPA) is increasing higher in non-neutropenic patients. This study aimed to assess the diagnostic performance of bronchoalveolar lavage fluid (BALF). Galactomannan (GM), serum GM, and 1,3-β-d-glucan (BDG) in non-neutropenic respiratory disease patients with IPA.

A total of 333 non-neutropenic patients suspected IPA were recruited from Xiamen University Zhong Shan hospital between January 2016 and February 2019. One, 33, and 92 cases were diagnosed with proven, and possible IPA.

BALF and serum GM were both elevated in the possible IPA group and the probable/proven IPA group (p < 0.001). BALF and serum GM showed a fair correlation in the possible IPA group (r = 0.286, p = 0.008), and moderate correlation in the probable/proven IPA group (r = 0.466, p = 0.005). When the cutoff value was 0.5, the sensitivity and negative likelihood ratio of BALF GM were superior to serum GM (78.3% vs 47.8%, 96.7% vs 91.6%). The specificity and positive likelihood ratio of BALF GM were slightly weaker than serum GM (91.8% vs 95.4%, 56.7% vs 85.0%). When the cutoff value was 1.0, the sensitivity and negative predictive value of BALF GM were better than serum GM (73.9% vs 26.1%, 94.5% vs 88.8%), and the specificity of were equivalent (99.2%). The optimal cutoff value of BALF GM was 0.6, wherein the sensitivity reached 78.3% and the specificity reached 95.4%. Given the extremely low sensitivity of serum BDG at different cutoff values (≥10 μg/mL = 5.3%, ≥20 μg/mL = 2.1%), it cannot be used as a preferred biomarker.

The diagnostic performance of BALF GM was superior to other biomarkers and the optimal cutoff value was 0.6.
Evaluation of ropivacaine combined with dexmedetomidine versus ropivacaine alone for epidural anesthesia
Authors: Zhao Jiani , Liao Chen , Wu Qian , Wang Li , Deng Fumou , Zhang Wenxiong
Published: April 2021

Background:

Ropivacaine is considered the most commonly used for epidural anesthesia. We compared the efficiency and safety of ropivacaine alone (R group) and ropivacaine combined with dexmedetomidine (RD group).

Method:

PubMed, the Cochrane Library, Google Scholar, Ovid Medline, the Web of Science, Scopus, Embase, and ScienceDirect were searched. We considered sensory and motor block, duration of anesthesia, time to rescue, hemodynamics, and adverse effects as the primary endpoints.

Results:

Eleven randomized controlled trials were included with 337 patients in the R group and 336 patients in the RD group. The RD group had a shorter time to onset of sensory (mean difference [MD]: 3.97 [1.90–6.04] minutes; P = .0002) and motor (MD: 2.43 [0.70–4.16] minutes; P = .006) block and a longer duration of anesthesia (MD: -164.17 [-294.43 to -33.91]; P = .01) than the R group. Comparison of the time to rescue between the groups showed no significant difference (MD: -119.01[-254.47–16.46] minutes; P = 0.09). The R group showed more stable hemodynamics than the RD group in heart rate and arterial pressure at 10 minutes. The R group had a lower incidence of bradycardia and a higher incidence of shivering than the RD group.

Conclusion:

RD may be a more suitable choice for epidural anesthesia with better anesthetic outcomes than R alone. However, the safety of the combination must be carefully assessed.
Repetitive transcranial magnetic stimulation in major depression
Authors: Johansson Kristoffer , Adler Mats , Båve Ullvi , Ekman Carl-Johan , Lundberg Johan
Published: April 2021

Background:

The optimal dose (number of pulses per session) of repetitive transcranial magnetic stimulation (rTMS), using the H-coil, in major depressive disorder (MDD) has not previously been reported.

Objective:

To explore the relationship between rTMS dose and antidepressant effect, and collect data for the design of a definitive trial.

Methods:

This was a double-blind, three-arm parallel-group, randomized [1:1:1], pilot trial conducted in Stockholm, Sweden (September 2014 to September 2016). The primary outcome was change in depression severity measured with the Montgomery Åsberg Depression Rating Scale (MADRS) after 4 weeks. Participants (n = 29) with MDD were randomized to 1000, 2000, or 4000 pulses of rTMS for 20 sessions during 4 weeks.

Results:

At 4 weeks, the 3 treatment groups reduced the mean MADRS (95% CI) by 11.6 (4.0–19.2), 9.1 (5.0–13.3), and 11.3 (4.1–18.5) points respectively. Eleven participants met criteria for response and 10 for remission. No serious adverse events occurred. Ratings of subjective memory improved in all groups. Exploring the effect of dose and time, 4000 pulses had the largest reduction in MADRS during the first 2 weeks. A comparison of change in MADRS between 2000 and 4000 pulses after 2 weeks will require a sample size of 66 patients at power .80 and alpha .05.

Conclusions:

It is feasible to conduct a definitive trial investigating whether a higher number of magnetic pulses per treatment session gives a more rapid antidepressive response.
Upregulation of a kinase interacting protein 1 in tongue squamous cell carcinoma correlates with lymph node metastasis and poor overall survival
Authors: Sun Ying , Shi Guang , Ma Chao , Jiao Jianjun , Liu Yingqi , Gao Qingling , Zhang Xueqiang , Feng Qiang
Published: April 2021

A kinase interacting protein 1 (AKIP1) is upregulated in cancer cells/tissues and associated with deteriorative tumor features, while it has not been investigated in tongue squamous cell carcinoma (TSCC). The goal of this study was to measure AKIP1 expression and analyze its correlation with clinical feature and prognosis in TSCC patients.

We retrospectively reviewed 194 TSCC patients, whose formalin fixed paraffin-embedded (FFPE) tumor tissue specimens and paired adjacent tissue specimens were accessible for AKIP1 detection by immunohistochemistry (IHC). Whereas only 107 patients whose fresh-frozen tumor tissue and paired fresh-frozen adjacent tissue that were still available in storage were included for AKIP1 mRNA detection by real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR).

AKIP1 expression (both the protein detected by IHC and mRNA detected by RT-qPCR) was higher in TSCC tissue than that in adjacent tissue. In addition, both tumor AKIP1 mRNA and protein expressions were correlated with advanced N stage and TNM stage, while they were not correlated with other clinical features in TSCC patients. As for survival, there was a correlation of AKIP1 mRNA with poor overall survival (OS), while the correlation of AKIP1 protein expression with OS was of limited statistical significance.

There is an upregulation of AKIP1 in TSCC and it correlates with lymph node metastasis as well as unfavorable prognosis in TSCC patients.
The relationship between nutritional status and the prognosis of COVID-19
Authors: Li Yuhong , Tong Shijun , Hu Xueyuan , Wang Yuanjun , Lv Ronghua , Ai Shaozheng , Hou Ming , Fan Haining , Shen Youlu
Published: April 2021

It is important for patients to maintain a good nutritional status as a health promotion strategy to improve the immune function and thus the prognosis of coronavirus disease 2019 (COVID-19).

The objective of this retrospective study is to analyze the relationships of nutritional status with inflammation levels, protein reserves, baseline immune status, severity, length of hospital stay, and prognosis of COVID-19 patients.

A total of 63 COVID-19 patients hospitalized in the People's Hospital and the Traditional Chinese Medicine Hospital of the Xinzhou District, Wuhan, China, from January 29, 2020 to March 17, 2020. Sixty-three patients were divided into 3 groups according to the guidelines, moderate (n = 22), severe (n = 14), and critical (n = 25), respectively. The differences in the total nutrition risk screening (NRS) score, inflammation level, protein reserve, baseline immune status, length of hospital stay, and prognosis were compared among patients with moderate, severe, and critical COVID-19.

Patients with higher NRS scores tend to have more severe COVID-19, higher C-reactive protein and serum procalcitonin levels, higher white blood cell counts, lower lymphocyte counts, and higher mortality rates (P < .05).

Nutritional status may be an indirect factor of the severity and prognosis of COVID-19.
Identification and validation of key non-coding RNAs and mRNAs using co-expression network analysis in pre-eclampsia
Authors: He Jing , Liu Kang , Hou Xiaohong , Lu Jieqiang
Published: April 2021

Pre-eclampsia (PE) is a common complication of pregnancy, associated with maternal and fetal morbidity and mortality. In this study, we aimed to explore important long non-coding RNAs (lncRNAs) and their possible mechanisms in PE.

GSE60438 expression profile including 25 PE samples and 23 normal samples were obtained from gene expression omnibus (GEO) database. After normalization with betaqn package in R, differentially expressed lncRNAs (DElncRNAs) and mRNAs (DEmRNAs) were identified using the limma package. Gene Ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway were analyzed using DAVID 6.7 and GSEA 3.0. LncRNAs-mRNAs coexpression was implemented using weighted gene co-expression network analysis (WGCNA). MicroRNAs linked with these DElncRNAs and DEmRNAs were predicted and a competitive endogenous RNA (ceRNA) network was built.

A total of 53 DElncRNAs and 301 DEmRNAs were identified between control and PE samples. These DEmRNAs were enriched into pathways such as protein digestion and absorption, osteoclast differentiation. WGCNA constructed a lncRNA-mRNA coexpression network, among which SUMO1P3, NACAP1, NCF1C, ANXA2P1, GTF2IP1, NAPSB, OR7E37P were hub genes. ceRNA network was constructed together with microRNAs (miRNAs), and functional analysis indicated cellular membrane and sugar binding were involved in PE progression. Five lncRNAsANXA2P1, GTF2IP1, NACAP1, NCF1C and OR7E37P were successfully validated in our clinical specimens.

The DElncRNAs, including ANXA2P1, GTF2IP1, NACAP1, NCF1C and OR7E37P might play important roles in PE. However, the exact mechanism of these lncRNAs in prediction and diagnosis of PE should be further explored.
A five-gene signature for predicting overall survival of esophagus adenocarcinoma
Authors: Lan Tian , Liu Weiguo , Lu Yunyan , Luo Hua
Published: April 2021

Esophageal adenocarcinoma (EAC) is common and aggressive with increasing trend of incidence. Urgent need for an effective signature to assess EAC prognosis and facilitate tailored treatment is required.

Differentially expressed mRNAs (DEMs) were identified by analyzing EAC tissues and adjacent normal samples from The Cancer Genome Atlas (TCGA). Then univariate regression analyses were performed to confirm prognostic DEMs. We used least absolute shrinkage and selection operator (LASSO) to build a prognostic mRNA signature whose performance was assessed by Kaplan–Meier curve, receiver operating characteristic (ROC). GSE72874 were used as an external test set. The performances of the signature were also validated in internal TCGA and external test sets. Gene set enrichment analysis (GSEA) and tumor immunity analysis were performed to decipher the biological mechanisms of the signature.

A 5-mRNA signature consisted of SLC26A9, SINHCAF, MICB, KRT19, and MT1X was developed to predict prognosis of EAC. The 5-mRNA signature was promising as a biomarker for predicting 3-year survival rate of EAC in the internal test set, the entire TCGA set, and the external test set with areas under the curve (AUC) = 0.849, 0.924, and 0.747, respectively. Patients were divided into low- and high-risk groups based on risk scores of the signature. The high-risk group was mainly associated with cancer-related pathways and low levels of B cell infiltration.

The 5-mRNA prognostic signature we identified can reliably predict prognosis and facilitate individualized treatment decisions for EAC patients.
A comparative study of functioning and non-functioning pituitary adenomas
Authors: Qin Jiayin , Li Kai , Wang Xijuan , Bao Yongzhen
Published: April 2021

Pituitary tumors commonly cause visual impairment and the degree of impairment can depend on the size, location, and type of the tumor. However, no studies have been made regarding the differences caused by functioning pituitary adenoma (FPA) and non-functioning pituitary adenoma (NFPA). We aimed to investigate the relationship between clinical characteristics and visual impairment in patients with FPA and NFPA.

This case series study included 73 pituitary adenoma patients. All patients underwent ophthalmic evaluations, and we retrospectively reviewed their medical records. Tumor types were confirmed by histological analysis, and the tumor volume was calculated. Magnetic resonance imaging was used to determine the tumor diameter. The observation indices of the two groups were compared. The correlation between the visual field and tumor volume was analysed using scatter plots.

We enrolled 30 patients in the FPA group and 43 in the NFPA group. The first symptoms presented in the eyes in 23% of FPA patients and 41.9% of NFPA patients. The best-corrected visual acuity of the FPA group was better than that of the NFPA group, and 34 (56.7%) and 73 (84.9%) eyes in these groups had visual field defects, respectively. The visual field defects of the FPA patients were lighter than those of the NFPA patients. Except for the anteroposterior diameter, there were no differences in the other parameters of tumor diameter between the groups. The tumor volume of the FPA group was smaller than that of the NFPA group. The tumor size was positively correlated with the mean deviation and negatively correlated with the mean sensitivity in both groups.

There was a longer delay between the onset of signs and symptoms and treatment in the FPA group than in the NFPA group. Future studies should focus on visual field defects caused by FPA and NFPA.
A rapid clinic-based service for an emergency department of a tertiary teaching hospital during a dengue outbreak
Authors: Shih Hsin-I. , Huang Yi-Ting , Hsieh Chih-Chia , Sung Tzu-Ching
Published: April 2021

The 2015 dengue outbreak in southern Taiwan turned into a public health emergency, resulting in a large-scale mobilization of personnel from the emergency department (ED) services operating in and near full capacity to assist with the outbreak. This study aimed to assess a rapid independent clinic-based service (RCS), which was set up and designed to relieve the overcrowding of the regular ambulatory and emergency services during an epidemic of dengue.

This is a retrospective cross-sectional study.

National Cheng Kung University Hospital, Tainan, Taiwan.

Patients with positive test results were enrolled and reviewed to evaluate the efficacy of RCS implementation between August and October 2015. The case-treatment rates stratified by length of stay (LOS) were used to examine the performance of the RCS that was set up outside the ED and designed to relieve the overcrowding of the regular ambulatory and emergency services.

Patients with dengue-like illnesses may arrive at the hospital and require optimal ED triage and management thereafter. Although the outbreak resulted in a shortage of spare space in the ED, a proper response from the hospital administration would ameliorate the work overload of the staff and would not decrease the quality of care for critical patients.

An early and restrictive intensive intervention was beneficial to health care facilities during a dengue outbreak. Further planning and training of the RCS could be crucial for hospital preparedness for infectious disease outbreaks.
Bandage lens for treatment of corneosclera melting two weeks after pterygium surgery
Authors: Gao Tao , Fan Xiaojing , Wu Yaying , Jin Xiuming
Published: April 2021

Introduction:

Pterygium is a common chronic ocular surface condition in ophthalmology.

At present, the main treatment modality is surgical resection. Although the recurrence rate can be controlled to varying degrees, some patients can still develop serious complications, such as scleral melting, corneal melting, and even corneal perforation.

We report a case of severe corneal and scleral melting after pterygium surgery treated with a bandage lens.

Patient information:

A 60-year-old male who developed corneoscleral melting after pterygium surgery.

Diagnosis:

This patient was diagnosed with corneoscleral melting.

Interventions:

This patient was treated with a bandage lens and eye drops.

Outcomes:

He was treated with a bandage lens, and the tear break-up time (BUT) was prolonged. After 12 days the cornea and sclera were completely cured and the bandage lens was removed after one month.

Conclusion:

After pterygium surgery, various factors affect the occurrence of serious complications of autolysis. Mainly on ocular parts, such as the cornea and sclera, a bandage lens can stabilize the ocular surface tear film and prolong the tear break-up time (BUT), effectively prevent corneoscleral melting and promote corneoscleral cure.
Treatment challenges in patients with early acute massive pulmonary thrombosis embolism (PTE) after lung cancer surgery
Authors: Shen Jian , Zhou Mi , Shao Weihua , Dai Haiyun
Published: April 2021

Introduction:

Early acute massive pulmonary thrombosis embolism (PTE) after lung cancer surgery is one of the most fatal surgical complications. It is often accompanied by shock and hypotension, with high mortality rate. Due to surgical wounds, patients with early acute massive PTE after lung cancer surgery have a high risk of thrombolytic bleeding, which renders treatment more challenging and there is currently no standard protocol on how to safely and effectively treat these patients in the clinic.

Patient concerns:

A 66-year-old woman after video-assisted thoracoscopic surgery for lung cancer, experienced sudden severe dyspnea, shock and hypotension with high D-Dimer, changed electrocardiogram (ECG), right ventricular dilatation, severe tricuspid regurgitation, and raised pulmonary arterial pressure on ultrasonic cardiogram (UCG), thromboses found on Ultrasonography of lower extremity vein.

Diagnosis:

Because of her clinical manifestations and results of bedside auxiliary examinations, the patient was finally diagnosed with acute high-risk PTE after lung cancer surgery.

Interventions:

1.5 hours after onset of symptoms, thrombolysis using a continuous micropump infusion of 20,000 units/kg urokinase into the peripheral vein for 2 hours was initiated for this patient.

Outcomes:

The patient died of massive hemorrhage after thrombolysis.

Lessons:

Treatment for patients with early acute PTE after lung cancer surgery is challenging due to a high risk of thrombolytic bleeding at the surgical site. Real-time monitoring of vital signs during thrombolysis and catheter-directed thrombolysis are recommended for these patients, in order to use the minimum drug dosage for quick curative effects and a low risk of bleeding.
Renal function-adjusted contrast medium volume is a major risk factor in the occurrence of acute kidney injury after endovascular aneurysm repair
Authors: Mun Jin-Ho , Kwon Su-kyung , Park Je-hyung , Chu Wongong , Kim Dong Hyun , Jung Hyuk Jae , Lee Sang Su
Published: April 2021

Acute kidney injury (AKI) is a complication that can occur during endovascular aneurysm repair (EVAR), increasing postoperative mortality and disease-related death. We therefore evaluated the incidence of AKI after elective EVAR, as well as related factors affecting AKI occurrence, investigating the volume of contrast medium (CV)/estimated glomerular filtration rate (eGFR) ratio as a predictive factor.

We retrospectively reviewed the data of patients who underwent EVAR for infrarenal abdominal aorta aneurysm at a single center between April 2011 and December 2018. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. We evaluated the occurrence of AKI within the first 7 days postoperatively, comparing serum creatinine levels, eGFR, CV, CV/eGFR ratio, fluid input and output, and morbidity between the AKI and no-AKI groups.

The data of 147 patients were analyzed, of which 131 (89.1%) were males (mean age: 72.10±7.40 years); the incidence of AKI was 4.1% (6/147 patients). The mean dose of contrast agents used was greater in the AKI group than in the no-AKI group (249.17 ± 83.21 mL vs 179.43 ± 84.32 mL, respectively; P = .05). The baseline eGFR was 42.69 ± 22.08 mL/kg/1.73 m2 in the AKI group and 77.96 ± 18.92 mL/kg/1.73 m2 in the no-AKI group (P = .001). The CV/eGFR ratio was significantly higher in the AKI group (8.21 ± 6.13 vs 2.46 ± 1.44; P = 0.003). Baseline eGFR (odds ratio [OR] = 0.922, P = .001) and the CV/eGFR ratio (OR = 2.049, P = .008) were observed to be factors related to the occurrence of AKI in the logistic regression analysis for patients’ characteristics, operation-related factors, and renal outcomes. In the receiver operating characteristic curve analysis, the area under the curve of the CV/eGFR ratio was 0.856, indicating the greatest influence. A CV/eGFR ratio cutoff value of 3.84 was considered the most appropriate, with an 83.3% sensitivity and 83.0% specificity.

The CV/eGFR ratio, rather than the absolute amount of contrast agents, was associated with the development of AKI after EVAR. The CV/eGFR ratio could be used as a possible indicator to limit the amount of contrast media required for the procedure.
Acupuncture for drooling in children with cerebral palsy
Authors: Xiong Wei , Cheng Ling , Tang Genhua , Hou Xinju , Zhu Manhua , Lu Lunbin , Zhong Zhiying
Published: April 2021

Background:

The aim of this study is to provide the methods used to evaluate the effectiveness and safety of acupuncture therapy for treating drooling in children with cerebral palsy.

Methods and analysis:

A comprehensive search of Pubmed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, 4 Chinese databases (China National Knowledge Infrastructure, Chinese Biomedical Literatures database, Wan-Fang Database and Chinese Science and Technology Periodicals will be conducted to identify randomized controlled trials of acupuncture for treating children with cerebral palsy salivation with no restriction on time or language. The primary outcome of this systematic review will be the effective rate. The risk of bias will be implemented according to Cochrane Handbook for Systematic Reviews of Interventions. We will conduct the meta-analysis to synthesize the evidence for each outcome, if possible. The heterogeneity will be evaluated statistically using the χ
2 test and the I
2 statistic. The random-effect model will be used to provide more conservative results, if significant heterogeneity is identified (I
2 > 50% or P < .10).

Ethics/dissemination:

Our findings will be disseminated in a peer-reviewed journal and at conference meetings. It is not necessary for formal ethical approval as no primary data are collected.

Trial registration number:

INPLASY2020110024
Negative-pressure wound therapy combined with artificial dermis (Terudermis) followed by split-thickness skin graft might be an effective treatment option for wounds exposing tendon and bone
Authors: Hsu Kuo-Feng , Chiu Yu-Lung , Chiao Hao Yu , Chen Chun-Yu , Chang Chun-Kai , Wu Chien-Ju , Peng Yi-Jen , Wang Chih-Hsin , Dai Niann-Tzyy , Chen Shyi-gen , Tzeng Yuan-Sheng
Published: April 2021

Skin grafts are not suitable for closing tendon- or bone-exposing wounds, which require flap surgery. Dermal regeneration templates have value for closing such wounds, but the disadvantages of the technique include implantation failures because of infection, hematoma formation, or inappropriate immobilization. Negative-pressure wound therapy was reported to increase graft acceptance in difficult wounds.

This retrospective case series of 65 patients evaluated negative-pressure therapy combined with artificial dermis for the treatment of acute or chronic tendon- or bone-exposing wounds. The artificial dermis was placed after adequate wound-bed preparation, with simultaneous application of a vacuum-assisted closure system. Split-thickness skin grafting was performed after the implanted artificial dermis had become established.

The overall success rate was 88.1% (59/67): 88.6% (39/44) in the chronic wounds group and 87% (20/23) in the acute-trauma group separately. The overall mean survival time of artificial dermis in success cases was 13.24 ± 7.14 days. In separately, the survival time of artificial dermis had no statistically difference in chronic wound group (13.64 ± 7.53 vs 12.60 ± 5.86. P = .943), but had significant statistical difference in acute trauma group (12.45 ± 6.44 days vs 23.33 ± 4.04 days, P = .018). Also, comorbidity of PAOD was found a strong risk factor of failure in chronic wound group (100% vs 23.1%, P < 0.001).

We concluded that artificial dermis combined with negative-pressure therapy followed by split-thickness skin grafting might be a reliable and effective option for surgical reconstruction of tendon- or bone-exposing wounds, and could decreasing waiting periods of autologous skin graft.