bluuebunny/crossref_metadata_2025 huggingface dataset:
Bioactivation of Indoles by Human Liver Microsomes with Glutathione as Trapping Agent: Formation of Novel Cyclic Cysteine and Cysteine‐Glycine Adducts
Authors: Wang Kai , Burton Richard , Anderson Shelby
Published: February 2021

Metabolic bioactivation of drug candidates to reactive electrophilic intermediates can result in covalent adducts with cellular macromolecules, potentially causing drug‐induced toxicity. Thus, awareness of “structural alerts” in drug design and understanding of reactive metabolite (RM) formation in lead optimization efforts are extremely important to minimize the potential of idiosyncratic drug toxicity. The indole motif is ubiquitously present in natural products and drugs. Although RMs are known to be involved in the chemical‐induced toxicity of some indole derivatives, a systemic study of RMs of the indole motif has not been performed. In this study, compounds containing indole moieties (10 μM) were incubated with 1 mg/mL human liver microsomes and 2 mM GSH. These samples were then analyzed by ultra‐performance liquid chromatography coupled to a quadrupole‐time‐of‐flight high definition mass spectrometer (UPLC/Q‐TOF HDMS). Novel oxidative cyclic cysteine and cysteine‐glycine adducts of a series of 2,3‐unsubstituted indole derivatives, including Pindolol, a marketed drug, were observed. These cyclic cysteine adducts were also observed with cysteine as the trapping agent. The mechanism for the formation of these thiazolidine adducts were investigated, in which cysteine could act as a binucleophile, and therefore comparable GSH adducts are not possible. In conclusion, the metabolic bioactivation of 2,3‐unsubstituted indoles forms a novel class of cyclic cysteine and cysteine‐glycine adducts when using GSH as trapping agent. These cyclic conjugates are likely to be a risk of false negative in a standard GSH conjugate screening process. The toxicological implications of these cyclic adducts are still unclear.
Sevoflurane Increases Proliferation, Adhesion on HUVEC and Incorporation in Tubular Structures of Endothelial Progenitor Cells
Authors: Munteanu Vlad Adelina , Isvoranu Gheorghita , Gilca Marilena , Ceafalan Laura , Surcel Mihaela , Stoian Irina , Manda Gina
Published: February 2021

As a pursuit of our previous finding that anesthetic preconditioning (APC) increases plasma and tissue levels of endothelial progenitors (EPCs) in rodents, we investigate here the effects of sevoflurane on proliferation and function of EPCs. Cultures of human cord blood mononuclear cells were exposed to sevoflurane 2% or 4% in air/5% CO2, or only to air/5% CO2 (sham control). The number of double staining cells for DiIAcLDL and UEAI‐FITC/20x microscopic field was increased following exposure to sevoflurane 2% (180.62 ± 19.09, n = 4, p<0,05) and 4% (167.36 ± 7.95, n = 4, p<0,05) versus control (123.98 ± 11.17). LDH cytotoxicity assay showed no significant effects of the anesthetic on EPCs, and a tetrazolium salt test indicated raised proliferation 24 hrs post‐exposure to sevoflurane 4% (0.156±0.024 vs. 0.124±0.011, n=4, p<0.05). Apoptosis was lowered, but without statistic significance. Adherence of DiI labelled EPCs to HUVEC monolayer was enhanced 24 hrs postexposure to sevoflurane 2% (58.28 ± 13.39 vs. 27.67 ± 5.15, n=4, p<0.05) and 4% (65.22 ± 13.16 vs. 23.35 ± 3.75, n=4, p<0.05), and incorporation in tubules of HUVEC was increased as well (sevoflurane 4%: 97.12±3.61 vs. 47.6±1.94, n=3, p<0.01). Thus, augmented EPCs proliferation, ability to adhere to endothelial cells and to incorporate in vascular structures are candidate mechanisms underlying the regenerative and anti‐ischemic processes of APC with sevoflurane. Financial support: research grant PN‐II‐RU‐TE‐2012‐3‐0463, UEFISCDI Romania.
A 15-Year Follow-up Retrospective Study on 959 Spine Surgeries
Authors: Plazier Mark , Raymaekers Vincent , Bruyneel Luk , Coeckelberghs Ellen , Sermeus Walter , Vanhaecht Kris , Duyvendak Wim
Published: February 2021

Study Design:

This was a retrospective study.

Objective:

The aim of this study was to investigate the patient flow and need for additional surgery after first-time lower back surgery. Next, we analyzed the patients who developed chronic low back pain (LBP) and were treated with spinal cord stimulation.

Summary of Background Data:

LBP has a lifetime prevalence of 84% and imposes a high economic burden. Treatment is focused on preventing chronic pain. Research has shown the efficacy of treatment options. However, less is known about who benefits the most from which therapy and when they should be positioned in the treatment algorithm.

Methods:

In this retrospective study, data of all patients who underwent first-time surgery from 2000 to 2004 were included. After 10–15 years, patients were contacted about their quality of life (QoL) (EuroQoL-5 Dimension) and life and heath perception (EuroQoL Visual Analogue Scale).

Results:

In all, 959 patients underwent surgery at the lower back area. Follow-up time ranged from 13 to 17 years; 225 patients (23.5%) underwent a second surgery. In total, 20 patients (2.1%) developed chronic neuropathic back pain and received spinal cord stimulation therapy. Ten years postsurgery, 438 (45.7%) patients completed the QoL and LBP questionnaires. The health-related QoL and health situation were significantly lower in patients with multiple surgeries (P<0.001).

Conclusions:

The study results indicate that large data sets, with multiple outcome measurements and long-term follow-up are necessary to improve our knowledge and to optimize the therapeutic pathway. In that way, we might learn how to select a patient for the right treatment or treatments at the right moment and shorten the circulation in our health care system.
Factors Contributing to Parents' Psychological and Medical Help Seeking During the COVID-19 Global Pandemic
Authors: Tambling Rachel , Russell Beth , Tomkunas Alexandria , Horton Abagail , Hutchison Morica
Published: February 2021

The COVID-19 pandemic and related quarantine orders will impact the mental health of millions of individuals in the United States. Mental health difficulties, including depression, anxiety, traumatic stress, and other negative mental health sequelae are likely and likely to persist. These challenges will require response from the psychotherapeutic and medical community that addresses the mental health needs of the population. Using binary logistic regression (n = 322 at time 1, and n = 189 at time 2), researchers in the present study examined promotive factors related to having sought medical or behavioral health treatment during a 30-day period in the midst of the COVID-19 pandemic in the United States. Approximately 10% of the sample indicated having sought either type of help. Results from the binary logistic regressions indicated those who sought counseling or medical help were those who reported increased depression symptoms at time 1. The likelihood of help seeking was heightened for those who reported greater caregiving burden, highlighting the need to consider the availability of services for those caring for children during this community-wide crisis.
Renin–angiotensin-system inhibitors and all-cause mortality in patients with COVID-19: a systematic review and meta-analysis of observational studies
Authors: Bavishi Chirag , Whelton Paul K. , Mancia Giuseppe , Corrao Giovanni , Messerli Franz H.
Published: February 2021

Aims:

We sought to evaluate the association of angiotensin-converting-enzyme inhibitors (ACEI) or AT1 blockers (ARB) therapy with clinical outcomes in patients with coronavirus disease 2019 (COVID-19).

Methods and results:

Electronic databases were searched to identify published studies that reported clinical outcomes in patients with COVID-19 who were or were not taking an ACEI/ARB. We studied all-cause mortality and/or severe disease outcomes. Fully adjusted effect estimates from individual studies were pooled using a random-effects model. In total, 34 (31 cohort-based and three case–control) studies met our eligibility criteria. Due to the inherent differences between cohort and case–control studies, we did not combine results of these studies but used them to identify the consistency of their results. The 31 cohort studies provided outcome data for 87 951 patients with COVID-19, of whom 22 383/83 963 (26.7%) were on ACEI/ARB therapy. In pooled analysis, we found no association between the use of ACEI/ARB and all-cause mortality/severe disease [relative risk: 0.94, 95% confidence interval (CI): 0.86–1.03, I
2 = 57%, P = 0.20] or occurrence of severe disease (relative risk: 0.93, 95% CI: 0.74–1.17, I
2 = 56%, P = 0.55). Analysis of three population-based case–control studies identified no significant association between ACEI/ARB (pooled odds ratio: 1.00, 95% CI: 0.81–1.23, I
2 = 0, P = 0.98) and all-cause mortality/severe disease. In 13 of the 31 cohort studies as well as in three case–control studies that reported outcomes separately for ACEI and ARB, there was no differential effect for mortality/severe disease outcomes.

Conclusion:

In patients with COVID-19, we found no association between ACEI/ARB treatment and mortality/severe disease. ACEI/ARB should not be discontinued, unless clinically indicated.
Optimal blood pressure levels in different phases of peripheral thrombolysis period in acute ischemic stroke
Authors: He Mingli , Wang Hongrui , Tang Yi , Cui Bing , Xu Bingchao , Sun Yongan , Zhang Guanghui , He Xiaobing , Niu Xiaoqin , Wang Bei , Xu Bei , Li Zaipo , Hui Rutai , Wang Yibo
Published: February 2021

Background:

Dramatic changes of blood pressure (BP) were observed in the peripheral thrombolysis period, however, there is no consensus about BP control targets in the different phases.

Methods:

We retrospectively studied a consecutive sample of 510 patients treated with intravenous thrombolysis and followed-up for 3 months. The peripheral thrombolysis period was divided into these phases: Phase 1 (from onset to thrombolysis), Phase 2 (thrombolysis), Phase 3 (from thrombolysis to 24 h after thrombolysis), and Phase 4 (from 24 h to 7 days after thrombolysis). Patients were divided into quintiles according to mean blood pressure in these phases, respectively. Neurological improvement was evaluated using the modified Rankin Scale score at 3-month after thrombolysis.

Results:

Lower risk of intracerebral hemorrhage within 7 days was found in lower quintiles of SBP (OR = 0.100, 95% CI 0.011–0.887, P = 0.039 in Phase 1 quintile Q1, OR = 0.110, 95% CI 0.012–0.974, P = 0.047 in Phase 2–3 quintile Q1, and OR, 0.175, 95% CI, 0.035–0.872; P = 0.033 in Phase 4 quintile Q2, respectively). Better neurological improvement was found in SBP quintiles: Q2–Q4 (127.3–155.7 mmHg) in Phase 4 (OR = 3.095, 95% CI 1.524–6.286, P = 0.002 for Q2; OR = 2.697, 95% CI 1.354–5.370, P = 0.005 for Q3; and OR = 2.491, 95% CI 1.263–4.913, P = 0.008 for Q4, respectively). Our results also showed higher average real variability of SBP was negatively associated with better neurological outcome in Phase 1 and Phase 2–3.

Conclusions:

Maintaining SBP levels (≤148 mmHg) from admission to the first 24 h after thrombolysis, then keeping SBP levels (127–138 mmHg) would be beneficial.
Psychosocial Factors and Tobacco Use Among Commercial Truck Drivers
Authors: Kagabo Robert , Okuyemi Kola , Eden Emilee , Kapellusch Jay , Murtaugh Maureen A. , Hegmann Kurt T. , Thiese Matthew S.
Published: February 2021

Objectives:

To explore the relationships between tobacco, social support, job satisfaction, and depression among truck drivers.

Methods:

Cross-sectional data were collected from 797 truck drivers in six US states. Data collected included self-reported medical history and biological samples. Modified Zung depression scale and Work Apgar scores were used to measure depression and social support. Adjusted logistic regression models were used to calculate odds ratios (OR).

Results:

24.0% of tobacco users were in the least depressed category and 18.2% were most depressed. 22.8% of the tobacco users had the most social support compared with 27.9% of the non-users. Drivers in the two most depressed categories were significantly less likely to use tobacco (OR = 0.62, 95% confidence interval [CI] = 0.39–0.96, and OR = 0.64, 95% CI = 0.41–0.99).

Conclusions:

Drivers with low social support or low levels of depression are more likely to be tobacco users.
Critical juncture: The doctor of nursing practice and COVID-19
Authors: Moore Karen S. , Hart Ann Marie
Published: February 2021

The year 2020 was one of tremendous challenge and change for our communities and our profession. As the next decade unfolds, the doctor of nursing practice (DNP) will be required for entry to practice as a nurse practitioner (NP), and we will all continue to recover individually and as a nation from the experiences of the year 2020. Doctor of nursing practice–prepared NPs need to be equipped to take the lead in post-COVID recovery and the challenges the US health care system faces through an increased emphasis on curricula and clinical experiences focused on health disparities, community health, and health promotion.
Microparticles: a link to increased thrombin generation
Authors: Gasa Noluthando , Meiring Muriel
Published: February 2021

Circulating microparticles in human plasma may play a significant role in thrombogenesis because they carry the initiator of blood coagulation, tissue factor. Microparticles in blood are derived from diverse cell types, including erythrocytes, endothelial cells and platelets. Thrombin generation is an important part of the coagulation system and might be influenced by the presence of microparticles in the circulation. With this study, we determined the contribution of microparticles to increased thrombin generation in plasma samples received for thrombophilia workup and compare that with normal plasma. Microparticles were isolated from 50 plasma samples with increased thrombin generation and 20 plasma samples with normal thrombin generation, using filtration. Thrombin generation assay were performed by adding a low concentration of tissue factor-containing phospholipids and a fluorescence substrate for thrombin formation to plasma samples and measuring fluorescence at 1-min intervals over a period of 90 min on all samples (with and without the presence of microparticles). The peak thrombin, velocity-index and area under the curve were calculated. Microparticles contribute to the different parameters in samples with increased thrombin generation as follows: 50 ± 19% for peak thrombin, 58 ± 24% for velocity-index and 35 ± 13% for area under the curve. Microparticles did not contribute to thrombin generation in plasma samples with normal thrombin generation. Microparticles play a significant role in coagulation and contribute largely to increased thrombin generation in plasma; however, microparticles do not contribute to coagulation in the plasma of participants with normal thrombin generation.
Prediction of expiratory desflurane and sevoflurane concentrations in lung-healthy patients utilizing cardiac output and alveolar ventilation matched pharmacokinetic models
Authors: Weber Jonas , Mißbach Claudia , Schmidt Johannes , Wenzel Christin , Schumann Stefan , Philip James H. , Wirth Steffen
Published: February 2021

The Gas Man simulation software provides an opportunity to teach, understand and examine the pharmacokinetics of volatile anesthetics. The primary aim of this study was to investigate the accuracy of a cardiac output and alveolar ventilation matched Gas Man model and to compare its predictive performance with the standard pharmacokinetic model using patient data.

Therefore, patient data from volatile anesthesia were successively compared to simulated administration of desflurane and sevoflurane for the standard and a parameter-matched simulation model with modified alveolar ventilation and cardiac output. We calculated the root-mean-square deviation (RMSD) between measured and calculated induction, maintenance and elimination and the expiratory decrement times during emergence and recovery for the standard and the parameter-matched model.

During induction, RMSDs for the standard Gas Man simulation model were higher than for the parameter-matched Gas Man simulation model [induction (desflurane), standard: 1.8 (0.4) % Atm, parameter-matched: 0.9 (0.5) % Atm., P = .001; induction (sevoflurane), standard: 1.2 (0.9) % Atm, parameter-matched: 0.4 (0.4) % Atm, P = .029]. During elimination, RMSDs for the standard Gas Man simulation model were higher than for the parameter-matched Gas Man simulation model [elimination (desflurane), standard: 0.7 (0.6) % Atm, parameter-matched: 0.2 (0.2) % Atm, P = .001; elimination (sevoflurane), standard: 0.7 (0.5) % Atm, parameter-matched: 0.2 (0.2) % Atm, P = .008]. The RMSDs during the maintenance of anesthesia and the expiratory decrement times during emergence and recovery showed no significant differences between the patient and simulated data for both simulation models.

Gas Man simulation software predicts expiratory concentrations of desflurane and sevoflurane in humans with good accuracy, especially when compared to models for intravenous anesthetics. Enhancing the standard model by ventilation and hemodynamic input variables increases the predictive performance of the simulation model. In most patients and clinical scenarios, the predictive performance of the standard Gas Man simulation model will be high enough to estimate pharmacokinetics of desflurane and sevoflurane with appropriate accuracy.
Salvia miltiorrhiza improves type 2 diabetes
Authors: Guo Ying , Sun Jianfeng , Zhang Renyan , Yang Peng , Zhang Sanyin , Wu Zhipeng
Published: February 2021

Background:

Diabetes refers to any group of metabolic diseases characterized by high blood sugar and generally thought to be caused by insufficient production of insulin, impaired response to insulin. Globally, patients with type 2 diabetes account for more than 85% of the total diabetic patients, and due to factors, such as obesity, aging, environment and lifestyle, the incidence of diabetes is rising. Salvia miltiorrhiza (SM) is a medicine used to treat diabetes in China. In recent years, it has been reported that SM has the effect of improving type 2 diabetes. However, there is no systematic review of its efficacy and safety yet. Therefore, we propose a systematic review to evaluate the efficacy and safety of SM for T2D.

Methods:

Six databases will be searched: China National Knowledge Infrastructure (CNKI), China Biological Medicine (CBM), China Scientific Journals Database (CSJD), Wanfang database, PubMed, and EMBASE. The information is searched from January 2010 to July 2020. Languages are limited to English and Chinese. The primary outcomes include 2 hour plasma glucose, fasting plasma glucose, hemoglobin A1c, homeostasis model assessment of insulin resistance, and fasting plasma insulin. The secondary outcomes include clinical efficacy and adverse events.

Results:

This systematic review will evaluate the efficacy and safety of Salvia miltiorrhiza in the treatment of type 2 diabetes.

Conclusion:

This systematic review provides evidence as to whether Salvia miltiorrhiza is effective and safe for type 2 diabetes.

Ethics:

Ethical approval is not necessary as this protocol is only for systematic review and does not involve in privacy data or an animal experiment.

Systematic review registration:

INPLASY2020110046.
Effect of advanced nursing care on psychological disorder in hypertensive retinopathy of pregnancy
Authors: Wang Xiao-fang , Liu Lin-juan
Published: February 2021

Background:

This study will assess the effect of advanced nursing care (ANC) on psychological disorder (PD) in hypertensive retinopathy of pregnancy (HTRP).

Methods:

This study will search electronic databases from inception to the present (Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, CNKI, and Chinese Biomedical Literature Database), and other sources. All literature sources will be searched without limitations to language and study status. All eligible case-controlled study (CCS) will be included in this study. Two authors will independently carry out literature selection, data collection, and study quality assessment. Any confusion will be solved by a third author through discussion. Statistical analysis will be conducted using RevMan 5.3 software. In addition, a narrative synthesis will be elaborated if it is necessary.

Results:

This study will summarize most recent high quality evidence to appraise the effect of ANC on PD in HTRP.

Conclusion:

The results of this study will seek to identify the effect of ANC on PD in HTRP among pregnancy population.

OSF registration:

osf.io/hgp93.
The effect of a micro-visual intervention on the accelerated recovery of patients with kinesiophobia after total knee replacement during neo-coronary pneumonia
Authors: Lu Guanzhen , Wu Tingting , Tan Qin , Wu Zhe , Shi Lingmei , Zhong Yan
Published: February 2021

Background:

The global neo-coronary pneumonia epidemic has increased the workload of healthcare institutions in various countries and directly affected the physical and psychological recovery of the vast majority of patients requiring hospitalization in China. We anticipate that post-total knee arthroplasty kinesiophobia may have an impact on patients’ postoperative pain scores, knee function, and ability to care for themselves in daily life. The purpose of this study is to conduct a micro-video intervention via WeChat to verify the impact of this method on the rapid recovery of patients with kinesiophobia after total knee arthroplasty during neo-coronary pneumonia.

Methods:

Using convenience sampling method, 78 patients with kinesiophobia after artificial total knee arthroplasty who met the exclusion criteria were selected and randomly grouped, with the control group receiving routine off-line instruction and the intervention group receiving micro-video intervention, and the changes in the relevant indexes of the two groups of patients at different time points on postoperative day 1, 3 and 7 were recorded and analyzed.

Results:

There were no statistical differences in the scores of kinesiophobia, pain, knee flexion mobility (ROM) and ability to take care of daily life between the two groups on the first postoperative day (P > .05). On postoperative day 3 and 7, there were statistical differences in Tampa Scale for kinesiophobia, pain, activities of daily living scale score and ROM between the two groups (P < .01), and the first time of getting out of bed between the two groups (P < .05), and by repeated-measures ANOVA, there were statistically significant time points, groups and interaction effects of the outcome indicators between the 2 groups (P < .01), indicating that the intervention group reconstructed the patients’ postoperative kinesiophobiaand hyperactivity. The level of pain awareness facilitates the patient's acquisition of the correct functional exercises to make them change their misbehavior.

Conclusions:

WeChat micro-video can reduce the fear of movement score and pain score in patients with kinesiophobia after unilateral total knee arthroplasty, shorten the first time out of bed, and improve their joint mobility and daily living ability.

Ethics:

This study has passed the ethical review of the hospital where it was conducted and has been filed, Ethics Approval Number: 20181203-01.
Hydronephrosis in patients with cervical cancer is an indicator of poor outcome
Authors: Yang You-Rong , Chen Szu-Ju , Yen Pin-Yeh , Huang Chi-Ping , Chiu Lu-Ting , Lin Wu-Chou , Chen Huey-Yi , Chen Yung-Hsiang , Chen Wen-Chi
Published: February 2021

Cervical cancer is a common malignancy in women. The presence of hydronephrosis in patients with cervical cancer can be a challenging clinical problem. The appropriate management of these patients and the prediction of their outcomes are concerns among gynecologists, urologists, medical oncologists, radiation oncologists, and nephrologists. We enrolled a total of 2225 patients with cervical cancer over a 12-year period from the nationwide database of Taiwan's National Health Insurance Bureau. Among them, 445 patients had concomitant hydronephrosis. The remaining 1780 patients without hydronephrosis were randomly enrolled as a control group for the analysis of associated factors. The results indicated that the proportions of patients with hypertension, chronic kidney disease, and diabetes were significantly higher in the hydronephrosis group. The hydronephrosis group showed a higher all-cause mortality than the non-hydronephrosis group (adjusted hazard ratio 3.05, 95% confidence interval 2.24–4.15, P < .001). The rates of nephrectomy and stone disease were also significantly higher in the hydronephrosis group. A higher percentage of other cancers was also observed in the hydronephrosis group than in the non-hydronephrosis group (12.36% vs 8.99%, respectively). This study shows that cervical cancer with hydronephrosis may have a higher morbidity and mortality than cervical cancer without hydronephrosis. Other factors such as human papilloma virus vaccination, smoking, and cancer staging need to be further studied.
Severe neonatal Marfan syndrome with a novel mutation in the intron of the FBN1 gene
Authors: Yoon Su Hyun , Kong Younghwa
Published: February 2021

Rationale:

Marfan syndrome (MFS) has been defined as a genetic disorder that affects various systems such as the musculoskeletal, orbital, and cardiovascular systems. Neonatal MFS is considered rare and the most severe form of MFS is characterized by rapidly progressive atrioventricular valve dysfunction, often leading to death during early childhood due to congestive heart failure.

Patient concerns:

A newborn with neonatal MFS and severe cardiac involvement. He presented various severe clinical features such as arachnodactyly, camptodactyly, elbow and knee joint contracture, senile facial appearance, and deep settling with down-slanting palpebral fissure, hypoplastic ear cartilage, sagging mouth, brachycephaly, and ectopia lentis.

Diagnosis:

Genetic analysis revealed a novel mutation at nucleotide 3964 (c.3964 + 1 G > T) in intron 32 of the fibrillin-1 gene. This mutation is identified to be in the so-called neonatal region of fibrillin-1 exon 24 to 32, as reported previously.

Interventions:

The patient was managed medically for improving the low cardiac output according to severe mitral regurgitation and aortic regurgitation. Afterload reduction, full sedation, and use of diuretic were attempted to improve the oliguria and heart failure.

Outcomes:

Despite the medical management, aortic regurgitation, mitral regurgitation, pulmonary hypertension, and cardiac contractility got worse. Surgical treatment is essential to prolong the patient's life, however, considerations for the grave progression of the disease make families decide to continue palliative care instead of surgical treatment. A few months after birth, he presented with rapidly progressive aortic regurgitation, mitral regurgitation, and congestive heart failure leading to death.

Conclusions:

This review demonstrated the prominent characteristics of neonatal MFS mutations, it would be helpful for the recognition of novel neonatal MFS variants and valuable for the understanding of the genotype-phenotype correlations and using the plans for managements and counseling in neonatal MFS.
Comparative study of verbal rating scale and numerical rating scale to assess postoperative pain intensity in the post anesthesia care unit
Authors: Lee Ho-Jin , Cho Yongjung , Joo Hyundeok , Jeon Jae Yeong , Jang Young-Eun , Kim Jin-Tae
Published: February 2021

Postsurgical patients usually have difficulty in answering the self-report pain scales due to the residual effects of anesthetic or sedative agents in the post-anesthesia care unit (PACU). A comparative analysis of pain assessment tools used in the PACU is lacking.

In this prospective observational study, we compared the intensity of pain using the 11-point numeric rating scale (NRS) and the 4-category verbal rating scale (VRS) thrice, 5 minutes after PACU admission, 20 minutes after the first assessment, and just before discharge from the PACU in 200 patients undergone surgery. Spearman rank correlation analysis was used to investigate the correlation between 2 scales, and the weighted kappa (κ) coefficient was performed to evaluate inter-scale reliability. Response rates of the 2 scales were also compared.

VRS and NRS were highly correlated during all 3 comparisons (r = 0.767, 0.714, and 0.653, respectively; P < .0001). Each category of VRS showed a statistically significant difference in pain intensity measured by NRS during all 3 assessments. Inter-scale reliability had a fair strength of agreement for all 3 measurements (weighted κ = 0.519, 95% CI: 0.421–0.618; weighted κ = 0.511, 95% C.I: 0.409–0.613; weighted κ = 0.452, 95% C.I: 0.352–0.551, respectively). VRS showed a higher response rate for PACU patients compared to NRS in all 3 measurements (96% vs 77.5%, 99% vs 81.5%, and 96.5% vs 86.5%, respectively; P < .0001).

In the PACU, VRS is a reasonable and practical pain intensity measurement tool for postsurgical patients, considering the high correlation between VRS and NRS, and a higher response rate.
Massage for simple obesity
Authors: Pang Yazheng , Wang Kai , Chen Shucheng , Huang Tian , Zhang Mengsen , Zhang Bin , Yu Juan
Published: February 2021

Background:

Obesity has become the most serious public health problem in developed and developing countries, and simple obesity accounts for approximately 95% of the total cases. This study aims to assess the effects and safety of massage therapy for the treatment of simple obesity.

Methods:

We will search foreign and Chinese databases, including PubMed, EMBASE, MEDLINE, CENTRAL, CNKI, WanFang Data, CBM, and VIP from the inception of the coverage of these databases to July 2020. Cochrane's collaboration tool will be used to assess the quality of the studies. RevMan 5.3 software will be used for the data analysis.

Results:

This study will evaluate whether massage therapy is an effective intervention for simple obesity.

Conclusion:

This study will provide evidence regarding whether massage therapy is beneficial for treating simple obesity in humans.

PROSPERO registration number:

NO.CRD42020197635.
Chinese herbal medicine for hypertension complicated with hyperlipidemia
Authors: Liu Yinan , Liu Yiqing , Yang Jing , Wang Xue , Xiu Chengkui , Hu Yanhong , Wu Dan , Wu Ye , Lei Yan
Published: February 2021

Background:

Hypertension combined with hyperlipidemia (HTN-HLP), as a common clinical chronic disease combination, will increase the incidence of cardiovascular and cerebrovascular diseases, increase the occurrence of sudden death and other adverse events. At present, the commonly used therapeutic drugs are mainly combined with antihypertensive drugs and lipid-lowering drugs, which not only have poor compliance, but also have adverse reactions. Currently, traditional Chinese medicine, as a traditional medicine in China, has been applied in clinical practice for thousands of years and has rich clinical experience in treating HTN-HLP. However, there is no systematic evaluation of the efficacy, safety and improvement of patients’ quality of life. This systematic review and meta-analysis will assess studies of the effects and safety of Chinese herbal medicine (CHM) for HTN-HLP patients.

Methods:

We will search PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science (ISI), China National Knowledge Infrastructure, Wan fang Database, Chinese Scientific Journals Full-Text Database (VIP) and China Biological Medicine Database from the time when databases were established to 01, February 2021. After a series of screening, randomized controlled trials (RCTs) will be included related to CHM for HTN-HLP. Two researchers will assess the RCTs through the Cochrane bias risk assessment tool. And the evidence grade of the results will be evaluated by GRADEprofiler software.

Results:

This study will provide a reliable evidence for the efficiency of antihypertensive and reducing blood lipids of CHM for HTN-HLP.

Conclusion:

We will summarize the methods and provide sufficient evidence to confirm the efficacy and safety of CHM for HTN-HLP.

INPLASY registration number:

INPLASY2020110144.
The relationship between CHRNA5/A3/B4 gene cluster polymorphisms and lung cancer risk
Authors: Yi Xingxu , Li Wanzhen , Wang Yiyuan , Chen Xueran , Ye Fang , Sun Gengyun , Chen Jingxian
Published: February 2021

Background:

Genetic polymorphisms in the 15q25 region have been associated with the risk of lung cancer (LC). However, studies have yielded conflicting results.

Methods:

Searches were conducted in databases, including PubMed, EMbase, Web of Science, CNKI, and Wanfang, for case-control studies up to August 1, 2019. After retrieving eligible studies and data extraction, we calculated pooled odds ratios with 95% confidence intervals. In the meta-analysis, we included 32 publications with a total of 52,795 patients with LC and 97,493 control cases to evaluate the polymorphisms in the CHRNA5/A3/B4 gene cluster in the 15q25 region.

Results:

Data of the meta-analysis showed a significantly increased risk of LC in the presence of genetic polymorphisms (rs1051730, rs16969968, rs8034191). In the smoking subgroup, the CHRNA3 rs1051730 polymorphism was found to contribute to LC risk using following 5 models: the allelic model, the homozygous model, the heterozygous model, the dominant model, and the recessive model. Thus, the rs1051730 polymorphism may modify LC susceptibility under the condition of smoking. Stratification studies for CHRNA5-rs8034191 showed that Caucasian groups with the wild-type genotype (C/C) may be susceptible to LC in all 5 models. No significant relationship between CHRNA3 rs6495309 or rs3743073 and LC susceptibility was found. However, Asians with the rs3743037 B-allele showed an obviously higher risk of LC susceptibility than the Caucasian population, observed via allelic, heterozygous, and dominant models.

Conclusions:

The 3 polymorphisms of rs1051730, rs16969968 and rs8034191 in the CHRNA5/A3/B4 gene cluster in the 15q25 region were associated with LC risk, which might be influenced by ethnicity and smoking status.
Successful management and technical aspects of major liver resection in children
Authors: Li Kewei , Jiang Fanwen , Aizpuru Matthew , Larson Ellen L. , Xie Xiaolong , Zhou Rongxing , Xiang Bo
Published: February 2021

Optimal treatment of patients with various types of liver tumors or certain liver diseases frequently demands major liver resection, which remains a clinical challenge especially in children.

Eighty seven consecutive pediatric liver resections including 51 (59%) major resections (resection of 3 or more hepatic segments) and 36 (41%) minor resections (resection of 1 or 2 segments) were analyzed. All patients were treated between January 2010 and March 2018. Perioperative outcomes were compared between major and minor hepatic resections.

The male to female ratio was 1.72:1. The median age at operation was 20 months (range, 0.33–150 months). There was no significant difference in demographics including age, weight, ASA class, and underlying pathology. The surgical management included functional assessment of the future liver remnant, critical perioperative management, enhanced understanding of hepatic segmental anatomy, and bleeding control, as well as refined surgical techniques. The median estimated blood loss was 40 ml in the minor liver resection group, and 90 ml in major liver resection group (P < .001). Children undergoing major liver resection had a significantly longer median operative time (80 vs 140 minutes), anesthesia time (140 vs 205 minutes), as well as higher median intraoperative total fluid input (255 vs 450 ml) (P < .001 for all). Fourteen (16.1%) patients had postoperative complications. By Clavien-Dindo classification, there were 8 grade I, 4 grade II, and 2 grade III-a complications. There were no significant differences in complication rates between groups (P = .902). Time to clear liquid diet (P = .381) and general diet (P = .473) was not significantly different. There was no difference in hospital length of stay (7 vs 7 days, P = .450). There were no 90-day readmissions or mortalities.

Major liver resection in children is not associated with an increased incidence of postoperative complications or prolonged postoperative hospital stay compared to minor liver resection. Techniques employed in this study offered good perioperative outcomes for children undergoing major liver resections.
Cross-sectional study of major procedure codes among hospitalized patients with traumatic brain injury by level of injury severity in the 2004 to 2014 Nationwide Inpatient Sample
Authors: Beydoun Hind A. , Butt Catherine , Beydoun May A. , Hossain Sharmin , Eid Shaker M. , Zonderman Alan B.
Published: February 2021

Despite its public health significance, TBI management across US healthcare institutions and patient characteristics with an emphasis on utilization and outcomes of TBI-specific procedures have not been evaluated at the national level.

We aimed to characterize top 10 procedure codes among hospitalized adults with TBI as primary diagnosis by injury severity.

A Cross-sectional study was conducted using 546, 548 hospitalization records from the 2004 to 2014 Nationwide Inpatient Sample were analyzed.

Data elements of interest included injury, patient, hospital characteristics, procedures, in-hospital death and length of stay.

Ten top procedure codes were “Closure of skin and subcutaneous tissue of other sites”, “Insertion of endotracheal tube”, “Continuous invasive mechanical ventilation for less than 96 consecutive hours”, “Venous catheterization (not elsewhere classified)”, “Continuous invasive mechanical ventilation for 96 consecutive hours or more”, “Transfusion of packed cells”, “Incision of cerebral meninges”, “Serum transfusion (not elsewhere classified)”, “Temporary tracheostomy”, and “Arterial catherization”. Prevalence rates ranged between 3.1% and 15.5%, with variations according to injury severity and over time. Whereas “Closure of skin and subcutaneous tissue of other sites” was associated with fewer in-hospital deaths and shorter hospitalizations, “Temporary tracheostomy” was associated with fewer in-hospital deaths among moderate-to-severe TBI patients, and “Continuous invasive mechanical ventilation for less than 96 consecutive hours” was associated with shorter hospitalizations among severe TBI patients. Other procedures were associated with worse outcomes.

Nationwide, the most frequently reported hospitalization procedure codes among TBI patients aimed at homeostatic stabilization and differed in prevalence, trends, and outcomes according to injury severity.
A double mutation of BRAF L597Q and V600E in situ and solitary brain metastasis of occult papillary thyroid carcinoma
Authors: Chen Ling , Wu Yue , Bai Huili , Liu Huandong , Li Xiaosong
Published: February 2021

Rationale:

The rare BRAF L597Q (c.T1790A) point mutation has been previously reported in childhood acute lymphoblastic leukemia. We present the first rare case of occult papillary thyroid carcinoma with BRAF L597Q mutation in a Tibetan patient.

Patient concerns:

A 57-year-old male patient presented with a protruding mass on the left forehead for 2 years and numbness in the right limb for 3 weeks.

Diagnoses:

The patient had a double mutation of BRAF L597Q and V600E in 2 separate lesions at thyroid and brain, the immunohistochemical staining showed that the cytokeratin (CK), thyroglobulin (Tg) and thyroid transforming factor-1 (TTF-1) were immunoreactive. All the findings supported the diagnosis of solitary brain metastasis of occult papillary thyroid carcinoma.

Interventions:

The patient underwent left frontal lobe metastasis (thyroid cancer) resection that involved craniectomy and artificial skull repair.

Outcomes:

During the 24-month follow-up, no postoperative complications or recurrence and metastasis were found.

Lessons:

This is the first case of solitary brain metastasis of occult papillary thyroid carcinoma with double mutation of BRAF L597Q and V600E in 2 separate lesions reported in the literature. Our study extends the disease spectrum of occult papillary thyroid carcinoma and suggests that the BRAF L597Q mutation might play a specific role in inducing the solitary brain metastasis of occult papillary thyroid carcinoma in a Chinese Tibetan patient, but the detailed molecular mechanism remains to be confirmed by a large number of functional experiments and clinical research.
Exosome as potential biomarkers for gastrointestinal tumors
Authors: Zhang Jinlong , Fu Shudan , Chen Wenshuo , Chen Haijin
Published: February 2021

Introduction:

Exosomes are polyvesicles that are formed by invagination of intracellular lysosomal particles, and are released into the extracellular matrix after the fusion of polyvesicular outer membrane and cell membrane. In the body, immune response, antigen presentation, cell migration, cell differentiation and tumor invasion are closely related to tumorigenesis and tumor progression. This study aimed to conduct a meta-analysis for evaluating the clinicopathological, diagnostic and prognostic significance of exosomal expression in gastrointestinal tumors.

Methods:

The original English articles were systematically searched in the online databases. The diagnostic accuracy, prognostic utility and clinicopathological correlation of gastrointestinal tumors were investigated. The quality assessment for studies of diagnostic accuracy II and Newcastle-Ottawa scale were used for quality evaluation, and the data was strictly extracted to judge the deviation of the study.

Results:

A total of 14 studies with 1837 gastrointestinal tumor patients were included. The change in exosomal expression showed significant correlation with poor clinicopathological parameters (tumor diameter: combined P = .00024394; differentiation: combined P = 2.796e-08; lymphatic metastasis: P = 9.610e-07; distant metastasis: combined P = .00017326; pathological classification: combined P = .00875213; invasion depth: combined P = 3.504e-08) carcinoembryonic antigen (combined P = . 04458857) and tumor location (combined P = .00145983). The difference in the area under the curve between gastrointestinal tumor patients and healthy people showed an area under the curve of 0.89 (95%Cl 0.85–0.91) and heterogeneity of 0.59, 95% CI=[0.55–0.68]. The sensitivity was 0.88 (95%Cl 0.83 mi 0.91), the specificity was 0.72 (95%Cl 0.63 mi 0.80), and the diagnostic odds ratio was 18 (10–33). The results of survival analysis revealed that the abnormally expressed exosomes were significantly correlated with poor overall survival (hazard ratio =2.81, 95% CI: 2.02–3.93, P=0.013∗ 62.7%∗).

Conclusion:

The abnormally expressed exosomes might act as auxiliary biomarkers in diagnosing gastrointestinal tumors and demonstrated good prognostic significance in predicting the survival of patients with gastrointestinal tumors.
The effects of IL-17/IL-17R inhibitors on atherosclerosis in psoriasis and psoriatic arthritis
Authors: Liu Ningyuan , Su Danni , Liu Keshuai , Liu Binbin , Wang Shibo , Zhang Xiaoyan
Published: February 2021

Background:

Psoriasis (PSO) is a systemic inflammatory disorder that presents with erythematous scaling of the skin and is associated with autoimmune dysfunction. Atherosclerosis is one of the major comorbidities of PSO. PSO-associated inflammatory factor IL-17 could lead to vascular endothelial cell injury and atherosclerosis. While some research results show that IL-17 helps stabilize plaque formation. Efficacy and safety on PSO and psoriatic arthritis (PSA) of existing IL-17/IL-17R biologics (secukinumab, ixekizumab, brodalumab, and bimekizumab) have been clinically validated, but whether they can improve atherosclerotic outcomes in psoriatic patients remains controversial.

Methods:

Seven electronic search engines will be searched from inception to December 1, 2020, including PubMed, Embase, Scopus, PsycINFO, Global Health, Web of Science and the Cochrane Library. Clinical trial registries, potential grey literature, relevant conference abstracts, and reference lists of identified studies will also be searched. Literature selection, data extraction, and quality assessment will be done by 2 independent authors. Based on the heterogeneity test, the fixed effect or random effect model will be used for data synthesis. Changes in lung function will be evaluated as the primary outcome. Assessment of symptoms, quality of life, medication use, exacerbations and adverse events will be assessed as secondary outcomes. RevMan V. 5.3.5 (The Nordic Cochrane Centre, Copenhagen, Denmark) will be used for meta-analysis.

Results:

This study will provide a synthesis of current evidence of IL-17/IL-17R inhibitors on atherosclerosis in PSO and PSA.

Conclusion:

The conclusion of our study will provide updated evidence to judge whether IL-17/IL-17R inhibitors is an effective solution to atherosclerosis as comorbidity of PSO and PSA.

PROSPERP registration number:

CRD42020209897
Prenatal detection of a 7q11.21 microdeletion (517–605 kb)
Authors: Zhang Hongguo , Li Leilei , Yu Yang , Li Linlin , Jiang Yuting , Liu Ruizhi
Published: February 2021

In the literature, 7q11 deletion was reported with various abnormalities. However, there were other genetic conditions combined with 7q11.21. It is necessary to have sufficient pure 7q11.21 microdeletions for classifying the pathogenic categories of variation.

Chromosomal karyotyping analysis was performed on cultured amniotic fluid cells. Eighteen pregnant women took chromosomal microarray using prenatal amniotic fluid samples at our center by Affymetrix CytoScan750K_Array. We followed the outcome of these pregnancies and determined postnatal health conditions.

Cytogenetic studies delineated that all patients had normal karyotypes. The exception was P17, who had 47, XN. Single nucleotide polymorphism array results showed 517 to 605 kb deletions of 7q11.21 (chr7: 64543313-65196780) in these cases. The microarray results were pure or combined 7q11.21 microdeletions. In 11 pure 7q11.21 microdeletions and 7 combined cases, there was no apparent abnormal phenotype associated with partial 7q11.21. Among them, only mothers of P10 and P17 decided to terminate the pregnancies due to 18 trisomy or ultrasound abnormal fetal strephenopodia. In the follow-up survey, the newborns had no apparent abnormalities.

In this study, we described 11 pure and 7 combined 7q11.21 microdeletions associating with no apparent postnatal phenotypic abnormalities. From this study, we can learn that the partial 7q11.21 deletion (chr7: 64543313-65196780) might be benign and have no association with human disorders.