bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel application of the traditional lipid ratios as strong risk predictors of nonsmall-cell lung cancer risk in a Chinese population
Authors: Qiu Xiaohua , Li Yanran , Ma Miao , Cao Min , Yan Xin , Cai Hourong
Published: September 2022

Dyslipidemia has been associated with cancer risk, yet the relationship between lipid ratios and nonsmall-cell lung cancer (NSCLC) is still unclear. This study aimed to explore the value of lipid ratios, including total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) and triglyceride/HDL-C (TG/HDL-C) as predictors of NSCLC in a Chinese population. Adult patients with histologically confirmed NSCLC, without a previous history of cancer, concomitant disease associated with lipid metabolism disorders, or usage of lipid-lowering drugs, were enrolled from a single center. Controls without NSCLC, matched for age and sex, were enrolled from the same Center. Lipid profile including TC, TG, HDL-C were measured in all participants. TC/HDL-C and TG/HDL-C were calculated based on the levels of TC, TG, HDL-C. Seven hundred eighty-two NSCLC cases and 599 controls were enrolled. NSCLC patients had significantly higher TG/HDL-C and TC/HDL-C levels than those in the control. After controlling for confounding factors, TG/HDL-C (OR = 4.489, 95% CI: 2.463–6.035, P < .001) and TC/HDL-C (OR = 2.396, 95% CI: 2.086–2.752, P = .001) were independently associated with NSCLC risk. The incidence of NSCLC was increased with rising tertiles of TG/HDL-C and TC/HDL-C. Moreover, patients with TNM II-IV stage NSCLC had higher TG/HDL-C and TC/HDL-C than those in TNM I and Tis stage. TG/HDL-C and TC/HDL-C are positively correlated with NSCLC risk and TG/HDL-C is more predictive than TC/HDL-C in predicting the risk of NSCLC. The highest AUC was that of TG/HDL (0.898), at a cutoff point of 0.62, with 83.6% sensitivity and 83.5% specificity.
Correlation of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) with gout activity: A monocentric and retrospective study
Authors: Wu Haihua , Zhou Hui , Chen Panfeng
Published: September 2022

To evaluate the correlation of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) with parameters related to gout activity. The general data of the patients and healthy controls (HCs), including complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum uric acid (SUA), and the presence of tophi were retrospectively analyzed. NLR, MPV, and PLR were calculated in patients with intercritical gout and gout flares. Correlation of the 3 markers with clinical features, like ESR, CRP, SUA, and the presence of tophi, were analyzed. The results revealed that NLR and PLR were elevated and MPV was markedly decreased in patients with gout compared with HCs (all P < .05). In patients with gout flares, NLR, and PLR were higher and MPV was lower than in intercritical gout patients (all P < .05). NLR and PLR were positively correlated with ESR and CRP, whereas MPV was negatively correlated with ESR. NLR, PLR, and MPV showed no obvious correlation with SUA and the presence of tophi. The receiver operating characteristic curve showed that NLR was more valuable in assessing gout disease activity. NLR, PLR, and MPV were correlated with inflammatory parameters in gout; they may be used as complementary tools to evaluate gout activity.
A meta-analysis of wenxin granule and metoprolol for the treatment of coronary heart disease and arrhythmia
Authors: Meng Ling-Li , Huang Wei
Published: September 2022

Background:

This meta-analysis aimed to systematically and comprehensively assess the effectiveness and safety of wenxin granule (WXG) and metoprolol in the treatment of elderly patients with coronary heart disease (CHD) and arrhythmia.

Methods:

We searched the electronic databases of the Cochrane Library, PUBMED, EMBASE, CNKI, Wangfang, and CBM from initiation to May 1, 2022, and selected a set of clinical indicators for WXG and metoprolol for CHD and arrhythmia. The methodological quality of the included studies was analyzed using the Cochrane risk-of-bias tool. Data were pooled using a fixed-effects or random-effects model, and a meta-analysis was conducted.

Results:

Eight randomized controlled trials involving 722 patients with CHD and arrhythmia were included. Our findings showed that WXG and metoprolol showed better effects than metoprolol alone on electrocardiogram change (odds ratio [OR] = 7.21, 95% confidence interval [CI] [1.48, 35.07]), clinical symptom improvement (OR = 5.83, 95% CI [1.52, 22.35]), overall clinical effect (OR = 5.51, 95% CI [2.65, 11.44], P < .001), atrial premature beat (mean difference [MD] = −109.85, 95% CI [−171.25, −48.46], P < .001), ventricular premature beat (MD = −195.43, 95% CI [−334.09, −56.77], P < .001), borderline premature beat (MD = −42.92, 95% CI [−77.18, −8.67], P = .01), short-burst ventricular tachycardia (MD = −35.98, 95% CI [−39.66, −32.30], P < .001), ST segment reduction (MD = −0.47, 95% CI [−0.54, −0.40], P < .001), ST segment decrease duration (MD = −0.76, 95% CI [−0.95, −0.57], P < .001). However, no significant differences were observed in adverse reactions (OR = 0.54, 95% CI [0.27, 1.09], P = .09).

Conclusion:

Compared to metoprolol alone, WXG and metoprolol can more effectively manage patients with CHD and arrhythmia. However, additional large-scale, multicenter, rigorous, and high-quality randomized controlled trials are warranted to verify the present findings.
Effects of mobile mindfulness training on mental health of employees: A CONSORT-compliant pilot randomized controlled trial
Authors: Yoon Seok-In , Lee Seung-Il , Suh Hyo-Weon , Chung Sun-Yong , Kim Jong Woo
Published: September 2022

Background:

Employee stress and well-being affect organizational efficiency and productivity, as well as physical and psychological health of employees. Mindfulness is believed to reduce stress, prevent diseases, and promote well-being. Mindfulness has been used as the main component of various smartphone-based healthcare applications. Previous studies have suggested that mindfulness applications have a positive effect on employee stress and mental health. However, relatively few randomized controlled trials have examined the effectiveness of mindfulness applications on employees. This study aims to evaluate whether mobile mindfulness training (MMT) as a stress self-management tool improves employees’ perceived stress, subjective well-being, and Mibyeong, a condition that is not a disease but shows obvious health abnormalities.

Methods:

Participants were recruited through advertisements displayed at 3 workplaces, including a patent attorney’s office, a construction company, and a public relations firm. A total of 45 employees were randomly assigned to 1 of 2 groups: the MMT group (Group A) receiving smartphone application-based mindfulness training, and a wait-list control (WLC) group (Group B), who received no intervention. Group A employees conducted MMT following daily and event guidelines for 4 weeks. In contrast, Group B employees did not receive any intervention in that time. The outcome variables were perceived stress, subjective well-being, and Mibyeong. Surveys were conducted at baseline, post-intervention, and follow-up (fourth week post-intervention).

Results:

Demographic characteristics and baseline assessments were not significantly different between the 2 groups. The results of this study revealed that subjective well-being and Mibyeong were significantly improved in the MMT group compared with the WLC group. Moreover, this improvement was maintained up to at least 4 weeks later. However, perceived stress was not significantly reduced in the MMT group compared to the WLC group.

Conclusion:

Four weeks of MMT improved the subjective well-being and Mibyeong of employees. However, further studies are required to investigate the effect of MMT on other areas of mental health.
Feasibility of dance therapy using telerehabilitation on trunk control and balance training in patients with stroke: A pilot study
Authors: Lee So Jung , Lee Eun Chae , Kim Muhyun , Ko Sung-Hwa , Huh Sungchul , Choi Woosik , Shin Yong-Il , Min Ji Hong
Published: September 2022

Background:

This randomized controlled trial aimed to investigate the effects of dance therapy using telerehabilitation on trunk control and balance training in patients with stroke and compare them with the effects of conventional treatment.

Methods:

We enrolled 17 patients with subacute or chronic stroke who were randomly assigned to either an experimental or a control group. In addition to conventional physical therapy, the experimental group (n = 9) participated in 40-minute, non-face-to-face, dance-therapy sessions and the control group (n = 8) received conventional physical therapy. The primary outcome measures were the Trunk Impairment Scale (TIS) scores to assess trunk control and balance function between the 2 groups as a measure of change from baseline to after the intervention.

Results:

We found that the TIS scores of the patients in the experimental group significantly improved (P= .017). The TIS results indicated non-inferiority within a predefined margin for dance therapy using telerehabilitation (difference = -0.86, 95% confidence interval [CI] = -2.21 to 0.50).

Conclusion:

Dance therapy using telerehabilitation significantly improved the TIS scores in the experimental group and was not inferior to conventional rehabilitation treatment when compared in a non-inferiority test. The remote dance program may therefore have similar effects to those of conventional treatment regarding trunk-control improvement in patients with stroke.
Effect of cataract incision type on corneal spherical aberration
Authors: Li Xiaochun , Cao Xiaoguang , Hou Xian-Ru , Yuan Li , Yu Ying-Ying , Bao Yong-Zhen
Published: September 2022

Corneal spherical aberration (CSA) plays an important role in the ocular refractive system. However, ophthalmologists have not considered the effect of difference cataract incisions on it. The purpose of this study is to investigate the effect of transparent corneal incision (TCI) and scleral tunnel incision (STI) on CSA after the cataract phacoemulsification with foldable IOLs. One hundred ninety-three eyes (61 males and 79 females) for 1-month observation and 114 eyes (29 males and 51 females) for 3-month observation with age-related cataracts (ARC) were included in this study. CSA was measured with dilated pupil by Pentacam Scheimpflug system at 1 day preoperative and 1, 3-month postoperative. Preoperative CSA >1.00 μm was excluded. Both TCI and STI are 3 mm incisions with Infiniti system and Ozil handpiece. No significant difference of age or gender was found between TCI and STI groups in 1 or 3-month observation. In 1-month observation, preoperative CSA for TCI and STI are 0.31 ± 0.29 and 0.41 ± 0.19 μm, which of postoperative are 0.42 ± 0.17 and 0.44 ± 0.35 μm, respectively. The change of CSA is 0.11 ± 0.32 and 0.04 ± 0.33 μm (P = .233). For 3-month observation, preoperative CSA for TCI and STI are 0.32 ± 0.28 and 0.36 ± 0.23 μm, which of postoperative are 0.43 ± 0.16 and 0.39 ± 0.26 μm, respectively. The change of CSA is 0.10 ± 0.34 and 0.03 ± 0.21 μm (P = .312). For the phacoemulsification combined with foldable IOL implantation, STI has minimal effect on CSA, but TCI might increase postoperative CSA.
Simple method of saddle nose correction: A double-layer dermofat graft: case report
Authors: Jeong Ho Yoon , Cho Kyu-Sup , Bae Yong Chan , Seo Hyung Joon
Published: September 2022

Introduction:

Saddle nose deformities are typically reconstructed with cartilage grafts; however, conchal cartilage grafts are and associated with a risk of damage to the posterior auricular ligament and insufficient amounts, and costal cartilage grafts require invasive surgery under general anesthesia. We proposed a double-layer dermofat graft as an alternative to these methods.

Patient concerns:

Two patients with type IV saddle nose deformity underwent reconstruction with nasal augmentation with a double-layer dermofat graft harvested from the gluteal sulcus.

Diagnosis:

After operation, photogrammetric analysis demonstrated an improvement in the dorsal depression area, which corresponded to the angle between the sellion, most depressed point, and pronasale. Rhinoplasty Outcome Evaluation questionnaire was assessed.

Interventions:

The graft was divided into 2 sections; the first section was implanted transversely into the depressed nasal framework, and the second section was inserted vertically from the nasion to the supratip break for augmentation.

Outcomes:

Both patients reported high satisfaction with the Rhinoplasty Outcome Evaluation questionnaire. The mean preoperative angle between the sellion, most depressed point, and pronasale was 157.8°, and the mean postoperative angle at 6 months was 176.9°.

Conclusion:

The simple method double-layer dermofat graft technique demonstrated excellent outcomes in saddle nose deformity correction, did not require cartilage, and was easily performed under local anesthesia.
Lung adenocarcinoma with EGFR 19Del and an ALK rearrangement benefits from alectinib instead of an EGFR-TKI: A case report
Authors: Wang Hongbiao , Zhu Sujuan , Li Zhifeng , Qi Xiaofang , Zhang Liwen , Ke Leiyu , Lin Yingcheng
Published: September 2022

Rationale:

A remarkable concurrence of an EGFR mutation and an EML4-ALK fusion (double positive) occasionally occurs within a narrow number of patients. Previous studies using targeted therapy on EGFR/ALK co-mutated patients have commonly focused on single tyrosine kinase inhibitors (TKIs) or on the sequential use of EGFR-TKIs and ALK-TKIs. At present, no consensus exists regarding the treatment of patients with double positive mutations. The effectiveness of precision therapy also remains unknown.

Patient concerns:

A 53-year-old female non-smoker who described recurrent coughing and blood in her sputum over a month-long interval was examined at a local hospital.

Diagnosis:

Using computed tomography (CT) and positron emission tomography CT (PET-CT), the patient was diagnosed with Stage IVb lung adenocarcinoma (T4N3M1).

Interventions:

The patient had a novel ALK-RAB10 rearrangement identified using DNA sequencing, which, at the transcript level, was actually a canonical ALK fusion that caused a response to alectinib therapy.

Outcomes:

The patient has achieved partial remission (PR), with a progression free survival (PFS) of 16 months, and continues to benefit.

Lessons:

Our results may indicate differential sensitivities to TKIs in patients harboring an EGFR mutation and an ALK rearrangement. Our patient’s response to alectinib, instead of to EGFR-TKIs, may lead to an expanded list of alectinib beneficiaries who have rare gene co-alterations in lung adenocarcinoma.
Meridian study on the response current affected by acupuncture needling direction
Authors: Lin Chien-Hung , Tan Yung-Fang , Tseng Shih-Ting , Chen Wen-Chung , Kuo Chuan-Wei , Wu Chia-Chuan , Tsai Tsung-Ming , Hu Wen-Long , Chang Ting-Chang , Hung Yu-Chiang
Published: September 2022

Acupuncture manipulation with needling direction is important for the therapeutic effect based on traditional Chinese medicine theory. However, there is controversy over directional manipulation and therapeutic effect, despite some research showing that acupuncture manipulations may have something to do with therapeutic effect. Moreover, research usually focuses on the therapeutic effects on the acupoints and acupuncture time rather than exploring the manipulation method. This study applies a semiconductor analyzer to investigate the effects of acupuncture manipulation. 10 healthy participants were recruited for the study. We used a cross-over design to compare the effect of different manipulation on individuals. This study employed an Agilent B1500A semiconductor analyzer to investigate the electric characteristics of meridians under directional supplementation and draining manipulation. We measured the electric current of meridians under different manipulation, and compared the difference between supplementation and draining manipulation in healthy individuals. The electric current was significantly larger in supplementation manipulation compared to draining manipulation in the meridians (P < .001). The measured electric current in the same manipulation methods did not show a statistical difference between meridians (P = .094). The different directional manipulation result in different electric currents in humans. Our finding implies that the supplementation and draining manipulation may result in different therapeutic effects clinically as the description of traditional Chinese medicine theory. Therefore, directional manipulation may need to be taken into consideration in future acupuncture studies and clinical management.
Identification of 5 microRNA biomarkers associated with the prognosis of uveal melanoma
Authors: Sun Yabin , Zhang Xinmin , Cong Zhongyi , Teng Siying
Published: September 2022

To uncover the role of microRNAs in the occurrence and development of uveal melanoma (UM), we used R language packages in this study to analyze the correlations between the expression of microRNA isoforms, their target genes, and the clinical data for UM patients retrieved from The Cancer Genome Atlas (TCGA). We used Weighted Correlation Network Analysis (WGCNA) to divide the expression profiles of different microRNAs into 10 modules, among which blue and yellow modules were associated with UM survival. Hsa-miR-513a-5p, miR-506-3p, miR-508-3p, miR-140-3p, and miR-103a-2-5p were further identified as the top 5 node microRNAs based on the risk scores in both modules using least absolute shrinkage and selection operator (LASSO) Cox regression analysis. After combining these 5 microRNAs into an integrated risk signature, the prognostic performance of the risk signature was evaluated by area under the receiver operating characteristic (AUROC) curve, and their association with UM clinical characteristics was further analyzed using multiple Cox regression. Our results showed that this risk signature was sensitivity and specificity, and could serve as an independent prognostic factor. In addition, Spearman correlation analysis showed that expression of almost all target mRNAs were significantly positively or negatively correlated with the associated microRNAs. The gene ontology (GO), pathways, and disease enrichment analyses also showed that these 5 microRNAs were closely related to the incidence and progression of tumor, indicating their potential for predicting the outcome of UM.
Rib and pericardium invaded huge abdominal mass in young woman: A case report with literature review
Authors: Park Han Wool , Do Jae Hyuk , Park Tae Young , Oh Hyoung-Chul , Park Joong-Min , Hong Soon Auck , Park Hyun Jeong
Published: September 2022

Rationale:

Desmoid fibromatosis is a rare benign tumor, but due to its rarity and diverse clinical course, treatment guidelines have not been established. However, since a good prognosis can be expected, an accurate diagnosis and appropriate treatment are required. We describe a rare case of desmoid fibromatosis on young female that presented as huge abdominal mass.

Patients concerns:

A 28-year-old female with left upper abdominal pain 1 month ago was referred.

Diagnoses:

Abdominal computed tomography and magnetic resonance imaging revealed a heterogeneous soft tissue mass approximately 29 × 17 cm in size in the left abdomen with abdominal wall invasion and pathological fracture in costochondral junction of the left 8th to 10th ribs.

Interventions:

Surgical resection was performed.

Outcomes:

33 × 23 × 6 cm sized tumorous mass showed proliferation of bland fibromatosis and myofibroblast with nuclear β-catenin expression on pathological examination. Desmoid fibromatosis arising from intra-abdominal soft tissue with ribs and pericardium invasion was diagnosed.

Lessons:

The mainstay of treatment of symptomatic desmoid fibromatosis is surgical resection, and in the case of abdominal tumor, it can be more dangerous when it invades adjacent organ. We report a case that required additionally multidisciplinary approach for surgery and postoperative treatment of huge abdominal desmoid tumor which infiltrate bone and pericardium beyond abdominal cavity.
Middle mediastinal paraganglioma enclosing the left anterior descending artery: A case report
Authors: Zhang Bing , Liu Guofang , Li Jian , Wan Pinghua , MD
Published: September 2022

Rationale:

Paragangliomas are extremely rare neuroendocrine tumors arising from ganglia. These tumors are barely found in the middle mediastinum.

Patient Concerns:

A 31-year-old male patient was admitted to our hospital for treatment of an middle mediastinal tumor which was found incidentally on echocardiography during a medical checkup. Contrast-enhanced chest computed tomography (CT) demonstrated a well-defined hypervascularized heterogeneous mass located in the middle mediastinum. The tumor showed strong 18F-fluorodeoxyglucose (FDG) activity on positron emission tomography-computed tomography (PET-CT).

Diagnosis:

Before the surgery, we presumed the mass was an angiogenic or neurogenic tumor. As a result, the histological features favored a diagnosis of paraganglioma.

Interventions:

The tumor was completely removed by anterior thoracotomy, along with the proximal segment of the left anterior descending artery (LAD), and coronary artery bypass grafting (CABG) was performed immediately after the tumor excision.

Outcomes:

The patient had an uneventful recovery. The patient did well in the postoperative follow-up without any complications and signs of recurrence at 3 months, 1 year, 2 year and 4 year.

Lessons:

This report can increase the confidence in surgeries of mediastinal paragangliomas adhering tightly the adjacent structures.
Specific aeroallergen sensitization associated with current rhinitis among adults in southwestern Saudi Arabia
Authors: Al-Ghamdi Badr Rashed , Omer Fakhreldin Mohamed , Awadalla Nabil J. , Mahfouz Ahmed A.
Published: September 2022

Data about allergic sensitization to rhinitis among adults are limited. The objectives were to explore the prevalence of current rhinitis (CR) and associated specific allergen sensitizations in southwestern Saudi Arabia. A cross-sectional study was conducted on 969 adults in southwestern regions of Saudi Arabia, namely Aseer, Jazan, and Al Baha. From each region, 5 primary health care centers were chosen. The validated Arabic Version of the International Study of Asthma and Allergies in Childhood questionnaire was used. Total immunoglobulin E (IgE) enzyme-linked immunosorbent assay, cytokine enzyme-linked immunosorbent assay (interleukin [IL]-4, IL-10, IL-13, and interferon-γ), aeroallergen-specific IgE immunoassay (a panel of 30 common aeroallergens; 9 indoor and 21 outdoors), and eosinophilic count were assessed. A prevalence of CR of 35.8% (95% confidence interval: 32.8%–38.9%) was found. Regarding outdoor aeroallergens, Mesquite-positive IgE antibodies were higher among CR adults (odds ratio = 1.52, 95% confidence interval: 1.02–2.21) compared to those without CR. The same significant pattern was found with Chenopodium, Ragweed, Pigweed, Russian thistle, Bermuda grass, Timothy grass, and Rye. All indoor aeroallergens were not significantly associated with CR. Total IgE and eosinophil count were significantly higher among adults with CR. In conclusion, CR in southwestern regions of Saudi Arabia is common and of significant public health importance. Aeroallergens that associate with adult sensitization to CR tend to be of the outdoor variety particularly the herbaceous grass and their pollens. The magnitude of CR and its association with exposure to outdoor aeroallergens should be taken into account by health policy decision makers, clinicians, and medical practitioners when diagnosing and treating related conditions.
A network meta-analysis of curative effect of different treatment methods on patients with brain metastasis of breast cancer
Authors: Wu Anhao , Zhang Fang , Yang Xin , Liu Yang , Tan Mingjian , Lai Yafang , Yang Zhuangqing
Published: September 2022

Background:

Breast cancer (BC) is a malignant tumor with the highest incidence rate worldwide, and its incidence of breast cancer brain metastases is increased in recent years. Although significant progress has been made in the systematic treatment of BC that of breast cancer brain metastases is still very difficult. Organically integrating local and systemic therapies remains an urgent problem to be solved. In this study, a network meta-analysis was performed to collect the treatment effects of different treatment measures on patients with BC brain metastasis in recent years, evaluate and screen the current best clinical treatment scheme, and assist doctors in formulating clinical treatment schemes.

Methods:

Keywords were used to search databases, such as the Chinese Journal Full-text Database, VIP Chinese Science and Technology Journal Full-text Database (VP-CSJFD), Wanfang Data Journal Paper Resources (Wangfang), PubMed, the Cochrane Library, and EMBASE. The retrieval period was from the establishment of each database to February 2022. Qualified randomized controlled studies were screened according to the inclusion and exclusion criteria, and Stata 16 software was adopted for mesh meta-analysis of binary variable data. Using R4 0.2 software, and calling GeMTC and JAGS packages in R software, the Bayesian network model analysis of survival data was completed.

Conclusion:

Combined with overall response rate, disease control rate, and overall survival, whole-brain radiation therapy + 3-dimensional conformal radiation therapy + Che may be the intervention measure with the highest objective remission rate for patients with brain metastasis of BC, besides, it may also be the intervention measure of the highest disease control rate in patients after treatment. In contrast, WBRT + Che may be the intervention with the lowest overall survival risk ratio after treatment.
Type 1 diabetes associated with immune checkpoint inhibitors for malignant melanoma: A case report and review of 8 cases
Authors: Ishiguro Akihiro , Ogata Dai , Ohashi Ken , Hiki Kojiro , Yamakawa Kohei , Jinnai Shunichi , Tsutsui Keita , Takahashi Akira , Namikawa Kenjiro , Yamazaki Naoya
Published: September 2022

Advanced malignant melanoma (MM) is treated with immune checkpoint inhibitor (ICI) therapy, which often results in several immune-related adverse events. Fulminant type 1 diabetes mellitus (T1DM) is a rare, rapidly progressive, life-threatening disease. Here, we summarize 8 cases of MM with ICI-induced T1DM and describe one case that developed fulminant T1DM due to nivolumab therapy. We retrospectively reviewed patients treated with ICI from 2014 to 2021 at our hospital. The clinical features and risk factors of ICI-induced T1DM were discussed. ICIs were administered to 426 MM patients at our hospital. Among these, nivolumab was administered in 5 cases, pembrolizumab in 1 case, and the combination of nivolumab and ipilimumab in 2 cases. The frequency of ICI-associated T1DM was 1.88%. The mean glycated hemoglobin level at T1DM onset was 8.0 ± 1.0%. Of the patients, 75% were diagnosed with fulminant T1DM, 62.5% developed diabetic ketoacidosis, and 25% had glutamic acid decarboxylase (GAD) antibodies (an early predictive marker for T1DM). The mean interval between the first ICI administration and T1DM development was 201 ± 187 days. The mean duration of resumption was 13 ± 7 days. We should monitor for T1DM development following treatment with ICIs. ICI can be continued to be used to treat MM if insulin therapy successfully controls T1DM.

A 67-year-old patient who received adjuvant nivolumab therapy developed fulminant T1DM and thyrotoxicosis 57 days later and tested positive for GAD antibodies. Subsequently, he developed hypophysitis and an isolated adrenocorticotropin deficiency. He continued receiving nivolumab along with self-injected insulin without developing recurrence.
Lens nucleus dislocation in hypermature cataract: Case report and literature review
Authors: Guan Jie-Ying , Ma Yun-Cheng , Zhu Ying-Ting , Xie Ling-Ling , Aizezi Mireayi , Zhuo Ye-Hong , Wumaier Aizezi
Published: September 2022

Introduction:

Hypermature cataract is a form of late-stage cataract progression that can lead to a variety of complications. Spontaneous capsular rupture with lens nucleus displacement in hypermature cataracts has rarely been reported. We describe 2 cases of spontaneous dislocation of the lens nucleus in a hypermature cataract and perform a review of the literature on this complication.

Patient Concerns:

We report 2 rural men aged 50 and 76 years with deteriorating vision.

Diagnosis:

The final diagnosis was senile hypermature cataract with dislocation of the lens nucleus in both patients and secondary glaucoma for the second patient.

Interventions and Outcomes:

During admission, both patients complained of deteriorating vision. Slit-lamp examination showed lens nucleus dislocation into the anterior chamber. The 50-year-old patient exhibited a residual lens capsule and a turbid cortex, with a normal anterior chamber and intraocular pressure. The 76-year-old patient presented a shrunken and ruptured capsule and no cortex in the pupillary area, mild inflammation in the anterior chamber, and high intraocular pressure. Both patients underwent intracapsular cataract extraction combined with anterior vitrectomy and achieved good postoperative recovery.

Conclusion:

Lens nucleus dislocation in hypermature cataracts can be seen in clinical practice, particularly in underdeveloped areas. Early recognition and surgery can improve vision.
Gene mining of immune microenvironment in hepatocellular carcinoma
Authors: Xu Zhi-Wei
Published: September 2022

Background:

Hepatocellular carcinoma (HCC) is a common malignant tumor worldwide with a poor prognosis. Recent studies have shown that the occurrence, development and prognosis of liver cancer are closely related to tumor microenvironment (TME) and tumor immune infiltration.

Methods:

Therefore, important information on various diseases can be obtained from public databases such as The Cancer Gene Atlas (TCGA), and ideas or schemes that may be effective for the treatment of various diseases can be screened and analyzed by screening various conditions. In this study, 424 cases of liver hepatocellular carcinoma (LIHC) in the TCGA database and CIBERSORT algorithm were used to calculate the proportion of tumor-invasive immune cells. Combined with the clinical data from TCGA database, it was concluded that T cells regulatory (Tregs) were correlated with the development and prognosis of HCC. Cox regression analysis was used to screen differentially expressed genes, and survival analysis was performed according to the screened differentially expressed genes to see whether there was a significant association with the prognosis of HCC. Then gene ontology and kyoto encyclopedia of genes and genomes analysis of differentially expressed genes were carried out to explore the possibility of differentially expressed genes becoming potential therapeutic targets of HCC.

Results:

Finally, I identified the gene centromere protein o (CENPO), which is associated with immune cells and improve the prognosis of HCC.

Conclusion:

CENPO may be a potential biological therapeutic target for hepatocellular treatment.
Evidence-based treatment recommendations for gastroesophageal reflux disease during pregnancy: A review
Authors: Altuwaijri Mansour
Published: September 2022

Gastroesophageal reflux disease (GERD) occurs in approximately two-thirds of all pregnancies. Around 25% of pregnant women experience heartburn daily. Symptomatic GERD usually presents in the first trimester and progresses throughout pregnancy. The treatment goal is to alleviate heartburn and regurgitation without jeopardizing the pregnancy or its outcome. An English language electronic literature search of MEDLINE, EMBASE, and Cochrane Reviews was undertaken to identify randomized controlled trials, observational studies, management recommendations and reviews of GERD and its treatment during pregnancy. The search period was defined by the date of inception of each database. The treatment in a pregnant GERD patient should follow the step-up approach, starting with lifestyle modification as the first step. If heartburn is severe, medication should be started after consultation with a physician (Recommendation Grade C). The preferred choice of antacids is calcium-containing antacids (Recommendation Grade A). If symptoms persist with antacids Sucralfate can be introduced at a 1g oral tablet, 3 times daily (Recommendation Grade C). Followed by histamine-2 receptor antagonist (Recommendation Grade B). Inadequate control while on histamine-2 receptor antagonist and antacid may mandate a step-up to proton pump inhibitors along with antacids as rescue medication for breakthrough GERD (Recommendation Grade C). This article presented the treatment recommendations for pregnant women with typical GERD, based on the best available evidence.
Strongyloides stercoralis hyperinfection presenting with shock and intermittent eosinophilia: A case report
Authors: Tan Jih Tze , Tseng Chih-Wei
Published: September 2022

Rationale:

Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis. The clinical presentation varies according to the stage of infection. Diagnosing strongyloidiasis is a challenge in clinical practice due to the inconsistency of eosinophilia and the low sensitivity of standard microscopic stool examination. Strongyloides infection presenting with shock is rare.

Patient concerns:

In this case, the condition of a 77-year-old immunocompromised patient with intermittent diarrhea progressed to shock and hypoalbuminemia. Reviewing her medical records, we learned that she had experienced intermittent peripheral eosinophilia during the past 10 months. Although a series of examinations were done, the disease progressed and the diagnosis remained uncertain.

Diagnosis:

Using standard microscopic stool examination and gastroduodenscopy with biopsy, a diagnosis of strongyloidiasis was made.

Interventions:

After the diagnosis of strongyloidiasis was made, 2 courses of ivermectin were administered.

Outcomes:

The patient recovered uneventfully after treatment and there is no recurrence of eosinophilia in 1 year follow-up.

Lessons:

This report provides a brief review of the current modalities used for diagnosing strongyloidiasis. It emphasizes the low sensitivity of microscopic examination, and highlights the role of gastroduodenoscopy in the diagnosis of strongyloidiasis. This report also assures that patients with strongyloidiasis have a good prognosis when they are treated timely and appropriately.
Successful Haploidentical Bone Marrow Transplantation of an Infant With a Novel Mutation in SAMD9L Gene (Ataxia-Pancytopenia Syndrome)
Authors: Alicea Marrero Minelys M. , Español María , Marrero-Rivera Gisela , Bauchat Andrea , Cruz Valerie , Yu Lolie , LeBlanc Zachary
Published: September 2022

Data regarding the outcomes of hematopoietic stem cell transplant (HSCT) for the management of SAMD9L-associated ataxia-pancytopenia syndrome remains limited. We depict the case of a 2-month-old male with a novel mutation in the SAMD9L gene, presenting with respiratory failure, pancytopenia and severe developmental delay. He experienced graft failure 2 months after a 4/6 HLA-matched cord HSCT. At 9 months old, an unsuccessful unrelated donor search prompted a haploidentical HSCT with successful engraftment. He sustains excellent donor chimerism and has improved developmentally over 2 years posttransplant. This case demonstrates haploidentical HSCT as a viable option for patients with SAMD9L mutation and no acceptable unrelated donor.
Small Biopsy and Cytology of Pulmonary Neuroendocrine Neoplasms: Brief Overview of Classification, Immunohistochemistry, Molecular Profiles, and World Health Organization Updates
Authors: Sung Simon , Heymann Jonas J. , Politis Michelle Garlin , Baine Marina K. , Rekhtman Natasha , Saqi Anjali
Published: September 2022

Pulmonary neuroendocrine neoplasms comprise ~20% of all lung tumors. Typical carcinoid, atypical carcinoid, small cell carcinoma, and large cell neuroendocrine carcinoma represent the 4 major distinct subtypes recognized on resections. This review provides a brief overview of the cytomorphologic features and the 2021 World Health Organization classification of these tumor types on small biopsy and cytology specimens. Also discussed are the role of immunohistochemistry in the diagnosis and molecular signatures of pulmonary neuroendocrine tumors.
Unusual Presentation of Cow’s Milk Protein Allergy
Authors: Cresoe Samantha , Setya Aniruddh , Beasley Genie , Gonzalo David Hernandez , Chan Albert
Published: September 2022

Cow’s milk protein allergy (CMPA) is an abnormal immunologic response to bovine protein that can result in various gastrointestinal and cutaneous manifestations including diarrhea, failure to thrive, malabsorption, and even protein-losing enteropathy. We describe a case of a 7-month-old breastfed male who presented with severe atopic dermatitis, emesis, oily diarrhea, failure to thrive, electrolyte disturbance, and hemodynamic instability. Following stabilization, additional evaluation revealed concern for abetalipoproteinemia. Ultimately, the patient’s symptoms resolved with introduction of an elemental formula and returned with reinitiation of cow’s milk protein, confirming the diagnosis of severe CMPA. It is important for the general practitioner to be aware of the various presentations and have a high index of suspicion for CMPA as no symptom or diagnostic test is pathognomonic for diagnosis. Even though it can mimic other causes of malabsorption, a trial with extensively hydrolyzed or elemental formula should be attempted before undertaking invasive testing.
Risk factors and prognostic significance of anemia in children with HIV infection on antiretroviral therapy
Authors: Lubega Joseph , Grimes Amanda , Airewele Gladstone , Bulsara Shaun , Kim Taylor Olmsted , Haq Heather , Peckham-Gregory Erin , Wanless Sebastian R. , Elyanu Peter , Musoke Philippa , Lumumba Mwita , Kekitiinwa Adeodata , Matshaba Mogomotsi , Despotovic Jenny , Scheurer Michael
Published: September 2022

Objectives:

To establish the incidence, risk factors and prognostic effect of anemia in children living with HIV (CLWH).

Design:

Retrospective nested case–control study of patients 0–18 years in five centers in sub-Saharan Africa, 2004–2014.

Methods:

Incident cases of anemia were identified from electronic records and matched with CLWH without anemia. We calculated the incidence density of anemia and used conditional logistic regression to evaluate its association with risk factors, stratified by severity and type of anemia. We used a Cox proportional hazards model to evaluate the impact of anemia on survival.

Results:

Two thousand, one hundred and thirty-seven children were sampled. The incidence density of anemia was 1 per 6.6 CLWH-years. Anemia was moderate in 31.8% and severe in 17.3% of anemia cases, which had 10-year mortality hazards of 3.4 and 4.5, respectively. Microcytic anemia (36% cases) was associated with 2.3-fold hazard of 10-year mortality, and with malnutrition and CD4+ suppression. Normocytic anemia (50.5% cases) was associated with 2.6-fold hazards of 10-year mortality, and with more severe malnutrition, CD4+ suppression, and WHO stage, but inversely associated with lamivudine and nevirapine therapy. Macrocytic anemia (13.5% cases) was neither associated with higher 10-year mortality nor with severe malnutrition or CD4+ suppression but was associated with WHO stage II/III and negatively associated with lamivudine therapy.

Conclusion:

This large multicountry study of CLWH found a high incidence density of anemia. Higher severity, normocytic and microcytic types of anemia were independently associated with long-term mortality. Laboratory studies are needed to decipher the mechanisms of anemia and how it impacts mortality in CLWH.
Computed Tomography Comparative Analysis of Nontuberculous Mycobacterial Lung Disease in the Elderly and Secondary Pulmonary Tuberculosis
Authors: Zhang Jinghua , Yang Yanying
Published: September 2022

Objectives

The study aimed to explore the key points of computed tomography (CT) differential diagnosis of nontuberculous mycobacteria (NTM) and secondary pulmonary tuberculosis in elderly patients.

Methods

We retrospectively analyzed 45 patients with NTM pulmonary disease and 65 patients with secondary pulmonary tuberculosis. All patients were older than 60 years. The diseases were confirmed by laboratory examination. The general data and CT images of the 2 groups were compared and analyzed using χ2 tests, single-factor analysis, and multivariate logistic regression analysis.

Results

Single-factor analysis showed significant differences between the 2 groups in 9 factors: bronchiectasis of the left upper lobe lingual segment, bronchiectasis of the right middle lobe, small nodules, large nodules, thin-walled cavities, thick-walled cavities, nonsubpleural hollows, strip opacity, and mediastinal lymph node enlargement (P < 0.05). Multivariate logistic regression analysis showed that thin-walled cavities, bronchiectasis of the right middle lobe, small nodules, and large nodules were important factors in the differential diagnosis of the two groups.

Conclusions

Nontuberculous mycobacteria show certain characteristics on CT, which are helpful for differential diagnosis when coupled with clinical and sputum smear examinations.
Health indicators as measures of individual health status, perceived importance, and their associated factors—an observational study
Authors: Jing Xia , Zhou Yuchun , Sokoya Temiloluwa , Diaz Sebastian , Law Timothy , Himawan Lina , Lekey Francisca , Shi Lu , Griffin Sarah , Gimbel Ronald W.
Published: September 2022

Background

Self-rated health status, a subjective measure, is used broadly to describe an individual’s overall health status. Our long-term goal is to create a more objective, comprehensive, and accurate measure of individual health status. We selected 29 health indicators and prioritized them by conducting online surveys. Thirteen of these 29 indicators received relatively more consistent ratings across 3 samples.

Objectives

To explore the main and interaction effects of 4 demographic factors as independent variables (age, gender, professional group, and educational level) in the importance ratings of the 13 health indicators.

Methods

We conducted a 4-way multivariate analysis of variance (MANOVA) with post-hoc testing to examine the effects of independent variables on all 13 dependent variables. Descriptive statistics and bivariate correlation analysis were also conducted.

Design

Cross-sectional study.

Setting

An online survey (≥ 18 years).

Participants

791 participants in the USA.

Results

13 health indicators were significantly correlated with each other. Age correlated with most of the health indicators (8 of 13). The MANOVA modeling results indicated that gender, age, and education levels significantly affected the combination of the 13 health indicators. There was a significant interaction effect by age and professional group on 5 health indicators.

Conclusions

Age is critical in rating the 13 health indicators. Among all the statistically significant main effects of demographic factors, the effect sizes descend regarding age, gender, educational level, and interaction between age and professional group. These results can provide a foundation for further studies to explore behavioral interventions for individual subgroups.

Article Summary

Strengths and limitations of this study

The work establishes the interactions and effects between demographic data (age, gender, education, and professional group) and the perceived importance of 13 health indicators via MANOVA analysis

The interactions and effects of demographic data on the importance ratings of the 13 health indicators

can guide future study designs for behavioral interventions

Deep analysis of the demographic variables and their effects on and interactions with the rating results are helpful for thoroughly understanding the perspectives

The study is an observational study despite with relatively large sample size and a robust analysis

The data are not racially representative
Ambient Air Pollution and Subclinical Cardiovascular Disease Measured by Magnetic Resonance Imaging in the Canadian Alliance for Healthy Hearts and Minds Study
Authors: Azab Sandi M , Schulze Karleen M , Brook Jeffrey R , Doiron Dany , Smith Eric E , Moody Alan R , Desai Dipika , Brauer Michael , Friedrich Matthias G , Bangdiwala Shrikant I , Zeraatkar Dena , Lee Douglas , Anand Sonia S , de Souza Russell J
Published: September 2022

Background

Long-term exposure to air pollution, even at levels below regulatory standards, has been associated with higher risk of cardiovascular-related mortality. Less is known about the association of air pollution and initial development of CVD in low-exposure settings in generally healthy human populations.

Objective

In the Canadian Alliance for Healthy Hearts and Minds Cohort Study (CAHHM), we aimed to investigate the association between low-level exposure to key air pollutants and subclinical carotid atherosclerosis in adults without known clinical CVD. To date, the association of ambient air pollution and atherosclerosis measured by magnetic resonance imaging (MRI) has not been studied.

Methods

We studied 6,645 Canadian adults recruited between 2014-2018 from the provinces of British Columbia, Alberta, Ontario, Quebec, and Nova Scotia, for whom average long-term exposures to nitrogen dioxide (NO2), ozone (O3), and fine particulate matter (PM2.5) were estimated for five years prior to the start of CAHHM recruitment, and who underwent MRI to assess carotid vessel wall volume (CWV). Linear mixed models were used to quantify associations between each air pollutant and CWV adjusting for individual-level and community-level risk factors for CVD. Secondary analyses included region-specific stratification and modeling the effect of one pollutant on CWV within low, medium, and high levels of a second pollutant to test for interactions.

Results

Higher PM2.5 was nominally associated with lower CWV (quintile 5: 893.3 mm3, quintile 1: 908.8 mm3; p-trend =0.05), but this was not robust in region-stratified analysis. Higher NO2 was associated with lower CWV (quintile 5: 889.5 mm3, quintile 1: 918.6 mm3; p-trend <.0001). Higher O3 was associated with higher CWV (quintile 5: 925.4 mm3, quintile 1: 899.7 mm3; p-trend =0.02). NO2 emerged as a consistent effect modifier of both PM2.5 and O3.

Conclusion

In a cohort of generally healthy adults living in Canada, a country with relatively low levels of air pollution, exposure to NO2 was negatively associated, and O3 was positively associated with CWV as a measure of subclinical atherosclerosis by MRI, while associations to PM2.5 were inconsistent. The reasons for these associations warrant further study.