bluuebunny/crossref_metadata_2025 huggingface dataset:
Menopausal symptoms inversely associated with quality of life: findings from a 5-year longitudinal cohort in Chinese breast cancer survivors
Authors: Lei Yuanyuan , Ho Suzanne C. , Kwok Carol , Cheng Ashley , Cheung Ka Li , Lee Roselle , Mo Frankie K.F. , Yeo Winnie
Published: April 2021

Objective:

This study assessed menopausal symptoms (MPS) after breast cancer in relation to quality of life (QoL) during the first 5 years of survival.

Methods:

An ongoing prospective study enrolled 1,462 Chinese women with early-stage breast cancer. They were longitudinally followed up at four time-points, namely baseline, 18-, 36-, and 60-month after diagnosis. At each follow-up, Menopause Rating Scale (MRS) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 were used to assess MPS and QoL, respectively.

Results:

In total, 1,462, 1,289, 1,125, and 1,116 patients were included into the analyses at baseline, 18-, 36-, and 60-months, respectively. The percentages of patients with no or little, mild, moderate, and severe MPS at baseline were 31.8%, 30.0%, 30.4%, and 7.7%, respectively; the corresponding figures at 18-, 36-, and 60-month follow-up were similar. Using data from four follow-ups, Generalized Estimating Equations analyses showed that MPS was inversely associated with QoL. Higher MRS scores were related to lower QoL scores. For instance, every 1 point increase in MRS score was associated with a 1.5 point decrease in global health status/QoL score (P < 0.01). In terms of symptoms, higher MRS scores were related to more severe symptoms.

Conclusions:

This study highlighted patients with more severe MPS tend to have worse QoL. Future investigation should be conducted to assess different means of alleviating MPS to improve patient's QoL.
Location, Location, Location: The Geographic Impact of Medical School on the Plastic Surgery Match
Authors: Glener Adam D. , Lebhar Michael , Hernandez J. Andres , Sergesketter Amanda R. , Shammas Ronnie L. , Cason Roger W. , Biswas Sonali , Phillips Brett T.
Published: April 2021

Background:

This resident application cycle posed academic leadership and applicants with an unprecedented challenge: how to virtually match applicants to mutually beneficial programs. The authors sought to refer to previous years' data, specifically geographic trends, to better inform both program directors and applicants. The authors hypothesized that geography, as it pertains to the transition from medical school to residency, impacts match patterns.

Methods:

The study was designed as a cross-sectional analysis including all current integrated plastic surgery residents. The independent websites of all accredited integrated plastic surgery programs were then queried for the desired demographic resident information. Additionally, as an illustrative endpoint, geospatial heat maps were generated to better understand geographic trends.

Results:

All (n = 78) integrated plastic surgery programs and 953 residents were included in the study. Nearly half (47.2%) of current residents remain in the same geographic region in which they obtained their medical degree, with 26% and 17% remaining in the same state and institution, respectively. Students within all regions (North, South, Midwest, West) were more likely to stay within that region for residency (OR 2.59, 2.39, 2.09, 3.80, respectively). Students attending medical schools with affiliated integrated plastic surgery residencies have matched to programs with significantly higher Doximity rankings (p < 0.0001).

Conclusions:

Matched integrated plastic surgery applicants are more likely to continue their training at institutions in closer geographic proximity to their medical schools. Students graduating from medical schools without affiliated integrated plastic surgery programs appear to be at a disadvantage during the match process.
Bone Marrow Mesenchymal Stromal Cell-mediated Resistance in Multiple Myeloma Against NK Cells can be Overcome by Introduction of CD38-CAR or TRAIL-variant
Authors: Holthof Lisa C. , Stikvoort Arwen , van der Horst Hilma J. , Gelderloos Anne T. , Poels Renée , Li Fengzhi , Groen Richard W. J. , Zweegman Sonja , van de Donk Niels W. C. J. , O’Dwyer Michael , Mutis Tuna
Published: April 2021

We have recently shown the strong negative impact of multiple myeloma (MM)-bone marrow mesenchymal stromal cell (BMMSC) interactions to several immunotherapeutic strategies including conventional T cells, chimeric antigen receptor (CAR) T cells, and daratumumab-redirected NK cells. This BMMSC-mediated immune resistance via the upregulation of antiapoptotic proteins in MM cells was mainly observed for moderately cytotoxic modalities. Here, we set out to assess the hypothesis that this distinct mode of immune evasion can be overcome by improving the overall efficacy of immune effector cells. Using an in vitro model, we aimed to improve the cytotoxic potential of KHYG-1 NK cells toward MM cells by the introduction of a CD38-specific CAR and a DR5-specific, optimized TRAIL-variant. Similar to what have been observed for T cells and moderately lytic CAR T cells, the cytolytic efficacy of unmodified KHYG-1 cells as well as of conventional, DR5-agonistic antibodies were strongly reduced in the presence of BMMSCs. Consistent with our earlier findings, the BMMSCs protected MM cells against KHYG-1 and DR5-agonistic antibodies by inducing resistance mechanisms that were largely abrogated by the small molecule FL118, an inhibitor of multiple antiapoptotic proteins including Survivin, Mcl-1, and XIAP. Importantly, the BMMSC-mediated immune resistance was also significantly diminished by engineering KHYG-1 cells to express the CD38-CAR or the TRAIL-variant. These results emphasize the critical effects of microenvironment-mediated immune resistance on the efficacy of immunotherapy and underscores that this mode of immune escape can be tackled by inhibition of key antiapoptotic molecules or by increasing the overall efficacy of immune killer cells.
Compensatory Gait Strategies in Persons with Transfemoral Amputations Walking with a Locked Prosthetic Knee Joint Compared with an Unlocked Knee Joint: A Crossover Trial
Authors: Sloth William , Fabricius Jesper , Pedersen Asger Roer
Published: April 2021

Introduction

Individuals with transfemoral amputation walking with a locked prosthetic knee joint (LPKJ) have compromised degree of freedom in leg movement compared with walking with an unlocked prosthetic knee joint (UPKJ), thus presenting a risk for compensatory gait strategies, with risk of lower back pain. The objective was to compare gait strategies in individuals with transfemoral amputation walking with an LPKJ and a UPKJ.

Materials and Methods

This was a crossover trial. Nine individuals with transfemoral amputation habitually walking with a UPKJ completed an intervention of 1 to 2 weeks of walking with a UPKJ followed by 1 to 2 weeks of walking with an LPKJ. Gait strategies were analyzed after each intervention using three-dimensional gait analysis. The outcome was pelvic and lumbar spinal movement from terminal stance to initial swing in the sagittal and transversal plane.

Results

The maximum anterior tilt of the pelvis in the sagittal plane and the pelvic rotation shifted from preswing to initial swing in the gait cycle when walking with an LPKJ compared with the UPKJ.

Conclusions

A compensatory gait strategy was observed among individuals with transfemoral amputation walking with an LPKJ compared with a UPKJ. Studies should investigate the incidence of low back pain in individuals with transfemoral amputation walking with LPKJ compared with those walking with UPKJ.
The effect of oral nutritional supplement therapy on nutritional status and quality of life in patients with esophageal cancer undergoing radiotherapy and chemotherapy
Authors: Chen Yunxia , Wu Xiancui , Wei Xiaowei , Xu Li , Ren Xiuqin
Published: April 2021

Background:

The incidence of malnutrition in patients with esophageal cancer is high, which seriously affects the therapeutic effect and quality of life. Oral nutritional supplement is the first choice of nutritional support recommended by current guidelines, which can supplement the lack of energy and protein in patients with esophageal cancer, improve nutritional status and improve the quality of life, but there are few clinical studies. Therefore, the purpose of this randomized controlled trial is to evaluate the effect of oral nutritional supplement therapy on nutritional status and quality of life in patients with esophageal cancer treated undergoing radiotherapy and chemotherapy.

Methods:

This is a prospective randomized controlled trial to study the effects of oral nutritional supplement therapy on nutritional status and quality of life in patients with esophageal cancer undergoing radiotherapy and chemotherapy. This study is approved by the Clinical Research Society of our hospital. Patients will be randomly divided into ONS group and traditional diet group. The nutritional status, quality of life score and adverse reactions will be observed before and after radiotherapy and chemotherapy. The data will be analyzed by SPSS 16.0.

Discussion:

This study will evaluate the effect of oral nutritional supplement therapy on nutritional status and quality of life of patients with esophageal cancer undergoing radiotherapy and chemotherapy. The results of this experiment will establish clinical evidence for the application of oral nutritional supplement therapy in patients with esophageal cancer undergoing radiotherapy and chemotherapy.

OSF Registration number:

DOI 10.17605/OSF.IO/9ZW34.
Radiation induced glioma in a sexagenarian
Authors: Peng You-Heng , Richard Seidu A. , Lan Zhigang , Zhang Yuekang
Published: April 2021

Introduction:

Radiation induced gliomas often occurs after radiation therapy for other brain tumors. Medulloblastoma often occurs in children and its associated radiation-induced glioblastoma multiforme's (GBM) after radiotherapy often has a long latency period. Our case is very unique because the medulloblastoma was detected at an advance age and the latency period of radiation-induced GBM was relatively shorter.

Patients Concerns:

A 64-year-old male was first admitted at our hospital in March 2018 with dizziness, vomiting, and blurred vision.

Diagnosis:

Magnetic resonance imaging of brain revealed a lesion with local mixed density and mass enhancement in left cerebellar region. Histopathology established medulloblastoma (World Health Organization) grade 4 and a classic histological subtype after surgery.

Intervention:

Surgical resection followed by radiation therapy were the initial therapeutic modalities.

Outcomes:

In April 2019, the patient was readmitted with dizziness and blurred vision. Magnetic resonance imaging showed the left cerebellar hemisphere bulky enhancement lesion. Again, a multimodal therapy comprising surgical resection, radiation therapy as well as chemotherapy was adapted after histopathology established GBM.

Lesion:

Radiotherapy for medulloblastoma patients at advance ages is a critical predisposing factor for the development of radiation-induced GBM in a very short period of time. We suggest that, radiotherapy as adjuvant therapy for medulloblastoma patients at advance ages should be chosen with extreme caution.
The effectiveness of different acupuncture therapies for neck pain
Authors: Jo Hyo-Rim , Noh Eun-Ji , Oh Se-Hee , Choi Seong-Kyeong , Sung Won-Suk , Choi Su-Ji , Kim Dong-Il , Hong Seung-Ug , Kim Eun-Jung
Published: April 2021

Background:

Neck pain is common musculoskeletal disorders in adult population. Acupuncture treatment has been widely used for treating neck pain. Nevertheless, previous systematic reviews (SRs) on acupuncture for neck pain remain controversial, and there is no SR for the comparative efficacy and safety of various types of acupuncture. Therefore, this study aims to evaluate and rank the effectiveness and safety of different types of acupuncture for neck pain by SR and network meta-analysis.

Methods:

Nine databases will be searched, including Ovid-MEDLINE, EMBASE, Cochrane library, China National Knowledge Infrastructure (CNKI), KoreaMed, Korean medical database (KMBASE), Korean Studies Information Service System (KISS), ScienceON, and Oriental Medicine Advanced Searching Integrated System (OASIS) from their inception to July 2021. The primary outcome is the change of pain intensity. A frequentist network meta-analysis will be performed to compare all relative outcomes of different acupuncture methods, using R software. The quality of included randomized controlled trials will be assessed by Cochrane Collaboration “risk of bias” tools and the evidence will be evaluated by the Grading of Recommendations Assessment, Development and Evaluation instrument.

Results:

The final findings of this network meta-analysis will be published in a recognized journal.

Conclusions:

Our study will evaluate and compare the effectiveness of various types of acupuncture for neck pain and provide clinicians with best option for what types of acupuncture treatments are effective.

Trial registration number:

INPLASY202120041
Identification of key genes and pathways in discoid lupus skin via bioinformatics analysis
Authors: Dong Qian , Chen Kang , Xie Jinye , Han Hui , Feng Yanping , Lu Jianqiang , Wang Weijia
Published: April 2021

Discoid lupus erythematosus (DLE) is the most common skin manifestation of lupus; however, the molecular mechanisms underlying DLE remain unknown. Therefore, we aimed to identify key differentially expressed genes (DEGs) in discoid lupus skin and investigate their potential pathways.

To identify candidate genes involved in the occurrence and development of the disease, we downloaded the microarray datasets GSE52471 and GSE72535 from the Gene Expression Database (GEO). DEGs between discoid lupus skin and normal controls were selected using the GEO2R tool and Venn diagram software (http://bioinformatics.psb.ugent.be/webtools/Venn/). The Database for Annotation, Visualization, and Integrated Discovery (DAVID), Enrichr, and Cytoscape ClueGo were used to analyze the Kyoto Encyclopedia of Gene and Genome pathways and gene ontology. Protein-protein interactions (PPIs) of these DEGs were further assessed using the Search Tool for the Retrieval Interacting Genes version 10.0.

Seventy three DEGs were co-expressed in both datasets. DEGs were predominantly upregulated in receptor signaling pathways of the immune response. In the PPI network, 69 upregulated genes were selected. Furthermore, 4 genes (CXCL10, ISG15, IFIH1, and IRF7) were found to be significantly upregulated in the RIG-I-like receptor signaling pathway, from analysis of Enrichr and Cytoscape ClueGo.

The results of this study may provide new insights into the potential molecular mechanisms of DLE. However, further experimentation is required to confirm these findings.
Prognostic value of long noncoding RNA urothelial carcinoma-associated 1 in esophageal carcinoma
Authors: Zhang Hong , Tian Jie , Tang Jianming , Wang TianHu
Published: April 2021

Background:

Currently, an increasing number of long noncoding RNAs (LncRNAs) have been reported to be abnormally expressed in human carcinomas and play a vital role in tumourigenesis. Some studies have been carried out to investigate the influence of the expression of LncRNA human urothelial carcinoma associated 1 (UCA1) on prognosis and clinical significance in patients with esophageal cancer, but the results are contradictory and uncertain. A meta-analysis and was conducted with controversial data to accurately assess the issue. We collected relevant TCGA data to further testify the result. In addition, bioinformatics analysis was conducted to investigate the mechanism and related pathways of LncRNA UCA1 in esophageal carcinoma.

Methods:

Wanfang, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, the Chongqing VIP Chinese Science and Technology Periodical Database, PubMed, Embase, and Web of Science were thoroughly searched for relevant information. Two reviewers independently performed data extraction and literature quality evaluation. Odd ratio and its 95% confidence intervals were applied to evaluate the relationship between LncRNA UCA1 and clinicopathological characteristics of esophageal carcinoma patients. Hazard ratios and its 95% confidence intervals were adopted to assess the prognostic effects of LncRNA UCA1 on overall survival and disease-free survival. Meta-analysis was performed with Stata 14.0 software. To further assess the function of LncRNA UCA1 in esophageal carcinoma, relevant data from The Cancer Genome Atlas (TCGA) database was collected. Three databases, miRWalk, TargetScan, and miRDB, were used for prediction of target genes. Genes present in these 3 databases were considered as predicted target genes of LncRNA UCA1. Venny 2.1 were used for intersection analysis. Subsequently, GO, KEGG, and PPI network analysis were conducted based on the overlapping target genes of LncRNA UCA1 to explore the possible molecular mechanism in esophageal carcinoma.

Results:

This study provides a high-quality medical evidence for the correlation between LncRNA UCA1 expression and overall survival, and between disease-free survival and clinicopathological features. Based on bioinformatics analysis, this study enhanced the understanding of the mechanism and related pathways of LncRNA UCA1 in esophageal carcinoma.

Conclusion:

The study provides updated evidence to evaluate whether the expression of LncRNA UCA1 is in association with poor prognosis in patients with esophageal carcinoma.

Ethics and dissemination

The private information from individuals will not be published. This systematic review also should not damage participants’ rights. Ethical approval is not available. The results may be published in a peer-reviewed journal or disseminated in relevant conferences.

OSF Registration Number:

DOI 10.17605/OSF.IO/8MCHW.
Identification of mutations in the ATP7B gene in 14 Wilson disease children
Authors: Wang Jiuxiang , Tang Lulu , Xu Anqi , Zhang Shijie , Jiang Hailin , Pei Pei , Li Hongmei , Lv Tingting , Yang Yue , Qian Nannan , Naidu Keegan , Yang Wenming
Published: April 2021

Introduction:

Wilson Disease (WD) is an autosomal recessive inherited metabolic disease caused by mutations in the ATPase copper transporting beta gene (ATP7B). WD can cause fatal neurological and hepatic disorders if not diagnosed and treated.

Objective:

To analyze the disease-causing mutations of 14 Chinese WD children, 11 of whom are diagnosed with hepatic disorders, 2 with neurological degeneration and 1 with both hepatic and neurological disorders.

Methods:

All ATP7B coding regions were analyzed by Sanger sequencing. Single nucleotide polymorphisms (SNPs) functional impacts were assessed by combining the results of four bioinformatics tools (Poly-phen-2, SIFT, PANTHER-PSEP and PhD-SNPs) in an index that reflects the combined probability (cPdel) of an amino acid change to be deleterious to the protein function.

Results:

Two novel variants involved in WD development, c.1448_1455del (p.Arg483SerfsX19) and c.4144G>T (p.Glu1382Stop), and 11 previously reported mutations were detected. Both new variants result in shortened and dysfunctional ATP7B proteins. cPdel score suggests that SNPs may be deleterious to the ATP7B functionality.

Conclusions:

This study enriches the library of the ATP7B mutations that lead to WD and can be used as a basis for genetic counseling, for WD prevention and clinical and prenatal diagnosis. Those SNPs that are believed to be harmless to ATP7B protein may be involved in the pathogenesis of WD.
The clinical characteristics and outcomes of patients with fever of unknown origin caused by parasitic infection
Authors: Liu Huiting , Fan Hongwei , Huang Xiaoming , Jiao Yang
Published: April 2021

There are over 200 causes of fever of unknown origin (FUO), and although parasitic infection is an increasingly uncommon cause, a definitive diagnosis remains important to ensure rapid treatment and to prevent adverse sequelae through delay. Here, we studied the clinical features and outcomes of patients admitted with FUO and diagnosed with parasitic infection to improve our understanding of the features of parasitic FUO.

Medical records of patients admitted to Peking Union Medical College Hospital between 2013 and 2019 with FUO and diagnosed with parasitic infection were reviewed. The clinical features and outcomes of patients for whom follow-up data were available were summarized.

Six patients were admitted with FUO and diagnosed with parasitic infections (6/1013; 0.59%). Patients were more commonly middle-aged men and had a relatively long disease course. Most suffered from hyperpyrexia and other non-specific symptoms. Routine examinations were non-specific, and some patients had positive tumor markers, antinuclear antibodies, or positron emission tomography/computed tomography results. Diagnoses were confirmed by bone marrow smears, serum antibody testing, or feces examination. All 6 cases received anthelmintic treatments and recovered well.

Parasitic infections must be screened for and actively excluded in FUO patients so that targeted therapy can be rapidly administered to ensure optimal outcomes.
Identification of TNIK as a novel potential drug target in thyroid cancer based on protein druggability prediction
Authors: Yang Yi-Fei , Yu Bin , Zhang Xiu-Xia , Zhu Yun-Hua
Published: April 2021

Thyroid cancer is a common endocrine malignancy; however, surgery remains its primary treatment option. A novel targeted drug for the development and application of targeted therapy in thyroid cancer treatment remain underexplored.

We obtained RNA sequence data of thyroid cancer from The Cancer Genome Atlas database and identified differentially expressed genes (DEGs). Then, we constructed co-expression network with DEGs and combined it with differentially methylation analysis to screen the key genes in thyroid cancer. PockDrug-Server, an online tool, was applied to predict the druggability of the key genes. Finally, we constructed protein-protein interaction (PPI) network to observe potential targeted drugs for thyroid cancer.

We identified 3 genes correlated with altered DNA methylation level and oncogenesis of thyroid cancer. According to the druggable analysis and PPI network, we predicted TRAF2 and NCK-interacting protein kinase (TNIK) sever as the drug targeted for thyroid cancer. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis indicated that genes in protein-protein interaction network of TNIK enriched in mitogen-activated protein kinase signaling pathway. For drug repositioning, we identified a targeted drug of genes in PPI network.

Our study provides a bioinformatics method for screening drug targets and provides a theoretical basis for thyroid cancer targeted therapy.
Determinants of life satisfaction among stroke survivors 1 year post stroke
Authors: Abualait Turki S. , Alzahrani Matar A. , Ibrahim Alaa I. , Bashir Shahid , Abuoliat Zainah A.
Published: April 2021

Stroke is the major leading cause of death and severe long-term disability worldwide. The consequences of stroke, aside from diminished survival, have a significant impact on an individual's capability in maintaining self-autonomy and life satisfaction (LS). Thus, this study aimed to assess LS and other specific domains of LS in stroke survivors following their first-ever stroke, and to describe the relationship using socio-demographic and stroke-related variables.

This study recruited 376 stroke survivors (244 men and 132 women, mean age: 57 years) 1 year following stroke. Data on participants’ LS (measured using the Life Satisfaction Questionnaire [LiSat-11]), socio-demographics, and stroke-related variables were collected.

Univariate analysis showed that LS and the 10 specific domains were not associated with the patients’ gender or stroke type; however, age at onset, marital status, and vocational situation were significantly associated with some domains in LiSat-11 (Spearman's rho = 0.42–0.87; all P < 0.05). Logistic regression revealed that verbal and cognitive dysfunction were the most negative predictors of LS (odds ratio 4.1 and 3.7, respectively).

LS is negatively affected in stroke survivors 1 year post onset. The results indicate that recovering social engagement is a positive predictor of higher LS in stroke survivors. More importantly, the findings revealed that cognitive and verbal dysfunctions were the most prominent negative predictors of the overall gross level of LS. Multidisciplinary rehabilitation for stroke survivors is therefore critical.
Low levels of anti-cyclic citrullinated peptide (CCP) 3.1 associated with diseases other than rheumatoid arthritis
Authors: Son James J. , Ishimori Mariko , Mirocha James , Weisman Michael H. , Forbess Lindsy J.
Published: April 2021

Our aim was to investigate the newest generation anti-cyclic citrullinated peptide (CCP) antibody 3.1 assay in diagnosing rheumatoid arthritis (RA) compared with other autoimmune and non-autoimmune diseases. We performed a retrospective observational chart review of patients with a positive CCP level over a one-year period at a single academic institution and assessed the associated diagnoses after at least six-months of follow-up. Of the 281 CCP positive patients during that period, 48% had a diagnosis of RA. The positive predictive value of RA in patients with a high CCP 3.1 assay was 0.619 compared to 0.248 with a low positive CCP 3.1 assay (P < .0001). Overall, there was a lower than expected positive predictive value of CCP 3.1 level with an RA diagnosis, though the likelihood of having an RA diagnosis was higher with a higher CCP level.
Acupoint catgut embedding for the treatment of peptic ulcers
Authors: Yi Xingqian , Wang Li , He Qingying , A Rigun , Le Yimin
Published: April 2021

Background:

Peptic ulcer (PU) is a common clinical disease of the digestive system, which can occur in all ages, gastric and duodenal ulcers are the most commonly seen PUs in clinical practice. The main manifestations are chronic and periodic rhythmic upper abdominal pain, accompanied by indigestion symptoms such as pantothenic acid, belching, and nausea. Serious complications such as bleeding, perforation, obstruction and canceration are easy to occur, endangering the life safety of patients. There are many ways to treat PU in clinic, and acupoint catgut embedding therapy has its unique advantages. Hence, our systematic review aims to evaluate the efficacy and safety of acupoint embedding therapy in the treatment of PU and to provide a reliable basis for physician.

Methods:

We will search electronic databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database (WF), China Biomedical Literature Database (CBM), and China Scientific Journals Database (VIP) from establishment to April 2021, and will manually searched the list of medical journals as a supplement. Two authors will screen the studies independently, as well as extract data information, and assess methodological quality through the Cochrane risk of bias (ROB) tool. The Stata software (Version 16.0) software will be used for statistical analysis.

Results:

By evaluating the current status of acupoint catgut embedding for Peptic ulcer disease, this study would prove the effectiveness and safety of acupoint embedding therapy, and will be published in a peer-reviewed journal.

Conclusion:

This systematic review will provide a credible evidence-based for acupoint catgut embedding in the treatment of peptic ulcer.

INPLASY Registration number:

INPLASY202130097
Postoperative extremity gangrene in a patient with type 2 diabetes taking SGLT2 inhibitors
Authors: Wong Yun Chin , Liu Kuan-Lin , Lee Chia-Ling
Published: April 2021

Rationale:

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been approved and marketed since March 2013. The proportion of patients with type 2 diabetes (T2D) taking SGLT2 inhibitors is increasing. The perioperative adverse effects of SGLT2 inhibitors, especially euglycemic diabetic ketoacidosis (euDKA), should be taken into consideration in perioperative patient evaluation in both elective and emergency surgeries.

Patient concerns:

A 57-year-old woman taking SGLT2 inhibitors for T2D developed euDKA after undergoing an emergency orthopedic surgery; the euDKA diagnosis was delayed, thereby causing extremity gangrene.

Diagnoses:

EuDKA was diagnosed based on the presence of strongly positive ketonuria, elevated blood beta-hydroxybutyrate level, and severe metabolic acidosis.

Intervention:

EuDKA was treated with insulin infusion with dextrose solution and intravenous fluid resuscitation.

Outcome:

Due to a delayed diagnosis of euDKA, the patient received a high-dose vasopressor, which led to limb gangrene and amputation 6 months later.

Lessons:

EuDKA is often misdiagnosed due to the absence of hyperglycemia. Serum beta-hydroxybutyrate levels or urinalysis could be used as screening tools for euDKA in patients scheduled for emergency surgery, in order to preoperatively administer rapid fluid resuscitation and insulin infusion with dextrose solution, which should continue postoperatively along with serum beta-hydroxybutyrate monitoring.
Drug-coated balloon angioplasty versus balloon angioplasty for treating patients with in-stent restenosis in the femoropopliteal artery
Authors: Cao Shaobo , He Tao , Xie Jinfeng , Feng Haijun , Liu Kui , Qu Bihui , Wu Xiaoling
Published: April 2021

Background:

The introduction of endovascular surgery has led to frequent stent use, although in-stent restenosis (ISR) remains a challenging issue. Drug-coated balloon (DCB) and conventional balloon angioplasty (BA) are common endovascular procedures for addressing ISR in the femoropopliteal artery. However, there is controversy regarding which procedure provides the greatest benefit to patients.

Methods:

The PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched for prospective controlled trials that compared DCB and BA for patients with ISR in the femoropopliteal artery. The study has been approved by Ethics Committee of Wuhan Central Hospital.

Results:

The meta-analysis included 6 prospective trials with 541 patients. We found that DCB use was associated with significant reductions in binary restenosis at 6 months (relative risk [RR]: 0.45, 95% confidence interval [CI]: 0.33–0.63; P < .00001), binary restenosis at 1 year (RR: 0.44, 95% CI: 0.34–0.57; P < .00001), target lesion revascularization (TLR) at 6 months (RR: 0.36, 95% CI: 0.20–0.65; P = .0006), and TLR at 1 year (RR: 0.38, 95% CI: 0.27–0.54; P < .00001). The DCB group also had significantly better clinical improvement (RR: 1.39, 95% CI: 1.13–1.71; P = .002), although we did not detect inter-group differences in terms of death, target vessel thrombosis, or ipsilateral amputation. The brand of DCB may a cause of heterogeneity.

Conclusion:

Relative to BA, DCB use increases the durability of treatment for ISR in the femoropopliteal artery, based on significant reductions in binary restenosis and TLR at 6–12 months after the procedure. Furthermore, DCB use was associated with better clinical improvement. However, additional randomized controlled trials are needed to validate these findings.
Current treatment and outcome of esophageal perforation
Authors: Deng Yufeng , Hou Luqi , Qin Dianyue , Huang Ting , Yuan Tianzhu
Published: April 2021

Background:

Esophageal perforation has been one of the serious clinical emergencies, because of the high mortality and complication rates. However, the current prognosis of esophageal perforation and the outcomes of available treatment methods are not well defined. This study attempted to pool the immediate outcomes of esophageal perforation in the past 2 decades.

Methods:

The clinical data of 22 consecutive adult patients with esophageal perforation in our center were analyzed. A pooled analysis was also conducted to summarize results from the literatures published between 1999 and 2020. Studies that met the inclusion criteria were assessed, and their methodological quality was examined.

Results:

The mortality and complication rates in our center were 4.55% and 31.82%, separately. The pooled analysis included 45 studies published between 1999 and 2019, which highlighted an overall immediate mortality rate of 9.86%. Surgical treatments were associated with a pooled immediate mortality of 10.01%, and for conservative treatments of 6.49%. Besides, in the past decade, the mortality and complication rates decreased by 27.12% and 46.75%, respectively.

Conclusions:

In the past 2 decades, the overall immediate mortality rate of esophageal perforation was about 10% in the worldwide, and the outcomes of esophageal perforation treatment are getting better in the last 10 years.

Ethics Registration Information:

LW2020011.
Assessment of cerebrovascular reserve with N-isopropyl-p-[123I]-iodoamphetamine time series analysis in patients with cerebrovascular disease
Authors: Kakuta Kiyohide , Asano Kenichiro , Katayama Kosuke , Ohkuma Hiroki
Published: April 2021

Using N-isopropyl-p-[123I]-iodoamphetamine(123I-IMP) and single-photon emission computed tomography (SPECT), the relationship between cerebrovascular reserve and the 123I-IMP redistribution phenomenon was investigated.

The 50 patients who matched the inclusion criteria were divided into control and ischemia groups, and the redistribution phenomenon was examined on resting images. The delayed images showed higher 123I-IMP accumulation in lesions in the middle cerebral artery(MCA) area and anterior cerebral artery(ACA) area, these watershed areas in the ischemia group than in the control group, confirming that the redistribution phenomenon exists with statistical significance (Wilcoxon test; control group vs ischemic group in the ACA area[P = .002], ACA-MCA watershed area(P = .014), MCA area(P = .025), and MCA-posterior cerebral artery(PCA) watershed area(P = .002). The patients were then divided into 4 types according to the Kuroda grading system, and the difference in the redistribution phenomenon was investigated between type III and the other 3 types.

Compared with type I and type II, type III had a significantly lower rate of decrease in the radioisotope (RI) count, verifying the redistribution phenomenon (Student t test: type I vs type III in the ACA area(P = .008), ACA-MCA watershed area(P = .009), MCA area(P < .001), and MCA-PCA watershed area(P = .002); type II vs type III in the ACA area(P = .004), ACA-MCA watershed area(P = .2575), MCA area(P < .001), and MCA-PCA watershed area(P < .001). No significant difference between type III and type IV was observed in any area [(Student t test: type III vs type IV in the ACA area(P = .07), ACA-MCA watershed area(P = .38), MCA area(P = .05), and MCA-PCA watershed area(P = .24)].

The redistribution phenomenon is associated with resting cerebral blood flow (CBF), but not necessarily with cerebral vascular reactivity (CVR).
Dose–response relationship between working hours and hypertension
Authors: Cheng Hao , Gu Xuan , He Zhenan , Yang Yanqiu
Published: April 2021

Hypertension causes a substantial burden to society. Some studies found that hypertension was associated with the working type and working hours. The purpose of the current study is to assess the dose–response relationship between working hours and hypertension.

Data of 12,080 adults aged 18 to 65 years who attended the China Health and Nutrition Survey (CHNS) between 1989 and 2011 were analyzed. Hypertension was determined based on systolic and/or diastolic blood pressure measures, or having doctor-diagnosed hypertension. Multivariable Cox regression and restricted cubic spline to assess the dose–response relationship between working hours and hypertension.

A total of 12,080 participants including 5852 females and 6228 males. By the last follow-up (2011), a total of 830 participants were hypertensive, with an incidence of 6.9%. After adjusting socio-demographic, lifestyle factors, as well as occupation type, compared with those who worked 35 to 49 hours per week, participants who worked no more than 34 hours per week (HR: 1.21, 95%CI: 1.03–1.41) and at least 56 hours per week (HR: 1.38, 95%CI: 1.19–1.59) had a higher risk of hypertension. The significant association between long working hours (at least 56 hours per week) and hypertension was observed among females (HR: 1.38, 95%CI: 1.16–1.64) and males (HR: 1.36, 95%CI: 1.04–1.78). Among manual workers, the relationship between long working hours and hypertension was observed (HR: 1.49, 95%CI: 1.10–2.02). The relationship between long working hours (HR: 1.21, 95%CI: 1.01–1.44) and short working hours (HR: 1.37, 95%CI: 1.16–1.61) and hypertension was observed among nonmanual workers. The hazard ratio of hypertension and working time displayed U-shape non-linear relationship (P
trend < .001, non-linear P < .001). The non-linear response–dose relationship was found in manual worker, nonmanual worker, and male (P
trend < .001, non-linear P < .001).

The association between working time and hypertension showed U-shape relationship. Specifically, overtime work was an important occupational risk factors for adults, and short work time was related to hazard ratio of hypertension in nonmanual workers.
Comparison of corneal thickness measurements using ultrasound pachymetry, noncontact tonopachy, Pentacam HR, and Fourier-domain OCT
Authors: Kim Jung Sub , Rho Chang Rae , Cho Yeon Woo , Shin Jeongah
Published: April 2021

We retrospectively compared the central corneal thickness (CCT) obtained by ultrasound pachymetry (USP; SP-3000, Tomey Corp., Nagoya, Japan), non-contact tonopachy (TP) (NT-530P, Nidek Co., Ltd., Gamagori, Japan), Pentacam HR (OCULUS Inc., Wetzlar, Germany), and RTVue optical coherence tomography (OCT) (Optovue Inc., Fremont, CA, USA) in 78 eyes of 78 healthy subjects with myopia. Agreement between the measurement methods was evaluated using 95% confidence intervals for the limits of agreement (LoA). The mean CCT values were 546.9 ± 34.7, 548.1 ± 33.5, 559.2 ± 34.0, and 547.2 ± 34.8 μm for USP, non-contact TP, Pentacam, and RTVue, respectively. The thickest and the thinnest mean CCT values corresponded to those obtained by Pentacam HR and USP, respectively. Plots of the differences against the means showed the best agreement between USP and RTVue (LoA, 10.14–10.70 μm), while the largest discrepancy was observed between RTVue and Pentacam systems (LoA, −25.47–1.44 μm). Our data showed that CCT measurements using these 4 instruments were well correlated. However, the results from Pentacam differed significantly from those of the other instruments.
Traditional Chinese medicine in collaboration with conservative conventional medicine for lumbar herniated intervertebral disc
Authors: Kim Hyungsuk , Chung Won-Seok
Published: April 2021

Background:

Lumbar herniated intervertebral disc (LHIVD) is a common disease that causes low back pain. Traditional Chinese medicine (TCM) with conservative conventional treatment is known to be effective at treating LHIVD, but evidence for complex TCM therapies with conventional intervention has not been sufficiently collected to facilitate quality assessment and synthesis of data.

Methods and analysis:

Studies were retrieved from the following databases: the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE/PubMed, 7 Korean databases (Korean Studies Information Service System, Korean Traditional Knowledge Portal, Oriental Medicine Advanced Searching Integrated System, Korean National Assembly Digital Library, Korean Association of Medical Journal Editors, National Digital Science Library, and Database Periodical Information Academic), Japan Medical Abstracts Society, and Chinese National Knowledge Infrastructure. The risk of bias of the included studies will be assessed using the Cochrane Assessment Tool for Risk of Bias. Eligible studies were quantitatively synthesized through a meta-analysis. The primary outcome will be pain scales, and the secondary outcomes will include range of motion, questionnaires for lumbar function, questionnaire for quality of life, etc.

Ethics and dissemination:

Ethical approval was waived for this study protocol because it does not provide any patient data. The results of this review will be disseminated through peer-reviewed publications.

Registration number:

DOI 10.17605/OSF.IO/K7NJ8 (https://osf.io/k7nj8).
Gerstmann-Sträussler-Scheinker syndrome misdiagnosed as cervical spondylotic myelopathy
Authors: Cao Liming , Feng Hongye , Huang Xuming , Yi Jiamei , Zhou Yanxia
Published: April 2021

Rationale:

Gerstmann-Sträussler-Scheinker syndrome (GSS) is a rare autosomal dominant disease caused by a mutation in the prion protein gene (PRNP) that is not well known among neurologists and is therefore easily misdiagnosed.

Patient concerns

: A 49-year-old man was admitted for the first time because of an unsteady walk with mogilalia for 1 year. He underwent a cervical discectomy and a plate-screw fixation 6 months prior, although postoperative gait instability did not improve.

Diagnosis:

Whole exome sequencing identified a pathogenic and heterozygous mutation in the PRNP 4 years after onset. The patient was eventually diagnosed with GSS.

Interventions:

Symptomatic treatment to improve cerebrocirculation and cerebrometabolism was provided.

Outcomes:

The neurological decline continued. The Mini-Mental State Examination and modified Rankin Scale scores changed from 19 to 11 and 2 to 5, respectively. Progressive cerebral and cerebellar atrophy on magnetic resonance imaging was observed.

Lessons:

Cerebral and cerebellar atrophy are neuroimaging features symptomatic of GSS that become more apparent as the disease progresses. This atrophy is positively correlated with the severity of symptoms and reduced quality of life. Neurologists treating middle-aged patients with progressive ataxia, cognitive impairment or dysarthria, and brain atrophy need to consider the possibility of GSS.
The Emergent Pelvic Artery Embolization in the Management of Postpartum Hemorrhage: A Systematic Review and Meta-analysis
Authors: Zhang Xiu Quan , Chen Xi Ting , Zhang Yu Ting , Mai Cai Xiu
Published: April 2021

Importance

Postpartum hemorrhage (PPH) is an emergent obstetric complication and the leading cause of maternal mortality. Pelvic arterial embolization (PAE) is an effective treatment for intractable PPH. However, a unique protocol has not been accepted in obstetrical practice.

Objective

To evaluate its efficiency, safety, complications, and outcomes, we conducted a systematic review and meta-analysis of PAE for PPH in the literature.

Evidence Acquisition

The Medline, the database of abstract of reviews, the index to allied health literature, and the Chinese database Sino-Med were searched on March 31, 2020, for studies on PAE for PPH. The data for PAE indication, agents, arteries, success rate, complications, and outcomes were extracted and syncretized for meta-analysis.

Results

From 1075 identified articles, 113 abstracts or full articles were retrieved and 43 studies were finally identified as meeting the including criteria. The results demonstrated that the indications for PAE were as follows: uterine atony, placental abnormality, delivery tract injury, disseminated intravascular coagulation, arteriovenous malformation, and vaginal hematoma. The embolization agents mostly in order were gelatin sponge particles, polyvinyl alcohol particles, Gelfoam, N-butyl cyanoacrylate, microcoil, and glue; for arteries, they were mostly uterine artery and internal iliac artery. The clinical success rate was 90.5%, whereas the technical success rate was 99.3%. The most common complications of PAE were postembolization syndrome and menstrual abnormality.

Conclusions and Relevance

The emergent PAE is a safe and effective method with high success rate in life-threatening PPH management. Gelatin sponge granules measuring 500 to 1000 μm in diameter have safe results. Pelvic arterial embolization may affect the recovery of menses and increase PPH in the subsequent pregnancy, but there was no noted correlation with fetal growth restriction.

Target Audience

Obstetricians and gynecologist, family physicians

Learning Objectives

After participating in this activity, physicians should be better able to explain the causes of PPH; identify which arteries should be chosen for embolization; and describe the advantages of PAE for PPH management.
Recommendations on the use of virtual interviews in the orthopaedic trauma fellowship match
Authors: Yong Taylor M. , Davis Max E. , Coe Marcus P. , Perdue Aaron M. , Obremskey William T. , Gitajn Ida L.
Published: April 2021

Objective

The aim of this study was to assess applicant and fellowship director (FD) perspectives on virtual interviewing based on the 2019 to 2020 orthopaedic trauma fellowship interview experience and to develop recommendations for future application cycles.

Methods

Web-based surveys were distributed to all matched applicants and orthopaedic trauma FDs after the 2019 and 2020 orthopaedic trauma fellowship match. Thirty-one applicants and 23 FDs completed the survey—response rates of 34% and 38%, respectively.

Results

Virtual interviews were completed by 68% of applicants and 17% of FDs. Twenty-nine percent of applicants felt they were able to familiarize themselves with the culture of programs, and 38% of applicants were satisfied with their ability to present themselves. Most (62%) were comfortable ranking programs based on the virtual interview, but 38% reported the format influenced them to rank a program lower. Among all applicants, 77% preferred the in-person interview. Most FDs (75%) reported virtual interviews limited their ability to familiarize themselves with an applicant, and only 50% were comfortable ranking an applicant afterward. Still, 78% of FDs believe there is a role for virtual interviews in the fellowship match. Choosing a virtual interview may negatively affect applicants as 97% of applicants worry the choice conveys less interest to programs, while 43% of FDs would interpret it as less interest.

Conclusions

Virtual interviews have multiple shortcomings but are technically feasible and provide reasonable information to applicants and FDs to complete the match process. Our recommendations, based on the perspectives of applicants and FDs, can guide their implementation.