bluuebunny/crossref_metadata_2025 huggingface dataset:
A case of Empty Sella syndrome with adrenal insufficiency masked by prednisolone after administration of immune checkpoint inhibitors
Authors: Iwamoto Yuichiro , Tatsumi Fuminori , Ohnishi Mana , Katakura Yukino , Kimura Tomohiko , Shimoda Masashi , Nakanishi Shuhei , Mune Tomoatsu , Kaneto Hideaki
Published: March 2024

Introduction:

The use of immune checkpoint inhibitors (ICIs) is gradually increasing; ICIs produce a variety of immune-related adverse events (irAEs), especially ICI-induced hypoadrenocorticism, which can be a lethal complication if treatment is delayed.

Patient concerns:

A 63-year-old man received chemotherapy with pembrolizumab for nonsmall cell lung cancer. He developed drug-induced interstitial pneumonia 366 days after receiving pembrolizumab and was treated with prednisolone. Five hundred thirty-seven days later, he developed drug-induced eosinophilic enteritis, and pembrolizumab was discontinued and prednisolone was continued. After discontinuation of prednisolone, general malaise and edema of the lower extremities appeared, and adrenal insufficiency was suspected.

Diagnosis:

In blood tests on admission adrenocorticotropic hormone (ACTH) was 2.2 pg/mL and cortisol was 15 μg/dL, with no apparent cortisol deficiency. However, the cortisol circadian rhythm disappeared and remained low throughout the day; a corticotropin-releasing hormone stimulation test showed decreased reactive secretion of ACTH. Pituitary magnetic resonance imaging showed pituitary emptying, suggesting Empty Sella syndrome.

Interventions and outcomes:

We started hydrocortisone and his symptoms were improved.

Conclusions:

The administration of high-dose steroids after ICI administration may mask the symptoms of hypoadrenocorticism as irAEs. Therefore, we should bear in mind the possibility of hypoadrenocorticism when we stop steroid therapy in patients who are treated with steroids after ICI administration.
Efficacy and safety of Xiaoyao Pill combined with Western medicine in the treatment of schizophrenia: A Meta-analysis and Systematic review
Authors: Cai Lili , Liu Lianqi , Jiang Zhibing , Liang Zhongxing , Yang Yuehua
Published: March 2024

Background:

The efficacy and safety of Xiaoyao Pill combined with Western medicine in the treatment of schizophrenia are still inconclusive. This meta-analysis summarized relevant studies to compare the efficacy and safety of Xiaoyao Pill combined with Western medicine and Western medicine alone in the treatment of schizophrenia, aiming to provide guidance for clinical treatment.

Methods:

In this meta-analysis, we searched PubMed, Embase, Cochrane Library, CNKI, Wanfang, CQVIP, and CBM databases from the establishment of the databases to August 2023. The study proposed to include studies that reported combination of Xiaoyao Pill with Western medicine and Western medicine alone in the treatment of schizophrenia, excluding published literature, unpublished literature, literature with incomplete or inadequate information, animal experiments, literature reviews and systematic studies. Data were analyzed using Review manager 5.3.

Results:

About 9 studies (6 RCTs and 3 case–control studies) were included in this meta-analysis. The sample size ranged from 60 to 128, with a total of 779 patients, including 395 in the combined treatment group and 384 in the control group. Pooled results showed that the total effective rate of combined treatment group was significantly higher than that of Western medicine alone (OR = 4.21, 95% CI: 1.50–11.83, P = .006). Positive and Negative Syndrome Scale (PANSS) (−) (MD = −2.30, 95% CI: −3.72 ~ −0.89, P = .001) and PANSS (+) (MD = −2.60, 95% CI: −3.34 ~ −1.86, P < .00001) of combined treatment group were all significantly lower than that of Western medicine alone. Additionally, PRL levels of combined treatment group was significantly lower than that of Western medicine alone (MD = −28.78, 95% CI: −42.20 ~ −15.35, P < .0001). However, there was no significant difference in BPRS and total PANSS between combined treatment group and Western medicine alone group. Notably, pooled results showed that there was no significant difference in incidence of adverse events between combined treatment group and Western medicine alone group.

Conclusion:

The effective rate of Xiaoyao Pill combined with Western medicine in the treatment of schizophrenia is higher than that of Western medicine alone, which can effectively relieve the positive and negative symptoms of schizophrenia, and can significantly reduce the level of PRL. In the treatment of schizophrenia, clinicians can give priority to Xiaoyao Pill combined with Western medicine therapy.
Intelligent diagnosis of lung nodule images based on machine learning in the context of lung teaching
Authors: Li Miaomiao , Zhuang Lilei , Hu Sheng , Sun Li , Liu Yangxiang , Dou Zhengwei , Jiang Tao
Published: March 2024

The vast majority of intelligent diagnosis models have widespread problems, which seriously affect the medical staff judgment of patients’ injuries. So depending on the situation, you need to use different algorithms, The study suggests a model for intelligent diagnosis of lung nodule images based on machine learning, and a support vector machine-based machine learning algorithm is selected. In order to improve the diagnostic accuracy of intelligent diagnosis of lung nodule images as well as the diagnostic model of lung nodule images. The objectives are broken down into algorithm determination and model construction, and the proposed optimized model is solved using machine learning techniques in order to achieve the original algorithm selected for intelligent diagnosis of lung nodule photos. The validation findings demonstrated that dimensionality reduction of the features produced 17 × 1120 and 17 × 2980 non-node matrices with 1216 nodes and 3407 non-nodes in 17 features. The support vector machine classification method has more benefits in terms of accuracy, sensitivity, and specificity when compared to other classification methods. Since there were some anomalies among both benign and malignant tumors and no discernible difference between them, the distribution of median values revealed that the data was symmetrical in terms of texture and gray scale. Non-small nodules can be identified from benign nodules, but more training is needed to separate them from the other 2 types. Pulmonary nodules are a common disease. MN are distinct from the other 2 types, non-small nodules and benign small nodules, which require further training to differentiate. This has great practical value in teaching practice. Therefore, building a machine learning-based intelligent diagnostic model for pulmonary nodules is of significant importance in helping to solve medical imaging diagnostic problems.
Effect of postoperative exercise training on physical function and quality of life of lung cancer patients with chronic obstructive pulmonary disease: A randomized controlled trial
Authors: Yu Zhonghua , Xie Guosheng , Qin Changlong , He Hongchen , Wei Quan
Published: March 2024

Background:

Postoperative rehabilitation programs consisting of exercise training are considered effective for unselected lung cancer patients. However, whether postoperative exercise is beneficial to lung cancer patients comorbid with chronic obstructive pulmonary disease remains unknown.

Methods:

Eighty-four patients diagnosed with both lung cancer and chronic obstructive pulmonary disease were randomized into the exercise group and control group. Both groups were given standard postoperative rehabilitation for 1 week. After that, oxygen therapy (if needed) and nebulization were given to the control group, while patients in the exercise group started to participate in exercise programs on the basis of receiving oxygen therapy and nebulization as in the control group. The exercise programs consisted of 24 training sessions.

Results:

In both groups, the functional status and the results of the pulmonary function test decreased from baseline to the endpoint. However, after surgery and the intervention program, both the maximal oxygen consumption in the cardiopulmonary exercise test and walking distance in the 6-minute walk test in the exercise group were significantly better than those in the control group [15.5 (±1.4) mL/kg/min vs 13.1 (±1.3) mL/kg/min, P = 0.016; 437.4 (±48.6) m vs 381.7 (±40.5) m, P = 0.040]. Force vital capacity and forced expiratory volume in the first second in the exercise group were better than those in the control group, but the differences were not statistically significant [1798.1 (±298.9) mL vs 1664.0 (±329.7) mL, P = 0.254; 1155.7 (±174.3) mL vs 967.4 (±219.4) mL, P = 0.497]. The decline in the standard score of the QLQ-C30 (V3.0) was smaller in the exercise group, but the difference did not meet a statistically significant level [61.7 (±5.7) vs 58.4 (±9.3), P = 0.318].

Conclusion:

This study demonstrates that a short-term postoperative exercise training program can facilitate the recovery of functional capacity in lung cancer patients with comorbidities of chronic obstructive pulmonary disease.
High expression of KIFC1 is a poor prognostic biomarker and correlates with TP53 mutation in lung cancer
Authors: Li Xiuying , Wang Susu , Ruan Pinglang , Bajinka Ousman , Zhang Weidong
Published: March 2024

The Kinesin Family Member C1 (KIFC1) is highly expressed in a variety of tumors. Since it is linked with tumorigenesis and progression, KIFC1 has emerged as a promising candidate for targeted chemotherapies. Thus, this study aims to find out the association between KIFC1 and lung cancer. The original data were assessed from The Cancer Genome Atlas and Gene Expression Omnibus databases. Compared to normal lung tissues, both mRNA and protein levels of KIFC1 were significantly increased in lung cancer tissues. The upregulation of KIFC1 was significantly correlated with sex, pathological stage, and TMN stage. Survival analysis revealed that increased KIFC1 expression was associated with poor overall survival, first-progression survival and post-progression survival in lung cancer. Based on the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis, we observed that KIFC1 upregulation was linked to enrichment of the cell cycle and TP53 signaling pathway. Additionally, the overexpression of KIFC1 was positively correlated with TP53 mutations in lung cancer. Based on real-world cohort results, western blotting and RT-qPCR showed high-KIFC1 expression in lung cancer, which may be related to the malignancy of lung cancer. Finally, experiments in vitro showed that KIFC1 inhibitor could significantly inhibit the proliferation and invasion of lung cancer cells. In conclusion, KIFC1 is a poor prognostic biomarker, and patients with high-KIFC1 levels may benefit from targeted therapy.
Study of radiomics based on dual-energy CT for nuclear grading and T-staging in renal clear cell carcinoma
Authors: Wang Ning , Bing Xue , Li Yuhan , Yao Jian , Dai Zhengjun , Yu Dexin , Ouyang Aimei
Published: March 2024

Introduction:

Clear cell renal cell carcinoma (ccRCC) is the most lethal subtype of renal cell carcinoma with a high invasive potential. Radiomics has attracted much attention in predicting the preoperative T-staging and nuclear grade of ccRCC.

Objective:

The objective was to evaluate the efficacy of dual-energy computed tomography (DECT) radiomics in predicting ccRCC grade and T-stage while optimizing the models.

Methods:

200 ccRCC patients underwent preoperative DECT scanning and were randomized into training and validation cohorts. Radiomics models based on 70 KeV, 100 KeV, 150 KeV, iodine-based material decomposition images (IMDI), virtual noncontrasted images (VNC), mixed energy images (MEI) and MEI + IMDI were established for grading and T-staging. Receiver operating characteristic analysis and decision curve analysis (DCA) were performed. The area under the curve (AUC) values were compared using Delong test.

Results:

For grading, the AUC values of these models ranged from 0.64 to 0.97 during training and from 0.54 to 0.72 during validation. In the validation cohort, the performance of MEI + IMDI model was optimal, with an AUC of 0.72, sensitivity of 0.71, and specificity of 0.70. The AUC value for the 70 KeV model was higher than those for the 100 KeV, 150 KeV, and MEI models. For T-staging, these models achieved AUC values of 0.83 to 1.00 in training and 0.59 to 0.82 in validation. The validation cohort demonstrated AUCs of 0.82 and 0.70, sensitivities of 0.71 and 0.71, and specificities of 0.80 and 0.60 for the MEI + IMDI and IMDI models, respectively. In terms of grading and T-staging, the MEI + IMDI model had the highest AUC in validation, with IMDI coming in second. There were statistically significant differences between the MEI + IMDI model and the 70 KeV, 100 KeV, 150 KeV, MEI, and VNC models in terms of grading (P < .05) and staging (P ≤ .001). DCA showed that both MEI + IDMI and IDMI models outperformed other models in predicting grade and stage of ccRCC.

Conclusions:

DECT radiomics models were helpful in grading and T-staging of ccRCC. The combined model of MEI + IMDI achieved favorable results.
A positive association between RDW and coronary heart disease in the rheumatoid arthritis population: A cross-sectional study from NHANES
Authors: Zhang Mei Qi , Tan Wen Tao , Li Wei Dong , Shen Xuan Yang , Shen Yuan , Jiang Xiao Lu , Wen Hong Fu
Published: March 2024

Previous research has indicated that higher red blood cell distribution width (RDW) increases the risk of coronary heart disease. However, no studies have established a link between RDW and coronary heart disease in the rheumatoid arthritis population. This research aims to explore the association between RDW and coronary heart disease among individuals with rheumatoid arthritis. We selected demographic data, laboratory data, lifestyle, and medical history from the National Health and Nutrition Examination Survey (NHANES), specifically including age, gender, poverty, RDW, race, BMI, diabetes, education, coronary heart disease, hypertension, cholesterol, smoking, and drinking. RDW and coronary heart disease were found to have a positive association in the rheumatoid arthritis population (OR = 1.145, 95%CI: 1.036–1.266, P = .0098), even after adjusting for factors such as age, gender, race, education level, smoking, and drinking. Subgroup analysis showed a stronger positive association, particularly in individuals aged 55–66 years, males, and the Hispanic White population with diabetes or hypercholesterolemia. There is a significant correlation between RDW and coronary heart disease among individuals with rheumatoid arthritis.
Unconsciousness as the main nonfocal symptom of anterior circulation transient ischemic attack: A case report
Authors: Dong Xiaomeng , Zhang Ziliang , Li Bin , Ma Wenbin , Chen Jinbo , Su Yipeng
Published: March 2024

Rationale:

Unconsciousness is a nonfocal symptom of transient ischemic attack (TIA) that is frequently observed in patients with vertebrobasilar artery stenosis or occlusion. Conversely, loss of consciousness due to anterior circulation involvement (e.g., middle cerebral artery [MCA]) is a rare occurrence in TIA.

Patient concerns:

This report describes a rare case in a 59-year-old woman who experienced recurrent episodes of altered consciousness because of the occlusion or stenosis of her MCAs.

Diagnoses:

The diagnosis of the case was updated from TIA to acute cerebral infarction, finally. Following initial loss of consciousness, cranial magnetic resonance imaging (MRI) did not reveal any evidence of acute cerebral infarction. However, following the second and third episodes of unconsciousness, the MRI revealed multiple new acute cerebral infarcts affecting both the cerebral hemispheres. Further evaluation through digital subtraction angiography disclosed complete occlusion of the left MCA and severe stenosis of the right MCA.

Interventions:

Early in her illness, the patient was treated with vasodilators, aspirin and atorvastatin. Finally, 2 stents in her right and left MCAs were placed respectively, followed by treatment with aspirin, clopidogrel, and double-dosed atorvastatin calcium. Meanwhile, the patient focused on avoiding conditions which may lead to dehydration in her daily life routine.

Outcomes:

The episodes of unconsciousness of this patient were completely resolved. During the 1-year postoperative follow-up, the patient remained clinically stable without any symptoms of unconsciousness, limb numbness or weakness, or dizziness.

Lessons:

These findings suggested that hypoperfusion in the bilateral cerebral hemispheres played a pivotal role in precipitating the patient episodes of unconsciousness. This case underscores the possibility that occlusion or severe stenosis in both MCAs can contribute to recurrent episodes of unconsciousness due to hypoperfusion. Moreover, it emphasizes the association between these episodes of unconsciousness and an increased risk of subsequent ischemic stroke.
Chronic infective arthritis with osteomyelitis of the ankle due to Pseudomonas aeruginosa infection in a middle-age woman: A rare causative pathogen requiring vigilance
Authors: Chen Chien-Liang , Chao Tai-Kuang , Yeh Fu-Chiang , Wu Ching-Lan , Wang Ching-Hsun
Published: March 2024

Rationale:

Pseudomonas aeruginosa-induced septic arthritis is a relatively uncommon phenomenon. It has been documented in children with traumatic wounds, young adults with a history of intravenous drug use, and elderly patients with recent urinary tract infections or surgical procedures.

Patient concerns:

Fifty-nine year-old female had no reported risk factors. The patient sought medical attention due to a 6-month history of persistent pain and swelling in her right ankle.

Diagnoses:

Magnetic resonance imaging and a 3-phase bone scan revealed findings suggestive of infectious arthritis with concurrent osteomyelitis. Histopathological examination of the synovium suggested chronic synovitis, and synovial tissue culture confirmed the presence of P aeruginosa.

Intervention:

Arthroscopic synovectomy and debridement, followed by 6 weeks of targeted antibiotic therapy for P aeruginosa.

Outcomes:

Following treatment, the patient experienced successful recovery with no symptom recurrence, although she retained a mild limitation in the range of motion of her ankle.

Lessons:

To our knowledge, this is the first reported case of chronic arthritis and osteomyelitis caused by P aeruginosa in a patient without conventional risk factors. This serves as a crucial reminder for clinicians to consider rare causative organisms in patients with chronic arthritis. Targeted therapy is imperative for preventing further irreversible bone damage and long-term morbidity.
Chromosome balanced translocation in newborn fetus founded during prenatal diagnosis: Three cases reports
Authors: Yao Lan , Kan Xun , Xia Yuxin , Wang Luyao , Zhao Xueyu , Lu Yingli
Published: March 2024

Rationale:

Because of the normal phenotype, carriers of specific chromosomal translocations are often diagnosed only after their development of associated malignancies, recurrent miscarriages, and reproductive difficulties. In this paper, we report primary balanced fetal chromosomal translocations by performing the necessary invasive prenatal diagnosis in couples with previous malformations coupled with prenatal testing suggesting a high risk for trisomy 21.

Patient concerns:

Case 1 and Case 2 couples had malformed children, and Case 3 couples had a high risk of trisomy 21 on noninvasive preconception serological testing.

Diagnosis and intervention:

A balanced chromosomal translocation diagnosis was confirmed by karyotyping of fetal cells obtained by amniocentesis.

Outcomes:

All 3 couples decided to continue their pregnancies after learning about the consequences of the chromosomal abnormalities. Approximately a year after the children were born, the staff of the Prenatal Diagnostic Center followed up with a phone call and found that the children physical development and intelligence were normal.

Lesson:

This case report reports healthy chromosomal balanced translocation newborns born to couples with poor maternal history and couples with abnormalities suggested by preconception testing, and followed up with the newborns to provide some experience in prenatal diagnosis and genetic counseling for chromosomal balanced translocations.
Associations among thyroid hormone levels and mean corpuscular volume in adults in the US: A cross-sectional examination of the NHANES 2007–2012 dataset
Authors: Wang Mingzheng , Lu Xiaofeng , Zheng Xiaogang , Zhu Xiaotao , Liu Junru
Published: March 2024

Mean corpuscular volume (MCV) is an important indicator used to determine the etiology of anemia and is associated with a variety of diseases. However, the link between thyroid function and MCV has yet to be clarified. This study was thus developed to assess relationships between thyroid function and MCV in a population of adults in the US. Results from the National Health and Nutrition Examination Survey study performed from 2007 to 2012 were used to conduct a cross-sectional analysis. Key thyroid-related variables included in this analysis were thyroid-stimulating hormone, total thyroxine (TT4), free triiodothyronine (FT3), total triiodothyronine (TT3), free thyroxine (FT4), antithyroglobulin, thyroglobulin, and antithyroid peroxidase levels. Generalized linear regression models were employed when estimating associations between MCV quartiles and thyroid parameters in 8104 adults 18 + years of age. In these participants, the weighted mean (SD) MCV was 89.36 (0.16) fL, with thyroid-stimulating hormone levels of 1.86 (0.03) mIU/mL, FT3 levels of 3.20 (0.01) pg/mL, FT4 levels of 0.80 (0.01) ng/dL, TT3 levels of 115.09 (0.64) ng/dL, and TT4 levels of 7.81 (0.04) μg/dL. When analyses were not adjusted, higher MCV values were related to reduced serum levels of FT3, TT3, or TT4. Following adjustment for possible confounding variables, this significant negative correlation between MCV and levels of FT3, TT3, and TT4 remained, and subgroup analysis revealed that this negative correlation was present in the male group and in the age group >50 years, but not in the female group and in the age group less than or equal to 50 years. These results suggest a significant negative correlation between MCV and FT3, TT3, and TT4, and this negative correlation originated more from the male population and those older than 50 years of age. The underlying mechanisms warrant additional investigation.
The prevalence of COVID-19 infection, associated risk factors and post-COVID-19 symptoms among vaccinated people, in Anhui Province, China: A cross-sectional study
Authors: Yu Tianyun , Zhai Yujia , Cui Can , Su Zengfeng
Published: March 2024

To investigate the infection status of coronavirus disease 2019 (COVID-19) among people in Anhui Province, China after the epidemic prevention and control measures were lifted, and to study and analyze its related influencing factors. From March 11 to May 20, 2023, questionnaires on COVID-19 were distributed on the Questionnaire Star platform, and Statistical Product and Service Solutions software (version 19.0) was used for statistical processing. The results showed that the infection rate of COVID-19 among respondents reached 72.24%. 58.81% of the infected people reported post COVID-19 symptoms. Fever, fatigue, and cough were the main symptoms during infection. The results of multi-factor logistic regression analysis showed that there is statistical significance between age (P = .002), residential area (P = .025), number of vaccine injections (P < .001) and the risk of new coronavirus infection. COVID-19 had a high infection rate, and children had a lower risk of COVID-19. People living in cities were more susceptible to COVID-19, and it was necessary to increase the number of vaccine doses.
Observation on efficacy and underlying mechanism of cheek acupuncture on ovulation induction for infertile women with PCOS: Case series
Authors: Yang Yi , Jin Lihua , Xu Shasha , Ye Huijun , Luo Xi , Li Ruilan , Yue Yuebing
Published: March 2024

Rationale:

Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder among women of childbearing age and is the primary cause of anovulatory infertility, accounting for 70% to 80% of cases. Ovulation induction is the main treatment approach for infertile patients with PCOS. Commonly utilized medications for this purpose are clomiphene citrate (CC) and letrozole (LE). Clomiphene citrate administration results in an ovulation rate ranging from 60% to 85%, while the pregnancy rate is limited to 35% to 40%, and a further reduction is observed in live birth rates. Letrozole demonstrates a slightly higher pregnancy rate and live birth rate compared to clomiphene citrate, although challenges persist in terms of longer stimulation cycles, multiple pregnancies, and the risk of ovarian hyperstimulation syndrome (OHSS). Clinical reports indicate that acupuncture therapy shows promising efficacy in treating patients with PCOS-related infertility, despite a partially unclear understanding of its underlying mechanisms.

Patient concerns:

In this study, one patient did not achieve pregnancy despite more than a year of ovulation induction using clomiphene citrate and letrozole. However, after 3 months of receiving cheek acupuncture therapy, she successfully conceived and gave birth to a liveborn baby. Another patient achieved natural conception and live birth after 2 months of exclusive cheek acupuncture therapy.

Diagnosis:

PCOS.

Interventions:

Cheek acupuncture therapy.

Outcomes:

Both of them successfully conceived and gave birth to a liveborn baby.

Lessons:

These findings suggest that cheek acupuncture therapy can effectively stimulate follicle development and ovulation, potentially improving endometrial receptivity. According to holographic theory, there is a biologically holographic model within the cheek region that shares a homology with the human body structure. This model provides an explanation for the regulatory effects of cheek acupuncture point stimulation on the Hypothalamic-Pituitary-Ovarian axis (HPO), which subsequently influences follicle development and ovulation in patients. Consequently, when cheek acupuncture therapy is applied alone or in combination with ovulation induction medication, patients have the ability to achieve successful pregnancy and experience a smooth delivery.
B-cell lymphoma with cytokine storm in serosal effusion: A case report and literature review
Authors: Zhang Xiaoli , Shi Xueze , Liu Xixi , Li Chencheng , Xu Zuqiong , Dai Xingbin , Ma Bangyun , Zhu Xuejun
Published: March 2024

Rationale:

Cytokine storm is now considered to be a systemic inflammatory response, but local cytokine storm may exist in systemic diseases of the blood system. Monitoring of regional cytokine storm is an important clue for the diagnosis of systemic diseases.

Patient concerns:

A 72-years-old male presented to our hospital with multiple serosal effusion without solid mass or enlarged lymph nodes. We found that the level of cytokines in ascites was tens to hundreds of times higher than that in plasma, mainly IL-6 and IL-8.

Diagnoses:

The patient was diagnosed with multiple serous effusion, hemophagocytic syndrome, B-cell lymphoma, Epstein–Barr virus infection, and hypoproteinemia.

Interventions:

During hospitalization, the patient was treated with 5 courses of R-CVEP therapy and supportive treatment.

Outcomes:

After the first R-CVEP regimen, the patient’s condition was evaluated as follows: hemophagocytic syndrome improved: no fever; Serum triglyceride 2.36 mmol/L; Ferritin 70.70 ng/L; no hemophagocyte was found in the bone marrow; the lymphoma was relieved, ascites disappeared, and bone marrow cytology showed: the bone marrow hyperplasia was reduced, and small platelet clusters were easily seen. Bone marrow flow cytometry showed that lymphocytes accounted for 13.7%, T cells increased for 85.7%, CD4/CD8 = 0.63, B cells decreased significantly for 0.27%, and NK cells accounted for 10.2%. Blood routine returned to normal: WBC 5.27 × 109/L, HB 128 g/L, PLT 129 × 109/L; Epstein–Barr virus DNA < 5.2E + 02 copies/mL; correction of hypoproteinemia: albumin 39.7 g/L.

Lessons:

Cytokines in ascites are significantly higher than those in plasma by tens to hundreds of times, suggesting that “regional cytokine storms” may cause serosal effusion.
Laryngeal mask airway combined with bronchial blocker achieved 1-lung ventilation in a patient with bilateral vocal cord paralysis: A case report
Authors: Li Yi , Zhang Yudong , Zhang Yu , Meng Lei , Li Chong , Li Jianli
Published: March 2024

Introduction:

One-lung ventilation (OLV) is a commonly used technique to facilitate surgical visualization during thoracic surgical procedures. Double-lumen endotracheal tubes and one-lumen tracheal tube combined with bronchial blocker might lead to intubation-related laryngeal injury.

Patient concerns:

In the perioperative period, how to avoid further damage to the vocal cord while achieving OLV during operation is challenging work.

Diagnosis:

She was diagnosed with systemic lupus erythematosus, bilateral vocal cord paralysis, and lung tumor.

Interventions:

We used a combination of a laryngeal mask airway with bronchial blocker to avoid further damage to the vocal cord when achieving OLV.

Outcomes:

At 1-month follow-up, she had fully recovered without obvious abnormalities.

Conclusion:

When OLV was required for patients with bilateral vocal cord paralysis, a combination of a laryngeal mask airway with bronchial blocker was considered a better choice.
Hybrid surgery of vertebral artery transposition combined with scallop and fenestration technique for the repair of type B aortic dissection patient with isolated left vertebral artery: A case report
Authors: Ge Shuxiong , Xu Zhongyou , Yan Jinlin
Published: March 2024

Rationale:

Acute type B aortic dissection (ABAD) is a fatal cardiovascular disease with high morbidity and mortality. Isolated left vertebral artery (ILVA) is a rare aortic arch mutation originating from the aortic arch. The simultaneous occurrence of both increases the complexity and difficulty of thoracic endovascular aortic repair. However, there have been few reports on the recommendation of thoracic endovascular aortic repair treatment strategies for aortic dissection patients concomitant ILVA with insufficient landing zone. Here, we report a case of ABAD combined with ILVA treated with hybrid surgery of left vertebral artery transposition alliance with Scallop and in vivo fenestration endograft.

Patient concerns:

A 38-year-old middle-aged man was transferred to our vascular department with persistent pain in his lower abdomen for 8 hours.

Diagnoses:

Preoperative computed tomography angiogram of the thoracic and abdominal aorta diagnosed with ABAD accompanied with ILVA.

Interventions:

Hybrid surgery of left vertebral artery transposition alliance with Scallop and in situ fenestration endograft for revascularization of ILVA, left subclavian artery, and left common carotid artery.

Outcomes:

The hybridization operation was successfully completed. There were no complications of cerebral and spinal cord ischemia after operation. Computed tomography angiogram examination indicated no internal leakage existed in the stent and patency of the arch vessels and the transposed left vertebral artery follow-up 3 months after surgery.

Lessons:

This study gave us experience in the treatment of aortic dissection with left vertebral artery variation and suggested that left vertebral artery transposition combined with scallop and in vivo fenestration stent is safe and effective.
In-hospital initiation of a PCSK9 inhibitor in patients with acute coronary syndrome: A systematic review and meta-analysis of randomized controlled trials
Authors: Shi Wenhai , Xu Yong , Zhou Lin , Wang Wuwan , Huang Wei , Zhou Bo
Published: March 2024

Background:

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to be effective and safe in patients with stable angina and previous myocardial infarction. However, evidence for initiating their use in patients hospitalized with acute coronary syndrome (ACS) is limited. This systematic review and meta-analysis was performed to provide more clinical evidence.

Methods:

PubMed, Embase, OVID, Cochrane Library and ClinicalTrials.gov were systematically searched for eligible randomized controlled trials up to March 20, 2023. The risk ratios, standardized mean differences and 95% confidence intervals were calculated for primary and secondary outcomes. The bias risk of the included studies was assessed using the Cochrane RoB 2 criteria.

Results:

About 8 randomized controlled trials involving 1255 inpatients with ACS were included. PCSK9 inhibitor treatment significantly reduced low-density lipoprotein cholesterol (LDL-C) (SMD −1.28, 95% CI −1.76 to −0.8, P = .001), triglycerides (TG) (SMD −0.93, 95% CI −1.82 to −0.05, P = .03), total cholesterol (SMD −1.36, 95% CI −2.01 to −0.71, P = .001), and apolipoprotein B (Apo B) (SMD −0.81, 95% CI −1.09 to −0.52, P = .001) within approximately 1 month. PCSK9 inhibitor treatment significantly reduced the total atheroma volume (TAV) (SMD −0.33, 95% CI −0.59 to −0.07, P = .012). It also significantly increased minimum fibrous cap thickness (FCT) (SMD 0.41, 95% CI 0.22–0.59, P = .001) in long-term follow-up (>6 months). PCSK9 inhibitor treatment significantly reduced the risk of readmission for unstable angina (RR 0.32, 95% CI 0.12–0.91, P = .032) in short-term follow-up (<6 months). There were no significant differences in all-cause mortality, cardiovascular death, myocardial infarction, ischemic stroke, coronary revascularization or heart failure. Only nasopharyngitis (RR 1.71, 95% CI 1.01–2.91, P = .047) adverse events were significantly observed in the PCSK9 inhibitor group.

Conclusion:

Application of a PCSK9 inhibitor in hospitalized patients with ACS reduced lipid profiles and plaque burdens and was well tolerated with few adverse events.
Intensive urate-lowering with pegloticase plus methotrexate co-therapy in uncontrolled gout patients with and without chronic kidney disease: A retrospective case series
Authors: Albert John , Broadwell Aaron , Padnick-Silver Lissa , Marder Brad , LaMoreaux Brian
Published: March 2024

Chronic kidney disease (CKD) and gout commonly co-occur. Pegloticase lowers serum urate (SU) in uncontrolled gout patients but antidrug antibodies limit urate-lowering response and increase infusion reaction (IR) risk. Methotrexate (MTX) co-administration increases pegloticase response rate and mitigates IR risk but CKD limits MTX use. This pooled case series examined pegloticase + MTX co-therapy in uncontrolled gout patients with and without CKD. Cases of pegloticase + MTX co-therapy in existing datasets were retrospectively examined. Baseline eGFR classified patients as CKD (eGFR < 60 mL/min/1.73 m2) or non-CKD (eGFR ≥ 60 mL/min/1.73 m2). Patient characteristics, treatment parameters, laboratory values, urate-lowering response rate (≥12 pegloticase infusions received and SU < 6 mg/dL just before infusion 12), and AEs were examined. Fifteen CKD (eGFR: 43.2 ± 11.3 mL/min/1.73 m2; SU: 8.6 ± 2.2 mg/dL), 27 non-CKD (eGFR: 82.9 ± 19.0 mL/min/1.73 m2; SU: 9.5 ± 1.7 mg/dL) patients were included. Comorbidity profiles were similar, but CKD patients were older (72.0 ± 9.9 vs 52.3 ± 14.3 years) and more often female (33.3% vs 7.4%). Treatment parameters were similar with 4-week MTX Run-in followed by mean of 14.7 ± 8.1 [CKD] vs 14.1 ± 7.1 [non-CKD] pegloticase infusions. However, CKD patients had lower MTX dose (14.8 ± 5.8 vs 19.3 ± 4.9 mg/week). Urate-lowering response was similar (92% vs 86%). eGFR increased during treatment in 60% of CKD (+11.5 ± 20.9 mL/min/1.73 m2, 87% stable/improved CKD-stage) and 44% of non-CKD (+4.2 ± 15.0 mL/min/1.73 m2) patients. AEs were similar (≥1 AE CKD: 53%, non-CKD: 67%; gout flare most-reported). One case each of pancytopenia and IR (mild) occurred in non-CKD patients. These real-world data show similar pegloticase + MTX efficacy in CKD and non-CKD patients. No new safety signals were identified, with most CKD patients showing renal function stability or improvement during therapy.
Second primary malignancy post immunotherapy: A case report of 2 cases
Authors: Miao Xian , Dong Shu , Tao Yuhua , Yang Xiaohui , Shen Shuijie
Published: March 2024

Rationale:

Immune checkpoint inhibitors have shown high efficacies as the first-line treatment of various advanced malignancies. Yet, the effect and practice patterns of immune checkpoint inhibitors on the second primary tumors are still unclear. Second primary malignancy post immunotherapy, there is paucity in such cases being reported.

Patient concerns:

We report 2 cases of a 57-year-old woman with nonsmall cell lung cancer and a 69-year-old man with metastatic clear cell renal carcinoma treated with immunotherapy who developed second primary malignancies during the therapy.

Diagnosis:

Second primary malignancy during the therapy.

Interventions:

In addition to the treatments of the second primary malignancies, maintenance immunotherapy was continued for the patients.

Outcomes:

Overall survival in both patients was longer than 12 months, and the treatments were well tolerated. The adverse reactions mainly included depigmentation of hair and facial and limb skin in patient 1 and diarrhea in patient 2.

Lessons:

It is necessary to recognize that the second primary malignancy may occur during the immunotherapy, and more clinical studies and practices are still needed for the adjustment of the regimens of immunotherapy. Full diagnosis, timely treatment, and long-term regular follow-up have important significance for patients with malignancies.
Cerebral venous thrombosis presented with symmetrical crescent-shaped intracranial hemorrhage in alcoholic liver disease: Case reports
Authors: Xu Lingjia , Fu Guoping
Published: March 2024

Rationale:

Cerebral venous thrombosis (CVT) is a relatively uncommon but fatal disease. It can be caused by a variety of hereditary or acquired thrombotic diseases. Initial presentation with intracranial hemorrhage (ICH) in CVT is rare but can further complicate the therapeutic measures and prognosis. Cases of CVT presented with ICH in patients with alcoholic liver disease (ALD) have not been described in the literature, and it might be related with hemostatic abnormalities in ALD patients.

Patient concerns:

We report 2 cases of men admitted to our hospital who were diagnosed with CVT but initially presented with symmetrical crescent-shaped ICH; both of them were ALD patients.

Diagnoses:

Cerebral imaging revealed extended CVT in both cases. The first case was a 64-year-old man with ALD deteriorated with unconsciousness and convulsions; computed tomography showed symmetrical crescent-shaped ICH in the right temporal lobe, and magnetic resonance venography revealed CVT. Another 50-year-old man with ALD complained about dizziness and weakness of his right limbs; computed tomography revealed symmetrical crescent-shaped ICH in bilateral parietal and occipital lobes, and magnetic resonance venography revealed CVT.

Interventions:

The first patient was referred to the endovascular thrombectomy. Both of them were treated with anticoagulation treatment.

Outcomes:

Favorable outcomes were observed in both patients.

Lessons:

Symmetrical or multiple crescent-shaped ICH requires a high suspicion in the diagnosis of CVT; even with hemorrhage, it is still important to initiate anticoagulation therapy promptly. The crescent-shaped ICH might be a new sign for CVT, and further studies are needed in the underlying mechanisms of ALD and potential thrombophilia.
Norepinephrine versus phenylephrine on cerebral tissue oxygen saturation during prophylactic infusion to prevent spinal hypotension for Caesarean birth
Authors: Wu Weiguo , Zheng Qiang , Zhou Jinfeng , Li Xiujuan , Zhou Haipeng
Published: March 2024

Background:

Phenylephrine may cause a reduction in maternal cerebral tissue oxygen saturation (SctO2) during Caesarean birth to prevent spinal hypotension; however, the effect of norepinephrine has not been assessed. We hypothesized that norepinephrine was more effective than phenylephrine in maintaining SctO2 when preventing spinal hypotension during Caesarean birth.

Methods:

We conducted a randomized, double-blind, controlled study. Sixty patients were randomly assigned to prophylactic norepinephrine or phenylephrine to maintain blood pressure during spinal anesthesia for Caesarean birth. SctO2, systolic blood pressure, and heart rate were recorded. The primary outcome was the incidence of a 10% reduction of intraoperative SctO2 from baseline or more during Caesarean birth.

Results:

The norepinephrine group had a lower incidence of more than 10% reduction of intraoperative SctO2 from baseline than that of the phenylephrine group (13.3% vs 40.0%, P = .02). The change in SctO2 after 5 minutes of norepinephrine infusion was higher than that after phenylephrine infusion (−3.4 ± 4.7 vs −6.2 ± 5.6, P = .04). The change in SctO2 after 10 minutes of norepinephrine infusion was higher than that after phenylephrine infusion (−2.5 ± 4.4 vs −5.4 ± 4.6, P = .006). The norepinephrine group showed greater left- and right-SctO2 values than the phenylephrine group at 5 to 10 minutes. However, the change in systolic blood pressure was comparable between the 2 groups.

Conclusion:

Norepinephrine was more effective than phenylephrine in maintaining SctO2 when preventing spinal hypotension during Caesarean birth. However, the changes in clinical outcomes caused by differences in SctO2 between the 2 medications warrant further studies.
Sodium citrate versus sodium bicarbonate for metabolic acidosis in patients with chronic kidney disease: A randomized controlled trial
Authors: Sorohan Bogdan Marian , Obrișcă Bogdan , Jurubiță Roxana , Lupușoru Gabriela , Achim Camelia , Andronesi Andreea , Frățilă Georgiana , Berechet Andreea , Micu Georgia , Ismail Gener
Published: March 2024

Background:

Metabolic acidosis (MA) is frequently associated with chronic kidney disease (CKD) progression. Our aim was to compare the effect of oral sodium citrate (SC) with that of oral sodium bicarbonate (SB) on renal function and serum bicarbonate correction, as well as to evaluate their safety profile in patients with MA of CKD.

Methods:

We conducted a prospective, single-center, randomized 1:1, parallel, controlled, unblinded clinical trial of 124 patients with MA and CKD stages 3b and 4. The primary outcome was the mean change in estimated glomerular filtration rate (eGFR). The secondary outcomes were mean change in serum bicarbonate level, eGFR decrease by 30%, eGFR decrease by 50%, dialysis, death or prolonged hospitalization, and a combined endpoint.

Results:

No significant difference was found between the groups in terms of mean eGFR change [adjusted mean difference = −0.99 mL/min/1.73 m2 (95% CI: −2.51 to 0.93, P = .20)]. We observed a mean serum bicarbonate change of 6.15 mmol/L [(95% CI: 5.55–6.74), P < .001] in the SC group and of 6.19 mmol/L [(95% CI: 5.54–6.83), P < .001] in the SB group, but no significant difference between the 2 groups [adjusted mean difference = 0.31 mmol/L (−0.22 to 0.85), P = .25]. Cox proportional hazard analysis showed similar risks regarding eGFR decrease by 30% (P = .77), eGFR decrease by 50% (P = .50), dialysis (P = .85), death or prolonged hospitalization (P = .29), and combined endpoint (P = .57). Study drug discontinuation due to adverse events was significantly more common in the SB group (17.7% vs 4.8%, P = .02).

Conclusions:

SC and SB have a similar effect on kidney function decline, both improve serum bicarbonate level, but SB is associated with higher rates of medication discontinuation due to adverse events.
Difference in mortality risk predicted by leukocyte and lymphocyte levels in COVID-19 patients infected with the Wild-type, Delta, and Omicron strains
Authors: Zhang Hongjun , Zhao Yanjun , Li Wenjie , Chai Yaqin , Gu Xing
Published: March 2024

This study aimed to investigate the changing trends, level differences, and prognostic performance of the leukocyte and lymphocyte levels of patients infected with the Wild strains, Delta strains and Omicron strains to provide a reference for prognostic assessment. In the current study, we conducted a retrospective cross-sectional study to evaluate the changing trends, level differences, and prognostic performance of leukocyte and lymphocyte of different strains at admission and discharge may already exist in patients with coronavirus disease-2019 (COVID-19) infected with the Wild type, Delta, and Omicron strains. A retrospective cross-sectional study was conducted. We recruited and screened the 243 cases infected with the Wild-type strains in Wuhan, the 629 cases infected with the Delta and 116 cases infected strains with the Omicron strains in Xi’an. The leukocyte and lymphocyte levels were compared the cohort of Wild-type infection with the cohort of Delta and the Omicron. The changes in the levels of leukocytes and lymphocytes exhibit a completely opposite trend in patients with COVID-19 infected with the different strains. The lymphocyte level at admission and discharge in patients with COVID-19 infected with Omicron strains (area under curve [AUC] receiver operating characteristic curve [ROC] 72.8–90.2%, 82.8–97.2%) presented better performance compared patients with COVID-19 infected with Wild type strains (AUC ROC 60.9–80.7%, 82.3–97.2%) and Delta strains (AUC ROC 56.1–84.7%, 40.3–93.3%). Kaplan–Meier curves showed that the leukocyte levels above newly established cutoff values and the lymphocyte levels below newly established cutoff values had a significantly higher risk of in-hospital mortality in COVID-19 patients with Wild-type and Omicron strains (P < .01). The levels of leukocyte and lymphocyte at admission and discharge in patients with COVID-19 infected with the Wild type, Delta, and Omicron strains may be differences among strains, which indicates different death risks. Our research may help clinicians identify patients with a poor prognosis for severe acute respiratory syndrome coronavirus 2 infection.
Clinical effects of a novel deep learning-based rehabilitation application on cardiopulmonary function, dynamic and static balance, gait function, and activities of daily living in adolescents with hemiplegic cerebral palsy
Authors: An Yeongsang , Min Seunghwa , Park Chanhee
Published: March 2024

Background:

Adolescents with hemiplegic cerebral palsy undergo conventional physical therapy (CPT) to improve static and dynamic balance, activities of daily living and cardiopulmonary function. To overcome this problem, we developed an innovative deep learning-based rehabilitation application (DRA) to provide a motivational and chaffed platform for such individuals. DRA evaluates the patients’ functional abilities and diagnosis an appropriate therapeutic intervention like CPT.

Methods:

We compared the effects of DRA and CPT on 6-minute walking test (6 MWT), Borg rating of perceived exertion scale, Berg balance scale, functional ambulation category, and modified Barthel index in adolescents with hemiplegic cerebral palsy. A convenience sample of 30 adolescents with hemiplegic cerebral palsy was randomized into either the DRA or CPT group. DRA and CPT were administered to the participants, with each session lasting 30 minutes and apportioned thrice a week for a total of 4 weeks.

Results:

Analysis of variance was performed and the level of significance was set at P < .05. The analysis indicated that DRA showed therapeutic effects on 6 MWT, Berg balance scale, and modified Barthel index compared to CPT.

Conclusion:

Our results provide evidence that DRA can improve cardiopulmonary function, balance, and activities of daily living more effectively than CPT in adolescents with hemiplegic cerebral palsy.