bluuebunny/crossref_metadata_2025 huggingface dataset:
Melatonin-Mediated Pak2 Activation Reduces Cardiomyocyte Death Through Suppressing Hypoxia Reoxygenation Injury–Induced Endoplasmic Reticulum Stress
Authors: Wang Suozhu , Bian Weishuai , Zhen Jie , Zhao Lei , Chen Wei
Published: July 2019

Cardiac reperfusion injury has been found to be associated with endoplasmic reticulum (ER) stress. Recently, p21-activated kinase 2 (Pak2) has been identified as a primary mediator of ER stress in chronic myocardial injury. Melatonin, a biological clock–related hormone, has been demonstrated to attenuate heart reperfusion burden by modulating ER stress and mitochondrial function. The aim of our study was to explore whether reperfusion-induced ER stress is modulated by melatonin through Pak2. Hypoxia reoxygenation (HR) was used in vitro to mimic reperfusion injury in cardiomyocytes. ER stress, oxidative stress, calcium overload, and cell death were measured through Western blotting, enzyme-linked immunosorbent assay, quantitative polymerase chain reaction, and immunofluorescence with the assistance of siRNA transfection and pathway blocker treatment. The results of our study demonstrated that HR decreased the levels of Pak2 in cardiomyocytes in vitro, and inactivation of Pak2 was associated with ER stress, oxidative stress, calcium overload, caspase-12 activation, and cardiomyocytes apoptosis in vitro. Interestingly, melatonin treatment attenuated HR-mediated ER stress, redox imbalance, calcium overload, and caspase-12–related cardiomyocytes apoptosis, and these protective effects were dependent on Pak2 upregulation. Knockdown of Pak2 abolished the beneficial actions exerted by melatonin on HR-treated cardiomyocytes in vitro. Finally, we found that melatonin reversed Pak2 expression by activating the AMPK pathway and blockade of the AMPK pathway suppressed Pak2 upregulation and cardiomyocytes survival induced by melatonin in the presence of HR stress. Overall, our study reports that the AMPK-Pak2 axis, a novel signaling pathway modulated by melatonin, sends prosurvival signals for cardiomyocytes reperfusion injury through attenuation of ER stress in vitro.
Low-Dose Adrenaline Reduces Blood Pressure Acutely in Anesthetized Pigs Through a β2-Adrenergic Pathway
Authors: Lubberding Anniek F. , Thomsen Morten B.
Published: July 2019

Adrenaline (epinephrine) is one of the prime messengers of the fight-or-flight response, favoring the activation of β-adrenergic receptors. Although general vasoconstriction to nonessential tissues is imperative, the vasodilatory effect of β-adrenergic receptor activation contends with this. We aimed to determine the dose-dependent effects of adrenaline on hemodynamics and to test whether adrenaline could lower blood pressure (BP) through a β2-adrenergic pathway. Nineteen Danish landrace pigs were used to pharmacologically probe the hemodynamic effect of adrenaline. Pigs were anesthetized, intubated, and electrocardiogram, systolic BP (SBP), diastolic BP (DBP), and left ventricular pressure (LVP) were monitored continuously. First, we tested the dose-dependent effects of adrenaline (0.01–10 µg/kg). Second, we determined the response to adrenaline (0.3 µg/kg) after atropine, prazosin, and propranolol pretreatment. Finally, we tested the hemodynamic effect of salbutamol in a subset of pigs. All doses of adrenaline increased heart rate, while BP showed a biphasic response: At low doses, adrenaline decreased SBP from 118 ± 3 to 106 ± 4 mm Hg (n = 15; P < 0.05) and DBP from 86 ± 3 to 71 ± 3 (n = 15; P < 0.05), while at high doses, SBP and DBP increased. LVP showed a similar pattern, with a tendency of decreased pressure at low doses, and an increased pressure at high doses (P < 0.05). Pretreatment with autonomic blockers revealed that the increase in BP was due to α-adrenergic activity, while the decrease was due to β-adrenergic activity. In confirmation, β-adrenergic activation through salbutamol showed a similar decrease in SBP, DBP, and LVP. We conclude that adrenaline dose-dependently increases heart rate, while producing a biphasic response in BP with a decrease at low doses and an increase at high doses in an anesthetized, large-animal model.
Increased risk of ankylosing spondylitis after Mycoplasma pneumonia
Authors: Chu Kuo-An , Chen Weishan , Hung Yao-Min , Wei James Cheng-Chung
Published: July 2019

This study aimed to investigate the relationship between Mycoplasma pneumonia (MP) infection and new development of ankylosing spondylitis (AS).

Using data from the Taiwan National Health Insurance Research Database, we included a total of 116,084 patients with newly diagnosed MP between 2000 and 2012. The control cohort consisted of patients who did not have MP, matched 1:4 by age, sex, and index year. The follow-up period was defined as the time from the initial diagnosis of MP to the date of diagnosis of AS, censoring, or 31 December 2013. Cox proportional hazards regression analysis was used to analyze the risk of autoimmune diseases by sex, age, and comorbidities, with hazard ratios (HRs) and 95% confidence intervals (CIs).

The eligible study participants included 116,084 patients in the MP group and 464,336 patients in the comparison group. The incidence rates of AS in the MP group and comparison groups were 1.49 and 0.74 per 1,000,000-person years, respectively. The adjusted HR of AS for the MP group was 2.45 (95% CI = 1.02−5.90) compared to the control group after adjustment for age, sex, and all covariates.

MP remained an independent risk factor for developing AS in terms of sex, age, and comorbidities.
Survival analysis of intraoperative blood salvage for patients with malignancy disease
Authors: Wu Wei-Wei , Zhang Wei-Yi , Zhang Wei-Han , Yang Lei , Deng Xiao-Qian , Ou Meng-Chan , Yang Yao-Xin , Liu Hai-Bei , Zhu Tao
Published: July 2019

Background:

Intraoperative blood salvage as a blood-saving strategy has been widely used in surgery. Considering its theoretic risk of malignant tumor cells being reinfused and the corresponding blood metastases, the safety of intraoperative blood salvage in cancer surgery remains controversial.

Methods:

Following the Preferred Reporting Items for Systemic Review and Meta-Analysis (PRISMA), we searched the Cochrane Library, MEDLINE and EMBASE to November 2017. We included only studies comparing intraoperative blood salvage with allogeneic blood transfusion.

Results:

This meta-analysis included 9 studies with 4354 patients with 1346 patients in the intraoperative blood salvage group and 3008 patients in the allogeneic blood transfusion group. There were no significant differences in the 5-year overall survival outcome (odds ratio [OR] 1.12; 95% confidence interval [CI], 0.80–1.58), 5-year disease-free survival outcome (OR 1.08; 95% CI 0.86–1.35), or 5-year recurrence rate (OR 0.86; 95% CI 0.71–1.05) between the 2 study groups. Subgroup analysis also showed no significant differences in the 5-year overall survival outcome (OR 0.97; 95% CI 0.57–1.67) of hepatocellular carcinoma patients in liver transplantation.

Conclusions:

For patients with malignant disease, intraoperative blood salvage did not increase the tumor recurrence rate and had comparable survival outcomes with allogeneic blood transfusion.
Long-term remarkable remission of SAPHO syndrome in response to short-term systemic corticosteroids treatment in an immunoglobulin E elevated patient
Authors: Wang Lun , Li Chen , Yu Meiyan , Cao Yihan , Jing Hongli , Li Junqiu
Published: July 2019

Rationale:

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare auto-inflammatory disease with no standardized treatment. Systemic corticosteroids are only transiently effective, but long-term use would bring complications and would not bring long-term remission. Bone scintigraphy is a first-line method for systematic evaluation of osteoarticular lesions but seems to show an “imprinting” pattern.

Patient concerns:

A 31-year-old female patient presented significant palmoplantar pustulosis and nail lesion as well as typical tracer accumulation feature on bone scintigraphy with normal hypersensitivity C-reactive protein and erythrocyte sedimentation rate, but an elevated serum immunoglobulin E level.

Diagnosis:

The diagnosis was made by dermatological manifestations and classical sign in bone scintigraphy in accordance with the diagnostic criteria proposed in 1988.

Interventions:

Methylprednisolone was given with a primary dose of 40 mg/day for 1 week followed with a subsequent 20 mg/day oral prednisone for another 1 week and then reduced in a rate of 5 mg/week until the eventual cessation.

Outcomes:

Long-term remarkable remission on clinical manifestations, MRI performance, and quantitative analysis of bone scintigraphy was achieved.

Lessons:

Identification of specific subtype of SAPHO patient according to skin and nail manifestations as well as immunoglobulin E level may guide the selection of short-term systemic corticosteroids strategy, leading to remarkable long-term remission. Besides, the lesions on bone scintigraphy can hardly disappear in SAPHO patients, and instead, the quantitative analysis of bone scintigraphy and MRI performances may better reflect the change of disease condition and serve as indicator for treatment efficiency.
Association between alcohol consumption and mild cognitive impairment
Authors: Hui Xu , Li Jing , Lao Yongfeng , Jia Bibo , Hou Lijuan , Lu Zhenxing , Gu Qinghong , Niu Junqiang , Bao Hairong , Yan Peijing , Yao Liang
Published: July 2019

Objective:

The objective of this study is to investigate the potential dose–response association between alcohol consumption and the risk of mild cognitive impairment (MCI).

Methods:

We will perform a dose–response meta-analysis (DRMA) of cohort studies to explore the dose–response relationship between alcohol intake and MCI. A comprehensive literature search of PubMed, EMBASE, The Cochrane Library, Chinese BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP, and Wan-Fang Database will be conducted. Two investigators will independently select studies, extract data, and assess the quality of the included study. The Newcastle-Ottawa Scale will be used to assess the quality of include studies. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) will be used to assess the quality of evidence and methodological quality. Any disagreement will be resolved by the third investigator. We will use the hazard ratio as the effect indicator, and piecewise linear regression model and restricted cubic spline model will be used for linear and nonlinear trend estimation, respectively. There is no requirement of ethical approval and informed consent.

Discussion:

This is the first DRMA to explore the dose–response relationship between alcohol intake and MCI. We predict it will provide high-quality evidence to prevent clinical MCI and dementia.

Registration:

The DRMA is registered in the PROSPERO (CRD42019127261) international prospective register of systematic review.
Clinical efficacy of oral immunoglobulin Y in infant rotavirus enteritis
Authors: Wang Xiaotong , Song Lijun , Tan Wenpan , Zhao Wenchang
Published: July 2019

Background:

Rotavirus (RV) can cause vomiting and diarrhea in infants and children, and could be treated clinically with immunoglobulin Y (IgY), which is an immunoglobulin extracted from chicken yolk. There is no systematic evaluation of immunoglobulin in the treatment of rotavirus enteritis. Therefore, we systematically evaluated rotavirus enteritis with oral immunoglobulin Y therapy using meta-analysis.

Methods:

We conducted a systematic search in CNKI, WANFANG DATA, VIP, PubMed, and the Cochrane Library databases (up to April 30, 2018). Using Revman 5.3 software for meta-analysis.

Results:

A total of 2626 subjects with rotavirus diarrhea from 17 randomized clinical trials were included in the meta-analysis. Of these, 1347 subjects received oral immunoglobulin Y and 1279 subjects received conventional treatment. The results of the meta-analysis indicated that the total number of effective cases and effective rates of immunoglobulin Y in treatment of rotavirus enteritis in infants and children was statistically different from that in the control group (odds ratio [OR] = 3.87, 95% confidence interval [CI] (3.17, 4.74),P < .00001) and (OR = 3.63, 95% CI [2.75, 4.80],P < .00001).

Conclusions:

Immunoglobulin Y is effective in the treatment of infantile rotavirus enteritis. Oral immunoglobulin Y can be widely used in the treatment of rotavirus enteritis in clinic.
Determinants of hypertension treatment adherence among a Chinese population using the therapeutic adherence scale for hypertensive patients
Authors: Pan Jingjing , Wu Lian , Wang Huichuan , Lei Tao , Hu Bin , Xue Xiaorong , Li Qiongge
Published: July 2019

To assess the adherence level of antihypertensive treatment and identify any associated risk factors in a sample of hypertensive patients from China.

A cross-sectional study involving 488 Chinese hypertensive patients was conducted in a tertiary hospital in Xi’an, China. Data were collected regarding socio-demographic factors and hypertension-related clinical characteristics. The adherence to treatment was assessed using the previously validated instrument: therapeutic adherence scale for hypertensive patients.

A total of 27.46% of patients were compliant with their antihypertensive treatments. Three factors were identified to be independently associated with antihypertensive treatment adherence: gender (P = .034), residence (P = .029), duration of high blood pressure (P < .001). Gender, residence, occupation, and the duration of antihypertensive drugs treatment used were found to have significant effects on treatment adherence in certain categories.

Treatment adherence among hypertensive patients in China was poor. More attention and effective strategies should be designed to address factors affecting treatment adherence. Education about hypertension knowledge should be strengthened for patients. Moreover, the importance of lifestyle modification during hypertension treatment is often neglected by patients, therefore, there is an urgent need to educate hypertensive patients about the adherence to lifestyle modifications.
Comparison of the effect of recombinant human pro-urokinase and tirofiban on myocardial blood flow perfusion in ST elevation myocardial infarction patients receiving primary percutaneous coronary intervention
Authors: Yao Zhuhua , Li Wenting , Cheng Lisong , Cao Mingying , Pang Zhihua , Li Yongbin
Published: July 2019

Ischemia/reperfusion (I/R) injury is associated with primary percutaneous coronary intervention (PPCI). The current study was performed to compare the effect of tirofiban and recombinant human pro-urokinase (rh-proUK) on the improvement of coronary slow blood after PPCI.

Sixty-five ST elevation myocardial infarction (STEMI) patients treated with rh-proUK and an equal number treated with tirofiban after PPCI were employed in the current study. The clinicopathological information regarding the biochemical parameters, thrombolysis in myocardial infarction (TIMI) grade, hemodynamics parameters, thrombus core (TS), sum-STR, left ventricular ejection fraction (LVEF), blood routine parameters, high-sensitivity C-reactive protein (CRP) level, uric acid, hepatorenal function, electrocardiogram (ECG), and echocardiography before and after the interventions were collected. The differences in those parameters between the 2 groups then compared with assess the treatment effect and side effects associated with the both therapies.

The results showed that the TIMI level post-intervention (P = .03), the proportion of TIMI myocardial perfusion grade level III (P = .04), the changes in thrombus score (P < .001) in rh-proUK group were significantly higher than those in tirofiban group while the corrected TIMI Frame Count (CTFC) (P = .02), the incidence of slow flow (P = .02), the thrombus score post-intervention (P < .001), the stent length (P = .02), and the number of receiving administration of sodium nitroprusside (P = .01) were significantly lower than those in tirofiban group. Moreover, the levels of CK (P < .001), CK-MB (P = .01), and NT-proBNP 24-hour post-intervention (P < .02) were significantly lower in rh-proUK group than those in tirofiban group and the sum-STR right after the intervention (P < .03) of rh-proUK group was significantly higher than that of tirofiban group. No significant difference was detected between the 2 therapies regarding major adverse cardiac events (MACE).

The findings outlined in the current study showed that the improvement effect of rh-proUK on blood flow condition was stronger right after the intervention and the therapy had a similar safety when compared with tirofiban during a 30-day follow-up.
Clinical characteristics and pregnancy outcomes of new onset epilepsy during pregnancy
Authors: Li Wei , Hao Nanya , Xiao Yingfeng , Zhou Dong
Published: July 2019

The occurrence of seizures during pregnancy is really a challenging situation which risks the health of both mothers and fetuses. However, new onset epilepsy is unpredictable in pregnancy, and its clinic feature is barely known. This study aimed to explore the clinical characteristics and pregnancy outcomes of new onset epilepsy during pregnancy.

We screened consecutive women with epilepsy and reproductive history from June 2013 to November 2018 from 3 hospitals in West China. Detailed demographics, clinical features, neurological status, related tests, managements, seizure and pregnancy outcomes were recorded and followed-up. Within them, patients with first seizure during pregnancy and spontaneous recurrent seizures after delivery or abortion were defined as new onset epilepsy during pregnancy.

We screened a total of 1041 consecutive women with epilepsy and reproductive history. Twenty-two of them (2.1%) had new onset epilepsy during pregnancy. The average age at seizure onset was 22.7 ± 3.0 years. All their first seizures occurred in pregnancy period, including 4 (18.2%) in the first trimester, ten (45.4%) in the second trimester and eight (36.4%) in the third trimester. Most patients delivered healthy babies, except one patient had to choose induced abortion because of the disappearance of fetal heart rate, one child was diagnosed with mild harelip and one was diagnosed with trisomy 21 syndrome, tetralogy of Fallot and congenital duodenal atresia. All 3 complications happened in patients with their first seizures in first trimester.

Although the risk of new onset epilepsy during pregnancy was relatively low, accurate diagnosis and appropriate treatment were required to reduce the damage to both mothers and fetuses. New onset epilepsy during pregnancy mostly began in middle and late pregnancy. However, seizures occurred from early pregnancy had bad effects on the embryo or fetus.
Embolization with microcoils for urethral hemorrhage
Authors: Liu Shiyi , Deng Jiangbei , Zeng Bin , Jia Yiping
Published: July 2019

Rationale:

Microcoils are a permanent embolic material, and blood vessels that have been embolized by a microcoil remain occluded for a prolonged period of time. The pudendal artery is an important functional vessel for penile erection. Whether simultaneous embolization of the bilateral pudendal artery using microcoils can seriously affect penile erection has not been sufficiently studied.

Patient concerns:

A 47-year-old male patient, after undergoing brain surgery, accidentally pulled out the Foley catheter causing a urethral hemorrhage. The patient was immediately treated using a new larger Foley catheter inserted under urethroscopic guidance and medication. However, massive bleeding occurred on the tenth day after the procedure.

Diagnosis:

A right internal iliac angiography performed after the bleeding event demonstrated a rupture at the end of the right internal pudendal artery with the contrast agent flowing out directly from the urethra. A super selective internal pudendal angiogram showed a small amount of hemorrhage at the end of the left internal pudendal artery.

Interventions:

The patient underwent interventional treatment. After the bilateral internal iliac angiography was performed, super-selective internal pudendal artery embolization with microcoils was performed. A subsequent bilateral internal pudendal angiogram did not show any abnormality.

Outcomes:

During the follow up period of 2 months, the patient had no complaints of difficulty in urination or sexual dysfunction.

Lessons:

Some doctors do not advocate the use of coils as embolic agents in bilateral pudendal artery lesions because of concerns over erectile dysfunction. There is rich vascular circulation in the perineum. Thus, in arterial embolization for the treatment of penile bleeding, regardless of the type of embolic material used, the key is to ensure accurate embolization to maintain good collateral circulation. This principle can help limit the occurrence of sexual dysfunction to the lowest possible levels after such procedures.
Nonsurgical integrative Korean Medicine treatment of discal cyst
Authors: Choi Hee-seung , Lee Sook-Hyun , Lee Yoon Jae , Ha In-Hyuk
Published: July 2019

Rationale:

Discal cysts are rare lesions characterized by pain caused by neurogenic compression with similar symptoms as those of disc herniation. This study aims to report the spontaneous regression of discal cyst achieved through nonsurgical integrative Korean Medicine treatment and the clinical epidemiological features of discal cyst cases collected from 4 institutions.

Patient concerns:

A 31-year-old woman had low back pain and radiating pain equivalent to a numeral rating scale (NRS) of 8 and had limitations in daily work and activities.

Diagnoses:

The patient was diagnosed as having discal cysts that compressed the left S1 based on findings of L-spine magnetic resonance imaging (MRI) performed at our hospital.

Interventions:

The patient received nonsurgical Korean Medicine treatment and after 24 days of treatment in the hospital, she underwent 16 additional treatments as an outpatient.

Outcomes:

Spontaneous regression was confirmed in the L-spine MRI follow-up at 36 days and 99 days after the initial test, and the patient underwent once-a-week follow up to examine NRS, Oswestry Disability Index (ODI), EuroQol-5 Dimensions (EQ-5D), and fear-avoidance beliefs questionnaire (FABQ) after 4 weeks, and 2, 3, and 6-month follow-ups after that. The patient was discharged in a painless condition, and she was able to carry on for 5 months without increased pain.

Lessons:

Discal cysts are more rapid progress than disc herniation, it seems valid to attempt nonsurgical treatment. Epidemiologically, this is the first study to present the clinical epidemiological characteristics of discal cysts, it would provide valuable information to clinicians who treat and study discal cysts.
Comparative study on the pregnancy outcomes of in vitro fertilization–embryo transfer between patients with different ovarian responses (a STROBE-compliant article)
Authors: Jin Hai-Xia , Lv Ai-Xiang , Wu Zhao-Ting , Wen Shuang , Zhang Xiang-Yang , Jin Da-Chuan , Sun Ying-Pu
Published: July 2019

There have been few studies on large-sample data of cleavage-stage embryo and blastocyst transfers. We compared the pregnancy outcomes of patients with different ovarian responses after the transfer of different numbers of embryos in different developmental stages.

Patients were divided into 3 groups including low response group, medium response group, and high response group according to different ovarian responses. Patients in each group were further divided into 4 subgroups including group A: transfer of 1 D3 embryo, group B: transfer of 2 D3 embryos; group C: transfer of 1 D5 blastocyst; and group D: transfer of 2 D5 blastocysts.

In low ovarian responders, the implantation rate, clinical pregnancy rate and live birth rate were significantly lower in the group A than in the groups B and C. In medium ovarian responders, the implantation rate was significantly higher, but the multiple pregnancy rate was significantly lower in the group C than in the group B. The multiple pregnancy rate was significantly higher in the group D than in the group C. In high ovarian responders, the implantation rate was significantly lower, but the multiple pregnancy rate was significantly higher in the group B than in group C.

Based on the above results, the single blastocyst transfer is preferable for the patients with different ovarian responses.
Impact of exercise on maternal gestational weight gain
Authors: Wang Jianying , Wen Danting , Liu Xiaofei , Liu Yingjie
Published: July 2019

Background:

Clinical evidence indicates that women will benefit from regular physical activity during pregnancy. This study aimed to summarize and update the evidence on the effect of exercise on maternal gestational weight gain (GWG).

Methods:

We conducted a systematic literature search of Pubmed, Embase, and Cochrane Library from inception until July, 2018 for randomized controlled trials (RCTs) that investigate the effect of physical exercises on the maternal GWG compared with that of no physical exercises or conventional medical care. We extracted data from eligible trials for study characteristics, interventions, patients’ baseline characteristics and outcomes for the study populations of interest. We conducted meta-analyses using random effects models.

Results:

From 844 citations, 23 RCTs including 4462 pregnant women met the inclusion criteria. Meta-analysis indicated that compared with that in women having conventional medical care, GWG was significantly decreased in pregnant women with physical exercise [weighted mean difference (WMD) −1.02, 95% CI −1.35 to −0.70; P < .01; I
2 = 48.4%]. Women appeared to benefit more for gestational weight control for exercise frequency of 3 times per week (WMD −1.22, 95% CI −1.55 to −0.90; I
2 = 40.3%) and exercise duration of 30 to 45 minutes each time (WMD −1.32, 95% CI −1.79 to −0.85; I
2 = 1.5%).

Conclusion:

This meta-analysis provides indications that exercise intervention can reduce maternal GWG for pregnant women, especially for those with exercise frequency of 3 times per week and duration of 30 to 45 minutes each time.
The association of 6 variants of 8q24 and the risk of glioma
Authors: Tong Yu , Ye Lv , Li Shiping , Zhao Fengyan , Ying Junjie , Qu Yi , Li Jinhui , Mu Dezhi
Published: July 2019

With the advances in sequencing technologies and genome-wide association studies (GWAS), several inherited variants that increase glioma risk have been identified. Ten studies including 8818 cases and 17,551 controls were collected to conduct a meta-analysis to evaluate the associations between 6 variants in 8q24 and glioma risk. Of the 6 variants located in 8q24, 2 have strong significant associations with the risk of glioma, including rs4295627 (P = .003, odds ratio [OR] = 1.21), rs55705857 (P = 2.31 × 10–35, OR = 3.54). In particular, both homozygous GG (P = 1.91 × 10–3, OR1 = 2.01) and heterozygous GT (P = 7.75 × 10–10, OR2 = 1.35) genotypes of rs4295627 were associated with glioma risk. Further studies are needed to explore the role of the 8q24 variants involved in the etiology of glioma.
Mortality rate and other clinical features observed in Open vs closed format intensive care units
Authors: Yang Qian , Du Jin Long , Shao Feng
Published: July 2019

Background:

Nowadays most of the intensive care units (ICUs) operate as a closed format in comparison to an open format. The new concept of a closed ICU is where patients are admitted under the full responsibility of a trained intensivist, whereas an open ICU is where patients are admitted under the care of another attending physician and intensivists are just available for consultation. In this analysis, we aimed to systematically compare mortality rate and other clinical features observed in open vs closed ICU formats.

Methods:

Biomedical and pharmacological bibliographic database Excerpta Medica database (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cochrane Central and www.ClinicalTrials.gov were searched for required English publications. Mortality, the frequency of patients requiring mechanical ventilation, central line, arterial line and pulmonary arterial catheter were assessed respectively. Statistical analysis was carried out by the RevMan software. Odds ratios (OR) with 95% confidence intervals (CIs) were used to represent the data following analysis.

Results:

Five studies with a total number of 6160 participants enrolled between years 1992 to 2007 were included. Results of this analysis showed that mortality rate was significantly higher in the open format ICU (OR: 1.31, 95% CI: 1.17–1.48; P = .00001) (using a fixed effect model) and (OR: 1.31, 95% CI: 1.09–1.59; P = .005) (using a random effect model). Closed format ICUs were associated with significantly higher number of patients that required central line (OR: 0.56, 95% CI: 0.34–0.92; P = .02). Patients requiring mechanical ventilation (OR: 1.08, 95% CI: 0.65–1.78; P = .77), patients requiring arterial line (OR: 1.05, 95% CI: 0.49–2.29; P = .89) and patients requiring pulmonary arterial catheter (OR: 0.86, 95% CI: 0.40–1.87; P = .71) were similar in the open vs the closed setting.

Conclusion:

This analysis showed that mortality rate was significantly higher in an open as compared to a closed format ICU. However, the frequency of patients requiring mechanical ventilation, arterial line and pulmonary arterial catheter was similarly observed. Larger trials are expected to further confirm those hypotheses.
Propylthiouracil-induced organizing pneumonia
Authors: Xiao Xue-Wen , An Jian , Hu Cheng-Ping , Luo Bai-Ling
Published: July 2019

Rationale:

Propylthiouracil (PTU) is a common antithyroid drug which can treat hyperthyroidism effectively. PTU is, however, associated to multiple adverse effects. In rare case, PTU can cause interstitial pneumonia.

Patient concerns:

A 40-year-old woman presented with dyspnea and was diagnosed with pulmonary infection at the first time. After the treatment with moxifloxacin, her symptoms still got worse.

Diagnosis:

The lung tissues biopsy confirmed the diagnosis of organizing pneumonia (OP) and the administration of PTU suggested the diagnosis of PTU-induced OP.

Intervention:

Withdrawal of PTU and the administration of methylprednisolone.

Outcomes:

The patient's symptoms relieved significantly 1 month later and lung computed tomography (CT) scan also demonstrated significant reduction of lung lesions.

Lessons:

Here we report the first case of histologically confirmed OP induced by PTU and conduct a literature review of the cases of PTU-induced interstitial pneumonia. The awareness of PTU-induced OP can help physicians reduce the possibility of misdiagnosis.
Bletilla striata promotes the healing of enterocutaneous fistula
Authors: Zhou Hong , Jin Yan , Gu Chen , Chen Yigang , Xia Jiazeng
Published: July 2019

Rationale:

Enterocutaneous fistula (ECF) has long been difficult to treat in clinical settings. The current approaches, including surgery, antibiotics, and nutritional support, cannot achieve satisfactory outcomes.

Patient concerns:

A 54-year-old man presented with intermittent discharge of purulent material from the fistula of an umbilical incision post colon surgery. His symptoms did not improve after receipt of antibiotic and surgical treatment.

Diagnosis:

The patient's symptoms, radiographic findings, and pathological examination led to a diagnosis of ECF.

Interventions:

Sterilized Bletilla striata was injected into the fistula once every 3 days for a total of 6 doses.

Outcomes:

The ECF completely healed, and the patient was symptom-free after 1 month.

Lessons:

The patient's pronounced improvement and the merit of this easy-to-perform low-cost method suggest that Bletilla striata may be used by surgeons for the treatment of chronic abdominal wall fistulas.
Factors related to home discharge in malnourished community-dwelling older adults
Authors: Anada Satoshi , Matsumoto Takuya , Nakano Masaru , Yamada Satoru
Published: July 2019

Patients who become malnourished during hospitalization because of illness or treatment often receive intervention from a nutrition support team (NST). The NST intervention not only enhances the nutritional status but also decreases medical expenses and catheter-related complications. However, the impact of the NST intervention on the home discharge of hospitalized community-dwelling older adults remains unclear. Hence, this study aims to investigate factors related to home discharge in malnourished community-dwelling older adults.

In this retrospective longitudinal cohort study, examined 191 community-dwelling older adults aged ≥65 years (108 males; mean age: 80.9 ± 7.8 years) who received the NST intervention. All participants were categorized into two groups based on whether they were home discharged or not (home discharge group and non-home discharge group). We performed intergroup comparisons using serum albumin (Alb) as an index of the nutritional status and functional independence measure (FIM: motor and cognitive items) as an index of activities of daily living (ADL). Furthermore, we constructed a prognostic model of home discharge using the logistic regression analysis.

The home discharge group had 94 participants, with a home discharge rate of 50.8%. Baseline body mass index (BMI), motor-FIM score, and cognitive-FIM score were significantly higher in the home discharge group compared with the non-home discharge group (P = .002, P < .001, P < .001, respectively). In the home discharge group, BMI declined significantly, Alb elevated significantly, and both motor-FIM and cognitive-FIM score enhanced significantly by the completion of the NST intervention (P < .001, P < .001, P < .001, P = .005, respectively). The adjusted logistic regression analysis extracted the baseline BMI (odds ratio [OR], 1.146; 95% confidence interval [CI]: 1.034–1.270), baseline motor-FIM score (OR, 1.070; 95% CI: 1.036–1.105), and extent of change in the motor-FIM score (OR, 1.061; 95% CI: 1.026–1.098) as independent factors that predict home discharge.

This study highlights the significance of higher baseline BMI, higher baseline ADL level, ADL enhancements, and improvements in the nutritional status by the NST intervention in malnourished community-dwelling older adults considering home discharge.
Traditional Chinese exercise (TCE) on pulmonary rehabilitation in patients with stable chronic obstructive pulmonary disease
Authors: Zheng Wenjiang , Li Meichen , Hong Yu , Xie Fuqi , Yan Qian , Peng Zijing , Huang Huiting , Liao Huili , Liu Xiaohong
Published: July 2019

Background:

Chronic obstructive pulmonary disease (COPD) has the characteristics of high incidence, mortality, disability rate, and heavy economic burden. Symptomatic measures such as anti-inflammatory, antispasmodic and anti-asthmatic are widely used in the treatment of COPD, and pulmonary rehabilitation has not been fully utilized. It is reported that up to 10 different kinds of Traditional Chinese exercises (TCEs) are often used for treating stable COPD. There are many randomized controlled trials (RCTs) and systematic reviews that have evaluated the efficacy of various TCEs for COPD. However, most of these studies were designed in comparison with conventional western medicine or health education. There are rarely studies to compare different TCEs head to head. Therefore, there remains uncertainty regarding the comparative efficacy among different TCEs. Thus, we plan to conduct a systematic review and Network meta-analysis (NMA) to compare the efficacy among 5 different TCEs and rank their benefits relative to each other. It is hoped that the findings of this study will facilitate the management and application of TCEs in the treatment of COPD.

Methods:

A systematic and comprehensive literature search will be performed from inception to April 2019 in both English and Chinese databases, involving Medline, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, China Biomedical Literature Database, and Chongqing VIP information. RCTs related to TCE in the treatment of COPD will be included. Quality of included trials will be assessed according to the risk of bias tool of Cochrane Handbook 5.1.0. The GRADE approach will be used to rate the certainty of the evidence of estimates derived from NMA. Data analysis will be conducted by using STATA 14.0.

Results:

This systematic review and NMA aims to summarize the direct and indirect evidence for different kinds of TCEs and to rank these TCEs. The findings of this NMA will be reported according to the PRISMA-NMA statement. The results of the NMA will be submitted to a peer-reviewed journal once completed.

Conclusion:

Using NMA, this study will provide an evidence profile which will be helpful to inform the selection of TCE for treating patients with COPD. The results will inform clinicians, bridge the evidence gaps, and identify promising TCE for future trials.

PROSPERO registration number:

PROSPERO CRD 42019132970.
A comparison of the prognosis of papillary and clear cell renal cell carcinoma
Authors: Deng Jun , Li Lei , Xia Haimei , Guo Ju , Wu Xin , Yang Xiaorong , Hong Yanyan , Chen Qingke , Hu Jieping
Published: July 2019

Objective:

To compare the prognosis of papillary and clear cell renal cell carcinoma (RCC) in order to determine the optimal follow-up and therapy for patients with RCC.

Methods:

A systematic search of Web of Science, EMBASE, Cochrane Library, and PubMed databases was conducted for articles published through July 30, 2018, reporting on a comparison of the prognosis of papillary RCC and clear cell RCC using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Results:

Of 1896 studies, 11 were considered for the evidence synthesis. A total of 35,832 patients were included. Of these patients, 6907 patients were diagnosed with papillary renal cell carcinoma, and 28,925 patients were diagnosed with clear cell renal cell carcinoma. The prognosis of papillary RCC was better than that of clear cell RCC (hazard ratio (HR) = 0.50; 95% confidence interval (CI) 0.45 to 0.56; P < .001; I
2 = 91.9%). A subgroup analysis indicated that papillary RCC was associated with better outcomes (HR = 0.76, 95% CI 0.50–1.16), and a trend toward a higher risk of mortality was observed in patients with metastatic RCC presenting with papillary histology, but the difference was not statistically significant (HR = 1.12, 95% CI 0.71–1.76, P = .085). Pooled data suggested a lack of a significant difference between papillary RCC (p-RCC) type 1 and clear cell RCC (cc-RCC) (HR = 0.30, 95% CI 0.12–0.73, P = .085). The pooled HR for the prognosis of p-RCC type 2 compared to cc-RCC was 1.69 (95% CI 0.93–3.08; P = .032).

Conclusion:

Papillary RCC is associated with better outcomes than clear cell RCC in patients without metastases, but not in patients with metastases. Optimal follow-up or therapy for patients with RCC should be assigned according to the tumor stage and subtype.
Association between ladybird homeobox 1 gene polymorphisms and adolescent idiopathic scoliosis
Authors: Jiang Hua , Yang Qinghua , Liu Yang , Guan Yewen , Zhan Xinli , Xiao Zengming , Wei Qingjun
Published: July 2019

The Ladybird Homeobox 1 (LBX1) gene has been implicated in the etiology of adolescent idiopathic scoliosis (AIS). The association between LBX1 gene polymorphisms and AIS has been investigated in several studies. However, these findings have yield contradictory results rather than conclusive evidence.

This study is to provide a meta-analysis of the published case-control studies on the association between LBX1 gene polymorphisms and AIS in Asian and Caucasian populations.

This meta-analysis conformed to the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We conducted a literature research on PubMed, Embase, Web of Science, and Cochrane Library until February 10, 2018. We included all case-control or cohort studies about association between LBX1 gene polymorphisms and AIS. The Risk Of Bias In Non-randomised Studies-of Interventions and Critical Appraisal Skills Programme were used to evaluate the risk of bias and study quality. We assessed the strength of association by pooled odds ratios (ORs) and 95% confidence intervals (CIs) in all genetic models under a fixed-effect model or random-effect model. We further performed subgroup analysis by ethnicity and sex. Sensitivity analysis and publication bias were also undertaken.

A total of 10 studies (11,411 cases and 26,609 controls) were included in this meta-analysis. The pooled results showed a statistically significant association between LBX1 gene polymorphisms and AIS (for rs11190870, T vs C, OR = 1.54, 95% CI = 1.48–1.61, P < .00001; for rs625039, G vs A, OR = 1.50, 95% CI: 1.38–1.62; P < .00001; for rs678741, G vs A, OR = 0.74, 95% CI: 0.63–0.86; P < .0001; for rs11598564, G vs A, OR = 1.41, 95% CI: 1.31–1.51; P < .0001). For stratified analyses by ethnicity and sex, robust significant associations were detected in Asian and Caucasian populations, and in women and men under all genetic models.

T allele of rs11190870 and G alleles of rs625039 and rs11598564 represent risk factors for AIS, but G allele of rs678741 may play a protective role in the occurrence of AIS. Further research is needed to confirm this finding and to understand its implications.
An ocular myasthenia gravis attack after oral pyrantel pamoate
Authors: Shen Chaolan , Li Min , Zhao Xin , Cui Lin
Published: July 2019

Rationale:

Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction that can be triggered by anticholinergic agents.

Patient concerns:

We present a 4-year-old female patient who was admitted to the outpatient clinic. She complained of drooped eyelids, which first appeared 2 days after taking a 200 mg dose of pyrantel pamoate. Past medical history is negative.

Diagnoses and treatment:

She was hospitalized with a diagnosis of ocular type MG, and pyridostigmine (40 mg/day) treatment was started.

Outcomes:

The patient recovered, and subsequently, the treatment dose was tapered.

Conclusion:

Pyrantel is an antihelminthic that acts as an agonist of nicotinic acetylcholine receptors (AChRs) of nematodes and exerts its therapeutic effects by depolarizing their muscle membranes. Consequently, there may be an association between pyrantel pamoate and MG.
Early onset Peutz–Jeghers syndrome, the importance of appropriate diagnosis and follow-up
Authors: Mărginean Cristina Oana , Meliţ Lorena Elena , Patraulea Florin , Iunius Simu , Mărginean Maria Oana
Published: July 2019

Rationale:

Peutz–Jeghers syndrome (PJS) is currently defined as an inherited condition, also called a familial hamartomatous polyposis syndrome, characterized by the association between pigmented mucocutaneous lesions and hamartomatous polyps in the gastrointestinal tract, especially in the small bowel.

Patient concerns:

We present the case of a 7-year-old male patients, diagnosed at the age of 3 years with PJS due to a surgical intervention for acute abdominal pain that revealed a rectal polyp associated with hyperpigmented maculae on the lips and oral mucosa. His family history revealed the same condition in his mother, who was diagnosed much later, at the age of 25 years.

Diagnoses:

The upper and lower digestive endoscopy revealed multiple polyps of different sizes within the stomach, and 2 polyps at 5 cm from the anal orifice. The barium enterography revealed 3 polyps within the ileum.

Interventions:

We administered blood transfusions and both recto-anal polyps were surgically removed.

Outcomes:

The outcome was favorable and the patient was discharged with the recommendations for clinical assessment at least every 6 months, annual laboratory tests, but also follow-up of the detected polyps and screening by upper digestive endoscopy, barium enterography and colonoscopy every 2 years.

Lessons:

Early onset of PJS presenting with polys is quite rare since they require time for their development manifesting usually after the first decade of life. Close monitoring is essential for PJS in order to prevent potential complications and early detect the development of related malignancies.
Predicting factors of lateral neck lymph node metastases in patients with papillary thyroid microcarcinoma
Authors: Wu Xin , Li Binglu , Zheng Chaoji , He Xiaodong
Published: July 2019

The incidence of papillary thyroid microcarcinoma (PTMC) has increased dramatically in recent years. Compared with central lymph node metastases, lateral neck lymph node (LNLN) metastases in patients with PTMC were less studied. The aim of the present study is to analyze the predicting factors associated with LNLN metastases in patients with PTMC.

A total of 3514 patients underwent thyroid surgery at our hospital from January 2017 to December 2017, and 936 patients with PTMC were selected and assessed retrospectively. They were further divided into 2 groups based on whether LNLN metastases existed or not. The relationship between LNLN metastases and clinicopathologic features of PTMC was analyzed.

LNLN metastases were confirmed in 126 patients. Univariate and multivariate analyses found 5 independent factors associated with LNLN metastases. They were tumor size (≥0.7 cm) [odds ratio (OR) = 1.960, 95% confidence interval (95% CI) 1.227–3.131; P = .005], multifocality (OR = 2.254, 95% CI 1.398–3.634; P = .001), tumor location (upper portion) (OR = 6.312, 95% CI 3.853–10.340; P < .001), thyroid cancer family history (OR = 7.727, 95% CI 2.227–26.818; P = .001), and central lymph node metastases (OR = 11.810, 95% CI 6.547–21.302; P < .001).

The findings of our study indicated that LNLN metastases were not rare in patients with PTMC, and tumor size (≥0.7 cm), multifocality, tumor location (upper portion), thyroid cancer family history, and central lymph node metastases were independent factors for LNLN metastases. In order to perform individualized management, LNLN should be meticulously evaluated when these features are detected.
Pulmonary tuberculosis mimicking radiation pneumonitis in a patient with neck malignancy
Authors: Bae Kyungsoo , Jeon Kyung Nyeo , Choi Hoon Sik , Song Dae Hyun , Kim Ho Cheol
Published: July 2019

Rationale:

Primary or reactivation pulmonary tuberculosis (TB) is frequent in immunocompromised patients such as those with human immunodeficiency virus (HIV) infection, chronic renal failure, poorly controlled diabetes, and hematologic malignancy. Immune system of patients with solid-organ cancer can be also altered by malignancy itself or chemotherapy. However, information on the effect of radiation on patient's immunity is scarce. Herein, we present a case of pulmonary TB occurring in a radiation field that mimics focal radiation pneumonitis in a patient who has received curative chemoradiation therapy for neck malignancy. We also performed literature review to understand the impact of radiation therapy on patients’ immunity.

Patient concern:

A 56-year-old male patient visited our hospital with a palpable mass in the right supraclavicular fossa which was later confirmed as metastatic squamous cell carcinoma. After completion of concurrent chemoradiation therapy, a focal consolidation was developed in the right upper lobe apex where radiation was applied. The patient did not have any symptoms or signs of infectious disease.

Diagnosis:

Pulmonary TB was diagnosed through polymerase chain reaction (PCR) test and culture of sputum.

Intervention:

Anti-TB medication was started.

Outcome:

The patient was tolerable to anti-TB medication and the size of TB lesion gradually decreased.

Lesson:

A suspicion of pulmonary TB should be given to patients with new infiltrates in radiation port due to impact of radiation therapy on local infection barriers and patients’ immune system.