bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance of Remsima® Monitor Drug Level versus RIDASCREEN IFX Monitoring in therapeutic drug monitoring of infliximab in patients with inflammatory bowel disease: A study of diagnostic accuracy
Authors: Song Joo Hye , Hong Sung Noh , Kim Eun Ran , Chang Dong Kyung , Kim Young-Ho
Published: September 2022

Therapeutic drug monitoring (TDM) is effective in optimizing the efficacy of infliximab in patients with inflammatory bowel disease (IBD). An affordable way of monitoring is in high demand. This study evaluated the analytical and clinical performances of the newly available Remsima monitor kits and compared them with the established enzyme-linked immunosorbent assay kits. The trough level of infliximab in patients with IBD treated with an infliximab originator (Remicade) or biosimilar compounds (Remsima and Remaloce) was measured using a Remsima® Monitor Drug Level (Remsima) kit at the Samsung Medical Center, Seoul, Korea. Twenty-six plasma samples were collected immediately before the infusion of infliximab from 18 patients with IBD (Remicade, n = 8; Remsima, n = 6; and Remaloce, n = 4). The intra-assay intraclass correlation coefficient (ICC) of the RIDA and Remsima kits was 0.951 (95% CI = 0.908–0.976) and 0.990 (95% CI = 0.981–0.995). The inter-assay ICC of infliximab trough level between the RIDA and Remsima kits was very high (R = 0.971; 95% CI = 0.935–0.987), and the mean difference between the kits was 1.458 (95% limits of agreement = −3.302 to 6.219). The intra- and inter-assay reliabilities of all types of infliximab did not show significant differences. Qualitative stratification revealed substantial similarities between the kits (weighted kappa = 0.798). This study indicated that the Remsima kit was reproducible and highly correlated with the RIDA kit.
Preoperative walking intervention did not appear to improve patient-reported postoperative recovery in older adults with frailty traits: Randomized trial
Authors: Sadiq Hammad , Rampam Sanjeev , Patel Jay , Crawford Sybil , Walz Matthias , Kapoor Alok
Published: September 2022

Objectives:

To assess the impact of a preoperative walking intervention on improving postoperative recovery in at-risk frail older adult patients.

Study Type:

Unblinded, randomized controlled trial which assigned patients to intervention versus control.

Population:

Patients aged 60+ scheduled for surgery 3–8 weeks from randomization scoring 4+ on the Edmonton Frail Scale.

Intervention:

Preoperative walking enhanced by goal setting with an activity monitor and telephonic coaching.

Main Outcomes:

Quality of Recovery 9-item instrument total score and a modified version of the Abdominal Surgery Impact Scale total score

Results:

A total of 83 patients were analyzed. Postoperative recovery scores were similar in intervention vs control – Quality of Recovery-9 item instrument total score 14.1 vs. 14.1 (P = .94) and modified Abdominal and Surgery Impact Scale total score 82.8 vs. 79.2 (P = .93). Few intervention patients met their daily step count goals. Despite this, intervention patients improved average daily step counts significantly.

Conclusions:

Preoperative walking bolstered with activity monitor and remote coaching did not appear to lead to improved postoperative recovery in older adults with frailty traits. Further research is necessary to see if a similar intervention in specific surgery types or a more intense version of the intervention can improve recovery.
Risk factors for postoperative delirium in elderly urological patients: A meta-analysis
Authors: Hua Yaqi , Chen Shoulin , Xiong Xiaoyun , Lin Chuyang , Li Dongying , Tu Ping
Published: September 2022

Background:

Avoiding postoperative delirium (POD) can have a significant detrimental effect on the rehabilitation and prognosis of elderly urological patients. It is necessary to explore the risk factors associated with POD in elderly urology to provide a basis for clinical recognition of delirium.

Methods:

For relevant studies, we comprehensively searched Embase, MEDLINE, Ovid, PubMed, Scopus, The Cochrane Library, and Web of Science. The search deadline was September 2021.

Results:

We identified 2046 studies, 8 of which were included in the ultimate analysis. A total of 8 articles, including 356 cases in the delirium group and 1813 cases in the non-delirium group, were included in the relevant literature. The 2 groups mentioned above differed significantly in the following factors: history of delirium (odds ratio [OR] = 6.98, 95% confidence interval [CI]: 1.63–29.86, P = .009); Preoperative use of psychotropic drugs (OR = 1.97, 95% CI: 1.11–3.52, P = .02); age (OR = 3.10, 95% CI: 2.08–4.12, P < .0001). The meta-analysis demonstrated that smoking, alcohol consumption, gender (male), mode of anesthesia (general anesthesia) and being unmarried did not have a significant effect on POD in elderly urological patients.

Conclusion:

The risk factors for POD in elderly urological patients include history of delirium, preoperative use of psychotropic drugs, and age. The present study provides guidance for taking targeted preventive measures to reduce risks.
Effect of chrono-moxibustion and its influence on circadian rhythm for rheumatoid arthritis: A study protocol for a randomized controlled trial
Authors: Yu Mingfang , Yang Shenqiao , Chen Bailu , Gan Lu , He Xinling , Wang Aiyang , Wu Xiao
Published: September 2022

Background:

Rheumatoid arthritis (RA) is a chronic disease which is characterized by a circadian variation of key clinical symptoms and findings, with prominent joint swelling, stiffness and pain occurring in the early morning and light clinical symptoms during the day. Chrono-moxibustion is carried out at different time, which could result in dissimilar therapeutic effects. However, its efficacy has seldom been systematically demonstrated and few studies have reported that Chrono-moxibustion may regulate the circadian rhythm of RA. We therefore designed a randomized trial to explore the effective difference of Chrono-moxibustion in RA treatment, as well as to study its influence on circadian rhythm of RA patients.

Methods:

This study is a randomized controlled trial involving 120 participants, and a total of 90 eligible RA patients will be randomly allocated to three groups in a 1:1:1 ratio as moxibustion at 7 to 9 am, moxibustion at 5 to 7 pm, and waiting list group, meanwhile, 30 healthy people will be divided into the control group. Patients in moxibustion groups will be treated for 30 minutes per session, 3 times a week, lasting 6 weeks. All of RA patients will be evaluated with questionnaires and laboratory tests before treatment, as well as 3 weeks, 6 weeks, and 3 months after treatment. One way analysis of variance (ANOVA) with multiple comparisons will be applied to identify differences more than two groups. Halberg cosiner software will be used to analysis the circadian rhythm.

Results:

The results of this study will be published in a peer-reviewed journal.

Conclusion:

This study will provide evidence-based evidence for the effective difference of Chrono-moxibustion in RA treatment and its influence on circadian rhythm of RA patients.
The thickness of erector spinae muscles can be easily measured by computed tomography for the assessment of physical activity: An observational study
Authors: Shimoda Masafumi , Takao Satoshi , Sugajima Yasushi , Tanaka Yoshiaki , Morimoto Kozo , Yoshida Naoyuki , Yoshimori Kozo , Ohta Ken , Senjyu Hideaki
Published: September 2022

The loss of muscle mass and changes in muscle composition are important factors for assessing skeletal muscle dysfunction. The cross-sectional area (CSA) of muscle is usually used to assess skeletal muscle function. However, the CSA of skeletal muscle can be difficult for clinicians to measure because a specific 3D image analysis system for computed tomography (CT) scans is needed. Therefore, we conducted a study to develop a new method of easily assessing physical activity, in which the thickness of the erector spinae muscles (ESMT) was measured by CT, and to compare ESMT to the CSA of the erector spinae muscles (ESMCSA) in patients with nontuberculous mycobacteria (NTM) pulmonary infections who underwent surgery after some preoperative examinations, such as laboratory tests, chest CT scans, spirometry, and 6-minute walk tests (6MWT). We retrospectively studied adult patients with NTM pulmonary infections who underwent a lobectomy at Fukujuji Hospital from April 2010 to March 2016. We assessed the correlations between ESMT and different variables, including ESMCSA. Sixty-one patients with NTM pulmonary infections were included. The median ESMT and ESMCSA were 1371 mm2 (IQR 1178–1784 mm2) and 28.5 mm (IQR 25.4–31.7 mm), respectively, and a very strong linear correlation was observed between ESMT and ESMCSA (R = 0.858, P < .001). ESMT and ESMCSA were positively associated with body weight (ESMT: R = 0.540, P < .001, ESMCSA: R = 0.714, P < .001), body mass index (ESMT: R = 0.421, P < .001, ESMCSA: R = 0.560, P < .001), the 6MWT value (ESMT: R = 0.413, P = .040, ESMCSA: R = 0.503, P = .010), vital capacity (ESMT: R = 0.527, P < .001, ESMCSA: R = 0.577, P < .001), and the forced expiratory volume in 1 second (ESMT: R = 0.460, P < .001, ESMCSA: R = 0.532, P < .001). We demonstrated that compared to ESMCSA, ESMT is easily measured by CT and can be a useful parameter for clinically evaluating physical activity. Furthermore, ESMT and ESMCSA were related to physical activity, as measured by the 6MWT and spirometry.
Anxiety level in severe asthmatics undergoing bronchial thermoplasty procedure: An observational study
Authors: Alismail Abdullah , Sutzko Kandice , Daher Noha , Welch Mark , Ramirez Raul , Webb Andrea , Tan Laren D.
Published: September 2022

Bronchial thermoplasty (BT) is one of the novel approved modalities in treating severe asthmatics to overcome their exacerbating symptoms such as increased anxiety. The purpose of this study was to evaluate anxiety level among severe asthmatics while undergoing BT procedure. This was an observational study where subjects self-evaluated their overall anxiety level using the burns anxiety inventory (BAI) questionnaire at baseline and prior to each of three BT treatments (broncho thermoplasty procedure 1, broncho thermoplasty procedure 2, and broncho thermoplasty procedure 3). The BAI questionnaire consisted of three different categories with each category having specific symptoms. Categories were grouped as: Anxious feelings, Anxious thoughts, and Physical symptoms. Subjects’ Asthma Control Tests were also collected for analysis before and after the BT procedure. A total of 17 subjects with a mean age of 55.9 ± 14.5 years participated in the study. Fifty three percent were females (n = 9) and 41.2% (n = 7) were on prescribed anxiety medications. There was a significant drop in the patients’ overall BAI anxiety level over time,P < .0001, in Anxious feelings (P = .0001), anxious thoughts (P = .001), and physical symptoms (P = .025). When analyzing the change in anxiety level among those who were not on prescribed anxiety medications, significant drop in overall anxiety level and in the subcategories were also noted. (P < .05). In addition, ACT scores showed a significant improvement (post vs pre) (18.5 ± 4.0 vs 13.3 ± 6.3,P = .03; Cohen’s d = 0.73). This study shows the effectiveness of BT in decreasing severe asthmatic anxiety levels from baseline to last BT treatment and this benefit was mostly noted in those who were not on any anxiety medications. A limitation of this study is that all subjects were recruited from a single center. Therefore, to further validate the study findings, a multi-center study needs to be conducted with a larger sample size.
Typeable ampicillin-resistant Haemophilus influenzae strains in Tunisian’s children
Authors: Mzilem Sabrine , Boukhchina Sadok
Published: September 2022

Background:

Here, we report the frequency of capsulated ampicillin-resistant Haemophilus influenzae strains isolated from children in Tunisia, particularly capsular serotype b, by polymerase chain reaction (PCR) to determine the molecular mechanisms underlying ampicillin resistance.

Methods:

We considered 22 capsulated H influenzae strains selected from a series of 91 ampicillin-resistant H influenzae strains isolated from children between 2010 and 2011 in Tunisia. The capsular serotypes of these strains were identified by slide agglutination and PCR.

Results:

By PCR, 19 (20.88%) serotype b, 1 (1.1%) serotype a, 2 (2.2%) serotypes d and f and 69 (75.82%) non-typeable strains were found among the 91 ampicillin-resistant H influenzae strains. 100% of the assumption between the consequences of antigenic examinations and PCR was found. The serotype b strains showed biotypes I, II, III, IV, VI, and VIII. The other capsulated strains showed biotypes IV and VIII. Thirteen of the serotype b strains created β-lactamase (14.28%). The 19 serotype b ampicillin-resistant H influenzae strains were subdivided into 3 bunches as indicated: The gathering of the β-lactamase positive, ampicillin-resistant where 11 strains (57.89%) were β-lactamase positive bla
TEM-1 (+) and ftsI (+). The second gathering of the β-lactamase negative, ampicillin-resistant strains, where 6 isolates (31.58%) were β-lactamase negative bla
TEM-1 (−) and ftsI (−), and lastly, the gathering of the β-lactamase positive, amoxicillin-clavulanate resistant where 2 isolates (10.52%) were β-lactamase positive bla
TEM-1 (+) and ftsI (−).

Conclusion:

PCR should be used in our country because it may contribute to decreasing the probability of transmission of these strains, especially those showing the two mechanisms of resistance among children in Tunisia.
To discuss the mechanism of colchicine in the treatment of acute cerebral infarction based on network pharmacology
Authors: Hu Qiaoxia , Luo Kena , Liu Puheng , Mei Yifei
Published: September 2022

To explore the mechanism of action of colchicine in the treatment of acute cerebral infarction (ACI) based on network pharmacology. The Swiss Target Prediction Database and CTD database were used to predict the target information of colchicine. ACI-related targets were retrieved using the GeneCards database, and the target protein interaction network (PPI) and active ingredient-target network were obtained by combining Cytoscape 3.7.1 software and R language. Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis and gene function analysis (GO) enrichment analysis were performed using R language to preliminarily explore the multiple pharmacological mechanisms of action of colchicine. There were 200 targets identified by network parameter analysis; 958 ACI targets were identified. Overlapping comparisons allowed the extraction of 143 overlapping targets, and the top 30 targets were screened according to the topological isomerization parameters. Component-target networks were constructed. A PPI of overlapping targets was established to identify key targets. In addition, Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis and GO functional enrichment analysis were performed to explore the multiple mechanisms of action of colchicine in the treatment of ACI. Colchicine treatment of ACI is characterized by multi-component, multi-target and multi-pathway, and can exert complex network regulation through the interaction between different targets, providing a new idea and new basis for further exploration of the mechanism of action of colchicine in the treatment of ACI.
YouTube as a source of information on endoscopic retrograde cholangiopancreatography
Authors: So Hoonsub , Kim Do Won , Hwang Jun Seong , Ko Sung Woo
Published: September 2022

Endoscopic retrograde cholangiopancreatography (ERCP) carries a higher risk of adverse events than standard endoscopy. Internet media platforms such as YouTube has emerged as a medical information source. Therefore, study aimed to identify whether YouTube videos provide appropriate information on ERCP to the general population. The YouTube search was performed using the terms “endoscopic retrograde cholangiopancreatography” and “ERCP”. The top 50 results of both searches, sorted by relevance and view count, were collected. After filtering according to a set of inclusion and exclusion criteria, a total of 26 videos were eligible for the final analysis. For quality assessment, we created a scoring system called ERCP Data Quality score (E-DQS), based on a colonoscopy education video available on the American Society of Gastrointestinal Endoscopy website. Healthcare professionals uploaded 14 (53.8%) videos, and 10 (38.6%) uploaded by medical websites. Only one video was uploaded by a layperson and one by a TV channel. The overall median E-DQS score for enrolled videos was 6.5 out of 20. The majority of videos did not describe the unique features of ERCP. Only 50% of videos informed viewers that patients would be irradiated and only six videos described at least one adverse event related to ERCP. ERCP videos on YouTube provide inadequate information regarding ERCP. Considering the unique characteristics of this procedure, professionals and academic societies need to be vigilant and proactive in producing and promoting high-quality videos.
Associations between different eGFR estimating equations and mortality for CVD patients: A retrospective cohort study based on the NHANES database
Authors: Zhang Zuhong , Zhu Maofang , Wang Zheng , Zhang Haiyan
Published: September 2022

To assess the associations of eGFRCKD-EPI (estimated glomerular filtration rate (eGFR) by chronic kidney disease epidemiology collaboration equation), eGFRMDRD (eGFR by modification of diet in renal disease), and serum creatinine (scr) on the death for American people diagnosed with cardiovascular disease (CVD) respectively, and to compare the predicted performance of eGFRCKD-EPI, eGFRMDRD, and scr. A total of 63,078 participants who derived from the National Health and Nutrition Examination Survey (NHANES) database, were obtained in this retrospective cohort study, and collected the baseline characteristics all participants. The outcomes of our study were defined as death, and eGFR estimating equations was defined as eGFRCKD-EPI, eGFRMDRD, and scr. Univariate and multivariate COX analysis were performed to assess the relationship. A subgroup analysis was conducted based on whether patients had anemia. Simultaneously, we also considered the predictive value of eGFRCKD-EPI, eGFRMDRD, and scr in the risk of death. All patients were followed for at most 5-years. After excluded participants who did not meet the inclusion criteria and had missing information, the present study included 2419 participants ultimately, and were divided into alive group (n = 1800) and dead group (n = 619). The mortality rate for CVD patients in this study was approximately 25.59% at the end of follow-up. After adjustment for covariates, the result showed that participants with eGFRCKD-EPI/eGFRMDRD < 30 mL/min/1.73 m2 or 30 to 45 mL/min/1.73 m2 had a higher risk of mortality. Similarly, participants with scr (Q4 ≥ 1.2) were associated with the increased risk of death. Additionally, eGFRCKD-EPI has a higher predictive value in 1-year, 3-years, and 5-years risk of death among patients with CVD than eGFRMDRD and scr. The lower level of eGFR was associated with higher risk of death among American population diagnosed with CVD, especially for non-anemic patients. Importantly, our study also displayed that CKD-EPI-based calculation equation of eGFR (eGFRCKD-EPI) provided for a better predictive value than eGFRMDRD and scr in the risk of death.
A clinical study to observe the efficacy and safety of Besunyen Detox Tea for constipation
Authors: Fei Wenting , Zhang Jianjun , Wang Linyuan , Yang Yi , Chen Yan , Chen Yawen , Tao Ran , Zhu Yingli
Published: September 2022

Introduction:

Functional constipation (FC) is a common functional gastrointestinal disease and is one of the most common outpatient diseases. The purpose of this study was to investigate the efficacy and safety of the traditional Chinese medicine Besunyen Detox Tea (BDT) for FC and to compare the effect of BDT between constipation patients with and non-dryness-heat syndrome.

Methods and analysis:

This multicenter, prospective, observational registry study included 1000 participants diagnosed with FC. This study will collaborate with 3 comprehensive hospitals and 15 community hospitals and recruit patients into the registry between July 2022 and July 2023. After enrollment, we will collect the individual characteristics of each patient, anthropometric data and general condition, bowel movement, patient assessment of constipation symptoms, patient assessment of constipation quality of life, TCM syndrome scale, and time to take the laxative product again after treatment. We will also record adverse events and economic indicators at each visit.

Discussion:

This is the first registry-based study to collect real-world data of participants diagnosed with FC receiving BDT treatment. The results of this registry may also reflect these characteristics and provide direct clinical evidence to verify the importance of syndrome differentiation and treatment for the use of TCM health care products.
Sintilimab combined with chidamide in the treatment of extranodal nature killer/T-cell lymphoma with secondary hemophagocytic lymphohistiocytosis: Two case reports and literature review
Authors: Xu Qing-Yuan , Yang Hai-Yan , Li Mei-Wei , He Zhen-Dong , Hong Hao-Yuan , Peng Zhi-Gang
Published: September 2022

Rationale:

Extranodal nature killer/T-cell lymphoma (ENKTL) failing in asparaginase-containing treatments is fatal, it has a higher mortality rate when accompanied by secondary hemophagocytic lymphohistiocytosis (HLH). The study reported 2 ENKTL-related HLH patients.

Patient concerns:

Patient 1 visited for nasal congestion and runny nose for 6 months then got a fever and serious myelosuppression after P-GEP (pegaspargase, gemcitabine, etoposide, and methylprednisolone) chemotherapy. Patient 2 complained of painless lymphadenectasis in the right neck for 4 months and experienced recurrent fever and poor performance status after 3 cycles of P-Gemox (pegaspargase, gemcitabine, and oxaliplatin) chemotherapy.

Diagnoses:

Patient 1 and patient 2 were diagnosed as ENKTL failing in asparaginase-based chemotherapy and involving secondary HLH.

Interventions:

The dose of chidamide was 20 mg twice a week for 2 weeks and sintilimab was 200 mg once every 3 weeks.

Outcomes:

ENKTL was relieved and the HLH was resolved after the therapy of sintilimab and chidamide. The patients had achieved durable survival without immune-related adverse events.

Lessons:

ENKTL-related HLH needs early diagnosis and treatment. The combined strategy of sintilimab plus chidamide help deal with HLH and solve ENKTL, it may be a useful treatment option for ENKTL-related HLH.
The efficacy of parecoxib in improving pain after total knee or total hip arthroplasty: Systematic review and meta-analysis
Authors: Hong Chuan , Xie Hai-Yan , Ge Wu-Kun , Yu Min , Lin Shuai-nan , Liu Cheng-Jiang
Published: September 2022

Background:

The cyclooxygenase-2 (COX-2) selective inhibitor parecoxib is widely used in the treatment of pain and inflammation. Parecoxib has been adopted for use for postoperative analgesia following a range of surgical procedures (orthopedic, general, gynecological, and dental surgery). Total knee or total hip arthroplasty (THA) surgery is mostly done in older patients, so postoperative analgesics need to be used more carefully, and the safety and efficacy of parecoxib in this type of surgery need to be further verified. The aim of this study was to investigate the effects of parecoxib on patient safety, cumulative morphine consumption and was at 24 and 48 hours in the analgesic treatment of total knee or THA for meta-analysis and systematic review, with few studies in this area so far.

Methods:

We searched the Online Database Cochrane Library, PubMed, Web of Science, EMBASE, and CBM (SinoMed), CNKI, VIP, WANFANG up to January 2021. According to the value of I
2, the random-effect model or fixed-effect model was supposed to combine data from studies, respectively. Publication bias was assessed through funneling plot and Beggs test. Review Manager 5.3 and Stata 16.0 software were applied to perform the statistical analyses.

Results:

Eleven RCTs which involved 1690 participants were included in this study. The meta-analysis indicated parecoxib sodium could not significantly reduce the incidence of adverse events after total knee or THA compared with placebo. There was no statistical significance in incidence of nausea and vomiting. 24 hours resting VAS score was statistically significant between the group. The 48-hour resting VAS scores did not indicate a significant difference between the groups.

Conclusion:

Parecoxib can reduce the incidence of adverse events after total knee or total hip surgery to some extent but cannot reduce the incidence of nausea and vomiting. Twenty-four hour postoperative analgesia is better than placebo, but 48 hours after operation analgesia is the same as placebo.
Outcome of ruptured anterior communicating artery aneurysm treatment compared between surgical clipping and endovascular coiling: A single-center analysis
Authors: Lee Sang Houn , Park Jung Soo
Published: September 2022

The optimal treatment modality for ruptured anterior communicating artery (ACoA) aneurysms is unclear. Therefore, in this study, we aimed to compare the outcomes of endovascular coiling and surgical clipping to treat ruptured ACoA aneurysms. A retrospective analysis of 213 consecutive patients with ruptured AcoA aneurysms, who were treated with coiling or clipping between January 2010 and December 2020, was conducted. Of the 213 patients, 94 and 119 underwent clipping and coiling, respectively. The mean age was higher in the coiling group than in the clipping group (60.3 ± 13.2 vs. 53.5 ± 13.4, P < .001). The mean diameter of the aneurysmal neck was larger in the clipping group (3.4 mm vs. 3.0 mm, P = .022), whereas the dome-to-neck ratio (1.53 ± 0.52 vs. 1.70 ± 0.60, P = .031) and aspect ratio (1.67 ± 0.51 vs. 1.92 ± 0.77, P = .005) were larger in the coiling group. The prevalence of vasospasm was higher in the clipping than in the coiling group (42.6% vs. 26.9%, P = .016). The coiling group had a shorter mean intensive care unit hospitalization (18.3 vs. 12.1, P = .002) and more frequently showed favorable outcomes (Glasgow Outcome Scale 4, 5; 57.4% vs 73.1%, P = .016) compared to the clipping group. Multivariable logistic analysis showed that good initial WFNS grade (odds ratio [OR] = 6.69, 95% confidence interval [CI]: 2.69–16.65, P < .001), treatment with coiling (OR = 3.67, 95% CI: 1.70–7.90, P = .001), and absence of the need for cerebrospinal fluid diversion (OR = 5.21, 95% CI: 2.38–11.39, P < .001) were independent predictors of favorable outcomes in patients with ruptured ACoA aneurysms. Ruptured ACoA aneurysms can be safely and effectively treated using both clipping and coiling modalities. However, it may be beneficial to consider coiling as the first option for treating these aneurysms.
Effects of schedule exercise therapy on chronic insomnia
Authors: Liao Yuan-Gao , Huang Feng-Zhen , Ni Xiao-Hong , Ke Hong-Yan , Tian Yu , Yu Mei , Jin Guo , Chen Gui-Hai
Published: September 2022

Schedule exercise therapy (SET) is a novel nonpharmacological intervention for the treatment of chronic insomnia disorder (CID). The aim of this study was to explore the effects of SET on CID. Methods: One hundred and eighteen CID were recruited and randomized into medication (MED) or medication combined with SET (MSET) groups. Over 12 observational weeks, sleep and mood status were evaluated using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS). At the end of the observational period, the rates of clinically effective hypnotic use were calculated. At 12 weeks, the PSQI progressively decreased for all subjects combined (P < .001) as well as ISI (P < .001), ESS (P < .001), SDS (P < .001), and SAS (P < .001). The decreases in PSQI (P < .05), ISI (P < .05), SDS (P < .01), and SAS (P < .05) in the MSET group were significantly larger than those in the MED group, but not the same as those in the ESS group (P > .05). At the trial endpoint, the clinically effective rate was significantly higher (P < .05) and the hypnotic usage rate was lower (P < .05) in the MSET group than in the MED group. SET may be an effective treatment for insomnia in patients with CID.
Assessment of physicians’ knowledge about brain death and organ donation and associated factors
Authors: Fernandes Vasconcelos Tauana , Gonçalves Menegueti Mayra , Corsi Carlos Alexandre Curylofo , Michelon-Barbosa Jéssyca , Sato Lucas , Basile-Filho Anibal , Becari Christiane , Dantas Rosana Aparecida Spadoti , Auxiliadora-Martins Maria
Published: September 2022

Precocity and assertiveness when diagnosing brain death are essential for identifying potential donors. To assess the knowledge of physicians about brain death and organ donation, cross-sectional web-based survey was carried out with physicians from different specialties. The knowledge about brain death and organ donation was assessed by a questionnaire with 12 multiple-choice or multiple-answer questions (possible range from 0 to 12). The nonparametric Mann–Whitney and Kruskal–Wallis tests were performed to verify the association between the physicians’ knowledge and others variables. The project was approved by the Research Ethics Committee of the Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, under number 4.022.657, and all patients agreed to participate and provided free prior-informed consent. Three hundred sixty physicians were included in this study, most of them have postgraduate (55%) and 59.2% were intensive care physicians. The median of responses was 5 (obtained range from 0 to 10). The participants were classified in 2 groups: with satisfactory knowledge (scores above 5) or without satisfactory knowledge (scores equal/below 5). There was better performance among participants who: completed graduation between 6 and 10 years (P < .012); were intensive care physicians (P < .002); had participated in training courses (P < .001); and those who had worked in intensive care unit (ICU) from 6 to 10 years (P < .023); had performed over 10 brain death protocols (P < .001), and felt safe to talk to family members about brain death (P < .001). The results showed that the participants had low knowledge about diagnosis of brain death and organ donation protocols despite the majority working in ICUs. Be an intensive care physician, had large time experience in ICU, and had performed brain death protocols were associated with unsatisfactory knowledge concerning the subject.
High frequencies of adaptive NK cells are associated with absence of coronary plaque in cytomegalovirus infected people living with HIV
Authors: Alsulami Khlood , Sadouni Manel , Tremblay-Sher Daniel , Baril Jean-Guy , Trottier Benoit , Dupuy Franck P. , Chartrand-Lefebvre Carl , Tremblay Cécile , Durand Madeleine , Bernard Nicole F.
Published: September 2022

The objective of this study was to evaluate whether adaptive NKG2C+CD57+ natural killer (adapNK) cell frequencies are associated with pre-clinical coronary atherosclerosis in participants of the Canadian HIV and Aging Cohort Study. This cross-sectional study included 194 Canadian HIV and Aging Cohort Study participants aged ≥ 40 years of which 128 were cytomegalovirus (CMV)+ people living with HIV (PLWH), 8 were CMV−PLWH, 37 were CMV mono-infected individuals, and 21 were neither human immunodeficiency virus nor CMV infected. Participants were evaluated for the frequency of their adapNK cells and total plaque volume (TPV). TPV was assessed using cardiac computed tomography. Participants were classified as free of, or having, coronary atherosclerosis if their TPV was “0” and ">0,” respectively. The frequency of adapNK cells was categorized as low, intermediate or high if they constituted <4.6%, between ≥4.6% and 20% and >20%, respectively, of the total frequency of CD3−CD56dim NK cells. The association between adapNK cell frequency and TPV was assessed using an adjusted Poisson regression analysis. A greater proportion of CMV+PLWH with TPV = 0 had high adapNK cell frequencies than those with TPV > 0 (61.90% vs 39.53%, P = .03) with a similar non-significant trend for CMV mono-infected participants (46.15% vs 34.78%). The frequency of adapNK cells was negatively correlated with TPV. A high frequency of adapNK cells was associated with a relative risk of 0.75 (95% confidence intervals 0.58, 0.97, P = .03) for presence of coronary atherosclerosis. This observation suggests that adapNK cells play a protective role in the development of coronary atherosclerotic plaques.
Association of blood pressure and hypertension with radiographic damage among the patients with ankyloing spondylitis
Authors: Chen Chun-Hsiung , Chen Hung-An , Liao Hsien-Tzung , Chou Chung-Tei , Chen Chen-Hung
Published: September 2022

To investigate the association of blood pressure and hypertension with disease severity among the patients with ankyloing spondylitis (AS). There were 167 AS patients enrolled in the cross-sectional study. Blood pressure was measured and the presence of hypertension was recorded. Patient’s disease severity, including disease activity, functional ability, patient’s global assessments, physical mobility and radiographic damage were evaluated. ESR and CRP levels were tested. We recorded patient’s medication use of NSAIDs, DMARDs and TNF-α blockers. Smoking, exercise habit, diabetes mellitus, hypercholesterolemia and obesity indices were assessed. Multivariate linear regression showed that systolic blood pressure was associated with TNF-α blocker [standard coefficient (β) = 0.194, P = .007], DMARDs (β = 0.142, P = .046), age (β = 0.211, P = .003), male gender (β = 0.242, P = .001) and body mass index (BMI) (β = 0.245, P = .001). Diastolic blood pressure was associated with cervical rotation (β = −0.174, P = .037), lateral lumbar flexion (β = −0.178, P = .019), m-SASSS (β = 0.198, P = .038) and BMI (β = 0.248, P = .003). Notably, multivariate logistic regression showed that hypertension was associated with m-SASSS (OR = 1.033, P = .033), age (OR = 1.098, P = .0010) and BMI (OR = 1.210, P = .003). Using ROC cure analyses, age, BASMI, BASRI-Total, m-SASSS, waist circumference, BMI and waist-to-height ratio were useful in predicting hypertension, and m-SASSS is the best (AUC = 0.784, P < .001). Advanced radiographic damage is an independent risk factor of hypertension in AS, and m-SASSS is the most useful disease severity parameter in predicting the presence of hypertension. Advanced radiographic damage, poor cervical rotation, lateral lumbar flexion, older age, male gender, TNF-α blocker, DMARDs use and obesity are associated with increased blood pressure.
Efficacy of immune checkpoint inhibitor as maintenance therapy for advanced or metastatic cancers: A meta-analysis of randomized controlled trials
Authors: Mo Dun-Chang , Huang Jian-Feng , Luo Peng-Hui , Huang Shang-Xiao , Wang Han-Lei
Published: September 2022

Background:

This study aimed to evaluate the efficacy of immune checkpoint inhibitors (ICIs) as maintenance therapy for advanced or metastatic cancers.

Methods:

The PubMed, Embase, and Cochrane Library databases were searched for eligible randomized controlled trials. A meta-analysis of eligible studies investigating the outcomes including progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) with a significance level set to 0.05 was performed.

Results:

Five RCTs (n = 2828) were identified in this analysis. The pooled hazard ratios (HRs) of PFS and OS for ICI maintenance therapy were 0.88 (95% CI: 0.68–1.13, P = .31) and 0.82 (95% confidence interval [CI]: 0.74–0.92, P = .0005), respectively; the pooled odds ratio (OR) of ORR was 2.24 (95% CI: 1.23–4.09, P = .0008). Subgroup analysis indicated that anti-PD-L1 antibody significantly improved the OS (P = .0008), while anti-PD-1 and anti-PD-1 plus anti-cytotoxic T lymphocyte antigen 4 antibodies significantly prolonged the PFS of patients.

Conclusion:

ICI maintenance therapy enhanced the survival of patients with advanced or metastatic cancers.
Brief Report: Use of Pre-Exposure Prophylaxis to Prevent Rapid HIV Transmission Among People Who Inject Drugs in Rural Counties in the United States: A Modeling Study
Authors: Jacka Brendan P. , Nolen Shayla , Bessey Sam E. , Zang Xiao , Goedel William C. , Yedinak Jesse L. , Marshall Brandon D.L.
Published: September 2022

Background:

Despite recent HIV outbreaks among people who inject drugs (PWID) in nonurban US settings, syringe service programs (SSP) are often inaccessible in these communities. Furthermore, pre-exposure prophylaxis (PrEP) awareness and coverage for PWID is limited. We aimed to model the impact of PrEP on HIV transmission among PWID in a rural setting.

Setting:

Using a calibrated agent-based model, we simulated HIV transmission in an adult population (n = 14,573 agents) in Scott County, Indiana between 2015 and 2024.

Methods:

We modeled PrEP eligibility according to CDC guidelines for PWID. PrEP coverage increased by 15% points in the range 10%–70%. Two counterfactual scenarios were modeled: Unrestricted access for PWID and PrEP for SSP attendees. We calculated the number of new HIV infections and number of person-years on PrEP per averted infection.

Results:

In the status quo scenario, 153 (95% Simulation Interval: 85, 259) new HIV infections occurred among PWID over 10 years. Compared with the status quo, 40% PrEP coverage resulted in 25% fewer HIV infections in the Unrestricted access for PWID scenario and 10% fewer HIV infections in the PrEP for SSP attendees scenario. The PYPAI was 21 and 43 in the Unrestricted access for PWID and PrEP for SSP attendees scenarios, respectively.

Conclusion:

Our modeling suggests that PrEP provides substantial benefit to PWID in rural US communities, with fewer restrictions on access providing the greatest effect. Control of HIV outbreaks will require expansion of public health interventions that meet the needs of all individuals.
Limited Impact of First-Line Drug Resistance Mutations on Virologic Response Among Patients Receiving Second-Line Antiretroviral Therapy in Rural Uganda
Authors: Moore David M. , Nanfuka Mastula , Zhang Wendy , Okoboi Steven , Kaleebu Pontiano , Kapaata Anne , Zhu Julia , Tibengana Baker , Birungi Josephine
Published: September 2022

Background:

Delayed detection of ART failure in settings without access to viral load (VL) monitoring has been hypothesized to lead to suboptimal response to second-line therapy due to accumulated drug resistance mutations (DRMs). We tested this hypothesis in a program setting in rural Uganda.

Methods:

From June 2012 to January 2014, we enrolled participants receiving nonnucleoside reverse transcriptase inhibitor–based first-line ART for ≥4 years, without access to VL monitoring. Participants who had a measured VL ≥ 1000 copies/mL on two occasions were switched to protease inhibitor–based regimens and followed every 6 months until September 2016. We measured VL at study exit. We conducted DRM testing at enrollment and study exit and examined factors associated with virologic failure.

Results:

We enrolled 137 participants (64.3% female) with a median age of 44 years and a median duration on ART of 6.0 years. In a median of 2.8 years of follow-up, 7 (5%) died, 5 (3.6%) voluntarily withdrew, and 9 (6.6%) became lost to follow-up. Of 116 participants with a VL result at study exit, 20 (17%) had VL > 1000 copies/mL. Virologic failure was associated with reporting suboptimal adherence (P = 0.028). Of patients with DRM data at enrollment, 103 of 105 (98%) had at least 1 DRM. Participants with thymidine analog mutations at enrollment were less likely to have virologic failure at study exit (11% vs. 36%; P = 0.007). No other DRMs were associated with failure.

Conclusion:

Even in the presence of multiple DRMs on first-line therapy, virologic failure after 3 years of protease inhibitor–based ART was infrequent. Suboptimal adherence to ART was associated with virologic failure.
A Modified Scapular-Parascapular Flap Design for Optimal Coverage of the Residual Limb
Authors: Wade Sean M. , Brandenburg Larissa R. , Michael Nicholas L. , Souza Jason M.
Published: September 2022

Background

Large soft tissue defects associated with major limb amputation pose a challenge to the reconstructive surgeon due to the 3-dimensional contour of the residual limb and the need to withstand the unnatural shear forces imparted by prosthetic sockets. Fasciocutaneous flaps based on the circumflex scapular system have proven useful for residual limb coverage due to the durability of the tissue provided, the absence of functional morbidity, and the ease of reelevation. A modified, bilobed flap design that incorporates large Burrow triangles into each limb serves to leverage the perforasome anatomy of the posterior trunk to provide maximal 3-dimensional coverage and favorable flap geometry while also facilitating donor site closure.

Methods

A retrospective medical record review was performed for all patients who underwent reconstruction of a residual limb after major amputation using the modified, bilobed scapular-parascapular free flap design at Walter Reed National Military Medical Center between 2018 and 2021. A computer-based application was used to calculate flap area and dimensions based on photographs of preoperative and intraoperative markings.

Results

Six patients with varying amputation levels (2 transtibial, 1 transfemoral, 1 hip-disarticulation, 1 hemipelvectomy, 1 transradial) underwent soft tissue coverage using the modified flap design. Mean flap area was 318.4 cm2 with 51.1 cm2 attributable to the modified design. This represents a 16% increase over a conventional bilobed design. There were no partial or complete flap failures.

Conclusions

The modified scapular-parascapular flap design enables harvest of a larger and more versatile fasciocutaneous flap with geometry that is well suited for coverage of the residual limb.
Long-Term Follow-up in Labiaplasty in 414 Women
Authors: Qiang Shuai , Li Feng Yong , Zhou Yu , Cao Yu Jiao , Liu Mei Chen , Li Qiang
Published: September 2022

Women with labial hypertrophy may opt for labiaplasty. The aim of the study was to analyze the complications, long-term follow-up of clinical outcomes and satisfaction in this population over the past 10 years.

All women who underwent labiaplasty with or without clitoral hood reduction at our center between January 2008 and August 2020 were retrospectively identified. Retrospective study was conducted, recording follow-up outcomes, motivations, techniques, postoperative complications, reasons requiring reoperation, and surgical satisfaction concerned different clinical characteristics. A concrete analysis of each specific outcome and a detailed knowledge of these procedures were performed.

A total of 52.41% reported functional impairment, 20.25% cited aesthetics complains, and 27.34% were motivated by both the previously mentioned reasons. Women undergoing surgical correction sometimes mixed with various psychological aspects. A total of 91.06% reported that they were moderately (6.04%) or extremely (85.02%) satisfied with the outcomes after surgery, and 37 (8.94%) reported dissatisfied. Revision surgery was needed in a small number of patients (n = 7 of 414 patients, 1.69%) because of undesirable appearance. The most common complication in our patients was asymmetry (6.28%). Women requested labiaplasty in the last 2 reasons or procedures or without psychological distress were more likely feel satisfied with the results (satisfaction rate >90%). There was a significant difference in satisfaction among the 3 concerns as well as between the 2 kinds of psychological conditions (P < 0.05). Satisfaction of patients with aesthetic complains compared with the other 2 worries was significantly lower (P < 0.05). There was no significant difference among the 3 procedures in this comparison group (P > 0.05). In addition, satisfaction in labiaplasty with or without clitoral hoodoplasty, neither of which was statistically different (P > 0.05). Patients aged 30 to 39 years reported the lowest satisfaction in comparison with the other age groups.

Labiaplasty of the labia minora is the most commonly performed genital cosmetic surgery procedure. This study on 414 patients demonstrated that it is associated with a high degree of patient satisfaction and low morbidity and provided evidence of safety and effectiveness preliminary, indicating that the procedure may be regarded as safe.
Comprehensive Management of Infantile Hemangiomas Involving the Periorbital Region
Authors: Chen Wei-liang , Lan Yu-qing , Hong Lei , Dong Xiao-yu
Published: September 2022

Periocular infantile hemangioma (pIH) is associated with a risk of vision loss and requires urgent medical intervention. We evaluated the outcomes of the comprehensive management of 44 pIH patients (aged 2–6 months) with superficial (n = 11), deep (n = 15), and mixed (n = 18) subtypes, treated with a standard propranolol dose (2 mg kg−1 d−1) without any obvious side effects. Obvious and slight improvements were observed in 70.5% and 29.5% of patients, respectively. Obvious improvement was found in 96.3% of patients 3 months or younger but only 29.4% of patients older than 3 months (P = 0.036) after 4 weeks of treatment. Thirteen patients demonstrated slight improvement and were treated with an increased propranolol dose (3 mg kg−1 d−1) in combination with corticosteroid injections or plastic surgery, which led to good outcomes. The patients were followed up for 12 to 18 months, with no cases of amblyopia or ametropia. Oral propranolol was effective in the treatment of pIH. Earlier propranolol use was associated with better outcomes. An increased propranolol dose combined with corticosteroid injections or plastic surgery is appropriate for patients with propranolol resistance.
Rv0233 is not essential for the survival of Mycobacterium tuberculosis in stress conditions
Authors: Ikeh Melanie A. , Parish Tanya
Published: September 2022

Mycobacterium tuberculosis

is an important global pathogen. We were interested in understanding the role of Rv0233, a proposed subunit of the class IB ribonucleotide reductase, and its role in surviving stress conditions. We constructed an in-frame, unmarked deletion strain of

M. tuberculosis

and characterized its growth and survival under replicating or non-replicating conditions. We confirmed previous studies that found that Rv0233 is not essential for aerobic growth or survival in the presence of nitrite. We demonstrated that the deletion of Rv0233 does not affect susceptibility to frontline tuberculosis drugs or hydrogen peroxide. The deletion strain survived equally well under nutrient starvation or in hypoxia and was not attenuated for growth in macrophages.