bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and safety of high-dose of mycophenolate mofetil compared with cyclophosphamide pulse therapy as induction therapy in Japanese patients with proliferative lupus nephritis
Authors: Ohkubo Naoaki , Iwata Shigeru , Nakano Kazuhisa , Miyagawa Ippei , Hanami Kentaro , Fukuyo Shunsuke , Miyazaki Yusuke , Kawabe Akio , Nakayamada Shingo , Tanaka Yoshiya
Published: December 2021

Objectives

To clarify the effectiveness and safety of induction therapy with mycophenolate mofetil (MMF) in patients with lupus nephritis (LN).

Methods

Patients with LN administered MMF (n = 35) or intravenous cyclophosphamide pulse therapy (IVCY) (n = 25) plus high-dose corticosteroids between July 2015 and June 2020 were included. MMF was increased from 2 to 3 g/day, with no adverse events (AEs). The primary endpoint was the 6 month renal remission rate. Secondary endpoints were retention rate and AEs.

Results

There were no significant differences in age, sex, disease duration, renal histological type, SLE disease activity index, and urine protein creatinine ratio between the two groups. Twenty-six patients (74%) continued with MMF therapy, whereas 12 (48%) completed six IVCY courses. The retention rate was significantly higher in the MMF than in the IVCY group (p = 0.048). Twenty-four and 14 patients in MMF and IVCY groups, respectively, achieved renal remission with insignificant differences. Grade 3 or higher AEs were observed in 8 and 14 patients in the MMF and IVCY groups, respectively (p = 0.014).

Conclusions

The efficacy of high-dose MMF was comparable to that of IVCY in Japanese patients with proliferative LN, with fewer AEs and a higher retention rate than IVCY, suggesting the high tolerability of MMF.
Blenderized formulations in home enteral nutrition: a narrative review about challenges in nutritional security and food safety
Authors: Santos Daiane Costa dos , Ataide Carla Daniela Gomes , Mota da Costa Nair , Oliveira Junior Valtemir Paula de , Egea Mariana Buranelo
Published: December 2021

Blenderized formulations (BFs) are prepared by homogenization of food that is normally used in oral nutrition. BFs are mainly used in home enteral nutrition (HEN), although their use has also been reported by hospitals when commercial enteral formulas are not available. HEN is applied when the patient has been discharged from the hospital. This nutritional therapy promotes the patient's reintegration into the family nucleus and promotes humanized care, and decreases treatment costs. However, the patient should continue to receive health and nutritional care, ranging from periodic nutritional re-evaluation to adaptation of the dietary plan. HEN provides the patient a greater contact with the family, whereas BFs promote the adaptation of the diet with food, respecting the food diversity and culture, lower cost, and easier access to food. Disadvantages of BFs include more time spent by the professional to calculate the dietary plan, greater difficulty in adjusting daily needs, and less microbiological and chemical stability. In this review, the nutritional, food security, and safety aspects of BF used in HEN are discussed. Technological quality aspects that are essential knowledge in the preparation of the patient's dietary plan also are presented.
Prevalence of Myofascial Pain Syndrome and Efficacy of Trigger Point Injection in Patients with Incurable Cancer: A Multicenter, Prospective Observational Study (MyCar Study)
Authors: Ishiki Hiroto , Hasuo Hideaki , Matsuda Yoshinobu , Matsuoka Hiromichi , Hiramoto Shuji , Higuchi Masaki , Yoshida Kohei , Tokoro Akihiro , Hatano Yutaka , Hori Tetsuo , Kinkawa Junya , Nojima Masanori
Published: December 2021

Objective

Myofascial pain syndrome (MPS) is caused by overload or disuse of skeletal muscles. Patients with cancer are often forced to restrict their movement or posture for several reasons. The study was conducted to investigate the prevalence and risks of MPS in patients with incurable cancer. The efficacy of trigger point injection (TPI) was also explored.

Methods

This was a multicenter, prospective observational study. Patients with incurable cancer who started receiving specialist palliative care were enrolled. We investigated the MPS in this population and accompanying risk factors for restricting body movement. Pre- and post-TPI pain was also evaluated using a Numerical Rating Scale (NRS) in patients who received TPI. The primary outcome was the prevalence of MPS.

Results

A total of 101 patients were enrolled from five institutions in Japan. Most of the patients (n = 94, 93.1%) had distant metastases, and half of the patients (50, 49.5%) received anticancer treatment. Thirty-nine (38.6%) patients had MPS lesions at 83 sites. Multivariate analysis revealed that the significant risk factor for MPS was poor Performance Status (PS) (odds ratio 3.26; 95% confidence interval [CI] 1.18–9.02, P = .023). We performed TPI for 40 out of 83 MPS lesions. Mean NRS for MPS before TPI was 7.95, which improved to 4.30 after TPI (P < .001).

Conclusions

MPS was common in patients with incurable cancer and the risk factor identified in this study was poor performance status. TPI could be a treatment option.
The Onset of Chronic Musculoskeletal Pain in High School Adolescents: Associated Factors and the Role of Symptoms of Central Sensitization
Authors: Andias Rosa , Silva Anabela Gonçalves
Published: December 2021

Objective

This study aimed to investigate the association between sociodemographic data, physical activity, depression, anxiety, and stress, sleep, and self-reported symptoms of central sensitization at baseline, in asymptomatic adolescents, and the onset of pain at 6-months follow-up.

Methods

A total of 252 asymptomatic adolescents were assessed at baseline with an online questionnaire that included sociodemographic data, the Nordic Musculoskeletal Questionnaire; the International Physical Activity Questionnaire for Adolescents; the Depression, Anxiety and Stress Scale for Children; the Basic Scale on Insomnia complaints and Quality of Sleep; and the Central Sensitization Inventory. The same questionnaire was repeated at 6-months follow-up.

Results

Of the 231 (91.7%) adolescents who completed the questionnaire at the follow-up, 127 (55.0%) remained asymptomatic and 88 (38.1%) reported a new onset of pain. At the 6-month follow-up, the mean (SD) number of painful body sites was 1.81 (1.04), and the neck region was the most reported (n = 29, 33%). Multivariable analysis showed that being female (OR = 2.34; 95% CI = 1.28–4.27) and reporting more self-reported symptoms of central sensitization (OR = 1.04; 95% CI = 1.01–1.07) were associated with the onset of chronic pain at follow-up.

Conclusion

Female sex and self-reported symptoms of central sensitization were considered risk factors for the onset of pain in adolescents but should be further explored in future studies.

Impact

Considering the increasing prevalence of chronic musculoskeletal pain in adolescents, understanding the factors that may be associated with its new onset may help to better design preventive strategies and thus minimize the appearance of this type of pain in adolescents.
Selection with Variation in Diagnostic Skill: Evidence from Radiologists
Authors: Chan David C , Gentzkow Matthew , Yu Chuan
Published: December 2021

Physicians, judges, teachers, and agents in many other settings differ systematically in the decisions they make when faced with similar cases. Standard approaches to interpreting and exploiting such differences assume they arise solely from variation in preferences. We develop an alternative framework that allows variation in preferences and diagnostic skill and show that both dimensions may be partially identified in standard settings under quasi-random assignment. We apply this framework to study pneumonia diagnoses by radiologists. Diagnosis rates vary widely among radiologists, and descriptive evidence suggests that a large component of this variation is due to differences in diagnostic skill. Our estimated model suggests that radiologists view failing to diagnose a patient with pneumonia as more costly than incorrectly diagnosing one without, and that this leads less skilled radiologists to optimally choose lower diagnostic thresholds. Variation in skill can explain 39% of the variation in diagnostic decisions, and policies that improve skill perform better than uniform decision guidelines. Failing to account for skill variation can lead to highly misleading results in research designs that use agent assignments as instruments.
T helper cells expressing fractalkine receptor and bearing T follicular helper 1-like cell functions in patients with IgG4-related disease
Authors: Inoue Yoshino , Nakayamada Shingo , Kubo Satoshi , Yamagata Kaoru , Sonomoto Koshiro , Iwata Shigeru , Miyazaki Yusuke , Tanaka Yoshiya
Published: December 2021

Objective

Because the pathological features of IgG4-related disease (IgG4-RD) include lymphocyte infiltration and fibrotic changes in the lesions, we investigated the significance of fractalkine (CX3CL1) and lymphocyte subsets in patients with IgG4-RD.

Methods

Peripheral blood and biopsied samples were obtained from healthy controls (HCs, n = 10), RA (n = 10) and IgG4-RD patients (n = 16) and were analysed by flow cytometry, immunohistology and costimulation assays.

Results

Peripheral CX3CR1+ CD4+ T cells had an approximately 3-fold increase in the IgG4-RD patients (15.4%), compared with the HCs (5.0%). In addition, CX3CR1+ CD4+ T cells were localized in the salivary glands of the IgG4-RD patients but not in those with Sicca syndrome. CX3CR1 was induced on 20% of CD4+ T cells after T-cell receptor (TCR) simulation with IL-12 for five days culture. CX3CR1+ T cells showed high expression of both CXCR5 and CXCR3. Moreover, they co-expressed Bcl-6 and T-bet, the master transcription factors for T helper 1 (Th1) and T follicular helper (Tfh) cells. After secondary stimulation, CX3CR1+ T cells produced both IFN-gamma (IFN-γ) and IL-21. Compared with their CX3CR1− counterparts, CX3CR1+ CD4+ T cells induced plasmablast differentiation from naïve B cells more efficiently (15.0 vs 5.0%) and increased the production of IgG2, IgG3 and IgG4 by B cells.

Conclusion

CX3CR1+ CD4+ T cells characteristically increased in the peripheral blood and the affected tissues and were associated with an increase in the serum IgG4 levels of patients with IgG4-RD. This CD4 subset has a Th1/Tfh-like phenotype and a B cell helper function.
Clinical picture, outcome and predictive factors of lymphoma in primary Sjögren’s syndrome: results from a harmonized dataset (1981–2021)
Authors: Chatzis Loukas G , Stergiou Ioanna E , Goules Andreas V , Pezoulas Vasilis , Tsourouflis Gerasimos , Fotiadis Dimitrios , Tzioufas Athanasios G , Voulgarelis Michael
Published: December 2021

Objectives

Primary Sjögren’s Syndrome (pSS) carries the highest risk for non-Hodgkin's lymphoma (NHL) development among systemic autoimmune diseases. However, the paucity of data on the long-term survival of those patients and the lack of established predictors for each lymphoma histologic subtype prompted our present study.

Methods

We retrospectively analysed 121 patients diagnosed with NHL according to the WHO classification criteria. All patients fulfilled the 2016 ACR-EULAR classification criteria for pSS. Cumulative clinical, laboratory, radiologic, treatment regimens and histologic data were recorded, harmonized and analysed. Overall survival (OS) and event-free survival (EFS) curves were calculated. A mucosa-associated lymphoid tissue lymphoma (MALTL) prediction model was developed by applying innovative data-driven analysis of clinical features present at the time of pSS diagnosis.

Results

MALTLs constituted the majority of lymphomas (92/121, 76.0%) followed by diffuse large B-cell lymphomas (DLBCL) (11/121, 9.0%) and nodal marginal zone lymphomas (NMZL) (8/121, 7%). MALTLs show salivary glands localization, limited disease and often bone marrow and nodal involvement. The 10-year OS and EFS rates were 79% and 45.5% for MALTLs, 40.9% and 24.2% for DLBCL and 46% and 31% for NMZL. Cryoglobulinemia, focus score and the total EULAR SS Disease Activity Index (ESSDAI) composite index at pSS diagnosis were proven independent MALTL predictors. Even though MALTLs have a comparatively good survival outlook, they are accompanied by frequent events throughout their clinical course.

Conclusions

Common features of pSS, present at diagnosis, can predict future lymphomagenesis meriting a more intensive follow-up plan.
Causal role of the right temporoparietal junction in selfishness depends on the social partner
Authors: Brethel-Haurwitz Kristin M , Oathes Desmond J , Kable Joseph W
Published: December 2021

The right temporoparietal junction (rTPJ) is a hub of the mentalizing network, but its causal role in social decisions remains an area of active investigation. While prior studies using causal neurostimulation methods have confirmed the role of the rTPJ in mentalizing and strategic social interactions, most of the evidence for its role in resource-sharing decisions comes from correlational neuroimaging studies. Further, it remains unclear if the influence of the rTPJ on decisions about sharing resources depends on whether the other person is salient and identifiable. To clarify the causal role of the rTPJ in social decision making, we examined the effects of putatively inhibitory rTPJ transcranial magnetic stimulation (TMS) on Dictator Game behavior with one partner that was physically present and one that was only minimally identified. Under control conditions, participants tended to create more advantageous inequity toward the partner that was only minimally identified, selfishly keeping more resources themselves. rTPJ TMS reduced this differential treatment of the two partners. Clarifying prior mixed findings, results suggest that the rTPJ may play a role in differentiating between others when deciding how equitably to divide resources, but may not play a general role in reducing selfishness by promoting aversion to advantageous inequity.
Concurrent Treatment with Vitamin K2 and D3 on Spine Fusion in Patients with Osteoporosis-Associated Lumbar Degenerative Disorders
Authors: Zhang Wencan , Li Le , Zhou Xin , Li Kunpeng , Liu Chen , Lin Xiangyu , Lubisi Njabulo , Chen Junfei , Si Haipeng
Published: December 2021

Study Design.

A prospective and nonrandomized concurrent controlled trial.

Objective.

To address the early effects of concurrent treatment with vitamin K2 and vitamin D3 on fusion rates in patients who have undergone spinal surgery.

Summary of Background Data.

Intervertebral pseudarthrosis has been reported after transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF), especially in patients with osteopenia or osteoporosis. No study has assessed the early effects of concurrent treatment with vitamin K2 and vitamin D3 on fusion rates.

Methods.

Patients with osteopenia or osteoporosis who underwent TLIF or PLIF in our department were included. Patients in the VK2+VD3 group received vitamin K2, vitamin D3, and calcium treatment, whereas subjects in the control group only received calcium and vitamin D3. Spine fusion was evaluated by computed tomography. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and visual analog scale (VAS) were used to assess the clinical and neurological symptoms. Bone mineral density (BMD) and bone metabolism markers were measured for osteoporotic evaluation.

Results.

Seventy-eight patients were included, and nine patients subsequently discontinued because of 2019-nCoV. At six months postoperatively, complete fusion rates were significantly higher in the VK2+VD3 group than that in the control group (91.18% vs 71.43%, P = 0.036). At six months postoperatively, BMD was increased in the VK2+VD3 group and was higher than that in the control group, although there was no significant difference. At three months postoperatively, a significant increase in procollagen type I amino terminal propeptide (91.81%) and a slight decrease in C-terminal end peptide (8.06%) were observed in the VK2+VD3 group. In both groups, the JOA-BPEQ and VAS scores were significantly improved after spine surgery.

Conclusion.

Administration of vitamin K2 and vitamin D3 can increase lumbar interbody fusion rates, improve clinical symptoms, promote bone information, and avoid further decline in BMD within six months after TLIF or PLIF.

Level of Evidence: 3
Long-term Results of Three-layered Closure of Oronasal Fistula: A Case Report
Authors: Zielinska-Kazmierska Bogna , Grodecka Joanna , Lucas Grzelczyk Weronika , Jozefowicz-Korczynska Magdalena
Published: December 2021

An oronasal fistula is an interconnection between the oral and nasal cavities. It interferes with normal functioning and affects quality of life by impeding eating and speech. The most common management strategy is surgical treatment. The aim of our study was to present the results of a long-term follow-up of effective treatment of a case of oronasal fistula that occurred without any cause and comorbidities. A 46-year-old woman reported the sudden appearance of a painless oronasal fistula. She demonstrated nasal regurgitation—that is, loss of fluids through the nose while drinking—and slurred‚ nasal speech. Clinical examination revealed a soft tissue defect (diameter: 5 mm) on the left side of the palate. Computed tomography revealed a gap in the hard palate bone, measuring 25 × 30 mm. No complications were noted following the procedure, nor at 10-year follow-up. It seems that the use of bone substitute and palatal flap for spontaneous oronasal fistula closure was fully justified. The patient may have had an undiagnosed congenital defect of the hard palate, and the deficit may have appeared due to bone loss occurring in her forties. However, no consensus exists regarding the best treatment management for oronasal fistulae located in the palatal region, and further comparative studies between the existing techniques are needed.
Targeted Muscle Reinnervation in Children: A Case Report and Brief Overview of the Literature
Authors: Pires Giovanna R. , Moss Whitney D. , Ormiston Laurel D. , Baschuk Christopher M. , Mendenhall Shaun D.
Published: December 2021

Absence of the proximal upper limb, whether congenital or acquired, has a profound impact on quality of life. Targeted muscle reinnervation (TMR) was originally developed to improve functional control over myoelectric prostheses; however, it has also been shown to decrease phantom limb pain and neuroma pain as well as prevent neuroma formation. In children, whose rates of prosthetic use are considerably lower than adults, the effects of amputation on limb function can be devastating. To date, there is very little literature regarding the use of TMR in children. In this case report, we review the current literature and present the case of a 9-year-old boy with a transhumeral amputation secondary to a traumatic injury who underwent acute TMR at the time of wound closure. At 22 months follow-up, the patient is doing well with minimal pain, no evidence of neuroma formation, and signs of muscle reinnervation.
The Epidemiology of COVID-19 in Pregnancy
Authors: OVERTON EVE E. , GOFFMAN DENA , FRIEDMAN ALEXANDER M.
Published: December 2021

As of November, 2021 there have been more than 250 million coronavirus disease-2019 (COVID-19) cases worldwide and more than 5 million deaths. Obstetric patients have been a population of interest given that they may be at risk of more severe infection and adverse pregnancy outcomes. The purpose of this review is to assess current epidemiology and outcomes research related to COVID-19 for the obstetric population. This review covers the epidemiology of COVID-19, symptomatology, transmission, and current knowledge gaps related to outcomes for the obstetric population.
Perioperative Cardiac Troponin T and Risk of Postoperative Atrial Fibrillation in Coronary Artery Bypass Graft Surgery
Authors: Farahani Ali Vasheghani , Omran Abbas Salehi , Abbasi Kyomars , Gholamrezaei Ali , Mansouri Pejman , Tafti Seyed Hossein Ahmadi , Jahangiri Mansour
Published: December 2021

Background:

Postoperative atrial fibrillation (AF) is a common complication after cardiac surgery. We investigated whether perioperative cardiac troponin T (cTnT) is associated with the risk of AF after coronary artery bypass grafting (CABG).

Methods:

Two thousand four hundred twenty-one patients with isolated CABG were studied. High sensitivity cTnT (hs-cTnT) was assessed before and then at 80 hour and 24 hour after the operation. Logistic regression models were applied to investigate the association of perioperative hs-cTnT with postoperative AF. The ROC curve analysis was applied to determine the optimal cutoff values.

Results:

Postoperative AF was occurred in 356 (14.7%) patients. Age (adjusted odds ratio [ORs] 1.087–1.090), male gender (OR 1.390), left atrium size (ORs 1.055–1.111), on-pump coronary bypass (OR 1.561), and application of intra-aortic balloon pump (ORs 2.890–2.966) were independently associated with AF. Preoperative hs-cTnT was associated with AF in patients with off-pump coronary bypass (ORs 1.997–2.375). However, the area under the curve for preoperative hs-cTnT was 0.625 in this group. On-pump coronary bypass had major influence on postoperative hs-cTnT levels regardless of the occurrence of AF.

Conclusions:

Preoperative hs-cTnT level is associated with the risk of AF after isolated CABG in patients undergoing off-pump coronary bypass, but the accuracy of this biomarker is yet inadequate. Postoperative levels of hs-cTnT have no predictive value considering large influence by the surgical technique and the cardiac surgery itself. Therefore, perioperative hs-cTnT is not a clinically useful biomarker for predicting AF following CABG.
CENTRAL RETINAL VEIN OCCLUSION FOLLOWING BNT162B2 (PFIZER-BIONTECH) COVID-19 MESSENGER RNA VACCINE
Authors: Shah Paras P. , Gelnick Samuel , Jonisch Jonathan , Verma Rashmi
Published: December 2021

Purpose:

Coronavirus disease 2019 has had a wide-ranging public health impact, contributing to at least five million deaths globally at the time of this report. Although thromboembolic events following coronavirus disease 2019 vaccination have been an ongoing concern, only a limited number of ophthalmic manifestations have been reported to date.

Methods:

A detailed history, hypercoagulable workup, best-corrected visual acuity (BCVA), Humphrey visual field, dilated fundus examination, and multimodal imaging including optical coherence tomography, fundus fluorescein angiography, and fundus photography were obtained.

Results:

A 27-year-old woman was diagnosed with central retinal vein occlusion a few days after her first dose of the BNT162b2 (Pfizer-BioNTech) coronavirus disease 2019 vaccine. Detailed elicitation of her history and a full hypercoagulable workup did not reveal any primary risk factors that could have explained her disease process. After the patient received the second dose, her symptoms deteriorated significantly and worsening peripapillary hemorrhage were seen on dilated fundus examination. The patient was treated with intravitreal injections of ranibizumab and followed closely, which showed improvement in her central retinal vein occlusion.

Conclusion:

Given the chronology of the patient's condition, it is believed that the central retinal vein occlusion that occurred as a result of the first dose was exacerbated by an intense immunological reaction after the second dose. The severity of this complication, despite its rarity, must be emphasized and weighed in but should not preclude the extensive benefits of vaccination.
Genetic Alterations in Melanocytoma Associated with Oculodermal Melanocytosis: Molecular Characteristics
Authors: Claxton Matthew R. , Dalvin Lauren A. , Guo Ruifeng , Tooley Andrea A.
Published: December 2021

Melanocytoma is a benign tumor with histologic similarity to oculodermal melanocytosis, which can undergo malignant transformation in rare cases. Melanocytoma more commonly involves the optic disc, and few cases of orbital melanocytoma have been reported. Primary orbital melanoma is a rare malignancy known to arise from pigmentary conditions, although there is little information on this tumor arising from melanocytoma. The authors present a case of malignant transformation of orbital melanocytoma in the setting of ipsilateral oculodermal melanocytosis. This case illustrates histopathologic features associated with malignant transformation and highlights the significance of GNAQ, BAP1, and specific intrachromosomal alterations occurring in oculodermal melanocytosis and melanocytoma. The molecular markers observed in this case are of interest as they have overlap with those present in uveal melanoma. This case demonstrates a timeline of genetic and molecular alterations occurring in the malignant transformation of orbital melanocytoma.
Efficacy and safety of clopidogrel and/or aspirin for ischemic stroke/transient ischemic attack
Authors: Yang Youwen , Huang Zongtao , Zhang Xueji
Published: December 2021

Objective:

Patients experiencing acute ischemic stroke or transient ischemic attack are commonly treated with clopidogrel and/or aspirin (mono- and dual-antiplatelet therapy) to minimize the risk for recurrent stroke. Updated data from systematic studies can be used to guide practice. The present study aimed to compare findings from systematic reviews and meta-analyses addressing the efficacy and safety of clopidogrel or aspirin – alone or in combination – in patients experiencing acute ischemic stroke or transient ischemic attack.

Methods:

The Cochrane Library, PubMed, Ovid, Scopus, EBSCO, and CINAHL databases were searched for relevant studies published from inception to 2020. Data from each study were extracted independently using a predefined data abstraction form. The Risk of Bias in Systematic Reviews tool and A Measurement Tool to Assess Systematic Reviews 2 were used to evaluate risk of bias and the quality of the included studies.

Results:

Seven studies, published between 2010 and 2020, were eligible for analysis. The included studies evaluated a wide range of outcomes, including recurrent stroke, myocardial infarction, recurrent ischemic stroke, vascular mortality and vascular events, bleeding events, all-cause mortality, functional disability, and quality of life. The risk of bias and methodological validity of the included studies ranged from low to high according to ROBIS and AMSTAR 2 parameters. Results revealed that clopidogrel plus aspirin was more effective than aspirin alone in reducing the risk for recurrent stroke (ischemic or hemorrhagic), with high-quality evidence. However, compared with aspirin, dual treatment increased major bleeding events (intracranial bleeding and extracranial bleeding), supported by high-quality evidence.

Conclusions:

High-quality evidence suggested that clopidogrel plus aspirin was more efficient than monotherapy, although the risk for hemorrhagic stroke was relatively higher in combined therapy regimens lasting >1 month.
Efficacy and safety evaluation of acupuncture in the treatment of impaired glucose regulation
Authors: Sun Jiabao , Wang Gaofeng , Zhi Xiaoyu , Zhao Xuewei , Sun Weichen , Chu Yunjie , Wu Xingquan
Published: December 2021

Background:

Impaired of glucose regulation belongs to the stage of prediabetes, which is a state of glucose metabolism between diabetes and normal blood glucose. The prevalence of prediabetes in people over 20 years old in China is significantly higher than that in diabetic patients. If no measures are taken to prevent the transition from prediabetes to diabetes, the number of diabetic patients in China will further increase. This study conducted a meta-analysis of the effectiveness of acupuncture in the treatment of impaired glucose regulation by collecting relevant literatures.

Methods:

Nine electronic databases: PubMed, EMBASE, Cochrane library, Web of Science, Google Scholar, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific and Journal Database, Wan Fang database, and 2 clinical trials register platforms: Chinese Clinical Trial Registry, ClinicalTrials.gov (www.ClinicalTrials.gov/) will be searched for randomized clinical trails of acupuncture for impaired glucose regulation. The screening process will be developed by 2 independent reviewers, and meta-analysis will be performed with RevMan (V5.3.5) software.

Results:

This meta-analysis further confirmed the benefits of acupuncture in the treatment of impaired of glucose regulation.

Conclusion:

This study will provide a high-quality evidence of the efficacy and safety of acupuncture on patients with impaired glucose regulation.

PROSPERO registration number:

INPLASY202170058.

Ethics and dissemination:

This systematics review will evaluate the efficacy and safety of acupuncture in the treatment of impaired of glucose regulation. Since all the data included were published, the systematic review did not require ethical approval.
Distribution of hepatitis B virus genotypes and subgenotypes
Authors: Liu Zhongping , Zhang Yafei , Xu Mengyuan , Li Xu , Zhang Zhenhua
Published: December 2021

Hepatitis B virus (HBV) genotypes and subgenotypes have distinct geographical distributions and influence a number of clinical disease features and responses to treatment. There are many reports on the distribution of HBV genotypes, but great differences are present between studies. What's more, a meta-analysis of HBV genotype- and subgenotype-distribution by country is lacking.

A comprehensive literature search was performed in PubMed and a systematic search of full-length HBV sequences and S gene sequences was conducted in the GenBank database. HBV genotypes were checked and subgenotypes were determined by phylogenetic comparison of full-length HBV sequences or S gene sequences. STATA 12.0 was used for the analysis for countries with multiple datasets. BEAST 2.5.2 was used for Bayesian phylogenetic analysis to infer the evolutionary time scales of HBV.

This study includes 309 datasets from 110 countries, including 188 relevant studies, 58 full-length gene datasets, and 63 S gene datasets. The meta-analysis was performed on 274 datasets from 75 countries. The distribution of genotypes is more detailed than those described by previous studies. While the overall genotype distribution is similar to that reported in previous studies, some notable aspects were different. The main genotypes present in south-eastern Africa, North Africa, and West Africa are genotypes A, D, and E, respectively. Genotypes G and H are mainly distributed in Mexico. Genotype F is mainly distributed in central and South America, but genotypes A and D are also common in Brazil, Cuba, and Haiti.

This study provides a more accurate description of the distribution of HBV genotypes and subgenotypes in different countries and suggests that the differences in genotype distribution may be related to ethnicity and human migration.
Efficacy and safety of cutting therapy in the treatment of migraine
Authors: Guo Wenping , Jin Hongguang , Wang Yiqiang , Zhu Xing , Zhang Guanwei , Wang Te , Fan Chunhui , Huang Yongsheng
Published: December 2021

Background:

Migraine is a chronic paroxysmal neurovascular disease in which pain on one or both sides of the head is the main manifestation and is accompanied by other neurological manifestations. Clinical practice has shown that cutting therapy as a complementary alternative medicine can play a role in relieving migraine attacks. However, there is no consensus on the efficacy of cutting treatment in the treatment of migraine. The aim of this study was to conduct a meta-analysis to systematically evaluate the efficacy and safety of cutting therapy in the treatment of migraine.

Methods:

First, databases were searched for relevant literature. The main databases we searched were PubMed, the Web of Science, MEDLINE, Embase, Cochrane Library, the Chinese National Knowledge Infrastructure, the Chinese Science Journal Database, Wanfang Data, and the Chinese Biomedical Literature Database. The keywords searched were “cutting treatment,” “ traditional Chinese medicine cutting treatment,” and “migraine.” The search was conducted from inception to November 2021. Second, 2 reviewers independently completed the process of study selection, data extraction, risk of bias assessment and data synthesis in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols statement guidelines. Finally, we will use Review Manager Version 5.3 software for meta-analysis.

Results:

This study will provide the most recent evidence related to the treatment of migraine by cutting therapy.

Conclusion:

The results of this systematic evaluation will provide an objective evidence-based framework for judging the effectiveness and safety of cutting therapy in the treatment of migraine.
Clinical efficacy and safety of Qingshu Yiqi decoction as a complementary and alternative therapy for COVID-19 with Delta variant
Authors: Xia Yu , Qi Weiyu , Li Xin , Yang Yuying , Cao Jianzhong
Published: December 2021

Background:

Qingshu Yiqi decoction combined with general western medicine are important and prevalent recently treatment method of corona virus disease 2019 (COVID-19) with Delta variant, but the efficacy and safety were not clear. This meta-analysis aims to clarify their clinical efficacy and safety thus to provide evidence for clinical application.

Methods:

We searched Chinese databases CNKI, Wanfang, VIP and English databases PubMed, Cochrane Library, Embase for the current study. The retrieval time was from the establishment to November, 2021. Literature quality was evaluated according to the bias risk assessment criteria of Cochrane Collaboration network. RevMan 5.3 and Stata 12.0 were used to perform this research.

Results:

The efficacy and safety of Qingshu Yiqi decoction combined with western medicine for COVID-19 with Delta variant were evaluated in terms of total effective rate, TCM syndrome score, negative conversation rate of viral nucleic acid, disappearance rate of clinical symptoms (such as fever, cough, and fatigue), CT improvement, white blood cell (WBC), lymphocyte (LYM) and adverse reaction rate.

Conclusion:

This study provides reliable evidence-based support for the clinical efficacy and safety of Qingshu Yiqi decoction as a complementary and alternative therapy for COVID-19 with Delta variant.

PROSPERO registration number:

CRD42021271606.
ANKRD1 and SPP1 as diagnostic markers and correlated with immune infiltration in biliary atresia
Authors: Kong Meng , Ma Teng , Xiang Bo
Published: December 2021

The diagnosis of biliary atresia (BA) remains a clinical challenge, reliable biomarkers that can easily distinguish BA and other forms of intrahepatic cholestasis (IC) are urgently needed.

Differentially expressed genes were identified by R software. The least absolute shrinkage and selection operator regression and support vector machine algorithms were used to filter the diagnostic biomarkers of BA. The candidate biomarkers were further validated in another independent cohort of patients with BA and IC. Then CIBERSORT was used for estimating the fractions of immune cell types in BA. Gene set enrichment analyses were conducted and the correlation between diagnostic genes and immune cells was analyzed.

A total of 419 differentially expressed genes in BA were detected and 2 genes (secreted phosphoprotein 1 [SPP1] and ankyrin repeat domain [ANKRD1]) among them were selected as diagnostic biomarkers. The SPP1 yielded an area under the curve (AUC) value of 0.798 (95% confidence interval [CI]: 0.742–0.854) to distinguish patients with BA from those with IC, and ANKRD1 exhibited AUC values of 0.686 (95% CI: 0.616–0.754) in discriminating BA patients and those with IC. Further integrating them into one variable resulted in a higher AUC of 0.830 (95% CI: 0.777–0.879). The regulatory T cells, M2 macrophages cells, CD4 memory T cells, and dendritic cells may be involved in the BA process. The ANKRD1 and SPP1 was negatively correlated with regulatory T cells.

In conclusion, the ANKRD1 and SPP1 could potentially provide extra guidance in discriminating BA and IC. The immune cell infiltration of BA gives us new insight to explore its pathogenesis.
Role of surfactant protein C in neonatal genetic disorders of the surfactant system
Authors: Tan Ya-Xin , Li Shu-Jun , Li Hai-Tao , Yin Xiao-Juan , Cheng Bo , Guo Jing-Li , Li Na , Zheng Cheng-Zhong , Chang Hong-Yu
Published: December 2021

Rationale:

Respiratory distress syndrome (RDS) refers to the symptoms of progressive dyspnea and respiratory failure in newborns shortly after birth. The clinical and genetic characteristics of patients with neonatal RDS have not been extensively reported.

Patient concerns:

A infant was in critical condition with repeated paroxysmal blood oxygen decline. Oxygen inhalation and noninvasive ventilator-assisted breathing relief were not effective. The etiology was unclear, and there was no family history of lung disease. Surface-active substance replacement therapy and positive pressure-assisted ventilation support were ineffective.

Diagnosis:

The infant was clinically diagnosed with RDS. Genetic tests revealed a heterozygous missense mutation in the c.168 surfactant protein C (SFTPC) gene.

Interventions:

Tracheal intubation was performed with invasive ventilator-assisted breathing, pulmonary surfactant was administered. Supportive treatment for liver protection and administration of a cardiotonic diuretic, vasodilator, human immunoglobulin (intravenous infusion), fresh frozen plasma, and suspended red blood cells were performed.

Outcomes:

The infant showed poor responses to respiratory and circulatory support, antibiotic treatment, and other treatment methods. The patient was discharged from hospital against the advice of us, cut off from us. The long-term prognosis of the patient after discharge remains unknown.

Lessons:

SFTPC gene mutations may be an important risk factor for the development of common lung diseases. Because of the important roles of surfactant functions and metabolism, mutations in these genes can affect the production and function of pulmonary surfactant, leading to severe lung disease in term newborns.
Recurrent thoracic duct cyst of the left supraclavicular fossa
Authors: Planchette Julie , Jaccard Clara , Nigron Audrey , Chadeyras Jean-Baptiste , Le Guenno Guillaume , Castagne Benjamin , Jamilloux Yvan , Resseguier Anne-Sophie , Sève Pascal
Published: December 2021

The transient occlusion of the terminal thoracic duct is a rare disease responsible for renitent supraclavicular cysts. The aim of this study was to describe the clinical characteristics, evolution, and treatment.

A retrospective multicenter study and literature review was carried out. The literature search (PubMed) was conducted including data up to 31 December 2020 and PRISMA guidelines were respected.

This study identified 6 observational cases between September 2010 and December 2020. The search results indicated a total of 24 articles of which 19 were excluded due to the lack of recurrent swelling or the unavailability of full texts (n = 5). Fourteen patients (8 from literature) mostly reported a noninflammatory, painless renitent mass in the supraclavicular fossa which appeared rapidly over a few hours and disappeared spontaneously over an average of 8 days (range: from about 2 hours to 10 days). Anamnesis indicated a high-fat intake during the preceding days in all cases and 7 from literature found in the Medline databases. Recurrences were noted in 10 patients. Thoracic duct imaging was performed in all cases to detect abnormalities or extrinsic compression as well as to eliminate differential diagnoses.

A painless, fluctuating, noninflammatory, and recurrent swelling of the left supraclavicular fossa in patients evoking an intermittent obstruction of the terminal portion of the thoracic duct was identified. A low-fat diet was found as safe and effective treatment.
Influence of aging on the color visual field in humans
Authors: Yada Takeshi , Tokumaru Osamu , Eshima Nobuoki , Kitano Takaaki , Yokoi Isao
Published: December 2021

Age-related narrowing of the visual field is observed in the elderly, which leads to reduced cognitive and psychomotor functions. The aim of the present cross-sectional study was to determine the influence of aging on the visual field for color vision in humans, with respect to angular thresholds for object detection and color detection.

The subjects were divided into the elderly group (mean 76.1-year-old [70–89]) and the control group (25.2 [18–47]). Visual fields for different colors (blue, green, yellow, and red) were measured by manual kinetic perimetry and evaluated in terms of 2 measures of visual-field width: angular thresholds for object detection and those for color detection.

While angular thresholds for object detection were significantly wider than those for color detection in the control group (P < .001), there was no difference in the elderly group (P = .06). Moreover, angular thresholds for object detection were significantly wider in the control group than in the elderly group (P = .019), but angular thresholds for color detection were not significantly different between the 2 groups (P = .903).

The observed age-related changes in angular thresholds for object detection in color vision may reflect an age-related reduction in rod function. Stable cone function might explain the preserved angular thresholds for color detection in the elderly.
Management of corticosteroid-dependent eosinophilic interstitial nephritis
Authors: Tanabe Katsuyuki , Matsuoka-Uchiyama Natsumi , Mifune Tomoyo , Kawakita Chieko , Sugiyama Hitoshi , Wada Jun
Published: December 2021

Introduction:

Drug-induced acute interstitial nephritis (DI-AIN) is an important cause of acute kidney injury. In renal biopsy specimens, tubulitis with eosinophilic infiltration is suggestive of DI-AIN. Although corticosteroid therapy and discontinuation of the offending drug can improve renal dysfunction in most cases of DI-AIN, some patients experience AIN recurrence, leading to corticosteroid dependency. Corticosteroid-dependent eosinophilic interstitial nephritis presents a difficult dilemma in diagnosis and information regarding optimum management is limited.

Patient concerns:

A 25-year-old man, who received treatment with carbamazepine, zonisamide, valproate, and lacosamide for temporal lobe epilepsy, showed an increase in serum creatinine level from 0.98 to 1.29 mg/dL over a period of 6 months. Although he exhibited no symptoms, his serum creatinine level continued to increase to 1.74 mg/dL.

Diagnosis:

Renal biopsy revealed tubulitis and interstitial inflammatory infiltrates with eosinophils. Immunological and ophthalmological examinations showed no abnormal findings, and thus, his renal dysfunction was presumed to be caused by DI-AIN. Although oral prednisolone (PSL) administration (40 mg/d) and discontinuation of zonisamide immediately improved his renal function, AIN recurred 10 months later. The increase in PSL dose along with discontinuation of valproate and lacosamide improved renal function. However, 10 months later, recurrent AIN with eosinophilic infiltration was confirmed by further biopsy. The patient was therefore diagnosed with corticosteroid-dependent eosinophilic interstitial nephritis.

Interventions:

To prevent life-threatening epilepsy, carbamazepine could not be discontinued; hence, he was treated with an increased dose of PSL (60 mg/d) and 1500 mg/d of mycophenolate mofetil (MMF).

Outcomes:

MMF was well tolerated and PSL was successfully tapered to 5 mg/d; renal function stabilized over a 20-month period.

Lessons:

The presence of underdetermined autoimmune processes and difficulties in discontinuing the putative offending drug discontinuation are contributing factors to corticosteroid dependency in patients with eosinophilic interstitial nephritis. MMF may be beneficial in the management of corticosteroid-dependent eosinophilic interstitial nephritis by reducing the adverse effects related to high-dose and long-term corticosteroid use.
Therapeutic interventions in Osgood-Schlatter disease
Authors: Gaweł Eliza , Zwierzchowska Anna
Published: December 2021

Rationale:

The purpose of this case study was to identify factors of bilateral etiopathogenesis of Osgood-Schlatter disease (OSD) and those supporting the effectiveness of the therapeutic process in a 12-year-old elite female Olympic karateka.

Patient concerns:

The present case study concerns OSD female karateka who started her sport-specific training at the age of 4 years.

Diagnoses:

The results of subjective palpation by the orthopedic surgeon and objective medical examination using ultrasonography, wall slide test, magnetic resonance imaging, and body height and weight measurements were collected.

Interventions:

The therapeutic intervention for the athlete's knee joints lasted 20 months (5 stages). Physical therapy, kinesiotherapy, and pharmacological treatment were administered, and physical activity was gradually introduced.

Outcomes:

The developmental trajectory was uniform for body height and labile for body weight. OSD was diagnosed after the second growth spurt, and significant progression was reported during the subsequent height and weight gains and increased volume and intensity of sports training. The rate and dynamics of changes in the distance from the patellar ligament to the tibial apophysis were irregular, with dominance in the right knee with the highest rate of change (–3.3 mm) and twice the regression of the rate of change (–2.5 mm). The analyzed distance never exceeded the baseline value (5.5 mm), which was the case in the left knee. Return to sports competition was possible from the second month of therapy, in which kinesiotherapy and static stretching were the most effective. A relatively correct distance of the patellar ligament from the tibial apophysis was recorded at the time of stabilization of the body height and weight gain. No pathological changes were observed following OSD, and full recovery was observed.

Lessons:

In the case discussed in this study, growth spurt, the specificity of the sport practiced, and early specialization including high-volume and high-intensity training should be considered as factors causing OSD and its progression. Kinesiotherapeutic management and static stretching are crucial for the treatment of OSD. Quick return to sports competition was possible due to early therapeutic intervention, which could also lead to the absence of pathological changes in the tibial tubercle and the absence of recurrence of OSD.