bluuebunny/crossref_metadata_2025 huggingface dataset:
Edoxaban: front-line treatment for brachiocephalic vein thrombosis in primitive mediastinal seminoma: A case report and literature review
Authors: Fioretti Agnese Maria , Leopizzi Tiziana , Puzzovivo Agata , Giotta Francesco , Lorusso Vito , Luzzi Giovanni , Oliva Stefano
Published: August 2022

Rationale:

Venous thromboembolism is a feared frequent complication of cancer with a 2-way relationship. Low molecular weight heparin is the mainstay of treatment. The use of direct oral anticoagulants is supported by established evidence for the treatment of deep vein thrombosis also in active cancer and they are prioritized over low molecular weight heparin for cancer-associated thrombosis according to current guidelines. However, upper limb deep vein thrombosis is poorly studied with scant data on the use of direct oral anticoagulants in noncatheter-related deep vein thrombosis. We report the case of a patient with noncatheter-related deep vein thrombosis and a rare tumor site effectively and safely treated with a direct oral anticoagulant, edoxaban, after lack of efficacy with low molecular weight heparin.

Patient concerns:

A 35-year-old man with primitive mediastinal seminoma presented at our Cardio-Oncology Unit for prechemotherapy assessment.

Diagnosis:

Persistent brachiocephalic deep vein thrombosis, despite full-dose enoxaparin, was detected at ultrasonography.

Intervention:

We decided to switch the anticoagulant treatment from enoxaparin to edoxaban.

Outcome:

The 3-month ultrasonography showed almost total regression of the deep vein thrombosis without any adverse effects and a good patient compliance.

Lessons:

We conducted a literature review on upper limb deep vein thrombosis, since its management is challenging due to inconsistency of evidence. This report highlights the benefits of direct oral anticoagulants compared to low molecular weight heparins in cancer-associated thrombosis therapy in terms of efficacy, safety and ease of use.
Pulse wave velocity demonstrates increased aortic stiffness in newly diagnosed, antiretroviral naïve HIV infected adults: A case-control study
Authors: Robbertse Pieter-Paul S. , Doubell Anton F. , Innes Steve , Lombard Carl J. , Herbst Philip G.
Published: August 2022

Increased aortic stiffness is an important predictor of cardiovascular disease (CVD). It remains controversial whether HIV infected persons have increased aortic stiffness at the time of HIV diagnosis. An explorative, case-control study was performed using carotid-femoral pulse wave velocity (PWV) in a newly diagnosed, antiretroviral treatment (ART)-naïve cohort with modest baseline cardiovascular risk.

We recruited 85 newly diagnosed adults without known CVD from health care facilities in South Africa (43 female; mean age 33). Median CD4 count was 285, IQR 156–393 cells/µL. Twenty two HIV uninfected controls were recruited from the same facilities (8 female; mean age 33). PWV was measured using the Vicorder module (Skidmore Medical, United Kingdom) using a corrective factor of 0.8.

The HIV infected group’s mean PWV measured 11% higher than controls (5.88 vs 5.28 m/s; P = .02). Median aortic distensibility in HIV infected persons was 18% lower than controls (0.37 vs 0.45 mm Hg−1; P = .009). Multivariate analysis revealed that the difference in PWV between groups remained significant when corrected for age, sex, mean blood pressure and kidney function (mean difference 0.52 m/s; P = .01). Mean blood pressure, estimated glomerular filtration rate, HIV infection per se, age and male sex were important associations with increased PWV.

Our study provides evidence for increased aortic stiffness in ART naïve adults already demonstrable at the time of HIV diagnosis. The cohort’s young age and recent HIV diagnosis makes atherosclerosis a less likely explanation for the difference. Alternative, potentially reversible, explanations that require further research include vasomotor tone abnormalities and endothelial dysfunction.
MAIT cells predict long-term prognosis in liver failure patients
Authors: Cheng Tiao-Chun , Xue Hong , Li Han , Liu Yi-Cun , Tian Li-Jun , Bian Zhao-Lian , Chen Feng-Song
Published: August 2022

Background:

Liver failure (LF) is a life-threatening clinical syndrome characterized by intense systemic inflammation and organ failure(s), leading to a high mortality rate. The pathogenesis of LF is multifactorial, immune response, and gut bacterial translocation are thought to be major contributing factors. Mucosal-associated invariant T (MAIT) cells play a critical role in immune response and gut bacterial translocation. We aimed to investigate changes of the MAIT cell ratio in patients with LF and to explore the predictive value for long-term prognosis in patients with LF.

Material and Method:

We recruited 75 patients with LF from Nantong Third People’s Hospital, isolated peripheral blood mononuclear cells, and detected the proportion of circulating MAIT cells by flow cytometry. Statistical analyses were performed using the GraphPad Prism software.

Results:

Our data showed that the proportion of MAIT cells alterations was independent of the cause of viral infection in patients with LF. Kaplan-Meier survival analysis showed that LF patients with low level of MAIT cells had poor long-term prognosis. The area under the receiver operating characteristic curve of the MAIT cell proportion was larger than that of the Model for End-Stage Liver Disease (MELD) score. More importantly, the combination of MAIT cell proportion and MELD score had a better effect in predicting long-term prognosis of LF patients than any single index (AUC = 0.91, 95% CI:0.84–0.97), and multivariate logistic regression analysis indicated that the circulating MAIT cell proportion was an independent risk factor for LF.

Conclusion:

The proportion of MAIT cells in PBMC is an outstanding predictor for the long-term prognosis in patients with LF.
National patterns of cessation of prescription opioids among Medicare beneficiaries, 2013–2018
Authors: Westra Jordan , Raji Mukaila , Kuo Yong-fang
Published: August 2022

Objective:

To understand the changes in opioid cessation surrounding the release of CDC guidelines and changes in state Medicaid coverage at the individual patient level.

Methods:

This study used a 20% national sample of Medicare beneficiaries between 2013 and 2018 with at least 90 days of consecutive opioid use in the first year of either of 2 study periods (2013–2015 or 2016–2018). Cessation of opioid use was assessed in year 3 of each period by generalized linear mixed models.

Results:

Opioid cessation rates were higher in period 2 (11.2%) compared to period 1 (10.1%). Adjusted for beneficiary characteristics, those in period 2 had 1.07 times the odds of cessation (95% CI: 1.05–1.09) compared to those in period 1. Additionally, the increase in opioid cessation over time was larger in states with Medicaid expansion compared to those without.

Conclusion:

The increase in opioid cessation after 2016 suggests the potential effects of the CDC guidelines on opioid prescribing and underscores the need for further research on the relationship between opioid cessation and subsequent change in pain control, quality of life, and opioid toxicity.
Novel predictor of pulmonary arterial hypertension: Monocyte to HDL cholesterol ratio
Authors: Bilik Mehmet Zihni , Oylumlu Muhammed , Oylumlu Mustafa , Acun Baris , Arik Baran , Arslan Bayram , Acet Halit , Polat Nihat , Akil Mehmet Ata
Published: August 2022

Monocyte to HDL cholesterol ratio (MHR), lymphocyte to monocyte ratio (LMR), and neutrophil to lymphocyte ratio (NLR) have been proposed as novel systemic inflammatory markers. The aim of this study was to explore the association between MHR, LMR and NLR with pulmonary arterial hypertension (PAH). The study is a single-center, retrospective Cross-sectional study. The study group consisted of 73 patients with PAH and the control group 77 participants without cardiac pathology as determined by echocardiography. On admission, blood sampling to calculate MHR, LMR, NLR, and detailed clinical data were obtained. According to the Pearson test, systolic pulmonary artery pressure (PAP) value Higher MHR, NLR and lower LMR that indicates an enhanced inflammation were significantly increased in patients with PAH when compared with controls. Compared to many other inflammatory markers, these markers are widely available.

positively correlated with the MHR and NLR (r:.35, P < .001 and r:.33, P < .001, respectively), but negatively correlated with LMR (r: −.26, P = .001). After multivariate logistic regression analysis, MHR, LMR, and NLR remained as significant predictors of PAH (OR: 2.651, 95% CI: 1.227–5.755, P = .007; OR: 0.647, 95% CI:0.450–0.931, P = .005; OR: 1.350, 95% CI: 1.054–1.650 P = .030, respectively).
Sleep apnea plays a more important role on sleep N3 stage than chronic tinnitus in adults
Authors: Tseng Hsin-Hao , Hwang Sheng-Wei , Hwang Shang-Rung , Hwang Juen-Haur
Published: August 2022

Sleep apnea is negatively associated with N3 sleep in children. However, the association between tinnitus and sleep N3 stage was still inconclusive. We aimed to clarify the relationship between sleep apnea, chronic tinnitus, and sleep N3 stage in adults. Clinical and overnight polysomnography data of 2847 adults were collected retrospectively. Univariate and multivariate linear regression was used to test the impacts of sleep apnea indices and chronic tinnitus on the percentage of sleep N3 stage in all adults. Univariate linear regression analysis showed that sleep apnea indices, chronic tinnitus, age, sex, hypertension, diabetes mellitus, dyslipidemia, subjective insomnia, sleep efficiency, and rapid eye movement sleep were significantly associated with sleep N3 stage. However, multivariate linear regression showed that apnea–hyponea index, but not chronic tinnitus, has a significant negative association with the percentage of sleep N3 stage. Sleep apnea plays a more important role on sleep N3 stage than chronic tinnitus in adults.
Robot-assisted anatrophic nephrolithotomy for complete staghorn stone
Authors: Fang Jen-Kai , Hsiao Po-Jen , Chiu Hung-Chieh , Huang Chi-Ping
Published: August 2022

To assess the efficacy and safety of robot-assisted anatrophic nephrolithotomy (RANL) as a choice of minimally invasive treatment for patients with complete staghorn stone.

In a single-tertiary referral center retrospective study, 10 consecutive patients underwent RANL for complete staghorn stone. After dissection to the renal hilum and clamping of the renal vessels, an incision was made along the Brodel line and exposed the collecting system to extract the stone. Then, the collecting system and parenchyma were closed in layers. The outcomes included reduction of the stone burden, short- and long-term postoperative kidney function, and pain score.

The average age of patients was 54.6 years and body mass index was 27.58 kg/m2. Mean warm ischemia time was 28.40 minutes, mean robotic console time was 137 minutes, and mean estimated blood loss was 83 mL. The mean length of stay was 5.4 days and there were no severe perioperative complications. Eight of 10 patients had >90% reduction in stone burden and 5 (50%) patients were completely stone-free. There was no significant decrease in postoperative estimated glomerular filtration rate compared with preoperative values after 1 month and 1 year.

Our experience with RANL demonstrated efficacy and safety in the minimally invasive treatment of complete staghorn stone in short- and long-term follow-up periods.
Maximum daily dose of G-CSF is critical for preventing recurrence of febrile neutropenia in patients with gynecologic cancer: A case–control study
Authors: Kim Nam Kyeong , Suh Dong Hoon , Kim Kidong , No Jae Hong , Kim Yong Beom
Published: August 2022

No study has evaluated the effect of therapeutic granulocyte colony-stimulating factor (G-CSF) in preventing recurrence of febrile neutropenia (FN) and survival outcomes in gynecologic cancer patients. Objective of this study is to optimize and to identify the use of G-CSF and identify the critical factors for preventing the recurrence of FN in women undergoing chemotherapy for the treatment of gynecologic cancer.

The medical records of consecutive patients who underwent chemotherapy for the treatment of gynecologic cancer and experienced FN at least once were retrospectively reviewed. Clinico-laboratory variables were compared between those with and without recurrence of FN to identify risk factors for the recurrence and the most optimal usage of G-CSF that can prevent FN. Student t test, χ
2 test, and multivariate Cox regression analysis were used.

A total of 157 patients who met the inclusion criteria were included. Of 157, 49 (31.2%) experienced recurrence of FN. Age ≥55 years (P = .043), previous lines of chemotherapy ≤1 (P = .002), thrombocytopenia (P = .025), total dose (P = .003), and maximum daily dose (P = .009) of G-CSF were significantly associated with recurrence of FN. Multiple regression analysis showed that age ≥55 years (HR, 2.42; 95% CI, 1.14–5.14; P = .022), previous chemotherapy ≤1 (HR, 4.01; 95% CI, 1.40–11.55; P = .010), and maximum daily dose of G-CSF ≤600 μg (HR, 5.18; 95% CI, 1.12–24.02; P = .036) were independent risk factors for recurrent FN. Multivariate Cox regression analysis showed that a maximum daily dose of G-CSF ≤600 μg was the only independent risk factor for short recurrence-free survival of FN (HR, 4.75; 95% CI, 1.15–19.56; P = .031).

Dose-dense administration of G-CSF >600 μg/day could prevent recurrence of FN in women who undergo chemotherapy for the treatment of gynecologic cancer and FN. Old age and FN at early lines of chemotherapy seem to be associated with FN recurrence.
Effect of procalcitonin on the severity and prognostic value of elderly patients with a severe infection of oral and maxillofacial space
Authors: Lin Xin-yan , Lin Yu-zhao , Lin Shao-hua , Lian Jun-Jie
Published: August 2022

This study aimed to investigate the effect on the severity and prognostic value of serum procalcitonin for elderly patients with oral and maxillofacial infections. We divided 163 elderly patients with severe oral and maxillofacial infection into survival and death groups according to the prognosis between June 2015 and May 2021, measured serum procalcitonin by enzyme-linked immunosorbent assay on the 1st, 2nd, 3rd, 5th, and 7th day after admission for the dynamic changes of serum procalcitonin level, collected the general physiological and biochemical indexes for the scores of acute physiology and general chronic condition, compared the correlation between serum procalcitonin, mean platelet count and APACHE score, analyzed the prognostic value of serum procalcitonin levels at different time after admission by ROC curve. The serum procalcitonin level increased significantly in both groups after admission, sharply increased at first and then rapidly decreased in the survival group, and continued to rise or declined slowly with fluctuation of high level in the death group. There was a negative correlation between serum procalcitonin level and mean platelet count (r = −0.698, P < .05) and a positive correlation between serum procalcitonin and APACHE II (R = 0.803, P < .05). The ROC curve showed that the serum procalcitonin level had little value on the first day and great value on the third day in predicting the prognosis of elderly patients with severe oral and maxillofacial infection (PCT1d = 0.539, PCT3d = 0.875, P < .05). The serum procalcitonin level is correlated with the severity of the disease in elderly patients with severe oral and maxillofacial space infection. Dynamic observation of it is helpful for the prognosis judgment of patients. After admission, serum procalcitonin level on the third day has a great value for the prognosis judgment of elderly patients with severe oral and maxillofacial space infection.
The optimal neoadjuvant regimen for nonsmall cell lung cancer: A meta-analysis
Authors: Liu Yi , Zhao Chong , Lu Qiuliang , Hu Yirong
Published: August 2022

Objective:

To compare the efficacy and complications of different neoadjuvant to determine the optimal regimens for nonsmall cell lung cancer (NSCLC) patients.

Methods:

A systematic search of the Web of Science, and PubMed databases was conducted through June 3, 2021, reporting a comparison of chemotherapy, chemoradiotherapy, and immunotherapy.

Results:

Of 3462 studies, 25 were considered for evidence synthesis. 1035 patients who received chemotherapy or radiotherapy before surgery did not prolong the overall survival (OS) compared with 1038 patients who received surgery alone (hazard ratio [HR] 1.13, 95% CI 1·00–1·28, P = 0·05). 1192 patients received chemoradiotherapy and 864 patients received chemotherapy or radiotherapy; chemoradiotherapy prolonged the OS compared with chemotherapy (HR 0.52, 95% CI 0·29 to 0.95, P = .03). Compared with 110 patients who received other therapy, 93 patients who received immunotherapy had prolonged the OS (HR 1.56, 95% CI 1·08–2·25, P = .02). Chemoradiotherapy increased the pathological response rate (HR 1.68, 95% CI 1·33–2·12, P < .0001), and grade 3 and 4 adverse effects were not increased (HR 5.90, 95% CI 0.88 to 39.60, P = .007). Immunotherapy increased the pathological response (HR 2.79, 95% CI 1·71–4·54, P < .0001), with no significant effects on grades 3 and 4 adverse(HR 0.71, 95% CI 0·19–2·64, P = .61).

Conclusion:

Our data showed that chemotherapy may prolong OS and PFS, but not statistically significant; however, the combination of chemotherapy and radiation did show an advantage, and immunotherapy may be also the choice for neoadjuvant therapy.
Risk factors related to early pregnancy loss in fresh IVF/ICSI: An analysis of 954 embryo transfer cycles
Authors: Wang Liyan , Wang Lin , Yang Xia , Jin Panpan , Zhang Rui , Jiang Yanbiao , Zhang Xuehong
Published: August 2022

Early pregnancy loss (EPL) is a common complication of assisted reproductive technology treatment; however, the exact factors involved in EPL are not fully understood. This study aimed to evaluate the risk factors for EPL in fresh in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles. This retrospective cohort study was conducted on all couples who underwent clinical pregnancy in fresh IVF/ICSI cycles from January to December 2019 at a single large reproductive medical center. In total, 954 cycles were included in this study. Univariate and multivariate logistic regression analyses were performed to evaluate relevant risk factors for EPL. Curve fitting and threshold analyses were used to explore the association between risk factors and EPL. Compared with women with a normal total antral follicle count (AFC) (≥10, <15), those with a low AFC (<10) had a higher risk of EPL (odds ratio 2.97, 95% confidence interval: 1.38–6.38, P < .05). Patients with an estradiol/progesterone ratio (E2/P) ≥ 1.1 had significantly lower odds of EPL than women with E2/P < 1.1 (odds ratio 0.51, 95% confidence interval 0.28–0.91, P < .05). E2/P and serum human chorionic gonadotropin (hCG) levels negatively correlated with EPL. By using a 2-piecewise regression model, the inflection point of serum hCG level was 599.9 IU/L. Our results showed that lower AFC, E2/P, and serum hCG levels were associated with a higher EPL risk in fresh IVF/ICSI cycles.
Mechanism of saikogenin G against major depressive disorder determined by network pharmacology
Authors: Hu Lili , Wang Jue , Zhao Xiaoge , Cai Donghui
Published: August 2022

Many classic decoctions of Chinese medicine including Radix Bupleuri are used to treat major depressive disorder (MDD). Saikosaponin D is a representative bioactive ingredient discovered in Radix Bupleuri. The mechanism of saikogenin G (SGG) as a metabolite in MDD remains unclear to date. This study aims to elucidate the mechanism of SGG in treating MDD with network pharmacology.

We evaluated the drug likeness of SGG with SwissADME web tool and predicted its targets using the SwissTargetPrediction and PharmMapper. MDD-related targets were identified from the following databases: DisGeNET, DrugBank, Online Mendelian Inheritance in Man, and GeneCards. The common targets of SGG and MDD were imported to the STRING11.0 database, and then a protein–protein interaction network was constructed. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment were analyzed with DAVID 6.8 database.

The molecular weight of SGG was 472.7 g/mol, the topological polar surface area was 69.92 A2 <140 A2, the octanol/water partition coefficient (Consensus LogP0/W) was 4.80, the rotatable bond was 1, the hydrogen bond donors was 3, and the hydrogen bond acceptors was 4. A total of 322 targets of SGG were obtained and there were 1724 MDD-related targets. A total of 78 overlapping genes were selected as targets of MDD treatment including albumin, insulin-like growth factor I, mitogen-activated protein kinase 1, proto-oncogene tyrosine-protein kinase Src, and epidermal growth factor receptor. Gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis suggested that proteoglycans in cancer, pathways in cancer, prostate cancer, hypoxia-inducible factor-1, central carbon metabolism in cancer, estrogen, PI3K-Akt, ErbB, Rap1, and prolactin signaling pathways played an important role(P < .0001).

This study showed that SGG exhibits good drug-like properties and elucidated the potential mechanisms of SGG in treating MDD with regulating inflammation, energy metabolism, monoamine neurotransmitters, neuroplasticity, phosphocreatine-creatine kinase circuits, and so on.
A network pharmacology approach to identify the mechanisms and molecular targets of curcumin against Alzheimer disease
Authors: Wu Xinyan , Zheng Xiaomei , Tang Huaqiao , Zhao Ling , He Changliang , Zou Yuanfeng , Song Xu , Li Lixia , Yin Zhongqiong , Ye Gang
Published: August 2022

Background:

Alzheimer disease (AD) is a degenerative brain disease, which may lead to severe memory loss and other cognitive disorders. However, few effective drugs are available in the clinic at present. Curcumin, a major ingredient of traditional Chinese medicine, Curcuma Longa, has various pharmacological activities. Therefore, exploring clinical drugs based on the inhibition of AD pathological features is imperative.

Methods:

First, we utilized the HERB database and Swisstarget Prediction database to get the related targets of curcumin and intersected with the AD targets. The intersection targets were used to construct the protein-protein interaction network and performed gene ontology and kyoto encyclopedia of genes and genomes analyses. Further, we obtained targets of curcumin against AD-related tau and aβ pathology via the AlzData database. These targets were applied to perform GEO and receiver operating characteristic analyses. Finally, the reliability of the core targets was evaluated using molecular docking technology.

Results:

We identified 49 targets of curcumin against AD, and kyoto encyclopedia of genes and genomes pathway enrichment analysis demonstrated that the Alzheimer disease pathway (has05010) was significantly enriched. Even more, we obtained 16 targets of curcumin-related Aβ and tau pathology. Among these targets, 8 targets involved the Alzheimer disease pathway and the biological process analyses showed that positive regulation of cytokine production (GO:0001819) was significantly enriched. Bioinformatic analyses indicated that HMOX1, CSF1R, NFKB1, GSK3B, BACE1, AR, or PTGS1 expression was significantly different compared to the control group in the AD patients. Finally, molecular docking studies suggested these genes have a good binding force with curcumin.

Conclusions:

In this study, we identified curcumin exerted the effect of treating AD by regulating multitargets and multichannels through the method of network pharmacology.
Management of unresectable and recurrent intra-abdominal desmoid tumors treated with ultrasound-guided high-intensity focused ultrasound: A retrospective single-center study
Authors: Yang Yongming , Zhang Jian , Pan Ying
Published: August 2022

To assess the efficacy and safety of ultrasound (US)-guided high-intensity focused ultrasound (HIFU) ablation for treatment of unresectable and recurrent intra-abdominal desmoid tumors. From June 2014 to March 2020, 15 patients with consecutive unresectable and recurrent diseases that pathologically proven to be intra-abdominal desmoid tumors had undergone the treatment of US-guided HIFU ablation. All patients underwent contrast-enhanced magnetic resonance imaging before and after HIFU treatment. Nonperfused volume ratio was used to evaluate the effect of HIFU therapy. Intraprocedural and postprocedural adverse effects and complications are recorded to assess the safety of the therapy. Outcome of HIFU ablation has been investigated through serial contrast-enhanced imaging examinations during follow up. Out of 15 patients 14 of them have successfully completed the whole therapy, 1 patient is ineffective and gives up further treatment. The mean nonperfused volume ratio is 71.1% (95% confidence interval, 3% to 88.2%). During a mean follow up of 29 months (range from 8 to 61 months), the mean tumor volume was reduced by 59% (95% confidence interval, +49% to −100%). No tumor spreads along the treated area in all patients except one. Complications have occurred in 5 patients (33.3%), including bowel rupture (1 case), intra-abdominal abscess (1 case), slight injury to the femoral nerve (1 case), and bone injury (2 cases), the bowel rupture patient underwent surgery; the others have been cured during the follow up. US-guided HIFU ablation is an effective treatment modality for patients suffered from unresectable and recurrent intra-abdominal desmoid tumors.
Individualized pharmaceutical care for a patient after pancreaticoduodenectomy with trypsin replacement nutritional therapy: A case report
Authors: Zhang Song , Tan Qin , He Hanjun
Published: August 2022

Rationale:

Optimal nutritional therapy for pancreaticoduodenectomy (PD) has been debated; however, little is known about key points of pancreatin enteric-coated capsule administration, a critical component of the PD treatment regimen. Patients often report elevations in tablet platoon and steatorrhea, and steatorrhea may adversely affect nutritional therapy for PD. Herein, we report a case of individualized pharmaceutical care for a patient after PD with trypsin replacement nutritional therapy.

Patient concerns and diagnosis:

After PD with trypsin replacement nutritional therapy, the patient developed acute steatorrhea.

Intervention:

Individualized pharmaceutical care was provided by clinical pharmacists to address intolerance to pancreatin enteric-coated capsules following PD.

Outcomes:

The clinical pharmacist’s integration into the patient’s treatment plan enhanced pharmacotherapy optimization, especially through pharmacokinetic monitoring and interventions related to nutritional therapy.

Lesson:

Pharmaceutical care by clinical pharmacists aids in ensuring the safety and efficacy of drugs and nutritional treatment. Clinical pharmacists should be members of the nutrition support team.
Biopsychosocial factors associated with complications in patients with frostbite
Authors: Endorf Frederick W. , Alapati Deepak , Xiong Yee , DiGiandomenico Cynthia , Rasimas Courtney S. , Rasimas Joseph J. , Nygaard Rachel M.
Published: August 2022

Cold weather injuries can be devastating and life changing. Biopsychosocial factors such as homelessness and mental illness (especially substance use disorders [SUDs]) are known risk factors for incurring frostbite. Based on clinical experience in an urban level 1 trauma center, we hypothesized that complications following frostbite injury would be influenced by homelessness, SUDs, and other forms of mental illness. The aim of this study was to examine the relationship between biopsychosocial factors and both amputations and unplanned hospital readmissions after cold injuries. Patients admitted with a diagnosis of frostbite between the winters of 2009 and 2018 were included in this retrospective cohort study. Descriptive statistics and multivariable regression assessed factors associated with outcomes of interest. Of the 148 patients in the study, 40 had unplanned readmissions within 1 year. Readmitted patients were significantly less likely to have a stable living situation (48.7% vs 75.0%, P = .005) and more likely to have an SUD (85.0% vs 60.2%, P = .005) or other psychiatric disorder (70.0% vs 50.9%, P = .042). Homelessness and SUDs were independent predictors of unplanned readmission. Overall, 18% of frostbite injuries resulted in amputation. Any history of drug and/or alcohol use independently predicted amputations. The study results suggest that additional hospital and community resources may need to be marshaled to prevent vulnerable patients with biopsychosocial risk factors from having complications after frostbite. Complications place a high downstream burden on healthcare systems. Clinicians caring for frostbite patients with comorbid conditions can use these findings to inform care and discharge decisions.
Association between the rs4784227-CASC16 polymorphism and the risk of breast cancer: A meta-analysis
Authors: Xu Wenji , Zhong Yao , Yang Haihui , Gong Yuhan , Dao Jun , Bao Liping
Published: August 2022

Objective:

Although several studies have identified an association between the rs4784227-cancer susceptibility candidate gene 16 (CASC16) polymorphism and breast cancer, the results remain inconclusive. Therefore, we conducted a meta-analysis to assess the relationship between the rs4784227-CASC16 polymorphism and breast cancer risk.

Methods:

Studies were searched in the PubMed, Web of Science, Embase, Google Scholar, and Cochran Library databases until June 10, 2021, to identify all potential literature on rs4784227-CASC16 polymorphism and breast cancer risk association. Fixed-effect or random-effect models were used to calculate odds ratios (ORs) and their corresponding 95% confidence intervals (95% CIs). Subgroup analyses, publication bias, and sensitivity analyses were also conducted.

Results:

Seventeen eligible studies involving 34,719 subjects (18,445 cases and 16,274 healthy controls) from 7 articles were included in the current meta-analysis. The pooled ORs regarding the association between the rs4784227-CASC16 polymorphism and breast cancer risk were statistically significant [T vs C: OR = 1.244, 95% CI = 1.202–1.287; TT vs CT + CC: OR = 1.407, 95% CI = 1.296–1.528; CC vs CT + TT: OR = 0.777, 95% CI = 0.745–0.811; TT vs CC: OR = 1.544, 95% CI = 1.419–1.681; CT vs CC: OR = 1.244, 95% CI = 1.189–1.301]. On subgroup analysis, the rs4784227-CASC16 T/C gene has a certain correlation with breast cancer susceptibility in Asian and North American populations, but no significant risk in the Australian population.

Conclusion:

Our pooled analysis showed a significant association between the rs4784227- (T) allele and breast cancer susceptibility in Asian and North American populations, and intervention with this mutation might be a new therapeutic strategy for breast cancer. However, large-scale and well-designed studies are needed in different populations to further evaluate the role of the rs4784227-CASC16 polymorphism in breast cancer.
Difference in macrophage migration inhibitory factor between preterm and term newborns and associating clinical factors: Preliminary study
Authors: Park Ji Sook , Jun Jin Su , Cho Jae Young , Yeom Jung Sook , Seo Ji-Hyun , Lim Jae Young , Park Chan-Hoo , Woo Hyang-Ok , Youn Hee-Shang
Published: August 2022

This study aimed to investigate the macrophage migration inhibitory factor (MIF) and associated clinical factors in neonates. Clinical information and blood samples were obtained from 77 neonates. Clinical details were reviewed from medical records, and MIF was measured by enzyme-linked immunosorbent assay using blood samples acquired within a week after birth. Statistical analyses were performed between plasma MIF concentration and clinical factors. Among the 77 newborn infants, 25 were born at <34 weeks of gestation (preterm), 25 at 34 to 37 weeks (late preterm), and 27 at term gestation. The mean MIF was 9849.5 ± 7187.8 pg/mL in preterm, 5718.7 ± 4596.4 in late preterm, and 5361.1 ± 3895.7 in term infants (P = .016). Among 25 preterm infants born at <34 weeks of gestation, MIF was significantly higher in infants with necrotizing enterocolitis (NEC, 19,478.6 ± 8162.4 pg/mL, n = 5) than that in infants without NEC (feeding intolerance 7173.7 ± 4203.0 pg/mL, n = 12 and others 7844.9 ± 5311.2 pg/mL, n = 8, P = .020). Elevated plasma MIF levels in the transitional period were significantly associated with preterm birth before 34 weeks of gestation and the development of NEC.
Primary mucosa-associated lymphoid tissue lymphoma in fallopian tubes: A case report and literature review
Authors: Ji Mengying , Jin Yichao , Chen Xing , Li Yujing , Rahman Juveria , Dai Huihua
Published: August 2022

Rationale:

Mucosa-associated lymphoid tissue (MALT) lymphoma accounts for 7%–8% of newly diagnosed lymphomas. The stomach is the most common organ of origin (nearly 50% of MALT lymphomas). Only 2% of MALT lymphomas arise from the female genital tract, and most originated from uterus. We described a rare case of MALT lymphoma primarily arising from the fallopian tube.

Patient concerns:

A 26-year-old woman was brought into our gynecological clinic because of a history of irregular menstruation. The transvaginal ultrasonography revealed cystic masses in bilateral adnexa and both of them showed rich vasculature. Laboratory tests showed a high level (455.3 U/mL) of cancer antigen-125 (CA-125).

Interventions:

A laparoscopy was performed.

Outcomes:

Frozen section of the removed specimen revealed acute and chronic inflammation with abundant inflammatory cells infiltrating the mesenchyme. The right fallopian tube was removed. However, the final histological results showed inflammation accompanied by hyperplasia of lymphoid tissue. Immunohistochemistry staining were consistent with MALT lymphoma. The patient received the second surgery to remove the left fallopian tube and also confirmed the same pathology.

Lessons:

Gynecologists should be aware of cystic masses which showed rich vasculature and high level of CA-125.
68Ga-DOTATATE PET/CT imaging for insulinoma in MEN1 patient with endogenous hyperinsulinemic hypoglycemia: A case report
Authors: Liu Yunuan , Zhao Xinming , Zhang Jingmian , Wang Jianfang , Zhang Zhaoqi , Dai Meng , Wang Na , Jing Fenglian , Wang Tingting , Tian Weiwei
Published: August 2022

Rationale:

Multiple endocrine neoplasia type 1 (MEN1) syndrome is a rare and complicated disease that is associated with several endocrine tumors. Here, we report a case of MEN1 associated with insulinoma, parathyroid, and pituitary tumors by 68Ga-DOTATATE positron emission tomography/computed tomography (PET/CT).

Patient concerns:

A 49-year-old woman presented with intermittent hypoglycemia for more than a year and developed indistinct consciousness without an apparent trigger.

Diagnoses:

Biochemical results showed abnormally high serum insulin and parathyroid hormone levels. She underwent an Abdominal magnetic resonance imaging revealed a small nodule in the uncinate process of the pancreas, but it did not clarify the nature of the small nodule. Pituitary magnetic resonance imaging scan revealed a micropituitary tumor, and parathyroid imaging showed no abnormalities. 18F-FDG PET/CT showed no apparent abnormal 18F-FDG uptake in the whole body. In contrast, 68Ga-DOTATATE PET/CT imaging showed pathological radiotracer uptake in the pancreatic uncinate process, accompanied by mild radiotracer uptake in the pituitary gland, and no apparent abnormal radiotracer uptake in the parathyroid area.

Interventions:

The patient underwent echoendoscopy for pancreatic uncinate process lesions and surgical resection.

Outcomes:

Histological analysis was suggested of insulinoma of pancreatic neuroendocrine tumor, the Ki-67 index was low (only 1% being positive).

Lessons:

This case demonstrates that 68Ga-DOTATATE can be used for the detection of MEN1-related tumors and preoperative localization of small and low-grade insulinomas by PET/CT.
Effect of cholesterol-lowering agents on soluble epidermal growth factor receptor level in type 2 diabetes and hypercholesterolemia
Authors: Lee Jun Choul , Joung Kyong Hye , Kim Ji Min , Kang Seon Mee , Kim Hyun Jin , Ku Bon Jeong
Published: August 2022

Soluble epidermal growth factor receptor (sEGFR) levels are elevated in patients with type 2 diabetes mellitus (T2DM) and positively correlate with blood glucose and cholesterol levels. However, how cholesterol-lowering treatment in patients with T2DM affects the sEGFR level is unknown. Therefore, we investigated the change of serum sEGFR after cholesterol-lowering treatment in type 2 diabetic patients with hypercholesterolemia. This study is a non-randomized, prospective observational study. A total of 115 patients were treated in either the rosuvastatin monotherapy group (R group, 5 mg/day, n = 59) or the rosuvastatin/ezetimibe combination therapy group (RE group, 5 mg/10 mg/day, n = 56) for 12 weeks. We measured serum levels of lipids and sEGFR using an ELISA kit before and after 12 weeks of treatment in each group. The low-density lipoprotein cholesterol (LDL-C) level was significantly reduced (from 130.27 ± 27.09 to 76.24 ± 26.82 mg/dL; P < .001) after 12 weeks of treatment and more so in the RE group than in the R group (from 131.68 ± 28.72 to 87.13 ± 27.04 mg/dL, P < .001 in the R group; from 128.78 ± 25.58 to 64.75 ± 21.52 mg/dL, P < .001 in the RE group; R vs RE group, P < .001). The sEGFR level was significantly decreased after 12 weeks of treatment (from 50.34 ± 13.31 to 45.75 ± 11.54 ng/mL; P = .007). The RE group only showed a significant reduction in the sEGFR level after treatment (from 50.94 ± 12.10 to 44.80 ± 11.36 ng/mL; P = .007). Moreover, the sEGFR level was significantly reduced only when the LDL-C level was significantly reduced (from 50.46 ± 10.66 to 46.24 ± 11.86 ng/mL; P = .043). The serum sEGFR level was significantly reduced by cholesterol-lowering treatment with rosuvastatin alone or rosuvastatin/ezetimibe. We suggested that sEGFR may play a significant role in insulin resistance (IR) and inflammation, which are central pathophysiological mechanisms. We confirmed the possibility of using sEGFR as a biomarker to predict a good response to lipid-lowering treatment in type 2 diabetes patients with hypercholesterolemia.
Combination therapy for pediatric patients with Kasabach–Merritt phenomenon: A single-center retrospective study
Authors: Zhang Li , Liu Lang , Luo Huanmin , Xu Wenbiao , Chen Huishan , Yan Muxia , Wang Yiqian
Published: August 2022

This study aimed to in the management of Kasabach–Merritt phenomenon (KMP), a severe thrombocytopenic coagulopathy that occurs in the presence of an enlarging vascular tumor. Here, we retrospectively evaluated 12 patients with KMP in Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, from 2017 to 2021. 12 patients, including 7 females and 5 males, were identified. Tumors were located in the leg (n = 4), neck (n = 1), face (n = 3), chest wall (n = 1), back (n = 2), and retroperitoneum (n = 1). A plaque-like lesion with ecchymosis was the most common cutaneous manifestation. All the patients underwent embolization therapy. Nine patients received steroid treatment and 7 patients were administered with sirolimus. The mean duration of treatment was 1.6 months. All the patients reported in this study were alive when discharged. Embolization combined with steroid and sirolimus appears effective in patients with KMP, as well as in those who experienced disease recurrence. However, a long-term follow-up of the children cured of KMP will be necessary to monitor its recurrence and improve the outcome.
Rectourethral fistula after external beam radiotherapy for prostate cancer in a patient with thromboangiitis obliterans: A case report
Authors: Ohira Keiichi , Konishi Kenta , Aramaki Shuhei , Kokubo Ryo , Wakabayashi Kouhei , Hirata Masanori , Imai Michiko , Nakamura Katsumasa
Published: August 2022

Introduction:

Thromboangiitis obliterans (TAO) is a rare disease of unknown cause that causes segmental vasculitis in peripheral blood vessels. It is uncertain whether its presence causes serious adverse events in patients receiving external beam radiotherapy.

Patient concerns:

A 73-year-old Japanese man with prostate cancer underwent external beam radiotherapy.

Diagnosis:

After completion of radiotherapy, fingertip pain occurred, leading to the diagnosis of TAO.

Interventions:

The patient was instructed to stop smoking, but was unable to do so.

Outcomes:

Nine months after the completion of radiotherapy, fecaluria appeared, and a rectourethral fistula was diagnosed by contrast enema. The patient’s TAO was poorly controlled, and the patient died from aspiration pneumonia 33 months after completion of the radiotherapy regimen. No tumor recurrence was observed during this process, and there were no risk factors other than TAO that may have formed a rectourethral fistula.

Lessons:

This is the first report of rectourethral fistula caused by external beam radiotherapy for prostate cancer in which TAO was suspected to be involved. Although little is known about the relationship between TAO and radiotherapy, it should be noted that radiotherapy itself may increase the risk of normal tissue toxicity in patients with TAO.
Diagnostic accuracy of S-Detect to breast cancer on ultrasonography: A meta-analysis (PRISMA)
Authors: Wang Xiaolei , Meng Shuang
Published: August 2022

Background:

Computer-aided diagnosis (CAD) systems have shown great potential as an effective auxiliary diagnostic tool in breast imaging. Previous studies have shown that S-Detect technology has a high accuracy in the differential diagnosis of breast masses. However, the application of S-Detect in clinical practice remains controversial, and the results vary among different clinical trials. This meta-analysis aimed to determine the diagnostic accuracy of S-Detect for distinguishing between benign and malignant breast masses.

Methods:

We searched PubMed, Cochrane Library, and CBM databases from inception to April 1, 2021. Meta-analysis was conducted using STATA version 14.0 and Meta-Disc version 1.4 softwares. We calculated the summary statistics for sensitivity (Sen), specificity (Spe), positive, and negative likelihood ratio (LR+/LR−), diagnostic odds ratio(DOR), and summary receiver operating characteristic (SROC) curves. Cochran Q-statistic and I2 test were used to evaluate the potential heterogeneity between studies. Sensitivity analysis was performed to evaluate the influence of single studies on the overall estimate. We also performed meta-regression analyses to investigate potential sources of heterogeneity.

Results:

Eleven studies that met all the inclusion criteria were included in the meta-analysis. A total of 951 malignant and 1866 benign breast masses were assessed. All breast masses were histologically confirmed using S-Detect. The pooled Sen was 0.82 (95% confidence interval(CI) = 0.74–0.88); the pooled Spe was 0.83 (95%CI = 0.78–0.88). The pooled LR + was 4.91 (95%CI = 3.75–6.41); the pooled negative LR − was 0.21 (95%CI = 0.15–0.31). The pooled DOR of S-Detect in the diagnosis of breast nodules was 23.12 (95% CI = 14.53–36.77). The area under the SROC curve was 0.90 (SE = 0.0166). No evidence of publication bias was found (t = 0.54, P = .61).

Conclusions:

Our meta-analysis indicates that S-Detect may have high diagnostic accuracy in distinguishing benign and malignant breast masses.
Defining the parameters for endovenous microwave ablation to achieve equivalence with endovenous laser ablation, using the porcine liver model.
Authors: Bachetta Anjali , Cheung Simon , Moore Emma , Nguyen Danny , Kiely Melissa , Whiteley Mark
Published: August 2022

  

ABSTRACT

Aims: Endovenous microwave ablation (EMWA) is a relatively new catheter-based endovenous thermoablation (EVTA) system to ablate incompetent truncal veins. Early results suggest that EMWA uses more power than endovenous laser ablation (EVLA) to get the same results. Therefore, we aimed to define the parameters for EMWA, which give the same tissue ablation as EVLA, using the previously validated porcine liver model.

Methods:  EVLA (1470nm and 600micron radial fibre) treatments were performed at 6W, 8W and 10W, at each pullback speed of 6, 7, 8 and 9 s/cm, giving a range of Linear Endovenous Energy Densities (LEEDs) between 36 – 90 J/cm. We repeated each combination of power and pullback five times. Following a preliminary screening process to identify parameters that gave similar results, we used EMWA in the same model. Powers of 35-75W and pullback speeds of 4-9 s/cm were used (LEEDs 140-675 J/cm). Ablation tracts from both devices were analysed by two blinded observers, noting thermal spread and carbonisation. 

Results: For each of the commonly used parameters for EVLA, we identified a range of power and pullback parameters for EMWA that produced similar tissue ablation in the porcine liver model. To keep the pullback speeds within the usual range, we used powers of 35-75W with EMWA, with mean EMWA LEEDs 3.9 - 5.8 times higher than EVLA LEEDs. We found the quicker the pullback speed, the higher the multiple of EMWA LEED we needed to get the same effect.

Conclusion: We have identified parameters for EMWA that gave equivalent tissue ablation in the validated porcine liver model to commonly used parameters and LEEDs for EVLA. As the power during EMWA is higher than EVLA, EVMA LEEDs are approximately 4-6 times higher than EVLA LEEDs to achieve the same thermal effect on the tissues.
Glucagon-like peptide-1 receptors in the gustatory cortex influence food intake
Authors: Dossat Amanda M. , Kokoska Milayna , Whitaker-Fornek Jessica , Kulkarni Aishwarya S. , Levitt Erica S. , Wesson Daniel W.
Published: August 2022

The gustatory region of the insular cortex (GC) processes taste information in manners important for taste-guided behaviors, including food intake itself. In addition to oral gustatory stimuli, GC activity is also influenced by physiological states including hunger. The specific cell-types and molecular mechanisms that afford with GC with such influences on food intake are unclear. Glucagon-like peptide 1 (GLP-1) is produced by neurons in the brain whereafter it can act upon GLP-1 receptor-expressing (GLP-1R+) neurons found in several brain regions. In these brain regions, GLP-1R agonism suppresses homeostatic food intake and dampens the hedonic value of food. Here, we report in mice of both sexes that cells within the GC express GLP-1R mRNA and further, by ex vivo brain slice recordings, that GC GLP-1R+ neurons are depolarized by the selective GLP-1R agonist, exendin-4 (Ex-4). Next we found that chemogenetic stimulation of GLP-1R+ neurons, and also pharmacological stimulation of GC-GLP-1Rs themselves, both reduced homeostatic food intake. When maintained on a high-fat diet, obese mice exhibited impaired food intake responses when Ex-4 was administered into the GC. Yet, when obese mice were switched to a low-fat diet, the effect of GC Ex-4 was restored – indicating that GC GLP-1R influences may depend upon palatability of the food. Together, these results provide evidence for a specific cell population in the GC which may hold roles in both homeostatic and hedonic food intake.